Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 General Medicine > Palpitations > Flashcards

Palpitations Flashcards

1
Q

what are palpitations

A

awareness of heart beating in your chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

palpitations can be normal

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe your approach to the patient with ‘palpitations’

A

take a history and perform a full examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

history taking for palpitations

A
  1. what is it like
  2. tap it out
  3. how long have you had it
  4. how long does it last
  5. how does it start or stop
  6. associated symptoms
  7. ask about past cardiac history - symptoms and interventions
  8. DH
  9. S/E - endocrine, GI, GU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the commonest heart rhythm disturbance

A

ectopic beats
/ extrasystoles
(most common cause of palpitations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how would patients classically describe ectopics

A

skip / stop / miss in heartbeat

followed by thump / forceful beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the SAN

A

the heart’s pacemaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

normal PR interval

A

0.12-0.20s
120-200ms
3-5 small squares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

bundle of His splits into?

A

left and right bundle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

left bundle branch splits into?

A

left anterior and posterior fascicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

why do you get narrow QRS

A

fast electrical conduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

narrow is normal

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

normal QRS complex duration

A

<120ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

wide might be worrying…

A

…because it might be coming from the Wentricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ventricular ectopic may be so weak that..

A

you cant feel the pulse or patient might not be able to feel the extra beat
compensatory pause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

compensatory pause

A

after an ectopic to get back on track

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the first beat after an ectopic going to feel like

A

very strong ie the ‘thump’ because of the compensatory pause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

narrow complex ectopic?

A

atrial ectopic beat

has the same effect as a ventricular ectopic beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

diagnosis

A

awareness of ectopic beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

p wave followed by ‘wide M shaped’ QRS

A

right bundle branch block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

aberrant conduction

A

right bundle goes to sleep leading to BBB

rhythm you can spot coming from the top of the heart but conduction gets stuck/slow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

regular broad complex tachycardia..

A

ventricular tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what can you ask the patient to do to describe the rhythm

A

tap out the rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

define tachycardia + bradycardia in bpm

A

> 100bpm

<60bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

profound bradycardia

A

<40bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

irregularly irregular

A

AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

some people can be aware of normal sinus rhythm, true or false

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

tachycardia
150bpm
D.Dx

A

atrial flutter
sinus tachycardia
VT
SVT - Atrial tachycardia, AVNRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

in the AVN, the fast pathway is slower to recover than the slower pathway

A

yes

remember the rowboat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what could cause a AVNRT

A

ectopic
it finds the faster pathway has not recovered and the slow pathway has
therefore forms reentrant electrical circuit and fires off atria back to front resulting in an inverted p wave after the QRS ‘retrograde’ p wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

atrial flutter

A

reentrant electrical circuit set up in the right atrium

organised = regular rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

atrial fibrillation

A

chaotic atrial activity

33
Q

what is the rate of atrial flutter

A

300bpm

34
Q

atrial rate of AF

A

300-600bpm

35
Q

maximum target heart rate calculations

A

220 - age

36
Q

what is the ventricular rate of atrial flutter

A

150bpm
2:1 conduction, 3:1, 4:1…
300:150
will always be regular

37
Q

4 things to ask for /adverse features in a patient with a fast heart rate

A

heart failure
ischaemia
syncope
BP <90

38
Q

vagal maneouvres

A

carotid sinus massage
valsalva
cold icy water

39
Q

what is the valsalva

A

deep breath in
shut mouth and nose
breath against this for 5 sec
and release violently

40
Q

20ml syringe

A

blow the plunger out

alternative valsalva

41
Q

valsalva breaks the AVNRT circuit

A

period where nothing happens then restoration of normal sinus rhythm

42
Q

what do you do if vagal maneouvres dont work

A

IV adenosine

have to warn the patient of impending doom sensation

43
Q

fleeting

A

ectopic

44
Q

triggers of palpitations

A 
anxiety - difficult to tease out 
caffeine 
alcohol 
IVDU
prescribed drugs
45
Q

relieving factors

A 
rest 
deep breath 
squat down 
vomiting 
all sound vagal
46
Q

associated symptoms with palpitations

A

cardiac syncope - LOC
near syncope
chest pain

47
Q

what is cardiac syncope

A

palpitations and pass out
no pro or post drome
wake up like what happened

48
Q

endocrine causes of palpitations

A

hyperthyroidism

menopause

49
Q

GI / GU causes of palpitations

A

pregnancy - 2nd trimester

anaemia

50
Q

what two conditions make palpitations more likely

A

anaemia

hyperthyroidism

51
Q

loss of nail bed angle, increased pulp density, increased nail bed fluctuation and increased curvature of the nails

A

finger clubbing

52
Q

what might you look for in the hands in a CVS examination

A 
pallor 
sweating 
koilonychia 
leukonychia 
finger clubbing 
erythema 
cyanosis 
splinter haemorrhages 
rheumatoid hand
53
Q

cause of palmar erythema

A 
too much oestrogen in the blood 
liver cirrhosis - cant break down oestrogen 
oestrogen producing breast tumour 
pregnancy 
contraception
54
Q

features of examining pulse

A 
rate 
rhythm 
character 
volume
R and L radial delay
55
Q

cause of regularly irregular pulse

A

Mobitz type 1 heart block aka Wenkebach’s

trigemy

56
Q

cause of irregularly irregular pulse

A

atrial fibrillation

completely unpredictable pulse in rhythm and volume

57
Q

causes of a thready weak pulse

A

hypovolaemia

shock

58
Q

causes of a bounding pulse

A

vasodilatation

CO2 retention

59
Q

conditions causing obstruction to ventricle pumping blood

A

aortic stenosis

60
Q

describe the pulse in aortic stenosis

A

slow rising low volume pulse

‘plateau pulse’

61
Q

describe the BP in aortic stenosis

A

narrow pulse pressure e.g. 90/70

62
Q

DBP in aortic regurgitation

A

low

63
Q

pulse pressure in aortic regurgitation

A

large pulse pressure

because blood falls back into ventricle

64
Q

describe the pulse in aortic regurgitation

A

collapsing pulse

65
Q

how do you test for a collapsing pulse

A

press with the MCP heads of your hand then raise the patients arm perpendicular
should feel a whoosh and then tapping

66
Q

what is a useful clue when assessing pulse

A

pulse pressure - check BP

67
Q

cause of asynchronous radial pulse

A

coarctation of the aorta

68
Q

investigations for palpitations

A 
FBC - anaemia
U+E - electrolyte abnormalities
TFT - hyperthyroidism
12 lead ECG 
if normal, 24/48hr/7day ECG tracing/holter/ambulatory
Loop recorder 
implantable loop recorder
exercise tolerance test
69
Q

ECG potential findings in palpitations

A

ectopics
AF
WPW

70
Q

what is a loop recorder

A

record when patient feels symptomatic

done for weekly/fortnightly symptoms

71
Q

what is a PVC

A

premature ventricular complex / ventricular ectopic / ventricular extrasystoles / ventricular premature beats

72
Q

ECG features of a PVC

A

broad QRS complex with abnormal morphology
premature
discordant ST segment and T wave changes
usually followed by a compensatory pause
+- retrograde capture of the atria (p wave inversion)

73
Q

what is bigemy

A

every other beat is a PVC/ectopic

74
Q

what is trigemy

A

every 3rd beat is a PVC/ectopic

75
Q

what is quadrigeminy

A

every 4th beat is a PVC/ectopic

76
Q

https://litfl.com/premature-ventricular-complex-pvc-ecg-library/

A

useful link

77
Q

frequent PVCs may cause palpitations, true or false

A

true

78
Q

causes of symptomatic / frequent PVC

A 
anxiety 
sympathomimetics 
B agonists 
excess caffeine 
hypokalaemia 
hypomagnesaemia 
digoxin toxicity 
MI

Year 4 General Medicine (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions