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Concise Lecture Outline
Physiology II PB 3325
Course Director: Mrs. Kay Brashear
Lecture Outline 1 Cardiac Cycle
I. Introduction
A. Arrangement of cardiac muscle spirals
B. Differences between left and right ventricles
II. Review of the cardiac cycle
A. Definition
B. Effect of heart rate on the cardiac cycle
C. Atria as pumps
D. Ventricles as pumps
1. Diastole
2. Systole
E. Concepts associated with the cardiac cycle
F. Aortic pulse pressure curve
G. Electrocardiogram
H. Heart sounds
III. Work output of the heart
A. Stroke work output
B. Two types of work
C. Pressure-volume loop
IV. Myocardial function
A. Preload
B. Afterload
C. Contractility
D. Heart rate
V. Cardiac energy
A. Cellular adaptations
B. Nutrients
C. Determination of myocardial oxygen consumption
D. Factors important in tension development
VI. Regulation of heart pumping
A. Intrinsic regulation of cardiac output
B. Extrinsic regulation of cardiac output
VII. Terminology
A. inotropic
B. chronotropic
C. bradycardia
D. tachycardia
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E. hypoeffective heart
F. hypereffective heart
VIII. Effect of ions on heart function
A. potassium ions
B. Calcium ions
C. Sodium ions
IX. Effect of temperature on cardiac function
Lecture Outline 2 Rhythmical Excitation of the Heart and Normal ECG
Rhythmical Excitation of the Heart
I. Specialized systems of the heart
II. Special excitatory and conductive system of the heart
A. Sinus node
B. Internodal pathways
C. Atrioventricular node
D. A-V bundle
E. Purkinje fibers
F. Transmission into cardiac muscle
G. Depolarization pattern in the ventricles related to the cardiac conduction
system
Normal ECG
I. Characteristics of the normal ECG
A. Depolarization
B. Repolarization
II. Organization of the ECG
A. Standardization
B. Analysis of waveforms (Lead II)
C. Waves recorded on the electrocardiogram (Lead II)
D. Refractory periods in relation to ECG complexes
E. Calculation of heart rate
III. Current flow around the heart during the cardiac cycle
A. Current flow and electrode orientation
B. 12 Lead ECG
1. Standard limb leads
2. Augmented leads
3. Precordial leads
Lecture Outline 3 Abnormal ECG
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I. Abnormal Electrocardiograms
A. Vectors
B. Axis of Lead
C. Depolarization/repolarization patterns
II. Mean Electrical Axis of the Ventricular QRS
A. Introduction to normal MEA
B. Lab determination of the mean electrical axis
C. Normal ventricular conditions that cause axis deviation
III. Axis Deviations
A. Left axis deviation
B. Right axis deviation
IV. Abnormal voltage
A. increase in voltage
B. decrease in voltage
V. Prolonged and wide and bizarre QRS complexes
A. Prolonged – hypertrophy
B. Wide and bizarre – bundle branch block
VI. Current of Injury
A. Causes
B. Effect
C. J point as a point of reference
D. S-T segment shift
E. Causes of current of Injury
F. Recovery from coronary thrombosis
G. Old myocardial infarctions
H. Current of Injury – Angina Pectoris
VII. Abnormalities of the T wave
A. Effect of slow conduction
B. Effect of prolonged depolarization
Lecture Outline 4 ECG and Cardiac Arrhythmias
I. Introduction to Arrhythmias
A. Diagnosis of cardiac rhythms
B. Origin of abnormal cardiac rhythms
C. Causes of cardiac rhythms
D. Location of a rhythmicity
II. Abnormal Sinus Rhythms
A. Sinus tachycardia
B. Sinus bradycardia
C. Sinus arrhythmias
D. Wandering atrial pacemaker
III. Abnormal Rhythms from Impulse Conduction Blocks
A. Atrio -ventricular blocks
B. Stokes-Adams Syndrome
C. Bundle branch blocks
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D. Wolff -Parkinson-White Syndrome
IV. Premature Contractions
A. Atrial
B. Junctional or nodal
C. Ventricular
V. Reentry
VI. Paroxysmal tachycardia
VII. Flutter and fibrillation
A. Atrial flutter
B. Fibrillation
VIII. Cardiac arrest
Lecture Outline 5 Heart Sounds
I. Causes of hypertrophy
A. Trained athletes
B. Continuous stress
II. Types of hypertrophy
A. Pressure overload – concentric hypertrophy
B. Volume overload – eccentric hypertrophy
III. Mechanisms of Heart Sounds
A. Heart Sounds and murmur defined
B. Mechanisms of heart sounds
IV. Areas for Auscultation
A. Atrio -ventricular valves
B. Semilunar valves
C. Phonocardiogram
V. Normal Heart Sounds
A. First heart sound
B. Second heart sound
C. Third heart sound
D. Fourth heart sound
VI. Types of Murmurs
A. Systolic murmurs
B. Diastolic murmurs
C. Mitral prolapse
VII. Valvular lesions
A. Rheumatic fever
B. Congenital
VIII. Heart Murmurs caused by Valvular Lesions
A. Aortic valve – stenosis and regurgitation
B. Mitral valve – stenosis and regurgitation
IX. Exercise in patients with valvular lesions
A. Mild cases
B Moderate to severe cases
X . Congenital Heart Defects
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A. Types
B. Stenosis
C. Left to Right Shunt
D. Right to Left Shunt
Lecture Outline 6 Vascular Flow and Resistance
I. Introduction: the circulation
A. Functions
B. Systemic circulation
C. Pulmonary circulation
II. Characteristics of segments of the Circulatory System
A. Physical properties
B. Distribution of blood volumes
C. Cross-sectional areas and velocity of flow
D. Blood pressure in the various portions of the circulation
E. Basic theory of circulation function
III. Pressure vs. Flow
A. Flow equation
B. Effect of vessel diameter on blood flow
IV. Resistance to blood flow
A. Resistance
B. Physiological regulation of flow
C. Circuit resistance
V. Types of blood flow
A. Laminar flow
B. Turbulent flow
C. Reynold’s number
VI. Rheological properties of blood
A. Viscosity vs. the hematocrit
B. Fahraeus-Lindquist effect
Lecture Outline 7 Vascular Distensibility and Functions
I. Introduction
A. Distensibility
B. Compliance
II. Vascular Distensibility and Compliance
A. Distensibility and compliance of selected vessels
B. Pressure-volume curves
C. Delayed compliance
III. Arterial Pulse Pressure
A. Introduction
B. Abnormal pulse contours
C. Radial pulse –characteristics
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D. Transmission of pressure pulses
E. Indirect Method of Measurement of Arterial Blood Pressure
IV. Veins and Their Functions
A. Venous pressures
B. Venous resistance and peripheral venous pressure
C. Effect of Gravitational (hydrostatic) Pressure on venous return
D. Veins – venous return to the heart
E. Veins as blood reservoirs
Lecture Outline 8 Microcirculation and the Lymphatic System
I. Introduction: Exchange of fluid between blood and tissues
A. Pattern of flow
B. Function of arterioles and capillaries
C. Structure of the capillary wall
II. Flow of Blood in the capillaries – vasomotion
A. Blood flow in capillaries
B. Average function of the capillary system
III. Exchange of Nutrients and Other Substances between Blood and Interstitial Fluid
A. Types of capillaries
B. Diffusion through a capillary membrane
IV. The Interstitium and Interstitial Fluid
A. Solid Structures
B. Gel
C. Free fluid in the interstitium
V. The Role of Proteins in Controlling Plasma and Interstitial Fluid Volumes
A. Introduction
B. Factors affection bulk flow across the capillary endothelium
C. Starling Equilibrium for capillary exchange
VI. Lymphatic System
A. Lymph channels of the body
B. Terminal lymphatic capillaries and their permeability
C. Formation of lymph
D. Role of the lymphatic system in controlling Interstitial fluid protein
concentration,
interstitial fluid volume and interstitial pressure
Lecture Outline 9 Local Blood Flow
I. Introduction
A. Relationship of flow to tissue metabolism
B. Variations in local blood flow
C. Importance of local blood flow
D. Mechanisms for regulation
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II. Mechanisms of blood flow control
A. Acute control
1. Vasodilator theory
2. Oxygen demand theory
B. Special acute control mechanisms
C. Long-term blood flow regulation – response to hypoxia
III. Hormonal regulation of the circulation
A. Vasoconstrictor agents
B. Vasodilator agents
C. Effects of different ions on vascular control
Lecture Outline 10 Nervous Regulation of the Circulation
Rapid Control of Arterial Blood Pressure
I. Nervous Regulation of the Circulation
A. ANS – most important in control of circulation
B. Vasomotor Center – Sympathetic vasoconstrictor system
C. Sympathetic vasomotor tone
D. Control of heart by vasomotor tone
E. Control of vasomotor tone by higher nervous centers
F. Norepinephrine and the adrenal medulla
G. Sympathetic vasodilator system
II. Role of the Nervous System – Rapid arterial blood pressure control
A. Increased arterial pressure during exercise and stress
B. Reflex mechanisms for maintaining normal arterial pressure
C. Chemoreceptor influence
D. Atrial and pulmonary arterial stretch reflexes
E. Central nervous system control
F. Special nervous control of arterial pressure
Lecture Outline 11 Long-Term Regulation of Arterial Blood Pressure
I. Introduction: Comparison of Rapid and Long -Term Blood Pressure Regulation
A. Rapid blood pressure control
B. Long-term blood pressure control
II. Renal Body Fluid System of Arterial Pressure Control
A. Pressure diuresis
B. Pressure natriuresis
C. Renal output curve
D. Pressure regulation “infinite gain principle”
E. Two determinates of long – term blood pressure regulation
F. Failure of TPR changes to affect long – term blood pressure
G. Effect of fluid volume in the regulation of arterial blood pressure
H. Importance of salt in the renal – body pressure regulation
III. Renin-Angiotensin-Aldosterone Mechanism
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A. Components of the Renin-Angiotensin system
B. Effect of renin-angiotensin in maintaining normal blood pressure
IV. Hypertension
A. Defined
B. Causes
C. Classification
D. Effects of hypertension
E. Treatment of hypertension
V. Summary of Integrated Arterial Blood Pressure Regulation
A. Rapid (Acute) pressure control mechanisms
B. Intermediate pressure control mechanisms
C. Long-term mechanisms for arterial pressure regulation
Lecture Outline 12 Regulation of Cardiac Output and Venous Return
I. Introduction
A. Cardiac output must equal venous return
B. Resting cardiac output values
C. Cardiac index
D. Relationship of cardiac output to metabolism
E. Age relationship to cardiac output
II. Regulation of Cardiac Output by Venous Return
A. Frank-Starling mechanism
B. Normal regulation of cardiac output
III. Cardiac Function Curve
A. Intrinsic
B. Sympathetic stimulation
C. Hypereffective heart
D. Hypoeffective heart
IV. Nervous System Regulation of Cardiac Output during Exercise
V. Factors That Alter Cardiac Output and Venous Return
A. High cardiac output conditions
B. Low cardiac output conditions
C. Factors that determine venous return
D. Venous return curve
VI. Analysis of Cardiac Output
Lecture Outline 13 Coronary Circulation and Ischemic Heart Disease
I. Coronary Circulation
A. Physiologic Anatomy of the Coronary Blood Supply
B. Normal Coronary Blood Flow
C. Control of Coronary Blood Flow
II. Ischemic Heart Disease
A. Ischemia
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B. Acute Coronary Occlusion
C. Myocardial Infarction
D. Causes of death following an acute coronary occlusion
E. Stages of recovery from an acute myocardial infarction
F. Pain in coronary disease
G. Treatment of coronary artery disease
Cardiac Failure
I. Dynamics of Circulation in Cardiac Failure
A. Acute effects of moderate cardiac failure
B. Chronic Stage of Failure
II. Compensated Heart Failure
A. Compensation
B. Results
III. Decompensated Heart Failure
A. Influence of normal renal function
B. Treatment
IV. Unilateral Heart Failure
A. Left Heart failure
B. Right Heart failure
Lecture Outline 14 Pulmonary Circulation, Pulmonary Edema and
Pleural Fluid
I. Introduction
A. Function of lung
B. Function of the pulmonary circulation
II. Physiological Anatomy of the Pulmonary Circulation
A. Right Ventricle
B. Pulmonary vessels
C. Bronchial circulation
D. Lymphatic system
III. Blood Pressures in the Pulmonary System
A. Pressure Curve in the right ventricle
B. Pressures in the pulmonary artery
C. Pulmonary arterial pulse pressure
D. PMAP
E. Pulmonary capillary pressure
F. Left atrial and pulmonary venous pressures
IV. Blood Volumes in the lungs
A. Lungs as blood reservoirs
B. Shift of blood between the pulmonary and systemic circulations
V. Blood Flow Through Lungs and its Distribution
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A. Effect of diminished alveolar oxygen
B. ANS control of blood flow
C. Effect of hydrostatic pressure on blood flow
VI. Effect of Increased Cardiac Output on Pulmonary Circulation
A. During exercise
B. Q = P/R
C. Decreased resistance
D. Pressures remain relatively low for the cardiac output
VII. Effect of Heart Failure on Left Atrial Pressure and the Pulmonary Circulation
A. Left Ventricular failure
VIII. Pulmonary Capillary Dynamics
A. Nature of pulmonary capillaries
B. Dynamics of fluid exchange
IX. Pulmonary Edema
A. Causes
B. Pulmonary Interstitial fluid edema vs. Pulmonary Alveolar edema
C. Pulmonary edema safety factor
X. Fluids in the Pleural Cavity
A. Negative pressure in the pleural fluid
B. Pleural effusion
Lecture 15 Pulmonary Ventilation
I. Introduction to Respiratory Function
A. Gas exchange
B. Acid-base balance
C. Phonation
D. Metabolism
II. Functions of Respiratory Passageways
A. Nasal cavity “air conditioning functions”
B. Mucous coat and cilia
C. Pharynx & Larynx
D. Trachea, bronchi & bronchioles
E. Control of bronchiolar musculature
III. Mechanics of Pulmonary Ventilation
A. Muscles that cause lung expansion
B. Respiratory pressures
C. Compliance of lungs
IV. Effect of the Thoracic Cage on Lung Expansion
A. Compliance of Thorax and lungs together
B. Work of Breathing (lungs)
C. Work of Breathing (thorax)
V. Pulmonary Volumes and Capacities
A. Spirometry – pulmonary volumes
B. Pulmonary capacities
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VI. Minute Respiratory Volume
VII. Alveolar Ventilation
A. Quiet breathing
B. Dead space
C. Rate of Alveolar Ventilation
Lecture Outline 16 Physical Properties of Gas Exchange
Diffusion of Oxygen and Carbon Dioxide through
The Respiratory Membrane
I. Physics of Diffusion and Gas Pressures
A. Effect of the concentration gradient
B. Gas pressure in a Mixture of gasses
C. Pressures of gases in water and tissues
D. Vapor pressure of water
E. Diffusion of gases through fluids
F. Diffusion of gases through tissues
II. Composition of Alveolar Air
A. Factors that determine the composition of Alveolar Air
B. Rate of alveolar air renewal
C. Oxygen concentration and partial pressure in the alveoli
D. Carbon dioxide concentration and partial pressures in alveoli
E. Expired air
III. Diffusion of Gas Through the Respiratory Membrane
A. Respiratory unit
B. Respiratory of pulmonary membrane
C. Factors that determine gas diffusion through the respiratory membrane
D. Diffusion capacity of the respiratory membrane
E. Ventilation-Perfusion ratio
Lecture Outline 17 Transport of Oxygen and Carbon Dioxide in
Blood and Body Tissues
I. Pressure of Oxygen and Carbon Dioxide in Lungs, Blood and Tissues
A. Uptake of oxygen by pulmonary blood
B. Transport of oxygen in arterial blood
C. Diffusion of oxygen from capillaries to interstitial fluid
D. Diffusion of oxygen from capillary to cells
E. Diffusion of carbon dioxide
II. Transport of Oxygen in Blood
A. Oxygen-Hemoglobin dissociation curve
B. Role of Hemoglobin as a “buffer” of tissue oxygen levels
C. Metabolic use of oxygen by cells
D. Transport of oxygen in the dissolved state
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E. Hemoglobin and carbon monoxide
III. Transport of Carbon Dioxide
A. Chemical forms
B. Carbon dioxide dissociation curve
C. Carbon dioxide transport and pH
D. Respiratory exchange ratio or Respiratory Quotient
Lecture Outline 18 Regulation of Respiration
I. Introduction
A. Basic elements of respiratory control
B. Two types of respiratory control
II. The Respiratory Center
A. Neurogenic control
B. Dorsal respiratory group
C. Pneumotaxic center
D. Apneustic center
E. Alternate mechanisms for respiratory control
F. Cortex
G. Other brain areas
III. Reflex Control
A. Stretch receptors
B. Hering-Breurer inspiration reflex
IV. Chemical Control
A. Types of receptors
B. Central receptors
V. Peripheral Chemoreceptors
A. Decrease in oxygen levels below 60 mm. Hg.
B. Hydrogen ions
C. Carbon dioxide
D. Low oxygen environments
E. Quantitative effect of low oxygen on alveolar ventilation
F. Effect of low oxygen when arterial carbon dioxide and hydrogen ions remain
normal
VI. Regulation of Respiration During Exercise
A. Brain
B. Proprioceptors in joints
C. Input directly from muscles
D. Memory
VII. Other Receptors
A. Irritant receptors
B. C fibers or J fibers
VIII. Periodic Breathing – Cheyne-Stokes Breathing
Lecture Outline 19 Aviation, Acceleration and High Altitude
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I. Effect of Low Oxygen on the Body
A. Barometric pressures at different altitudes
B. Alveolar partial pressure of oxygen at different altitudes
C. Effect of breathing pure oxygen on alveolar oxygen levels at different altitudes
D. Acute effects of hypoxia
E. Acclimation to low partial pressures of oxygen
F. Natural acclimation of natives living at thigh altitudes
G. Chronic mountain sickness
H. Acute mountain sickness
II. Effects of Acceleratory Forces on the Body
A. Measurement of acceleratory forces
B. Effects of positive G force
C. Effects of negative G force
D. Anti-G suits
E. Effects of linear acceleratory forces on the body
Physiology of Deep Sea Diving and other Hyperbaric Conditions
I. Introduction
A. Physiological effects of water pressure
B. Relationship of sea depth to pressure and air volume
C. Effect of depth on volume of gas – Boyle’s law
II. Effect of partial Pressure of Gases on the Body
A. Nitrogen narcosis
B. Oxygen toxicity
C. Carbon dioxide toxicity at great depths
III. Decompression of Diver
A. Volume of nitrogen dissolved in body fluids at different depths
B. Decompression sickness
C. Barotrauma
IV. Hyperbaric Oxygen Therapy
A. High pressure oxygen
B. Treatment
C. Oxygen toxicity
Lecture Outline 20 Special Circulations During Exercise
I. Muscle
A. Blood flow in isotonic and isometric muscle contractions
B. Control of blood flow through muscles
C. Circulatory adjustments during exercise
II. Cerebral Circulation
A. Regulation of blood flow – metabolic
B. Regulation of flow when arterial pressure changes
III. Splanchnic Circulation
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A. Liver
B. Intestinal flow
C. Splenic flow
IV. Circulation in the Skin
A. Two functions
B. Types of vessels
C. Regulation
V. Renal
A. Normal function
B. Changes during exercise
VI. Summary of Control of Special Circulations
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