Key 37 and more- Ventricular Ectopic and Questions

Ventricular Ectopic is

abnormal heartbeats from the ventricle

Three beats pattern = Ventricular Trigeminy

Symptoms and sign of Ventricle Ectopic

1. asymptomatic

2. sense of missed/ skipped beat

3. Unsustained palpitation

4. Dyspenia

5. Dizziness

   sign: Broad QRS complex

Causes of Ventriculars Ectopics

Benign and Pathological

Benign:

1. Naturally, anxiety, caffiene, alcohol, stress, cocaine

Pathological

1. MI

2. Cardiomyopathies

3. Medications

______ and ______ should not be given for patients with CKD, CHD, IHD

1. NSAIDS - ibuprofen

2. COX 2 inhibitor - celecoxib

These drugs can worsen HF and renal function

Base on MI complication for pricarditis we give full dose NSAIDs

NSAIDS inhibits systhesis of prostaglandin, thus decrease____, retain more salt and water

eGFR

Thiazide Diuretic and Loop Dieuretics Decrease clearence of uric acid leading to____

GOUT( hyperuricemia)

A patient with chronic heart failure developed gout. A medication for his gout is prescribed. A few days later, the patient came back to the hospital complaining of worsening of his Heart Failure symptoms (SOB, Orthopnea).

• The likely cause of this patient's gout
  → Thiazide like diuretics (e.g. bendroflumethiazide) or Loop Diuretics (Both can cause hyperuricemia (Gout) and both can be used to treat volume overload caused by Heart Failure)

• The likely cause of this patient's worsening of SOB and Orthopnea → NSAIDs (e.g. Ibuprofen) that was prescribed to treat his gout.

In-Hospital Cardiac Arrest Algorithm

1. Collapse /sick patient

2. Shout for help and assess patient

3. Are there sign of life ? (Breathing, pulse)

If YES what to do? If NO what to do?

No sign

1. Ring emergency bell call resus team

2. Start CPR 30:2

3. Get defib

4. ALS(advance life support) when resus team arrive

UK guidelines recommendation of Alcohol consumption:

No more than 14 units a week

No more than 3 units a day

with at least 2 alcohol-free days a week

If someone drinks 7 units of alcohol a week and smoke 20 cigarette a day, we should refer him to

→ Smoking Cessation Clinic.

This is because his alcohol intake is insignificant as per NICE whereas his smoking is significant.

Heart Murmurs

PAS(PA stenosis) - systolic murmur

MTS(MT stenosis) - diastolic murmur

*remember one side only, regurgitation is opposite

Points of Auscultation for Hearts Murmurs all

From PAMT stenosis and regurgitation

Pulmonary - Left 2nd ICS

Aortic - Right 2nd ICS

Mitral Stenosis - Apex of Heart (5th ICS mid claviculr line (MR - apex same but radiates to axialla

Triscuspid - 4-5th ICS left sternum border

A Young adult presents with frequent fainting attacks since childhood and prolonged QT. There are sinus rhythm and normal P-R interval. No Hx of arrhythmias or sudden death. Diagnsis?

TDP

An elderly patient with a Hx of stroke presents with exertional dyspnea.

ECG shows Atrial Fibrillation. Chest X-ray shows Straight left heart border. what is the likely diagnosis?

→ Mitral Stenosis.

Straight left heart border because:

Mitral Stenosis blocks LV filling, increase Left Atrium pressure causes LEFT ATRIAL HYPERTROPHY. CXR shows straight left side heart border.

This causes: blood return back to lungs, pulmonary congestion then Right Ventricular failure( hepatomegaly, Ascites, Edema)

The most common cause of Mitral Stenosis is________

Rheumatic Fever

What causes left atrial hypertrophy?

Mitral Stenosis

Features of Mitral Stenosis

1. Mid late diastolic murmur(low pitched) during expiration

2. Loud S1, opening snap

3. Atrial Fibrillation

lEft heart Murmur is heard during_____.

rIght heart murmurs is heard during___.

E - expiration

R - inspiration

ECG, CXR and Echo of Mitral Stenosis

ECG - sign of right ventricular hypertrophy

• P mitrale/ bifid p wave (P wave with 2 humps)

• Afib

CXR - Left Atrium Enlargement/ straighten left border of heart

Echo - Thickening if Mitral Valve Leaflets/ mitral valve tissue

1. Decrease Ejection Fraction + Decrease Wall Thickness=

2. Increase EF + Increase Septal Wall Thickness =

1. DILATED Cardiomyopathy

2. HYPERTHROPHIC Cardiomyopathy

What is Dilated Cardiomyopathy?

• Dilated cardiomyopathy is a condition in which the heart muscle becomes stretched and weakened

*All chambers but, particularly the left ventricle, leading to poor pumping ability (reduced ejection fraction)

Symptoms of SVT and TDP

SVT - lightheadness, palpitations, recurrence

TDP - episode faintings

An elderly patient suddenly fell unconscious, he recovered completely within a few minutes, he remembers the event very well, he did not trip, he felt hot and flushed after the episodes but he did not feel dizzy or sweaty before the fall.

Best investigation?

12 lead ECG

Analysis cause of fall:

1. Cardiac Cause (Arrythmias)

2. Postural Hypotension

   • fall usually follow a standing from a sitting + dizzi before fall

3. Hypoglycaemia

   • felt sweaty and dizzy + not recovered till glucose administered

4. Seizure

   • someone eyewitness + post-ictal features like confusion and drowsiness.

Analysis and Causes of Falls

Causes:

1. Cardiac Cause (Arrythmias) - stokes adams attack

   • feel hot and flushed

2. Postural Hypotension

   • fall usually follow a standing from a sitting + dizzi before fall

3. Hypoglycaemia

   • felt sweaty and dizzy + not recovered till glucose administered

4. Seizure

   • eyewitness + post-ictal features like confusion and drowsiness.

An elderly patient fell and collapsed "syncope"

. He was transferred to the A&E

and now he is fully conscious. ECG shows irregular rhythm. What is the next best investigation?

1. Echocardiogram

2. Holter ECG/ 24 hour ecg

*but this case no need holter ecg cause normal ecg already show pathology.