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Flashcards in 12.8.2013(palpitations) Deck (57):
0

Characteristics of palpitation

Intermittent Vs persistent
Regular Vs irregular

1

Irregular sustained palpitations

AF

2

Regular sustained palpitations

Regular supra ventricular and ventricular tachycardias

3

CVS causes of palpitations

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

4

Common cause of Intermittent palpitation

Premature atrial or ventricular contractions

5

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

Post extrasystolic beat

6

Are all arrythmias associated with palpitation?

MOST arrythmias are not associated with palpitation

7

Catecholaminergic Hyperdynamic states causing palpitations

Pheochromocytoma
Exercise
Stress

8

Drugs causing palpitations

Caffeine
Theophylline
Tobacco
Atropine
Thyroxine
Cocaine
Amphetamine
Beta agonists
Digitalis
Phenothiazines

9

Psychiatric causes constitute _________ % of palpitations

31

10

Psychiatric causes of palpitation

Panic attacks
Anxiety
Somatisation

11

Features of psychiatric causes of palpitation

Longer duration(>15min)
Associated with other symptoms

12

Miscellaneous causes of palpitations

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

13

Palpitations caused by sustained tachyarrythmias in CAD pts is associated with

Angina
Dyspnea

14

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

Dyspnea

15

Palpitations due to life threatening arrythmias are associated with

Symptoms of hemodynamic compromise like syncope,light headedness

16

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

Implantable loop recorder
Mobile cardiac outpatient telemetry

17

Rx of benign atrial or ventricular premature contractions

Betablockers

18

Arrythmias that cause palpitations

Any arrythmia

19

Non-cardiac causes of palpitations

Hypoglycemia
Vasovagal syncope
Hyperthyroidism
Fever
Anemia
Electrolyte imbalance
Hypovolemia
Pulmonary disease

20

Nonarrythmic cardiac causes of palpitations

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

21

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

Premature contractions

22

Orthostatic intolerance

Inadequate cerebral perfusion on upright posture

23

Orthostatic intolerance is common in

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