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_MS2 Cardio > 8/19- Sudden Cardiac Death > Flashcards

8/19- Sudden Cardiac Death Flashcards

1
Q

What are the biggest risk factors for atherosclerosis?

A
  • High cholesterol
  • HTN (> 140/90)
  • Diabetes
  • Smoking (current/recent!)
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2
Q

What are 2 broad diseases that can lead to heart failure?

A
  • Coronary Artery Disease (from Atherosclerosis)
  • Valvular Heart Disease
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3
Q

How can CAD (coronary artery disease) present?

A
  • Arrhythmias -> Sudden Cardiac Death
  • Angina (stable or unstable)
  • Myocardial Infarction
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4
Q

What is included in “Acute Coronary Syndromes”?

A
  • Unstable angina
  • Myocardial infarction
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5
Q

T/F: > 1 million people suffer SCD/yr in the US

A

False

  • 1300 cases/d (400,000/yr) in the US
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6
Q

T/F: The most common cause of SCD in adults is asystole

A

False

The most common cause of SCD in adults is ventricular fibrillation

  • Primary VF is the most common cause of out-of-hospital SCD
  • Asystole is usually the result of sustained myocardial anoxia during initial episode of VF rather than the primary cause of death
  • Asystole is the MCC of SCD in infants
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7
Q

T/F: ASH/IHSS are the most common etiology of SCD in the US

A

False

  • This is the most common etiology in 15-35 yo
  • In general, most common cause is CAD
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8
Q

T/F: Most SCD are due to VF complicating AMI

A

False

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9
Q

T/F: VF without AMI rarely recurs unlike VF with AMI

A

False

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10
Q

Define: sudden cardiac death (SCD)

A

Sudden unexpected death due to cardiac causes occurring within one hour after the onset of cardiac symptoms

  • NHLBI: death within 24 hrs of Sx
  • WHO: un-witnessed death
  • Uniformly fatal (unless successfully resuscitated; 1/3 survive)
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11
Q

Define: ventricular fibrillation (VF). What does the ECG look like?

A

Chaotic and asynchronous electrical ventricular activity arising from multiple foci and spreading erratically throughout the myocardium

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12
Q

Define: asystole (flat line “___”)

A

Asystole is usually the result of sustained myocardial anoxia during initial episode of VF rather than the primary cause of death

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13
Q

Define: primary vs. secondary VF

A

Primary VF: no associated MI

Secondary VF: associated MI (as proven by post-mortem changes on autopsy or cardiac enzymes)

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14
Q

What is the public health impact of SCD?

A
  • 1300 cases/d (400,000/yr) in the US
  • 50% of all CAD deaths
  • 1/3 of all deaths age 20-64
  • Gradual decline since 1971 (due to EMS, decreased coronary risk factors, and the coronary care unit)
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15
Q

Which has the higher recurrence: primary or secondary VF?

A

SCD recurrence is 5-10x higher in primary VF (that not associated with an MI)

  • i.e. probably have some kind of factor/tissue very vulnerable to arrhythmias that hasn’t been fixed
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16
Q

Primary vs. Secondary VF:

  • 55 yo man presents w/ crushing diffuse anterior chest pain 10/10 with diaphoresis and dyspnea
  • No change in ECG or chest pain with SL NTG

What is the pt suffering from?

A. Acute massive viral pericarditis

B. Unstable angina with a “platelet plug”

C. LAD Vasospasm refractory to SL NTG

D. Acute ST elevation MI due to fibrin/RBC “red” clot completely occluding the LAD

E. Intense coronary constriction due to anxiety

A

ECG: acute anterolateral MI

  • Local ST elevation (leads I, aVL, and V2-V5)
  • Acute MI likely due to occlusion in the pulmonary artery (?)

What is the pt suffering from?

A. Acute massive viral pericarditis

B. Unstable angina with a “platelet plug”

C. LAD Vasospasm refractory to SL NTG

D. Acute ST elevation MI due to fibrin/RBC “red” clot completely occluding the LAD

E. Intense coronary constriction due to anxiety

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17
Q

Primary vs. Secondary VF (pt 2):

  • 55 yo man who presented with chest pain sustains a sudden unexpected cardiac arrest 3-4 hrs later

- How would you manage him after initial resuscitation?

- How likely is recurrent SCD after hospital discharge?

A
  • This was a secondary cardiac arrest (or secondary VF); SCD associated with MI
  • Chance of recurrence is low; no need for ICD after discharge
18
Q

Which of the following best applies to this 55 yo man (with chest pain and unexpected cardiac arrest 3-4 hrs later)?

A. Primary VF

B. Secondary VF

C. Massive anterolateral MI complicated by VF

D. Low risk of recurrent SCD

E. B, C, and D

A

Which of the following best applies to this 55 yo man (with chest pain and unexpected cardiac arrest 3-4 hrs later)?

A. Primary VF

B. Secondary VF

C. Massive anterolateral MI complicated by VF

D. Low risk of recurrent SCD

E. B, C, and D

19
Q

What is an AICD? For who is it routinely recommended?

A

Automatic Implantable Cardioverter Defibrillator (or just ICD)

  • Routinely recommended for primary VF (high chance of recurrence); NOT recommended for secondary
20
Q

What can an AICD do? (Don’t need to memorize)

A
  • Provide shock in cases of ventricular fibrillation (VF)
  • ATP- anti-tachycardiac pacing- try to recognize VT before above shock is required (will pace ventricle faster for just a few s in “overdrive pacing”)
21
Q

What is this?

A

Ventricular fibrillation

22
Q

What is the most common cause of SCD?

A

Tachy-arrhythmias

- Ventricular fibrillation**

  • Ventricular tachycardia
  • Ventricular flutter

Brady-arrhythmias

  • Asystole
  • Bradycardia
23
Q

What is this?

A

Ventricular Tachycardia (3+ consecutive beats)

24
Q

What is VT and AIVR? Features?

A

VT- ventricular tachycardia

AIVR - accelerated idioventricular rhythm

  • Both are wide QRS regular tachycardia with no P (but AIVR does not -> SCD)

- VT has a rate >110/min while AIVR is under 110/min; this is the only difference!

25
Q

Risk of ventricular fibrillation is higher with what?

A
  • Longer VTs > 12 beats
  • Faster VTs > 160/min
26
Q

Which kills, VT or AIVR?

A

VT!

27
Q

What is the most common cause of SCD in adults?

A

Ventricular fibrillation

  • Primary VF is the most common cause of out-of-hospital SCD
28
Q

What triggers an actual episode causing SCD at a particular moment (SCD triggers)?

A
  • PVC with R-on-T
  • Coronary reperfusion
  • CNS stimulation: sympathetic and vagal activity
  • Psychological stress
29
Q

What is the significance of a sympathetic activity as SCD “trigger”?

A

BB prevent VF post-MI

30
Q

CAD is a responsible for __% of all SCD

A

CAD is a responsible for 80% of all SCD

31
Q

Etiologies of SCD

A

CAD (80%!)

Acquired non-coronary heart disease:

  • Cardiac tamponade
  • Cardiac rupture
  • Myocardial disease: IHSS
  • Valvular heart disease: AS
  • Aortic diseases

*Metabolic imbalance: K, Ca

*Drugs: cocaine, TCA, phenothiazine

32
Q

You are called to see a pt who just arrest in CCU and has this ECG. What is it?

A. Polymorphic VT

B. Monomorphic VT

C. QT is probably under 360 ms

D. QTc is probably > 440 ms

A

You are called to see a pt who just arrest in CCU and has this ECG. What is it?

A. Polymorphic VT

B. Monomorphic VT

C. QT is probably under 360 ms

D. QTc is probably > 440 ms

  • Polymorphic VT associated with prolonged QT
33
Q

What is normal rate for QTc?

A

440 ms

34
Q

ECG changes for electrolyte imbalances:

  • Low Ca
  • High Ca
A

Low Ca: short QT interval

High Ca: long QT interval

35
Q

Which of the following is the MOST COMMON cause of Long QT?

A. Low K

B. Low Ca

C. Low Mg

D. Low Na

A

Which of the following is the MOST COMMON cause of Long QT?

A. Low K

B. Low Ca

C. Low Mg

D. Low Na

  • We commonly use drugs that lower K (e.g. loop diuretics)
36
Q

Is the pts age useful in predicting the underlying cause of SCD?

A

Yes

  • CAD is the most common etiology of VF in middle aged and older adults
  • IHSS is the commonest cause of SCD in 15-35 yo younger adults
37
Q

Which valvular abnormality is MOST likely to cause SCD?

A. Mitral stenosis

B. Aortic stenosis

C. Aortic insufficiency

D. Mitral regurgitation

A

Which valvular abnormality is MOST likely to cause SCD?

A. Mitral stenosis

B. Aortic stenosis

C. Aortic insufficiency

D. Mitral regurgitation

38
Q

Which cardiomyopathy is MOST likely to cause SCD?

A. Congestive

B. Hypertrophic

C. Restrictive

A

Which cardiomyopathy is MOST likely to cause SCD?

A. Congestive

B. Hypertrophic

C. Restrictive

39
Q

Who are appropriate candidates for ICD implantation: secondary prevention?

A
  1. Pt surviving cardiac arrest not associated with acute MI or other reversible causes (ischemia, electrolyte/metabolic abnormalities)
  2. Pt suffering from sustained ventricular tachycardia (without cardiac arrest) associated with structural heart disease (HCM, ARVD, valvular heart disease, congenital heart disease…)
40
Q

Who are appropriate candidates for ICD implantation: primary prevention?

A
  1. Pt with structural heart disease (ischemic or non-ischemic) with severe LV systolic dysfunction with the LVEF under 35%
  2. Pt with known arrhythmogenic condition and certain high risk features for developing life-threatening arrhythmias (inc. first line family Hx of sudden death)
    - LQTS
    - Brugada
    - HCM
    - ARVD
    - CPVT

_MS2 Cardio (35 decks)

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