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Intercommissural Lead Placement into a Right Ventricular Coronary Sinus

Age Gender Occupation Working Diagnosis 61 Years Male Ebstein’s Anomaly with High-Grade Atrioventricular Block History A 61-year-old man with a history of Ebstein’s anomaly, which initially went to had repaired in 1997; he then underwent tricuspid valve replacement with a 35-mm bioprosthesis in 2001. The initial surgery also involved an intraoperative ablation of an accessory pathway and right atrial maze procedure. For recurrent paroxysmal atrial fibrillation,…

Pacemaker Indication

Age Gender Occupation Working Diagnosis 73 Years Male Retired Chef Complete Heart Block History The patient was a nonsmoker and enjoyed good health in the past. He had a history of new-onset dizziness and one episode of syncope. He was admitted to the hospital, and electrocardiogram (ECG) showed complete heart block with ventricular escape rate about 40 bpm. Clinically, he was not in heart failure, and…

Efficacy of Cardiac Resynchronization Therapy in New York Heart Association II

Age Gender Occupation Working Diagnosis 66 Years Female Housewife Nonischemic Cardiomyopathy History The patient is a 66-year-old woman who first came to medical attention for her heart disease 3 years ago. She had been on a cruise when she initially noticed some functional limitation. She began to have difficulty climbing the stairs and found it necessary to use the elevator. By the end of the cruise…

Role of Optimal Medical Therapy

Age Gender Occupation Working Diagnosis 51 Years Male Professional Driver Ischemic Dilated Cardiomyopathy History The patient was a nonsmoker. He had experienced a myocardial infarction in 2003. A coronary angiogram performed in 2003 showed severe left main artery disease and triple vessel disease. He underwent coronary artery bypass grafting (CABG) the same year. Echocardiography was done 6 months after CABG showed left ventricular ejection fraction (LVEF)…

Cardiac Resynchronization Therapy in Patients with Right Heart Failure Resulting from Pulmonary Arterial Hypertension

Age Gender Occupation Working Diagnosis 79 Years Female Retired Homemaker Worsening Right Heart Failure Resulting from Right Ventricular Apical Pacing History In 1985 this previously healthy patient had a syncopal episode while driving. Presumably she was found to have high-degree atrioventricular block that was treated with implantation of a permanent dual-chamber pacemaker. Except for the diagnosis of moderate chronic obstructive pulmonary disease, the patient’s clinical course…

Cardiac Resynchronization Therapy in a Patient with QRS Duration Between 120 and 150 Milliseconds

Age Gender Occupation Working Diagnosis 68 Years Female Retired Congestive Heart Failure Leading to Diagnosis of Primary Left Ventricular Dysfunction with Severe Dyssynchrony, Moderately Prolonged QRS, and Lack of Left Ventricular Dilation History This patient had a history of lymph node tuberculosis during childhood, thyroid carcinoma (treated surgically and with radiotherapy), and depressive disorders. A normal electrocardiogram (ECG) was recorded 20 years earlier at the time…

Efficacy of Cardiac Resynchronization Therapy in Right Bundle Branch Block

Age Gender Occupation Working Diagnosis 71 Years Male Retired Electrician Ischemic Heart Disease and Persistently Reduced Ejection Fraction History The patient is a 71-year-old man who has been followed for 20 years. He is a former smoker, having smoked from the age of 20, with 50 years of smoking at one pack per day. He formerly had hypertension. His mother had a myocardial infarction at the…

Implantation of a Biventricular Implantable Cardioverter-Defibrillator Followed by Catheter Ablation in a Patient with Dilated Cardiomyopathy and Permanent Atrial Fibrillation

Age Gender Occupation Working Diagnosis 64 Years Male Teacher Dilated Cardiomyopathy and Permanent Atrial Fibrillation History The patient has dilated cardiomyopathy with an initial left ventricular ejection fraction (LVEF) of 25%, permanent atrial fibrillation (AF), and the cardiovascular risk factors of obesity (body mass index 32 kg/m²) and arterial hypertension. The diagnosis of nonischemic dilated cardiomyopathy was established 1 year previously after angiographic exclusion of significant…

Paroxysmal Atrial Fibrillation in Patients Undergoing Cardiac Resynchronization Therapy : Challenge or Routine?

Age Gender Occupation Working Diagnosis 58 Years Female Housewife Dilated Cardiomyopathy History The patient has had a known cardiomyopathy for 3 years. She had coronary artery disease, with implantation of a bare metal stent (BMS) in the proximal circumflex artery in 2006. The left ventricular ejection fraction was 32% at the last visit to the cardiologist. The patient reported a rhythm disorder, but an electrocardiogram (ECG)…

End-of-Chapter Case Study Answers

Case 1.1 1. b is correct. The circulation time will be shortened because some blood passes through the shunt (short circuit). Case 2.1 1. c is correct. When the extracellular K + concentration increases, the Nernst equation indicates that the transmembrane potential will become less negative. 2. d is correct. When the extracellular K + concentration increases and depolarizes the membrane, the rate of rise of…

Interplay of Central and Peripheral Factors That Control the Circulation

Objectives 1. Describe the sequence of cardiovascular events during exercise. 2. Describe how most cardiovascular functions are integrated in exercise. 3. Describe the effects of blood loss on the cardiovascular system. 4. Explain the various compensatory mechanisms that protect against hemorrhagic shock. 5. Explain the various decompensatory mechanisms that intensify the effects of blood loss. The primary function of the circulatory system is to deliver the…

Special Circulations

Objectives 1. Describe the regulation of cutaneous blood flow and its role in maintaining a constant body temperature. 2. Indicate the relative importance of the local and neural factors in adjustments of skeletal muscle blood flow at rest and during exercise. 3. Describe the regulation of cerebral blood flow. 4. Explain the regulation of the pulmonary circulation. 5. Describe the characteristics of the renal circulation. 6.…

Coronary Circulation

Objectives 1. Delineate the physical, neural, and metabolic factors that affect coronary blood flow. 2. Explain the relative importance of these factors in the regulation of the coronary circulation. 3. Compare the oxygen requirements of the heart during pressure work versus volume work. 4. Discuss the metabolic changes caused by ischemia and the role of interstitial adenosine in ameliorating the effects of ischemia. 5. Describe the…

Control of Cardiac Output: Coupling of Heart and Blood Vessels

Objectives 1. Describe the principal determinants of cardiac output. 2. Describe the principal determinants of cardiac preload and afterload. 3. Explain the mechanical coupling between the heart and blood vessels. 4. Explain the effects of gravity on venous function and on arterial pressure. Cardiac output (CO) is defined as the total flow of blood out of the left ventricle. It could be measured in the aorta,…

The Peripheral Circulation and Its Control

Objectives 1. Indicate the intrinsic and extrinsic (neural and humoral) factors that regulate peripheral blood flow. 2. Explain autoregulation of blood flow and the myogenic mechanism for local adjustments of blood flow. 3. Elucidate metabolic regulation of blood flow. 4. Explain the role of the sympathetic nerves in blood flow regulation. 5. Describe vascular reflexes in the control of blood flow. 6. Describe the role of…

The Microcirculation and Lymphatics

Objectives 1. Describe the regulation of regional blood flow by the arterioles. 2. Enumerate the physical and chemical factors that affect the microvessels. 3. Explain the roles of diffusion, filtration, and pinocytosis in transcapillary exchange. 4. Describe the balance between hydrostatic and osmotic forces under normal and abnormal conditions. 5. Describe the lymphatic circulation. The entire circulatory system is geared to supply the body tissues with…

The Arterial System

Objectives 1. Explain how the pulsatile blood flow in the large arteries is converted into a steady flow in the capillaries. 2. Discuss arterial compliance and its relation to stroke volume and pulse pressure. 3. Explain the factors that determine the mean, systolic, and diastolic arterial pressures and the arterial pulse pressure. 4. Describe the common procedure for measuring the arterial blood pressure in humans. The…

Hemodynamics

Objectives 1. Define the relationship between the velocity of blood flow and vascular cross-sectional area. 2. Describe the factors that govern the relationship between blood flow and pressure gradient. 3. Distinguish between resistances in series and resistances in parallel. 4. Distinguish between laminar flow and turbulent flow. 5. Describe the influence of the particulates in blood on blood flow. The precise mathematical expression of the pulsatile…

Regulation of the Heartbeat

Objectives 1. Describe the neural control of heart rate. 2. Explain the role of preload in the regulation of myocardial contraction. 3. Describe the neural regulation of myocardial contraction. 4. Explain the effects of hormones on myocardial contraction. 5. Explain the effects of blood gases on myocardial contraction. The quantity of blood pumped by the heart each minute (i.e., cardiac output, CO ) may be varied…