Syncope

Question 1

when do coronaries receive blood flow

Answer 1

during diastole as the blood come back down the ascending aorta

Question 2

what supplies the apex of the heart with blood

Answer 2

marginal artery off of the right coronary

Question 3

what does the left main coronary separate into

Answer 3

LAD and left circumflex

Question 4

what feeds the anterior 2/3 of the interventricular septum toward the apex

Answer 4

LAD

Question 5

what is syncope

Answer 5

transient loss of consciousness secondary to lack of cerebral blood flow
self-limited with loss of postural tone
typically patients recover rapidly with full return to baseline

Question 6

what are the rules of 15

Answer 6

15% of PE pts will present with syncope
15% of AAA pts present with syncope
15% of ruptured ectopic patients present with syncope
15% of SAH pts present with syncope
15% of ACS pts present with syncope

Question 7

What is CHESS PIECES

Answer 7

C- CHF
H - HCT < 30
E - ECG abnormality
S - SOB
S - SBP < 90

P- Premature SCD (FHx)
I - Ischemic heart disease
E - EF < 35%
C - Cardiomyopathy
E - exertional syncope
S - structural heart disease

Question 8

what is included in ACS

Answer 8

unstable angina, NSTEMI, STEMI

Question 9

what is the 6 step ECG approach

Answer 9

Rate
Rhythm (P waves, regular/irregular, QRS)
Intervals
Dsyrhythmia
ischemia
axis

Question 10

what is the QT segment

Answer 10

time it takes for ventricles to depolarize and repolarize

Question 11

what is long QT syndrome

Answer 11

prolonged if >440ms in men and >460 ms in women

> 500ms has increased risk for badness

Question 12

what can be causes of acquired long QT syndrome

Answer 12

hypokalemia, hypomagnesemia, hypocalcemia, MI, elevated ICP, Meds

Question 13

what is Wolf Parkinson white

Answer 13

pre-excitation syndrome - abnormal conduction pathway along the bundle of Kent directly connecting the atria to ventricles and bypassing the AV node
may be familial

Question 14

what is WPW pattern

Answer 14

seen on ECG but asymptomatic

Question 15

what is WPW syndrome

Answer 15

symptomatic arrhythmia
palpitations, dizzy, syncope, CP, Sudden cardiac death
commonly associated with afib

Question 16

what is the ECG triad with WPW

Answer 16

Delta wave on ECG
short PR < 0.12 sec / no PR seg
Wide QRS > 0.12-0.2

Question 17

what is a sodium channelopathy

Answer 17

brugada

Question 18

what occurs with Brugada

Answer 18

repolarization issue associated with sodium ion channels which can lead to ventricular strain and fibrillation and sudden cardiac death

Question 19

what is brugada pattern and syndrom

Answer 19

pattern: ECG findings with no symptoms
syndrome: ECG + palpitations, syncope, dyspnea (all indicators of vtach)

Question 20

what is the treatment of brugada syndome

Answer 20

ICD

Question 21

What is hypertrophic obstructive cardiomyopathy (HOCM)

Answer 21

genetic cardiomyopathy that leads to myocyte hypertrophy and myocardial disarray (autosomal dominant)
leads to increased LV thickness which reduces filling and ultimately CO
increased risk of arrhythmias and SCD

Question 22

what is seen on HOCM ECGs

Answer 22

‘dagger like” Q wave in lateral leads (1, avl, v5-6), LVH

Question 23

what is tamponade

Answer 23

acute or chronic increase in fluid around the heart that can cause pressure on the heart - decreased size of chambers of the heart

Question 24

what is the exam presentation of tamponade

Answer 24

tachycardia
hypotension
evelevated JVP
pulsus paradoxus
pericardiual rub
Becks triad

Question 25

what is beck's triad

Answer 25

hypotension muffled heart sounds elevated JVP

Question 26

what is a PE

Answer 26

venous thromboembolism that blocks the pulmonary vasculature

Question 27

what is a massive PE

Answer 27

hemodynamic instability with hypotension, mortality rate 25-52%

Question 28

what is a submassive PE with right heart strain

Answer 28

elevated troponin, BNP, strain on imaging (CT or ECG)

Question 29

what are the risks for getting PE

Answer 29

time of immobility surgery trauma cancer estrogen replacement procoagulant syndromes hx dvt or pe

Question 30

what is the presentation of PE

Answer 30

pleuritic chest pain SOB, hypoxia syncope shock (right side HF) finding of DVT cough hemoptysis tachycardia

Question 31

what is the workup for PE

Answer 31

if low risk - d-dimer high risk: CTA - PERC rule

Question 32

what are PERC rule used for

Answer 32

rule for PE risk

Question 33

what are the ECG findings for PE

Answer 33

s waves in lead 1 Q waves in lead 3 inverted T-waves in lead 3

Question 34

what is severe pulmonary hypertension

Answer 34

increase pulmonary vascular resistance which leads to right sided HF due to HF, COPD, vasculitis, infection presents with: SOB, CP, effusion, edema

Question 35

what is pulmonary hypertension

Answer 35

elevation in the normal pulmonary vascular pressures increases RV pressure - decrease CO, decrease ability to exert themselves, fluid retention - may lead to death

Question 36

what are common causes of pulmonary arterial hypertension

Answer 36

PE, ARDS, COPD, Interstitial lung disease

Question 37

What is aortic dissection

Answer 37

separation between layers of the aorta with a false lumen that spreads secondary to pulse and BP