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3 CLASP & Transition Block > Sudden Cardiac Death - Conditions > Flashcards

Sudden Cardiac Death - Conditions Flashcards

1
Q

a patient with a cardiac caused sudden death tend to die between _ hours of previous wellbeing

A

6

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2
Q

name cardiac causes of sudden death

A

inherited arrhythmia syndrome
inherited cardiomyopathy
inherited multisystem disease with CVS involvement eg myotonic dystrophy

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3
Q

arrhythmia syndromes can also be called…

A

channelopathies

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4
Q

give examples of inherited channelopathies

A 
congenital long QT syndrome
brugada syndrome
catecholaminergic polymorphic VT
short QT syndrome
familial AF or WPW
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5
Q

give examples of inherited cardiomyopathies

A

hypertrophic cardiomyopathies

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6
Q

screening is normal in what cardiomyopathies?

A

dilated
hypertrophic
ARVC (arrhythmogenic right ventricular cardiomyopathy)

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7
Q

what process keeps the SA node firing

A

automaticity

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8
Q

2 main reasons for arrhythmias

A

problems with automaticity

re-entry

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9
Q

what are after depolarisations

A

abnormal depolarisations of cardiac myocytes that interrupt phases 2, 3 and 4 of the cardiac AP

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10
Q

what do after depolarisations cause in the heart?

A

triggered automaticity

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11
Q

when do early repolarisations occur?

A

during phases 2 and 4 of the cardiac AP

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12
Q

what do early repolarisations cause?

A

torsades de pointes

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13
Q

when in the cardiac AP do delayed depolarisations occur?

A

phase 4

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14
Q

what do delayed depolarisations cause?

A

bidirectional VT

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15
Q

inheritance pattern of cardiac conditions?

A

AD

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16
Q

inheritance pattern of cardiac conditions?

A

AD

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17
Q

commonest inherited cardiac cause of sudden death?

A

long QT

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18
Q

how many people are carriers of long QT gene

A

1 in 2000

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19
Q

what cardiac changes are seen in long qt

A

torsades de pointes (polymorphic VT)

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20
Q

trigger for the cardiac changes seen in long qt?

A

adrenergic stimulation eg by excitement, exercise

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21
Q

what is romano-ward syndrome? what is its inheritance?

A

most common form of long qt

AD

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22
Q

what long qt syndrome is associated with deafness? is it AD or AR inheritance?

A

jervell and lange-nielsen syndrome

AR

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23
Q

pathophysiology behind long qt

A

reduced ionic current = prolonged cardiac repol = wt interval prolongation

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24
Q

how is long qt diagnosed?

A

QT >480ms in repeated ECGs
if your long qt risk score is >3
presence of LQTS mutation

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25
Q

symptoms of long qt

A

syncope
stress
potentially Hx of deafness (JALNS)

26
Q

what drugs should be avoided in long qt?

A

clarithromycin
azithromycin
imipramine
amitryptiline

27
Q

LQTS1 main prophylactic advice?

A

avoid strenuous exercise

28
Q

LQTS2 main prophylactic advice?

A

avoid loud noises

29
Q

pathophysiology of short qt

A

K+ channels

30
Q

how long is the qt interval in short qt

A

<300ms

31
Q

who gets short qt

A

young children

32
Q

youre at increased risk of what arrhythmias

A 
polymorphic VT (TDP)
VF
33
Q

what cardiac condition do people with brugada syndrome get?

A

AF

34
Q

what are the ECG findings in brugada syndrome

A

ST elevation and RBBB in V1-3

35
Q

inheritance of brugada syndrome? who gets it?

A

AD

adult males

36
Q

triggers for VF in brugada syndrome

A

excess alcohol
large meals
rest
fever

37
Q

Tx brugada syndrome

A

avoid triggers
avoid Na channel blockers/anti-arrhythmias
go into hospital if fever
ICD if severe

38
Q

what is CPVT? what triggers it?

A

adrenergic induced TDP, SVTs that are triggered by stress and exercise

39
Q

ECG and ECHO are what in CPVT?

A

normal

40
Q

Tx CPVT?

A

sedate
defibrillate

avoid triggers
b blockers long term (blocks adrenergic stimulation)
+/- ICD

41
Q

ECG features of WPW syndrome

A

short PR interval
delta waves
venticular preexcitation

42
Q

most common arrhythmia in WPW syndrome

A

AVRT

43
Q

pathophysiology of WPW syndrome

A

no conduction delay between atria and ventricles because of an accessory pathway

44
Q

Tx WPW

A

leave it if the accessory pathway does not conduct quickly

cardiac ablation if it does

45
Q

commonest cardiomyopathy?

A

hypertrophic

46
Q

mutation is where in hypertrophic cardiomyopathy

A

sarcomeric genes

47
Q

how many patients will die per year of HOCM?

A

1%

48
Q

ECG changes that suggest hypertrophy?

A

positive deflection in V5

negative deflection in V2

49
Q

different presentations of HOCM

A

sudden death
HF (from progressive ischaemia)
end stage HF
AF (thick muscles inc diastolic pressure)

50
Q

Tx HOCM

A

ICD if previous cardiac arrest or sustained VT OR if high risk eg 1st degree FH, thick LV wall, recent syncope
if none, leave it esp if risk is under 4%

51
Q

who gets dilated cardiomyopathy

A

adulthood-elderly

men>women

52
Q

pathophysiology of DCM

A

sarcomere protein problem (20% is genetic related)

53
Q

what does DCM progress to?

A

HF

54
Q

pathophysiology of ARVC?

A

fibrofatty replacement of myocytes allowing more space for reentry (VT most common)

55
Q

how common is LV invovlement in ARVC?

A

50%

56
Q

features of ARVC on ECG?

A

QRS prolongation

57
Q

Tx ARVC

A

avoid competitive sports

  1. beta blockers
  2. ICD if severe
58
Q

diagnosis of inherited cardiac conditions

A

clinical and genetic testing

family screening

59
Q

what does defibrillation do?

A

delivers high energy causing cardiac myocytes to depolarise, resets all cardiac myocytes to restore electrical signal

60
Q

what does ICD mean?

A

implantable cardioverter defibrillator

61
Q

complications of ICDs?

A

leads can cause infection eg endocarditis
can cuse pneumo/haemothorax
thromboembolic eg PE
lead fractures (can slit the SVC on removal)

62
Q

how long do ICD leads last?

A

20 yrs

3 CLASP & Transition Block (20 decks)

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