arrythmias Flashcards
presentation
Palpitations
• Transient Loss of Consciousness
• Cardiac Arrest
• Thromboemolism/Stroke
palpitations?
An abnormal awareness of the heart beat
Ectopics
- Extra beats, skipped beats, heart stopping/starting,
heart thump. Ectopic associated with compensatory
pause
Paroxysmal Tachycardia
- Rapid sustained heart racing
- Regular or irregular (“all over the place”)
- Sudden onset
- Abrupt termination
clinical asessment?
Hx Presenting Complaint
– Describe palpitations
– Syncope?
– Exercise capacity
– Risk factors atherosclerosis
• PHx
- Prior MI, CABG, CHF
• Family Hx
- Sudden unexplained death < 35 yrs
- Any first degree relative
Drug Hx
- QT prolonging?
- K+ losing
Social History
Occupation
Driving
Stimulants
12 lead ECg analysis?
Primary Electrical Disorders?
- WPW syndrome – Delta Wave
- Long QT syndrome - QT measurement
• LV Abnormality?
- Prior myocardial infarction (Q waves)
- Left ventricular hypertrophy (HCM)
RV abnormality?
- T wave inversion V1-V3 ARVC
- RBBB pattern + ST ↑ V1-V2 Brugada
documenttion of palpitations?
Attend GP surgery or A+E during typical symptoms
– 12 lead ECG of tachycardia
– Response to vagal manoeuvres, adenosine
• 24 Hour tape
– Almost daily symptoms
• Event monitor
– Weekly or few times per month
– Continuous loop recorder
– Post event monitor
• Implantable Loop Recorder
– Infrequent
– Potentially lefe threatening
management of ectopics?
Reassurance
- Beneign, not associated with MI
• Life-style modification
- Alcohol, caffeine
• ECG
• Echocardiogram
Empiric Tx – beta-blockers
long term management:
- Antiarrhythmic Drugs
- Catheter Ablation
- Device Therapy
clinical history
transient loss of consciosness symptos?
cardio (two types)
- prodromal symptoms
- motionless twitch
- pallor
1. reflex - nausea
- sweating
- post event fatgue
2. cardiac/arrythmia - abrupt onset
- no identifiable trigger
- quick recovery
seizue
- aura
- tonic-clinic
- post event confusion
causes of syncopy?
Tachycardias
– Scar related VT
– Channelopathies (LQTS, Brugada)
– WPW syndrome
– Atrial Flutter + 1:1 conduction
• Symptomatic Bradycardia
- Sinus node disease
- Complete heart Block
• Mechanical Obstruction
- LV outflow tract obstruction (AS, HCM)
- Atrial myxoma
who is atr risk of TLOC?
• Significant structural heart disease
- PHx MI
- CHF
- New or unexplained SOB
- Exertional T-LOC
• FHx Sudden death < 35 years
• Abnormal 12 lead ECG
-WPW syndrome, channelopathy (Long QT), cardiomyopathy
who is not at risk of a TLOC?
- Structurally normal heart
- No FHx Sudden death < 35 years
- Normal 12 lead ECG
Classical features of reflex syncope
(vagal stimulation, typical trigger)
Discharge
Non-invasive work-up if recurrent T-LOC
primary prevention?
Early Access
- 999
• Early CPR
- Bystander
• Early Defibrillation
- First Responder
- Public-Access AEDs
- ICD
prevent SCD?
Risk factor modification
• Revascularisation
• Thrombolysis
• Aspirin
Remodelling • ACE inhibitors
