Describe the pathogenesis of coxsackievirus type B and how it relates to viral myocarditis. (Sigs Case 6.2a)
GI tract (stable at low gI pH)→infects mucosal epithelial cells→viremia→infects + lyse heart/pleural surfaces
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15
Describe how cardiac chamber dilation results in global hypokinesis and systolic dysfunction.(Sigs Case 6.2b)
constant backup fluid-> dilation chambers-> decrease ability to contract & overstretching-> impaired contraction-> less EF-> systolic dysfunct-> systolic fail
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15
Describe the potential benefits and precautions for the use of CoQ10 and L-carnitine for cardiac function. (SIGS 6.3b)
CoQ10: facilitates ATP production via ETC in mitochondria; body can become dependant- do not stop abruptly; L-Carn.: "shuttle" for FA to mitochondria in L vent.
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15
What are the challenges with treating Klebsiella pneumoniae? (Sigs Case 6.5b)
facultative anaerobe (can be w/wout oxygen); resistant to ampicillin; spread from lungs = dangerous superbug; Community + Hospital acquired
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15
What is the MOA and side effects of thiazide diuretics?(Sigs Case 6.6b)
Used to decrease sodium reabsorption-> decrease fluid reabsorption-> directly decrease levels of circulating sodium; AE: ion imbalance, incr. urination
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15
Explain the role of metoprolol in the management of HCM.(Sigs Case 6.3b)
antagonizes catecholamine binding at Beta1 adren. receptors (card. nodal cells)-> decrease HR; antagonize B1-adren. recept. on card. myocytes-> decr. contract
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15
Describe integrative approaches to asthma (Sigs 6.4a)
Define the characteristic histopathologic features of acute viral myocarditis.(Sigs Case 6.2a)
lymphohistocytic; infiltration of lymphocytes that bring about T lymphocytes; myocyte is elongated w/ nuclei
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15
Explain how CO2, pH, Temp., and 2,3 diphosphoglycerate (DPG) or biphosphoglycerate (BPG) would shift the hemoglobin saturation curve and how this affects tissue oxygenation.(Sigs Case 6.5a)
Right shift: tissue oxygenation increased; Left shift: holds onto oxygen
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15
Compare/contrast expected PFT findings of obstructive vs. restrictive lung diseases (Sigs Case 6.6b)
O: volumes greater than normal, ratio lower than normal, loop shifts left; R: volumes less than normal, ratio elevated, loop shifts right
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15
Explain how low oxygen levels can alter the electrical and mechanical functions of the heart.(Sigs Case 6.5a)
Low O2-> ischemia of heart myocardium-> decrease in contractility (LV)-> reduces CO, increased preload-> ecc. hypertrophy-> dilation-> systolic dysfunction-> HF
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15
Explain how multiple wandering re-entrance circuits can result in atrial fibrillation. (SIGS 6.1a)
Wandering re-entrance circuits able to continuously find excitable tissue--> depolarization of atria--> fibrillatory contractions in atrial myocytes
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15
What is the MOA of Colchicine and how does it relate to the management of pericarditis?(Sigs Case 6.2a)
used as a theoretical anti-inflamm. agent; inhibits IL-1 from cascading, interferes w/ NFK-B; binds to microtubular tubulin in neutrophils-> inhibits mitosis
