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    Diabetes clinical trails PPT Diabetes clinical trails PPT Presentation Transcript

    •  
      • The cardiovascular system incorporates the heart blood vessels and lymphatic vessels.
      • The main purpose is to maintain adequate blood circulation and hence the distribution of nutrients to tissues and the delivery of metabolic wastes to excretory/urinary organs
      • Angina pectoris
      • Atherosclerosis
      • Myocardial infarction
      • Hypertension
      • Congestive heart failure
      • Arrythmias
      • In vitro is performed not in a living organism but in a controlled environment, such as in a test tube or Petri dish.
      • In vivo is experimentation using a whole, living organism as opposed to a partial or dead organism,
      • Blood Tests
      • Angiography
      • Cardiac Catheterization
      • Computed Tomography (CT scan)
      • Echocardiography
      • Electrocardiogram (ECG or EKG)
      • Electrophysiology Studies (EPS)
      • Cardiac Magnetic Resonance Imaging (Cardiac MRI)
      • Gated Blood Pool Scan
      • A complete blood count (CBC) is one of the most common blood tests.
      • It helps to detect a number of blood disorders, such as anemia, infections, clotting problems, blood cancers, and immune system problems.
      • A CBC test measures many different parts of your blood, including the number of red blood cells, white blood cells, and platelets.
      • It also measures the hemoglobin (iron) levels in your blood.
      • Cardiac enzyme tests (CK, CK-MB, LDH)
      • Myoglobin test
      • Troponin tests
      • Lipoprotein (cholesterol) profile (TC, HDL, LDL, VLDL, FFA, PL)
      • Cardiac enzyme tests , which measure the cardiac enzyme levels in the blood. Certain enzymes will be present if the heart muscle (myocardium) has been damaged by a heart attack, because damaged heart cells release these enzymes into the blood.
      • The most common cardiac enzyme that is released is creatine kinase.
      • Creatine kinase (CK), also known as creatine phosphokinase (CPK) is an enzyme expressed by various tissues and cell types
      • Clinically, creatine kinase is assayed in blood tests as a marker of myocardial infarction (heart attack)
      • Creatine kinase is composed of two subunits, CK-M (muscle type) and CK-B (brain type), which are combined into three distinct isoenzymes: CK-MM, CK-MB, and CK-BB.
      • CK-MB is a more sensitive marker of myocardial injury than total CK activity, because it has a lower basal level and a much narrower normal range. Medical literature commonly states that CK-MB levels become elevated in 4 to 6 hours, peak at 10 to 24 hours, and return to normal within 3 to 4 days after an acute myocardial infarction. 
      • Lactate dehydrogenase (LDH or LD) is an enzyme present in a wide variety of organisms, including plants and animals. Lactate dehydrogenases exist in four distinct enzyme classes.
      • Two of them are cytochrome c-dependent enzymes with each acting on either D-lactate or L-lactate . The other two are NAD(P)-dependent enzymes with each acting on either D-lactate or L-lactate .
      • Myoglobin is an iron- and oxygen-binding protein found in the muscle tissue of vertebrates in general and in almost all mammals. It is related to hemoglobin, which is the iron- and oxygen-binding protein in blood, specifically in the red blood cells. The only time myoglobin is found in the bloodstream is when it is released following muscle injury. It is an abnormal finding, and can be diagnostically relevant when found in blood.
      • Myoglobin is released from damaged muscle tissue (rhabdomyolysis), which has very high concentrations of myoglobin. The released myoglobin is filtered by the kidneys but is toxic to the renal tubular epithelium and so may cause acute renal failure.
      • Myoglobin is a sensitive marker for muscle injury, making it a potential marker for heart attack in patients with chest pain. However, elevated myoglobin has low specificity for acute myocardial infarction (AMI) and thus CK-MB, cTnT, ECG, and clinical signs should be taken into account to make the diagnosis.
      • Troponin tests , which measure the amount of troponin (a type of protein) in the blood. Troponin affects how the heart muscle contracts. If there are high levels of troponin in the blood (troponin T or troponin I), there is most likely damage to the heart muscle.
      • The amount of troponin released into the blood correlates with the degree of damage to the heart muscle.
      • Troponin is a complex of three regulatory proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle.
      • Troponin often pertain to its functional characteristics and/or to its usefulness as a diagnostic marker for various heart disorders.
      • Troponin activation. Troponin C (red) binds Ca2+, which stabilizes the activated state, where troponin I (yellow) is no longer bound to actin. Troponin T (blue) anchors the complex on tropomyosin.
      • Lipoprotein (cholesterol) profile, which measures how much fat or lipid is in the blood.
      • A lipoprotein is a biochemical assembly that contains both proteins and lipids.
      • Many enzymes, transporters, structural proteins, antigens, adhesins and toxins are lipoproteins.
      • The function of lipoprotein particles is to transport lipids (fats) (such as triacylglycerol) around the body in the blood.
      • Chylomicrons carry triglycerides (fat) from the intestines to the liver, skeletal muscle, and to adipose tissue.
      • Very low density lipoproteins (VLDL) carry (newly synthesised) triacylglycerol from the liver to adipose tissue.
      • Intermediate density lipoproteins (IDL) are intermediate between VLDL and LDL. They are not usually detectable in the blood.
      • Low density lipoproteins (LDL) carry cholesterol from the liver to cells of the body. LDLs are sometimes referred to as the "bad cholesterol" lipoprotein.
      • High density lipoproteins (HDL) collect cholesterol from the body's tissues, and bring it back to the liver. HDLs are sometimes referred to as the "good cholesterol" lipoprotein.
      • abnormal cholesterol levels (hypercholesterolemia) - that is, higher concentrations of LDL and lower concentrations of functional HDL-are strongly associated with cardiovascular disease because these promote atheroma development in arteries (atherosclerosis).
      • LDL particles are often termed "bad cholesterol" because they have been linked to atheroma formation. On the other hand, high concentrations of functional HDL, which can remove cholesterol from cells and atheroma, offer protection and are sometimes referred to as "good cholesterol".
      • Blood cultures, which can be used to determine if there are microorganisms (like the bacteria that causes endocarditis { Endocarditis is an inflammation of the inner layer of the heart, the endocardium } ) in the body’s system.
      • After the blood is drawn, it is placed on a culture, which helps the bacteria grow. The bacteria is then analyzed to determine what type it is and what medicines can be used to kill it.
      • Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers.
      • This is traditionally done by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray.
      • Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart.
      • This is done for both investigational and interventional purposes.
      • This technique are mainly involving the catheterization of the coronary arteries, and catheterization of cardiac chambers and valves.
      • Catheters are inserted using a guidewire and moved towards the heart.
      • Once in position above the aortic valve the guidewire is then removed.
      • The catheter is then engaged with the origin of the coronary artery (either left main stem or right coronary artery) and
      • x-ray opaque iodine-based
      • contrast is injected to make the
      • coronary vessels show up on
      • the x-ray fluoroscopy image.
      • A CT scan ("cat scan") is an x-ray technique that uses a computer to create cross-sectional (or slice-like) pictures of the heart.
      • The CT scanner is a large X-ray machine that has a short, open-ended tube in the middle (like a very short tunnel).
      • The patient lies on a scanning table, which slides through the middle of the CT scanner.
      • The CT scanner takes many x-ray pictures of thin slices of heart.
      • A computer then puts these images together to make one detailed picture.
      • In some cases, a contrast dye is injected into the bloodstream to get a clearer picture.
      • Echocardiography uses sound waves to produce an image of the heart and to see how it is functioning.
      • Depending on the type of echocardiography test they use, we can learn about the size, shape, and movement of heart muscle.
      • This test can also show how the heart valves are working and how blood is flowing through heart.
      • Echocardiography can also give the information about arteries.
      • Echocardiography uses high-frequency sound waves (also called ultrasound) that can provide a moving picture of heart.
      • The sound waves are sent through the body with a device called a transducer.
      • The sound waves bounce off of the heart and return to the transducer as echoes.
      • The echoes are converted into images on a television monitor to produce pictures of heart.
      • An electrocardiogram (ECG or EKG) is a routine test that is used to look at the electrical activity of the heartbeat.
      • An electrocardiogram can tell a lot about your heart and how it is working. This test can help to learn more about heart rhythm, the size and function of the chambers of your heart, and heart muscle.
      • A healthy person's electrocardiogram has a certain pattern. When there are changes in that pattern, we can tell that there is a problem with heart.
      • For example, during a heart attack, the EKG machine records the changing pattern of the heart's electrical activity.
      • P wave -  Atrial depolarization
      • QRS complex - rapid depolarization of the right and left ventricles
      • T wave - Repolarization of the ventricles
      • Electrophysiology studies, or EPS, use cardiac catheterization techniques to study patients who have irregular heartbeats (called arrhythmias).
      • EPS shows how the heart reacts to controlled electrical signals. These signals can help to find out where in the heart the arrhythmia starts and what medicines will work to stop it.
      • MRI is a scan that lets to see inside the body without having to perform surgery.
      • The test is painless, and uses no radiation. Cardiac MRI is a test that gives a detailed picture of the heart, including the chambers and valves, without patients having to undergo cardiac catheterization.
      • A gated blood pool scan is a test using radioisotope dye that shows how blood pools in heart during rest, exercise, or both.
      • The test can tell how well the heart is pumping blood and if it is working harder to make up for one or more blocked arteries.
      • This test is also very useful for finding your "ejection fraction," which is the percentage of blood that is pumped out of heart's lower chambers (called the ventricles) with each heartbeat.
      • This test is also called multi-unit gated analysis or MUGA.
      • TREATMENT
      • HMG-CoA reductase inhibitors (statins)
      • Bile acid sequestrants (colestipol, cholestyramine, colesevelam)
      • α –glucosidase inhibitiors
      • Fibrates
      • . Cardiac Glycosides
      • . Phosphodiesterase inhibitors
      • . Beta-adrenergic receptor antagonists
      • . Sympathomimetics
      • . ACE inhibitors
      • . Vasodilators
      • . Diuretics
      • . Aldosterone antagonists
      • Three classes
        • Beta-adrenergic antagonists
        • Calcium channel blockers
        • Organic nitrates
          • Short acting
          • Long acting
      • β-adrenergic receptor antagonists
      • Thiazide diuretics
      • ACE inhibitors
      • Ca 2+ antagonists
      • α 1 -adrenergic receptor antagonists
      • Centrally acting drugs: α 2 -adrenergic receptor agonists
      • D. K. Spady, J. M. Dietschy: Interaction of dietary cholesterol and triglycerides in the regulation of hepatic low density lipoprotein transport in the hamster. J. Clin. Invest. 81 (1988) 300–309.
      • L. A. Woollett, D. K. Spady, J. M. Dietschy: Mechanism by which saturated triacylglycerols elevate the plasma low density lipoprotein-cholesterol concentrations in hamsters. J. Clin. Invest. 84 (1989) 119–128.
      • H. Ohtani, K. Hayashi, Y. Hirata, S. Dojo, K. Nakashima, E. Nishio, H. Kurushima, M. Saeki, G. Kajiyama: Effects of dietary cholesterol and fatty acids on plasma cholesterol level and hepatic lipoprotein metabolism. J. Lipid Res. 31 (1990) 1413–1422.
      • M. L. Fernandez, A. E. Soscuia, G. S. Sun, M. Tosca, D. J. McNamara, B. E. McDonald: Olive oil and rapeseed oil differ in their effect on plasma low-density lipoprotein metabolism in the guinea-pig. Br. J. Nutr. 76 (1996) 869–880.
      • A. H. Lichtenstein, L. M. Ausman, W. Carrasco, J. L. Jenner, L. J. Gualtieri, B. R. Goldin, J. M. Ordovas, E. J. Schaefer: Effects of canola, corn, and olive oils on fasting and postprandial plasma lipoproteins in humans as part of a National Cholesterol Education Program Step 2 Diet. Arterioscler. Thromb. 13 (1993) 1533–1542.
      • P. J. H. Jones, A. H. Lichtenstein, E. J. Schaefer, G. L. Namchuk: Effect of dietary fat selection on plasma cholesterol synthesis in older, moderately hypercholesterolemic humans. Arterioscler. Thromb. 14 (1994) 542–548.
      • Thank you !