Weakness, Syncope, and Sudden Death- CardioRush

False (both cardiac and noncardiac causes)
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Terms in this set (76)
False (both cardiac and noncardiac causes)
True or false: there are only cardiac causes of episodic weakness
Muscular weakness, orthopedic, neurological, hypovolemia, thromboembolic
What are some examples of noncardiac causes of episodic weakness?
Reduced CO due to arrhythmias, obstructive lesions, poor contractile function, pericardial disease
What are some examples of cardiac causes of episodic weakness?
Which limbs, altered consciousness, duration, recurrence or frequency, exercise related, rate of onset, other known metabolic or systemic diseases, shortness of breath or dyspnea present
What are the key history details to get from an owner when they are describing an episodic weakness?
Etiology
What will the PE findings of a patient that has episodic weakness help you determine?
CBC, chem, UA, thoracic rads, limb or spine rads, MRI or CT, ECG, echo, abdominal US
What are some baseline diagnostic tests you can run when investigating episodic weakness?
Adrenal glands, kidneys, liver, spleen issues
What would you be looking for on US of the abdomen when investigating causes of episodic weakness?
Syncope
What is the term for sudden, transient loss of consciousness with spontaneous recovery?
Sudden death
What can syncope be a precursor for?
True
True or false: the period before syncope is sometimes called pre-syncope or aborted syncope if syncope doesn't occur, and it is similar to episodic weakness
Dogs with cardiac disease and certain systemic diseasesWhat animals are more likely to exhibit syncope?Horses, catsWhat species less commonly exhibit syncope?False (it is a clinical event, not a diagnosis)True or false: syncope is a clinical diagnosisSome animals have only one episode of syncope before sudden death, others have no progression (depends on the individual)Why should the underlying cause of syncope be sought aggressively?42%What percentage of dogs with syncope resolve without intervention?16%What percentage of dogs with syncope has sycope as the cause of death?Hypoglycemia, hypoxemia, mild to severe anemia, hyperviscosity syndromes, hypotensionWhat are some systemic causes of syncope?Hypovolemia, inadequate vascular tone, cardiovascular causesWhat are 3 examples of situations that result in hypotension leading to syncope?Bradycardia, tachycardia, low CO, cardiac restriction, vasovagal or neurocardiogenic syncope, cough syncopeWhat are some cardiovascular causes of syncope?Pulmonic stenosis, subaortic stenosis, myocardial failureWhat are some examples of cardiac conditions that result in low CO?Pericardial tamponade, tension pneumothoraxWhat are 2 examples of cardiac restriction conditions that may lead to syncope?Cardiac mechanoreceptors and aortic baroreceptors sense overstimulation, signal to CNS to decrease SNS and increase PSNS, HR and BP decreasesWhat is the mechanism by which vasovagal syncope occurs?Profound bradycardia and plummeting BP, reduced CNS perfusionWhat is the CV effect of the vasovagal response?Anemia, hypovolemia, CHF in dogs, being a Boxer, not enough sleep, too much alcohol, emotional stimulationWhat are some triggers of vasovagal syncope?TrueTrue or false: vasovagal syncope is a relatively benign form of syncope, it's unlikely to lead to a sudden death eventSeizure, narcolepsy, catalepsy, collapse from muscular or orthopedic weaknessWhat are some differential diagnoses for when a patient presents with syncope?Flaccid muscles, precipitated by exercise or cough, no pre ictal period, short duration (30 seconds), normal limb motion when trying to recover, fast recovery, no hypersalivation or chompingWhat are some characteristics of syncope that help differentiate it from a seizure based on the owners description?Urination or defecation more likely, rigidity, no relationship to activity, pre ictal and post ictal phase, lasts slightly longer than syncope, hypersalivation and facial chompingWhat are some characteristics of a seizure that help differentiate it from syncope?NormalWhat is often the PE findings when a patient presents with history of syncope?CV signs like arrhythmia, gallop, murmur, or CHF, MM pallor, abdominal distension, lack of neuro deficitsIf there are signs present when a patient presents with syncope, what are some possible signs?False (fairly common that an underlying cause cannot be identified despite testing)True or false: in the majority of cases, we have enough tests to narrow down what is causing syncopeOften misses transient arrhythmiasWhat is the problem with using ECG in the clinic to determine cause of syncope?ECG, echo, thoracic rads, CBC, chem, UA, blood gas, event or Holter monitor, BP, abdominal USWhat are some examples of diagnostic tests that can be used to determine the cause of syncope?No report or quantification, must watch for abnormalitiesWhat is the drawback of using continuous ECG monitoring in an ICE setting?Continuous loop recording, saves portion when button pressed, external or internal devices availableWhat are the characteristics of using an event recorder to find underlying arrhythmias?Records multiple ECG channels for 1-2 days, gives quantification data, useful for frequent syncopeWhat are the characteristics of using a Holter Recorder for determining underlying cause of syncope?Number of QRS complexes, VPCs, repetitive arrhythmias, minimum HR, maximum HRWhat are some examples of quantification data that is obtained from Holter monitors?Underlying causeWhat does the management of syncope depend on?Pacemaker placementWhat is the only definitive treatment for 3rd degree AV block?Digoxin, theophyllineWhat are some examples of drugs that may be used to treat CHF and baroreceptor dysfunction?False (Don't prescribe anything without knowing the cause or you may make it worse)True or false: if you can't find an underlying cause of syncope, then you should make a best guess and treat with drugs based on that to see if it improvesSudden cardiac deathWhat is the term for an unexpected death from a cardiac cause generally occurring within 1 hour of onset of signs?Arrhythmias, cardiomegaly, MI, pericardial hemorrhageWhat are some cardiac causes of sudden death?Thromboembolism, pulmonary hemorrhage, CNS event, GDV, splenic massWhat are some non-cardiac causes of sudden death?V fibWhat is this arrhythmia?Asystole, pulseless electrical activity, advanced AV block, v tach, v fib, SVTWhat are some examples of cardiac rhythms that are associated with syncope or sudden death?AsystoleWhat is the term for no heart rhythm at all?V tach, AsystoleWhat is this arrhythmia?Advanced myocardial failure, electrolyte abnormalities, hypovolemiaWhat are some potential causes of pulseless electrical activity?QRS waves on ECG but not heart sounds or pulses feltWhat are the characteristics of pulseless electrical activity?Pulseless electrical activityThe following ECG is from a patient that doesn't have any pulses or heart sounds on auscultation. What is the diagnosis?3rd degree AV blockWhat is this arrhythmia?Propantheline, terbutaline, theophyllineWhat are the medical therapies for advanced AV block if putting in a pacemaker isn't an option?Atropine response testWhat test can be used in patients with bradycardia to determine is medical management is an option?Ventricular arrhythmiaWhat type of arrhythmia is this?Thoracic rads, echo, troponin IWhat should you do to investigate for underlying cardiac disease when trying to determine the cause of ventricular arrhythmias?Acid base status, electrolytes, hypoxemia, anemia, coagulopathy, blood volume, pain, drug toxicityWhat are some systemic conditions or issues that may result in ventricular arrhythmias?Lidocaine bolusWhat is the drug of choice when trying to control a ventricular arrhythmia on acute presentation?Implantable cardioverter defibrillatorsWhat is the backbone of treatment of arrhythmias that may cause sudden death in people?Sotalol, mexiletine, beta blocks, amiodaroneWhat are some drugs we may use to try to treat arrhythmias to prevent sudden death in dogs?Defibrillation (also called DC countershock)What is the term for termination of ventricular or atrial fibrillation, usually by electroshock?Time to defibrillationWhat is the most important factor in human survival from cardiac arrest?80%What is the chance of survival from a ventricular fibrillation event if defibrillation occurs within 2 minutes?60%What is the chance of survival from a ventricular fibrillation event if defibrillation occurs within 4 minutes?20%What is the chance of survival from a ventricular fibrillation event if defibrillation occurs within 8 minutes?No chanceWhat is the chance of survival from a ventricular fibrillation event if defibrillation occurs past 10 minutes?Current must traverse heart, many cells depolarized at once, new rhythm hopefully generates pulse, repeated shocks as needed, drugsWhat is required for successful defibrillation with a defibrillator?Increases threshold, harder to defibrillateWhat is the effect of lidocaine on the defibrillation threshold?V fib, ventricular flutter, torsades de pointes, pulseless v tachWhat are the indications for defibrillation?False (intrathoracic defibrillation also available)True or false: we can only defibrillate using external devicesCoarser, higher frequencyWhat are the characteristics of a waveform that is easier to defibrillate?Coarsen, increase frequencyWhat is the effect of Epi and vasopressin on the waveforms during ventricular fibrillation?TrueTrue or false: Vasopressin is more successful than epinephrine in increasing fibrillation frequency, amplitude, and in restoring normal sinus rhythmDiltiazem, esmololWhat drugs can be used IV to convert a SVT rapidly?Ca channel blockers, beta blockers, digoxin, sotalol, procainamideWhat drugs can be used for oral treatment of SVT?Vagal maneuverWhat is the action performed by creating abnormal increase in pressure on carotid sinus, inducing the vasovagal response to decrease SNS tone and increase PSNS tone to treat SVT?