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Základ teoretickej a experimentálnej medicíny
Peter Celec
Ústav molekulárnej biomedicíny, LF UK
www.imbm.sk
Basics of theoretical and experimental medicine
Peter Celec
Institute of Molecular Biomedicine, LF UK
www.imbm.sk
Who?
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Mgr. Janka Bábíčková, PhD.h-index: 3
MUDr. Mgr. Július Hodosy, PhD., MPH.h-index: 11
RNDr. Barbora Vlková, PhD.h-index: 6
Why?
Biomedical research
biology and medicine
Future career
Master theses
PhD
IMBM, BMC
Bidirectional
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What?
Principles of common diseases
Etiology
Pathogenesis
Symptoms & signs
Treatment approaches
Models
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Syllabus
Introduction Syllabus, motivation, examination
Cardiovascular diseases Heart failure, hypertension, atherosclerosis, coronary artery disease, shock
Respiratory diseases Asthma, COPD, emphysema, pulmonary edema, acid base balance
Blood and immune disorders Anemia, inflammation, immunosuppression, autoimmune diseases, allergy, leukemia, lymphoma
Endocrine diseases Disorders of the thyroid, adrenal and pituitary gland, hypogonadism, hypergonadism
Metabolic diseases Diabetes mellitus, gout, hemochromatosis
Gastrointestinal diseases Ulcers, diarrhea, constipation, icterus, pancreatitis, portal hypertension, liver failure
Nephrology and disorders of the genitourinary tract Renal failure, glomerulonephritis, preeclampsia, urinary tract infection, amenorrhea
Neuropsychiatric disorders Stroke, multiple sclerosis, epilepsy, migraine, autism, depression, schizophrenia, neurodegeneration
Musculoskeletal diseases Osteoporosis, carpal tunnel syndrome, rheumatoid arthritis, osteoarthrosis, psoriasis
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Information sources
Lectures
www.imbm.sk
Textbooks
Pathophysiology, internal medicine
Review articles
Pubmed
CVTI
www.cvtisr.sk
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Examination
Oral exam
Questions acording to the syllabus
Seminar paper
1.5.
One disease reviewed in detail
Tasks to solve
Questions every week
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Basic terms
Physiology vs. Pathophysiology
Pathology vs. Pathophysiology
Etiology vs Pathogenesis
Symptoms vs Signs
Syndrome
Health vs Disease
Latin terms
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Latin I.
-brady – bradypnoe, bradykardia -tachy – tachypnoe, tachykardia -hypo – hypopnoe, hypoglycemia -hyper – hyperpnoe, hyperglycemia -poly – polydipsia, polyphagia -oligo – oliguria, oligofrénia -a/an – apnoe, anuria -pseudo – pseudocyst -endo – endoscopy -ekto – ectopic
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Latin II.
-osis – degeneration - arthrosis -itis – inflammation - hepatitis -oma – tumor - myoma -algia – pain - artralgia -stenosis – narrowing - pylorostenosis -pathia – disease - hepatopatia -lithiasis – stone - nephrolithiasis -rrhagia – bleeding - metrorrhagia -emia – blood - glycemia, natriemia, kaliemia -uria – urine - glykosuria, natriuria
Selected symptoms & signs
Cyanosis
Dyspnoe
Icterus
Struma
Edema
Palpitations
Syncope
Ascites
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Syndrome
Anemic syndrome
Paleness
Fatique
Dyspnea
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Cardiovascular system I
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Heart valves
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Circulation
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Conducting system
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Cardiac output
Preload
Contractility
Afterload
Frequency
Synchronisation
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Mechanisms of heart
Frank-Starling mechanism
Inotropy – lusitropy
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Cardiovascular diseases
Hypertension
Atherosclerosis
Coronary artery disease Angina pectoris
Acute myocardial infarction
Heart failure
Stroke
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Neurohumoral regulation
Autonomous nervous system
RAAS system
Endothelin
Natriuretic peptides
NO
Autonomous nervous system
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RAAS system
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Endothelin
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Natriuretic hormones
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NO
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Heart failure
Insufficient perfusion of tissues
Normal filling
Forward failure
Ejection fraction
Backward failure
Edema
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Heart failure
Systolic
Low ejection fraction
Contraction failure
Diastolic
Normal ejection fraction
Filling failure
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NYHA classification
Class I No limitations of physical activity. Dyspnoe with heavy
physical exertion.
Class II Some limitation of physical activity. Dyspnoe with
ordinary exertion.
Class III Definite limitation of physical activity. Dyspnoe with
minimal exertion.
Class IV Severe limitation of physical activity. Dyspnoe at rest.
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Heart failure
Compensation
Catecholamines
Frank-Starling
Hypertrophy
Decompensation
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Heart failure
Epidemiology
20/1000 – adult population
150/1000 – over 75 years
5-year mortality 50%
Therapy
ACE-inhibitors
Beta-blockers
Diuretics
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Pathophysiology of heart failure
Work overload
Myocardial dysfunction
Filling failure
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Symptoms of heart failure
Think FACES...
• Fatigue
• Activities limited
• Chest congestion
• Edema or ankle swelling
• Shortness of breath
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Decompensation
Increased pulmonary venous pressure
Insterstitial edema
Alveolar edema
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Acute pulmonary edema
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Hypertrophy
Overload
Pressure
Afterload
Concentric hypertrophy
Volume
Preload
Excentric hypertrophy
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Valvular defects
Mitral/Tricuspidal
Stenosis
Insufficiency
Aortal/Pulmonary
Stenosis
Insufficiency
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Valvular defects
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Healthy heart
Dilation
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Healthy heart
Concentric hypertrophy
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Healthy heart
Excentric hypertrophy
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Blood pressure
Hypertension
140/90 mm Hg, but...
Many confounding factors
Hypertrophy, encephalopathy, stroke, hypertensive nephropathy, retinopathy...
Primary – essential
Secondary Renal
Renovascular
Endocrine
Neural, iatrogenic, gestational...
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Afterload & blood pressure
BP = CO x SVR
Cardiac output
Systemic vascular resistance
If CO is low, BP is maintained by SVR
SVR = afterload
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Complications of hypertension
Atherosclerosis
Stroke
AMI
Nephropathy
Blindness
Cardiovascular models
Hypertesion
L-NAME, SHR, Dahl salt-sensitive rats
Atherosclerosis
High fat diet
AMI
Coronary surgery
Heart failure
Isoprenalin
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Questions
Which genetic factors are associated with hypertension? Heritability?
What is the evolutionary origin of the RAAS system?
What is the effect of ACE inhibitors on mortality in hypertension and heart failure?
Which promoters are myocardium-specific?
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