Palpitations

Question 1

History for palpitations

Answer 1

Ask patient to tap out - reg or irreg
When it started
How often
Onset and offset
Radiates to neck?
Associated symptoms - syncope, pain, polyuria (ANP release due to atrial stretch in SVT)
Family history of channelopathies e.g HOCM, brugada

Question 2

Pathophysiology of cannon waves

Answer 2

Atria contracting against a closed tricuspid valve leading to palpitation radiating to neck

Question 3

Describe bigeminy and trigeminy

Answer 3

Bigeminy- 1 normal beat followed by 1 ectopic (originates from left side in RBBB and vice versa)
Trigeminy- 2 normal beats followed by 1 ectopic (originates from left side in RBBB and vice versa)

Question 4

What does CHA2DS2-VASc score predict

Answer 4

Stroke risk in AF patients

Question 5

Criteria for CHA2DS2-VASc score

Answer 5

CHF
Hypertension
Age (<65/65-74/75+)
Diabetes 
Stroke/TIA/VTE history 
Vascular disease history
Female sex

Question 6

What does HAS-BLED criteria predict

Answer 6

Major bleeding risk for AF patients on anticoagulation

Question 7

What is HAS-BLED score

Answer 7

Hypertension
Abnormal renal function
Abnormal liver function
Age >65
Stroke history 
Bleeding history (major or a predisposition to major)
Labile INR
Ethanol >8 drinks a week 
Drug predisposing to bleeding

Question 8

What is preferable to flecainide in elderly

Answer 8

Amiodarone because flecainide has more potential to be proarrythmic in cardiac scarring

Question 9

Why can’t you give AVN conduction blockers in WPW

Answer 9

Go into VF

Question 10

What is tachybrady syndrome

Answer 10

Rhythm switches between tachycardia and type 1 second degree heart block

Question 11

Treatment for tachybrady syndrome

Answer 11

Treat heart block first with pacemaker

Then treat tachycardia

Question 12

Definition of presyncope

Answer 12

Feeling dizzy and lightheaded but with no loss of consciousness
Often cardiac related

Question 13

Causes of presyncope

Answer 13

Arrhythmia
Silent MI
Aortic stenosis
Postural hypotension

Question 14

Describe AVRT

Answer 14

Atrioventricular re-entrance tachycardia
Accessory pathway from ventricles to Atria leads to atria contracting without another impulse from SAN.
Sets up a conduction loop (atria-AVN-ventricles-atria+purkinje fibres)

Question 15

Example of AVRT

Answer 15

WPW

Question 16

What’s the accessory pathway in WPW syndrome

Answer 16

Bundle of Kent

Question 17

Examples of regular and irregular narrow complex tachycardias

Answer 17

Regular: sinus tachycardia, AVRT, AVNRT, atrial flutter

Irregular: atrial fibrillation, atrial flutter with variable block, sinus arrhythmia (rate changes on inspiration and expiration), sinus rhythm with ectopics

Question 18

Describe AVNRT

Answer 18

Atrioventricular nodal reentrance tachycardia
Alpha pathway (slow conduction but has a short refractory period) sets up a loop of excitation within AVN if not cancelled out by beta pathway (opposite).
This causes atria and ventricle contraction on each loop.