Cardiac Arrhythmias: Interpretation, Diagnosis ... \/\/FREE\\\\
A specialized interprofessional team is always necessary to perform an EPS. An operator is required for the invasive procedure and another one for the operation of the recording system and the external stimulator. The care of the patient (monitoring of vital signs, administration of oxygen, and intravenous medications) is the responsibility of the nursing staff. Nurses can also help with the setup of the examination and have a critical role in the early diagnosis and treatment of complications. Moreover, they can play a significant role in post-procedural care, and the long-term follow up of the arrhythmia patient. A clinical cardiologist ideally specialized in the care of patients with heart failure, a cardiac surgeon, and a geneticist should also be available for consultation as members of the arrhythmia team. This integrated team approach, although not extensively tested yet, is expected to significantly improve the management of patients with cardiac arrhythmias.[21] [Level 2]
Cardiac Arrhythmias: Interpretation, Diagnosis ...
The diagnosis and management of cardiac arrhythmias is not an easy task. Training of the medical and non-medical personnel in high volume centers, along with their active participation in updating educational sessions, is of paramount importance for the achievement of high-quality standards in the electrophysiology laboratory.
Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disorder that is defined by the presence of increased left ventricular (LV) wall thickness that is not solely explained by loading conditions [1]. In terms of genetic conditions, it is relatively common; historical studies have estimated a prevalence of 1 in 500 [2], but recent work demonstrates this to be closer to 1 in 200 [3]. HCM is clinically heterogenous as individuals with severe hypertrophy may remain asymptomatic but those with mild hypertrophy may develop significant arrhythmias, heart failure and/or sudden death. Classic HCM is primarily caused by variants in the genes encoding proteins of the cardiac sarcomere [4] and follows an autosomal dominant pattern of inheritance. Although rarer, a number of multisystem diseases are genocopies of HCM, which require additional surveillance, treatment options, and may follow a different inheritance pattern. Some examples include Fabry disease, PRKAG2-related disease, Danon disease, neuromuscular diseases, mitochondrial myopathies and the RASopathies such as Noonan syndrome. Obtaining a correct diagnosis is therefore of utmost importance for medical management purposes, but also for the identification of at-risk family members who require ongoing screening.
The diagnostic yield in this heterogeneous cohort of patients is lower than what has previously been reported in other published cohorts, likely due to differences in patient cohorts, study inclusion criteria, improvements in variant classifications and HCM gene curation efforts. The majority of LP/P variants were in genes that are definitively associated with HCM [18]. An important proportion of patients referred for HCM genetic testing have a LP/P variant in a RASopathy gene. An evaluation for syndromic features is warranted, as the phenotypic spectrum of the RASopathy syndromes continues to expand. A comprehensive inclusion of RASopathy genes on HCM panels may increase the diagnostic yield, and the findings in these genes have important implications for patients given the need for extra-cardiac management. Offering a broader panel may be of value in some patients as, despite a clinical suspicion of HCM, their presentation may actually be explained by a different diagnosis. Further work is needed to understand how to increase the diagnostic yield of genetic testing in patients with HCM. Thus far, the analysis of deep intronic/non-coding variants has been shown to provide the most substantial increase in diagnostic yield [29], more so than new gene discovery at this time.
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The Clinical Cardiac Electrophysiology Fellowship program (CCEP) is designed to provide a structured training experience in the evaluation and management of a wide spectrum of patients with acute and chronic cardiac conditions. Our program offers a 2-year clinical fellowship for qualifying trainees for subspecialty board certification in clinical cardiac electrophysiology. Complete training is provided in the diagnosis and management of cardiac rhythm disturbances, interpretation of electrophysiology studies, catheter ablation procedures, laser lead extraction and the evaluation and implantation of permanent pacemakers and implantable cardioverter defibrillator systems. The mandated clinical experience conforms to the American College of Graduate Medical Education guidelines for Clinical Cardiac Electrophysiology. The CCEP fellowship is directed by Arvindh Kanagasundram, MD, FHRS and Jay Montgomery, MD (associate program director).
ECG is done, but unless the recording is done while symptoms are occurring, it may not provide a diagnosis. Many cardiac arrhythmias are intermittent and show no fixed ECG abnormalities; exceptions include
Sometimes tilt-table testing Tilt Table Testing Tilt table testing is used to evaluate syncope in Younger, apparently healthy patients Elderly patients when cardiac and other tests have not provided a diagnosis Tilt table testing produces... read more is done in patients with postural syncope.
This course offers an interdisciplinary updates to nurse practitioners, physician assistants and healthcare providers who deliver preventive, acute and chronic disease-based care to infants, children, and adolescents. Topics presented include the most recent strategies for timely and effective evidence-based diagnosis and management plans for cardiac, neurological, and dermatological conditions, as well as updated immunization practices, information on infectious diseases, sports medicine, and mental health disorders for pediatric and adolescent health. 041b061a72