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
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
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
more than minial what percentages of coronal arterial luminal narrowing cause symptoms?Luminal narrowing >70% causes temporary cardiac ischemia
→symptomatic cardiovascular HirotoShishido
difference between Stanford and DeBakey classification of aortic dissectionStanford→classification based on the dissected region
DeBakey→based on intimal tear(内膜亀裂)
(BAD Ⅰ→Both ascending and descending, Ⅱ→Ascending, Ⅲ→Descending)
Persistent Pulmonary Hypetension of the Newborn(PPHN)(Eisenmenger syndrome)
first line therapyinhaled nitric oxide (iNO)
used to dilate the pulmonary vasculature and promote blood flow through the lungs
where do embolized thrombus most likely originate in the patient with atrial fibrillationthe left atrial appendage is particularly vulnerable to losing contractile function cardiovascular HirotoShishido
pterygium colli deformity=webbed neck
→Turner syndrome
(juxtaductal coarctation, ☆bicuspid aortic valve, shield chest, lymphedema in feet or hands) reproductivecardiovascular 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
