The Arrhythmic Patient in the Emergency Department: A Practical Guide for Cardiologists and Emergency Physicians

214 Pages·2016·11.02 MB·English

by  Massimo Zecchin

The Arrhythmic Patient
in the Emergency
Department
A Practical Guide for
Cardiologists and
Emergency Physicians
Massimo Zecchin
Gianfranco Sinagra
Editors
123
The Arrhythmic Patient in the Emergency
Department

Massimo Zecchin (cid:129) Gianfranco Sinagra
Editors
The Arrhythmic Patient
in the Emergency
Department
A Practical Guide for Cardiologists
and Emergency Physicians
Editors
Massimo Zecchin Gianfranco Sinagra
Cardiovascular Department Cardiovascular Department
Cattinara University Hospital Cattinara University Hospital
Trieste Trieste
Italy Italy
ISBN 978-3-319-24326-9 ISBN 978-3-319-24328-3 (eBook)
DOI 10.1007/978-3-319-24328-3
Library of Congress Control Number: 2015958251
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2016
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Foreword
T reatment of patients with cardiovascular diseases has dramatically changed over
the past 20 years. Accompanied by an incredible increase in pathophysiological
understanding and availability of treatment options, specialized fi elds of expertise
have rapidly evolved.
Electrophysiology is one of these newcomers. Based on the analysis of basic prin-
ciples of electrical activation in the human heart, the fi eld has developed into sophis-
ticated treatment strategies of device therapy and catheter ablation. The majorities
of today’s EP patients originate from the mainstream of everyday clinical cardiol-
ogy and present with endemic, bradycardic, and tachycardic arrhythmias.
With this background, electrophysiology has also arrived in the ER department.
N ow it is our obligation to transport our knowledge and expertise for treatment
of arrhythmia patients to our cardiology colleagues and specialized ER physicians
who encounter emergency situations due to or accompanied by cardiac arrhythmias
in a signifi cant number of patients, next to a variety of other medical emergencies.
Dedicated literature on that topic is really scarce. I therefore want to thank the
editors and authors of this book to take the challenge, efforts, and work and to
bring together a vast amount of EP knowledge and to focus it to the special situa-
tion in the ER.
T his book should become an integral part of training for young cardiology fel-
lows, and it will be a practical guide and help for all medical staff involved into the
management of ER patients.
Christopher Piorkowski
Head of EP Department – University of Dresden
v

Pref ace
T he book is a practical guide designed for physicians (both emergency physicians
and cardiologists) who fi rst evaluate and treat patients with arrhythmias or poten-
tially arrhythmic problems in the emergency setting. It can also be a useful learning
tool for students and residents in Cardiology and Emergency Medicine.
In all chapters, every effort was made to provide a brief but comprehensive sum-
mary of the topic with both theoretical and practical suggestions, considering the
different needs of the specialists involved in the primary care of arrhythmic patients.
T he diagnostic pathways and treatment options of patients presenting in the
Emergency Department with syncope or arrhythmias, including bradyarrhythmias,
atrial fi brillation, and narrow and wide QRS tachycardias, are discussed. In addi-
tion, clear advice for the management of patients with cardiac devices and possible
dysfunction, electrical storm, or a requirement for urgent surgery are provided.
Practical suggestions are offered for short-term management, e.g., regarding the
decision on when to hospitalize the patient and some hints for long-term pharmaco-
logical and non-pharmacological treatment.
I n the fi rst chapter, an overview of the management of arrhythmic patients, from
the emergency physician’s point of view, is provided. In the second chapter, some
considerations, beyond published guidelines, for the management of syncope are
given by a leading expert. An extensive theoretical overview of brady- and tachyar-
rhythmias are then followed by practical fl owcharts in Chaps. 3 , 4 and 5 , while in
the following chapter the differential diagnosis of wide-QRS tachycardias with
clear examples are discussed by one of the greatest experts in this fi eld. Chapters 7
and 8 deal with quite rare cardiac conditions, sometimes not so known by emer-
gency physicians and even by cardiologists, who nonetheless in such cases some-
times face diffi cult decisions. Differently, situations frequently observed in the
Emergency Department, but with an arrhythmogenic potential which is not always
well defi ned, are presented in Chaps. 9 and 10 . Finally, in the last three chapters,
some indications for the management of patients with implanted cardiac devices
presenting in Emergency Department or who need urgent surgery are provided,
again considering the different skills of the various medical fi gures involved in the
primary care of such patients.
vii
viii Preface
Considering the heterogeneity of the topics, some differences in the chapters’
frameworks were necessary. However, the book was conceived to offer quick infor-
mation and solutions to the single issues, as required in the emergency setting,
rather than providing a systematic review.
Trieste, Italy Massimo Zecchin
Gianfranco Sinagra
Contents
1 Management of Arrhythmic Patients in the Emergency
Department: General Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Alessandro Surian and Luca Visintin
2 Syncope: First Evaluation and Management
in the Emergency Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Franco Giada and Andrea Nordio
3 Management of Bradyarrhythmias in Emergency . . . . . . . . . . . . . . . . 29
Luca Salvatore , Silvia Magnani , Gerardina Lardieri ,
and Elena Zambon
4 Supraventricular Arrhythmias in Emergency . . . . . . . . . . . . . . . . . . . . 43
Elisabetta Bianco , Marco Bobbo , and Davide Stolfo
5 Atrial Flutter and Fibrillation in the Emergency Setting . . . . . . . . . . . 61
Ermanno Dametto , Martino Cinquetti , Federica Del Bianco ,
and Matteo Cassin
6 Wide QRS Complex Tachycardia in the Emergency Setting . . . . . . . . 89
Giuseppe Oreto , Francesco Luzza , Gaetano Satullo ,
Antonino Donato , Vincenzo Carbone , and Maria Pia Calabrò
7 Acute Management of Arrhythmias in Patients
with Known Congenital Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . 109
Francesca Bianchi and Stefano Grossi
8 Acute Management of Arrhythmias in Patients
with Channelopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Francesca Bianchi and Stefano Grossi
9 Acute Management of Patients with Arrhythmias
and Non-cardiac Diseases: Metabolite Disorders
and Ion Disturbances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Stefano Bardari , Biancamaria D’Agata and Gianfranco Sinagra
10 Cardiac Arrhythmias in Drug Abuse and Intoxication . . . . . . . . . . . . 151
Laura Vitali - Serdoz , Francesco Furlanello , and Ilaria Puggia
ix