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Rice BIOE 301 - Lecture Notes

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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 TimeHow do we treat coronary artery disease?CABGPTCAStentPreventionPrevention vs. TreatmentRisk Factors for Heart DiseaseTobacco useHigh blood pressure – Over 70% not under controlHigh cholesterol – Over 80% not under control Inappropriate dietObesityLow levels of physical activitySuper Size MeProgression of Heart DiseaseHigh Blood PressureHigh Cholesterol LevelsAtherosclerosisIschemiaHeart AttackHeart FailureWhat is Heart Failure?Heart FailureHeart 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 sidesUsually affects the left side firstAbout85 million Americans are living with heart failure550,000 new cases diagnosed each yearQuantifying Heart PerformanceEjection Fraction (EF)Fraction of blood pumped out of ventricle relative to total volume (at end diastole)EF = SV/EDVNormal value > 60%Measured using echocardiographyNormal echocardiogramhttp://www.ardingerphoto.com/pcawebsite/cardiology/movies/sssmovies/normallao2cycle.htmlDilated cardiomyopathyhttp://www.ardingerphoto.com/pcawebsite/cardiology/movies/sssmovies/dilcardiomyopsss.htmlLeft Sided Heart FailureInvolves left ventricleSystolic failure Left ventricle loses ability to contractCan't push enough blood into circulation Diastolic failureVentricle loses ability to relax; muscle has become stiffCan't properly fill during resting period between beatsPulmonary edema Blood coming into left chamber from lungs "backs up," causing fluid to leak into the lungsAs 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 Transplant1960s:First heart transplants performed1980s: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 transplantOnly about 2,300 donor hearts become available for transplantation each yearSurgical Procedurehttp://www.pbs.org/wgbh/nova/eheart/transplantwave.htmlRejectionRisk of rejection is highest right after surgeryIn one study, first year after transplant:37% of patients had no rejection episodes 40% had one episode23% had more than one episodeInduction therapy:Use of drugs to heavily suppress immune system right after transplant surgeryPatients 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 PresentationAll cells have MHC molecules on surfaceWhen virus invades cell, fragments of viral protein are loaded onto MHC proteinsT Cells inspect MHC proteins and use this as a signal to identify infected cellsMHC ReceptorsTwo types of MHC moleculesClass I MHC molecules are found on all nucleated cellsClass II MHC molecules are found on antigen presenting immune cellsSelf-ToleranceT cells which recognize class I MHC-self antigens are destroyed early in developmentWhen this fails: auto-immune diseaseType 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 MatchingThe greater the difference in peptide sequences of MHC receptors between donor and recipient:The stronger the immune responseThe greater the chance of organ rejectionMatching:200 different histocompatibility antigensEach


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Rice BIOE 301 - Lecture Notes

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