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  • CARDIO1_1

    • Introduction

    • Cardiovascular Course Objectives:

    • Learning Objectives

  • CARDIO1_2

    • Adrenergic Receptors in Cardiovascular System

  • CARDIO1_3

    • Cardiac Output and the Fick Principle

    • Mean Arterial Pressure

    • Cardiac Output Variables

    • Example of Inotropes

  • CARDIO1_4

    • Laplace’s law and blood flow

    • Preload and LVEDV

    • Afterload and MAP

    • Frank-Starling 1

    • Frank Starling 2

    • Ejection Fraction

  • CARDIO1_5

    • Resistance

    • Flow

    • Flow and Resistance 2

    • Flow and Resistance 3

    • Venous return vs. EDV Curve

  • CARDIO2_1

    • Learning Objectives

    • LV pressure volume loop

    • PV loop summary

    • LV pressure volume loop 2

    • Frank-Starling curve review

    • Afterload effects on PV loop

    • Preload effects on PV loop

    • Afterload and preload on PV loop

    • LV pressure volume loop 3

  • CARDIO2_2

    • Cardiac Cycle and Atrial Tracing

  • CARDIO2_3

    • Part 2 Learning Objectives

    • Mean arterial pressure

    • Baroreceptor reflex basics

    • Feedback volume control and blood pressure

    • Atrial natriuretic peptide

    • Baroreceptor basics

    • Baroreceptor basics

    • Baroreceptor basics

    • Chemoreceptors

    • Cushing’s Triad

  • CARDIO3_1

    • Learning Objectives

    • Distribution of blood flow by organ

    • Autoregulation of blood flow

    • Autoregulation in the pulmonary and skeletal muscle vasculature

    • Regulation of blood flow in the skin

    • Capillary Exchange

  • CARDIO3_2

    • Direct sympathomimetics

    • The effects of epinephrine

    • Effects of norepinephrine

    • Slide Number 4

    • Alpha Agonists

    • Indirect sympathomimetics

  • CARDIO3_3

    • Sympathoplegics

  • CARDIO3_4

    • Catheterization of the heart

  • CARDIO4_1

    • Learning Objectives

    • Cardiomyocyte physiology

    • Ventricular Action Potential

    • Cardiomyocyte gap junctions

    • Basic action potential of cardiac muscle

    • Cardiac voltage gated Na+-channels

    • Basic action potential of cardiac muscle

    • Pacemaker action potential

    • Changes to pacemaker action potential

    • Cardiac action potentials in slow-response fibers

  • CARDIO4_2

    • Basic ECG

    • Basics of ECG leads I

    • Basics of ECG leads II

    • Breakdown of the ECG

  • CARDIO5_1

    • Learning Objectives

    • Arrhythmias

    • Torsades de pointes

    • Wolff-Parkinson-White syndrome

    • Arrhythmias: Atria

    • Arrhythmias: AV Block

    • Arrhythmias: Ventricular

  • CARDIO5_2

    • Antiarrhythmic drugs

  • CARDIO5_3

    • Cardiac action potential and antiarrhythmics: 1

    • Sodium channels and antiarrhythmics

    • The cardiac action potential and antiarrhythmics: 2

    • Antiarrhythmics as a cause of arrhythmias

    • Toxicity profiles of class I antiarrhythmics

    • Cardiac action potential and antiarrhythmics: 3

    • Toxicity profiles of class I antiarrhythmics

  • CARDIO5_4

    • Class II antiarrhythmics - beta blockers: 1

    • Beta blockers and the pacemaker

    • Class II antiarrhythmics - beta blockers: 2

  • CARDIO5_5

    • Cardiac action potential and antiarrhythmics: 4

    • Toxicities of class III antiarrhythmics

  • CARDIO5_6

    • Class IV antiarrhythmics: calcium channel blockers

  • CARDIO5_7

    • Miscellaneous antiarrhythmics

  • CARDIO6_01

    • Learning Objectives

  • CARDIO6_2c

    • Abnormal Splitting of S2

    • ASD causes Fixed Splitting

    • Paradoxical Splitting

  • CARDIO6_3

    • Auscultating the normal heart sounds

  • CARDIO6_4

    • Auscultation of heart murmurs

  • CARDIO6_6a

    • Aortic stenosis

  • CARDIO6_7a

    • Ventricular septal defect

  • CARDIO6_8a

    • Mitral valve prolapse

  • CARDIO6_9a

    • Aortic regurgitation

  • CARDIO6_10a

    • Mitral stenosis I

    • Mitral stenosis II

  • CARDIO6_11a

    • Patent ductus arteriosus

  • CARDIO6_12a

    • Extra heart beats: S3

  • CARDIO6_12c

    • Extra heart beats: S4

  • CARDIO6_12e

    • Auscultation of heart sounds

  • CARDIO7_1

    • Lecture Objectives

    • Hypertension basics

  • CARDIO7_2

    • Renal artery stenosis as a cause of secondary HTN

    • R-A-A-S and HTN

  • CARDIO7_3

    • Effects of HTN on arterioles

  • CARDIO7_4

    • LVH is a long-term consequence of HTN

  • CARDIO7_5

    • Histopathology of arteriosclerosis

    • Atherosclerosis

  • CARDIO7_6

    • Common locations of Aneurysms

    • Histopathology of aortic dissection

    • CXR of aortic dissection

  • CARDIO7_7

    • Pearls for treating hypertension

    • Cellular mechanisms of antihypertensives 1

    • Calcium channel blocker (CCB) spectrum

    • Cellular mechanisms of antihypertensives 2

    • Alpha-Antagonists to treat hypertension

    • Beta blockers to treat hypertension

  • CARDIO8_1

    • Lecture Objectives

  • CARDIO8_2

    • Lipoprotein metabolism 1

    • Bile

    • Lipid breakdown

    • Lipoprotein Metabolism 2

    • Degradation of triglycerides

    • Lipoprotein Metabolism 3

  • CARDIO8_3

    • Apoproteins

  • CARDIO8_4

    • Classification of lipoproteins

  • CARDIO8_5

    • Primary Hyperlipidemias

    • Abetalipoproteinemia

  • CARDIO8_6

    • Mechanism of action of statins

    • Statins

    • Niacin

    • Bile acid sequestrants

    • Ezetimibe

    • Fibrates

  • CARDIO9_1

    • Learning Objectives

    • Arterial supply of the heart

    • Structures of the mediastinum

  • CARDIO9_2

    • Atheromatous plaque

  • CARDIO9_3

    • Location of aneurysms

    • Classifying aortic dissections: 1

    • Histology of aortic dissection

    • Classifying aortic dissections: 2

    • Aortic Dissection on CXR

  • CARDIO9_4

    • Ischemic heart disease

  • CARDIO10_1

    • Learning Objectives

    • Tissue changes in myocardial infarction

    • Diagnosis of myocardial infarction

  • CARDIO10_2

    • Types of myocardial infarction

    • ECG changes in myocardial infarction

    • Locating an infarction

  • CARDIO10_3

    • Post-MI complications - immediate

    • Post-MI complications - delayed

    • Post-MI complications - pericarditis

  • CARDIO10_3b

    • Listening to Pericardial rub

  • CARDIO10_4

    • Antianginal therapy - goals

    • Antianginal therapy - nitrates

    • Antianginal therapy - beta blockers

    • Antianginal therapy - combination therapy

    • Antianginal therapy - calcium channel blockers

    • Prinzmetal’s angina

  • CARDIO11_1

    • Learning Objectives

    • Dilated cardiomyopathy

    • Dilated cardiomyopathy causes

    • Dilated cardiomyopathy signs

    • Dilated cardiomyopathy - chest X-ray

  • CARDIO11_2

    • Hypertrophic cardiomyopathy

    • Hypertrophic cardiomyopathy - complications

  • CARDIO11_3

    • Restrictive cardiomyopathy

  • CARDIO11_4

    • The failing heart

    • Heart failure symptoms

  • CARDIO11_5

    • Cardiac tamponade

  • CARDIO11_6

    • Mechanism of cardiac glycosides

    • Digoxin & digitalis

  • CARDIO12_1

    • Learning Objectives

    • Heart development

    • Truncus arteriosus development

    • Interventricular septum formation

  • CARDIO12_2

    • Endocardial cushion defects

  • CARDIO12_3

    • Eisenmenger’s syndrome

  • CARDIO12_4

    • Atrial septum formation

    • Atrial septal defects

  • CARDIO12_5

    • Fetal erythropoiesis

    • Fetal circulation and shunts

  • CARDIO12_6a

    • Congenital heart disease

    • Persistent truncus arteriosus

    • Tricuspid Atresia

    • Acyanotic congenital heart disease

    • Tetralogy of fallot

    • Transposition of the Great Vessels

    • Coarctation of the aorta

    • Patent ductus arteriosus

  • CARDIO12_6b

    • Listening to PDA machine-like murmur

  • CARDIO12_7

    • Congenital heart disease associations

  • CARDIO13_1

    • Learning Objectives

    • Structure of gram positive cocci

    • Gram positive cocci diagram

    • Examples of hemolysis: beta-hemolysis

    • Gram positive cocci diagram

    • Tests with gram (+) cocci: Catalase and Coagulase: 1

  • CARDIO13_2

    • Chronic granulomatous disease (CGD)

  • CARDIO13_3

    • Tests with gram (+) cocci: Catalase and Coagulase: 2

  • CARDIO13_4

    • Staphylococcus aureus

    • S. aureus and the superantigen

  • CARDIO13_5

    • The many outcomes of S. aureus infections

    • Prostheses and S. epidermidis

  • CARDIO13_6

    • Streptococcus viridans

    • Group D streptococci

  • CARDIO13_7

    • Common Signs of Endocarditis

    • Acute vs. subacute bacterial endocarditis

  • CARDIO13_8

    • HACEK cause culture-negative endocarditis

  • CARDIO13_9

    • Tricuspid vs. mitral valve involvement in endocarditis

  • CARDIO13_10

    • Libman-Sacks endocarditis

  • CARDIO13_11

    • Syphilis and heart disease

  • CARDIO13_12

    • RF and RHD

  • CARDIO14_1

    • Learning Objectives

    • Varicose veins

  • CARDIO14_2

    • Raynaud disease

  • CARDIO14_3

    • Wegener’s granulomatosis

    • C-ANCA

    • P-ANCA

    • Wegener’s treatment

  • CARDIO14_4

    • Other ANCA-associated vasculitides

  • CARDIO14_5

    • Sturge-Weber disease

  • CARDIO14_6

    • Henoch-Schonlein purpura

    • HSP association with IgA nephropathy

  • CARDIO14_7

    • Buerger’s disease

  • CARDIO14_8

    • Kawasaki disease

  • CARDIO14_9

    • Polyarteritis nodosa

  • CARDIO14_10

    • Takayasu’s arteritis

  • CARDIO14_11

    • Temporal arteritis histopathology

    • Temporal arteritis

  • CARDIO14_12

    • Hemangiomas

  • CARDIO14_13

    • Turner syndrome and cystic hygroma

  • CARDIO14_14

    • Vascular tumors

  • CARDIO14_15

    • Myxomas: 1

    • Myxomas: 2

  • CARDIO14_16

    • Rhabdomyoma

Nội dung

Introduction Cardiovascular System Lecture I Stephen Bagley, M.D Resident Physician University of Pennsylvania CA01.1- Cardiovascular System Course Objectives: To understand the following topics and how they may be tested on USMLE Step – Cardiac physiology • Fluid dynamics • The cardiac cycle • Electrophysiology – – – – – Heart sounds Biochemistry of lipids Ischemic heart disease and cardiomyopathies Congenital heart disease Vasculitis CA01.1- Learning Objectives – Beta and alpha adrenergic receptors and their role in the cardiovascular system – Cardiac output – Resistance, pressure, and flow – Cardiac function curve CA01.1- Kaplan Pharmacology 2011 : Table II-3-2 FA 2012: 263.1 • FA 2011: 236 • FA 2010: 232 • ME 3e: 169 CA01.2- KNOW THE FICK PRINCIPLE CO = O2 Consumption / (Arterial O2 – Venous O2) • • • O2 Consumpsion  often given Arterial O2 = [Hgb] x [1.34] x [Arterial O2 Saturation] Venous O2 = [Hgb] x [1.34] x [Venous O2 Saturation] FA 2012: 280.2 • FA 2011: 254.2 ME 3e: 249 • FA 2010: 250 • CA01.3- Mean Arterial Pressure (MAP)… MAP = (CO) X (TPR) MAP = (2/3 Diastolic Pressure) + (1/3 Systolic Pressure) When heart rate increases, so does the cardiac output and the mean arterial pressure, all things being equal FA 2012: 280.2 • FA 2011: 254.2 ME 3e: 248 • FA 2010: 250 • CA01.3- What changes cardiac output By changing: Preload Contractility FA 2012: 281.1 • FA 2011: 255.1 ME 3e: 243 • Afterload FA 2010: 251 • CA01.3- + Ca2+ (SERCA) Kaplan Pharmacology 2011 : Figure III-4-2 FA 2012: 281.1 • FA 2011: 255.1 ME 3e: 271 • FA 2010: 251 • CA01.3- Kaplan Physiology 2011 : Figure IV-1-9 FA 2012: 281.1 • FA 2011: 255.1 ME 3e: 251 • FA 2010: 251 • CA01.4- PRELOAD = Left Ventricular EDV FA 2012: 281.2 • FA 2011: 255.2 ME 3e: 242 • FA 2010: 251 • CA01.4- Sturge-Weber disease (capillary-sized vessels) Congenital capillary malformations Signs and Symptoms • Port-wine stain (nevus flammeus) on face • Leptomeningeal angiomatosis (intracerebral AVM) • Seizures • Early-onset glaucoma Gaillard commons.wikimedia.org Used With Permission FA 2012: 305.1 • FA 2011: 277.6 • 3e: 263 FA 2010: 274 • ME CARDIO14_5-1 Henoch-Schưnlein Purpura (small vessels) • Most common childhood systemic vasculitis • IgA-mediated vasculitis, circulating IgA complexes • Linked to parvovirus Signs and Symptoms • Typically develops after URI • “Palpable purpura” skin rash (buttocks and legs) • Arthralgia (wrists, ankles) • Intestinal involvement: hemorrhage, melena • Nephritis – IgA nephropathy • Normal complement levels FA 2012: 305.1 • FA 2011: 278.1 • 3e: 262 FA 2010: 274 • ME CARDIO14_6-1 Crescent formation in rapidly progressive glomerulonephritis, as seen with trichrome stain Kaplan Pathology: Figure 16-3 FA 2012: 305.1 • FA 2011: 278.1 • 3e: 262 FA 2010: 274 • ME CARDIO14_6-2 Buerger’s disease - thromboangiitis obliterans (small and medium vessels in the extremities) Signs and Symptoms • Heavy smokers • Rapidly progressive thrombosing vasculitis • Claudication (vascular insufficiency) • Cold sensitivity (Raynaud’s phenomenon) • Ulceration, gangrene, autoamputation Treatment: improves rapidly with smoking cessation Geirunited commons.wikimedia.org Used With Permission FA 2012: 304.1 • FA 2011: 278.2 • 3e: 262 FA 2010: 275 • ME CARDIO14_7-1 Kawasaki disease (small and medium vessels) • Acute, segmental necrotizing vasculitis • Commonly affects infants/children ( 50 yo and ESR > 50 Signs and Symptoms • Unilateral headache • Unilateral jaw claudication (pain on chewing) • Unilateral visual disturbance • Associated with polymyalgia rheumatica (proximal muscles) Treatment: corticosteroids FA 2012: 305.1 • FA 2011: 278.1 • 3e: 263 FA 2010: 275 • ME CARDIO14_11-2 Hemangioma Kaplan Pathology: Figure 13-3 FA 2012: 305.2 • FA 2011: 279.2 • 3e: 266 FA 2010: 276 • ME CARDIO14_12-1 Cystic Hygromas • Most commonly associated with Turner Syndrome • Usually found in the posterior aspect of the neck Kaplan Pathology: Figure 6-4 FA 2012: 305.2 • FA 2011: 279.2 • 3e: 266 FA 2010: 276 • ME CARDIO14_13-1 Angiosarcoma Kaposi’s Sarcoma KGH commons.wikimedia.org Used With Permission FA 2012: 305.2 • FA 2011: 279.2 • 3e: 266 FA 2010: 276 • ME CARDIO14_14-1 Atrial Myxoma (Ball valve obstruction) Myxoma Mitral valve ventricle James Moon commons.wikimedia.org Used With Permission FA 2012: 303.1 • FA 2011: 277.1 • 3e: 261 FA 2010: 273 • ME CARDIO14_15-1 Atrial Myxoma • Stellate cells • Myxoid background Nephron commons.wikimedia.org Used With Permission FA 2012: 303.1 • FA 2011: 277.1 • 3e: 261 FA 2010: 273 • ME CARDIO14_15-2 Rhabdomyoma • Most common primary cardiac tumor in children • Patients with tuberous sclerosis often develop these tumors FA 2012: 303.1 • FA 2011: 277.1 • 3e: 261 FA 2010: 273 • ME CARDIO14_16-1 ... function curve CA01.1- Kaplan Pharmacology 2011 : Table II-3-2 FA 2012: 263 .1 • FA 2011: 2 36 • FA 2010: 232 • ME 3e: 169 CA01.2- KNOW THE FICK PRINCIPLE CO = O2 Consumption / (Arterial O2 – Venous... resistance to flow than a capillary FA 2012: 282.2 • FA 2011: 2 56. 1 ME 3e: 248 • FA 2010: 252 • CA01.5- FA 2012: 282.2 • FA 2011: 2 56. 1 ME 3e: 248 • FA 2010: 252 • CA01.5- Velocity = Q/CSA Q = flow... : Figure V-1-5 FA 2012: 282.2 • FA 2011: 2 56. 1 ME 3e: 249 • FA 2010: 252 • CA01.5- Kaplan Physiology 2011 : Figure V-1-4 FA 2012: 282.2 • FA 2011: 2 56. 1 ME 3e: 249 • FA 2010: 252 • CA01.5- Cardiac

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