Your progress

Saved on this device.

Target exams

Red flags

• A patient with palpitations and syncope, or palpitations on exertion in a patient with structural heart disease, has a high-risk presentation requiring urgent cardiology referral and exclusion of ventricular tachycardia — these features carry a significant risk of sudden cardiac death
• A patient with a family history of sudden cardiac death under the age of 40, palpitations, and a long QT interval on the ECG has a channelopathy (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia) requiring specialist evaluation, beta-blockade and consideration of an ICD
• A patient with a regular broad-complex tachycardia on the ECG should be assumed to have ventricular tachycardia until proven otherwise — do not assume SVT with aberrancy in a haemodynamically stable patient, especially with a history of ischaemic heart disease
• A patient with Wolff-Parkinson-White syndrome who develops atrial fibrillation is at risk of degeneration to ventricular fibrillation if the accessory pathway has a short antegrade refractory period — do not give AV nodal blocking agents (verapamil, adenosine, beta-blockers, digoxin) in pre-excited AF, as they preferentially block the AV node and accelerate conduction down the accessory pathway
• A patient with palpitations, chest pain, dyspnoea and haemodynamic instability requires immediate assessment for a tachyarrhythmia or bradyarrhythmia causing cardiovascular compromise — synchronised DC cardioversion if unstable tachycardia, transcutaneous pacing if unstable bradycardia