Diagnosis and treatment of arrythmias

Question 1

Define cardiovascular syncope

Answer 1

TLOC due to cerebral hypoperfusion characterised by a rapid onset, short duration and spontaneous complete recovery

Causes: vasovagal/vasodepressor/neurally mediated
Cardiac syncope - arrythmias/HF etc

Question 2

What are avoidance techniques for vasovagal syncope?

Answer 2

Attention to fluid balance
Physical counterpressure manoeuvres - crossing your legs, clenching the muscles in your lower body, squeezing your hands into a fist, tensing arm muscles

Ideally lie down/squat
Fludrocortisone?

Question 3

What is hypertrophic cardiomyopathy?

Answer 3

Commonest inherited heart condition - most frequently autosomal dominant sarcomere protein

Question 4

Pacemaker

Answer 4

• Chamber paced
• Chamber sensed
• Response to beat
• Special features

Usually for conducting tissue disease
Usually following cardiac syncope/presyncope

Question 5

ICDs/CRTs

Answer 5

ICD - detect VT/VF
Mostly ischaemic cardiomyopathy and HCM (hypertrophic cardiomyopathy)
ATP vs shock

CRT - HF device (cardiac resynchronisation therapy) - sends small electrical impulses to both lower chambers of the heart to help them beat together in a more synchronized pattern
‘Tighten’ QRS, more effective ejection

Question 6

Reflex (naturally mediated) syncope examples

Answer 6

• Orthostatic VVS - standing, less common sitting or emotional - fear, pain, blood phobia
• Situational - micturation, GI stimulation, cough/sneeze, post-exercise, laughing

Question 7

Cardiac syncope

Answer 7

Arryththmia as primary cause - brady/tachycardia