Basic Electrophysiology
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1 Basic Electrophysiology Michael Eldar, M.D. Heart Institute Sheba Medical Center Caesaria 2008
2 ? מי מהבאים יוצא דופן.1 Ica Ik Ryanodin receptor Na/K ATPase pump Ca/Na exchanger ' התשובה ג THE HEART INSTITUTE
3 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:40
4 Transmembrane Ion-Transfer Modes Opie LH, The Heart 1998:75
5 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:70
6 Inward Rectifier Ik1 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:69
7 Voltage-Gated Sodium channel Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:64
8 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:43
9 Whalley DW et al, PACE 1995;18:1561
10 Channel Pore Model Opie LH, The Heart 1998:76
11 .2 מי מהתעלות הבאות האחראית העיקרית לשלב II של פוטנציאל הפעולה החדרי? Ica,l Ina Ik Ik1 Ik,ach התשובה א'
12 Berne & Levy,Physiology 1998:30
13 Berne & Levy,Physiology 1998:330
14 Electro-Mechanical Relation Opie LH, The Heart 1998:74
15 Berne & Levy,Physiology 1998:335
16 Whalley DW et al, PACE 1995;18:1565
17 .3 אחת מהפרעות הקצב להלן נגרמת עקב..Abnormal automaticity איזו היא? א PAT עקב הרעלת דיגוקסין ב TdP מקינידין ג RVOT VT במאמץ ד AVNRT ה AIVR - התשובה הנכונה ה'
18 Normal Automaticity Ik decay If If Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:55
19 Normal Automaticity Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:199
20 ACh and Automaticity Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:202
21 Acceleration of Normal Automaticity Control MDP Threshold Slope Phase 4 Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:201
22 Abnormal automaticity - Depolarized myocytes ( mv) - ph - [O2] - [K+]o
23 Depolarization-induced Automaticity Low High Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:206
24 Abnormal automaticity Clinical Arrhythmias - Myocardial infarction minutes hours AIVR [K+]o - Ischemia Injury currents
25 .4 המשפטים הבאים מתייחסים ל.Triggered Activity- אחד אינו נכון, מהו? א ב ג ד - ה DAD גדלים עקב טכיקרדיה LQT3 נגרם בשל מוטציה בתעלת אשלגן TdP מתרופות נגרם מחסימת תעלת אשלגן מחויב להיגרם ע"י פוטנציאל פעולה קודם עודף יונים חיוביים בתא גורם להארכת QT התשובה הנכונה ב'
26 Triggered Activity - activity arising from membrane potential oscillations during or immediately following an AP - Should occur following a previous AP (spontaneous or driven)
27 Triggered Activity Zipes & Jaliffe, Cardiac Electrophysiology1995:208
28 Digoxin induced DAD Rate-Dependence of DAD s Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:211
29 DAD Clinical Arrhythmias - Dig. Intoxication - atrial tach: - VT - Accelerated VT during AMI - Reperfusion induced arrhythmias - CPVT - Exercise (catecholamine, camp dependent) induced RVOT VT
30 Early Afterdepolarization ((EAD Pathophysiology Outward current and/or Inward current
31 Quinidine-induced EAD s Jalife et al. Basic Cardiac Electrophysiology for the Clinician, 1998:215
32 EAD Clinical arrhythmias - TDP - acquired LQTS - congenital LQTS
33 LQTS- net outward current I,II,V,VI III Viskin, Lancet 99;354:1625
34 Acquired EAD - hypokalemia ( K conductance) Acidosis Bradycardia Ikr blockers - AAD Phenothiazine Antihistamines Antibiotics antidepressants
35 .5 המשפטים הבאים מתייחסים ל.REENTRY אחד אינו נכון, מהו? א ב ג ד - ה המנגנון השכיח ביותר לאריתמיות באדם אחראי לאריתמיה בתסמונת ברוגדה אחראי עיקרי ל VT לאחר אוטם ישן חסם חד כיווני אינו תנאי הכרחי להתחלתו בטכיקרדיה, אורך הגל קצר מאורך המסלול התשובה הנכונה ד'
36 Circus Movement Reentry 1. Intact anatomic circuit 2. Unidirectional block (onset) 3. Area of slow conduction 4. Wavelength of tach. < length of circuit
37
38
39 Reentry EPS-Diagnosis 1. Continuous electric activity 2. Inducibility/termination by electrical stimulation 3. Inverse relationship of C.I. of initiating extrastimulus/1st tachycardia beat 4. Entrainment (resetting) by external stimuli
40 AVNRT
41 slow fast
42 WPW Syndrome
43 Viskin, Prog Cardiovasc Dis 1998;41:17
44 K+ channel opener rate Yan Gan-Xin, Circulation 1999;100:1660
45 Phase II Reentry Di Diego, Circulation 1993;88:1177
46 Phase II Reentry
47 Clinical Reentry Tachyarrhythmias Definite SANRT AVNRT AVRT A Flutter Post MI VT BBR VT Probable A Fibrillation PVT VF
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