Sudden Death Flashcards by Rose Leckie

what are the four H’s that can cause cardiac arrest?

hypoxia
hypovolaemia
hyperkalaemia + other metabolic
hypothermia

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what are the four T’s that can cause cardiac arrest?

thrombosis
tamponade
toxins
tension pneumothorax

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what is the definition of shock?

a condition of inadequate perfusion to sustain normal organ function

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what are the four main classes of shock?

hypovolaemic
cardiogenic
obstructive
distributive

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what is hypovolaemic shock?

a state of shock due to insufficient circulating volume

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what can cause hypovolaemic shock?

any loss of fluids

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what does the clinical presentation of hypovolaemic shock depend on?

the degree of hypovolaemia

how the body is compensating

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describe how young people with hypovolaemic shock compensate

initially very well

decompensate rapidly if fluid loss continues

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what is cardiogenic shock?

a state of shock due to the heart being unable to pump to meet circulatory demands

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what is the most common cause of cardiogenic shock?

acute MI

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what is another possible cause of cardiogenic shock?

acute valve dysfunction e.g. acute mitral valve prolapse

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clinical signs in cardiogenic shock are caused by what two things?

poor flow

backpressure

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what clinical signs are present in cardiogenic shock due to poor flow?

hypotension
fatigue
syncope

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what clinical signs are present in cardiogenic shock due to back pressure?

pulmonary oedema
elevated JVP
hepatic congestion

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what is obstructive shock?

shock due to a physical obstruction to the heart or great vessels

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what is the mechanism of shock in obstructive shock?

blockage affects cardiac filling and reduces the blood volume available

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what are three possible causes of obstructive shock?

PE
cardiac tamponade
tension pneumothorax

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what are other names for distributive shock?

vasodilatory shock

warm shock

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what happens in distributive shock?

vessels dilate so there is not enough blood to maintain pressure and perfusion

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what are the three subtypes of distributive shock?

septic
anaphylactic
neurogenic

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what causes septic shock?

microbes release toxins that cause impaired vasoconstriction

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what can be used to detect hypoperfusion in septic shock?

rising lactate levels

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what drugs need to be given ASAP in septic shock?

antibiotics

vasopressors

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what causes anaphylactic shock?

mast cells release vasodilators

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what drug should be given in anaphylactic shock?

adrenaline

what can be measured to confirm diagnosis of anaphylactic shock?

serum try-tase

what causes neurogenic shock?

loss of sympathetic outflow due to a spinal injury

what is the mechanism of shock in neurogenic shock?

loss of sympathetics = vasodilation, hypotension and bradycardia

what drugs are given for neurogenic shock?

dopamine | vasopressors

what is clinical death?

the period of respiratory, cardiac and nervous system arrest when resuscitation can restore life

what does the duration of clinical death depend on?

how long the cerebral cortex survives

what is the normal duration of clinical death?

3-6 minutes

what is penetrance?

the likelihood of getting a disease if you have the mutation

what does it mean if a disease has 100% penetrance?

you will always get the disease if you have the mutation

name one way of analysing genes

next generation sequencing

what is a variant?

any change in DNA sequence

what is a mutation?

a pathogenic variant

what is a polymorphism?

a variant that is prevalent in the general population that is often benign

what does it mean if a variant is class 1?

it is benign

what does it mean if a variant is class 3?

it is a variant of uncertain significance

what does it mean if a variant is class 5?

it is pathogenic

mutations in what gene causes Marfan syndrome?

fibrillar

mutations in what genes can cause Loeys Dietz syndrome?

TBR1 | TBR2

what is the definition of sudden cardiac death?

non-traumatic unexpected death due to sudden cardiac arrest within six hours of normal health

what are the two categories of arrhythmogenic inherited cardiac conditions?

channelopathies | cardiomyopathies

name a channelopathy

congenital long QT

what causes an arrhythmia in a channelopathy?

ion current imbalance

what causes an arrhythmia in a cardiomyopathy?

physical barrier to electrical current

what arrhythmia can occur in patients with congenital LQTS?

polymorphic VT (torsades de pointes)

what triggers torsades de pointes in congenital LQTS?

adrenergic stimulation

what is the risk of death from congenital LQTS associated with?

the severity of the QT prolongation

how many types of congenital LQTS are there?

thirteen

what is the name of the syndrome in which patients have isolated congenital LQTS?

romano ward syndrome

what two syndromes exist where patients have congenital LQTS and extra cardiac features?

Anderson tawil Timothy

what autosomal recessive form of congenital LQTS is associated with deafness?

jervell and lange nielsen syndrome

what are the three criteria that can be used to diagnose congenital LQTS?

QT interval >480ms LQTS risk score >3 presence of pathogenic mutation

what causes congenital short QT syndrome?

a mutation in cardiac K+ channels

what is the criteria for congenital short QT syndrome?

QT <300ms at a heart rate <80bpm

what arrhythmia can congenital short QT syndrome be associated with?

who may present with congenital short QT syndrome?

young children

what is the mortality like in congenital short QT syndrome?

most patients die

what arrhythmias are possible complications of brugada syndrome?

VT VF AF

what is seen on ECG in brugada syndrome?

ST elevation and RBBB in V1-V3

what type of drugs can be given to illicit the ECG changes in brugada syndrome?

cardiac sodium channel blockers

name two cardiac sodium channel blockers

flecainide | ajmaline

how many genes are associated with brugada syndrome and what do they code for?

12 cardiac sodium and calcium channels

what is the inheritance pattern for brugada syndrome?

autosomal dominant

name four triggers for VF in brugada syndrome?

sleep fever alcohol large meals

what four classes of drugs should be avoided in brugada syndrome?

anti arrhythmias psychotropics analgesics anaesthetics

what triggers VT in catecholaminnergic polymorphic VT?

emotional stress | physical activity

what does an ECG and ECHO look like in catecholaminnergic polymorphic VT?

normal

what gene causes autosomal dominant catecholaminnergic polymorphic VT?

RyR2

what gene causes autosomal recessive catecholaminnergic polymorphic VT?

CASQ2

mutations in which genes cause hypertrophic cardiomyopathy?

sarcomeric genes

what three ways can patients with hypertrophic cardiomyopathy present?

sudden death heart failure AF