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Cardiac Functioning, Disorders, Challenges and Therapies
Mahira Parveen
CHAPTER 1:
The Mammalian Sinoatrial Node: Functioning and Autonomic Regulation
INTRODUCTION
STRUCTURE OF THE SAN
BIOELECTRIC ACTIVITY OF THE SAN CELLS
Characteristics of Electric Activity in the Mammalian SAN
Currents Supporting the AP Depolarization Phase
Currents Responsible for the AP Repolarization
Currents Supporting the Slow DD
The Na-Ca Exchanger Current and the Hypothesis of “Calcium Clock”
THE ACTIVATION SEQUENCE OF THE SAN REGION
MECHANISMS OF NEGATIVE CHRONOTROPIC EFFECT OF ACETYLCHOLINE
MECHANISMS OF POSITIVE CHRONOTROPIC EFFECT OF CATECHOLAMINES
THE PACEMAKER SHIFT WITHIN THE SAN REGION
THE FUNCTIONAL AND MOLECULAR DETERMINANTS OF THE SAN HETEROGENEITY
CONCLUSION
CHAPTER 2:
The Trifascicular Nature of the Human Left Intraventricular His System and its Electrovectorcardiographic Demonstration
INTRODUCTION
ANATOMICAL CONSIDERATIONS OF THE LEFT INTRAVENTRICULAR CONDUCTION SYSTEM
Blood Supply (modified from Frink and James 1973)
Electrophysiology of the Left Intraventricular Conduction System
TERMINOLOGY: CRITICAL ANALYSIS AND SEMANTIC DISCUSSIONS
LEFT SEPTAL FASCICULAR BLOCK: ALL POSSIBLE ETIOLOGIES
LEFT SEPTAL FASCICULAR BLOCK: ELECTROCARDIOGRAPHIC CRITERIA (DABROWSKA ET AL 1978, MORI ET AL 1992, SANCHES ET AL 2001, MACALPIN 2002, 2003, MADIAS 1993)
I. Major Criterion
II. Minor Criteria
LEFT SEPTAL FASCICULAR BLOCK VECTORCARDIOGRAPHIC CRITERIA (ALL IN THE HP) (TRANCHESI ET AL 1979, DE PÁDUA ET AL 1976, 1978)
DIAGNOSIS OF LSFB
CAUSES OF PROMINENT ANTERIOR FORCES (PAF) DIFFERENTIAL DIAGNOSIS OF LSFB
CONCLUSION
CHAPTER 3:
Cardiac Purkinje Fibers: Normal Function and its Derangements
INTRODUCTION
NORMAL FUNCTIONS OF PURKINJE FIBERS
The Resting and Action Potential
Brief Outline of Major Ionic Events Underlying Resting and Action Potential
Outline of Major Ionic Events Underlying Diastolic Depolarization
Diastolic Depolarization and the Pacemaker Current
Contribution of the Oscillatory Potentials to the Pacemaking Process
The Slowly Inactivating Sodium Current INa3
CONTROL OF IDIOVENTRICULAR PACEMAKER AUTOMATICITY
Overdrive Suppression
Mechanisms of Overdrive Suppression in Purkinje Fibers
Ionic Mechanisms Underlying Overdrive Suppression
Vagal Stimulation and Overdrive Suppression
Autonomic Control of Purkinje Fibers Automaticity and of Overdrive Suppression
DERANGEMENTS OF PURKINJE FIBER FUNCTIONS
Failure of Conduction between the Atria and Ventricles
Decrease in Resting Potential
Modification of the Upstroke
Abnormality at Plateau Level and During Phase 3 Repolarization
Increase in Inward Currents
Decrease in Outward Currents
Increase in Outward Currents
Decrease in Inward Currents
Abnormalities During Diastole: Calcium Overload and Arrhythmias
The Mechanism Underlying Vos
The Mechanism Underlying the Nonoscillatory Vex
Calcium Overload and Overdrive Excitation
The Inhibition of the Na-pump Activity
CONCLUSIONS
ACKNOWLEDGEMENT
CHAPTER 4:
Sympathetic Innervations in Human Heart
INTRODUCTION
SYMPATHETIC REGULATION OF PACEMAKER ACTIVITY
SYMPATHETIC NERVES AND HEART DISEASES
DEVELOPMENT OF CARDIAC INNERVATION
NERVE SPROUTING AND SCD
ROLE OF NERVE GROWTH FACTOR (NGF)
ROLE OF THE CLASS 3 SECRETED SEMAPHORIN (SEMA3A)
PHARMACOLOGIC SYMPATHETIC BLOCKADE
HEART RATE VARIABILITY
CONCLUSION
CHAPTER 5:
Stepwise Approach for Ablation of Persistent Atrial Fibrillation
INTRODUCTION
MECHANISMS OF CHRONIC AF
ABLATION FOR PERSISTENT AF
CATHETER ABLATION OF PERSISTENT AF: THE STEPWISE APPROACH
ATRIAL FIBRILLATION CYCLE LENGTH: A REAL-TIME GUIDE TO ABLATION
PULMONARY VEIN ISOLATION
COMPLEX FRACTIONATED ATRIAL ELECTROGRAMS
Electrophysiological Mechanisms
Clinical Results
Linear Lesions
Autonomic Targets
Right Atrium
Atrial Tachycardia: Mapping Approach
The Procedural Endpoint for Persistent AF Ablation
PREDICTORS OF SUCCESS
RELATED COMPLICATIONS AND POTENTIAL BENEFITS
INDICATIONS FOR PERSISTENT AF ABLATION
FUTURE PERSPECTIVES
CONCLUSION
ACKNOWLEDGEMENTS
CHAPTER 6:
Idiopathic Ventricular Fibrillation: Electrophysiological Mechanisms, Mapping and Ablation
INTRODUCTION
BASIC MECHANISMS IMPLICATED IN IDIOPATHIC VENTRICULAR FIBRILLATION
Triggering Sources
Arrhythmia Perpetuation
Crucial Role of the Purkinje System
ELECTROCARDIOGRAPHIC AND ENDOCARDIAL CHARACTERISTICS OF THE TRIGGERING VPBS
CATHETER ABLATION FOR IDIOPATHIC VENTRICULAR FIBRILLATION
Long-term Follow-up after Idiopathic VF Catheter Ablation
CONCLUSION
ACKNOWLEDGEMENTS
CHAPTER 7:
Blood Cholinesterase Level and QTc Interval in Patients with Organophosphate Poisoning
INTRODUCTION
PHARMACOKINETICS OF ORGANOPHOSPHATE INSECTICIDES
PATHOPHYSIOLOGY OF ORGANOPHOSPHATE INSECTICIDES
CLINICAL FEATURES OF ORGANOPHOSPHATE POISONING
The Intermediate Syndrome (IS)
Organophosphate-induced Delayed Polyneuropathy (OPIDP)
Other Sequelae of Exposure
MECHANISMS OF CARDIOVASCULAR TOXICITY IN ORGANOPHOSPHATE POISONING
ELECTROCARDIOGRAPHIC ABNORMALITIES RELATED TO ORGANOPHOSPHATE POISONING
CONCLUSION
CHAPTER 8:
Are There Sex Differences in Serum Troponin in Cardiac Surgery?
INTRODUCTION
THE AIMS OF THE PRESENT STUDIES
Inclusion Criteria
Exclusion Criteria
Study 1
Study 2
ANESTHETIC MANAGEMENT
SURGICAL AND CARDIOPULMONARY BYPASS MANAGEMENT
BLOOD SAMPLING AND SPECIMEN PROCESSING
STATISTICAL METHODS
Study 1
a. Coronary Bypass
b. Valve Surgery
Study 1
Study 2
CONCLUSION
Study 1
Study 2
ACKNOWLEDGEMENTS
CHAPTER 9:
Angiomyogenesis for Myocardial Repair
INTRODUCTION
CARDIOMYOGENESIS
ANGIOGENESIS
Angiogenesis by Angiogenic Growth Factors Treatment
Angiogenesis Using Angiogenic Growth Factor Gene Delivery
Angiogenesis by Stem/Progenitor Cell Engraftment
Stem Cell Based Gene Delivery for Myocardial Angiomyogenesis
FUTURE DEVELOPMENT
CHAPTER 10:
Cardiac Dysfunction and Therapies (Part 1): Pathophysiology, Diagnosis and Medical Management
INTRODUCTION
PATHOPHYSIOLOGY
Sympathetic Nervous System
Renin-Angiotensin-Aldosterone System (RAAS)
Natriuretic Peptides
Arginine Vasopressin
Oxidative Stress
Vasoconstrictor Peptides
Nitric Oxide
Cytokines
CAUSES OF HEART FAILURE
CLINICAL PRESENTATION
DIAGNOSTIC TESTS
Routine Laboratory Tests
Electrocardiogram
Chest X-ray
Echocardiogram
Stress Testing
Cardiovascular Magnetic Resonance (CMR)
Invasive Catheterization
MANAGEMENT OF HEART FAILURE
Management of Acute Exacerbation
Preventive Measures
Pharmacological Therapy
a. Diuretics
b. Beta Blockers
c. ACE Inhibitors
d. Angiotensin Receptor Blockers (ARBs)
e. Digoxin
f. Inotropic Medications
HYDRALAZINE/NITRATE COMBINATION
ALDOSTERONE ANTAGONISTS
CHAPTER 11:
Cardiac Dysfunction and Therapies (Part 2): Nonpharmacological Management and Future Directions
INTRODUCTION
DEVICE-BASED THERAPY FOR HEART FAILURE
Implantable Cardioverter-Defibrillators (ICD)
a. ICD for Secondary Prevention
b. ICD for Primary Prevention in Ischemic Cardiomyopathy
c. ICD for Primary Prevention in Nonischemic Cardiomyopathy
Cardiac Resynchronization Therapy (CRT)
Implanted Device Based Invasive Hemodynamic Monitoring
NONREPLACEMENT SURGICAL THERAPIES
Coronary Artery Bypass (CABG) Surgery
Mitral Valve Repair
Surgical Ventricular Reconstruction (SVR)
Passive Cardiac Restraint Devices (PCRD)
CIRCULATORY SUPPORT DEVICES (CSD)
Intraaortic Balloon Counterpulsation
Extracorporeal Membrane Oxygenation (ECMO)
Impella Circulatory Assist Device
Ventricular Assist Devices (VAD)
a. Short-term VADs
b. Intermediate and Long-term VADs
REPLACEMENT SURGICAL THERAPY
Total Artificial Heart (TAH)
Heart Transplantation
Prerequisites
Indications
Exclusion criteria
FUTURE DIRECTIONS
Stem Cell Therapy
a. Embryonic Stem Cells
b. Adult Stem Cells
Gene Therapy
Neurohormones
CHAPTER 12:
Artificial Cardiac Pacemaker–Its Structure, Implantation and Working
INTRODUCTION
WHAT IS A PACEMAKER?
THE HISTORY AND DEVELOPMENT OF CARDIAC PACING
New Features in Modern Pacemakers
Detection and Sensing Circuitry
WHY PACEMAKERS ARE USED?
DIAGNOSTIC TESTS
EKG (Electrocardiogram)
Echocardiography
Electrophysiology Study
Stress Test
FUNCTIONS OF PACEMAKER
TYPES OF PACEMAKERS
COMPONENTS AND STRUCTURE OF PACEMAKER
Generator
Battery
Circuit
Connector Block
Types of Connector Blocks
Leads
The Five Basic Types of Leads
Electrode
Materials Used to Make Electrode
Insulation
Types of Insulation Commonly Used
Conductor Coil
Types of Conductor Coil
Fixation
Types of Fixation Mechanisms
Connector
Types of Connectors
Pacing System
Types of Pacing System
WORKING OF PACEMAKERS
IMPLANTATION OF PACEMAKER
POSTIMPLANTATION OF PACEMAKER
COMPLICATIONS WHICH MAY OCCUR WITH PACEMAKERS SURGERY
SOME DEVICES CAN INTERFERE WITH PACEMAKERS
PACEMAKER CODES
COMMON UNITS FOR PACEMAKERS
INDEX
TOC
Index
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