The Case Of The Fluttering Heart Flashcards
reasons for tachycardia
negative fluid status sepsis pain awareness in surgery response to intubation drug interactions adrenal crisis thyroid electrolytes PE
signs of inadequate anaesthesia depth
tachycardia hypotension sweating pupils dilated increased RR movement if not given muscle relaxant
signs of sepsis
tachycardia hypotension fever rising lactate acidosis low urine output
why is falling BP a late sign of decreased arterial pressure ?
initially baroreceptors cause HR to increase as compensation, eventually decompensated and that causes a drop in BP
Causes of adrenal storm
tumours
overdose of stimulants e.g. cocaine
subarachnoid haemorrhage
how much does AF decrease cardiac output by?
10%
ECG signs of AF
ECG signs of AF
irregularly irregular
absent p waves
f waves
causes of sinus bradycardia
age degeneration
beta blockers
athletic
Path of electrical conduction of the heart
SA node, AV node, AV bundle, bundle branches, Purkinje fibers
categories of AF
paroxysmal
persistent
longstanding persistent
permanent
persistent vs longstanding persistent AF
persistent more than 7 days
long standing more than 12 months
risk factors for AF
high BMI inactivity age CVD valve disease (MR) smoking high alcohol intake COPD OSA male intense physical activity high cholesterol
why can mitral regurgitation result in atrial fibrillation
causes left atrium to dilate
pros of 12 lead ECG
cheap
easy to do
instant result
good evidence
indications for 24/48hr tape
investigating palpitations or syncope silent AF daily symptoms classifying burden of disease assessing chronotropic incompetence
Chronotropic incompetence
a condition in which the heart rate increases slowly during exercise and never reaches maximum, never goes high enough for the activity
Holter monitor
portable ECG monitor worn by patient usually for 7 days (can be up to 2 weeks) which records any irregular rhythm
cons of exercise tolerance test
patient must be mobile
some meds cause false negatives e.g. beta blockers
not sensitive if coronary anatomy unknown
pros of exercise tolerance test
dynamic test
urgent findings can be flagged straight away
Implantable loop recorder
An electronic device that is surgically placed in the patient’s body and connected to the heart in order to detect dysrhythmias, can have for up to 3yrs
tilt table testing
patient placed at 60 degree angle for 45mins ± GTN and see if they faint
indications for tilt table testing
mainly used for unexplained recurrent syncope or POTS
