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Lecture

heart chemistry, mental illness 1.pdf

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Department
Chemistry
Course
CHEM 183
Professor
Joe Schwarcz
Semester
Fall

Description
Lecture8 October-23-12 8:21 PM HEARTCHEMISTRY/MENTAL ILLNESS 1 • Historicallywasthoughtthattheheartwasthecenterofemotionsandintellect • Whentheymadethemummies,tookoutthebrain,butputtheheartinajar, thenputback in thebody ○ Thoughttheheartheldemotionsandwasneededintheafterlife • AncientRomansthoughttheheartmadebloodandpumpeditthroughthearteriestodeliver"vitalspirit" • LeonardodaVincifirstrealscientisttolookatheart • Drewveryaccurateanatomicaldiagramsoftheheart • DrawingsweresogoodthatasurgeoninEnglanddevelopedamethodtorepairavalveintheheartbasedondaVinci'sdrawings • WilliamHarvey(Britishphysician)recognizedwhatheartdid ○ Heartwasa pumpthatcirculatedbloodaroundthebody ○ Hearthad 2mainfunctions:  Pumpoutbloodintolungsthroughpulmonaryartery  Bloodwouldcomebackfromlungs(oxygenated)andwouldbedeliveredtotherestofthebody • Heartpumps5-6litresofbloodperminutethrough100,000km of bloodvesselsbeatingupto2.6billiontimesthroughlifetime • Changesrateonpumpingbasedonneed • Arteries(red)carryoxygenatedblood • Venus(blue)bloodcarriesbloodbacktoheart&lungsto pickup oxygen • Largestvein:venacava- comesback to heartaftercollectedusedbloodfrombody,thenitispumpedouttolungstopickoutoxygen,thenbackto theheartandto thecellsinthebody • Bloodvesselsaresmallerfartherawayfromheart • Smallestvesselsarecalledcapillaries ○ RBCsneedtopass throughcapillariesindividually • Capillaries-->arterioles-->arteries Thingsthat can go wrong: • Failuretopumpenoughblood,cellsbecomestarvedofoxygen • Impairmentofelectricalactivity ○ Beatingofheartguidedbysetofmusclesonsurfaceofheartcalledpacemaker-->stimulatesheartelectrically • Reducedflowofbloodthroughcoronaryarteries ○ Heartwillnotgetenoughoxygenandcannotpumpproperly • Improperfunctioningofheartvalves ○ Blooddoesn’tmakeproperpassage-->leadtoheartdisease RiskFactors: Theseareallindependentriskfactor • Familyhistory • Acrease inthe earlobe ○ Markerforheartdisease ○ Creasedoesnotcauseheartdisease(justamarker) ○ Samegenesthatcontrolfunctioningofheartcontrolthecreaseintheearlobe • Baldness ○ Menwhogo baldearlyhaveagreatriskof heartdisease ○ Hormonalconnection ○ Baldmenhavehigherlevelsofdihydrotestosterone(maybeinvolvedinheartdisease) • Borna male ○ Menhaveheartattacks atgreaterrates thanwomen(untilmenopause,itevensout) ○ Heartdiseaseisstillthe#1killerofwomen ○ Women'ssymptomscandifferfrommen(morediffusedsymptomslikesweating,panic,paininthearm)  Estrogen?Ifitwasprotectivefactor,thenmakessensethatmenopausalwomenarehigheratriskforheartdisease  Isnotthe case,estrogendoesnotreduceriskofheartdisease  Slightlyincreasesriskofbreastcancer • Smoking ○ Greaterlinktoheartdiseasethancancerand heartdisease • Obesity • Diabetes ○ Morelikelytodevelopifyouareoverweight ○ Glucoselevelstoohighinblood ○ Glucosegetsconvertedtofatifitisnotusedup anddepositsincells • Howdoyou knowifyouhavehighbloodglucose? ○ Mustmeasureif ○ Nosymptoms ○ 2system: i. mg/dL=mmol/L*18 126 = 7x 18 ○ Fastingbloodglucose:(notconclusive,mustberepeatedoruseoralglucosetest)  Diabetes>7mmol/L  Prediabetes5.5-7mml/L ○ Oralglucosetolerance:moreaccurate,drinkaliquidwithfixedamountofglucose,thentheymeasurehowquicklyglucosedissipatesinbody  Diabetes>11mmol/L  Prediates7.8-11mmol/L • HemoglobinA1c • Averagebloodsugarover2-3months • Toomuch glucose,glucosewillbindtoproteinsonsurfaceofRBC • Lessthan7% saturation(correspondstoaveragebloodglucoseof8.3mmol/L) • Upto 50% of prediabeticswilldevelopdiabetesin5-10years! • Cholesterol ○ Buildsupinbodytofactors indiet ○ Essentialbiochemical ○ Neededtomakeadrenalglandhormones,sexhormones ○ Toomuch willtriggeractivitiesinbloodvessel,causedepositstoformandthiswillcauseaheartattack ○ Around1/3ofallheartattacks and strokescan beavoidedinpeopleathighriskbyusingstatin drugsto lowercholesterol ○ Statindrugworkswelltobringdowncholesterol  Callthemaclass(Lipitor)becausetheyallbehavethesame  Majorsideeffect:muscleaches(canbesevere)  Needtomonitorliverfunctionssincestatincanaffectthat • Homocysteine-formedinbodynaturally ○ BrokendownnaturallytoobyBvitamins ○ WithoutadequateBvitamins,homocysteinereacheslevelsthataretoxictothecellsthatlinebloodvessels ○ Notacauseof heartdisease,butassociatedwithit ○ Bvitaminsdidnotpreventheartdisease • Inflammation ○ Whentissuesgetred,swollen,riseintemperature,andpain-->classicsignsofinflammation ○ Canhappeninsideofcoronaryarteries(morelikelytogetdeposits=higherchanceofheartdisease) ○ C-reactiveproteinmeasureinflammationinbody  Measuredbybloodtest ○ Givesyouaguideifthereisariskin internalinflammation ○ 1997 Harvard study:healthymenwiththehighestlevelofC-reactiveproteinhad3xtheriskfactor ○ HighCRP(>100mg/L) is morelikelytooccurin bacterialthanviralinfection,adanormalCRPis unlikelyinthepresenceofbacterialinfection, (couldalsobeLupis) ○ However,immediateCRPlevels(10-50mg/L)maybeseeninbothbacterialandviralconditions • Chlamydiapneumoniae ○ Triedtoseeifthisbacteriawasrelatedtoheart disease • Ayearafterreceivingaweek-longcourseofantibiotics,heartdiseasepatientswere40%lesslikelytosufferanotherheartattackorhospitalization forchestpain(earlystudies) • Asbettertestsstartedbeingdoneinearly2000, antibioticswerenotveryeffective • Wasshownthatheartdiseasewasn'trelatedtobacterialinfection(bacterianotresponsible) • Hypertension=highbloodpressure • Systolic/diastolic • Systolicrepresentspressureofbloodwhenheartispumping • Diastolicispressurebetweenbeats • Averageis120mmHg/80mmHg • Ifsystolicisover134, and diastolicisover90, startingto lookathypertension • Onlywaytoknowbloodpressureistomeasureit • Whitecoldhypertension-bloodpressureishigherwhenyouarenervous,soyouneedtotakeseveralbloodpressureteststoactuallydetermineif youhavehypertension • Highbloodpressurepredisposestoheartdisease • Study:103 hypertensionpeoplestudied,25%had6mmHgincreasewhentheywerewiththeirpartners(notloving),anddecreased6mmHgin loving • Showsthatthereisalinkbetweenemotionalsituationsandbloodpressure Howcan hypertensionbelowered? • Exercise,equivalentof30minutesaday • Or30 minutes*7days a weekofexercise • Dietaryapproachtostophypertension(DASH) • Adiethighinwholegrains,fruits,vegetablesandlow-fatdairyproductsandrestrictedinfat(restrictedinredmeat) • IncorporatebananasbecausetheyarehighinK+ ○ Helpslowerbloodpressure • Needtocontrolsaltintake ○ Saltcausesbodytoretainwater,so themoreliquidyouhaveinyourveins,thehigherthebloodpressure ○ Foundinplacesyouwouldnotthink(cakes,cookies,breads)-->readlabel • IncreaseK,decreasesodium • Ifexerciseanddietdon'twork-->needtotakemedications Medicationsthatlowerbloodpressure: • Diuretics(bestprofileinreducingsideeffect) ○ Causeyoutourinatemore ○ Losemoisture,reducebloodvolume,thusloweringbloodpressure ○ Usedtobe issuesbecausewhenyouurinatemore,moreK+islost ○ ButnowK+is inthepill ○ Dyazide(medicationbrand) ○ Mostphysiciansprescribediureticsfirst ○ Makeitdifficultforkidneystoretainwaterandsalt,whicharethenfilteredoutintotheurine ○ Increasingtheamountofurinereducestheamountoffluidinthebloodstream,andhencethepressureonarterywalls ○ Hastheleastsideeffects • Aceinhibitors ○ BlocksformationofangiotensinIIwhichincreasesbloodpressure ○ Vasotec ○ Normalroleistomaintainequilibriumwhenbloodpressuredrops ○ Itacts directlyonthearteries,tighteningthemuptoraisethepressure ○ Aceinhibitorscanbringbloodpressuredownquicklybutinveryrarecasescan causekidneydamageorareductioninthenumberofwhite bloodcells(leadingtoincreasedsusceptibilitytoinfection) • Betablockers ○ Blockactionofadrenalin ○ Inderal ○ Easestheworkoftheheart ○ Reducehighbloodpressurebythrottlingbacktheforceandspeedoftheheart ○ Mayalso reducebloodpressurebyadirecteffectontheCNS ○ Sideeffectcanbebaddreams,musclepains • Calciumchannelblockers ○ Actsbydilatingarteriesandreducingresistancetotheflowofblood ○ Provedtobebeneficialnotonlyforhighbloodpressure,butalsoforanginaandotherproblemsofaweakenedheart ○ SomeCa+channelblocksarenowavailablecombinedwithanACEinhibitorinasinglepill • Angiotensinreceptorantagonists ○ Newest,thereforetheleastused ○ Diovan ○ InsteadofblockingformationofangiotensinII(likeACE),theyblockreceptorsiteforangiotensinIIinsmoothmusclesofthebloodvessels ○ Thisblockingactionstopstheangiotensinfromtighteningthearteriesandraisingthebloodpressure ○ "wrongkey"andpreventsangtiotensinIIfromfitting Angina • Chestpain • Happenswhenheartisstarvedofoxygen • Needsconstantsupplyofglucoseandoxygen • Heartissurroundedbybloodvessels • Coronaryarteries: a. Leftdescendingcoronaryartery b. Rightdescendingcoronaryartery c. Circumflexartery(goesaroundtheback) ○ Eachoriginateinaorta,whichcomesfromleftventricleanddeliversoxygenatedbloodaroundbody(includingheart) ○ Ifthereisablockageinthesearteries,thecellsbelowtheblockagewillnotgetoxygen ○ Willdieafterafewminuteswithoutoxygen ○ Liningofbloodvesselsinwhichbloodvesselballoonsout ○ Stucktoinsidelining ○ Whenyougetexpansionofartery,itcanburst ○ Bodywillperceiveitasinjuryandrushesplateletstoformabloodclot(intheartery),whichwillpreventbloodflowandcauseaheartattack • Anginapectoris ○ Notsufficientbloodflow • Exerciseinduced • Vasospasticunstableangina(happenswhenyouareatrest) • Arteriescanspasm • Ifheartisnotsufficient,youknowarteriesareblocked • Othertests: ○ Stresstests ○ Injectwithcertaindyes,thenusex-ra
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