* Are common and often benign, but can indicate underlying heart disease. They often occur intermittently and so can be difficult to diagnose.
* Can present with palpitations, chest pain, presyncope/syncope, hypotension, pulmonary oedema. Some are asymptomatic e.g. AF.
* History taking make sure include:
* Precipitating factors, onset, nature (fast/slow, regular/irregular), duration, associated symptoms (chest pain, dyspnoea, collapse).
* LV aneurysm.
* Mitral valve disease.
* Aberrant ...view middle of the document...
* Acute management: vagotonic manoeuvres, IV adenosine/verapamil, DC shock if compromised.
* Atrial Fibrillation:
* Often incidental finding, but can present with chest pain, palpitations, dyspnoea or presyncope.
* Atrial rhythm 300-600bpm (no P waves on ECG).
* AVN responds intermittently causing irregular contraction of ventricles.
* Risk of embolic stroke – give warfarin.
* Common causes:
* Heart failure.
* Cardiac ischaemia.
* Mitral valve disease.
* O/E – pulse is irregularly irregular, first heart sounds is of variable intensity.
* ECG – absent P waves, irregular QRS complexes.
* Bloods: FBC, U&Es, cardiac enzymes.
* Echo – look for LA enlargement, mitral valve disease, poor LV function and other structural abnormalities.
* Control ventricular rate with digoxin.
* Maintenance: digoxin, verapamil, β-blocker or amiodarone.
* Atrial Flutter = continuous atrial depolarisation producing a ‘saw-tooth’ appearance on the ECG (possibly with 2:1 block). Carotid sinus massage transiently blocks the AVN and so can unmask flutter waves. Try AF treatment or consider ablation if unsuccessful.
* Ventricular Tachycardia:
* Broad complex tachycardia (HR >100bpm, widened QRS).
* Acute management = IV lignocaine/amiodarone. DC shock if compromised.
* Wolf Parkinson White:
* Caused by congenital accessory conduction pathway between atria and ventricles.
* Resting ECG:
* Short P-R interval.
* Widened QRS – slurred upstroke a ‘delta’ wave.
* 2 types of WPW:
1. WPW type A = positive delta wave in V1.
2. WPW type B = negative delta wave in V1.
* Present with superventricular tachycardia.
Fever (of unknown origin) and new murmur = infective endocarditis until proven otherwise.
* Normal valves – infection presents acutely with heart failure (tricuspid valve is usually involved).
* Abnormal valves – subacute course. Patient will have an abnormal valve e.g. aortic or mitral disease.
* Streptococcus viridans – lives in the mouth (think about recent dental work).
* Staphylococcus aureus/epidermis – found on the skin (think about IV drug use).
* UTI, urinary catheterization, cystoscopy, IV cannulation can increase the risk of infective endocarditis.
* Often no cause is found.
* Clinical Features:
* Signs of infection:
* Fever (of unknown origin)/rigors/night sweats.
* Malaise/weight loss.