Sudden Death Flashcards by Sophie Baird

What are motifs in genetics?

sequences which indicate where splicing should take place

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What is the most likely genetic change to cause long QT syndrome?

premature stop codon in the exon

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Why is NGS better than conventional sequencing?

allows more efficient analysis of multiple genes

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What is PCR used for?

looking for one gene

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What is the penetrance/frequency of Mendelian disorders?

high penetrance

low population frequency

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What are good drugs for hypercholesterolaemia?

PCSK9 inhibitors

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What is the major side-effect of statins?

myalgia

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How do you calculate the correct QT interval for long QT syndrome?

QT interval/square root R-R interval

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What arrhythmia are people with long QT at risk of?

Torsades de Pointes

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What are the observations in sepsis?

tachycardia
low BP
longer capillary return
tachypnoea

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What is the treatment for long QT?

beta blockers and an ICD if recurrent

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What is shock?

condition of inadequate perfusion to sustain normal organ function with resulting organ dysfunction and eventual death

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What are the types of shock?

hypovolaemic
cardiogenic
obstructive
distributive
cytotoxic

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What is the cause of hypovolaemic shock?

loss of circulating volume with fall in CO due to hemorrhage, third space loss (eg massive inflammation) or severe dehydration

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What is the compensatory mechanism for hypovolaemic shock?

baroreceptor reflexes (receptors in carotid sinus and aortic arch inhibit parasympathetic and increase sympathetic) –> sympathetic neurohormonal response (chronotropy and inotropy with adrenaline, angiotensin, vasopressin etc which causes fluid redirection and lactic acidosis) –> capillary absorption of interstitial fluid –> endocrine response (renin is released and then angiotensin 2 enhances vasoconstriction and ADH secretion so renal reabsorption of Na and H2O)

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What is cardiogenic shock?

failure of heart to pump well so reduced CO, eg complication of acute MI, myocarditis or acute valve pathology

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What is the presentation of a patient with cardiogenic shock?

hypotension, fatigue, syncope, pulmonary oedema, high JVP and hepatic congestion (poor forward flow and backpressure)

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How is cardiogenic shock treated?

increase inotropy by beta and dopaminergic stimulation with adrenaline or dopamine or an intra-aortic balloon pump can be used

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What is obstructive shock?

physical obstruction to heart or great vessels which impairs cardiac filling eg PE or tamponade

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What is distributive shock?

septic, anaphylactic and neurogenic shock ie uncontrolled vasodilation and reduction in SVR overcomes the compensatory mechanisms of increased CO

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What is septic shock?

bacterial endotoxins so there are rising lactate levels

- vasopressors needed to improve perfusion

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What is anaphylactic shock?

mast cell release and degranulation or histaminergic vasodilators
adrenaline is needed to vasoconstrict and stabilise mast cells
diagnosis is confirmed with serum mast cell tryptase levels

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What is neurogenic shock?

loss of thoracic sympathetic outflow due to spinal injury and there will be bradycardia too
treatment is with dopamine and vasopressors

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What is cytotoxic shock?

haemoglobin or mitochondrial poisoning impairing oxygen transport or utilization eg from CO or cyanide poisoning

What is clinical death?

reversible state but there is only a certain amount of time to reverse this

What is biologic death?

irreversible state of cellular destruction

What is agonal breathing?

can occur just before a cardiac arrest and is not a sign of life

What is the best depth for CPR?

5-6cm

What is trans thoracic impedance?

natural resistance of the body to current flow and is related to size, age and skin type

What are the drugs given in CPR and when?

amiodarone and adrenaline are given after three shocks and then every 3-5 minutes

Where does each colour of ECG lead go?

leads on each shoulder and down at the top of left pelvis (red right arm, yellow left arm and green leg)

What is the normal PR interval?

0.12-0.20s

What is the normal QRS width?

0.08-0.12s

What is the normal QT interval?

0.35-0.43s

What is one small square on an ECG?

0.04s

What are the different ways to calculate HR on an ECG?

300/R-R interval in large squares OR number of cardiac cycles in 6s (30 large squares) and times by 10

What is pre-load of the heart?

volume and stretch of the ventricular myocardium at the end of diastole

What is after-load of the heart?

amount of pressure against which the left ventricle must work during systole to open the aortic valve

What is the diagnosis of a patient who is clammy and unwell but is then normal again?

- Brugada - wide QRS and potential ST elevation - test=provocation testing

What is a stillbirth?

baby dies after 24 weeks of pregnancy which can be ante-partum or intrapartum

What is a miscarriage?

loss of a baby before 24 weeks

What are the main causes of stillbirth?

- placental causes - congenital abnormalities - during birth (can be infection, placental abruption etc) - mother’s health

What are the risk factors for stillbirth?

- obesity - lifestyle - extremes of age - ethnic minorities - prolonged pregnancies - twins - smoking during pregnancy - previous stillbirths

What should women who are pregnant take?

- vit D - folic acid - get flu jab

What is used within the MDT to review baby deaths?

Perinatal Mortality Review Tool

What is SUDI?

Sudden unexpected death in infancy includes all deaths which happen suddenly with no reason and will be called this if and when a cause can be found PM

What is sudden infant death syndrome?

no pathology or risk factors present and this is a diagnosis of exclusion so these are a subset of all the SUDIs investigated

What are the risk factors for SIDS?

- preterm birth - being small - maternal smoking - infection - prone position - overheating - head covering - deprived areas - co-sleeping

What is the best way to protect babies from dying young?

sleep on their backs

What are the main causes of unexplained SUDI?

infections including pneumonia, myocarditis and sepsis

What are the possible additional tests done during a post-mortem?

- histology - toxicology - genetics - neuropathology - microbiology

What is sudden death?

death within 24 hours of the onset of symptoms

What are the reversible causes of cardiac arrest?

- hypoxia - hypovolaemia - hypo/hyperkalaemia - hypothermia - thrombosis - tamponade - toxins - tension pneumothorax

How do hypoxia and hypovolaemia cause cardiac arrest?

- Hypoxia: asthma, epiglottitis/swollen tonsils, pneumothorax, choking (small red capillaries from struggle), drowning, respiratory depression from drugs and aspiration - Hypovolaemia: upper or lower GI bleed, aneurysms including AAA and trauma of various types

How do hypo/hyperkalaemia and hypothermia cause cardiac arrest?

- Hypo/Hyperkalemia: diabetic or alcoholic ketoacidosis and toxins, treated with calcium chloride and then insulin and dextrose solution - Hypothermia: cold (Wischnewski ulcers), alcoholic and drugs

How does tamponade cause cardiac arrest?

- after MI - pericarditis - aortic dissection - trauma - neoplasm

How do toxins and tension pneumothorax cause cardiac arrest?

- Toxins: overdose, incorrect dose and poisoning | - Tension pneumothorax: trauma or due to chronic lung disease

How does thrombosis cause cardiac arrest?

- lungs from DVT or otherwise - coronary arteries (ear lobe crease or corneal arcus from hyperlipidaemia) leading to MI (and then to pericarditis and cardiac aneurysm) - hypertensive heart disease (cardiomegaly) - significantly frightening altercation or event