cardiorespiratory responses to exercise and environmental

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Course: Cardiorespiratory Responses to Exercise and Environmental Stress

Code: SCPS 667

Credit: 2 (2 – 0)

Prerequisite: -

Study hour: In class, 2 h / wk

Study period: Semester 1

Academic year: 2021

Course Organizer: Dr Ioannis Papadimitriou

Room B. 522 Tel. 5516

E-mail: [email protected]

Teaching Staff: Department of Physiology, Faculty of Science, Mahidol University

Course Description

Systems physiology of the cardiovascular and respiratory system; mechanisms underlying the cardiovascular &

respiratory responses to acute and chronic exercise and environmental stress.

Course Objectives:

After class, the students should be able to:

1. Explain the principle of the Cardiovascular System (CVS) and Respiratory System (RS).

2. Describe the principle of gas and fluid dynamics.

3. Discuss the oxygen and carbon dioxide transportation.

4. Discuss the Cardiac Electrophysiology, ECG and Cardiodynamics.

5. Explain Respiratory Control and Acid-Based Regulation

6. Describe the cardiovascular and respiratory responses to acute exercise and adaptations to chronic

exercise.

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Cardiorespiratory Responses to Exercise and Environmental Stress

(SCPS 667) - 2(2-0-4)

Academic year 2021

Department of Physiology, Faculty of Science, Mahidol University

Date Time Topics h Instructors

Mon 20 Sep 09:00-09:30 Course orientation 0.5 IP

Wed 22 Sep 09:00-10:00 Lecture 1: Introduction to CVS and Respiratory System 1 IP

Mon 04 Oct 09:00-10:00 Lecture 2: Gas and Fluid Dynamics 1 TB

Mon 04 Oct 10:00-11:00 Lecture 3: Oxygen and Carbon dioxide Transportation 1 TB

Wed 06 Oct 09:00-11:30 Lecture 4: Cardiac Electrophysiology and ECG 2.5 VS

Fri 08 Oct 09:00-11:30 Lecture 5: Cardiodynamics 2.5 JW

Mon 11 Oct 09:00-12:00 Lecture 6: Structure and Function of Vascular System 3 TB

Fri 15 Oct 09:00-11.30 Lecture 7: Cardiovascular Control 2.5 JW

Mon 18 Oct 09:00-12:00 EXAMINATION I (BASIC CVS) 3 IP

Wed 20 Oct 09:00-12:00 Lecture 8: Common Pathophysiology of cardiovascular diseases 3 TB

Wed 27 Oct 09:00-11:00 Lecture 9: CVS Response to Acute Exercise 2 IP

Fri 29 Oct 09:00-11:00 Lecture 10: CVS Adaptation to Chronic Exercise 2 IP

Mon 1 Nov 09:00-12:00 Lecture 11: Mechanical of Breathing 3 TB

Wed 03 Nov 09:00-10:00 Lecture 12: Ventilation and Gas Exchange 1 TB

Wed 03 Nov 10:00-11:00 Lecture 13: Ventilatory perfusion and V/Q mismatch 1 TB

Wed 03 Nov 13:00-14:00 Lecture 14: Respiratory Control and Acid-Based Regulation 1 TB

Mon 08 Nov 10:00-10:00 Lecture 15: Respiratory Response during Exercise 1 TB

Wed 10 Nov 09:00-12:00 Lecture 16: Problem Base Learning in Respiratory Disorders 3 TB

Wed 17 Nov 09:00-12:00 EXAMINATION II (BASIC RESPIRATION) 3 IP

Mon 22 Nov 09:00-12:00 EXANMINATION III (CARDIO-RESPIRATORY EXERCISE PHYSIOLOGY) 3 IP

Course coordinator

Ioannis Papadimitriou Ph.D.

Department of Physiology,

Faculty of Science, Mahidol University

Rama VI Road, Ratchathewi, Bangkok 10400, THAILAND

Email Address: [email protected]

Tel: 02-201-5516

mailto:[email protected]

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Expected Learning Outcome (ELO)

ELO Teaching and Learning

Approach Assessment

ELO1 Apply the proper

knowledge in exercise

physiology with ethical

mindset

1) Lecture/Self-study

2) Discussion

3) Assignment

4) Presentation

1) Essay exam

2) Class participation and discussion

3) Quality of report

4) Quality of presentation (Rubrics)

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Lecture 1 Topic Introduction to CVS and respiratory system Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Ioannis Papadimitriou Ph.D Department of Physiology, Faculty of Science, Mahidol University Students M.S. and Ph.D. studentsIntroduction to CVS and respiratory system Learning Objectives: Students should be able to define and describe: 1. Define and describe the main parts of CVS 2. Define and describe the main parts of respiratory system Learning Organization: 1. Study the learning material provided in advance 2. Self-study of the following topics 3. Lecture 40 minutes 4. Q & A 10 minutes Learning Materials: 1. PowerPoint slide presentation 2. Electronic handout References:

1. Koeppen BM and Stanton BA (2018) Berne and Levy Physiology: 7th Edition, Chapter 38: Introduction to CVS and respiratory system.

Student Assessment: Written Exam

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Lecture 2 Topic Gas and Fluid Dynamics Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students Background & Synopsis

Gas and fluid dynamics are the principle of movement of gas and blood flow. Gas and fluid dynamics explains the physical laws that govern the movement of gas and blood in the respiratory airway and blood vessels, respectively. Disturbance in physical and physiological properties of gas and fluid flow can lead to cardiovascular and respiratory abnormality. Objectives Students should be able to:

1. Discuss the physical factors affecting pressure of the gas 2. Discuss the relationship between pressure gradient, flow, and resistance to flow 3. Describe factors determining the flow in terms of the Poiseuille’s equation 4. Describe the pressure changes that occur as blood flows through a simple vascular

network and relate them to the vascular resistance of the various vascular segments 5. Discuss factors affecting gas and fluid movement across the membrane

Lecture Outline

1. Basic gas law 2. Physic of the flow

a. Pressure gradient and resistance b. Poiseuille’s equation c. Fahraeus-Linqvist effect d. Reynold’s number

3. Bernoulli’s principle 4. Diffusion

Learning Organization

1. Flip-Class: Study the suggested reading materials in advance 2. 50-min class discussion

Learning Materials

1. Video clips: Fluid dynamics (By strong medicine) 2. PowerPoint: case discussion 3. Video record for review

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Suggested Readings

1. Guyton AC and Hall JE. Textbook of Medical Physiology. 11th ed. Philadelphia: Elsevier Saunders, 2006.

2. Levick JR. An Introduction to Cardiovascular Physiology 4th ed. Arnold, London, 2003. Student Assessment

1. MCQ and/or Written Exam

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Lecture 3 Topic Oxygen and Carbon dioxide Transportation Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students Background & Synopsis

At the lung alveolar, gases are exchanged between alveolar sac and alveolar capillary. Various factors affect the gas exchange including concentration gradients, gas-water solubility, area of gas diffusion, etc. In addition, the chapter also describes mechanism that are used for transportation of each gas in the blood. Objectives Students should be able to:

1. State the Fick’s law of gas diffusion. 2. Define diffusing capacity of the lung. 3. Express the total lung diffusion capacity in terms of diffusing capacity of the

alveolocapillary membrane and the blood. 4. Explain how O2 and CO2 are transported by the blood. 5. Draw the O2 dissociation curve and describe its physiological significance. 6. Describe the factors determining the affinity of hemoglobin for O2. 7. Discuss factors affecting the O2 and the CO2 dissociation curves.

Lecture Outline

1. Concepts of gas diffusion across a barrier and factors determining rate of gas diffusion

2. The alveolocapillary membrane and the limitation of gas transfer across pulmonary membrane

3. Oxygen transport and carbon dioxide transport Learning Organization

1. Studying the learning materials provided in advance. 2. Lecture 70 min. 3. Questions and answer 20 min. 4. Self-study.

Learning Materials

1. Transcripts of lecture outline. 2. Slides from Power Point lecture presentation.

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Suggested Readings

1. Koeppen BM, Stanton BA. (2008) Berne & Levy Physiology, 6th ed. Philadelphia: Mosby. 2. Levitzky MG. (2003) Pulmonary Physiology. 6th Ed. New York McGraw-Hill. 3. West JB. (2005) Respiratory Physiology: The essentials. 7th ed. Philadelphia: Lippincott

Williams & Wilkins. Student Assessment

1. Class participation 2. Written examination

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Lecture 4 Topic: Cardiac Electrophysiology and ECG Lecturer: Assoc. Prof. Vitoon Saengsirisuwan, Physiology, Faculty of Science Students M.S. and Ph.D. students Background & Synopsis The heart serves as a pump such that the ventricles must be activated by the proper electrical activation including the cardiac action potentials; the conduction of action potentials along specialized conducting tissues; excitability and the refractory periods; the modulating effects of the autonomic nervous system on heart rate, conduction velocity, and excitability. Due to the sequence and the timing of the spread of depolarization and repolarization in the myocardium, small potential differences are established between different portions of the heart. The electrocardiogram (ECG) is a measurement of potential differences which can be detected by electrodes placed on the body surface and reflect the electrical activity of the heart. Learning Objectives: Students should be able to: 1. Explain the ionic basis of cardiac resting membrane potential, fast response action potential, and slow response action potential 2. Describe the mechanism and significance of action potential duration, diastolic depolarization, refractory periods, and conduction velocity 3. Identify the components and propagation pathway of cardiac electrical signals 4. Describe the sequence of activation of the heart and indicate the importance of timing of the various events to efficient function 5. Describe the principle of dipole and apply the dipole principle for ECG recording 6. Draw a typical ECG record labeling the waves and indicate the timing of the electrical activation of cells following the sequence of activation of the heart 7. Indicate the ECG conventions of leads I, II and III as well as determine the mean electrical axis of a heart

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Content Outline: 1. Cardiac resting membrane potentials

• Ionic gradients • Role of pumps and exchangers

2. Cardiac cell action potentials • Ionic basis of the fast response • Ionic basis of the slow response

3. Cardiac excitability 4. Conduction velocity 5. Propagation pathway of cardiac action potentials 6. Physiological changes in action potentials of the heart 7. Principles of Electrocardiography 8. Vectors and the sequence of activation 9. Electrodes and recording leads 10. Recording the dipole in a specific lead 11. ECG, the conduction system, and timing Learning Organization: 1. Study the suggested reading materials in advance 2. Two sessions of 50-min lecture 3. A session of 30-min class discussion Learning Materials: 1. Transcripts of lecture outline 2. PowerPoint lecture presentation References: 1. Koeppen BM and Stanton BA. Berne & Levy Physiology. 7th ed. Philadelphia: Elsevier, 2018. 2. Levick JR. An Introduction to Cardiovascular Physiology. 4th ed. Arnold: London, 2003. 3. Costanzo LS. Physiology. 6th ed. Philadelphia: Elsevier, 2018. 4. Hall JE. Guyton and Hall Medical Physiology. 13th ed. Philadelphia: Elsevier, 2016. Student Assessment:

Written Exam

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Lecture 5 Topic : Cardiodynamics Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Prof. Dr. Jonggonnee Wattanapermpool Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. student in the Program of Exercise Physiology and related Programs Background & synopsis The heart impressively performs great amount of work over the lifetime of individual. It is a four-chambered striated muscular organ that contracts and relaxes in a regular repeating cycle to pump blood. The relationship between the structure and function of the heart is useful to understand how the heart accomplishes its important task. The force generation by the heart is modified by moving along the ascending limb of the length–tension relationship via mechanisms whereby the force-generation capacity of individual cells can be altered. The contractile ability of the heart can be modified by either the loading conditions or the cellular inotropic state (contractility). The ability to modify muscle performance by changing the inotropic state of individual cells is a hallmark of the physiologic control of myocardial contraction. Learning Objectives Students should be able to: 1. Define the cardiac cycle and describe its events 2. Explain the contractile events underlying pressure generation 3. Discuss the determinants of cardiac stroke volume and their effects on cardiac output 4. Discuss the determinants of heart rate and their effects on cardiac output 5. Explain how the cardiac function curve is generated and alterations of the curve

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Lecture Outline 1. The heart and circulation 2. Structure of the heart in relation to function 2.1 Cardiac chambers and valves 2.2 Myocardial cell a) Frank-Starling relationship b) Excitation-contraction coupling c) Myocardial contractile machinery and contractility d) Heart sounds 3. Cardiac pump cycle 3.1 The cardiac volumes 3.2 Left ventricular dynamics 3.3 The cardiac pump cycle in terms of left ventricular volume-pressure relationship a) Volume-pressure relation during a “beat” of the heart b) Heterometric autoregulation c) Homeometric regulation 3.4 Regulation of cardiac output 3.5 The cardiac function curve or so called Starling curve a) Generation of the cardiac function curve b) Alterations in Starling (cardiac function) curves 3.6 Subcellular mechanism for regulation of cardiac function 4. Measurement of cardiac output Learning Organization 1. Study the learning materials provided in advance 2. Lecture 2 x 55 min. 3. Questions and answers 2 x 20 min. 4. Self-study Learning Materials 1. Transcript of lecture objectives and outline 2. Textbooks and References 3. Power point presentation of the lecture 4. Video record for review Suggested Readings 1. Koeppen B.M. and Stanton B.A. (2018) Berne & Levy Physiology, 7th edition, Chapter 16: Elements of Cardiac Function, pp. 317-328, MOSBY Elsevier, Philadelphia, PA, USA. 2. Rhoades RA and Bell DR. (2013) Medical Physiology: Principles for Clinical Medicine, 4th ed., Chapter 13: Cardiac Muscle Mechanics and the Cardiac Pump, pp. 248-266, Wolters Kluwer/Lippencott Williams & Wilkins, China. Student Assessment Written Exam

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Lecture 6 Topic Structure and Function of Vascular System Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students Background & Synopsis In the circulation, vascular system is made up of the vessels that carry blood through the body. The arteries and veins carry blood throughout the body, delivering oxygen and nutrients to the body tissues and taking away tissue waste matter. At the tissue, arteries bench into small vessel called capillary. Capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter, and having a wall one endothelial cell thick. These microvessels are the site of exchange of many substances with the interstitial fluid surrounding them. Objectives Students should be able to: 1. Discuss the basic relationships between cardiac output, systemic arterial pressure, and total peripheral resistance to the flow of blood 2. Discuss the relationships between stroke volume, heart rate, systemic vascular resistance, mean arterial pressure, pulse pressure, and vascular compliance 3. Describe the significance of capillary network on capillary flow 4. List the modes of transcapillary exchange 5. Discuss the physical factors governing fluid movement across the capillary membrane 6. Discuss the vasoactive substances generated from endothelial cells 7. Describe the function of the venous system as the blood reservoir 8. Discuss the factors influencing the distribution of blood volume 9. Explain the effects of external pressures on venous return 10. Define phlebostatic axis and significance of venous pressure measurement 11. Explain the basis of the vascular or systemic function curve and factors affecting the curve.

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Lecture Outline 1. Where do the pressure and pressure gradients come from? Dissipation of energy across resistance vessels Hydrostatic pressure (weight of columns of blood) Recoil pressure and active changes in wall tension 2. Arterial elasticity 3. Determinants of the arterial blood pressure Mean arterial pressure Pulse pressure 4. Measurement of arterial blood pressure 5. Capillary network 6. Capillary blood flow 7. Transcapillary exchange a. Diffusion b. Capillary filtration a). Balance of hydrostatic and osmotic forces b). Disturbances in hydrostatic-osmotic balance c. Pinocytosis 8. Other functions of the endothelial lining 9. Basic features of the venous system Low resistance to flow Large volume capacity Low-pressure system 10. Factors that alter venous pressure and venous return Factors that influence blood flow in and out of the venous system a). Arteriolar resistance b). Contractile state of venous smooth muscle c). Inotropic state of myocardial or venous pressure waves Changes in blood volume External Pressures 11. The vascular or systemic function curve Learning Organization 1. Study the learning materials provided in advance 2. Lecture 100 min. 3. Questions and answers 10 min. 4. Self-study

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Learning Materials 1. Transcript of lecture objectives and outline 2. Textbooks and References 3. Power point presentation of the lecture 4. Video record for review Suggested Readings 1. Koeppen B.M. and Stanton B.A. (2008) Berne & Levy Physiology, 6th edition, Chapter 17: Properties of the Vasculature, pp. 336-342, MOSBY Elsevier, Philadelphia, PA, USA. 2. Levy M.N., Koeppen B.M., and Stanton B.A. (2006) Berne & Levy Principles of Physiology, 4th edition, Chapter 21: Arterial System & Chapter 23: Peripheral Circulation and Its Control, pp. 288-297 and pp. 309-319, MOSBY Elsevier, Phiadelphia, PA, USA. 3. Rhoades R.A. and Tanner G.A. (2004) Medical Physiology, 2nd edition, Chapter 15: The Systemic Circulation, pp. 252-261, Lippencott Williams & Wilkins, Baltimore, MD, USA. Student Assessment 1. MCQ and/or Written Exam

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Lecture 7 Topic Cardiovascular control Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Prof. Dr. Jonggonnee Wattanapermpool Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. students in the Program of Exercise Physiology and related Programs Background & Synopsis The cardiovascular controls involve individual and cooperative effects among three control mechanisms, including neural, hormonal, and local control mechanisms. Neural and hormonal mechanisms are primarily involved with the control of central blood volume and arterial pressure. In addition, autoregulation of blood flow would not function properly without some mechanisms to maintain a relatively constant arterial blood pressure. Blood volume and arterial pressure are monitored by stretch receptors in the heart and arteries. Afferent nerve traffic from these receptors is integrated with other afferent information in the cardiovascular center located in the medulla oblongata, which leads to activity in sympathetic and parasympathetic nerves that adjust heart rate, myocardial contraction, arterial resistance and venous tone. Local vascular control mechanisms involve responses of the vascular smooth muscle cells around arterioles and venules to a wide variety of physical and chemical stimuli in altering the vascular resistance. However, the dominant regulatory system of the vasculature is the sympathetic nervous system. Learning Objectives Students should be able to: 1. Explain the factors involved in the cardiovascular control system 2. Describe the role of autonomic (sympathetic and parasympathetic) outflow in controlling cardiovascular system 3. Discuss the functions of the baroreceptors and chemoreceptors in the cardiovascular control system 4. Discuss the involvements of humoral and physical factors in cardiovascular control

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Content Outline 1. Vascular smooth muscle 2. Factors involved in cardiovascular control 1.1 Extrinsic control a) Neural influences on circulatory control • Arterial baroreceptors • Chemoreceptors b) Humoral factors 1.2 Intrinsic or local control a) Autoregulation and myogenic regulation b) Endothelial-mediated regulation c) Metabolic regulation 3. Balance between extrinsic and intrinsic factors in regulation of peripheral blood flow 4. Coupling between the heart and the blood vessels 5. How does the cardiovascular control operate? Learning Organization 1. Study the learning materials provided in advance 2. Lecture 2 x 55 min. 3. Questions and answers 2 x 20 min. 4. Self-study Learning Materials 1. Transcript of lecture objectives and outline 2. Textbooks and References 3. Power point presentation of the lecture 4. Video record for review Suggested Readings 1. Koeppen B.M. and Stanton B.A. (2018) Berne & Levy Physiology, 7th edition, Chapter 18: Regulation of the Heart and Vasculature & Chapter 19: Integrated Control of the Cardiovascular System, pp. 370-405, MOSBY Elsevier, Philadelphia, PA, USA. 2. Rhoades RA and Bell DR. (2013) Medical Physiology: Principles for Clinical Medicine, 4th ed., Chapter 17: Control Mechanisms in Circulatory Function, pp. 311-325, Wolters Kluwer/Lippencott Williams & Wilkins, China. Student Assessment Written Exam

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Lecture 8 Topic Common Pathophysiology of Cardiovascular diseases Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students Background & Synopsis Pathophysiology of common cardiovascular diseases are explained in this class including hemorrhagic hypotension, congestive heart failure, myocardial ischemia, atherosclerosis/ arteriosclerosis, venous occlusion. Objectives Students should be able to: 1. Describe the pathophysiology during the early phase of different classes of hemorrhage 2. Explain the major organ systems involved in the compensatory mechanisms to blood loss 3. Discuss the effect of heart failure and myocardial ischemia on cardiovascular function 4. Explain the pathophysiology of plague formation in atherosclerosis 5. Discuss the effect of arteriosclerosis on cardiovascular function 6. Explain the effect of superficial venous thrombosis Lecture Outline 1. Hemorrhagic hypotension: classes and severity 2. Compensatory mechanisms (negative feedback mechanisms): 3. Myocardial ischemia and congestive heart failure 4. Atherosclerosis and arteriosclerosis 5. Varicose vein Learning Organization 1. Lecture in 3 sections, 50 minute each section 2. Self-study Learning Materials 1. Transcript of lecture objectives and outline 2. Textbooks and References 3. Power point presentation of the lecture 4. Video record for review

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Suggested Readings 1. Koeppen B.M. and Stanton B.A. (2008) Berne & Levy Physiology, 6th edition, Chapter 17: Properties of the Vasculature, pp. 336-342, MOSBY Elsevier, Philadelphia, PA, USA. 2. Levy M.N., Koeppen B.M., and Stanton B.A. (2006) Berne & Levy Principles of Physiology, 4th edition, Chapter 21: Arterial System & Chapter 23: Peripheral Circulation and Its Control, pp. 288-297 and pp. 309-319, MOSBY Elsevier, Phiadelphia, PA, USA. 3. Rhoades R.A. and Tanner G.A. (2004) Medical Physiology, 2nd edition, Chapter 15: The Systemic Circulation, pp. 252-261, Lippencott Williams & Wilkins, Baltimore, MD, USA. Student Assessment 1. Class Performance

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Lecture 9 Topic CVS response to acute exercise Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Ioannis Papadimitriou Ph.D Department of Physiology, Faculty of Science, Mahidol University Students M.S. and Ph.D. students Background The cardiovascular response to acute exercise involves three different control mechanisms: neural, hormonal, and local control mechanisms. During exercise, blood pressure is monitored by stretch receptors in the heart and main arteries. Afferent nerves from these receptors can adjust heart rate, myocardial contraction, arterial resistance and venous tone during exercise. Last but not least local vascular control mechanisms involve acute responses of CVS during acute exercise. Learning Objectives: Students should be able to define and describe: a) Vasodilation & Vasoconstriction b) Neural and Chemical Control, c) Increased Tidal Volume and d) Lactic Acid System. Students should be able to:

1. Explain the factors involved in the cardiovascular control system. 2. Explain sympathetic and parasympathetic in controlling cardiovascular system. 3. Gain an understanding of the basic functions of the baroreceptors and

chemoreceptors in the cardiovascular control. 4. Discuss the influence of physical and humoral and factors in cardiovascular

control

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Content Outline

1. Vascular smooth muscle 2. Factors involved in cardiovascular control 3. Extrinsic control 4. Arterial baroreceptors 5. Chemoreceptors 6. Humoral factors 7. Intrinsic or local control 8. Autoregulation 9. Interactions between extrinsic and intrinsic factors in regulation of peripheral blood flow

during exercise. Learning Organization: 1. Study the learning material provided in advance 2. Self-study of the following topics 3. Lecture 100 minutes 4. Q & A 20 minutes Learning Materials: 1. PowerPoint slide presentation 2. Electronic handout References:



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Lecture 10 Topic CVS adaptation to chronic exercise Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Ioannis Papadimitriou Ph.D Department of Physiology, Faculty of Science, Mahidol University Students M.S. and Ph.D. students Background The cardiovascular response to chronic exercise involves structural and functional adaptations as well. After chronic endurance exercise, formation of new capillaries and eccentric cardiac hypertrophy affects blood pressure, resting heart rate, myocardial contraction, arterial resistance and venous tone during exercise and rest. Other types of exercise such as resistance training, high intensity interval exercise can promote different training adaptations to CVS. Learning Objectives: Students should be able to explain: a) Blood pressure response to endurance and resistance training. b) Formation of new capillaries, the arterial blood pressure decreases as a result of endurance and resistance training. c) The structural and functional differences between eccentric and concentric cardiac hypertrophy, c) The mechanism of the differences in blood pressure at rest, during sub-maximal exercise and maximal exercise. Learning Organization: 1. Study the learning material provided in advance 2. Self-study of the following topics 3. Lecture 100 minutes 4. Q & A 20 minutes

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Learning Materials: 1. PowerPoint slide presentation 2. Electronic handout References:



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Lecture 11

Topic Mechanics of breathing Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students Background & Synopsis Respiratory physiology functions in exchanging gas molecules between environment and body. Functions are included air ventilation, blood perfusion, and gas exchange between air and blood. In this chapter, structure and mechanism of ventilation is described along with various physical and physiological factors that affect ventilation. Objectives Students should be able to:

1. Discuss structure and function of upper and lower airways. 2. Outline the sequential steps of gas transfer between the cells and the external

environment 3. Understand the basic physical principles that govern the process of gas transfer in

the respiratory physiology 4. Describe the mechanical events associated with breathing. 5. Explain the relative roles of the respiratory muscles and lung elasticity in effecting

lung volumes. 6. Discuss the role of surfactant and its physiological significant 7. Define airways resistance and list factors that alter the resistance to airflow.

Lecture Outline

1. Structural organization of the respiratory system 2. Steps of gas transfer between the cells and the external environment 3. Pulmonary ventilation: Inspiration and Expiration 4. Lung volumes and capacities 5. Lung compliance: Surfactant and surface tension 6. Airway resistance 7. The work of breathing Learning Organization 1. Studying the learning materials provided in advance 2. Lecture is divided in to 3 sessions, each session is 50 minute 3. Questions and answers 10 min 4. Self-study

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Learning Materials 1. Transcripts of lecture outline 2. Power point presentation/handout 3. Video record for review Suggested Readings 1. Koeppen BM, Stanton BA. Berne & Levy Physiology, 6th ed. Philadelphia: Mosby, 2008. 2. Levitzky MG. Pulmonary Physiology, 6th ed. New York: McGraw-Hill, 2003. 3. West JB. Respiratory Physiology – The essential, 7th ed. Baltimore: Williams & Wilkins, 2005. Student Assessment


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Lecture 12 Topic Ventilation and Gas Excahnge Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students Background & Synopsis Ventilation is the process in which air is moving in and out of the lung. This process provides the new air coming to the exchange area and eliminates volatile waste out of the respiratory system. It is important to known that ventilation to each part of the lung is unequal. Many factors can disturb the degree of ventilation. Objectives Students should be able to: 1. Distinguish anatomical and physiological dead space. 2. Discuss the role of dead space in governing partial pressure of alveolar gases. 3. Describe the effect of hypo- and hyperventilation on alveolar gas tension. 4. Describe the factors causing non-uniform distribution of ventilation in the lungs. Lecture Outline 1. Minute ventilation, dead space, and alveolar ventilation 2. Effects of ventilation on alveolar gases. 3. Regional distribution of inspired gas in the lungs. Learning Organization 1. Studying the learning materials provided in advance. 2. Lecture 80 min. 3. Questions and answer 10 min. 4. Self-study. Learning Materials 1. Transcripts of lecture outline. 2. Slides from Power Point lecture presentation. 3. Video record for review Suggested readings 1. Koeppen BM, Stanton BA. (2008) Berne & Levy Physiology, 6th ed. Philadelphia: Mosby. 2. Levitzky MG. (2003) Pulmonary Physiology. 6th Ed. New York McGraw-Hill. 3. West JB. (2005) Respiratory Physiology: The essentials. 7th ed. Philadelphia: Lippincott Williams & Wilkins.

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Student assessment


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Lecture 13 Topic Ventilatory Perfusion and V/Q mismatch Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students

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Lecture 14 Topic Respiratory Control and Acid-Based Regulation Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students Background & Synopsis In order to control blood gas level in our body, respiratory system works in negative feedback homeostasis mechanism. Depth and frequency of breathing are controlled by respiratory center at the medulla oblongata. Respiratory center control breathing by both voluntary and involuntary mechanism. Various sensing can activate changes in minute ventilation. Objectives Students should be able to: 1. Identify the groups and function of neurons that are thought to play a role in the regulation of breathing. 2. Give two examples of reflexes involving pulmonary receptors that influence pattern of breathing. 3. Identify the location of chemoreceptors in the respiratory system. 4. Describe the effects of changes in the partial pressure of oxygen, carbon dioxide, and hydrogen ion level on the control of breathing. 5. Describe the role of respiratory system in acid-base regulation. Lecture Outline 1. Neural control of breathing 1.1 Generation of spontaneous respiratory pattern 1.2 Medullary respiratory center 1.3 The pons respiratory center 1.4 Reflexes control of respiration 2. Chemical control of breathing 2.1 The peripheral arterial chemoreceptor 2.2 The central chemoreceptor 3. Acid-base regulation Learning Organization 1. Studying the learning materials provided in advance. 2. Lecture 70 min. 3. Questions and answer 20 min. 4. Self-study.

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Learning Materials 1. Transcripts of lecture outline. 2. Slides from Power Point lecture presentation. Suggested Readings 1. Koeppen BM, Stanton BA. (2008) Berne & Levy Physiology, 6th ed. Philadelphia: Mosby. 2. Levitzky MG. (2003) Pulmonary Physiology. 6th Ed. New York McGraw-Hill. 3. West JB. (2005) Respiratory Physiology: The essentials. 7th ed. Philadelphia: Lippincott Williams & Wilkins. Student Assessment


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Lecture 15 Topic Respiratory Response during Exercise Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students Background & synopsis During exercise, respiratory system increases the activity to serve the oxygen requirement and to eliminate an over carbon dioxide and acid production. Mechanistic stimulus on respiratory center during acute exercise is explained. Respiratory response to heavy and light exercise and ventilator threshold are compared. Objectives Students should be able to:

1. Explain the stimuli that activate respiratory activity during exercise 2. Explain the respiratory response during acute exercise 3. Discuss different responses on breathing between heavy and light exercise 4. Explain the mechanism affecting ventilator threshold

Discussion Outline

1. Respiratory center stimuli 2. Tidal volume and respiratory rate during exercise 3. Ventilatory threshold

Learning Organization

1. Learning material studied in advance 2. Lecture for 50 minutes 3. Questions and answer for 10 minutes 4. Self-study after lecture

Learning Materials

1. Transcripts of the lecture outline 2. Presentation slides for the lecture 3. Video record for review

Suggested Readings

1. Kuman V. (2010) Robbins and Cotran Pathologic Basis of Disease, 8th ed. Philadelphia, PA : Saunders/Elsevier.

Student Assessment

1. MCQ Exam

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Lecture 16 Topic Problem Base Learning in Respiratory Disorders Room PR.401, Department of Physiology, Faculty of Science, Mahidol University Lecturer Assoc. Prof. Dr. Tepmanas Bupha-Intr, D.V.M. Department of Physiology, Faculty of Science, Mahidol University E-mail: [email protected] Students M.S. and Ph.D. students Background & synopsis In order to understand the functions and mechanism of respiratory system, examples from the respiratory diseases are essential. In this discussion class, mechanical of breathing, ventilation processes, ventilation/ perfusion balance, alveolar diffusion and regulation of breathing under various respiratory diseases including COPD, emphysema, lung fibrosis and pneumothorax will be deliberated. Objectives Students should be able to:

5. Define common respiratory disorders 6. Correlate physiology and pathophysiology of common respiratory disorders

Discussion Outline

4. Clinical manifestations of respiratory disorders 5. Pathophysiology of common respiratory disorders

a. Causes of hypoxemia and hypoxia b. Diseases of the airways and alveoli Learning Organization

5. Learning material studied in advance 6. Lecture for 50 minutes 7. Questions and answer for 10 minutes 8. Self-study after lecture

Learning Materials

4. Transcripts of the lecture outline 5. Presentation slides for the lecture 6. Video record for review

Suggested Readings

2. Kuman V. (2010) Robbins and Cotran Pathologic Basis of Disease, 8th ed. Philadelphia, PA : Saunders/Elsevier.

Student Assessment

2. MCQ Exam

cardiorespiratory responses to exercise and environmental

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