Question

Q1. Make a list comparing characteristics of skelet vs cardiac muscle; what characteristics are found in BOTH

Q2. A short (2 page at MOST) – presentation on aortic stenosis - - text and pictures & flowcharts allowed; should include:      

Prevalence in population ; Anatomy; Pathophysiology; Treatment possibilities and Outcomes.

Q3. The definition of a HR is the number of times the heart beats in 1 minute. The true HR for this patient was taken for one whole minute and was found to be ~ 70bpm, which of the 3 methods would offer then the most accurate HR measurement on this strip. Explain your answer.

Answer 1

ANSWER 1:

	CHARACTERISTICS	SKELETAL MUSCLE	CARDIAC MUSCLE
	CELLS	long tube shaped, multinucleated,	long vranching cells
	STRIATIONS	yes	yes
	LOCATION OF NUCLEI	periphery	cental
	T TUBULES	parts of triad A-I junction	parts of diad at z disc
	SARCOPLASMIC RETICULUM	abundant	less abundant
	CONTRACTION MECHANISM	Ca2+ binding at myosin	same
	STRUCTURE	highly organized	gap at junction, intercalated junction
	CONNECTIVE TISSUE	endomysium, perimysium, epimysium	endomysium, subendocardial pericardial
	INNERVATION	voluntary movement	involuntary
	LOCATION	tongue, muscle, eye	heart
	GROWTH/ RENEWAL	hypertrphy, limited renewal	limited or no renewal hypertrophy

ANSWER 2:

DEFINITION:  it is the narrowing of aortic valve resulting in obstruction of blood flow from left ventricle to ascending aorta during systole.

ETIOLOGY :

• Congenital aortic stenosis
• Congenital subvalvular aortic stenosis
• Congenital supravalvular aortic stenosis
• Calcification and fibrosis of congenitally bicuspid
• AV Rheumatic aortic stenosis
• Senile degenerative aortic stenosis
• Calcification of bicuspid valve
• Rheumatic aortic stenosis.

PATHOPHYSIOLOGY:

CLINICAL MANIFESTATIONS:

The classic symptoms due to AS are heart failure (HF):

• syncope
• angina. However, these “classic” symptoms reflect end-stage disease
• Dyspnea on exertion or decreased exercise tolerance
• Exertional dizziness
• Exertional angina
• Heart palpitations — sensations of a rapid, fluttering heartbeat

COMPLICATIONS:

Aortic valve stenosis can cause complications, including:

• Heart failure
• Stroke
• Blood clots
• Bleeding
• Heart rhythm abnormalities (arrhythmias)
• Infections that affect the heart, such as endocarditis
• Death

PREVENTIONS:

• Taking steps to prevent rheumatic fever.
• Addressing risk factors for coronary artery disease
• Taking care of your teeth and gums. There may be a link between infected gums (gingivitis) and infected heart tissue (endocarditis).  

DIAGNOSIS :

• ECG
• CHEST X RAY
• ECHO
• CARDIAC CATHETERIZATION
• COMPLETE BLOOD COUNT

TREATMENT:

• Patients with moderate aortic stenosis (valve area 1.5 to 1.0 square centimeters) are advised to avoid strenuous activities such as weight lifting or sprinting
• patients are usually examined annually and evaluated by echocardiography periodically to monitor disease progression.
• these patients are usually given antibiotics prior to any procedure in which bacteria may be introduced into the bloodstream. This includes routine dental work, minor surgery, and procedures that may traumatize body tissues
• oral amoxicillin (Amoxil) and erythromycin (E-Mycin, Eryc, PCE), as well as intramuscular or intravenous ampicillin (Unasyn), gentamicin (Garamycin), and vancomycin (Lyphocin, Vancocin).
• use of diuretics to reduce high lung pressures and remove lung fluid can provide only temporary relief of symptoms.

SURGICAL MANAGEMENT

• Replacement aortic valves processed from pigs (porcine) or cows (bovine) are called bioprostheses.
• Recently, aortic valves from human cadavers have been used in younger patients to avoid the need for anticoagulation medication
• mechanical prosthetic valves all require life-long anticoagulation with blood thinners such as warfarin (Coumadin) to prevent clot formation on the valve surfaces
• (balloon valvuloplasty) which is introduced in much the same way as in cardiac catheterization.
• transcutaneous aortic valve insertion (TAVI) a prosthetic aortic valve is inserted through the artery in the groin or via direct insertion into the heart, but without the need for open heart surgery

ANSWER 3 :

METHODS TO CHECK HEART RATE ARE:

Carotid pulse

To check your pulse using this method, you’ll be finding the carotid artery.

• Place your pointer and middle fingers on the side of your windpipe just below the jawbone. You may need to shift your fingers until you can easily feel your heart beating.
• Count the pulses you feel for 15 seconds.
• Multiply this number by 4 to obtain your heart rate.

  wireless monitor

that’s strapped around your chest. It reads out to a fitness tracker worn on your wrist

RADIAL PULSE

To check your pulse using this method, you’ll be finding the radial artery.

1. Place your pointer and middle fingers on the inside of your opposite wrist just below the thumb.
2. Don’t use your thumb to check your pulse, as the artery in your thumb can make it harder to count accurately.
3. Once you can feel your pulse, count how many beats you feel in 15 seconds.
4. Multiply this number by 4 to get your heart rate. For instance, 20 beats in 15 seconds equals a heart rate of 80 beats per minute (bpm).

THESE METHODS ARE MORE ACCURATE THAN OTHER METHODS LIKE:

DIGITAL TRACKER

SMARTPHONE APP

PEDIAL PULSE

EXERCISE MACHINES

Aortic Stenosis Progressive decrease in the area of the aortic valve Decrease antegrade velocity when aortic area decrease at least by half Adaptation by hypertrophy Early Changes Late Changes Diastolic Dysfunction Systolic Dysfunction Atrial fibrillation Decreased compliance Increased left ventricular diastolic pressure Myocardial ischemia Myocardial fibrosis Abnormal wall motion Mitral regurgitation Unchanged contractility: Normal stroke volume Decreased Contractility Decreased stroke volume Heart Failure

REFERENCES;

https://www.slideshare.net/pratapsagar/aortic-stenosis-43626607

https://www.slideshare.net/SilahAysha/aortic-stenosis-119354131

https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139#:~:text=Overview,the%20rest%20of%20your%20body.