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Harrison- Approach to Symptoms > 12.8.2013(palpitations) > Flashcards

12.8.2013(palpitations) Flashcards

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0
Q

Irregular sustained palpitations

A

AF

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1
Q

Characteristics of palpitation

A

Intermittent Vs persistent

Regular Vs irregular

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2
Q

Regular sustained palpitations

A

Regular supra ventricular and ventricular tachycardias

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3
Q

CVS causes of palpitations

A

Premature atrial and ventricular contractions
Supra ventricular and ventricular arrythmias
Mitral valve prolapse(with or WITHOUT associated arrythmias)
AR
Atrial myxoma
Pulmonary embolism
Pericarditis
CCF

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4
Q

Common cause of Intermittent palpitation

A

Premature atrial or ventricular contractions

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5
Q

Which Beat is sensed by the patient in premature atrial or ventricular contraction?

A

Post extrasystolic beat

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6
Q

Are all arrythmias associated with palpitation?

A

MOST arrythmias are not associated with palpitation

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7
Q

Catecholaminergic Hyperdynamic states causing palpitations

A

Pheochromocytoma
Exercise
Stress

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8
Q

Drugs causing palpitations

A 
Caffeine
Theophylline
Tobacco
Atropine
Thyroxine
Cocaine
Amphetamine
Beta agonists
Digitalis
Phenothiazines
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9
Q

Psychiatric causes constitute _________ % of palpitations

A

31

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10
Q

Psychiatric causes of palpitation

A

Panic attacks
Anxiety
Somatisation

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11
Q

Features of psychiatric causes of palpitation

A 
Longer duration(>15min)
Associated with other symptoms
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12
Q

Miscellaneous causes of palpitations

A 
Drugs
Thyrotoxicosis 
Systemic mastocytosis
Pheochromocytoma 
Ethanol
Spontaneous skeletal muscle contractions of chest wall
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13
Q

Palpitations caused by sustained tachyarrythmias in CAD pts is associated with

A

Angina

Dyspnea

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14
Q

Palpitations in patients with ventricular dysfunction,AS,HOCM,MS are associated with

A

Dyspnea

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15
Q

Palpitations due to life threatening arrythmias are associated with

A

Symptoms of hemodynamic compromise like syncope,light headedness

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16
Q

Strategies that are better for evaluation of pts with unexplained,recurrent palpitations

A

Implantable loop recorder

Mobile cardiac outpatient telemetry

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17
Q

Rx of benign atrial or ventricular premature contractions

A

Betablockers

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18
Q

Arrythmias that cause palpitations

A

Any arrythmia

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19
Q

Non-cardiac causes of palpitations

A 
Hypoglycemia
Vasovagal syncope
Hyperthyroidism 
Fever 
Anemia
Electrolyte imbalance 
Hypovolemia 
Pulmonary disease
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20
Q

Nonarrythmic cardiac causes of palpitations

A 
ASD,VSD
congenital heart disease
CCF
Cardiomyopathy
MVP
Pacemaker induced tachycardia
Pericarditis
Valvular diseases
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21
Q

Pounding or jumping palpitations when the patient is quietly sitting down or lying

A

Premature contractions

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22
Q

Orthostatic intolerance

Study These Flashcards
A

Inadequate cerebral perfusion on upright posture

23
Q

Orthostatic intolerance is common in

Study These Flashcards
A

Women of child bearing age

24
Are panic disorders and significant arrythmias mutually exclusive
No
25
Single question screening tool for panic disorder
Have you ever experienced brief periods of overwhelming panic or terror that was accompanied by racing heartbeats,dizziness,shortness of breath?
26
Single skipped beats
Benign ectopy
27
Feeling of unable to catch one's breath
VPC
28
Single pounding sensations
VPC
29
Rapid,regular pounding in neck
Supra ventricular arrythmias
30
Palpitations that are worse at night
Benign ectopy | AF
31
Palpitations associated with emotional distress
Psychiatric | Catecholamine sensitive arrythmias
32
Palpitations associated with activity
CAD
33
Palpitations associated with general anxiety
Panic attacks
34
Rapid palpitations with exercise
Supra ventricular arrythmias | AF
35
Positional palpitations
AV nodal tachycardia | Pericarditis
36
Palpitations since childhood
Supra ventricular tachycardia
37
Rapid,irregular rhythm
AF | Tachycardia with variable block
38
Palpitation terminated by Vagal manuevers
Supra ventricular tachycardia
39
Who donot require further diagnostic testing for palpitations?
Low risk for CAD,normal ECG,not associated with syncope,negative physical exam findings
40
Ventricular tachycardia is associated with
Previous MI Idiopathic dilated cardiomyopathy Significant valvular lesions Hypertrophic cardiomyopathies
41
Cardiac activity monitors
Implantable loop recorder Holter monitor Transtelephonic cardiac event monitor
42
Holter monitor
ECG recording device that is worn by the patient for 24-48hours
43
Transtelephonic event monitors
Continuous loop event monitor Record data only few min before and after activation Activated by the patient Sends the recorded ECG activity to physician
44
Body weight and edema
Weight gain of several kgs precede overt symptoms of Edema | Weight loss by diuresis can be induced in edematous patient
45
Subtle signs of Edema
Difficulty in putting shoes in evening Imprint of steth over chest wall Tight ring
46
Features of inflammatory Edema due to capillary damage
Nonpitting Localised Accompanied by other signs of inflammation
47
Angiotensin 1 is a _____ peptide
Deca
48
Angiotensin 2 is a _______ peptide
Octa
49
Aldosterone in heart failure
Levels increased | Half life increased(reduced hepatic metabolism due to decreased hepatic blood flow)
50
Why aldosterone escape doesnot occur in CCF,nephrotic syndrome,cirrhosis?
No pressure natriuresis due to decreased effective circulating volume
51
Cause of AVP secretion in CCF
Non osmotic stimulus | Decreased effective circulating volume
52
Endothelin levels in heart failure
Increased
53
Types of natriuretic peptides
ANP(atria) BNP(ventricles) CNP(endothelial and renal)
54
Receptors for natriuretic peptides
ANP and BNP bind to natriuretic peptide receptor A found in myocardium CNP binds to natriuretic peptide receptor B found in veins
55
In mild heart failure the decreased arterial filling is offset by
Increase in circulating blood volume
56
Renal Na+ in cirrhosis is attenuated by
Increased prostaglandins PGE2 and PGI2

Harrison- Approach to Symptoms (11 decks)

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