An 82-year-old white female is admitted to the hospital for observation after presenting to the emergency department with dizziness. After being placed on a cardiac monitor in the ER, the rhythm strip below was recorded.
There is no past history of cardiac disease, diabetes, or hypertension. When asked in more detail the patient discloses several prior episodes of transient dizziness and one episode of brief syncope in the past. Physical examination is unremarkable.
What is the diagnosis and how will you manage this patient?
Answer And Discussion:
Diagnosis: The patient in question has symptomatic tachycardia-bradycardia syndrome.
Pathophysiology: In this condition the sinus node automaticity is suppressed by the tachyarrhythmia and results in a prolonged sinus pause following termination of the tachycardia.
Management: The patient in this case is symptomatic, and pacemaker placement is warranted, Although a pacemaker will prevent bradycardia, it does not prevent tachycardia. The patient may need medication to prevent tachycardia if she continues to be symptomatic after pacemaker placement.
The tachy-brady syndrome does increase the patient’s risk of cardioembolic event, and anticoagulation should be considered.