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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