Cardio Flashcards
what do you do for vasovagal syncope?
leave them flat on the floor until they feel better (put pillow under head etc)
what is syncope?
temporary loss of consciousness causes by a sudden fall in blood pressure causing transient global cerebral hypoperfusion
how is syncope characterised?
rapid onset
short duration
spontaneous complete recovery
most common group of causes of syncope?
cardiovascular causes
esc classification of syncope?
reflex syncope
orthostatic syncope
cardiac syncope
types of reflex syncope?
vasovagal
situational
carotid sinus syncope
atypical
what is vasovagal syncope?
reflex activation causing vasodilation, bradycardia or both
syncope occurs due to decreased cerebral blood flow
get pooling of blood in peripheries
3 Ps of vasovagal syncope?
posture (happens when standing or can be prevented by sitting down) provoking factors (pain or medical procedure) prodromal features (sweats, dizzy etc)
risks of vasovagal syncope?
no risk from event itself
doesnt indicate any cardio problem
risk only comes from injury during fall
what is situational syncope?
type of reflex syncope which is clearly and consistently provoked by trigger (eg having blood taken, coughing, straining, difficult swallow, post exertion etc)
types of orthostatic syncope?
primary autonomic failure
secondary autonomic failure
drug induced
volume depletion
types of orthostatic hypotension?
classic - drop in systolic BP 20+mmHg and diastolic 10+mmHg within 3 mins of standing
initial - immediate decrease on standing up of >400mmHg then rapidly returns to normal
delayed/progressive - common in elderly where they slowly develop hypotension and sometimes a mild bradycardia
types of cardiac syncope?
bradycardia tachycardia tachy-brady syndrome structural disease other (PE, aortic dissection etc)
types of structural problems causing syncope?
obstructive (aortic stenosis, hypertrophic cardiomyopathy)
pump failure
(MI, tamponade)
extra-cardiac (aortic dissection, PE)
non-syncope causes of loss of consciousness?
epilepsy
what features suggest epilepsy as cause of loss of consciousness?
tongue biting head turning to one side no memory of abnormal behaviour unusual posturing prolonged limb jerking post event confusion prodromal deja vu
red flags in loss of consciousness?
abnormal ECG heart failure family history of sudden cardiac death new/unexplained breathlessness TLoC during exertion heart murmur
how do physiological palpitations happen?
taking substances which causes increases adrenergic activity or decreased vagal activity
exercise, emotion, stress etc
reassuring features in patient with palpitations?
no other features
identifiable triggers (anxiety, alcohol, caffeine)
occurring at rest or at night
short lived
concerning features in palpitations?
syncope chest pain long duration on exertion patients with other heart disease fam history abnormal ECG
investigations for palpitations?
bloods
ECG (stress testing or long term monitoring etc)
ECHO
BP
what defines low risk palpitations which can be managed in primary care?
skipped beats (means ectopics) thumping beats short fluttering slow pounding and normal ECG and no fam history and no structural heart disease
mod risk palpitations which should be referred to cardiology?
history suggestive of recurrent tachyarrhythmia
palpitations with associated symptoms and/or abnormal ECG and/or known structural disease
high risk palpitations which should be urgently referred to cardiology?
palpitations during exercise
palpitations with syncope or near syncope
high risk structural disease
fam history of inherited heart disease/SADS
high degree AV block
what do you look for on ECG in palpitations?
conduction abnormalities (QT prolongation, pre-excitation) structural abnormalities (hypertrophy, T wave changes, heart failure)
who should be offered ambulatory monitoring?
all people with unexplained syncope (including those with syncope after carotid sinus massage)
how is ambulatory monitoring done?
R test monitors = if TLoC several times per week
external event monitoring = if TLoC every 1-2 weeks
loop recorder = if
what is the tilt test?
used if patients have a positional component to their palpitations
attempts to trigger arrhythmia, palpitations or drop in BP
what test if palpitations come on when exrcising?
exercise ECG
advise patient to refrain from exercise until advise otherwise
why is ECHO done?
if there are concerns of structural disease (eg previous known heart disease, abnormal ECG, presence of murmur)
when is EEG done?
if you suspect seizures
can show type of seizures
summary of palpitations investigations?
everyone gets 12 lead ECG
if symptoms lasting hrs then tell patient to go get ECG next time they come on
daily or frequent short lived symptoms = 24hr tape or R test
less frequent symptoms but still weekly = 7 day R test
exertional symptoms = exercise ECG
very intermittent symptoms = event monitor (ILR if red flags)
recurrent but infrequent syncope or high risk = ILR
murmur/abnormal ECG = ECHO
seizures = neurology
