Office hours (2) Formation of practical skills on the theme «The subject, purposes and methods of pathological physiology”.

The purpose of the office hour: • Development of skills for experimental work • Formation of communicative skills for group work

• Formation of skills for pathophysiological analysis of cases Tasks of study: • To master the technique of functional studies of the respiratory and cardiovascular systems in load tests (Martine, Genche , Shtange) • To analyze and evaluate the results of the experiment

Methods of teaching Work in groups: experimental work, pathophysiological analysis of case study

The task № 1.

To study the reaction of cardiovascular system in physical loading test (Martine) with the purpose of diagnose predisease

Technique: For performance of practical work students share on some working groups. In each group should be not less than four person:

1 - tested (student - volunteer)

2 - the student who measures arterial blood pressure

3 - the student who measures pulse

4 - the student who registers data into table.

Arterial blood pressure (BP) is measured in sitting position, the average size of pulse for 10 seconds is measered. For this purpose pulse for 10 seconds is measured six times, received data are summarized and deviced by six, so we receive average pulse.

Further the examinee, without taking off cuff of tonometer from a shoulder, does 20 deep squattings within 30 seconds. Just after loading the BP and number of heart beats for 10 seconds is registered. The further counting of pulse and BP measurement are fulfilled every minute after loading until there is restoration of parameters to initial sizes. The received data are written in the table:

Researched parameters	before loading	Just after loading	Every other minute after loading
			1	2	3	4	5
1. Pulse for 10 sec. 2. The arterial blood pressure: systolic dyastolic pulse

Criteria of test estimation:

- The analysis of heart beat:

1. Time of pulse restoration after loading is 3 – 4 minutes.

2. Increase of pulse rate after loading is 50 – 70 %, is count by formula:

(pulse after loading – initial pulse) х 100

initial pulse

- The analysis of arterial blood pressure changes

1. At once after physical loading systolic pressure usually raises on 10-20 mm of hg, dyastolic pressure is reduced on 10 – 20 mm of Hg, pulse pressure increases for 20-40 mm of Hg.

2. The BP is restored after loading through 4 – 5 minutes.

It is NORMOTONIC REACTION of cardiovascular system response to physical loading and is peculiar to healthy unexercised people with a normal function of heart and vessels and sufficient adaptive abilities.

There are pathological (inadequate) types of response:

1. HYPERTONIC REACTION

Systolic pressure considerably grows – up to 180-200 mm of a hg, diastolic – does not vary or raises. The gain of pulse rate increases, pulse and the BP return to initial figures in a longer time after loading, than in norm.

Such type of reaction is observed at persons with atherosclerotic changes of vessels, at sportsmen during high training loading.

2. DISTONIC REACTION

Systolic pressure after loading sharply raises sometimes up to 225 mm of hg and higher, and diastolic pressure is defined on zero – a phenomenon of "infinite" tone.

3. ASTHENIC REACTION

It is observed at decreased heart function. Systolic pressure after loading goes down. The gain of a pulse rate is increased. Normalization of pulse and BP occurs later.

The task № 3.

To study the reaction of respiratory system to physical loading.

Technique: Volunteer in standing position does inspiration, expiration, then deep inspiration and holds the breath (a nose is clamped by fingers). The time of breath holding is marked by a timer (Shtange’ test). After minute rest in sitting position the examinee does a deep inspiration, the maximal expiration and holds the breath. The time of breath holding is marked by timer (Genche’s test).

Further similar tests are carried out just after physical loading (20 deep squattings for 30 seconds). The received data is written down in the table:

Researched parameters	before loading	right after loading
Shtange’s test
Henche’s test

The estimation of the tests is made by comparison of the received data with normal:

At healthy unexercised people:

Shtange’s test is 30-40 сек.

Henche’s test is 20-30 сек.

After physical loading duration of both tests is shortened on 10-15 sec.