A7- Palpatations Flashcards
What is palpitations
Uncomfortable awareness of heart beat or undue awareness of heart action
Defined as a thumping, pounding or fluttering sensation in the chest This sensation can either be intermittent or sustained and either regular or irregular
Often noted when the patient is quietly resting
Often described as skipped or missed beats
Palpitations - Pathophysiolog
- Alteration in heart rate
- Alteration in heart rhythm
- Augmentation of myocardial contraction
- Panic attacks and anxiety states
Nature of Palpitations
What do these features suggest
- Heart misses or thumps
- Very fast regular
- Sudden onset
- Offset with vagal manoeuvres
- Fast and irregular
- Severe dizziness or syncope
- Heart misses or thumps - Ectopic beats
- Very fast regular - SVT/VT
- Sudden onset - SVT/VT
- Offset with vagal manoeuvres - SVT
- Fast and irregular - AF or A Flutter
- Severe dizziness or syncope - VT or brady arrhythmias
What are some Structural conditions associated with palpitations
- Reduced EF%
- Valvular heart disease
- Congenital heart disease
- Mitral valve prolapse
- Atrial myxoma
- Hypertension
- Pacemaker induced tachycardia
Name some Miscellaneous causes of palpitations
- Hyperkinetic circulatory states: fever, anaemia, thyrotoxicosis, hypoglycaemia, phaeochromocytoma
- Drugs: Thyroxine, anti-depressants, vasodilators
- Others: caffeine, cocaine, amphetamines, alcohol, tobacco
- Physiological: pregnancy, spontaneous muscle contractions of the chest wall
What are some Red Flags associated with Palpitations
- Patients with IHD and / or LV dysfunction are at greater risk of ventricular arrhythmias as the cause of palpitations
- Associated symptoms of syncope, pre-syncope or light-headedness supports potential ventricular arrhythmias
- Other associated symptoms: chest pain, breathlessness, polyuria, sweating
- Precipitating factors: exercise, stress, alcohol, drugs
- Associated IHD or valvular heart disease
What are some Good Tips When Taking the History
Ask the patient to tap out the rhythm
Has the patient taken their pulse or have they got a smart watch report to show you!
Are the palpitations altered by position of the patient?
Further Investigations of Palpitations
ECG
- Blood tests – what will you request?
- Echocardiogram – what are you looking for?
- Further imaging – what are you looking for?
- Looking for the arrhythmia – what to choose?
what is holter monitoring
A Holter monitor is a small, wearable device that records the heart’s rhythm. It’s used to detect or determine the risk of irregular heartbeats (arrhythmias).
A Holter monitor test may be done if a traditional electrocardiogram (ECG or EKG) doesn’t provide enough details about the heart’s condition. If the irregular heartbeats are infrequent, a longer term monitor called an event recorder may be needed.
What is loop recorder implantation?
An implantable loop recorder, or ILR, is a heart recording device that is implanted in the body underneath the chest skin. It has several uses. The most common ones include looking for causes of fainting, palpitations, very fast or slow heartbeats, and hidden rhythms that can cause strokes
WHat is ablation
Ablation is a procedure to treat atrial fibrillation. It uses small burns or freezes to cause some scarring on the inside of the heart to help break up the electrical signals that cause irregular heartbeats. This can help the heart maintain a normal heart rhythm.
Name some other Arrhythmias for Ablation
- Supra-ventricular tachycardia
- Wolff-Parkinson-White
- Atrial Flutter
- Atrial Fibrillation
- Atrial Tachycardia
- Ventricular Tachycardia
What is first line for AF
Beta blocker or calcium channel blocker (verapamil or ditiazem) Effective with rest and on exertion
IV metoprolol or diltiazem used if needing IV
If symptoms of palpations still occur after trying to control heart rate with med?
Where to do you refer
to cardioversion who will provide rate-control strategy
Is anticoagulation required for AF
if so what do you use
Yes to prevent embolisation of thrombus from the LA/AA. Use NOAC’s r wardarin
WHat is the CHA2DsS2 VASc score
