Hemodynamic Disorders 3 Flashcards
1
Q
The most common cause of right heart failure
A
an increase in afterload due to left heart failure
2
Q
Isolated right heart failure is generally due to
A
pulmonary vascular or parenchymal disease
3
Q
cor pulmonale
A
enlargement of the right ventricle due to pressure from the lungs
4
Q
Acute cor pulmonale is characterized by
A
dilation
5
Q
Chronic cor pulmonale is characterized by
A
hypertrophy
6
Q
Acute-on-chronic cor pulmonale
A
hypertrophy with dilation
7
Q
Permanent destruction of airspaces, with the elimination of the capillaries in the alveolar walls that have been destroyed.
A
Pulmonary emphysema
8
Q
Pulmonary edema, recurrent pulmonary thromboembolism, interstitial lung disease and the acute respiratory distress syndrom.
A
Common causes of chronic cor pulmonale
9
Q
The first and generally most prominent symptom of right heart failure.
A
lower leg edema, starting with the feet
10
Q
Chronic low-grade RUQ discomfort can be caused by
A
stretching of the liver capsule due to right heart failure
11
Q
Common manifestations of right heart failure
A
leg edema
hepatomegaly
ascites
jugular venous distention
12
Q
One drug that dilates pulmonary arterial vessels
A
sildenafil (Viagra)
13
Q
total lack of cardiac pumping
A
asystole
14
Q
15% of all deaths in the US per year (250,000) come from
A
sudden heart disease
15
Q
Sudden cardiac death epidemiology
A
males (3:1)
AA
16
Q
80% of sudden cardiac deaths are attributed to
A
CAD
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
18
Q
hereditary diseases of the cardiac conduction system involving Na, K, or Ca channels
A
channelopathies
19
Q
sudden cardiac death is usually due to a
A
ventricular tachyarrythmia
20
Q
Phase 1 is carried out by
A
an outflux of K ions
21
Q
Phase 2 is mediated by an inflow of ____ and an outflow of ____.
A
Ca; K
22
Q
In Phase 3 the ____ channels have closed and there is an outflux of ____.
A
Ca; K
23
Q
a disease associated with mutations in the genes for cell adhesion proteins
A
right ventricular cardiomyopathy
24
Q
In phase 2, Ca enters through _____ channels.
A
L-type
25
L-type channels are in close apposition to
ryanodine receptors
26
A disease associated with mutations in the genes for ryanodine receptors
familial catecholeminergic polymorphic ventricular tachycardia
27
When the resting membrane potential of cardiac myocytes is less negative than ___mV, spontaneous phase 4 depolarization can occur, initiating an _____.
-60 mV; arrhythmia
28
Abnormal _____ refers to the spontaneous depolarization of injured cardiac myocytes.
automaticity
29
Afterdepolarizations occurring in phase 2 or phase 3 are called
early
30
After depolarizations occurring in phase 4 are called
delayed
31
Abnormal ion fluxes that interrupt repolarization cause
afterdepolarization
32
Early afterdepolarization during phase 2 is associated with increased _____ inflow.
Ca
33
Early afterdepolarization during phase 3 can be due to abnormal _____ inflow.
Na
34
Delayed afterdepolarization during phase 4 is associated with high intracellular levels of ____, which can be due to marked _____ stimulation.
Ca; catecholamine
35
Afterdepolarizations lead to _____ which lead to _____.
spontaneous action potentials; tachyarrhythmias
36
Small patches of myocardial disease, especially scarring, are a common anatomic substrate for fatal _____.
reentrant ventricular tachycardia
37
Another word for the right bundle branch and the anterior and posterior left bundle branch.
fascicles
38
Can an impulse travel from the atria to the ventricles in a bifascicular block?
Yes
39
Trifascicular block has the same effect as _____ in preventing signals from the atria to the ventricles.
AV node blockade
40
2 things that can block the fascicles
myocardial scarring from infarction
| amyloidosis
41
A cardiac arrhythmia, especially heart block, in a young AA suggests the possibility of
cardiac sarcoidosis
42
the time it takes for signals to propagate from the SA node through the AV node is represented by the
PR interval
43
A normal PR interval
120-200 milliseconds
44
PR intervals longer than 200 milliseconds, but with all impulses from the atria getting through.
first degree AV block
| OR first degree heart block
45
The QRS is normally less than or equal to
100 milliseconds
46
_____ represent aberrantly conducted impulses or impulses from abnormal places.
QRS intervals longer than 100 milliseconds (wide complexes)
47
If the QRS interval is not widened, the QT interval represents
ventricular repolarization
48
QTc
QT interval corrected for the heart rate
49
QTc is normally less than or equal to
440 milliseconds
50
Causes of a prolonged QT interval
```
myocardial ischemia (#1)
blood electrolyte abnormalities
```
51
Abnormalities in leads _____ reflect disease of the anterior left ventricle served by the LAD.
V1-V4
52
Abnormalities in leads _____ reflect disease of the lateral left ventricle served by the left circumflex coronary artery.
V5-V6
53
Abnormalities in leads _____ reflect disease in right coronary artery territory, in inferior left ventricle.
II, III, aVF
54
Acute blockage of a major epicardial coronary artery is associated with elevation of the _____ segment.
ST; T wave can invert
55
True or False. All Q waves are pathologic.
False
56
A large transmural MI can leave a permanently misshapen ____ with an abnormally large, long and deep initial downward deflection, a pathologic ____ wave.
QRS; Q
57
sinus tachycardia will not go over a rate of
220 minus the patient's age
58
Sort of innocent supraventricular tachyarrhythmias
Atrial fibrillation
Atrial flutter
Supraventricular tachycardia
59
Rhythm is regular. Rate is high or normal (60-220) and there are no P waves.
Atrial fibrillation
60
Results from a reentrant circuit around the tricuspid valve. Usually features 2 P waves for each QRS and yields a HR around 150/min.
Atrial flutter
61
Usually due to a reentrant pathway in the atria near the AV node.
supraventricular tachycardia
62
Supraventricular tachycardia can respond to home remedy vagal maneuvers. Such as
Valsalva maneuver
carotid sinus massage
face in ice water
63
True or False. Ventricular tachyarrhythmias are dangerous.
True
64
The two major types of ventricular tachyarrhythmias.
Ventricular tachycardia
| Ventricular fibrillation
65
The QRS complexes of ventricular tachycardia are typically
wide; over 120 milliseconds
66
Ventricular tachycardia usually has a rate lower than
200/min
67
If all QRS complexes look alike, the ventricular tachycardia is called
monomorphic
68
If the QRS complexes vary in morphology, ventricular tachycardia is called
polymorphic
69
Ventricular tachycardia, especially polymorphic ventricular tachycardia, can degenerate into
ventricular fibrillation
70
True or False. Ventricular fibrillation is immediately life-threatening.
True.
71
A totally disordered rapid stimulation of the ventricles.
Ventricular fibrillation
72
Electrocardiogram of ventricular fibrillation shows
chaotic pattern without discrete QRS complexes
73
Treatment for ventricular fibrillation
electrical defibrillation
74
Backup for no defibrillator
PUNCH TO THE STERNUM
75
When a blow to the sternum in a healthy person precipitates a fatal arrhythmia.
commotio cordis
76
Channelopathies cause sudden death in
infants
children
young adults
77
There are at lease ___ types of congenital long QT syndrome (kill 3-4,000 kids in the US)
13
78
Characteristic arrhythmia associated with long QT syndrome
torsades de pointes
79
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.
torsades de pointes
80
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.
Type 1 congenital long QT syndrome (the most common type)
81
Young adult asian males
Brugada syndrome
82
Persistently elevated ST segments descending with an upward convexity to an inverted T wave in leads V1-V3, and with ventricular fibrillation
Brugada syndrome
83
Mutations in the gene for a subunit of the cardiac Na channel.
Brugada syndrome
84
_____ may account for at least 1/7 cases of sudden unexplained death.
Familial catecholeminergic polymorphic ventricular tachycardia
85
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.
Familial catecholeminergic polymorphic ventricular tachycardia
86
majority of cases are due to mutations in the cardiac ryanodine receptor
Familial catecholeminergic polymorphic ventricular tachycardia
87
2 methods for preventing life-threatening arrhythmias
beta-blockade
| implanted defibrillator
88
Inflammation of the heart muscle
myocarditis
89
Most frequent agents of myocarditis
parvovirus B19 and herpes virus 6
90
commonly occurs in young healthy individuals
viral myocarditis
91
pale mottled flabby dilated heart, with multifocal interstitial, usually mononuclear inflammation.
myocarditis
92
True or false. Myocarditis may cause sudden death due to arrhythmia.
True
93
Prognosis for myocarditis.
90% recover
| 10% progress to chronic dilated cardiomyopathy
94
Incidence higher in northern italy
right ventricular cardiomyopathy
95
Mutations in desmosome proteins. Requires a second hit.
right ventricular cardiomyopathy
96
Disease begins in the right ventricular apex and is characterized by fatty replacement of myocytes, frequently with lymphocytic infiltration and later fibrous scarring.
right ventricular cardiomyopathy
97
a terminal upward notch of the QRS in lead V1
epsilon wave
98
Disease causes reentrant ventricular tachycardia originating from the right ventricle.
right ventricular cardiomyopathy
99
Inverted T waves in leads V1-V3 and sometimes and epsilon wave.
right ventricular cardiomyopathy
100
Sudden death from right ventricular cardiomyopathy can be prevented with
implanted defibrillator
