Download Cycle 4:

DENTISTRY FACULTY – CYCLE II (2012/2013):
PHYSIOLOGY OF THE CARDIOVASCULAR SYSTEM.
Unit
Topic
Date
8
Physiology of the striated and smooth muscles.
19/21-11-2012
9
Cardiac muscle.
26/28-11-2012
10
Heart as a pump. Physical assessment of the cardiac action.
03/05-12-2012
11
Electrophysiology of the heart.
10/12-12-2012
12
CVS – part I: Arterial circulation.
17/19-12-2013
13
CVS – part II: Functional tests of the arterial system. Venous circulation.
Regulation of the cardiovascular function.
07/09-01-2013
14
Repetition of absent and/or failed activities in cycle 2.
Credit of the cycle 2. Topics of seminars VII – XII and units 8 – 13
15-01-2013
22-01-2013
Seminar VII: Heart as an excitable tissue (13-11-2012).
1. Morphology of the cardiac muscle.
2. Cell in heart. Ion channels.
3. Specificity of the cardiac calcium metabolism.
4. Pacemaker cells. Origin of the prepotential.
5. Cardiomyocytes. Specificity of the action potential in cardiomyocyte.
6. Tropic effects in heart: chronotropism, inotropism, dromotropism, batmotropism, tonotropism.
7. Influence of the sympathetic and parasympathetic system on heart.
Seminar VIII: Phases of cardiac cycle (27-11-2012).
1. Ventricular relaxation (diastole)
 Protodiastole
 Isovolumetric relaxation
 Rapid filling
 Diastasis
 Atrial systole
2. Ventricular systole
 Isovolumetric ventricular contraction
 Ejection (rapid; reduced)
3. Heart sounds.
4. Changes of volume during cardiac cycle:
 End diastolic volume – EDV
 End systolic volume – ESV
 Stroke volume – SV
 Ejection fraction – EF
5. Changes of pressure during cardiac cycle.
Seminar IX: Electrocardiography (04-12-2012).
1. Heart as a volume conductor.
2. Action potential of the cardiomyocyte and electrocardiogram.
3. Origin and features of the P wave.
DENTISTRY FACULTY – CYCLE II (2012/2013):
4.
5.
6.
7.
8.
Function of the cardiac conduction system – PQ interval.
Electrical vector of the ventricular depolarization – QRS complex.
Location of the heart in the chest.
Repolarization of ventricles.
ECG leads.
Seminar X: Autonomic nervous system (11-12-2012).
1. Autonomic nervous system – anatomy, division.
2. Chemical transmission at autonomic junctions - neurotransmitters and receptors.
3. Adrenergic (,) and cholinergic (Nicotinic, Muscarinic) receptors.
4. Transmission in sympathetic ganglia.
5. Response of effector organs to activation of the sympathetic part of ANS.
6. Response of effector organs to activation of the parasympathetic part of ANS.
7. Co-operation of the ANS with hormones of the adrenal medulla.
Seminar XI: Regulation of cardiac output (18-12-2012).
1. Cardiac output – definition, equation.
2. Regulation of heart rate – influence of the autonomic nervous system.
3. Intrinsic regulations of cardiac output.
 Heterometric regulation
 Homeometric regulation
4. Heterometric regulation / Sterling’s law of heart
 End diastolic volume – index of preload
 EDV – regulation (venous return, phases of cardiac cycle)
5. Homeometric regulation
 Afterload
 Law of augmentation
 Law of restitution
6. Extrinsic regulation of contractility.
Seminar XII. Factors affecting peripheral resistance (08-01-2013).
1. Resistant vessels
2. Passive (elastic) tension.
3. Active tension:
 Myogenic = basic,
 Neurogenic.
4. Vasoconstricting, vasodilating nerve fibers.
5. Factors synthesized in the vascular endothelium:
A. Eicosanoids
 Prostacycline (PGI) – vasodilator,
 Prostaglandins (PGE2 – vasodilators, PGF – vasoconstrictors),
 Leucotriens – mostly vasoconstrictors,
 EDCF2.
B. Non-eicosanoids.
 Endotelines – vasoconstrictors,
 EDRF (NO).
Unit 8. Physiology of the striated and smooth muscles.
1. Morphology of the sarcomere. Regulatory and contractile proteins in the striated muscles.
2. The sequence of events in contraction and relaxation of the skeletal muscle.
3. Isotonic, isometric, auxotonic, tetanic contractions.
DENTISTRY FACULTY – CYCLE II (2012/2013):
4. Specific features of smooth muscles.
5. Specificity of neuromuscular transmission and contraction in smooth muscles.
6. Visceral and single unit smooth muscles.
Computer programs/simulations:
 Neuromuscular junction.
 Sliding filament theory.
Obligatory terms and problems:
Definition and division of muscle tissues. Regulatory and contractile proteins of muscles. Energetic
sources of the muscles. Neuromuscular junction. Electromechanical and electrosecretory coupling in
muscles. Isotonic, isometric, auxotonic, tetanic contraction. Motor unit.
Division of smooth muscles. Basic electric rhythm. Characteristics of contraction of the smooth muscle cell.
Unit 9. Cardiac muscle.
1. Prepotential in P cells – basic phenomenon of the cardiac automatism.
2. Specificity of the excitation-contraction coupling in heart.
3. Re-takes of absent or failed activities.
Computer programs/simulations:
 Influence of various chemical substances on heart.
 Cardiac action potential.
Unit 10. Heart as a pump. Physical assessment of the cardiac action.
1. Phases of the cardiac cycle:
 Function of atria and ventricles, atrioventricular and arterial valves.
 Characteristics and origin of the cardiovascular sounds.
2. Physical examination of the heart:
 Observation of the chest and the precordium.
 Palpation of the chest. Examination of the apical impulse (apex beat).
 Percussion of the chest. Assessment of the borders of cardiac dullness.
 Auscultation of the heart.
3. Regulation of strength the cardiac contraction and stroke volume.
Obligatory terms and problems:
Phases of the cardiac cycle. Mechanism of generation of cardiac sounds, and their characteristics. End
Systolic Volume (ESV); End Diastolic Volume; Stroke Volume; Ejection Fraction; Minute Cardiac Output
(Q, CO); Cardiac Index (CI). Specific features of calcium metabolism in cardiomyocytes. Contractility of the
heart. Heterometric and homeometric regulation of the cardiac tropisms. Preload and afterload. Innervation
of the heart – influence of the sympathetic and parasympathetic system on heart.
Unit 11. Electrophysiology of the heart.
1. Cardiac conduction system – generation and spreading of the cardiac excitation.
2. Electrocardiography – recording of the electrical activity of the heart (unipolar and bipolar,
precordial and limb leads, Einthoven’s triangle).
3. Assessment of the ECG recording:
 Electrical waves, complexes, intervals and segments.
 Assessment of the rhythmicity and the origin of the heart rhythm, heart rate.
 Assessment of waves and complexes, segments and intervals (their duration and shape).
 Assessment of the cardiac vectors (the electrical axis of the heart).
 Location of the heart in the chest.
Obligatory terms and problems:
Types of cardiac myocytes. Electrophysiological features of the pacemaker cells, atrial and ventricular
cardiomyocytes. Action potentials of particular cardiomyocytes. Changes of excitability during action
potential of cardiomyocytes. Cardiac conduction system. Basis cardiac automatism – function of the P cell.
DENTISTRY FACULTY – CYCLE II (2012/2013):
Spread of excitation in cardiac musculature. ECG - unipolar and bipolar, precordial and limb leads. ECG
recording – waves, complexes, intervals and segments. Assessment of the cardiac rhythmicity, origin of
the rhythm and heart rate. Waves, complexes, segments and intervals of ECG. Cardiac vectors (the
electrical axis of the heart). Location of the heart in the chest.
Unit 12. CVS – part I: Arterial circulation.
1. Examination of the arterial pulse.
2. Assessment of the arterial pressure (palpation method, auscultatory method and oscillatory
method).
3. Factors determining value of the arterial pressure and organ perfusion – discussion.
Obligatory terms and problems:
The functional division of the blood vessels. Vessel wall - the morphology. Function of the various parts of
the cardiovascular system. Motive pressure of the blood flow. The arterial pressure: primary, secondary,
tertiary waves, systolic pressure, diastolic pressure, mean arterial pressure, factors which determine the
systolic-diastolic amplitude, effect of gravity. Sphigmography, features of the pulse.
The peripheral resistance: essence, location and value. The local regulation of the blood flow, active
(arterial) and passive (venous) hyperaemia. Factors influencing the vessel diameter. Precapillary
sphincters – the function. Passive (elastic) tension of vessels. Active (myogenic and neurogenic) tension of
vessels. Vasomotor innervation in the various parts of the circulation system. Vasomotor ligands acting
through endothelial receptors. Humoral (metabolic) and hormonal factors. Autoregulation of the blood flow.
Critical closing pressure.
Unit 13. CVS – part II: Functional tests of the arterial system. Venous circulation. Regulation of the
cardiovascular function.
1. The measurement of the blood pressure in the different body positions.
2. Martinette test.
3. Methods of assessment of the venous pulse.
4. Reflex regulation of the arterial pressure – discussion.
Obligatory terms and problems:
Chemoreceptors, baroreceptors and mechanoreceptors of the cardiopulmonary area. Nuclei of the solitary
tract. Organisation of medullary neurones (vasomotor centre of the medulla oblongata) responsible for
regulation in cardiovascular system. Reflexes in cardiovascular system: carotid sinus (Hering) reflex and
aortic arch (Cyon-Ludwig) reflex, Bezold-Jarisch reflex, Bainbridge reflex. Orthostatic reflex
(decompression of arterial baroreceptors).
Mechanism of the venous return. Central and peripheral venous pressure – definition and values. Jugular
venous pulse (phlebography) – waveforms of the jugular venous pressure.
Forces regulating filtration and reabsorption in microcirculation.
Unit 14. Repetition of absent and/or failed activities in cycle 2.
Credit of the cycle 2: Topics discussed on seminars VII – XII and units 8 – 13. (22-01-2012).