8/19- Sudden Cardiac Death Flashcards Preview

_MS2 Cardio > 8/19- Sudden Cardiac Death > Flashcards

Flashcards in 8/19- Sudden Cardiac Death Deck (40)
Loading flashcards...
1

What are the biggest risk factors for atherosclerosis?

- High cholesterol

- HTN (> 140/90)

- Diabetes

- Smoking (current/recent!)

2

What are 2 broad diseases that can lead to heart failure?

- Coronary Artery Disease (from Atherosclerosis)

- Valvular Heart Disease

3

How can CAD (coronary artery disease) present?

- Arrhythmias -> Sudden Cardiac Death

- Angina (stable or unstable)

- Myocardial Infarction

4

What is included in "Acute Coronary Syndromes"?

- Unstable angina

- Myocardial infarction

5

T/F: > 1 million people suffer SCD/yr in the US

False

- 1300 cases/d (400,000/yr) in the US

6

T/F: The most common cause of SCD in adults is asystole

False

The most common cause of SCD in adults is ventricular fibrillation

- Primary VF is the most common cause of out-of-hospital SCD

- Asystole is usually the result of sustained myocardial anoxia during initial episode of VF rather than the primary cause of death

- Asystole is the MCC of SCD in infants

7

T/F: ASH/IHSS are the most common etiology of SCD in the US

False

- This is the most common etiology in 15-35 yo

- In general, most common cause is CAD

8

T/F: Most SCD are due to VF complicating AMI

False

9

T/F: VF without AMI rarely recurs unlike VF with AMI

False

10

Define: sudden cardiac death (SCD)

Sudden unexpected death due to cardiac causes occurring within one hour after the onset of cardiac symptoms

- NHLBI: death within 24 hrs of Sx

- WHO: un-witnessed death

- Uniformly fatal (unless successfully resuscitated; 1/3 survive)

11

Define: ventricular fibrillation (VF). What does the ECG look like?

Chaotic and asynchronous electrical ventricular activity arising from multiple foci and spreading erratically throughout the myocardium 

12

Define: asystole (flat line "___")

Asystole is usually the result of sustained myocardial anoxia during initial episode of VF rather than the primary cause of death

13

Define: primary vs. secondary VF

Primary VF: no associated MI

Secondary VF: associated MI (as proven by post-mortem changes on autopsy or cardiac enzymes)

14

What is the public health impact of SCD?

- 1300 cases/d (400,000/yr) in the US

- 50% of all CAD deaths

- 1/3 of all deaths age 20-64

- Gradual decline since 1971 (due to EMS, decreased coronary risk factors, and the coronary care unit)

15

Which has the higher recurrence: primary or secondary VF?

SCD recurrence is 5-10x higher in primary VF (that not associated with an MI)

- i.e. probably have some kind of factor/tissue very vulnerable to arrhythmias that hasn't been fixed

16

Primary vs. Secondary VF:

- 55 yo man presents w/ crushing diffuse anterior chest pain 10/10 with diaphoresis and dyspnea

- No change in ECG or chest pain with SL NTG

What is the pt suffering from?

A. Acute massive viral pericarditis

B. Unstable angina with a "platelet plug"

C. LAD Vasospasm refractory to SL NTG

D. Acute ST elevation MI due to fibrin/RBC "red" clot completely occluding the LAD

E. Intense coronary constriction due to anxiety 

ECG: acute anterolateral MI

- Local ST elevation (leads I, aVL, and V2-V5)

- Acute MI likely due to occlusion in the pulmonary artery (?)

What is the pt suffering from? 

A. Acute massive viral pericarditis 

B. Unstable angina with a "platelet plug" 

C. LAD Vasospasm refractory to SL NTG

D. Acute ST elevation MI due to fibrin/RBC "red" clot completely occluding the LAD

E. Intense coronary constriction due to anxiety 

17

Primary vs. Secondary VF (pt 2):

- 55 yo man who presented with chest pain sustains a sudden unexpected cardiac arrest 3-4 hrs later

- How would you manage him after initial resuscitation?

- How likely is recurrent SCD after hospital discharge?

- This was a secondary cardiac arrest (or secondary VF); SCD associated with MI

- Chance of recurrence is low; no need for ICD after discharge

18

Which of the following best applies to this 55 yo man (with chest pain and unexpected cardiac arrest 3-4 hrs later)?

A. Primary VF

B. Secondary VF

C. Massive anterolateral MI complicated by VF

D. Low risk of recurrent SCD

E. B, C, and D

Which of the following best applies to this 55 yo man (with chest pain and unexpected cardiac arrest 3-4 hrs later)? 

A. Primary VF 

B. Secondary VF 

C. Massive anterolateral MI complicated by VF 

D. Low risk of recurrent SCD 

E. B, C, and D

19

What is an AICD? For who is it routinely recommended?

Automatic Implantable Cardioverter Defibrillator (or just ICD)

- Routinely recommended for primary VF (high chance of recurrence); NOT recommended for secondary 

20

What can an AICD do? (Don't need to memorize)

- Provide shock in cases of ventricular fibrillation (VF)

- ATP- anti-tachycardiac pacing- try to recognize VT before above shock is required (will pace ventricle faster for just a few s in "overdrive pacing")

21

What is this? 

Ventricular fibrillation

22

What is the most common cause of SCD?

Tachy-arrhythmias

- Ventricular fibrillation**

- Ventricular tachycardia

- Ventricular flutter

Brady-arrhythmias

- Asystole

- Bradycardia

23

What is this? 

Ventricular Tachycardia (3+ consecutive beats)

24

What is VT and AIVR? Features?

VT- ventricular tachycardia

AIVR - accelerated idioventricular rhythm

- Both are wide QRS regular tachycardia with no P (but AIVR does not -> SCD)

- VT has a rate >110/min while AIVR is under 110/min; this is the only difference!

25

Risk of ventricular fibrillation is higher with what?

- Longer VTs > 12 beats

- Faster VTs > 160/min

26

Which kills, VT or AIVR?

VT!

27

What is the most common cause of SCD in adults?

Ventricular fibrillation

- Primary VF is the most common cause of out-of-hospital SCD

28

What triggers an actual episode causing SCD at a particular moment (SCD triggers)?

- PVC with R-on-T

- Coronary reperfusion

- CNS stimulation: sympathetic and vagal activity

- Psychological stress

29

What is the significance of a sympathetic activity as SCD "trigger"?

BB prevent VF post-MI

30

CAD is a responsible for __% of all SCD

CAD is a responsible for 80% of all SCD