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What is the biggest risk factor for getting CV disease?
What does hypertension do specifically to increase the risk of CV disease?
- increased hypertrophy of left ventricle
- increased risk of CAD
- increased norepinephrine
What is the goal BP for a normal person?
What is the goal BP for a diabetic?
What is the second biggest risk factor for developing CV disease?
- **Altered protein function
How can you directly target or lower the risk of CHD in a diabetic patient?
lower the hemoglobin A1C
What are AGEs?
advanced glycation endproducts
What is the third greatest risk factor for developing CV disease?
What are some common biomarkers associated with hyperlipidemia?
- BMI greater than 25 kg/m2HDL lower than 50 mg/dL
- TG greater than 150 mg/dL
- LDL greater than 70 mg/dL
- Total Cholesterol
- Lipid ratios
- Ratio of apo B/A-1 (apolipoproteins)
What do C-Reactive Proteins have to do with CV disease?
- they are a sign of inflammation and a risk factor for CV disease
- made in the liver
- clearly associated with increased risk in men (not nec. women)
What is the only recommended marker of inflammation at this point in time?
hsC-Reactive Protein (hsCRP)
What is hsCRP?
- an acute phase inflammatory protein produced in the hepatocytes of the liver
- increased during any systemic infection
- its exact role in the body is unknown, but it might contribute to innate immunity and suppression of autoimmunity
What types of infections might you see elevated levels of hsCRP?
- gastric inflammation
- hormone replacement therapy
What other markers (besides CRP assay) could show presence of inflammation, but are more difficult to perform?
- oxidized low-density lipoproteins
- adhesion molecules
- SAA (serum amyloid A)
What used to be a popular way to lower homocysteine levels?
consuming large amounts of folic acid and B vitamins
Are increased homocysteine levels bad for you (increase CV risk)?
used to think so, but not so much anymore
Do B vitamins and folic acid really have a benefit in reducing CV disease?
no, they may lower the levels, but there is no hard evidence
What do elevated levels of homocysteine put you at risk for?
- forming a clot
- high levels modify fibrinogen lysine by thiolactone
What are the three main potential issues with homocysteine?
- modification of fibrinogen
- modification of fibronectin
- modification of cytochrome C
This molecule probably plays a role in artherosclerotic plaque formation but is NOT a cause of CVD?
Name some lifestyle habits that would increase your risk for CVD.
- poor diet
- alcohol abuse
- lack of physical exercise
- sleep disorder breathing (apnea)
Which increased serum level would indicate an increased risk for CVD?
GGT (gamma-glutamyltransferase): a liver enzyme
T/F: Genetic factors can increase your risk for CVD.
Can you reverse left ventricle hypertrophy and hypertension? If so, how?
Yes, with beta 1 selective beta blockers (must be started early)
What neurotransmitter causes left ventricular hypertrophy in excessive amounts?
Which cardiac drug class is absolutely critical to be used in acute heart failure?
What part of the inflammatory immune process does CRP affect when it binds to phosphocholine groups in cell membranes?
What is the primary mechanism of diuretics?
direct inhibition of sodium transport at one or more of the four major anatomical sites in the nephron where sodium reabsorption occurs
What are 3 telltale signs that someone might have acute heart failure, but are usually overlooked?
- use more pillows
- shoes don't fit
- dry cough attributed to something else
What are five under-appreciated aspects of acute heart failure?
- 50% have systemic HTN (greater than 140)
- 40% have preserved left ventricular ejection fraction
- kidney problems
- process of care is important
What does 'wet' mean (in respect to heart failure)?
patient comes into ER with a large amount of fluid retention
_____ are classified by their electrolyte excretion patterns?
What makes each type of diuretic agent have a unique action on different locations of the nephron in the kidney?
rigid structural features
What is SAR and what is it's significance?
- Structure Activity Relationship
- it is data for diuretics that was determined in humans and animals, but can give misleading efficacy data
What are the 6 different types of diuretics classified according to electrolyte excretion patterns?
Which of the 6 types of diuretics is the most effective?
This diuretic enhances sodium excretion?
This diuretic enhances chloride excretion?
This diuretic enhances both sodium and chloride excretion?
This diuretic enhances potassium excretion?
This diuretic enhances sodium bicarbonate excretion?
This diuretic enhances calcium excretion?
Each renal tubule contains 4 functional areas that diurectics act on. Name the 4.
- Proximal tubule
- Loop of Henle
- Distal convoluted tubule
- Collecting tubule
Where do the most potent diuretics act in the renal tubules?
Loop of Henle
What is the main function of the proximal tubules in the kidney?
resorption of Sodium, Potassium, Chloride, and all glucose and amino acids by active transport
The interstitial fluid in this area of the kidney has an increasing osmotic pressure gradient (280 to 1400 mOsm/L)?
Loop of Henle
10% of filtered water is reabsorbed here?
descending limb of Loop of Henle
25% of filtered sodium and chloride are reabsorbed here?
ascending limb of Loop of Henle
What does carbonic anhydrase do in the kidney?
- creates an electrochemical gradient that aids in sodium reabsorption by proton exchange
- carbon dioxide + water = H+ and HCO3-
Each kidney contains approximately how many nephrons?
What is the juxtaglomerular apparatus?
it is the connection between the ascending limb of the Loop of Henle and the glomerulus
What is the function of the juxtaglomerular apparatus?
- feedback regulation of blood flow and GFR
- secretion of renin
66% of water is reabsorbed where in the kidney?
What are three important factors to consider about diuretics?
- Relative potency
the amount of drug (mg/kg) needed to produce a desired effect
Define relative potency.
- a means of comparing two diuretics as expressed as a ratio of "equi-effective doses"
- a small dose of Drug A compared to a large dose of Drug B