Pathophsiology Summary

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Pathophysiology summary2nd exam lectureDone by :abeer dirawi & ahmed alshamary & oday noa'man & hadeel sumrain

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First lecture Summary Right and left side of the heart are separated from each other by fibrous tissue . There are two opening in the heart in the fetal life and should be closed after birth : 1-foramin ovali. 2-ductus arteriosus.For your information ductus arteriosus ,what is it?? In the developing fetus, the ductus arteriosus (DA), is a blood vessel connecting the pulmonary artery to the aortic arch. Upon closure at birth, it .becomes the ligamentum arteriosum

The impulse transmit in the heart by the conductive system not direct between the atrium &ventricle ,except in rare situation called muscular bridge. The location of the heart: in the mediastinum between the 2nd -5th intercostal space. PMI= point of maximum impulse "where you can feel the impulse". Cardiomegaly :enlargement of the heart "the PMI will increase ". Papillary muscle: it's the muscle attached to the atrioventricular valves via the chordae tendinae. Arteriole: control blood pressure. Vein: blood reservoir . The heart is self-excited . The heart work not under the direct control of the Brian ,but it's affected by the sympathetic and parasympathetic system. Atrium innervated mainly by parasympathetic system & ventricle mainly by sympathetic system. The heart is affected by hormones mainly adrenaline and noradrenaline which is secreted by adrenal gland, they cause central vasodilation and peripheral vasoconstriction.

Alpha 1 :blood vessel vasoconstriction Beta 1 : increase heart rate & contractility

Alpha 2 : heart vasodilatation Beta 2 : bronchi dilatation

The vein affected by the sympathetic system more than any other blood vessels because they are blood reservoir .

Done by: Hadeel sumrain.

Hypertension lec. summary Hypertension : It is sustained blood pressure beyond the normal average . - The normal blood pressure : - systolic : 120-139 mm - diastolic : 80-89 mm - BP = diastolic + 1/3(systolic diastolic ) Regulation of blood pressure : A. Short term regulation : moment to moment regulation controlled by barrow receptors . B. Long term regulation: the mechanism to maintain blood volume there is compensated blood loss ! Signs & symptoms of hypertension : silent killer usually no symptoms but rarely it shows : - Headache - Blurry vision - Chest pain - Frequent urination at night Blood pressure measurement : - Optimal : systolic < 120 & diastolic < 80 - normal : systolic < 130 & diastolic < 85 - high normal : systolic < 130-139 & diastolic < 85 89 Causes of hyper tension : 1. Primary hyper tension: which is 90 -95 % of the cases that the cause of it is unknown. 2. Secondary hypertension , its only 5-10% that the cause might be cardiac , renal or endocrine ( these systems involved in the maintenance of blood pressure )

We can classify the factors which cause hypertension into two categories: a) Controllable factors : increased salt intake , obesity , alcohol , stress, lack of exercise and smoking . b) Uncontrollable factors : heredity , race and age ( men 35-50 , women after menopause ).

Hypertension may lead to

Ischemic heart disease Myocardial infraction Stroke Congestive heart failure Kidney failure Heart attack Heart rhythm problems Aneurysm (localized, blood-filled

balloon-like bulge . in the wall of a blood vessel).

Medications : 1. Diuretics get rid of excess fluids 2. Beta blockers reduce HR 3. Calcium antagonist reduce HR & relax BV 4. Angiotensin II receptors blockers 5. Vasodilators

- malignant hypertension if its not treated it will be fatal - resistant doesnt respond to treatment of three medications

Done by: Abeer dirawi.

Heart Failure lec. summary

Definitionsoccur together

Heart Failure The inability of the heart to maintain an output adequate to maintain the metabolic demands of the body.

Pulmonary Edema An abnormal accumulation of fluid in the lungs.

Causes of Heart Failure 1-Ischemic Heart Disease 2-Cardiomyopathy 3-Hypertension

Valvular Heart Disease Congenital Heart Disease Alcohol and Drugs. Arrhythmias Ventricular Dilatation. Myocyte Hypertrophy. Salt and Water Retention. Sympathetic Stimulation. Peripheral Vasoconstriction.

When we need more Blood due to the body demand but at that time we were suffering from HF and low Cardiac Output then the Heart will do the Following 1-Sympathetic stimulation ( lead to #2) 2-Increase in heart rate , contractility ,cardiac output . 3-Release/formation of Angiotensin II to increase of the volume. 4-Vasoconstriction (Increase in the after load ) 5-Increase in the heart size (cardiomegaly ) How can we discover that we have HF Signs: Cardiomegaly Elevated Jugular Venous Pressure Tachycardia Hypotension Bi-basal crackles in the lungs Pleural effusion Ankle Edema Ascites Tender hepatomegaly Classification of heart failure " Symptoms of HF occur at rest and are exacerbated by any physical activity." Category No limitation. Mild limitation Marked limitation Symptoms heavy exercise normal physical activity gentle physical activity

Note that ! Kussmauls sign Seen in an increase in jugular 1-constrictive pericarditis venous pressure and it is 2-right heart failure a sign of Right side heart 3-right ventricular infarction failure . 4-tricuspid stenosis 5-restrictive cardiomyopathy 6-"VIP" tamponade + degree of constricive pericardiditis Kussmauls sign Not Seen in 1- acute cardiac tamponade

What is PMI and Where ?is the furthermost point outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be felt. PMI is at left 5th intercostals space, at the point of intersection with the left midclavicular line.

PMI Abnormalities!1- Dextrocardia, the apex beat may be felt on the right side. 2-Cardiomegaly , enlargement of the heart (at the 6th or 7th intercostals space).

Heart SoundName S1 S2 S3 "Pathological after 40" S4 "always Pathological " Time Close of AV valve Close of Semilunar valve Start of Diastole After Aerial Contraction

To do Compensatory mechanism

Increased HR -Sympathetic -Norepinephrine

Dilation -Frank Starling - Contractility

Neurohormonal Redistribution of Blood to the Brain

NOTE THAT! Vicious cycle will-Decrease in cardiac output -The body demand for more

ALSO ,Increase in the afterlaod TPR + Increase in the preload COP lead to more and more deteriorated of the heart !

ALSO ,People who developed acute pulmonary edema , should have endotracheal, To get rid of excessive fluid

Treatment of HF !1. Diuretics . 2. Beta blockers . (Decrease CO)

3. ACE inhibitors (both preload and afterload will decrease .) Digoxin - increase the force of contraction by increase the Ca concentration inthe myocytes and decrease the HR. - Digoxin isnt a safe drug the therapeutic index of it is narrow

- Digoxin toxicity: High amount of the DrugLeads to 1. Dizziness. 2. Confusion 3. Discoloration, the patient will have yellowish discoloration 4. Loose of consciousness Note About Viagra Treatment: - general vasodilator -Digoxin immune fab - Cause Tachycardia -antidote for Digoxin - Fatal for Old people What is Cyanosis! It is the Blue discoloration of skin and mucus membranes, we can see it in the patient who has heart failure. We Can't treat the acute pulmonary edema by chest tube there is no air or fluid in the pleural cavity(cover the lung) excessive fluid usually are absorbed.

Done By Prince Ahmed Al-Shamary

arrhythmia lec. SummaryArrhythmia :abnormality in the conductive system of the heart. The SA node is the pacemaker of the heart where the impulse should be initiated ,but some time the impulse could be initiated elsewhere in the heart this is called "ectopic beat ". Refractory period : the period of time come after each AP and the heart muscle can't be excited through it because of the inactivation of fast Na channel. Herat block : o 1-Block at the level of AV node : a- first degree heart block (PR > 0.22 sec.) b- second degree heart block(some P wave conduct ). C-third degree heart block(complete heart block). o 2- block below the AV node: a- block at bundle of his. b- block at the branches. Causes :acute MI, calcify aortic stenosis ,cardiomyopathy, drug,ischemia. Tachycardia : the HR more than 100/min (in ECG short PR interval) Bradycardia : the HR is less than 60/min( in ECG prolonged PR interval). The main cause of fibrillation are: o Strong electrical shock. o Sever ischemic heart disease. The main cause of AP re-entry : o Long pathway around the circle. o Decrees velocity of conduction . o Shortened refractory period of the muscle . Premature beat: o Premature atrial contraction:- the P wave occur too soon o Premature ventricular contraction:- the QRS complex prolonged . Ventricular tachy-arrhymia : Decrees in the COP , the ECG is odd shape. Anti-arrhythmic drug: B blockers & Ca or Na channels blockers & digoxin.

Done by : Hadeel sumrain.

The kidney lec. summaryReview of kidney structure and function

Functions of the kidneys : excretion metabolic waste products ( Urea , Uric acid , Creatinine and Bilirubin ) e xcretion foreign chemicals ( Food additives , toxins , pesticides , drugs ) secretion , metabolism & excretion of hormones ( Renal erythropoietic factor, Renin and 1,25 dihydroxycholecalciferol ) Regulation of erythrocytes production Regulation of vitamin D activity (Vitamin D3 is important in calcium and phosphate metabolism ) Gluconeogenesis ( synthesis of Glucose ) Regulation of acid-base balance Regulation of arterial pressure ( Endocrine Organ and Control of Extracellular Fluid