Icm Fall Palpitations

Front 1

what is the first think you determine in a pt with palpataion

Back 1

determine it its a life threatening arrhythemia: does the person look sick, are VS stable

Life threatening Arrhythemias:
1. V tach: stable- BP and mental status WNL. Unstable- altered mental status, abnormal BP

2. MI with PVC: ST change with PVC

3. SVT (supraventricular tachy) with hypotension, poor endo organ perfusion. abnomral EKG and BP

Front 2

what are hte 3 life threatening arrhythemias htat you need to ro in person with palpatations

Back 2

1. V tach
2. MI with PVC
3. Supravent tachy with hypotension

Front 3

ok so you have a pt with palpatations and you have determined there is no V tach, MI with PVC or supraventricular tachy. what is the next thing you want to determine

Back 3

1. is there a cardiogenic problem
-Sick Sinus *tachy-brady) sydndrome
-Preexcitation syndrome
-CAD
-MI
-Valvular heart disease
-Mitral Valve

2. Risk Factos: male, >40 smoke, family Hx

Front 4

what are hte cardiogenic problmes associated with palpatations

Back 4

1. Sick Sinus (tachy-brady syndrome): older ppl. fast and slow HR with syncope or near syncope

2. Preexcitation syndrome: younger pts. 12 lead with short PR or delta wave

3. CAD- hx of angina, do stress test

4. MI: hx suggestive of ischemic pain

5. Valvular heart disease: murmua, PE with murmur

6. Mitral falve: F>M, 30-50's. Fam Hx. Midsystolic click/murmur

Front 5

what are hte 6 main categories that can cause palpatasion

Back 5

1. Cardiogenic: sick sinus, pre-excitation syndrome, CAD, MI, valvular disease

2. Metabolic: hypokalemia, hypoxia

3. Endocrine: thyrotoxicosis, pheochromocytoma

4. Infections: septic

5. Physological: anxiety. dx of exclusion

6. Toxins: tob, caffeine, epinepherine, EtOH, cocaine, amphetamines, atropine, digoxin, thyroid replacement

Front 6

what are hte metabolic issues that can cause palpitations

Back 6

hypokalemia
hypoxia

Front 7

if a pt says -_____ what are you thinking

1. jumps, skips
2. Attacks, abrupt onset, >120
3. Independent of exercise/excitement, anemia, febrile, hypoglycemia, anxiety
4. Attacks are sudden but not rapid, unrellated to exciteation or exertion
5. sx on standing
6. middle aged woman that is flushed and sweating
7. Rate/rhythem is Reg

Back 7

1. extra systole
2. paroxysmyl rapid tachy
3. A fib, A flutter, thyrotoxicosis
4. Hemmorage, hypoglycemia, adrenal medullary tumor
5. postural hypotension
6. menopause
7. anxiety by exclusion

Front 8

what is PE for pt with MVP

Back 8

Female, 30-50 yo (14-30 in notes)

*mid systolic click, murmur. Dx with echo. Hx palpitations

**click goes away with valsalva

Front 9

whats the presentation of pts with MVP

Back 9

1. female 14-30
2 asx
3. PE- midsystolic click, confirm with echo

Front 10

at what stage is tx instituted in pts with MVP

Back 10

REASSUREANCE IS KEY!

**AB for prevention of infective endocarditis- prophylax with dental procedures

**tx when arrhytemias are common

Front 11

that are hte complications of MVP

Back 11

1 regurg. chordal rupture
2. l vent hypertrophy
3. sudden death (rare)

Front 12

what are the clicks

1. aortic/pulmonic
2. Dilation of great vessel
3. MVP

Back 12

1. Aortic/Pulmonic: most common. systolic ejection click. early in systole, usually with systolic ejection murmur

2. DIlation of Great Vessels (aorta or pulm a): ejection click

3. MVP: mid systolic click

Front 13

whats the cause of MVP

Back 13

unknown

Front 14

what arrhythemias are common in MVP

Back 14

venticle

*premature vent contraction
*paroxysmal supravent/vent tachy

**tx when you get this