Please see the Remedy Page on Arrhythmia
NICE CKS has information on Palpitations including red flags and urgency of review required.
Arrhythmia Clinics available across BNSSG are listed on the Remedy.
The Arrythmia Advice Line at the BRI is no longer available.
NICE CKS lists the following as Red Flags warranting immediate hospital review:
- Ventricular tachycardia
- Persistent supraventricular tachycardia (SVT). Before deciding to admit, if trained and competent to do so, attempt to terminate the SVT if appropriate by:
- Valsalva manoeuvre — for example the person blows into a syringe whilst lying down (face up) for 15 seconds.
- Carotid sinus massage — ensure that a defibrillator is available, as very rarely terminating an SVT can provoke other arrhythmias. Ideally, record an electrocardiogram (ECG) continuously during and after the procedure.
- Haemodynamic instability (hypotension and/or tachycardia).
- High risk structural heart disease including ischemic heart disease.
- Features suggestive of a serious underlying cardiac cause or complication:
- High degree atrioventricular block on ECG.
- Significant breathlessness.
- Chest pain.
- Syncope or near syncope.
- Family history of sudden cardiac death under the age of 40 years.
- Onset of palpitations precipitated by exercise.
- Consider admission for a person with current palpitations and evidence of a serious or life-threatening systemic cause, such as thyrotoxicosis, severe anaemia, or sepsis.
Weekday Professional Line
BRI
Consider the Arrythmia service
If complete heart block – consider discussion with cardiology SpR via switchboard and generally send to ED.
NBT
Generally AMU can deal with most arrythmias including complete heart block. Usually arrythmias are not appropriate for SDEC as there are no cardiac monitors.
WGH
Admit to Medical Take via ED.
WGH will take patients with heart block/bradycardia and can perform temporary pacing. They transfer to BHI when needed. If the patient is identified to be in complete heart block in the community it would be worthwhile having a conversation with Cardiology at the BHI - the patient needs to be admitted there to have definitive treatment and if they are stable can be conveyed directly there instead of going to WGH first.