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Block 10 > Hemodynamic Disorders 3 > Flashcards

Hemodynamic Disorders 3 Flashcards

1
Q

The most common cause of right heart failure

A

an increase in afterload due to left heart failure

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2
Q

Isolated right heart failure is generally due to

A

pulmonary vascular or parenchymal disease

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3
Q

cor pulmonale

A

enlargement of the right ventricle due to pressure from the lungs

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4
Q

Acute cor pulmonale is characterized by

A

dilation

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5
Q

Chronic cor pulmonale is characterized by

A

hypertrophy

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6
Q

Acute-on-chronic cor pulmonale

A

hypertrophy with dilation

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7
Q

Permanent destruction of airspaces, with the elimination of the capillaries in the alveolar walls that have been destroyed.

A

Pulmonary emphysema

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8
Q

Pulmonary edema, recurrent pulmonary thromboembolism, interstitial lung disease and the acute respiratory distress syndrom.

A

Common causes of chronic cor pulmonale

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9
Q

The first and generally most prominent symptom of right heart failure.

A

lower leg edema, starting with the feet

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10
Q

Chronic low-grade RUQ discomfort can be caused by

A

stretching of the liver capsule due to right heart failure

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11
Q

Common manifestations of right heart failure

A

leg edema
hepatomegaly
ascites
jugular venous distention

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12
Q

One drug that dilates pulmonary arterial vessels

A

sildenafil (Viagra)

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13
Q

total lack of cardiac pumping

A

asystole

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14
Q

15% of all deaths in the US per year (250,000) come from

A

sudden heart disease

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15
Q

Sudden cardiac death epidemiology

A

males (3:1)

AA

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16
Q

80% of sudden cardiac deaths are attributed to

A

CAD

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17
Q

Causes of sudden cardiac death

A 
CAD
hypertensive heart disease
myocarditis
channelopathies
hypertrophic cardiomyopathy
idiopathic dilated cardiomyopathy
cardiac sarcoidosis
cardiac amyloidosis
right ventricular cardiomyopathy
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18
Q

hereditary diseases of the cardiac conduction system involving Na, K, or Ca channels

A

channelopathies

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19
Q

sudden cardiac death is usually due to a

A

ventricular tachyarrythmia

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20
Q

Phase 1 is carried out by

A

an outflux of K ions

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21
Q

Phase 2 is mediated by an inflow of ____ and an outflow of ____.

A

Ca; K

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22
Q

In Phase 3 the ____ channels have closed and there is an outflux of ____.

A

Ca; K

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23
Q

a disease associated with mutations in the genes for cell adhesion proteins

A

right ventricular cardiomyopathy

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24
Q

In phase 2, Ca enters through _____ channels.

A

L-type

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25
Q

L-type channels are in close apposition to

A

ryanodine receptors

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26
Q

A disease associated with mutations in the genes for ryanodine receptors

A

familial catecholeminergic polymorphic ventricular tachycardia

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27
Q

When the resting membrane potential of cardiac myocytes is less negative than ___mV, spontaneous phase 4 depolarization can occur, initiating an _____.

A

-60 mV; arrhythmia

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28
Q

Abnormal _____ refers to the spontaneous depolarization of injured cardiac myocytes.

A

automaticity

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29
Q

Afterdepolarizations occurring in phase 2 or phase 3 are called

A

early

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30
Q

After depolarizations occurring in phase 4 are called

A

delayed

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31
Q

Abnormal ion fluxes that interrupt repolarization cause

A

afterdepolarization

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32
Q

Early afterdepolarization during phase 2 is associated with increased _____ inflow.

A

Ca

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33
Q

Early afterdepolarization during phase 3 can be due to abnormal _____ inflow.

A

Na

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34
Q

Delayed afterdepolarization during phase 4 is associated with high intracellular levels of ____, which can be due to marked _____ stimulation.

A

Ca; catecholamine

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35
Q

Afterdepolarizations lead to _____ which lead to _____.

A

spontaneous action potentials; tachyarrhythmias

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36
Q

Small patches of myocardial disease, especially scarring, are a common anatomic substrate for fatal _____.

A

reentrant ventricular tachycardia

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37
Q

Another word for the right bundle branch and the anterior and posterior left bundle branch.

A

fascicles

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38
Q

Can an impulse travel from the atria to the ventricles in a bifascicular block?

A

Yes

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39
Q

Trifascicular block has the same effect as _____ in preventing signals from the atria to the ventricles.

A

AV node blockade

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40
Q

2 things that can block the fascicles

A

myocardial scarring from infarction

amyloidosis

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41
Q

A cardiac arrhythmia, especially heart block, in a young AA suggests the possibility of

A

cardiac sarcoidosis

42
Q

the time it takes for signals to propagate from the SA node through the AV node is represented by the

A

PR interval

43
Q

A normal PR interval

A

120-200 milliseconds

44
Q

PR intervals longer than 200 milliseconds, but with all impulses from the atria getting through.

A

first degree AV block

OR first degree heart block

45
Q

The QRS is normally less than or equal to

A

100 milliseconds

46
Q

_____ represent aberrantly conducted impulses or impulses from abnormal places.

A

QRS intervals longer than 100 milliseconds (wide complexes)

47
Q

If the QRS interval is not widened, the QT interval represents

A

ventricular repolarization

48
Q

QTc

A

QT interval corrected for the heart rate

49
Q

QTc is normally less than or equal to

A

440 milliseconds

50
Q

Causes of a prolonged QT interval

A 
myocardial ischemia (#1)
blood electrolyte abnormalities
51
Q

Abnormalities in leads _____ reflect disease of the anterior left ventricle served by the LAD.

A

V1-V4

52
Q

Abnormalities in leads _____ reflect disease of the lateral left ventricle served by the left circumflex coronary artery.

A

V5-V6

53
Q

Abnormalities in leads _____ reflect disease in right coronary artery territory, in inferior left ventricle.

A

II, III, aVF

54
Q

Acute blockage of a major epicardial coronary artery is associated with elevation of the _____ segment.

A

ST; T wave can invert

55
Q

True or False. All Q waves are pathologic.

A

False

56
Q

A large transmural MI can leave a permanently misshapen ____ with an abnormally large, long and deep initial downward deflection, a pathologic ____ wave.

A

QRS; Q

57
Q

sinus tachycardia will not go over a rate of

A

220 minus the patient’s age

58
Q

Sort of innocent supraventricular tachyarrhythmias

A

Atrial fibrillation
Atrial flutter
Supraventricular tachycardia

59
Q

Rhythm is regular. Rate is high or normal (60-220) and there are no P waves.

A

Atrial fibrillation

60
Q

Results from a reentrant circuit around the tricuspid valve. Usually features 2 P waves for each QRS and yields a HR around 150/min.

A

Atrial flutter

61
Q

Usually due to a reentrant pathway in the atria near the AV node.

A

supraventricular tachycardia

62
Q

Supraventricular tachycardia can respond to home remedy vagal maneuvers. Such as

A

Valsalva maneuver
carotid sinus massage
face in ice water

63
Q

True or False. Ventricular tachyarrhythmias are dangerous.

A

True

64
Q

The two major types of ventricular tachyarrhythmias.

A

Ventricular tachycardia

Ventricular fibrillation

65
Q

The QRS complexes of ventricular tachycardia are typically

A

wide; over 120 milliseconds

66
Q

Ventricular tachycardia usually has a rate lower than

A

200/min

67
Q

If all QRS complexes look alike, the ventricular tachycardia is called

A

monomorphic

68
Q

If the QRS complexes vary in morphology, ventricular tachycardia is called

A

polymorphic

69
Q

Ventricular tachycardia, especially polymorphic ventricular tachycardia, can degenerate into

A

ventricular fibrillation

70
Q

True or False. Ventricular fibrillation is immediately life-threatening.

A

True.

71
Q

A totally disordered rapid stimulation of the ventricles.

A

Ventricular fibrillation

72
Q

Electrocardiogram of ventricular fibrillation shows

A

chaotic pattern without discrete QRS complexes

73
Q

Treatment for ventricular fibrillation

A

electrical defibrillation

74
Q

Backup for no defibrillator

A

PUNCH TO THE STERNUM

75
Q

When a blow to the sternum in a healthy person precipitates a fatal arrhythmia.

A

commotio cordis

76
Q

Channelopathies cause sudden death in

A

infants
children
young adults

77
Q

There are at lease ___ types of congenital long QT syndrome (kill 3-4,000 kids in the US)

A

13

78
Q

Characteristic arrhythmia associated with long QT syndrome

A

torsades de pointes

79
Q

A form of polymorphic ventricular tachycardia with frequent variations of the QRS size, morphology or both. The peaks of the closely spaced QRS complexes appear to twist around the baseline of the electrocardiogram, resembling a twisted ribbon.

A

torsades de pointes

80
Q

Caused by mutations in the gene for a subunit of the Iks potassium channel resulting in decreased K outflow, impairing repolarization, prolonging the QT interval, allowing early afterdepolarizations from multiple foci.

A

Type 1 congenital long QT syndrome (the most common type)

81
Q

Young adult asian males

A

Brugada syndrome

82
Q

Persistently elevated ST segments descending with an upward convexity to an inverted T wave in leads V1-V3, and with ventricular fibrillation

A

Brugada syndrome

83
Q

Mutations in the gene for a subunit of the cardiac Na channel.

A

Brugada syndrome

84
Q

_____ may account for at least 1/7 cases of sudden unexplained death.

A

Familial catecholeminergic polymorphic ventricular tachycardia

85
Q

Pts have a normal QT interval and typically present with life-threatening ventricular tachycardia or ventricular fibrillation during emotional or physical stress, with syncope often being the first manifestation of the disease.

A

Familial catecholeminergic polymorphic ventricular tachycardia

86
Q

majority of cases are due to mutations in the cardiac ryanodine receptor

A

Familial catecholeminergic polymorphic ventricular tachycardia

87
Q

2 methods for preventing life-threatening arrhythmias

A

beta-blockade

implanted defibrillator

88
Q

Inflammation of the heart muscle

A

myocarditis

89
Q

Most frequent agents of myocarditis

A

parvovirus B19 and herpes virus 6

90
Q

commonly occurs in young healthy individuals

A

viral myocarditis

91
Q

pale mottled flabby dilated heart, with multifocal interstitial, usually mononuclear inflammation.

A

myocarditis

92
Q

True or false. Myocarditis may cause sudden death due to arrhythmia.

A

True

93
Q

Prognosis for myocarditis.

A

90% recover

10% progress to chronic dilated cardiomyopathy

94
Q

Incidence higher in northern italy

A

right ventricular cardiomyopathy

95
Q

Mutations in desmosome proteins. Requires a second hit.

A

right ventricular cardiomyopathy

96
Q

Disease begins in the right ventricular apex and is characterized by fatty replacement of myocytes, frequently with lymphocytic infiltration and later fibrous scarring.

A

right ventricular cardiomyopathy

97
Q

a terminal upward notch of the QRS in lead V1

A

epsilon wave

98
Q

Disease causes reentrant ventricular tachycardia originating from the right ventricle.

A

right ventricular cardiomyopathy

99
Q

Inverted T waves in leads V1-V3 and sometimes and epsilon wave.

A

right ventricular cardiomyopathy

100
Q

Sudden death from right ventricular cardiomyopathy can be prevented with

A

implanted defibrillator

Block 10 (16 decks)

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