Module – 3

HUMAN ORGAN SYSTEMS AND BIO DESIGNS - 1 (QUALITATIVE):Brain as a CPU system (architecture,
CNS and Peripheral Nervous System, signal transmission, EEG, Robotic arms for prosthetics. Engineering
solutions for Parkinson’s disease).Eye as a Camera system (architecture of rod and cone cells, optical
corrections, cataract, lens materials, bionic eye).Heart as a pump system (architecture, electrical
signalling - ECG monitoring and heart related issues, reasons for blockages of blood vessels, design of
stents, pace makers, defibrillators).

HUMAN ORGAN SYSTEMS AND BIO DESIGNS:

⮚ The human body is a biological machine made of body systems; groups of organs that work
together to produce and sustain life.
⮚ Organ systems are: Skeletal system, Muscular system, Cardiovascular system, Respiratory
system, Nervous system, Digestive system, Urinary system, Endocrine system, Lymphatic
system, Reproductive system, Integumentary system.
⮚ Biodesign is the use of living organisms in design. Its processes can be used in the creation of
fashion, textiles, furniture and architecture.
⮚ Nonprofits, design companies and universities around the world, including UC Davis, increasingly
implement biodesign practices into research and product development.
⮚ Bio-design (actual or conceptual) embodies an emerging design movement which incorporates
the use of living materials, or ‘moist media,’ such as fungi, algae, yeast, bacteria, and cultured
tissue.
 ⮚ This can be as part of standard crafting methods or the more complex fields of biomimicry and
synthetic biology. The idea is to create a product whose properties are enhanced as a result of
the use of these living materials. Some examples are explained below.

BRAIN AS A CPU SYSTEM:

⮚ Both CPU and brain use electrical signals to send messages. The brain uses chemicals to transmit
information; the computer uses electricity.
⮚ Even though electrical signals travel at high speeds in the nervous system, they travel even
faster through the wires in a computer.
⮚ Both transmit information. A BCI system is a computer-based system that takes brain signals,
analyses them and translates them into commands that are relayed to a device to trigger a
desired action.
⮚ A BCI system does not use peripheral nerves and head muscles. The CNS (Central Nervous
System), for example, is used to measure signals produced by the central nervous system.
⮚ Thus, for example, a sensor that is activated by the voice or the movement of a muscle is not a
BCI system.
⮚ Also an EEG is not BCI itself, because it only records brain signals but it does not produce an
output that acts on the user's environment. It is also wrong to think that BCI is a mind-reader.
⮚ They do not export information from unsuspecting users or users unwillingly using the system.
They allow users to act in their environment when they want it by reading their brain signals
rather than muscles.
⮚ The user and the BCI work together. The user, after a training session, produces brain signals
encoded by the BCI system.
⮚ The BCI then translates these commands and transmits them into an output device.
⮚ Brain computer interfaces have contributed to various areas of research.
⮚ Applications that are about medicine, neuro-technology and smart environment, neuro-
marketing and advertising, education and self-regulation, games and entertainment, as well as
security and identification.

The nervous system has two main parts: The central nervous system is made up of the
brain and spinal cord. The peripheral nervous system is made up of nerves that branch off from the
spinal cord and extend to all parts of the body.

1) CNS:

⮚ CNS includes the brain and spinal cord.

⮚ The brain is the body’s “control center.”
⮚ The CNS has various centers located within it that carry out the sensory, motor and
integration of data.
⮚ These centers can be subdivided to Lower Centers (including the spinal cord and brain stem)
and higher centers communicating with the brain via effectors.

2) PNS:

⮚ PNS is a vast network of spinal and cranial nerves that are linked to the brain and the spinal
cord.
⮚ It contains sensory receptors which help in processing changes in the internal and external
environment.
⮚ This information is sent to the CNS via afferent sensory nerves. The PNS is then subdivided
into the autonomic nervous system and the somatic nervous system.
⮚ The autonomic has involuntary control of internal organs, blood vessels, smooth and cardiac
muscles.
⮚ The somatic has voluntary control of skin, bones, joints, and skeletal muscle.
⮚ The two systems function together, by way of nerves from the PNS entering and becoming
part of the CNS, and vice versa.
TRANSMISSION:

⮚ A neuron sending a signal (i.e., a presynaptic neuron) releases a chemical called a

neurotransmitter, which binds to a receptor on the surface of the receiving (i.e., postsynaptic)
neuron.
⮚ Neurotransmitters are released from presynaptic terminals, which may branch to communicate
with several postsynaptic neurons.
⮚ Axon terminals are where neurotransmission begins.
⮚ Hence, it is at axon terminals where the neuron sends its OUTPUT to other neurons.
⮚ At electrical synapses, the OUTPUT will be the electrical signal itself.
⮚ At chemical synapses, the OUTPUT will be neurotransmitter.
⮚ The correct outline for the sequence of transmission of an electrical impulse through a neuron is
dendrites, cell body, axon, axon terminal.
ELECTRO ENCEPHALO GRAM [EEG]:

⮚ An electroencephalogram (EEG) is a test that measures electrical activity in the brain using
small, metal discs (electrodes) attached to the scalp.
⮚ Brain cells communicate via electrical impulses and are active all the time, even during asleep.
⮚ This activity shows up as wavy lines on an EEG recording. An EEG is one of the main diagnostic
tests for epilepsy.
⮚ An EEG can also play a role in diagnosing other brain disorders.
⮚ An EEG can find changes in brain activity that might be useful in diagnosing brain disorders,
especially epilepsy or another seizure disorder.
⮚ An EEG might also be helpful for diagnosing or treating:

• Brain tumors
• Brain damage from head injury
• Brain dysfunction that can have a variety of causes (encephalopathy)
• Sleep disorders
• Inflammation of the brain (herpes encephalitis)
• Stroke

⮚ An EEG might also be used to confirm brain death in someone in a persistent coma.
⮚ A continuous EEG is used to help find the right level of anesthesia for someone in a
medically induced coma.
⮚ Voltage fluctuations measured by the EEG bioamplifier and electrodes allow the evaluation
of normal brain activity including the posterior dominant rhythm (PDR), first described by
Hans Berger.
⮚ EEG can detect abnormal electrical discharges such as sharp waves, spikes or spike-andwave
complexes that are seen in people with epilepsy, thus it is often used to inform the medical
diagnosis.
⮚ EEG can detect the onset and spatio-temporal evolution of seizures and the presence of
status epilepticus.
 ⮚ It is also used to help diagnose sleep disorders, depth of anesthesia, coma,
encephalopathies, cerebral hypoxia after cardiac arrest, and brain death. EEG used to be a
firstline method of diagnosis for tumors, stroke and other focal brain disorders, but this use
has decreased with the advent of high-resolution anatomical imaging techniques such as
magnetic resonance imaging (MRI) and computed tomography (CT).
⮚ Despite limited spatial resolution, EEG continues to be a valuable tool for research and
diagnosis.
⮚ It is one of the few mobile techniques available and offers millisecond-range temporal
resolution which is not possible with CT, PET or MRI.
⮚ Derivatives of the EEG technique include evoked potentials (EP), which involves averaging
the EEG activity time-locked to the presentation of a stimulus of some sort (visual,
somatosensory, or auditory).
⮚ Event-related potentials (ERPs) refer to averaged EEG responses that are time-locked to
more complex processing of stimuli; this technique is used in cognitive science, cognitive
psychology, and psychophysiological research.

ROBOTIC ARMS FOR PROSTHETICS:

⮚ Robotic prosthetic limb is a well-established research area that integrates advanced
mechatronics, intelligent sensing, and control for achieving higher order lost sensorimotor
functions while maintaining the physical appearance of amputated limb.
⮚ Robotic prosthetic limbs are expected to replace the missing limbs of an amputee restoring the
lost functions and providing aesthetic appearance.
⮚ The main aspects are enhanced social interaction, comfortable amputee’s life, and productive
amputee to the society.

⮚ With the advancement of sensor technology, in the last few decades significant contributions
have been made in this area.
⮚ Most current robotic prostheses work by recording—from the surface of the skin—electrical
signals from muscles left intact after an amputation.
⮚ Some amputees can guide their artificial hand by contracting muscles remaining in the forearm
that would have controlled their fingers.
⮚ If you are missing an arm or leg, an artificial limb can sometimes replace it.
 ⮚ The device, which is called a prosthesis, can help you to perform daily activities such as walking,
eating, or dressing.
⮚ Robotic arms can be used to automate the process of placing goods or products onto pallets.
⮚ By automating the process, palletizing becomes more accurate, cost-effective, and predictable.
⮚ The use of robotic arms also frees human workers from performing tasks that present a risk of
bodily injury.
Parkinson's disease
⮚ Parkinson's disease is a progressive disorder that affects the nervous system and the parts of
the body controlled by the nerves.
⮚ Symptoms start slowly.
⮚ The first symptom may be a barely noticeable tremor in just one hand.
⮚ Tremors are common, but the disorder may also cause stiffness or slowing of movement.
⮚ In Parkinson's disease, certain nerve cells (neurons) in the brain gradually break down or die.
⮚ Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your
brain called dopamine.
⮚ When dopamine levels decrease, it causes atypical brain activity, leading to impaired
movement and other symptoms of Parkinson's disease.
⮚ Parkinson's disease can't be cured, but medications can help control the symptoms, often
dramatically.
⮚ In some more advanced cases, surgery may be advised. Your health care provider may also
recommend lifestyle changes, especially ongoing aerobic exercise.
ENGINEERING SOLUTIONS TO THIS DISEASE ARE:
⮚ Deep Brain Stimulation – Deep Brain Stimulation (DBS) involves surgically implanting a
neurotransmitter that sends electrical impulses to specific areas of your brain.
⮚ This procedure has helped many people with Parkinson's reduce symptoms such as tremor,
rigidity, and bradykinesia.
⮚ There are six main types of medications available to treat symptoms of Parkinson disease:
● Levodopa,
● Dopamine agonists,
● Inhibitors of enzymes that inactivate dopamine (monoamine oxidase type B [MAO B]
● Catechol-O-methyl transferase [COMT] inhibitors,
● Anticholinergic drugs
● Amantadine

ENGINEERING NEURONS are another treatment method for this.

⮚ Transplantation of embryonic neurons can restore functional dopaminergic neurons in the
brains of patients with Parkinson's disease.
⮚ But while promising, cell transplantation therapy is still out of reach to most patients, in part
because of the inaccessibility of human embryonic tissue.
⮚ First obtained neuronal stem cells from mouse cells transfected with a transcription factor that
encourages cells to adopt a neuronal fate.
⮚ They then co-cultured the cells with astrocytes, which release a factor that induces development
into dopaminergic neurons.
⮚ The engineered cells released dopamine, and some maintained the characteristics of
dopaminergic neurons for up to two weeks after implantation into mouse brains.

EYE AS A CAMERA SYSTEM:

⮚ The human eye is a wonderful instrument, relying on refraction and lenses to form images.
⮚ There are many similarities between the human eye and a camera, including: A diaphragm to
control the amount of light that gets through to the lens.
⮚ This is the shutter in a camera, and the pupil, at the center of the iris, in the human eye. A lens
to focus the light and create an image.
⮚ The image is real and inverted.
⮚ A method of sensing the image.
⮚ In a camera, film is used to record the image; in the eye, the image is focused on the retina, and
a system of rods and cones is the front end of an image-processing system that converts the
image to electrical impulses and sends the information along the optic nerve to the brain.
⮚ There are two photoreceptors: RODS AND CONES These photoreceptors are localized around an
area near the centre of the retina called the macula, which is the functional center of the retina.
⮚ The fovea is located in the centre of the macula. The macula is responsible for high-resolution,
color vision, provided by different types of photoreceptors.
 ⮚ Photoreceptors in the retina are classified into two groups, named after their physical
morphologies.
⮚ Rod cells are highly sensitive to light and function in night vision, whereas cone cells are capable
of detecting a wide spectrum of light photons and are responsible for colour vision.
⮚ Rods and cones are structurally compartmentalized. They consist of five principal regions: Outer
segment, connecting cilium, Inner segment, nuclear region, Synaptic region, Rods are
responsible for vision at low light levels (scotopic vision).
⮚ They do not mediate color vision and have a low spatial acuity.
⮚ Cones are active at higher light levels (photopic vision), are capable of color vision and are
responsible for high spatial acuity.
⮚ The central fovea is populated exclusively by cones.
⮚ There are 3 types of cones which we will refer to as the short-wavelength sensitive cones, the
middlewavelength sensitive cones and the long-wavelength sensitive cones or S-cone, M-cones,
and Lcones for short.

OPTICAL CORRECTIONS:
⮚ A slight modification of geometrically correct lines (as of a building) for the purpose of making
them appear correct to the eye.
⮚ The ability to see images or objects with clear, sharp vision results from light entering the eye.
⮚ Light rays bend or refract when they hit the retina, sending nerve signals to the optic nerve,
which then sends these signals to the brain.
⮚ The brain processes them into images, allowing you to understand what you see.
⮚ When these light rays bend incorrectly, it results in a refractive error and typically causes blurry
or cloudy vision.
⮚ Since the primary cause of vision problems is caused by light bending incorrectly as it enters the
eye, virtually any method of treatment that changes this can be categorized as a form of vision
correction.
⮚ Eyeglasses and contact lenses – the most common types of corrective measures – are almost
always recommended as the first course of treatment for vision problems.
⮚ While they are considered a very basic method of vision correction, they are unable to control
the refractive error from progressing.
⮚ Patients whose vision worsens over time need new glasses or contacts. In these cases, longer-
term solutions are needed
CATARACT

⮚ A cataract is a clouding of the normally clear lens of the eye.

⮚ At first, the cloudiness in your vision caused by a cataract may affect only a small part of the
eye's lens and you may be unaware of any vision loss. As the cataract grows larger, it clouds
more of your lens and distorts the light passing through the lens.
⮚ This may lead to more-noticeable symptoms.
⮚ A cataract is a cloudy lens.
⮚ The lens is positioned behind the colored part of your eye (iris).
⮚ The lens focuses light that passes into your eye, producing clear, sharp images on the retina —
the light-sensitive membrane in the eye that functions like the film in a camera.
⮚ As you age, the lenses in your eyes become less flexible, less transparent and thicker.
⮚ Age-related and other medical conditions cause proteins and fibers within the lenses to break
down and clump together, clouding the lenses.
⮚ As the cataract continues to develop, the clouding becomes denser.
⮚ A cataract scatters and blocks the light as it passes through the lens, preventing a sharply
defined image from reaching your retina. As a result, your vision becomes blurred.
⮚ Cataracts generally develop in both eyes, but not always at the same rate.
⮚ The cataract in one eye may be more advanced than the other, causing a difference in vision
between eyes.
⮚ Cataracts may be partial or complete, stationary or progressive, hard or soft.
⮚ Histologically, the main types of age-related cataracts are nuclear sclerosis, cortical, and
posterior subcapsular.

LENS MATERIALS:
⮚ Corrective spherocylindrical lenses are commonly used to treat refractive errors such as myopia,
hyperopia, presbyopia, and astigmatism.
⮚ Both lenses and prisms are also frequently used to improve eye alignment and treat diplopia in
strabismus.
 ⮚ Eyeglasses also serve an important role in protecting the eyes from physical trauma and harmful
radiation.
⮚ Lenses can be produced using a variety of materials and designed with several optical profiles to
optimize use in specific applications.
⮚ Critical lens properties include refractive index, Abbe number (chromatic dispersion), specific
gravity, and ultraviolet absorption.
⮚ The most common lens material is, of course, optical glass, but crystals and plastics are
frequently used, while mirrors can be made of essentially anything that is capable of being
polished.
⮚ There are 5 main types of lens materials for eyeglasses and sunglasses. Each type of lens
material can help correct refractive errors such as nearsightedness, farsightedness, astigmatism,
or presbyopia.
Types of lens materials:
1. CR-39:
● The most used plastic lens material for years was CR-39.
● It was first developed as a replacement for glass lenses during World War II. It still has 55% of
world market at age 60.
● The patent was awarded to Muskat and Strain of Pittsburgh Plate Glass Company (now named
PPG) in 1946.
● CR-39 is available in all lens styles and from multiple manufacturers. The basic monomer comes
from PPG, and then each company adds their own materials to create their lenses.
● Advantages include light weight, good optical properties, and tinting well.
● Disadvantages of CR-39 are that it is the thickest material and scratches easily.

2. Crown Glass
● Crown Glass is the most commonly used clear glass for ophthalmic lenses.
● In general, glass is the most durable material used for lenses.
● Crown glass is used mainly for single vision lenses and the distance carrier for most glass bifocals
and trifocals.
● It has an index of refraction of 1.523, and an Abbey value of 59.
● It is approximately 4% thinner than CR-39 resin lenses and is 40% heavier than polycarbonate
lenses and is slightly lighter than high index glass.
● It blocks out about 10% of UV light.

3. Flint Glass
● Flint Glass uses lead oxides in its chemical make up to increase its index of refraction to
approximately 1.58 to 1.69.
● Its Abbey value ranges from 30 to 40. This material is relatively soft, displays a brilliant luster
and has chromatic aberration.
● Although it was used in the past as a single vision alternative for higher Rx lenses, its use today is
often limited to segments for some fused bifocals.
 ● The advantages of glass lenses include optical clarity, resistance to scratches, and it is the least
susceptible to chemicals.
● The disadvantages include that it is the heaviest material and it is less impact resistant than
other materials.

4. Polycarbonate Lenses:
● Polycarbonate lenses were first developed by a company named Gentex.
● Polycarbonate is a thermoplastic which means it is moldable under sufficient heat.
● In the 1950's it was marketed under the name Lexan and due to its extraordinary resistance to
impact was originally manufactured for safety devices.

BIONIC EYES:

⮚ bionic eye, electrical prosthesis surgically implanted into a human eye in order to allow for the
transduction of light (the change of light from the environment into impulses the brain can
process) in people who have sustained severe damage to the retina.
⮚ The bionic eye comprises an external camera and transmitter and an internal microchip.
⮚ The camera is mounted on a pair of eyeglasses, where it serves to organize the visual stimuli of
the environment before emitting high-frequency radio waves.
⮚ The stimulator microchip consists of an electrode array that is surgically implanted into the
retina.
⮚ That functions as an electrical relay in place of degenerated retinal cells.
⮚ The radio waves that are emitted by the external camera and transmitter are received by the
stimulator, which then fires electrical impulses.
⮚ The impulses are relayed by the few remaining retinal cells and are transducer as normal to the
optic nerve pathway, resulting in vision.
⮚ The bionic vision system consists of a camera, attached to a pair of glasses, which transmits
highfrequency radio signals to a microchip implanted in the retina.
⮚ Electrodes on the implanted chip convert these signals into electrical impulses to stimulate cells
in the retina that connect to the optic nerve.
 ⮚ It is an expensive treatment and not everyone can afford it. b. Since research is still going on
results are yet not 100% successful.
⮚ It’s an artificial eye which provides visual sensations to the brain. It consists of electronic
systems having image sensors, microprocessors, receivers, radio transmitters and retinal chips.
⮚ Technology provided by this help the blind people to get vision again.
⮚ It consists of a computer chip which is kept in the back of effected person eye and linked with a
mini video camera built into glasses that they wear.
⮚ Then an image captured by the camera is focused to the chip which converts it into electronic
signal that brain can interpret.
⮚ The images produced by Bionic eye we’re not be too much perfect but they could be clear
enough to recognize.
⮚ The implant bypasses the diseased cells in the retina and goes through the remaining possible
cells.

HEART AS A PUMP SYSTEM:

⮚ Heart is sort of like a pump, or two pumps in one.

⮚ The right side of your heart receives blood from the body and pumps it to the lungs.
⮚ The left side of the heart does the exact opposite: It receives blood from the lungs and pumps it
out to the body.
⮚ While an LVAD consists of thick tubes and a pump connected externally to the heart muscle and
aorta, percutaneous heart pumps place a much smaller tube inside the heart's chambers.
⮚ These tiny heart pumps are placed in the heart via a thin tube called a catheter that is threaded
through a puncture site in the skin.
⮚ The human heart is very strong and is capable of pumping blood up to 30 feet distance.
⮚ An average heart beats maximum of 70-80 beats per minute and is considered healthy.
⮚ The efficiency of the heart can be maintained and improved by performing physical activity.
⮚ The heart is called a double pump because each side pumps blood to a different circulation.
⮚ Deoxygenated blood from the body drains to the right side of the heart.
 ⮚ This is the first pump that sends blood to the lungs, called the pulmonary circulation, where it
becomes oxygenated and releases carbon dioxide.
⮚ The human heart is a four-chambered muscular organ, shaped and sized roughly like a man's
closed fist with two-thirds of the mass to the left of midline.
⮚ The heart is enclosed in a pericardial sac that is lined with the parietal layers of a serous
membrane.
⮚ The visceral layer of the serous membrane forms the epicardium. The myocardium of the heart
wall is a working muscle that needs a continuous supply of oxygen and nutrients to function
efficiently.
⮚ For this reason, cardiac muscle has an extensive network of blood vessels to bring oxygen to the
contracting cells and to remove waste products.

ELECTRICAL SIGNALING:

⮚ The sinus node generates an electrical stimulus regularly, 60 to 100 times per minute under
normal conditions.
⮚ The atria are then activated.
⮚ The electrical stimulus travels down through the conduction pathways and causes the heart's
ventricles to contract and pump out blood.

ECG MONITORING:

⮚ ECG monitoring systems have been developed and widely used in the healthcare sector for the
past few decades and have significantly evolved over time due to the emergence of smart
enabling technologies.
⮚ Nowadays, ECG monitoring systems are used in hospitals, homes, outpatient ambulatory
settings, and in remote contexts.
⮚ They also employ a wide range of technologies such as IoT, edge computing, and mobile
computing.
⮚ In addition, they implement various computational settings in terms of processing frequencies,
as well as monitoring schemes.
⮚ They have also evolved to serve purposes and targets other than disease diagnosis and control,
including daily activities, sports, and even mode-related purposes.
⮚ This massive diversity in ECG monitoring systems’ contexts, technologies, computational
schemes, and purposes makes it hard for researchers and professionals to design, classify, and
analyze ECG monitoring systems.
⮚ Some efforts attempted to provide a common understanding of ECG monitoring systems’
processes, guiding the design of efficient monitoring systems.
⮚ However, these studies lack comprehensiveness and completeness.
⮚ They work for specific contexts, serve specific targets, or are suitable for specific technologies.
⮚ This makes the available ECG monitoring system processes and architectures hard to generalize
and reuse.
⮚ On the other hand, some studies attempted to analyze ECG monitoring systems’ attributes and
provide classification taxonomies, supporting better analysis and understanding of the ECG
systems reported in the literature.
⮚ However, exiting reviews related to ECG monitoring in the literature can be intuitive and
incomprehensive.
⮚ They do not consider the latest technological trends, and they target very narrow research
niches, such as wearable sensors, mobile sensors, disease diagnosis, heartbeat detection,
emotion recognition, or ECG compression methods.
⮚ Hence, there is a need to provide a comprehensive, expert-verified taxonomy of ECG
monitoring systems, a common architecture, and a complete set of processes to guide the
classification, analysis, and design of these systems.
⮚ Electrocardiography (ECG) is a quick and easily accessible method for diagnosis and screening of
cardiovascular diseases including heart failure (HF).
⮚ Artificial intelligence (AI) can be used for semi-automated ECG analysis. The aim of this
evaluation was to provide an overview of AI use in HF detection from ECG signals and to
perform a meta-analysis of available studies.
⮚ Evaluation of symptoms suggestive of HF currently demands physicians to valuate various
parameters including imaging and laboratory data and the electrocardiogram (ECG).
 ⮚ Besides a standard examination that includes an ECG, imaging information, such as
echocardiography or magnetic resonance imaging, is seen as gold standard in diagnosis of HF.
⮚ Nevertheless, an adequate use of such imaging data is associated with relevant technical
infrastructure and medical expertise. The ECG is a well-established, quick, and easily accessible
method for diagnosis and screening of various cardiovascular diseases.
⮚ It provides specific features that indicate presence of HF or prognosis in HF patients especially
to rule out HF in case of a normal ECG. However, use of an ECG as primary diagnostic
instrument often only yields insufficient diagnostic specificity.
⮚ Further, general practitioner–based ECG reporting has varying results, introducing further
diagnostic uncertainty

REASONS FOR BLOCKAGES OF BLOOD VESSELS

⮚ Coronary artery disease is a common heart condition.

⮚ The major blood vessels that supply the heart (coronary arteries) struggle to send enough blood,
oxygen and nutrients to the heart muscle.
⮚ Cholesterol deposits (plaques) in the heart arteries and inflammation are usually the cause of
coronary artery disease.
⮚ Signs and symptoms of coronary artery disease occur when the heart doesn't get enough
oxygenrich blood.
⮚ If you have coronary artery disease, reduced blood flow to the heart can cause chest pain
(angina) and shortness of breath.
⮚ A complete blockage of blood flow can cause a heart attack.
⮚ Coronary artery disease starts when fats, cholesterols and other substances collect on the inner
walls of the heart arteries. This condition is called atherosclerosis. The buildup is called plaque.
Plaque can cause the arteries to narrow, blocking blood flow. The plaque can also burst, leading
to a blood clot.

DESIGN OF STENTS:
 ⮚ A stent is a tiny tube that can play a big role in treating your heart disease.
⮚ It helps keep your arteries -- the blood vessels that carry blood from your heart to other parts of
your body, including the heart muscle itself -- open.
⮚ Most stents are made out of wire mesh and are permanent. Some are made out of fabric.
⮚ These are called stent grafts and are often used for larger arteries.
⮚ Others are made of a material that dissolves and that your body absorbs over time.
⮚ They're coated in medicine that slowly releases into your artery to prevent it from being
blocked again.

Why Would You Need a Stent? If a fatty substance called plaque builds up inside an artery,
it can reduce blood flow to your heart.

⮚ This is called coronary heart disease and it can cause chest pain.
⮚ The plaque can also cause a blood clot that blocks blood flowing to your heart, which may lead
to a heart attack. By keeping an artery open, stents lower your risk of chest pain. They can also
treat a heart attack that's in progress.
⮚ Doctor usually inserts a stent using a minimally invasive procedure.
⮚ They will make a small incision and use a catheter to guide specialized tools through your blood
vessels to reach the area that needs a stent.
⮚ This incision is usually in the groin or arm.
⮚ One of those tools may have a camera on the end to help your doctor guide the stent.
⮚ During the procedure, doctor may also use an imaging technique called an angiogram to help
guide the stent through the vessel.
⮚ Using the necessary tools, doctor will locate the broken or blocked vessel and install the stent.
⮚ Then they will remove the instruments from your body and close the incision.

DESIGN:
⮚ Most of these stents are constructed from a nickel titanium alloy.
⮚ Balloon expandable stents are susceptible to permanent deformation when they are
compressed extrinsically, which is not an issue in the coronary tree.
⮚ Self-expanding stents do not have this limitation. Furthermore, selfexpanding stents have less
axial stiffness and are thus more flexible and will conform to the shape of the vessel rather than
the vessel conforming to the shape of the stent.
 ⮚ Balloon expandable stents, by virtue of their design, resist expansion by the balloon, but they
have less acute recoil when they are placed in a poorly compliant lesion.
⮚ However, after the initial deployment, the stent is at its maximal diameter and cannot get
larger, whereas a self-expanding stent that is appropriately oversized for the vessel will exhibit a
chronic outward force on the lesion and may lead to a larger lumen over time.
⮚ For the reasons above, there are some coronary lesions where balloon expandable stents are
not ideal, such as aneurysmal, ectatic vessels, thrombus laden vessels, and vessels that are
tapering with a large size mismatch between distal reference and proximal reference vessels.

PACE MAKERS:

⮚ A pacemaker is a small device that's placed (implanted) in the chest to help control the
heartbeat. It's used to prevent the heart from beating too slowly.
⮚ Implanting a pacemaker in the chest requires a surgical procedure.
⮚ A pacemaker is also called a cardiac pacing device.

Types:
❖ Single chamber pacemaker.
● This type usually carries electrical impulses to the right ventricle of your heart.

❖ Dual chamber pacemaker.

● This type carries electrical impulses to the right ventricle and the right atrium of your heart to
help control the timing of contractions between the two chambers.
● Biventricular pacemaker. Biventricular pacing, also called cardiac resynchronization therapy, is
for people who have heart failure and heartbeat problems.
● This type of pacemaker stimulates both of the lower heart chambers (the right and left
ventricles) to make the heart beat more efficiently.
● A pacemaker is implanted to help control your heartbeat.
● Your doctor may recommend a temporary pacemaker when you have a slow heartbeat
(bradycardia) after a heart attack, surgery or medication overdose but your heartbeat is
otherwise expected to recover.
 ● A pacemaker may be implanted permanently to correct a chronic slow or irregular heartbeat or
to help treat heart failure. Pacemakers work only when needed.
● If your heartbeat is too slow (bradycardia), the pacemaker sends electrical signals to your heart
to correct the beat.
● Some newer pacemakers also have sensors that detect body motion or breathing rate and
signal the devices to increase heart rate during exercise, as needed.

A pacemaker has two parts:

1) Pulse generator. This small metal container houses a battery and the electrical circuitry that controls
the rate of electrical pulses sent to the heart.
2) Leads (electrodes). One to three flexible, insulated wires are each placed in one or more chambers of
the heart and deliver the electrical pulses to adjust the heart rate. However, some newer pacemakers
don't require leads. These devices, called leadless pacemakers, are implanted directly into the heart
muscle.

DEFIBRILLATORS:
 ⮚ Defibrillators are devices that send an electric pulse or shock to the heart to restore a normal
heartbeat.
⮚ They are used to prevent or correct an arrhythmia, an uneven heartbeat that is too slow or too
fast.
⮚ If the heart suddenly stops, defibrillators can also help it beat again.
⮚ Different types of defibrillators work in different ways.
⮚ Automated external defibrillators (AEDs), which are now found in many public spaces, are used
to save the lives of people experiencing cardiac arrest.
⮚ Even untrained bystanders can use these devices in an emergency.
⮚ Other defibrillators can prevent sudden death among people who have a high risk of a
lifethreatening arrhythmia.
⮚ They include implantable cardioverter defibrillators (ICDs), which are surgically placed inside
your body, and wearable cardioverter defibrillators (WCDs), which rest on the body.
⮚ It can take time and effort to get used to living with a defibrillator, and it is important to be
aware of possible complications.
There are three types of defibrillators:
⮚ AEDs, ICDs, and WCDs. An AED is a lightweight, battery-operated, portable device that checks
the heart’s rhythm and sends a shock to the heart to restore normal rhythm.
⮚ The device is used to help people having cardiac arrest.
⮚ Sticky pads with sensors, called electrodes, are attached to the chest of someone who is having
cardiac arrest.
⮚ The electrodes send information about the person's heart rhythm to a computer in the AED.
⮚ The computer analyzes the heart rhythm to find out whether an electric shock is needed. If it is
needed, the electrodes deliver the shock.
⮚ ICDs are placed through surgery in the chest or stomach area, where the device can check for
arrhythmias.
⮚ Arrhythmias can interrupt the flow of blood from your heart to the rest of your body or cause
your heart to stop.
⮚ The ICD sends a shock to restore a normal heart rhythm. An ICD can give off a low-energy shock
that speeds up or slows down an abnormal heart rate, or a high-energy shock to correct a fast or
irregular heartbeat.
⮚ If low-energy shocks do not restore your normal heart rhythm, the device may switch to high-
energy shocks for defibrillation.
⮚ ICDs are similar to pacemakers, but pacemakers deliver only low-energy electrical shocks.
⮚ ICDs have a generator connected to wires that detect your heart’s beats and deliver a shock
when needed.
⮚ Some ICDs have wires that rest inside one or two chambers of the heart.
⮚ Others do not have wires going into the heart chambers but instead rest on the heart to monitor
its rhythm.
⮚ The ICD can also record the heart's electrical activity and heart rhythms.
⮚ The recordings can help your healthcare provider fine-tune the programming of the device so it
works better to correct irregular heartbeats.
⮚ The device is programmed to respond to the type of arrhythmia you are most likely to have.
⮚ WCDs have sensors that attach to the skin.
⮚ They are connected by wires to a unit that checks your heart’s rhythm and delivers shocks when
needed.
⮚ Like an ICD, the WCD can deliver low- and high-energy shocks.
⮚ The device has a belt attached to a vest that is worn under your clothes.
⮚ Your provider fits the device to your size. It is programmed to detect a specific heart rhythm