sudden death Flashcards
what are the reversible causes of cardiac death
4 H’s
4 T’s
hypoxia, hypovolaemia, hypo/hyperkalaemia(metabolic), hypothermia
Tamponade, thrombosis, toxins, tension pneumothorax
what are the types of shock
hypovolaemia, cardiogenic, septic, anaphylactic and neurogenic
what is hypovolaemic shock
Loss of circulating volume leading to reduced preload and reduced output
cause of hypovolaemic shock
bleeding, third space volume loss, severe dehydration
compensatory mechanism for hypovolaemic shock
baroreceptor reflex
sympathetic mediated neurohormonal response
renal and hypothalmopituitary
how to fix hypovolaemia
fluid and blood replacement
what is cardiogenic shock
Myocardial dysfunction causing reduction in systolic function and cardiac output
causes of cardiogenic shock
MI, myocarditis, acute valve lesion
treatment for cardiogenic shock
Enhancing inotropy = increasing sympathetic nervous system via dobutamine, adrenaline, dopamine, dopexamine
vassopressors
careful fluid management
treat underlying cause
what is obstructive sock
Physical obstruction to filling of the heart causing a reduced preload and cardiac output
obstructive shock causes
Causes = tamponade, PE, tension pneumothorax
treatment for obstructive shock
treat underlying cause
PE = anticoagulation +/- thrombolysis
Cardiac tamponade = pericardial drainage
Tension pneumothorax = decompression
treatment for anaphylaxis
Adrenaline, antihistamines, steroids and fluids
treatment for neurogenic shock
vasopressors
what is neurogenic shock
spinal cord trauma leading to loss of sympathetic tone
what is anaphylactic shock
uncontrolled activation of mast cell causing vasodilation
main differentiation between each shock type
hypovolaemic- maintained bp at start then reduced in later stage + cool and pale skin
Cardiogenic- skin swollen and oedematous
Septic- pyrexia- could also be too cold
anaphylaxis- rash
neurogenic- bradycardia and unregulated temp
what is long qt syndrome
Mutation in ion channel results in reduced/ dysfunctional ionic current which prolongs repolarization
most common is the potassium channel
long qt symptoms
Syncope and palpitations are a result of torsades de pointes by adrenergic stimulation. This may degenerate to VF = SCD
which disease can long qt progress to
torsades de points
management of long qt
acute management = treat cause, magnesium infusion, defibrillation
Long term management = BB, avoid QT prolonging drugs (antipsychotics), pacemakers
what is brugada
AD – 12 associated genes with sodium and calcium channels
what can brugada lead to
ECG – risk of polymorphic VT, VF, AF is common, ST elevation and RBBB in V1-3 along with T wave invesions after qrs complex
diagnostic test for brugada
ecg by provoking Na channels
Treatment for brugada
Mx = avoid triggers, avoid certain drugs and triggers
can have ICD incase
what is WPW
Patients have accessory pathway known as bundle of Kent which allows signal to return to atria from ventricles (re-entrant route)
Short PR interval, ventricular pre-excitation
what can be seen on ecg for wpw
ECG – delta wave- slurred upstroke with wide qrs complex, AVRT, AF
treatment for WPW
definitive is radiofrequency ablation
what are cardiomyopathies
arrythmias related to scar/electric barrier formation and subsequent re-entry
examples of cardiomyopathy
HOCM
Arrhythmogenic right ventricular cardiomyopathy
Dilated cardiomyopathy
what is HOCM
an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins.
most common cause of sudden death in young people
symptoms of HOCM
dyspnoea, AF, syncope, palpitations and angina
ecg findings in HOCM
T wave inversion
treatment for HOCM
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*
what is still birth
Baby dies after 24 weeks of pregnancy and before or during birth
risk factors for still birth
way to many- basically anything that puts the baby under excess stress
placental causes, IGR, congenital, maternal infections, extremes of ages, medical complications, multiple pregnancies, prolonged pregnancy, obesity, smoking, previous stillbirth, antepartum hemorrhage
how to reduce still birth
SLEEP ON SIDE IN 3RD TRIMESTER
Stop smoking
Avoid alcohol and drugs
Attend check ups
After still birth what must be conducted
Post mortem
Skin biopsy
Placental histopathology
Blood results
Microbiology results
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