Learning Objectives for Cardiac Pathophysiology
Normal Heart Function and CHF:
©
The
cardiac cycle
©
Compliance
curves
©
Preload
and afterload
©
Components
of and determination of cardiac output
©
Frank-Starling
curves
©
The
Fick Method
©
Diastolic
versus systolic dysfunction
©
Definition
of backward and forward heart failure
©
Causes
and mechanisms of heart failure
©
Compensatory
mechanisms in CHF
Valvular Heart Disease:
©
Pathophysiology
of aortic stenosis and insufficiency
©
Pathophysiology
of mitral stenosis and insufficiency
©
Murmurs
and physical findings associated with each of the above
©
Etiologies
of each of the above
©
Differences
between acute and chronic mitral regurgitation
©
Differences
between acute and chronic aortic regurgitation
©
Hemodynamic
findings (pressure tracings or readouts) for above
©
Basic
treatments (pharmacological and surgical) of above
Ischemic Heart Disease and Acute MI & Complications of MI:
©
Determinants
of myocardial supply and demand
©
Pathophysiology
of stable and unstable coronary syndromes
©
Pathophysiology
of acute myocardial infarction
©
Timing
of the “ischemic cascade”
©
Enzymatic
markers of myocardial injury (CPK, troponin, etc)
©
Clinical
presentation of acute myocardial infarction
©
Pathophysiology
of complications of MI including:
o
RV infarct
o
Congestive
heart failure
o
Hypotension
o
Arrhythmias
o
Heart
block
o
Acute
VSD
o
Acute
MR
o
Cardiogenic
shock
o
o
Ischemic Heart Disease and Acute MI & Complications
of MI (cont'd):
©
Mechanisms
by which ischemic syndromes and complications of MI can be treated pharmacologically
and mechanically
©
Differentiating
pathophysiology of inferior MI versus anterior MI
©
Hemodynamic
findings of different mechanical complications of MI
©
Hemodynamic
findings in cardiogenic shock, CHF and hypotension
EKGs and Arrhythmias:
©
Basic
electrophysiology, including:
o ions involved
o currents
o resting membrane potential
o action potentials
o excitability
o refractoriness
o normal impulse formation
©
Anatomy
of the conduction system, including abnormal A-V connections
©
Components
of the EKG: P wave; PR, QRS & ST intervals; T wave
©
Definition
of bradycardia and tachycardia
©
Mechanisms
of tachyarrhythmias including automaticity, re-entry, and triggered activity
©
Distinction
between action potentials in automatic vs. non-automatic cells
Pharmacologic treatment of atrial and ventricular arrhythmias
©
Mechanisms
and features of these basic arrhythmias:
o
atrial
fibrillation
o
atrial
flutter
o
ventricular
tachycardia
o
ventricular
fibrillation
o
Torsades
des Pointes
o
Sinus
bradycardia
o
Sinus
tachycardia
o
Atrial
premature beats
o
SVT
with the WPW syndrome
Pericardial Diseases and Cardiomyopathies:
©
Definitions,
etiologies, hemodynamics and clinical features of:
o
Dilated
cardiomyopathy
o
Hypertrophic
cardiomyopathy
o Restrictive cardiomyopathy
©
Diagnostic
studies used to diagnose the above
©
Effect
of maneuvers and loading conditions on hypertrophic cardiomyopathy
©
Etiologies
and clinical features of pericarditis
©
Hemodynamic
distinctions between cardiac tamponade, constrictive pericarditis and restrictive
cardiomyopathy
Congenital Heart Disease:
©
Normal
fetal circulation, including shunt pathways
© Hemodynamics of:
o
secundum
ASD
o
membranous
VSD
o
Tetralogy
of Fallot
o
Eisenmenger’s
syndrome
o transposition of the great vessels