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M103 T3 > M103 T3 Symposium sudden death 1 - Harry Witchel > Flashcards

M103 T3 Symposium sudden death 1 - Harry Witchel Flashcards

1
Q

What are the systems that, when affected, can cause sudden death?

A

Heart and/or its vessels
Non cardiac vessels (stroke or aneurysm)
Pulmonary system (pulmonary embolism)
CNS - rare seizures in epilepsy

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2
Q

What are the disorders leading to risks for sudden cardiac death?

A

CHD / low LVEF
structural heart disease (e.g. cardiomyopathies)
developmental/genetic structural pathologies of the heart
primary arrhythmia

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3
Q

What are primary cardiac arrhythmias caused by?

A

mutations in genes primarily encoding ion channels

leads to a fundamental electrical failure of the heart that causes heart failure where it discontinues beating

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4
Q

What is a Cardiac Arrest otherwise known as?

A

cardiopulmonary arrest

circulatory arrest

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5
Q

What can an acute myocardial infarction sometimes cause?

A

cardiac arrest

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6
Q

What can happen to the heart during an acute myocardial infarction?

A

usually it will continue pumping, but less effectively

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7
Q

What are the broad categories of arrhythmia causes?

A

Electrical (Primary or Arrhythmogenic)
Structural
Ischaemic

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8
Q

What are electrical arrhythmias caused by?

A

when there are problems with ion channels and electrical issues at cellular level
when there might be extra conduction pathways at the organ level

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9
Q

What are structural arrhythmias caused by?

A

unusual shape or size of cardiac tissue that changes signal pathway

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10
Q

What are ischaemic arrhythmias caused by?

A

when the patient has hypoxia
it makes local heart tissue electrically unstable
it effectively changes signal pathway, leading to delays that interfere with cardiac conduction cycle

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11
Q

What can changes to the signal pathway in structural arrhythmias result in?

A

signal delays that interfere with cardiac conduction cycle

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12
Q

What can changes to the signal pathway in structural arrhythmias result in?

A

signal delays that interfere with cardiac conduction cycle

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13
Q

What are the causes of primary arrhythmia?

A

Unstable myocardium
Ion channel pathologies
Accessory conduction pathways

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14
Q

What is an unstable myocardium caused by in a primary arrhythmia?

A

damaged or hypoxic tissue

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15
Q

What is an example of an unstable myocardium caused by in a primary arrhythmia?

A

Atrial Fibrillation

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16
Q

What is an example of a channelopathy?

A

Long QT syndrome

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17
Q

What happens when Accessory conduction pathways malfunction?

A

sometimes the transmission of electrical signals along the heart goes in the reverse direction
so rather than going from the atria to the ventricles, it goes the other way

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18
Q

If a patient’s QT intervals are longer than normal, what are they at risk of?

A

primary arrhythmia

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19
Q

If a patient’s QT intervals are longer than normal, what are they at risk of?

A

primary arrhythmia

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20
Q

What are the consequences of cardiomyopathy?

A

there is a risk of pumping dysfunction
there is a risk of low output heart failure
there is a risk of conduction abnormalities

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21
Q

Why does cardiomyopathy cause negative effects?

A

bc the normal pathways of electrical conduction are altered

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22
Q

What are the two types of cardiomyopathy?

A

Hypertrophic

Dilated

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23
Q

What are other terms for hypertrophic and dilated cardiomyopathy?

A

hy - concentric

di - eccentric

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24
Q

What are the differences between hypertrophic and dilated cardiomyopathy?

A

hy - any age or gender

di - most common in 20 - 60 year olds and in males

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25
Q

What causes hypertrophic cardiomyopathy?

A

Inner LV chamber shrinks

Myocardium thickens

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26
Q

What is an effect of hypertrophic cardiomyopathy?

A

Sudden death in young athletes

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27
Q

What is an example of a developmental defect in the heart?

A

Tetralogy of Fallot

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28
Q

What are two examples of developmental defects in the heart?

A

an extrasystole

a nearby focus of rapid firing

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29
Q

What might be the causes for cardiac tissue becoming a substrate?

A

a predisposing factor

an electrical defect

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30
Q

What are examples of structural defects in the heart?

A

fibrosis or inflammation caused by IHD

31
Q

What are examples of electrical defects in the heart?

A

genetic or pharmacological problems with ion channels or electrolytes

32
Q

What happens during an R on T?

A

a premature QRS complex occurs during the previous T wave

33
Q

What is the vulnerable period?

A

the T wave

34
Q

When does the vulnerable period occur?

A

During repolarisation of ventricular AP

Refractory period is ending

35
Q

What is the resulting QRS wave after the vulnerable period?

A

a premature ventricular contraction

36
Q

Which conditions are Implanted Electronic Devices mostly used to treat?

A

bradyarrhythmias

heart block

37
Q

What is the difference between and an Implanted Electronic Device and an Implantable Cardioverter Defibrillator?

A

electronic - applies electrical pulses on each beat

cardioverter - applies electrical impulses ONLY when ventricular dysrhythmias detected

38
Q

When might an implantable cardioverter defibrillator be implanted?

A

cardiac arrest due to ventricular fibrillation
symptomatic heart failure with low LVEF
Low output heart failure after MI (40 days later)
cardiomyopathies
congenital

39
Q

What is an example of a cardiomyopathy?

A

Dilated cardiomyopathy

40
Q

What is an example of a congenital reason for why an implantable cardioverter defibrillator be implanted?

A

Tetralogy of Fallot

41
Q

What is an example of a Channelopathy?

A

long QT syndrome

42
Q

What is the effect of antiarrhythmic drugs?

A

they usually affect ion channel activity or sympathetic drive

43
Q

What are examples of antiarrhythmic drugs?

A

Amiodarone

Beta blockers

44
Q

Which antiarrhythmias are antiarrhythmic drugs used for?

A

supraventricular arrhythmias

Arrhythmias arising from atria or AV node

45
Q

Which works least effectively, antiarrhythmic drugs or pacing or ICDs?

A

antiarrhythmic drugs

46
Q

What can reperfusion injury lead to?

A

electrical irregularities

risk of sudden cardiac death

47
Q

When might there be an increased risk of reperfusion injury?

A

in the myocardium after percutaneous coronary intervention

in the brain tissue after an ischaemic stroke

48
Q

How does reperfusion injury occur?

A

circulation is restored

this results in inflammation and oxidative damage

49
Q

What are preventative treatments for reperfusion injury?

A

Cooling
Immunosuppression - to prevent inflammation
Oxygen radical scavengers

50
Q

How do xxygen radical scavengers work to stop oxygen radicals in reperfusion injury?

A

they pick up oxygen radicals and and get rid of their electrons
so it prevents the oxygen radicals from causing a chain reaction of damage

51
Q

What are both syncope and seizures associated with?

A

a loss of consciousness

the symptoms are described as “black outs”

52
Q

What can delay the diagnosis of syncope and seizures?

A

figuring out which condition matches the symptoms bc they’re so similar
Can be difficult to differentiate from a patient’s description

53
Q

When does syncope occur?

A

when the heart and the vessels aren’t supplying blood to the brain effectively

54
Q

What visual effects do seizures tend to be associated with?

A

stiffness
unusual postures/ movements
patients “tip over”

55
Q

What visual effects does syncope tend to be associated with?

A

patients crumple into themselves

56
Q

How might a seizure or syncope patient present which might make it hard to diagnose?

A

might have nothing abnormal on examination

57
Q

How is syncope recognised in a patient?

A

it might be registered by Holter monitor

58
Q

How do Holter monitors work?

A

involves measuring their ECG for either 24 hrs or up to five or seven days

59
Q

How are seizures recognised in a patient?

A

an EEG

a brain scan

60
Q

What does an electroencephalogram involve?

A

electrodes on the scalp

61
Q

Why are brain scans used in regard to seizures?

A

when seizures are caused by underlying structural abnormalities, the brain imaging can sometimes show what might be causing the seizures

62
Q

Why are brain scans used in regard to seizures?

A

when seizures are caused by underlying structural abnormalities, the brain imaging can sometimes show what might be causing the seizures

63
Q

What causes the different ways in which syncope and seizure patients fall?

A

syn - crumple - bc the brain has lost all power so it loses control of all the muscles
seiz - tip over - bc the brain is over active, patients remain stiff

64
Q

Which condition features the same effects as a normal seizure?

A

convulsive syncope

65
Q

What are two common types of syncope?

A

Exertional syncope

Vasovagal Syncope

66
Q

What is Vasovagal Syncope associated with?

A

Vagal increase (& symp decrease)
vasodilatation
low heart rate

67
Q

Where in the body are Vasovagal Syncopes triggered from?

A

centrally - the brain

not triggered at level of heart

68
Q

What causes Vasovagal Syncope?

A

the physiological changes in the body that vasovagal syncope is associated with leads to a pressure drop throughout the NS
so blood will stop going uphill against gravity and will not go to the brain

69
Q

What is the most common form of syncope?

A

Vasovagal Syncope

70
Q

What group is Vasovagal Syncope most common in?

A

in young adults

71
Q

Where in the body are Vasovagal Syncopes triggered from?

A

it has neurogenic origin

72
Q

What does the Number Needed to Treat indicate?

A

describes how good / bad / effective a particular treatment might be IOT to compare it to other treatments

73
Q

What happens if a mutation in the gene responsible for a particular autosomal dominant disorder has 95% penetrance?

A

95% of those with the mutation will develop the disease, while 5% will not

74
Q

What happens if a mutation in the gene responsible for a particular autosomal dominant disorder has 95% penetrance?

A

95% of those with the mutation will develop the disease, while 5% will not

M103 T3 (21 decks)

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