Rishi Desai, MD, MPH

Pulmonary changes during exercise

Wikipedia

NOTES NOTES  NORMAL VARIATIONS  PULMONARY CHANGES DURING EXERCISE osms.it/pulmonary_changes_during_exercise RESPIRATORY RESPONSE TO EXERCISE  ▪ Exercise → muscle workload increase → consumption of signiﬁcant O2 amounts, above baseline production of CO2, lactic acid ▪ Increased O2 demand → hyperpnea (ventilation increases 10–20x to compensate) ▪ Hyperpnea vs. hyperventilation ▫ Hyperpnea: aims to maintain homeostasis → blood O2 ,CO2 levels remain relatively constant ▫ Hyperventilation: excessive ventilation, blowing off too much CO2 → low PCO2, respiratory alkalosis ▪ Exercise-induced ventilation not initially prompted by alterations in blood gases (rising PCO2 , declining PO2, pH) ▪ Ventilation increases abruptly as exercise begins due to neural factors ▫ Psychological stimuli (conscious exercise anticipation) ▫ Simultaneous cortical motor activation of skeletal muscle, respiratory centers ▫ Proprioceptors moving muscles, tendons, joints → stimulate respiratory centers ▫ Initial neural regulation → early compensation to exercise as opposed to waiting for change in blood values ▪ Initial abrupt increase in ventilation is followed by gradual increase (reﬂective of lung CO2 delivery rate) → eventually, steady state of ventilation appropriate for intensity achieved  ▪ Exercise cessation → initial small abrupt decline in ventilation (higher neurological stimulation ends) → followed by gradual decrease to pre-exercise respiratory rate (gradual decrease in CO2 ﬂow to lungs)  PULMONARY CIRCULATORY RESPONSE  ▪ Cardiac output increases to meet tissue O2 demand → increased right heart output → increased blood ﬂow through pulmonary circulation → increased blood return to left heart → increased output to systemic circulation → increased O2 tissue delivery ▪ Exercise → pulmonary resistance decrease → perfusion of more pulmonary capillary beds → more even distribution of pulmonary perfusion, ventilation → improved V/Q ratio (decreased physiological dead space) → increased gas exchange efﬁciency  HEMATOLOGICAL RESPONSE Bohr effect ▪ Hemoglobin’s oxygen binding afﬁnity is inversely related to acidity, carbon dioxide concentration ▫ Exercise → increased tissue PCO2, decreased tissue pH, increased temperature → right shift of O2hemoglobin dissociation curve → decreased afﬁnity of hemoglobin for O2 → greater unloading of oxygen to exercising muscle  OSMOSIS.ORG 625   

Cardiovascular system anatomy and physiology

Lymphatic system anatomy and physiology

Coronary circulation

Anatomy and physiology

Blood pressure, blood flow, and resistance

Pressures in the cardiovascular system

Laminar flow and Reynolds number

Resistance to blood flow

Compliance of blood vessels

Control of blood flow circulation

Microcirculation and Starling forces

Hemodynamics

Measuring cardiac output (Fick principle)

Stroke volume, ejection fraction, and cardiac output

Cardiac contractility

Frank-Starling relationship

Cardiac preload

Cardiac afterload

Law of Laplace

Cardiac and vascular function curves

Altering cardiac and vascular function curves

Cardiac output

Cardiac cycle

Cardiac work

Pressure-volume loops

Changes in pressure-volume loops

Cardiac cycle and pressure-volume loops

Physiological changes during exercise

Cardiovascular changes during hemorrhage

Cardiovascular changes during postural change

Cardiovascular physiological responses

Normal heart sounds

Abnormal heart sounds

Auscultation of the heart

Action potentials in myocytes

Action potentials in pacemaker cells

Excitability and refractory periods

Cardiac excitation-contraction coupling

Myocyte electrophysiology

Electrical conduction in the heart

Cardiac conduction velocity

ECG basics

ECG normal sinus rhythm

ECG intervals

ECG QRS transition

ECG axis

ECG rate and rhythm

ECG cardiac infarction and ischemia

ECG cardiac hypertrophy and enlargement

Electrocardiography

Baroreceptors

Chemoreceptors

Renin-angiotensin-aldosterone system

Blood pressure regulation

Cardiovascular system

Endocrine system anatomy and physiology

Hunger and satiety

Hypothalamic hormones

Adrenocorticotropic hormone

Growth hormone and somatostatin

Oxytocin and prolactin

Antidiuretic hormone

Pituitary gland hormones

Thyroid hormones

Insulin

Glucagon

Somatostatin

Pancreatic hormones

Synthesis of adrenocortical hormones

Cortisol

Adrenal gland hormones

Testosterone

Estrogen and progesterone

Gonadal hormones

Phosphate, calcium and magnesium homeostasis

Parathyroid hormone

Vitamin D

Calcitonin

Calcium, phosphate and magnesium homeostasis

Endocrine system

Anatomy and physiology of the eye

Photoreception

Optic pathways and visual fields

Anatomy and physiology of the ear

Auditory transduction and pathways

Vestibular transduction

Vestibulo-ocular reflex and nystagmus

Olfactory transduction and pathways

Taste and the tongue

Special senses

Thyroid and parathyroid glands

Eyes, ears, nose and throat

Gastrointestinal system anatomy and physiology

Anatomy and physiology of the teeth

Liver anatomy and physiology

Enteric nervous system

Esophageal motility

Gastric motility

Gastrointestinal tract motility

Gastrointestinal hormones

Chewing and swallowing

Carbohydrates and sugars

Fats and lipids

Proteins

Vitamins and minerals

Intestinal fluid balance

Pancreatic secretion

Bile secretion and enterohepatic circulation

Prebiotics and probiotics

Digestion and absorption

Gastrointestinal system

Blood components

Erythropoietin

RBC production

Blood groups and transfusions

Platelet plug formation (primary hemostasis)

Coagulation (secondary hemostasis)

Role of Vitamin K in coagulation

Clot retraction and fibrinolysis

Hemostasis

Hematological system

Introduction to the immune system

Cytokines

Innate immune system

Complement system

T-cell development

B-cell development

MHC class I and MHC class II molecules

T-cell activation

B-cell activation and differentiation

Cell-mediated immunity of CD4 cells

Cell-mediated immunity of natural killer and CD8 cells

Antibody classes

Somatic hypermutation and affinity maturation

VDJ rearrangement

Contracting the immune response and peripheral tolerance

B- and T-cell memory

Anergy, exhaustion, and clonal deletion

Vaccinations

Adaptive immune system

Type I hypersensitivity

Type II hypersensitivity

Type III hypersensitivity

Type IV hypersensitivity

Hypersensitivity reactions

Immune system

Skin anatomy and physiology

Hair, skin and nails

Wound healing

Integumentary system

Skeletal system anatomy and physiology

Bone remodeling and repair

Cartilage structure and growth

Fibrous, cartilage, and synovial joints

Skeletal system, cartilage and joints

Muscular system anatomy and physiology

Brachial plexus

Neuromuscular junction and motor unit

Sliding filament model of muscle contraction

Slow twitch and fast twitch muscle fibers

Muscle contraction

Muscle spindles and golgi tendon organs

Neuromuscular system

Musculoskeletal system

Nervous system anatomy and physiology

Neuron action potential

Cerebral circulation

Blood brain barrier

Cerebrospinal fluid

Cranial nerves

Ascending and descending spinal tracts

Motor cortex

Pyramidal and extrapyramidal tracts

Spinal cord reflexes

Sensory receptor function

Somatosensory receptors

Somatosensory pathways

Somatic nervous system

Sympathetic nervous system

Adrenergic receptors

Parasympathetic nervous system

Cholinergic receptors

Autonomic nervous system

Body temperature regulation (thermoregulation)

Hypothalamus

Cerebellum

Basal ganglia: Direct and indirect pathway of movement

Basal ganglia

Memory

Sleep

Consciousness

Learning

Stress

Language

Emotion

Attention

Higher order brain functions

Nervous system

Pulmonary changes during exercise

Videos

Notes