another super lecturer, dr. richard padgett, ohvi medical ......jackson, ms eugene, or mn is low! hi...
TRANSCRIPT
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BI 358 Lecture 8
Another Super Lecturer, Dr. Richard Padgett, OHVI Medical Director!
I. Announcements Dr. Padgett next Tuesday! Quiz 3 Q?II. Vaccines for Atherosclerosis…Immune & CVS link!
https://www.hindawi.com/journals/jdr/2018/1638462/#B9III. Blood Chemistry Connections Blood typing & Rhesus factorIII.Lymphatic System Alternative circulation Torstar, DC…IV.Cardiovascular Physiology Torstar, G&H, Katz, LS,…
A. structure & function LS, Torstar, G&H fig 9-8 +… in lab!B. Blood flow through & periphery G&H fig 9-1, LS…C. Coronary circulation & the cardiac cycle G&H, Katz +…
V. CVDs Definitions, US Disease Statistics: CDC 2012 + AHAVI.Atherosclerosis + Mechanisms Torstar Books, G&H, +…
A. Linking proposed historical mechanismsEndothelial Injury Hypothesis (Ross & Glomset)Lipid Infiltration Hypothesis (Steinberg & Witzum) + new!
B. Cholesterol metabolism: Dr. Kottke’s bathtub analogyC. 10 modifiable risks: cigarette smoking, hypertension,
hypercholesterolemia/hyperlipidemia, lack of exerciseD. Treatment triad, PTCA, CABG, prevention, practical tips!
VII.Additional Resources Development, electrical highway…
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https://www.peacehealth.org/ohvi?from=/sacred-heart-ri
Oregon Heart& Vascular INSTITUTE
Richard C. PadgettMedical Director
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Josef KhalifehWBC DifferentialLab 012715
Lymphocyte
Lymphocyte
Lymphocyte
Lymphocyte
Neutrophil Twins!!
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10 Q? Clumping in Any Wells?
Here?
Here?
Type AB+
Source: S Wong, BI 121 Lab, 2016
Here?
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Blood Type Distributionwithin the United States
38%
34%
6%
9%
2% 3% 1%
7%
NB: O+ & A+ make up > 2/3, + > -
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Erythroblastosis Fetalis?
Rh- momRh+ baby
http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/001298.ht
m#Alternative%20Names
https://www.nlm.nih.gov/medlineplus/rhincompatibility.html
https://www.stanfordchildrens.org/en/topic/default?id=
hemolytic-disease-of-the-newborn-90-P02368
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Erythroblastosis Fetalis or Hemolytic Disease of the Unborn/Newborn
Throw
Blanket
Over
This
Step!
X
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Inject Mom with RhoGam < 48-72 hr> each Rh+ Pregnancy
The Blanket is RhoGam Masks the Mom’s Immune System!
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Wear Red next Friday Feb 7th!)Help raise awareness about
Women & diseasehttp://www.goredforwomen.org/
https://www.goredforwomen.org/en/about-heart-disease-in-women/facts
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Life’s Simple 7 to Improve Health
• Manage blood pressure
• Control cholesterol
• Reduce blood sugar
• Get active
• Eat a healthy diet
• Lose weight
• Stop smoking!https://www.heart.org/en/healthy-living/healthy-
lifestyle/my-life-check--lifes-simple-7https://www.goredforwomen.org/en/about-heart-disease-
in-women/signs-and-symptoms-in-women/just-a-little-heart-attack
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+
+
Cardiovascular (CV) = Heart + Vessels + Blood!
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ENDO
EPI
Torstar 1984 p 34
MYO
PERI
EPI
MYOENDO
PERI
Heart Protection & Layers
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What the heck’s a bruit? (brwe, broot) [Fr.] sound >
25 subclassifications!Aneurysmal b. a blowing sound over an aneurysm.
b. de canon [Fr. sound of cannon] abnormally loud 1st heart sound heard in complete heart block.
b. de craquement [Fr. sound of crackling] a crackling pericardial or pleural bruit.
False b. artifact caused by pressure of the stethoscope or derived from circulation of the ear.
b. de lime [Fr. sound of a file] cardiac sound resembling filing.
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Human = 4-chambered box?2 separate pumps?
Upper =
Atria
Lower =
Ventricles
Primer
Pumps
Power
Pumps
RA LA
RV LV
LR
Pulmonary Systemic
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RA
RV
LA
LV
Torstar 1984 p 53
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https://www.mayoclinic.org/diseases-conditions/coarctation-of-
the-aorta/symptoms-causes/syc-20352529
Coarctation, Crimping or Narrowing of the Aorta
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Human = 4 unique valves?
2 valve sets?
Semilunar = Half-moon shaped
AV = Atrioventricular
1. Pulmonic/Pulmonary
2. Aortic
3. R AV = Tricuspid
4. L AV = Mitral/Bicuspid
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G&H 2006 fig 9-6; G&H 2011 fig 9-7; G&H 2016 fig 9-8
SL
L AV
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Torstar Books 1984
Heart Valve Orientation & Scaffolding
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Torstar 1984 p 40
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Torstar 1984 p 40
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TAVR Transcatheter Aortic Valve Replacement
https://www.mayoclinic.org/tests-procedures/transcatheter-aortic-
valve-replacement/about/pac-20384698
Dr. Padgett is a TAVR pro & doing several right now!
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Torstar 1984 p 41
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Veins Atria Ventricles Arteries
https://www.mayoclinic.org/diseases-conditions/heart-disease/multimedia/circulatory-system/vid-20084745
LS2016
cf: G&H fig 9-1 2011 & 2016 ed
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LS2007
Veins Atria Ventricles Arteries
https://www.nhlbi.nih.gov/health-topics/how-heart-workshttps://www.youtube.com/watch?v=zJXAlh9VDDU
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G&H 2006, 2011 & 2016 fig 21-3
Coronary Circulation ≡ Crowns the Heart!
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Torstar 1984 p 47
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AM Katz 1992 p 12
Heart Dominance May Influence Survival?
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G&H 2011 & 2016 fig 21-5
Coronary Arteries Pierce the Heart from Epi to Endo
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Anastomoses May Provide Lifesaving Collateral Circulation!!
G&H 2011 & 2016 fig 21-6
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Cardiac Cycle
Systole DiastoleContract& Empty
Relax& Fill
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Contract
& Empty
Relax
& Fill
G&H 2011 & 2106 fig 21-4
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Did you know?
~630,000 Americans die of heart disease each yr – that’s 1 in every 4 deaths. Heart disease is the leading cause of death for both men and women.
Every 40 seconds, someone has a heart attack in the US!
Heart disease costs the US ~ $200 billion per yr in health care, medications & lost productivity. By 2035, CVD costs are projected to top $1 trillion annually.
SOURCE: Heart Disease Facts & Statistics, Centers for Disease Control, Aug 23, 2017.
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Jackson, MS
Eugene, OR
MN is low!
HI is low!
Heart Disease Death Rates, 2014-2016Adults, Ages 35+, by County
Age-AdjustedAverage Annual
Rates per 100,000
Rates are spatially smoothed to enhance the stability of rates in counties with small populations.
Data Source: National Vital Statistics SystemNational Center for Health Statistics
103.4 – 284.2
284.3 – 324.9
325.0 – 365.9
366.0 – 426.5
426.6 – 1170.5
Insufficient Data
https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm
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AMI
CVDs
CVA
HTN
PVD
TIA
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L Sherwood 2004 p 336
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What is the Ultimate Cause of Death?
2. Pulmonary damming w/edema
3. Cardiac fibrillation
5. Thromboembolism(2011 ed. but not 2016)
G&H 2016 p 266
G&H 2011 p 250
1. ↓ Q, CO or Cardiac Output.
4. Cardiac rupture (occasionally)
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G&H 2016, 2011 fig 21-7
Systolic Stretch
Nonfunctional Muscle
Normal Muscle
Systolic Stretch Due to Necrotic Tissue
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G&H 2016, 2011 fig 21-8
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Treatment Triad
ExerciseDietary
Modification
Drugs/Surgery
NB: Last blasted resort!!
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Sizer & Whitney
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F Sizer & E Whitney (S&W) 2003 p 147 +
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Sizer & Whitney
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Selected Atherosclerotic Genetic Determinants – Ultra-short List!
? ?
Genes for HDL, LDL+ receptors, Apolipoproteins Apo B-100, Apo-E, Apo-M, lipoprotein a/Lpa, homocysteine metabolism enzymes N5,N10-
methylene-tetrahydrofolate reductase, cystathione beta-synthase, Type I antithrombin, mitochondrial haplogroup A, Protein tyrosine phosphate PTPN22
C/T single nucleotide polymorphism (SNP) @ + 1858, HMG COA reductase, SNPs in TNF-alpha, IL-
1beta & TGF-beta1, IL-6, IL-10, CD14, TLR-4 receptors, Human Leukocyte Antigens HLA-DRB1*01, HLA-B*07 + haplotype LTA+253a-
LTA+633g-C4A3-C4B1, HDL-associated paraoxonase (PON1), lysosomal acid lipase (LAL),
MEF2A protein affecting artery walls…
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HDL = Drain
-VLDL
+
LDL
Total Cholesterol Level
= Faucet
Bruce Kottke’s Bathtub Analogy
5 forms of cholesterol:
Chylomicrons, VLDL, LDL, IDL, HDL
Atherogenic Anti-AtherogenicBruce Kottke
Biological
Artifact!?
Bathtub
β
β
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Historical Hypotheses for Atherosclerosis Development
Endothelial
Injury
Platelet
Adherence
PDGF
Release
Cell
Proliferation
Advanced
Lesion
Ross & Glomset Steinberg & Witztum
High Plasma
LDL
LDL Infiltration
into Intima
Oxidized LDL
+
Macrophages
Foam
Cells
Fatty
Streak
Other
Growth
Factors
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2032127/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC295745/
https://link.springer.com/article/10.1007%2Fs00109-017-1575-8https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121590/
10 regulator of lipoprotein
metabolism!
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NAHL Jan/Feb 2009, p 5
How Inflammation Attacks the HeartLDL Oxidized Monocytes Migrate Monocytes Macrophages
Fatty Streak
Fibrous Plaque
Cap Breakdown
Cap Rupture
Clot Formation
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NAHL CSPI Jan-Feb 2014
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MRI Hyperintensities, Hypertension & Dementia
NAHL CSPI, Jan-Feb 2014
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SOURCE: Lifeline Screening, 2007
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R
L
Middle CerebralArtery Branches
SOURCE: McMinn & Hutchins, 1977.
…Cerebral vasculature! Oh my!
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= Artery of StrokeSOURCE: Liebman, 1979.
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The Window to the CV System?
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Renal Vasculature
SOURCE: McMinn & Hutchins, 1977.
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SO
UR
CE
: W
illers
on &
Cohn
, 2000.
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SOURCE: Pollock & Wilmore, 1990.
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SOURCE: Kahn & Clark, National
Geographic, Feb 2007.
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SOURCE: Kahn & Clark, National
Geographic, Feb 2007.
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SOURCE: Kahn & Clark, National Geographic, Feb 2007.
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CABG = Coronary Artery Bypass Graft
SI Fox 2013 fig 14.19
Double?
Triple?
Quadruple?
Quintuple?
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SOURCE: Torstar 1984 p 128.
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National G
eogra
phic
, 2007
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Artificial heart = $125,000 - $250,000! 5400 await transplants, but only 2000 -
2600 donors are available…
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http://ngm.nationalgeographic.com/2007/02/hearts/hearts-text.html
Photograph by Robert Clark
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Questions + Discussion
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Additional Resource Slides:
Development, ‘s Electrical
Highway, Coordinated Events…
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Fetal Circulation
≡ Aqua Animal
Bypass Lungs
R L Shunt
G&H 2016 fig 84-4, G&H 2011 fig 83-4
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(Automatically) Shock the Heart then it Contracts!
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Intrinsic Regulation: Autorhythmic
G&H 2016, 2011, 2006 fig 10-1
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LS 2012 fig 9-8 p 237
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Extrinsic Regulation: Nervous
NB: + Extrinsic Hormonale.g. Adrenal Epi + NE
G&H 2011 fig 9-12
G&H 2016 fig 9-13
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G&H 2011 & 2016 fig 9-6
Electrical Events Precede Mechanical Events!