Year 1 CR1: Cardiorespiratory 1
- Dr Rachel Ashworth
- r.ashworth@qmul.ac.uk
Introduction
Welcome to the Cardiorespiratory System introductory course. This course is designed to introduce you to the basic structure and function of the body systems that enable oxygen and metabolic fuel to reach tissues, and carbon dioxide and waste products to be removed. By the end of the course you should be able to:
- Describe the structure and function of the different types of cells in the blood
- Explain the mechanisms of haemostasis and blood clotting, and describe the commonest medical conditions where these mechanisms malfunction
- Explain the method by which oxygen is carried from the lungs to the tissues
- Describe the basic structure and functions of blood vessels, the heart and lungs
- Describe how the heart works as a pump, including the pressures of the cardiac cycle and the heart's electrical activity as measured by the ECG; understand what is meant by heart failure and how it may be managed.
- Explain the role of blood pressure, cardiac output and peripheral resistance in the distribution of blood to the various organs of the body; describe the neuronal and hormonal control of these parameters
- Describe the role of the sympathetic nervous system in the control of blood pressure at rest and during exercise and injury
- Describe the mechanisms of gaseous exchange in the lungs, and the mechanisms whereby blood carried gases to and from tissues to the lungs; describe the commonest medical conditions where these mechanisms malfunction
- Describe the main classes of drugs used to treat the most common pathological conditions in the cardiorespiratory system
- Carry out basic clinical physical examinations related to the cardiorespiratory system
Sessions
Lecture: The Mediastinum
- Identify the divisions of the mediastinum
- Describe the organisation of the structures in the superior mediastinum
- Describe the arrangement of the pericardium
- Describe the contents of the posterior mediastinum
- Explain the arterial supply and the venous drainage of the thoracic wall
- Distinguish between the pulmonary and the systemic blood supply to the lungs
Lecture: Anatomy of the Heart and Coronary Arteries
- Describe the functional anatomy of the valves of the heart
- Describe the conduction system of the heart and innervation to the nodes
- Describe the pericardium
- Trace the flow of blood through the heart and identify the great vessels
- Explain the anatomy and the perfusion of the coronary arteries
- Describe the arrangement/landmarks and the main features of the chambers of the heart
Lecture: Clinical Skills (CVS)
- Can show how correct positioning of the patient and attention to appropriate lighting improves the sensitivity of the examination.
- Can explain that a physical sign points to causes.
- Is competent to gain consent for physical touching.
- Is competent at maintaining the privacy and dignity of patients and volunteers
- Is competent at maintaining the co-operation of patients and volunteers
Lecture: Heartbeat and the ECG
- Explain the layout and connections of the 12 standard ECG leads
- Briefly describe the events of cardiac muscle cell contraction.
- Describe how the heart beat is generated.
- Name the components of the conduction system of the heart, and trace the conduction pathway.
- Draw a diagram of a normal electrocardiogram tracing; name the individual waves and intervals, and indicate what each represents.
- Name some abnormalities that can be detected on an ECG tracing
Lecture: Anatomy of the Respiratory Tract
Lecture: Smooth and Cardiac Muscle
- Describe briefly the structure and function of cardiac muscle.
- Explain briefly the electrophysiology of cardiac and smooth muscle.
- Describe the innervation of cardiac and smooth muscle
- List the structures where smooth muscle is found
- Describe the heterogeneity of smooth muscle and link to function
- Describe the excitation - contraction coupling in smooth muscle and briefly contrast with cardiac and skeletal muscle
- Describe how external factors may contract or relax smooth muscle
Lecture: The Heart as a Pump
- Explain how the heart is adapted to supply the pulmonary and systemic circulations.
- Draw a diagram of the pressure profiles in the left atrium, left ventricle and the aorta for a single cardiac cycle. Label the vertical axis in units of pressure. Indicate the points at which the cardiac valves open and close, and the periods of iso-volumetric contraction and relaxation.
- Explain the origin and significance of heart sounds
- Describe Starling’s law of the heart and explain how cardiac output is balanced on the two sides.
- Explain the concepts of preload and afterload.
- Note the differences between pulmonary and systemic capillaries.
- Outline the main processes ensuring adequate venous return to the heart
Lecture: Haemodynamics
- Define the terms pulse pressure and mean blood pressure, and state values for these in the normal healthy young adult.
- Comment on the importance of Laplace's law relating vessel radius and pressure, and how this relates to aneurysm formation.
- Explain the relationships between cardiac output, peripheral resistance and blood pressure
- Explain the concept of arterial compliance, and describe the relationship between pulse pressure, stroke volume and compliance
- Know the importance of Poiseuille's Law relating vessel radius and resistance to flow, and the relevance of this to changes in pressure in the circulation
Lecture: Review of the Sympathetic Nervous System
- Describe the anatomy of the sympathetic nervous system, with particular reference to the innervation of blood vessels.
- Describe the transmitters used by the sympathetic nervous system.
- Describe the role of the sympathetic nervous system in the control of blood pressure and cardiac output
- Describe the changes in the blood flow to muscle during exercise
- Describe how the sympathetic nervous system reacts after injury or haemorrhage
Lecture: Neural Control of Blood Pressure
- Describe the physiological sensors and effectors for the neuronal control of arterial blood pressure.
- Describe the position and innervation of the aortic and carotid sinus baroreceptors, their central connections and the role of the brainstem in the control of blood pressure.
- Describe the role of the vagus nerve and the sympathetic nervous system in the control of blood pressure.
Lecture: Carriage of Oxygen in the Blood
- Describe the structure of haemoglobin and explain why it is uniquely suitable for the carriage of oxygen in the blood
- Explain the significance of the subunit structure of haemoglobin and the consequences of mutations in the haemoglobin genes.
- Comment on the significance of methaemoglobin in erythrocytes
- Draw a fully labelled diagram of an oxygen-haemoglobin dissociation curve. Explain how the curve shifts under the influence of temperature and pH
- Explain what is meant by haematocrit and how it is regulated.
- Explain the ways in which carbon dioxide is transported by the blood
Lecture: Structure of Blood
Lecture: Clinical Skills II
Lecture: Hormonal Control of Blood Pressure
Lecture: Microcirculation and Oedema
- Draw a labelled diagram showing the anatomy of the microcirculation.
- Describe the three types of capillaries, continuous, fenestrated and discontinuous, with reference to their structure, distribution and function.
- Describe how lipid insoluble molecules can move across the capillary endothelium.
- Draw a labelled diagram showing filtration and reabsorption of fluid along an average capillary.
- Explain how capillary pressure, plasma colloid osmotic pressure and interstitial colloid osmotic pressure can affect fluid movements between plasma, interstitium and lymph.
- Know the different causes of oedema and explain the pathophysiology of each.
Lecture: Pulmonary Circulation
- Define the term ventilation perfusion ratio (Va/Q) and give values for the whole lung, the base and the apex of the lung in a normal subject in the upright position, explaining why these differ. Illustrate, by means of diagrams, how the perfusion of the lung may be considered as a ‘three zone model’.
- Briefly explain the changes in circulation at birth (this will be covered again in more detail in the human development course).
- Outline the main differences between the systemic and pulmonary circulations.
- Describe the responses of bronchiolar and arteriolar smooth muscle which maintain a balance between ventilation of the alveoli and blood flow (perfusion) to the alveoli in normal conditions.
- Comment briefly on the effects, on blood passing through the lungs, of a high or a low Va/Q.
Lecture: Vascular Anatomy of the Limbs
Lecture: Renal Structure and Function 1
- Outline the general organisation of the kidney, ureter, bladder and urethra.
- Identify the parts of the nephron and describe the role of each component in the physiologic processes involved in urine production
- Describe the vasculature of the kidney, relating its unique features to the physiology of urine production and nourishment of the nephron
- Identify the components of the juxtaglomerular apparatus and describe its role in regulation of blood and urine volumes and renal homeostasis.
- Explain the ‘clearance concept’ and how this is used to measure glomerular filtration rate (GFR). State the properties of suitable marker substances and show how clearance, and hence GFR, are calculated. State normal values for the GFR.
Lecture: Drug Treatment of Cardiovascular Disorders
Lecture: Renal Structure and Function 2
- Distinguish between the terms 'water diuresis', 'osmotic diuresis', 'diabetes insipidus' and 'diabetes mellitus'.
- By means of labelled diagrams show the changes in volume and osmolality of tubular fluid along the length of the nephron, in the presence or absence of anti-diuretic hormone (ADH).
- State the source, nature and mechanisms of release of ADH. Describe the stimuli for the release of ADH and explain how ADH controls urine volume and osmolality.
- Explain how the thick-walled, ascending limb of the loop of Henle plays a key role (in conjunction with ADH) in the production of either a dilute or concentrated urine to meet the requirements of water balance.
Lecture: Anatomy of the Sinuses
Lecture: Introduction to the Respiratory System
- Explain the partial pressures of gases in different parts of the respiratory tree
- List the functions of the respiratory system.
- Name the main structural features of the lungs.
- Distinguish between respiratory and non-respiratory components of the lungs and show how histological features are related to function.
- Describe the branching pattern of the respiratory tree, commenting on the significance of the cross-sectional area at different levels.
- Outline the causes and social impact (in terms of mortality and morbidity) of a) airways disease; and b) respiratory infection
- Comment on the major social, environmental and occupational factors associated with pulmonary disease.
Lecture: Chest X-Rays
- Demonstrate normal anatomy
- How to interpret a chest X-ray- ABCDE
- What is termed an adequate chest X-ray
- How X-rays produce an image
- How x-rays are produced.
- How x-rays produce an image.
- What is termed an adequate chest x-ray.
- How to interpret a chest x-ray – ABCDEF.
- Demonstrate normal anatomy.
- Introduce clinical case.
Lecture: Respiratory Physiology I: Lung Mechanics
Lecture: Respiratory Physiology II
- Explain the balance between the elastic properties of the lung and chest wall.
- Outline the relationships between the lungs, pleura and chest wall
- Define the term intrapleural pressure
- Describe how intrapleural pressure changes during normal breathing and during pneumothorax
- Draw the pressure-volume curve for the lung and state how it is used as a measurement of compliance
- State the role of surface tension (and surfactant) in lung compliance
- Name diseases that affect compliance of the lung and chest wall
- Understand the principles of airway resistance, the main sites of airway resistance and factors that affect it
- Describe what determines the work of breathing
Lecture: Acid-Base and the Contol of Breathing
- Describe the location and properties of the peripheral chemoreceptors and show, by means of simple graphs, how alterations in PaO2 and PaCO2 alter ventilation.
- Briefly describe the brainstem structures involved in the production of breathing and list the inputs to the brainstem which influence breathing.
- State the location of the central chemoreceptors and describe how these receptors regulate ventilation by detecting changes in csf pH.
Lecture: Gas Exchange and Lung Function Testing
Lecture: Pharmacology of the Airways
- Describe mode of action of agents which induce bronchoconstriction and bronchosecretion.
- Describe the actions of the autonomic nervous system on bronchial smooth muscle and secretory mucosa, relating these actions to the microscopic structure of the airway.
- Outline the consequences of antigen interaction with fixed mast cell antibody and the actions of mediators released from mast cells.
Lecture: CR Review
Lecture: Introduction to MedPro and its Assessment
Lecture: Microanatomy Anatomy Revision Lesson
