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Sudden Death Flashcards

1
Q

What is the difference between histopathology and histocytology?

A

Histopathology: exams tissue specimen
Histocytology: exams cells floating in liquid

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2
Q

Name the autosomal dominant condition caused by a mutation in PKP2 arginine?
It has 60% penetrance and equally affects males and females.
It can cause sudden death.
It is most common in Dutch populations.?

A

ARVC/D arrhythmogenic right ventricular cardiomyopathy/dysplasia

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3
Q

What is shock:

A

Inadequate organ perfusion > inadequate O2 delivery > organ failure

(Acute circulatory failure)

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4
Q

Distributive shock is a group term for which types of shock?

A

Septic, anaphylactic, neurogenic

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5
Q

What is preload?

A

Volume entering ventricles

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6
Q

What is afterload?

A

Resistance LV must overcome to pump blood

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7
Q

What is the Frank-Starling mechanism?

A

> EDV = >CO

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8
Q

HR X SV =

A

CO

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9
Q

CO X SVR =

A

MAP

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10
Q

What effect does hypovolaemic shock have on CO, BP, HR, temp and skin appearance?

A 
Decreased CO
Decreased BP
Increased HR
Normal temp
Cool/pale clammy
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11
Q

What effect does anaphylactic shock have on CO, BP, HR, temp and skin appearance?

A 
Decreased CO
Decreased BP
Increased HR
Normal temp
Hives, edema
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12
Q

What effect does cardiogenic shock have on CO, BP, HR, temp and skin appearance?

A 
Decreased CO
Decreased BP
Increased HR
Normal temp
Edema
Clammy peripheries
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13
Q

What effect does septic shock have on CO, BP, HR, temp and skin appearance?

A 
Decreased BP 
Increased CO
Increased HR
Raised temp
Initially flushed / warm, then cool / pale
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14
Q

What effect does neurogenic shock have on CO, BP, HR, temp and skin appearance?

A 
Decreased CO
Decreased BP
DECREASED HR
No change to temp - vasodilation below lesion
No change to skin appearance
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15
Q

What is the Mx of hypovolaemic shock?

A 
Fluid
Blood
Vasopressor
FFP
Warm
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16
Q

What is the Mx of anaphylactic shock?

A

Adrenaline

IV fluid

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17
Q

What is the Mx of cardiogenic shock?

A

Vasopressor

Inotrope dobutamine

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18
Q

What is an inotrope?

A

Increase HR and force

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19
Q

Vasopressors cause vasoconstriction or vasodilation?

A

Vasoconstriction

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20
Q

NA is a vasopressor. T or F

A

True

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21
Q

What immune factors are found in anaphylactic shock?

A 
Mast cells
PG
Leukotrienes
Histamine
PAF
Chemokines
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22
Q

What causes edema in anaphylactic shock?

A

Leak capillaries so fluid escapes

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23
Q

What types of edema are present in cardiogenic shock?

A

Skin + pulmonary

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24
Q

Define septic shock

A

Sepsis + 25% decrease in systolic BP

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25
Q

Why is lactate a measure of shock?

A

Anaerobic metabolism product - hence measures inadequate O2 delivery

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26
Q

What group of bacteria are strongly associated with septic shock and why?

A

Group A strep

Release toxic mediators

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27
Q

In neurogenic shock, there is [vasodilation / vasoconstriction] below the lesion

A

Vasodilation

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28
Q

What is the pathology of neurogenic shock?

A

Unopposed vagal action

No sympathetic outflow

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29
Q

Ivacaftor is a genetic drug used in the management of what condition?

A

CF

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30
Q

The definition of sudden cardiac death:

  • non-_____
  • non-_____
  • Unexpected
  • Within _____ of a previously _____ heart
A

The definition of sudden cardiac death:

  • non-TRAUMATIC
  • non-VIOLENT
  • Unexpected
  • Within 6 HOURS of a previously NORMAL heart
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31
Q

Myotonic dystrophy can cause sudden cardiac death. T or F

A

True

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32
Q

Name 2 conditions associated with aortic dissections

A

Loeys Dietz syndrome

Marfan syndrome

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33
Q

What protein is mutated in Marfan syndrome?

A

Fibrillin

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34
Q

Genetic causes of aortic dissections are associated with mutations in what gene?

A

TGF-B2

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35
Q

If a patient has a family history of several family members in every generations who had MIs before age 50, what is a likely genetic cause?

A

Familial hypercholesterolemia

LDL receptor mutation

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36
Q

What is the easier diagnostic test for familial hypercholesterolemia?

A

Measure cholesterol / LDL

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37
Q

What is the management of familial hypercholesterolemia?

A

Statin

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38
Q

What are some SEs of statins?

A

Myalgia

Rhabdomyolysis

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39
Q

Where should a baby sleep in the 1st 6 months to prevent SUDI?

A

In a cot in parents bedroom

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40
Q

Who should you report a SUDI death to?

A

Procurator fiscal
Police
Bereavement service

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41
Q

Where should you not allow a baby to sleep to prevent SUDI?

A

On sofa/armchair
In parents bed
In carseat when not driving

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42
Q

Whats the difference between a cardiomyopathy and channelopathy?

A 
Channelopathy = ion channel mutations; effects depolarisation
Cardiomyopathy = structural problem
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43
Q

After depolarisations interrupt phase ____ of the cardiac AP which leads to ____

A

After depolarisations interrupt phase 2, 3 or 4 of the cardiac AP which leads to TRIGGERED ACTIVITY

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44
Q

What is Romano ward syndrome? What is the inheritance pattern?

A

AD, isolated LQT

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45
Q

What is Jervel Lange Nielsen syndrome? What is the inheritance pattern?

A

AR, LQT + deaf

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46
Q

What is the commonest mutation in congenital LQT syndrome?

A

KCNQ1

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47
Q

What phase of the cardiac AP is interrupted in an early after-depolarisation?

A

2 or 3

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48
Q

What is the commonest inheritance pattern of congenital long QT syndrome?

A

AD

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49
Q

What is required for a Dx of LQT synd?

A 
QT >480 
OR
Mutation 
OR
QT >460 + unexplained syncope
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50
Q

What is congenital long QT syndrome?

A

Adrenergic trigger causes polymorphic VT Torsade de Pointes

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51
Q

Congenital LQT syndrome has variable ______

A

penetrance

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52
Q

What should be avoided in CLQT syndrome?

A

QT prolonging drugs (clarithromycin, azithromycin, others0
Competitive sport

(Also alarm clocks and diving)

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53
Q

What is the Mx of LQT synd?

A

BB nadolol

Consider ICD

54
Q

What is the % SCD risk in untreated CLQT synd?

55
Q

What is the inheritance pattern in short QT syndrome? What age group is it associated with SCD in?

A

AD

Infants

56
Q

What is the inheritance pattern of Brugada syndrome?

57
Q

What arrhythmias is Brugada syndrome associated with?

A

Polymorphic VT
VF
AF

58
Q

What is seen on ECG in Brugada syndrome?

A

Intermittent

ST elevation + RBBB in V1-V3

59
Q

What are the arrhythmia triggers in Brugada syndrome?

A

Fever, sleep, alcohol, big meal

60
Q

What is the diagnostic test for Brugada syndrome?

A

ECG with flecainide or ajmaline

61
Q

What is the Tx for VF in Brugada syndrome?

A

The only Tx for VF is defibrillation

62
Q

What is the Mx of Brugada synd?

A

BB
Other drugs - not sure whether to learn
Consider ICD

63
Q

What is CPVT?

A

Adrenergic induced bi-directional polymorphic VT/SVT

64
Q

What is seen on ECG in CPVT?

65
Q

What is seen on echo in CPVT?

66
Q

What is the commonest mutation in CPVT?

67
Q

What is the Mx of CPVT?

A

Avoid trigger
Flecainide
Consider ICD

68
Q

What is seen on ECG in WPW?

A

Short PR interval, delta wave

69
Q

What arrhythmia is associated with WPW?

70
Q

What is the Mx of WPW?

71
Q

What is the diagnostic test for HOCM?

72
Q

How might HOCM present?

73
Q

What protein is mutated in HOCM?

74
Q

What is the Mx of HOCM?

A

Consider ICD

Avoid competitive sport

75
Q

Dilated cardiomyopathy is more common in which gender? What is the diagnostic test?

A

Males

Echo

76
Q

What does ARVC stand for?

A

Arrhythmogenic RV cardiomyopathy / dysplasia

77
Q

What is the pathology of ARVC?

A

Fibro-fatty replacement of cardiac myocytes - causes a re-entry pathway

78
Q

What is the inheritance pattern in ARVC?

79
Q

What gene is ARVC associated with?

80
Q

ARVC has a 60% _____

A

penetrance

81
Q

What is the presentation of ARVC?

A

SCD

Syncope

82
Q

What is the Mx of ARVC?

A

BB
Consider ICD
Avoid competitive sport

83
Q

What is clinical death?

A

Resp + circulatory + brain arrest that is reversible if resuscitated

84
Q

How long does clinical death last?

A

3-6 minutes

85
Q

What is the commonest cause of clinical death?

86
Q

What are the causes of clinical death?

A

4Hs, 4Ts

Hypovolaemia
Hypothermia
Hypokalaemia
Hypoxia
Toxin
Tamponade
Thrombus
Tension pneumothorax
87
Q

What is the aetiology of cardiac tamponade?

A

Penetrating chest trauma or post cardiac surgery

88
Q

What is the Mx of cardiac tamponade?

A

Needle pericardiocentesis / thoracotomy

89
Q

What is the Mx of hyperkalaemia?

A

Calcium chloride, insulin/dextrose

90
Q

What is the Mx of a tension pneumothorax?

A

Needle decompression or thoracotomy

91
Q

What is biologic death?

A

Irreversible cellular destruction

After clinical death

92
Q

In CPR, how many chest compressions should be done per second?

93
Q

What is the correct depth in CRP?

94
Q

How often should CPR providers switch roles to prevent fatigue?

A

Every 2 minutes

95
Q

How long should it take to perform to ventilations in CPR?

A

10 seconds

96
Q

When should ventilations be performed before compressions in CPR?

A

Child

Drowned

97
Q

In CPR, when should defibrillation be done?

A

As soon as defibrillator arrives

98
Q

What is the mechanism of defibrillation?

A

Depolarises and resets all cardiac myocytes

99
Q

When is defibrillation appropriate?

A

VF

Pulseless VT

100
Q

When is defibrillation inappropriate? What should be done instead?

A

PEA, asystole

Continue CPR, for 2 minutes then check rhythm again

101
Q

In cardiac arrest, if VF or pulseless VT persists after 3 shocks, what should be done?

A 
CPR for 2min 
\+ 
1mg IV adrenaline 
\+
300mg IV amiodarone
102
Q

What drug should be given in asystole / PEA cardiac arrest?

A

1mg IV adrenaline every 3-5min

103
Q

What airways devices are used in cardiac arrest MX?

A

Supraglottic airway device or tracheal tube

104
Q

Once an airway device is secured in cardiac arrest, should you still stop CPR for ventilation?

105
Q

How do you calculate HR from an ECG?

A

1500/small squares between QRS complexes
OR
300/large squares between QRS complexes

106
Q

What does the P wave represent on an ECG?

A

Atrial depolarisation

107
Q

What does the PR interval represent on an ECG?

A

AVN delay to allow ventricle filling

108
Q

What does the QRS complex represent on an ECG?

A

Ventricle depolarisation

109
Q

What does the T wave represent on an ECG?

A

Ventricular repolarisation

110
Q

What arrhythmia is being described?

Bizarre irregular waveform, no recognisable QRS complexes, random freq/amplitude, uncoordinated electrical activity

111
Q 
What arrhythmia is being described?
Absent ventricular (QRS) activity, atrial activity P waves may persist
112
Q

What arrhythmia is being described?

Broad complex rhythm constant QRS morphology

A

Monomorphic VT

113
Q

What arrhythmia is being described?

Atrial rate 250-350bpm, regular QRS, most 2:1 conduction (150 ventricular, 300 atrial bpm)

A

Atrial flutter

114
Q

What arrhythmia is being described?

Irregularly irregular QRS, no p waves, atrial rate >350bpm, fast/slow AV conduction

115
Q

What arrhythmia is being described?

100-120bpm, regular, occosional dissociated p waves, wide bizzarre QRS

116
Q

What arrhythmia is being described?
Twisting of the axis, 200-250bpm, regular or irregular, sinusoidal pattern, may revert to VF or SR, RF electrolyte abnormality

A

Torsade de Pointes

117
Q

What arrhythmia is being described?

-Arctic Monkeys AM

A

Torsade de Pointes

118
Q

What arrhythmia is being described?

Regular, PR >0.2sec, physiological block to AVN, aetiology drug/vagal stimulation/disease

A

1st degree HB

119
Q

What arrhythmia is being described?

regularly irregular, increasing PR interval till drop beat, diseased AVN with long refractory period

A

Mobitz I 2nd degree HB

120
Q

What arrhythmia is being described?

Same PR for all beats, regular P wave, some absent P waves, progress to CHB

A

Mobitz II 2nd degree HB

121
Q

What arrhythmia is being described?

A-V dissociation, regular P waves + QRS; no relationship, Mx pacemaker

A

Complete 3rd degree HB

122
Q

What is the mechanism of cool clammy skin in shock?

A

Peripheral vasoconstriction

123
Q

What effect does distributive shock have on BV resistance, BV diameter, MAP, CO?

A

Decreased systemic resistance
Vasodilation
Decreased MAP
Increased CO

124
Q

How would you describe the pulse in distributive shock?

A

Bounding hyperdynamic pulse

125
Q

What are the CI to giving fluid in hypovolaemic shock?

A

Heart failure

Pulmonary edema

126
Q

What type of shock can acute heart valve failure cause?

A

Cardiogenic

127
Q

What type of shock can a saddle embolus cause?

A

Obstructive

128
Q

What type of shock can cardiac tamponade cause? What is the management?

A

Obstructive

Pericardiocentesis

129
Q

What type of shock can a tension pneumothorax cause? What is the management?

A

Obstructive

Thoracentesis

130
Q

What is a really important sign of kidney damage in shock?

Y3 CLASP (4 decks)

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