What is the normal cardiac rhythm rate originating from the sino-atrial node (SAN)?
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60 to 100 beats per minute (bpm).
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What is the normal cardiac rhythm rate originating from the sino-atrial node (SAN)?
60 to 100 beats per minute (bpm).
What are the signs of cardiac arrest?
No cardiac output, no pulse, no blood pressure, no respiration, and ECG shows no coordinated complexes.
What are common types of arrhythmia?
Atrial fibrillation, atrial flutter, ventricular and atrial extrasystoles.
What are some causes of arrhythmia?
Underlying structural abnormality, electrolyte imbalance, increased circulating catecholamines, and effects of some drugs.
What is the role of diuretics in heart failure treatment?
They help reduce fluid overload.
What imbalances can contribute to heart failure?
Water and electrolyte imbalance, acid-base disturbance, and over intravenous infusion.
How do the clinical features of LVF and RVF initially differ?
Initially, the clinical features of LVF and RVF are different.
Why is controlling cardiac rhythm important in heart failure treatment?
To improve heart function and reduce symptoms.
Which imaging technique is used to diagnose shock?
Chest X-ray.
What does the blood picture in heart failure diagnosis help to exclude?
Anemia and infection.
Where should a patient in shock be observed?
In an intensive care unit.
What is the urinary output threshold indicating shock?
Decreased urinary output <20 ml/hour.
What can cause cardiovascular diseases?
Risk factors include hypertension, high cholesterol, smoking, diabetes, and obesity.
What are some physical signs of Left Heart Failure?
Tachycardia, gallop rhythm, moist sounds in the lung bases, cardiac enlargement, pleural effusion, cyanosis, and pulsus alternans.
What does right heart failure (RVF) lead to?
Systemic venous congestion.
What is the first sign of left heart failure (LVF)?
Dyspnea, caused by pulmonary congestion and edema, especially during exertion.
What causes hypokalemia in heart failure patients?
It can result from treatment with diuretics or intrinsic factors.
What is hyponatremia and how can it occur in heart failure?
A condition caused by diuretic therapy, water retention, or failure of cell membrane ion pumps.
How does heart failure affect liver function?
It can lead to impaired liver function due to congestion and poor perfusion.
What are some other clinical features of left heart failure?
Fatigue, tachycardia, atrial fibrillation, cardiac enlargement, and moist sounds at the lung bases.
What aspects can be abnormal in cardiac arrhythmias?
Origin, rate (frequency), regularity, and conduction of impulses.
How does digoxin assist in heart failure management?
It improves heart contractility and controls heart rate.
How does a pacemaker differ from a defibrillator?
A pacemaker regulates slow heart rates, while a defibrillator delivers shocks for fast, life-threatening arrhythmias.
What occurs in Left Heart Failure (LVF) regarding organ perfusion?
Perfusion to the brain and other vital organs is inadequate, leading to congestion in the lungs.
What is pressure overload in the context of heart failure?
Conditions like systemic hypertension, aortic stenosis, and pulmonary stenosis.
What is a common clinical feature of patients who experience Sudden Cardiac Death (SCD)?
Approximately 70% had recently discovered or progressive coronary artery disease.
What are some treatment options for cardiovascular diseases?
Treatment may include lifestyle changes, medications, and surgical interventions.
What is the primary function of an implantable cardiac defibrillator (ICD)?
To monitor heart rhythms and deliver shocks to restore normal rhythm in case of life-threatening arrhythmias.
What percentage of patients who suffered from acute myocardial infarction died within one hour of onset?
About 50%.
What does ventricular asystole indicate?
The heart stands still, and the ECG shows a straight line.
What is uremia in the context of heart failure?
A complication resulting from poor renal perfusion.
What is heart failure?
It is the terminal stage of all cardiac diseases, not a disease itself.
What can happen to edema in right heart failure?
It can become generalized, leading to pleural effusion, pericardial effusion, and peritoneal effusion (ascites).
What type of fluid is present in effusions associated with right heart failure?
Low protein content fluid (transudate).
What are examples of intra-cardiac shunting?
Ventricular septal defect, atrial septal defect, patent arterial duct.
Why is the exact time of death often unverifiable in SCD patients?
In many cases, the exact time of death cannot be determined.
What is one effect of activating the sympathetic system in heart failure?
Increased heart rate and myocardial contractility.
What are mechanical restrictions that can affect ventricular filling?
AV valve stenosis, acute cardiac tamponade, constrictive pericarditis.
How can environmental changes affect heart failure risk?
Environmental and weather changes can contribute.
What underlying conditions should be treated to manage heart failure?
Hypertension, valvular heart diseases, ischemic heart diseases, and high output failures.
What are common signs of Right Heart Failure?
Ankle edema, sacral edema, and raised jugular venous pressure.
What are the two main types of thromboembolism mentioned?
Deep vein thrombosis and pulmonary embolism.
How can cardiovascular diseases be diagnosed?
Through physical exams, blood tests, imaging tests, and electrocardiograms.
What happens in patients with severe left heart failure?
Features of right heart failure will also appear.
What can severe left heart failure (LVF) lead to?
Right heart failure (RVF).
What imaging technique is used to show the position of an implanted pacemaker?
Chest X-ray.
What type of heart conditions are typically treated with an implantable cardiac defibrillator?
Life-threatening arrhythmias such as ventricular fibrillation and ventricular tachycardia.
What does a chest X-ray reveal after pacemaker implantation?
The correct positioning of the implanted pacemaker.
What clinical features may be present in severe mitral stenosis?
Clinical features of both left ventricular failure (LVF) and right ventricular failure (RVF).
What is the typical procedure for implanting an ICD?
It involves a minor surgical procedure where the device is placed under the skin and connected to the heart.
What is hepato-jugular reflux?
A sign of raised jugular venous pressure in Right Heart Failure.
What can a chest X-ray reveal in heart failure diagnosis?
Cardiac enlargement, pulmonary congestion, pulmonary edema, pleural effusion, and chest infection.
What can lead to non-cardiac sudden death through drug-related issues?
Overdose.
What type of sputum is associated with heart failure?
Cough with pink, frothy sputum.
What are the features of forward failure in LVF?
Fatigue, weakness, irritability, somnolence, and palpitation.
What can lead to systemic embolism?
Atrial fibrillation or intracardiac thrombus.
What are some symptoms of impaired liver function due to heart failure?
Mild jaundice, reduced synthesis of clotting factors, leading to bleeding tendency and prolonged prothrombin time.
What are Angiotensin converting enzyme inhibitors (ACEI) used for in heart failure?
They help relax blood vessels and lower blood pressure.
What are common causes of arrhythmia?
Coronary artery disease, AMI, valvular heart disease, carditis, digoxin toxicity, post heart surgery, electrolyte disturbance, endocrine disorder, anxiety, hypothermia, alcohol, caffeine, and drugs.
What are some components of basic life support?
Keeping the airway clear, giving artificial ventilation, and performing external cardiac massage.
What respiratory symptoms are associated with shock?
Tachypnea and hyperventilation.
What system is activated alongside the sympathetic system in heart failure?
The Renin-angiotensin-aldosterone system.
What type of pulse is typically observed in shock?
Fast, thready pulse.
What imaging technique is used to evaluate heart structure in arrhythmia diagnosis?
2D echo.
What does cavity dilatation do to cardiac fibers?
It increases fiber length.
What happens to blood flow during cardiac output redistribution?
Blood flow to skin, muscle, and gastrointestinal tract is diverted to vital organs such as the heart and brain.
What is sinus node disease?
A condition affecting the heart's natural pacemaker, leading to irregular heart rhythms.
What is a primary cause of hypovolemic shock?
Massive bleeding.
What are the basic cardiac causes of heart failure?
Primary myocardial damage, cardiac overload, restricted ventricular filling.
What are examples of primary myocardial damage?
Myocardial ischemia, myocardial infarct, myocarditis, myopathy, toxicity (drugs, toxins).
What is paroxysmal nocturnal dyspnea?
Sudden shortness of breath that wakes the patient up in the middle of the night.
What are the potential origins of arrhythmia?
Sino-atrial node (SAN), atrioventricular node (AVN), or ventricle.
Which arrhythmia is a risk factor for heart failure?
Atrial fibrillation and other tachyarrhythmias.
What happens when the heart is overloaded?
A series of compensatory mechanisms are activated to maintain cardiac output.
What is the mechanism of action for radiofrequency catheter ablation?
It uses heat to destroy abnormal electrical pathways in the heart.
Can arrhythmias occur in patients without other cardiac abnormalities?
Yes, they can occur in patients without any other cardiac abnormality.
What is a key prevention strategy for Sudden Cardiac Death?
Preventing atherosclerosis.
What is the first step in the diagnosis of heart failure?
History and physical examination.
What is one method used for diagnosing arrhythmia?
History and physical examination.
What is the blood pressure threshold indicating hypotension in shock?
Systolic BP <90 mmHg.
How can blood pressure be restored during advanced life support?
By using pressor agents.
What additional interventions are included in advanced life support?
Institute positive pressure ventilation, correct acidosis, and normalize electrolytes.
What does an ECG assess in the context of heart failure?
Cardiac rhythm, chamber enlargement, pericardial disease, ischemia, and infarction.
What are common symptoms of heart failure related to breathing?
Orthopnea and paroxysmal nocturnal dyspnea.
What is the primary function of the cardiovascular system?
To transport blood, nutrients, oxygen, and waste products throughout the body.
What are the features of backward failure in LVF?
Dyspnea, orthopnea, cough, sputum, hemoptysis, and central cyanosis in severe cases.
What type of infections can contribute to heart failure?
Pulmonary, cardiac, and systemic infections.
How does transudate fluid differ from exudate fluid?
Transudate has low protein content, while exudate has high protein content due to inflammation.
What is a consequence of pulmonary hypertension?
Right ventricular hypertrophy (RVH) and eventually right ventricular failure (RVF).
How does the sympathetic system affect diastolic filling?
It increases diastolic filling.
What are some causes of ventricular asystole?
Hypovolemia, hypoxia, hypothermia, hypoglycemia, toxins, myocardial infarction, cardiac tamponade.
What is the goal of advanced life support in cardiac arrest?
To restore normal cardiac activity.
What happens to urine output in Right Heart Failure?
There is a decrease in urine output.
What types of drugs are used to control arrhythmia?
ß blockers, Ca++ blockers, digoxin, membrane stabilizers, and drugs that lengthen action potential.
What is one cause of non-cardiac sudden death related to breathing?
Apnea due to respiratory obstruction, such as a foreign body in the trachea, drowning, or asphyxia.
When is a pacemaker implant indicated?
For very slow heart rates.
What is the prognosis for shock, particularly in certain populations?
Poor, especially in elderly, septicemic & cardiogenic shock.
What is heart failure?
A condition where the heart is unable to pump sufficiently to maintain blood flow.
What allergic reactions can cause non-cardiac sudden death?
Anaphylaxis to drugs or allergens.
What are some signs of fluid retention in heart failure?
Ankle edema, pleural effusion, and ascites.
What is sudden non-cardiac death?
An unexpected death due to causes other than heart-related issues.
What is orthopnea?
Shortness of breath when lying flat.
What is the purpose of radiofrequency catheter ablation in the left atrium?
To treat atrial fibrillation.
What constitutes volume overload in heart failure?
Regurgitation of heart valves, such as aortic regurgitation and mitral regurgitation.
What is the most common cause of cardiac arrest and sudden death?
Ventricular fibrillation.
What conditions can lead to whole heart overload?
Thyrotoxicosis, anemia, multiple pregnancy, thiamine deficiency.
How is Sudden Cardiac Death typically diagnosed?
At autopsy.
What are the clinical features of arrhythmia?
Palpitation, dizziness, and syncope.
What types of cardiac operations may be performed for heart failure?
Valvular operations, dilating stenotic coronary arteries, repairing congenital heart diseases, and heart transplantation.
What are the effects of the Renin-angiotensin-aldosterone system activation?
Causes vasoconstriction, Na+ and fluid retention, increasing preload and cardiac output.
What are premature atrial and ventricular contractions?
Early heartbeats originating in the atria or ventricles.
What is exertional dyspnea?
Difficulty in breathing during physical activity.
What is the effect of myocardial hypertrophy?
It increases muscle mass.
What is the purpose of 2D echocardiography in diagnosing heart failure?
To evaluate myocardial function, valvular issues, pericardial tamponade, constriction, and congenital heart diseases.
What is catheter ablation?
A procedure to identify the origin of arrhythmia and ablate the site using radiofrequency energy.
What is a sign of severe left heart failure?
Cyanosis (central).
What is the definition of Sudden Cardiac Death (SCD)?
SCD is unexpected death resulting from an abrupt loss of cardiac function within one hour of onset of symptoms.
What percentage of Sudden Cardiac Death cases are attributed to coronary artery disease?
75%.
What physical signs may be observed in heart failure?
Cardiac enlargement, murmurs, and gallop rhythm.
What is liver enlargement a sign of in heart failure?
It indicates congestion due to fluid overload.
What are the clinical features of systemic venous congestion in right heart failure?
Distended neck veins, enlarged liver, and soft tissue edema, especially in the ankles and feet.
What is the definition of heart failure?
The heart cannot maintain cardiac output to supply the body and cannot eject venous blood returning to the heart, resulting in congestion.
What does left heart failure (LVF) lead to?
Pulmonary venous congestion.
Which part of the heart is targeted in radiofrequency catheter ablation for atrial fibrillation?
The left atrium.
What is an example of extra-cardiac shunting?
Large arterio-venous fistula.
What leads to pulmonary hypertension in severe left ventricular failure (LVF)?
Severe pulmonary congestion.
What are the initial steps in the diagnosis of shock?
History & physical examination.
What eventually happens to the features of heart failure?
Features of whole heart failure set in over time.
What diagnostic test provides information about the heart's electrical activity in shock?
ECG.
What methods are used in advanced life support to restore cardiac activity?
Defibrillation or pacing.
What is electrical cardioversion used for?
To restore normal heart rhythm.
What is important to do after initiating life support in cardiac arrest?
Identify treatable causes and treat accordingly.
What is atrial flutter?
A type of arrhythmia where the atria beat rapidly but in a more organized manner than in fibrillation.
What is supraventricular tachycardia?
A rapid heart rate originating above the ventricles.
What type of edema may occur if a patient with Right Heart Failure lies down?
Sacral edema.
What is heart block?
A condition where the electrical signals in the heart are partially or completely blocked.
What is a cause of neurological shock?
Blood vessels lose tone, leading to severe vasodilatation.
What is a severe condition that can lead to cardiogenic shock?
Acute cardiac tamponade.
What type of arrhythmia is treated with radiofrequency catheter ablation in the left atrium?
Atrial fibrillation.
Why is understanding cardiac arrhythmias clinically important?
They are a common complaint and can indicate serious conditions like sudden cardiac death.
What lifestyle factors can increase the risk of heart failure?
Overexertion, stress, and emotional disturbance.
What role does vasoconstriction play in heart failure compensation?
It increases afterload and venous return, ultimately increasing cardiac output.
What blood chemistry tests are important in diagnosing heart failure?
Electrolytes, liver function, and kidney function.
What can cause peripheral cyanosis in Right Heart Failure?
Venous stasis.
What happens after correcting factors causing low cardiac output in shock?
The shock still persists.
What hormone causes fluid retention and increased vasoconstriction?
Vasopressin (Anti-diuretic hormone).
What is ventricular fibrillation?
A life-threatening arrhythmia where the ventricles quiver instead of pumping blood.
What is bradycardia?
A slower than normal heart rate.
What is sudden cardiac death?
An unexpected death caused by loss of heart function.
What can lead to severe cardiac failure causing cardiogenic shock?
Cardiac rupture.
What is the purpose of pacemaker implantation?
To regulate heart rhythms in patients with arrhythmias.
What are some causes of cardiac arrest?
Myocardial infarction (MI), ischemia, pre-existing serious heart disease, drugs, electrolyte imbalance, electrocution.
What is the first step in the management of cardiac arrest?
Basic life support should be instituted urgently.
What iatrogenic factors can lead to heart failure?
Over-medication, under-medication, and wrong medication.
What is a key echocardiographic tool used in diagnosing shock?
2D echocardiogram.
Which disease is a potential cause of non-cardiac sudden death?
Cerebrovascular disease.
What imbalances can lead to non-cardiac sudden death?
Electrolyte and acid-base imbalance.
What does raised jugular venous pressure indicate?
It is a sign of heart failure.
What does decreased urine output indicate in heart failure?
It suggests fluid retention and poor kidney perfusion.
What are common clinical features of shock related to consciousness?
Fatigue, decreased conscious level, somnolence, irritability, or coma.
In cases of heart failure, which side's features may usually predominate?
Features of one-sided failure may usually predominate.
What is the primary aim of diagnosing heart failure?
To find the cause of heart failure to treat appropriately.
What causes a decrease in myocardial pliability?
Severe myocardial hypertrophy, myocardial tumor, restrictive myopathy, endocardial fibrosis.
What intervention may be used in known high-risk patients to prevent Sudden Cardiac Death?
Implantation of an internal cardiac defibrillator.
What conditions can complicate heart failure?
Thyrotoxicosis, anemia, and pulmonary embolus.
Which test can assess electrolyte levels in relation to arrhythmia?
Electrolytes test.
What is the function of an implantable cardioverter-defibrillator?
To detect cardiac arrhythmia and correct it by delivering a jolt of electricity.
What is a consequence of cytokines in anaphylactic shock?
Severe vasodilatation and bronchial constriction.
What is a primary symptom of Right Heart Failure (RVF)?
Upper abdominal distending discomfort.
Can an implantable cardiac defibrillator also function as a pacemaker?
Yes, some ICDs have dual functions and can act as both a defibrillator and a pacemaker.
What are the signs of peripheral circulation in shock?
Peripheral vasoconstriction, pallor, cold and clammy limbs, cyanosis.
What diagnostic tool is used to monitor heart activity over 24 hours?
24-hour ECG.
What is atrial fibrillation?
A common type of arrhythmia characterized by rapid and irregular beating of the atria.
What is a common gastrointestinal symptom in Right Heart Failure?
Loss of appetite.
What symptoms indicate fatigue in heart failure patients?
Weakness, dizziness, somnolence/insomnia, and palpitations.
What electrical hazard can cause non-cardiac sudden death?
Electrocution.
What condition can lead to cardiogenic shock?
Acute myocardial infarction.
What vital parameters need to be monitored closely in shock treatment?
Vital signs.
What types of replacement may be necessary in the treatment of shock?
Blood, fluid, electrolyte replacement as appropriate.
What is a potential consequence of severe Right Heart Failure?
Whole-body edema.
What medical procedures can lead to non-cardiac sudden death?
Anaesthetic, surgical, or other manipulations.
What percentage of Sudden Cardiac Death cases are due to ventricular fibrillation or ventricular tachycardia?
About 80 - 90%.
What are some less common causes of Sudden Cardiac Death?
Pump failure and cardiac rupture.
What triggers anaphylactic shock?
Hypersensitivity reactions.
What causes severe vasodilatation in septicemic shock?
Bacterial toxins.
What are late-stage signs of Right Heart Failure?
Ascites and pleural effusion.
What specialized test can be performed to study the electrical activity of the heart?
Electrophysiology.
What type of injury can result in non-cardiac sudden death?
Head injury.
What is one surgical option for treating arrhythmia?
Heart surgery.
What is shock in the context of cardiovascular diseases?
A critical condition resulting from inadequate blood flow to the body's tissues.
What is cardiogenic shock?
A type of shock caused by the heart's inability to pump blood effectively.
What are the other causes of Sudden Cardiac Death aside from coronary artery disease?
20% from other cardiac diseases, and a small percentage with no definite cardiac cause found.
What percentage of Sudden Cardiac Death cases are due to slow heart rate?
10 - 20%.
What is crucial to do in addition to treating shock?
Find out & treat the cause.
What is accessory pathway tachycardia?
A type of tachycardia caused by an extra electrical pathway in the heart.
What is ventricular tachycardia?
A fast heart rate that originates in the ventricles.
How is tissue oxygen extraction affected in heart failure?
It is increased.
What is the consequence of chronotropic and inotropic effects on the heart?
They overwork the heart further, worsening heart failure.
What is cardiac arrhythmia?
An irregular heartbeat that can affect the heart's ability to pump blood.
What can cause severe dehydration leading to hypovolemic shock?
Massive burns.
What is cardiac arrest?
A sudden loss of heart function, leading to cessation of blood flow.
What are common presentations of cardiovascular diseases?
Symptoms may include chest pain, shortness of breath, fatigue, and palpitations.
