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Medicine > Palpitations/ECG > Flashcards

Palpitations/ECG Flashcards

1
Q

Questions to ask to clarify palpitations?

A

Onset:

  • When and how did it start?
  • Sudden vs gradual onset?
  • Dehydration, fear, food

Character:

  • Fast, slow, or irregular?
  • Did you check your pulse at the time?

Timecourse:

  • Precipitating/relieving factors (exercise is a red flag)
  • Duration
  • Resolution - fast/slow, confusion?
  • Previous episodes/FHx (e.g. sudden death)
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2
Q

Associated symptoms of palpitations

A

Dyspnoea

Syncope -> seizures/witnesses

Dizziness/light-headedness

Chest pain

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3
Q

Differential for irregular fast palpitations

A

Atrial flutter, atrial fibrillation

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4
Q

Important PMHx for palpitations

A

Rheumatic fever

Angina/IHD

Previous ECG monitoring/angiograms

Diabetes

HTN

Operations (e.g. CABG)

Thyroid function

Valvular heart disease

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5
Q

Differential for slow palpitations

A

Drug-related bradycardias, ventricular bigeminy, heart block

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6
Q

Differential for regular fast palpitations

A

SVTs:

AVNRT (young women, 70% of SVTs)

AVRT: Assoc w/ WPW syndrome

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7
Q

Differential for ‘missed beats’

A

Atrial, ventricular ectopics

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8
Q

What is atrial fibrillation?

A

Irregular atrial rhythm from extranodal depolarisation –> variable conduction through AVN leads to irregular ventricular rhythm

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9
Q

What is the main risk/complication of AF?

A

Embolic stroke

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10
Q

Causes of AF?

A

IHD

Mitral valve disease/rheumatic heart disease

Hypertension

Thyrotoxicosis

Precipitants:

  • Pneumonia/endocarditis
  • PE
  • Caffeine, alcohol, post-op
  • Hypokalaemia/Hypomagnasaemia
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11
Q

Management of acute AF in unstable patient

A

DC cardioversion

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12
Q

Management of acute AF in stable patient within 48h of onset

A

Rate OR rhythm control (DC cardioversion or flecainide)

Give heparin if DC cardioversion delayed

Correct underlying

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13
Q

Management of acute AF in stable patient >48h from onset

A

Rate control only!

Need >3wks anticoagulation before rhythm control

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14
Q

Pharmacological rate control in AF

A

Ca channel blockers (non-dihydropiridine, e.g. verapamil/diltiazem not amlodipine)

Beta blockers (e.g. bisoprolol)

Digoxin

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15
Q

Rhythm control for AF

A

Beta blocker

Sotalol

Amiodarone

Flecainide

Electricity

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16
Q

Contraindications for flecainide

A

Structural heart disease (e.g. previous MI)

Ischaemic heart disease

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17
Q

Management of chronic AF

A

Anticoagulate with DOAC (e.g. apixaban) or warfarin

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18
Q

Management of atrial flutter

A

Same as atrial fibrillation!

DC cardioversion preferred

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19
Q

Lifestyle risk factors for atrial flutters/arrhythmias

A

Stress

Caffeine

Alcohol

Nicotine

20
Q

Contraindications of atropine for bradycardia

A

Mobitz Type II/complete heart block (only affects SAN not AVN)

Long Q-T –> increase risk of ectopics –> torsades de pointes

21
Q

Differential for narrow-complex tachycardia

A

Atrial flutter, atrial tachycardia

AV nodal reentrant tachycardia (75% of SVTs, younger women)

AV reentrant tachycardia (associated with WPW)

22
Q

Which tachycardia is treated with adenosine

A

AVNRT (adenosine blocks AVN only!)

23
Q

ECG features of WPW

A

Short PR interval

Delta wave (slurred upstroke of QRS)

24
Q

Differential of broad-complex tachycardia

A

Ventricular tachycardia (80% of broad-complex tachys, 95% of those w/ pre-existing heart disease)

SVT + WPW/BBB

25
Q

Initial treatment of broad-complex tachycardia

A

Lidocaine

26
Q

Differentiating VT from SVT + BBB

A

LAD, regularity, QRS >160ms –> Suggest VT

27
Q

T-wave inversion + palpitations DDx

A

LV hypertrophy/LBBB: Aortic stenosis, HTN

RV hypertrophy: Pulmonary HTN

Hypertrophic cardiomyopathy (young patients)

28
Q

What is pre-excited AF?

A

AF + re-entry circuit (e.g. WPW) –> Fast + irregular QRS (>200) –> predispose to VT/VF

29
Q

Causes of prolonged Q-T syndrome

A

Anti-arrhythmic drugs: e.g. amiodarone, sotalol

Psychiatric drugs: Tricyclic antidepressants, antipsychotics

Antimicrobial drugs: macrolides, antimalarials

5 hypos: Hypothyroid, hypothermia, hypokalaemia, hypocalcaemia, hypomagnasaemia

30
Q

What causes torsades de pointes

A

QRS ectopic landing on T-wave

31
Q

How do you calculate corrected Q-T interval (should be <450)

A

QT/sqrt(RR interval)

32
Q

Management of VT

A

DC cardioversion

Correct K+ and Mg2+ via central line

Amiodarone via central line if refractory

33
Q

Prolonged PR interval

A

First degree heart block

34
Q

Mobitz Type II block

A

Form of second degree heart block

Some P waves not followed by QRS complexes

35
Q

Leads where T-wave inversion is normal

A

VR

III

V1-V2

(V3-V4 in black people)

36
Q

Normal septal Q waves

A

I, VL, V6

<1x2mm

37
Q

Causes of LBBB

A

MI

Myocardial fibrosis: HTN/AS/HCM –> LV hypertrophy

38
Q

Peaked P waves

A

P Pulmonale

RA hypertrophy: Tricuspid stenosis, pulmonary HTN

39
Q

Bifid P waves

A

M-shaped –> P mitrale

LA hypertrophy (mitral stenosis)

40
Q

ECG changes RV hypertrophy

A

Dominant R wave in V1, deep S wave in V6

RAD

Peaked P waves

?T-wave inversion in V1-V2

41
Q

Posterior MI

A

Dominant R wave in V1

42
Q

T-wave inversion differential

A

STEMI (if Q waves or ST changes)

NSTEMI: no Q-waves/ST changes

Ventricularl hypertrophy

BBB

Digoxin treatment (reverse tick)

43
Q

ECG effects of hypokalaemia/hypomagnasaemia

A

Flattened T wave

Presence of U wave

Prolonged PR interval

Increased P-wave amplitude

44
Q

ECG effects of hyperkalaemia/hypermagnasaemia

A

Peaked T waves

Prolonged PR interval

Flattened P waves

Broad QRS complexes

45
Q

Symmetric T-wave inversion in non-coronary distribution

A

HOCM

46
Q

Causes of raised troponin

A

MI

Myocarditis

SVT

HF

PE

Renal failure

severe sepsis

Medicine (8 decks)

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