Complexity Variations

Arrhythmias are tricky from standpoint of physical therapy. There are many types of arrhythmias. The basic arrhythmias have been discussed in the lecture that has been provided to you. There are many more, complex arrhythmias. Arrhythmias cause reduced cardiac output, hence there is reduced blood flow to the brain, and thereby, the common complaint of dizziness, and the almost certain fall if the arrhythmia persists. Check the link for an overview of the arrhythmias.

The primary reason for consultation is usually the fall associated with the arrhythmia. However, sometimes, the only complaint can be dizziness. This is why, the clinician should approach the evaluation of the patient from the angle of differential diagnosis of dizziness.

Medical diagnosis the cause of dizziness can be difficult because symptoms are often nonspecific and the differential diagnosis is broad.  The burden of the differential diagnosis is not isolated to the physical therapist – it is not our role to figure out precisely what is causing the dizziness if it is beyond our training or ultimate role. For example, if it is cardiogenic arrhythmia- induced dizziness, we can wait for a cardiologist to verify it. However, it behooves are practice to isolate OUT those causes that we are skilled in evaluating, such as orthostatic hypotension, from any underlying issue.

To do that, we need to have an appreciation of all the causes of dizziness, and investigate those causes which could be a potential cause. If we find the potential cause that is PT responsive, we address it. Otherwise, we inform the referring team that patient is cleared from standpoint of the causes that we investigated. This helps the medical team to focus elsewhere and follow up accordingly.

Generally speaking, there are 4 main types of dizziness:

The definitions, and differential diagnostic considerations for each of these causes have been discussed at the link (same as above). It is important for you to review this at length.

If there has been no fall, despite primary diagnosis of arrhythmia, then most usually, the consultation is either an automatic order set, or, due to additional variable comorbidities that are unpredictable. It could be that patient complains of localized pain, or other mobility impairments, regardless of time duration. In any case, such scenarios are evaluated on a per case basis.

Assessment Write-up (including Problem Statement)

xx-year old male, who is admitted to hospital after a witnessed fall, and is begin evaluated by multiple specialties for underlying cause. Neuro, Cards, & PT have been consulted for differential and management needs. On examination, patient is (here is where you describe your exclusion & triage examination… and  describe if you were able to recreate the dizziness, and how).

DME Decision-making