ASSIGNMENT

Subject Code: PDA101T

Subject Name: HUMAN ANTOMY AND PHYSIOLOGY
Programme/Course: PHARM D
Department: PHARMACOLOGY
Faculty: PHARMACY

Name of the Student: ANTO AMITH BIJU

Reg. No: 16PHPH010005
Semester/Year: 1st YEAR/2016

Subject Leader/s: Dr. J. ANBU

i
 M. S. Ramaiah University of Applied Sciences
University House, Gnanagangothri Campus, New BEL Road,
M S R Nagar, Bangalore, Karnataka, INDIA - 560 054.

<Subject Title> ii
 Declaration Sheet
Student Name ANTO AMITH BIJU
Reg. No 16PHPH010005
Programme/Cours
PHARM D Semester/Year 1st YEAR/2016
e
Subject Code PDA101T
Subject Title HUMAN ANATOMY AND PHYSIOLOGY
Subject Date 22/8/16 to 18/1/17
Subject Leader Dr.J.BIJU

Declaration

The assignment submitted herewith is a result of my own investigations and that I have
conformed to the guidelines against plagiarism as laid out in the Student Handbook.
All sections of the text and results, which have been obtained from other sources, are
fully referenced. I understand that cheating and plagiarism constitute a breach of
University regulations and will be dealt with accordingly.

Signature of the Student Date 18/1/17

Submission date stamp

(by Examination & Assessment
Section)

Signature of the Subject Leader and date Signature of the Reviewer and date

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 Contents
____________________________________________________________________________

Declaration Sheet.....................................................................................................................................ii
Contents...................................................................................................................................................iii
List of Tables.............................................................................................................................................v
List of Figures...........................................................................................................................................vi
List of Symbols........................................................................................................................................vii
Question No. 1..........................................................................................................................................8
1.1 Overview:........................................................................................................................................8

1.2 Solution to the question:................................................................................................................8

1.3 Discussions /Suggestions/Views/Recommendations......................................................................8

1.4 Conclusions.....................................................................................................................................8

Question No. 2..........................................................................................................................................9

2.1 Overview:........................................................................................................................................9

2.2 Solution to the question:................................................................................................................9

2.3 Discussions /Suggestions/Views/Recommendations......................................................................9

2.4 Conclusions.....................................................................................................................................9

Question No. 3........................................................................................................................................10

3.1 Overview:......................................................................................................................................10

3.2 Solution to the question:..............................................................................................................10

3.3 Discussions /Suggestions/Views/Recommendations....................................................................10

3.4 Conclusions...................................................................................................................................10

Question No. 4........................................................................................................................................11

4.1 Overview:......................................................................................................................................11

4.2 Solution to the question:..............................................................................................................11

4.3 Discussions /Suggestions/Views/Recommendations....................................................................11

4.4 Conclusions...................................................................................................................................11

Question No. 5........................................................................................................................................12

5.1 Overview:......................................................................................................................................12

5.2 Solution to the question:..............................................................................................................12

5.3 Discussions /Suggestions/Views/Recommendations....................................................................12

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 5.4 Conclusions...................................................................................................................................12

<Subject Title> v
 Introduction
Infertility is a typical issue of around 10% of ladies matured 15 to 44. Infertility in men can be expected
by varicocele, less or truant sperm count , sperm harm or certain illness. Chance elements for men's
infertility incorporate liquor, poisons, smoking, age, medical issues, meds, radiation, and
chemotherapy. However, on the off chance that you are 35 years or more seasoned, you ought to start
the infertility assessment after around six months of unprotected intercourse instead of a year, so as
not to postpone conceivably required treatment. On the off chance that you have motivation to
presume a hidden issue, you ought to look for care prior. For example, on the off chance that you have
extremely sporadic menstrual cycles (proposing that you are not ovulating or discharging an egg), or in
the event that you or your accomplice has a known ripeness issue, you most likely ought not hold up
an whole year before looking for treatment. On the off chance that you and your accomplice have
been notable have an infant, you're definitely not alone. No less than one out of seven couples
experiences difficulty considering. Amid this time, it is typical to encounter sentiments of frustration,
envy, outrage and stress.
Reference:
https://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and
_Info_Booklets/infertility_overview.pdf

REASONS FOR INFERTILITY IN COUPLES

Infertility In Martin And Chirstina Is Due To:
May be infertility in martin due to:
 Martin is an athlete in high school who as been forced and stressed by universities.
 He also have physiological problems like severely high blood pressure, slightly elevated
levels of low- and density lipoproteins(LDL) , atherosclerosis
 From above details we came to that martin as been consumed AAS(anabolic androgenic
steroids) which is a synthetic derivative of the male hormone testosterone. They can
shows strong effects on the human beings that may be advantage for athletic
performance. In most laboratory studies did not investigate the actual doses of AAS
currently abused in the field. Therefore, those studies may not shows the actual (adverse)
effects of steroids. The available scientific literatures describes that short-term
administration of these drugs by athletes can increase strength and bodyweight.
 Martin is an athlete so obviously he will do exercises to build body and may be because of
strenuous exercises which will lead to decrease total testosterone level.
 All this factors will leads to hormonal change which also causes infertility in couples.

http://endurancesupport.com/wp-content/uploads/2012/01/SportsMed-AAS-
review.Hartgens.2004.pdf

May be infertility in chirstina due to:

 Due to hormonal imbalance in chirstina and cystic formation in ovary or cystic fibrosis lead
to infertility.
http://press.endocrine.org/doi/abs/10.1210/en.2007-1581

DIAGNOSIS

By the below table martin and chirstina can diagnose their problems.

Martin semen analysis comparing with normal level.

Sperm Concentration ~ 7.9 15 millions/ml

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 (Millions/ml)

Total Sperm Count ~ 9.7 39 M/ejaculate

(M/ejaculate)

Motility (.5 - 2 hr after < 30 50% or more motile

ejaculation)

Vitality (% live) 44 % 50% or more live

Sperm concentration, total sperm count, motility, vitality rate of martin is less than normal
values.
Martins hormone level comparing with normal level.
Hormone Martin’s values Normal values
FSH 0.8 mIU/ml 1-18 mIU/ml
LH 33 pg/ml 2-18 mIU/ml
Prolactin 24 ng/ml <20 ng/ml

Free testosterone 0.96 ng/dl 0.95-4.3 ng/dl

Total testosterone 243 ng/dl 270-1100 ng/dl

Progesterone 0.8 ng/ml 0.3-1.2 ng/ml

Martin FSH,LH, and total testosterone levels are less than normal level and prolactin level is high
due to AAS(anabolic androgenic steroids) which is a synthetic derivative of the male hormone
testosterone and due hike level of LDL in martin.

Chirstina hormone level comparing with normal level.

Hormone Christina’s values Normal values
FSH 2.2 uIU/ml 3 - 20 mIU/ml
LH 3.2 mIU/ml <7 mIU/ml
Prolactin 31 ng/ml <24 ng/ml
Total testosterone 30 ng/dl 6-86 ng/dl
Estradiol 148 pg/ml 25-75 pg/ml
Progesterone 1.2 ng/ml <1.5 pg/ml

Chirstina have increased level of prolactin and estradiol is due to decreased level of FSH in
chirstina may be due to cystic formation or poor egg health and less ovarian reserve.

https://i.ytimg.com/vi/r_0vg1E8_tI/maxresdefault.jpg
https://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and
_Info_Booklets/infertility_overview.pdf

List of drugs involved in infertility

 Bromocriptine (Parlodel) – reduces the amount of prolactin released by the pituitary gland.
This medication is prescribed in cases where infertility is linked to irregular ovulation resulting
from over-production of prolactin.
 Methylprednisolone (Medrol) – a steroid used for its anti-inflammatory effect after IVF
oocyte retrieval.

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  Leuprolide Acetate (Lupron) – initially accelerates the pituitary gland and then stops it from
producing LH and FSH, allowing for a controlled stimulation cycle prior to IVF. 
 Pre-Natal Vitamins – contain folic acid (folate), which may reduce the risk of certain birth
defects such as spina bifida and other neural tube defects.
 Follicle Stimulating Hormones (Gonal F, Follistim) – consisting primarily of FSH, with little or
no LH, they bypass the hypothalamus and pituitary glands to stimulate growth of multiple
follicles.
 https://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sh
eets_and_Info_Booklets/ovulation_drugs.pdf

Conculsions
Sometimes the factors affecting your fertility are easy to detect and treat, but in many cases a specific
reason for infertility may be difficult to identify. After a full evaluation, your physician can give you a
reasonable idea of your chances of achieving pregnancy with various treatment options. Thanks to the
many options existing today, including advanced reproductive technologies and adoption, most
infertile couples will be able to experience the joy of parenthood. The sooner you meet with a
specialist, the sooner you will find answers and be able to realize your dream of having a child.

B.2
Introduction
Cardiovascular disease.
Cardiovascular infection is the main source of death among ladies and men. It represents half
of all passings in Europe bringing about more than 4.35 million passings every year in the 53
part conditions of the World Health Organization. Cardiovascular sickness is likewise a
noteworthy reason for inability and of lessened personal satisfaction. WHO appraises that
humble populace wide and synchronous decreases in circulatory strain, heftiness, cholesterol

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 and tobacco utilize would more than split cardiovascular ailment rate. Cardiovascular disease is
killing more people than all cancers combined, with a higher percentage of women (55% of all
deaths) than men (43% of all deaths), and a higher mortality among men and women with a
lower socio-economic position.
https://www.iconceptpress.com/book/cardiovascular-disease-
i/11000116/1303000892/download/1303000892.pdf

Environmental factors involved in induction of cardiovascular diseases

Ecological variables required in acceptance of cardiovascular ailments CVD peril will be affected in light
of the fact that movements in dietary and way of life choices. Natural cardiology suggests that
Ecological poisons moreover affect CVD. Presentation to tobacco smoke is paradigmatic about such
Ecological threat mortal sin.. Exposure to other chemicals such as polyaromatic
hydrocarbons, aldehydes, and metals has also been reported to elevate CVD risk by affecting
atherogenesis, thrombosis, or blood pressure regulation. Maternal exposure to drugs, toxins, and
infection has been linked with cardiac birth defects and premature CVD in later life. Aggregately, the
information AGREED the thought that ceaseless ecological anxiety is an essential determinant of CVD
hazard..

CARDIOTOXIC ENVIROMENTAL POLLUTANTS

A few pollutants extending starting with tobacco smoke,. Particulates, metals, Furthermore
pollutant gasses bring been. Appeared for whichever fuel CVD or precipitate. Intense clinical
occasions. The helter skelter powerlessness about. Cardiovascular tissue with such an
extensive variety for. Pollutants vehemently underscores the secondary. Defenselessness of
the heart Also blood vessels should. Xenobiotic toxicity, despite the fact that such tissues are.
Sometimes the site from claiming to start with introduction. It takes after that point. That
cardiovascular poisonous quality will be as a rule a optional. Effect, and that recognizing how
pollutants would. Altered or modified at those webpage from claiming entrance will be
necessary,. Regardless of they show up in the blood stream Also influence. Cardiovascular
tissues specifically.
Environmental tobacco smoke
Cigarette smoking and second-hand exposure to environmental tobacco smoke is strongly and
positively associated with an increase in CVD risk. Tobacco smoke causes an estimated 1.69 million
deaths per year worldwide according to 2013, with the cardiovascular burden of smoking far
outweighing the risk for cancer. Smoking is an independent risk factor for CVD. Thus, the mechanisms
by which smoking affects CVD cannot be fully accounted for by other major risk factors like
hypertension or hypercholesterolemia. Nonetheless, smoking profoundly affects both risk factors.
Smokers maintain lower levels of high-density lipoproteins (HDL);

Air pollution
Ambient air consists of an aerosolized mixture of particulate matter (PM) suspended in gas. The
particles are regularly grouped by their size and structure, and unmistakable classifications seem to
have trademark inceptions, physical properties, reactivity, and respiratory framework entrance.

cardiovascular pathology affected by pollutant exposure.

In addition to these well-described effects of toxin exposures in adult humans and in animal models,
variety of structural and developmental defects of cardiovascular organs occurs following
environmental exposure in utero. Moreover, in utero exposures can also predispose (referred to as
'programming') to the development of all forms of adult-based CVDs (for example, atherosclerosis,
hypertension).

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Stress
Negative feelings like depression, stress, and anxiousness may just have an effect on the body in
approaches that trigger plaque buildup or clot formation within the arteries and might elevate our
hazard of constructing heart disorder. So, taking good care of our emotional well being can be an
primary part of caring for our heart wellbeing.

http://dabamirror.sci-hub.cc/f9ae5e3fb8b24abb8f2daf91aa6e665b/otoole2008.pdf

1.2 CARDIOVASCULAR DISORDERS AND DIAGNOSING DEVICES

Cardiovascular sicknesses influence many individuals in middle age, all the time extremely
restricting the pay and reserve funds of influenced people and their families. Lost profit and out of
pocket medicinal services installments undermine the financial improvement of groups and countries.

A)RHP(right sided heart failure): RHF is a clinical syndrome that occurs when the right ventricle, due
to systolic and/or diastolic dysfunction, is unable to produce adequate cardiac output for the needs of
the individual, or is unable to do so with normal filling pressures RHF may happen as unadulterated
right-sided disappointment (unprecedented), or in relationship with left-sided heart disappointment
(LHF) (normal). RHF to be diagnosed, at least two features should be present: signs and symptoms
consistent with RHF; and objective evidence of abnormal right-sided cardiac structure or function or
elevated intra cardiac pressures. The basic pathophysiology of RHF may incorporate venous blockage,
RV development, expanded aspiratory corridor weights and tricuspid or pneumonic valvular
brokenness.
Diagnosing of right sided heart failure
RV dysfunction can be confirmed by imaging techniques. Typically, trans-thoracic echocardiography
(TTE) is the primary modality chosen because it provides detailed anatomical and functional
information about both ventricles, cardiac valves, pulmonary artery pressure, inferior vena cava dis
tensiblity and pericardium.
Echocardiography
This test utilizes sound waves to make a moving photo of the heart. This is furthermore a simple test
where a test is moved over the storage compartment and the machine makes the photo of the heart
on the screen. This gives data on the shape, measure, workings, valves and councils of the heart.
Echocardiography may likewise be joined with Doppler to demonstrate the territories of poor blood
supply to the heart. It demonstrates the ranges of the heart muscle that are not contracting typically,
and past harm to the heart muscle.
B) Cor pulmonale
Cor pulmonale is portrayed as RV development and brokenness brought on by a basic or helper
pneumonic pathology in association with aspiratory hypertension (described as a mean aspiratory vein
weight higher than 25 mmHg). Pathophysiological systems bringing on pneumonic hypertension
incorporate aspiratory vasoconstriction, anatomical trade off of the pneumonic vascular bed auxiliary
to lung issue, expanded blood thickness and idiopathic essential pneumonic hypertension. This
outcomes in expanded aspiratory blood vessel weight, expanded RV afterload bringing about RV
widening, and diminished capacity.

Diagnosing of cor pulmonale

Identification of patients with cor pulmonale should be suspected in patients with either lung disease
or PAH, and signs and symptoms of RHF(right sided heart failure).
Once cor pulmonale is suspected, trying ought to be coordinated toward the presumed etiology.
Normally, this would incorporate an electrocardiogram (ECG), trunk x-beam, echocardiography (with a
particular demand for assessment of RV capacity, aspiratory weights and left-to-right shunting),
ventilation/perfusion check, aspiratory work tests (with dissemination of carbon monoxide) and CT of
the trunk.
Electrocardiogram

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 Electrocardiogram This is a straightforward and an effortless test that records the heart's electrical
action. The patient is strapped to the instrument with a few fixes or leads put over his or her trunk,
wrists and lower legs. A little versatile machine records the exercises of the heart on a piece of diagram
paper.The test demonstrates how quick the heart is pulsating and its cadence. The quality and timing
of the electrical flags as they go through the heart are additionally observed. An EKG/ECG can
recognize a heart assault, assaults of angina, arrhythmias and so forth.

Trunk X-beam
EBCT recognizes the calcium stores or calcifications in the dividers of the coronary courses. These are
early markers of atherosclerosis and coronary illness. This is not a standard test in coronary illness.

c)constrictive pericarditis
Constrictive pericarditis has been suspected in patients with unexplained RHF(right sided heart failure)
in whom there is a background marked by pericardial infection or inclining pericardial damage. The
most regular causes are idiopathic pericarditis, past cardiovascular surgery, past mediastinal radiation
and, if from a region at hazard, tuberculosis. Less regular causes incorporate contamination,
drugs/poisons, neoplasm, connective tissue malady, late myocardial localized necrosis (frequently
went before by Dressler's disorder), past injury and uremia, among others.

Diagnosing of constrictive pericarditis

The diagnosis of constrictive pericarditis is based on a combination of compatible clinical, imaging and
hemodynamic findings . Chest x-ray may show pericardial calcification. CT and CMRI are both sensitive
tests for detecting pericardial thickening (greater than 2 mm to 4 mm).
Chest x-ray
This is a test that demonstrates the shape and size of the heart lungs and significant veins. This is a test
from time to time utilized as a part of conclusion of heart ailments as it doesn't give included data over
echocardiography and other imaging contemplates.
CMRI(cardiac magnetic resonance imaging)
Cardiac MRI (magnetic resonance imaging) that utilizations radio waves, magnets, and a PC to make
photos of the heart. This gives a 3D picture of the moving and in addition still photos of the heart.

http://cyber.sci-hub.cc/MTAuMTAxNi9zMDgyOC0yODJ4KDA5KTcwNDc3LTU=/howlett2009.pdf

1.3 ARTIFICAL DEVICES WHICH ENCHANCE NORMAL FUNCTION OF HEART.

IABP(INTRA-AORTIC BALLOON PUMP)

Intra-aortic balloon pump (IABP) contraptions had been developed as a treatment for cardiogenic
shock. IABPs include a helium-filled balloon positioned in the aorta that deflates throughout cardiac
systole to broaden ahead blood glide. The inflation and deflation of the balloon is computer-managed,
and might be regulated with the aid of either a pressure-sensing catheter or an electrocardiogram.

WORKING
The Intra-aortic balloon pump (IABP) is a mechanical device that raises myocardial oxygen perfusion
at the same time whilst growing cardiac output. Growing cardiac output increases coronary blood float
and consequently myocardial oxygen delivery. It consists of a cylindrical polyethylene balloon that sits
in the aorta, roughly 2 centimeters (zero.79 in) from the left subclavian artery[1] and counter pulsates.
That is, it actively deflates in systole, increasing ahead blood glide by means of decreasing after load
via a vacuum result. It actively inflates in diastole, increasing blood flow to the coronary arteries
through retrograde glide. These movements combine to cut down myocardial oxygen demand and
broaden myocardial oxygen deliver.
Example: Maquet CS300™ IABP

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 IABP

 Left Ventricular Assist Device (LVAD)

A LVAD is a kind of fake heart pump. It is used to treat people with genuine heart dissatisfaction and is
from time to time given to people on the sitting tight once-over for a heart transplant. Regularly, the
left ventricle, one of your heart's four loads, pumps blood into your aorta (the huge corridor leaving
the heart) and around your body. If somebody has extreme heart disappointment, the heart is
excessively frail, making it impossible to pump enough blood around the body.
A few patients being considered for a heart transplant may need a LVAD embedded on the off chance
that they are probably not going to get by until an appropriate benefactor heart gets to be distinctly
accessible. The gadget helps the coming up short heart and means to reestablish typical blood stream.

Working
Having an LVAD is a big operation and involves open heart surgery. We connect one end of the LVAD
pump to one side ventricle and the flip side to the aorta. Blood streams from the ventricle into the
LVAD. The gadget pumps the blood out into the aorta, where it then streams to whatever is left of the
body. A fine link called the driveline interfaces the LVAD, which is inside the body, through the skin and
to a controller, which is outside the body. The controller detects the capacity of the LVAD and controls
the ability to make it work. The controller connects to an external battery pack.

EXAMPLE: Novacor® LVAD ,DeBakey VAD® Child.

LVAD (LEFT VENTRICULAR ASSIST DEVICE)

Conclusion

So to keep away from cardiovascular ailments Eat solid nourishment and Engage in physical movement
Engaging in physical action for atleast 30 minutes each day of the week will forestall heart assaults and
strokes. Eating no less than five servings of foods grown from the ground a day, and constraining your
salt admission to short of what one teaspoon a day, likewise anticipates heart assaults and strokes. To
keep up a perfect body weight, take general physical action and eat a solid eating routine.

https://www.bhf.org.uk/heart-matters-magazine/medical/lvads
https://en.wikipedia.org/wiki/Intra-aortic_balloon_pump

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b.2

2.1 What is causing this murmur and "S3" heart sound

The low-pitched, thundering systolic murmur is typically observed into contracted or stenotic valve
The upper, left a portion of trunk territory is the place the end sound of the aspiratory valve is heard
flawlessly. Since Maria's murmur is heard correctly around that area, she would have more probability
of pulmonic valve stenosis(PS), low pitched if the pressure gradient is low(i.e pulmonic valve leaflets
are not fully opening, there is resistance to the forward flow of blood through this valve during
ventricular systole)which is seen in the  pulmonic valve post (left upper sternal border or LUSB) during
ventricular systole and S3 sound in heart is early systolic murmur is mostly seen with acute severe
mitral regurgitation or congestive heart faliure(e.g., chordal or papillary muscle rupture).the murmur
starts with a noisy S1, second sound as pressures quickly equalize between the left venticle and left
atrium which creating the "S3" heart sound.
http://www.blaufuss.org/arrow/ESM.html

2.2 Is her history of rheumatic fever relevant to her current symptoms? Explain.
Rheumatic fever is brought on by a response to the microscopic organisms that causes strep throat,
amass A streptococcus. Despite the fact that not all instances of strep throat result in rheumatic fever,
this genuine confusion might be averted with conclusion and treatment of strep throat. . For that
reason, an immune response to the bacterium may just purpose abnormal destruction of human heart
tissue, including the pericardium, myocardium, and endocardium. Destruction of the myocardium can,
itself, result in congestive coronary heart failure. Destruction of the endocardium can contain the
valves, although by way of a long way the most on the whole affected are the valves within the left
aspect of the guts (i.E. The mitral or aortic valves). Since it's Maria's pulmonic valve that is stenotic, it
may be unrelated to her prior history of rheumatic fever. So rheumatic fever might be or may not be
identified with her present manifestations.
http://www.healthline.com/health/rheumatic-fever#Causes2

2.3 How a chest X-ray of maria will help to rule out a possible problem with her heart? Explain.
A "chest x ray " does not show out a problem with Maria's heart. She is affected by pulmonic stenosis
which increases more consitency to the outflow of blood from the right ventricle to the pulmonary
artery, cardiac swelling with spotted marks of the pulmonic trunk and diminished pulmonary vascular
markings and, no perfect significant relationship between the constellation of findings and the
seriousness of the stenosis was found. so the outcomes demonstrate that, in the individual case, the
analysis of pulmonic stenosis with in place ventricular systole can't be set up from the standard trunk
X-beam or chest x-ray.
https://www.ncbi.nlm.nih.gov/pubmed/6450150

2.4 Pitting edema in her ankles is relevant to her cardiovascular problem. Explain this finding

The pitting edema in ankles of maria is caused by an inflammation of veins(increase in venous systolic
pressure). Liquid holes from the fringe vessels into the accessible spaces of her legs causes swelling in
anklesis called edematous lower leg. This condition is aggravated when Martha spends several hours of
the day standing or sitting, and it is also alleviated to some extent when Martha lies down with her feet
above heart level.
http://www.lymphedemapeople.com/thesite/lymphedema_and_congestive_heart_failure.htm

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