Presentations of Arrhythmias: Palpitations, Syncope, Sudden Death Flashcards
Too fast
Too slow
Too ugly
SVT
Third degree HB
Torsade de Poitnes
Palpitations
Sensory problem…unpleasent awareness of forceful, rapid or irregular beating of the heart
Flip-flopping
Rapid fluttering
Pounding in neck
Heart seems to stop and start…due to PAC or PVC…post extrasystole potentiation
Sustained rhythm
AV dissocitation
POunding in the nck
Frog Sign
Rapid and regular neck pulsations due to prominant A waves
Atria and ventrilce activate simultaneously
Atria always contracting against a closed mitral and TC valve
Seen with complete HB, VT, and AVNRT
Features of benign ectopic activity
Pause and thump At rest Relieved by exercise No associated chest pain syncope or breathlessness No fam hx Normal ECG and exam
PVC
Premature…earlier than expected from R to R
Ectopic - orginate outsite the SA node…means QRS different
Wide complexes - come from ventricles and don’t use normal conducting system…means AP needs to travel from mycocyte to myocyte and its slower
Unlike a premature atrial contraction - PAC uses normal
COnducting system has to re-set after a PVC so more time to fill ventricles during diastole and therefre increased CO and BP
May be experienced as missed or skipped beats…VPB is not sensed but the following augmented isnus beat is
Tx of benign ectopy
Reassure
Reduce alcohol, caffiene, asthma inhalers
Relaxation therapy
Avoid drugs
Syncope - with pathophys
Trnaisent LOC with loss of postural tone from which recovery is spontaenous…when you fall, there is less gravity to compete with so blodo restores
Loss of neurologic fxn due to sudden reduction of cerebral blood flow
Only diff between syncope and death is that you wake up in syncope
SCD
Sudden cardiac death - within 1 hr of sx onset
Unexpected death due to cardaic causes
Sudden death
Cardiac accounts for about 80%
Ventricular fibrillation
Frequent PVCs with R on T phenomenon..polymorphic VT which begins to degenerate to VF
R on T - PVC falls on a T wave from prvious contraction, ventricular fibrillation and death can occur…during the T wave (repolarization), the heart muslce is very senstivie to outside stimulus thius a strong PVC can send mycoardium into fib
Combination of mildly prolonged GTC and frequent PVCs - bigeminy is commonly seen in acute myocardial ischemia and is high risk for deterioraton to PVT/VF
Syncope in general
Could be benign
NEED to distinguish whether cardiac in origin or not
Syncope vs other T-LOC
Pre-syncope
Drop attack
Coma
Seizure
Lightheadwithout LOC
Loss of posture without LOC
LOC without spont recorvery
TOnic-clonic that start with LOC…post-ictal recovery
HYpoglycemia, hypoxia, TIA
Vasovagal
Most common cause of syncope
Visceral organs- micturition, defecation, cough
Carotid baroreceptors - carotid sinus hypersensitivity
Psych - site of blood
Activation of the vagues nerve leads to bradycardia and vasodilation and decreased perfusion of the brain
Preceded by prodrome in 70%
Carotid sinus syndrome
Associated iwht abnormalities or meds (digoxin, alphamethyldopa or pronanolool)
Two ttypes - cardioinhibitory or vasodepressor
Suspect in elderly pts (tight collar, shaving, head turning)
Carotid sinus massage
Carotid arterial pulse just below thyroid cartilage
Method - examine for bruits…IV access and monitor with atropine
Right followed by left, pause between
Massag,e NOT occlusion
5-10 secs
POsture - supine and erect
Carotid sinus massage outcome and contra
3 sec asystole and/or 50 fall in systolic BP with reproduction of sx - carotid sinus syndrome
Contraindications - bruits, significant carotid arterial dz, previous CVA
Risk - 1/5000 with TIA
Orthostasis causes
Volume - dehydration, diarrhea, drugs (diuretics or antiHTN)
Autonomic dysfxn - parkinsons’, dibaetes, elderly
Def - SBP drop 20 and DBP drop 10…after 3 minutes of standing
Post prandial hypotension
30-75 minutes after eating meals
Dool diverted ot intestines to facilitate digestio nand absorption…must increase CO and vasoconstriction
Caused by autonomic nervous system not compensating appropriately
More in older people
Systolic drop by 20…drink water with the meal
Mechanical causes
Sudden onset, no prodrome and occurs with exercise
Impediment of blood flow from the heart
ECHO and murmur to dx
Sick sinus syndrome
Variety of conditions involving sinus node dysfunction and most in elderly
May rpesent with syncope
ECG - sinus bradycardia, sinus arrest, sinoatrial block
Alternating patterns of bradycardia and tachycardia, supraventricular arryhthmias usually atrial fibbrillation (bradycardia-tachycardia syndrome)
Sick sinus syndrome dx and tx
HOlter monitor or ECG
Pacemaker
Cerebral syncope
Neurological syncope can occur from transient attack from vertebrobasiolar insuff
Elderly men with isch heart dz
May after neck motion
Dx - CTA or MRA of vertebral system
WBW
A fib or a flutter
