1. Clinical pathophysiology of the cardiovascular system.

2. Blood Pressure Exhibits a normal distribution within the population Exhibits a normal distribution within the population Increasing blood pressure is associated with a progressive increase in the risk of stroke and cardiovascular disease Increasing blood pressure is associated with a progressive increase in the risk of stroke and cardiovascular disease Risk however rises exponentially and not linearly with pressure Risk however rises exponentially and not linearly with pressure

3. At what blood pressure is a patient hypertensive? BHS140/90 BHS140/90 JNC-VI 140/90Opt <120/<80 JNC-VI 140/90Opt <120/<80 WHO-ISH140/90 WHO-ISH140/90 The current recommendation in the UK is 140/90 The current recommendation in the UK is 140/90 However risk is important and in diabetes 130/80 However risk is important and in diabetes 130/80

4. In 95% of cases no cause can be found In 95% of cases no cause can be found In 5-10% a cause can be found In 5-10% a cause can be found –Chronic renal disease –Renal artery stenosis –Endocrine disease, Cushings, Conn’s Syndrome, Phaeochromocytoma, GRA

5. Home Blood Pressure Monitoring Home Blood Pressure Monitoring –Mercury sphygmomanometer  Standard for BP monitoring  No calibration  May be bulky  Need a second person to use machine  May be difficult for hearing impaired or patients with arthritis

6. Home Blood Pressure Monitoring Home Blood Pressure Monitoring –Aneroid equipment  Inexpensive, lightweight and portable  Two person operation/need stethoscope  Delicate mechanism, easily damaged  Needs calibration with mercury sphygmomanometer

7. Home Blood Pressure Monitoring Home Blood Pressure Monitoring –Automatic equipment  Contained in one unit  Portable with easy-to-read digital display  Expensive, fragile  Must be calibrated  Requires careful cuff placement

8. Electrocardiogram It is the method of registration of heart bioelectrical potential from the chest of patient It is the method of registration of heart bioelectrical potential from the chest of patient

9. Electro gram of cardiac muscle

12. Waves of ECG 1. P wave – depolarization of atria, precedes atria systole 1. P wave – depolarization of atria, precedes atria systole 2. QRS wave is depolarization of ventricles, precedes ventricular systole 2. QRS wave is depolarization of ventricles, precedes ventricular systole 3. atria repolarization also occurs at QRS 3. atria repolarization also occurs at QRS 4. T wave indicates ventricular repolarization 4. T wave indicates ventricular repolarization

14. ECG leads a) Bipolar limb leads. The bipolar limb leads record the voltage between electrodes placed on the wrists and legs. These leads were proposed by Einthoven in 1913. a) Bipolar limb leads. The bipolar limb leads record the voltage between electrodes placed on the wrists and legs. These leads were proposed by Einthoven in 1913. I lead: left arm (+) - right arm (-); I lead: left arm (+) - right arm (-); II lead: left leg (+) - right arm (-); II lead: left leg (+) - right arm (-); III lead: left arm (+) - left leg (-). III lead: left arm (+) - left leg (-). For recording limb leads we put red electrode on right arm, yellow - on left arm, green - on left leg and black - on right leg. Black electrode has zero potential (ground). For recording limb leads we put red electrode on right arm, yellow - on left arm, green - on left leg and black - on right leg. Black electrode has zero potential (ground).

16. ECG leads The unipolar limb leads were proposed by Goldberger in 1942. They record voltage between single “exploratory electrode” fro one limb and zero joined electrode from two other limbs. So there are three leads AVR, AVL, AVF. In fact zero electrodes records middle voltage of two limbs. Bipolar limb leads and unipolar limb leads record electrical power in frontal projection. The unipolar limb leads were proposed by Goldberger in 1942. They record voltage between single “exploratory electrode” fro one limb and zero joined electrode from two other limbs. So there are three leads AVR, AVL, AVF. In fact zero electrodes records middle voltage of two limbs. Bipolar limb leads and unipolar limb leads record electrical power in frontal projection.

18. ECG leads V1 - in crossing right IV right intercostal space and parasternal line; V1 - in crossing right IV right intercostal space and parasternal line; V2 - in crossing left IV intercostal space and parasternal line; V2 - in crossing left IV intercostal space and parasternal line; V3 - between V2 and V4; V3 - between V2 and V4; V4 - in crossing V left intercostal space and medioclavicular line; V4 - in crossing V left intercostal space and medioclavicular line; V5 - in crossing V left intercostal space and anterior axilar line; V5 - in crossing V left intercostal space and anterior axilar line; V6 - in crossing V left intercostal space and middle axilar line. V6 - in crossing V left intercostal space and middle axilar line.

28. Holter Monitor

29. Echocardiography 1. M-measure 1. M-measure 2. D-measure 2. D-measure 3. Doppler 3. Doppler 4. Contrasting 4. Contrasting

31. II position

32. АО

38. Cardiac Biomarkers 1.MI is diagnosed when blood levels of sensitive and specific biomarkers, such as cardiac troponin (I or T) and CK-MB (mass assay) are increased to values greater than 99% of a normal reference population (with less than 10% coefficient of variation of the assay) 2.These biomarkers reflect myocardial damage, but do not indicate its mechanism 3.ASAT, LDH isoenzymes should not be used to diagnose myocardial damage

42. Roentgenogram NORMAL MITRAL STENOSIS

43. ROENTGENOGRAM NORMAL AORTIC STENOSIS

44. Thank you! Thank you!