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Year 4 General Medicine > Palpitations > Flashcards

Palpitations Flashcards

1
Q

what are palpitations

A

awareness of heart beating in your chest

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2
Q

palpitations can be normal

A

yes

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3
Q

describe your approach to the patient with ‘palpitations’

A

take a history and perform a full examination

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4
Q

history taking for palpitations

A
  1. what is it like
  2. tap it out
  3. how long have you had it
  4. how long does it last
  5. how does it start or stop
  6. associated symptoms
  7. ask about past cardiac history - symptoms and interventions
  8. DH
  9. S/E - endocrine, GI, GU
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5
Q

what is the commonest heart rhythm disturbance

A

ectopic beats
/ extrasystoles
(most common cause of palpitations)

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6
Q

how would patients classically describe ectopics

A

skip / stop / miss in heartbeat

followed by thump / forceful beat

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7
Q

what is the SAN

A

the heart’s pacemaker

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8
Q

normal PR interval

A

0.12-0.20s
120-200ms
3-5 small squares

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9
Q

bundle of His splits into?

A

left and right bundle

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10
Q

left bundle branch splits into?

A

left anterior and posterior fascicles

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11
Q

why do you get narrow QRS

A

fast electrical conduction

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12
Q

narrow is normal

A

yes

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13
Q

normal QRS complex duration

A

<120ms

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14
Q

wide might be worrying…

A

…because it might be coming from the Wentricle

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15
Q

ventricular ectopic may be so weak that..

A

you cant feel the pulse or patient might not be able to feel the extra beat
compensatory pause

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16
Q

compensatory pause

A

after an ectopic to get back on track

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17
Q

what is the first beat after an ectopic going to feel like

A

very strong ie the ‘thump’ because of the compensatory pause

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18
Q

narrow complex ectopic?

A

atrial ectopic beat

has the same effect as a ventricular ectopic beat

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19
Q

diagnosis

A

awareness of ectopic beat

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20
Q

p wave followed by ‘wide M shaped’ QRS

A

right bundle branch block

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21
Q

aberrant conduction

A

right bundle goes to sleep leading to BBB

rhythm you can spot coming from the top of the heart but conduction gets stuck/slow

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22
Q

regular broad complex tachycardia..

A

ventricular tachycardia

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23
Q

what can you ask the patient to do to describe the rhythm

A

tap out the rhythm

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24
Q

define tachycardia + bradycardia in bpm

A

> 100bpm

<60bpm

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25
profound bradycardia
<40bpm
26
irregularly irregular
AF
27
some people can be aware of normal sinus rhythm, true or false
true
28
tachycardia 150bpm D.Dx
atrial flutter sinus tachycardia VT SVT - Atrial tachycardia, AVNRT
29
in the AVN, the fast pathway is slower to recover than the slower pathway
yes | remember the rowboat
30
what could cause a AVNRT
ectopic it finds the faster pathway has not recovered and the slow pathway has therefore forms reentrant electrical circuit and fires off atria back to front resulting in an inverted p wave after the QRS 'retrograde' p wave
31
atrial flutter
reentrant electrical circuit set up in the right atrium | organised = regular rhythm
32
atrial fibrillation
chaotic atrial activity
33
what is the rate of atrial flutter
300bpm
34
atrial rate of AF
300-600bpm
35
maximum target heart rate calculations
220 - age
36
what is the ventricular rate of atrial flutter
150bpm 2:1 conduction, 3:1, 4:1... 300:150 will always be regular
37
4 things to ask for /adverse features in a patient with a fast heart rate
heart failure ischaemia syncope BP <90
38
vagal maneouvres
carotid sinus massage valsalva cold icy water
39
what is the valsalva
deep breath in shut mouth and nose breath against this for 5 sec and release violently
40
20ml syringe
blow the plunger out | alternative valsalva
41
valsalva breaks the AVNRT circuit
period where nothing happens then restoration of normal sinus rhythm
42
what do you do if vagal maneouvres dont work
IV adenosine | have to warn the patient of impending doom sensation
43
fleeting
ectopic
44
triggers of palpitations
``` anxiety - difficult to tease out caffeine alcohol IVDU prescribed drugs ```
45
relieving factors
``` rest deep breath squat down vomiting all sound vagal ```
46
associated symptoms with palpitations
cardiac syncope - LOC near syncope chest pain
47
what is cardiac syncope
palpitations and pass out no pro or post drome wake up like what happened
48
endocrine causes of palpitations
hyperthyroidism | menopause
49
GI / GU causes of palpitations
pregnancy - 2nd trimester | anaemia
50
what two conditions make palpitations more likely
anaemia | hyperthyroidism
51
loss of nail bed angle, increased pulp density, increased nail bed fluctuation and increased curvature of the nails
finger clubbing
52
what might you look for in the hands in a CVS examination
``` pallor sweating koilonychia leukonychia finger clubbing erythema cyanosis splinter haemorrhages rheumatoid hand ```
53
cause of palmar erythema
``` too much oestrogen in the blood liver cirrhosis - cant break down oestrogen oestrogen producing breast tumour pregnancy contraception ```
54
features of examining pulse
``` rate rhythm character volume R and L radial delay ```
55
cause of regularly irregular pulse
Mobitz type 1 heart block aka Wenkebach's | trigemy
56
cause of irregularly irregular pulse
atrial fibrillation | completely unpredictable pulse in rhythm and volume
57
causes of a thready weak pulse
hypovolaemia | shock
58
causes of a bounding pulse
vasodilatation | CO2 retention
59
conditions causing obstruction to ventricle pumping blood
aortic stenosis
60
describe the pulse in aortic stenosis
slow rising low volume pulse | 'plateau pulse'
61
describe the BP in aortic stenosis
narrow pulse pressure e.g. 90/70
62
DBP in aortic regurgitation
low
63
pulse pressure in aortic regurgitation
large pulse pressure | because blood falls back into ventricle
64
describe the pulse in aortic regurgitation
collapsing pulse
65
how do you test for a collapsing pulse
press with the MCP heads of your hand then raise the patients arm perpendicular should feel a whoosh and then tapping
66
what is a useful clue when assessing pulse
pulse pressure - check BP
67
cause of asynchronous radial pulse
coarctation of the aorta
68
investigations for palpitations
``` FBC - anaemia U+E - electrolyte abnormalities TFT - hyperthyroidism 12 lead ECG if normal, 24/48hr/7day ECG tracing/holter/ambulatory Loop recorder implantable loop recorder exercise tolerance test ```
69
ECG potential findings in palpitations
ectopics AF WPW
70
what is a loop recorder
record when patient feels symptomatic | done for weekly/fortnightly symptoms
71
what is a PVC
premature ventricular complex / ventricular ectopic / ventricular extrasystoles / ventricular premature beats
72
ECG features of a PVC
broad QRS complex with abnormal morphology premature discordant ST segment and T wave changes usually followed by a compensatory pause +- retrograde capture of the atria (p wave inversion)
73
what is bigemy
every other beat is a PVC/ectopic
74
what is trigemy
every 3rd beat is a PVC/ectopic
75
what is quadrigeminy
every 4th beat is a PVC/ectopic
76
https://litfl.com/premature-ventricular-complex-pvc-ecg-library/
useful link
77
frequent PVCs may cause palpitations, true or false
true
78
causes of symptomatic / frequent PVC
``` anxiety sympathomimetics B agonists excess caffeine hypokalaemia hypomagnesaemia digoxin toxicity MI ```

Year 4 General Medicine (16 decks)

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