sudden death

Question 1

what are the reversible causes of cardiac death

Answer 1

4 H’s
4 T’s

hypoxia, hypovolaemia, hypo/hyperkalaemia(metabolic), hypothermia

Tamponade, thrombosis, toxins, tension pneumothorax

Question 2

what are the types of shock

Answer 2

hypovolaemia, cardiogenic, septic, anaphylactic and neurogenic

Question 3

what is hypovolaemic shock

Answer 3

Loss of circulating volume leading to reduced preload and reduced output

Question 4

cause of hypovolaemic shock

Answer 4

bleeding, third space volume loss, severe dehydration

Question 5

compensatory mechanism for hypovolaemic shock

Answer 5

baroreceptor reflex

sympathetic mediated neurohormonal response

renal and hypothalmopituitary

Question 6

how to fix hypovolaemia

Answer 6

fluid and blood replacement

Question 7

what is cardiogenic shock

Answer 7

Myocardial dysfunction causing reduction in systolic function and cardiac output

Question 8

causes of cardiogenic shock

Answer 8

MI, myocarditis, acute valve lesion

Question 9

treatment for cardiogenic shock

Answer 9

Enhancing inotropy = increasing sympathetic nervous system via dobutamine, adrenaline, dopamine, dopexamine

vassopressors

careful fluid management

treat underlying cause

Question 10

what is obstructive sock

Answer 10

Physical obstruction to filling of the heart causing a reduced preload and cardiac output

Question 11

obstructive shock causes

Answer 11

Causes = tamponade, PE, tension pneumothorax

Question 12

treatment for obstructive shock

Answer 12

treat underlying cause

PE = anticoagulation +/- thrombolysis
Cardiac tamponade = pericardial drainage
Tension pneumothorax = decompression

Question 12

treatment for anaphylaxis

Answer 12

Adrenaline, antihistamines, steroids and fluids

Question 12

treatment for neurogenic shock

Answer 12

vasopressors

Question 12

what is neurogenic shock

Answer 12

spinal cord trauma leading to loss of sympathetic tone

Question 12

what is anaphylactic shock

Answer 12

uncontrolled activation of mast cell causing vasodilation

Question 13

main differentiation between each shock type

Answer 13

hypovolaemic- maintained bp at start then reduced in later stage + cool and pale skin

Cardiogenic- skin swollen and oedematous

Septic- pyrexia- could also be too cold

anaphylaxis- rash

neurogenic- bradycardia and unregulated temp

Question 14

what is long qt syndrome

Answer 14

Mutation in ion channel results in reduced/ dysfunctional ionic current which prolongs repolarization

most common is the potassium channel

Question 15

long qt symptoms

Answer 15

Syncope and palpitations are a result of torsades de pointes by adrenergic stimulation. This may degenerate to VF = SCD

Question 16

which disease can long qt progress to

Answer 16

torsades de points

Question 17

management of long qt

Answer 17

acute management = treat cause, magnesium infusion, defibrillation

Long term management = BB, avoid QT prolonging drugs (antipsychotics), pacemakers

Question 18

what is brugada

Answer 18

AD – 12 associated genes with sodium and calcium channels

Question 19

what can brugada lead to

Answer 19

ECG – risk of polymorphic VT, VF, AF is common, ST elevation and RBBB in V1-3 along with T wave invesions after qrs complex

Question 20

diagnostic test for brugada

Answer 20

ecg by provoking Na channels

Question 21

Treatment for brugada

Answer 21

Mx = avoid triggers, avoid certain drugs and triggers can have ICD incase

Question 22

what is WPW

Answer 22

Patients have accessory pathway known as bundle of Kent which allows signal to return to atria from ventricles (re-entrant route) Short PR interval, ventricular pre-excitation

Question 23

what can be seen on ecg for wpw

Answer 23

ECG – delta wave- slurred upstroke with wide qrs complex, AVRT, AF

Question 24

treatment for WPW

Answer 24

definitive is radiofrequency ablation

Question 25

what are cardiomyopathies

Answer 25

arrythmias related to scar/electric barrier formation and subsequent re-entry

Question 26

examples of cardiomyopathy

Answer 26

HOCM Arrhythmogenic right ventricular cardiomyopathy Dilated cardiomyopathy

Question 27

what is HOCM

Answer 27

an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins. most common cause of sudden death in young people

Question 28

symptoms of HOCM

Answer 28

dyspnoea, AF, syncope, palpitations and angina

Question 28

ecg findings in HOCM

Answer 28

T wave inversion

Question 29

treatment for HOCM

Answer 29

Amiodarone Beta-blockers or verapamil for symptoms Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis*

Question 30

what is still birth

Answer 30

Baby dies after 24 weeks of pregnancy and before or during birth

Question 31

risk factors for still birth

Answer 31

way to many- basically anything that puts the baby under excess stress placental causes, IGR, congenital, maternal infections, extremes of ages, medical complications, multiple pregnancies, prolonged pregnancy, obesity, smoking, previous stillbirth, antepartum hemorrhage

Question 32

how to reduce still birth

Answer 32

SLEEP ON SIDE IN 3RD TRIMESTER Stop smoking Avoid alcohol and drugs Attend check ups

Question 33

After still birth what must be conducted

Answer 33

Post mortem Skin biopsy Placental histopathology Blood results Microbiology results SUPPORT