Nichols- Hemodynamics 3

Question 1

Most common cause of RHF?

Answer 1

LHF

Question 2

What is isolated RHF due to? What is this called?

Answer 2

Due to pulmonary vascular or parenchymal disease. Called cor pulmonale

Question 3

What are some causes of cor pulmonale?

Answer 3

1. Pulmonary emphysema
2. Recurrent pulmonary thromboembolism
3. Interstitial lung disease
4. ARDS

Question 4

Lower leg edema, hepatosplenomegaly, ascites, JVD, and weight gain from fluid retention are signs of?

Answer 4

RHF

Question 5

Cardiac myocytes (except for SA and AV nodes) are dependent of what ion for their resting membrane potential?

Answer 5

K+

Question 6

Ca2+ induced Ca2+ release is from Ca2+ binding to _________ receptors on the ______?

Answer 6

ryanodine receptors on the SR

Question 7

A mutation in the gene for ryanodine receptors leads to a disease called?

Answer 7

Familial catecholeminergic polymorphic ventricular tachycardia. It would probably lead to reduced capacity for cardiac contraction

Question 8

Abnormal depolarizations that interrupt phase 2, 3, or 4 and can lead to arrhythmias

Answer 8

Afterdepolarizations

Question 9

These afterdepols occur during phase 2 or 3

Answer 9

Early afterdepols

Question 10

A phase 2 early afterdepol is due to?

Answer 10

increased Ca2+ inflow

Question 11

A phase 3 early afterdepol is due to?

Answer 11

increased Na+ inflow

Question 12

Delayed afterdepols (DADs) occur during phase 4 due to?

Answer 12

increased intracellular Ca2+ probably from increased catecholamine stimulation

Question 13

Describe a re-entrant tachycardia

Answer 13

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

Question 14

Conduction thru SA node is?

Answer 14

Slow

Question 15

Conduction thru atrial muscle fibers is?

Answer 15

Fast

Question 16

Conduction thru AV node is?

Answer 16

Slow

Question 17

Conduction thru His/Purkinje system is?

Answer 17

Fast as shit

Question 18

Conduction thru ventricular muscle is?

Answer 18

Slow

Question 19

A heart block in a young black patient suggests?

Answer 19

Sarcoidosis

Question 20

PR interval represents?

Answer 20

Length of time for conduction signal to travel from SA node through the AV node and the His/Purkinje system

Question 21

A lengthened PR interval >200ms suggests?

Answer 21

AV block

Question 22

QRS interval represents?

Answer 22

depolarization of ventricles

Question 23

Wide QRS implies?

Answer 23

Impulse form abnormal place (ectopic pacemaker)

Question 24

QT interval represents?

Answer 24

ventricular repolarization; shorter QT implies faster HR.. Longer QT implies myocardial ischemia, electrolyte abnormalities, or channelopathy.. its a bad thing!

Question 25

Lead V1-V4 abnormality implies?

Answer 25

ANTERIOR LV disease (LAD artery territory)

Question 26

Lead V5-V6 abnormality implies?

Answer 26

LATERAL LV disease (left circumflex artery)

Question 27

Lead II, III, VF abnormality implies?

Answer 27

INFERIOR LV disease (RCA)

Question 28

How can you decide whether a person has normal sinus tachycardia or whether their tachycardia is excessive?

Answer 28

Even during exercise, tachycardia should never breach 220-age

Question 29

This abnormal heart rhythm is irregular with increased HR and no P wave

Answer 29

Atrial fibrillation

Question 30

This abnormal heart rhythm has a HR of about 150 bpm and features 2 P waves for every QRS

Answer 30

Atrial flutter (usually from re-entrant circuit around tricuspid valve

Question 31

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

Answer 31

Supraventricular tachycardia

Question 32

There are two types of ventricular tachyarrhythmias: tachycardia and fibrillation. Which one has a wide QRS complex and can be monomorphic or polymorphic?

Answer 32

Ventricular tachycardia

Question 33

Which ventricular tachyarrhythmia is fatal as dookie and must be defibrilated like freakin yesterday

Answer 33

Ventricular fibrillation

Question 34

Long QT syndrome known as Torsades de Pointes is a channelopathy affecting which cardiac ion channel?

Answer 34

Potassium channels

Question 35

What is the effect of the mutated K+ channel?

Answer 35

Decreased outward K+ current during repolarization --> prolonged repolarization --> long QT interval --> early afterdepolarizations

Question 36

Typical presentation of a channelopathy?

Answer 36

Baby that died in its sleep

Question 37

This channelopathy has a mutation in sodium channels

Answer 37

Brugada syndrome

Question 38

Brugada presents in what population?

Answer 38

Young Asian males

Question 39

Reduced Na+ channel functionality results in reduced Na+ inflow which leads to?

Answer 39

Shortened AP's

Question 40

In Brugada syndrome, the presence of both normal & abnormal Na+ channels in the same tissue can lead to?

Answer 40

Ventricular arrhythmias --> vent fib

Question 41

Familial catecholemineric polymorphic ventricular tachycardia is a channelopathy with mutations in?

Answer 41

Ryanodine receptors in SR

Question 42

How do FCPVT patients present?

Answer 42

Life threatening vent tachy or vent fib during physical/emotional stress

Question 43

What is myocarditis?

Answer 43

Inflammation of heart muscle

Question 44

What usually causes myocarditis?

Answer 44

Parvovirus or HHV 6

Question 45

Myocarditis has 2 phases. Describe the early phase

Answer 45

Direct viral infection of myocytes

Question 46

Describe the late phase of myocarditis

Answer 46

Autoimmune attack on myocytes

Question 47

What does a heart with myocarditis look like?

Answer 47

Pale, mottled, flabby, dialated.. With inflammation

Question 48

This is a commonly underdiagnosed disease that presents in NORTHERN ITIALIANS!!!

Answer 48

Right ventricular cardiomyopahty

Question 49

What is RV cardiomyopathy?

Answer 49

Fatty replacement of myocytes in RV apex

Question 50

RV cardiomyopathy comes from a mutation in the gene that codes for?

Answer 50

Desmosomal proteins