peter celec Ústav molekulárnej biomedicíny, lf uk … · 2017. 3. 28. · basics of theoretical...

Základ teoretickej a experimentálnej medicíny

Peter Celec

Ústav molekulárnej biomedicíny, LF UK

www.imbm.sk

petercelec@gmail.com

Basics of theoretical and experimental medicine

Peter Celec

Institute of Molecular Biomedicine, LF UK

www.imbm.sk

petercelec@gmail.com

Who?

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Mgr. Janka Bábíčková, PhD.h-index: 3

MUDr. Mgr. Július Hodosy, PhD., MPH.h-index: 11

RNDr. Barbora Vlková, PhD.h-index: 6

Why?

Biomedical research

biology and medicine

Future career

Master theses

PhD

IMBM, BMC

Bidirectional

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What?

Principles of common diseases

Etiology

Pathogenesis

Symptoms & signs

Treatment approaches

Models

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Syllabus

Introduction Syllabus, motivation, examination

Cardiovascular diseases Heart failure, hypertension, atherosclerosis, coronary artery disease, shock

Respiratory diseases Asthma, COPD, emphysema, pulmonary edema, acid base balance

Blood and immune disorders Anemia, inflammation, immunosuppression, autoimmune diseases, allergy, leukemia, lymphoma

Endocrine diseases Disorders of the thyroid, adrenal and pituitary gland, hypogonadism, hypergonadism

Metabolic diseases Diabetes mellitus, gout, hemochromatosis

Gastrointestinal diseases Ulcers, diarrhea, constipation, icterus, pancreatitis, portal hypertension, liver failure

Nephrology and disorders of the genitourinary tract Renal failure, glomerulonephritis, preeclampsia, urinary tract infection, amenorrhea

Neuropsychiatric disorders Stroke, multiple sclerosis, epilepsy, migraine, autism, depression, schizophrenia, neurodegeneration

Musculoskeletal diseases Osteoporosis, carpal tunnel syndrome, rheumatoid arthritis, osteoarthrosis, psoriasis

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Information sources

Lectures

www.imbm.sk

Textbooks

Pathophysiology, internal medicine

Review articles

Pubmed

CVTI

www.cvtisr.sk

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Examination

Oral exam

Questions acording to the syllabus

Seminar paper

1.5.

One disease reviewed in detail

Tasks to solve

Questions every week

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Basic terms

Physiology vs. Pathophysiology

Pathology vs. Pathophysiology

Etiology vs Pathogenesis

Symptoms vs Signs

Syndrome

Health vs Disease

Latin terms

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Latin I.

-brady – bradypnoe, bradykardia -tachy – tachypnoe, tachykardia -hypo – hypopnoe, hypoglycemia -hyper – hyperpnoe, hyperglycemia -poly – polydipsia, polyphagia -oligo – oliguria, oligofrénia -a/an – apnoe, anuria -pseudo – pseudocyst -endo – endoscopy -ekto – ectopic

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Latin II.

-osis – degeneration - arthrosis -itis – inflammation - hepatitis -oma – tumor - myoma -algia – pain - artralgia -stenosis – narrowing - pylorostenosis -pathia – disease - hepatopatia -lithiasis – stone - nephrolithiasis -rrhagia – bleeding - metrorrhagia -emia – blood - glycemia, natriemia, kaliemia -uria – urine - glykosuria, natriuria

Selected symptoms & signs

Cyanosis

Dyspnoe

Icterus

Struma

Edema

Palpitations

Syncope

Ascites

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Syndrome

Anemic syndrome

Paleness

Fatique

Dyspnea

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Cardiovascular system I

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Heart valves

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Circulation

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Conducting system

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Cardiac output

Preload

Contractility

Afterload

Frequency

Synchronisation

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Mechanisms of heart

Frank-Starling mechanism

Inotropy – lusitropy

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Cardiovascular diseases

Hypertension

Atherosclerosis

Coronary artery disease Angina pectoris

Acute myocardial infarction

Heart failure

Stroke

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Neurohumoral regulation

Autonomous nervous system

RAAS system

Endothelin

Natriuretic peptides

NO

Autonomous nervous system

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RAAS system

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Endothelin

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Natriuretic hormones

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NO

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Heart failure

Insufficient perfusion of tissues

Normal filling

Forward failure

Ejection fraction

Backward failure

Edema

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Heart failure

Systolic

Low ejection fraction

Contraction failure

Diastolic

Normal ejection fraction

Filling failure

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NYHA classification

Class I No limitations of physical activity. Dyspnoe with heavy

physical exertion.

Class II Some limitation of physical activity. Dyspnoe with

ordinary exertion.

Class III Definite limitation of physical activity. Dyspnoe with

minimal exertion.

Class IV Severe limitation of physical activity. Dyspnoe at rest.

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Heart failure

Compensation

Catecholamines

Frank-Starling

Hypertrophy

Decompensation

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Heart failure

Epidemiology

20/1000 – adult population

150/1000 – over 75 years

5-year mortality 50%

Therapy

ACE-inhibitors

Beta-blockers

Diuretics

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Pathophysiology of heart failure

Work overload

Myocardial dysfunction

Filling failure

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Symptoms of heart failure

Think FACES...

• Fatigue

• Activities limited

• Chest congestion

• Edema or ankle swelling

• Shortness of breath

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Decompensation

Increased pulmonary venous pressure

Insterstitial edema

Alveolar edema

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Acute pulmonary edema

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Hypertrophy

Overload

Pressure

Afterload

Concentric hypertrophy

Volume

Preload

Excentric hypertrophy

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Valvular defects

Mitral/Tricuspidal

Stenosis

Insufficiency

Aortal/Pulmonary

Stenosis

Insufficiency

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Valvular defects

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Healthy heart

Dilation

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Healthy heart

Concentric hypertrophy

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Healthy heart

Excentric hypertrophy

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Blood pressure

Hypertension

140/90 mm Hg, but...

Many confounding factors

Hypertrophy, encephalopathy, stroke, hypertensive nephropathy, retinopathy...

Primary – essential

Secondary Renal

Renovascular

Endocrine

Neural, iatrogenic, gestational...

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Afterload & blood pressure

BP = CO x SVR

Cardiac output

Systemic vascular resistance

If CO is low, BP is maintained by SVR

SVR = afterload

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Complications of hypertension

Atherosclerosis

Stroke

AMI

Nephropathy

Blindness

Cardiovascular models

Hypertesion

L-NAME, SHR, Dahl salt-sensitive rats

Atherosclerosis

High fat diet

AMI

Coronary surgery

Heart failure

Isoprenalin

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Questions

Which genetic factors are associated with hypertension? Heritability?

What is the evolutionary origin of the RAAS system?

What is the effect of ACE inhibitors on mortality in hypertension and heart failure?

Which promoters are myocardium-specific?

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