][

Pathophysiology summary
2nd exam lecture
Done by :abeer dirawi & ahmed alshamary & oday noa'man & hadeel sumrain

samsung ][ ][

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

Definitions
occur 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 Sound
Name 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 in
the myocytes and decrease the HR. - Digoxin isnt a safe drug the therapeutic index of it is narrow

- Digoxin toxicity: High amount of the Drug

Leads 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. Summary

Arrhythmia :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. summary

Review 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 Volume. ) Regulation of water and electrolytes balances:

And these functions are acomplished by a sereis of processes like Filtration , reabsorption , Secretion and Excertion of urine

Very Important note :

 Urine Formation by the Kidneys: Glomerular Filtration Renal Blood Flow, The functional unit of the kidney is the Nephron the reabsorption and the secretion happened between the pretubular capillaries and the tubules Filtration occurs between the glomerulus and Bowman's capsule Filtration: not selective (except for proteins), averages 20% of renal plasma flow Excretion = filtration reabsorption + secretion Reabsorption: highly variable and selective

We have 3 layers glomerulus ( a network of capillaries ) : 1-Epithelium of the glomerulus 2-Basement membrane 3-Endothelium Wall of bowman's capsule ( consists of non-dividing epithelial cells ( podocytes ) )

Pathophysiology of the renal system 1-Disorders of urine volume ( Anuria , Oliguria and polyria ) 2-Disorders in urine composition Hematuria ( blood od RBCs in urine ) Proteinuria ( presence of abnormal concentration of proteins in urine )

Hematuria 1-Glomerular bleeding suggests fracture in the GBM. 2-Glomerular bleeding may develop after strenuous exercise. 3-Recurrent episodes of gross hematuria associated with respiratory tract infection indicates IgA nephropathy . 4-Glomerulonephritis with deposition of IgA in mesangial cell. 5-Red urine due to haematuria must be differentiated from other causes of red or black.

Proteinuria 1-Normally low molecular weight proteins are filtered at the glomeruli. 2-Normally albumin ( has a high M.W ) is not filtered at glomeruli 3-Minor leakage of albumin into glomerular filtrate may occur temporarily after vigorous exercise fever and heart disease. 4-Albuminuria is seen in early stages of glomerular disease of diabetes mellitus "diabetic nephropathy " also in hypertension.

6-Red urine can sometimes be 5-Apperes in hypertention and due to other reasons like food dye diapetus maletuas. or drugs.

Done by: Oday noa'man.

Kind of anemia
1-iron deficiency anemia.

Cause
Due to deficiency of iron. Either by : a-loss of iron because of bleeding. b-inadequate iron intake. c-malabsorption. D- parasites. Due to deficiency of vit.B12 and /or folic acid. By: a-inadequate intake. b-IF deficiency(for vit.B12) c-diseases of terminal ileum(site of vit.B12 absorption) D-parasites. e-malabsorption (folate is mainly absorbed in jejunum) f- increase demand for folic acid. Due to failure or reduction in the ability of the bone marrow to produce RBC's. the cause is either idiopathic, or because of :abone marrow inhibition by drugs. bchemical effect. c-radiation. D- disease ex.viral hepatitis. Associated with chronic diseases due to the inhibitory effects of cytokines on iron metabolism or erythropoiesis process. Due to excessive destruction of RBC's. either congenital :a-RBC membrane abnormalities . b- haemoglobinopathies. c-RBC's enzyme defect. OR..acquired: a- immune disease. b- non- immune :*mechanical causes . *infections. *drugs & chemicals. *malaria. Inheritance autosomal recessive trait.

2-megaloblastic anemia.

3-Aplastic anemia.

4-Anaemia of chronic diseases. 5-Haemolytic anemia.

6-Sickle cell anemia.

7-Anemia due to deficiency of (G 6 P D).

"G6PD" is important to generate "NADPH".

.. .. .. .. 7 Has two of the following.. .. 1-unilateral location.. . 2-pulsating quality.. . 3-severe intensity.. . 4-aggravated by activity.. ." "

migraine
Unilateral Pulstating quality Severe intensity Aggravated by activity Associated with vomiting or photophobia/phonophobia . Photophobia:

Tension headache
bilateral constant Not severe Do not Aggravate by activity Not Associated with vomiting or photophobia/phonophobia

Phonophobia:

Test your self

Q)the impulse in the heart conduct directly between the atrium and ventricle, True or false? A-false. Q)in normal person the PMI should be on which intercostal space? A- on the 5th intercostal space. Q) what will happen if one of the papillary muscles get ruptured ? A-the blood will back to the atrium and that will reduce the output of the heart.

Q)The resting coronary blood flow equal ? A- 225 ml/min Q) The perfusion occurs during the systole , True or false ? A- False, during diastole . Q) if the metabolic regulation increase then the blood flow will? A- increase. Q) sympathetic stimulation increase the heart rate and contractility and decrees the cardiac output , True or false ? A- false, "increase the cardiac output" . Q) when there is a complete occlusion of the coronary artery this will lead to necrosis . necrosis is less severe than ischemia ,true or false ? A- 1- True . -2- false. Q) The location of the obstruction do not affect the quantity of myocardial ischemia, true or false ? A- false. Q) What do we mean by " ectopic beat" ? A- it's an abnormal case when the impulse of the heart initiated not in the SA node but elsewhere .

Q)regarding Refractory period why the heart muscle can't be excited through it? A- because of the inactivation of fast Na channel.

Thanx alooot for :Abeer dirawi & Ahmed Al shamary & Oday noa'man .. the best of luck