Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Sinoatrial Block Sinusitis 1351

■If heart rate < 40 bpm when a clear association between significant

symptoms and actual presence of SA block has not been documented

(Type IIa indication).

■Chronic HR < 30 bpm while awake in patients with minimal symp-

toms.

Side Effects & Contraindications

■none

follow-up

■ECG and Holter monitoring if symptoms appear.

complications and prognosis

■In asymptomatic patients, no long term complication.

■Pacemaker: cardiac perforation, lead dislodgement, infected pace-

maker pocket, lead fracture, failure to sense, failure to pace, pulse

generator depletion. Requires specialized pacemaker followup.

SINUSITIS

ANDREW N. GOLDBERG, MD

history & physical

■Diagnosis supported by 3 components:

■History, exam, imaging (CT)

History

■Frequency, duration, intensity of symptoms

■Adequacy and extent of previous treatment (antibiotics, systemic or

topical steroids, decongestants, triggers of infection, seasonality)

■Predisposing conditions

➣Allergy

➣Immunocompromise

➣Smoking/irritants

➣Asthma and aspirin sensitivity

➣Other causes of nasal edema

Signs & Symptoms

■Purulent nasal discharge

■Facial fullness

■Facial pain or pressure

■Hyposmia or anosmia