Learning objectives
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.
Prerequisites
Basic notions of electrophysiology, fluid dynamics, gas laws, chemistry and anatomy
Course unit content
ELECTROCARDIOGRAPHY
RESPIRATORY APPARATUS
PHYSIOLOGY OF THE BODY FLUIDS
RENAL PHYSIOLOGY
ACID-BASE BALANCE
Full programme
ELECTROCARDIOGRAPHY AND POLYVAGAL THEORY (Vittorio Gallese)
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.
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.
Bibliography
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
L'ABC DELL' EQUILIBRIO ACIDO-BASE di Davenport, per l'equilibrio acido-base.
Slides available online.
Dale Dubin, Interpretazione dell’ECG. Monduzzi, 2008.
