Your doctor will ask about your family history of coronary artery disease, cardiac arrhythmias, fainting spells or sudden death from heart problems. Your doctor also will review your personal medical history, including any possible risk factors for cardiac arrhythmias (coronary artery disease, rheumatic fever, thyroid disorders, certain medications). You will be asked to describe your specific cardiac symptoms, including any possible triggers for those symptoms.
During the physical examination, your doctor will check your heart rate and rhythm, together with your pulses. This is because certain cardiac arrhythmias cause a mismatch of the pulse and the heart sounds. Your doctor also will check for physical signs of an enlarged heart and for heart murmurs, one sign of a heart valve problem.
A test called an electrocardiogram (EKG) often can confirm the diagnosis of a cardiac arrythmia. However, because cardiac arrhythmias may come and go, a one-time office EKG may be normal. If this is the case, an ambulatory EKG may be required. During an ambulatory EKG, the patient wears a portable EKG machine called a Holter monitor, usually for 24 hours, but sometimes much longer. You will be taught to press a button to record the EKG reading whenever you experience symptoms. This approach is especially useful if your symptoms are infrequent. Some newer heart rhythm recording devices can be used for patients with rare symptoms, including monitors that can be implanted under the skin and used to evaluate possible rhythm problems for months.
When a patient has ventricular fibrillation, it is an emergency. The patient is unconscious, not breathing, and doesn't have a pulse. If available, electrical cardioversion must be administered as soon as possible. If not available, then cardiopulmonary resuscitation (CPR) should be started.
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