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Clasp Sudden Death Flashcards

1
Q

What is central dogma?

A

how genes become protein

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2
Q

What is the function of exons?

A

part of genetic code that codes for protein

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3
Q

What happens to introns to make a protein?

A

have to be spliced

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4
Q

What is a promotor sequence?

A

Part of genetic code that tells RNA transcriptase where to start

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5
Q

What is a missense mutation

A

point mutation in which a single nucleotide change results in a codon which codes for a different amino acid

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6
Q

What is a conserved gene?

A

a gene that has remained essentially unchanged through evolution- suggests its unique and essential

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7
Q

How do you correct QT interval for HR?

A

QT interval/ (square root of R-R)

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8
Q

What cardiac arrhythmia is classically associated with long QT syndrome?

A

torsades de pointes

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9
Q

What is the defining characteristic of ventricular tachycardia?

A

QRS complex is greater than 120ms

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10
Q

What drug class is used in the treatment of long QT syndrome?

A

beta blockers

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11
Q

What is shock?

A

inadequate organ perfusion leading to inadequate oxygen delivery to tissues and eventually organ failure

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12
Q

What are the 5 types of shock?

A

hypovolaemic; cardiogenic; septic; anaphylactic and neurogenic

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13
Q

What is the most common infection to cause septic shock?

A

gram positive bacterial infection

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14
Q

What are examples of causes of neurogenic shock?

A

spinal cord injury; spinal anaesthesia

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15
Q

What are the common signs of shock?

A

tachycardia; hypoxia; tachypnoea; increased capillary refill time; decreased UO; pallor; cold

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16
Q

What is Frank Starling’s Law?

A

increasing end diastolic volume eg preload increased the cardiac output

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17
Q

What is afterload?

A

resistance LV must overcome to circulate blood

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18
Q

What are the two equations for CO?

A

CO=HRxSV; CO=MAP/SVR

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19
Q

What is oxygen delivery (DO2) equal to?

A

CO x CaO2

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20
Q

What makes up arterial oxygen content?

A

o2 with haemoglobin and dissolved o2

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21
Q

What is the pathogenesis of anaphylactic shock?

A

sensitised mast cells have IgE on surface which allergen binds to, causing mast cell degranulation and release of inflam mediators eg histamine and PGs, histamine activate H1 receptors on endothelium making hte vessels leaky

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22
Q

How does adrenalide counteract anaphylaxis?

A

binds to adrenergic receptors on endothelium to close up leaks which reverses process of anaphylaxis

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23
Q

What are the features of cardiogenic shock?

A

pulmonary oedema and hypotension

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24
Q

What is the key issue in cardiogenic shock?

A

heart failure

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25
Q

What is the key issue in neurogenic shock?

A

loss of sympathetic outflow in thoracic spine

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26
Q

What is sepsis 6?

A 
Blood cultures 
Urine output
Fluid challenge
Antibiotics 
Lactate
Oxygen
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27
Q

What are the reversible causes of cardiac arrest?

A

hypovolaemia; hypoxia; hypothermia; metabolic causes; tension pneumo; cardiac tamponade; toxin and thrombus

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28
Q

What heart rhythms is immediate defibrillation appropriate for?

A

VF and pulseless VT

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29
Q

What is the pathophysiological process underlying cardiac arrest with hypovolaemia?

A

inadequate stroke volume to maintain cardiac output

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30
Q

What is the pathophysiological process underlying cardiac arrest with hypoxia?

A

lack of oxygen at amitochondrial level in the myocytes

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31
Q

What is the pathophysiological process underlying cardiac arrest with hypothermia?

A

slows metabolic activity until enzymes stop functioning

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32
Q

What is the pathophysiological process underlying cardiac arrest with metabolic causes?

A

destroys electro-chemical balance across cell membrane

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33
Q

What is the pathophysiological process underlying cardiac arrest with tension pneumo?

A

greater pressure in pleural cavity then in lung squashes the lung

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34
Q

What is the pathophysiological process underlying cardiac arrest with tamponade?

A

myocardium squashed by pericardial fluid

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35
Q

What is the pathophysiological process underlying cardiac arrest with thrombus?

A

clot in lungs/coronary vessels preventing flow

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36
Q

What is the treatment for cardiac arrest caused by hypoxia?

A

oxygen and atropine

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37
Q

What is atropine?

A

a muscarinic receptor antagonist

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38
Q

What is cardiac arrest?

A

cardiac output is not sufficient for a palpable carotid pulse

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39
Q

What drugs are used in cardiogenic shock?

A

inotropes eg dobutamine, milnarone

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40
Q

What are the indicators of severe sepsis?

A

tachypnoea >=22; hypotension systolic <100mmHg; altered mental status

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41
Q

What are the 3 important types of thrombus causing cardiac arrest?

A

PE; atherosclerotic plaque; amniotic fluid embolism

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42
Q

What is the time for clinical death to biologic death under normal temp?

A

3-6mins

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43
Q

What is the difference between biologic death and clinical death?

A

clinical death is a reversible state

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44
Q

What is the most common cause ofcardiac arrest?

A

coronary heart disease

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45
Q

How often should adrenaline be given in ALS?

A

every 3-5mins

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46
Q

When should amiodarone be given in ALS?

A

after 3 shocks

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47
Q

How deep should cardiac compression be?

A

5-6cm

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48
Q

How many cardiac compressions be done?

A

100-120/min

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49
Q

Why should you not lean whilst doing CPR?

A

to ensure recoil without losing contact between hands and sternum

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50
Q

What can be used to meausre CPR in real time?

A

waveform capnography

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51
Q

What are the non-shockable rhythms?

A

PEA and asystole

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52
Q

What are the features of VF?

A

bizarre irregular waveform; no recognisable QRS complexes; random freq and amplitude

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53
Q

What are the causes of transthoracic impedenace?

A

electrode size; distance between electrodes; size of chest; hairy chest; poor electrode contact; air trapping

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54
Q

What are the features of monomorphic VT?

A

broad compex rhythm; rapid rate; constant QRS morphology

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55
Q

What are the clinical signs of a tension penumo?

A

decreased breath sounds; hyper-resonant percussion note; tracheal deviation

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56
Q

When should cardiac tamponade be considered as a diagnosis?

A

penetrating chest trauma or after cardiac surgery

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57
Q

what is the immediate post cardiac arrest treatment?

A

use ABCDE approach; aim for SpO2 of 94-98; normal PaCO2; ECG; treat cause

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58
Q

How long is seconds in one big box on ECG?

A

0.2s

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59
Q

How long is a small box on ECG?

A

0.04s

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60
Q

How is HR calculated from ECG?

A

300/large squares of R-R

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61
Q

What is the normal length of the PR interval?

A

0.12-0.2s

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62
Q

What is the normal QRS complex interval?

A

<120ms

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63
Q

How long should QT interval be?

A

<0.44s - F; <0.4s in M

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64
Q

What suggests a risk of asystole with bradycardia?

A

recent asystole; Mobitz II AV block; complete heart block with broad QRS; ventricular pause >3s

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65
Q

What is bradycardia often associated with?

A

shock; syncope; myocardial ischaemia; heart failure

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66
Q

what is the first line treatment for bradycardia

A

atropine

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67
Q

What is classic picture seen on ECG with atrial flutter?

A

saw tooth

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68
Q

What is the difference between atrial flutter and atrial fibrillation?

A

atrial flutter the atria beat regularly and more often than the ventricles whereas AF is irregular and produced in the pulmonary veins not atria

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69
Q

What are the features of AF on ECG?

A

irregularly irregular QRS; no p waves

70
Q

What is typical atrial rate in AF?

71
Q

What are the features of ventricular tachycardia on ECG?

A

regular, wide bizarre QRS

72
Q

What are the features of torsades de pointes on ECG?

A

200-250bpm; regular or irregular; sinusoidal pattern; twisting of axis

73
Q

What is torsades de pointes typically associated with?

A

electrolyte abnormalities

74
Q

What is the definition of first degree AV block?

A

regular prolonged PR interval >0.2s

75
Q

What are the features of type 1 Mobitz?

A

regularly irregular; increased PR interval until dropped beat then cycle starts over

76
Q

What are the features of Mobitz second degree?

A

some p waves not conducted but p waves usually regular and same PR interval for all conducted beats

77
Q

What are the features of complete heart block on ECG?

A

regular p waves and regular QRS complexes but no relationship between them

78
Q

What channel do class I anti-arrhythmic drugs target?

A

sodium channels

79
Q

What do class II anti-arrhymic drugs target?

A

beta-adrenoceptor antagonists- beta blockers

80
Q

What do class III anti-arrhythmic drugs target?

A

potassium channels

81
Q

What do class 4 anti-arrhythmic drugs target?

A

calcium channels

82
Q

Which classes of anti-arrhythmics are involved in rate control?

A

classes II and IV

83
Q

Waht classes of anti-arrhythmics are invovled in rhythm control?

A

class I and III

84
Q

What is the mechanism of action of adenosine?

A

opens potassium channels in the AV node

85
Q

What is the MOA of digoxin?

A

stimulates vagal activity- slows conduction and prolongs refractory period in AV ndoe and bundle of His

86
Q

Give an example of type 1a agents?

A

disopyramide and procainamide

87
Q

give an example of a type Ib agent?

A

lignocaine

88
Q

Give an example of a type Ic agent?

A

flecainide

89
Q

Give examples of type III agents?

A

amiodarone and sotolol

90
Q

When do afterdepolarisations occur?

A

during phase 3 or 4 of an AP

91
Q

When are afterdepolarisations more likley to occur?

A

when the AP duration is abnormally long

92
Q

When do early afterdepolarisations occur?

A

during late phase 2 or 3

93
Q

When do delayed afterdepolarisations occur?

A

late phase 3 or early phase 4

94
Q

What arrythmia is asssociated with early afterdepolarisations?

A

torsades de pointes

95
Q

What is the most common mutation causing long QT syndrome?

A

KCNQ1- potassium channel

96
Q

What arrhythmia is associated with long QT syndrome?

A

torsades de pointes

97
Q

What is the difficulty with diagnosing long AT syndrome?

A

no set length of QT so where is the line drawn- but, as length increases. risk of SCD increases

98
Q

What is the most common mutation associated iwth Brugada syndrome?

A

SCN5A-15%: most patietns do not have an ideentified mutation

99
Q

What is isolated LQT known as?

A

Romano-Ward Syndrome

100
Q

What is the LQT associated with deafness known as?

A

Jerrell Lange-Neilson syndrome

101
Q

What happens in torsades de pointes?

A

normal SA beat and the abnormal beat lands when half of heart is refractory and half is ready so ready half receives beat then it passes to the other half which is now ready and etc.

102
Q

What is LQTS defined as?

A

QTc >=480ms in repeated ECGs

103
Q

What are the common triggers for SCD in LQTS?

A

sleep; stress and exercise

104
Q

Why is congenital short QT syndrome rarely seen?

A

not compatible with life- usually die in utero or as baby

105
Q

What channels are affected in short QT syndrome?

A

potassium channels

106
Q

What is seen on ECG with Brugada syndrome?

A

ST elevation and RBBB in V1-3

107
Q

What common arrhythmia is associated with Brugada syndrome?

108
Q

What arrthmias are pts with Brugada syndrome at risk of?

A

AF; torsades; VF

109
Q

Why is it difficult to diagnose Brugada syndrome?

A

intermittnet and changeble ECG changes

110
Q

What is the problme channel in Brugada syndrome?

A

sodium channels

111
Q

What are the triggers for ECG changes in Brugada syndrome?

A

stress esp. fever; flecainide- blocks sodium channels

112
Q

How is brugada syndrome inherited?

113
Q

Which sex is brugada syndrome more common in?

114
Q

What is catecholaminergic polymoprhic VT?

A

adrenaline induced (exaggerated reaction to normal levels of adrenaline) bidirectional VT

115
Q

How is catecholaminergic polymorphic VT inherited?

116
Q

What is the treatment for catecholaminergic polymorphic VT?

A

beta blockers; felcainide; sympathetic denervation surgery

117
Q

What is the problem in Wolff-Parkinson White syndrome?

A

accessory pathway between atria and ventricles

118
Q

Waht is needed to diagnosed WPW syndrome?

A

palpitations and ECG appearnace

119
Q

What is a delta wave?

A

slurred upstroke into QRS; delayed onset into QRS

120
Q

Waht is seen on ECG with WPW syndrome?

A

delta waves and short PR interval

121
Q

What is the most common arrhthmia with WPW syndrome?

A

atrioventricular reentrant tachycardia- SVT

122
Q

What is the most common mutation in hypertrophic cardiomyopathy?

A

sarcomere genes

123
Q

What is the risk of mortality with HCM?

A

1% per year risk of mortality

124
Q

How do you determine whether to give an ICD to HCM patients?

A

HCM risk calculator

125
Q

What is affected in dilated cardiomyopathy?

A

sarcomeres and desmosomes

126
Q

What is the RF for developing dilated cardiomyopathy?

127
Q

Which gender gets dilated cardiomyopathy more commonly?

128
Q

What happens in arrhythmogenic right ventricular cardiomyopathy?

A

fibro-fatty replacement of cardiomyocytes- loss of heart structure and change in conduction

129
Q

What increases your isk of SCD with arrhythmogenic RV cardiomyopathy?

A

FHx of premature SCD; secerity of RV and LV function; ECG- QRS prolongation; male, older at presentation

130
Q

What drug is particularly useful in arrhythmogenic RV cardiomyopathy?

A

sotalol- has some class III anti-arrhytmic action

131
Q

What is the significance of an intronic variant?

A

low likelihood of effect

132
Q

What is the significance of a mutation of the edge of an exon?

A

splicing error

133
Q

What is the significance of an exonic variant?

A

1- change amino acid
2- create stop codon
3- cause frameshift
4- have no effect

134
Q

What does cDNA stand for?

A

complementary DNA

135
Q

What is cDNA?

A

essentialy mature mRNA sequence with introns removed

136
Q

What is Loeys Dietz syndrome associated with?

A

bifid uvula; down-slanting eyes and aortic aneurysms

137
Q

Above which grading intensity of heart murmurs are thrills present?

138
Q

When is JVP raised?

A

if >4cm above sternal angle

139
Q

What is a positive abdominojugular reflex?

A

JVP is raised through 15s compression

140
Q

What does a positive abdominojugular reflex mean?

A

RV failure

141
Q

What is the treatmnet for native valve indolent endocarditis?

A

amoxicillin and gentamicin

142
Q

What is the main bug associated with native valve indolent endocarditis?

A

strep. viridans

143
Q

what is the treatment for acute native valve endocarditis?

144
Q

What is the main bug associated with native valve acute endocarditis?

145
Q

What is the treatment for prosthetic vlave of MRSA endocarditis?

A

vancomycin, rifampicin and gent

146
Q

What are roth spots?

A

boat-shaped retinal haemorrhage with pale centre

147
Q

What vessel is ST elevation in V2-V4 assocaited with?

A

diagnoal branch of LAD

148
Q

What vessel is ST elevation in V1 and V2 assocatied iwth?

A

septal branch of LAD

149
Q

what vessel is ST elevation in V1-6 associated iwth?

150
Q

What vessel is ST elevation in I, AvL, V5 and V6 associated iwth?

A

circumflex branch of LCA

151
Q

What vessel is ST elevation in II, III and aVF associated iwth?

152
Q

What is first line tx for SVT?

A

vagal manoeuvres

153
Q

what is 2nd line for SVT?

154
Q

What is 3rd line for SVT?

A

beta blocker

155
Q

What paitnets is adenosine CI in?

156
Q

What should be used instead of adenosine in asthmatics?

157
Q

What is used for pharma cardioversion with AF/flutter?

A

flecainide

158
Q

what should be used with structural heart damage in pharm cardioversion with AF/flutter?

A

amiodarone

159
Q

What is the treatment for sustained VT?

A

amiodarone

160
Q

What is hte treatment for torsades?

A

magnesium sulphate

161
Q

What is the treatment for bradycardia?

162
Q

Which korotkoff sound is systolic pressure?

163
Q

Which korotkoff sound in diastolic pressure

164
Q

What is the mnemonic for classses of antiarrhythmics?

A

South Beach Polka

165
Q

What is the difference between the dihydropyridines and non-dihydropiridines?

A

dihydropirimidines work only on vascular smooth muscle, whereas non- heart and vascular

166
Q

What does hepb surface antigen mean?

A

infected with hep b -acute or chronic

167
Q

what does hep b surface antibody ?

A

devloped immunity to hep b- natural or vaccinr

168
Q

What does HBeAg mean?

A

virus is multiplying

169
Q

What does hep b core antibody mean?

A

person has been infected with hep b-dont get with vaccine

170
Q

What does IgM anti-Hbc mean?

A

acute infection

Reproduction (52 decks)

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