Download Theme: «CARDIAC INSUFFICIENCY»

THE MINISTRY OF PUBLIC HEALTH OF UKRAINE
VINNITSIA NATIONAL MEDICAL UNIVERSITY
named after M.I. PIROGOV
METHODICAL RECOMMENDATION
FROM PATHOPHYSIOLOGY
RD
FOR 3 COURSE STUDENTS OF MEDICAL FACULTY
Modul № 2
PATHOLOGY OF ORGANS AND SYSTEMS
Practical training №5 PATHOLOGY OF RESPIRATORY AND
CARDIOVASCULAR SYSTEMS
VINNITSIA- 2012
1
The methodical recommendations from pathophysiology is approved and
recommended for the introduction into the educational process at pathophysiology
department meeting.
Protocol № 9
Authors:
from 30.12.2011
Head of Department, Dr. of Med. Sc.
As. Grytsenko A.S.
Rikalo N.A.,
The manual is recommended for the foreign students of the medical (3 rd
course) faculty.
2
Thematic plan of practical classes:
Lesson 1 «Pathophysiology of systemic blood circulation. Cardiac failure».
Lesson 2 «Pathophysiology of peripheral vassels. Arrhythmias».
Lesson 3 «Pathophysiology of external breathing. Respiratory insufficiency».
Lesson 4 «Pathological type of breathing».
3
Theme: «CARDIAC INSUFFICIENCY».
Actuality of the theme.
Cardiac insufficiency is one of the frequent reasons for loss of capacity,
disability and death of patients, which suffer from diseases of the cardiovascular
system. Study of their etiology and pathogenesis is necessary for practical activity of
a doctor. Knowledge of reasons and mechanisms of development of the given
pathology will assist to development of clinical thought, choice of rational
approaches to medical treatment of every concrete patient.
The study in the experiment on the animals of cardiac insufficiency allows
exposing the mechanisms of development of these pathological states.
General purpose of the lesson to characterize cardiac insufficiency, to explain
reasons for origin and mechanisms of development of different forms of cardiac
insufficiency; to explain the pathogenetical methods of its treatment.
For this it is necessary to know (the concrete purposes):
 To marked typical pathological states and violations at the blood circulation
system: cardiac insufficiency, arrhythmias; arterial hypertension, arterial
hypotension; arteriosclerosis, atherosclerosis.
 To analyze and use present classification of typical disorders of blood circulation
system.
 To analyse changes of main indexes of hemodynamic and cardiodynemic at
cardiac insufficiency (frequency and power of cardiac contractions, minute and
systolic volume of heart; systolic, diastolic and puls pressure of heart, venous
blood pressure).
 To analyse cause-effective relationships, separate changes pathological and
compensative-adaptative, local and systemic changes at the pathogenesis of
insufficiency of systemic blood circulation, cardiac insufficiency, myocardial
infarction, shock states (cardiogenic shock).
 To analyse the mechanisms of clinical manifestations development at cardiac
insufficiency and insufficiency of systemic blood circulation.
 To analyse the reasons and mechanisms of coronary insufficiency, explain its
possible consequences.
 To analyse violations of main heart functions at acute coronary insufficiency.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills.
1. To explain the mechanism of heart contraction (Normal Physiology Department)
2. To explain the role of cardiac and extra cardiac mechanisms in regulation of hearts
work (Normal Physiology Department)
3. To interpret the basic indexes of heart work (Normal Physiology Department)
4. To explain the influence of change of heartbeats frequency and volume of the
stroke volume on efficiency of hearts work (department of normal physiology)
4
The checking of primary level of knowledges.
Give the answers to the following questions:
1. Definition of notion «cardiac insufficiency».
2. Basic indexes of cardiac insufficiency.
3. Definition of notion «insufficiency of blood circulation». To compare with notion
"cardiac insufficiency".
4. Classification of insufficiency of blood circulation.
5. Reasons for insufficiency of blood circulation.
6. Classification of cardiac insufficiency according pathogenesis, clinical course,
intensity of clinical symptoms.
7. Reasons for cardiac insufficiency, which arises up as a result of overload by a
volume.
8. Reasons for cardiac insufficiency, which arises up as a result of overload by
resistance.
9. Reasons for cardiac insufficiency, which arises up as a result of damage of
myocardium.
10.Reasons for outcardiac insufficiency.
11.Mechanism of development of cardiac insufficiency as a result of overload by a
volume.
12.Mechanism of development of cardiac insufficiency as a result of overload by
resistance.
13.Mechanism of development of cardiac insufficiency as a result of damage of
myocardium.
14.Mechanism of development of cardiac insufficiency as a result of damage of
pericardium.
15.Hypertrophy of heart, definition. Notion about tonogenic and myogenic dilatation
of heart.
16.Feature of structure, function and metabolism of myocardium during compensate
hyperfunction ( basic stages by F.Z. Meerson).
17.Reasons and mechanisms of development of sharp cardiac insufficiency.
18.Reasons and mechanisms of development of chronic cardiac insufficiency.
19.Indexes of cardiac insufficiency (gemodinamichni, clinical), mechanisms of their
development.
Standards of answers on the questions of the primary level of knowledges:
Insufficiency of systemic blood circulation – it is the state of inability of the
cardiovascular system to provide organs and tissues of an organism by the necessary
amount of blood.
Insufficiency of heart - it is the pathological state conditioned by inability of heart to
furnish circulation of organs and tissues in accordance with their necessities.
Classification of cardiac insufficiency according pathogenesis:
1. Cardiac insufficiency as a result of the cardiac overload:
5
1.1 cardiac overload of heart by volume (reasons: heart disease with valvular
insufficiency, hypervolemia);
1.2. cardiac overload of heart by resistance (reasons: heart disease with
valvular stenosis, arterial hypertension);
2. Cardiac insufficiency as a result of the damage of myocardium (reasons:
arrhythmias, myocarditis, myocardiopathys);
3. Cardiac insufficiency as a result of the violation of the coronary blood circulation
(reasons: atherosclerosis, tromboembolism or spasm of coronal vessels);
4. Cardiac insufficiency as a result of the injury of pericardium (acute and chronic
pericarditis, cardiac [pericardial] tamponade);
5. Mixed.
Intracardiac mechanisms of cardiac insufficiency compensation as a result
of cardiac overload:
The heterometric mechanism provides compensation at the cardiac
overload by a volume (reasons: heart disease with valvular insufficiency,
hypervolemia). Its essence consists in the increase of force of the heartbeats in the
case of entrance to the heart of bigger blood volume. A law of Frank-Starling's lies in
the basis of this compensatory mechanism: according to which the longer initial
length of muscular fibre (to 25% from initial), the more force of it contraction. At this
mechanism the length of cardiac hystiocyte increases, so it is named heterometric.
The homeometric mechanism provides compensation at the cardiac
overload by resistance (reasons: heart disease with valvular stenosis, arterial
hypertension). Its essence consists in the increase of force of the heartbeats in case of
the increase of resistance to blood flow. At this mechanism the tension of cardiac
hystiocyte increases, but length of it does not changes, so it is named homeometric.
Hypertrophy of heart - it is the structural changes in a heart, which arise up
at the protracted increase of loading on a heart and provide long-term adaptation.
By F. Meerson two variants of hypertrophy are selected:
Hypertrophy of heart at sportsmen - develops at the gradually growing
loadings; thus all components of heart (balanced hypertrophy) are evenly multiplied
and its functional backlogs are substantially multiplied.
Compensatory hypertrophy of heart:
- hypertrophy due to overloads (develops at the cardiac insufficiency, arterial
hypertension);
- hypertrophy from the myocardium damage (develops at atherosclerosis,
myocardiopathys).
At compensatory hypertrophy a pathogenic factor acts constantly; it is
unbalanced (are increased amount only cardiomyocytes, the amount of vessels and
nerves is not multiplied); quickly results in insufficiency of heart.
Stages of development of compensatory hypertrophy of heart according
F. Meerson:
1. Emergency stage;
2. Stage of completed hypertrophy and relatively proof hyperfunction;
6
3. Stage of gradual exhaustion and progressive cardiosclerosis.
Tonogenic dilatation - this expansion of heart cavities, that is accompanied by the
increase of shock volume of blood. It develops as a result of activating of
heterometric mechanism of compensation.
Myogenic dilatation arises up at the dystrophic changes of myocardium. It is
characterized by expansion of cavities of heart and decline of force of cardiac
contractions. Arises up during decompensation of cardiac insufficiency.
Acute cardiac insufficiency develops quickly, at the surplus loading on a heart,
when the compensatory mechanisms are not corrected with it, e.g., at the
myocardium infarction and its complications (cardiogenic shock, tamponade of
hearts), at arrhythmias (fibrillation of heart, paroxismal tachycardia, complete
atrioventricular blockade), acute pericarditis, myocarditis, embolism of pulmonary
artery.
Chronic (stagnant) cardiac insufficiency develops gradually, mainly as a result
of metabolic violations in myocardium at protracted hyperfunction of heart or
different types of myocardium damage (e.g., arterial hypertension, cardiomyopathies,
and others).









Indexes of hemodinamics:
speed of blood stream;
volume of blood circulation
stroke volume of heart
minute volume of heart
frequency of heartbeats
arterial pressure
vein pressure
common peripheral resistance in vessels
coefficient of oxygen utilization








Clinical manifestations of cardiovascular insufficiency:
tachycardia;
circulatory hypoxia;
shortness of breathing;
cyanosis;
edema;
cardiac cirrhosis of liver;
violation of ABB;
secondary hyperaldosteronism;
7
Тheoretical questions for the FMC №2.
1. Insufficiency of systemic blood circulation, definition, principles of classification,
characteristics of cardio- and hemodynamic violations.
2. Concept about acute and chronic insufficiency of systemic blood circulation.
3. Etiology, pathogenesis, stages of chronic insufficiency of systemic blood
circulation.
4. Mechanisms of main clinical signs of chronic cardiac insufficiency development
(dyspnea, cyanosis, edema).
5. Cardiac failure, definition, principles of classification.
6. Cardiac failure resulted by cardiac overload.
7. Reasons of heart overload by volume and resistance.
8. Mechanisms of immediate and long-term adaptation of heart to the overload:
tachycardia, hyperfunction (hetero- and homeometric), hypertrophy of
myocardium.
9. Hypertrophy of myocardium: kind, reasons, mechanisms of development, stages
(according to F. Meerson).
10.Features of hypertrophic myocardium, reasons and mechanisms of it
decompensation.
11.Myocardial cardiac failure.
12.Coronarogenic injury of myocardium.
13.Coronary insufficiency (absolute and relative), mechanisms of development.
14.Role of psychical factor at the development of ischemic heart disease and its
complications.
15.Concept about “critical stenosis”.
16.Consequences about ischemic heart disease: depression of contractive ability,
electric dystability, injury/ necrosis of cardiomyocytes, additional injury at
reperfusion.
17.Ischemic heart disease as a sign of coronary insufficiency, its kind.
18.Clinlcal-laboratory criterias, manifestations and complications of myocardial
infarction.
19.Pathogenesis of cardiogenic shock.
20.Principles of prophylaxis and treatment of ischemic heart disease.
21.Etiology and pathogenesis of noncoronarogenic injury of myocardium.
22.Cardiomyopathy. Classification. Characteristic of reasons and mechanisms of
development, main clinical manifestations.
Themes of abstracts:
 Cardiac insufficiency, that develops at the myocardium infarction.
 Cardiac insufficiency, that develops as a result of inborn cardiomyopathy.
 Cardiac insufficiency, that develops at arrhythmias.
 Cardiac insufficiency, that develops at tamponade of hearts.
8
Literature is necessary for studying of the theoretical questions.
1. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р. 207-216.
2. Handbook of general and Clinical Pathophysiology/ Edited by prof.
A.V.Kubyshkin, CSMU, 2005. – P.221-232
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p.460-478
Question for checking final level of knowledges.
Testing according system "Krok-I"
Tests of an open database (2010)
1. A patient suffering from stenocardia was taking nitroglycerine which caused
restoration of blood supply of myocardium and relieved pain in the cardiac area.
What intracellular mechanism provides restoration of energy supply of insulted
cells?
A Intensification of ATP resynthesis
B Reduction of ATP resynthesis
C Increased permeability of membranes
D Intensification of oxygen transporting into the cell
E Intensification of RNA generation
2. In course of a preventive examination of a miner a doctor revealed changes of
cardiovascular fitness which was indicative of cardiac insufficiency at the
compensation stage. What is the main proof of cardiac compensation?
A Myocardium hypertrophy
B Tachycardia
C Rise of arterial pressure
D Dyspnea
E Cyanosis
3. A patient ill with essential arterial hypertension had a hypertensic crisis that
resulted in an attack of cardiac asthma. What is the leading mechanism of
cardiac insufficiency in this case?
A Heart overload caused by high pressure
B Heart overload caused by increased blood volume
C Absolute coronary insufficiency
D Myocardium damage
E Blood supply disturbance
4. ECG of a 44-year-old patient shows signs of hypertrophy of both ventricles
and the right atrium. The patient was diagnosed with the tricuspid valve
insufficiency. What pathogenetic variant of cardiac dysfunction is usually
observed in case of such insufficiency?
A Heart overload by volume
9
B Heart overload by resistance
C Primary myocardial insufficiency
D Coronary insufficiency
E Cardiac tamponade
5. Dystrophic changes of the heart muscle are accompanied with cardiac cavity
enlargement, decrease of the strength of heart contraction, increased amount of
blood, which remains in the heart during systolic phase, overfilled veins. For
what state of heart is it characteristic?
A Myogenic dilatation
B Tonogenic dilatation
C Emergency stage of hyperfunction and hypertrophy
D Cardiosclerosis
E Tamponage of the heart
6. Transmural myocardial infarction in the patient was complicated with
progressive acute left ventricle insufficiency. What is the most typical for this
state?
A Edema of the lungs
B Edema of the extremities
C Cyanosis
D Ascites
E Arterial hypertension
7. Processes of repolarisation are disturbed in ventricular myocardium in
examined person. It will cause amplitude abnormalities of configuration and
duration of the wave:
AT
BQ
CR
DS
EP
8. After a serious psycho-emotional stress a 45-year-old patient suddenly felt
constricting heart pain irradiating to the left arm, neck and left scapula. His face
turned pale, the cold sweat stood out on it. The pain attack was stopped with
nitroglycerine. What process has developed in this patient?
A Stenocardia
B Myocardial infarction
C Stroke
D Psychogenic shock
E Stomach ulcer perforation
10
9. A patient who suffers from severe disorder of water-salt metabolism
experienced cardiac arrest in diastole. What is the most probable mechanism of
cardiac arrest in diastole?
A Hyperkaliemia
B Hypernatremia
C Organism dehydratation
D Hypokaliemia
E Hyponatremia
10. A 56 year old patient suffering from cardiac insufficiency has edema of feet
and shins, edematous skin is pale and cold. What is the leading mechanism of
edema pathogenesis?
A Rise of hydrostatic pressure in venules
B Drop of oncotic pessure in capillaries
C Increase of capillary permeability
D Disorder of lymph outflow
E Positive water balance
11. A 59 year old patient is a plant manager. After the tax inspection of his plant
he felt intense pain behind his breastbone irradiating to his left arm. 15 minutes
later his condition came to normal. Which of the possible mechanisms of
stenocardia development is the leading in this case?
A High catecholamine concentration in blood
B Coronary atherosclerosis
C Intravascular aggregation of blood corpuscles
D Coronary thrombosis
E Functional heart overload
12. The patient with acute miocardial infarction was given intravenously
different solutions during 8 hours with medical dropper 1500ml and oxygen
intranasally. He died because of pulmonary edema. What caused the pulmonary
edema?
A Volume overload of the left ventricular
B Decreased oncotic pressure due to hemodilution
C Allergic reaction
D Neurogenic reaction
E Inhalation of the oxygen
13. A patient who suffers from acute myocarditis has clinical signs of
cardiogenic shock. What of the under-mentioned pathogenetic mechanisms
plays the main part in shock development?
A Disturbance of pumping ability of heart
B Depositing of blood in organs
C Reduction of diastolic flow to the heart
D Decrease of vascular tone
E Increase of peripheral vascular resistance
11
Correct answers:
1-A; 2-A; 3-A; 4-A; 5-A; 6-A; 7-A; 8-A; 9-A; 10-A; 11-A; 12-A; 13-A.
(2009)
1. A 49-year-old driver complains about unbearable constricting pain behind the
breastbone irradiating to the neck. The pain arose 2 hours ago. Objectively: the
patient's condition is grave, he is pale, heart tones are decreased. Laboratory
studies revealed high activity of creatine kinase and LDG.What disease are these
symptoms typical for?
A. Acute myocardial infarction
B. Diabetes mellitus
C. Acute pancreatitis
D. Cholelithiasis
E. Stenocardia
Correct answers:
1-A.
(2008-2004)
1. Acute cardiac insufficiency appeared in a patient with arterial hypertension
due to hypertensive crisis. What mechanism of cardiac insufficiency is the main
in this case?
A. Overload of heart by resistance;
B. Absolute coronary insufficiency;
C. Relative incompetence;
D. Overload of heart by rush of blood;
E. Myocardial impairment.
2. A patient aged 59 was hospitalized at cardiological department in a severe
state with the diagnosis of acute myocardial infarction of the posterior wall of
the left ventricle and septum, and starting pulmonary edema. What is primary
mechanism which causes the development of pulmonary oedema in the patient?
A. Pulmonary arterial hypertension;
B. Left ventricular failure;
C. Pulmonary venous hypertension;
D. Hypoxemia;
E. Decrease of alveolocapillary diffusion of oxygen.
3. While climbing upstairs on the 5th floor a patient has got an increased arterial
pressure. The cause is the increase of:
A. Minute volume of the blood
B. The number of functioning capillaries
C. Content of ions in blood plasma
D. Viscosity of the blood
E. Circulating volume of the blood
12
4. On the diagnosis of myocardial infarction the main role belongs to
enzymodiagnosis. The definition of content level in the blood of what enzyme is
the most important during the first 2-4 hours after infarction?
A. Aldolase
B. Lipoprotein lipase
C. Alanine aminotranspherase
D. Creatin phosphokinase
E. Acetylcholinesterase
5. One of the most dangerous moments in pathogenesis of myocardial necrosis is
the further increase of the zones of necrosis, dystrophy and ischemia. The
important role in this belongs to the increase of the use of the oxygen by
myocardium. What substance contributes to this process?
A. Chlorine ion
B. Cholesterol
C. Catecholamine
D. Acetylcholine
E. Adenosinus
6. During the examination of blood for activity of AsAT and AlAT in the patient
who complained of pain in the chest and in upper part of the abdomen, the
following results were received: activity of AsAT 2 times higher than AlAT
activity. What disease does the patient have?
A. Acute infectious hepatitis
B. Acute pancreatitis
C. Myocardial infarction
D. Chronic hepatitis
E. Cirrhosis of the liver
7. Redistribution of organ blood supply took place in a young man, aged 20
during the load. What organ did the blood flow increase in most of all?
A. Brain
B. Kidneys
C. Liver
D. Skeletal muscles
E. Heart
8. Clinical signs of developing pulmonary edema appeared in a patient with
cardiac insufficiency of left ventricular type. Which of the pointed pathogenic
mechanism is the primary in such pathology?
A. Hydrodynamic
B. Congestive
C. Colloid-osmotic
D. Lymphogenous
E. Membranogenous
13
9. A patient has cyanosis, increase of the liver, oedema of the lower extremities
due to the right ventricular insufficiency. What is the cause of the development
of right ventricular failure?
A. Cardiogenic cirrhosis of the liver.
B. Functional shunting in lungs
C. Hypercatecholaminemia
D. Increase of venous pressure
E. Hypotension of pulmonary circulation
10. A woman, aged 25, complains of constant pain in the heart area,
breathlessness on movement, and general malaise. She has pale and cold skin,
acrocyanosis. Her pulse is 96/min and her BP is 105/70 mmHg. Heart border in
her shifted 2 cm left. The first sound is weakened over the apex of heart; there is
systolic murmur over the apex. Diagnosis is insufficiency of the mitral valve of
the heart. What is the cause of the blood circulation failure?
A. Myocardial overload by the increased blood volume
B. Myocardial overload by the increased of resistance of blood outflow
C. Myocardial failure
D. Volume decreased of circulating blood
E. Volume increased of vascular bed
11. A patient with acute myocardial infarction was being given 1500ml of
different solutions intravenously during 8 hours, oxygen intranasally. Death
occurs due to pulmonary edema. What was the cause of the pulmonary edema?
A. Overload of the left ventricle by the volume
B. Decrease of oncotic pressure due to hemodilution
C. Allergic reaction
D. Neurogenic reaction
E. Oxygen inhalation
12. Functional hypertrophy of the left ventricle of the heart developed in a
sportsman, aged 20, due to constant physical load. What morphofunctional
process do these changes result from?
A. Increase of cell size and number of contractile organelles
B. Increase of fibroblast number
C. Increase of the number of conductive cardiomyocytes
D. Increase of the amount of connective tissue
E. Increase of the amount of fat tissue
13. Acute cardiac insufficiency appeared in a patient with arterial hypertension
due to hypertensive crisis. What mechanism of cardiac insufficiency is the main
in this case?
A. Overload of heart by resistance;
B. Absolute coronary insufficiency;
C. Relative incompetence;
D. Overload of heart by rush of blood;
E. Myocardial impairment.
14
14. A patient aged 59 was hospitalized at cardiological department in a severe
state with the diagnosis of acute myocardial infarction of the posterior wall of
the left ventricle and septum, and starting pulmonary edema. What is primary
mechanism which causes the development of pulmonary oedema in the patient?
A. Pulmonary arterial hypertension;
B. Left ventricular failure;
C. Pulmonary venous hypertension;
D. Hypoxemia;
E. Decrease of alveolocapillary diffusion of oxygen.
15. While climbing upstairs on the 5th floor a patient has got an increased
arterial pressure. The cause is the increase of:
A. Minute volume of the blood
B. The number of functioning capillaries
C. Content of ions in blood plasma
D. Viscosity of the blood
E. Circulating volume of the blood
16. On the diagnosis of myocardial infarction the main role belongs to
enzymodiagnosis. The definition of content level in the blood of what enzyme is
the most important during the first 2-4 hours after infarction?
A. Aldolase
B. Lipoprotein lipase
C. Alanine aminotranspherase
D. Creatin phosphokinase
E. Acetylcholinesterase
17. One of the most dangerous moments in pathogenesis of myocardial necrosis
is the further increase of the zones of necrosis, dystrophy and ischemia. The
important role in this belongs to the increase of the use of the oxygen by
myocardium. What substance contributes to this process?
A. Chlorine ion
B. Cholesterol
C. Catecholamine
D. Acetylcholine
E. Adenosinus
18. During the examination of blood for activity of AsAT and AlAT in the
patient who complained of pain in the chest and in upper part of the abdomen,
the following results were received: activity of AsAT 2 times higher than AlAT
activity. What disease does the patient have?
A. Acute infectious hepatitis
B. Acute pancreatitis
C. Myocardial infarction
D. Chronic hepatitis
E. Cirrhosis of the liver
15
19. Redistribution of organ blood supply took place in a young man, aged 20
during the load. What organ did the blood flow increase in most of all?
A. Brain
B. Kidneys
C. Liver
D. Skeletal muscles
E. Heart
20. Clinical signs of developing pulmonary edema appeared in a patient with
cardiac insufficiency of left ventricular type. Which of the pointed pathogenic
mechanism is the primary in such pathology?
A. Hydrodynamic
B. Congestive
C. Colloid-osmotic
D. Lymphogenous
E. Membranogenous
21. A patient has cyanosis, increase of the liver, oedema of the lower extremities
due to the right ventricular insufficiency. What is the cause of the development
of right ventricular failure?
A. Cardiogenic cirrhosis of the liver.
B. Functional shunting in lungs
C. Hypercatecholaminemia
D. Increase of venous pressure
E. Hypotension of pulmonary circulation
22. A woman, aged 25, complains of constant pain in the heart area,
breathlessness on movement, and general malaise. She has pale and cold skin,
acrocyanosis. Her pulse is 96/min and her BP is 105/70 mmHg. Heart border in
her shifted 2 cm left. The first sound is weakened over the apex of heart; there is
systolic murmur over the apex. Diagnosis is insufficiency of the mitral valve of
the heart. What is the cause of the blood circulation failure?
A. Myocardial overload by the increased blood volume
B. Myocardial overload by the increased of resistance of blood outflow
C. Myocardial failure
D. Volume decreased of circulating blood
E. Volume increased of vascular bed
23. A patient with acute myocardial infarction was being given 1500ml of
different solutions intravenously during 8 hours, oxygen intranasally. Death
occurs due to pulmonary edema. What was the cause of the pulmonary edema?
A. Overload of the left ventricle by the volume
B. Decrease of oncotic pressure due to hemodilution
C. Allergic reaction
D. Neurogenic reaction
E. Oxygen inhalation
16
24. Functional hypertrophy of the left ventricle of the heart developed in a
sportsman, aged 20, due to constant physical load. What morphofunctional
process do these changes result from?
A. Increase of cell size and number of contractile organelles
B. Increase of fibroblast number
C. Increase of the number of conductive cardiomyocytes
D. Increase of the amount of connective tissue
E. Increase of the amount of fat tissue
25. Large amount of isoenzymes of creatine kinase of MV-form was revealed in
the blood of the patient with destructive changes in the muscular tissue. What is
the most possible diagnosis?
A. Myocardial infarction
B. Muscular atrophy
C. Muscular dystrophy
D. Polymyositis
E. Myopathy
26. Sharp marked pains in the substernal area that radiate to the left arm
cannot be controlled by nitroglycerine for 30 minutes. What changes developed
in the patient’s hearts?
A. Myocardial ischemia
B. Pathological myocardial hypertrophy
C. Sharp increase of coronary blood flow
D. Mitral incompetence
E. Inflammation of pericardium
27. The activity of what enzymes is it necessary to determine in pathology of
cardiac muscle with diagnostic and prognostic aim?
A. Arginase, peptidase, phosphatase
B. Decarboxylase, decanidase, lactate dehydrogenase
C. Creatin kinase, transaminase, lactate dehydrogenase
D. Lysozyme, citrate synthatase, succinate dehydrogenase
E. Neuroaminase, aldolase, hexakinase.
28. A severe stress was caused in an experimental animal. Necrotic injuries of
myocardium developed in this stage. What is the main cause in the pathogenesis
of these injuries?
A. Increase of calcium content in cardiomyocytes
B. Decrease of adenosinus triphosphoric acid synthesis in mitochondria
C. Changes in the work of Na+-K+ pump
D. Insufficiency of coronary circulation
E. Decrease of adenosinus triphosphoric acid activity of myosin
17
29. At examination of a patient strengthening of a second pulmonic sound,
hypertrophy of the right ventricle wall are determined. What changes of
hemodynamic take place in pulmonary circulation?
A. Hyperperfusion of the lungs
B. Hypoperfusion of the lungs
C. Manifestation of Hering-Breuer reflex
D. Development of broncho-alveolar vascular anastomosis
E. Spasm of resistant vessels in the lungs.
30. A patient with myocardial infarction has a mark paleness of skin, oliguria,
AP 100/90 mm Hg, and pulse 100 beats/min. What compensative mechanism
maintains relative high level of AP?
A. Hypokalemia
B. Hypoperfusion of the lungs
C. Centralization of blood circulation
D. Increase of the level of vasodilators in blood
E. Secondary aldosteronism
31. In cardiac pathology homeometric mechanism of compensation in the work
of the left ventricle takes place in:
A. Stenosis of atrioventricular foramen
B. Mitral incompetence
C. Aortic incompetence
D. Hypertension of pulmonary circulation
E. Hypertension of systemic circulation.
32. In cardiac pathology heterometric mechanism of compensation connected
with overloading of left ventricle volume takes place in:
A. Stenosis of atrioventricular foramen
B. Stenosis of aortic osteum
C. Aortic incompetence
D. Hyper tension of pulmonary circulation
E. Hypertension of systemic circulation.
33. Sharp increase of AsAT activity was determined in the blood serum of a
patient 12 hrs later after an acute attack of pain in the substernal area. Which of
the pathogenesis is the most possible?
A. Collagenosis
B. Diabetes mellitus
C. Myocardial infarction
D. Virus hepatitis
E. Diabetes insipidus
18
34. Pressing pain in the heart area with irradiation to the left arm, neck and
under the left shoulder blade suddenly appeared in a male patient aged 45, after
considerable psycho-emotional exertion. His face became pale and covered with
cold perspiration. Nitro-glycerin relieved the attack of pain. What process in the
patient?
A. Angina pectoris
B. Perforation of stomach ulcer
C. Psychogenetic shock
D. Myocardial infarction
E. Insult
35. In recreation of the arterial hypertension in a dog a thickness in the left
ventricle wall increased 1.7 times in a month, but the circulating blood volume
was not changed in comparison with the initial data. What stage of myocardial
hypertrophy is observed in the animal?
A. Initial
B. Repair
C. Complete hypertrophy
D. Decompensation
E. Progressive cardiosclerosis
36. The rate of spread of pulse wave turned out to be considerably higher in a
man aged 70, than in a man aged 25. The cause of this is decrease of:
A. Arterial pressure
B. Cardiac output
C. Elasticity of vascular wall
D. Rate of cardiac contractions
E. Circulation rate
37. A patient excretes water from the organism less than he uses it for 24 hours.
What disease may lead to this state?
A. Cardiac insufficiency
B. Pancreatitis
C. Cystitis
D. Hepatitis
E. Infectious diseases
38. A patient who underwent myocardial infarction a month and a half ago had
Dressler’s syndrome with typical triad: pericarditis, pleurisy, and pneumonia.
The cause of its development is:
A. Sensibilization of the organism by myocardial antigens
B. Decrease of resistance to infectious agents
C. Activation of saprophytic micro flora
D. Intoxication of the organism by necrotic products
E. Injection of myocardial enzymes in the blood.
19
39 A patient with rheumatism had incompetence of the left atrioventricular
foramen and decompensation of cardiac activity. The characteristic
hemodynamic index of this state is:
A. Decrease of cardiac output
B. Slowing down of blood flow
C. Decrease of arterial pressure
D. Increase of venous pressure
E. Widening of microcirculatory bed
40. Considerable increase of myocardial mass of left ventricle was determined in
a patient with hypertension. It was due to:
A. Increase of cardiomyocyte volume
B. Increase in amount of cardiomyocytes
C. Enlargement of connective tissue
D. Retention of water in myocardium
E. Fat infiltration of myocardium
41. A patient with aortic atherosclerosis has left ventricular hypertrophy as a
compensatory phenomenon. Compensatory role of hypertrophy comes to:
A. Normalization of load on each cardiomyocyte
B. Improvement of delivery of oxygen to myocardium
C. Activation of synthesis of macroergs in myocardium
D. Economical use of energy by cardiomyocytes
E. Increase of stroke volume of the blood
42. A patient aged 47 with mitral incompetence has the symptoms of cardiac
insufficiency: breathlessness, cyanosis, oedema of lower limbs. Objectively: the
borders of the heart are dilated, the heart rate is 104 beats per min, and arterial
pressure is 125/85 mm hg. These symptoms are due to:
A. Increase of peripheral resistance
B. Autoallergic changes of myocardium
C. Increase of diastolic filling
D. Insufficiency of coronary circulation
E. Neurotrophic disturbances
43. After suffered rheumatism a patient had aortic stenosis. Point out what
mechanism of compensation takes place in the left ventricle:
A. Homeometric
B. Heterometric
C. Systolic
D. Diastolic
E. Coronary
20
44. After suffered rheumatism a patient had aortic incompetence. Indicate what
mechanism of compensation takes place in the left ventricle in this case:
A. Homeometric
B. Heterometric
C. Systolic
D. Diastolic
E. Coronary
45. A patient with acute myocardial infarction, which was caused by thrombosis
of coronary arteries, was treated with fibrinolytc preparation urkinase that led
to the development of reperfusion syndrome. Which of the mentioned
syndromes is associated with reperfusion?
A. Dressler’s
B. Chediak-Higashi
C. Morgagni-Adams-Stokes
D. No-reflow
E. Wolff-Parkinson-White
46. Which of the factors is the most frequent cause of formation of acquired
valvular heart disease?
A. Septic endocarditis
B. Syphilis
C. Atherosclerosis
D. Mechanical factor
E. Rheumatism
47. Acute pain in the heart area, marked skin paleness and loss of consciousness
developed in a patient after short intensive physical excretion. What heart
failure may be suspected in this patient?
A. Mitral incompetence
B. Stenosis of aortic osteum
C. Stenosis of mitral orifice
D. Aortic incompetence
E. Stenosis of the right atrioventricular opening
48. A patient aged 40, complains of increased fatigue, appearance of pain in the
heart area on physical exertion. Objectively: cyanotic skin (especially on the
fingers of the hands and legs, lobule of the ear), pulse rate 96 beats/min, AP110/85 mm of hg. There are oedemas in the lower and middle third of the cruses.
The edge of the liver projects 3 cm from under the costal arch. Which form of
circulatory insufficiency may be suspected in this patient?
A. Acute left ventricular failure
B. Acute vascular insufficiency
C. Chronic left ventricular failure
D. Chronic right ventricular failure
21
E. Acute right ventricular failure
49. A patient complains of breathlessness that appears even on slight physical
exertion, cough with sputum, which recently has obtained bloody character.
Objectively: the skin of the face and mucous membrane of the lips particularly
are cyanotic. Which impairment of the heart work may be suspected in this
patient?
A. Stenosis of mitral orifice
B. Mitral incompetence
C. Stenosis of aortic osteum
D. Aortic incompetence
E. Stenosis of the right atrioventricular opening
50. A patient, female, aged 48 complains of breathlessness on slight physical
exertion, pains of pressing character in substernal area, appearance of syncope
on exertion. According to a case history the patient suffered rheumatism. Heart
failure was diagnosed - stenosis of aortic osteum, myocardial hypertrophy. What
is the main mechanism of the development of myocardial hypertrophy?
A. Hypertrophy of myocardiocytes
B. Diffuse oedema of interstice
C. Synthesis increase of contractile proteins in myocardium
D. Hyperplasia of intermediate tissue of myocardium
E. Accumulation of water and electrolytes in myocardiocytes
51. A patient 45 complains of breathlessness on slight physical exertion, oedema
of the legs, frequent quinsies are pointed out in case history, she is being ill for 2
years. Rheumocarditis, combined mitral incompetence, insufficiency of blood
circulation were diagnosed. What is hemodynamic mechanism of
decompensation?
A. Decrease of circulating blood volume
B. Decrease of venous pressure
C. Increase of arterial pressure
D. Decrease of minute volume of the heart
E. Tachycardia
52. A patient with ischemic heart disease had a sudden severe attack of angina
pectoris: the face is pale, cold, damp skin, AP-70/50 mm Hg, extrasystolia.
Myocardial infarction and cardiogenic shock were diagnosed. Name the leading
link of pathogenesis?
A. Hypotension
B. Pain syndrome
C. Toxaemia
D. Extrasystolia
E. Decrease of minute blood volume
22
53. Mitral incompetence without impairment of blood circulation was revealed
in a patient aged 25. What mechanism provided the state of the heart
compensation?
A. Heterometric mechanism
B. Homeometric mechanism
C. Inotropic action of catecholamines
D. Increase of the heart mass
E. Strengthening of protein synthesis
54. Aortic stenosis was revealed in a girl aged 15, but without impairments of
blood circulation. What the mechanism provided the condition of heart
compensation?
A. Homeometric mechanism
B. Inotropic action of catecholamines
C. Heterometric mechanism
D. Decrease of heart mass
E. Strengthening of protein synthesis
55. During the experiment a white rat was given intraperitoneal injection of
0.1% adrenalin solution at 1 mg/100g of body mass. 30 minutes later respiration
become hurried and shallow, then sharp and convulsive, foamy fluid appeared
from the nasal cavity, there was acrocyanosis. The animal died when acute
pulmonary edema developed. What pathogenetic mechanism is the leading in
this case?
A. Toxic
B. Membranogenous
C. Lymphogenous
D. Hydrodynamic
E. Colloid-osmotic
56. The planned investigation of cardiohemodinamics readings of patient M.
with chronic cardiac insufficiency was carried out. Which of the named readings
is the main sign of the development of cardiac decompensation?
A. Development of tachycardia
B. Decrease of stroke volume
C. Tonogenic dilatation
D. Increase of peripheral vascular resistance
E. Increase of central venous pressure
57. During ultra-sound investigation dilation of heart cavities was revealed in
patient S. who suffered from hypertension. Which of the below mentioned signs
are evidence of development of tonogenic dilation?
A. Dilation of heart cavities with increase if stroke volume
B. Dilation of cavities without change if stroke volume
C. Dilation of cavities with change of stroke volume
D. Uniform dilations of heart borders
E. Irregular dilations of heart borders
23
58. Increase of blood viscosity was revealed in a patient with chronic cardiac
insufficiency, the damage of the walls of vessels of microcirculatory channel was
found out on capillaroscopy. Which of the impairments of peripheral circulation
are possible in this case?
A. Slage phenomenon
B. Thrombosis
C. Arterial hyperemia
D. Embolism
E. Venous hyperaemia.
59. Patient, aged 44, complains of strangulation, palpitation, pains in the right
costal interspace, and edemas on the legs. Pulsation of cervical veins,
enlargement of the liver, edemas of the lower extremities were found out on
examination. ECG shows the signs of hypertrophy of both ventricles and right
auricle. Tricuspid incompetence was diagnosed. What is pathophysiological
variant of this incompetence?
A. Overloading of the heart by exertion
B. Primary myocardial insufficiency
C. Overloading of the heart by volume
D. Coronary insufficiency
E. Cardiac tamponade.
60. Choose in what form below mentioned states that cause of cardiac
insufficiency heterometric mechanism of compensation (Frank-Starling) takes
place:
A. Hypertension of systemic circulation
B. Hypertension of pulmonary circulation
C. Stenosis of mitral orifice
D. Stenosis of aortic osteum
E. Aortic incompetence
61. Name the condition, which accompanied by pressure overload of left
ventricle.
A. Stenosis of mitral orifice
B. Stenosis of aortic orifice
C. Incompetence of mitral valve
D. Incompetence of aortic valve
E. Pulmonary hypertension
24
62. A patient died from myocardial infarction, which was proved by data of
clinical and electrocardiographical examinations. No changes of coronary vessels
were found at autopsy of this patient. What evokes myocardial infarction in this
patient?
A. Increase in tonus of sympathetic nervous system
B. Enhanced secretion of catecholamines
C. Obstruction of vessel with embolus
D. Thrombosis of coronary vessels
E. Rheumatic coronaritis
63. Thrombosis of anterior intraventricular coronary artery developed after
coronarography in a patient with ischemic heart disease and atherosclerosis of
coronary arteries. What mechanism is the most significant for development of
this complication?
A. Slowing of blood flow
B. Injury of endothelium of vessel wall
C. Increase in blood coagulant concentrations
D. Decrease in blood anticoagulant concentrations
E. Reduction of fibrinolytic system activity
64. Under hypertrophy of myocardium mass of heart increases due to:
A. Enlargement of each muscular fiber
B. Growth of connective tissue
C. Increase in number of myocardiocytes
D. Growth of adipose tissue
E. Enhancement of blood supply of heart muscle
65. Dystrophic alterations of heart are accompanied with dilation of heart
cavities, decreased force of heard contractions, increased blood volume that
remains during systole in the heart cavity, vein overfill. What heart condition is
it typical for?
A. Emergency stage of hyperfunction and hypertrophy
B. Cardiosclerosis
C. Myogenic dilatation
D. Tonogenic dilatation
E. Cardiac tamponade
Correct answers:
1-A; 2-B; 3-A; 4-D; 5-C; 6-C; 7-D; 8-B; 9-D; 10-A; 11-A; 12-A; 13-A; 14-B; 15-A;
16-D; 17-C; 18-C; 19-D; 20-B; 21-D; 22-A; 23-A; 24-A; 25-A; 26-A; 27-C; 28-D;
29-E; 30-C; 31-E; 32-C; 33-C; 34-A; 35-C; 36-C; 37-A; 38-A; 39-A; 40-A; 41-A;
42-A; 43-A; 44-B; 45-D; 46-E; 47-B; 48-D; 49-A; 50-C; 51-D; 52-E; 53-A; 54-A;
55-D; 56-B; 57-A; 58-A; 59-C; 60-E; 61-B; 62-B; 63-B; 64-A; 65-C.
25
Situational task
1. A patient, 65 years old, has general weakness, palpitation and dyspnea at the
moderate physical loading, dizziness. In the evening she has edema of the lower
extremities. Pulls - 80 per min., AP - 140/70 mm Hg. On ECG there are the signs
of ischemia and dystrophy of myocardium. During ultrasonic research the
decline of stroke volume is exposed. A conclusion about a presence at the woman
of cardiac insufficiency was done.
1. Cardiac insufficiency, definition.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. Classification of cardiac insufficiency according to pathogenesis.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Main pathogenetical principles of cardiac insufficiency treatment.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. A man, 28 years old, has dyspnea, rapid fatigue ability during the walk. He
had these symptoms from birth due to insufficiency of aortic valves. His skin is
pale, cyanosis of lips. Left side of heart is extended. Pulls - 78 min, AP - 110/80
mm Hg.
1. Explain the basic mechanism of cardiac insufficiency development in this
case?
____________________________________________________________________
2. Explain the mechanisms of intracardiac adaptation, which provide
compensation in this case?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. A man, 27 years old, has dyspnea, rapid fatigue ability during the walk. He
had these symptoms after rheumatism, when insufficiency of mitral valves was
set.
1. What type of cardiac insufficiency according to pathogenesis at a patient?
____________________________________________________________________
2. Explain the mechanisms of intracardiac adaptation, which provide
compensation in this case?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
26
4. A girl, 18 years old, has dyspnea, rapid fatigue ability after physical loading.
She had these symptoms from birth due to stenosis of the aortic valves.
1. What type of cardiac insufficiency according to pathogenesis at a patient?
____________________________________________________________________
2. Explain the mechanisms of intracardiac adaptation, which provide
compensation in this case?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
5. A patient, who suffers from arterial hypertension during 15 years, has edema
of legs.
1. What is the reason for cardiac insufficiency origin?
____________________________________________________________________
2. Classification of cardiac insufficiency according to pathogenesis.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
6. A patient with insufficiency of the mitral valve every evening after work has
mark edema on lower extremities.
1. What is the mechanism of these edema development?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. How to explain their localization?
____________________________________________________________________
____________________________________________________________________
7. Patient, 35 years, suffers on dyspnea, rapid fatigue ability during the walk. At
the ultrasonic research the the stenosis of mitral valve was diagnosed. Physical
development is satisfactory, skin is pale, cyanosis of the lips. Left side of heart is
extended. Pulls - 78 min, AP - 110/80 mm Hg.
1. What type of cardiac insufficiency according to pathogenesis at a patient?
____________________________________________________________________
2. Explain the mechanisms of intracardiac adaptation, which provide
compensation in this case?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
27
8. A patient suffers from mitral stenosis during 10 years. During the
investigation cardiac insufficiency was diagnosed.
1. What is the mechanism of such complication development?
____________________________________________________________________
____________________________________________________________________
2. What is the difference between tonogenic and myogenic dilatation?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
9. Rheumatic myocarditis was diagnosed at the patient 25 years old.
1. What is the main mechanism of cardiac insufficiency devellopment?
____________________________________________________________________
2. Explain the mechanisms of main clinical signs of cardiac insufficiency
development?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
10. Hypertrophy of left ventricle developed at the patient 50 years old with the
insufficiency of mitral valve.
1. What is the starting mechanism of hypertrophy development at a patient?
____________________________________________________________________
____________________________________________________________________
2. Explain the hemodynamic indexes of cardiac insufficiency.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
11. Acute pain at the area of heart with irradiation to the left arm, neck, left
scapula and fear of death feeling developed at the men 45-years old after
significant emotional stress. Face became pale and covered by clammy sweat.
Nitroglycerin didn’t stop the pain.
1. What disease developed at the patient? Explain your answer.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. Name the possible reasons of this pathology development.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
28
3. Name the possible complications of described disease.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
4. Principles of pathogenetic treatment.
____________________________________________________________________
____________________________________________________________________
12. Pain in the heart and joints, fever, dry cough appeared at the patient in 3
weeks after acute myocardial infarction. At auscultation - pericardium friction
rub, at the X-ray examination – pleuritis. At the general blood test –
eosinophilia, increase of ESR.
1. What complication of acute myocardial infarction developed at the patient?
____________________________________________________________________
2. What is the mechanism of it development?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
13. Acute drop of arterial blood pressure to 60 mm Hg with tachycardia 140
/min, dyspnea, loss of consciousness developed at the patient on the 2nd day after
acute myocardial infarction.
1. What complication of acute myocardial infarction developed at the patient?
____________________________________________________________________
____________________________________________________________________
2. What is the mechanism of it development?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Principles of pathogenetic treatment.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
14. Acute pain at the area of heart with irradiation to the left arm, neck, left
scapula and fear of death feeling developed at the men 48-years old after
significant emotional stress. Face became pale and covered by clammy sweat.
Nitroglycerin didn’t stop the pain. Myocardial infarction was diagnosed. After
the trearment with use of fibrinolytic medicine the condition of the patient
became grave because of development of reperfusion syndrome.
1. Name the reasons and mechanisms for reperfusion syndrome development.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
29
Theme: " THE DISTURBANCE OF CARDIAC RHYTHM".
Actuality of the theme.
Violations of normal cardiac rhythm of heart – arrhythmias – are investigation
of different violations of automatism, excitability and conductivity of myocardium
and have various etiology and pathogenesis. The origin of arrhythmia predetermine
the organic changes in myocardium, nervous and refectory factors, defeat of the
nervous system, endocrine disorders, toxic action of some medications. In the case
the arrhythmia there can be the changes of correlation between intra- and extra
cellular maintenance of potassium, sodium, calcium and magnesium ions, that
predetermines violation of electro-physiology descriptions of the sinus node, leading
system and contractive activity of myocardium.
Knowledge of reasons for origin of arrhythmias, their pathogenesis needs for
understanding of mechanisms of violations of functions of the cardiovascular system,
possibility of their correction.
General purpose of the lesson: To learn reasons and mechanisms of
development of violations of rhythm of heart, possible consequences.
For this it is necessary to know (the concrete purposes):
 To explain the mechanisms of arrhythmias development.
 To use the knowleges about typical disorders of cardiac rhythm (disorder af
automatism, excitability, conductivity, combined) for the ECG analyses.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills.
1. Basic properties of cardiac muscle (Normal Phisiology Department).
2. Automatism. Pacemakers of cardiac rhythm (Normal Phisiology Department).
3. Excitability. Notion about potentials of rest. Features of pacemakers action
potentials (Normal Phisiology Department).
4. Conductivity. Structure of the conductive system of heart (Normal Phisiology
Department).
5. ECG – as a research method (Normal Phisiology Department).
6. Basic indexes of ECG (Normal Phisiology Department).
The checking of primary level of knowledges.
Give the answers to the following questions:
1. Arrhythmia, definition.
2. Classification of arrhythmias.
3. Arrhythmias resulted by violation of automatism.
4. Arrhythmias resulted by violation of excitability.
5. Arrhythmias resulted by violation of conductivity.
6. Arrhythmias resulted by simultaneous violation of conductivity and
excitability.
30
Standards of answers on the questions of the primary level of knowledges:
1. Arrhythmia – it is violation of main electro-phisiological properties of
myocardium that leads to disorder of time of origin and sequence of
irritation extension at the different parts of myocardium.
2. a). Arrhythmias resulted by violation of automatism.
b). Arrhythmias resulted by violation of excitability.
c). Arrhythmias resulted by violation of conductivity.
d). Arrhythmias resulted by simultaneous violation of conductivity and
excitability.
3. I. Nomotopic arrhythmias:
а) sinus tachycardia
б) sinus bradicardia
в) sinus (respiratory) arrhythmia
II. Heterotopic arrhythmias
- sick sinus syndrome
- wandering of pacemaker syndrome
4. Extrasystole.
Paroxysmal tachycardia.
5. 1. Heart block.
2. Accelerated conductivity of impulses:
– Wolff-Parkinson-White syndrome
6. 1. Atrial flutter.
2. Atrial fibrillation.
3. Ventricular flutter.
4. Ventricular fibrillation.
Тheoretical questions for the FMC №2
1. Arrhythmias: classification , reasons, mechanisms of development, ECGfetures.
2. Role of additional conduction pathways at the arrhythmias development.
3. Reasons and mechanisms of ectopic areas of excitation formation at the
myocardium; re-entry and impulses circulation mechanisms.
4. Fibrillation and defibrillation of heart.
Literature is necessary for studying of the theoretical questions.
1. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р. 217-221.
2. Handbook of general and Clinical Pathophysiology/ Edited by prof.
A.V.Kubyshkin, CSMU, 2005. – P.240-250.
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p.489-500
31
Themes of abstracts for individual work of students:
1. Role of additional conductive ways of heart in development of arrhythmias.
2. Role of hormonal violations in etiology of arrhythmias of heart.
3. Possibilities of prophylaxis of arrhythmias of heart.
4. Violation of vegetative innervations of heart in genesis of arrhythmias.
Question for checking final level of knowledges.
Situation tasks.
1. At a patient C. with neurocirculatory dystonia the gradual increase of
frequency of heartbeats is marked to 130/min. Symptoms of organic injury of
heart it is exposed. At a diagnostic vagal test (pressure on a carotid sinus) the
rhythm of heart diminished for a while, and then again went back to highfrequency.
1. How is this violation of cardiac rhythm named?
____________________________________________________________________
2. What group of arrhythmias does it belong to?
____________________________________________________________________
3. Which electro-physiological processes lie in its basis?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
4. Why did the irritation of carotid sinus give normalizing influence on a
cardiac rhythm at the given patient?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. Acute palpitation, pain in the heart, weakness, arterial hypertension, puls
deficiency (Jackson's symptom) appeared at the patient, 50 years old, in time of
workaround of stomatologist. At ECG: absence of P wave at different interval
R-R.
1. Arrhytmia, definition.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. What violation of cardiac rhythm developed at the patient?
____________________________________________________________________
3. To what group this arrhythmia refers?
____________________________________________________________________
32
3. ECG analysis.
Norm
Find out changes of ECG. What pathology this changes characteristic for?
Explain the reasons and mechanisms of development.
3.1.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3.2.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3.3.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
33
3.4.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3.5.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3.6.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3.7.
34
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3.8.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3.9.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
35
3.10
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3.11.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Testing according system "Krok-I"
Tests of an open database (2010)
1. Person has stable HR, not more than 40 bpm. What is the pacemaker of the
heart rhythm in this person?
A Atrioventricular node
B Sinoatrial node
C His' bundle
D Branches of His' bundle
E Purkinye' fibers
2. In a 45-year-old patient on ECG it was revealed: sinus rhythm, the number of
auricular complexesexceeds number of ventricular complexes; progressing
extension of the P-Q interval from complex to complex; fallout of some
ventricular complexes; Р waves and QRST complexes are without changes.
Name the type of heart rhythm disfunction.
A Atrioventricular block of the II degree
B Synoauricular block
C Atrioventricular blockade of the I degree
D Intraatrial block
E Complete atrioventricular block
36
3. Processes of repolarisation are disturbed in ventricular myocardium in
examined person. It will cause amplitude abnormalities of configuration and
duration of the wave:
AТ
BQ
CR
DS
EP
4. ECG of a patient shows such alterations: P-wave is normal, P-Q-interval is
short, ventricular QRST complex is wide, R-wave is double-peak or two-phase.
What form of arrhythmia is it?
A WPW syndrome (Wolff-Parkinson-White)
B Frederick's syndrome (atrial flutter)
C Atrioventricular block
D Ventricular fibrillation
E Ciliary arrhythmia
5. A 49 y.o. woman consulted a doctor about heightened fatigue and dyspnea
during physical activity. ECG: heart rate is 50/min, PQ is extended, QRS is
unchanged, P wave quanity exceeds quantity of QRS complexes. What type of
arrhythmia does the patient have?
A Atrioventricular block
B Extrasystole
C Sinus bradycardia
D Ciliary arhythmia
E Sinoatrial block
6. A patient has extrasystole. ECG shows no P wave, QRS complex is deformed,
there is a full compensatory pause. What extrasystoles are these?
A Ventricular
B Atrial
C Atrioventricular
D Sinus
E7. A 45 year old patient was admitted to the cardiological department. ECG
data: negative P wave overlaps QRS complex, diastolic interval is prolonged
after extrasystole. What type of extrasystole is it?
A Atrioventricular
B Sinus
C Atrial
D Ventricular
E Bundle-branch
37
Correct answers:
1-A; 2-A; 3-A; 4-A; 5-A; 6-A; 7-A.
(2009)
1. In course of an experiment a peripheral section of vagus of an expiremental
animal is being stimulated. What changes will be observed?
A. Increase of respiration rate
B. Bronchi dilation
C. Heart rate fall
D. Pupil dilation
E. Heart hurry
2. Heart rate of a man permanently equals 40 beats pro minute. What is the
pacemaker?
A. His΄bundle
B. Purkinje΄s fibers
C. His΄bundle branches
D. Sinoatrial node
E. Atriventricular node
3. A peripheral segment of vagus nerve on a dog΄s neck was being stimulated in
course of an experiment. The following changes of cardiac activity could be
meanwhile observed:
A. Enhancement of atrioventricular conduction
B. Heart hurry
C. Heart rate and heart force amplification
D. Heart rate fall
E. Increased excitability of myocardium
Correct answers:
1-C; 2-E; 3-D.
(2008-2004)
1. Acceleration of the heartbeat during breathing in and deceleration during
breathing out were revealed in a youth, aged 16, on examination. ESG showed
shortening of RR interval during inspiration and its lengthening during
expiration. Name the kind of arrhythmia.
A. Ciliary arrhythmia
B. Sinus tachycardia
C. Idioventricular rhythm
D. Sinus arrhythmia
E. Sinus bradycardia
38
2. A patient, aged 58, was hospitalised with complaints of unpleasant feelings in
the heart area; there was myocardial infarction in anamnesis. ECG shows
registration of fibrillation waves (F) instead of P-waves; QRST complexes are
widened and deformed. Ventricular rhythm is right; the rate of contractions of
ventricles is 48 per minute. What is the most possible impairment of the rhythm
in this case?
A. Frederic’s syndrome
B. Morgagni-Adams-Stokes syndrome
C. Wolf-Parkinson-White syndrome
D. Atrioventricular block of II stage. Mobits’ type I
E. Atrioventricular block of II stage. Mobits’ type II
3. In a patient with hypertension the pulse rate dropped from 72 to 52 bpm
during hypertonic crisis and maintained at this level for 10 days. Intramuscular
injection of 1 mg of atropine led to increasing of pulse rate at 16 bpm. What
group of arrhythmias does described disorder of cardiac rhythm belong to?
A. Ventricular fibrillation
B. Atrial palpitation
C. Disturbance of rhythm formation
D. Disturbance of rhythm conduction
E. Disturbance of automatism
4. Decrease in pulse rate down to 50 bpm was observed in a patient with
cerebral hemorrhage. His pulse was rhythmic. What is the mechanism of this
disorder of cardiac rhythm?
A. Irritation of nervus vagus
B. Reduction of rate of free diastolic repolarization
C. Influence of sympathetic mediator
D. Extension of site of sinoatrial node
E. Elevation of rate of free diastolic repolarization
5. A patient with neuro-circulatory distony has heartbeat rate increased up to
130 bpm. Clinical symptoms of organic heart injury were not found in this
patient. At pressing on carotid sinus heart rate decreased, but after returned to
previous frequency. What is the origin of this disorder of heart rhythm?
A. Fluctuations of parasympathetic tonus
B. Inflammatory lesion of myocardium
C. Enhanced influence of sympathetic nervous system
D. Ischemic injury of myocardium
E. Toxic injury of myocardium
39
6. Changes in ECG was shown at first by lengthening of P-Q interval, after that
by falling out of single QRS complexes, later by increasing in number of fallen
out ventricle complexes, and at last atriums constrict with frequency of 70 bpm
and ventricles constrict with frequency of 35 bpm. Described changes are
characteristic for:
A. Intraatrial block
B. Cross-sectional block
C. Intraventricular block
D. Arrhythmia due to disturbances of automatism
E. Arrhythmia due to disturbances of conduction
7. A patient suddenly lost consciousness and develop cramps. At his ECG
followings were revealed: 2 to 3 P cogs related to 1 QRST complex. What
property of heart conductive system is impaired?
A. Automatism
B. Excitability
C. Conduction
D. Constriction
E. Reproduction of frequency of excitement
8. On analysis ECG it was determined: sinus rhythm, correct, interval RR is
0.58 sec, location and duration of other intervals, waves and segments are not
changed. Call the type of arrhythmia:
A. Sinus tachycardia
B. Sinus bradycardia
C. Indioventricular rhythm
D. Sinus arrhythmia
E. Ciliary arrhythmia
9. The functioning of certain structures is stopped on the isolated heart by
means of cooling. What structure is cooled if due to this the contractions stopped
at first, but then they began with a rate 2 times slower than initial one?
A. Sinoatrial node
B. Purkinje’s fibres
C. Limbs of His’ bundle
D. Atrioventricular node
E. His’ bundle
10. The patient’s ECG shows that interval RR=1.5 sec, heart rate - 40 per min.
What is the pacemaker of the heart?
A. Left limb of His’ bundle
B. Sinus node
C. His’ bundle
D. Right limb of the His bundle
E. Atrioventricular node
40
11. During the operation reflex increased of vagus nerve influence on the heart
happened. What may occur in this case?
A. Cardiac arrest
B. Increase of atrioventricular node conduction
C. Increase of myocardium conduction
D. Intensification of myocardium contractions
E. Increase of heart rate
12. Decrease of R-R interval was revealed on ECG of a man. What changes in
the heart work are observed in this case?
A. Increase of heart rate
B. Decrease of heart rate
C. Increase of force of contractions
D. Decrease of force contraction
E. Decrease of force and rate of contractions
13. Patient’s attack of tachycardia was stopped by pressing on the eyeballs
(Danini-Ashner reflex). In the decrease of the heart rate there is intensification
of the influence on the sinoatrial node of:
A. Vagus nerves
B. Sympathetic nerves
C. Autonomic nervous system
D. Sympathoadrenal system
E. Catecholamines
14. Considerable increase of PQ interval was found out on ECG. It means that
conduction of stimulation is delayed by:
A. AV node
B. Atria
C. His’ bundle
D. Purkinje’s fibres
E. Ventricles
15. During the attack of heartbeat a patient with thyrotoxicosis has an irregular
pulse of different filling, pulse deficiency is observed. Waves P are absent; small
in amplitude, disorderly undulations (P waves), and irregular ventricular
complexes of ordinary configuration are noted. What kind of rhythm
impairment is observed in a patient?
A. Sinus tachycardia
B. Sinoatrial block
C. Ciliary arrhythmia
D. Paroxysmal tachycardia
E. Ventricular extrasystole
41
16. Marked frequency of the patients pulse was determined during the
examination, what is sinus tachycardia due to?
A. Hypothyrosis
B. Hypokalemia
C. Tonus increase of vagus nerve
D. Increase of speed of slow diastolic depolarisation
E. Excess of acetylcholine
17. Considerably slow pulse was determined in a patient at examination. What is
sinus bradycardia due to?
A. Decrease of speed of slow diastolic depolarisation
B. Hypercatecholaminemia
C. Decrease of circulating blood volume
D. Hyperkalemia
E. Haemic hypoxia
18. On recording ECG of a patient with hyperfunction of the thyroid gland
increase of rate of cardiac contractions was registered. Shortening of what ECG
element indicates this?
A. Interval R-R
B. Interval P-Q
C. Interval P-T
D. Segment P-Q
E. Complex QRS
19. A man has got an electro trauma. Current went through the cardiac muscle.
What dangerous impairment in the work of the heart demanding urgent
measures may appear in this situation?
A. Bradycardia
B. Extrasystole
C. Atrial fibrillation
D. Ventricular fibrillation
E. Tachycardia
20. A patient with rheumatic myocarditis began to feel intermissions in the work
of heart. By means of auscultation of the heart, feeling the pulse and ECG
investigation it was determined that this was connected with the appearance of
ventricular extra systoles the characteristic feature of which is compensatory
pause. Its appearance is due to:
A. Refractivity of ventricular myocardium to the next impulse
B. Retention of stimulation in atrioventricular node
C. Retrograde conduction of stimulation to atria
D. Inhibition of function of sinoatrial node
E. Impairment of contraction of ventricular myocardium
42
21. A patient who is treated for myocardial infarction at the in-patient
department has lost suddenly his consciousness several times a day. During the
attack pulse is absent, heart sounds are not heard, face is cyanotic, and
convulsions appear, arterial pressure is not determined. The diagnosis is
Morgagni-Adams-Stokes syndrome. It appears due to:
A. Development of full atrioventricular blockade
B. Weakness of sinoatrial node
C. Attack of ventricular paroxysmal tachycardia
D. Impairment of excitability of ventricular myocardium
E. Cardiosclerotic changes in the heart
22. Electrocardiography examination of a patient with hypertension showed
such results: right sinus rhythm, rate of cardiac constrictions is 92 per min;
duration of PQ - 0.2 sec, QRS without change, a patient has disturbance of:
A. Refractivity
B. Conduction
C. Automatism
D. Stimulation
E. Contractility
23. By electrocardiogram investigation the following data were determined in a
patient who had suffered the grippe; the rate of heart is 140 beats per min, sinus
rhythm, the range of R-R is not more than 0.15 c; duration of PQ-0.2 c; QRS is
not changed. These indicate of the development of:
A. Sinus tachyarrhythmia
B. Sinus tachycardia
C. Nonparoxysmal tachycardia
D. Paroxysmal tachycardia
E. Ventricular fibrillation
24. Acute myocardial infarction of a patient includes three areas: zone of
necrosis, dystrophy and ischemia. The changes of what ECG wave characterises
the place of necrosis in this case?
A. R
B. S
C. Q
D. T
E. P
25. ECG of a child aged 5 shows the impairment of action of cardiac rhythm. On
holding breathing the cardiac rhythm becomes normal. What kind of
impairment was found out on ECG?
A. Sinus extrasystole
B. Ciliary arrhythmia
C. Respiratory arrhythmia
D. Atrial extrasystole
E. Transversal heart block
43
26. Strong palpitation, pain in the heart, sharp weakness, increase of AP,
irregular pulse with deficiency developed suddenly in a man aged 50. ECG
showed absence of wave P and different R-R intervals. What impairment of
cardiac rhythm has a patient?
A. Transversal heart block
B. Paroxysmal tachycardia
C. Respiratory arrhythmia
D. Ciliary arrhythmia
E. Sinus extrasystole
27. ECG show that wave P overlaps the wave T what is observed in case of atrial
obstruction. At what rate of the heart contractions will it occur?
A. 150 beats per minute
B. 160 beats per minute
C. 170 beats pr minute
D. 140 beats per minute
E. 130 beats per minute
28. While analyzing the ECG of the patient with myocardial infarction attention
was paid to absence of wave P, presence of wavy isoelectric line with plenty of
small waves, frequent and irregular location of QRS complex. What impairment
of rhythm does the described picture of ECG correspond to?
A. Ventricular fibrillation
B. Idioventricular fibrillation
C. Atrial fibrillation
D. Paroxysmal tachycardia
E. Ventricular extrasystole
29. Periodical appearance of ventricular extrasystole was revealed during ECG
investigation of patient P. It was determined that wave P was absent before
extrasystole. What is the cause of its disappearance?
A. Appearance if refractory period in atria
B. Impulse block in sinus node
C. Appearance of refractory period in ventricles
D. Block of impulse conduction round the atria
E. Impossibility of retrograde conduction through A-V node
30. Quick fatigue, breathlessness on physical exertion, feeling of “sink” and
momentary cardiac arrest appeared in a patient D, aged 13, 2 weeks later after
secondary suffered tonsillitis. ECG showed decrease of voltage of waves
periodical prolapse of some cardiac cycles PQRST, RCC-55 beats/minute. What
is the most possible mechanism of the impairment of heart functions?
A. Toxic impairment of sinus node
B. Impairment of sinus node by immune complexes
C. Sclerotic changes in sinus node
D. Ischemic impairment of sinus node
E. Parasympathetic irritation of sinus node
44
31. During ECG investigation irregular atrioventricular extrasystoles were
determined in a patient aged 38. The impairment of what properties of
myocardium composes the base of extra systole pathogenesis?
A. Excitability
B. Automatism
C. Conduction
D. Contractility
E. Tonicity
32. Changes that testify to the impairment of cardiomyocytes were recorded on
the ECG of an experimental animal after the injection of uabain (substance
which blockades K+/Na+-depending ATP). What molecular mechanisms had
decisive significance in this case?
A. Electrono-osmotic
B. Lipid
C. Acidotic
D. Calcic
E. Protein
Correct answers:
1-D; 2-A; 3-E; 4-A; 5-C; 6-B; 7-C; 8-A; 9-A; 10-B; 11-A; 12-A; 13-A; 14-A; 15A; 16-D; 17-A; 18-A; 19-D; 20-A; 21-A; 22-C; 23-B; 24-C; 25-C; 26-D; 27-C;
28-C; 29-E; 30-B; 31-A; 32-A.
45
Theme:: " PATHOLOGY OF VASCULAR TONE".
Actuality of theme.
Arterial hypertension behaves to the number of the most widespread forms of
pathology of the cardiovascular system. From data of WHO, essential hypertension
have 20-25% population of earth. Arterial hypertension conduces to development of
atherosclerosis, violations of coronary and cerebral circulation of blood. Knowledge
of reasons and mechanisms of development of the given pathology will assist to
development of clinical thought and choice of rational methods of pathogenetical
treatment.
General purpose of the lesson. To learn reasons and mechanisms of
development of different types of arterial hypertension, arterial hypotension and
atherosclerosis.
For this it is necessary to know (the concrete purposes):
 To characterize diferrent forms of atherosclerosis? Explain modern teories of
atherosclerosis pathogenesis.
 To use modern criterias of arterial hypertension diagnistic.
 To analyze classifications of arterial hypertension;
 To apply knowledge about the experimental design of secondary arterial
hypertension (kidney, endocrine, neurogenic) for the analysis of their
pathogenesis.
 To interpret primary arterial hypertension as multifactorial disease.
 To analyze genetic defects as basis of primary arterial hypertension pathogenesis.
 To apply knowledge about the experimental models of typical violations in the
system of circulation (coronal insufficiency, arteriosclerosis, arterial
hypertension) of blood for the analysis of their pathogenesis.
 To explain the reasons and mechanisms of arterial hypotension development.
 To analyse the reasons of origin and mechanisms of development of primary and
secondary hypertension in the system of vessels of small circle of blood
circulation.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills.
1. Classification of vessels according to Folkow (Normal Physiology Department).
2. Regulation of circulation of blood in vessels (Normal Physiology Department).
3. Mechanisms of regulation of hemodinamics (Normal Physiology Department).
4. Regulation of vascular tone (Normal Physiology Department).
The checking of primary level of knowledges.
Give the answers to the following questions:
1. Classification of vessels according to Folkow.
46
2. Indexes of arterial pressure in a norm.
3. Reasons of origin of violations of vascular tone.
4. Determination of notion «arterial hypertension».
5. Types of arterial hypertension.
6. Consequences of arterial hypertension.
7. Arterial hypotension, definition.
8. Types of arterial hypotension.
9. Consequences of arterial hypotension.
10.Atherosclerosis, definition.
11. Reasons foratherosclerosis origin.
12.Consequences of atherosclerosis.
Standards of answers for the primary level of knowledges
1.
Classification of vessels by Folkow:
a) Compensative vessels are: aorta and arteries of elastic type.
b) Resistive vessels (vessels of resistance) are arteriole and venule located in
the pre- and postcapillary areas.
c) The vessels of exchange are capillaries and venule.
d) Capacity vessels are mainly big veins.
e) The vessels of redistribution are vessels and arterial-vein shunts.
2. Arterial pressure (AP)
-100 - 120/70-80 mm Hg (17 - 20 y.o.)
-120 - 140/80-90 mm Hg (21 - 60 y.o.)
3. Psychoemotional overload, surplus consumption of white salt, atherosclerosis,
pathology of the endocrine system, disease of kidney, violation of water-electrolyte
exchange, tumor of adrenal glands, heart disease and vessels, disease of the nervous
system.
4. Arterial hypertension is the increase of systolic pressure more than 120mm Hg
and diastolic more than 80mm Hg.
5.Primary (essential), secondary (symptomatic).
6.Hypertensive crisis, hemorrhages, stroke.
7.Arterial hypotension is the decrease of systolic pressure less than J 00 Hg and
diastolic less than 60 mm Hg.
8.Primary (neurocirculatory), secondary (symptomatic).
9.Collapse, ischemia of organs and tissues.
10.Atherosclerosis - is pathology of vascular wall, which characterize by the
sedimentation of lipids, elements of blood, calcium and connecting tissue in its
internal membrane.
11.Metabolic disturbances, hormonal violations, pathology of vascular wall.
12.Ischemia, heart attack, aneurism.
Theoretical questions to FMC 2.
1. Concept about vascular insufficiency. Types, reasons and mechanisms of its
development.
2. Atherosclerosis. Risk factors for atherosclerosis. Experimental models. Modern
theories of atherogenesis.
47
3. Role of endothelium injury, inflammation, hereditary and aquiered violations of
lipoproteins transport (disorders of LP receptors, defects of LP molecules,
modification of LP) at atherogenesis.
4. Arterial hypertension, definition, principles of classification.
5. Hemodynamic variants of arterial hypertension.
6. Role of pressor and depressor systems at the arterial hypertension development.
7. Primary and secondary arterial hypertension. Etiology, pathogenesis.
Experimental models.
8. Primary arterial hypertension as multifactorial disease: role af heredity and
external environmental factors at pathogenesis af arterial hypertension.
9. Role af psychogenic actors at pathogenesis af arterial hypertension.
10. Theories of pathogenesis of primary arterial hypertension.
11. Mechanisms of the development of primary and secondary hypertension of
small circle of blood circulation.
12. Arterial Hypotension: definition, criteria.
13. Etiology and pathogenesis of acute and chronic arterial hypotension.
14. Collapse. Reasons and mechanisms of development, signs.
Literature is necessary for studying of the theoretical questions.
1. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р. 222-229.
2. Handbook of general and Clinical Pathophysiology/ Edited by prof.
A.V.Kubyshkin, CSMU, 2005. – P.233-241.
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p.478-489
Themes of abstracts for individual work of students:
1. Inherited predisposition as etiologic factor of essential hypertension
development.
2. Reasons and mechanism of development of atherosclerosis.
3. Mechanisms of development of pulmonary hypertension.
Practical work: «PATHOLOGY OF VASCULAR TONE»
EXPERIMENT 1. To define orthostatic stability of blood circulation at a
human.
Determine the initial breathing and AP at the student in horizontal position.
Then, without taking off the cuff, propose to the student being tested to get up not too
sharply, but quickly enough.
Determine the breathing and AP at the student in vertical position in the 1,2, 3 and 5
min.
48
Functional indexes
Pulse
І-1 min.
ІІ-2 min.
ІІІ-3 min.
ІV-5 min.
Horizontal position
Vertical position
Conclusion:___________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Question for checking final level of knowledges.
Situation tasks:
1. Patient, 45 years, was entered in a clinic with complaints of headache, general
weakness. In urine albumen is present, red corpuscles. Rest nitrogen of blood –
80 mcmol/l. AT – 200/100 mm Hg.
1. What form of hypertension has the patient?
____________________________________________________________________
____________________________________________________________________
2. What mechanism of development of this hypertension?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. Patient, 58 years with ulcer disease of stomach was entered the surgical
department with the complicated bleeding. After the stomach resection a sharp
weakness appeared on a next day, paleness of skin, then loss of consciousness.
AT - 70/40 mm Hg, pulse-160/min. In the blood test: Hb - 70 g/l, RBC 2,3x1012/l.
1. What pathology arose up at a patient?
____________________________________________________________________
2. Classification of the given pathology.
____________________________________________________________________
____________________________________________________________________
3. Mechanism of development of the given pathology.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
4. Principles of this pathology pathogenetic treatment.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
49
3. The students of a 3 course conducted the experiment on an experimental
animal. In the experiment one kidney was remote and ligature was put on the
artery of other kidney.
1. Arterial hypertension, definition.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. What type of hypertension arose up at an animal? Explain the answer.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Explain the mechanism of development of the given pathology.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
4. Patient was in the cardiologic department for medical treatment. As a result
of overdosing of some vasodilatators arterial pressure was decrease to 60/40 mm
Hg and lead to collapse.
1. Collapse, definition.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. Types of collapse.
____________________________________________________________________
____________________________________________________________________
3. Explain the mechanism of development of the given pathology.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
4. Name complications of this pathology.
____________________________________________________________________
____________________________________________________________________
5. Patient, 18 years, has general weakness, rapid fatigue ability. Has the asthenic
type of constitution. Pulse - 68/min. AT - 90/60 mm Hg.
1. What pathology has a patient?
____________________________________________________________________
3. Definition of the given pathology.
____________________________________________________________________
____________________________________________________________________
3. What types of the given pathology do you known?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
50
4. Explain the mechanism of development of the given pathology.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
6. At the critical decrease of body temperature in the third period of fever on a
background tachycardia AT is 80/60 mm Hg.
1. What form of violation of vascular tone does this phenomenon belong to?
____________________________________________________________________
____________________________________________________________________
2. Determination of the given pathology.
____________________________________________________________________
____________________________________________________________________
3. Explain the mechanism of development of the given pathology.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
7. At a patient with pneumonia after the acute decrease of body temperature in
the 3 period (crisis) on a background tachycardia AT is 80/55 mm Hg.
1. What type of collapse is observed at a patient?
____________________________________________________________________
2. Collapse, definition.
____________________________________________________________________
____________________________________________________________________
3. Types of collapse.
____________________________________________________________________
____________________________________________________________________
4. Explain the mechanism of development of the given pathology.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
8. Patient with Cushing's disease has headache, general weakness, AP 200/100
mm Hg, pulse 96/mic.
1. What pathology of the vascular tone has a patient?
____________________________________________________________________
2. What types of the given pathology to you are known?
____________________________________________________________________
____________________________________________________________________
3. Name the reasons for origin and mechanisms of development of the given
pathology.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
51
9. A man, 63 y.o., is present in the cardiologic department of hospital concerning
the repeated infarction of myocardium. At the inspection of the blood analyses
the level of low density lipoproteins is increased.
1. What pathological process has a patient?
____________________________________________________________________
____________________________________________________________________
2. Definition of the given pathology.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. What reasons of origin and «factors of risk» of the given pathology.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
10. During the prophylaxy examination of men, 40 years old, who is driver, the
level ef arterial blood pressure was 150/90 mmHg. At the end of working day he
marks the ear noise, general weakness that disappear after the rest. Hypertonic
disease was diagnosed.
1. Hypertonic disease, definition.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. Risk factors for hypertonic disease origin.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Pahtogenesis of essential arterial hypertension.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Testing according system "Krok-I"
Tests of an open database (2010)
1. Arterial hypertention is caused by the stenosis of the renal arteries in the
patient. Activation of what system is the main link in the pathogenesys of this
form of hypertension?
A Renin-angiotensin
B Sympathoadrenal
C Parasympathetic
D Kallikrein-kinin
E Hypothalamic-pituitary
52
2. Prophylactic medical examination of a 36 year old driver revealed that his AP
was 150/90 mm Hg. At the end of working day he usually hears ear noise, feels
slight indisposition that passes after some rest. He was diagnosed with essential
hypertension. What is the leading pathogenetic mechanism in this case?
A Neurogenic
B Nephric
C Humoral
D Endocrinal
E Reflexogenic
3. Arterial pressure of a surgeon who performed a long operation rised up to
140/110 mm Hg. What changes of humoral regulation could have caused the rise
of arterial pressure in this case?
A Activation of sympathoadrenal system
B Activation of formation and excretion of aldosterone
C Activation of renin angiotensive system
D Activation of kallikrein kinin system
E Inhibition of sympathoadrenal system
4. A 58-year-old patient suffers from the cerebral atherosclerosis. Examination
revealed hyperlipoidemia. What class of lipoproteins will most probably show
increase in concentration in this patient’s blood serum?
A Low-density lipoproteins
B High-density lipoproteins
C Fatty acid complexes with albumins
D Chylomicrons
E Cholesterol
5. A 70 year old man is ill with vascular atherosclerosis of lower extremities and
coronary heart disease. Examination revealed disturbance of lipidic blood
composition. The main factor of atherosclerosis pathogenesis is the excess of the
following lipoproteins:
A Low-density lipoproteins
B Cholesterol
C High-density lipoproteins
D Intermediate density lipoproteins
E Chylomicrons
Correct answers:
1-A; 2-A; 3-A; 4-A; 5-A.
53
(2009)
1. Prophylactic medical examination of a 36 year old pacemacer revealed that
his AP was 150/90 mm Hg. At the end of working day he usually hears ear noise,
feels slight indisposition that passes after some rest. He was diagnosed with
essential hypertension. What is the leading pathogenetic mechanism in this case?
A. Neurogenic
B. Endocrinal
C. Humoral
D. Reflexogenic
E. Nephric
2. Arterial pressure of a surgeon who performed a long operation rised up to
140/110 mm Hg. What changes of humoral regulation could have caused the rise
of arterial pressure in this case?
A. Activation of kallikrein kinin system
B. Activation of renin angiotensive system
C. Inhibition of sympathoadrenal system
D. Activation of sypathoadrenal system
E. Activation of formation and excretion of aldosterone
Correct answers:
1-A; 2-D.
(2008-2004)
1. A female patient aged 18, complains of general weakness, quick fatigability,
depressed mood. She has asthenic type of constitution. Pulse 68 per min., AP90/60mm Hg. Primary neurociculatory arterial hypertension was diagnosed.
What is the main factor of decreasing of arterial pressure in a patient?
A. Decrease of minute volume of the blood;
B. Decrease of cardiac output;
C. Decrease of the tension of resistant vessels;
D. Hypovolemia;
E. Deposition of the blood in the vines of systemic circulation.
2. A patient has stable and marked increase of arterial pressure, increased
extracellular fluid volume, increased content of Na+ and decrease of K+ in the
blood, positive effect of saluretic treatment. What is the mechanism of
development of hypertension in the patient?
A. Mineralocorticoid
B. Renin-angiotensinus
C. Renovascular
D. Reflexogenic
E. Cento-ischemic
54
3. A patient with chronic glomerulonephritis has edema, BP is 210/100 mmHg;
the rate of heartbeat is 85 per minute; the borders of the heart are dilated. What
is the leading mechanism in the development of arterial hypertension?
A. Increase of the activity of sympathetic adrenal system
B. Hyperfunction of the heart
C. Activation of renin-angiotensin-aldosterone system
D. Increase of circulating volume of the blood
E. Increase of vasopressin output
4. A patient with renal disease accompanied by parenchyma ischemia has a high
arterial pressure. What leading factor is the cause of the increase of AP in this
patient?
A. Excess of angiotensin II
B. Excess of antidiuretic hormone
C. Increase of heart output
D. Increase of sympathetic nervous system tonus
E. Hypercatecholaminemia
5. A patient male has had a chronic disease of kidneys for 12 years. AP 200/130mmHg. Pulse –75 beats per min. The main factor that causes the
increase of pressure in this case is the increase of:
A. Minute volume of the heart
B. Heart rate
C. Circulating volume of the blood
D. Systemic peripheral resistance
E. Venous recurrence.
6. A patient with mitral failure has an enlargement of the liver, edema of lower
limbs. What is the leading mechanism of the development of cardiac edema?
A. Increase of venous recurrence
B. Increase of tissue drainage
C. Participation of renin-angiotensin-aldosteron system
D. Decrease of oncotic pressure
E. Decrease of transudation.
7. At examination a patient’s arterial pressure is 190/100 hg. What factors leads
to increase of arterial pressure?
A. Spasm of resistance vessels
B. Increase of venous recurrence
C. toxygenic dilation of cardiac muscle
D. Aler-Lilestrand reflex
E. Kitaevs reflex.
55
8. The signs of heart failure appeared in a man aged 56, during carrying out
hard work, feelings of air shortage, heart beating, and general weakness.
Objectively heart borders are dilated, the heart rate is 92 beats per min and
arterial pressure is 180/110 mm hg. These signs are due to:
A. Increase of peripheral resistance
B. General hypoxia of an organism
C. Insufficiency of coronary circulation
D. Increase of diastolic filling
E. Neurotrophic disturbances
9. Dilation of the heart, AP-155/100 mm hg, the heart rate 95 beats per min, was
revealed in a patient aged 63 with hypertension during the examination. The
most effective mechanism, which will contribute to the normalization of AP, is:
A. Inhibition of aldosteron synthesis
B. Blocking of angiotensin synthesis
C. Inhibition of catecholamine action
D. Blocking of vasopressin action
E. Administration of salt low diet
10. A patient has constant high arterial pressure - 160/110 mm of hg.
Periodically it may rise up to 220-240/120-130 mm of hg. What type of
hypertension has this patient?
A. Psycho emotional
B. Cerebral
C. Renal
D. Adrenal
E. Essential
11. Patient V., aged 67 suffers from atherosclerosis of heart vessels and brain
vessels. Hyperlipidemia was revealed on examination. What class of lipoproteins
of blood serum is of greatest importance in the pathogenesis of atherosclerosis?
A. Lipoproteins of low density
B. Chylomicrones
C. Beta lipoproteins
D. Lipoproteins of high density
E. Complex of fat acids with albumins
12. Pulmonary edema developed in a patient with hypertonic crisis. What is the
main factor in the pathogenesis of his state?
A. Increase of arterial pressure
B. Permeability increase of the vessels of pulmonary circulation
C. Increase of hydrostatic pressure in the capillary of the lungs.
D. Resistibility increase of the lung vessels
E. Decrease of oncotic pressure of blood plasma.
56
13. A 24-year-old female patient was admitted to the hospital with complaints of
headache, pain in kidney area, and general weakness. She was suffered from
tonsillitis one month before. At examination patient has BP of 180/110 mmHg; in
patient’s blood analysis erythrocytes – 3.1x10^12/L, leucocytes – 12.6x10^9/L,
ESR – 28 mm/hour; in patient’s urinalysis – marked proteinuria, hematuria,
leukocyturia. What is the mechanism of hypertension development?
A. Renovascular
B. Reflexogenic
C. Aldosteron-induced
D. Renal
E. Mineralocorticoid-induced
14. Thrombosis of anterior intraventricular coronary artery developed after
coronarography in a patient with ischemic heart disease and atherosclerosis of
coronary arteries. What mechanism is the most significant for development of
this complication?
A. Slowing of blood flow
B. Injury of endothelium of vessel wall
C. Increase in blood coagulant concentrations
D. Decrease in blood anticoagulant concentrations
E. Reduction of fibrinolytic system activity
15. The first link in atherosclerosis development is:
A. Slowing of blood flow
B. Degenerative-proliferative changes of internal layer of arteries
C. Excessive depositions of blood plasma lipoproteins in internal layer of
arteries
D. Formation of fibrous plaque on internal layer of arteries
E. Disorders of intactness of arterial wall
Correct answers:
1-C; 2-A; 3-C; 4-A; 5-D; 6-C; 7-A; 8-A; 9-C; 10-D; 11-A; 12-C; 13-D; 14-B; 15-E.
57
Theme: " PATHOLOGY OF THE EXTERNAL BREATHING"
(Respiratory insufficiency).
Actuality of theme.
The system of the external breathing is one of the most important systems of
life-support of organism, main task of which - providing of tissues by oxygen and
elimination of carbonic acid of an organism. Knowledge of reasons and mechanisms
of the given pathology will assist to development of clinical thought and choice of
rational approaches to medical treatment of the given pathology. The study of
violations of the external breathing will allow exposing the mechanisms of
development and course of shortness of breath.
General purpose of the lesson to learn reasons, mechanisms of development
and basic forms of violations of the external breathing.
For this it is necessary to know (the concrete purposes):
 To determine insufficiency of the external breathing through violation of gas
composition of blood, to know criteria;
 To analyze classifications of insufficiency of the external breathing after reasons
and mechanisms of development;
 To characterize the reasons of origin of insufficiency of the external breathing;
 To explain reasons and mechanisms of development of restrictive and obstructive
violations of alveolar ventilation;
 To analyze cause-effective intercommunications, to be here able to separate the
changes pathological and adaptive-compensate in pathogenesis of insufficiency of
breathing;
For realization of purposes of lesson it is necessary to have the base
knowledges-skills.
1.
Regulation of breathing (Normal Physiology Department) .
2.
Notion about pulmonary volumes (Normal Physiology Department).
Checking of primary level of knowledges.
Give the answer on following questions.
1. What are the main mechanisms of respiratory insufficiency development?
2. Main reasons for alveolar ventilation disorders.
3. What is in the base of diffusive ability of the lungs disorders?
4. Main reasons for pulmonary perfusion violations.
5. Classification of respiratory insufficiency according to Votchal.
6. Classification of respiratory insufficiency according to pathogenesis.
7. Main indexes of respiratory insufficiency.
Standarts of answers on the questions of primary level of knowledges:
58
1. The basic mechanisms of development of insufficiency of breathing consist in
violation as actually processes of ventilation, diffusions, perfusion, and so
quantitative correlation of them.
2. Alveolar ventilation consists in the regular changing of alveolar gases in
accordance with the necessities of organism. Every minute in alveolar space at a man
4,5-5 1 of air gets in a state of rest. In this process take part central nervous system
(respiratory center of cerebrum, motoneurons of spinal cord), peripheral nerves
(motor and sensory nerve), upper airways, thorax and lungs. Disorder of function an
one of the transferred links can entail violation of alveolar ventilation.
The reasons of narrowing of upper airways or even complete closing of them
can be:
1) Foreign bodies in the upper airways;
2) Thickening of walls of respiratory tracts (inflammatory edema of mucus
membranes of nose, larynges, tracheas or tumor in these places);
3) Spasm of muscles of larynx (laryngospasm);
Compression of respiratory tracts from outside (development of tumor in tissues
which surround respiratory tracts, retropharyngeal abscess, increase of surrounding
organs, e.g., thyroid gland and others)
3. Diffusive ability of lungs depends mainly on the thickness of alveolar and capilary
membrane, and also from the degree of its permeability for gases. In addition, total
area of diffusion matters for normal diffusion. The change of one of these factors can
results respiratory insufficiency.
4. Reductions of perfusion of lungs. Reasons:
1)violation of contractive ability of right ventricle (myocardium infarction,
myocarditis, cardiosclerosis, exudative pericarditis and others);
2)violation of contractive ability of left ventricle, which causes development of
pulmonary edema;
3)inborn and acquired heart-diseases (stenosis or atresia of the pulmonary trunk,
valvular stenosis);
4)vascular insufficiency (shock, collapse):
5)embolism of pulmonary artery.
5. Classification of insufficiency of the external breathing according
VOTCHAL:
1. Centrogenic:
 at the violation of work of the respiratory center (hemorrhage, tumor,
depression of CNS at shock);
 depression of central regulation of breathing as a result of poisoning by
narcotic drugs, barbiturates.
2. Nervous-muscular: violation of activity of respiratory muscles at the
damage
of
spinal cord (trauma, poliomyelitis).
59
3. Thoraco-diaphragmal violation of biomechanics of breathing is related to
pathology of thorax (fractures of ribs, kyphoscoliosis); high standing of diaphragm
(paresis of stomach, intestine, ascitis, obesity, pregnancy); hemothorax,
pneumothorax.
4. Broncho-pulmonary - pathological processes in lungs and respiratory tracts:
a) obstructive form (bronchospasm, compression by tumor, edema of
bronchs);
b) restrictive form- at reduction of respiratory surface of alveoli (surfactant
insufficiency; pneumonia, pneumosclerosis, emphysema, resection of lungs);
c) diffusive form at the thickening of alveolar-capillary membrane (black-lung
disease, fibrosis of lungs).
6. Classification of respiratory insufficiency according to pathogenesis
Alveolar ventilation disorders
Alveolar diffusion disorders
а) primary-dyskinetic
а) diffusive-restrictive
(violation of biomechanic of breathing) [decrease of summary internal surface
of alveolis – pneumonia, edema of
b) obstructive
lungs, atelectasis, emphisema]
(increase of resistance of the
respiratory tract to the air passage)
b) diffusive-pneumonose
(thickening
of
alveoli-capilary
c) ventilative-restrictive
membrane)
(decrease of general volume of lungs –
pneumonia, edema of lungs)
7. The indexes of respiratory insufficiency are divided into:
1. direct - change of gas composition of blood:
- hypoxemia and hypercapnia
2. indirect - change of lungs volumes (RV, RVinsp., RVex., VLV, MVL)
1.
2.
3.
4.
5.
6.
7.
Theoretical questions for the FMC №2
Definition "insufficiency of the external breathing", criterias, principles of
classification.
Pulmonary and extrapulmonary violations of alveolar ventilation: central, neuromuscular, thoraco-diaphragmal, obstruction of respiratory tract, disorders of
elastic properties of lungs, decrease of number of functional alveolies.
Mechanisms of alveolar ventilation violations: dysregulatory, resrictive,
obstructive.
Reasons and mechanisms of pulmonary diffusion disorders.
Disorders of pulmo9nary perfusion.
Changes of gas blood composition at different kind of respiratory insufficiency,
its significance for the organism.
Pathogenesis of main clinical manifestations of respiratory insufficiency.
60
Literature is necessary for studying of the theoretical questions.
1. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р. 198-206.
2. Handbook of general and Clinical Pathophysiology/ Edited by prof.
A.V.Kubyshkin, CSMU, 2005. – P.251-264.
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p.500-520
Themes of abstracts for individual work of students:
1. Value of violations of the surfactant system in the origin of insufficiency of the
external breathing.
2. Respiratory distress syndrome. Reasons, mechanisms of development.
Question for checking final level of knowledges.
Situation tasks:
1. Acute inhibition of breathing developed at the patient after the operation
under the narcosis. Puls became infrequent and weak. Cyanosis appeared.
Emmergensy treatment liquidated this disorder.
1. What is the reason for respiration inhibition?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. How changed composition of gases (О2 and СО2) in the arterial blood?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Explain cyanosis development.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
4. Explain changes of puls at the patient?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. Teen-ager entered to the clinic without consciousness with the signs of
poisoning by morphin. Breathing is superficial and infrequent, that resulted by
inhibition of respiratory center.
1. What is the type of respiratory insufficiency?
____________________________________________________________________
2. Classification of respiratory insufficiency according to Votchal.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
61
3. Patient, 27 years old, suffers on general weakness, dyspnea, fever (37-380С).
He became sick few days before after the overcooling. Cyanosis of lips is
merked. Respiratory rate – 28/min. Puls rate – 90/min. Right part of thorax is
behind at the respiration. Diagnosis: right-side exudative pleuritis.
1. Respiratory insufficiency, definition.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. What is the mechanism of respiratory insufficiency at the patient?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Classification of respiratory insufficiency according to pathogenesis.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
4. Main principles of pathogenetic treatment of respiratory insufficiency.
____________________________________________________________________
____________________________________________________________________
________________________________________________________________
4. Woman, 30 years, delivered in a hospital in the grave condition. Temperature
of body - 39.90С, strong cough, cyanosys, pulse – 116/min. Was diagnosed acute
pneumonia.
1. What form of respiratory insufficiency takes place in this case?
____________________________________________________________________
____________________________________________________________________
2. Pathogenetical classification of violations of the external breathing.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
5. On the prophylaxy investigation came a patient with the marked signs of
respiratory insufficiency. From anamnesis it is known that he suffers from
pneumoconiosis during last 10 years.
1. What is the form of respiratory insufficiency?
____________________________________________________________________
____________________________________________________________________
2. Indexes of respiratory insufficiency.
____________________________________________________________________
____________________________________________________________________
62
Testing according system "Krok-I"
Tests of an open database (2010)
1. A 62-year-old patient was admitted to the neurological department due to
cerebral haemorrage. Condition is grave. There is observed progression of
deepness and frequency of breath that turnes into reduction to apnoea,and the
cycle repeates. What respiration type has developed in the patient?
A Cheyne-Stockes respiration
B Kussmaul respiration
C Biot's respiration
D Gasping respiration
E Apneustic respiration
2. While having the dinner the child choked and aspirated the food. Meavy
cough has started, skin and mucose are cyanotic, rapid pulse, rear breathing,
expiration is prolonged. What disorder of the external breathing developed in
the child?
A Stage of expiratory dyspnea on asphyxia
B Stage of inspiratory dyspnea on asphyxia
C Stenotic breathing
D Alternating breathing
E Biot's breathing
3. A 12 y.o. boy who suffers from bronchial asthma has an acute attack of
asthma: evident expiratory dyspnea, skin pallor. What type of alveolar
ventilation disturbance is it?
A Obstructive
B Restrictive
C Throracodiaphragmatic
D Central
E Neuromuscular
4. Examination of a miner revealed pulmonary fibrosis accompanied by
disturbance of alveolar ventilation. What is the main mechanism of this
disturbance?
A Limitation of respiratory surface of lungs
B Constriction of superior respiratory tracts
C Disturbance of neural respiration control
D Limitation of breast mobility
E Bronchi spasm
63
5. A patient staying in the pulmonological department was diagnosed with
pulmonary emphysema accompanied by reduced elasticity of pulmonary tissue.
What type of respiration is observed?
A Expiratory dyspnea
B Inspiratory dyspnea
C Superficial respiration
D Infrequent respiration
E Periodic respiration
6. An unconscious young man with signs of morphine poisoning entered
admission office. His respiration is shallow and infrequent which is caused by
inhibition of respiratory centre. What type of respiratory failure is it?
A Ventilative dysregulatory
B Ventilative obstructive
C Ventilative restrictive
D Perfusive
E Diffusive
Correct answers:
1-A; 2-A; 3-A; 4-A; 5-A; 6-A.
(2009)
1. An unconscious young man with signs of morphine poisoning entered
admission office. His respiration is shallow and infrequent which is caused by
inhibition of respiratory center. What type of respiratory failure is it?
A. Diffusive
B. Ventilative dysregulatory
C. Perfusive
D. Ventilative restrictive
E. Ventilative obstructive
2. Examination of a miner revealed pulmonary fibrosis accompained by
disturbance of alveolar ventilation. What is the main mechanism of this
disturbance?
A. Disturbance of neural respiration control
B. Bronchi spasm
C. Limitation of respiratory surface of lungs
D. Limitation of breast mobility
E. Constriction of superior respiratory tracts
3. A 12 y.o. boy who suffers from bronchial asthma has an acute attack of
asthma: evident expiratory dyspnea, skin pallor. What type of alveolar
ventilation disturbance is it?
A. Obstructive
64
B. Restrictive
C. Neuromuscular
D. Thoracodiaphragmatic
E. Central
Correct answers:
1-B; 2-C; 3-A
(2008-2004)
1. A young man with suspicion on narcotic poisoning was admitted into
neurological department. Which of the disorders of external respiration can be
expected?
A. Asphyxia
B. Alveolar hyperventilation
C. Kussmal respiration
D. Biot’s Respiration
E. Alveolar hypoventilation
2. In pathogenesis of which types of respiration the main link is the fall of
excitability of respiratory centre to carbon dioxide due to oxygen starvation of
this centre?
A. Accelerated and deep breathing
B. Expiratory dyspnoea
C. Periodic respiration
D. Inspiratory dyspnoea
E. Combined dyspnoea
3. As a result of casualty the obturation of the lung trachea occurred. Which
stage of respiration will be impaired first?
A. Tissue respiration
B. Lung ventilation
C. Exchange of gases in the lungs
D. Exchange of gases in tissues
E. Transport of oxygen and carbon dioxide
4. The functional state of respiratory system was examined in a patient with
emphysema. What is more characteristic for this state?
A. Increase of tidal volume
B. Increase of vital volume of the lungs
C. Increase of inspiratory reserve volume
D. Decrease of total volume of the lungs
E. Decrease of inspiratory reserve volume
65
5. The syndrome of respiratory insufficiency is often observed in premature
born children. What is the main cause of this?
A. Swallowing of amniotic water
B. Immaturity of lung alveoli due to deficiency of surfactant
C. Intrauterine hypercapnia
D. Imperfection of the nervous regulation of the respiratory act
E. Intrauterine asphyxia
6. Paleness of the skin, accelerated superficial respiration is observed in a
newborn. Numerous diffused atelectasis are revealed at X-ray examination.
What is the most possible cause of this condition?
A. Pneumothorax
B. Hydrothorax
C. Tuberculosis
D. Bronchial asthma
E. Surfactant deficiency
7. A partial respiratory insufficiency developed in a patient due to a chronic
impairment of the organs of respiratory system. What is a characteristic sign of
partial respiratory insufficiency?
A. Hypoxemia and hypercapnia
B. Hypoxemia and decrease of alveolar ventilation
C. Decrease of alveolar ventilation and hypercapnia
D. Hypoxemia and gas acidosis
E. Hypoxemia without hyperapnia
8. When developing of pulmonary emphysema in a patient the following is
notified:
A. Increase of functional “dead space”.
B. Inspiratory dyspnoea
C. Cardiac insufficiency (left ventricular type)
D. Decrease of resistance to the airflow in the respiratory tract
E. Decrease of functional “dead space”
9. Decrease of the passage at the level of middle and small bronchi is observed in
a patient. What process will be the leading in the development of respiratory
insufficiency?
A. Disturbance of diffusion
B. Hyperperfusion
C. Hypoventilation
D. Hypoperfusion
E. Hyperventilation
10. In the decrease of the middle and small bronchial passages in a patient the
following is observed:
66
A. Development of gas alkalosis
B. Decrease of pressure in pulmonary circulation
C. Development of inspiratory dyspnoea
D. Hypocapnia
E. Decrease of pO2 and increase of pCO2 in the alveolar air
11. In obstructive type of respiratory disturbances in a patient it will be
determined
A. Increase in forced vital volume of the lungs
B. Expiratory dyspnoea
C. Increase in vital volume of the lungs
D. Decrease of the tidal volume
E. Decrease of the total volume of the lungs
12. In restrictive type of respiratory disturbances in a patient the following is
revealed
A. Decrease of rate and increase of depth of respiration
B. Expiratory dyspnoea
C. Increase of vital capacity of the lungs
D. Increase of tidal volume of the lungs
E. Decrease of tidal volume of the lungs
13. Gas alkolosis is revealed in the patient is blood. What process impairment is
connected with this development?
A. Impairment of diffusion
B. Hyperventilation
C. Hyperperfusion
D. Hypoventilation
E. Hypoperfusion
14. A patient has developed athelectasis, which was accompanied by alveolar
collapse. What contributes to this?
A. Hyperventilation
B. Spasm of lung vessels
C. Arterial hypertension
D. Surfactant deficiency
E. Respiratory acidosis
15. Patient’s respiratory rate is 10 per min, respiratory volume - 1.1 l whistling
rals are heard over the lungs on auscultation. Which of pathogenetic forms of
external respiratory disturbance has this patient:
A. Diffuse-pneumonia
B. Diffuse-restrictive
C. Ventilative-restrictive
D. Primary-dyskinetic
E. Obstructive
67
16. Which of the pathogenetic forms of external respiratory disturbance may
develop in traumatic costal fracture?
A. Primary-dyskinetic
B. Ventilative-restrictive.
C. Obstructive
D. Diffuse-restrictive
E. Diffuse pneumonia
17. Which of pathogenetic forms of external respiratory disturbance may appear
in cerebrospinal trauma of the level of cervico-thoracic part of the spine?
A. Obstructive
B. Primary-dyskinetic
C. Ventilative-restrictive
D. Diffuse-restrictive
E. Diffuse pneumonic
18. In which of pathologic processes does ventilative-restrictive form of external
respiratory disturbance develop?
A. Pulmonary edema
B. Bronchial asthma
C. Poliomyelitis
D. Syringomyelitis
E. Bronchitis
19. In what form of dyspnea develops in insufficiency of surfactant system of the
lungs?
A. Rare shallow respiration
B. Fast deep respiration
C. Fast shallow respiration
D. Expiratory dyspnea
E. Rare deep respiration
20. Which of pathogenetic forms of external respiratory disturbance may
develop in craniocerebral trauma?
A. Diffuse-pneumonic
B. Diffuse-restrictive
C. Ventilative-restrictive
D. Primary dyskinetic
E. Obstructive
21. A patient aged 64 was admitted to the hospital with complaints of cough with
sputum, marred dyspnea. Objectively forced position, respiratory rate - 32 per
min: additional muscles take part in the act of respiration. X-ray examination:
the lungs have increased transparency. What is the main link in the pathogenesis
of respiratory insufficiency of this patient?
68
A. Decrease of elastic abilities of the lungs
B. Accumulation of sputum in the lungs
C. Thin mucus membranes of bronchi
D. Impairment of surfactant system of the lung
E. Pneumosclerosis
22. Both vagus nerves were cut during experiment on animal. How may vagus
respiration be characterized?
A. Frequent and deep
B. Very rare and deep
C. Rare and shallow
D. Frequent and shallow
E. Periodic
23. In which of pathologic processes does obstructive form of disturbance of
external respiration appear?
A. Pulmonary edema
B. Pneumonia
C. Pleurisy
D. Bronchial asthma
E. Open pneumothorax
24. A patient with bronchial asthma has developed acute respiratory
insufficiency. What type of respiratory insufficiency appears in this case?
A. Disregulative disorder of alveolar ventilation
B. Diffuse
C. Perfuse
D. Restrictive disturbance of alveolar ventilation
E. Obstructive disturbance of alveolar ventilation
25. 0.5 ml of air was introduced into a rat’s pleural cavity. What type of
respiratory insufficiency appears in this case?
A. Restrictive disturbance of alveolar respiration
B. Obstructive disturbance of alveolar ventilation
C. Perfuse
D. Diffuse
E. Disregulative disturbance of alveolar ventilation
26. Acute respiratory insufficiency appeared in a patient with tetanus. What
type of respiratory insufficiency develops in this case?
A. Restrictive disturbance of alveolar respiration
B. Disregulative disturbance of alveolar ventilation
C. Obstructive disturbance of alveolar ventilation
D. Perfuse
E. Diffuse
69
27. Increased content of carbon dioxide is in a room. How does respiration
change (its depth and rate) in a man entered this room?
A. Depth of respiration increases
B. Rate of respiration increases
C. Depth and rate of respiration increase
D. Depth of respiration decreases
E. Rate of respiration decreases
28. A 56-year-old patient, who is fitter by occupation, has been suffering form
fibrous-cavernous tuberculosis of lungs for 10 years. During later 3 weeks cough
and weakness intensify, amount of purulent-mucous phlegm with blood
increases in him. What is the reason for developed ventilation insufficiency in
this case?
A. Decrease in number of functioning alveoli
B. Disturbances of functions of respiratory center
C. Disturbances of functions of neuro-muscular apparatus
D. Disturbances of agility of the thorax
E. Disturbances of airways passage
29. Attack of suffocation developed in a 45-year-old woman suffered from
bronchial asthma for a long time. What pathogenetic mechanism does this
phenomenon have?
A. Expiratory narrowing of small bronchi
B. Loose of elasticity of lung tissue
C. Decrease in sensitivity of respiratory center
D. Disorders of agility of the thorax
E. Impairment of perfusion of lung tissue
30. Edema of larynx developed in a child on the background of allergic reaction.
What kind of respiratory failure has developed in this case?
A. Obstructive
B Restrictive
C. Disregulative
D. Parenchimatous
E. 31. A patient with both-sided lung edema was in the emergency department.
What kind of dyspnea is observed in this case?
A Shallow frequent respiration
B. Deep frequent respiration
C. Shallow rare respiration
D. Shallow respiration
E. Asphyxic respiration
70
32. Lung fibrosis with disorders of alveolar ventilation developed in a miner.
What is the leading mechanism in this disorder development?
A. Restriction of respiratory surface of lungs
B. Narrowing of upper airways
C. Disorders of neural regulation of respiration
D. Restriction of agility of the thorax
E. Spasm of bronchi
Correct answers:
1-E; 2-A; 3-B; 4-A; 5-B; 6-E; 7-E; 8-A; 9-C; 10-E; 11-B; 12-E; 13-B; 14-D; 15-E;
16-B; 17-B; 18-A; 19-C; 20-D; 21-A; 22-B; 23-D; 24-E; 25-A; 26-B; 27-C; 28-A;
29-A; 30-A; 31-A; 32-A.
Theme: " PATHOLOGY OF THE EXTERNAL BREATHING"
(asphyxia, pneumothorax, pathological types of breathing)
Actuality of theme.
Study of etiology and pathogenesis of disorders of the external breathing it is
necessary for practical activity of doctor, because respiratory insufficiency arises up
at different diseases of the respiratory system, and also can lead to violations of
functions of other organs and systems.
General purpose of the lesson to learn reasons, mechanisms of development and
basic forms of pneumothorax and asphyxia.
For this it is necessary to know (the concrete purposes):
 To explain the reasons of origin and pathogenesis of asphyxia;
 To explain reasons and mechanisms of origin of shortness of breathING;
 To analyse the mechanisms of development of different types of the periodic
and terminal breathing;
For realization of purposes of lesson it is necessary to have the base
knowledges-skills.
1. Regulation of breathing (Normal Physiology Department) .
2. Notion about pulmonary volumes (Normal Physiology Department).
Chacking of primary level of knowleges.
1.
2.
3.
4.
5.
Give the answer on folowing questions:
Classification of pathological type of breathing.
Dyspnea, definition.
Reasons for dyspnea development.
Kind of dyspnea.
Mechanisms of dyspnea development.
71
6. Periodical breathing, definition.
7. Kind of periodical breathing.
8. Kind of terminal preathing?
Standarts of answers for the questions of the primary level of knowleges
1. Classification of pathological types of breathing
1 . Dyspnea or Shortness of breathing
2. Periodical breathing
3. Terminal breathing - in the terminal stages of life.
2. Dyspnea - it is the pathological type of breathing, which is characterized by the
change of frequency, depth and breathing rhythm and is accompanied by feeling of
leak of air.
3. Reasons for dyspnea development:
1) insufficient oxygenation of blood in lungs (decline of p02 in air, that inhales,
violation of pulmonary ventilation and pulmonary circulation);
2) violation of transport of gases (anemia, insufficiency of blood circulation);
3) difficulty of motions of thorax and diaphragm;
4) acidosis;
5) functional and organic defects CNS (strong emotional stress, hysteria,
encephalitis, violation of cerebral circulation of blood and others).
4. Dyspnea can be:
 inspiratory, expiratory
 permanent, periodical.
5. Mechanisms of shortness of breathing:
1. neurohumoral
2. neuroreflectory
6. Periodical breathing - pathological type of breathing, which is characterized by
breathing periods and periods of stop of breathing (apnea).
7. Kinds:
 Cheyn — Stokes respiration (breathing amplitude grows gradually,
gradually diminishes and apnea appears)
 Biot respiration (is characterized by constant amplitude but both stop and
begin suddenly).
8. Terminal breathing - in the terminal stages of life. Kinds:
 Apneustic respiration
 Gasping respiration
 Kussmaul respiration
72
PATHOLOGICAL TYPES OF BREATHING
NORM
CHEIN-STOCK’S BREATHING
TACHIPNOE
GASPING-BREATHING
BRADIPNOE
APNEUSTIC BREATHING
HYPERPNOE
(Kussmaul’s breathing)
EXPIRATORY DYSPNEA
INSPIRATORY DYSPNEA
BIOT’S BREATHING
73
1.
2.
3.
4.
Theoretical questions for the FMC №2
Pathological type of breathing. Classification.
Dyspnea: kind, reasons, mechanisms of development.
Asphyxia, reasons for origin and mechanisms of development.
Pathological breathing. Types of periodical and terminal breathing.
Practical work: «PATHOLOGIVAL TYPE OF BREATHING»
Object of work: to show how respiratory regulation occurs in the case of the
stricture of the airways and effect of the chemical irritants; to show the changes
of breathing in case of experimental pneumothorax and asphyxia.
Description of experiment:The work is of demonstration type with the assistance of
the students.
The rabit is tied to the bench. The graphic recording of the initial respiration
is performed on the tape measure of the kimograph with the help of the cuff applied
to the Thoracic cavity and connected by means of a rubber tube with a capcule of
Mareae.
EXPERIMENT 2. Cause a full asphyxia claming the trachea. To study the
development of the stages of asphyxia averting the animal from death.
Conclusion:___________________________________________________________
____________________________________________________________________
____________________________________________________________________
________________________
Question for checking final level of knowledges.
Testing according system "Krok-I"
Tests of an open database (2010)
1. A patient who was at a resuscitation department with skull injury suddenly
developed convulsions on the background of regaining consciousness, and short
arrest of breathing was changed by solitary sighs with calming down character.
What types of respiration appeared in the patient?
A. Gasping respiration
B. Cheyne-Stokes respiration
74
C. Biot’s respiration
D. Kussmaul respiration
E. Apnoeystic respiration
2. During meal a child breathe in a seed. What respiratory changes will develop
in the child?
A. First expiratory dyspnoea, then inspiratory one
B. At first inspiratory dyspnoea, then expiratory one
C. At first arrest of breathing, then expiratory dyspnoea
D. Expiratory dyspnoea, then Cheyne-Stokes respiration
E. Inspiratory dyspnoea, then Biot’s respiration
3. Patient aged 62 was admitted into neurological department due to cerebral
haemorrhage. Grave condition. Increase of depth and rate of respiration and
then its decrease and apnoea is observed. After that the cycle of respiratory
movements start again. What type of respiration appeared in the patient?
A. Apneustic respiration
B. Kussmaul respiration
C. Gasping respiration
D. Cheyne-Stokes respiration
E. Biot’s respiration
4. A patient with craniocerebral trauma has respiration, which is characterized
by respiratory movements becoming deeper and then becoming shallower and
after that short pause in respiration occurs. What periodical respiration is this
type characteristic for?
A. Chain-Stocks’ respiration
B. Biot’s respiration
C. Kussmaul’s respiration
D. Gasping respiration
E. Apneastic respiration
5. A female patient N., aged 16, with asphyxia was admitted to the emergency
department. She has expiratory dyspnea with respiration rate of 8 per minute,
BP of 80/50 mmHg, heartbeat rate of 40 bpm, and narrowed pupils. What phase
of asphyxia does this patient have?
A. II phase
B. I phase
C. II phase
D. IV phase
E. 6. A boy was admitted to resuscitation department. He has inspiratory dyspnea,
general excitation, widened pupils, tachycardia, and BP of 160/100 mmHg. What
phase of asphyxia does this patient have?
75
A. I phase
B. II phase
C. III phase
D. IV phase
E. 7. While having the dinner the child choked and aspirated the food. Heavy
cough has started, skin and mucose are cyanotic, pulse is rapid, respiration is
infrequent, and expiration is prolonged. What disorder of the external
respiration has the child?
A. Biots respiration
B. Stenotic respiration
C. Stage of expiratory dyspnea on asphyxia
D. Alternating respiration
E. Stage of inspiratory dyspnea on asphyxia
8. A patient aged 23 was admitted to the hospital with a craniocerebral injury in
a poor condition. Respiration is characterised by spasmatic effort of inspiration
which does not stop and sometimes is broken by expiration. What type of
respiration is this typical for?
A. Apneustic respiration
B. Gasping respiration
C. Kussmal’s respiration
D. Cheyne-Stokes’ respiration
E. Biot’s respiration
9. A child with diphtheria developed larynx edema. What type of respiration is
observed?
A. Gasping respiration
B. Apneustic respiration
C. Kussmal’s respiration
D. Dyspnea
E. Biot’s respiration
10. When eating a child aspired some food. Strong cough, cyanosis of skin and
mucous membranes, increase in pulse rate, rare respiration, and lengthening of
inspiration developed in him. What kind of disorder of external respiration
developed in this child?
A. Stenotic respiration
B. Expiratory dyspnea stage in asphyxia
C. Inpiratory dyspnea stage in asphyxia
D. Biot’s respiration
E. Alternative respiration
76
11. A 50-year-old unconscious patient was admitted to the endocrinology
department. It is known that patient has been suffering from diabetes mellitus
for many years. What kind of disorders of external respiration will be present in
this patient?
A. Kussmaul’s respiration
B. Asphyxia
C. Biot’s respiration
D. Stenotic respiration
E. Chain-Stocks respiration
12. A 60-year-old male patient in severe condition was admitted to the hospital.
The patient has been suffering from diabetes mellitus for 10 years. At second
day of his stay at the in-patient department his condition sharply worsened:
coma developed, noisy respiration appeared, which was accompanied by deep
inspirations with forced expirations and participation of expiratory muscles.
What kind of disorders of respiration is observed in the patient?
A. Kussmaul’s respiration
B. Stenotic respiration
C. Tachipnea
D. Chain-Stocks’ respiration
E. Biot’s respiration
Correct answers:
1-A; 2-B; 3-D; 4-A; 5-A; 6-A; 7-B; 8-A; 9-D; 10-B; 11-A; 12-A.
Situational tasks:
1. A patient with a cerebral hemorrhage was delivered to a hospital in the grave
condition. Objectively: there is growth of depth and frequency of breathing, and
then his reduction to apnoe, whereupon the cycle of respiratory motions
renewal.
1. What type of breathing arose up at a patient?
____________________________________________________________________
2. What pathological types of breathing to you are known? Give their
description.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. At a patient the disorders of breathing appeared on a background
meningoencephalitis. They are characterized by permanent amplitude, however
halted respiratory motions are suddenly, and then also renewal suddenly.
77
1. What pathological type of breathing takes place at a patient?
____________________________________________________________________
2. Which kinds of periodic types of breathing do you know?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. A patient, 23, was delivered to a hospital with a craniocerebral trauma the
grave condition. Breathing is characterized by the convulsive strengthening of
inhalation, which is not halted, and then broken by exhalation.
1. What type of breathing this observed? Explain.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. What kind of terminal breathing? Name kinds.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
5. A patient was delivered in a hospital in a state of diabetic comma. A patient
noisily breathes; the increased exhalation goes after deep inhalation.
1. What type of breathing is observed at this patient?
____________________________________________________________________
2. What is terminal breathing? Name kinds.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
78
Practical training from the topics: “Pathophysiology of systemic blood
circulation and External breathing”.





1. Provide analysis:
Cause-effective relationships (local and general changes, pathological and
adaptive-compensative changes, specific and nonspecific signs; main and
additional links) in pathogenesis of typical disorders of systemic blood
circulation and expiratory breathing;
Conformities of systemic blood circulation and expiratory breathing pathology
origin and development;
General principles of ischemic heart disease and arrhythmias prophylaxis and
treatment;
General principles of hypertonic disease prophylaxis and treatment;
Principles of respiratory insufficiency treatment.
2. Ability and skills:
 Decision of situation tasks with definition of typical violations of systemic
blood circulation and expiratory breathing, their main varieties (through
application of knowledges about their classifications principles), reasons of
origin and mechanisms of development.
 On the basis of results of laboratory research (biochemical blood test, ECG,
spirography) to determine the level of disorders at the systemic blood
circulation and expiratory breathing systems, to estimate a result.
Theoretical questions for the practical training from the topics:
“Pathophysiology of systemic blood circulation and External breathing”
1. Insufficiency of systemic blood circulation, definition, principles of classification,
characteristics of cardio- and hemodynamic violations.
2. Concept about acute and chronic insufficiency of systemic blood circulation.
3. Etiology, pathogenesis, stages of chronic insufficiency of systemic blood
circulation.
4. Mechanisms of main clinical signs of chronic cardiac insufficiency development
(dyspnea, cyanosis, edema).
5. Cardiac failure, definition, principles of classification.
6. Cardiac failure resulted by cardiac overload.
7. Reasons of heart overload by volume and resistance.
8. Mechanisms of immediate and long-term adaptation of heart to the overload:
tachycardia, hyperfunction (hetero- and homeometric), hypertrophy of myocardium.
9. Hypertrophy of myocardium: kind, reasons, mechanisms of development, stages
(according to F. Meerson).
10. Features of hypertrophic myocardium, reasons and mechanisms of it
decompensation.
11. Myocardial cardiac failure.
12. Coronarogenic injury of myocardium.
79
13. Coronary insufficiency (absolute and relative), mechanisms of development.
14. Role of psychical factor at the development of ischemic heart disease and its
complications.
15. Concept about “critical stenosis”.
16. Consequences about ischemic heart disease: depression of contractive ability,
electric dystability, injury/ necrosis of cardiomyocytes, additional injury at
reperfusion.
17. Ischemic heart disease as a sign of coronary insufficiency, its kind.
18. Clinlcal-laboratory criterias, manifestations and complications of myocardial
infarction.
19. Pathogenesis of cardiogenic shock.
20. Principles of prophylaxis and treatment of ischemic heart disease.
21. Etiology and pathogenesis of noncoronarogenic injury of myocardium.
22. Cardiomyopathy. Classification. Characteristic of reasons and mechanisms of
development, main clinical manifestations.
23. Arrhythmias: classification , reasons, mechanisms of development, ECG-fetures.
24. Role of additional conduction pathways at the arrhythmias development.
25. Reasons and mechanisms of ectopic areas of excitation formation at the
myocardium; re-entry and impulses circulation mechanisms.
26. Fibrillation and defibrillation of heart.
27. Concept about vascular insufficiency. Types, reasons and mechanisms of its
development.
28. Atherosclerosis. Risk factors for atherosclerosis. Experimental models. Modern
theories of atherogenesis.
29. Role of endothelium injury, inflammation, hereditary and aquiered violations of
lipoproteins transport (disorders of LP receptors, defects of LP molecules,
modification of LP) at atherogenesis.
30. Arterial hypertension, definition, principles of classification.
31. Hemodynamic variants of arterial hypertension.
32. Role of pressor and depressor systems at the arterial hypertension development.
33. Primary and secondary arterial hypertension. Etiology, pathogenesis.
Experimental models.
34. Primary arterial hypertension as multifactorial disease: role af heredity and
external environmental factors at pathogenesis af arterial hypertension.
35. Role af psychogenic actors at pathogenesis af arterial hypertension.
36. Theories of pathogenesis of primary arterial hypertension.
37. Mechanisms of the development of primary and secondary hypertension of small
circle of blood circulation.
38. Arterial Hypotension: definition, criteria.
39. Etiology and pathogenesis of acute and chronic arterial hypotension.
40. Definition "insufficiency of the external breathing", criterias, principles of
classification.
41. Pulmonary and extrapulmonary violations of alveolar ventilation: central,
neuro-muscular, thoraco-diaphragmal, obstruction of respiratory tract, disorders of
elastic properties of lungs, decrease of number of functional alveolies.
80
42. Mechanisms of alveolar ventilation violations: dysregulatory, resrictive,
obstructive.
43. Reasons and mechanisms of pulmonary diffusion disorders.
44. Disorders of pulmo9nary perfusion.
45. Changes of gas blood composition at different kind of respiratory
insufficiency, its significance for the organism.
46. Pathogenesis of main clinical manifestations of respiratory insufficiency.
47. Pathological type of breathing. Classification.
48. Dyspnea: kind, reasons, mechanisms of development.
49. Asphyxia, reasons for origin and mechanisms of development.
50. Pathological breathing. Types of periodical and terminal breathing.
81