S5 Ep92: Don’t Miss a Beat: Evaluation of Stable Arrhythmias in the Outpatient Setting
Aug 30, 2023
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Dr. Anna Camp, a pediatric electrophysiologist at Nationwide Children's Hospital, shares her expertise on evaluating stable arrhythmias in children. She discusses crucial 'red flags' that indicate urgent referral to cardiology and the use of wearable EKG technology for monitoring. The conversation highlights strategies for differentiating between anxiety and treatable arrhythmias, as well as the role of thorough evaluations in ensuring patient safety. Personal reflections on building confidence in clinical decisions add a relatable touch to the discussion.
Identifying 'red flags' in patient history and symptoms is crucial for deciding when to refer to cardiology for arrhythmia evaluation.
Incorporating wearable EKG technology can facilitate monitoring of pediatric arrhythmias, but accuracy must be carefully evaluated for age-appropriate usage.
Effective communication with families about the risks of arrhythmias and reassurance about sudden cardiac death can foster trust and collaboration in care.
Deep dives
Understanding Pediatric Arrhythmias
Pediatric arrhythmias vary significantly by age and can range from benign conditions to potentially life-threatening events. Common arrhythmias in neonates include premature atrial contractions and premature ventricular contractions, which usually self-resolve. In older children and teenagers, supraventricular tachycardia (SVT) is prevalent, occurring in about one in 250 children. It is crucial to identify potentially dangerous arrhythmias, such as those associated with congenital heart disease, which require careful monitoring and assessment.
Determining Symptoms and Risk Factors
Symptoms play a vital role in evaluating pediatric patients with suspected arrhythmias, particularly exertional syncope, which signals the need for urgent assessment. A thorough history should focus on the frequency, duration, and context of symptoms like palpitations, particularly those that occur during physical activity or could lead to fainting. Family history is also essential, especially if there are first-degree relatives with cardiac disease. Additionally, considering environmental factors, such as recreational drug use or herbal supplements, is important, as they may contribute to arrhythmia risk.
The Role of Technology in Monitoring
Wearable technology, including devices like the Apple Watch and Cardio Mobile, has become increasingly useful in monitoring arrhythmias in pediatric patients. These devices allow for the recording of electrocardiograms (ECGs) during symptomatic events, providing valuable data to healthcare providers. However, caution is necessary regarding the accuracy of algorithmic interpretations, as they are often tailored for older populations with different physiological conditions. Training patients and families to use these devices can enhance symptom tracking and improve diagnosis.
The Importance of Comprehensive Evaluation
When a child presents with arrhythmias, a complete clinical assessment, including a physical exam and ECG, is imperative to determine an appropriate referral to cardiology. If ECGs show normal sinus rhythm but the patient continues to report symptoms, further monitoring through Holters or event monitors may be warranted, although the necessity for such tests should be carefully evaluated to avoid unnecessary costs. Emergency referrals should be prioritized for patients exhibiting concerning symptoms such as syncope or exertional limitations. Clinicians should always be aware of their limitations and seek advice when uncertain about a diagnosis.
Navigating Patient Concerns and Management
Communicating effectively with families is crucial, especially when addressing their concerns about potential arrhythmias following troubling events like sudden cardiac arrest in athletes. Emphasizing that rates of sudden cardiac death in young athletes are very low can help alleviate anxiety while ensuring that appropriate assessments are performed. Providing clear guidance on warning signs to watch for at home, along with a reassuring but informative follow-up plan, can foster trust and encourage collaboration in the child's ongoing care. Ultimately, maintaining a healthy work-life balance as a physician is also essential for long-term effectiveness and patient care.
Does hearing about your patient’s palpitations give YOU palpitations because you don’t know what to do next? Treat your tachycardia with this episode of the Cribsiders, as we talk with special guest Dr. Anna Kamp, a pediatric electrophysiologist at Nationwide Children’s Hospital, about her approach to stable arrhythmias in the outpatient setting. We learn about “red flags” in the history and physical exam that warrant immediate referral to cardiology, whether you should order an echo or event monitor before sending a patient to cardiology, and how you can incorporate wearable EKG technology into your practice.
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