prompt_front: Now, answer the following question based on the text below, only give me the answer and do not output any other words.

Question: What was the best performing model for the Spanish language in Track-1?

Read the following text and answer briefly.

Context 1: Paper Info

Title: Two-stage Pipeline for Multilingual Dialect Detection
Publish Date: Unkown
Author List: Ankit Vaidya (from Pune Institute of Computer Technology), Aditya Kane (from Pune Institute of Computer Technology)

Figure

Figure 1: Class distribution of dialects
Figure 2: System diagram for dialect classification The LID classifies the input into one of 3 languages The sample is then further classified into dialects by language specific models 
Figure 3: Confusion matrix of 9-way classification Note that rows are normalized according to the number of samples is that class 
Our complete results for Track-1 using the two-stage dialect detection pipeline Model-* denotes the language of the models used for the experiments 
Performance on Track-1 validation dataset of individual models used in the two-stage pipeline "Lg" stands for language of the model used 
Comparative results of two-way classification using the finetuned (F T ) predictions and predictions adapted from three-way classification models 

abstract

Dialect Identification is a crucial task for localizing various Large Language Models  This paper outlines our approach to the VarDial 2023 DSL-TL shared task  Here we have to identify three or two dialects from three languages each which results in a 9-way classification for Track-1 and 6-way classification for Track-2 respectively 
Our proposed approach consists of a two-stage system and outperforms other participants' systems and previous works in this domain  We achieve a score of 58 54% for Track-1 and 85 61% for Track-2  Our codebase is available publicly 1  

Introduction

Language has been the primary mode of communication for humans since the pre-historic ages  Studies have explored the evolution of language and outlined mathematical models that govern the intricacies of natural language   Inevitably, as humans established civilization in various parts of the world, this language was modified by, and for the group of people occupied by that particular geographical region 
This gave rise to multiple national dialects of the same language  The VarDial workshop (colocated with EACL 2023) explores various dialects and variations of the same language  We participated in the Discriminating Between Similar Languages -True Labels (DSL-TL) shared task  In this task, the participants were provided with data from three languages, with each language having three varieties 
This shared task consisted of two tracks -Track-1 featuring nine-way classification and Track-2 featuring six-way classification  The second track included two particular national dialects of each language (eg  American English and British English), and the first track had one general  We ranked 1 st in both of the tracks 
Moreover, we beat the next best submission by a margin of 4 5% in the first task and 5 6% in the second task We were the only team to surpass the organizer baseline scores  We present our winning solution in this paper  We used an end-to-end deep learning pipeline which consisted of a language identification model and three language-specific models, one for each language 
We converged upon the best combination by doing an elaborate analysis of various models available  Furthermore, in this work we also analyze the performance of the pipeline as a whole and also provide an ablation study  Lastly, we provide some future directions in this area of research 

Related Work

The present literature encompasses various aspects of dialect identification  We study this from three perspectives: large language models, language identification and dialect classification problems 

Large Language Models

The success of transformers and BERT based models was inevitable since the initial boom of the transformer  2017) model  In recent years, many other architectures like RoBERTa and ELECTRA have further pushed the state-of-the-art in this domain  Moreover, autoregressive models like GPT and GPT-2 have also shown their prowess 
Multilingual versions of RoBERTA, namely XLM-RoBERTa are also available  Lastly, language specific models like Spanish BERT (la Rosa y Eduardo G  Ponferrada y Manu Romero y Paulo Villegas y Pablo González de Prado Salas y María Grandury, 2022) and Portuguese BERT are available as well  Our winning solution makes use of these large language models trained on specific languages 

Language Identification Models

Many multilingual language identification models have been developed in order to classify the language of the input sentence beforehand  Even though the initial works used n-gram models and generative mixture models or even conditional random fields and other classical machine learning methods like naive bayes , modern methods have shifted to the use of deep learning for language identification  
Recent works have mainly focused on deep learning based language identification, where handling codemixed data is a big challenge in the domain  For our experiments, we use a version of XLM-RoBERTa finetuned on a language identification dataset 2   This model has near-perfect test accuracy of 99 6% 

Dialect Classification

Dialect classification has been previously solved using statistical methods like Gaussian Mixture Models and Frame Selection Decoding or Support Vector Machines (SVM)   It has been explored relatively sparsely, mostly in the case for local languages   Deep learning approaches have been explored in previous editions of the VarDial workshop shared tasks and otherwise  
Dialect classification was also explored previously as a part of other shared tasks   We want to stress that given the multilingual nature of the dataset, using the present methods directly was not an option  In our work, although we take inspiration from the previous works, we propose a novel system that surpasses the performance of the previous systems by a large margin 

Data

The dataset  We observed that the class PT-BR had the most number of samples (2,724) and the class EN had the least number of samples (349), and thus the imbalance ratio was almost 1:8  We have illustrated the data distribution in Figure   We tried to mitigate this imbalance using over-sampling and weighted sampling methods 
However, the improved data sampling method did not affect the performance 

System Description

This was a problem of multi-class classification having 9 classes for Track-1 and 6 classes for Track-2  The samples were belonging to 3 languages having 3 varieties each, so the classification pipeline was made in 2 stages  The Language Identification (LID) model which is the first stage classifies the sentence into 3 languages: English (EN), Spanish (ES) and Portuguese (PT) 
The LID is a pretrained XLM-RoBERTa that is fine-tuned for the task of language identification  It is able to classify the input sentence into 20 languages  We classify and separate the samples according to their language  The samples corresponding to the specific languages are then fed into the language specific models for dialect identification 
For dialect identification we have used models like BERT and RoBERTa with a linear layer connected to the pooler output of the models  Then fine-tuning is done on the models for dialect identification   using the samples corresponding to the specific languages  For the task of dialect identification we experimented with several pretrained models like XLM-RoBERTa, BERT, ELECTRA, GPT-2 and RoBERTa 
All models were fine-tuned for 20 epochs with a learning rate of 1e-6 and weight decay 1e-6 with a batch size of 8  The best performing model checkpoint was chosen according to the epoch-wise validation macro-F1 score  5 Experiments and Results

Experiments using Large Language Models

For the task of Dialect Identification we have tried various language specific models like XLM-RoBERTa, BERT, ELECTRA, RoBERTa and GPT- 2  The base variant of all these models were used and all the models were used through the Hugging-Face library  The pooler output of these models was passed through a linear layer and the models were fine-tuned 
First, we experimented with different models for Track-1  All the models were trained for 20 epochs with learning rate 1e-6, weight decay 1e-6 and a batch size of 8  We used XLM-RoBERTa as the baseline for all 3 languages  The best performing models for the English language were RoBERTa and BERT whereas GPT-2 was the worst performing 
Similarly the language specific versions of RoBERTa and BERT performed well for the Spanish and Portuguese respectively  Overall the worst performing model was GPT-2 across all 3 languages  The validation F1 scores are present in Table   The two best-performing models for every language were chosen for Track-2 
The same procedure as specified above was used and the F1 scores are present in Table   The train and validation F1 scores for 2-class classification are higher for all models as compared to the F1 score of the same models for 3-class classification  This was mainly due to the poor representation and accuracy of classification of the third class 
We observed symptoms of overfitting in all models after 12-15 epochs and the best validation F1 score was obtained in the range of 4-8 epochs 

LID experiments

The pipeline for dialect identification is divided into two parts as the sentences in the dataset belong to different languages  The stages are described in Section 4  The XLM-RoBERTa we have used for language classification has a test accuracy of 99 6% meaning it correctly classifies all input sentences and hence, can be considered as a perfect classifier 
For the final pipeline we experimented using the two best performing models for each language in Track-1 and Track-2  For both the tracks we experimented with all 8 (2 3 ) possible combinations of models and calculated the validation F1 score for the combined validation dataset which had sentences belonging to all languages 
The validation scores for Track-1 and Track-2 are shown in Table and Table respectively  For both the tracks, the three pipelines with the best validation F1 scores were chosen for submission 

Using 3-way classifier as a 2-way classifier

In Track-1, participants are expected to train a classifier which classifies amongst 9 classes, and in Track-2, participants are expected to train a classifier which classifies amongst 6 classes  These 6 classes are a proper subset of the 9 classes from Track-1  Thus, an intuitive baseline for Track-2 is to use the model finetuned for Track-1, whilst considering only the relevant classes for the latter task 
The classes EN , ES and P T , i e  the classes without any national dialect associated with them are not included in Track-2 as compared to Track-1  Thus, we calculate the predictions for the Track-2 validation dataset using the models for Track-1 and exclude the metrics for Track-1 specific classes to get the metrics for this "adapted" 2-way classification 
We show the results of this experiment in Table and observe that, as expected, the adapted 2-way classification performs worse compared to the explicitly finetuned variant 

Results for Track-1 and Track-2

We now present our experiments and their performance for both tracks  Our experiments for Track-1 are described in Table and our experiments for Track-2 are described in Table   The participants were allowed three submissions for evaluation on the test set, so we submitted predictions using the three systems which performed the best on the validation set 
As mentioned in Section 5 2, we performed 2 3 , i e  a total of 8 experiments using the two best models for each language  We observed that RoBERTa base on English, Spanish BERT base on Spanish and Portuguese BERT base performed the best on the testing set for Track-1  The same combination, with RoBERTa base for English, worked best for Track-2 
All of our submissions were the top submissions for each track, which surpassed the next best competitors by a margin of 4 5% and 5 6% for Track-1 and Track-2 respectively 

Ablation of best submissions

We hereby make some observations of our submissions and other experiments  To assist this, we plot the confusion matrices of our best submissions for Track-1 and Track-2 in Figures respectively  Note that these confusion matrices have their rows (i e  true labels axes) normalized according to the number of samples in the class 
Here are observations from our experiments: 1  BERT-based models outperform other models across all languages: We observe that BERT-based models outperform ELECTRA-based and GPT-2-based models, as shown in Table   We speculate this is because of the inherent architecture of BERT, which combines semantic learning with knowledge retention 
This combination of traits is particularly useful for this task  2  Common labels perform the worst across all languages: We observe that the common labels EN , ES and P T perform the worst, both in the individual as well as the two-stage setup  We hypothesize this is because of the absence of dialect specific words, or words that are specific to the geographical origin of the national dialect (for example, "Yankees" for EN-US and "Oxford" for EN-GB) 
3  English models work better than models of other languages: It can be noted from Figures 4 and 3 that the English models have the best performance across all classes  This can be attributed to two reasons: absence of national dialect specific words and lesser pretraining data in the case of Portuguese 
4  British English is most correctly classified class: We can observe that the Spanish or Portuguese models make equal number of mistakes in the case of either national dialect, in the case of Track-2 (see Figure )  However, in the case of English, the label EN − GB is correctly classified for more than 95% of the cases 
We speculate this is because British English involves slightly distinctive grammar and semantics, which help the model separate it from other classes  5  The proposed 2-step method is scalable for multiple language dialect classification: We can strongly assert that the novel 2-step deep learning method for multilingual dialect classification is a scalable method for the task due to two specific reasons: firstly, the multilingual models (like XLM-RoBERTa) might not have the vocabulary as well as the learning capabilities to learn the minute differences between individual dialects 
Secondly, this system can be quickly expanded for a new language by simply adding a language specific dialect classifier, provided the language identification model supports that particular language 

Conclusion

In this paper we propose a two-stage classification pipeline for dialect identification for multilingual corpora  We conduct thorough ablations on this setup and provide valuable insights  We foresee multiple future directions for this work  The first is to expand this work to many languages and dialects 
Secondly, it is a worthwhile research direction to distill this multi-model setup into a single model with multiple prediction heads  The obvious limitation of this system is the excessive memory consumption due to the usage of language specific models  For low resource languages this system is difficult to train and scale 
We hope that these problems will be addressed by researchers in future works 
Context 2: Do you know the difference between V T  and T V?
Like any exclusive club, heart disease has its own jargon, understandable only by other members of the club, particularly by cardiac care providers  For example, I remember lying in my CCU bed (that’s the Coronary Intensive Care Unit), trying to memorize the letters LAD (that’s the Left Anterior Descending, the large coronary artery whose 99% blockage had caused my MI (myocardial infarction – in my case, the so-called ‘widowmaker’ heart attack) 
To help others needing simultaneous translation of this new lingo in your research or in your own medical records, here’s a helpful list of some of the most common acronyms/terms you’ll likely find around the cardiac ward 
NOTE from CAROLYN: This entire patient-friendly, jargon-free glossary (all 8,000 words!) is also part of my book “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press, November 2017) 
AA – Anti-arrhythmic: Drugs used to treat patients who have irregular heart rhythms 
Ablation – See Cardiac Ablation 
ACE Inhibitor – Angiotension Converting Enzyme inhibitor: A drug that lowers blood pressure by interfering with the breakdown of a protein-like substance involved in regulating blood pressure 
ACS – Acute Coronary Syndrome: An emergency condition brought on by sudden reduced blood flow to the heart  The first sign of acute coronary syndrome can be sudden stopping of your heart (cardiac arrest) 
AED – Automatic External Defibrillator: A portable defibrillator for use during a cardiac emergency; it can be used on patients experiencing sudden cardiac arrest by applying a brief electroshock to the heart through electrodes placed on the chest 
AF or Afib – Atrial Fibrillation: An irregular and often rapid heart rate that can cause poor blood flow to the body  Afib symptoms include heart palpitations, shortness of breath, weakness or fainting  Episodes of atrial fibrillation can come and go, or you may have chronic atrial fibrillation 
AFL – Atrial Flutter: A type of arrhythmia where the upper chambers of the heart (the atria) beat very fast, causing the walls of the lower chambers (the ventricles) to beat inefficiently as well 
A-HCM – Apical Hypertrophic Cardiomyopathy: Also called Yamaguchi Syndrome or Yamaguchi Hypertrophy, a non-obstructive form of cardiomyopathy (a disease of the heart muscle that leads to generalized deterioration of the muscle and its pumping ability) in which a portion of the heart muscle is hypertrophied (thickened) without any obvious cause although there may be a genetic link  It was first described in individuals of Japanese descent 
AI – Aortic Insufficiency: A heart valve disease in which the aortic valve does not close tightly, leading to the backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (a chamber of the heart) 
AIVR – Accelerated Idioventricular Rhythm: Ventricular rhythm whose rate is greater than 49 beats/min but less than 100 beats/min, usually benign  (Ventricles are the two main chambers of the heart, left and right) 
Angina (stable) – A condition marked by distressing symptoms typically between neck and navel that come on with exertion and go away with rest, caused by an inadequate blood supply to the heart muscle typically because of narrowed coronary arteries feeding the heart muscle  Also known as Angina Pectoris  Unstable angina (UA) occurs when fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, blocking or reducing flow through a narrowed artery, suddenly and severely decreasing blood flow to the heart muscle  Unstable angina is not relieved by rest; it’s dangerous and requires emergency medical attention 
Antiplatelet drugs – Medications that block the formation of blood clots by preventing the clumping of platelets (examples: Plavix, Effient, Brillinta, Ticlid, etc)  Heart patients, especially those with implanted stents after PCI, are often prescribed dual antiplatelet therapy (DAPT) which includes one of these prescribed meds along with daily low-dose aspirin 
Aorta – The main artery of the body, carrying blood from the left side of the heart to the arteries of all limbs and organs except the lungs 
Aortic Stenosis: A disease of the heart valves in which the opening of the aortic valve is narrowed  Also called AS 
Aortic valve – One of four valves in the heart, this valve allows blood from the left ventricle to be pumped up (ejected) into the aorta, but prevents blood from returning to the heart once it’s in the aorta 
AP – Apical Pulse: A central pulse located at the apex (pointy bottom) of the heart 
Apex – the lowest (pointy) tip of the heart that points downward at the base, forming what almost looks like a rounded point 
Apical Hypertrophic Cardiomyopathy (A-HCM): Also called Yamaguchi Syndrome or Yamaguchi Hypertrophy, a non-obstructive form of cardiomyopathy (a disease of the heart muscle that leads to generalized deterioration of the muscle and its pumping ability) in which a portion of the heart muscle is hypertrophied (thickened) without any obvious cause  There may be a genetic link  It was first described in people of Japanese descent 
Arrhythmia – A condition in which the heart beats with an irregular or abnormal rhythm 
AS – Aortic Stenosis: A disease of the heart valves in which the opening of the aortic valve is narrowed 
ASD – Atrial Septal Defect: See Septal Defect 
Atrial Flutter – A heart rhythm problem (arrhythmia) originating from the right atrium, most often involving a large circuit that travels around the area of the tricuspid valve (between the right atrium and the right ventricle (this is called typical atrial flutter)  Less commonly, atrial flutter can also result from circuits in other areas of the right or left atrium that cause the heart to beat fast (called atypical atrial flutter) 
Atrial Septum, the membrane that separates the left and the right upper chambers of the heart (the atria) 
Atrium – A chamber of the heart that receives blood from the veins and forces it into a ventricle or ventricles  Plural: atria 
AV – Atrioventricular: A group of cells in the heart located between the upper two chambers (the atria) and the lower two chambers (the ventricles) that regulate the electrical current that passes through it to the ventricles  Also Atrioventricular Block: An interruption or disturbance of the electrical signal between the heart’s upper two chambers (the atria) and lower two chambers (the ventricles)  Also Aortic valve: The valve that regulates blood flow from the heart into the aorta 
AVNRT – Atrioventricular Nodal Re-entry Tachycardia: a heart rhythm problem that happens when there’s an electrical short circuit in the centre of the heart, one of the most common types of SVT, most often seen in people in their twenties and thirties, and more common in women than in men 
BAV – Bicuspid Aortic Valve: The most common malformation of the heart valves in which the aortic valve has only two cusps instead of three 
BB – Beta Blocker: A blood pressure-lowering drug that limits the activity of epinephrine, a hormone that increases blood pressure 
BBB – Bundle Branch Block: – A condition in which parts of the heart’s conduction system are defective and unable to normally conduct the electrical signal, causing an irregular heart rhythm (arrhythmia) 
BMI – Body mass index: A number that doctors use to determine if you’re overweight  BMI is calculated using a formula of weight in kilograms divided by height in meters squared (BMI =W [kg]/H [m2])  Better yet, just click here to figure out your own BMI 
BNP blood test – BNP (B-type Natriuretic Peptide) is a substance secreted from the ventricles or lower chambers of the heart in response to changes in pressure that happen when heart failure develops and/or worsens  The level of BNP in the blood increases when heart failure symptoms worsen, and decreases when the heart failure condition is stable 
BP – Blood Pressure: The force or pressure exerted by the heart in pumping blood; the pressure of blood in the arteries  See also hypertension 
BrS – Brugada Syndrome: Brugada syndrome is a genetic heart disease that is characterized by distinctively abnormal electrocardiogram (EKG/ECG) findings and an increased risk of sudden cardiac arrest 
CAA – Coronary artery anomaly: A congenital defect in one or more of the coronary arteries of the heart 
CABG – Coronary Artery Bypass Graft: A surgical procedure that reroutes blood flow around a diseased or blocked blood vessel that supplies blood to the heart by grafting either a piece of vein harvested from the leg or the artery from under the breastbone 
CA – Coronary Artery: The arteries arising from the aorta that arch down over the top of the heart and divide into branches  They provide blood to the heart muscle 
CAD – Coronary Artery Disease: A narrowing of the arteries that supply blood to the heart  The condition results from a plaque rupture/blood clot or spasm and greatly increases the risk of a heart attack 
Cardiac Ablation – A procedure performed by an Electrophysiologist (EP) – a cardiologist with specialized training in treating heart rhythm problems – that typically uses catheters — long, flexible tubes inserted through a vein in the groin and threaded to the heart — to correct structural problems in the heart that cause an arrhythmia  Cardiac ablation works by scarring or destroying the tissue in your heart that triggers an abnormal heart rhythm 
Cardiac Arrest – Also known as Sudden Cardiac Arrest: The stopping of the heartbeat, usually because of interference with the electrical signal that regulates each heartbeat (often associated with coronary heart disease)  Can lead to Sudden Cardiac Death 
Cardiac Catheterization – An invasive procedure in which a catheter is inserted through a blood vessel in the wrist/arm or groin with x-ray guidance  This procedure can help provide information about blood supply through the coronary arteries, blood pressure, blood flow throughout the chambers of the heart, collection of blood samples, and x-rays of the heart’s ventricles or arteries  It’s typically performed in the cath lab during angiography 
Cardiac Resynchronization Therapy (CRT) also called bi-ventricular pacemaker: an electronic pacing device that’s surgically implanted in the chest to treat the delay in heart ventricle contractions that occur in some people with heart failure 
Cardiac Tamponade – Pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium)  Also called Tamponade 
Cardiomyopathy – a chronic disease of the heart muscle (myocardium), in which the muscle is abnormally enlarged, thickened, and/or stiffened 
Cardioversion – A medical procedure in which an abnormally fast heart rate (tachycardia) or cardiac arrhythmia like atrial fibrillation is converted to a normal rhythm using electricity or drugs  Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart at a specific moment in the cardiac cycle  Chemical cardioversion uses medications to convert to normal rhythm 
Cath lab – the room in the hospital/medical clinic where cardiac catheterization procedures take place (for example, when a stent is implanted into a blocked coronary artery) 
CCB – Calcium Channel Blocker: A drug that lowers blood pressure by regulating calcium-related electrical activity in the heart 
CDS – Cardiac Depression Scale: A scale that can help assess the effects of depression occurring as a result of a heart disease diagnosis 
CHF – Heart Failure (also called Congestive Heart Failure): A condition in which the heart cannot pump all the blood returning to it, leading to a backup of blood in the vessels and an accumulation of fluid in the body’s tissues, including the lungs 
CM – Cardiomyopathy: A disease of the heart muscle that leads to generalized deterioration of the muscle and its pumping ability 
CO – Cardiac Output: The amount of blood the heart pumps through the circulatory system in one minute 
Collateral arteries – These extra coronary blood vessels are sometimes able to bypass a blockage in an artery in order to supply enough oxygenated blood to enable the heart muscle to survive when in danger of being damaged because of blockage(s) 
Collateral arteries – Blood vessels that provide an alternative arterial supply of blood to an area of the heart that’s in danger of being deprived of oxygenated blood because of one or more blocked arteries 
Congenital heart defect – one of about 35 different types of heart conditions that happen when the heart or the blood vessels near the heart don’t develop normally before a baby is born (in about 1% of live births)  Because of medical advances that treat babies born with heart defects, there are now for the first time more adults with congenital heart disease than children 
Congestive heart failure (CHF) – a chronic progressive condition that affects the pumping power of your heart muscle  Often referred to simply as heart failure, CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently 
COPD – Chronic Obstructive Pulmonary Disease: A lung disease defined by persistently poor airflow as a result of breakdown of lung tissue (known as emphysema) and dysfunction of the small airways Often associated with smoking, it typically worsens over time 
Coronary Microvascular Disease – A heart condition that causes impaired blood flow to the heart muscle through the small vessels of the heart  Also called Microvascular Disease or Small Vessel Disease 
Coronary Reactivity Test – An angiography procedure specifically designed to examine the blood vessels in the heart and how they respond to different medications  Physicians use these images to distinguish different types of blood vessel reactivity dysfunction (such as Coronary Microvascular Disease) 
Costochondritis– the cause of severe chest pain, but NOT heart-related; it’s an inflammation of the cartilage that connects a rib to the breastbone 
Coumadin – A drug taken to prevent the blood from clotting and to treat blood clots  Coumadin is believed to reduce the risk of blood clots causing strokes or heart attacks  See also Warfarin 
Cox Maze procedure – A complex “cut-and-sew” surgical procedure done to treat atrial fibrillation through a complicated set of incisions made in a maze-like pattern on the left and right atria (the upper chambers of the heart) to permanently interrupt the abnormal electrical signals that are causing the irregular heartbeats of Afib  See also: Mini-Maze 
CP – Chest Pain (may also be felt as squeezing, pressure, fullness, pressure, heaviness, burning or tightness in the chest) 
CPR – Cardiopulmonary Resuscitation: An emergency procedure in which the heart and lungs are made to work by manually compressing the chest overlying the heart and forcing air into the lungs, used to maintain circulation when the heart stops pumping during Cardiac Arrest  Current guidelines suggest hands-only CPR  See also AED 
CQ10 – Co-enzyme Q10: A dietary supplement sometimes recommended for heart patients taking statin drugs 
CRP – C-reactive protein: A byproduct of inflammation, produce by the liver, found in the blood in some cases of acute inflammation 
CRT – Cardiac Resynchronization Therapy also called bi-ventricular pacemaker: an electronic pacing device that’s surgically implanted in the chest to treat the delay in heart ventricle contractions that occur in some people with heart failure 
CT – Computed tomography (CT or CAT scan): An x-ray technique that uses a computer to create cross-sectional images of the body 
CTA – Computerized Tomographic Angiogram: An imaging test to look at the arteries that supply the heart muscle with blood  Unlike a traditional coronary angiogram, CT angiograms don’t use a catheter threaded through your blood vessels to your heart but instead rely on a powerful X-ray machine to produce images of your heart and heart vessels 
CV – Coronary Vein: One of the veins of the heart that drain blood from the heart’s muscular tissue and empty into the right atrium 
CV – Cardiovascular: Pertaining to the heart and blood vessels that make up the circulatory system 
DBP – Diastolic blood pressure: The lowest blood pressure measured in the arteries  It occurs when the heart muscle is relaxed between beats 
DCM – Dilated Cardiomyopathy: A disease of the heart muscle, primarily affecting the heart’s main pumping chamber (left ventricle)  The left ventricle becomes enlarged (dilated) and can’t pump blood to your body with as much force as a healthy heart can 
DDI – Drug-drug interaction: A situation in which a medication affects the activity of another medication when both are administered together 
DIL – Diltiazem: A calcium channel blocker drug that acts as a vasodilator; used in the treatment of angina pectoris, hypertension, and supraventricular tachycardia 
Diuretic – A class of drugs used to lower blood pressure  Also known as “water pills” 
Dobutamine stress echocardiography: This is a form of a stress echocardiogram diagnostic test  But instead of exercising on a treadmill or exercise bike to stress the heart, the stress is obtained by giving a drug that stimulates the heart and makes it “think” it’s exercising  The test is used to evaluate your heart and valve function if you are unable to exercise  It is also used to determine how well your heart tolerates activity, and your likelihood of having coronary artery disease (blocked arteries), and it can evaluate the effectiveness of your cardiac treatment plan  See also TTE and Stress Echocardiogram 
Dressler’s syndrome – Happens to a small number of people three to four weeks after a heart attack  The heart muscle that died during the attack sets the immune system in motion, calling on lymphocytes, one of the white blood cells, to infiltrate the coverings of the heart (pericardium) and the lungs (pleura)  It also starts generating antibodies, which attack those two coverings  Chest pain (CP) is the predominant symptom; treated with anti-inflammatory drugs 
Dual Antiplatelet Therapy – Medications that block the formation of blood clots by preventing the clumping of platelets (examples Plavix, Effient, Brillinta, Ticlid, etc ) are often prescribed along with aspirin as part of what’s known as dual antiplatelet therapy, especially to patients who have undergone PCI and stent implantation 
DVT – Deep Vein Thrombosis: A blood clot in a deep vein in the calf 
ECG / EKG – Electrocardiogram: A test in which several electronic sensors are placed on the body to monitor electrical activity associated with the heartbeat 
Ectopic beats – small changes in an otherwise normal heartbeat that lead to extra or skipped heartbeats, often occurring without a clear cause, most often harmless 
EF – Ejection Fraction: A measurement of blood that is pumped out of a filled ventricle  The normal rate is 50-60% 
EKG/ECG – Electrocardiogram: A test in which several electronic sensors are placed on the body to monitor electrical activity associated with the heartbeat 
Endothelium: A single-cell layer of flat endothelial cells lining the closed internal spaces of the body such as the inside of blood vessels  Endothelial dysfunction affects the ability of these cells to help dilate blood vessels, control inflammation or prevent blood clots  The endothelium is associated with most forms of cardiovascular disease, such as hypertension, coronary artery disease, chronic heart failure, peripheral vascular disease, diabetes, chronic kidney failure, and severe viral infections 
Enhanced External Counterpulsation – EECP is an FDA-approved non-invasive, non-drug treatment for angina  It works by promoting the development of collateral coronary arteries  The therapy is widely used in prominent heart clinics such as the Cleveland Clinic, Mayo Clinic and Johns Hopkins – especially for patients who are not good candidates for invasive procedures such as bypass surgery, angioplasty or stenting 
EP – Electrophysiologist: A cardiologist who has additional training in diagnosing/treating heart rhythm disorders 
EPS – Electrophysiology Study: A test that uses cardiac catheterization to study patients who have arrhythmias (abnormal hear rhythm)  An electrical current stimulates the heart in an effort to provoke an arrhythmia, which is immediately treated with medications  EPS is used primarily to identify the origin of the arrhythmia and to test the effectiveness of medications used to treat abnormal heart rhythms 
EVH – Endoscopic Vessel Harvesting: To create the bypass graft during CABG open heart surgery, a surgeon will remove or “harvest” healthy blood vessels from another part of the body, often from the patient’s leg or arm  This vessel becomes a graft, with one end attaching to a blood source above and the other end below the blocked area  See CABG 
Exercise stress test – An exercise test (walking/running on a treadmill or pedalling a stationary bike) to make your heart work harder and beat faster  An EKG is recorded while you exercise to monitor any abnormal changes in your heart under stress, with or without the aid of drugs to enhance this assessment  See also: MIBI, Echocardiogram, Nuclear Stress Test 
Familial hypercholesterolemia (FH) – A genetic predisposition to dangerously high cholesterol levels  FH is an inherited disorder that can lead to aggressive and premature cardiovascular disease, including problems like heart attacks, strokes, or narrowing of the heart valves 
Femoral Artery: a major artery in your groin/upper thigh area, through which a thin catheter is inserted, eventually making its way into the heart during angioplasty to implant a stent; currently the most widely used angioplasty approach in the United States, but many other countries now prefer the Radial Artery access in the wrist 
FFR – Fractional Flow Reserve: A test used during coronary catheterization (angiogram) to measure pressure differences across a coronary artery stenosis (narrowing or blockage) defined as as the pressure behind a blockage relative to the pressure before the blockage 
HC – High Cholesterol: When fatty deposits build up in your coronary arteries 
HCTZ – Hydrochlorothiazide: A drug used to lower blood pressure; it acts by inhibiting the kidneys’ ability to retain water  Used to be called “water pills” 
Heart Failure – a chronic progressive condition that affects the pumping power of your heart muscle  Sometimes called Congestive Heart Failure (CHF) 
Holter Monitor – A portable monitoring device that patients wear for recording heartbeats over a period of 24 hours or more 
HTN – Hypertension: High blood pressure, the force of blood pushing against the walls of arteries as it flows through them 
Hypokinesia – Decreased heart wall motion during each heartbeat, associated with cardiomyopathy, heart failure, or heart attack  Hypokinesia can involve small areas of the heart (segmental) or entire sections of heart muscle (global)  Also called hypokinesis 
ICD – Implantable Cardioverter Defibrillator: A surgically implanted electronic device to treat life-threatening heartbeat irregularities 
IHD – Ischemic Heart Disease: heart problems caused by narrowing of the coronary arteries, causing a decreased blood supply to the heart muscle  Also called coronary artery disease and coronary heart disease 
INR – International Normalized Ratio: A laboratory test measure of blood coagulation, often used as a standard for monitoring the effects of the anti-coagulant drug, warfarin (coumadin) 
IST – Inappropriate sinus tachycardia: A heart condition seen most often in young women, in which a person’s resting heart rate is abnormally high (greater than 100 bpm), their heart rate increases rapidly with minimal exertion, and this rapid heart rate is accompanied by symptoms of palpitations, fatigue, and/or exercise intolerance 
Interventional cardiologist – A cardiologist who is trained to perform invasive heart procedures like angiography, angioplasty, percutaneous coronary intervention (PCI), implanting stents, etc 
IVS – Interventricular Septum: The stout wall that separates the lower chambers (the ventricles) of the heart from one another 
IVUS – Intravascular Ultrasound: A form of echocardiography performed during cardiac catheterization in which a transducer (a device that can act as a transmitter (sender) and receiver of ultrasound information) is threaded into the heart blood vessels via a catheter; it’s used to provide detailed information about the blockage inside the blood vessels 
LAD – Left Anterior Descending coronary artery: One of the heart’s coronary artery branches from the left main coronary artery which supplies blood to the left ventricle 
LAFB – Left Anterior Fascicular Block: A cardiac condition,distinguished from Left Bundle Branch Block because only the anterior half of the left bundle branch is defective and more common than left posterior fascicular block 
LAHB – Left Anterior Hemiblock: The Left Bundle Branch divides into two major branches – the anterior and the posterior fascicles  Occasionally, a block can occur in one of these fascicles 
Left Circumflex Artery – The artery carries oxygenated blood from the heart to the body; it’s a branch of the Left Main Coronary Artery after the latter runs its course in between the aorta and the Main Pulmonary Artery 
Left Main Coronary Artery – The artery that branches from the aorta to supply oxygenated blood to the heart via the Left Anterior Descending Artery (LAD) and the Left Circumflex Artery 
Lipids – fat-like substances found in your blood and body tissues; a lipid panel is a blood test that measures the level of specific lipids in blood to help assess your risk of cardiovascular disease, measuring four types of lipids: total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides 
Lipoprotein-a or Lp(a) – molecules made of proteins and fat, carrying cholesterol and similar substances through the blood  A high level of Lp(a) is considered a risk factor for heart disease; detectable via a blood test 
Long QT syndrome (LQTS): A heart rhythm disorder that can potentially cause fast, chaotic heartbeats that may trigger a sudden fainting spell or seizure  In some cases, the heart may beat erratically for so long that it can cause sudden death 
LV – Left Ventricle – One of four chambers (two atria and two ventricles) in the human heart, it receives oxygenated blood from the left atrium via the mitral valve, and pumps it into the aorta via the aortic valve 
LVAD – Left ventricular assist device: A mechanical device that can be placed outside the body or implanted inside the body  An LVAD does not replace the heart – it “assists” or “helps” it pump oxygen-rich blood from the left ventricle to the rest of the body, usually as a bridge to heart transplant 
LVH – Left Ventricular Hypertrophy: A thickening of the myocardium (muscle) of the Left Ventricle (LV) of the heart  
Lumen – The hollow area within a tube, such as a blood vessel 
Main Pulmonary Artery – Carries oxygen-depleted blood from the heart to the lungs 
MIBI – Nuclear Stress Test/Cardiac Perfusion Scan/Sestamibi: tests that are used to assess the blood flow to the heart muscle (myocardium) when it is stressed by exercise or medication, and to find out what areas of the myocardium have decreased blood flow due to coronary artery disease  This is done by injecting a tiny amount of radionuclide like thallium or technetium (chemicals which release a type of radioactivity called gamma rays) into a vein in the arm or hand 
Microvascular disease – a heart condition that causes impaired blood flow to the heart muscle through the small blood vessels of the heart  Symptoms mimic those of a heart attack  Also called Coronary Microvascular Disease or Small Vessel Disease  I live with this diagnosis and have written more about it here, here and here 
Mini-Maze – a surgical procedure to treat atrial fibrillation, less invasive than what’s called the Cox Maze III procedure (a “cut-and-sew” procedure), and performed on a beating heart without opening the chest 
Mitral Valve: One of four valves in the heart, the structure that controls blood flow between the heart’s left atrium (upper chamber) and left ventricle (lower chamber)  The mitral valve has two flaps (cusps)  See also MV and/or Valves 
Mitral valve prolapse: a condition in which the two valve flaps of the mitral valve don’t close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium; also known as click-murmur syndrome, Barlow’s syndrome or floppy valve syndrome 
MR – Mitral regurgitation: (also mitral insufficiency or mitral incompetence) a heart condition in which the mitral valve does not close properly when the heart pumps out blood  It’s the abnormal leaking of blood from the left ventricle, through the mitral valve and into the left atrium when the left ventricle contracts 
MRI – Magnetic Resonance Imaging: A technique that produces images of the heart and other body structures by measuring the response of certain elements (such as hydrogen) in the body to a magnetic field  An MRI can produce detailed pictures of the heart and its various structures without the need to inject a dye 
MS – Mitral Stenosis: A narrowing of the mitral valve, which controls blood flow from the heart’s upper left chamber (the left atrium) to its lower left chamber (the left ventricle)  May result from an inherited (congenital) problem or from rheumatic fever 
MUGA – Multiple-Gated Acquisition Scanning: A non-invasive nuclear test that uses a radioactive isotope called technetium to evaluate the functioning of the heart’s ventricles 
Murmur – Noises superimposed on normal heart sounds  They are caused by congenital defects or damaged heart valves that do not close properly and allow blood to leak back into the originating chamber 
MV – Mitral Valve: The structure that controls blood flow between the heart’s left atrium (upper chamber) and left ventricle (lower chamber) 
Myocardial Infarction (MI, heart attack) – The damage or death of an area of the heart muscle (myocardium) resulting from a blocked blood supply to the area  The affected tissue dies, injuring the heart
Context 3: Vitamin K - Wikipedia
(Redirected from Vitamin k)
This article needs more medical references for verification or relies too heavily on primary sources  Please review the contents of the article and add the appropriate references if you can  Unsourced or poorly sourced material may be challenged and removed  (November 2015)
This article is about the family of vitamers  For vitamin K1 the form usually used as a supplement, see Phytomenadione 
Vitamin K structures  MK-4 and MK-7 are both subtypes of K2 
Vitamin K deficiency, Warfarin overdose
Vitamin K is a group of structurally similar, fat-soluble vitamins the human body requires for complete synthesis of certain proteins that are prerequisites for blood coagulation and which the body also needs for controlling binding of calcium in bones and other tissues  The vitamin K-related modification of the proteins allows them to bind calcium ions, which they cannot do otherwise  Without vitamin K, blood coagulation is seriously impaired, and uncontrolled bleeding occurs  Low levels of vitamin K also weaken bones and promote calcification of arteries and other soft tissues[citation needed] 
Chemically, the vitamin K family comprises 2-methyl-1,4-naphthoquinone (3-) derivatives  Vitamin K includes two natural vitamers: vitamin K1 and vitamin K2 [1] Vitamin K2, in turn, consists of a number of related chemical subtypes, with differing lengths of carbon side chains made of isoprenoid groups of atoms 
Vitamin K1, also known as phylloquinone, is made by plants, and is found in highest amounts in green leafy vegetables because it is directly involved in photosynthesis  It may be thought of as the plant form of vitamin K  It is active as a vitamin in animals and performs the classic functions of vitamin K, including its activity in the production of blood-clotting proteins  Animals may also convert it to vitamin K2 
Bacteria in the gut flora can also convert K1 into vitamin K2  In addition, bacteria typically lengthen the isoprenoid side chain of vitamin K2 to produce a range of vitamin K2 forms, most notably the MK-7 to MK-11 homologues of vitamin K2  All forms of K2 other than MK-4 can only be produced by bacteria, which use these forms in anaerobic respiration  The MK-7 and other bacterially derived forms of vitamin K2 exhibit vitamin K activity in animals, but MK-7's extra utility over MK-4, if any, is unclear and is a matter of investigation 
Three synthetic types of vitamin K are known: vitamins K3, K4, and K5  Although the natural K1 and all K2 homologues and synthetic K4 and K5 have proven nontoxic, the synthetic form K3 (menadione) has shown toxicity [2]
1 2 Cardiovascular health
1 4 Coumarin poisoning
4 1 Conversion of vitamin K1 to vitamin K2
4 2 Vitamin K2
6 Absorption and dietary need
7 Dietary reference intake
10 Biochemistry
10 1 Function in animals
10 2 Gamma-carboxyglutamate proteins
10 3 Methods of assessment
10 4 Function in bacteria
11 Injection in newborns
11 3 Controversy
A review of 2014 concluded that there is positive evidence that monotherapy using MK-4, one of the forms of Vitamin K2, reduces fracture incidence in post-menopausal women with osteoporosis, and suggested further research on the combined use of MK-4 with bisphosphonates  In contrast, an earlier review article of 2013 concluded that there is no good evidence that vitamin K supplementation helps prevent osteoporosis or fractures in postmenopausal women [3]
A Cochrane systematic review of 2006 suggested that supplementation with Vitamin K1 and with MK4 reduces bone loss; in particular, a strong effect of MK-4 on incident fractures among Japanese patients was emphasized [4]
A review article of 2016 suggested to consider, as one of several measures for bone health, increasing the intake of foods rich in vitamins K1 and K2 [5]
Cardiovascular health[edit]
Adequate intake of vitamin K is associated with the inhibition of arterial calcification and stiffening,[6] but there have been few interventional studies and no good evidence that vitamin K supplementation is of any benefit in the primary prevention of cardiovascular disease [7]
One 10-year population study, the Rotterdam Study, did show a clear and significant inverse relationship between the highest intake levels of menaquinone (mainly MK-4 from eggs and meat, and MK-8 and MK-9 from cheese) and cardiovascular disease and all-cause mortality in older men and women [8]
Vitamin K has been promoted in supplement form with claims it can slow tumor growth; there is however no good medical evidence that supports such claims [9]
Coumarin poisoning[edit]
Vitamin K is part of the suggested treatment regime for poisoning by rodenticide (coumarin poisoning) [10]
Although allergic reaction from supplementation is possible, no known toxicity is associated with high doses of the phylloquinone (vitamin K1) or menaquinone (vitamin K2) forms of vitamin K, so no tolerable upper intake level (UL) has been set [11]
Blood clotting (coagulation) studies in humans using 45 mg per day of vitamin K2 (as MK-4)[12] and even up to 135 mg per day (45 mg three times daily) of K2 (as MK-4),[13] showed no increase in blood clot risk  Even doses in rats as high as 250 mg/kg, body weight did not alter the tendency for blood-clot formation to occur [14]
Unlike the safe natural forms of vitamin K1 and vitamin K2 and their various isomers, a synthetic form of vitamin K, vitamin K3 (menadione), is demonstrably toxic at high levels  The U S  FDA has banned this form from over-the-counter sale in the United States because large doses have been shown to cause allergic reactions, hemolytic anemia, and cytotoxicity in liver cells [2]
Phylloquinone (K1)[15][16] or menaquinone (K2) are capable of reversing the anticoagulant activity of the anticoagulant warfarin (tradename Coumadin)  Warfarin works by blocking recycling of vitamin K, so that the body and tissues have lower levels of active vitamin K, and thus a deficiency of vitamin K 
Supplemental vitamin K (for which oral dosing is often more active than injectable dosing in human adults) reverses the vitamin K deficiency caused by warfarin, and therefore reduces the intended anticoagulant action of warfarin and related drugs [17] Sometimes small amounts of vitamin K are given orally to patients taking warfarin so that the action of the drug is more predictable [17] The proper anticoagulant action of the drug is a function of vitamin K intake and drug dose, and due to differing absorption must be individualized for each patient [citation needed] The action of warfarin and vitamin K both require two to five days after dosing to have maximum effect, and neither warfarin or vitamin K shows much effect in the first 24 hours after they are given [18]
The newer anticoagulants dabigatran and rivaroxaban have different mechanisms of action that do not interact with vitamin K, and may be taken with supplemental vitamin K [19][20]
Vitamin K2 (menaquinone)  In menaquinone, the side chain is composed of a varying number of isoprenoid residues  The most common number of these residues is four, since animal enzymes normally produce menaquinone-4 from plant phylloquinone 
A sample of phytomenadione for injection, also called phylloquinone
The three synthetic forms of vitamin K are vitamins K3 (menadione), K4, and K5, which are used in many areas, including the pet food industry (vitamin K3) and to inhibit fungal growth (vitamin K5) [21]
Conversion of vitamin K1 to vitamin K2[edit]
Vitamin K1 (phylloquinone) – both forms of the vitamin contain a functional naphthoquinone ring and an aliphatic side chain  Phylloquinone has a phytyl side chain 
The MK-4 form of vitamin K2 is produced by conversion of vitamin K1 in the testes, pancreas, and arterial walls [22] While major questions still surround the biochemical pathway for this transformation, the conversion is not dependent on gut bacteria, as it occurs in germ-free rats[23][24] and in parenterally-administered K1 in rats [25][26] In fact, tissues that accumulate high amounts of MK-4 have a remarkable capacity to convert up to 90% of the available K1 into MK-4 [27][28] There is evidence that the conversion proceeds by removal of the phytyl tail of K1 to produce menadione as an intermediate, which is then condensed with an activated geranylgeranyl moiety (see also prenylation) to produce vitamin K2 in the MK-4 (menatetrione) form [29]
Vitamin K2[edit]
Main article: Vitamin K2
Vitamin K2 (menaquinone) includes several subtypes  The two subtypes most studied are menaquinone-4 (menatetrenone, MK-4) and menaquinone-7 (MK-7) 
Vitamin K1, the precursor of most vitamin K in nature, is a stereoisomer of phylloquinone, an important chemical in green plants, where it functions as an electron acceptor in photosystem I during photosynthesis  For this reason, vitamin K1 is found in large quantities in the photosynthetic tissues of plants (green leaves, and dark green leafy vegetables such as romaine lettuce, kale and spinach), but it occurs in far smaller quantities in other plant tissues (roots, fruits, etc )  Iceberg lettuce contains relatively little  The function of phylloquinone in plants appears to have no resemblance to its later metabolic and biochemical function (as "vitamin K") in animals, where it performs a completely different biochemical reaction 
Vitamin K (in animals) is involved in the carboxylation of certain glutamate residues in proteins to form gamma-carboxyglutamate (Gla) residues  The modified residues are often (but not always) situated within specific protein domains called Gla domains  Gla residues are usually involved in binding calcium, and are essential for the biological activity of all known Gla proteins [30]
At this time[update], 17 human proteins with Gla domains have been discovered, and they play key roles in the regulation of three physiological processes:
Blood coagulation: prothrombin (factor II), factors VII, IX, and X, and proteins C, S, and Z[31]
Bone metabolism: osteocalcin, also called bone Gla protein (BGP), matrix Gla protein (MGP),[32] periostin,[33] and the recently discovered Gla-rich protein (GRP) [34][35]
Vascular biology: growth arrest-specific protein 6 (Gas6)[36]
Unknown function: proline-rich γ-carboxyglutamyl proteins (PRGPs) 1 and 2, and transmembrane γ-carboxy glutamyl proteins (TMGs) 3 and 4 [37]
Like other lipid-soluble vitamins (A, D and E), vitamin K is stored in the fatty tissue of the human body 
Absorption and dietary need[edit]
Previous theory held that dietary deficiency is extremely rare unless the small intestine was heavily damaged, resulting in malabsorption of the molecule  Another at-risk group for deficiency were those subject to decreased production of K2 by normal intestinal microbiota, as seen in broad spectrum antibiotic use [38] Taking broad-spectrum antibiotics can reduce vitamin K production in the gut by nearly 74% in people compared with those not taking these antibiotics [39] Diets low in vitamin K also decrease the body's vitamin K concentration [40] Those with chronic kidney disease are at risk for vitamin K deficiency, as well as vitamin D deficiency, and particularly those with the apoE4 genotype [41] Additionally, in the elderly there is a reduction in vitamin K2 production [42]
The National Academy of Medicine (NAM) updated an estimate of what constitutes an adequate intake (AI) for vitamin K in 2001  The NAM does not distinguish between K1 and K2 – both are counted as vitamin K  At that time there was not sufficient evidence to set the more rigorous estimated average requirement (EAR) or recommended dietary allowance (RDA) given for most of the essential vitamins and minerals  The current daily AIs for vitamin K for adult women and men are 90 μg and 120 μg respectively  The AI for pregnancy and lactation is 90 μg  For infants up to 12 months the AI is 2–2 5 μg, and for children aged 1 to 18 years the AI increases with age from 30 to 75 μg  As for safety, the FNB also sets tolerable upper intake levels (known as ULs) for vitamins and minerals when evidence is sufficient  In the case of vitamin K no UL is set, as evidence for adverse effects is not sufficient  Collectively EARs, RDAs, AIs and ULs are referred to as dietary reference intakes [43] The European Food Safety Authority reviewed the same safety question and did not set an UL [44]
For U S  food and dietary supplement labeling purposes, the amount in a serving is expressed as a percentage of daily value (%DV)  For vitamin K labeling purposes the daily value was 80 μg, but as of May 2016 it has been revised upwards to 120 μg  A table of the pre-change adult daily values is provided at reference daily intake  Food and supplement companies have until 28 July 2018 to comply with the change 
See also: Vitamin K2 § Dietary sources
K1 (μg)[45]
Kale, cooked
Collards, cooked
Collards, raw
Swiss chard, cooked
Swiss chard, raw
Turnip greens, raw
Romaine lettuce, raw
Table from "Important information to know when you are taking: Warfarin (Coumadin) and Vitamin K", Clinical Center, National Institutes of Health Drug Nutrient Interaction Task Force [46]
Vitamin K1 is found chiefly in leafy green vegetables such as dandelion greens (which contain 778 4 μg per 100 g, or 741% of the recommended daily amount), spinach, swiss chard, lettuce and Brassica vegetables (such as cabbage, kale, cauliflower, broccoli, and brussels sprouts) and often the absorption is greater when accompanied by fats such as butter or oils; some fruits, such as avocados, kiwifruit and grapes, are also high in vitamin K  By way of reference, two tablespoons of parsley contains 153% of the recommended daily amount of vitamin K [47] Some vegetable oils, notably soybean oil, contain vitamin K, but at levels that would require relatively large calorie consumption to meet the USDA-recommended levels [48] colonic bacteria synthesize a significant portion of humans' vitamin K needs; newborns often receive a vitamin K shot at birth to tide them over until their colons become colonized at five to seven days of age from the consumption of breast milk 
The tight binding of vitamin K1 to thylakoid membranes in chloroplasts makes it less bioavailable  For example, cooked spinach has a 5% bioavailability of phylloquinone, however, fat added to it increases bioavailability to 13% due to the increased solubility of vitamin K in fat [49]
Main article: Vitamin K deficiency
Average diets are usually not lacking in vitamin K, and primary deficiency is rare in healthy adults  Newborn infants are at an increased risk of deficiency  Other populations with an increased prevalence of vitamin K deficiency include those who suffer from liver damage or disease (e g  alcoholics), cystic fibrosis, or inflammatory bowel diseases, or have recently had abdominal surgeries  Secondary vitamin K deficiency can occur in people with bulimia, those on stringent diets, and those taking anticoagulants  Other drugs associated with vitamin K deficiency include salicylates, barbiturates, and cefamandole, although the mechanisms are still unknown  Vitamin K1 deficiency can result in coagulopathy, a bleeding disorder [50]Symptoms of K1 deficiency include anemia, bruising, nosebleeds and bleeding of the gums in both sexes, and heavy menstrual bleeding in women 
Osteoporosis[51][52] and coronary heart disease[53][54] are strongly associated with lower levels of K2 (menaquinone)  Vitamin K2 (as menaquinones MK-4 through MK-10) intake level is inversely related to severe aortic calcification and all-cause mortality [8]
Function in animals[edit]
Mechanism of action of vitamin K1 
The function of vitamin K2 in the animal cell is to add a carboxylic acid functional group to a glutamate (Glu) amino acid residue in a protein, to form a gamma-carboxyglutamate (Gla) residue  This is a somewhat uncommon posttranslational modification of the protein, which is then known as a "Gla protein"  The presence of two −COOH (carboxylic acid) groups on the same carbon in the gamma-carboxyglutamate residue allows it to chelate calcium ions  The binding of calcium ions in this way very often triggers the function or binding of Gla-protein enzymes, such as the so-called vitamin K-dependent clotting factors discussed below 
Within the cell, vitamin K undergoes electron reduction to a reduced form called vitamin K hydroquinone, catalyzed by the enzyme vitamin K epoxide reductase (VKOR) [55] Another enzyme then oxidizes vitamin K hydroquinone to allow carboxylation of Glu to Gla; this enzyme is called gamma-glutamyl carboxylase[56][57] or the vitamin K-dependent carboxylase  The carboxylation reaction only proceeds if the carboxylase enzyme is able to oxidize vitamin K hydroquinone to vitamin K epoxide at the same time  The carboxylation and epoxidation reactions are said to be coupled  Vitamin K epoxide is then reconverted to vitamin K by VKOR  The reduction and subsequent reoxidation of vitamin K coupled with carboxylation of Glu is called the vitamin K cycle [58] Humans are rarely deficient in vitamin K1 because, in part, vitamin K1 is continuously recycled in cells [59]
Warfarin and other 4-hydroxycoumarins block the action of VKOR [60] This results in decreased concentrations of vitamin K and vitamin K hydroquinone in tissues, such that the carboxylation reaction catalyzed by the glutamyl carboxylase is inefficient  This results in the production of clotting factors with inadequate Gla  Without Gla on the amino termini of these factors, they no longer bind stably to the blood vessel endothelium and cannot activate clotting to allow formation of a clot during tissue injury  As it is impossible to predict what dose of warfarin will give the desired degree of clotting suppression, warfarin treatment must be carefully monitored to avoid overdose 
Gamma-carboxyglutamate proteins[edit]
Main article: Gla domain
The following human Gla-containing proteins ("Gla proteins") have been characterized to the level of primary structure: blood coagulation factors II (prothrombin), VII, IX, and X, anticoagulant proteins C and S, and the factor X-targeting protein Z  The bone Gla protein osteocalcin, the calcification-inhibiting matrix Gla protein (MGP), the cell growth regulating growth arrest specific gene 6 protein (Gas6), and the four transmembrane Gla proteins (TMGPs), the function of which is at present unknown  Gas6 can function as a growth factor to activate the Axl receptor tyrosine kinase and stimulate cell proliferation or prevent apoptosis in some cells  In all cases in which their function was known, the presence of the Gla residues in these proteins turned out to be essential for functional activity 
Gla proteins are known to occur in a wide variety of vertebrates: mammals, birds, reptiles, and fish  The venom of a number of Australian snakes acts by activating the human blood-clotting system  In some cases, activation is accomplished by snake Gla-containing enzymes that bind to the endothelium of human blood vessels and catalyze the conversion of procoagulant clotting factors into activated ones, leading to unwanted and potentially deadly clotting 
Another interesting class of invertebrate Gla-containing proteins is synthesized by the fish-hunting snail Conus geographus [61] These snails produce a venom containing hundreds of neuroactive peptides, or conotoxins, which is sufficiently toxic to kill an adult human  Several of the conotoxins contain two to five Gla residues [62]
Methods of assessment[edit]
Vitamin K status can be assessed by:
The prothrombin time (PT) test measures the time required for blood to clot  A blood sample is mixed with citric acid and put in a fibrometer; delayed clot formation indicates a deficiency  This test is insensitive to mild deficiency, as the values do not change until the concentration of prothrombin in the blood has declined by at least 50% [63]
Undercarboxylated prothrombin (PIVKA-II); in a study of 53 newborns, found "PT (prothrombin time) is a less sensitive marker than PIVKA II",[64] and as indicated above, PT is unable to detect subclinical deficiencies that can be detected with PIVKA-II testing 
Plasma phylloquinone was found to be positively correlated with phylloquinone intake in elderly British women, but not men,[65] but an article by Schurgers et al  reported no correlation between FFQ[further explanation needed] and plasma phylloquinone [66]
Urinary γ-carboxyglutamic acid responds to changes in dietary vitamin K intake  Several days are required before any change can be observed  In a study by Booth et al , increases of phylloquinone intakes from 100 μg to between 377 and 417 μg for five days did not induce a significant change  Response may be age-specific [67]
Undercarboxylated osteocalcin (UcOc) levels have been inversely correlated with stores of vitamin K[68] and bone strength in developing rat tibiae  Another study following 78 post-menopausal Korean women found a supplement regimen of vitamins K and D, and calcium, but not a regimen of vitamin D and calcium, was inversely correlated with reduced UcOc levels [69]
Function in bacteria[edit]
Many bacteria, such as Escherichia coli found in the large intestine, can synthesize vitamin K2 (menaquinone-7 or MK-7, up to MK-11),[70] but not vitamin K1 (phylloquinone)  In these bacteria, menaquinone transfers two electrons between two different small molecules, during oxygen-independent metabolic energy production processes (anaerobic respiration) [71] For example, a small molecule with an excess of electrons (also called an electron donor) such as lactate, formate, or NADH, with the help of an enzyme, passes two electrons to menaquinone  The menaquinone, with the help of another enzyme, then transfers these two electrons to a suitable oxidant, such fumarate or nitrate (also called an electron acceptor)  Adding two electrons to fumarate or nitrate converts the molecule to succinate or nitrite plus water, respectively 
Some of these reactions generate a cellular energy source, ATP, in a manner similar to eukaryotic cell aerobic respiration, except the final electron acceptor is not molecular oxygen, but fumarate or nitrate  In aerobic respiration, the final oxidant is molecular oxygen (O2), which accepts four electrons from an electron donor such as NADH to be converted to water  E  coli, as facultative anaerobes, can carry out both aerobic respiration and menaquinone-mediated anaerobic respiration 
Injection in newborns[edit]
The blood clotting factors of newborn babies are roughly 30–60% that of adult values; this may be due to the reduced synthesis of precursor proteins and the sterility of their guts  Human milk contains 1–4 μg/L of vitamin K1, while formula-derived milk can contain up to 100 μg/L in supplemented formulas  Vitamin K2 concentrations in human milk appear to be much lower than those of vitamin K1  Occurrence of vitamin K deficiency bleeding in the first week of the infant's life is estimated at 0 25–1 7%, with a prevalence of 2–10 cases per 100,000 births [72] Premature babies have even lower levels of the vitamin, so they are at a higher risk from this deficiency 
Bleeding in infants due to vitamin K deficiency can be severe, leading to hospitalization, blood transfusions, brain damage, and death  Supplementation can prevent most cases of vitamin K deficiency bleeding in the newborn  Intramuscular administration is more effective in preventing late vitamin K deficiency bleeding than oral administration [73][74]
As a result of the occurrences of vitamin K deficiency bleeding, the Committee on Nutrition of the American Academy of Pediatrics has recommended 0 5–1 mg of vitamin K1 be administered to all newborns shortly after birth [74]
In the UK vitamin K supplementation is recommended for all newborns within the first 24 hours [75] This is usually given as a single intramuscular injection of 1 mg shortly after birth but as a second-line option can be given by three oral doses over the first month [76]
Controversy arose in the early 1990s regarding this practice, when two studies suggested a relationship between parenteral administration of vitamin K and childhood cancer,[77] however, poor methods and small sample sizes led to the discrediting of these studies, and a review of the evidence published in 2000 by Ross and Davies found no link between the two [78] Doctors reported emerging concerns in 2013,[79] after treating children for serious bleeding problems  They cited lack-of newborn vitamin K administration, as the reason that the problems occurred, and recommended that breastfed babies could have an increased risk unless they receive a preventative dose 
In the early 1930s, Danish scientist Henrik Dam investigated the role of cholesterol by feeding chickens a cholesterol-depleted diet [80] He initially replicated experiments reported by scientists at the Ontario Agricultural College (OAC) [81] McFarlane, Graham and Richardson, working on the chick feed program at OAC, had used chloroform to remove all fat from chick chow  They noticed that chicks fed only fat-depleted chow developed hemorrhages and started bleeding from tag sites [82] Dam found that these defects could not be restored by adding purified cholesterol to the diet  It appeared that – together with the cholesterol – a second compound had been extracted from the food, and this compound was called the coagulation vitamin  The new vitamin received the letter K because the initial discoveries were reported in a German journal, in which it was designated as Koagulationsvitamin  Edward Adelbert Doisy of Saint Louis University did much of the research that led to the discovery of the structure and chemical nature of vitamin K [83] Dam and Doisy shared the 1943 Nobel Prize for medicine for their work on vitamin K (K1 and K2) published in 1939  Several laboratories synthesized the compound(s) in 1939 [84]
For several decades, the vitamin K-deficient chick model was the only method of quantifying vitamin K in various foods: the chicks were made vitamin K-deficient and subsequently fed with known amounts of vitamin K-containing food  The extent to which blood coagulation was restored by the diet was taken as a measure for its vitamin K content  Three groups of physicians independently found this: Biochemical Institute, University of Copenhagen (Dam and Johannes Glavind), University of Iowa Department of Pathology (Emory Warner, Kenneth Brinkhous, and Harry Pratt Smith), and the Mayo Clinic (Hugh Butt, Albert Snell, and Arnold Osterberg) [85]
The first published report of successful treatment with vitamin K of life-threatening hemorrhage in a jaundiced patient with prothrombin deficiency was made in 1938 by Smith, Warner, and Brinkhous [86]
The precise function of vitamin K was not discovered until 1974, when three laboratories (Stenflo et al ,[87] Nelsestuen et al ,[88] and Magnusson et al [89]) isolated the vitamin K-dependent coagulation factor prothrombin (factor II) from cows that received a high dose of a vitamin K antagonist, warfarin  It was shown that, while warfarin-treated cows had a form of prothrombin that contained 10 glutamate (Glu) amino acid residues near the amino terminus of this protein, the normal (untreated) cows contained 10 unusual residues that were chemically identified as γ-carboxyglutamate (Gla)  The extra carboxyl group in Gla made clear that vitamin K plays a role in a carboxylation reaction during which Glu is converted into Gla 
The biochemistry of how vitamin K is used to convert Glu to Gla has been elucidated over the past thirty years in academic laboratories throughout the world 
^ "Vitamin K Overview"  University of Maryland Medical Center  ^ a b Higdon, Jane (Feb 2008)  "Vitamin K"  Linus Pauling Institute, Oregon State University  Retrieved 12 Apr 2008  ^ Hamidi, M  S ; Gajic-Veljanoski, O ; Cheung, A  M  (2013)  "Vitamin K and bone health"  Journal of Clinical Densitometry (Review)  16 (4): 409–413  doi:10 1016/j jocd 2013 08 017  PMID 24090644  ^ Cockayne, S ; Adamson, J ; Lanham-New, S ; Shearer, M  J ; Gilbody, S; Torgerson, D  J  (Jun 2006)  "Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials"  Archives of Internal Medicine (Review)  166 (12): 1256–1261  doi:10 1001/archinte 166 12 1256  PMID 16801507  ^ O'Keefe, J  H ; Bergman, N ; Carrera Bastos, P ; Fontes Villalba, M ; Di Nicolantonio, J  J ; Cordain, L  (2016)  "Nutritional strategies for skeletal and cardiovascular health: hard bones, soft arteries, rather than vice versa"  Open Heart (Review)  3 (1): e000325  doi:10 1136/openhrt-2015-000325  PMC 4809188  PMID 27042317  ^ Maresz, K  (Feb 2015)  "Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health"  Integrative Medicine (Review)  14 (1): 34–39  PMC 4566462  PMID 26770129  ^ Hartley, L ; Clar, C ; Ghannam, O ; Flowers, N ; Stranges, S ; Rees, K  (Sep 2015)  "Vitamin K for the primary prevention of cardiovascular disease"  The Cochrane Database of Systematic Reviews (Systematic review)  9 (9): CD011148  doi:10 1002/14651858 CD011148 pub2  PMID 26389791  ^ a b Geleijnse, J  M ; Vermeer, C ; Grobbee, D  E ; Schurgers, L  J ; Knapen, M  H ; van der Meer, I  M ; Hofman, A ; Witteman, J  C  (Nov 2004)  "Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study"  Journal of Nutrition  134 (11): 3100–3105  PMID 15514282  ^ Ades, T  B , ed  (2009)  "Vitamin K"  American Cancer Society Complete Guide to Complementary and Alternative Cancer Therapies (2nd ed )  American Cancer Society  pp  558–563  ISBN 978-0-944235-71-3  ^ Lung, D  (Dec 2015)  Tarabar, A , ed  "Rodenticide Toxicity Treatment & Management"  Medscape  WebMD  ^ Rasmussen, S  E ; Andersen, N  L ; Dragsted, L  O ; Larsen, J  C  (Mar 2006)  "A safe strategy for addition of vitamins and minerals to foods"  European Journal of Nutrition  45 (3): 123–135  doi:10 1007/s00394-005-0580-9  PMID 16200467  ^ Ushiroyama, T ; Ikeda, A ; Ueki, M (Mar 2002)  "Effect of continuous combined therapy with vitamin K2 and vitamin D3 on bone mineral density and coagulofibrinolysis function in postmenopausal women"  Maturitas  41 (3): 211–221  doi:10 1016/S0378-5122(01)00275-4  PMID 11886767  ^ Asakura, H ; Myou, S ; Ontachi, Y ; Mizutani, T ; Kato, M ; Saito, M ; Morishita, E ; Yamazaki, M ; Nakao, S  (Dec 2001)  "Vitamin K administration to elderly patients with osteoporosis induces no hemostatic activation, even in those with suspected vitamin K deficiency"  Osteoporosis International  12 (12): 996–1000  doi:10 1007/s001980170007  PMID 11846334  ^ Ronden, J  E ; Groenen-van Dooren, M  M ; Hornstra, G ; Vermeer, C  (Jul 1997)  "Modulation of arterial thrombosis tendency in rats by vitamin K and its side chains"  Atherosclerosis  132 (1): 61–67  doi:10 1016/S0021-9150(97)00087-7  PMID 9247360  ^ Ansell, J ; Hirsh, J ; Poller, L ; Bussey, H ; Jacobson, A ; Hylek, E (Sep 2004)  "The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy"  Chest  126 (3 Suppl ): 204S–233S  doi:10 1378/chest 126 3_suppl 204S  PMID 15383473  ^ Crowther, M  A ; Douketis, J  D ; Schnurr, T ; Steidl, L ; Mera, V ; Ultori, C ; Venco, A ; Ageno, W  (Aug 2002)  "Oral vitamin K lowers the international normalized ratio more rapidly than subcutaneous vitamin K in the treatment of warfarin-associated coagulopathy  A randomized, controlled trial"  Annals of Internal Medicine  137 (4): 251–254  doi:10 7326/0003-4819-137-4-200208200-00009  PMID 12186515  ^ a b "Important Information to Know When You Are Taking: Warfarin (Coumadin) and Vitamin K" (PDF)  National Institute of Health Clinical Center Drug-Nutrient Interaction Task Force  Retrieved 17 Apr 2015  ^ "Guidelines For Warfarin Reversal With Vitamin K" (PDF)  American Society of Health-System Pharmacists  Retrieved 17 Apr 2015  ^ "Pradaxa Drug Interactions"  Pradaxapro com  19 Mar 2012  Retrieved 21 Apr 2013  ^ Bauersachs, R ; Berkowitz, S  D ; Brenner, B ; Buller, H  R ; Decousus, H ; Gallus, A  S ; Lensing, A  W ; Misselwitz, F ; Prins, M  H ; Raskob, G  E ; Segers, A ; Verhamme, P ; Wells, P ; Agnelli, G ; Bounameaux, H ; Cohen, A ; Davidson, B  L ; Piovella, F ; Schellong, S  (Dec 2010)  "Oral rivaroxaban for symptomatic venous thromboembolism"  New England Journal of Medicine  363 (26): 2499–2510  doi:10 1056/NEJMoa1007903  PMID 21128814  ^ McGee, W  (1 Feb 2007)  "Vitamin K"  MedlinePlus  Retrieved 2 Apr 2009  ^ Shearer, M  J ; Newman, P  (Oct 2008)  "Metabolism and cell biology of vitamin K"  Thrombosis and Haemostasis  100 (4): 530–547  doi:10 1160/TH08-03-0147  PMID 18841274  ^ Davidson, R  T ; Foley, A  L ; Engelke, J  A ; Suttie, J  W  (Feb 1998)  "Conversion of dietary phylloquinone to tissue menaquinone-4 in rats is not dependent on gut bacteria"  Journal of Nutrition  128 (2): 220–223  PMID 9446847  ^ Ronden, J  E ; Drittij-Reijnders, M  J ; Vermeer, C ; Thijssen, H  H  (Jan 1998)  "Intestinal flora is not an intermediate in the phylloquinone–menaquinone-4 conversion in the rat"  Biochimica et Biophysica Acta  1379 (1): 69–75  doi:10 1016/S0304-4165(97)00089-5  PMID 9468334  ^ Thijssen, H   H ; Drittij-Reijnders, M  J  (Sep 1994)  "Vitamin K distribution in rat tissues: dietary phylloquinone is a source of tissue menaquinone-4"  The British Journal of Nutrition  72 (3): 415–425  doi:10 1079/BJN19940043  PMID 7947656  ^ Will, B  H ; Usui, Y ; Suttie, J  W  (Dec 1992)  "Comparative metabolism and requirement of vitamin K in chicks and rats"  Journal of Nutrition  122 (12): 2354–2360  PMID 1453219  ^ Davidson, R  T ; Foley, A  L ; Engelke, J  A ; Suttie, J  W  (Feb 1998)  "Conversion of dietary phylloquinone to tissue menaquinone-4 in rats is not dependent on gut bacteria"  Journal of Nutrition  128 (2): 220–223  PMID 9446847  ^ Ronden, J  E ; Drittij-Reijnders, M  J ; Vermeer, C ; Thijssen, H  H  (Jan 1998)  "Intestinal flora is not an intermediate in the phylloquinone-menaquinone-4 conversion in the rat"  Biochimica et Biophysica Acta  1379 (1): 69–75  doi:10 1016/S0304-4165(97)00089-5  PMID 9468334  ^ Al Rajabi, Ala (2011)  The Enzymatic Conversion of Phylloquinone to Menaquinone-4 (PhD thesis)  Tufts University, Friedman School of Nutrition Science and Policy  ^ Furie, B ; Bouchard, B  A ; Furie, B  C  (Mar 1999)  "Vitamin K-dependent biosynthesis of gamma-carboxyglutamic acid"  Blood  93 (6): 1798–1808  PMID 10068650  ^ Mann, K  G  (Aug 1999)  "Biochemistry and physiology of blood coagulation"  Thrombosis and Haemostasis  82 (2): 165–174  PMID 10605701  ^ Price, P  A  (1988)  "Role of vitamin-K-dependent proteins in bone metabolism"  Annual Review of Nutrition  8: 565–583  doi:10 1146/annurev nu 08 070188 003025  PMID 3060178  ^ Coutu, D  L ; Wu, J  H ; Monette, A ; Rivard, G  E ; Blostein, M  D ; Galipeau, J (Jun 2008)  "Periostin, a member of a novel family of vitamin K-dependent proteins, is expressed by mesenchymal stromal cells"  Journal of Biological Chemistry  283 (26): 17991–18001  doi:10 1074/jbc M708029200  PMID 18450759  ^ Viegas, C  S ; Simes, D  C ; Laizé, V ; Williamson, M  K ; Price, P  A ; Cancela, M  L  (Dec 2008)  "Gla-rich protein (GRP), a new vitamin K-dependent protein identified from sturgeon cartilage and highly conserved in vertebrates"  Journal of Biological Chemistry



ground_truth: The best performing model for the Spanish language in Track-1 was Spanish BERT.

prompt_front: Now, answer the following question based on the text below, only give me the answer and do not output any other words.

Question: What is the purpose of an ICD?

Read the following text and answer briefly.

Context 2: 
Myocardium – The muscular tissue of the heart 
New Wall-Motion Abnormalities – Results seen on an echocardiogram test report (see NWMA, below) 
Nitroglycerin – A medicine that helps relax and dilate arteries; often used to treat cardiac chest pain (angina)  Also called NTG or GTN 
NSR – Normal Sinus Rhythm: The characteristic rhythm of the healthy human heart  NSR is considered to be present if the heart rate is in the normal range, the P waves are normal on the EKG/ECG, and the rate does not vary significantly 
NSTEMI – Non-ST-segment-elevation myocardial infarction: The milder form of the two main types of heart attack  An NSTEMI heart attack does not produce an ST-segment elevation seen on an electrocardiogram test (EKG)  See also STEMI 
Nuclear Stress Test – A diagnostic test that usually involves two exercise stress tests, one while you’re exercising on a treadmill/stationary bike or with medication that stresses your heart, and another set while you’re at rest  A nuclear stress test is used to gather information about how well your heart works during physical activity and at rest  See also: Exercise stress test, Nuclear perfusion test, MIBI 
Open heart surgery – Any surgery in which the chest is opened and surgery is done on the heart muscle, valves, coronary arteries, or other parts of the heart (such as the aorta)  See also CABG 
Pacemaker – A surgically implanted electronic device that helps regulate the heartbeat 
PAD – Peripheral Artery Disease: A common circulatory problem in which narrowed arteries reduce blood flow to the limbs, usually to the legs  Symptoms include leg pain when walking (called intermittent claudication) 
PAF – Paroxysmal Atrial Fibrillation: Atrial fibrillation that lasts from a few seconds to days, then stops on its own  See also Atrial Fibrillation 
Palpitations – A noticeably rapid, strong, or irregular heartbeat due to agitation, exertion or illness 
Paroxysmal Atrial Fibrillation – An unusual heart arrhythmia of unknown origin, at one time believed to be associated with an unusual sensitivity to alcohol consumption 
PDA – patent ductus arteriosus: A persistent opening between two major blood vessels leading from the heart  The opening is called ductus arteriosus and is a normal part of a baby’s circulatory system before birth that usually closes shortly after birth  But when it remains open, it’s called a patent ductus arteriosus  If it’s small, it may never need treatment, but a large PDA left untreated can allow poorly oxygenated blood to flow in the wrong direction, weakening the heart muscle and causing heart failure or other complications 
Pericardium: two thin layers of a sac-like tissue that surround the heart, hold it in place and help it work 
PET – Positron Emission Tomography: A non-invasive scanning technique that uses small amounts of radioactive positrons (positively charged particles) to visualize body function and metabolism  In cardiology, PET scans are used to evaluate heart muscle function in patients with coronary artery disease or cardiomyopathy 
PFO – Patent Forman Ovale: An opening between the left and right atria (the upper chambers) of the heart  Everyone has a PFO before birth, but in 1 out of every 3 or 4 people, the opening does not close naturally as it should after birth 
Plaque – A deposit of fatty (and other) substances in the inner lining of the artery wall; it is characteristic of atherosclerosis 
POTS – Postural Orthostatic Tachycardia Syndrome: A disorder that causes an increased heart rate when a person stands upright 
PPCM – Post-partum cardiomyopathy: A form of cardiomyopathy that causes heart failure toward the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure 
Preeclampsia – a late-pregnancy complication identified by spikes in blood pressure, protein in the urine, possible vision problems  Women who experience pregnancy complications like preeclampsia are at significantly higher risk for heart disease 
Prinzmetal’s Variant Angina – Chest pain caused by a spasm in a coronary artery that supplies blood to the heart muscle 
PSVT – Paroxysmal Supraventricular Tachycardia: – An occasional rapid heart rate (150-250 beats per minute) that is caused by events triggered in areas above the heart’s lower chambers (the ventricles)  “Paroxysmal” means from time to time  See also supraventricular tachycardia (SVT) 
Pulmonary Valve: One of the four valves in the heart, located between the pulmonary artery and the right ventricle of the heart, moves blood toward the lungs and keeps it from sloshing back into the heart 
PV – Pulmonary Vein: A vein carrying oxygenated blood from the lungs to the left atrium of the heart 
PVC – Premature Ventricular Contraction: An early or extra heartbeat that happens when the heart’s lower chambers (the ventricles) contract too soon, out of sequence with the normal heartbeat  In the absence of any underlying heart disease, PVCs do not generally indicate a problem with electrical stability, and are usually benign 
RA – Right Atrium: The right upper chamber of the heart  The right atrium receives de-oxygenated blood from the body through the vena cava and pumps it into the right ventricle which then sends it to the lungs to be oxygenated 
Radial Artery: the artery in the wrist where a thin catheter is inserted through the body’s network of arteries in the arm and eventually into the heart during a procedure to implant a stent  Doctors may also call this transradial access, the transradial approach, or transradial angioplasty  Because it’s associated with fewer complications, this is increasingly considered the default access approach in most countries, except in the U S  where the traditional Femoral Artery (groin) approach is still the most popular access 
RBBB – Right Bundle Branch Block: A delay or obstruction along the pathway that electrical impulses travel to make your heart beat  The delay or blockage occurs on the pathway that sends electrical impulses to the right side of your heart  See also Left Bundle Branch Block 
RCA – Right Coronary Artery: An artery that supplies blood to the right side of the heart 
Restenosis – The re-closing or re-narrowing of an artery after an interventional procedure such as angioplasty or stent placement  Sometimes called “stent failure” 
RHD – Rheumatic Heart Disease: Permanent damage to the valves of the heart caused especially by repeated attacks of rheumatic fever 
RM – Right Main coronary artery: A blood vessel that supplies oxygenated blood to the walls of the heart’s ventricles and the right atrium 
RV – Right Ventricle: The lower right chamber of the heart that receives de-oxygenated blood from the right atrium and pumps it under low pressure into the lungs via the pulmonary artery 
SA – Sinus node: The “natural” pacemaker of the heart  The node is a group of specialized cells in the top of the right atrium which produces the electrical impulses that travel down to eventually reach the ventricular muscle, causing the heart to contract 
SB – Sinus Bradycardia: Abnormally slow heartbeat 
SBP – Systolic Blood Pressure: The highest blood pressure measured in the arteries  It occurs when the heart contracts with each heartbeat  Example: the first number in 120/80 
SCAD – Spontaneous Coronary Artery Dissection: A rare emergency condition that occurs when a tear forms in one of the blood vessels in the heart, causing a heart attack, abnormalities in heart rhythm and/or sudden death  SCAD tends to strike young healthy women with few if any cardiac risk factors 
SD – Septal defect: A hole in the wall of the heart separating the atria (two upper chambers of the heart) or in the wall of the heart separating the ventricles (two lower chambers) 
Sestamibi stress test – See MIBI 
Short QT intervals (SQT): An abnormal heart rhythm where the heart muscle takes a shorter time to recharge between beats  It can cause a variety of complications from fainting and dizziness to sudden cardiac arrest 
Sick Sinus Syndrome (also known as sinus node dysfunction) is caused by an electrical problem in the heart; a group of related heart conditions that can affect how the heart beats, most commonly in older adults, although it can be diagnosed in people of any age  “Sick sinus” refers to the sinoatrial node (see below)  In people with sick sinus syndrome, the SA node does not function normally 
Sinoatrial node (SA): also commonly called the sinus node; it’s a small bundle of neurons situated in the upper part of the wall of the right atrium (the right upper chamber of the heart)  The heart’s electrical impulses are generated there  It’s the normal natural pacemaker of the heart and is responsible for the initiation of each heartbeat 
Spontaneous Coronary Artery Dissection (SCAD) – A rare emergency condition that occurs when a tear forms in one of the blood vessels in the heart, causing a heart attack, abnormalities in heart rhythm and/or sudden death  SCAD tends to strike young healthy women with few if any cardiac risk factors 
SSS – Sick Sinus Syndrome: The failure of the sinus node to regulate the heart’s rhythm 
ST – Sinus Tachycardia: A heart rhythm with elevated rate of impulses originating from the sinoatrial node, defined as greater than 100 beats per minute (bpm) in an average adult  The normal heart rate in the average adult ranges from 60–100 bpm  Also called sinus tach or sinus tachy 
Statins – Any of a class of drugs that lower the levels of low-density lipoproteins (LDL) – the ‘bad’ cholesterol in the blood – by inhibiting the activity of an enzyme involved in the production of cholesterol in the liver  Examples of brand name statins: Lipitor, Crestor, Zocor, Mevacor, Levachol, Lescol, etc  Also available as a cheaper generic form of the drug 
STEMI – ST-elevation heart attack (myocardial infarction)  The more severe form of the two main types of heart attack  A STEMI produces a characteristic elevation in the ST segment on an electrocardiogram (EKG)  The elevated ST segment is how this type of heart attack got its name  See also NSTEMI 
Stent – An implantable device made of expandable, metal mesh (looks a bit like a tiny chicken wire tube) that is placed (by using a balloon catheter) at the site of a narrowing coronary artery during an angioplasty procedure  The stent is then expanded when the balloon fills, the balloon is removed, and the stent is left in place to help keep the artery open  TRIVIA ALERT: the coronary stent was named after Charles Stent (1807-1885), an English dentist who invented a compound to produce dentures and other things like skin grafts and hollow tubes (essentially what a metal coronary stent is)  His real claim to fame occurred when he suggested using his material to coat underwater trans-Atlantic cable, which had broken several times as a result of corrosion by seawater  You’re welcome 
Stint – a common spelling mistake when what you really mean is the word “stent” (see above) 
Stress Echocardiography – A standard echocardiogram test that’s performed while the person exercises on a treadmill or stationary bicycle  This test can be used to visualize the motion of the heart’s walls and pumping action when the heart is stressed, possibly revealing a lack of blood flow that isn’t always apparent on other heart tests  The echocardiogram is performed just before and just after the exercise part of the procedure  See also TTE 
Sudden Cardiac Arrest – The stopping of the heartbeat, usually because of interference with the electrical signal (often associated with coronary heart disease)  Can lead to Sudden Cardiac Death 
Takotsubo Cardiomyopathy – A heart condition that can mimic a heart attack  Sometimes called Broken Heart Syndrome, it is not a heart attack, but it feels just like one, with common symptoms like severe chest pain and shortness of breath  It sometimes follows a severe emotional stress  Over 90% of reported cases are in women ages 58 to 75  Also referred to as Broken Heart Syndrome, stress cardiomyopathy, stress-induced cardiomyopathy or apical ballooning syndrome 
TAVR – Transcatheter aortic valve replacement: A minimally invasive procedure to repair a damaged or diseased aortic valve  A catheter is inserted into an artery in the groin and threaded to the heart  A balloon at the end of the catheter, with a replacement valve folded around it, delivers the new valve to take the place of the old  Also called TAVI (Transcatheter aortic valve implantation) 
Tetralogy of Fallot – A rare condition caused by a combination of four heart defects that are present at birth, affecting the structure of the heart and causing oxygen-poor blood to flow out of the heart and into the rest of the body  Infants and children with Tetralogy of Fallot usually have blue-tinged skin because their blood doesn’t carry enough oxygen  Often diagnosed in infancy, but sometimes not until later in life depending on severity 
Tg – Triglycerides: The most common fatty substance found in the blood; normally stored as an energy source in fat tissue  High triglyceride levels may thicken the blood and make a person more susceptible to clot formation  High triglyceride levels tend to accompany high cholesterol levels and other risk factors for heart disease, such as obesity 
TIA – Transient Ischemic Attack: A stroke-like event that lasts only for a short time and is caused by a temporarily blocked blood vessel 
TEE – Transesophageal echocardiogram: This test involves an ultrasound transducer inserted down the throat into the esophagus in order to take clear images of the heart structures without the interference of the lungs and chest 
Treadmill Stress Test – See Exercise Stress Test 
troponin – a type of cardiac enzyme found in heart muscle, and released into the blood when there is damage to the heart (for example, during a heart attack)  A positive blood test that shows elevated troponin is the preferred test for a suspected heart attack because it is more specific for heart injury than other blood tests, especially the newer high sensitivity troponin tests (hs-cTnT) 
TTE – Transthoracic Echocardiogram: This is the standard echocardiogram, a painless test similar to X-ray, but without the radiation, using a hand-held device called a transducer placed on the chest to transmit high frequency sound waves (ultrasound)  These sound waves bounce off the heart structures, producing images and sounds that can be used by the doctor to detect heart damage and disease 
TV – Tricuspid Valve: One of four one-way valves in the heart, a structure that controls blood flow from the heart’s upper right chamber (the right atrium) into the lower right chamber (the right ventricle) 
UA or USA – Unstable Angina: Chest pain that occurs when diseased blood vessels restrict blood flow to the heart; symptoms are not relieved by rest; considered a dangerous and emergency crisis requiring immediate medical help 
Valves: Your heart has four one-way valves that keep blood flowing in the right direction  Blood enters the heart first through the tricuspid valve, and next goes through the pulmonary valve (sometimes called the pulmonic valve) on its way to the lungs  Then the blood returning from the lungs passes through the mitral (bicuspid) valve and leaves the heart through the aortic valve 
Vasodilator: A drug that causes dilation (widening) of blood vessels 
Vasospasm: A blood vessel spasm that causes sudden constriction, reducing its diameter and blood flow to the heart muscle  See also Prinzmetal’s Variant Angina 
VB – Ventricular Bigeminy: A heart rhythm condition in which the heart experiences two beats of the pulse in rapid succession 
Vena Cava – a large vein that carryies de-oxygenated blood into the heart  There are two in humans, the inferior vena cava (carrying blood from the lower body) and the superior vena cava (carrying blood from the head, arms, and upper body) 
Ventricle – each of the two main chambers of the heart, left and right 
VF – Ventricular Fibrillation: A condition in which the ventricles (two lower chambers of the heart) contract in a rapid, unsynchronized fashion  When fibrillation occurs, the ventricles cannot pump blood throughout the body  Most sudden cardiac deaths are caused by VF or ventricular tachycardia (VT) 
VLDL – Very Low Density Lipoprotein: Molecules made up of mostly triglycerides, cholesterol and proteins  VLDL, also known as the “very bad” cholesterol, carries cholesterol from the liver to organs and tissues in the body  It may lead to low density lipoproteins (LDL), associated with higher heart disease risks  VLDL levels are tricky to measure routinely, and are usually estimated as a percentage of your triglyceride levels  By reducing triglycerides, you are usually also reducing your VLDL levels 
Warfarin – A drug taken to prevent the blood from clotting and to treat blood clots  Warfarin is believed to reduce the risk of blood clots causing strokes or heart attacks  Also known as Coumadin 
Widowmaker heart attack – The type of heart attack I survived, since you asked  A nickname doctors use to describe a severely blocked left main coronary artery or proximal left anterior descending coronary artery of the heart  This term is used because if the artery gets abruptly and completely blocked, it can cause a massive heart attack that will likely lead to sudden cardiac death  Please note the gender imbalance here: despite the number of women like me who do experience this type of cardiac event, doctors are not calling this the widowermaker, after all 
WPW – Wolff-Parkinson-White Syndrome: A condition in which an extra electrical pathway connects the atria (two upper chambers) and the ventricles (two lower chambers)  It may cause a rapid heartbeat 
NOTE FROM CAROLYN: I was very happy when we were able to include this entire glossary in my book, “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press, 2017) 
Are we missing any important heart acronyms/terms from this list? Let me know!
Please can someone explain something for me  I am a 53 yr old woman and generally fit and healthy  Had 2 ECG’s due to a one off dizzy spell during a stressful time dealing with my fathers terminal diagnosis  The 2nd ECG request did give me concern as i did not know why i had to have one  On 24/01/19 at my doctors appointment she explained that on 3 the leads it showed inverted T waves  And she explained that it may suggest angina  I was so shocked  Wasn’t expecting that  She gave me a GNT (nitroglycerin) spray in case I do get pain and take 75Mg of aspirin  I’m now waiting for a Cardiology referral 
I am so stressed and consumed by what might be wrong  My maternal grandmother had angina and valve issues  Her 3 brothers all had double bypasses  Could I have inherited this? I am not overweight at 63kg and 5 ft 9  I walk 20-25 miles a week at work and general walking here and there  I started HRT (patches evorol 25 -50) in July as menopause pain was making me feel like I was 90 and was getting me down 
I am worried so much now and analysing every ache/ twinge I get  I feel like a hypochondriac at the moment  I’m worried what will happen at the cardiologist and what the test will entail and tell me  I am waiting on cholesterol test which I had on 25/01/19  Can I have inverted T waves and be fine  Please help I am so scared and crying far too much 
Hello Colleen – the first thing is: please take a big deep breath before you read another word here! I’m not a physician so of course cannot comment on your specific case, but I can tell you generally that the definition of “angina” (as this glossary lists above) is “distressing symptoms”, typically chest pain that gets worse with exertion, and goes away with rest  That’s classic stable angina… typically caused by something that’s reducing blood flow to the heart muscle (causing the chest pain of angina) 
A family history that might make a difference for you personally is only in what’s called your ‘first degree’ relatives: for example, if your mother or sister were diagnosed with heart disease before age 65, or if your Dad or brother were diagnosed before age 55, then doctors would consider that you have a family history as a risk factor for heart disease  There’s little if any scientific evidence that a grandparent or uncle’s heart disease history has any effect on your own risk 
It is a very good thing that you’re having further tests and a referral to a cardiologist, if only to ease your mind  There are many reasons for inverted T-waves, ranging from cardiac issues to completely benign conditions  One way of looking at this is choosing to believe that seeing a cardiologist will ease your mind one way or the other – so this is something to look forward to, not dread  If the cardiologist spots something suspicious, a treatment plan will be created  If not, you can wave goodbye and go back to happily living your life 
Try thinking of this cardiology appointment just as you would if your car were making some frightening noises and you were bringing it to your mechanic for a check up  You could work yourself into a complete state worrying ahead of time if the car trouble is going to be serious, or you could look at this appointment as the solution – at last! – to figuring out what’s wrong so the mechanic can recommend the next step 
Thank you for this list of so many definitions provided in plain English  what a valuable resource this is  THANK YOU, I have been looking for translations FOR PATIENTS not med school graduates– like this for three years 
My family doctor had me wear a 24 hr EKG  After reading the results, she has scheduled a scope to look inside my heart by a specialist  Completely forgoing a stress test  Said I have major changes in the EKG, what type of changes could they be looking at? Had LAD STENT INSERTED 7 YRS AGO – WHAT COULD THEY BE LOOKING FOR?
This is a great wealth of information, Carolyn! I looked and did not see my diagnosis, which is aortic stenosis  I looked under aortic as well as stenosis  Did I just miss it somehow?
I learned some new information, I am a bit familiar now, but not when I had my MI, it was like learning a new language  But, my favorite part was seeing SCAD on this list! Thank you 
Thanks and welcome! I was thinking of editing that SCAD definition actually: I suspect that that it isn’t so much that SCAD is “rare”, but it’s more that it’s “rarely correctly diagnosed” 
I totally agree that SCAD is not as rare as I believed for many years  Once awareness is spread to all medical staff, I believe many lives will be saved  Hoping for a brighter future for all SCAD patients 
I hope so too, Cathy  Perhaps when more SCAD studies (like Mayo Clinic’s) are published and read by more and more MDs, it will no longer be “rarely correctly diagnosed” 
It’s great to see IST on here  I was diagnosed with it 9 years ago and the lack of awareness is frustrating 
What a great resource for heart patients and their families!
Thanks so much, Ashley  I recently updated my original 2011 list after the world-famous Cleveland Clinic tweeted their glossary recently and I noticed that their list had a few glaring omissions (like SCAD and Brugada Syndrome) so this made me wonder what my list might be missing, too  Let me know if there’s anything else you think should be included, okay?
How is your health these days? How are you feeling?
New for me too  I have just been diagnosed with A-HCM: Apical Hypertrophic Cardiomyopathy 
I’ll add that one to my list, Kathleen – thanks!
Just saw this, Carolyn, and you’ve compiled a great resource  One note on A-HCM: Present thinking is that it’s due to a genetic modification  Runs in families though sometimes occurs spontaneously  I have not as yet done genetic testing, though it’s been offered 
Thanks Kathleen – like many cardiac diagnoses, it sounds like a moving target… Good luck to you!
This list is great  I’ve just been diagnosed and am utterly overwhelmed  Even in the WomenHeart online support community, I often have no clue most days what others are talking about with all these initials about their heart tests and specific disease  This is VERY helpful, thank you SO MUCH  Love your website which has been a godsend since my diagnosis 



ground_truth: Implantable Cardioverter Defibrillator (ICD) is a surgically implanted electronic device to treat life-threatening heartbeat irregularities.

prompt_front: Now, answer the following question based on the text below, only give me the answer and do not output any other words.

Question: What are the three synthetic types of vitamin K?

Read the following text and answer briefly.

Context 3:  283 (52): 36655–36664  doi:10 1074/jbc M802761200  PMC 2605998  PMID 18836183  ^ Viegas, C  S ; Cavaco, S ; Neves, P  L ; Ferreira, A ; João, A ; Williamson, M  K ; Price, P  A ; Cancela, M  L ; Simes, D  C  (Dec 2009)  "Gla-rich protein is a novel vitamin K-dependent protein present in serum that accumulates at sites of pathological calcifications"  American Journal of Pathology  175 (6): 2288–2298  doi:10 2353/ajpath 2009 090474  PMC 2789615  PMID 19893032  ^ Hafizi, S ; Dahlbäck, B  (Dec 2006)  "Gas6 and protein S  Vitamin K-dependent ligands for the Axl receptor tyrosine kinase subfamily"  The FEBS Journal  273 (23): 5231–5244  doi:10 1111/j 1742-4658 2006 05529 x  PMID 17064312  ^ Kulman, J  D ; Harris, J  E ; Xie, L ; Davie, E  W  (May 2007)  "Proline-rich Gla protein 2 is a cell-surface vitamin K-dependent protein that binds to the transcriptional coactivator Yes-associated protein"  Proceedings of the National Academy of Sciences of the United States of America  104 (21): 8767–8772  doi:10 1073/pnas 0703195104  PMC 1885577  PMID 17502622  ^ "Vitamin K"  MedlinePlus  US National Library of Medicine, National Institutes of Health  Sep 2016  Retrieved 26 May 2009  ^ Conly, J; Stein, K  (Dec 1994)  "Reduction of vitamin K2 concentrations in human liver associated with the use of broad spectrum antimicrobials"  Clinical and Investigative Medicine  17 (6): 531–539  PMID 7895417  ^ Ferland, G ; Sadowski, J  A ; O'Brien, M  E  (Apr 1993)  "Dietary induced subclinical vitamin K deficiency in normal human subjects"  Journal of Clinical Investigation  91 (4): 1761–1768  doi:10 1172/JCI116386  PMC 288156  PMID 8473516  ^ Holden, R  M ; Morton, A  R ; Garland, J  S ; Pavlov, A ; Day, A  G ; Booth, S  L  (Apr 2010)  "Vitamins K and D status in stages 3-5 chronic kidney disease"  Clinical Journal of the American Society of Nephrology  5 (4): 590–597  doi:10 2215/CJN 06420909  PMC 2849681  PMID 20167683  ^ Hodges, S  J ; Pilkington, M  J ; Shearer, M  J ; Bitensky, L ; Chayen, J (Jan 1990)  "Age-related changes in the circulating levels of congeners of vitamin K2, menaquinone-7 and menaquinone-8"  Clinical Science  78 (1): 63–66  PMID 2153497  ^ "Vitamin K"  Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (PDF)  National Academy Press  2001  p  162–196  ^ Tolerable Upper Intake Levels For Vitamins And Minerals (PDF), European Food Safety Authority, 2006 ^ a b Rhéaume-Bleue, p  42
^ "Important information to know when you are taking: Warfarin (Coumadin) and Vitamin K" (PDF)  National Institutes of Health Clinical Center  ^ "Nutrition Facts and Information for Parsley, raw"  Nutritiondata com  Retrieved 21 Apr 2013  ^ "Nutrition facts, calories in food, labels, nutritional information and analysis"  Nutritiondata com  13 Feb 2008  Retrieved 21 Apr 2013  ^ "Vitamin K"  Vivo colostate edu  2 Jul 1999  Retrieved 21 Apr 2013  ^ "Vitamin K"  Micronutrient Data Centre  ^ Ikeda, Y ; Iki, M ; Morita, A ; Kajita, E ; Kagamimori, S ; Kagawa, Y ; Yoneshima, H  (May 2006)  "Intake of fermented soybeans, natto, is associated with reduced bone loss in postmenopausal women: Japanese Population-Based Osteoporosis (JPOS) Study"  Journal of Nutrition  136 (5): 1323–1328  PMID 16614424  ^ Katsuyama, H ; Ideguchi, S ; Fukunaga, M ; Saijoh, K ; Sunami, S  (Jun 2002)  "Usual dietary intake of fermented soybeans (Natto) is associated with bone mineral density in premenopausal women"  Journal of Nutritional Science and Vitaminology  48 (3): 207–215  doi:10 3177/jnsv 48 207  PMID 12350079  ^ Sano, M ; Fujita, H ; Morita, I ; Uematsu, H ; Murota, S  (Dec 1999)  "Vitamin K2 (menatetrenone) induces iNOS in bovine vascular smooth muscle cells: no relationship between nitric oxide production and gamma-carboxylation"  Journal of Nutritional Science and Vitaminology  45 (6): 711–723  doi:10 3177/jnsv 45 711  PMID 10737225  ^ Gast, G  C ; de Roos, N  M ; Sluijs, I ; Bots, M  L ; Beulens, J  W ; Geleijnse, J  M ; Witteman, J  C ; Grobbee, D  E ; Peeters, P  H ; van der Schouw, Y  T  (Sep 2009)  "A high menaquinone intake reduces the incidence of coronary heart disease"  Nutrition, Metabolism, and Cardiovascular Diseases  19 (7): 504–510  doi:10 1016/j numecd 2008 10 004  PMID 19179058  ^ Oldenburg, J ; Bevans, C  G ; Müller, C  R ; Watzka, M  (2006)  "Vitamin K epoxide reductase complex subunit 1 (VKORC1): the key protein of the vitamin K cycle"  Antioxidants & Redox Signaling  8 (3–4): 347–353  doi:10 1089/ars 2006 8 347  PMID 16677080  ^ Suttie, J  W  (1985)  "Vitamin K-dependent carboxylase"  Annual Review of Biochemistry  54: 459–477  doi:10 1146/annurev bi 54 070185 002331  PMID 3896125  ^ Presnell, S  R ; Stafford, D  W  (Jun 2002)  "The vitamin K-dependent carboxylase"  Thrombosis and Haemostasis  87 (6): 937–946  PMID 12083499  ^ Stafford, D  W  (Aug 2005)  "The vitamin K cycle"  Journal of Thrombosis and Haemostasis  3 (8): 1873–1878  doi:10 1111/j 1538-7836 2005 01419 x  PMID 16102054  ^ Rhéaume-Bleue, p  79 
^ Whitlon, D  S ; Sadowski, J  A ; Suttie, J  W  (Apr 1978)  "Mechanism of coumarin action: significance of vitamin K epoxide reductase inhibition"  Biochemistry  17 (8): 1371–1377  doi:10 1021/bi00601a003  PMID 646989  ^ Terlau, H ; Olivera, B  M  (Jan 2004)  "Conus venoms: a rich source of novel ion channel-targeted peptides"  Physiological Reviews  84 (1): 41–68  doi:10 1152/physrev 00020 2003  PMID 14715910  ^ Buczek, O ; Bulaj, G ; Olivera, BM (Dec 2005)  "Conotoxins and the posttranslational modification of secreted gene products"  Cellular and Molecular Life Sciences  62 (24): 3067–3079  doi:10 1007/s00018-005-5283-0  PMID 16314929  ^ "Prothrombin Time"  WebMD  ^ Dituri, F ; Buonocore, G ; Pietravalle, A ; Naddeo, F ; Cortesi, M; Pasqualetti, P; Tataranno M  L ; R , Agostino (Sep 2012)  "PIVKA-II plasma levels as markers of subclinical vitamin K deficiency in term infants"  Journal of Maternal, Fetal & Neonatal Medicine  25 (9): 1660–1663  doi:10 3109/14767058 2012 657273  PMID 22280352  ^ Thane, C  W ; Bates, C  J ; Shearer, M  J ; Unadkat, N; Harrington, D  J ; Paul, A  A ; Prentice, A ; Bolton-Smith, C  (Jun 2002)  "Plasma phylloquinone (vitamin K1) concentration and its relationship to intake in a national sample of British elderly people"  British Journal of Nutrition  87 (6): 615–622  doi:10 1079/BJNBJN2002582  PMID 12067432  ^ McKeown, N  M ; Jacques, P  F ; Gundberg, C  M ; Peterson, J  W ; Tucker, K  L ; Kiel, D  P ; Wilson, P  W ; Booth, SL (Jun 2002)  "Dietary and nondietary determinants of vitamin K biochemical measures in men and women" (PDF)  Journal of Nutrition  132 (6): 1329–1334  PMID 12042454  ^ Yamano, M ; Yamanaka, Y ; Yasunaga, K ; Uchida, K  (Sep 1989)  "Effect of vitamin K deficiency on urinary gamma-carboxyglutamic acid excretion in rats"  Nihon Ketsueki Gakkai Zasshi  52 (6): 1078–1086  PMID 2588957  ^ Matsumoto, T ; Miyakawa, T ; Yamamoto, D  (Mar 2012)  "Effects of vitamin K on the morphometric and material properties of bone in the tibiae of growing rats"  Metabolism  61 (3): 407–414  doi:10 1016/j metabol 2011 07 018  PMID 21944271  ^ Je, S -H ; Joo, N -S ; Choi, B -H ; Kim, K -M ; Kim, B -T ; Park, S -B ; Cho, D -Y ; Kim, K -N ; Lee, D -J  (Aug 2011)  "Vitamin K supplement along with vitamin D and calcium reduced serum concentration of undercarboxylated osteocalcin while increasing bone mineral density in Korean postmenopausal women over sixty-years-old"  Journal of Korean Medical Science  26 (8): 1093–1098  doi:10 3346/jkms 2011 26 8 1093  PMC 3154347  PMID 21860562  ^ Bentley, R ; Meganathan, R  (Sep 1982)  "Biosynthesis of vitamin K (menaquinone) in bacteria" (PDF)  Microbiological Reviews  46 (3): 241–280  PMC 281544  PMID 6127606  ^ Haddock, B  A ; Jones, C  W  (Mar 1977)  "Bacterial respiration" (PDF)  Bacteriological Reviews  41 (1): 47–99  PMC 413996  PMID 140652  ^ Shearer, M  J  (Jan 1995)  "Vitamin K"  Lancet  345 (8944): 229–234  doi:10 1016/S0140-6736(95)90227-9  PMID 7823718  ^ Greer, J  P ; Foerster, J ; Lukens, J  N ; Rodgers, G  M ; Paraskevas, F ; Glader, B  (eds )  Wintrobe's Clinical Hematology (11th ed )  Philadelphia, Pennsylvania: Lippincott, Williams and Wilkens  ^ a b American Academy of Pediatrics Committee on Fetus Newborn  (Jul 2003)  "Controversies concerning vitamin K and the newborn  American Academy of Pediatrics Committee on Fetus and Newborn" (PDF)  Pediatrics  112 (1 1): 191–192  doi:10 1542/peds 112 1 191  PMID 12837888  ^ Logan, S ; Gilbert, R  (1998)  "Vitamin K For Newborn Babies" (PDF)  Department of Health  Retrieved 12 Oct 2014  ^ "Postnatal care: Routine postnatal care of women and their babies [CG37]"  www nice org uk  NICE  Jul 2006  Retrieved 12 Oct 2014  ^ Parker, L ; Cole, M ; Craft, A  W ; Hey, E  N  (1998)  "Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study"  BMJ (Clinical Research Edition)  316 (7126): 189–193  doi:10 1136/bmj 316 7126 189  PMC 2665412  PMID 9468683  ^ McMillan, D  D  (1997)  "Routine administration of vitamin K to newborns"  Paediatric Child Health  2 (6): 429–431  ^ "Newborns get rare disorder after parents refused shots"  Having four cases since February just at Vanderbilt was a little bit concerning to me ^ Dam, C  P  H  (1935)  "The Antihaemorrhagic Vitamin of the Chick: Occurrence And Chemical Nature"  Nature  135 (3417): 652–653  doi:10 1038/135652b0  ^ Dam, C  P  H  (1941)  "The discovery of vitamin K, its biological functions and therapeutical application" (PDF)  Nobel Prize Laureate Lecture  ^ McAlister, V  C  (2006)  "Control of coagulation: a gift of Canadian agriculture" (PDF)  Clinical and Investigative Medicine  29 (6): 373–377  ^ MacCorquodale, D  W ; Binkley, S  B ; Thayer, S  A ; Doisy, E  A  (1939)  "On the constitution of Vitamin K1"  Journal of the American Chemical Society  61 (7): 1928–1929  doi:10 1021/ja01876a510  ^ Fieser, L  F  (1939)  "Synthesis of Vitamin K1"  Journal of the American Chemical Society  61 (12): 3467–3475  doi:10 1021/ja01267a072  ^ Dam, C  P  H  (12 Dec 1946)  "The discovery of vitamin K, its biological functions and therapeutical application" (PDF)  Nobel Prize lecture  ^ Warner, E  D ; Brinkhous, K  M ; Smith, H  P  (1938)  "Bleeding Tendency of Obstructive Jaundice"  Proceedings of the Society of Experimental Biology and Medicine  37 (4): 628–630  doi:10 3181/00379727-37-9668P  ^ Stenflo, J; Fernlund, P ; Egan, W ; Roepstorff, P  (Jul 1974)  "Vitamin K dependent modifications of glutamic acid residues in prothrombin"  Proceedings of the National Academy of Sciences of the United States of America  71 (7): 2730–2733  doi:10 1073/pnas 71 7 2730  PMC 388542  PMID 4528109  ^ Nelsestuen, G  L ; Zytkovicz, T  H ; Howard, J  B  (Oct 1974)  "The mode of action of vitamin K  Identification of gamma-carboxyglutamic acid as a component of prothrombin" (PDF)  Journal of Biological Chemistry  249 (19): 6347–6350  PMID 4214105  ^ Magnusson, S ; Sottrup-Jensen, L ; Petersen, T  E ; Morris, H  R ; Dell, A  (Aug 1974)  "Primary structure of the vitamin K-dependent part of prothrombin"  FEBS Letters  44 (2): 189–193  doi:10 1016/0014-5793(74)80723-4  PMID 4472513  Bibliography[edit]
Rhéaume-Bleue, Kate (2012)  Vitamin K2 and the Calcium Paradox  John Wiley & Sons, Canada  ISBN 1-118-06572-7  External links[edit]
"Vitamin K: Another Reason to Eat Your Greens"  v
TPP / ThDP (B1)
FMN, FAD (B2)
NAD+, NADH, NADP+, NADPH (B3)
Coenzyme A (B5)
PLP / P5P (B6)
THFA / H4FA, DHFA / H2FA, MTHF (B9)
AdoCbl, MeCbl (B12)
Phylloquinone (K1), Menaquinone (K2)
non-vitamins
Coenzyme B
Heme / Haem (A, B, C, O)
Molybdopterin/Molybdenum cofactor
THMPT / H4MPT
Fe2+, Fe3+
vitamins: see vitamins
Antihemorrhagics (B02)
(coagulation)
Phytomenadione (K1)
Menadione (K3)
intrinsic: IX/Nonacog alfa
VIII/Moroctocog alfa/Turoctocog alfa
extrinsic: VII/Eptacog alfa
common: X
II/Thrombin
I/Fibrinogen
XIII/Catridecacog
combinations: Prothrombin complex concentrate (II, VII, IX, X, protein C and S)
Carbazochrome
thrombopoietin receptor agonist (Romiplostim
Eltrombopag)
Tetragalacturonic acid hydroxymethylester
Epinephrine/Adrenalone
amino acids (Aminocaproic acid
Aminomethylbenzoic acid)
serpins (Aprotinin
Alfa1 antitrypsin
Camostat) 



ground_truth: Vitamins K3, K4, and K5.