Hemodynamic Disorders III

Question 1

The most common cause of right heart failure is:

Answer 1

Increase in afterload due to left heart failure. Left heart failure causes increased pressure in pulmponary veins, capillary beds and then pulmonary arteries, which increases the afterload faced by the right heart.

Question 2

Isolated Right heart failure is usually caused by what>

Answer 2

Pulmonary vascular or parenchymal disease.

Question 3

Cor pulmonale

Answer 3

heart disease caused by lung disease

Question 4

Causes of chronic cor pulmonale

Answer 4

pulmonary emphysema, recurrent pulmonary thromboembolism, interstitial lung disease, and ARDS

Question 5

Clinical manifestations of Right heart failure

Answer 5

Lower leg Edema (though this is nowhere near specific for right heart failure), Right upper quadrant pain if blood backed up from the right heart stretches out the liver capsule. Hepatomegally, JVD, ascites, decresased appetite.

Question 6

Asystole

Answer 6

total lack of cardiac pumping.

Question 7

Slow death from heart failure is associated with what?

Answer 7

Increasing dyspnea

Question 8

Sudden cardiac death is more common in what sex>

Answer 8

Males

Question 9

80% of sudden cardiac deaths are associated with what?

Answer 9

Coronary artery disease

Question 10

Second most common cause of cardia death?

Answer 10

hypertensive heart disease.

Question 11

What is automaticity?

Answer 11

a cell’s ability to depolarize itself to a threshold generating a spontaneous action potential

Question 12

How can myocytes acquire automaticity pathologically

Answer 12

Injured myocytes have leaky membranes and lose part of their concentration gradients of ions. This results in a less than normal membrane potential. When that membrane potential is less negative than -60 spontaneous depolarization can occur.

Question 13

afterdepolarizations in stage 2 or 3 are referred to as early

Answer 13

true

Question 14

Afterdepolarizations in ohase 4 are

Answer 14

delayed

Question 15

afterdeploarization during the long phase 2 can be attributed to

Answer 15

increased calcium inflow which is due to defected calcium channels

Question 16

afterdepolarization during phase 3

Answer 16

abnormal sodium inflow

Question 17

What does the PR interval tell you

Answer 17

The length of time it takes a signal to propagate from the SA node through the AV node

Question 18

Normal PR interval

Answer 18

.12-.20 seconds

Question 19

First degree heart block

Answer 19

PR interval longer than .20 secs

Question 20

QRS interval time

Answer 20

usually less than .1 secs

Question 21

wide complex

Answer 21

thats how you refer to a wide QRS. Its bad

Question 22

QT interval

Answer 22

ventricular repolarization

Question 23

QTc

Answer 23

QT interval corrected for heart rate

Question 24

Prolonged QT

Answer 24

BAD…most common cause is myocardial ischemia….can also be from blood electrolyte abnormalities

Question 25

how to differentiate sinus tacchycardia from taccharrythmia

Answer 25

sinus tacchycardia will not go over a rate of 220-the pts age

Question 26

sinus tacchycardia is not associated with heart disease

Answer 26

true

Question 27

atrial fibrillation on an EKG

Answer 27

regular rhythm, rate is high or normal, no P waves

Question 28

Most common tachyarrhythmia

Answer 28

A Fib

Question 29

Second most common

Answer 29

atrial flutter

Question 30

Ventricular tachyarrhthmias are the dangerous ones

Answer 30

truth

Question 31

Two major ventricular tacchyarhthmias

Answer 31

ventricular tachycardia and ventricular fibrilation

Question 32

ventricular tachycardia QRS

Answer 32

``` wide QRS (over 120 ms or .12 secs) If all the QRS complexes look alike, its monomorphic. If the QRS vary in morphology, its polymorphic ```

Question 33

Ventricular fibrillation is immediately what

Answer 33

lifethreatening

Question 34

Totally disordered rapid stimulation of ventricles

Answer 34

Ventricular fibrilation

Question 35

A prolonged QT over how many milliseconds is dangerous

Answer 35

440

Question 36

acute cor pulmonale is characterized by what?

Answer 36

dilatation of the right heart chambers

Question 37

Chronic cor pulmonale

Answer 37

hypertrophy of the right heart....eventually if the workload comes to exceed the capability of the hypertrophied right ventricle it begins to dilate. You get dilation superimposed on hypertrophy

Question 38

What is pulmonary emphysema

Answer 38

permanant destructin of airspaces with the elimination of the capillaries in the alveolar walls that have been destroyed. THis is problematic for the heart because you are still pumping the same amount of blood through a decreased vascular bed. Causes increased afterload for the right heart. Can lead to occlusion of the pulmonary arteries.

Question 39

What type of cardiac environment predisposes to re-entry

Answer 39

Small pathces of myocardial ischemia or scarring. Re erntry occurs when signals are re-directed around areas of injury and encounter myocytes that are finished with their repolarization and no longer refractory. this abnormally conducted impulse can reenter the normal conduction pathway adding an extra impulse and causing a tacchyarrhythmia.

Question 40

If you see a cardiac conduction block in a young african american, what is it most likely?

Answer 40

Cardiac sarcoidosis

Question 41

Explain the conduction pathway after the AV node

Answer 41

AV node-> bundle of His -> Left and Right branches of the bundle of His -> Left bundle branch divides into anterior and posterior, right keeps going (now you have threeconducting fiber bundles

Question 42

How many leads are electrocardiograms

Answer 42

12

Question 43

How do you differentiate sinus tachycardia from an arrhythmia

Answer 43

Sinus tacchycardia will not go over a rate of 220 minus the patients age.

Question 44

Many supaventricular tacchyarrhythmias are innocent

Answer 44

truth

Question 45

What is a channelopathy?

Answer 45

hereditary diseases of sodium, potassium, or calcium channels

Question 46

Torsades de pointes is a channelopathy and features what?

Answer 46

closely spaced QRW complexes twisting around the baseline of the electrocardiogram

Question 47

What is the most common type of congenital long QT syndrome?

Answer 47

Type 1. It is caused by mutations in the gene for a subunit of the Iks potassium channel. DOesnt allow potassium to flow out like it should and thus presents problems with depolarization

Question 48

Brugada syndrome

Answer 48

young adult asian males. mutation in gene for cardiac sodium channels. Reduce action potential durations. Inverted T wave in leads V1-3 with ventricular fib