12.8.2013(palpitations) Flashcards

0
Q

Irregular sustained palpitations

A

AF

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1
Q

Characteristics of palpitation

A

Intermittent Vs persistent

Regular Vs irregular

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2
Q

Regular sustained palpitations

A

Regular supra ventricular and ventricular tachycardias

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3
Q

CVS causes of palpitations

A

Premature atrial and ventricular contractions
Supra ventricular and ventricular arrythmias
Mitral valve prolapse(with or WITHOUT associated arrythmias)
AR
Atrial myxoma
Pulmonary embolism
Pericarditis
CCF

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4
Q

Common cause of Intermittent palpitation

A

Premature atrial or ventricular contractions

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5
Q

Which Beat is sensed by the patient in premature atrial or ventricular contraction?

A

Post extrasystolic beat

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6
Q

Are all arrythmias associated with palpitation?

A

MOST arrythmias are not associated with palpitation

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7
Q

Catecholaminergic Hyperdynamic states causing palpitations

A

Pheochromocytoma
Exercise
Stress

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8
Q

Drugs causing palpitations

A
Caffeine
Theophylline
Tobacco
Atropine
Thyroxine
Cocaine
Amphetamine
Beta agonists
Digitalis
Phenothiazines
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9
Q

Psychiatric causes constitute _________ % of palpitations

A

31

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10
Q

Psychiatric causes of palpitation

A

Panic attacks
Anxiety
Somatisation

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11
Q

Features of psychiatric causes of palpitation

A
Longer duration(>15min)
Associated with other symptoms
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12
Q

Miscellaneous causes of palpitations

A
Drugs
Thyrotoxicosis 
Systemic mastocytosis
Pheochromocytoma 
Ethanol
Spontaneous skeletal muscle contractions of chest wall
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13
Q

Palpitations caused by sustained tachyarrythmias in CAD pts is associated with

A

Angina

Dyspnea

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14
Q

Palpitations in patients with ventricular dysfunction,AS,HOCM,MS are associated with

A

Dyspnea

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15
Q

Palpitations due to life threatening arrythmias are associated with

A

Symptoms of hemodynamic compromise like syncope,light headedness

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16
Q

Strategies that are better for evaluation of pts with unexplained,recurrent palpitations

A

Implantable loop recorder

Mobile cardiac outpatient telemetry

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17
Q

Rx of benign atrial or ventricular premature contractions

A

Betablockers

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18
Q

Arrythmias that cause palpitations

A

Any arrythmia

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19
Q

Non-cardiac causes of palpitations

A
Hypoglycemia
Vasovagal syncope
Hyperthyroidism 
Fever 
Anemia
Electrolyte imbalance 
Hypovolemia 
Pulmonary disease
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20
Q

Nonarrythmic cardiac causes of palpitations

A
ASD,VSD
congenital heart disease
CCF
Cardiomyopathy
MVP
Pacemaker induced tachycardia
Pericarditis
Valvular diseases
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21
Q

Pounding or jumping palpitations when the patient is quietly sitting down or lying

A

Premature contractions

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22
Q

Orthostatic intolerance

A

Inadequate cerebral perfusion on upright posture

23
Q

Orthostatic intolerance is common in

A

Women of child bearing age

24
Q

Are panic disorders and significant arrythmias mutually exclusive

A

No

25
Q

Single question screening tool for panic disorder

A

Have you ever experienced brief periods of overwhelming panic or terror that was accompanied by racing heartbeats,dizziness,shortness of breath?

26
Q

Single skipped beats

A

Benign ectopy

27
Q

Feeling of unable to catch one’s breath

A

VPC

28
Q

Single pounding sensations

A

VPC

29
Q

Rapid,regular pounding in neck

A

Supra ventricular arrythmias

30
Q

Palpitations that are worse at night

A

Benign ectopy

AF

31
Q

Palpitations associated with emotional distress

A

Psychiatric

Catecholamine sensitive arrythmias

32
Q

Palpitations associated with activity

A

CAD

33
Q

Palpitations associated with general anxiety

A

Panic attacks

34
Q

Rapid palpitations with exercise

A

Supra ventricular arrythmias

AF

35
Q

Positional palpitations

A

AV nodal tachycardia

Pericarditis

36
Q

Palpitations since childhood

A

Supra ventricular tachycardia

37
Q

Rapid,irregular rhythm

A

AF

Tachycardia with variable block

38
Q

Palpitation terminated by Vagal manuevers

A

Supra ventricular tachycardia

39
Q

Who donot require further diagnostic testing for palpitations?

A

Low risk for CAD,normal ECG,not associated with syncope,negative physical exam findings

40
Q

Ventricular tachycardia is associated with

A

Previous MI
Idiopathic dilated cardiomyopathy
Significant valvular lesions
Hypertrophic cardiomyopathies

41
Q

Cardiac activity monitors

A

Implantable loop recorder
Holter monitor
Transtelephonic cardiac event monitor

42
Q

Holter monitor

A

ECG recording device that is worn by the patient for 24-48hours

43
Q

Transtelephonic event monitors

A

Continuous loop event monitor
Record data only few min before and after activation
Activated by the patient
Sends the recorded ECG activity to physician

44
Q

Body weight and edema

A

Weight gain of several kgs precede overt symptoms of Edema

Weight loss by diuresis can be induced in edematous patient

45
Q

Subtle signs of Edema

A

Difficulty in putting shoes in evening
Imprint of steth over chest wall
Tight ring

46
Q

Features of inflammatory Edema due to capillary damage

A

Nonpitting
Localised
Accompanied by other signs of inflammation

47
Q

Angiotensin 1 is a _____ peptide

A

Deca

48
Q

Angiotensin 2 is a _______ peptide

A

Octa

49
Q

Aldosterone in heart failure

A

Levels increased

Half life increased(reduced hepatic metabolism due to decreased hepatic blood flow)

50
Q

Why aldosterone escape doesnot occur in CCF,nephrotic syndrome,cirrhosis?

A

No pressure natriuresis due to decreased effective circulating volume

51
Q

Cause of AVP secretion in CCF

A

Non osmotic stimulus

Decreased effective circulating volume

52
Q

Endothelin levels in heart failure

A

Increased

53
Q

Types of natriuretic peptides

A

ANP(atria)
BNP(ventricles)
CNP(endothelial and renal)

54
Q

Receptors for natriuretic peptides

A

ANP and BNP bind to natriuretic peptide receptor A found in myocardium
CNP binds to natriuretic peptide receptor B found in veins

55
Q

In mild heart failure the decreased arterial filling is offset by

A

Increase in circulating blood volume

56
Q

Renal Na+ in cirrhosis is attenuated by

A

Increased prostaglandins PGE2 and PGI2