Human Health & Disease Mondays, Tuesdays, Thursdays and Fridays 9:00 - 11:50 AM Lectures: Room M-112, Labs: Fleischmann IINNDDEE 222211 SSpprriinngg 22001100 Syllabus SSyyllllaabbuuss PPaarrtt 22 (2010) Year's Last Syllabus (2010) Year's Last Human Health & Disease Inde 221 Spring 2010 Table of Contents CARDIOVASCULAR BLOCK SYLLABUS SCHEDULE 7 SYLLABUS PREFACE 11 CARDIAC MUSCLE AND FHC 15 EXCITATION-CONTRACTION COUPLING Syllabus27 NERNST POTENTIAL AND OSMOSIS 43 EXCITABILITY AND CONDUCTION 51 CIRCULATORY VESSEL HISTOLOGY LAB 63 CARDIAC ACTION POTENTIAL 71 CONTROL OF HEART RHYTHM (2010) 85 AUTONOMIC DRUGS OVERVIEW I 97 ELECTROCARDIOGRAM (ECG) 99 LESIONS OF BLOOD VESSELS 109 THROMBOEMBOLIC DISEASE 117 CARDIAC REFLEXESYear's 123 AUTONOMIC DRUGS OVERVIEW II 141 ECG SMALL GROUPS 143 LastAUTONOMIC DRUGS: CHOLINERGICS 147 CARDIAC MUSCLE MECHANICS 149 AUTONOMIC DRUGS: ANTICHOLINERGICS 175 ARRHYTHMIAS 177 AUTONOMIC DRUGS: SYMPATHOMIMETICS I 203 VENTRICULAR PHYSIOLOGY 205 AUTONOMIC DRUGS: SYMPATHOMIMETICS II 235 STARLING CURVE AND VENOUS RETURN 237 CARDIAC OUTPUT AND CATHETERIZATION 245 AUTONOMIC DRUGS: ADRENOCEPTOR BLOCKERS 267 PHYSICS OF CIRCULATION Syllabus269 CASE DISCUSSIONS: AUTONOMIC DRUGS 289 SMOOTH MUSCLE 291 ISCHEMIC AND VALVULAR HEART DISEASE 303 RENAL CIRCULATION (2010) 323 HYPERTENSION 333 CARDIOMYOPATHY, MYOCARDITIS AND ATRIAL MYXOMA 351 ENDOTHELIUM AND CORONARY CIRCULATION 369 ANGINA PECTORIS 389 DRUGS USEDYear's IN HYPERTENSION 397 SHOCK 399 ADULT CARDIAC LAB 413 CARDIAC ANESTHESIA & BYPASS 421 LastEXERCISE PHYSIOLOGY 431 ISCHEMIC HEART DISEASE PHARMACOLOGY 441 CONGESTIVE HEART FAILURE 443 DRUGS USED IN ANGINA PECTORIS 475 AN INTRO TO CARDIAC AND TOMOGRAPHIC ANATOMY OF THE HEART 477 POSITIVE INOTROPIC AGENTS 485 CONGESTIVE HEART FAILURE PHARMACOLOGY 487 FETAL CIRCULATION AND CONGENITAL HEART DISEASE 489 CONGENITAL HEART DISEASE 527 ANTIARRHYTHMIC DRUGS Syllabus547 CARDIOVASCULAR PHARMACOLOGY CASE DISCUSSIONS 549 PEDIATRIC CARDIAC LAB 551 (2010) Year's Last Syllabus (2010) Year's Last Human Health & Disease Inde 221 Spring 2010 Syllabus Schedule Weekday Date Time Room Topic Instructor Tues 4/27 9 - 9:50 M112 Cardiac Muscle and FHC R. Tsien 10 - 10:50 M112 Excitation-Contraction Coupling R. Tsien 11 - 11:50 M112 Nernst Potential & Osmosis D. Madison Thurs 4/29 9 - 9:50 M112 Excitability & Conduction R. Tsien 10 – 11:50 FLRC Circulatory Vessel Histology Lab A. Connolly Fri 4/30 9 – 9:50 M112 Cardiac Action Potential R. Tsien 10 – 10:50 M112 Control of Heart Rhythm R. Tsien Wk 5 ends 11 – 11:50 M112 Autonomic Pharmacology Overview 1 J. Whitlock Mon 5/3 9 - 9:50 M112 ECG SyllabusR. Tsien 10 – 10:50 M112 Lesions of Blood Vessels A. Connolly 11 – 11:50 M112 Thromboembolic Disease A. Connolly Tues 5/4 9 - 10:50 M112 Cardiac Reflexes B. Kobilka 11 - 11:50 M112 Autonomic Pharmacology Overview 2 J. Whitlock Thurs 5/6 9 – 10:50 FLRC ECG Small Groups Faculty 11 - 11:50 M112 Autonomic Drugs (Cholinergics) J. Whitlock Fri 5/7 9 - 10:50 M112 Muscle Mechanics R. Turcott Wk 6 ends 11 - 11:50 M112 Autonomic Drugs (Anticholinergics) J. Whitlock Mon 5/10 9 – 10:50 M112 Arrhythmias(2010) P. Wang 11 – 11:50 M112 Autonomic Drugs (Sympathomimetics 1) J. Whitlock Tues 5/11 9 – 10:50 M112 Ventricular Physiology R. Turcott 11 - 11:50 M112 Autonomic Drugs (Sympathomimetics 2) J. Whitlock Thurs 5/13 9 – 9:50 M112 Starling Curve and Venous Return J. Wong 10 – 10:50 M112 Cardiac Output and Catheterization R. Dash 11 - 11:50 M112 Autonomic Drugs (Adrenoceptor Blockers) J. Whitlock Fri 5/14 9 – 10:50 M112 Physics of Circulation M. McConnell Wk 7 ends Year's 11 - 11:50 M112 Case Discussions (Autonomic Drugs) J. Whitlock Sat 5/15 9 – 11:00 H2152 Saturday Treadmill Session #1 (Last Name A-K) – OPTIONAL Last Syllabus (2010) Year's Last Mon 5/17 9am-12pm FLRC EXAM DAY (Basic CV / Autonomics) Tues 5/18 9 – 9:50 M112 Smooth Muscle R. Tsien 10 – 10:50 M112 Ischemic Heart Disease A. Connolly 11 – 11:50 M112 Valvular Heart Disease A. Connolly Thurs 5/20 9 – 9:50 M112 Renal Circulation S. Rockson 10 - 10:50 M112 Hypertension S. Rockson 11 - 11:50 M112 Cardiomyopathy, Myocarditis and Atrial Myxoma G. Berry Fri 5/21 9 – 9:50 M112 Endothelium & Coronary Circulation J. Topper 10-10:50 M112 Angina Pectoris J. Topper Wk 8 Ends 11-11:50 M112 Drugs Used in Hypertension J. Whitlock Sat 5/22 9 – 11:00 H2152 Saturday Treadmill Session #2 (Last Name L-Z) – OPTIONAL Mon 5/24 9 – 9:50 M112 Shock M. Rosenthal 10 – 11:50 FLRC Adult Cardiac Lab SyllabusFaculty Tues 5/25 9 – 9:50 M112 Cardiac Anesthesia & Bypass M. Kanevsky 10 – 10:50 M112 Exercise Physiology R. Fishman 11 - 11:50 M112 Ischemic Heart Disease J. Whitlock Thurs 5/27 9 – 10:50 M112 Congestive Heart Failure A. Patterson 11 - 11:50 M112 Drugs Used in Angina Pectoris J. Whitlock Into to Cardiac & Tomographic Anatomy of the Fri 5/28 9 - 9:50 M112 N. Silverman Heart 10 – 10:50 M112 (2010)Positive Inotropic Agents J. Whitlock Wk 9 Ends 11 – 11:50 M112 Congestive Heart Failure Pharmacology J. Whitlock Mon 5/31 Holiday Tues 6/1 9 – 9:50 M112 Fetal Circulation & Congenital Heart Disease D. Bernstein 10 – 10:50 M112 Congenital Malformations of the Heart G. Berry 11 – 11:50 M112 Antiarrhythmic Drugs J. Whitlock Thurs 6/3 9 – 9:50 M112 Cardiovascular Pharm Case Discussions J. Whitlock 10 – 11:50 FLRC Pediatric Cardiac Lab Faculty Fri Year's6/4 9am-12pm FLRC EXAM DAY (End-CV) Mon - Tues 6/7 - 6/8 STUDY TIME Wed 6/9 9am-12pm FLRC INTEGRATED FINAL EXAM DAY Last Syllabus (2010) Year's Last Human Health & Disease Inde 221 Spring 2010 Syllabus Preface (CV) The following information has been provided to communicate any important updates in the course that have been made since the previous syllabus (Inde 221 2010 Part 1, Pulmonary and Neoplasia). TEXTBOOKS The following book is recommended for the CV Physiology sessions: Cardiovascular Physiology, by Berne and Levy, 8th edition (2000, paperback). Please note: the B&L book is available for purchase at the Stanford University Bookstore. The HHD course will not be providing copies of this book.Syllabus SATURDAY TREADMILL SESSIONS There will be two Saturday treadmill sessions that you are strongly encouraged to attend. The session dates are Saturday, May 15 and Saturday, May 22. Students whose last name begins with the letter A to K are scheduled to attend the treadmill session on May 15. Students whose last name begins with the letter L to Z are scheduled(2010) to attend the treadmill session on May 22. If you are unable to attend your scheduled session, please find someone in the other session to switch places with you. Both sessions begin at 9:00am and last approximately two hours. Please meet in the CV Clinic, room H-2152, which is located next to the ECG Lab of the hospital (North ICU). The objective of the treadmill session is to demonstrate practical applications of ECG and Echocardiography, and show you how a treadmill diagnostic is performed.Year's Last Syllabus (2010) Year's Last HUMAN HEALTH & DISEASE Spring 2010 CCVV BBlloocckk SSyyllllaabbuuss Syllabus (2010) Year's Last Syllabus (2010) Year's Last Cardiac Muscle and FHC - Richard Tsien, Ph.D. HHD221 Spring 2010 Page 15 CARDIAC MUSCLE AND FAMILIAL HYPERTROPHIC CARDIOMYOPATHY REQUIRED READING: B&L pp. 55-61 OBJECTIVES: 1. To review the important contractile proteins for the cardiac contraction 2. To appreciate the plasticity of the heart arising from the regulation of contractile protein genes 3. To appreciate the significance of those genes in the pathophysiology of hypertrophy of the heart due to either familial hypertrophic cardiomyopathy or hypertension. I. A CLINICAL CASE: FAMILIAL HYPERTROPHIC CARDIOMYOPATHYSyllabus (FHC) A. FHC is both a sporadic and an autosomal dominant disorder characterized by unexplained myocardial hypertrophy, a wide spectrum of clinical symptoms including arrhythmias, and early death. Sudden death can occur in both symptomatic and asymptomatic individuals. Pathological change in the heart consists of focally increased cardiac mass (regional hypertrophy) and myofibrillar disarray within varied anatomic regions of the heart. The figure illustrates septal hypertrophy. In the extreme case, the mitral valve will touch the(2010) septum, causing systolic anterior motion and creating an obstruction. It turns out that FHC can arise from defects in any one of a number of heart cell contractile proteins. It is really a disease of the sarcomere. Current hypotheses suggest that FHC, while a relatively uncommon disorder, may offer clues to the basis of heart Year's failure, a very common disease that may affect half a million people a year in the U.S. alone. We will return to this theme at the end of the lecture. Last Cardiac Muscle and FHC - Richard Tsien, Ph.D. HHD221 Spring 2010 Page 16 II. THE SARCOMERE AND CONTRACTILE PROTEINS A. Here we briefly review the structure of the striated muscle cells in cardiac and skeletal muscle. Most of you will have had ample exposure to this material in earlier courses. B. The sarcomere is the basic contractile unit. The z-line marks the edges of the sarcomere. The thin filaments are attached to the z- line and these filaments contain the actin. In the center of the sarcomere is the A-band which is formed by the thick filaments containing myosin that extend to either side of the M-line. Syllabus C. The contraction of the muscle is produced by the movement of the myosin along the actin filaments. This draws the thin filaments in towards the center of the sarcomere and thereby shortens the distance from Z-line to Z-line. The overlap of actin and myosin filaments will be a short stretch at rest but in a contracted muscle, the Z-line may be pulled in almost to the edge of the thick filaments.