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




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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              Alpha 2 : heart vasodilatation
vasoconstriction
Beta 1 : increase heart rate &     Beta 2 : bronchi dilatation
contractility

      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 , it’s 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 it’s not treated it will be fatal
       - resistant  doesn’t respond to treatment of three
         medications




      Done by: Abeer dirawi.
Heart Failure lec. summary



                           Definitions
                            occur together




  Heart Failure                                  Pulmonary Edema

   The inability of the
  heart to maintain an                           An abnormal
  output adequate to                             accumulation of
  maintain the metabolic                         fluid in the lungs.
  demands of the body.




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                         Symptoms
             No limitation.                   heavy exercise
             Mild limitation              normal physical activity
            Marked limitation             gentle physical activity

    Kussmaul’s sign Seen in                          Note that !
1-constrictive pericarditis                          an increase in jugular
2-right heart failure                                venous pressure and it is
3-right ventricular infarction                       a sign of Right side heart
4-tricuspid stenosis                                 failure .
5-restrictive cardiomyopathy
6-"VIP" tamponade + degree of constricive pericardiditis
 
    Kussmaul’s 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                                Time
                       S1                         Close of AV valve
                       S2                      Close of Semilunar valve
           S3 "Pathological after 40"              Start of Diastole
            S4 "always Pathological "          After Aerial Contraction
To do Compensatory mechanism




                                                 Neurohormonal
  Increased HR                    Dilation        Redistribution of
   -Sympathetic               -Frank Starling    Blood to the Brain
-Norepinephrine                - Contractility




              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 isn’t 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 RBC’s in urine )
    Proteinuria ( presence of abnormal concentration of proteins in
      urine )
Hematuria                           Proteinuria
1-Glomerular bleeding suggests      1-Normally low molecular
fracture in the GBM.                weight proteins are filtered at
                                    the glomeruli.
2-Glomerular bleeding may
develop after strenuous exercise.   2-Normally albumin ( has a
                                    high M.W ) is not filtered at
3-Recurrent episodes of gross       glomeruli
hematuria associated with           3-Minor leakage of albumin
respiratory tract infection         into glomerular filtrate may
indicates IgA nephropathy .         occur temporarily after
                                    vigorous exercise fever and
4-Glomerulonephritis with           heart disease.
deposition of IgA in mesangial
cell.                               4-Albuminuria is seen in early
                                    stages of glomerular disease of
5-Red urine due to haematuria       diabetes mellitus "diabetic
must be differentiated from other   nephropathy " also in
causes of red or black.             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                                 Cause
1-iron deficiency anemia.   Due to deficiency of iron. Either by :
                            a-loss of iron because of bleeding.
                            b-inadequate iron intake.
                            c-malabsorption. D- parasites.
2-megaloblastic anemia.     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.
3-Aplastic anemia.
                            Due to failure or reduction in the ability of
                            the bone marrow to produce RBC's. the
                            cause is either idiopathic, or because of :a-
                            bone marrow inhibition by drugs. b-
                            chemical effect.
                            c-radiation. D- disease ex.viral hepatitis.

4-Anaemia of chronic        Associated with chronic diseases due to the
diseases.                   inhibitory effects of cytokines on iron
                            metabolism or erythropoiesis process.
5-Haemolytic anemia.        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.
6-Sickle cell anemia.       Inheritance autosomal recessive trait.



7-Anemia due to             "G6PD" is important to generate "NADPH".
deficiency of
(G 6 P D).
.. ً‫مقارنة بٌن الصداع العادي ..والصداع النصف‬
                                     ..‫اوال ..فً سالٌد 7 هً تفسٌر بعض االشٌاء‬

Has two of the following..

‫ٌعنً عشان نحكً انه صداع نصفً الزم ٌكون عنا على االقل اثنٌن من هذه‬
.. ‫االعراض‬
1-unilateral location..

.‫بٌكون بجهة واحدة اما بالٌمٌن او الٌسار‬
2-pulsating quality..

. ً‫ٌعنً االلم زي النبض بٌروح وبٌج‬
3-severe intensity..
.‫الم حاد‬
4-aggravated by activity..

."‫بٌزٌد مع القٌام بالنشاطات "العمل‬

migraine                                  Tension headache

Unilateral                                bilateral
Pulstating quality                        constant
Severe intensity                          Not severe
Aggravated by activity                    Do not Aggravate by activity
Associated with vomiting or               Not Associated with vomiting
photophobia/phonophobia                   or photophobia/phonophobia


.‫ ٌنزعج من الضوء‬Photophobia:

ً‫ ٌنزعج من الصوت العال‬Phonophobia:
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 

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93084257 pathophsiology-summary

  • 1. ]‫[السنة‬ Pathophysiology summary 2nd exam lecture Done by :abeer dirawi & ahmed alshamary & oday noa'man & hadeel sumrain samsung ]‫[اكتب اسم الشركة‬ ]‫[اختر التارٌخ‬
  • 2. 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.
  • 3. Alpha 1 :blood vessel Alpha 2 : heart vasodilatation vasoconstriction Beta 1 : increase heart rate & Beta 2 : bronchi dilatation contractility The vein affected by the sympathetic system more than any other blood vessels because they are blood reservoir . Done by: Hadeel sumrain.
  • 4. 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 , it’s only 5-10% that the cause might be cardiac , renal or endocrine ( these systems involved in the maintenance of blood pressure )
  • 5. 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 it’s not treated it will be fatal - resistant  doesn’t respond to treatment of three medications Done by: Abeer dirawi.
  • 6. Heart Failure lec. summary Definitions occur together Heart Failure Pulmonary Edema The inability of the heart to maintain an An abnormal output adequate to accumulation of maintain the metabolic fluid in the lungs. demands of the body. 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.
  • 7. 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 Symptoms No limitation. heavy exercise Mild limitation normal physical activity Marked limitation gentle physical activity
  • 8. Kussmaul’s sign Seen in Note that ! 1-constrictive pericarditis an increase in jugular 2-right heart failure venous pressure and it is 3-right ventricular infarction a sign of Right side heart 4-tricuspid stenosis failure . 5-restrictive cardiomyopathy 6-"VIP" tamponade + degree of constricive pericardiditis  Kussmaul’s 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 Time S1 Close of AV valve S2 Close of Semilunar valve S3 "Pathological after 40" Start of Diastole S4 "always Pathological " After Aerial Contraction
  • 9. To do Compensatory mechanism Neurohormonal Increased HR Dilation Redistribution of -Sympathetic -Frank Starling Blood to the Brain -Norepinephrine - Contractility 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
  • 10. 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 isn’t 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
  • 11. 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.
  • 12. 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 :
  • 13.  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 RBC’s in urine )  Proteinuria ( presence of abnormal concentration of proteins in urine )
  • 14. Hematuria Proteinuria 1-Glomerular bleeding suggests 1-Normally low molecular fracture in the GBM. weight proteins are filtered at the glomeruli. 2-Glomerular bleeding may develop after strenuous exercise. 2-Normally albumin ( has a high M.W ) is not filtered at 3-Recurrent episodes of gross glomeruli hematuria associated with 3-Minor leakage of albumin respiratory tract infection into glomerular filtrate may indicates IgA nephropathy . occur temporarily after vigorous exercise fever and 4-Glomerulonephritis with heart disease. deposition of IgA in mesangial cell. 4-Albuminuria is seen in early stages of glomerular disease of 5-Red urine due to haematuria diabetes mellitus "diabetic must be differentiated from other nephropathy " also in causes of red or black. 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.
  • 15. Kind of anemia Cause 1-iron deficiency anemia. Due to deficiency of iron. Either by : a-loss of iron because of bleeding. b-inadequate iron intake. c-malabsorption. D- parasites. 2-megaloblastic anemia. 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. 3-Aplastic anemia. Due to failure or reduction in the ability of the bone marrow to produce RBC's. the cause is either idiopathic, or because of :a- bone marrow inhibition by drugs. b- chemical effect. c-radiation. D- disease ex.viral hepatitis. 4-Anaemia of chronic Associated with chronic diseases due to the diseases. inhibitory effects of cytokines on iron metabolism or erythropoiesis process. 5-Haemolytic anemia. 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. 6-Sickle cell anemia. Inheritance autosomal recessive trait. 7-Anemia due to "G6PD" is important to generate "NADPH". deficiency of (G 6 P D).
  • 16. .. ً‫مقارنة بٌن الصداع العادي ..والصداع النصف‬ ..‫اوال ..فً سالٌد 7 هً تفسٌر بعض االشٌاء‬ Has two of the following.. ‫ٌعنً عشان نحكً انه صداع نصفً الزم ٌكون عنا على االقل اثنٌن من هذه‬ .. ‫االعراض‬ 1-unilateral location.. .‫بٌكون بجهة واحدة اما بالٌمٌن او الٌسار‬ 2-pulsating quality.. . ً‫ٌعنً االلم زي النبض بٌروح وبٌج‬ 3-severe intensity.. .‫الم حاد‬ 4-aggravated by activity.. ."‫بٌزٌد مع القٌام بالنشاطات "العمل‬ migraine Tension headache Unilateral bilateral Pulstating quality constant Severe intensity Not severe Aggravated by activity Do not Aggravate by activity Associated with vomiting or Not Associated with vomiting photophobia/phonophobia or photophobia/phonophobia .‫ ٌنزعج من الضوء‬Photophobia: ً‫ ٌنزعج من الصوت العال‬Phonophobia:
  • 17. 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 .
  • 18. 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 