8/20- Sudden Cardiac Death- CASES Flashcards Preview

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Flashcards in 8/20- Sudden Cardiac Death- CASES Deck (22):
1

What is sudden cardiac death?

Sudden, unexpected death occurring within 1 hr of the presence of symptoms (here, actually "instantaneous cardiac death"

2

What is the commonest etiologic cause of SCD in the US?

A. Valvular heart disease

B. Cardiomyopathy

C. Coronary artery disease

D. Pericardial disease

What is the commonest etiologic cause of SCD in the US?

A. Valvular heart disease

B. Cardiomyopathy 

C. Coronary artery disease

D. Pericardial disease

3

Is patient's age useful in predicting the underlying cause of SCD?

Yes

Most common etiology of SCD:

- MIddle aged and older adults: CAD

- 15-35 yo: IHSS (also ARVD)

Overall, CAD is the most common cause

4

What does "biphasic" mean in regards to ECGs?

Having 2 phases- one positive and one negative

5

What does a biphasic P wave in lead I mean?

Sensitive but nonspecific finding of left atrial enlargement

6

Which of the following is an ECG voltage criterion for LVH?

A. Tall R wave in V5/6 and Deep S wave in V1/V2 adding up (R+S) to at least 35 mm

B. Tall R wave in V1 or V2 and Deep S wave in V5/V6...

C. R in any lead > 35 mm...

D....

Which of the following is an ECG voltage criterion for LVH? 

A. Tall R wave in V5/6 and Deep S wave in V1/V2 adding up (R+S) to at least 35 mm 

B. Tall R wave in V1 or V2 and Deep S wave in V5/V6...

C. R in any lead > 35 mm... 

D....

7

What does it mean if patient has:

- Bifid P wave

- Tall R wave in V5/6 and Deep S wave in V1/V2 adding up (R+S) to at least 35 mm

Left ventricular hypertrophy (voltage) and Left atrial enlargement (bifid P wave)

8

With a positive family Hx at young age, how do you explain exertional chest pains and dizziness in this pt (LVH and LAE)?

A. Dilated cardiomyopathy

B. Restrictive cardiomyopathy

C. Aortic stenosis due to bicupsid aortic valve

D. Hypertrophic cardiomyopathy

With a positive family Hx at young age, how do you explain exertional chest pains and dizziness in this pt (LVH and LAE)? 

A. Dilated cardiomyopathy 

B. Restrictive cardiomyopathy 

C. Aortic stenosis due to bicupsid aortic valve

D. Hypertrophic cardiomyopathy

9

What is the mechanism of the systolic murmur in this pt (LVH, LAE with HCM)?

A. Narrowing of the aortic valve

B. Septal hypertrophy

C. Obstruction in the LVOT due to septal hypertrophy

D. Dilated ventricle

E. Mitral regurgitation

What is the mechanism of the systolic murmur in this pt (LVH, LAE with HCM)? 

A. Narrowing of the aortic valve 

B. Septal hypertrophy 

C. Obstruction in the LVOT due to septal hypertrophy

D. Dilated ventricle

E. Mitral regurgitation

10

How do you explain the louder and longer systolic murmur with standing (LVH/LAE due to HCM)?

A. Greater venous return

B. Small venous return

C. Smaller LV size

D. Greater contractility

E. B and C

How do you explain the louder and longer systolic murmur with standing (LVH/LAE due to HCM)?

A. Greater venous return

B. Small venous return

C. Smaller LV size 

D. Greater contractility

E. B and C

11

You noticed a weaker pulse following a pause (in this pt with LVH/LAE due to HCM). Is this normal and why?

A. Yes, due to reduced preload

B. Yes, due to reduced contractility

C. No, it is due to higher contractility worsening the LVOT obstruction

You noticed a weaker pulse following a pause (in this pt with LVH/LAE due to HCM). Is this normal and why?

A. Yes, due to reduced preload 

B. Yes, due to reduced contractility 

C. No, it is due to higher contractility worsening the LVOT obstruction

12

What is post-extrasystolic potentiation?

Beat after pause (from early beat) normally results in stronger subsequent beat.

Due to:

- Increased preload

- Increased contractility

13

What happens to cardiac output in IHSS if you increase contractility? Preload?

- Greater contractility decreases CO in IHSS

- Greater preload increases CO in IHSS

(In BWB phenomenon, contractility outweighs preload and beat following pause will be weaker; decreased CO)

14

Why is this pt (LVH/LAE with HCM) dizzy after exertion?

A. Venous pooling sharply REDUCES preload thus wrosening the LVOT obstruction

B. Venous pooling sharply INCREASES contractility thus worsening the LVOT obstruction

C. I am not really sure

Why is this pt (LVH/LAE with HCM) dizzy after exertion?

A. Venous pooling sharply REDUCES preload thus wrosening the LVOT obstruction

B. Venous pooling sharply INCREASES contractility thus worsening the LVOT obstruction 

C. I am not really sure

15

What is the most likely cause of SCD in this pt (LVH/LAE with HCM)?

A. Exercise induced VT/VFIB

B. AFIB due to WPW

C. Severe heart failure

D. Heart just gave up

What is the most likely cause of SCD in this pt (LVH/LAE with HCM)?

A. Exercise induced VT/VFIB 

B. AFIB due to WPW 

C. Severe heart failure 

D. Heart just gave up

- Exercise increases oxygen demands

- Oxygen demand outstrips supply of blood to myocardium, causing ischemia

- Myocardium is pro-arrhythmic substrate

16

Does hypertrophy itself interfere with conduction in the heart (itself)?

No

17

Possibilities for early diastolic extra sound

- A2/P2 fixed ?

- Atrial myxoma

- Mitral stenosis (opening snap)

- Aortic regurgitation

18

What is the most likely cardiac disease predisposing this episode of SCD (pt 2: HTN, smoking, past hx of MIs)?

A. Atherosclerosis

B. Valvular heart disease

C. Idiopathic DCM

D. HCM

What is the most likely cardiac disease predisposing this episode of SCD (pt 2: HTN, smoking, past hx of MIs)? 

A. Atherosclerosis 

B. Valvular heart disease

C. Idiopathic DCM

D. HCM

19

What clinical syndrome explains his cardiomegaly, hypokinetic LV, and low EF of 28% (pt has atherosclerosis)?

A. CHF due to ischemic CM

B. CHF due to HCM

C. CHF due to idiopathic DCM

D. CHF due to alcohol-related DCM

What clinical syndrome explains his cardiomegaly, hypokinetic LV, and low EF of 28% (pt has atherosclerosis)? 

A. CHF due to ischemic CM 

B. CHF due to HCM 

C. CHF due to idiopathic DCM

D. CHF due to alcohol-related DCM

20

Could prolonged QT predispose to SCD in this pt?

A. Yes, since it may cause VT or VFIB

B. Yes, since it may cause AV block

C. No, because only short QT causes SCD D. No, because only short QT causes VT or VFIB

Could prolonged QT predispose to SCD in this pt? 

A. Yes, since it may cause VT or VFIB 

B. Yes, since it may cause AV block 

C. No, because only short QT causes SCD D. No, because only short QT causes VT or VFIB

21

If this pt had ST elevation relieved with SL NTG and had NO elevation of cardiac enzymes, what is the most likely cause of SCD?

A. Primary SCD due to V Fib

B. Secondary SCD due to VT

C. Secondary SCD associated with CHF

If this pt had ST elevation relieved with SL NTG and had NO elevation of cardiac enzymes, what is the most likely cause of SCD? 

A. Primary SCD due to V Fib 

B. Secondary SCD due to VT 

C. Secondary SCD associated with CHF

- Recall, primary SCD is NOT accompanied by heart attack (concomitant myocardial infarction)

22

T/F: the likelihood of recurrent SCD is greater if he had suffered an cute MI?

False?

- Greater chance of recurrence with primary SCD (no MI)