palpitations and syncope (W5) Flashcards
syncope meaning?
loss of consciousness due to reduced cerebral perfusion. may also refer to any transient loss of consciousness
what is vertigo
sensation that you or the environment is moving/spinning
common causes of syncope
cardiovascular
postural/orthostatic hypotension
neurally mediated
vasovagal syncope/neural reflex syncope
drug intoxications
hypoglycaemia
causes of cardiovascular syncope
arrhythmia
structural heart disease
causes of neurally mediated syncope
epilepsy
what is vasovagal syncope/neural reflex syncope
associated with stress/anxiety - whole system slows down, vagal activity
ectopic beat
extra beat then pause
when might sinus tachycardia occur pathophysiologically
infection/fever
dehydration
sinus tachycardia appearance on ECG? BPM?
shorter than 3 squares
over 100 bpm
sinus bradycardia bpm?
less than 60 bpm
arrhythmias 3 categories?
too fast
too slow
intermittent
too fast arrhythmias types
atrial fibrillation
ventricular tachycardia
too slow arrhythmias types
heart block
intermittent arrhythmias types
supraventricular tachycardia
paroxysmal AF
ectopic beats
supraventricular tachycardia description
intermittent rapid tachycardia with abrupt onset and offset
narrow complex tachycardia
2 types of tachycardia
narrow complex tachycardia
broad complex tachycardia
narrow complex tachycardia meaning
QRS duration in normal limits of 120 milliseconds (less than 3 squares)
SVT presentation
palpitations
light headedness
nausea
chest pain
breathlessness
usually haemodynamically stable
haemodynamically stable meaning?
blood pressure sufficient to maintain organ perfusion
activation of which nerve in the autonomic nervous system would increase blockade at the atrioventricular node
vagus nerve
how can you activate the vagus nerve
water on face for children (cold flannel)
carotid sinus massage
Valsalva manoeuvre
if previous dont work give IV adenosine
what is the Valsalva manoeuvre
performance of forced expiration against a closed glottis
how does IV adenosine treat SVT
slows conduction through
AV node
ventricular tachycardia features? who does it occur in?
broad complex tachycardia
normally in patients with underlying heart disease
what is broad complex tachycardia
QRS complex larger than 3 squares or over 120ms
VT presentation
palpitations
chest pain
shortness of breath
loss of consciousness
VT treatment if unconscious
synchronised DC cardioversion
synchronised to R wave
medical emergency!!!!
VT treatment if unconscious
give antiarrhythmic - most commonly amiodarone
first degree heart block?
conduction is slowed from atrium to ventricle (PR interval prolonged)
second degree heart block?
intermittent conduction
(some beats not conducted from atrium to ventricle)
third degree heart block?
no conduction from atrium to ventricles. P waves and QRS complex dissociated. bradyarrhythmia.
where is the problem (usually) in complete heart block (third degree heart block)
AV node
complete heart block presentation
syncope and pre-syncope
fatigue (can’t augment heart rate eg when exercising)
breathlessness
cardiac arrest
usually have underlying heart disease
complete heart block treatment
muscarinic cholinergic agonist - atropine! (short term solution for symptoms)
definitive treatment - cardiac pacemaker
atrial fibrillation ECG features
no regular P waves, irregular QRS complex. narrow complex tachycardia. irregularly irregular
most common cause of arrhythmia
atrial fibrillation
atrial fibrillation presentation
incidental finding
palpitations
breathlessness
fatigue
worsened by alcohol
treatment of atrial fibrillation (rate control)
increase block at AV node using
-beta blockers (bisoprolol)
-calcium-channel antagonist (diltiazem)
AF and stroke?
allows clot to form in fibrillating left atrium (passive movement of blood, pooling), embolus passes to cerebral circulation and leads to stroke
how is risk of stroke calculated
CHA2DS2-VASc score
stroke prevention medication?
offer anticoagulation
-apixaban
-rivaroxaban
-warfarin
