lecture 25 Patient assessment-palpatation,Syncope,presyncope Flashcards
What are palpitations?
common sx - feeling or sensation that heart is pounding or racing, forceful beating, awareness of heartbeat, skipped beats
can be normal and abnormal
regular or irregular
What are components of evaluating palpitations, what areas on the body?
Central Pulses: Carotid - palpitation reflects aortic valve and ascending aortic fxn, auscultation for bruit, carotid stenosis, cardiac murmur radiation
Brachial
most reliable measure of HR
must be used if pt has Afib or irregular HR
Components: assess HR, regularity of pulse
regular rhythm = count 15 sec x 4, if irregular count 30-60 secs from central pulse
What are normal, borderline, and prolonged QTc times?
Normal: female <460, male <450
Borderline: female 460-479, male 450-469
Prolonged: female >480, male >470
What are key offenders of QT prolongation?
ABCDEF ⇒ A: Anti-Arrhythmics (ex. amiodarone, dronedarone, procainamide, quinidine, sotalol)
B: AntiBiotics (ex. macrolides, fluoroquinolones)
C: AntiPsyChotics (ex. amisulpride, chlorpromazine, haloperidol, ziprasidone)
D: AntiDepressants (ex. SSRIs - citalopram, escitalopram
TCAs - amitriptyline)
E: Anti-Emetics (ex. domperidone, ondansetron)
F: AntiFungals (ex. azoles - fluconazole,, pentamidine)
Other: methadone, hydroxychloroquine, donepezil
What are risk fx for QT prolongation?
heart disease or cardiac abnormalities, age > 65, females, >1 QT-prolonging drugs, higher conc of QT-prolonging meds, electrolyte abnormalities (ex. hypokalemia, hypomagnesemia), bradycardia, genetic fx or congenital QT syndrome
What are drugs that may be associated with orthostatic hypotension?
nitrates, alpha and beta blockers, diuretics, CCBs, antidepressants, benzos, antipsychotics, opioids, trazodone
