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Pathology in SM L1.doc

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Italian Studies
Rob Pryce

Pathology in Sport Med. Lecture 1 Evidence based medicine is the conscientious, explicit and judicious use of the best available information. It is used to make decisions about the care of patients. Example: Cardiac Arhythmia Supression Trail (~late1980’s/early 90’s) Problem- a 8-15% mortality rate post heart attack (MI), half of which died of heart rate problems (arrhythmias). Controlling HR: - SA node (innervated by vagus nerve X) = primary control (100bpm) Parasympathetic nervous system decreases HR via acetacholine (60-80bpm) Sympathetic NS increases HR via epinephrine. [Fight or flight vs Rest and digest] Options for Controlling HR: • Beta-blockers (CLASS II)—reduce sympathetic input to cells (which decreases HR). They do this by binding/interfering with receptors for norepinephrine and epinephrine. • NA+ channel blockers (CLASS I)—NA+ initiates depolarizations of a nerve cell (from a negative resting potential (-70mv)). There is more NA+ outside the cell. NA+ blockers cause it to take longer to depolarize (for NA+ to rush into cell) which slows HR. • K+ channel blockers (CLASS III)—More K+ inside cell, K+ initiates repolarization (K+ rushes out, decreases conc. Gradient= cell becomes negative). K+ blockers prevent/increase the time to repolarize (prevents 2 ndaction potential), which decreases HR. • Ca+ channel blockers (CLASS IV)—CA+ initiates muscle contractions in skeletal and cardiac muscle. Sarcoplasmic Reticulum= troponin- tropomyosin-actin/myosin. In cardiac muscle, Ca+ helps
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