12.8.2013(palpitations) Flashcards
Irregular sustained palpitations
AF
Characteristics of palpitation
Intermittent Vs persistent
Regular Vs irregular
Regular sustained palpitations
Regular supra ventricular and ventricular tachycardias
CVS causes of palpitations
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
Common cause of Intermittent palpitation
Premature atrial or ventricular contractions
Which Beat is sensed by the patient in premature atrial or ventricular contraction?
Post extrasystolic beat
Are all arrythmias associated with palpitation?
MOST arrythmias are not associated with palpitation
Catecholaminergic Hyperdynamic states causing palpitations
Pheochromocytoma
Exercise
Stress
Drugs causing palpitations
Caffeine Theophylline Tobacco Atropine Thyroxine Cocaine Amphetamine Beta agonists Digitalis Phenothiazines
Psychiatric causes constitute _________ % of palpitations
31
Psychiatric causes of palpitation
Panic attacks
Anxiety
Somatisation
Features of psychiatric causes of palpitation
Longer duration(>15min) Associated with other symptoms
Miscellaneous causes of palpitations
Drugs Thyrotoxicosis Systemic mastocytosis Pheochromocytoma Ethanol Spontaneous skeletal muscle contractions of chest wall
Palpitations caused by sustained tachyarrythmias in CAD pts is associated with
Angina
Dyspnea
Palpitations in patients with ventricular dysfunction,AS,HOCM,MS are associated with
Dyspnea
Palpitations due to life threatening arrythmias are associated with
Symptoms of hemodynamic compromise like syncope,light headedness
Strategies that are better for evaluation of pts with unexplained,recurrent palpitations
Implantable loop recorder
Mobile cardiac outpatient telemetry
Rx of benign atrial or ventricular premature contractions
Betablockers
Arrythmias that cause palpitations
Any arrythmia
Non-cardiac causes of palpitations
Hypoglycemia Vasovagal syncope Hyperthyroidism Fever Anemia Electrolyte imbalance Hypovolemia Pulmonary disease
Nonarrythmic cardiac causes of palpitations
ASD,VSD congenital heart disease CCF Cardiomyopathy MVP Pacemaker induced tachycardia Pericarditis Valvular diseases
Pounding or jumping palpitations when the patient is quietly sitting down or lying
Premature contractions
Orthostatic intolerance
Inadequate cerebral perfusion on upright posture
Orthostatic intolerance is common in
Women of child bearing age
Are panic disorders and significant arrythmias mutually exclusive
No
Single question screening tool for panic disorder
Have you ever experienced brief periods of overwhelming panic or terror that was accompanied by racing heartbeats,dizziness,shortness of breath?
Single skipped beats
Benign ectopy
Feeling of unable to catch one’s breath
VPC
Single pounding sensations
VPC
Rapid,regular pounding in neck
Supra ventricular arrythmias
Palpitations that are worse at night
Benign ectopy
AF
Palpitations associated with emotional distress
Psychiatric
Catecholamine sensitive arrythmias
Palpitations associated with activity
CAD
Palpitations associated with general anxiety
Panic attacks
Rapid palpitations with exercise
Supra ventricular arrythmias
AF
Positional palpitations
AV nodal tachycardia
Pericarditis
Palpitations since childhood
Supra ventricular tachycardia
Rapid,irregular rhythm
AF
Tachycardia with variable block
Palpitation terminated by Vagal manuevers
Supra ventricular tachycardia
Who donot require further diagnostic testing for palpitations?
Low risk for CAD,normal ECG,not associated with syncope,negative physical exam findings
Ventricular tachycardia is associated with
Previous MI
Idiopathic dilated cardiomyopathy
Significant valvular lesions
Hypertrophic cardiomyopathies
Cardiac activity monitors
Implantable loop recorder
Holter monitor
Transtelephonic cardiac event monitor
Holter monitor
ECG recording device that is worn by the patient for 24-48hours
Transtelephonic event monitors
Continuous loop event monitor
Record data only few min before and after activation
Activated by the patient
Sends the recorded ECG activity to physician
Body weight and edema
Weight gain of several kgs precede overt symptoms of Edema
Weight loss by diuresis can be induced in edematous patient
Subtle signs of Edema
Difficulty in putting shoes in evening
Imprint of steth over chest wall
Tight ring
Features of inflammatory Edema due to capillary damage
Nonpitting
Localised
Accompanied by other signs of inflammation
Angiotensin 1 is a _____ peptide
Deca
Angiotensin 2 is a _______ peptide
Octa
Aldosterone in heart failure
Levels increased
Half life increased(reduced hepatic metabolism due to decreased hepatic blood flow)
Why aldosterone escape doesnot occur in CCF,nephrotic syndrome,cirrhosis?
No pressure natriuresis due to decreased effective circulating volume
Cause of AVP secretion in CCF
Non osmotic stimulus
Decreased effective circulating volume
Endothelin levels in heart failure
Increased
Types of natriuretic peptides
ANP(atria)
BNP(ventricles)
CNP(endothelial and renal)
Receptors for natriuretic peptides
ANP and BNP bind to natriuretic peptide receptor A found in myocardium
CNP binds to natriuretic peptide receptor B found in veins
In mild heart failure the decreased arterial filling is offset by
Increase in circulating blood volume
Renal Na+ in cirrhosis is attenuated by
Increased prostaglandins PGE2 and PGI2
