Transcript ST2 Small Group 15/6/11

“Palpitations” Cases
Tom Gamble
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25 year old medical student. Recently noticed
palpitations lasting a few seconds, getting
several a day. No associated Sx but has to gasp
for breathe.
What more would you like to know?
How would you examine/investigate and
manage this lady?
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Jane Wiedlin: 38 year old lady. Has had several
episodes of palpitations, describes feeling heart
racing for between 2 and 15 minutes. Feels very
panicky when it happens and short of breathe.
How would you approach this case?
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54 year old patient, marathon runner.
Complaining of palpitations since yesterday.
Chest feels a little tight also. On examining him
you notice his heart rate is about 130-140.
What would you do?
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62 year old gentleman with a history of an MI
two years ago, and anxiety. Complains of
episodes of a ‘missed heart beat’, feels it 3 or 4
times a day.
How would you investigate this?
You arrange an ECG at the surgery, which
shows some old T-wave inversion, but is
otherwise unremarkable except for a single
ventricular ectopic beat. What would you do
next.
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History most important source information
Hierarchy of investigation: ECG – bloods
(TFT/FBC/U&E) - cardiac monitoring –
echocardiogram/exercise tolerance test
Re-assurance often only necessary treatment
(but this may include an ECG)
Consideration of risk of underlying heart
disease important part of assessment
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Common:
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Occasional:
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Anxiety/ sinus tachycardia
Atrial ectopics
Ventricular ectopics (?underlying problem but can
be normal)
SVT (AF, atrial flutter with rapid ventricular
response, AV re-entrant tachycardia)
Thyrotoxicosis; menopause; iatrogenic (digoxin,
nifedipine)
Rare:
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Heart Block; sick sinus syndrome; drug abuse; VT
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Teach patients to take their own pulse
Suggest they attend A&E/GP surgery when
event happens to capture ECG
Remember red flags
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previous CV disease especially recent MI
FHx sudden death/arrythmias
Associated falls/syncope or Sx on exercise
If found to be in AF probably paroxysmal or
recent onset AF – consider urgent referral for
anticoagulation