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

• Pressure-Volume Loops

• 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

• Basic EKG findings in acute MI

• Pathophysiology of complications of MI including:

• RV infarct

• Congestive heart failure

• Hypotension

• Arrhythmias

• Heart block

• Acute VSD

• Acute MR

• Cardiogenic shock

• LV free wall rupture

• LV apical aneurysm formation

• 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:

• atrial fibrillation

• atrial flutter

• ventricular tachycardia

• ventricular fibrillation

• Torsades des Pointes

• Sinus bradycardia

• Sinus tachycardia

• Atrial premature beats

• Ventricular premature beats

• SVT with the WPW syndrome

Pericardial Diseases and Cardiomyopathies: 

• Definitions, etiologies, hemodynamics and clinical features of:

• Dilated cardiomyopathy

• Hypertrophic cardiomyopathy

• 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:

• secundum ASD

• membranous VSD

• Tetralogy of Fallot

• Eisenmenger’s syndrome

• transposition of the great vessels