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Scenario: Cardiac arrhythmias

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Scenario: Cardiac arrhythmias

Gladys Underwood has been to her GP about a fluttering feeling in her chest and comes into
the pharmacy clutching a small cuboidal device...

“Dr Garroway at the surgery has just done an ECG,” Gladys tells Parveen. “It didn’t pick anything up so he said I need to use an ECG event machine. He was really pushed for time so has made me an appointment to go and see the nurse about it in a few days’ time, but I think he has given me the wrong thing. It is not right, is it?” asks Gladys. “It doesn’t have wires to attach to my chest...”

Answer

Cardiac event monitors are small hand-held devices that someone can hold to their chest when they are experiencing symptoms in order to record the heart rhythm.
As there is no need to record every single heartbeat and instead store only small
periods of heart rhythm, cardiac event monitors are much more comfortable than full electrocardiogram (ECG) monitors, which have electrodes that attach to the skin, and considerably less invasive than implantable loop recorders that are inserted under the skin.

The patient either returns the cardiac event monitor to the GP so the rhythms can
be listened to and a diagnosis reached, or, in some cases, hospitals may ask for the recording to be sent via a telephone answering service. The patient is then informed of the results at a follow-up appointment.

The bigger picture

Cardiac rhythm disorders are experienced by more than 1 million people a year in the UK, and are among the top 10 reasons for someone going to hospital. While some are completely benign, others are most definitely not.

According to the Arrhythmia Alliance charity, sudden cardiac death kills 100,000 people a year. Cardiac arrhythmias are usually classified by where in the heart the arrhythmia originates – the ventricles (which tend to be more serious) or the atria (which slightly confusingly is sometimes referred to as ‘supraventricular’) – and whether the heart rate increases or decreases. The commonest arrhythmia is atrial fibrillation.

Extend your learning

Question: When does NICE recommend 24-hour ambulatory ECG monitoring rather than a cardiac event recorder in its guidance on atrial fibrillation?

Answer: It is recommended for those with symptomatic episodes less than 24 hours apart or who are thought to be experiencing asymptomatic arrhythmia episodes.

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