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Y1-3 CLASP > Sudden Death > Flashcards

Sudden Death Flashcards

1
Q

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

A

hypoxia
hypovolaemia
hyperkalaemia + other metabolic
hypothermia

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2
Q

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

A

thrombosis
tamponade
toxins
tension pneumothorax

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3
Q

what is the definition of shock?

A

a condition of inadequate perfusion to sustain normal organ function

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4
Q

what are the four main classes of shock?

A

hypovolaemic
cardiogenic
obstructive
distributive

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5
Q

what is hypovolaemic shock?

A

a state of shock due to insufficient circulating volume

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6
Q

what can cause hypovolaemic shock?

A

any loss of fluids

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7
Q

what does the clinical presentation of hypovolaemic shock depend on?

A

the degree of hypovolaemia

how the body is compensating

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8
Q

describe how young people with hypovolaemic shock compensate

A

initially very well

decompensate rapidly if fluid loss continues

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9
Q

what is cardiogenic shock?

A

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

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10
Q

what is the most common cause of cardiogenic shock?

A

acute MI

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11
Q

what is another possible cause of cardiogenic shock?

A

acute valve dysfunction e.g. acute mitral valve prolapse

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12
Q

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

A

poor flow

backpressure

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13
Q

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

A

hypotension
fatigue
syncope

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14
Q

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

A

pulmonary oedema
elevated JVP
hepatic congestion

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15
Q

what is obstructive shock?

A

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

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16
Q

what is the mechanism of shock in obstructive shock?

A

blockage affects cardiac filling and reduces the blood volume available

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17
Q

what are three possible causes of obstructive shock?

A

PE
cardiac tamponade
tension pneumothorax

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18
Q

what are other names for distributive shock?

A

vasodilatory shock

warm shock

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19
Q

what happens in distributive shock?

A

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

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20
Q

what are the three subtypes of distributive shock?

A

septic
anaphylactic
neurogenic

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21
Q

what causes septic shock?

A

microbes release toxins that cause impaired vasoconstriction

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22
Q

what can be used to detect hypoperfusion in septic shock?

A

rising lactate levels

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23
Q

what drugs need to be given ASAP in septic shock?

A

antibiotics

vasopressors

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24
Q

what causes anaphylactic shock?

A

mast cells release vasodilators

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25
Q

what drug should be given in anaphylactic shock?

A

adrenaline

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26
Q

what can be measured to confirm diagnosis of anaphylactic shock?

A

serum try-tase

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27
Q

what causes neurogenic shock?

A

loss of sympathetic outflow due to a spinal injury

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28
Q

what is the mechanism of shock in neurogenic shock?

A

loss of sympathetics = vasodilation, hypotension and bradycardia

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29
Q

what drugs are given for neurogenic shock?

A

dopamine

vasopressors

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30
Q

what is clinical death?

A

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

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31
Q

what does the duration of clinical death depend on?

A

how long the cerebral cortex survives

32
Q

what is the normal duration of clinical death?

A

3-6 minutes

33
Q

what is penetrance?

A

the likelihood of getting a disease if you have the mutation

34
Q

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

A

you will always get the disease if you have the mutation

35
Q

name one way of analysing genes

A

next generation sequencing

36
Q

what is a variant?

A

any change in DNA sequence

37
Q

what is a mutation?

A

a pathogenic variant

38
Q

what is a polymorphism?

A

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

39
Q

what does it mean if a variant is class 1?

A

it is benign

40
Q

what does it mean if a variant is class 3?

A

it is a variant of uncertain significance

41
Q

what does it mean if a variant is class 5?

A

it is pathogenic

42
Q

mutations in what gene causes Marfan syndrome?

A

fibrillar

43
Q

mutations in what genes can cause Loeys Dietz syndrome?

A

TBR1

TBR2

44
Q

what is the definition of sudden cardiac death?

A

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

45
Q

what are the two categories of arrhythmogenic inherited cardiac conditions?

A

channelopathies

cardiomyopathies

46
Q

name a channelopathy

A

congenital long QT

47
Q

what causes an arrhythmia in a channelopathy?

A

ion current imbalance

48
Q

what causes an arrhythmia in a cardiomyopathy?

A

physical barrier to electrical current

49
Q

what arrhythmia can occur in patients with congenital LQTS?

A

polymorphic VT (torsades de pointes)

50
Q

what triggers torsades de pointes in congenital LQTS?

A

adrenergic stimulation

51
Q

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

A

the severity of the QT prolongation

52
Q

how many types of congenital LQTS are there?

A

thirteen

53
Q

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

A

romano ward syndrome

54
Q

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

A

Anderson tawil

Timothy

55
Q

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

A

jervell and lange nielsen syndrome

56
Q

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

A

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

57
Q

what causes congenital short QT syndrome?

A

a mutation in cardiac K+ channels

58
Q

what is the criteria for congenital short QT syndrome?

A

QT <300ms at a heart rate <80bpm

59
Q

what arrhythmia can congenital short QT syndrome be associated with?

A

AF

60
Q

who may present with congenital short QT syndrome?

A

young children

61
Q

what is the mortality like in congenital short QT syndrome?

A

most patients die

62
Q

what arrhythmias are possible complications of brugada syndrome?

A

VT
VF
AF

63
Q

what is seen on ECG in brugada syndrome?

A

ST elevation and RBBB in V1-V3

64
Q

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

A

cardiac sodium channel blockers

65
Q

name two cardiac sodium channel blockers

A

flecainide

ajmaline

66
Q

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

A

12

cardiac sodium and calcium channels

67
Q

what is the inheritance pattern for brugada syndrome?

A

autosomal dominant

68
Q

name four triggers for VF in brugada syndrome?

A

sleep
fever
alcohol
large meals

69
Q

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

A

anti arrhythmias
psychotropics
analgesics
anaesthetics

70
Q

what triggers VT in catecholaminnergic polymorphic VT?

A

emotional stress

physical activity

71
Q

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

A

normal

72
Q

what gene causes autosomal dominant catecholaminnergic polymorphic VT?

A

RyR2

73
Q

what gene causes autosomal recessive catecholaminnergic polymorphic VT?

A

CASQ2

74
Q

mutations in which genes cause hypertrophic cardiomyopathy?

A

sarcomeric genes

75
Q

what three ways can patients with hypertrophic cardiomyopathy present?

A

sudden death
heart failure
AF

Y1-3 CLASP (4 decks)

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