CVS

DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

Subject : Specific Learning Objectives ( SLOs) Topic “Cardiovascular Physiology (CVS) “

Competency Specific Learning objectives

At the end of the session , first professional MBBS student
must be able to
PY 5.1 1. Describe the functional anatomy of heart including
Describe the functional anatomy location , chambers , valves. with the help of a diagram
of heart including chambers, 2. Describe the flow of blood in heart . with the help of a
sounds; and Pacemaker tissue and diagram
conducting system. 3. Mention three major types of cardiac muscle—atrial
muscle, ventricular muscle, and specialized excitatory and
conductive muscle fibers.
4. Describe the pacemaker tissue and conducting system of
the heart with the help of a diagram ( To be explained
with PY 5.4 : Generation and conduction of cardiac impulse
)

FPY 5.2 Describe the properties 1. Describe the functional morphology ( striation ,
of cardiac muscle including its branching , intercalated discs ,gap junction) of cardiac
morphology, electrical, muscle with the help of a diagram (Recap)
mechanical and metabolic 2. Enumerate the properties of cardiac muscle
functions (Autorthymicity , Excitability , Conductivity , and
Contractility)
3. Describe the electrical activity of cardiac muscle
(Pacemaker and Plateau potential ) with the help of a
diagram. (Recap)
4. Describe the mechanism of contraction of cardiac
muscle with the help of a diagram . (Recap)
5. Factors affecting contractility : Effect of
temperature, Refractory period , All or none law ,
Length tension relationship( Starling Law ) , Effect of
a
low an load , effect of sympathetic and parasympathetic
is stimulation( ANS) .
bridg cond
gap in e aReasoning question : Explain why?
6. Cardiac muscle acts like a syncytium
↓ ([Link]
33s)
connect
cytoplasm
.

7. T tubule of cardiac muscle is more developed in cardiac

muscle.
↓ 8. Decrease calcium decreases ( hypocalcaemia : decrease
transmission ECF calcium ) impairs cardiac contractility ?
faster
.

9. Cardiac muscle cannot be tetanized.

[Link]
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

s
PY 5.3 Discuss the events 1. Describe the cardiac cycle, including its phases and the
occurring during the cardiac duration of each phase.
cycle 2. Explain the Mechanical events of each phase
Si Sa 3. Explain the Pressures changes in Ventricles ,Atria , Aorta
& losure of Al * SL .

and in each phase

waller value
water
4. Explain the Volume changes in left ventricles
more *
&
larger pliable
stiffer
shorter 5. Describe the heart sounds
longeduration
-
- duration
6. Discuss the correlation of each phase with ECG
vibration
7. Draw the Graphical Representation of cardiac cycle

↑
8. Calculate ejection fraction from the given values of stroke
volume and diastolic volume and systolic volume correctly .
9. Explain the physiological basis of cause cardiac murmurs
correctly
MIL
Reasoning question : Explain why?
10. 2nd heart sound has higher frequency than first heart
sound .
PY 5.4 Describe generation, and 1. Components of conducting system of heart
conduction of cardiac impulse 2. Pathway of conduction of cardiac Impulse
3. Velocity of conduction in different components of
conductive system
4. AV Nodal Delay & its physiological significance
5. Explain the physiological of heart block
Reasoning question : Explain why?
6. SA Node the pacemaker of the heart?
7. AV Nodal delay is physiologically important .

PY 5.5 Describe the physiology of 1. Describe the basic principles of electrocardiography.

electrocardiogram (E.C.G), its 2. Describe the spread of cardiac impulse resulting the
applications and the cardiac axis electrical changes in heart using a well labelled diagram .
ECG 3. Describe the physiological basis of various components of
ECG using the diagram
4. Describe the normal ECG using the diagram including
intervals and segments
5. Clinical importance of ECG
6. Clinical significance of PR interval
7. Application of cardiac axis

Py5.6 Describe abnormal ECG, 1. Steps of Interpretation of Normal ECG

arrythmias, heart block and 2. ECG in tachycardia , bradycardia , and sinus arrythmias
myocardial Infarction 3. ECG in heart block
4. ECG in Myocardial Infarction
PY5.7 Describe and discuss 1. Describe general organization of circulatory system using a
haemodynamics of circulatory well labelled diagram.
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

system 2. Describe Characteristic of blood vessels ( Resistance

Capacitance and Exchange vessels ).
3. Define blood flow Explain the Physiological basis of
Korotkoff heard when measuring blood pressure
4. Describe the interrelation of Flow, Pressure and
Resistance in the circulatory system.
5. Pressure in the systemic and Pulmonary circulation
6. Factors affecting resistance to the blood flow (
Poiseuille equation )
7. Parallel and series resistance
8. Types of blood flow and Reynolds number.
9. Compliance and elastase of blood vessels
10. Explain the Physiological basis of Windkessel effect
11. Velocity of blood flow in different vessels of circulatory
system
12. Law of Laplace and its application
13. Methods of measurement of blood flow
Reasoning question : Explain why ?
14. Increase blood flow in anemia
15. Decrease blood flow in Polycythemia
16. Increased blood flow in cyanide poisoning .
17. Capillaries do not rupture although they are thin walled .

PY 5.8 Describe and discuss local Local ( Intrinsic ) cardiovascular regulatory mechanisms
and systemic cardiovascular
regulatory mechanisms 1. Discuss the concept of autoregulation and its role in
maintaining constant blood flow despite changes in
perfusion pressure
2. Discuss the importance of local metabolic factors such as
oxygen and carbon dioxide levels , pH, and temperature , in
regulating blood flow .
3. Explain how local factors endothelial factors ( e.g. Nitric
oxide ) , and metabolic by products ( e.g./ adenosine )
influence vasodilation and vasoconstriction ) .
4. Mechanism of acute control of local blood flow .
5. Enumerate the long -term blood flow regulation

Systemic ( Extrinsic ) cardiovascular regulatory mechanisms

6. Hormonal regulation
7. Discuss the main hormones ( Vasoconstrictors and
vasodilators ) involved in the regulation of blood flow .
8. Nervous regulation of circulation
9. Autonomic innervation and its effect on blood vessels and
heart
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

10. Areas in the brain that play important role in nervous

regulation of circulation .
11. Explain the various reflexes : Baroreceptor reflex ,
Chemoreceptor reflex, Bainbridge reflex ,Atrial reflex ,
Volume reflex

Reasoning question : Explain why ?

12. Blood flow to skeletal muscle increases during

exercise

PY 5.9 Describe the factors Heart rate

affecting heart rate, regulation 1. Define heart rate
of cardiac output & blood 2. normal value and normal range
pressure 3. Factors affecting heart rate
4. Variation in heart rate : Tachycardia : (Physiological and
pathological causes ) and Bradycardia (Physiological and
pathological causes )
5. Regulation of heart rate ( Hormonal and Nervous regulation
)
6. Explain the inverse relationship of heart rate with blood
pressure ( Marey’s Law )
7. Effect of heart rate on cardiac cycle
8. Difference between heart rate and pulse rate
Reasoning question : Explain why ?
9. Heart increases during inspiration and decreases during
expiration
10. Bradycardia in athletes
11. Higher heart rate in infants
12. Massaging eye balls reduces heart rate
13. Increase heart rate in fever .
14. Increase heart rate in anemia
15. Increase heart rate in hyperthyroidism
16. Heart rate increases with exercise .
17. Heart rate decreases on standing from supine position .
Cardiac output ( CO)
18. Define cardiac output
19. Factors affecting cardiac output
20. Cardiac index
21. Cardiac reserve
22. Physiological conditions altering CO
23. Pathological conditions altering CO
24. Regulation of cardiac output
25. Measurement of cardiac output
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

Reasoning question : Explain why ?

26. Increase cardiac output during exercise .
27. Increase cardiac output in Beri Beri
28. Cardiac output changes with posture
Blood Pressure ( BP)
29. Define arterial pressure mentioning its function
30. Components of blood arterial along with normal values
31. Determinants of blood pressure
32. Factors affecting arterial blood pressure
33. Regulation of BP
34. Physiological basis of Hypertension and antihypertension
drugs
Reasoning question : Explain why ?
35. Pressure in the blood vessels above the heart decreases
and pressure in the vessels below the heart level
increases
36. Increase in diastolic pressure during sudden change of
change in posture from lying position to standing .
37. Changes of BP during exercise

PY 5.10 Describe & discuss regional circulation including microcirculation, lymphatic circulation,
coronary, capillary,

Cerebral , Skin , Foetal, Pulmonary (Will be covered with the system )

Splanchnic circulation(Already Covered in GIT)
Capillary Circulation 1. Components of microcirculation
Br
water into 2. Structure and types of capillaries
pull
-protein
(Hyphophritis
. 3. Functions of capillaries
som
proteind ↓ - ?
.

now

4. Fluid filtration across capillaries

oucotic
preser ICM
(In
5. Explain the physiological basis of edem
. verb)
loss of frid from
.

.
to Intential space
Reasoning question : Explain why ?
to 6. Edema in hypoproteinaemia
in edema
. 7. Edema in inflammation
resuthing 8. Edema in Congestive heart failure
&

Lymphatic circulation 1. Describe the Components of lymphatic system

2. Functions of lymphatic system
3. Definition of lymph
4. Composition of lymph
5. Formation and transport of Lymph
6. Factors increases lymph flow
7. Explain the physiological basis of Lymphedema
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

Coronary circulation 1. Physiologic anatomy of coronary circulation

2. Normal coronary blood flow
3. Phasic changes in coronary blood flow
4. Regulation of coronary blood flow
5. Most common cause of compromised coronary blood
flow is Coronary artery disease(CAD)
Coronary artery disease
6. Definition
7. Presentation
8. Pathophysiology
9. Risk factors
10. Physiological basis of pain in angina
11. Physiological basis of pain in myocardial infarction
12. Diagnosis ( Mainly Cardiac enzymes and ECG )
13. Physiological basis of managing CAD
Reasoning question : Explain why ?
14. Subendocardial part is a common site of MI
15. Aspirin use in Angina and MI
16.

PY 5.11 Describe the patho- Shock

physiology of shock, syncope and 1. Define shock
heart failure 2. Classify shock
3. Discuss the etiology of each type of shock
4. Discuss the physiological basis of clinical features of shock
5. Discuss the physiological basis of management of shock
6. Difference between compensated and uncompensated
shock
Syncope
7. What is syncope
8. Pathophysiology of syncope
9. Clinical types
10. Physiological basis of management of syncope
Heart failure
11. Define heart failure
12. Types of heart failure
13. Causes of heart failure
14. Physiological basis of clinical features of heart failure
15. Physiological basis of treatment of heart failure-

Reasoning question : Explain why ?

16. Digitalis is used in cardiac failure heart failure
Questions
(PYD's)
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

Subject : Specific Learning Objectives ( SLOs) Topic “Cardiovascular Physiology (CVS) “

Competency Specific Learning objectives

At the end of the session , first professional
MBBS student must be able to
Cardiac Muscle , Action potential : Pacemaker Potential and Plateau Potential , Mechanical
properties of cardiac muscle contraction
FPY 5.2 Describe the properties of cardiac Short note : Pacemaker Potential (Define ,
muscle including its morphology, electrical, Phases , Ionic basis of each phase , Diagram ,
mechanical and metabolic functions amplitude , duration )
Short note : Plateau potential (Define ,
Phases , Ionic basis of each phase , Diagram ,
amplitude , duration )
Short note : Refractory period
Short note : Length tension relationship(
Frank Starling Law ) of heart ,
Explain why : Cardiac muscle acts like a
syncytium
Problem based question : A 65-years old -man
with a history of hypertension is prescribed a
Ca2+ channel blocker to reduce his blood
pressure . what is the likely effect of this
drug on ventricular contractility .
1. Decrease calcium decreases (
hypocalcaemia : decrease ECF calcium )
impairs cardiac contractility ?
2. Explain why : Cardiac muscle cannot be
tetanized.
Problem based question : A 65-year-old man is
admitted with fever and severe hypotension .
he is found to have pneumonia of the left lower
lobe , which is treated with antibiotics.. His low
blood pressure is increased with
norepinephrine .Explain the physiological basis
of increased blood pressure with sympathetic
effect of norepinephrine .
Cardiac Cycle
PY 5.3 Discuss the events occurring during Short note : Isovolumetric contraction phase
the cardiac cycle Short Note : Isovolumetric relaxation phase
Short Note : Heart Sound
Problem based question : A 38-years -old man
has a murmur that ceases with the onset of
the second heart sound .
a. Define cardiac cycle and its duration
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

b. Name the phases of the cardiac cycle

c. The second heart sound occurs at the
onset of which phase of the cardiac
cycle ?
d. Describe that phase .
e. Draw the diagram of Pressures changes
in Ventricles ,Atria , Aorta in each
phase
Explain the physiological basis of Dicrotic
notch in aortic pressure curve

Cardiac Impulse
PY 5.4 Describe generation, and conduction Short note : Origin and spread of cardiac
of cardiac impulse impulse
Short note : Describe conduction pathway of
the heart
Explain why : SA Node the pacemaker of the
heart?
Short Note : AV Nodal Delay & its
physiological significance
ECG
PY 5.5 Describe the physiology of Short note : Draw and Label the normal waves
electrocardiogram (E.C.G), its applications in a lead II ECG
and the cardiac axis Short Note on : Sinus arrythmias
ECG Short Note : Explain the correlation of ECG
Py5.6 Describe abnormal ECG, arrythmias, with cardiac cycle with the help of diagram .
heart block and myocardial Infarction Short Note: PR interval
Short Note: Heart block with ECG findings
Short note : Describe the normal ECG using
the diagram including intervals and segments
Short note : Causes and significance of ST
Segment .
Short note : ECG in hyperkalemia
Haemodynamics
PY5.7 Describe and discuss haemodynamics 1. Short Note : Resistance Capacitance and
of circulatory system Exchange vessels
2. Short Note : Define blood flow and explain
the factors affecting blood flow .
3. Short Note : Turbulent blood flow and
Reynolds number
4. Explain the Physiological basis of
Windkessel effect
5. Short Note : Law of Laplace and its
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

application
6. Explain why: A patient of anemia presents
to you in OPD . Auscultation reveals a
murmur. Echocardiogram reveals that the
heart valve and vessels are structurally
normal. Explain the physiological basis of
murmur in patient with anemia .
7. Explain why : Capillaries do not rupture
although they are thin walled .

Local and Systemic cardiovascular regulatory mechanisms

PY 5.8 Describe and discuss local and Short Note : Autoregulation of blood flow .
systemic cardiovascular regulatory
mechanisms Short Note : Hormonal regulation of blood
flow

Short Note : Nervous regulation of circulation

Short Note : Baroreceptor reflex ,

Short Note : Chemoreceptor reflex

Short Note : Bainbridge reflex

Heart Rate
PY 5.9 Describe the factors affecting Explain the physiological basis of sinus
heart rate, regulation of cardiac output & arrythmias
blood pressure Explain the physiological basis of Bradycardia
in athletes
Explain the physiological basis of increased
Heart rate with exercise .
Cardiac output
PY 5.9 Describe the regulation of cardiac
output Shot note : Define cardiac output and cardiac
index. Give its normal values . Enumerate in
brief the factors affecting cardiac output
Short note : Difference between Homometric
and heterometric regulation of cardiac output .
Define cardiac output
Short note: Explain Fick’s principle for
calculation of cardiac output
Short note : Give the physiological basis of
JVP
Short Note : Effects of autonomic (vagal and
sympathetic stimulation ) on heart .
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

Short note : How cardiac output is regulated

by changes in preload and contractility .
Short note : Heart sound

Blood Pressure
PY 5.9 Describe the regulation of blood 1. Short note : Sino-aortic mechanism of
pressure blood pressure regulation .
2. Explain why : Sino-aortic nerve are called
as buffer nerves :
3. Explain why : Blood Pressure comes to
normal on standing up from lying position
.
4. Explain why : There may be syncope if
one exercises soon after a heavy meal .
5. Short Note : Short term Regulation of
BP
6. Short Note : Role of kidney in regulation
of blood pressure / Long term regulation
of Blood Pressure .
Circulations
Capillary Circulation Explain the physiological basis of Edema in
hypoproteinaemia / Chronic renal failure
Short note : Starling forces
Lymphatic circulation Short Note : Lymph ( Definition , composition ,
Formation and transport of Lymph, Factors
increases lymph flow, Lymphedema)

Coronary circulation Short Note : Coronary circulation

Short Note : Phasic Changes in coronary blood
flow
Explain why : Coronary blood flow occurs
during diastole of cardiac cycle
Applied question : Coronary artery
disease(CAD): Definition ,Presentation
,Pathophysiology ,Risk factors
Explain the Physiological basis of pain in angina
and myocardial infarction
Short note : ECG in Myocardial infarction
Short note : ECG in angina
Explain why : Aspirin in low dose prevents
Myocardial infarction
Problem based question : A middle- aged
patient complained of chest pain on exertion ,
which radiates to the medial side of the left
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

shoulder. Patient gets instant relief on taking

vasodilator drug and a few minutes rest .
a. What is the likely diagnosis of the
patient?
b. Describe the phasic flow of coronary
circulation ?
c. Describe the ECG of the diagnosed
disease ?
d. Describe the physiological basis of pain
relief
1. with vasodilators and rest.
Shock
PY 5.11 Describe the patho-physiology of Short Note : Define shock and classify it
shock, Short note : Describe hemorrhagic shock .
Write in brief about rapid and long term
compensatory reactions to hemorrhage.
Explain why reflex warming of a shock patient
is not advisable .
Short note : Refractory shock
Short Note : Anaphylactic shock
Problem based question : A patient was
brought to hospital after an accident having an
estimated more than 35% of blood volume lost
. He was pale , diaphoretic and irritable and
had intense thirst. His extremities were pale
and cold , Pulse was feeble and rapid . Following
values were examined. Pulse: 120 /min ,
Respiratory rate : 22/min and shallow ,
Systolic BP : 60mmHg .
a. Identify the condition
b. How will you explain physiological basis
of signs and symptoms ?
c. What factors can make this condition
irreversible ?
d. What will be the changes in arterial
blood gas values in this patient.
e. What will be the treatment for above
condition .
Problem based question : Parents of a 5-
years-old girl had brought her to
emergency in a semi-conscious state. She
had 7-8 episodes of loose motions and 4
episodes of vomiting in a day. It was
associated with intermittent abdomen pain
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

. Previously she had some food from a

street vendor. On general examination
:The patient is drowsy , opening eyes only
on painful stimuli, Pulse : 100/min , regular
, Low volume pulse , BP: 90/70
,temperature 1000F. Skin turgor is reduced
, mouth is dry .
a. What is the likely diagnosis for this
patient?
b. What is the cause of the diagnosed
condition?
c. How the blood pressure of the patient
brings back to the normal.
Problem based question : History: A 70-
years old boy hiking in a forest is stung on
his left foot and , within minutes , has
swelling , localised pain and itching at the
site of the sting . His condition worsens ,
and he develops generalised chest
tightness , and shortness of breath. He
becomes unresponsive while being
transported to the emergency department
and is cyanotic upon arrival . On general
examination , BP 70/50 , PR : 120 beats /
min
a. What is the likely diagnosis for this
patient?
b. What is the cause of the diagnosed
condition ?
Problem based question : Sara is a 22
years old female who is brought into the
ER by ambulance after sudden change in
her level of consciousness and difficulty
speaking when talking at party. Vital signs
on admission were: BP : 80/60, Resp: 8 per
min with difficulty, Pulse 120 , Temp: 39.2 .
Oxygen saturation : 82 .On admission , The
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

patient was still conscious but confused

and disoriented and unable to speak.
Patient was very restless and anxious. A
few of her friends said that she has eaten
some cookies that were thought to have
peanuts in them just before the event .
A. What is the likely diagnosis for this
patient?
B. What is the cause of the diagnosed
condition ?
Problem based question : 51- year-old male
having hypertensive from 15 years on
irregular treatment presented with the
chest pain associated with nausea and
vomiting . BP was 75/45mmHg, Pulse rate :
120bpm. ECG showed ST segment elevation
A. What is the likely diagnosis for
this patient

b. What is the cause of the diagnosed

condition ?

Problem based question : A -35-years-old

male with a history of motor vehicle
accident with car was brought to the
emergency department in an unconscious
state . He had low Blood pressure , Slow
heart rate ( Bradycardia ) , Increased
Respiratory rate , Warm and pink skin .
a. What is the likely diagnosis for this
patient?
b. What is the cause of the diagnosed
condition ?

Syncope
PY 5.11 Describe the patho-physiology of Short Note : Syncope ( Define ,
syncope Pathophysiology , Clinical types
 DEAPERTMENT OF PHYSIOLOGY
MMCMSR , SADOPUR , AMBALA ( HARYANA )

Heart Failure
PY 5.11 Describe the patho-physiology of Short note : Difference between Right heart
heart failure failure and left heart failure Heart failure
Explain why : Digitalis is used in cardiac failure
heart failure
Problem based question : In a 55 year old
individual following acute MI on
echocardiography , left ventricular ejection
fraction was found to be 45%
1. What does this indicate
2. Define ejection fraction
3. Give its physiological significance
Problem based question : A 65-years -old
woman with a 60 pack -year smoking history
comes to her primary care physician with 3
months of shortness of breath and dry cough .
Until recently , she was able to walk the four
blocks to her local grocery store without
shortness of breath, however now she is able
to walk only one block . She has been waking
from sleep with difficulty breathing and feels
uncomfortable lying flat in bed . Her physical
examination is notable for crackles at the lung
base . There is no evidence of hepatomegaly or
jugular venous distension . The patient has
been diagnosed as a case of left ventricular
failure .Answer the following questions :
a. How will you differentiate this patient
on the basis of clinical features from
right heart failure .
b. Describe the pathophysiology of
patient’s complaints symptoms
c. What is the physiological basis of the
use of cardiac glycosides in this patient
.