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MC > Palpitations > Flashcards

Palpitations Flashcards

1
Q

Perhaps the commonest arrhythmia causing a

patient to visit the family doctor is the _____

A

symptomatic
premature ventricular beat/complex (ventricular
ectopic).

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2
Q

The commonest cause of an apparent pause on the

ECG is a_______`

A

blocked premature atrial beat/complex

(atrial ectopic

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3
Q

Consider drugs as a cause, including prescribed

drugs and non-prescribed drugs such as ____, _____ and ______`

A

alcohol,

caffeine and cigarettes

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4
Q

Common triggers of paroxysmal supraventricular

tachycardia (PSVT) include _____ and _____

A

anxiety and cigarette

smoking

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5
Q

The commonest mechanism of any arrhythmia is

_____

A

re-entry

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6
Q

If the palpitations are not caused by anxiety or

fever, the common causes are____ and _____

A

sinus tachycardia and premature complexes/ectopics (atrial or ventricula

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7
Q

If the palpitations are not caused by anxiety or

fever, the common causes are _____ and _____

A

sinus tachycardia and

premature complexes/ectopics (atrial or ventricular

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8
Q

Sinus tachycardia can be differentiated clinically
from PSVT in that it starts and stops more gradually
than PSVT (abrupt) and has a ________

A

lower rate of 100–150

compared with 160–220

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9
Q

Sinister life-threatening arrhythmias are

A
  • ventricular tachycardia
  • atypical ventricular tachycardia (torsade de pointes)
  • sick sinus syndrome (SSS)
  • complete heart block
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10
Q

The rare tumour,________ presents with
palpitations and the interesting characteristic of
postural tachycardia (a change of more than 20 beats/
min).

A

phaeochromocytoma,

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11
Q

As a working guide, a rate estimated to be about
________ suggests PSVT, atrial flutter/
fibrillation or ventricular tachycardia

A

150 beats/minute

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12
Q

MC cause of palpitations in children

A

exercise, fever or anxiety

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13
Q

Palpitations needing special attention in children

A

PSVT, heart block and ventricular arrhythmias

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14
Q

________ is characterised by beats at 200–300 per

minute, the fastest rates occurring in infants

A

PSVT

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15
Q

The recommended firstline
treatment of PSVT is________ via the
application of ice packs to the upper face (forehead,
eyes and nose) of the affected infant

A

vagal stimulation

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16
Q

Medical Tx of PSVT

A

Intravenous

adenosine will usually terminate the episode.

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17
Q

They are prone to develop
ventricular tachyarrhythmias, which may lead to
sudden death. Consider it in children developing
syncope on exertion.

A

familial long QT syndrome

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18
Q

Occasional atrial

and ventricular arrhythmias, especially___________, occur in 40% of old people

A

premature

complexes (ectopics)

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19
Q

A ____________ is the
only indication for digoxin in the elderly but beware
of _______, especially if dizziness or syncope accompanies
the fibrillation.

A

rapid ventricular rate with symptoms

SSS

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20
Q

In the elderly, thyrotoxicosis may present as sinus
tachycardia or atrial fibrillation with only minimal
signs—the so-called________—so it is
easy to overlook it

A

‘masked thyrotoxicosis’

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21
Q

Avoid digoxin in cases with an _______

A

accessory pathway

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22
Q

The two main indications for permanent

pacemaking are_____ and ______

A

SSS (only if symptomatic) and

complete heart block

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23
Q

When to Tx sinus bradycardia

A

Treatment is required only if symptomatic, which is uncommon at rates >40–45 beats/min.

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24
Q 
• Sudden onset without warning
• Patient falls to ground
• Collapse with loss of consciousness
• Pallor and still as if dead with slow or absent
pulse
A

Stokes–Adams attack

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25
Q

• These are usually asymptomatic.
• Management is based on reassurance.
• Check lifestyle factors such as excess alcohol,
caffeine, stress and smoking; avoid precipitating
factors

A

Premature (ectopic) atrial

complexes

26
Q

Medical Mx of PACs

A

atenolol or metoprolol 25–100 mg (o) daily
or
verapamil SR 160–480 mg (o) daily

27
Q

• These are also usually asymptomatic (90%).
• They occur in 20% of people with ‘normal’ hearts.
• Symptoms are usually noticed at rest in bed at
night

A

Premature (ectopic) ventricular

complexes

28
Q

Approximately 60% of SVT are due to____ and _______

A

atrioventricular (AV) node re-entry and 35% due to accessory pathway tachycardia (e.g. WPW).

29
Q

The structural basis for the arrhythmia of SVT

in WPW syndrome is an ______

A

accessory pathway that bypasses the AV node.

30
Q

_____ is the first treatment of choice for PSVT

A

Carotid sinus massage

31
Q

Other methods of vagal stimulation

A
  • Valsalva manoeuvre (easiest for patient)
  • self-induced vomiting
  • ocular pressure (avoid)
  • cold (ice) water to face or swallowing ice
  • immersion of the face in water
32
Q

How to give Adenosine if vagal stim does not work

A

give adenosine IV (try 6 mg first over
5–10 seconds, then 12 mg in 2 minutes if
unsuccessful, then 18 mg in 2 minutes if
necessary and well tolerated

33
Q

2nd line of Tx if vagal stim does not work

A

Second-line treatment is verapamil IV 1 mg/min up to
10–15 mg (provided patient is not taking a beta
blocker).

34
Q

Adenosine causes less hypotension than
verapamil but may cause ______ in
asthmatics

A

bronchospasm

35
Q

When to avoid Verapamil

A

AVOID verapamil if taking β -blockers
and
persistent tachycardia with QRS complexes
>0.14 s (suggests ventricular tachycardia

36
Q

In the rare event of failure of medical treatment in SVT,

consider ____ and ____

A

DC cardioversion or overdrive pacing.

37
Q

Meds to prevent recurrences of SVT

A

To prevent recurrences (frequent episodes) use
atenolol or metoprolol, flecainide (only if no structural
heart damage) or sotalol

38
Q

In SVT,

_______, which is usually curative, is indicated for
frequent attacks not responding to medical therapy

A

Radiofrequency catheter

ablation

39
Q

_________ causes vagal stimulation and

its effect on SVT is all or nothing

A

Carotid sinus massage

40
Q

T or F,

Carotid sinus massage has no effect on
ventricular tachycardia

A

T

41
Q

How does carotid massage work?

A

It slows the sinus rate and

breaks the SVT by blocking AV nodal conduction.

42
Q

In general, right carotid pressure tends to________and left carotid pressure tends to ____

A

slow the sinus rate

impair AV nodal conduction

43
Q

Wc pts to avoid carotid massage?

A

Avoid in the elderly (risk of embolism or bradycardia

44
Q

No cause is found in ________—isolated atrial

fibrillation

A

12%

45
Q

With sustained atrial fibrillation there is a______
chance per annum of embolic episodes. There is a
fivefold risk of CVA overall

A

5%

46
Q

in Af, _______ controls the ventricular rate but does not

terminate or prevent attacks

A

Digoxin

47
Q

______, ________, _______are used
for conversion of atrial fibrillation and
maintenance of sinus rhythm

A

Sotalol, flecainide and amiodarone

48
Q

in AF,________ should
never be prescribed in patients with reduced LV
function

A

Flecainide

49
Q

Beta blockers and calciumchannel
antagonists benefited rate control
but ________ was much less effective than
amiodarone at restoring cardiac rhythm

A

verapamil

50
Q

The ECG of _________has a regular saw-tooth
baseline ventricular rate of 150 with narrow
QRS complexes. This is a 2:1 AV block

A

atrial flutter

51
Q

The _______study confirmed that there was no
statistically significant difference between the rate
and rhythm of control groups. However, patients
fare marginally better (in terms of mortality) with
just rate control rather than trying to get them back
into sinus rhythm if they are asymptomatic in atrial
fibrillation.

A

AFFIRM

52
Q

Mx of Rapid, urgent control of ventricular rate:

A

verapamil 1 mg/min IV up to maximum 15 mg then orally
or
metoprolol 5 mg (1 mg/min) IV to max 20 mg (provided no evidence of heart failure and wellmonitored BP)

53
Q

Routine control and maintenance of AF

A 
verapamil SR 160–480 mg (o) daily
or
diltiazem CR 180–360 mg (o) daily
or
atenolol or metoprolol 25–100 mg (o) bd
54
Q

In AF Tx, when do we consider rhythm control?

A

This should be considered if the patient is
symptomatic and the arrhythmia is of recent onset—
less than 6 months

55
Q

If the rate cannot be well controlled despite

maximal medical therapy, consider _____ and ______

A

AV node ablation

and a permanent pacemaker

56
Q

What surgical procedure?

Specific abnormal foci in the conducting pathways
can be ablated using direct current electrical surgery
or radiofrequency ‘burns’ via a catheter electrode

A

Catheter electrode ablation

57
Q

_________which will probably
supplant surgery as a form of treatment, is indicated
for recurrent episodes of supraventricular tachycardia

A

Radiofrequency ablation,

58
Q

This expensive implant is the most effective therapy
yet devised for the prevention of sudden cardiac death
in patients with documented sustained ventricular
tachycardia or fibrillation

A

Automatic implantable cardiac

defibrillator (AICD)

59
Q

IACD

Operative mortality should be less than ______, after which survival at 1 year is over _____

A

10%

90%.

60
Q

T or F

A normal ECG in sinus rhythm does not exclude an
accessory pathway

A

t

61
Q

Consider conduction disorders such as the WPW
syndrome in PSVT. Avoid ______ in WPW
syndrome.

A

digoxin

MC (90 decks)

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