NEET MDS Lessons
Physiology
HEART DISORDERS
- Pump failure => Alters pressure (flow) =>alters oxygen carrying capacity.
- Renin release (Juxtaglomerular cells) Kidney
- Converts Angiotensinogen => Angiotensin I
- In lungs Angiotensin I Converted => Angiotensin II
- Angiotensin II = powerful vasoconstrictor (raises pressure, increases afterload)
- stimulates thirst
- stimulates adrenal cortex to release Aldosterone
(Sodium retention, potassium loss) - stimulates kidney directly to reabsorb Sodium
- releases ADH from Posterior Pituitary
- Myocardial Infarction
- Myocardial Cells die from lack of Oxygen
- Adjacent vessels (collateral) dilate to compensate
- Intracellular Enzymes leak from dying cells (Necrosis)
- Creatine Kinase CK (Creatine Phosphokinase) 3 forms
- One isoenzyme = exclusively Heart (MB)
- CK-MB blood levels found 2-5 hrs, peak in 24 hrs
- Lactic Dehydrogenase found 6-10 hours after. points less clearly to infarction
- Serum glutamic oxaloacetic transaminase (SGOT)
- Found 6 hrs after infarction, peaks 24-48 hrs at 2 to 15 times normal,
- SGOT returns to normal after 3-4 days
- Creatine Kinase CK (Creatine Phosphokinase) 3 forms
- Myocardium weakens = Decreased CO & SV (severe - death)
- Infarct heal by fibrous repair
- Hypertrophy of undamaged myocardial cells
- Increased contractility to restore normal CO
- Improved by exercise program
- Prognosis
- 10% uncomplicated recovery
- 20% Suddenly fatal
- Rest MI not fatal immediately, 15% will die from related causes
- Congenital heart disease (Affect oxygenation of blood)
- Septal defects
- Ductus arteriosus
- Valvular heart disease
- Stenosis = cusps, fibrotic & thickened, Sometimes fused, can not open
- Regurgitation = cusps, retracted, Do not close, blood moves backwards
Blood is a liquid tissue. Suspended in the watery plasma are seven types of cells and cell fragments.
- red blood cells (RBCs) or erythrocytes
- platelets or thrombocytes
- five kinds of white blood cells (WBCs) or leukocytes
- Three kinds of granulocytes
- neutrophils
- eosinophils
- basophils
- Two kinds of leukocytes without granules in their cytoplasm
- lymphocytes
- monocytes
- Three kinds of granulocytes
A heart rate that is persistently greater than 100bpm is termed tachycardia. A heart rate that is persistantly lower than 60 pulse per min is termed bradycardia. Let's examine some factors that could cause a change in heart rate:
- Increased heart rate can be caused by:
- Increased output of the cardioacceleratory center. In other words, greater activity of sympathetic nerves running to the heart and a greater release of norepinephrine on the heart.
- Decreased output of the cardioinhibitory center. In other words, less vagus nerve activity and a decrease in the release of acetylcholine on the heart.
- Increased release of the hormone epinephrine by the adrenal glands.
- Nicotine.
- Caffeine.
- Hyperthyroidism - i.e., an overactive thyroid gland. This would lead to an increased amount of the hormone thyroxine in the blood.
- Decreased heart rate can be caused by:
- Decreased activity of the cardioacceleratory center.
- Increased activity of the cardioinhibitory center.
- Many others.
Factors , affecting glomerular filtration rate :
Factors that may influence the different pressure forces , or the filtration coefficient will affect the glomerular filtration rate .
1. Dehydration : Causes decrease hydrostatic pressure , and thus decreases GFR
2- Liver diseases that may decrease the plasma proteins and decrease the oncotic pressure , and thus increases glomerular filtration rate .
3- Sympathetic stimulation : will decrease the diameter of afferent arteriole and thus decreases glomerular filtration rate.
4- Renal diseases : Nephrotic syndrome for example decreases the number of working nephrons and thus decreases the filtration coefficient and thus decreases the glomerular filtration rate.
Glomerulonephritis will causes thickening of the glomerular basement membrane and thus decreases the glomerular filtration rate by decreasing the filtration coefficient too.
Conductivity :
Means ability of cardiac muscle to propagate electrical impulses through the entire heart ( from one part of the heart to another) by the excitatory -conductive system of the heart.
Excitatory conductive system of the heart involves:
1. Sinoatrial node ( SA node) : Here the initial impulses start and then conducted to the atria through the anterior inter-atrial pathway ( to the left atrium) , to the atrial muscle mass through the gap junction, and to the Atrioventricular node ( AV node ) through anterior, middle , and posterior inter-nodal pathways.
The average conductive velocity in the atria is 1m/s.
2- AV node : The electrical impulses can not be conducted directly from the atria to the ventricles , because of the fibrous skeleton , which is an electrical isolator , located between the atria and ventricles. So the only conductive way is the AV node . But there is a delay in the conduction occurs in the AV node .
This delay is due to:
- the smaller size of the nodal fiber.
- The less negative resting membrane potential
- fewer gap junctions.
There are three sites for delay:
- In the transitional fibers , that connect inter-nodal pathways with the AV node ( 0.03 ) .
- AV node itself ( 0.09 s) .
- In the penetrating portion of Bundle of Hiss ( 0.04 s) .
This delay actually allows atria to empty blood in ventricles during the cardiac cycle before the beginning of ventricular contraction , as it prevents the ventricles from the pathological high atrial rhythm.
The average velocity of conduction in the AV node is 0.02-0.05 m/s
3- Bundle of Hiss : A continuous with the AV node that passes to the ventricles through the inter-ventricular septum. It is subdivided into : Right and left bundle. The left bundle is also subdivided into two branches: anterior and posterior branches .
4- Purkinje`s fibers: large fibers with velocity of conduction 1.5-4 m/s.
the high velocity of these fibers is due to the abundant gap junctions , and to their nature as very large fibers as well.
The conduction from AV node is a one-way conduction . This prevents the re-entry of cardiac impulses from the ventricles to the atria.
Lastly: The conduction through the ventricular fibers has a velocity of 0.3-0.5 m/s.
Factors , affecting conductivity ( dromotropism) :
I. Positive dromotropic factors :
1. Sympathetic stimulation : it accelerates conduction and decrease AV delay .
2. Mild warming
3. mild hyperkalemia
4. mild ischemia
5. alkalosis
II. Negative dromotropic factors :
1. Parasympathetic stimulation
2. severe warming
3. cooling
4. Severe hyperkalemia
5. hypokalemia
6. Severe ischemia
7. acidosis
8. digitalis drugs.
CNS PROTECTION
- Bones of the Skull Frontal, Temporal, Parietal, Sphenoid, Occipital
- Cranial Meninges Dura mater, Arachnoid Space, Pia mater
- Cerebrospinal Fluid
Secreted by Chroid Plexi in Ventricles
Circulation through ventricles and central canal
Lateral and Median apertures from the 4th ventricle into the subarachnoid space
Arachnoid villi of the superior sagittal sinus return CSF to the venous circulation
Hydrocephalic Condition, blockage of the mesencephalic aqueduct, backup of CSF, Insertion of a shunt to drain the excess CSF
Carbohydrates:
- about 3% of the dry mass of a typical cell
- composed of carbon, hydrogen, & oxygen atoms (e.g., glucose is C6H12O6)
- an important source of energy for cells
- types include:
- monosaccharide (e.g., glucose) - most contain 5 or 6 carbon atoms
- disaccharides
- 2 monosaccharides linked together
- Examples include sucrose (a common plant disaccharide is composed of the monosaccharides glucose and fructose) & lactose (or milk sugar; a disaccharide composed of glucose and the monosaccharide galactose)
- polysaccharides
- several monosaccharides linked together
Examples include starch (a common plant polysaccharide made up of many glucose molecules) and glycogen (commonly stored in the liver)