Sudden Death Flashcards
(130 cards)
1
Q
What is the difference between histopathology and histocytology?
A
Histopathology: exams tissue specimen
Histocytology: exams cells floating in liquid
2
Q
Name the autosomal dominant condition caused by a mutation in PKP2 arginine?
It has 60% penetrance and equally affects males and females.
It can cause sudden death.
It is most common in Dutch populations.?
A
ARVC/D arrhythmogenic right ventricular cardiomyopathy/dysplasia
3
Q
What is shock:
A
Inadequate organ perfusion > inadequate O2 delivery > organ failure
(Acute circulatory failure)
4
Q
Distributive shock is a group term for which types of shock?
A
Septic, anaphylactic, neurogenic
5
Q
What is preload?
A
Volume entering ventricles
6
Q
What is afterload?
A
Resistance LV must overcome to pump blood
7
Q
What is the Frank-Starling mechanism?
A
> EDV = >CO
8
Q
HR X SV =
A
CO
9
Q
CO X SVR =
A
MAP
10
Q
What effect does hypovolaemic shock have on CO, BP, HR, temp and skin appearance?
A
Decreased CO Decreased BP Increased HR Normal temp Cool/pale clammy
11
Q
What effect does anaphylactic shock have on CO, BP, HR, temp and skin appearance?
A
Decreased CO Decreased BP Increased HR Normal temp Hives, edema
12
Q
What effect does cardiogenic shock have on CO, BP, HR, temp and skin appearance?
A
Decreased CO Decreased BP Increased HR Normal temp Edema Clammy peripheries
13
Q
What effect does septic shock have on CO, BP, HR, temp and skin appearance?
A
Decreased BP Increased CO Increased HR Raised temp Initially flushed / warm, then cool / pale
14
Q
What effect does neurogenic shock have on CO, BP, HR, temp and skin appearance?
A
Decreased CO Decreased BP DECREASED HR No change to temp - vasodilation below lesion No change to skin appearance
15
Q
What is the Mx of hypovolaemic shock?
A
Fluid Blood Vasopressor FFP Warm
16
Q
What is the Mx of anaphylactic shock?
A
Adrenaline
IV fluid
17
Q
What is the Mx of cardiogenic shock?
A
Vasopressor
Inotrope dobutamine
18
Q
What is an inotrope?
A
Increase HR and force
19
Q
Vasopressors cause vasoconstriction or vasodilation?
A
Vasoconstriction
20
Q
NA is a vasopressor. T or F
A
True
21
Q
What immune factors are found in anaphylactic shock?
A
Mast cells PG Leukotrienes Histamine PAF Chemokines
22
Q
What causes edema in anaphylactic shock?
A
Leak capillaries so fluid escapes
23
Q
What types of edema are present in cardiogenic shock?
A
Skin + pulmonary
24
Q
Define septic shock
A
Sepsis + 25% decrease in systolic BP
25
Why is lactate a measure of shock?
Anaerobic metabolism product - hence measures inadequate O2 delivery
26
What group of bacteria are strongly associated with septic shock and why?
Group A strep
| Release toxic mediators
27
In neurogenic shock, there is [vasodilation / vasoconstriction] below the lesion
Vasodilation
28
What is the pathology of neurogenic shock?
Unopposed vagal action
| No sympathetic outflow
29
Ivacaftor is a genetic drug used in the management of what condition?
CF
30
The definition of sudden cardiac death:
- non-_____
- non-_____
- Unexpected
- Within _____ of a previously _____ heart
The definition of sudden cardiac death:
- non-TRAUMATIC
- non-VIOLENT
- Unexpected
- Within 6 HOURS of a previously NORMAL heart
31
Myotonic dystrophy can cause sudden cardiac death. T or F
True
32
Name 2 conditions associated with aortic dissections
Loeys Dietz syndrome
| Marfan syndrome
33
What protein is mutated in Marfan syndrome?
Fibrillin
34
Genetic causes of aortic dissections are associated with mutations in what gene?
TGF-B2
35
If a patient has a family history of several family members in every generations who had MIs before age 50, what is a likely genetic cause?
Familial hypercholesterolemia
| LDL receptor mutation
36
What is the easier diagnostic test for familial hypercholesterolemia?
Measure cholesterol / LDL
37
What is the management of familial hypercholesterolemia?
Statin
38
What are some SEs of statins?
Myalgia
| Rhabdomyolysis
39
Where should a baby sleep in the 1st 6 months to prevent SUDI?
In a cot in parents bedroom
40
Who should you report a SUDI death to?
Procurator fiscal
Police
Bereavement service
41
Where should you not allow a baby to sleep to prevent SUDI?
On sofa/armchair
In parents bed
In carseat when not driving
42
Whats the difference between a cardiomyopathy and channelopathy?
```
Channelopathy = ion channel mutations; effects depolarisation
Cardiomyopathy = structural problem
```
43
After depolarisations interrupt phase ____ of the cardiac AP which leads to ____
After depolarisations interrupt phase 2, 3 or 4 of the cardiac AP which leads to TRIGGERED ACTIVITY
44
What is Romano ward syndrome? What is the inheritance pattern?
AD, isolated LQT
45
What is Jervel Lange Nielsen syndrome? What is the inheritance pattern?
AR, LQT + deaf
46
What is the commonest mutation in congenital LQT syndrome?
KCNQ1
47
What phase of the cardiac AP is interrupted in an early after-depolarisation?
2 or 3
48
What is the commonest inheritance pattern of congenital long QT syndrome?
AD
49
What is required for a Dx of LQT synd?
```
QT >480
OR
Mutation
OR
QT >460 + unexplained syncope
```
50
What is congenital long QT syndrome?
Adrenergic trigger causes polymorphic VT Torsade de Pointes
51
Congenital LQT syndrome has variable ______
penetrance
52
What should be avoided in CLQT syndrome?
QT prolonging drugs (clarithromycin, azithromycin, others0
Competitive sport
(Also alarm clocks and diving)
53
What is the Mx of LQT synd?
BB nadolol
| Consider ICD
54
What is the % SCD risk in untreated CLQT synd?
1%
55
What is the inheritance pattern in short QT syndrome? What age group is it associated with SCD in?
AD
| Infants
56
What is the inheritance pattern of Brugada syndrome?
AD
57
What arrhythmias is Brugada syndrome associated with?
Polymorphic VT
VF
AF
58
What is seen on ECG in Brugada syndrome?
Intermittent
| ST elevation + RBBB in V1-V3
59
What are the arrhythmia triggers in Brugada syndrome?
Fever, sleep, alcohol, big meal
60
What is the diagnostic test for Brugada syndrome?
ECG with flecainide or ajmaline
61
What is the Tx for VF in Brugada syndrome?
The only Tx for VF is defibrillation
62
What is the Mx of Brugada synd?
BB
Other drugs - not sure whether to learn
Consider ICD
63
What is CPVT?
Adrenergic induced bi-directional polymorphic VT/SVT
64
What is seen on ECG in CPVT?
Normal
65
What is seen on echo in CPVT?
Normal
66
What is the commonest mutation in CPVT?
RYR2
67
What is the Mx of CPVT?
Avoid trigger
Flecainide
Consider ICD
68
What is seen on ECG in WPW?
Short PR interval, delta wave
69
What arrhythmia is associated with WPW?
SVT
70
What is the Mx of WPW?
Ablation
71
What is the diagnostic test for HOCM?
Echo
72
How might HOCM present?
SCD
HF
AF
73
What protein is mutated in HOCM?
Sarcomere
74
What is the Mx of HOCM?
Consider ICD
| Avoid competitive sport
75
Dilated cardiomyopathy is more common in which gender? What is the diagnostic test?
Males
| Echo
76
What does ARVC stand for?
Arrhythmogenic RV cardiomyopathy / dysplasia
77
What is the pathology of ARVC?
Fibro-fatty replacement of cardiac myocytes - causes a re-entry pathway
78
What is the inheritance pattern in ARVC?
AD
79
What gene is ARVC associated with?
PKP2
80
ARVC has a 60% _____
penetrance
81
What is the presentation of ARVC?
SCD
| Syncope
82
What is the Mx of ARVC?
BB
Consider ICD
Avoid competitive sport
83
What is clinical death?
Resp + circulatory + brain arrest that is reversible if resuscitated
84
How long does clinical death last?
3-6 minutes
85
What is the commonest cause of clinical death?
IHD
86
What are the causes of clinical death?
4Hs, 4Ts
```
Hypovolaemia
Hypothermia
Hypokalaemia
Hypoxia
Toxin
Tamponade
Thrombus
Tension pneumothorax
```
87
What is the aetiology of cardiac tamponade?
Penetrating chest trauma or post cardiac surgery
88
What is the Mx of cardiac tamponade?
Needle pericardiocentesis / thoracotomy
89
What is the Mx of hyperkalaemia?
Calcium chloride, insulin/dextrose
90
What is the Mx of a tension pneumothorax?
Needle decompression or thoracotomy
91
What is biologic death?
Irreversible cellular destruction
| After clinical death
92
In CPR, how many chest compressions should be done per second?
2
93
What is the correct depth in CRP?
5-6cm
94
How often should CPR providers switch roles to prevent fatigue?
Every 2 minutes
95
How long should it take to perform to ventilations in CPR?
10 seconds
96
When should ventilations be performed before compressions in CPR?
Child
| Drowned
97
In CPR, when should defibrillation be done?
As soon as defibrillator arrives
98
What is the mechanism of defibrillation?
Depolarises and resets all cardiac myocytes
99
When is defibrillation appropriate?
VF
| Pulseless VT
100
When is defibrillation inappropriate? What should be done instead?
PEA, asystole
Continue CPR, for 2 minutes then check rhythm again
101
In cardiac arrest, if VF or pulseless VT persists after 3 shocks, what should be done?
```
CPR for 2min
+
1mg IV adrenaline
+
300mg IV amiodarone
```
102
What drug should be given in asystole / PEA cardiac arrest?
1mg IV adrenaline every 3-5min
103
What airways devices are used in cardiac arrest MX?
Supraglottic airway device or tracheal tube
104
Once an airway device is secured in cardiac arrest, should you still stop CPR for ventilation?
No
105
How do you calculate HR from an ECG?
1500/small squares between QRS complexes
OR
300/large squares between QRS complexes
106
What does the P wave represent on an ECG?
Atrial depolarisation
107
What does the PR interval represent on an ECG?
AVN delay to allow ventricle filling
108
What does the QRS complex represent on an ECG?
Ventricle depolarisation
109
What does the T wave represent on an ECG?
Ventricular repolarisation
110
What arrhythmia is being described?
| Bizarre irregular waveform, no recognisable QRS complexes, random freq/amplitude, uncoordinated electrical activity
VF
111
```
What arrhythmia is being described?
Absent ventricular (QRS) activity, atrial activity P waves may persist
```
Asystole
112
What arrhythmia is being described?
| Broad complex rhythm constant QRS morphology
Monomorphic VT
113
What arrhythmia is being described?
| Atrial rate 250-350bpm, regular QRS, most 2:1 conduction (150 ventricular, 300 atrial bpm)
Atrial flutter
114
What arrhythmia is being described?
| Irregularly irregular QRS, no p waves, atrial rate >350bpm, fast/slow AV conduction
AF
115
What arrhythmia is being described?
| 100-120bpm, regular, occosional dissociated p waves, wide bizzarre QRS
VT
116
What arrhythmia is being described?
Twisting of the axis, 200-250bpm, regular or irregular, sinusoidal pattern, may revert to VF or SR, RF electrolyte abnormality
Torsade de Pointes
117
What arrhythmia is being described?
| -Arctic Monkeys AM
Torsade de Pointes
118
What arrhythmia is being described?
| Regular, PR >0.2sec, physiological block to AVN, aetiology drug/vagal stimulation/disease
1st degree HB
119
What arrhythmia is being described?
| regularly irregular, increasing PR interval till drop beat, diseased AVN with long refractory period
Mobitz I 2nd degree HB
120
What arrhythmia is being described?
| Same PR for all beats, regular P wave, some absent P waves, progress to CHB
Mobitz II 2nd degree HB
121
What arrhythmia is being described?
| A-V dissociation, regular P waves + QRS; no relationship, Mx pacemaker
Complete 3rd degree HB
122
What is the mechanism of cool clammy skin in shock?
Peripheral vasoconstriction
123
What effect does distributive shock have on BV resistance, BV diameter, MAP, CO?
Decreased systemic resistance
Vasodilation
Decreased MAP
Increased CO
124
How would you describe the pulse in distributive shock?
Bounding hyperdynamic pulse
125
What are the CI to giving fluid in hypovolaemic shock?
Heart failure
| Pulmonary edema
126
What type of shock can acute heart valve failure cause?
Cardiogenic
127
What type of shock can a saddle embolus cause?
Obstructive
128
What type of shock can cardiac tamponade cause? What is the management?
Obstructive
| Pericardiocentesis
129
What type of shock can a tension pneumothorax cause? What is the management?
Obstructive
| Thoracentesis
130
What is a really important sign of kidney damage in shock?
Oliguria
