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Cardio Session 4 Flashcards

1
Q

All cardiac tachyarrhythmia are result of what? (2)

A
  1. Disorders of impulse initiation

2. Disorders of impulse conduction

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2
Q

When does an ectopic focus become the new pacemaker?

A

If firing rate of ectopic focus > SA node.

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3
Q

Triggered activity results from problems with what?

A

rECOVERY OF REPOLIARIZATION

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4
Q

What is the most common arrhythmia mechanism?

A

Re-entry

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5
Q

Re-entry occurs as what?

A

Repetitive excitation of a region of the heart and is a result of conduction of an electrical impulse around a fixed obstacle.

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6
Q

What does re-entry arrhythmia require?

This is the result of what?

A

Unidirectional conduction block.

  1. Accelerated heart rate
  2. Block of a premature impulse
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7
Q

How do paroxysmal arrhythmias present?

A

Asymptomatic

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8
Q

Arrhythmia related symptoms? (6)

A
  1. Palpitations
  2. Fatigue
  3. Light headedness
  4. Chest discomfort
  5. Dyspnea
  6. Presyncope
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9
Q

What % of arrhythmia patients have syncope?

A

15%

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10
Q

What age groups are affected by arrhythmia?

A

All

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11
Q

In young, people does arrhythmia occur when detectable heart disease?

A

Not usually

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12
Q

Define syncope

A

Transient loss of consciousness due to trnasient global cerebral hypoperfusion

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13
Q

What is syncope’s onset?
Duration?
Type of recovery?

A

Rapid onset
Short duration
Spontaneous complete recovery

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14
Q

What are symptoms of prodromal syncope? 5

A
  1. lightheadedness
  2. Nausea
  3. Sweating
  4. Weakness
  5. Visual disturbances
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15
Q

Syncope normally lasts how long?

A

Less than 20 seconds

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16
Q

Pre-syncopal is defined how?

A

Symptoms and signs that occur before consciouness in syncope

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17
Q

Define pre-syncope and near-syncope?

A

State the is similar to prodrome of syncope but is not followed by LOC.

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18
Q

What two things determine whether real syncope occurred?

A
  1. Loss of consciousness

2. Four defining features (transient, rapid onset, short duration, spontaneous recovery)

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19
Q

What are disorders with LOC but no hypoperfusion? (4)

A
  1. Epilepsy
  2. Metabolic disorders
  3. Intoxication
  4. TIA
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20
Q

In terms of patho, how is syncope defined?

A

Fall in systemic BP with a decrease in global cerebral blood flow

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21
Q

Systemic BP is determined by what?

A

CO

Total peripheral vascular resistance

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22
Q

Causes of transient low CO?

Which is most common

A
  1. Reflex causing bradycardia (most common)
  2. Orthostatic hypotension
  3. Cardiovascular syncope
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23
Q

What is most common cardiovascular cause of syncope?

A

Arrhythmia

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24
Q

When are the two peaks in syncope incidence?

A

15 and 65

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25
What is most common cause of syncope at 15?
Reflex
26
Orthostatic hypotension is common cause of syncope in what population?
Elderly
27
What is most common etiology of syncope in ER?
Uncomplicated faints
28
What are the 3 P's of uncomplicated faints?
1. Posture: Prolonged standing 2. Provoking factors: Pain or medical procedure 3. Prodromal symptoms: Sweating, or feeling warm
29
What test has the highest yield in terms of diagnosing and managing syncope? What other quality does this test have?
Postural blood pressure | Cheapest
30
How is orthostatic hypotension defined in measurements?
Reduction of systolic BP by at least 20 mm Hg and diastolic BP by at least 10 mm Hg within 3 minutes of standing
31
When does orthostatic hypotension test work best?
Patient goes from lying to standing
32
In the Baggish article, what percentage of syncope in athletes was related to exercise?
1.3%
33
Most common cause of sudden cardiac death in US youth is what?
Hypertrophic cardiomyopathy
34
Most widely used form of performance enhancing agents?
Androgenic anabolic steroids
35
In passive surveillance, what is most common cause of sudden death of youth?
Hypertrophic cardiomyopathy
36
In acute surveillance, what is most common cause of sudden death in youth?
No identifiable structural abnormality
37
Difference in sexes in military sudden death?
Mortality rate 4X as high in males
38
Morality from nontraumatic cardiac events increases with what?
Age
39
Difference between sexes in mortality when less than 24 years old?
Non
40
40% of deaths in military study were due to what?
Exertion
41
Sudden death during exertion was most common in what age group?
<35
42
Pre-existing condition was in what % of military sudden deaths?
53%
43
Abnormal heart sounds in military sudden deaths?
1. Vent fib = half | 2. Asystole = third
44
What % of military sudden death had structural abnormality?
80%
45
Leading cause of death in those less than 35 years old?
Sudden unexplained death
46
Leading cause of death in those older than 35?
ASCAD
47
What % of military had deaths due to hypertrophic cardiomyopathy?
6%
48
Is sudden death dependent on level of competition?
No
49
Most common cause of sudden death in middle aged athletes?
ASCAD
50
What is the single most common cause of athletes deaths?
Hypertrophic cardiomyopathy
51
Define HCM
LV and/or RV hypertrophy that is usually assymmetrical and associated with myocardial fiber disarray
52
What is most common type of asymmetric hypertrophy?
Ventricular septal hypertrophy
53
What causes the subaortic obstructive HCM?
1. Narrow LV outflow tract due to ventricular septal hypertrophy and anterior displacement of papillary muscles
54
What causes mitral regurg in subaortic obstructive HCM?
Failure of mitral leaflets to close properly due to hypertrophy
55
Systolic function changes in HCM?
High ejection fraction
56
Diastolic dysfunction changes in HCM?
Impaired relaxation (chamber compliance decrease)
57
Symptoms of obstructive HCM? (3)
1. Dyspnea 2. Angina 3. Presyncope/Syncope
58
RV involvement in HCM is detected how?
Prominent A wave
59
LV involvement in HCM is detected how? 2
Displaced LV impulse w | S4
60
LV involvement in obstructive HCM is seen how? 3
1. bifid arterial pulse 2. Increased # of beats 3. Reversed splitting of S2
61
HCM is more rapid in what age group?
Children
62
Best predictor of HCM outcome?
Nature of molecular genetic defect
63
2 characteristics of HCM?
Myocyte hypertrophy | Fiber disarray
64
Left ventricular outflow tract (LVOT) obstruction occurs in what % of HCM?
70
65
LVOT results in? (4)
1. Diastolic dysfunction 2. Elevated LV EDP 3. Mitral regurg 4. Myocardial ischemia
66
Clinically, LVOT causes what? (3)
1. Dyspnea 2. Ischemic chest pain 3. Presyncope or syncope with exertion
67
What is most common genetic heart disease?
HCM
68
HCM mutation occur in what genes?
Proteins of sarcomere, most commonly beta myosin heavy chain and myosin binding protein C
69
``` When a person stands, effect on venous return? PVR? Stroke volume? Volume of blood in LV? ```
Decrease Decrease Decrease Decrease
70
``` When a person stands, effect on venous return? PVR? Stroke volume? Volume of blood in LV? ```
All increase
71
Strain phase of valsalva results in what?
Decreased LV volume from decreased venous return Decreased PVR and BP
72
Release of valsalva has what effect?
Increased LV volume form increased venous return | Increased PVR and BP
73
Isometric exercise has what effect on aortic and mitral regurg? Effect on click of mitral valve prolapse HCM murmur effect
Louder murmur Click later Softer murmur
74
Amyl nitrate inhalation has what effect on mitral and aortic regurg? Effect on aortic stenosis Effect on hypertrophic cardiomyopathy
Softer murmur Louder murmur Louder murmur
75
Standing/Valsalva has what effect on murmur of MVP, HCM, and AS?
MVP: Louder HCM: Louder AS: Softer
76
Squatting/Valsalva release has what effect on murmur of MVP, HCM, and AS?
MVP: Softer HCM: Softer AS: Louder

ICM (4 decks)

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