Palpitations and Management of Arrhythmias 1 7/8/2011 Fernando Vega, M.D. 1 Palpitations and Management of Arrhythmias 7/8/2011 Fernando Vega, M.D. 2 Fernando Vega, M.D. Palpitations • A sensory symptom • An unpleasant awareness of the forceful, rapid or irregular beating of the heart 7/8/2011 Fernando Vega, M.D. 3 • Can be described as: – Rapid fluttering in the chest – Flip-flopping in the chest – Pounding sensation in chest or neck Differential Diagnosis Cardiac Causes -Arrhythmia -Cardiac and extracardiac shunts 7/8/2011 Fernando Vega, M.D. 4 Cardiac and extracardiac shunts -Valvular Heart Disease -Atrial Myxoma -Cardiomyopathy -Pericarditis Differential Diagnosis Psychiatric -Panic Attack -Obsessive Disorder 7/8/2011 Fernando Vega, M.D. 5 Obsessive Disorder -Somatization -Depression -Loneliness -Grief Differential Diagnosis Medications -Sympathomimmetic Agents -Vasodilators 7/8/2011 Fernando Vega, M.D. 6 Vasodilators -Anticholinergics -Beta Blocker withdrawal
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Fernando Vega, M.D. - University of Washingtonfaculty.washington.edu/fvega/HIHIM2010/Class Notes slides 2010/Week 3... · contract against an occasionlly closed AV valve. Cannon A
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Palpitations and Management of Arrhythmias 1
7/8/2011 Fernando Vega, M.D. 1
Palpitations and Management of Arrhythmias
7/8/2011 Fernando Vega, M.D. 2
yFernando Vega, M.D.
Palpitations• A sensory symptom• An unpleasant awareness of the forceful,
rapid or irregular beating of the heart
7/8/2011 Fernando Vega, M.D. 3
• Can be described as:– Rapid fluttering in the chest– Flip-flopping in the chest– Pounding sensation in chest or neck
Differential Diagnosis
Cardiac Causes-Arrhythmia-Cardiac and extracardiac shunts
7/8/2011 Fernando Vega, M.D. 4
Cardiac and extracardiac shunts-Valvular Heart Disease-Atrial Myxoma-Cardiomyopathy-Pericarditis
7/8/2011 Fernando Vega, M.D. 54Narrow QRS Tachycardia
Palpitations and Management of Arrhythmias 10
Palpitations: Narrow QRS Tachycardia
• Regular? No → AF AT/AFL with variable block MAT
7/8/2011 Fernando Vega, M.D. 55
Regular? No → AF, AT/AFL with variable block, MAT• Visible P waves? No → AVNRT• Atrial rate greater than ventricular rate? Yes → AT/AFL• Short RP interval? AVNRT, AVRT, AT• Long RP interval? AT, PJRT, Atypical AVNRT
Palpitations: Narrow QRS Tachycardia
Take the “Adenosine Challenge”Take the “Adenosine Challenge”
7/8/2011 Fernando Vega, M.D. 56
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• Sudden termination → AVNRT, AVRT, SNRT• Persistent Atach, high-degree AV block → AFL, AT• Gradual slowing, then reacceleration → ST, JT• No change in rate → inadequate dose, VT
Palpitations: ECG with Symptoms
7/8/2011 Fernando Vega, M.D. 57
Wide QRS Tachycardia
Palpitations: Wide QRS Tachycardia
• Regular? No → AF/AFL/AT with BBB or AP
7/8/2011 Fernando Vega, M.D. 58
• Is QRS identical to that of SR? Yes → SVT with BBB, antidromic AVRT
• A-V dissociation or fusion beats? Yes → VT• QRS morphology? Bizarre → VT• Previous MI or structural heart disease? Yes → VT