Arrhythmias from a Primary Care perspective

36 Pages·2011·1.24 MB·English

Arrhythmias from a Primary
Care perspective
Newcastle Cardiac Update Course,
19th May 2011
Dr Andreas Wolff
Westcliffe Cardiology Service
Darlington cardiology service
questionnaire
• GPs were asked their preferences on a variety
of potential cardiology service developments
• High completion rate 72%
• Highest on the wish list:
– Rapid access arrhythmia / AF service 88%
– Rapid access syncope service 60%
5% of presenting complaints
potentially have an arrhythmic cause
• Palpitations
• Blackouts
• Dizziness
• Fatigue
• Breathlessness
• Chest discomfort
The role of General Practice in
arrhythmia care
• Assessment of initial presentation
• Triage and signposting
• Diagnostics
• Management of appropriate conditions
• Screening
• Patient and carer support
Palpitations: why not just
refer them all ?
• Common presentation
• Majority do not have a significant arrhythmia
• Assessment is simple
• No fancy tests required
• Common reason for cardiology referral
• Prioritisation
Waste of resources and
cause of unnecessary anxiety
Palpitations
•Have you taken a good history?
•Any associated symptoms?
•Any structural heart disease?
•Any family history?
•Any contributing factors?

Investigations
•FBC
•U/Es
•TFTs
Risk stratification
•Skipped beats
•Hx suggests •Palpitation during
•Thumping
recurrent exercise
beats
tachyarrhythmia •Palpitations with
•Short
•Palpitations with syncope / near
fluttering
associated symptoms syncope
•Slow
AND / OR •High risk structural
pounding
•Abnormal ECG heart disease
AND
AND / OR •FHx of inheritable
•Normal ECG
•Structural heart heart disease / SADS
AND
disease •High degree AV
•No FHx
block
AND
•No structural
heart disease
Refer to cardiology
Low risk Refer to cardiology /
with
Manage in Arrhythmia care
urgency
Primary Care Co-ordinator
Wolff A., Cowan C. Brit J Cardiol 2009;16