cardiac_monitoring

who needs cardiac monitoring, and for how long?

see also:

almost certainly need cardiac monitoring

condition duration
possible cardiac chest pain until 2nd trop is normal unless high risk features mandate further monitoring
hyperkalaemia until K+ < 6.5
acute pulmonary oedema
acute coronary syndrome 24hrs from onset of pain and then reassess
STEMI or non-STE-ACS
life threatening arrhythmias: 24hrs from onset
post cardiac arrest
VF / V flutter
asystole
VT
accessory pathway (eg. WPW) with rapid vent. response tachycardias
syncope or tachycardia or bradycardia with haemodynamic compromise possibly due to primary cardiac condition excl. vasovagal, hypovolaemia, etc
temporary cardiac pacing
Mobitz II or 3rd degree AV blocks
Long QTc syndrome with ventricular arryhythmia
new RAF in pts with certain heart diseases (eg. HOCM) where new onset AF may be lethal
pharmacologic
IV cardiac drug Rx such as inotropes, vasoactive drugs, type I/III antiarrhythmic agents (amiodarone, sotalol, quinidine, procainamide, lignocaine, phenytoin, flecainide, propafenone)
overdose of substance with potential pro-arrhythmic effects (eg. VT, prolonged QTc) as per toxicologist or cardiologist

patients where cardiac monitoring should be strongly considered

condition duration
delayed presentation NSTEMI cease once troponins negative or after 24hrs whichever is earlier
post-op patients at high risk of ischaemia
AF with rapid ventricular response until HR < 120
syncope with no obvious cause, especially in the elderly or with either: LBBB; RBBB+fasc. block; QRS >= 0.12sec; Mobitz I; HR < 50; sinus pause > 3sec; pre-excited QRS complexes; Brugada syndrome; Q waves suggesting AMI; possible arrhythmogenic RV dysplasia (neg. T waves R precordial leads, epsilon waves, ventricular late potentials); vent. dysplasia excl. vasovagal, postural, micturition, carotid sinus syncope, POTS, autonomic failure, hypovolaemic
significant risk of resp. or cardiac arrest

patients where cardiac monitoring may be indicated

pericarditis
large perocardial effusion
suspected cardiac blunt trauma
stable patients with PVCs
very high voltage electrocution
electrocution with abnormal ECG or cardiac symptoms
chronic AF with haemodynamic compromise

patients where cardiac monitoring NOT indicated

chronic AF on iv digoxin loading
chronic AF without haemodynamic compromise
asymptomatic 1st degree heart block
patients with a stable, functioning ICD or PPM which has been checked
raised troponin due to non-coronary ischaemia (although these patients may need ICU/HDU for undelying issue)
household voltage or lower voltage electrocution / electrical injury with normal ECG and no cardiac symptoms
cardiac_monitoring.txt · Last modified: 2016/11/02 06:58 by gary1