Arrhythmias, Syncope, Palpitations Flashcards
“Temporary loss of consciousness caused by a sudden fall in BP causing transient global cerebral hypoperfusion” is the definition of what
Syncope
Syncope is
- Slow/rapid onset
- Short/lung duration
- Quick/slow recovery
Rapid onset, short duration, spontaneous complete recovery
Define orthostatic hypotension
Decrease in SBP by 20 and BDP by 10
Autonomic failure causes what kind of syncope
Orthostatic hypotension
Parkinson’s disease, multiple system atrophy, diabetes, amyloidosis all increase risk of syncope through what mechanism
Autonomic failure causing orthostatic hypotension
Bradycardia, tachycardia and structural disease all cause what type of syncope?
Cardiac syncope
Carotid sinus syncope, vasovagal syncope and situational syncope are all what type of syncope?
Reflex syncope
Prolonged standing in a hot environment eg on a ward or in a school assembly cause what type of syncope
Vasovagal (postural)
Looking at needles can cause what type of syncope?
Vasovagal (provoking factors)
Straining during micturition or coughing cause what type of syncope?
Situational reflex syncope
Drug induced syncope is most likely what type of syncope?
Orthostatic hypotension
Or could be bradycardia (cardiac syncope)
“Awareness of the heart rhythm” is the definition of what?
Palpitation
What is more concerning… Palpitations at rest or exertional?
Prolonged persistent or short duration?
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’
Ectopic beats are also known as what?
Extrasystole
“Skipped beat then compensatory pause then a thump” is the description of what
Ectopic beat AKA extrasystole
Ectopic beats are generally ventricular or atrial?
How could you distinguish on ECG?
Ventricular
(both have the same symptoms)
Ventricular would have a wide QRS and atrial would have a narrow QRS
What is bigeminy and trigeminy?
Bigeminy ectopic every second beat
Trigeminy ectopic every third beat
AF, thyroid disease and anxiety can all cause ____
Palpitations
Consider TFTs in patient with palpitations
1st line investigation for palpitations
12 lead ECG
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?
- 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
Out of transvenous and subcutaneous ICD, which is the standard type and which is used in paediatrics?
Standard type transvenous
Subcutaneous used in paediatrics
Radiofrequency ablation has high success rates in ….
SVT or atrial flutter or AF?
SVT and atrial flutter
Moderate chance of success in AF
Sinus tachycardia, SVT, VT and atrial flutter are generally all around what HR?
150 bpm
What is the atrial rate in atrial flutter?
Atrial flutter is described as 2:1 conduction, what does this mean?
Atrial rate 300bpm
2: 1 conduction = number of beats AVN lets though
atrial: ventricular
ECG appearance in atrial flutter
Saw tooth pattern
Management of atrial flutter
Anticoagulate (thrombus risk)
Ablation
ECG appearance of SVT
Narrow complex tachycardia
QRS <120ms
Commonest type of SVT?
AVNRT
AN nodal re-entrant tachycardia
1st, 2nd 3rd line Mx of SVT?
1st - vagal manoeuvres
2nd - IV adenosine
3rd - IV verapamil or DC cardioversion
Name 3 vagal manouevres
Valsalva: deep breath in, close mouth, pinch nose, hold 5 seconds, forced expiration violently
Carotid sinus massage
Immerse face in cold water
Delta wave (slurred upstroke on QRS) and a short PR interval is the classic ECG appearance of …
Wolf Parkinson White
What arrhythmia does WPW mainly cause
SVT
Monomorphic and polymorphic are the two types of what arrhythmia?
Ventricular tachycardia
What is the main risk in VT?
Deteriorating into VF
What is the QRS duration in VT?
Wide QRS >120ms
Management of pulseless VT?
Management of unstable VT?
Management of stable VT?
Pulseless VT - advanced life support algorithm
Unstable VT - IV 300mg amiodarone or unsyncronized defibrillation
Stable IV - lidocaine or cardioversion
‘Chaotic disorganised’ is the ECG appearance of what arrhythmia
Ventricular fibrillation
Management of VF
Shockable rhythm (long term Mx often ICD)
Wenckeback’s is also known as
Mobitz type 1
Second degree heart block
“Complete dissociation of atria and ventricles” is the definition of what?
Complete heart block
may have progressed from Mobitz 2 or occur in acute MI
Acute management of Mobitz type 2 and complete heart block?
Atropine
may later need temporary pacing
What is 1st degree heart block
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)
What is Mobitz type 1 heart block?
Progressive PR prolongation until a dropped beat
Generally benign
What is Mobitz type 2 heart block?
Regularly dropped beat eg 2:1 or 3:1
(May progress to complete heart block)
Requires treatment
Describe the QRS in bundle branch block
Broad QRS >120ms
ECG appearance in LBBB
Broad QRS >120ms
V1 = W
V6 = M
ECG appearance in RBBB
Broad QRS >120ms
V1 = M
V6 = W
ECG appearance in right axis deviation
I negative
aVF postive
ECG appearance in left axis deviation
I positive
aVF negative
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?
Ughhhh
