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3 CLASP & Transition Block > Sudden Cardiac Death - Conditions > Flashcards

Sudden Cardiac Death - Conditions Flashcards

(62 cards)

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1
Q

a patient with a cardiac caused sudden death tend to die between _ hours of previous wellbeing

A

6

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2
Q

name cardiac causes of sudden death

A

inherited arrhythmia syndrome
inherited cardiomyopathy
inherited multisystem disease with CVS involvement eg myotonic dystrophy

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3
Q

arrhythmia syndromes can also be called…

A

channelopathies

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4
Q

give examples of inherited channelopathies

A 
congenital long QT syndrome
brugada syndrome
catecholaminergic polymorphic VT
short QT syndrome
familial AF or WPW
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5
Q

give examples of inherited cardiomyopathies

A

hypertrophic cardiomyopathies

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6
Q

screening is normal in what cardiomyopathies?

A

dilated
hypertrophic
ARVC (arrhythmogenic right ventricular cardiomyopathy)

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7
Q

what process keeps the SA node firing

A

automaticity

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8
Q

2 main reasons for arrhythmias

A

problems with automaticity

re-entry

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9
Q

what are after depolarisations

A

abnormal depolarisations of cardiac myocytes that interrupt phases 2, 3 and 4 of the cardiac AP

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10
Q

what do after depolarisations cause in the heart?

A

triggered automaticity

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11
Q

when do early repolarisations occur?

A

during phases 2 and 4 of the cardiac AP

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12
Q

what do early repolarisations cause?

A

torsades de pointes

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13
Q

when in the cardiac AP do delayed depolarisations occur?

A

phase 4

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14
Q

what do delayed depolarisations cause?

A

bidirectional VT

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15
Q

inheritance pattern of cardiac conditions?

A

AD

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16
Q

inheritance pattern of cardiac conditions?

A

AD

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17
Q

commonest inherited cardiac cause of sudden death?

A

long QT

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18
Q

how many people are carriers of long QT gene

A

1 in 2000

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19
Q

what cardiac changes are seen in long qt

A

torsades de pointes (polymorphic VT)

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20
Q

trigger for the cardiac changes seen in long qt?

A

adrenergic stimulation eg by excitement, exercise

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21
Q

what is romano-ward syndrome? what is its inheritance?

A

most common form of long qt

AD

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22
Q

what long qt syndrome is associated with deafness? is it AD or AR inheritance?

A

jervell and lange-nielsen syndrome

AR

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23
Q

pathophysiology behind long qt

A

reduced ionic current = prolonged cardiac repol = wt interval prolongation

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24
Q

how is long qt diagnosed?

A

QT >480ms in repeated ECGs
if your long qt risk score is >3
presence of LQTS mutation

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25
symptoms of long qt
syncope stress potentially Hx of deafness (JALNS)
26
what drugs should be avoided in long qt?
clarithromycin azithromycin imipramine amitryptiline
27
LQTS1 main prophylactic advice?
avoid strenuous exercise
28
LQTS2 main prophylactic advice?
avoid loud noises
29
pathophysiology of short qt
K+ channels
30
how long is the qt interval in short qt
<300ms
31
who gets short qt
young children
32
youre at increased risk of what arrhythmias
``` polymorphic VT (TDP) VF ```
33
what cardiac condition do people with brugada syndrome get?
AF
34
what are the ECG findings in brugada syndrome
ST elevation and RBBB in V1-3
35
inheritance of brugada syndrome? who gets it?
AD | adult males
36
triggers for VF in brugada syndrome
excess alcohol large meals rest fever
37
Tx brugada syndrome
avoid triggers avoid Na channel blockers/anti-arrhythmias go into hospital if fever ICD if severe
38
what is CPVT? what triggers it?
adrenergic induced TDP, SVTs that are triggered by stress and exercise
39
ECG and ECHO are what in CPVT?
normal
40
Tx CPVT?
sedate defibrillate avoid triggers b blockers long term (blocks adrenergic stimulation) +/- ICD
41
ECG features of WPW syndrome
short PR interval delta waves venticular preexcitation
42
most common arrhythmia in WPW syndrome
AVRT
43
pathophysiology of WPW syndrome
no conduction delay between atria and ventricles because of an accessory pathway
44
Tx WPW
leave it if the accessory pathway does not conduct quickly | cardiac ablation if it does
45
commonest cardiomyopathy?
hypertrophic
46
mutation is where in hypertrophic cardiomyopathy
sarcomeric genes
47
how many patients will die per year of HOCM?
1%
48
ECG changes that suggest hypertrophy?
positive deflection in V5 | negative deflection in V2
49
different presentations of HOCM
sudden death HF (from progressive ischaemia) end stage HF AF (thick muscles inc diastolic pressure)
50
Tx HOCM
ICD if previous cardiac arrest or sustained VT OR if high risk eg 1st degree FH, thick LV wall, recent syncope if none, leave it esp if risk is under 4%
51
who gets dilated cardiomyopathy
adulthood-elderly | men>women
52
pathophysiology of DCM
sarcomere protein problem (20% is genetic related)
53
what does DCM progress to?
HF
54
pathophysiology of ARVC?
fibrofatty replacement of myocytes allowing more space for reentry (VT most common)
55
how common is LV invovlement in ARVC?
50%
56
features of ARVC on ECG?
QRS prolongation
57
Tx ARVC
avoid competitive sports 1. beta blockers 2. ICD if severe
58
diagnosis of inherited cardiac conditions
clinical and genetic testing | family screening
59
what does defibrillation do?
delivers high energy causing cardiac myocytes to depolarise, resets all cardiac myocytes to restore electrical signal
60
what does ICD mean?
implantable cardioverter defibrillator
61
complications of ICDs?
leads can cause infection eg endocarditis can cuse pneumo/haemothorax thromboembolic eg PE lead fractures (can slit the SVC on removal)
62
how long do ICD leads last?
20 yrs

3 CLASP & Transition Block (20 decks)

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