Gen Med Flashcards
Brugada Syndrome
Genetic disorder
Predisposes to sudden cardiac death
Caused by defect in SCN5A Gene
If symptomatic
- Tachyarrhythmias
- ST elevation +/- T wave inversion on ECG
- T wave inversion may be called ‘cove’ or ‘saddleback’
Jervel and Lange-Nielsen Syndrome v
Romano-Ward Syndrome
Form of Long QT syndrome
- Prolonged T interval, can cause arrhythmias
- Also presents w sensorineural hearing loss.
- Hearing loss absent in Romano-Ward Syndrome
Lown-Ganong-Levine Syndrome
Pre-excitation syndrome
Presents with a shortened PR interval and normal QRS complexes
Usually benign
Wolff-Parkinson-White syndrome
May present with tachyarrhythmias, particularly Supraventricular tachycardia
Due to accessory pathway linked atria and ventricles separate to AV node, called bundle of Kent
Characteristic Delta Wave
Wellen’s syndrome
Resolved chest pain with deeply inverted T waves in V2-3 in patients with unstable angina ?Wellen’s pattern
Suggests critical stenosis of proximal LAD artery
Starts as biphasic T wave inversion morphs into deep T wave inversion in V2-3
No Q waves
Normal ECG variants in athlete
The following ECG changes are considered normal variants in an athlete:
- sinus bradycardia
- junctional rhythm
- first degree heart block
- Mobitz type 1 (Wenckebach phenomenon)
SVT Management
Acute management
-
vagal manoeuvres:
- Valsalva manoeuvre: e.g. trying to blow into an empty plastic syringe
- carotid sinus massage
-
intravenous adenosine
- rapid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg
- contraindicated in asthmatics - verapamil is a preferable option
electrical cardioversion
Prevention of episodes
beta-blockers
radio-frequency ablation
Stroke Assesment Tool?
ROSIER Score
Stroke Investigations
A non-contrast CT head scan is the first line radiological investigation for suspected stroke
- one of the key questions to answer is whether there is an ischaemic stroke or haemorrhagic stroke. Rarely a third pathology such as a tumour may also be detected
- this is especially important given the increasing role of thrombolysis and thrombectomy in acute stroke management
-
acute ischaemic strokes
- may show areas of low density in the grey and white matter of the territory. These changes may take time to develop
- other signs include the ‘hyperdense artery’ sign corresponding with the responsible arterial clot - this tends to visible immediately
-
acute haemorrhagic strokes
- typically show areas of hyperdense material (blood) surrounded by low density (oedema)
Hypercalcaemia: features
Features
- ‘bones, stones, groans and psychic moans’
- corneal calcification
- shortened QT interval on ECG
- hypertension
Proton pump inhibitors action & adverse effects
Proton pump inhibitors (PPI) cause irreversible blockade of H+/K+ ATPase of the gastric parietal cell.
Examples include omeprazole and lansoprazole.
Adverse effects
- hyponatraemia, hypomagnasaemia
- osteoporosis → increased risk of fractures
- microscopic colitis
- increased risk of Clostridium difficile infections
Metformin MOA
Mechanism of action
- acts by activation of the AMP-activated protein kinase (AMPK)
- increases insulin sensitivity
- decreases hepatic gluconeogenesis
- may also reduce gastrointestinal absorption of carbohydrates
Metformin Adverse Effects
Urinary incontince + gait abnormality + dementia?
Normal pressure hydrocephalus
Normal pressure hydrocephalus is a reversible cause of dementia seen in elderly patients. It is thought to be secondary to reduced CSF absorption at the arachnoid villi. These changes may be secondary to head injury, subarachnoid haemorrhage or meningitis.
A classical triad of features is seen
- urinary incontinence
- dementia and bradyphrenia
- gait abnormality (may be similar to Parkinson’s disease)
It is thought around 60% of patients will have all 3 features at the time of diagnosis. Symptoms typically develop over a few months.
Imaging
- hydrocephalus with ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement
Management
- ventriculoperitoneal shunting
- around 10% of patients who have shunts experience significant complications such as seizures, infection and intracerebral haemorrhages
