old persons 18/10 Flashcards
Difference in symptoms before syncope between cardiac cause and vaso-vagal?
Cardiac syncope:
-Immediate
-Collapse without warning
-Regain consciousness quickly
Vaso Vagal:
-Theres a build up (patient may complain of nausea, weakness and blurred vision, and appear pale with bradycardia on examination)
-Bp remains low afterwards
Presentation of syncope with fainting. Caused by cardiac syncope secondary to aortic stenosis. What ausculation sign would be found?
A soft second heart sound and an ejection systolic murmur radiating to the carotids characterises aortic valvular stenosis.
Presentation of acute bronchitis
**Cough **
(May or may not have sputum, wheeze, or breathlessness. Substernal or chest wall pain may be present when coughing. Sometimes mild constitutional symptoms)
Acute bronchitis is temporary inflammation of the airways that causes a cough and mucus. It lasts up to 3 weeks. Acute bronchitis is usually caused by a viral infection.
What is predominant feature in both acute bronchitis and community acquired pneumonia?
Cough is the predominant symptom in both acute bronchitis and community-acquired pneumonia
Whats the difference in chest xrays between a community acquired pneumonia and Acute bronchitis?
Acute bronchitis chest xray = normal
Cap chest xray =Chest X-ray abnormal (new infiltrate provides definitive diagnosis of pneumonia)
Causes of syncope examples
Cardiac (e.g. Aortic stenosis on excertion) (e.g. Supraventricular tachycardia)
Respiratory (e.g: hyperventilating due to anxiety)
Metabolic (e.g. hypoglycaemic)
Neurological (e.g. epilepsy)
Vaso-vagal attack
Presentation of supraventricular tachycardia (SVT) with syncope?
Since syncope episode:
Lightheadness
Palpatations
dyspnoea
On ECG Sinus tachycardia have only one P wave for each QRS complex. Whereas SVT mostly have one P wave, but some can have no P waves or more than one.
Research into the ECG stuff to check this is correct
Need to research into the difference between presentations of SVT and sinus tachycardia.
What is syncope?
Syncope is a transient loss of consciousness and postural tone followed by spontaneous recovery
Ultimately results from decreased cerebral perfusion.
What is Atrioventricular nodal reentrant tachycardia (AVNRT).
A type of supraventricular tachycardia.
Side effects of adenosine?
Bronchospasm, dyspnea, facial flushing and the feeling of impending doom
Treatment of SVT syncope
Vagal manoevours,
Carotid sinus massage
IV Adenosine
Mechanism of adenosine for treating SVT?
The A 1 receptor is responsible for its effect on the AV node. These receptors are linked to the same cardiac potassium channel that is activated by acetylcholine, and adenosine hyperpolarises cardiac conducting tissue and slows the rate of rise of the pacemaker potential accordingly.
**Adenosine [ah-DEN-oh-seen] is a naturally occurring nucleoside, but at high doses, the drug decreases conduction velocity, prolongs the refractory period, and decreases automaticity in the AV node. **
(In cardiac nodal tissue, adenosine binds to type 1 (A1) receptors, which are coupled to Gi-proteins. Activation of this pathway opens potassium channels, which hyperpolarizes the cell. Thus AV node and SA node are hyperpolarised. This decreases HR. Activation of the Gi-protein also decreases cAMP, which inhibits L-type calcium channels and therefore calcium entry into the cell. Reduced calcium currents leads to increased refractory period in AV node.)
Whats the refractory period (e.g. for AV node)?
a period immediately following stimulation during which a nerve or muscle is unresponsive to further stimulation.
Presentation of Pericarditis?
The most common sign of acute pericarditis is chest pain, usually worsened when taking a deep breath.
Pleuritic chest pain and pericardial friction rub on auscultation of the left lower sternal border. (sharp chest pain)
ECG of pericarditis?
Widespread concave ST elevation and PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6).
Reciprocal ST depression and PR elevation in lead aVR (± V1).
Sinus tachycardia is also common in acute pericarditis due to pain and/or pericardial effusion.
ECG Findings in Massive Pericardial Effusion?
Consecutive, normally-conducted QRS complexes that alternate in height.
Occurs when the heart swings backwards and forwards within a large fluid-filled pericardium
Framework for A to E assessment:
At end ask about Past medical history, medications and allergies
