Y3 ALS > Palpitations > Flashcards

Palpitations Flashcards

(57 cards)

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1
Q

Are all palpitations caused by tachyarrhythmia?

A

No.

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2
Q

What proportion of ED visits for palpitations have a cardiac diagnosis?

A

~34%.

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3
Q

What is the most common non-cardiac cause of palpitations?

A

Panic, stress, or anxiety (>60%).

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4
Q

Can tachyarrhythmias be asymptomatic?

A

Yes.

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5
Q

How common are short asymptomatic SVT bursts on Holter in the elderly?

A

Seen in ~50%.

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6
Q

What is the commonest cause of palpitations?

A

Extrasystoles (ectopic beats).

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7
Q

How do extrasystoles feel to patients?

A

Missed beats, fluttering, or extra beats.

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8
Q

Are ectopics usually associated with structural heart disease?

A

No.

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9
Q

What may frequent ectopics in patients >55 years indicate?

A

Occult coronary artery disease.

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10
Q

What can very frequent ectopics (>20% of beats) cause?

A

LV systolic dysfunction.

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11
Q

Why clarify what the patient means by “palpitations”?

A

They may actually mean chest discomfort or another symptom.

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12
Q

Why ask the patient to tap out the rhythm?

A

To identify fast (tachycardia), irregular (AF), or missed beats (extrasystoles).

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13
Q

Why ask about duration and frequency?

A

Helps differentiate benign from significant arrhythmias.

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14
Q

Why assess severity?

A

Collapse or syncope suggests serious arrhythmia.

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15
Q

Why are exertional palpitations concerning?

A

May indicate cardiomyopathy, ischaemia, or channelopathy → urgent referral.

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16
Q

What does sudden onset and sudden termination suggest?

A

Paroxysmal SVT.

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17
Q

What suggests SVT if episodes terminate with Valsalva/coughing/diving reflex?

A

AV node–dependent tachycardia (e.g. AVNRT).

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18
Q

What does a brief “breath taken away” sensation suggest?

A

Extrasystoles.

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19
Q

Extrasystoles.

A

Heart failure or myocardial ischaemia.

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20
Q

Chest pain during palpitations suggests what?

A

Coronary artery disease or tachyarrhythmia.

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21
Q

Lifestyle triggers of palpitations?

A

Alcohol, caffeine, illicit drugs.

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22
Q

Social factors lowering arrhythmia threshold?

A

Stress, lack of sleep, fever.

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23
Q

Conditions associated with tachyarrhythmias?

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A

Anaemia, thyrotoxicosis.

24
Q

Anaemia, thyrotoxicosis.

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A

Suggests inherited arrhythmia/channelopathy.

25
What should you look for on examination?
Signs of heart failure, thyrotoxicosis, anaemia.
26
Blood tests to order?
U&Es (BCP), FBC, TFTs.
27
First-line investigation?
12-lead ECG.
28
Is Holter monitoring required in all patients?
No.
29
What to advise if infrequent sustained episodes?
Attend GP or A&E during symptoms.
30
What arrhythmias are often grouped as nuisance SVTs?
- AVNRT - AVRT - atrial flutter (excluding WPW risks).
31
Typical symptoms of nuisance SVT?
Palpitations; rarely syncope or chest pain.
32
How has management evolved?
Previously long-term medical therapy, now catheter ablation common.
33
First-line drug classes for SVT?
Beta blockers, calcium channel blockers.
34
Class 1c antiarrhythmics?
Flecainide, propafenone.
35
Class 3 antiarrhythmics?
Amiodarone, sotalol, dronedarone.
36
Success rate of AVNRT ablation?
95%.
37
Recurrence rate after AVNRT ablation?
2–5%.
38
Pacemaker risk after AVNRT ablation?
1–2%.
39
Is ablation effective in elderly patients?
Yes, equally successful.
40
Success rate of flutter ablation?
90–95%.
41
How long does flutter ablation take?
1–2 hours.
42
Is anticoagulation required for procedure?
Yes.
43
What proportion develop AF later?
~30%.
44
First-line ablation conditions?
AVNRT, AVRT, atrial flutter.
45
Second-line ablation conditions?
AF, atrial tachycardia, ventricular tachycardia.
46
AF prevalence in developed world?
2–3%.
47
Median age of AF patients?
75 years.
48
Percentage aged 65–85?
~70%.
49
Did rhythm control improve survival over rate control?
No.
50
Why was rhythm control less effective historically?
- Antiarrhythmic drugs ineffective long-term - Proarrhythmic risk
51
What are malignant arrhythmias?
VT and VF.
52
Where do malignant arrhythmias usually occur?
Failing hearts.
53
What is often the first presentation?
Sudden death or aborted sudden death.
54
Symptoms of VT?
Palpitations with syncope, presyncope, or chest pain.
55
Main management of malignant arrhythmias?
ICD (defibrillator), medication, optimal HF therapy.
56
Can VT be ablated?
Yes, in resistant cases.
57
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