EKG
A 45-year-old woman comes in for a routine check-up. Her ECG shows a completely normal rhythm, but her heart rate is measured at 115 beats per minute. Every P wave is followed by a normal QRS complex.
Sinus Tachycardia
This type of cardiomyopathy is characterized by ventricular enlargement, impaired contraction, and an ejection fraction under 40%.
What is Dilated Cardiomyopathy (DCM)?
These lung sounds occur when left ventricular pump failure backs pressure up into the pulmonary veins, forcing fluid into the air sacs.
What are bibasilar crackles?
Successful diuresis during hospitalization leads to a rapid drop in this physical measurement as extra fluid is flushed out.
What is body weight?
This potent loop diuretic flushes excess sodium and water through the kidneys to relieve fluid congestion backing up into the lungs.
What is furosemide?
An elderly patient with a history of hypertension has an ECG that shows an "irregularly irregular" rhythm with no visible P waves. Instead, there is a wavy, disorganized baseline between QRS complexes.
Atrial Fibrillation (A-Fib)
Explain the role of acetaldehyde in this case
Toxic damage to cardiac mitochondria and cell death in alcohol-induced DCM are caused by ethanol and acetaldehyde
In a dilated heart, the point of maximum impulse (apex) shifts outward but feels this way rather than strong or "heaving.
What is soft (or diffuse)?
Compared to a normal heart, the Pressure-Volume loop in Dilated Cardiomyopathy shifts in these two directions on a graph.
What are right and down?
This medication blocks aldosterone to prevent permanent heart tissue scarring (fibrosis) and extend lifespan in heart failure.
What is spironolactone?
A patient's telemetry display shows a repeating pattern where the PR interval gets progressively longer with each beat until a P wave fails to conduct and a QRS complex is completely dropped ("long, longer, longest, drop").
Mobitz Type I (Wenckebach)
Mutations in this massive muscle protein gene represent one of the primary non-alcoholic, genetic causes of Dilated Cardiomyopathy.
What is the titin gene?
Because the gene is immense, it is prone to numerous genetic variations. Variants in the TTN gene are a leading genetic cause of dilated cardiomyopathy
A Levine Grade 2/6 murmur in DCM is commonly caused by stretching of this valve's ring, leading to functional regurgitation.
What is the mitral valve?
On a Pressure-Volume loop, the narrower width seen in DCM reflects a reduction in this calculated parameter per beat.
What is stroke volume?
Abruptly stopping this energy-supporting enzyme supplement risks a sudden drop in cellular energy and a potential heart failure flare-up.
What is Co-Enzyme Q10 (Co-Q10)?
A 50-year-old man presents to the ED with severe crushing chest pain. His ECG shows classic ST-segment elevation in leads V2, V3, and V4
Acute Myocardial Infarction (STEMI / Heart Attack)
According to the physical law governing fluid containers, wall stress increases when this chamber dimension expands without a proportional increase in wall thickness.
What is the chamber radius?
An iron panel measuring this protein is routinely ordered during a DCM workup to rule out excess iron storage disease.
What is ferritin?
Successful treatment of fluid overload reduces stretching of the heart walls, leading to a downward trend in this laboratory biomarker.
What is BNP (or NT-proBNP)?
Beta-blockers like carvedilol help improve long-term ejection fraction by shielding the heart from chronic overload of this hormone signal.
What is adrenaline (or catecholamines)?
Scenario: An 84-year-old woman is admitted for a urinary tract infection and is treated with ciprofloxacin. She has a history of depression treated with citalopram. On telemetry, her heart rate suddenly degrades into a polymorphic ventricular tachycardia where the QRS, complexes appear to twist around the baseline at a rate of 200 bpm
Torsades de Pointes
In HFrEF, heart muscle cells are added in this specific geometric arrangement to cause chamber widening rather than wall thickening.
What is end-to-end?
Ischemic causes of heart failure are excluded by confirming clear coronary arteries and normal levels of this cardiac enzyme.
What is troponin?
The flattened slope of the end-systolic pressure-volume relationship line in DCM reflects severe loss of this baseline myocardial property.
What is contractility?
Graded exercise improves daily energy in heart failure patients primarily by helping these body structures extract oxygen more efficiently.
What are arms and legs (or peripheral skeletal muscles)?