B4-015 Big Case: Cardiac Arrest Flashcards

1
Q

sudden, irreversible cessation of all biologic functions

A

sudden cardiac death

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2
Q

abrupt cessation of cardiac activity such that victim becomes unresponsive

A

sudden cardiac arrest

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3
Q

sudden loss of effective blood flow because of cardiac/vascular factors that may reserve spontaneously or require interventions

A

cardiovascular collapse

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4
Q

prodrome of cardiac arrest

A

new/worsening cardiac symptoms:
* chest pain
* palpitations
* dyspnea
* fatigability

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5
Q

symptoms at onset of cardiac arrest

A

abrupt change in clinical status:
* arrhythmia
* hypotension
* chest pain
* dyspnea
* lightheadedness

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6
Q

symptoms of cardiac arrest

A

sudden collapse:
* loss of effective circulation
* loss of consciousness

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7
Q

biologic death

A
  • failure of resuscitation OR
  • failure of electrical, mechanical, or CNS function after intial resuscitation
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8
Q

arrhythmias preceding SCD

A
  • monomorphic VT
  • polymorphic VT
  • birectional VT
  • torsades de pointes
  • ventricular flutter
  • ventricular fibrillation
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9
Q

most common substrate of SCD

A

ischemic heart disease

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10
Q

cause up to 70% of SCD

A

CAD

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11
Q

development of artherosclerosis

A

adaptive intimal thickening
foam cells
lipid pools
fibrous cap
calcification

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12
Q
  • comes on with activity
  • brief in duration (minutes)
  • relieved with nitrates
A

stable angina

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13
Q
  • comes on at rest
  • recent increase in frequency or duration)
A

unstable angina

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14
Q
  • nonthrombotic plaque
  • ST segment elevation absent
  • no increase in biomarker level
A

unstable angina
demand related

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15
Q
  • nonthrombotic plaque
  • ST segment elevation absent
  • increased biomarker level
A

non STEMI type 2

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16
Q
  • partially occluding thrombus
  • ST elevation absent
  • no increase in biomarker level
A

unstable angina
thrombosis mediated

17
Q
  • partially occluding thrombus
  • ST elevation absent
  • increased biomarker level
A

Non-STEMI
type 1

18
Q
  • fully occluding thrombus
  • ST elevation present
  • increased biomarker level
A

STEMI type 1

19
Q

non Q wave MI

A

non-STEMI

20
Q

Q wave MI

A

STEMI

21
Q

modifiers to MI survival

A
  • ischemic burden
  • hemodynamic fluctuations
  • autonomic variations
  • drugs/electrolytes
  • genetic profile
22
Q

MI pathology:

1 day

A

wavy fibers

23
Q

MI pathology:

3-4 days

A
  • extensive coagulation necrosis
  • acute inflammation with neutrophils
24
Q

MI pathology:

7-10 days

A
  • macrophages
  • granulation tissue
25
Q

MI pathology:

2 weeks to several months

A

contracted collagenous scar

26
Q

lowers O2 levels in the heart and decreases ATP formation

A

ischemia

27
Q

ischemia impairs […] channels

A

L type Ca+ channels

28
Q

ischemia causes K+ to accumulate, causing

A

local hyperkalemia

29
Q

local hyperkalemia causes the resting postential to be

A

more positive than normal

30
Q

results in scar with adjecent border zones

A

MI

31
Q

post MI scarring may still be ischemic. This can cause

A
  • abnormal conduction
  • abnormal refractory
  • altered excitability
  • automaticity
  • foci of re-entry
  • foci of impulse origin
32
Q

risk stratification post MI depends largely on

A

LV function

33
Q

high risk markers for SCD

A
  • arrhythmic
  • hemodynamic
34
Q

moderate risk marker for SCD

A

acute coronary syndromes

35
Q

main causes of SCD in young people

A

Hypertrophic cardiomyopathy
commotio cordis
coronary artery anomalies

36
Q

causes syncope during exercise and may lead to SCD due to ventricular arrythmia

A

hypertrophic cardiomyopathy

37
Q

in older patients with SCD think

A

ischemic diease

38
Q

in younger patients with SCD,

A

keep broad ddx