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Midterm 2 Notes (part 2) .pdf

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CHEM 183
Joe Schwarcz

World of Chem Drugs: Midterm 2 Notes CHEMISTRY OF THE HEART - Ancient Egyptians fascinated by heart, believed it was the center of emotions and intellect - Ancient Romans intrigued by heart - Galen, Roman Physician – observed heart in open chest cavities (he took care of gladiators) – believed heart manufactured blood and it pumped this blood through arteries, delivering vital spirit to the body - Leonardo Da Vinci – first real scientist to look at heart – diagrams of the heart very detailed, allowed for development of surgical procedure - Francis Wells developed technique to repair mitral valves based on drawings - William Harvey (1600s) – realized heart was a pump and did not manufacture blood - Heart had 2 functions: 1.Pump out blood into the lungs, then oxygenated through pulmonary artery 2.Pump blood back from lungs (picked up oxygen in lungs) into heart to be circulated through body (comes out of heart through aorta – subdivides to deliver blood and nutrients to body – smallest subdivision called Capillaries, so narrow RBCs pass through individually) - Heart located at centre of chest cavity, size of human fist, pumps 5–6 L of blood/min through 100,000km of blood vessels, beats 2.6B times in our life How the Heart Works - Red – blood vessels carrying oxygenated blood; Blue – blood on way to heart and lungs to pick up oxygen - Blood returns to heart via Vena Cava (largest vein) – there are 2: one from lower body and legs, one from head and arms – veins enter in Right Atrium, right side of heart collects used blood. Blood pumped down into Right Ventricle, which pumps blood to lungs via Pulmonary Artery. Newly oxygenated blood comes back via Pulmonary Vein into Left Atrium. Blood pumped down to Left Ventricle – needs to be the strongest to give oxygen to heart, fed by coronary arteries. Blood pumped out through Aorta (biggest artery) to rest of body. - Arteries: carry blood away from the heart - All arteries carry oxygenated blood except for Pulmonary Artery - Veins: carry blood to the heart - All veins carry deoxygenated blood except Pulmonary Vein What Can Go Wrong? – Heart Diseases - Failure to Pump Enough Blood: cells oxygen starved – heart needs constant supply of oxygen b/c it is a muscle - Impairment of Electrical Signal: cells on heart that act as a pacemaker, heart will not pump regularly when signal is defected - Reduced Flow of Blood Through Coronary Arteries: arteries feed heart constant supply of oxygen (Corona means crown, arteries surround heart like a crown) - Improper Functioning of Heart Valves: hearts pumping efficiency decreased Risk Factors Predisposing us to Heart Disease - Downward wrinkle or crease on earlobe – indicates greater susceptibility to heart disease - Baldness – men who go bald earlier have a higher risk of developing heart disease - There are all independent risk factors, the more of these risk factors you have the more you should pay attention to them - Being Male – risk factor - Men more likely to develop heart disease, after women undergo menopause the amount of heart attacks evens out b/w men and women - Prior to menopause risk of heart attacks for men 10x greater – estrogen has nothing to do with it, women in menopause taking estrogen just as likely to get a heart attack as those who are not - Heart disease not as prevalent in women, but is a #1 killer – physicians assume problem is something else, heart disease may not manifest itself with classic symptoms - Smoking – huge risk factor, bigger risk factor for heart disease than for lung cancer - Obesity – more weight you have, more blood vessels, harder heart has to work - Diabetes - Glucose is a source of energy, cells burn glucose (why we need oxygen) – blood delivers oxygen to burn glucose, which gets converted into CO and water - If blood glucose levels are high and all glucose is not used for energy, starts to get converted to fat deposits in fat cells – Glucose gives rise to glycocerated end products, risk factors for heart disease - How do you know if you have higher blood glucose? - Measure: Milligrams/Deciliter (mg/dl used in US) or Millimoles/Liter (mmol/L in Can, Europe) - Conversion Factor: mg/dl = (mmol/L)(18) 15 World of Chem Drugs: Midterm 2 Notes - Blood glucose b/w 5.5–7 mmol/L – Pre-Diabetes - Cutoff Level: blood glucose = 7mmol/L after an overnight fast - Blood Glucose + 7mmol/L after overnight fast do an Oral Glucose Tolerance Test: given a fixed amount of glucose to drink, 30m and 1h later check levels, if result is over 11mmol/L after 1 hour you have diabetes (7.8–11 mmol/L = Pre-Diabetes) - Hemoglobin A1C Test – gives idea of your average blood glucose levels over past 2–3 months, analyze how much hemoglobin in RBCs reacted with breakdown products of glucose, less than 7% = blood glucose of 8.3 mmol/L (diabetes) - 50% of pre-diabetics develop diabetes in 5 to 10 years unless blood glucose is lowered - First Symptoms/Signs: double vision, excessive thirst, excessive urination Fasting/Pre-Meal 1/2hrs. Post-Meal Ideal 4–6 mmol/L 5–8 mmol/L Optimal 4–7 mmol/L 5–10 mmol/L Sub-Optimal 7.1–10 mmol/L 10.1–14 mmol/L Inadequate 10+ mmol/L 15+ mmol/L - Cholesterol – essential biochemical for life – our body makes it, we do not need to consume it - High levels in blood leads to deposits forming in blood vessels, can cause heart attack - Saturated fats are the main cause of high cholesterol, they induce the body into making more cholesterol - 1/3 of all heart attacks and strokes could be prevented by taking Statins: drugs that reduce cholesterol - Statins prevent liver from producing cholesterol by interfering with enzyme that makes cholesterol - All Statins have side effects, liver function needs to be constantly examined - Lipitor most popular Statin, main side effect is muscle ache; Zocor another example - Homocysteine – chemical that is thought to be a risk factor – higher levels of this naturally occurring compound (formed from amino acid, Methionine) linked to a greater cause of heart disease - Metabolized by B vitamins, inadequate B vitamin intake can lead to high levels of homocysteine, which can be toxic to cells lining blood vessels where deposits can then form - Inflammation – swelling, increase in temperature, pain, redness (internal inflammation) - When inflammation inside arteries, deposits build and risk increases - C-reactive Protein (CRP): inflammatory marker – high levels indicate high risk of heart disease - Harvard, 1997 – healthy men with high levels of CRP had highest levels of heart attack risk - Chalmydia Penumoniae – theory that bacteria can cause heart disease (developed after ulcer bacteria) - Treatment of heart disease using antibiotics was investigated – not true - Hypertension – elevated blood pressure - Measuring blood pressure: Systolic/Diastolic 1.Systolic Blood Pressure: when heart is pumping out blood, during a heartbeat 2.Diastolic Blood Pressure: while heart is resting inb/w pumping, blood flowing back into heart - Normal = 120/80mm Hg (millimeters of mercury); Hypertension 135/90mm Hg - White Coat Hypertension: when people stress about their blood pressure being taken and it goes up - Blood pressure needs to be measure several times for this reason - 2 Types of Hypertension: Mental Stress-Caused and Essential Hypertension (cause unknown) - Case Study – bad marriage can raise blood pressure, people in bad marriages have 6mm Hg higher blood pressure - Reducing Blood Pressure: - Exercise – 30m/day, 7 days/week - Diet – DASH (Dietary Approach to Stop Hypertension) – whole grains, fruit, vegetables, low-fat dairy, restricted fat (low in animal fat and red meat) – bananas important b/c contain potassium, which reduces blood pressure – apples high in antioxidants – cut down salt intake (increase blood pressure b/c sodium causes body to retain water, more liquid, more pressure) - Medications to Reduce Blood Pressure: - Diuretics – should be first used, best safety profile – make you urinate more, causing more excretion of water and salt, decreases blood pressure by removing water from blood which lowers total amount of liquid – drugs normally end in ‘ide’ – may cause potassium loss - ACE Inhibitors (Angiotensin Converting Enzyme Inhibitor) – Ex. Vasotec 16 World of Chem Drugs: Midterm 2 Notes - Block formation of Angiotensin II by blocking enzyme that makes it – Angiotensin II required to raise blood pressure when body is exercising , blood pressure drops by blocking formation - Beta Blockers – Ex. Inderal – interfere with activity of Adrenaline by blocking Adrenaline receptor sites, beta blockers reduce blood pressure by throttling back the force and speed of heart – side effects are bad dreams and muscle aches - Calcium Channel Blockers – Ex. Adelate – cause arteries to relax and dilate, lets blood flow through more easily – calcium important for nerve function - Angiotensin II Receptor Antagonist Drugs – Ex. Diovan – work by blocking reception Angiotensin II would normally bind to - New class of drugs so not widely used Angina – Symptom of Heart Disease - Angina: painful constriction in the chest - Anginas are mainly exercised induced - Occurs when heart not getting enough oxygen – Aorta is filled with oxygenated blood as it comes out of L Ventricle of heart, it subdivides, one subdivision is coronary arteries, which deliver oxygenated blood to heart – Problem when coronary arteries are blocked and oxygen supply to heart is slowed (pain due to low supply of oxygen) - Decrease in cross section of coronary arteries, less blood can flow through – deposits become a part of lining of artery wall causing ballooning of lining – heart put under stress and unable to meet its own oxygen requirements b/c not enough blood flowing through coronary arteries - Dangerous if a plaque bursts, blood clot forms, plugging arteries completely which causes tissue being fed by artery to die - Vasospastic Angina: Angina during rest, arteries go into spasm which chokes off flow of blood – if there are large plaques already deposited in arteries, less intense spasm can choke off flow of blood - Treatments: common to be on beta blockers and calcium channel blockers - Nitroglycerine used to treat Anginas (also used in dynamite, flammable and explosive substance) - Dilates
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