Syllabus (Fourth Edition, 2023)
Structure and Function of the Heart
Electrical Properties of the Heart
Determinants and Control of Cardiac Output
The Peripheral Circulation
Applied Cardiovascular Physiology
Cardiovascular Measurement
Cardiovascular Pharmacology
Pharmacopeia: Cardiovascular
Structure and Function of the Heart
i. Describe the anatomy of the heart including the chambers, valves, pericardium, and the orientation of the heart.
ii. Describe the coronary circulation and its regulation.
iii. Describe the structure and functional significance of the excitatory, conductive, and contractile elements of the heart.
iv. Describe the normal pressure and flow patterns of the cardiac cycle.
v. Describe the foetal circulation.
vi. Describe the circulatory and respiratory changes that occur at birth.
Electrical Properties of the Heart
i. Explain the ionic basis of spontaneous electrical activity of cardiac muscle cells.
ii. Describe the normal processes of cardiac excitation and electrical activity.
iii. Correlate the mechanical events of the cardiac cycle with the physical, electrical, and ionic events
Determinants and Control of Cardiac Output
i. Explain the Frank-Starling mechanism and its relationship to excitation-contraction coupling.
ii. Explain the measurement of central venous pressure, the components of its waveform and the factors that determine its magnitude.
iii. Define the components and determinants of cardiac output including the effects of positive pressure ventilation.
iv. Describe myocardial oxygen demand and supply and the conditions that may alter each.
v. Describe and explain cardiac output curves, vascular function curves and their correlation.
vi. Describe the pressure-volume relationships of the ventricles and their clinical applications.
vii. Describe the cardiac reflexes.
The Peripheral Circulation
i. Describe the essential features of the micro-circulation including fluid exchange and its control mechanisms.
ii. Describe the distribution of the blood volume and flow in the various regional circulations and explain the factors that influence them, including autoregulation.
iii. These include but are not limited to the cerebral and spinal cord, hepatic, and splanchnic, coronary, renal, and utero-placental circulations.
iv. Explain the factors that determine systemic blood pressure and its regulation.
v. Describe the physiological factors that may contribute to pulse variations in blood pressure.
vi. Describe total peripheral vascular resistance and the factors that affect it.
vii. Describe the factors that affect venous oxygen saturation.
Applied Cardiovascular Physiology
i. Explain the cardiovascular responses to changes in posture, hypovolaemia, a fluid bolus, anaemia, exercise, and aging.
ii. Explain the physiological consequences of intermittent positive pressure ventilation, positive end-expiratory pressure (see also F10 i.) and the Valsalva manoeuvre.
Cardiovascular Measurement
i. Describe the principles behind the electrocardiogram (ECG).
ii. Describe the invasive and non-invasive measurement of blood pressure, including limitations, potential sources of error and the need for calibration.
iii. Describe the methods of measurement of cardiac output including limitations, potential sources of error, the need for calibration and the values obtained.
Cardiovascular Pharmacology
i. Understand the pharmacology of inotropes and vasopressors.
ii. Understand the pharmacology of anti-hypertensive drugs.
iii. Understand the pharmacology of anti-arrhythmic drugs.
iv. Understand the pharmacology of anti-anginal drugs.
Pharmacopeia: Cardiovascular
LEVEL 1 | LEVEL 2 | LEVEL 3 |
---|---|---|
Adrenergic Drugs | ||
Adrenaline (Epinephrine) | Ephedrine | Dopamine |
Noradrenaline | Metaraminol | Dobutamine |
Isoprenaline / Isoproterenol | ||
Phenylephrine | ||
Non-Adrenergic Drugs | ||
Phosphodiesterase II inhibitors – Milrinone | Calcium Sensitisers – Levosimendan | |
Vasopressin | ||
Antiarrhythmics | ||
Amiodarone | Adenosine | Beta Blockers – Not listed before |
Atropine | Calcium channel antagonists – Verapamil | |
Magnesium | Digoxin | |
Sodium channel antagonists – Lignocaine | Sodium channel antagonists – Flecainide | |
Sotalol | ||
Antihypertensive Drugs | ||
Glyceryl Trinitrate | ACE inhibitors | |
Sodium Nitroprusside | Alpha blockers – Prazosin | |
Mixed antagonist – Labetalol | Angiotensin receptor blockers | |
Beta-blockers – Esmolol | Beta blockers – not listed before | |
Calcium channel antagonists – Non-dihydropyridines and Dihydropyridines | ||
Centrally acting drugs – Clonidine | ||
Hydralazine | ||
Mixed antagonists – Carvedilol |
SAQs
VIVAs
2023B | LV P-V loop Sympathomimetic pharmacology, Activity and metabolism of metaraminol vs adrenaline. LV P-V loop – shape, values Relationship between baroreceptor output and MAP Cardiovascular effects of PEEP ECG components, explain axes |
2023A | Compare pulmonary and bronchial circulations Cardiovascular physiology, graph, factors that affect venous return to heart CVS in elderly Beta adrenergic receptors and signal transduction, adrenergic and steroid pharmacology Cardiovascular physiology, graph, factors that affect venous return to heart |
2022B | Idealized LV P-V loop LV P-V loop – Mechanical events Cardiovascular function curves |
2022A | Stroke volume change with heart rate Distribution of blood in different parts of circulation CVP components |
2021B | CVP, Cardiac events Cardiac muscle structure, function Left and Right Coronary arteries Cardiac action potential, anti-arrhythmics |
2021A | Invasive arterial monitoring systems, improve accuracy MeasurementL CO, SVR Baroreceptor reflexes, rapid onset hypovolemia (20% blood volume loss over 10 mins) Arterial waveform: label, what determines shape of waveform |
2020B | AP of pacemaker cell, anti-arrhythmic agents, ECG Systemic vs pulmonary circulation Coronary blood flow regulation Structure of left ventricle, beta-blockers CVP, Fluctiations in right atrial pressure |
2019B | Structure activity relationships: catecholamines P-V loop: Mechanical events Contractility |
2019A | ECG, electrical currents in heart, phases of Ventricular myocyte Action potential Components of PA catheter trace |
2018B | Catecholamines, Adrenaline, structural components LV P-V loop Coronary circulation |
2018A | This viva will examine pacemaker cells and antiarrhythmic drugs – ionic currents responsible for spontaneous electrical activity of sinus nodepacemaker cells. antibiotics and antiarrhythmics – Which classes of antibiotics are effective against Gram positive organisms? cardiovascular physiology and blood – Describe the important features of a left ventricular pressure-volume loop. adreno-receptors, second messengers and calcium |
2017B | LV PV relationship. Cardiac cycle with image cardiovascular physiology, afterload and components, and calcium physiology and pharmacology as it relates to blood volume and tonicity. Outline the response to loss of 1 L of circulating blood in an adult. cardiac electrical physiology and anti-arrhythmic drugs. Normal lead II ECG trace. Right heart physiology. Draw the right atrial pressure trace. |
2017A | myocardial performance, lusitropy and blood pressure regulation. cardiac physiology and measurement, cardiac conduction pathway diagram cardiovascular response to a rapid and sudden loss of 1000 mls of blood? CVP anatomy and physio. |
2016B | Cardiovascular physio – CO, Valsalva, aleterations with acute blood loss Measurement of Arterial BP, Beta blockers |
2016A | Cardiac output, SV, myocardial contractility, calcium, catecholamines, digoxin Aging physio + pharm, oPioid pharmacology |
2015B | Response to 10% blood loss, volureceptors, baroreceptors, RAS, mechanism and limitations of automated NIBP (DINAMAP), Coronary artery blood flow |
2015A | cardiovascular physiology, ECG and Antiarrhythmic cardiovascular pharmacology and pharmacodynamics obesity and focused on the physiological cardiovascular changes, consequences for various other organ systems and drug pharmacology. |
2014B | Cariovascular physio and measurement, Caridac pressure waves, alterations with vasopressors, invasive BP monitoring |
2014A | Cardiovascular physiology, Venous return, cardiac function curves, ICC anatomy |
2013B | ECG – principles, error, statistics Control of HR, regulation, catecholamines, dobutamine pharmacokinetics Calcium Caclcium channel antagonists |
2013A | knowledge of coronary perfusion and blood pressure measurement Pressure waveforms with Rt heart, Rt atrial pressure trace (CVP) |
2012B | Calcium , Verapamil |
2012A | beta blockers, basic pharm, dose response curves, PV loop of cardiac cycle, changes in loop following administration of esmolol and labetalol |
2011B | Anatomy and physiology of coronary circulation, physiology of beta receptors Caridac AP, RMP, ionic mechanism, Ventricular vs SA node AP, pharamacological agents affecting pacemaker potential |
2011A | Pharm and Physio of peripheral circ, SNiP, Endothelium and secretions (prostacyclin, EDRF, endothelin), Vasomotor cenre |
2010B | beta blockers, basic pharm, dose response curves Cardiovascular physiology, CO, SW, V loops,Rt heart pressures and function, BP measurement |
2010A | ABP trace, variation with resp, PPV, myocardial contractility, trnsducer |
2009B | Diuretics, Vasoactive agents Cardiovascular physiology, draw ECG tracing + Statistics |
2009A | action potential of the ventricle, sinus node and the atrioventricular node. It will also assess knowledge of anti-arrhythmic drugs |
2008B | NIBP vs Invasive BP monitor Noradrenaline – Physio, Pharm, PV loop changes, effect on Myocardial oxygen consumption, work and efficiency. Dobutamine infusion on PV loop |
2008A | You are considering starting a patient on captopril. Discuss the pharmacology of this drug. Name this molecule? How can we make this molecule biologically active? – Phenylethylamine – precursor of catecholamines Identify features on diagram of fetal circulation What equipment do you require to measure cardiac output via thermodilution techniques? |
2007B | Explain physiological basis of ECG Cardiogenic shock (BP,CI,SCR given). What drugs would you use to improve BP |
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