ZIO PATCH
ZIO PATCH RESULTS
DATES OF HOOKUP:
The Zio Patch was performed to evaluate the complaint of
RESULTS:
Baseline rhythm is sinus rhythm, with heart rates ranging from ___ bpm, giving
an average heart rate of __ bpm.
Supraventricular Ectopy / Rhythms:
(a) There was rare supraventricular ectopy
(b) There were __ episodes of Paroxysmal Supraventricular Tachycardia
(PSVT):
-The longest of which occured on ____, and lasted
for __ seconds at an average ventricular rate of __
Ventricular Ectopy / Rhythms:
(a) There was rare ventricular ectopy with a PVC burden < __%
(b) The longest episode of ventricular bigeminy was __ minutes __
seconds
(c) The longest episode of ventricular trigeminy was __ minutes __
seconds
*****Patient Activated Episodes*********
(a) There were __ patient triggered events:
(b) There were 0 patient diary entries.
IMPRESSION:
1. Unremarkable Zio Patch
2. No pathological sustained tachyarrhythmias or bradyarrhythmias.
Duration < 7 Days
93242
93244
Duration > 7 Days
93246
93248
PVCs
2. Frequent PVCs with PVC burden ~ 8.6%
-Overall, PVC burden is < 10% and considered low burden
-In patients with structurally normal heart (as determined by TTE), no
known CAD, work up of PVCs is typically first centered around
eliminating potential secondary triggers, which can include (but are
not limited to):
-Caffeine
-Drugs
-EToH
-High Catecholamine states (pain, anxiety, stress, carcinoid
etc)
-Hypoxia / Lung disease
-Infection
-Thyroid Disesae
-It is also important to try to detemine if the patient is symptomatic
from his PVCs, and to what degree
-Are symptoms mild?
-Are symptoms severe / activity limiting / life style limiting?
-If severe symptoms are present, after careful eliminating
potential secondary triggers (please see above), can consider
initial trial of beta-blocker or Calcium Channel blocker
-If symtoms are mild or asymptomatic, and provided TTE shows no
significant structural abnormalities, can carefully observe
1. Occasional PVCs
-PVC Burden ~ 5.9% which is considered low burden
-In many patients, this is typically a benign finding
-In patients with structurally normal heart (as determined by TTE), no
known CAD, work up of PVCs is typically first centered around
eliminating potential secondary triggers, which can include (but are
not limited to):
-Caffeine
-Drugs
-EToH
-High Catecholamine states (pain, anxiety, stress, carcinoid
etc)
-Hypoxia / Lung disease
-Infection
-Thyroid Disease
--> Please note that these triggers are NON-cardiac in etiology
-Prior to any consideration of a cardiology consultation:
-Please determine if the severity of these symptoms (mild?
severe? Activity limiting?)
-Please assess and rule out the above secondary triggers
-If the patient is relatively asymptomatic or mildly symptomatic, and
has a normal LVEF / no evidence of structural heart disease, then it is
reasonable to observe and eliminate as many of the above secondary
triggers
IMPRESSION:
1. No obvious pathological sustained tachyarrhythmias or bradyarrhythmias.
2. Relatively high average resting heart rate raises suspicion for
either appropriate sinus tachycardia vs inappropraite sinus tachycardia.
Inappropriate sinus tachycardia is a diagnosis of exclusion. As such,
causes of appropriate sinus tachycardia need to be ruled out prior to any
consideration of inappropriate sinus tachycardia. Many causes of
appropriate sinus tachycardia are non-cardiac in etiology. Would
recommend ruling these out. Some of these include but are not limited to:
-Thyroid Disease
-Infection
-High catecholamine state
-Pain
-Stress
-Anxiety
-Carcinoid etc
-EToH / Drugs
-Anemia
-Caffeine
-HTN
-OSA
-Fever
--> Please note that these classic triggers of apppropriate
sinus tachycardia are non-cardiac in etiology
--> Please note that the above classic triggers of PVCs are non-
cardiac in etiology and PRIOR to any consideratoin of a
Cardiology consultation, the triggers should be assessed and
attempted to be eliminated as outlined above, as these PVCs at
this point may be a secondary phenomena, and NOT a primary one
-For instance, if patient has high anxiety or thyroid
disease or high caffeine intake that secondarily
results in PVCs, the goal of treatment is to find and
eliminate the trigger (in this scenario, management
of anxiety / correction of thyroid abnormality /
reduction in caffeine intake)
2. Elevated average heart rate = 101 bpm
-Potential Differential Diagnoses includes:
-Appropriate Sinus Tachycardia
-Inappropriate Sinus Tachycardia
-This is a diagnosis of exclusion
-Atrial Tachycardia
-However, no findings on this zio patch is highly
suggestive of an Atrial Tachycardia
-Overall, suspect Appropriate Sinus Tachycardia which is a physiologic
phenomena. It is **NOT** a cardiac arrhythmia nor pathologic. Given
that inappropriate sinus tachycardia is a diagnosis of exclusion, the
work up of this finding typically begins by assessing and ruling out
any potential triggers of appropriate sinus tachycardia, which can
include (but not limited to):
-Pain
-Fever
-Infection
-Anemia
-Fever
-Thyroid Disease
-EToH/ Drugs
-Caffeine
-High catecholamine state such as:
-Pain
-Stress
-Anxiety
-Carcinoid etc
**Please kindly note that the above mentioned triggers are NON-
cardiac in origin. Appropriate sinus tachycardia is NOT a
cardiac arrhythmia nor pathological. It is a physiologic
response to a secondary trigger and as noted above, the common
triggers are typically non-cardiac in etiology**
**AS SUCH, THE ABOVE TRIGGERS SHOULD BE ASSESS PRIOR TO
ANY CONSIDERATION OF A CARDIOLOGY CONSULTATION**