palpitations and syncope (W5)

Question 1

syncope meaning?

Answer 1

loss of consciousness due to reduced cerebral perfusion. may also refer to any transient loss of consciousness

Question 2

what is vertigo

Answer 2

sensation that you or the environment is moving/spinning

Question 3

common causes of syncope

Answer 3

cardiovascular
postural/orthostatic hypotension
neurally mediated
vasovagal syncope/neural reflex syncope
drug intoxications
hypoglycaemia

Question 4

causes of cardiovascular syncope

Answer 4

arrhythmia
structural heart disease

Question 5

causes of neurally mediated syncope

Answer 5

epilepsy

Question 6

what is vasovagal syncope/neural reflex syncope

Answer 6

associated with stress/anxiety - whole system slows down, vagal activity

Question 7

ectopic beat

Answer 7

extra beat then pause

Question 8

when might sinus tachycardia occur pathophysiologically

Answer 8

infection/fever
dehydration

Question 9

sinus tachycardia appearance on ECG? BPM?

Answer 9

shorter than 3 squares
over 100 bpm

Question 10

sinus bradycardia bpm?

Answer 10

less than 60 bpm

Question 11

arrhythmias 3 categories?

Answer 11

too fast
too slow
intermittent

Question 12

too fast arrhythmias types

Answer 12

atrial fibrillation
ventricular tachycardia

Question 13

too slow arrhythmias types

Answer 13

heart block

Question 14

intermittent arrhythmias types

Answer 14

supraventricular tachycardia
paroxysmal AF
ectopic beats

Question 15

supraventricular tachycardia description

Answer 15

intermittent rapid tachycardia with abrupt onset and offset
narrow complex tachycardia

Question 16

2 types of tachycardia

Answer 16

narrow complex tachycardia
broad complex tachycardia

Question 17

narrow complex tachycardia meaning

Answer 17

QRS duration in normal limits of 120 milliseconds (less than 3 squares)

Question 18

SVT presentation

Answer 18

palpitations
light headedness
nausea
chest pain
breathlessness
usually haemodynamically stable

Question 19

haemodynamically stable meaning?

Answer 19

blood pressure sufficient to maintain organ perfusion

Question 20

activation of which nerve in the autonomic nervous system would increase blockade at the atrioventricular node

Answer 20

vagus nerve

Question 21

how can you activate the vagus nerve

Answer 21

water on face for children (cold flannel)
carotid sinus massage
Valsalva manoeuvre

if previous dont work give IV adenosine

Question 22

what is the Valsalva manoeuvre

Answer 22

performance of forced expiration against a closed glottis

Question 23

how does IV adenosine treat SVT

Answer 23

slows conduction through
AV node

Question 24

ventricular tachycardia features? who does it occur in?

Answer 24

broad complex tachycardia
normally in patients with underlying heart disease

Question 25

what is broad complex tachycardia

Answer 25

QRS complex larger than 3 squares or over 120ms

Question 26

VT presentation

Answer 26

palpitations chest pain shortness of breath loss of consciousness

Question 27

VT treatment if unconscious

Answer 27

synchronised DC cardioversion synchronised to R wave medical emergency!!!!

Question 28

VT treatment if unconscious

Answer 28

give antiarrhythmic - most commonly amiodarone

Question 29

first degree heart block?

Answer 29

conduction is slowed from atrium to ventricle (PR interval prolonged)

Question 30

second degree heart block?

Answer 30

intermittent conduction (some beats not conducted from atrium to ventricle)

Question 31

third degree heart block?

Answer 31

no conduction from atrium to ventricles. P waves and QRS complex dissociated. bradyarrhythmia.

Question 32

where is the problem (usually) in complete heart block (third degree heart block)

Answer 32

AV node

Question 33

complete heart block presentation

Answer 33

syncope and pre-syncope fatigue (can't augment heart rate eg when exercising) breathlessness cardiac arrest usually have underlying heart disease

Question 34

complete heart block treatment

Answer 34

muscarinic cholinergic agonist - atropine! (short term solution for symptoms) definitive treatment - cardiac pacemaker

Question 35

atrial fibrillation ECG features

Answer 35

no regular P waves, irregular QRS complex. narrow complex tachycardia. irregularly irregular

Question 36

most common cause of arrhythmia

Answer 36

atrial fibrillation

Question 37

atrial fibrillation presentation

Answer 37

incidental finding palpitations breathlessness fatigue worsened by alcohol

Question 38

treatment of atrial fibrillation (rate control)

Answer 38

increase block at AV node using -beta blockers (bisoprolol) -calcium-channel antagonist (diltiazem)

Question 39

AF and stroke?

Answer 39

allows clot to form in fibrillating left atrium (passive movement of blood, pooling), embolus passes to cerebral circulation and leads to stroke

Question 40

how is risk of stroke calculated

Answer 40

CHA2DS2-VASc score

Question 41

stroke prevention medication?

Answer 41

offer anticoagulation -apixaban -rivaroxaban -warfarin