mutation in the TTR(transthyretin)can cause familial amyloid cardiomyopathy
Transthyretin get misfolded, producing an
amyloid protein that infiltrates the myocardium (infiltrative cardiomyopathy).
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 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 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 HirotoShishido
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 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 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 HirotoShishido
more than minial what percentages of coronal arterial luminal narrowing cause symptoms?Luminal narrowing >70% causes temporary cardiac ischemia
→symptomatic cardiovascular HirotoShishido