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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
Q

how to treat VT?

A
  • Unstable patients: Immediate cardioversion

- Stable patients: Baseline ECG, troponin, Check electrolytes, Review medications, Consult cardiology

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26
Q

what will sick sinus syndrome cause?

A

bradycardia

Episodic or persistent failure of sinus node; most common indication for pacemaker placement

27
Q

etiology of sick sinus syndrome?

A

o Elderly
o Fibrosis and degeneration of sinus node
o Medication depression of sinus node = beta blockers, verapamil, digoxin, clonidine, lithium, methlydopa

28
Q

clinical presentation of sick sinus syndrome?

A

o Severe and prolonged bradyarrhythmia = sudden syncope

o Mild bradycardia = weakness, dyspnea on exertion, angina, near syncope, TIA

29
Q

ECG findings in sick sinus syndrome?

A

o Sinus bradycardia

o Sinus block exit

30
Q

how to treat sick sinus syndrome?

A

o Discontinue medications causes node dysfunction o Pacemaker placement if indicated
o Anticoagulation if patient in AF

31
Q

what does AV block cause?

A

bradycardia

Secondary to conduction abnormalities in the AV node, bundle of His or bundle branches

32
Q

classification of AV heart block?

A

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
Q

1st degree heart block?

A

prolonged conduction

34
Q

2nd degere type 1

A

progressive prolongation

35
Q

2nd degree type 2

A

sudden failure of conduction

36
Q

3rd degree

A

no conduction

37
Q

aetiology of heart block?

A 
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
Q

how to treat heart block?

A

o Discontinue medications
o Treat ischemia
o Correct electrolyte abnormalities o Atropine
o Pacemaker insertion if needed

39
Q

what is channelopathies?

A

Mendelian disorders that affect ion channels distributing action potential formation in cardiac myocytes

40
Q

types of channelopathies?

A

o Congenital long QT syndrome

o Short QT syndrome

o Brugada syndrome

41
Q

what is congenital long QT syndrome?

A
  • 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
Q

what is short QT syndrome?

A
  • 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
Q

Brugada syndrome

A
  • ECG abnormality with high incidence of sudden death
    –incomplete BBB and ST elevations
  • Due to autosomal dominant mutation in sodium channel gene
44
Q

morphology of HCM?

A

Impairment of compliance (diastolic dysfunction) – obstructive and non- obstructive types
Thickening of ventricular septum Septal muscle bulges into LV outflow tract

45
Q

histology of HCM

A

Massive myocyte hypertrophy Haphazard disarray of bundles of myocytes and contractile elements

46
Q

pathogenesis of HCM

A

(1) Genetics – autosomal dominant, beta-myosin heavy chain, alpha- tropomyosin
(2) Friedreich ataxia
(3) Infants of a diabetic mother

47
Q

presentation of HCM?

A 
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
Q

ECG on HCM?

A

ST elevation, depression T wave inversion Prominent Q waves

Left atrial enlargement Left axis deviation

49
Q

Complication of HCM?

A 
Atrial fibrillation
Mural thrombus formation leading to embolisation – stroke
Cardiac failure
Ventricular arrhythmias
Sudden death
50
Q

Mx of HCM?

A

Beta blockers, CCBs, amiodarone Avoid inotropes, digitalis and diuretics Pacemaker insertion
Septal reduction surgery
Implantable cardiac defibrillator (ICD)

51
Q

Pathogenesis of myocarditis?

A

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
Q

morphology of myocarditis?

A

o Normal or dilated

o Late stage – ventricular myocardium is flabby and mottled with focal myocyte necrosis

53
Q

Clinical presentation of myocarditis?

A

o (1) Asymptomatic
o (3) Fatigue, dyspnea, palpitations, precordial discomfort and fever
o (2) Onset of heart failure or arrhythmias

54
Q

causes of Aortic stenosis?

A

o Degeneration of a normal valve
o Congenital bicuspid valve
o Rheumatic heart disease

55
Q

pathogenesis of aortic stenosis?

A

o Thickening and calcification of valve leaflets results in progressive obstruction of blood flow
o LVH develops to compensate for obstruction

56
Q

presentation of aortic stenosis

A

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
Q

how to treat aortic stenosis?

A

o Asymptomatic
§ Re-evaluate every 6months o Symptomatic
§ Mechanical correction–valve replacement

58
Q

complication of aortic stenosis ?

A

§ Atrial fibrillation

§ Increased bleeding tendency

59
Q

what is Wolff-Parkinson White Syndrome

A

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
Q

pathophysiology of WPW syndrome?

A

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
Q

presentation of WPW syndrome?

A 
o Can be asymptomatic 
o Palpitations
o Near syncope 
o Syncope
o Sudden death
62
Q

ECG of WPW syndrome?

A

Short PR interval

Delta wave

63
Q

causes of coma

A 
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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