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Y4 Cardiology > Arrhythmias, Syncope, Palpitations > Flashcards

Arrhythmias, Syncope, Palpitations Flashcards

1
Q

“Temporary loss of consciousness caused by a sudden fall in BP causing transient global cerebral hypoperfusion” is the definition of what

A

Syncope

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2
Q

Syncope is

  • Slow/rapid onset
  • Short/lung duration
  • Quick/slow recovery
A

Rapid onset, short duration, spontaneous complete recovery

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3
Q

Define orthostatic hypotension

A

Decrease in SBP by 20 and BDP by 10

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4
Q

Autonomic failure causes what kind of syncope

A

Orthostatic hypotension

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5
Q

Parkinson’s disease, multiple system atrophy, diabetes, amyloidosis all increase risk of syncope through what mechanism

A

Autonomic failure causing orthostatic hypotension

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6
Q

Bradycardia, tachycardia and structural disease all cause what type of syncope?

A

Cardiac syncope

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7
Q

Carotid sinus syncope, vasovagal syncope and situational syncope are all what type of syncope?

A

Reflex syncope

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8
Q

Prolonged standing in a hot environment eg on a ward or in a school assembly cause what type of syncope

A

Vasovagal (postural)

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9
Q

Looking at needles can cause what type of syncope?

A

Vasovagal (provoking factors)

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10
Q

Straining during micturition or coughing cause what type of syncope?

A

Situational reflex syncope

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11
Q

Drug induced syncope is most likely what type of syncope?

A

Orthostatic hypotension

Or could be bradycardia (cardiac syncope)

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12
Q

“Awareness of the heart rhythm” is the definition of what?

A

Palpitation

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13
Q

What is more concerning… Palpitations at rest or exertional?
Prolonged persistent or short duration?

A

Exertional and prolonged persistent are concerning features of palpitations.
Other red flags are syncope, chest pain and a family history of sudden cardiac death
Features of innocent palpitations: occur at night or when quiet, benign trigger eg alcohol, normal ECG, short-lived, no associated symptoms, ‘skipped beat’, ‘thumping beat’

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14
Q

Ectopic beats are also known as what?

A

Extrasystole

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15
Q

“Skipped beat then compensatory pause then a thump” is the description of what

A

Ectopic beat AKA extrasystole

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16
Q

Ectopic beats are generally ventricular or atrial?

How could you distinguish on ECG?

A

Ventricular
(both have the same symptoms)
Ventricular would have a wide QRS and atrial would have a narrow QRS

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17
Q

What is bigeminy and trigeminy?

A

Bigeminy ectopic every second beat

Trigeminy ectopic every third beat

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18
Q

AF, thyroid disease and anxiety can all cause ____

A

Palpitations

Consider TFTs in patient with palpitations

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19
Q

1st line investigation for palpitations

A

12 lead ECG

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20
Q

What type of recorder for palpitations that are:

  • Daily or very frequently and short lived
  • Less frequent but weekly
  • Exercise induced
  • Very intermittent
  • Very infrequent but high risk

What additional investigation would you do if a murmur or abnormal ECG point you towards structural disease?

A
  • Daily or very frequently and short lived = ambulatory 24 hour Holter monitor
  • Less frequent but weekly = ambulatory 7 day r test
  • Exercise induced = exercise treadmill ECG
  • Very intermittent = event recorder
  • Very infrequent but high risk = implantable loop recorder

ECHO

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21
Q

Out of transvenous and subcutaneous ICD, which is the standard type and which is used in paediatrics?

A

Standard type transvenous

Subcutaneous used in paediatrics

22
Q

Radiofrequency ablation has high success rates in ….

SVT or atrial flutter or AF?

A

SVT and atrial flutter

Moderate chance of success in AF

23
Q

Sinus tachycardia, SVT, VT and atrial flutter are generally all around what HR?

A

150 bpm

24
Q

What is the atrial rate in atrial flutter?

Atrial flutter is described as 2:1 conduction, what does this mean?

A

Atrial rate 300bpm

2: 1 conduction = number of beats AVN lets though
atrial: ventricular

25
Q

ECG appearance in atrial flutter

A

Saw tooth pattern

26
Q

Management of atrial flutter

A

Anticoagulate (thrombus risk)

Ablation

27
Q

ECG appearance of SVT

A

Narrow complex tachycardia

QRS <120ms

28
Q

Commonest type of SVT?

A

AVNRT

AN nodal re-entrant tachycardia

29
Q

1st, 2nd 3rd line Mx of SVT?

A

1st - vagal manoeuvres
2nd - IV adenosine
3rd - IV verapamil or DC cardioversion

30
Q

Name 3 vagal manouevres

A

Valsalva: deep breath in, close mouth, pinch nose, hold 5 seconds, forced expiration violently
Carotid sinus massage
Immerse face in cold water

31
Q

Delta wave (slurred upstroke on QRS) and a short PR interval is the classic ECG appearance of …

A

Wolf Parkinson White

32
Q

What arrhythmia does WPW mainly cause

A

SVT

33
Q

Monomorphic and polymorphic are the two types of what arrhythmia?

A

Ventricular tachycardia

34
Q

What is the main risk in VT?

A

Deteriorating into VF

35
Q

What is the QRS duration in VT?

A

Wide QRS >120ms

36
Q

Management of pulseless VT?
Management of unstable VT?
Management of stable VT?

A

Pulseless VT - advanced life support algorithm
Unstable VT - IV 300mg amiodarone or unsyncronized defibrillation
Stable IV - lidocaine or cardioversion

37
Q

‘Chaotic disorganised’ is the ECG appearance of what arrhythmia

A

Ventricular fibrillation

38
Q

Management of VF

A 
Shockable rhythm 
(long term Mx often ICD)
39
Q

Wenckeback’s is also known as

A

Mobitz type 1

Second degree heart block

40
Q

“Complete dissociation of atria and ventricles” is the definition of what?

A

Complete heart block

may have progressed from Mobitz 2 or occur in acute MI

41
Q

Acute management of Mobitz type 2 and complete heart block?

A

Atropine

may later need temporary pacing

42
Q

What is 1st degree heart block

A

PR interval >0.2 seconds (5 small squares)
1:1 conduction
(Normal in athletes and those with high vagal tone)
(Generally doesn’t require investigations or treatments)

43
Q

What is Mobitz type 1 heart block?

A

Progressive PR prolongation until a dropped beat

Generally benign

44
Q

What is Mobitz type 2 heart block?

A

Regularly dropped beat eg 2:1 or 3:1
(May progress to complete heart block)
Requires treatment

45
Q

Describe the QRS in bundle branch block

A

Broad QRS >120ms

46
Q

ECG appearance in LBBB

A

Broad QRS >120ms
V1 = W
V6 = M

47
Q

ECG appearance in RBBB

A

Broad QRS >120ms
V1 = M
V6 = W

48
Q

ECG appearance in right axis deviation

A

I negative

aVF postive

49
Q

ECG appearance in left axis deviation

A

I positive

aVF negative

50
Q

Not included causes of axis deviation, causes of BBB, don’t know what aberrancy is, or a premature ventricular complex? What is the ECG appearance of a PE?

A

Ughhhh

Y4 Cardiology (9 decks)

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