Learning outcomes of the course unit
The course will enable students to acquire novel and critical knowledge on the electrocardiographic technique, on its diagnostic and prognostic values, by integrating notions of heart physiology and neurophysiology. The knowledge of the functional mechanisms of the human body apparatuses, the knowledge of their dynamic integration in apparatuses and the general mechanisms of functional control in normal conditions and in particular pathological conditions.
Basic notions of electrophysiology, fluid dynamics, gas laws, chemistry and anatomy
Course contents summary
PHYSIOLOGY OF THE BODY FLUIDS
GENERAL PHYSIOLOHY (Giuseppe Luppino)
Cell membrane. Mechanisms of passive permeability. Selective permeability. Simple diffusion. Facilitated diffusion. Active transport. Osmosis. Filtration.
Electrical properties of the biological membranes. Electrochemical gradient. Nerst equation. Properties of cell channels. Action potential. Properties and mechanisms of gating of cell channels. Voltage-gated channels. Slow potential. Propagation of the slow potentials and of the action potentials.
MUSCULAR PHYSIOLOGY NEUROPHYSIOLOGY (Giuseppe Luppino)
Basic Physiology of the Nervous System. Functional properties of nerve fibers. Basic anatomy and functional properties of skeletal and smooth muscles. Synaptic transmission. Neurotransmitters. Membrane receptors. Reflexes. Flexion and stretch reflexes. Muscle spindles.
PHISIOLOGY OF NUTRITION AND GASTROINTESTINAL TRACT (Stefano Rozzi)
Food intake: consequences of overfeeding and deficiency of food intake. Neural and hormonal control mechanisms of GI functions. Motility of GI: chewing, swallowing, gastric and intestinal motility, defecation. Secretions of GI: saliva, gastric secretion, intestinal secretion, pancreatic secretion and biliary secretion. Digestion, absorption and transport of carbohydrates, lipids, proteins and vitamins.
CARDIOVASCULAR APPARATUS. (Stefano Rozzi, Roberto Tirindelli)
Physical principles of hemodynamics. Physical properties of blood. Myocardial properties: rhythm, conduction, excitability, contraction. Heart electrophysiology. Ionic theories of resting and action potentials. Electrocardiogram. Heart mechanics and the cardiac cycle. Cardiac output. Intrinsic and extrinsic regulation of heart activity. The vascular system. Passive mechanical properties. Vascular smooth muscles. Nervous and endocrine regulation of blood vessels. Blood pressure; systolic, diastolic, mean and pulsatory. Measuring blood pressure. Venous pressure and blood circulation. Arterial and venous pulse. Coronary circulation and heart metabolism. Local circulation: muscle, skin, kidney, splanchnic. Brain circulation: chemical, metabolic and nervous regulation.
ELECTROCARDIOGRAPHY (Stefan Rozzi)
ECG: its history and basic principles of heart electrophysiology. P wave (electrogenesis; relation to the heart cycle, morphology, notion of its diagnostic features in relation to atrial heart pathology. PR interval (electrogenesis, relation to the heart cycle, morphology, notion of its diagnostic features in relation to heart pathology of conduction tissue. QRS complex (electrogenesis; relation to the heart cycle, morphology, notion of its diagnostic features in relation to the diagnosis of heart hypertrophy and infarct. ST segment (electrogenesis; relation to the heart cycle, morphology, notion of its diagnostic features in relation to the diagnosis of ischemia. T wave (electrogenesis; relation to the heart cycle, morphology, notion of its diagnostic features in relation to the diagnosis of heart overload. U wave. QTcB interval (absolute and relative refractory periods). ECG as prognostic tool (short excursus on the prognostic meaning of “traditional waves”, followed by the introduction of “alternative/innovative” measures applied to the ECG: waves dispersion in the spatial and temporal domains, post-potentials, etc.). ECG applied to the study of the autonomic nervous system. Hearth rate variability, HRV (temporal and spectral domains, notions of “complexity”): analysis methodology and its implications. The heart-brain relationship. The Polyvagal Theory of Porges.
RESPIRATORY APPARATUS. (Stefano Rozzi)
Physical laws of gases. Chest and respiration muscles. Alveolar and pulmonary ventilation. Lung volumes and capacities. Anatomic and functional dead space. Mechanics of breathing. Intra-pulmonary and intra-pleural pressures. Compliance. Pressure-volume curves. Airway resistance. Work of breathing. Inspirated air, alveolar air, and expirated air. Blood-tissue gas exchange in the lung: relationships between ventilation and alveolar pressures of gases. Distribution of ventilation. Gas exchange between alveoli and capillaries. Blood transport of oxygen and carbon dioxide. Pulmonary circulation. Ventilation-perfusion relationships. Respiratory centers: Genesis of the rhythm of respiration. Ventilation responses to variation in alveolar pressures of oxygen and carbon dioxide. Chemical and central regulation of respiration. Hypoxia. Respiratory mechanisms controlling the acid-base status.
THERMOREGULATION (Roberto Tirindelli)
Homoeothermic and poikilothermic animals. Laws of the thermodynamics. Heat distribution in the body. Body temperature detection. Physical mechanisms of heat exchange. Physiological mechanisms of heat conservation, heat dispersion, thermogenesis, and their hormonal control. Perspiratio insensibilis, sweating and evaporation. Heat balance. Adapting mechanism to hot and cold temperatures. Fever and heat shock.
Central thermoregulatory centers.
METABOLISM (Roberto Tirindelli)
The energy balance. Units of measure of the energy metabolism. Thermodynamic considerations.
Direct and indirect calorimetry. Caloric equivalent for oxygen. Basal and total metabolic rate. Caloric consumption from protein metabolism. Caloric values of food substances. The isodynamic Law of food substances. Thermogenic actions of food substances. Hormonal control of metabolism. Fasting.
EXERCISE PHYSIOLOGY (Roberto Tirindelli)
Ergometry. Oxygen consumption during exercise. Respiratory quotient.
Metabolic costs during physical activity. Concept of mechanical and chemical efficiency. Energy costs and efficiency during different physical activities. Internal and external work. Analysis of the aerobic and anaerobic muscular power. Modifications of the physiological parameters during the exercise: neuro-hormonal responses. Metabolic pathways during the physical exercise. The lactate during the anaerobic exercise. The oxygen debt (Excess post-exercise oxygen consumption, EPOC).Effect of training on physical activities.
PHYSIOLOGY OF THE BODY FLUIDS (Roberto Tirindelli)
The body fluids. Body water and its subdivision. Intracellular and extracellular fluids. Measurement of body fluid compartments. Units for measuring solute concentration. Measurement of total electrolyte content of body fluids. Osmolality and isotonicity. Analysis of plasma osmolality and its relationship with plasma sodium concentration. Sodium and potassium balance and consequences of their plasma concentrations. Colloid-osmotic pressure. Donnan equilibrium. Capillary exchange. Regulation of plasma calcium and phosphorus concentration.
RENAL PHYSIOLOGY (Roberto Tirindelli)
Renal functions: filtration, reabsorption and excretion. Calculation of filtered, excreted and reabsorbed load. Glomerular filtration (GFR). Properties of the glomerular filtration barrier. Forces involved in filtration. Concept of renal clearance. Measurement of GFR, clearance of inuline and creatinine. The renal blood flow (RBF). The para-amino-hippurate clearance. Calculation of the filtration fraction. Physiological control of GFR and RBF. Mechanism of tubular reabsorption and secretion. Regulation of the tubular reabsorption and excretion. The excretion fraction. The countercurrent multiplication. Quantification of urinary concentration and dilution. Osmolar and free water clearance. The antidiuretic hormone. Renal treatment of glucose, sodium, potassium, chloride, bicarbonate, hydrogen ions, calcium, phosphorus, magnesium, organic cations and anions. The renin-angiotensin-aldosterone system. Mineralcorticoid escape. Quantification of the hydrogen ions in urine.
ACID-BASE BALANCE (Roberto Tirindelli)
Buffers and their action mechanisms. Titration curves. The acid-base buffer system of the body. pH calculation. Titration curve of the bicarbonate and blood buffer system. The pH-bicarbonate diagram. Base deficit and excess. Renal, respiratory and hormonal control of the acid-base equilibrium. Acidosis and alkalosis. Anionic gap. Hyperbarism. Hypobarism.
FISIOLOGIA MEDICA a cura di Fiorenzo Conti, Ed. Edi-Ermes per i corsi Apparato Cardiovascolare e Respiratorio
BASI FISIOLOGICHE DELLA PRATICA MEDICA di West, Ed. Piccin per l'Apparato Urinario ed equilibrio idrico-salino, termmoregolazione, esercizio muscolare
L'ABC DELL' EQUILIBRIO ACIDO-BASE di Davenport, per l'equilibrio acido-base.
Slides disponibili online.
Dale Dubin, Interpretazione dell’ECG. Monduzzi, 2008.
Lectures will be held on-site in compliance with safety standards, provided that further instructions on the ongoing health emergency are not implemented. Supporting material will be available on the specific, student-reserved platform (Elly) and will include slide presentations, audio-video aids or video-recording of the lectures.
Assessment methods and criteria
In case of the persistence of the health emergency, the exams will be conducted remotely, as follows:
remote oral questions, through the Teams platform (guide http://selma.unipr.it/).
Students with SLD / BSE must first contact Le Eli-che: support for students with disabilities, D.S.A., B.E.S. (https://sea.unipr.it/it/servizi/le-eli-che-supporto-studenti-con-disabil...)