Mod10 Sudden Cardiac Death

Question 1

Sudden Cardiac Death (SCD)

Answer 1

unexpected natural death resulting from cardiovasc abnormality occuring shortly after the onset symptoms in individuals that appear otherwise healthy; usually caused by sustained VT

Question 2

Most common substrate for SCD

Answer 2

ischemic heart disease

Question 3

Influences of SCD

Answer 3

AGE (increase risk with age; responsible for 20% of deaths of pp under 20), RACE (african american have highest incidence followed by white, then asian). GENDER (rates are higher in men)

Question 4

RF’s of SCD (similar to those of atherosclerotic CAD)

Answer 4

Underlying CAD (80%) (or history of); Smoking, Hypertension, Cholestrol, Alcohol, Diabetes

Question 5

Abnormalities that are predictive of SCD

Answer 5

arrhythmia, premature ventricular contractions (PVCs), left ventricular hypertrophy, cardiomegaly

Question 6

Triggers of Tachyarrhymias

Answer 6

ischemia and electrolyte imbalance; know these triggers in order to eliminate these factors

Question 7

Mechanisms of SCD

Answer 7

Structure and function, Tachyarrythmias, Ischemia, mechanoelectrical feedback

Question 8

Structure and function

Answer 8

1/4 mechanisms of SCD; cardiac structural abnormalities are common in SCD; these provide substrate for ventricular tachyarrythmias

Question 9

Tachyarrhythmias

Answer 9

1/4 mechanisms of SCD; VF is first recorded rhythm in 75% of patients that have cardiac arrest; VT generally degenerates into VF; asysole is a later manifestation of cardiac arrest (CA)

Question 10

Ischemia

Answer 10

1/4 mechanisms of SCD; Acute MI causes Acidosis affecting membrane integrity; this causes electrical abnormalities causing conduction delays, unidirectional blocks and reentrant arrhythmias

Question 11

Mechanoelectrical Feedback

Answer 11

1/4 mechanisms of SCD; altered contractility and preload have electrophysiologic effects that may ppt arrhythmias

Question 12

Management of SCD requires immediate:

Answer 12

early assessment, early CPR, early defibrillation and early cardiac life support

Question 13

Defibrillation

Answer 13

essential for management of acute cardiac arrest

Question 14

AED

Answer 14

portable electronic device that helps the heart return to normal rhythm

Question 15

Steps of CPR

Answer 15

if not AED start CPR immediately; start with COMPRESSIONS (push down atleast 2inches at 100/min; push on chest 30times, AIRWAYS: open airway by tilting head backward and lift chin; BREATHING give two mouth to mouth breaths with 2 sec btw. REPEAT

Question 16

Management of Cardiac Arrest Survivors

Answer 16

prompt stabilization of patient’s cardiopulmonary status; detect and treat any potential triggers; take patients history, give thorough exam, lab test, ECG and catheterization; IF AT HIGH RISK= treat underlying associated heart condition

Question 17

Treatment options of SCD

Answer 17

DRUGS (b-blockers, ace inhibitors, hydroxymethylglutaryl-coenzyme A reductase inhibitor, sotalol, amiodarone), IMPLANTED CARDIOVERTER DEFIB (ICD)

Question 18

B-blockers

Answer 18

treatment option for SCD; stabilizes autonomic balance; improves contractility and reduces ischemia

Question 19

ACE inhibitors

Answer 19

treatment option for SCD; reduction in pump failure (similar to B-blockers)

Question 20

Hydroxymethylglutaryl-Coenzyme A Reductase Inhibitors

Answer 20

reduces incidence of coronary plaque rupture and/or platelet aggregation/thrombosis

Question 21

Amiodarone

Answer 21

treatment option for SCD; most effective antiarrythmic agent for therapy of tachyarrhythmias

Question 22

Implanted cardioverter defibrillator (ICD)

Answer 22

used as an intervention/prevention measure; they recognize and internally cardiovert VT or defibrillate VF soon after its initiation