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M103 T3 > M103 T3 Symposium sudden death 2 - Steve Koons > Flashcards

M103 T3 Symposium sudden death 2 - Steve Koons Flashcards

1
Q

What is the trigger for arrhytmia?

A

ectopic activity

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2
Q

What is required in a patient for them to develop arrhytmia?

A

substrate
trigger
re-entry
wave break

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3
Q

What are the two types of substrate?

A

structural

electrical

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4
Q

When can ectopic activity occur?

A

early after depolarisation
short coupling interval
delayed after depolarisation

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5
Q

How does the concept of re-entry lead to sudden death?

A

it allows a scenario where the usual organised electrical activity of the heart is lost
it is replaced with more chaotic and less stable electrical patterns
leads to clinical arrhythmia and sudden death

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6
Q

re entry

A

there is a conduction barrier

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7
Q

What is a property of scar tissue?

A

often it can only propogate an electrical wave in one direction

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8
Q

What is the effect of ectopic activity?

A

it causes an extra electrical signal to fire off

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9
Q

What would happen if multi directional conduction was allowed to be generated around the conduction barrier?

A

the two waves would meet on the other side of the conduction barrier
causing the electrical depolarisation to come to an end

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10
Q

What is the role of the area of the heart that allows for uni directional conduction only?

A

it will stop any wave from generating around that side of the conduction barrier

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11
Q

When might tissue be able to contract again during the refractory period?

A

when the refractory period is abnormal

when the circuit is made larger

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12
Q

When might tissue be able to contract again during the refractory period?

A

when the refractory period is abnormal
when the circuit is made larger
when conduction through the conduction barrier loop is slowed again

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13
Q

How might the circuit is made larger?

A

if there’s a dilatation of chambers within the heart

if there’s large areas of scar tissue which extend the length of the circuit

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14
Q

What might be responsible for the speed of conduction through the conduction barrier loop being reduced?

A

an area of scar tissue

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15
Q

What three types of conditions can lead to sudden cardiac death?

A

ischaemic heart disease
structural heart disease
primary arrhythmic SCD

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16
Q

What types of ventricular remodelling may result from ischaemic heart disease?

A 
scar formation
myocardial fibrosis
coupling
dilatation
poor function
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17
Q

What is an example of a structural heart disease?

A

dilated cardiomyopathy

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18
Q

What are the common causes of dilated cardiomyopathy?

A 
idiopathic
viral 
alcohol
chemotherapy drugs
autoimmune disorders
19
Q

Which factors are involved in the pathophysiology of dilated cardiomyopathy?

A

subendocardial myocardial fibrosis
neurohumoral activation
increased sympathetic tone
electrolyte disturbances

20
Q

What does dilated cardiomyopathy lead to?

A

ectopy
re-entry
VT / VF

21
Q

What is a rare type of cardiomyopathy and the most common cause of sudden cardiac death in young athletes?

A

hypertrophic cardiomyopathy

22
Q

What type of condition is hypertrophic cardiomyopathy genetically?

A

autosomal dominant

incomplete penetrance

23
Q

What is hypertrophic cardiomyopathy caused by?

A

when there are over 45 mutations in the cardiac muscle sarcomere genes

24
Q

How does hypertrophic cardiomyopathy occur?

A

there is a combination of central hypertrophy and an increase in ventricular contractile force
this pulls the mitral valve out of position when the heart contracts
AAR, the whole mitral valve structure moves forward to meet the septum
this blocks the aorta
can lead to a risk of sudden cardiac death

25
Q

What is the term of the motion that occurs when the whole mitral valve structure moves forward to meet the septum in hypertrophic cardiomyopathy?

A

systolic anterior motion

26
Q

What are the symptoms of hypertrophic cardiomyopathy?

A

may be asymptomatic
exertional chest pain / dyspnoea
exertional syncope
palpitations

27
Q

What does Arrhythmogenic right ventricular cardiomyopathy lead to?

A

hypertrophy and dilatation of the right ventricle

28
Q

How does Arrhythmogenic right ventricular cardiomyopathy present?

A

asymptomatic

29
Q

What can Arrhythmogenic right ventricular cardiomyopathy lead to?

A

sudden cardiac death

30
Q

Which conditions are associated with Arrhythmogenic right ventricular cardiomyopathy?

A

exertional syncope

atrial arrhythmia

31
Q

What are epsilon waves caused by?

A

postexcitation of the myocytes in the right ventricle

32
Q

What is a feature of an ECG of a patient with Arrhythmogenic right ventricular cardiomyopathy?

A

there will be an epsilon wave present

33
Q

What are examples of structural heart diseases?

A

aortic stenosis
mitral stenosis
mitral valve prolapse
congenital heart disease

34
Q

Which syndromes fall under primary arrhythmia?

A

long QT
Wolff-Parkingson-White
Brugada
Primary VT / VF

35
Q

What causes Wolff-Parkingson-White syndrome?

A

the normal anatomical conduction barriers are disrupted.

36
Q

What type of condition is the Brugada syndrome?

A

primary arrhytmia

channelopathy

37
Q

Which ion channel is affected by Brugada syndrome?

A

the SCN5A channel

38
Q

What is the effect of the Brugada syndrome?

A

the expression of SCN5A sodium channels within the heart is not unilateral
AAR, there are particular areas most commonly in the right ventricular outflow tract where there is a discrepancy in conduction velocities.
this means that different layers of heart tissue are able to conduct electrical signals at different speeds.
this means there is potential for re-entry in that area

39
Q

How is SCD avoided?

A

identify at risk groups
preventative treatment
family screening where appropriate
resusitation

40
Q

What preventative treatment is applicable for SCD management?

A

treat the underlying cause, not just the symptoms
avoid precipitants
anti-arrhythmic medication
implantable defillibrators

41
Q

Where are Transvenous ICDs positioned?

A

under the skin between the muscle and the subcutaneous tissue on the left hand side of the chest.

42
Q

Why are Transvenous ICDs positioned as they are?

A

allows access the venous system
allows electrodes to be passed into the heart itself
allows the delivery of a defibrillator - a wave of energy to the heart if required

43
Q

Where are S-ICDs positioned?

A

the generator and lead are placed either side of the heart, without either component entering the chest cavity

44
Q

Which groups of patients are best suited for an ICD?

A 
survivors of cardiac arrest
patients with Ventricular tachycardia and haemodynamic compromise
patients with CHD
patients with poor LV function
congenital heart disease

M103 T3 (21 decks)

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