Presentation of Syncope and Palpitations

Question 1

What is a palpitation?

Answer 1

-Common
-Due to disorder of cardiac rhythm
-Describe unusually erratic, fast, slow, or forceful heart beat or even chest pain or breathlessness

Question 2

Questions to evaluate palpitations

Answer 2

-Is the palpitation continuous or intermittent?
-Is the heart beat regular or irregular?
-What is the approximate heart rate?
-Do symptoms occur in discrete attacks?
=Is the onset abrupt? How do attacks terminate?
-Are there any associated symptoms?
=Chest pain, light-headedness, polyuria (a feature of supraventricular tachycardia)
-Are there any precipitating factors, such as exercise or alcohol excess?
-Is there a history of structural heart disease, such as coronary artery disease or valvular heart disease?

Question 3

Non irregular heart beats

Answer 3

-Ectopic beats (atrial/ ventricular extra systoles)- flip or jump in chest/ dropped or missed beats, more frequent during periods of stress, debility, alcohol, nicotine
-AF

Question 4

Regular heart beat, discrete attacks of tachycardia (>120)

Answer 4

-SVT
-VT

Question 5

Regular heart beat, no discrete attacks of tachycardia

Answer 5

-Sinus tachycardia
-High stroke volume, due to anaemia (hyperdynamic circulation), anxiety (pounding, forceful and relatively fast), valve disease (AR)

Question 6

Investigation of palpitations

Answer 6

-ECG recording during an episode (ambulatory ECH monitor)
=Smartphones and smart watches with additional hardware

Question 7

Management of palpitations

Answer 7

-Explanation and reassurance (benign)
-Pre-syncope and syncope= may reflect serious structural or electrical disease

-Drugs
-Ablation

Question 8

What is syncope and pre-syncope?

Answer 8

-Syncope= Loss of consciousness due to reduced cerebral perfusion, cardiac= due to mechanical cardiac dysfunction or arrhythmia
-Presyncope= light-headedness, feels they may blackout

Question 9

Cardiac causes of impaired cerebral perfusion

Answer 9

-Arrhythmia
-Left ventricular dysfunction
-AS
-HOCM

Question 10

Typical symptoms of cardiac syncope

Answer 10

-Premonitory
=Often none
=Light-headedness
=Palpitation
=Chest pain
=Breathlessness

-Unconscious period
=Extreme death-like pallor

-Recovery
=Rapid (<1 min)
=Flushing

Question 11

Clinical assessment for cardiac syncope

Answer 11

-History
=Diuretics, vasodilators

-Examination
=Heart murmur (AS, HOCM)
=BP (symptomatic postural hypotension)

Question 12

Cardiac syncope investigations

Answer 12

-ECG (bradycardia, arrhythmia)