Palpitations 2- Specific Diseases

by | Nov 26, 2017

A quick revision of some likely cardiac diseases that cause palpitations. 

Supraventricular Tachycardia

Causes of SVT

  • Accessory pathway
  • Thyrotoxicosis
  • Sick sinus syndrome
  • 60% from AV node re-entry
  • 35% due to accessory pathway – WPW

Features of history  in SVT

  • Passing copious urine afterwards
  • Sudden onset in young person
  • rate 150-220

Management of acute PVST

  • Valsalva
  • Self-induced vomiting
  • Ice water to face
  • Immerse face in water
  • Adenosine 6mg over 10 sec then 12 mg in 2  minutes then 18mg in 2 minutes
  • Verapamil 1mg/min up to 10mg if not taking beta blocker
  • Overdrive pacing or DC cardioversion

Ongoing prophylaxis of SVT

  • Atenolol 25-100mg daily
  • Metoprolol 25-100mg BD
  • Sotalol 80-160mg BD
  • Flecainide 100-200mg BD
  • Verapamil SR 160-480mg daily

 

 

_________________________________________________________________________________________________________________________

 

Wolf-Parkinson White Syndrome

Complications of WPW

  • 30% will develop AF or flutter

Management of WPW

  • referral for RF ablation even after one episode

_________________________________________________________________________________________________________________________

 

 

Stokes Adams Attack

History features of Stokes-Adams attack

  • transient bradycardia due to complete heart lock
  • Sudden onset
  • Falls to ground
  • LOC
  • Pallor and still as if dead with slow or absent pulse
  • Recovery in seconds
  • Patient flushed as pulse increases
  • May be a forerunner of other arrhythmias

 

_________________________________________________________________________________________________________________________

Atrial Ectopic Complexes

Management of atrial ectopic complexes

  • Lifestyle – alcohol, caffeine, stress, smoking
  • reassurance
  • If intolerable give atenolol 25-100mg daily
  • Metoprolol 25mg – 100mg daily
  • Verapamil 160-480mg daily

 

_________________________________________________________________________________________________________________________

Premature Ventricular Complexes

Significance of PVCs

  • Usually asymptomatic (90%)
  • usually noticed in bed at night
  • Can be forerunner of other arrhythmias (VT)

 

Causes of PVCs

  • Digoxin
  • Sympathetomimetics
  • Lifestyle factors
  • IHD
  • Thyrotoxicosis
  • Mitral valve prolapse
  • Left ventricular failure

Examination in PVC

  • Evidence of IHD
  • Evidence of mitral valve prolapse
  • Thyrotoxicosis
  • LVF

Investigations in asymptomatic ventricular premature complexes

  • CXR
  • ECG
  • – if normal then reassure

Management of premature ventricular complexes

  • Need echo before commencing drug therapy