mutation in the TTR(transthyretin)can cause familial amyloid cardiomyopathy
Transthyretin get misfolded, producing an
amyloid protein that infiltrates the myocardium (infiltrative cardiomyopathy).
(*TTN → encodes titin= anchors β-myosin heavy chain to z-disc, contributing to passive myocardial tension) cardiovascularUWorld Mar 28, 2020, 8:10 AM HirotoShishido
pathogenesis/triggers of Prinzmetal(Variant, vasospastic) anginahyperactivity of coronary smooth muscle
due to ☆endothelial dysfunction & autonomic dysfunction
☆dihydroergotamine, triptan(both for migrane), cocaine, amphetamine
triptan ☆blocks calcitonine gene-related peptides(CGRP), decrease neurologic lnflammation and work as vasoconstrictor
sacubitril
mechanisminhibit neprilysin
can be used in combination with valsartan
(Sacubitril is found to decrease mortality and morbidity of patients with chronic heart failure with decreased ejection fraction) pharmacologycardiovascular Dec 31, 2019, 4:28 AM HirotoShishido
neprilysin
mechanism, hypothermia☆metalloprotease that inactivates several peptide hormones including ☆ANP, BNP, glucagon, substance P etc.
hypothermia→
central blood volume increases→ baroreceptors (will register this relative increase as volume overload and) increase the rate of firing→
downregulate ADH ,neprilysin→
↓ADH, ↓neprilysin, ↑ANP, ↑BNP→
increase urinary frequency cardiovascularendocrinology Dec 31, 2019, 3:46 AM HirotoShishido
anatomy of the carotid sheathThe common carotid artery is medial, the internal jugular vein is lateral, and the vagus nerve is posterior within the carotid sheath. anatomycardiovascular Dec 23, 2019, 10:10 AM HirotoShishido
HOCM
mutationmutations in genes encoding sarcomeric proteins, such as myosin binding protein C and ☆β-myosin heavy chain cardiovascular Dec 19, 2019, 4:12 AM HirotoShishido
which papillary muscle will rupture if MI occurs to LADLAD,LCX→anterolateral muscle rupture
PDA(branch from the dominant circulation)→ posteromedial muscle rapture (more common) cardiovascular Dec 11, 2019, 6:25 AM HirotoShishido
Picture
chronic, acuteMicroscopic features of chronic pulmonary edema
→ acute buildup of intra-alveolar transudative fluid and the presence of ☆hemosiderin-laden macrophages, representing chronic fluid congestion within the lungs.
acute→ ☆engorged alveolar capillaries are evident and the intraalveolar transudate appears as acellular pink material. cardiovascularUWorld Dec 7, 2019, 11:37 PM HirotoShishido
the most common site of infective endocarditis in intravenous drug userstricuspid valve
in intravenous drug users, infected venous blood (most often with S. aureus) returns to the right side of the heart, and seeds the tricuspid valve cardiovascular Dec 6, 2019, 9:55 PM HirotoShishido
what patient is contraindicated in the use of β-blockercocaine user
By blocking presynaptic reuptake of norepinephrine and increasing release of catecholamines from the adrenal glands, cocaine results in a high degree of adrenergic activity
→unopposed α adrenergic receptor agonist activity
→ increase in hypertension and further ischemia in the coronary arteries cardiovascularpharmacology Dec 4, 2019, 8:05 AM HirotoShishido
which areas have higher prevalence of Brugada syndromeasian males cardiovascular Oct 29, 2019, 8:33 AM HirotoShishido
more than minial what percentages of coronal arterial luminal narrowing cause symptoms?Luminal narrowing >70% causes temporary cardiac ischemia
→symptomatic cardiovascular Oct 27, 2019, 7:24 AM HirotoShishido