Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

AV-Nodal Reentrant Tachycardia Back or Neck Pain 213

■Radio frequency ablation of the slow or fast (rare) AVN pathway often

best Rx.

Side Effects & Contraindications

■Excessive suppression of AVN or sinus node activity with beta block-

ers or calcium channel blockers. Inadvertent ablation of the AVN

during RF ablation requiring permanent pacemaker.

follow-up

■During chronic Rx with beta blockers and calcium channel blockers

monitor BP and HR and AV conduction. Holter to identify asymp-

tomatic AVNRT or heart block from drug Rx.

complications and prognosis

■Cardiomyopathy with incessant AVNRT

Back or Neck Pain....................................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Pain in back or neck, sometimes w/ radiation to limbs

■May be segmental weakness, numbness or paresthesias in limbs

■May be sphincter or sexual dysfunction

■May be history of trauma or unaccustomed activity

■May be past history of malignancy, structural spinal disorder, osteo-

porosis, inflammatory disease, predisposition to infection

■Spasm of paraspinal muscles commonly present

■Spinal movement may be limited

■Spinal tenderness common

■Focal neurologic deficit may indicate root or cord involvement

■Rectal or pelvic exam may reveal local cause of back pain

■May be evidence of underlying psychiatric disorder

tests

■MRI will reveal bone or joint disease, disc herniation, local infection

■CBC may suggest infection or coagulopathy

■ESR may be increased in infective, inflammatory or neoplastic dis-

orders