Radiographic and Other Studies

1. Twelve-lead ECG, rhythm strip. ECG and rhythm strips obtained during tachycardia are the most important studies for diagnosing type of tachycardia. If patient is not experiencing tachycardia when ECG is obtained, assess for delta wave (Wolff-Parkinson-White syndrome) or signs of myopathic changes (hypertrophy, strain, ischemia). If patient has an irregular rhythm, a multilead rhythm strip is important for diagnosing origin of irregularity (premature atrial or ventricular contraction).

2. Chest x-ray. Examine for abnormal cardiac size, signs of interstitial lung disease, evidence of mediastinal mass, pneumothorax, or bony abnormalities.

3. Echocardiogram. Used to confirm cardiac disease when suspected or to determine presence or absence of cardiac disease in cases less certain. Transthoracic or transesophageal echocardiography is performed in patients with congenital heart disease and atrial flutter or fibrillation because of possibility of clot formation in left atrial appendage.

4. Other imaging studies. CT or MRI scanning or ultrasonogra-phy of head, chest, or abdomen may be performed if neurologic disease, adrenal abnormalities, or mediastinal abnormalities are suspected.

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