Collapse/blackout

Question 1

What are the syncopal causes of collapse?

Answer 1

ACS, dissecting AAA, arrhythmia, anaemia, reflex syncope, postural hypotension

Question 2

What are the non-syncopal causes of collapse?

Answer 2

hypoglycaemia, infection, seizure, SAH

Question 3

Define syncope

Answer 3

transient loss of consciousness due to global reduction in blood flow to the brain

Question 4

What are the differentials for regular narrow-complex tachycardia?

Answer 4

sinus tachy
AVNRT
AVRT (due to WPW)
Atrial flutter

Question 5

What is the first line management of SVT?

Answer 5

vagal manouvres- valsalva

Question 6

Explain the valsalva maneouvre

Answer 6

ask the patient to blow into a syringe and combine this with a passive leg raise

Question 7

What is the effect of employing the valsalva manouvre?

Answer 7

elicits the parasympathetic system by stimulating the vagal release of acetylcholine. This has four effects: slows rate of impulse at SA, AV node conduction slows, atrial myocardium refractory period shortens, ventricular myocardium contraction decreases

Question 8

If the vasovagal manouvre fails, what is the next management step?

Answer 8

6mg bolus of adenosine

other antiarrhythmic drugs are not indicated

Question 9

What are the differentials for palpitations?

Answer 9

1. Cardiac- ACS, cardiomyopathy, valvular heart disease
2. psychosomatic- stress, anxiety
3. medication and drugs- alcohol, caffeine, salbutamol, nicotine, theophylline
4. Systemic- fever, hypoglycaemia, pregnancy, anaemia, exercise, thyroid disorders

Question 10

What are the triggers for AF?

Answer 10

heart failure, HTN, IHD, PE, mitral valve disease, pneumonia, hyperthyroidism, caffeine, alcohol, hypokalaemia, hypomagnesaemia