Physiologically Speaking

FEBRUARY 16, 2024

Welcome to the Physiology Friday newsletter. Physiologically Speaking is a reader-supported publication. There’s a long-running debate in exercise physiology about what limits VO2 max. Physiology is integrative, not isolated. To receive new posts and support my work, consider becoming a free or paid subscriber.

Physiology 52

Physiology Exercise Pulmonary Circulation 52

Journal of Cardiovascular Pharmacology

JULY 1, 2024

Abstract: Angiomotin-like 2 (AMOTL2) is related to numerous physiological and pathological conditions by affecting signal transduction. However, whether AMOTL2 is linked to pulmonary arterial hypertension (PAH) has not been addressed. AMOTL2 was downregulated in hypoxia-stimulated pulmonary arterial smooth muscle cells (PASMCs).

Pulmonary 40

Pulmonary Hypertension Physiology Article 40

Journal of the American Heart Association

MARCH 8, 2024

This approach allowed us to evaluate the effect of childhood body size on 11 measures of right heart and pulmonary circulation independent of other anthropometric traits at various stages in the lifecourse. 0.33];P=3×10−7) independent of adulthood body size.

Pulmonary 40

Pulmonary Circulation Physiology 40

Heart BMJ

MARCH 22, 2024

Challenges in the diagnosis of pulmonary hypertension Pulmonary hypertension (PH) is a clinical–physiological syndrome thought to affect 1% of the global population. 1 PH is defined haemodynamically by mean pulmonary artery pressure >20 mm Hg, resulting in right ventricular (RV) overload and often RV failure.

Pulmonary 40

Pulmonary Hypertension Physiology 40

Frontiers in Cardiovascular Medicine

MARCH 3, 2024

Methods Here, a mathematical and physiological framework to define the patient-specific tipping point of myocardial energetics is defined. A novel hemodynamic parameter known as the myocardial performance score (MPS), a marker of power and efficiency, is introduced that allows for the objective assessment of the physiological tipping point.

Heart Failure 85

Heart Failure Cardiogenic Shock Physiology Transplant 85

DAIC

APRIL 18, 2024

This forms the physiologic rationale for the accepted convention of a three-month blanking period, during which arrhythmia recurrences are presumed to be relatively benign and not indicative of treatment failure. also emphasize the importance of continuous monitoring.

Atrial Fibrillation 111

Atrial Fibrillation Ablation Heart Rhythm Article 111

Journal of the American Heart Association

JANUARY 9, 2025

Cardiopulmonary exercise testing is a valuable tool for assessing functional capacity, evaluating cardiac and pulmonary pathology, and providing guidance on prognosis and interventional recommendations.

Congenital Heart Disease 75

Congenital Heart Disease Congenital Exercise Heart Disease 75

HeartRhythm

MARCH 6, 2024

Extensive ablation, including posterior wall isolation (PWI) is advocated for radiofrequency ablation (RFA) of persistent atrial fibrillation (peAF) to decrease the high recurrence-rates reported when only pulmonary vein isolation (PVI) is performed.1

Atrial Fibrillation 45

Atrial Fibrillation Ablation Physiology Pulmonary 45

Circulation: Cardiovascular Interventions

NOVEMBER 6, 2023

Background:Neonates with complex congenital heart disease and pulmonary overcirculation have been historically treated surgically. 3.3]) underwent a PFR procedure; 15 (88%) had single ventricle physiology; 15 (88%) were high-risk surgical candidates. Circulation: Cardiovascular Interventions, Ahead of Print. kilograms [IQR, 2.1–3.3])

Congenital Heart Disease 40

Congenital Heart Disease Congenital Heart Disease Pulmonary 40

Journal of Cardiothoracic Surgery

DECEMBER 7, 2023

Frailty develops as a result of age-related decline in many physiological systems and is associated with increased vulnerability to adverse outcomes following thoracic surgery. We prospectively tested our hypo.

Cancer 40

Cancer Physiology Pulmonary Outcomes 40

European Journal of Heart Failure

DECEMBER 28, 2023

Moreover, the definitions of elevated exercise pulmonary artery (PA) and PA wedge pressure (PAWP) for this population have not been described. Abstract Background The normal (i.e., expected) hemodynamics in adults post-Fontan remain poorly delineated.

Exercise 40

Exercise Physiology Article Pulmonary 40

Hypertension Journal

DECEMBER 7, 2023

ET (endothelin) is a powerful vasoconstrictor 21-amino acid peptide present in many tissues, which exerts many physiological functions across the body and participates as a mediator in many pathological conditions. Hypertension, Ahead of Print.

Kidney Disease 45

Kidney Disease Hypertension Pulmonary Atherosclerosis 45

All About Cardiovascular System and Disorders

APRIL 1, 2024

That is, right ventricle is connecting to aorta, and left ventricle to pulmonary artery. That is, pulmonary artery is transposed over to the right ventricle, and aorta over to the left ventricle, so that normal anatomy is restored. In dextro transposition of great arteries or D-TGA, there is ventriculoarterial discordance.

Pulmonary 52

Pulmonary Stenosis Anatomy Physiology 52

Dr. Smith's ECG Blog

DECEMBER 20, 2010

link] Briefly, this woman without significant cardiac history went into pulmonary edema with respiratory failure. I refer you to the video case presentation by one of my colleagues, Dr. Rob Reardon (who has, by the way, a fantastic collection of ED ultrasound cases). The apparent trigger was stress from losing custody of children.

Echocardiogram 52

Echocardiogram Cardiomyopathy Ultrasound STEMI 52

Ken Grauer, MD

SEPTEMBER 22, 2023

KEY Point: Although true that patients with longstanding, severe pulmonary disease may manifest a QRST complex in standard lead I with marked overall reduction in QRST amplitude ( See ECG Blog #65 — regarding Schamroth’s Sign ) — you should never normally see a completely flat line in any of the standard limb leads.

Blog 174

Blog Chest Pain Bradycardia Physiology 174

Circulation

NOVEMBER 11, 2024

The CardioMEMS PA (pulmonary artery) sensor allows remote pulmonary artery diastolic (PAD) pressure monitoring to adjust diuresis in heart failure with preserved ejection fraction (HFpEF). Circulation, Volume 150, Issue Suppl_1 , Page A4123391-A4123391, November 12, 2024.

Preserved Ejection Fraction 40

Preserved Ejection Fraction Cardiomyopathy Heart Failure Pulmonary 40

Dr. Smith's ECG Blog

OCTOBER 10, 2022

The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CT angiogram showed extensive saddle pulmonary embolism. He had multiple cardiac arrests with ROSC regained each time. This is a quiz.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

DECEMBER 24, 2023

Smith's ECG Blog — the presence of an almost “null vector” in standard lead I ( ie, P wave, QRS complex and T wave all under 2mm in size ) — is highly suggestive of longstanding and severe pulmonary disease. It simply does not make physiologic sense to suddenly see an all-negative QRS complex in this most lateral chest lead.

Atrial Flutter 127

Atrial Flutter Blog Aortic Aortic valve 127

Dr. Smith's ECG Blog

MARCH 12, 2018

Notice I did not say "pulmonary embolism," because any form of severe acute right heart strain may produce this ECG. This includes, but is not limited to, PE, asthma/COPD exacerbation, hypoxic vasoconstriction from pneumonia, acute pulmonary hypertension exacerbation. Differences of Pulmonary Embolism T-waves from Wellens' T-waves: 1.

Chest Pain 40

Chest Pain Pulmonary Embolism Tachycardia 40

Circulation

NOVEMBER 11, 2024

However, stabilization was expected to be temporary due to ongoing physiologic changes of pregnancy. After discharge, she was scheduled for a 2-week postpartum visit including echocardiogram, EKG, and NT-proBNP.Discussion:Given the patient's acute decompensation and fluid overload, medical optimization was essential prior to delivery.

Heart Failure 40

Heart Failure Cardiogenic Shock ICU Cardiothoracic 40

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

My answer: "This is classic for PE, but it can also be present in any hypoxia due pulmonary hypoxic vasoconstriction and resulting acute pulmonary hypertension and acute right heart strain. The ECG of most patients with longstanding pulmonary disease show more r wave progression than I see in ECG #1. This is NOT Wellens.

Chest Pain 52

Chest Pain Pulmonary Tachycardia Embolism 52

Dr. Smith's ECG Blog

FEBRUARY 12, 2023

This suggests that there is pulmonary hypertension and thus possibly RVH. The estimated pulmonary artery systolic pressure is 31 mmHg + RA pressure. In a patient with RVH — the finding of a qR pattern has been closely correlated with pulmonary hypertension. Right atrial enlargement, severe. Severe tricuspid regurgitation. --The

Pulmonary 40

Pulmonary Chest Pain Hypertension Tricuspid 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed. In cardiogenic shock, fluid may worsen the pulmonary edema associated with acute heart failure, but may still be required to support the hemodynamic status of the patient. The mean MAP for these patients was 81 +/- 13.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

JULY 3, 2020

The estimated pulmonary artery systolic pressure is 49 mmHg + RA pressure. Echo: Technically difficult study. The estimated left ventricular ejection fraction is 76 %. There is no left ventricular wall motion abnormality identified. Normal left ventricular cavity size. Hyperdynamic systolic performance.

Hemorrhage 52

Hemorrhage Critical Care Blood Pressure Laboratory 52

Circulation

NOVEMBER 11, 2024

Background:Sex differences in physiology and presentation have been well established across the heart failure (HF) spectrum. Circulation, Volume 150, Issue Suppl_1 , Page A4146478-A4146478, November 12, 2024. Women had a worse Minnesota Living with Heart Failure physical subscore (34.6±5 p=0.008) and more physical signs of congestion (10.7±2.3

Heart Failure 40

Heart Failure Biomarkers Pulmonary Bicuspid/Mitral 40

Frontiers in Cardiovascular Medicine

MARCH 20, 2025

Intra-atrial baffles of pulmonary and systemic venous flows are relatively rarely used but are important surgical procedures for late-presenting d-transposition of the great arteries (D-TGA) or heterotaxy with anomalous venous connections.

Pulmonary 52

Pulmonary Physiology Pediatrics 52

Frontiers in Cardiovascular Medicine

JANUARY 6, 2025

This study aims to evaluate an application-based remote IHM program for infants with shunt- or duct-dependent pulmonary circulation. ConclusionApplication-based remote IHM for infants with duct- or shunt-dependent pulmonary perfusion is feasible, with high acceptance and adherence.

Pulmonary 52

Pulmonary Physiology Education Outcomes 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Of the 67 patients who underwent targeted tests, suspected diagnoses were confirmed in 49 (73%) patients: aortic stenosis (n = 8, 1%), pulmonary embolism (n = 8, 1%), seizures/stroke (n = 30, 5%), and other diseases (n = 3). Fourth, syncope in the elderly often results from polypharmacy and abnormal physiologic responses to daily events.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. S. Venkatesan MD

JANUARY 28, 2025

For right or wrong reasons, the world of electrophysiology has pushed us into a belief system that, if it is AF, the culprit must be pulmonary veins. In fact, non-pulmonary vein origins can be a staggering 70% in some series. Only 20% of focal AT arise from pulmonary veins. I guess, the same should be true for AF. Aronson JK.

Atrial Fibrillation 52

Atrial Fibrillation Pulmonary Tachycardia Electrophysiology 52