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Emergency & Acute > Palpitations > Flashcards

Palpitations Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is complete heart block?

A

Complete dissociation of the atria + ventricles, so no conduction through the AVN

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2
Q

How may someone with complete heart block present?

A

Syncope
Hypotension
CV collapse
Sudden cardiac death

Others: fatigue, dizziness, reduced exercise tolerance, chest pain

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3
Q

In complete heart block, where do ventricular escape mechanisms occur?

A

Anywhere from the AVN to bundle branches

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4
Q

Which patients are less likely to be symptomatic?

A

Those with narrow complex escape rhythms (e.g. occurring above the bundle of His)

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5
Q

Two most common causes of complete heart block

A

Ischaemia or infarct

Drugs

Pathology: infiltration/ fibrosis

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6
Q

Metabolic causes of complete heart block

A

Hyperkalaemia

Hypothyroidism

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7
Q

Drugs causing complete heart block

A

Excess digoxin

Combination of beta blockers + CCB

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8
Q

ECG in complete heart block

A

Regular P-P

No relationship between P waves + QRS (more P waves than QRS)

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9
Q

Mx of acute complete heart block

A

ABCDE!

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10
Q

What drug is 1st line in acute complete heart block?

Dose/ Route/ Max dose

A

Atropine (500mcg IV)

Can repeat dose <3mg

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11
Q

What drug can be used as a temporary measure in acute complete heart block?

A

Adrenaline

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12
Q

Definitive Mx of complete heart block

A

Cardiac pacing

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13
Q

Difference between ICD + pacemaker

A

Pacemaker: helps control abnormal rhythms. Uses electrical impulses to prompt heart beat. Can speed up slow HR or control a fast HR etc

ICD: monitors heart rhythm. If it senses a dangerous rhythm a shock is delivered. ICD = PACEMAKER + DEFIBRILATOR

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14
Q

What is first degree heart block?

A

Prolonged PR

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15
Q

Second degree heart block:
Mobitz I
Mobitz II

A

Mobitz I: PR becomes longer + longer until a QRS is dropped (Wenckebach phenomenon)

Mobitz II: QRS is regularly missed (e.g 2:1 block)

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16
Q

What is SVT?

A

Supraventricular tachycardia
Originates above the ventricles - in atria or AVN

Abnormal electrical activity triggers abnormal rhythm (hear accelerates too quickly + doesn’t allow time for it to fill before contraction0

17
Q

RFs of SVT

A

Age, heart disease, thyroid problems, drugs, anxiety, obstructive sleep apnoea

18
Q

What is the most common SVT?

Who does it affect?

A

AVNRT (atrioventricular nodal re-entrant tachycardia)

YOUNG WOMEN

19
Q

Mx of SVT

A

Vagal manouvre (1st line)

If ineffective, given ADENOSINE

20
Q

Does adenosine have a long or short duration of action?

A

VERY SHORT!

21
Q

Symptoms of SVT

A

Palpitations, dizziness + light-headedness

22
Q

What is VT?

A

Abnormal electrical signals in the ventricles = heart beats fast + out of sync with atria

23
Q

When is VT usually symptomatic?

A

When it lasts >30 seconds

24
Q

Symptoms of VT

A

Dizziness, light-headedness, palpitations, chest pain, LOC

25
Q

Sustained episodes of VT may lead to…

A

LOC + cardiac arrest

26
Q

Biggest RF for VT

A

Pre-existing heart problem (e.g. post-MI)

27
Q

What factors make VT a more likely diagnosis than SVT

A

Patient is >60
History of IHD
QRS >0.13
Capture/ fusion beats

28
Q

ECG criteria for VT

A

Brugada criteria

29
Q

What is toursades de pointes?

A

Rare polymorphic VT with QRS of increasing + decreasing magnitude

30
Q

Causes of toursades de pointes?

A

Hypomagnesia, hypokalaemia, prolonget QT (e.g. in tricyclics OD)

31
Q

Mx of VT:
If unstable
If stable

A

Unstable: DC x 3, followed by IV amiodarone

Stable: IV amiodarone

32
Q

What else can be used to treat VT in haemodynamically stable

A

IV lidocaine

33
Q

Pathophysiology of VF

A

Rapid, erratic heartbeats = hear abruptly stops beating

34
Q

Cause of VF

A

Problem with the heart’s electrical impulses after a previous MI or something else causing scarring of the myocardium

35
Q

Is there a pulse in VF?

A

NO!!

36
Q

Management of VF

A

CPR + immediate defibrilation

37
Q

What is the most common cause of sudden cardiac death?

A

VF

Emergency & Acute (21 decks)

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