Palpitations and AF

Question 1

Define palpitations?

Answer 1

Awareness of heart beat due to stress/ventricular ectopics/atrial ectopics

Question 2

Which two forms of palpitations are the most commonest to warrant admission?

Answer 2

Supraventricular tachycardia

Paroxysmal AF

Question 3

With a patient presenting with palpitations it is important to exclude common causes of sinus tachycardia - name three things that can cause this?

Answer 3

Hyperthyroidism
Phaechromocytoma
Anaemia

Question 4

Describe the clinical features of supraventricular ectopics? (4)

Answer 4

Often occurs at rest
Exacerbated by caffeine, stress, alcohol
Pt aware of ‘jump’ or ‘flutter’ of heart then pause
NO syncope/pre-syncope

Question 5

Describe the clinical features of AF? (4)

Answer 5

Pt aware of speed and irregularity
Often lasts hours at a time
NO syncope however sometimes pre-syncope (falls in elderly)
Often made worse with alcohol

Question 6

Name six risk factors for AF?

Answer 6

Age - increased risk of diseased tissue
Inflammation (post-op)
Mitral stenosis (enlarged atrium)
Chronic hypertension (enlarged atrium)
Lung diseases
Alcohol abuse

Question 7

What two classically distinctive features are apparent on an ECG with AF?

Answer 7

Irregularly irregular pattern

ABSENT P-waves

Question 8

Describe the clinical features of supraventricular tachycardias? (4)

Answer 8

Unpredictable
Sudden onset with sudden offset
No specific provoking factors
Pt feels unwell

Question 9

State 7 questions to ask with a Hx of palpitations?

Answer 9

Time
Duration
Frequency
Tap out rhythm
Syncope/pre-syncope
Prev. cardiac disease
Caffeine/alcohol intake

Question 10

Define true cardiac syncope? (5)

Answer 10

No pre-warning
Can be associated with exertion
Not specifically positional
NO post syncope confusion/delay coming around
No associated tongue biting/incontinence

Question 11

Define neurological syncope? (4)

Answer 11

Often associated with aura
Post-event confusion
Associated tongue biting and incontinence
Post-event fatigue

Question 12

Define neurogenic syncope? (4)

Answer 12

Aggressive fainting episode
Often diaphoresis beforehand (feeling like fainting)
Fall
Conciousness returns - pt feels groggy and unwell

Question 13

What five questions should be asked in a Hx of syncope?

Answer 13

How often
Before/during/after
Palpitations
Known FHx
Prev. cardiac Hx