Syllabus
1. Heart 1.1. Electrical activity of the heart
Rhythmicity of heartbeats and its origin, regulation of heart rate
Action potential (AP) at various parts of the conductive system, the causes of their shape variations, involvement of various ion channels, cardiac pacemaker, timing of the action potential spreading through the conductive heart system, factors affecting heart rate - sympathetic effect, vagal control, receptors, effect.
Action potential and its spread through cardiac muscles
The shape of the AP myocardial curve, the contributing ion channels, the timing of their action potentiation, the principle of "plateau" and its implication, intercellular propagation, absolute and relative refractory phases, the effect of changes in the composition of the internal environment on AP myocardium.
ECG (the recording principle, basic description)
Types of connections, registration principle, Einthoven's triangle, principle of recording from leads, heart vector and axis, factors that affect them, basic description of the ECG curve elements - intervals, waves, interpretation. 1.2. Mechanical properties of the cardiac action
Comparison of cardiac muscle fiber, skeletal and smooth muscle contraction
Involvement of contractile apparatus components, energy consumption, tetanic contraction, relaxation.
Comparison of the excitation and contraction coupling in cardiac and skeletal muscles
Principles of muscle cell excitation, signal transduction, pathways resulting in the activation of the contractile apparatus, the role of calcium
Mechanisms regulating the force of cardiac contraction
Homeometric, heterometric, contractility, factors affecting it, influence of calcium concentration, effect of vegetative control, Frank-Starling's law, principle, consequences, preload, afterload, factors affecting them, central venous pressure, their significance for cardiac contraction strength and cardiac output.
Cardiac cycle, cardiography, changes of essential points and segments of the curve
Systolic and diastolic cycles, causes and consequences of pressure / volume changes, Laplace's law
Cardiac minute output
Calculation, Fick's principle, dilution method, echocardiographic estimation, its setting, affecting factors, the influence of changes on the heart rate on its systolic and diastolic durations, the relationship between heart work and oxygen consumption
Ventricular function measurements
Cardiac output, ejection fraction, interpretation, relation to end-diastolic filling, end-systolic pressure and volume, cardiac index, ergometry, influence of the load on the volume of the cardiac output, cardiac work, oxygen consumption and blood pressure 2. Circulation 2.1 General principles
Relationship between pressure and blood flow
Measurement methods, factors affecting the pressure and the flow, elasticity, laminar and turbulent flow, determining factors and thier significance, closing pressure, what determines it and its significance for organ perfusion, parallel and series connection and significance for pressure-flow values 2.2. The pressure-flow relationship at different sections of the vascular bed and its regulation
Factors determining blood pressure, its importance, measurement
High-pressure and low-pressure system, significance, capacitive and resistant flow, flow rate and its relationship to pressure at different flow intervals and phases of cardiac cycle, measurement of blood pressure, mean arterial pressure, significance, influence of body position, relation to capillary filtration
Time factor in blood pressure regulation and involvement of individual regulatory mechanisms
Mechanisms of long-term maintenance of blood pressure stability, the importance of the kidneys, RAAS
Neuroregulation of blood flow distribution, baroreceptors, baroreflex, resetting.
Local regulation of blood flow, autoregulation of blood flow by organs (metabolic, myogenic, vasoconstrictive, vasodilatory factor). 2.3. Local specifics of blood flow, pressure / flow changes at rest and during exercise
Coronary blood flow
Oxygen consumption by the heart muscles at rest and during exercise, coronary reserve, influence of Laplace's law, subepicardial and subendocardial blood flow.
Other specific organs blood flow brain (HEB), liver, splanchnicus, kidneys
Circulatory changes after birth
Circulatory changes during exercise
Static, dynamic load, differences 3. Blood and hematogenous gas transport
Transport of gases via the blood, affecting factors
Total blood transport capacity and modifying factors, solubility of gases in the liquids, partial pressure, transport in plasma, hemoglobin role in gas transportation and its affecting factors, hemoglobin saturation, Astrup - predictive value, limitations.
Hemoglobin dissociation curve
Types of hemoglobin and its O2 and CO2 affinity and its affecting factors, consequences. Explanation of the sigmoidal character of the curve, shifts of the dissociation curve, factors causing it, Bohr effect, Halden effect.
Blood groups, Rh maternal-fetal incompatibility
Antigenic definition of individual types, determination of blood groups, consequences of incompatibility - transfusion, mother / fetus, preventive methods.
Hemostasis, hemocoagulation, anticoagulant factors, their interaction, coagulation tests
Vasoconstriction and its factors, platelet reaction, hemocoagulation, binding of individual factors, calcium, vitamin K, formation of definitive thrombus, interaction of coagulation and anticoagulation mechanisms within the coagulation cascade, Quick test, APTT, INR, their significance
Hematological tests
Hemoglobin, hematocrit, mean erythrocyte volume, erythrocyte count, leukocytes, platelets, erythrocyte color intensity, blood count, FW 4. Breathing 4.1. Ventilation and respiratory mechanics
Factors determining the composition of alveolar air, the effect of dead space size
Alveolar ventilation versus tidal volume, effective alveolar ventilation, anatomical and functional dead space, partial pressures of gases in the respiratory system, composition of exhaled air during breathing, affecting factors, hypoventilation, hyperventilation, influence on gases partial pressure within alveolar air and blood , calculations.
Mechanism of inhalation and exhalation, respiratory muscles, respiratory pattern
Barometric, interpleural, alveolar pressure, measurements, their values when breathing is stopped, relation to inspiration and expiration and their changes, its relation to the respiratory rate, inspiratory and expiratory muscles, their activity, management.
Factors determining pulmonary compliance and airway resistance, respiratory work
Relationship of the volume change versus the pressure change, tissue elasticity and surface tension and their affecting factors, surfactant, lung compliance curve, shape interpretation, airway flow resistance and its indicating factors, regulation of bronchial lumen, static, dynamic work, measurement
Examination of lung function
Spirometry: TLC, VC, TV, IRV, ERV, RV, FRC, flow-volume curve: FVC, PEF, resting versus forced expiration, plethysmography, lung and airway resistance. 4.2. Blood-alveolar air gas exchange
Causes and consequences of pulmonary ventilation-perfusion mismatch disproportion and their ratio
Rahn-Fenn scheme, alveolar dead space, venous admixture, O2 and CO2 partial pressures alveolar and arterial
Gas transport across the alveolo-capillary membrane, perfusion and diffusion limitations
Diffusion surface, diffusion path, concentration gradient, gases solubility and membrane diffusion, flow rate, diffusion capacity, measurement, A-V difference
Functional differences between systemic and pulmonary circulation
Pulmonary and systemic bed triggered hypoxic reaction, hypoxic pulmonary vasoconstriction, mechanism, consequences for oxygen saturation, circulation 4.3. Respiratory regulation
Mechanisms of chemical regulation
Central, peripheral, localization, response to change in O2 and CO2, mechanism, adaptation
Neuroregulation of respiration
Defensive reflexes of respiration, origin of respiratory rhythm, inspiratory and expiratory neurons, activity, lung receptors, peripheral receptors of the thorax and respiratory muscles, peripheral receptors of the limbs, baroreceptors, thermoreceptors, pain. 4.4. Hypoxia - causes and implications
Types of hypoxia
Hypoxic, ischemic, anemic, histotoxic, causes, consequences for oxygen transport to tissues, hemoglobin saturation, arterial and venous pO2 and pCO2, dissociation curve in these designated conditions.
Hyperbaria, hypobaria
Influence on gas transport, respiratory center reactions, dissociation curve shift, ABR shift, effect on hematocrit, effect on pulmonary perfusion
Respiratory quotient 5. Kidneys 5.1. Glomerular function
Renal blood flow. Regulation, relation to glomerular filtration.
Flow autoregulation, cortical and medullary flow, differences, significance, blood flow myogenic and tubuloglomerular feedback regulation, changes in vas afferens and vas efferens resistance, relation to GF size, influence of RAAS system, ANP, prostaglandins, sympathetic, effective flow
Factors determining glomerular filtration
Differences in hydrostatic pressures, their causes and consequences, oncotic pressure, permeability of the glomerular membrane and factors influencing it, composition and osmolarity of primary urine,
Measurement of glomerular filtration rate and renal blood flow
Clearance, principle, calculation, creatinine, insulin, advantages, disadvantages, cystatin C, flow measurement using the PAH clearance method. 5.2. Tubular function
Measurement of tubular transport, fractional excretion of solutes and water
Fractional excretion, tubular resorption, calculations, significance, osmolar fractional excretion, osmolality deficit, osmolar clearance, solute-free water clearance
Transport mechanisms and their i
Annotation
The subject is conceived as part of the basic professional subjects for the Master's degree program. During the course the students learn about the function and regulatory mechanisms of the human organism, organs and their parts.