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Module 103: Theme 3: Physiology of the cardiovascular system. Principles of pathology, diagnosis and treatment of cardiovascular disease > Sudden cardiac death > Flashcards

Sudden cardiac death Flashcards

1
Q

Define sudden death

A

Not trauma, toxicity or poison (i.e. natural)
Not due to a chronic illness
“natural death within one hour of the onset of acute symptoms”

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2
Q

List the causes of sudden cardiac death

A

Heart and/or its vessels
Noncardiac vessels (e.g. stroke or aneurysm)
Pulmonary system (pulmonary embolism)
Central nervous system (CNS) (rare seizures in epilepsy)

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3
Q

Describe the 3 qualities of sudden death

A

Natural, rapid, unexpected

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4
Q

Define sudden cardiac death

A

Sudden death due to cardiovascular/coronary vessel causes

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5
Q

List some direct causes of sudden cardiac death

A

Coronary obstruction
infarct
embolism
Arrhythmia / Dysrhythmia

Disorders Leading to Risks for Sudden Cardiac Death
CHD / low LVEF
structural heart disease (e.g. cardiomyopathies)
Also developmental/genetic structural pathologies of the heart
primary arrhythmia

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6
Q

List some disorders which lead to the risk of sudden cardiac death

A

Disorders Leading to Risks for Sudden Cardiac Death
CHD / low LVEF
structural heart disease (e.g. cardiomyopathies)
Also developmental/genetic structural pathologies of the heart
primary arrhythmia

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7
Q

Describe cardiac arrest

A

A sudden stop in effective blood circulation due to the failure of the heart to contract effectively or at all

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8
Q

Cardiac arrest is not the same as…

A

Myocardial infarction

Heart failure

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9
Q

Describe arrhythmia and its causes

A

A variation in the normal beating pattern or rhythm of the heart
Arrhythmia is usually due to disorganisation of the electrical signals running through the heart

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10
Q

List 3 causes of arrythmia

A

Electrical -ion channels and electrical issues at a cellular level
Structural- shape or size of cardiac tissue electrically unstable, causes signal delays
Ischaemic- low oxygen delivery causing electrical instability

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11
Q

List the causes of primary arrythmia

A

Unstable myocardium - Often due to damaged or hypoxic tissue
Non-ischemic
Ion channel pathologies (channelopathies) - Long QT syndrome
Accessory conduction pathways

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12
Q

What is a cardiomyopathy?

A

Pathology when heart size, shape or thickness is abnormal

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13
Q

What can a cardiomyopathy cause?

A 
Risk of pumping dysfunction or low output heart failure
conduction abnormalities (normal conduction pathways are altered)
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14
Q

Lift the two types of cardiomyopathy

A

Dilated (eccentric)

Hypertrophic (concentric)

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15
Q

Describe tetralogy of fallot

A

Associated with a higher risk of sudden cardiac death even after surgery

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16
Q

To have arrythmia, you usually need both…

A

Substrate and trigger

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17
Q

Describe a trigger

A

Brief event required to initiate a period of arrhythmia

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18
Q

Describe a substrate

A

Ongoing underlying tissue instability that increases triggers or allows for maintenance and amplification or dysrhythmia

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19
Q

What is R on T?

A

Early activity on the ECG that interferes with a T wave where the R wave is interfering with the next T wave and causing this new wave to come early. New beat starts even when the old beat has not yet finished

20
Q

What is a pacemaker?

A

Implanted Electronic Device

Has electrodes that can stimulate the heart and consistently applies impulses for each heart beat

21
Q

When are pacemakers used?

A

Mostly used for bradyarrhythmias and heart block

22
Q

What is an implantable cardioverter defibrillator?

A

Implanted Electronic Device
Has electrodes that can stimulate the heart
Applies electrical impulses ONLY when ventricular dysrhythmias detected
Not at other times (cf pacemaker)
Protects from fast or uncontrolled rhythms for example ventricular fibrillation

23
Q

When should an ICD be considered to be implanted?

A

Cardiac arrest due to ventricular fibrillation
Symptomatic heart failure with low LVEF
Low output heart failure after MI (40 days later)

24
Q

What are antiarrhythmic drugs used for?

A

Mostly for supraventricular arrhythmias - Arrhythmias arising from atria or AV node

25
Q

What do antiarrhythmic drugs do?

A

Usually affect ion channel activity or sympathetic drive

26
Q

List some examples of antiarrhythmic drugs

A

Amiodarone
Beta blocker
Digoxin for AF (not really an antiarrhythmic drug)

27
Q

What is reperfusion injury?

A

Tissue damage caused when blood supply returns to the tissue after a period of ischemia or hypoxia.
Tissue damage and/or hypoxia lead to electrical irregularities & risk. The restoration of circulation results in inflammation and oxidative damage

28
Q

How can you prevent reperfusion injury?

A

Cooling
Immunosuppression
Oxygen radical scavengers

29
Q

What do syncope and seizures have in common?

A

Blackouts- unexplained losses of consciousness

30
Q

What are seizures involved in?

A

Central nervous system problems

31
Q

Describe vasovagal seizures

A

Vagal increase causes vasodilatation and low heart rate
Triggered centrally not triggered at level of heart
Most common form of syncope.
Common in young adults
Recurrent

32
Q

Describe exertional seizures

A

Neurocardiogenic origin

Benign

33
Q

What is the index case/probrand?

A

In medical genetics, the index case is the case of the original patient that stimulates investigation of other members of the family. The initial patient in the population of an epidemiological investigation- primary case

34
Q

What is meant by the number needed to treat?

A

Statistical measurement of the impact of a medicine or therapy
The average number of patients needed to be treated to prevent 1 additional bad outcome

35
Q

What do most cases of sudden death relate to?

A

Arrhythmia

36
Q

List the mechanisms of arrhythmia

A

Substrate for arrhythmia - Structural or electrical
Ectopic activity - Early afterdepolarization, Short coupling interval and Delayed afterdepolarization
Re-entry
Wave break

37
Q

Describe the process of ventricular remodelling

A 
Ventricular remodelling
Scar formation
Myocardial fibrosis
Coupling
Dilatation
Poor function
38
Q

How does IHD provide substrate for arrhythmia?

A

Acute ischemia and ventricular remodelling

39
Q

How does fibrosis cause arrythmia?

A

Barrier to electrical conductivity
Patches of viable tissue however it is damaged
Transmission of electrical impulses is very slow

40
Q

List some causes of dilated cardiomyopathy

A 
Idiopathic
Viral
Alcohol
Drugs (chemotherapy)
Autoimmune
41
Q

What does dilated cardiomyopathy lead to?

A

Ectopy
Re-entry
VT/VF

42
Q

Describe the pathophysiology of dilated cardiomyopathy

A 
Trigger is inflammation of the heart
Subendocardial myocardial fibrosis
Neurohumoral activation
Increased sympathetic tone
Electrolyte disturbances
43
Q

Describe hypertrophic cardiomyopathy

A

Most common cause of SCD in young athletes
Autosomal dominant, incomplete penetrance
Mutation of cardiac muscle sarcomere genes
Asymmetrical septal hypertrophy
Systolic anterior motion of mitral valve
LV outflow tract obstruction

44
Q

List the symptoms of hypertrophic cardiomyopathy

A

May be asymptomatic
Exertional chest pain/dyspnoea
Exertional syncope
Palpitations

45
Q

Describe Arrhythmogenic RV Cardiomyopathy

A

Genetic condition
Multigenomic
Replacement of the right ventricle myocardium with fibro-fatty tissue
Hypertrophy and dilation of the right ventricle
Ventricular tachycardia and ventricular fibrillation due to re-entry around interstitial fibrosis

46
Q

Describe the symptoms of Arrhythmogenic RV cardiomyopathy

A

Often asymptomatic
Exertional syncope and SCD
Atrial arrhythmia common
Epsilon wave on ECG

47
Q

List some other structural heart diseases which increase the risk of sudden cardiac death

A

Aortic stenosis
Mitral stenosis
Mitral valve prolapse
Congenital Heart Disease:

Module 103: Theme 3: Physiology of the cardiovascular system. Principles of pathology, diagnosis and treatment of cardiovascular disease (19 decks)

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