Syncope Flashcards
when do coronaries receive blood flow
during diastole as the blood come back down the ascending aorta
what supplies the apex of the heart with blood
marginal artery off of the right coronary
what does the left main coronary separate into
LAD and left circumflex
what feeds the anterior 2/3 of the interventricular septum toward the apex
LAD
what is syncope
transient loss of consciousness secondary to lack of cerebral blood flow
self-limited with loss of postural tone
typically patients recover rapidly with full return to baseline
what are the rules of 15
15% of PE pts will present with syncope
15% of AAA pts present with syncope
15% of ruptured ectopic patients present with syncope
15% of SAH pts present with syncope
15% of ACS pts present with syncope
What is CHESS PIECES
C- CHF
H - HCT < 30
E - ECG abnormality
S - SOB
S - SBP < 90
P- Premature SCD (FHx)
I - Ischemic heart disease
E - EF < 35%
C - Cardiomyopathy
E - exertional syncope
S - structural heart disease
what is included in ACS
unstable angina, NSTEMI, STEMI
what is the 6 step ECG approach
Rate
Rhythm (P waves, regular/irregular, QRS)
Intervals
Dsyrhythmia
ischemia
axis
what is the QT segment
time it takes for ventricles to depolarize and repolarize
what is long QT syndrome
prolonged if >440ms in men and >460 ms in women
> 500ms has increased risk for badness
what can be causes of acquired long QT syndrome
hypokalemia, hypomagnesemia, hypocalcemia, MI, elevated ICP, Meds
what is Wolf Parkinson white
pre-excitation syndrome - abnormal conduction pathway along the bundle of Kent directly connecting the atria to ventricles and bypassing the AV node
may be familial
what is WPW pattern
seen on ECG but asymptomatic
what is WPW syndrome
symptomatic arrhythmia
palpitations, dizzy, syncope, CP, Sudden cardiac death
commonly associated with afib
what is the ECG triad with WPW
Delta wave on ECG
short PR < 0.12 sec / no PR seg
Wide QRS > 0.12-0.2
what is a sodium channelopathy
brugada
what occurs with Brugada
repolarization issue associated with sodium ion channels which can lead to ventricular strain and fibrillation and sudden cardiac death
what is brugada pattern and syndrom
pattern: ECG findings with no symptoms
syndrome: ECG + palpitations, syncope, dyspnea (all indicators of vtach)
what is the treatment of brugada syndome
ICD
What is hypertrophic obstructive cardiomyopathy (HOCM)
genetic cardiomyopathy that leads to myocyte hypertrophy and myocardial disarray (autosomal dominant)
leads to increased LV thickness which reduces filling and ultimately CO
increased risk of arrhythmias and SCD
what is seen on HOCM ECGs
‘dagger like” Q wave in lateral leads (1, avl, v5-6), LVH
what is tamponade
acute or chronic increase in fluid around the heart that can cause pressure on the heart - decreased size of chambers of the heart
what is the exam presentation of tamponade
tachycardia
hypotension
evelevated JVP
pulsus paradoxus
pericardiual rub
Becks triad
what is beck’s triad
hypotension
muffled heart sounds
elevated JVP
what is a PE
venous thromboembolism that blocks the pulmonary vasculature
what is a massive PE
hemodynamic instability with hypotension, mortality rate 25-52%
what is a submassive PE with right heart strain
elevated troponin, BNP, strain on imaging (CT or ECG)
what are the risks for getting PE
time of immobility
surgery
trauma
cancer
estrogen replacement
procoagulant syndromes
hx dvt or pe
what is the presentation of PE
pleuritic chest pain
SOB, hypoxia
syncope
shock (right side HF)
finding of DVT
cough
hemoptysis
tachycardia
what is the workup for PE
if low risk - d-dimer
high risk: CTA
- PERC rule
what are PERC rule used for
rule for PE risk
what are the ECG findings for PE
s waves in lead 1
Q waves in lead 3
inverted T-waves in lead 3
what is severe pulmonary hypertension
increase pulmonary vascular resistance which leads to right sided HF
due to HF, COPD, vasculitis, infection
presents with: SOB, CP, effusion, edema
what is pulmonary hypertension
elevation in the normal pulmonary vascular pressures
increases RV pressure - decrease CO, decrease ability to exert themselves, fluid retention - may lead to death
what are common causes of pulmonary arterial hypertension
PE, ARDS, COPD, Interstitial lung disease
What is aortic dissection
separation between layers of the aorta with a false lumen that spreads secondary to pulse and BP
