Flashcards in Syncope Deck (12)
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1
Q
What is Syncope?
A
Transient loss of consciousness due to hypoperfusion of the brain (regardless of the cause)
“like dying, but you wake up”
2
Q
What is the direct effect of vagal nerve stimulation on the CV system?
A
- Decreased HR
- No effect on force of contraction of LV
- No effect on PVR
3
Q
The (SNS/PNS) directly innervates the heart itself, the (SNS/PNS) does not.
A
SNS
PNS
4
Q
How do you treat vasovagal syncope?
A
- Increase volume status (also mineralocorticoid drugs)
- alpha 1 agonist: midodrine
- Fludrocortisone not as effective
- Possible beta blocker (strange)
- Block triggering event (intense sympathetic discharge) to prevent event from occuring
- Pacemaker
5
Q
What are some ways to diagnose vasovagal syncope?
A
- ECG
- Echocardiogram
- Tilt-table test
- Holter monitor
- Implantable loop recorder
6
Q
young atheletes
LVH
outflow tract obstruction
A
hypertrophic cardiomyopathy
7
Q
How is HCM diagnosed?
A
- Classic murmur
- Harsh systolic murmur at apex & lower LSB
- Increases from squatting to standing
- Passive leg elevation decreases murmur
- Echocardiogram
- LV wall thickening
- Septal hypertrophy
8
Q
What are the 4 phases of the ventricular myocyte AP?
A
- Phase 0 - INa
- Phase 1 - ITO
-
Phase 2 (Plateau Phase)
- ICa-L, INaCa, IKr, IKs
-
Phase 3 (Repolarization Phase)
- IKr, IKsIK1, IK-ACh/ATP
-
Phase 4 (Resting State)
- IK1, IK-ACh/ATP
- If (funny current, SA node, pacemaker)
9
Q
How does prolonged QT lead to TdP?
A
- Prolonged QT leading to early after depolarization
- Early after depolarization breaking threshold & leading to ectopic beat (TdP)
- Sustained trigger activity
10
Q
In long QT what happens to each of these?
- IKs
- IKr
- IK1
- INa
- ICa-L
A
- IKs decrease
- IKr decrease
- IK1 decrease
- INa increase
- ICa-L increase
11
Q
________ prolongs the QT interval, but is rarely associated with TdP.
A
Amiodarone
12
Q
What medications cause acquired long QT?
A
- Anti-arrhythmics
- Class 1: Quinidine, Procainamide
- Class 3: sotalol, amiodarone, dofetilide
- Anti-depressants
- Anti-psychotics
- Antibiotics/Antifungals