Nichols- Hemodynamics 3 Flashcards
Most common cause of RHF?
LHF
What is isolated RHF due to? What is this called?
Due to pulmonary vascular or parenchymal disease. Called cor pulmonale
What are some causes of cor pulmonale?
- Pulmonary emphysema
- Recurrent pulmonary thromboembolism
- Interstitial lung disease
- ARDS
Lower leg edema, hepatosplenomegaly, ascites, JVD, and weight gain from fluid retention are signs of?
RHF
Cardiac myocytes (except for SA and AV nodes) are dependent of what ion for their resting membrane potential?
K+
Ca2+ induced Ca2+ release is from Ca2+ binding to _________ receptors on the ______?
ryanodine receptors on the SR
A mutation in the gene for ryanodine receptors leads to a disease called?
Familial catecholeminergic polymorphic ventricular tachycardia. It would probably lead to reduced capacity for cardiac contraction
Abnormal depolarizations that interrupt phase 2, 3, or 4 and can lead to arrhythmias
Afterdepolarizations
These afterdepols occur during phase 2 or 3
Early afterdepols
A phase 2 early afterdepol is due to?
increased Ca2+ inflow
A phase 3 early afterdepol is due to?
increased Na+ inflow
Delayed afterdepols (DADs) occur during phase 4 due to?
increased intracellular Ca2+ probably from increased catecholamine stimulation
Describe a re-entrant tachycardia
An area of ischemia/infarction can slow down the conduction form the SA node. If the conduction can go around the infarction and reach it via a different pathway, you can get an ectopic pacemaker which can lead to ventricular tachyarrhythmia
Conduction thru SA node is?
Slow
Conduction thru atrial muscle fibers is?
Fast
Conduction thru AV node is?
Slow
Conduction thru His/Purkinje system is?
Fast as shit
Conduction thru ventricular muscle is?
Slow
A heart block in a young black patient suggests?
Sarcoidosis
PR interval represents?
Length of time for conduction signal to travel from SA node through the AV node and the His/Purkinje system
A lengthened PR interval >200ms suggests?
AV block
QRS interval represents?
depolarization of ventricles
Wide QRS implies?
Impulse form abnormal place (ectopic pacemaker)
QT interval represents?
ventricular repolarization; shorter QT implies faster HR.. Longer QT implies myocardial ischemia, electrolyte abnormalities, or channelopathy.. its a bad thing!
Lead V1-V4 abnormality implies?
ANTERIOR LV disease (LAD artery territory)
Lead V5-V6 abnormality implies?
LATERAL LV disease (left circumflex artery)
Lead II, III, VF abnormality implies?
INFERIOR LV disease (RCA)
How can you decide whether a person has normal sinus tachycardia or whether their tachycardia is excessive?
Even during exercise, tachycardia should never breach 220-age
This abnormal heart rhythm is irregular with increased HR and no P wave
Atrial fibrillation
This abnormal heart rhythm has a HR of about 150 bpm and features 2 P waves for every QRS
Atrial flutter (usually from re-entrant circuit around tricuspid valve
This abnormal heart rhythm is typically from a re-entrant circuit around the AV node. It can be cured by Valsalva, carotid sinus massage, or ice water to the face
Supraventricular tachycardia
There are two types of ventricular tachyarrhythmias: tachycardia and fibrillation. Which one has a wide QRS complex and can be monomorphic or polymorphic?
Ventricular tachycardia
Which ventricular tachyarrhythmia is fatal as dookie and must be defibrilated like freakin yesterday
Ventricular fibrillation
Long QT syndrome known as Torsades de Pointes is a channelopathy affecting which cardiac ion channel?
Potassium channels
What is the effect of the mutated K+ channel?
Decreased outward K+ current during repolarization –> prolonged repolarization –> long QT interval –> early afterdepolarizations
Typical presentation of a channelopathy?
Baby that died in its sleep
This channelopathy has a mutation in sodium channels
Brugada syndrome
Brugada presents in what population?
Young Asian males
Reduced Na+ channel functionality results in reduced Na+ inflow which leads to?
Shortened AP’s
In Brugada syndrome, the presence of both normal & abnormal Na+ channels in the same tissue can lead to?
Ventricular arrhythmias –> vent fib
Familial catecholemineric polymorphic ventricular tachycardia is a channelopathy with mutations in?
Ryanodine receptors in SR
How do FCPVT patients present?
Life threatening vent tachy or vent fib during physical/emotional stress
What is myocarditis?
Inflammation of heart muscle
What usually causes myocarditis?
Parvovirus or HHV 6
Myocarditis has 2 phases. Describe the early phase
Direct viral infection of myocytes
Describe the late phase of myocarditis
Autoimmune attack on myocytes
What does a heart with myocarditis look like?
Pale, mottled, flabby, dialated.. With inflammation
This is a commonly underdiagnosed disease that presents in NORTHERN ITIALIANS!!!
Right ventricular cardiomyopahty
What is RV cardiomyopathy?
Fatty replacement of myocytes in RV apex
RV cardiomyopathy comes from a mutation in the gene that codes for?
Desmosomal proteins