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Title
Chapter 1 CARDIOLOGY
Cardiology (from Greek καρδίᾱ, kardiā, "heart"; and -λογία, -logia) is a medical specialty
dealing with disorders of the heart (specifically the human heart). The field includes diagnosis
and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart
disease and electrophysiology. Physicians who specialize in this field of medicine are called
cardiologists.
Subchapter 1 Circulatory system
The circulatory system is an organ system that passes nutrients (such as amino acids,
electrolytes and lymph), gases, hormones, blood cells, etc. to and from cells in the body to
help fight diseases, stabilize body temperature and pH, and to maintain homeostasis.
This system may be seen strictly as a blood distribution network, but some consider the
circulatory system as composed of the cardiovascular system, which distributes blood, and the
lymphatic system, which distributes lymph. While humans, as well as other vertebrates, have
a closed cardiovascular system (meaning that the blood never leaves the network of arteries,
veins and capillaries), some invertebrate groups have an open cardiovascular system. The
most primitive animal phyla lack circulatory systems. The lymphatic system, on the other
hand, is an open system.
Two types of fluids move through the circulatory system: blood and lymph. The blood, heart,
and blood vessels form the cardiovascular system. The lymph, lymph nodes, and lymph
vessels form the lymphatic system. The cardiovascular system and the lymphatic system
collectively make up the circulatory system.
Subchapter 2 Heart Structure
The human heart has a mass of between 250 and 350 grams and is about the size of a fist.
It is enclosed in a double-walled protective sac called the pericardium.The double membrane
of pericardium consist of the pericardial fluid which nourishes the heart and prevents shocks.
The superficial part of this sac is called the fibrous pericardium. The fibrous pericardial sac is
itself lined with the outer layer of the serous pericardium (known as the parietal pericardium).
This composite (fibrous-parietal-pericardial) sac protects the heart, anchors its surrounding
structures, and prevents overfilling of the heart with blood. The inner layer also provides a
smooth lubricated sliding surface within which the heart organ can move in response to its
own contractions and to movement of adjacent structures such as the diaphragm and lungs.
The outer wall of the human heart is composed of three layers. The outer layer is called the
epicardium, or visceral pericardium since it is also the inner wall of the (serous) pericardium.
The middle layer of the heart is called the myocardium and is composed of muscle which
contracts. The inner layer is called the endocardium and is in contact with the blood that the
heart pumps. Also, it merges with the inner lining (endothelium) of blood vessels and covers
heart valves.
The human heart has four chambers, two superior atria and two inferior ventricles. The atria
are the receiving chambers and the ventricles are the discharging chambers.
The pathways of blood through the human heart is part of the pulmonary and systemic
circuits. These pathways include the tricuspid valve, the mitral valve, the aortic valve, and the
pulmonary valve. The mitral and tricuspid valves are classified as the atrioventricular (AV)
valves. This is because they are found between the atria and ventricles. The aortic and
pulmonary semi-lunar valves separate the left and right ventricle from the pulmonary artery
and the aorta respectively. These valves are attached to the chordae tendinae (literally the
heartstrings), which anchors the valves to the papilla muscles of the heart.
The interatrioventricular septum separates the left atrium and ventricle from the right atrium
and ventricle, dividing the heart into two functionally separate and anatomically distinct units.
Functioning
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Blood flows through the heart in one direction, from the atria to the ventricles, and out
of the great arteries, or the aorta for example. Blood is prevented from flowing
backwards by the tricuspid, bicuspid, aortic, and pulmonary valves.
The heart acts as a double pump. The function of the right side of the heart (see right
heart) is to collect de-oxygenated blood, in the right atrium, from the body (via
superior and inferior vena cavae) and pump it, via the right ventricle, into the lungs
(pulmonary circulation) so that carbon dioxide can be dropped off and oxygen picked
up (gas exchange). This happens through the passive process of diffusion.
The left side (see left heart) collects oxygenated blood from the lungs into the left
atrium. From the left atrium the blood moves to the left ventricle which pumps it out
to the body (via the aorta).
On both sides, the lower ventricles are thicker and stronger than the upper atria. The
muscle wall surrounding the left ventricle is thicker than the wall surrounding the right
ventricle due to the higher force needed to pump the blood through the systemic
circulation. Atria facilitate circulation primarily by allowing uninterrupted venous
flow to the heart, preventing the inertia of interrupted venous flow that would
otherwise occur at each ventricular systole.
Starting in the right atrium, the blood flows through the tricuspid valve to the right
ventricle. Here, it is pumped out of the pulmonary semilunar valve and travels through
the pulmonary artery to the lungs. From there, blood flows back through the
pulmonary vein to the left atrium. It then travels through the mitral valve to the left
ventricle, from where it is pumped through the aortic semilunar valve to the aorta and
to the rest of the body. The (relatively) deoxygenated blood finally returns to the heart
through the inferior vena cava and superior vena cava, and enters the right atrium
where the process began.
Subchapter 3 Electrocardiography
Electrocardiography (ECG or EKG from the German Elektrokardiogramm) is a transthoracic
(across the thorax or chest) interpretation of the electrical activity of the heart over a period of
Time, as detected by electrodes attached to the outer surface of the skin and recorded by a
device external to the body.[1] The recording produced by this noninvasive procedure is
termed as electrocardiogram (also ECG or EKG). An electrocardiogram (ECG) is a test that
records the electrical activity of the heart.
ECG is used to measure the rate and regularity of heartbeats as well as the size and position of
the chambers, the presence of any damage to the heart, and the effects of drugs or devices
used to regulate the heart (such as a pacemaker). See also stress test and Holter monitor (24h).
The etymology of the word is derived from the Greek electro, because it is related to electrical
activity, kardio, Greek for heart, and graph, a Greek root meaning "to write". In English
speaking countries, medical professionals often use "EKG" (the abbreviation for the German
word Elektrokardiogramm) in order to avoid audible confusion with "EEG," in emergency
situations where background noise is high.
Most EKGs are performed for diagnostic or research purposes on human hearts, but may also
be performed on animals, usually for research.
Chapter 2 ORTHOPEDIC SURGERY
Orthopedic surgery or orthopedics (also spelled orthopaedic surgery and orthopaedics in
British English) is the branch of surgery concerned with conditions involving the bones and
muscles musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical
means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections,
tumors, and congenital disorders.
Nicholas Andry coined the word "orthopaedics" in French as orthopedie, derived from the
Greek words orthos ("correct", "straight") and paideion ("child"), when he published
Orthopedie (translated as Orthopaedia: or the Art of Correcting and Preventing Deformities in
Children) in 1741. The correction of spinal and bony deformities became the cornerstone of
orthopedic practice.
In the United States orthopedics is standard, although the majority of college, university and
residency programs, and even the American Academy of Orthopaedic Surgeons, still use the
spelling with the Latinate digraph ae. Elsewhere, usage is not uniform; in Canada, both
spellings are acceptable; orthopaedics usually prevails in the rest of the Commonwealth,
especially in Britain.
Rheumatology
Rheumatology is a sub-specialty in internal medicine and pediatrics, devoted to diagnosis and
therapy of rheumatic diseases. Clinicians who specialize in rheumatology are called
rheumatologists. Rheumatologists deal mainly with clinical problems involving joints, soft
tissues, autoimmune diseases, vasculitis, and heritable connective tissue disorders.
The term rheumatology originates from the Greek word rheuma, meaning "that which flows
as a river or stream," and the suffix -logy, meaning "the study of."
Rheumatology is a rapidly evolving medical specialty, with advancements owing largely to
new scientific discoveries related to immunology of these disorders. Because characteristics
of some rheumatological disorders are often best explained by immunology, pathogenesis of
many major rheumatological disorders are now described in terms of the autoimmune system,
i.e. as an autoimmune disease. Correspondingly, most new treatment modalities are also based
on clinical research in immunology and the resulting improved understanding of the genetic
basis of rheumatological disorders. Future treatment may include gene therapy as well. At
present evidence-based medical treatment of rheumatological disorders has helped patients
with rheumatism lead a near-normal life.
Human musculoskeletal system
A musculoskeletal system (also known as the locomotor system) is an organ system that gives
animals (including humans) the ability to move using the muscular and skeletal systems. The
musculoskeletal system provides form, support, stability, and movement to the body.
It is made up of the body's bones (the skeleton), muscles, cartilage, tendons, ligaments, joints,
and other connective tissue that supports and binds tissues and organs together. The
musculoskeletal system's primary functions include supporting the body, allowing motion,
and protecting vital organs. The skeletal portion of the system serves as the main storage
system for calcium and phosphorus and contains critical components of the hematopoietic
system.
This system describes how bones are connected to other bones and muscle fibers via
connective tissue such as tendons and ligaments. The bones provide the stability to a body in
analogy to iron rods in concrete construction. Muscles keep bones in place and also play a
role in movement of the bones. To allow motion, different bones are connected by joints.
Cartilage prevents the bone ends from rubbing directly on to each other. Muscles contract
(bunch up) to move the bone attached at the joint.
There are, however, diseases and disorders that may adversely affect the function and overall
effectiveness of the system. These diseases can be difficult to diagnose due to the close
relation of the musculoskeletal system to other internal systems. The musculoskeletal system
refers to the system having its muscles attached to an internal skeletal system and is necessary
for humans to move to a more favorable position. Complex issues and injuries involving the
musculoskeletal system are usually handled by a physiatrist (specialist in Physical Medicine
and Rehabilitation) or an orthopaedic surgeon.
Subchapter 1 Bones
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support,
and protect the various organs of the body, produce red and white blood cells and store
minerals. Bone tissue is a type of dense connective tissue. Bones come in a variety of shapes
and have a complex internal and external structure, are lightweight yet strong and hard, and
serve multiple functions. One of the types of tissue that makes up bone is the mineralized
osseous tissue, also called bone tissue, that gives it rigidity and a honeycomb-like threedimensional internal structure. Other types of tissue found in bones include marrow,
endosteum and periosteum, nerves, blood vessels and cartilage. At birth, there are over 270
bones in an infant human's body, but many of these fuse together as the child grows, leaving a
total of 206 separate bones in an adult. The largest bone in the human body is the femur and
the smallest bones are auditory ossicles.
Bones have eleven main functions:
Protection — bones can serve to protect internal organs, such as the skull protecting the brain
or the ribs protecting the heart and lungs.
Structure — bones provide a frame to keep the body supported.
Movement — bones, skeletal muscles, tendons, ligaments and joints function together to
generate and transfer forces so that individual body parts or the whole body can be
manipulated in three-dimensional space. The interaction between bone and muscle is studied
in biomechanics.
Sound transduction — bones are important in the mechanical aspect of overshadowed
hearing.
Blood production — the marrow, located within the medullary cavity of long bones and
interstices of cancellous bone, produces blood cells in a process called hematopoiesis.
Mineral storage — bones act as reserves of minerals important for the body, most notably
calcium and phosphorus.
Growth factor storage — mineralized bone matrix stores important growth factors such as
insulin-like growth factors, transforming growth factor, bone morphogenetic proteins and
others.
Fat storage — the yellow bone marrow acts as a storage reserve of fatty acids.
Acid-base balance — bone buffers the blood against excessive pH changes by absorbing or
releasing alkaline salts.
Detoxification — bone tissues can also store heavy metals and other foreign elements,
removing them from the blood and reducing their effects on other tissues. These can later be
gradually released for excretion.
Endocrine organ — bone controls phosphate metabolism by releasing fibroblast growth
factor – 23 (FGF-23), which acts on kidneys to reduce phosphate reabsorption. Bone cells
also release a hormone called osteocalcin, which contributes to the regulation of blood sugar
(glucose) and fat deposition. Osteocalcin increases both the insulin secretion and sensitivity,
in addition to boosting the number of insulin-producing cells and reducing stores of fat.
The primary tissue of bone, osseous tissue, is a relatively hard and lightweight composite
material, formed mostly of calcium phosphate in the chemical arrangement termed calcium
hydroxylapatite (this is the osseous tissue that gives bones their rigidity). It has relatively high
compressive strength, of about 170 MPa (1800 kgf/cm²) but poor tensile strength of 104–121
MPa and very low shear stress strength (51.6 MPa), meaning it resists pushing forces well,
but not pulling or torsional forces. While bone is essentially brittle, it does have a significant
degree of elasticity, contributed chiefly by collagen. All bones consist of living and dead cells
embedded in the mineralized organic matrix that makes up the osseous tissue.
Subchapter 2 Skeletal muscle
Skeletal muscle is a form of striated muscle tissue existing under control of the somatic
nervous system, that is it is voluntarily controlled. It is one of three major muscle types, the
others being cardiac and smooth muscle. As their name suggests, most skeletal muscles are
attached to bones by bundles of collagen fibers known as tendons.
Skeletal muscle is made up of individual components known as myocytes, or "muscle cells",
sometimes colloquially called "muscle fibers". They are formed from the fusion of
developmental myoblasts (a type of embryonic progenitor cell that gives rise to a muscle cell).
These long, cylindrical, multinucleated cells are composed of myofibrils.
The myofibers are in turn composed of myofibrils. The myofibrils are composed of actin and
myosin myofibrils repeated as a sarcomere, the basic functional unit of the muscle fiber and
responsible for skeletal muscle's striated appearance and forming the basic machinery
necessary for muscle contraction. The term muscle refers to multiple bundles of muscle fibers
held together by connective tissue.
Subchapter 3 Joint
A joint is the location at which two or more bones make contact.They are constructed to allow
movement and provide mechanical support, and are classified structurally and functionally.