BME 301Review of Last TimePrevention vs. TreatmentProgression of Heart DiseaseWhat is Heart Failure?Heart FailureQuantifying Heart PerformanceLeft Sided Heart FailureSlide 9Symptoms of Heart FailureSlide 11Heart Failure VideoHow Do We Treat Heart Failure?How Do We Treat Heart Failure?Slide 15Heart TransplantSurgical ProcedureRejectionRemember from our vaccine unit:MHC ReceptorsSlide 21Slide 22Donor MHC MatchingImmunosuppressive RxHow To Become An Organ DonorUniform Donor CardWhy Inform Your FamilyMore About Organ DonationHistory of Cardiac DevicesRequirements of Mechanical SupportTypes of Mechanical SupportSlide 32LVADSlide 34Axial Flow PumpsSlide 36Artificial Heart - HistorySlide 38Slide 39Slide 40Slide 41Slide 42Slide 43History of Artificial HeartSlide 45Slide 46Slide 47AbioCor Artificial HeartSlide 49Slide 50BME 301Lecture NineteenReview of Last TimeHow do we treat coronary artery disease?CABGPTCAStentPreventionPrevention vs. TreatmentRisk Factors for Heart DiseaseTobacco useHigh blood pressure – Over 70% not under controlHigh cholesterol – Over 80% not under control Inappropriate dietObesityLow levels of physical activitySuper Size MeProgression of Heart DiseaseHigh Blood PressureHigh Cholesterol LevelsAtherosclerosisIschemiaHeart AttackHeart FailureWhat is Heart Failure?Heart FailureHeart failure:Occurs when left or right ventricle loses the ability to keep up with amount of blood flow Can involve the heart's left side,8right side8or both sidesUsually affects the left side firstAbout85 million Americans are living with heart failure550,000 new cases diagnosed each yearQuantifying Heart PerformanceEjection Fraction (EF)Fraction of blood pumped out of ventricle relative to total volume (at end diastole)EF = SV/EDVNormal value > 60%Measured using echocardiographyNormal echocardiogramhttp://www.ardingerphoto.com/pcawebsite/cardiology/movies/sssmovies/normallao2cycle.htmlDilated cardiomyopathyhttp://www.ardingerphoto.com/pcawebsite/cardiology/movies/sssmovies/dilcardiomyopsss.htmlLeft Sided Heart FailureInvolves left ventricleSystolic failure Left ventricle loses ability to contractCan't push enough blood into circulation Diastolic failureVentricle loses ability to relax; muscle has become stiffCan't properly fill during resting period between beatsPulmonary edema Blood coming into left chamber from lungs "backs up," causing fluid to leak into the lungsAs ability to pump decreases, blood flow slows, causing fluid to build up in tissues throughout body (edema) Congestive Heart FailureSymptoms of Heart FailureSymptom Why It Happens People May Experience:Shortness of breath (also called dyspnea)Blood "backs up" in pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can't keep up with the supply. Causes fluid to leak into lungsBreathlessness during activity, at rest, or while sleeping, which may come on suddenly and wake them up. Often have difficulty breathing while lying flat; may need to prop up upper body and head on pillowsPersistent coughing or wheezingFluid builds up in lungs Coughing that produces white or pink blood-tinged phlegm. Buildup of excess fluid in body tissues (edema)As flow out of heart slows, blood returning to heart through veins backs up, causing fluid build up in tissues. Swelling in feet, ankles, legs or abdomen or weight gain. May find that shoes feel tightSymptoms of Heart FailureSymptom Why It Happens People May Experience:Increased heart rateTo "make up for" loss in pumping capacity, heart beats fasterHeart palpitations, which feel like the heart is racing or throbbing.Confusion, impaired thinkingChanging levels of blood substances, such as sodium, can cause confusion Memory loss and feelings of disorientation.Lack of appetite, nauseaDigestive system receives less blood, causing problems with digestionFeeling of being full or sick to their stomach.Tiredness, fatigueHeart can't pump enough blood to meet needs of tissues. Body diverts blood away from less vital organs (limb muscles) and sends it to heart & brain.Tired feeling all the time and difficulty with everyday activities, such as shopping, climbing stairs, carrying groceries or walking.Heart Failure VideoHow Do We Treat Heart Failure?How Do We Treat Heart Failure?Heart TransplantCardiac Assist DevicesArtificial Heart http://www.cbsnews.com/htdocs/health/heart/framesource.htmlHow Do We Treat Heart Failure? Heart TransplantHeart Transplant1960s:First heart transplants performed1980s:Anti-rejection meds became available (Cyclosporine)Today:About 80% of heart transplants are alive two years after the operation 50% percent survive 5 years Need:4,000 patients are on the national patient waiting list for a heart transplantOnly about 2,300 donor hearts become available for transplantation each yearSurgical Procedurehttp://www.pbs.org/wgbh/nova/eheart/transplantwave.htmlRejectionRisk of rejection is highest right after surgeryIn one study, first year after transplant:37% of patients had no rejection episodes 40% had one episode23% had more than one episodeInduction therapy:Use of drugs to heavily suppress immune system right after transplant surgeryPatients keep taking some anti-rejection drugs for the rest of their lifeRemember from our vaccine unit:How Do T Cells Identify Virus Infected Cells? Antigen PresentationAll cells have MHC molecules on surfaceWhen virus invades cell, fragments of viral protein are loaded onto MHC proteinsT Cells inspect MHC proteins and use this as a signal to identify infected cellsMHC ReceptorsTwo types of MHC moleculesClass I MHC molecules are found on all nucleated cellsClass II MHC molecules are found on antigen presenting immune cellsSelf-ToleranceT cells which recognize class I MHC-self antigens are destroyed early in developmentWhen this fails: auto-immune diseaseType 1 diabeteshttp://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/medialib/Image_Bank/CH22/FG22_05.jpghttp://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/medialib/Image_Bank/CH22/FG22_14.jpgDonor MHC MatchingThe greater the difference in peptide sequences of MHC receptors between donor and recipient:The stronger the immune responseThe greater the chance of organ rejectionMatching:200 different histocompatibility antigensEach
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