Arrhythmia

Question 1

Patient presents with palpitations. What are the most possible causes?

Answer 1

1. Arrhythmias
2. Stress
3. Increased awareness of normal heart beats/ extrasystoles

Question 2

What are the first line Ixs for a patient presenting with palpitations?

Answer 2

First-line investigations include:

1. 12-lead ECG: this will only capture the heart rhythm for a few seconds and hence is likely to miss episodic arrhythmias. However, other abnormalities linked to the underlying arrhythmia (for example a prolonged QT interval or PR interval, or changes suggesting recent myocardial ischaemia) may be seen.
2. Thyroid function tests: thyrotoxicosis may precipitate atrial fibrillation and other arrhythmias
3. urea and electrolytes: looking for disturbances such as a low potassium
4. full blood count

Question 3

What are the cardiac causes of arrhythmias?

Answer 3

Ischaemic Heart Disease

Structural changes eg left atrial dilatation secondary to mitral regurg

Cardiomyopathy

Pericarditis

Myocarditis

Aberrant conduction pathways

Question 4

What are the non cardiac causes of arrhythmias?

Answer 4

Caffeine
Alcohol
Smoking
Pneumonia
Drugs (B2- agonists, digoxin, L-dopa, tricyclics, doxorubicin)
Metabolic imbalance (K+, Ca2+, hypoxia, hypercapnia, metabolic acidosis, thyroid disease)
Phaeochromocytoma

Question 5

How do arrhythmias present?

Answer 5

Palpitations
Chest pain
Presyncope/ syncope 
Hypotension 
Pulmonary oedema 
Could be asymptomatic or incidental findings like AF

Question 6

What tests would you carry out for someone with arrhythmias?

Answer 6

FBC
U&Es
Calcium 
Magnesium
TSH 
ECG