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29 Cards in this Set

  • Front
  • Back
Vertigo and cause
Feeling of spinning; abnormal eye movements; a disorder of the vestibular system.

Causes: acute labyrinthitis (viral infection), Transient ischemic attack, stroke, acoustic neuroma
Postural syncope
1. related to acute volume loss (GI bleed, diuretic use, sweating, n/v, diarrhea)
2. related to loss of neurologic tone of autonomic nervous system (multiple system atrophy = Shy-Drager Syndrom, diabetic peripheral neuropathy)
3.Medication use- alpha methyl dopa, clonidine, antihypertensives
Vasovagal syncope
Most common cause of syncope, nausea often involved, affects men more, situational causes (ups parasympathetic and withdraw sympathetic at same time), history of passing out, tilt table testing may help diagnose, it is benign
Carotid Sinus Hypersensitivity
old men; caused by things like tight collar or turning head too much; diagnosis acquired through history and evidence of carotid sinus hypersensitivity
Glossopharyngeal neuralgia
syncope with swallowing; usually a history of head and neck surgery; stimulating CN 9 will also stimulate CN 10; must transect 9 to treat
Spinal Cord injury
Injory of C5 or higher; poor prognonis; immediate systole upon stimulation
Cardiac Syncope
Sudden onsent and offset of syncope; history of cardiac disease; potentially lethal; be careful when a cardiac patient has syncope! syncope during exercise is usually bad (often due to ventricular fibrillation)

-Causes are either bradycardia or tachycardia or obstruction to flow
Sinus node dysfunction
Sinus arrest or sinus bradycardia; Older people; Aggravated by medication such as digoxin, beta-blockers, and calcium channel blockers; rarely causes sudden death; can treat wtih a permanent pacemaker
Tachycardia-bradycardia Syndrome
Bradycardia or a long pause occurs after termination of atrial fibrillation or atrial flutter; treat with pacemaker
Atrial fibrillation vs. Atrial Flutter
Atrial Fibrillation- rapid irregular twitchings of the muscular wall and the ventricles respond irregularly too

Atrial Flutter- Rapid regular atrial contractions (up to 350 per minute); often makes sawtooth pattern on EKG
Secondary Mobitz I block
"AV Wenckebach Block"
Progressive PR interval prolongation then miss QRS
-Block is in the AV node
Mobitz II Secondary AV Block
-Result of a block in BBB
-3:2 conduction ratio
-PR interval is the same
-Wide QRS complex
-Poor prognosis and always requires pacing
Tertiary AV Block of AVN
-Complete AV block and complete atrioventricular dissociation
-Narrow QRS
-Usually need pacing because it is usually symptomatic
Tertiary AV Block in Bundle Branches
-Complete AV block but QRS is wider and prolonged
-always needs pacemaker
What are the common causes of AV block
Most common- idiopathic bilateral bundle branch fibrosis which is fibrosis of the conducting system

2. cardiomyopathy
3. ischemic coronary artery disease
3. bilateral destruction of bundle branches
What type of arrhythmia is irregularly irregular
Atrial Fibrillation
-Conduction is very fast
-may have syncope
-it is the most common type of sustained arrhythmia
-treatment is to slow AV nodal conduction
Atrial Flutter
Regular rhythm within the atrium
-sawtooth flutter waves in leads II and III and aVF
-300 per minute
-usually AV conduction ratio is 2:1 or 3:1
-treat with catheter ablation in the right atrium to stop re-entrant rhythm around the tricuspid valve
AV Nodal Reciprocating Tachycardia
-Most common regular narrow complex tachycardia
-no P waves; there is reentry within the region of the AV node
-Syncope is common
-Treat with beta-blockers, calcium channel blockers and catheter ablation of slow AV nodal pathway
What could make a teenage athlete suddenly drop dead?
Wolff-Parkinson-White Syndrome
-short PR interval with presence of a delta wave- a slurred QRS
-There is an accessory pathway from a bundle of atrial muscle bridging the atria and ventricle
-Impluse bypasses the AV node by taking bridge and this makes a wide QRS and short PR
-Tachycardia results when the impulse is carried through the AV node and reenters the atria through the accessory pathway
-preexcited atrial fibrillation occurs
-may cause sudden death. need electrical shock
-usually present with syncope or dead
-similar morphological waves to ventricular tachycardia... can be treated same way
What is the most lethal of all causes of syncope
Ventricular Tachyarrhythmias
-significant structural heart disease is frequently present
-If patient presents with syncope and history of heart disease, they need an implantable cardioverter-defibrillator
Causes of Ventricular Tachycardia
1. Coronary Artery Disease
2. Dilated cardiomyopathy
3. congenital hear disease
4. valvular heart disease
5. arrhythmogenic right ventricular cardiomyopathy (genetic disease that dtypically causes sudden cardia death in young people)
6. traumatic heart disease
What genetic disease causes sudden cardia death in young athletes
Arrhythmogenic right ventricular cardiomyopathy
What causes most cardiac deaths in US
Sudden Cardiac Death
-5% survival
-involves ventricular fibrillation
-They go from VF to asystole
-if defibrillation occurs soon, they have a good chance
-CPR makes a difference
-time to defibrillation is the most important factor
-can implant defibrillators
What are some congenital causes of syncope and sudden death?
Long QT syndrome, Brugada Syndrome, Benign Ventrical Tachycardia, obstructive cardiac syncope
Torsades de Pointes VT
-long QT
-almost always a congenital disorder of sodium or potassium or drug induced
-special malignant form of VT
Causes of Torsades de Pointes
-Type 1a anti-arrhythmics- quinidine, procainamide, disopyramid
-Amiodarone, erythromycin
-T-type calcium channel blockers
-Long QT syndrome
Why would a young man in SE Asia drop dead after a fever
Brugada syndrome
-one of most common causes of SD in young men in SE Asia
-Preceded by fever and usually occurs overnight
-Right BBB and ST elevation V1-V3.
-Treatment is ICD
-T wave inversion seen in V2 leads
Benign Ventricular tachycardia
-no structural heart disease
-treatment is ablations with catheters
-may have syncope
What could cause syncope in exertion?
Obstructive cardiac syncope
-blood flow not getting to heart
-Aortic stenosis
-Hypertrophic obstructive cardiomyopathy
-Coronary artery disease
-Pulmonary hypertension