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semester 2 year 2 week 9-16 > Fits, faints and funny turns > Flashcards

Fits, faints and funny turns Flashcards

1
Q

what is syncope?

A
  • Transient loss of consciousness due to impaired cerebral perfusion
  • Only difference between syncope and sudden death, is that in one you wake up
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2
Q

types of syncopes?

A
  1. Vagal
  2. Arrhythmia
  3. Structurally cardiac
  4. Orthostatic
  5. Cerebrovascular
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3
Q

types of non-syncopal blackout?

A
  1. Ictal (seizure)
  2. Migrainous
  3. Psychogenic
  4. Acute hydrocephalus
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4
Q

classify syncope into 4 groups?

A
  1. reflex syncope
  2. orthostatic syncope
  3. structural cardiac syncope
  4. arrhythmic
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5
Q

reflex syncope includes?

A
  1. vasovagal syncope
    2, situational ( cough, micturition)
  2. carotid sinus syndorme( hypersensitivity)
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6
Q

orthostatic syncope caused by?

A
  1. dehydration+ Hämorrhagie
  2. autonomic failure: DM, PD
  3. drugs: alcohol, diuretics,vasodilators
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7
Q

structural cardiac syncope include?

A
  1. aortic stenosis
  2. HCM
  3. cardiac tamponade
  4. PE
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8
Q

arrhythmic syncope include?

A
  1. tachycardia: VT, long QT syncope, electrolytes derangement, medication, Wolff-Parkinson
    white syndrome
  2. bradycardia: sinus, AV block
  3. channolopathies
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9
Q

types of cerebrovascular disorders?

A
  1. VBI

2. Subclavian steal

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10
Q

how to define high risk in pt with syncope ?

A 
San Francisco Syncope criteria
• Congestive heart failure hx
• Haematocrit <30%
• ECG abnormal
• Shortness of breath symptoms
• Systolic BP <90mmHg at triage
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11
Q

epidemiology of vasovagal syncope?

A

most common reflex syncope

usually in your pt while standing

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12
Q

aetiology of vasovagal syncope?

A

upright posture with or without stress( hot weather, lack of food, fear, prolonged standing, acute pain)

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13
Q

pathophysiology of vasovagal syncope?

A

(1) Patients often in low preload state due to venous pooling –prolonger standing or dehydration
(2) Superimposed anxiety and pain triggers sympathetic surge, causing ventricular contraction
(3) Vigorous contraction with low preload = low end diastolic volume
(4) Low EDV triggers intra-cardiac mechanoreceptors, which trigger the vagal reflex
(5) Vagal reflex causes bradycardia + vasodilation = hypotension + syncope

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14
Q

investigation for vasovagal syncope?

A

echo, tilet table testing, ILRs

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15
Q

how to treat vasovagal syncope?

A

education, eliminate vasodilators, diuretics, alcohol, hand grip, arm tensing, leg crossing( raising BP), alpha agonist( Midodrine), PPM

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16
Q

what is cardiac syncope?

A

Syncope secondary to a disorder arising within the heart; most commonly tachyarrhythmias and bradyarrhythmias

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17
Q

tachycardias causing syncope include?

A

§ VT

§ Supraventricular tachycardias associated with accessory pathway(WPW syndrome)

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18
Q

bradycardia causing syncope include?

A

§ Sinus node dysfunction
§ AV heart block(second/third degree)
§ AF with slow ventricular response

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19
Q

presentation of cardiac syncope?

A

o Syncope during exercise – CAD, HCM, long QT syndrome, WPW
o Palpitations
o Dyspnea

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20
Q

ECG changes in cardiac syncope?

A

o Evidence of prior MI or long QT = increased likelihood of VT
o Bradycardia, second/third degree heart block = sick sinus syndrome or AV block o Right BBB = PE
o Ischemic changes = MI
o Delta wave or short PR = accessory pathway (WPW syndrome)

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21
Q

what pt will you most commonly see VT?

A

patients with CAD and HF

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22
Q

what cases VT?

A
  • IHD – CAD associated in 80% cases
  • HF
  • Structural heart disease
  • others: Hypokalaemia, Hypomagnesemia, Hypoxia,
  • Drugs, anti-arrhythmics ,TCAs, macrolides,
  • Congenital=long QT syndrome, Brugada syndrome
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23
Q

clinical presentation of VT ?

A

o Light-headedness
o Near syncope or syncope
o Sudden cardiac death

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24
Q

ECG change in VT?

A

o Wide complex
o Fusion beats
o Capture beats
o AV dissociation

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25
how to treat VT?
- Unstable patients: Immediate cardioversion | - Stable patients: Baseline ECG, troponin, Check electrolytes, Review medications, Consult cardiology
26
what will sick sinus syndrome cause?
bradycardia | Episodic or persistent failure of sinus node; most common indication for pacemaker placement
27
etiology of sick sinus syndrome?
o Elderly o Fibrosis and degeneration of sinus node o Medication depression of sinus node = beta blockers, verapamil, digoxin, clonidine, lithium, methlydopa
28
clinical presentation of sick sinus syndrome?
o Severe and prolonged bradyarrhythmia = sudden syncope | o Mild bradycardia = weakness, dyspnea on exertion, angina, near syncope, TIA
29
ECG findings in sick sinus syndrome?
o Sinus bradycardia | o Sinus block exit
30
how to treat sick sinus syndrome?
o Discontinue medications causes node dysfunction o Pacemaker placement if indicated o Anticoagulation if patient in AF
31
what does AV block cause?
bradycardia | Secondary to conduction abnormalities in the AV node, bundle of His or bundle branches
32
classification of AV heart block?
o First degree – all of sinus impulses (P waves) are conducted, but PR interval is prolonged presentation o Second degree – some P waves are conducted o Third degree – none of the P waves are conducted
33
1st degree heart block?
prolonged conduction
34
2nd degere type 1
progressive prolongation
35
2nd degree type 2
sudden failure of conduction
36
3rd degree
no conduction
37
aetiology of heart block?
``` o Fibrosis of conduction system o IHD o Medications – beta blockers, verapamil, diltiazem, digoxin, amiodarone o Hyperkalaemia o Valvular heart disease o Increased vagal tone ```
38
how to treat heart block?
o Discontinue medications o Treat ischemia o Correct electrolyte abnormalities o Atropine o Pacemaker insertion if needed
39
what is channelopathies?
Mendelian disorders that affect ion channels distributing action potential formation in cardiac myocytes
40
types of channelopathies?
o Congenital long QT syndrome o Short QT syndrome o Brugada syndrome
41
what is congenital long QT syndrome?
- Rare - Delayed repolarisation of the heart (prolongation of the QT interval) - Increases risk of episodes of torsades de pointes and other ventricular arrhythmias - Presents as syncope and sudden cardiac death
42
what is short QT syndrome?
- Extremely short atrial and ventricular refractory periods - Paroxysmal atrial and ventricular fibrillation ,syncope and sudden death - Patients typically young and healthy, no structural abnormalities - Most common presenting symptom is cardiac arrest
43
Brugada syndrome
- ECG abnormality with high incidence of sudden death –incomplete BBB and ST elevations - Due to autosomal dominant mutation in sodium channel gene
44
morphology of HCM?
Impairment of compliance (diastolic dysfunction) – obstructive and non- obstructive types Thickening of ventricular septum Septal muscle bulges into LV outflow tract
45
histology of HCM
Massive myocyte hypertrophy Haphazard disarray of bundles of myocytes and contractile elements
46
pathogenesis of HCM
(1) Genetics – autosomal dominant, beta-myosin heavy chain, alpha- tropomyosin (2) Friedreich ataxia (3) Infants of a diabetic mother
47
presentation of HCM?
``` Harsh systolic ejection murmur heard at apex and lower left sternal border Young athletes – sudden cardiac death Exertional dyspnea Orthopnoea Syncope and presyncope Angina Palpitations CHF Dizziness ```
48
ECG on HCM?
ST elevation, depression T wave inversion Prominent Q waves | Left atrial enlargement Left axis deviation
49
Complication of HCM?
``` Atrial fibrillation Mural thrombus formation leading to embolisation – stroke Cardiac failure Ventricular arrhythmias Sudden death ```
50
Mx of HCM?
Beta blockers, CCBs, amiodarone Avoid inotropes, digitalis and diuretics Pacemaker insertion Septal reduction surgery Implantable cardiac defibrillator (ICD)
51
Pathogenesis of myocarditis?
Viruses – coxsackievirus, influenza, HIV, CMV o Chlamydiae o Rickettsiae o Candida o Neiserria meningococcus, corynebacterium diphtheriae o Post-streptococcal o SLE o Transplant rejection o Cardiotoxicity by chemotherapeutic drugs – anthracyclines – doxorubicin + daunorubicin o Other drugs – lithium, chloroquine
52
morphology of myocarditis?
o Normal or dilated | o Late stage – ventricular myocardium is flabby and mottled with focal myocyte necrosis
53
Clinical presentation of myocarditis?
o (1) Asymptomatic o (3) Fatigue, dyspnea, palpitations, precordial discomfort and fever o (2) Onset of heart failure or arrhythmias
54
causes of Aortic stenosis?
o Degeneration of a normal valve o Congenital bicuspid valve o Rheumatic heart disease
55
pathogenesis of aortic stenosis?
o Thickening and calcification of valve leaflets results in progressive obstruction of blood flow o LVH develops to compensate for obstruction
56
presentation of aortic stenosis
o Loud crescendo-decrescendo systolic murmur at R second intercostal space o May radiate to the carotids o When it becomes severe, 3 cardinal symptoms: HF (typically dyspnea on exertion), syncope and angina
57
how to treat aortic stenosis?
o Asymptomatic § Re-evaluate every 6months o Symptomatic § Mechanical correction–valve replacement
58
complication of aortic stenosis ?
§ Atrial fibrillation | § Increased bleeding tendency
59
what is Wolff-Parkinson White Syndrome
Congenital disorder in which an accessory bundle directly connects the atria and ventricular muscle by bypassing the AV node; life threatening arrhythmias may develop
60
pathophysiology of WPW syndrome?
Aberrant loop means atria and ventricles are not in sync Life threatening arrhythmias can develop: § Antidromic tachycardia - impulse spreads down accessory pathway and then back up His- Purkinje system (retrograde) § Atrialfibrillation
61
presentation of WPW syndrome?
``` o Can be asymptomatic o Palpitations o Near syncope o Syncope o Sudden death ```
62
ECG of WPW syndrome?
Short PR interval | Delta wave
63
causes of coma
``` toxin(alcohol, drug) trauma stroke infection( meningitis, encephalitis) failure ( CVS, Resp, liver, renal) hypolglycemia, hyperglycemia, hypothermia, hyperthemia brain tumor hypoTH cerebral malaria, yellow fever, trpanosomiasis, typhoid, rabies ```

semester 2 year 2 week 9-16 (11 decks)

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