Sudden Death

Question 1

Define sudden death

Answer 1

Death within 24 hours from the onset of symptoms

Question 2

State the four H’s of cardiac arrest

Answer 2

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia

Question 3

State the four T’s of cardiac arrest

Answer 3

Thrombosis
Tamponade
Toxins
Tension pneumothorax

Question 4

What are non-suspicious causes of hypoxia?

Answer 4

Asthma, pneumothorax, obstruction, respiratory depression, aspiration

Question 5

What would be classed as a suspicious cause of hypoxia?

Answer 5

Obstruction, overdose, negligence, poisoning, drowning

Question 6

State the main causes of hypovolaemia

Answer 6

GI haemorrhage, haemoperitoneum, trauma

Question 7

How can aortic valve disease cause sudden death?

Answer 7

Congenital bicuspid valve is more prone to calcification/endocarditis and may lead to increased heart size due to increased load

Question 8

What is a typical sign of cholesterol deposition in the eye?

Answer 8

Corneal arcus

Question 9

How do baroreceptors compensate for hypovolaemia?

Answer 9

Stretch receptors in carotid/aortic arch sense reduced stretch and enhance sympathetic output with inhibition of parasympathetic

Question 10

What is the sympathetic neurohormonal response?

Answer 10

Release of vasoconstrictors redirects fluid from peripheral/secondary organs

Question 11

What is the effect of capillary absorption of interstitial fluid?

Answer 11

Reduced hydrostatic pressure

Question 12

How does the HPA respond to hypovolaemia?

Answer 12

Intrarenal baroreceptors lead to renin release from JGA resulting in Ang II vasoconstriction and ADH secretion

Question 13

Describe the presentation of cardiogenic shock

Answer 13

Hypotension, fatigue, syncope, raised JVP, oedema, hepatic congestion

Question 14

Define positive inotropy

Answer 14

Increase force of contraction for any preload

Question 15

What can cause cardiogenic shock?

Answer 15

Acute MI 
Acute valve dysfunction 
Myocarditis
Cardiomyopathy 
Contusion

Question 16

Name three causes of obstructive shock

Answer 16

PE
Cardiac tamponade
Tension pneumothorax

Question 17

What is McConnells sign?

Answer 17

Hyperkinetic RV apex

Question 18

Name the types of shock that come under distributive

Answer 18

Septic
Anaphylactic
Neurogenic

Question 19

Name two shockable rhythms

Answer 19

VF

Pulseless VT

Question 20

Name two non-shockable rhythms

Answer 20

Pulseless electrical activity

Asystole

Question 21

What does VF look like on an ECG?

Answer 21

Bizarre irregular waveform, no QRS, uncoordinated electrical activity

Question 22

What does pulseless VT look like on ECG?

Answer 22

Monomorphic - broad complex, rapid, constant QRS

Polymorphic - torsade de pointes

Question 23

Describe drug treatment during arrest

Answer 23

Adrenaline given after 3 shocks Img IV

Amiodarone 300mg IV

Question 24

What does asystole look like on ECG?

Answer 24

Absent QRS may be atrial activity

Question 25

What is PEA?

Answer 25

Organised electrical activity in the absence of a pulse

Question 26

What does each letter of the ECG pattern indicate?

Answer 26

P - atrial depolarisation QRS - ventricular depolarisation T - ventricular depolarisation

Question 27

How do you calculate heart rate on ECG?

Answer 27

regular - 300/number of large squares between beats | irregular - number of QRS in 30 and multiply by 10

Question 28

Describe the stages of ECG analysis

Answer 28

1. Verify patient details 2. Check date and time 3. Check calibration 4. Determine axis 5. Rate and rhythm 6. Individual leads

Question 29

Which views of the heart correspond to which artery?

Answer 29

Lateral - circumflex Inferior - RCA Septal - LAD Anterior - RCA

Question 30

What is first degree heart block?

Answer 30

SA node depolarisation conducted to ventricles but there is a delay - PR prolonged

Question 31

What is the problem in second degree heart block?

Answer 31

Excitation intermittently fails to pass through the AV node/bundle of His

Question 32

Describe Mobitz type 1

Answer 32

Gradually PR increases until failure of conduction and beat is missed

Question 33

Describe Mobitz type 2

Answer 33

Constant PR but occasionally no ventricular contraction

Question 34

What is third degree heart block?

Answer 34

No APs from SA to AV node

Question 35

What is a useful way to remember ECG patterns in bundle branch block?

Answer 35

William Marrow

Question 36

Describe bundle block ECG

Answer 36

RBBB - big R wave in V1 and deep S wave in V6 | LBBB - M shape V6, V1 deep S wave

Question 37

What is normal heart deviation on ECG?

Answer 37

I and aVF are positive

Question 38

What does atrial flutter look like on ECG?

Answer 38

Saw tooth

Question 39

What does AF look like on ECG?

Answer 39

Irregularly irregular - p wave abnormality

Question 40

State the components of the triple risk model

Answer 40

1. Critical development period 2. Vulnerable infant 3. Exogenous stress

Question 41

Name some of the risk factors for SUDI

Answer 41

``` Acute illness Premature Congenital anomaly Small for gestation Multiple births Male Depression in carer Alcohol/substance misuse Maternal smoking Poor housing Co-sleeping/soft surface ```

Question 42

What is a genetic variant?

Answer 42

Change to DNA sequence

Question 43

What is a polymorphism?

Answer 43

Variant that is prevalent in the population

Question 44

What gene is mutated in Marfans?

Answer 44

Fibrillin

Question 45

Describe Loeys Dietz Syndrome

Answer 45

TBR1 or TBR2 mutations

Question 46

What is a diagnostic feature of familial hypercholesterolaemia?

Answer 46

Tendon xanthoma

Question 47

Name some genes associated with FH

Answer 47

LDLR APOB PCSK9