Cardiovascular Conditions 2 Flashcards
What are the signs and symptoms of Ectopic tachycardia?
A tachycardia – a rapid heart rate of over 100 beats per minute, which a person would notice. Ectopic (means anything outside of the normal rhythm) tachycardia (or atrial tachycardia) is defined as rapid heart action in response to impulses arising outside of the main pacemaker of the heart – that is, the sinoatrial node.
Signs and symptoms:
* Palpitations
* Dizziness
* Fainting
* Shortness of breath
* Chest pain/discomfort - be aware of what kind of pain it is will help diagnosis
What causes Ectopic tachycardia?
Aetiology
There are several potential causative factors involved, these include:
* Congestive heart failure
* Lung disease such as COPD
* Ischemic heart disease (coronary artery disease) - where there is a lack of blood supply to the heart itself
* As a side effect of digoxin drug
What is the pathophysiology of Ectopic tachycardia?
Pathophysiology
All cardiac muscle cells possess automaticity – they can generate an electrical impulse
The sinoatrial node has the highest automaticity and so usually dictates the overall
electrical signalling
So an area of cells firing on their own is considered an ‘ectopic focus’ - outside the normal patten - and if located in the atrium generates ectopic atrial tachycardia.
What are the signs and symptons of Sinus tachycardia?
Sinus tachycardia is a very rapid (100-160 beats per minute) beat that originates in the sinoatrial node. It is a normal occurrence during exercise or with short term stress. It becomes pathological however if occurring at rest - this is abnormal
Signs and symptoms:
* Abnormally forceful heartbeat
* Irregular heartbeat
* Chest pain
* Dizziness
* Fainting
* Blood pressure change
What causes Sinus tachycardia?
A number of the causes of sinus tachycardia are normal physiological events including
pregnancy and menopause, or linked to drinking coffee.
Stress and anxiety if short-term are not considered pathological, but prolonged stress may lead to sinus tachycardia at rest so presenting risk to cardiovascular health.
Metabolic disturbance such as hyperthyroidism, hypotension, anaemia or the presence of acute illness or infection, may also trigger sinus tachycardia.
What is the pathophysiology of Sinus tachycardia?
Pathophysiology - all related to fight or flight
* Increased sympathetic stimulation
* Endocrine response – release of epinephrine
What are the signs and symptoms of Atrial Fibrillation? What are the complications?
A major condition to understand as it can have serious complications.
Signs and symptoms:
* Palpitations - racing and fluttering
* Chest pain
* Dizziness and lightheadedness
* Fatigue - very tired, a chronic sign of AF
* Weakness
* Shortness of breath - usually around the attacks
Complications
Thromboembolic disease (a formation of a clot that moves around), especially stroke
What causes Atrial Fibrillation?
Aetiology
Risk factors are numerous and include the following
* Family history of AF
* Increasing age
* Mitral or tricuspid valve dysfunction
* Hypertension - persistent high blood pressure
* Coronary ischaemia
* Myocarditis; pericarditis
* Pulmonary embolism, pneumonia, lung cancer
* Hyperthyroidism
* Diabetes
* Stroke
What is the pathophysiology of Atrial Fibrillation?
Pathophysiology – key points
* Remodelling of heart fibres occurs during the progress of AF
* AF requires an **initiating event **and atrial tissue being vulnerable to this event
* As with ectopic tachycardia, foci of increased
automaticity, frequently in pulmonary veins, may be key initiators
What diagnostics or investigations might be run for Atrial Fibrillation?
Diagnosis/investigations - suspected AF requires proper tests as a matter of urgency
* Electrocardiogram
* Echocardiogram
* X-ray
* Blood tests to check for conditions which may impact heart rate and rhythm, such as anaemia and hyperthyroidism
What is convential treatment for AF? How might herbs help?
Conventional treatment includes:
* Beta blockers - damp down automaticity
* Calcium channel blockers - movement of calcium is what causes contractility of the heart, so this will reduce that
* Potentially digoxin
Potential impact on future wellbeing
Given the risk of thromboembolic disease, apart from prescribed medications, lifestyle changes may be required to minimise the risks. Patients may require support to accept their
increased risk of mortality.
What are the signs and symptoms of POTS – Postural Orthostatic Tachycardia Syndrome?
An abnormally large increase in heart rate - on standing. Not the normal slight pounding but a really big change.
Signs and symptoms:
* Light-headedness
* Brain fog
* Fatigue and weakness
* Palpitations
* Nausea
* Tremor
* Chest pain
* Shortness of breath
What causes POTS?
Aetiology
A key risk factor is family history, but causes may include:
* Pregnancy
* Trauma
* Viral infection
* Surgery
Autoimmunity has been suggested as possible initiator of the condition.
What is the pathophysiology of POTS?
Pathophysiology
Hypovolaemia (low blood volume) can contribute to a compensatory rise in heart rate, although elevated epinephrine levels are more central to the increase.
What are the signs and symptoms of Supraventricular Tachycardia?
This is an irregularly fast or erratic heartbeat affecting the atria of the heart – heartbeat typically between 150 and 220 beats per minute - some of its highest rates!
Signs and symptoms:
* Very rapid heartbeat - quite scary
* Palpitations
* Extreme fatigue or weakness
* Dizziness
* Sweating
* Fainting
* A pounding sensation in the neck
* Chest pain
* Shortness of breath
What causes Supraventricular Tachycardia?
Aetiology
Pathological
* Heart disease and heart failure
* Thyroid disease
* Chronic lung disease
Physiological/lifestyle
* Drinks excess caffeine or alcohol - or energy drinks
* Drug misuse
* Smoking
* Pregnancy
* Certain asthma and cold medications can trigger this racing heart
What is the pathophysiology of Supraventricular Techcardia?
Pathophysiology
Diagnosed when it occurs at or above the level of the atrioventricular node
There is potentially retrograde conduction back from ventricles to arteries secondary to normal conduction
What are the signs and symptoms of Ventricular Tachycardia?
Defined as any rhythm faster than 100 beats per minute, including three or more consecutive irregular beats, arising **distal to the location of the bundle of His **in the electrical conduction pathways of the heart. (Further down in the electrical condition system).
Signs and symptoms:
* Lowered blood pressure
* Sweating
* Pallor
* Dizziness
* Shortness of breath
* RED FLAG FOR THIS – chest pain, difficulty breathing, loss of consciousness - call ambulance
What causes Ventricular Tachycardia?
Aetiology
Causes can include
* Ischemic heart disease
* Electrolyte imbalances such as hypokalaemia
* Systemic diseases such as sarcoidosis, amyloidosis, SLE, RA
* Structural heart disease such as hypertrophic cardiomyopathy
* Congenital structural cardiac disorders
What is the pathophysiology of Ventricular Tachycardia?
Pathophysiology
Electrical re-entry (i.e. incorrect direction of flow of electrical conduction in the heart - going the wrong way) or
disordered automaticity are responsible for the occurrence of ventricular tachycardia.
The likelihood of incidence is greatly increased by any scarring to the myocardium from e.g. prior myocardial infarction.
What are the signs and symptoms of Heart Block?
Three types – atrioventricular, bundle branch and tachybrady
Impairment or dysregulation of electrical conduction around the pathways of the heart, often the partial or complete interruption of impulse transmission from atria to ventricles in the case of AV block
Signs and symptoms:
* Palpitations
* Shortness of breath
* Dizziness
* Nausea
All indications of heart block should raise
concerns - chest pain and fainting is a
particular cause for alarm. hospital that same day
What causes Heart Block?
Aetiology
The impairment of electrical conduction in the heart may have numerous causes, including:
* Cardiomyopathy
* Cardiac hypertrophy
* Coronary heart disease
* Congenital heart disease
* Ageing
* Lung disease
What are the signs and symptoms of Bradycardia?
Going the other way - a heart beat of less than 60 beats per minute.
Signs and symptoms:
* Impairment of oxygen delivery to the brain causes confusion/memory problems
* Fatigue
* Dizziness
* Shortness of breath
* Chest pain
* Fainting
What causes Bradycardia?
Aetiology
Causes of bradycardia are varied but all relate to tissue damage or imbalance of substances/processes
* Age related deterioration of heart tissue
* Congenital heart defect
* Myocarditis
* Damage to heart tissues subsequent to heart disease or heart attack
* Hypothyroidism
* Electrolyte imbalance
* SLE”
