Palpitations

Question 1

what verbal history do you need from a patient presenting with palpitations?

Answer 1

RADSOE
r - rhythm - patient tap out palpitations
A - associated symptoms
D - duration
S - severity/ exacerbation
O - onset
E - end

Question 2

if a patient has SoB and palpitations, what does it suggest?

Answer 2

MI, heart failure,

Question 3

if a patient has ‘breath taken away’ and palpitations, what does this indicate?

Answer 3

extrasystoles

Question 4

if a patient has chest pain and palpitations, what does this suggest?

Answer 4

CAD/ tachyarrthymias

Question 5

what do you do if a patient experiences syncope with palpitations?

Answer 5

specialist
implantable loop recorder

Question 6

if a patient experiences palpitations following exercise/ exertion, what does this suggest?

Answer 6

MI, myocardiopathy, chanelopathy

Question 7

would suggest paroxysmal supraventricular tachycardia in relation to the end of palpitation episode?

Answer 7

sudden
following breath holding
coughing/ straining action

Question 8

what drugs make you more at risk for tachyarrthymias?

Answer 8

b blockers
theophylline
antimuscranics
class 1 anti-arrthymics
prolonged QT drugs
coke/ ket
dihydropidine CCB

Question 9

what medical conditions are linked to AF:

Answer 9

hypertension
valvur heart
HF
CAD
diabetes
obesity
thyrotoxicosis
sleep apnoea

Question 10

what lifestyle habits link to palpitations?

Answer 10

caffeine, illicit drugs, alcohol excess

Question 11

what medical conditions are linked to tachyarrthymias?

Answer 11

anaemia, thyrotoxicosis

Question 12

what family history death can increase risk?

Answer 12

sudden cardiac death in <40yrs

Question 13

how does heart failure present in exam?

Answer 13

raised jugular pressure
ankle swelling
crackles when listening

Question 14

what does pallor inidicate?

Answer 14

anaemia

Question 15

how does thyrotoxicosis present?

Answer 15

tremor, thinness, goitre

Question 16

when investigating palpitations, what should be looked for within bloods?

Answer 16

anaemia, infection
serum/ creatinine/ electrolytes - liver/ kidney impairment
thyroid - excess can increase HR, increase contractibility and oxygen demands

Question 17

when would you use a 24hr ambulatory rhythm monitor?

Answer 17

holter monitor
daily symptoms
in clinic - decipher morphology and anatomical origin

Question 18

when would you use a 48hr ambulatory rhythm monitor?

Answer 18

almost daily symptoms

Question 19

when would you use a 7 day ambulatory rhythm monitor?

Answer 19

weekly symptoms

Question 20

when would use a patient event recorder?

Answer 20

longer investigation
infrequent and prolonged symptoms

Question 21

when would you use an implantable loop recorder?

Answer 21

small battery placed under skin to measure heart - constantly on so good in patients wiht syncope and doesnt need activated

Question 22

what are palpitations?

Answer 22

rapid pulsations/ abnormally rapid or irregular beating of the heart

Question 23

how are some of the symptoms described as?

Answer 23

strong, skipping, fluttering, racing, pounding, thudding/ jumping sensation
breath taken away

Question 24

what is the aetiology of palpitations?

Answer 24

half are heart rhythm abnormalities
anxiety
most frequent is ventricular extrasystoles - skips a beat
AF, paraoxysmal supraventricular tachycardia
medication
exercise stress

Question 25

what is the pathophysiology of palpitations?

Answer 25

extra systoles by premature ventricular contractions
flip flop sensation - result of forceful contraction following a pause
irregular pounding in the neck - atrioventricular dissociation - subsequent atria are contracting against closed tricuspid and mitral valves