Hemodynamics III

Question 1

What is the most common cause of Right side heart failure?

Answer 1

Left side heart failure

Question 2

How does LHF cause RHF?

Answer 2

LHF causees increased pressure in pulmonary veins, capillary beds and then pulmonary arteries which increases Right heart afterload

Question 3

What is the most common cause of isolated RHF?

Answer 3

1.Pulmonary vascular
2.Parenchymal disease
Things like Pulmonary emphysema, recurrent pulmonary thromboembolism, and interstitial lung disease

Question 4

What is Cor pulmonale?

Answer 4

Right heart disease caused by pulmonary hypertensive diseases Things like Pulmonary emphysema, recurrent pulmonary thromboembolism, and interstitial lung disease

Question 5

What are the characteristics of Acute Cor Pulmonale?

Answer 5

Dilation of the right heart chambers

Question 6

What is the core characteristic of chronic Cor Pulmonale?

Answer 6

Right ventricular hypertrophy, with dilation if the workload exceeds its capacity

Question 7

What do all the diseases that cause Cor Pulmonale have in common?

Answer 7

The cause pulmonary hypertension

Question 8

What are the clinical manifestations of RHF?

Answer 8

!.Lower leg edema starting with the feet

2. Chronic low-grade RUQ discomfort from hepatic hypertension
3. Ascites (increased abdominal girth)

Question 9

What are the signs of RHF?

Answer 9

Peripheral edema especially of the legs, hepatomegaly, ascites and JVD

Question 10

What tools are helpful in diagnosing RHF

Answer 10

Echocardigraphy

Question 11

What drugs can work to lower pulmonary blood pressure?

Answer 11

Sildenafil (viagra)

Question 12

What is asystole?

Answer 12

Total lack of cardiac pumping

Question 13

What is slow death from heart failure characterized by?

Answer 13

Progressive dyspnea due to pulmonary edema.

Question 14

How does the incidence of sudden cardiac failure change with age?

Answer 14

Increases with age reaching its peak in the elderly

Question 15

In what gender is sudden cardiac death more prevalent?

Answer 15

Males

Question 16

What is the most common cause of sudden cardiac death?

Answer 16

Coronary Artery disease

2.Hypertensive heart disease

Question 17

What is sudden cardiac death usually due to?

Answer 17

Ventricular tachyarrythmia

Question 18

What is associated with Right ventricular cardiomyopathy?

Answer 18

Mutations in the genes for cell adhesion proteins that function in the low resistance gap junctions between myocytes

Question 19

What is familial catecholeminergic polymorphic ventricular tachycrdia?

Answer 19

Mutation in the genes for the Ryanodine receptors

Question 20

What are afterpolarizations?

Answer 20

tAbnormal triggered activity due to abnormal iron fluxes that interrupt repolarization

Question 21

Afterdepolarizations that occur during phase 2 or 3 are called?

Answer 21

Early

Question 22

Afterpolarization that occurs during phase 4 are called?

Answer 22

Delayed

Question 23

What is the normal cause of Afterrepolarization during phase 2?

Answer 23

Increased Calcium inflow which can be due to defective calcium channels

Question 24

What is the normal cause of Afterrepolarization during phase 3?

Answer 24

Abnormal sodium inflow due to defective sodium channels

Question 25

What causes delayed after polarizations?

Answer 25

High intracellular levels of calcium which can be due to marked catecholamine stimulation

Question 26

What do Afterdepolarizations lead to?

Answer 26

Lead to tachyarrhythmias

Question 27

Where is reentrant tachyarrhythmia mostlikely to happen?

Answer 27

In an area of patchy myocardial ischemia or scarring

Question 28

What causes reentry?

Answer 28

Injured or abnormal myocytes intiating a signal that encounters a pathway of myocytes no longer refractory. The abnormal impulse e

Question 29

Which blocks cause a cessation of conduction of electrical signal from Atria to ventricles?

Answer 29

Trifascicular block and AV node blockade

Question 30

What are some of the causes of signal blockade?

Answer 30

1. Myocardial scarring from infarction 2. Amyloidodid 3. Sarcoidosis

Question 31

What does sarcoidosis in the heart do?

Answer 31

Sarcoidosis in the heart favors the base and this fibrosing disease causes conduction block or arrhythmias especially in young African Americans

Question 32

What causes prolongation of the PR interval?

Answer 32

Delays in getting through the AV node most commonly

Question 33

What is the normal PR interval?

Answer 33

120-200 milliseconds (0.12 and .20 seconds)

Question 34

What is first degree AV block?

Answer 34

PR intervals longer than 200 milliseconds but with all impulses from Atria getting through

Question 35

What is the QT interval?

Answer 35

From the beginning of QRS to end of T wave

Question 36

What is the most common cause of prolonged QT interval?

Answer 36

Myocardial ischemia also low potassium calcium or magnesium or a channelopathy

Question 37

Where would the defect most likely be with abnormalities in leads V1-V4?

Answer 37

Anterior left ventricle served by the left anterior descending coronary artery.

Question 38

Where would the defect most likely be with abnormalities in leads V5-V6?

Answer 38

Lateral left ventricle served by the Left circumflex coronary Artery

Question 39

Where would the defect most likely be with abnormalities in leads II, III, and aVF?

Answer 39

Inferior left ventricle served by the right coronary artery

Question 40

What does acute blockage of a major epicardial coronary artery present as on the EKG?

Answer 40

ST segment elevation

Question 41

What is the ST segment?

Answer 41

The portion of the wave between the end of the QRS wave and the T wave

Question 42

What does acute blockage of a major epicardial coronary artery also present as on the EKG?

Answer 42

Inverted T wave

Question 43

What are the EKG features of Atrial fibrillation?

Answer 43

Irregular rhythm, the rate is high or normal and there are no P waves.

Question 44

What is the cause of Atrial flutter?

Answer 44

A reentrant circuit around the tricupid valve

Question 45

What are the features of Atrial flutter?

Answer 45

Two P waves for each QRS and yeilds a heart rate around 150 per minute

Question 46

What is the cause of supraventricular tachycardia?

Answer 46

Reentrant pathway in the atria right near the AV node

Question 47

What is a home remedy one can do that would help with supraventricular tachycardia?

Answer 47

Valsalva manuver, carotid sinus massage or immersion of the face in a pan of ice

Question 48

What is important about Ventricular fibrillation?

Answer 48

It is immediately life-threatening

Question 49

What is the cause of Ventricular Fibrillation?

Answer 49

Due to fragmentation of the wave of depolarization into numerous tiny wavelets going every which way

Question 50

How would Ventricular fibrillation appear on ECG?

Answer 50

Chaotic pattern without discrete QRS complexes

Question 51

What is the treatment for ventricular fibrillation?

Answer 51

Electrical defib if not available a punch to the sternum

Question 52

What is the characteristic arrhythmia associated with long QT syndrome?

Answer 52

Torsades de Pointes

Question 53

What is the cause of congenital long QT syndrome

Answer 53

Mutations in the gene for a subunit of the Iks potassium channel resulting in decreased outward potassium current, which impairs the repolarizing current prolonging the QT interval and allowing early afterdepolarizations

Question 54

In what subset of patients is Brugada syndrome most prevalent?

Answer 54

Young adult Asian males

Question 55

What is the cause of Brugada?

Answer 55

Genetic mutations in gene for cardiac sodium channel

Question 56

What are the effects of the mutated sodium channels in Brugada

Answer 56

1. Reduced duration of action potentials 2. Persistently elevated ST segments 3. Inverted T-Wave in leads V1-V3 4. Ventricular Fibrillation