兴奋收缩耦联和心力衰竭的治疗

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1、田野教授哈医大二院心内科兴奋收缩耦联和心力衰竭的治疗TOPICSExcitation-contraction(EC)couplingExcitationCalciumCyclingContractionAlterationsofE-CcouplinginHFInotropicagentsforHFExcitation-contractioncoupling"Thepoweroflocomotionisthatwhichcontractsandrelaxesthemuscleswherebythemembersandjointsaremoved,exte

2、ndedorflexed.Thispowerreachesthelimbsbywayofthenervesandthereareasmanyformsofpowerasthereareofmovement.Eachmusclehasitsownpeculiarpurposeanditobeysthedecreeofthecompositesense."Avicenna(1167~1248)WilliamHarvey(1578~1657)HewasanEnglishmedicaldoctor/physician,whoiscreditedwithbein

3、gthefirsttocorrectlydescribe,inexactdetail,thesystemiccirculationandpropertiesofbloodbeingpumpedaroundthebodybytheheart.Weshalldesignatetheentireseque-nceofreactions:excitation,inwardactinglink,andactivationofcontra-ctionbythetermexcitation-contractioncoupling.ALEXANDERSANDOW,19

4、52(NewYorkUniversity)SandowA.YaleJBiolMed.1952.25(3):176–201Cardiacexcitation–contractioncouplingistheprocessfromelectricalexcitationofthemyocytetocontractionoftheheart(whichpropelsbloodout).TheubiquitoussecondmessengerCa2+isessentialincardiacelectricalactivityandisthedirectacti

5、vatorofthemyofilaments,whichcausecontraction.BersDM.Nature,2002,415(6868):198-205.ExcitationThecardiacactionpotentialAnotabledifferencebetweenskeletalandcardiacmyocytesishoweachelevatesthemyoplasmicCa2+toinducecontraction.Incardiacmyocytes,thereleaseofCa2+fromthesarcoplasmicreti

6、culumisinducedbyCa2+influxintothecellthroughvoltage-gatedcalciumchannels.CalciumCyclingPictorialOFCalciumCyclingCa++Ca++Ca++Ca++PlbCa++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++

7、Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Ca++Na+Na+Na+Ca++SERCASRRyRL-TypeCa++ChannelNa+/Ca++ExchangerCa++SarcolemmaCa++CardiactissueandcellsConductelectricalwavesContractinresponsetoanelectricalstimulus(Guinea-pigventricularcell)CardiactissueFunctionBSarcoplasmicReticulum(SR

8、)PLNandSERCAthesitesofinteractionbetweenPLNandS