Arrhythmias, Syncope, Palpitations

Question 1

“Temporary loss of consciousness caused by a sudden fall in BP causing transient global cerebral hypoperfusion” is the definition of what

Answer 1

Syncope

Question 2

Syncope is

• Slow/rapid onset
• Short/lung duration
• Quick/slow recovery

Answer 2

Rapid onset, short duration, spontaneous complete recovery

Question 3

Define orthostatic hypotension

Answer 3

Decrease in SBP by 20 and BDP by 10

Question 4

Autonomic failure causes what kind of syncope

Answer 4

Orthostatic hypotension

Question 5

Parkinson’s disease, multiple system atrophy, diabetes, amyloidosis all increase risk of syncope through what mechanism

Answer 5

Autonomic failure causing orthostatic hypotension

Question 6

Bradycardia, tachycardia and structural disease all cause what type of syncope?

Answer 6

Cardiac syncope

Question 7

Carotid sinus syncope, vasovagal syncope and situational syncope are all what type of syncope?

Answer 7

Reflex syncope

Question 8

Prolonged standing in a hot environment eg on a ward or in a school assembly cause what type of syncope

Answer 8

Vasovagal (postural)

Question 9

Looking at needles can cause what type of syncope?

Answer 9

Vasovagal (provoking factors)

Question 10

Straining during micturition or coughing cause what type of syncope?

Answer 10

Situational reflex syncope

Question 11

Drug induced syncope is most likely what type of syncope?

Answer 11

Orthostatic hypotension

Or could be bradycardia (cardiac syncope)

Question 12

“Awareness of the heart rhythm” is the definition of what?

Answer 12

Palpitation

Question 13

What is more concerning… Palpitations at rest or exertional?
Prolonged persistent or short duration?

Answer 13

Exertional and prolonged persistent are concerning features of palpitations.
Other red flags are syncope, chest pain and a family history of sudden cardiac death
Features of innocent palpitations: occur at night or when quiet, benign trigger eg alcohol, normal ECG, short-lived, no associated symptoms, ‘skipped beat’, ‘thumping beat’

Question 14

Ectopic beats are also known as what?

Answer 14

Extrasystole

Question 15

“Skipped beat then compensatory pause then a thump” is the description of what

Answer 15

Ectopic beat AKA extrasystole

Question 16

Ectopic beats are generally ventricular or atrial?

How could you distinguish on ECG?

Answer 16

Ventricular
(both have the same symptoms)
Ventricular would have a wide QRS and atrial would have a narrow QRS

Question 17

What is bigeminy and trigeminy?

Answer 17

Bigeminy ectopic every second beat

Trigeminy ectopic every third beat

Question 18

AF, thyroid disease and anxiety can all cause ____

Answer 18

Palpitations

Consider TFTs in patient with palpitations

Question 19

1st line investigation for palpitations

Answer 19

12 lead ECG

Question 20

What type of recorder for palpitations that are:

• Daily or very frequently and short lived
• Less frequent but weekly
• Exercise induced
• Very intermittent
• Very infrequent but high risk

What additional investigation would you do if a murmur or abnormal ECG point you towards structural disease?

Answer 20

• Daily or very frequently and short lived = ambulatory 24 hour Holter monitor
• Less frequent but weekly = ambulatory 7 day r test
• Exercise induced = exercise treadmill ECG
• Very intermittent = event recorder
• Very infrequent but high risk = implantable loop recorder

ECHO

Question 21

Out of transvenous and subcutaneous ICD, which is the standard type and which is used in paediatrics?

Answer 21

Standard type transvenous

Subcutaneous used in paediatrics

Question 22

Radiofrequency ablation has high success rates in ….

SVT or atrial flutter or AF?

Answer 22

SVT and atrial flutter

Moderate chance of success in AF

Question 23

Sinus tachycardia, SVT, VT and atrial flutter are generally all around what HR?

Answer 23

150 bpm

Question 24

What is the atrial rate in atrial flutter?

Atrial flutter is described as 2:1 conduction, what does this mean?

Answer 24

Atrial rate 300bpm

2: 1 conduction = number of beats AVN lets though
atrial: ventricular

Question 25

ECG appearance in atrial flutter

Answer 25

Saw tooth pattern

Question 26

Management of atrial flutter

Answer 26

Anticoagulate (thrombus risk) | Ablation

Question 27

ECG appearance of SVT

Answer 27

Narrow complex tachycardia | QRS <120ms

Question 28

Commonest type of SVT?

Answer 28

AVNRT | AN nodal re-entrant tachycardia

Question 29

1st, 2nd 3rd line Mx of SVT?

Answer 29

1st - vagal manoeuvres 2nd - IV adenosine 3rd - IV verapamil or DC cardioversion

Question 30

Name 3 vagal manouevres

Answer 30

Valsalva: deep breath in, close mouth, pinch nose, hold 5 seconds, forced expiration violently Carotid sinus massage Immerse face in cold water

Question 31

Delta wave (slurred upstroke on QRS) and a short PR interval is the classic ECG appearance of ...

Answer 31

Wolf Parkinson White

Question 32

What arrhythmia does WPW mainly cause

Answer 32

SVT

Question 33

Monomorphic and polymorphic are the two types of what arrhythmia?

Answer 33

Ventricular tachycardia

Question 34

What is the main risk in VT?

Answer 34

Deteriorating into VF

Question 35

What is the QRS duration in VT?

Answer 35

Wide QRS >120ms

Question 36

Management of pulseless VT? Management of unstable VT? Management of stable VT?

Answer 36

Pulseless VT - advanced life support algorithm Unstable VT - IV 300mg amiodarone or unsyncronized defibrillation Stable IV - lidocaine or cardioversion

Question 37

'Chaotic disorganised' is the ECG appearance of what arrhythmia

Answer 37

Ventricular fibrillation

Question 38

Management of VF

Answer 38

``` Shockable rhythm (long term Mx often ICD) ```

Question 39

Wenckeback's is also known as

Answer 39

Mobitz type 1 | Second degree heart block

Question 40

"Complete dissociation of atria and ventricles" is the definition of what?

Answer 40

Complete heart block | may have progressed from Mobitz 2 or occur in acute MI

Question 41

Acute management of Mobitz type 2 and complete heart block?

Answer 41

Atropine | may later need temporary pacing

Question 42

What is 1st degree heart block

Answer 42

PR interval >0.2 seconds (5 small squares) 1:1 conduction (Normal in athletes and those with high vagal tone) (Generally doesn't require investigations or treatments)

Question 43

What is Mobitz type 1 heart block?

Answer 43

Progressive PR prolongation until a dropped beat | Generally benign

Question 44

What is Mobitz type 2 heart block?

Answer 44

Regularly dropped beat eg 2:1 or 3:1 (May progress to complete heart block) Requires treatment

Question 45

Describe the QRS in bundle branch block

Answer 45

Broad QRS >120ms

Question 46

ECG appearance in LBBB

Answer 46

Broad QRS >120ms V1 = W V6 = M

Question 47

ECG appearance in RBBB

Answer 47

Broad QRS >120ms V1 = M V6 = W

Question 48

ECG appearance in right axis deviation

Answer 48

I negative | aVF postive

Question 49

ECG appearance in left axis deviation

Answer 49

I positive | aVF negative

Question 50

Not included causes of axis deviation, causes of BBB, don't know what aberrancy is, or a premature ventricular complex? What is the ECG appearance of a PE?

Answer 50

Ughhhh