Student:Maj D Paul Moderator:Col V Joshi

HEART (PUMP) AUTOREGULATION NEURAL HORMONAL RENAL-BODY FLUID CONTROL SYSTEM REGULATION CARDIOVASCULAR SYSTEM

VESSELS (DISTRIBUTION SYSTEM)

PULMONARY CIRCULATION 1. LOW RESISTANCE 2. LOW PRESSURE (25/10 mmHg) SYSTEMIC CIRCULATION 1. HIGH RESISTANCE 2. HIGH PRESSURE (120/80 mmHg) PARALLEL SUBCIRCUITS UNIDIRECTIONAL FLOW

ARTERIES (LOW COMPLIANCE) HEART DIASTOLE VEINS CAPACITY VESSELS 80 mmHg 120 mmHg

SYSTOLE

CAPILLARIES

AUTOMATICITY

+ Na
K+

Gradually increasing PNa

Na+

+ K
-0

-70 mV

THRESHOLD RESTING

Atrio-ventricular (AV) node Sino-atrial (SA) node

BUNDLE BRANCHES PURKINJE FIBERS

Sino-atrial (SA) node Atrio-ventricular (AV) node Bundle of His Bundle branches Purkinje fibers

PHASE 0 = Rapid Depolarization Mechanical Response (inward Na+ current) 1 1 = Overshoot 2 2 = Plateau (inward Ca++ current) 3 = Repolarization (outward K+ current) 0 3 4 = Resting Potential

-90 TIME

ACTION POTENTIALS MEMBRANE POTENTIAL (mV) VENTRICULULAR CELL 1 2 SAN 0 0 -50 0 3 -50 4 -100 -100 4 3

SINGLE VENTRICULAR ACTION POTENTIAL ENDOCARDIAL FIBER EPICARDIAL FIBER

ATRIAL FIBER

R 1 mV ECG P T QS Repolarization of ventricles Depolarization of ventricles

Depolarization of atria

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly) 3 Bipolar Limb Leads: RA LA I = RA vs. LA (+)

LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly) 3 Bipolar Limb Leads: RA LA I = RA vs. LA (+) II = RA vs. LL (+)

LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly) 3 Bipolar Limb Leads: RA LA I = RA vs. LA (+) II = RA vs. LL (+) III = LA vs. LL (+)

LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly) 3 Bipolar Limb Leads: RA LA I = RA vs. LA (+) II = RA vs. LL (+) III = LA vs. LL (+) 3 Augmented Limb Leads: aVR = (LA-LL) vs. RA(+) LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly) 3 Bipolar Limb Leads: RA LA I = RA vs. LA (+) II = RA vs. LL (+) III = LA vs. LL (+) 3 Augmented Limb Leads: aVR = (LA-LL) vs. RA(+) aVL = (RA-LL) vs. LA(+) LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly) 3 Bipolar Limb Leads: RA LA I = RA vs. LA (+) II = RA vs. LL (+) III = LA vs. LL (+) 3 Augmented Limb Leads: aVR = (LA-LL) vs. RA(+) aVL = (RA-LL) vs. LA(+) aVF = (RA-LA) vs. LL(+) LL

6 PRECORDIAL (CHEST) LEADS Spine

V6 V5 Sternum V1 V2 V3 V4

ECG Recordings: (QRS vector---leftward, inferiorly and posteriorly 3 Bipolar Limb Leads I = RA vs. LA(+) II = RA vs. LL(+) III = LA vs. LL(+) 3 Augmented Limb Leads aVR = (LA-LL) vs. RA(+) aVL = (RA-LL) vs. LA(+) aVF = (RA-LA) vs. LL(+) 6 Precordial (Chest) Leads: Indifferent electrode (RA-LA-LL) vs. chest lead moved from position V1 through position V6.

THE CARDIAC CYCLE DIASTOLE

LATE DIASTOLE

ISOMETRIC VENTRICULAR RELAXATION

ATRIAL SYSTOLE

VENTRICULAR EJECTION

ISOMETRIC VENTRICULAR CONTRACTION

ISOVOLUMETRIC RELAXATION RAPID INFLOW ISOVOLUMETRIC DIASTASIS CONTRACTION ATRIAL SYSTOLE

PRESSURE (mmHg)

EJECTION

AORTIC PRESSURE ATRIAL PRESSURE VENTRICLE PRESSURE ECG PHONOCARDIOGAM SYSTOLE DIASTOLE SYSTOLE

VOLUME (ml)

MEASUREMENT OF CARDIAC OUTPUT

THE FICK METHOD:

VO2 = ([O2]a - [O2]v) x Flow Spirometry (250 ml/min) VO2 Flow = [O2]a - [O2]v Pulmonary Artery Blood (15 ml%) Arterial Blood (20 ml%) CARDIAC OUTPUT PULMONARY BLOOD FLOW VENOUS RETURN PERIPHERAL BLOOD FLOW

. VO2 CARDIAC OUTPUT (Q) = [O ] - [O ] 2 a 2 v = 250 ml/min 20 ml% - 15 ml%

= 5 L/min . Q = HR x SV . Q SV = HR . CARDIAC INDEX = Q 2 m body surface area = 5 L/min 5 L/min 70 beats/min = 1.6 m2 = 0.0714 L or 71.4 ml = 3.1 L/min/m2

REGULATION OF CARDIAC OUTPUT

Heart Rate via sympathetic & parasympathetic nerves Stroke Volume

Frank-Starling Law of the Heart Changes in Contractility

MYOCARDIAL CELLS (FIBERS)

Regulation of Contractility Length-Tension and Volume-Pressure Curves The Cardiac Function Curve

Autoregulation (Frank-Starling Law of the Heart) CARDIAC OUTPUT = STROKE VOLUME x HEART RATE Contractility Sympathetic Nervous System Parasympathetic Nervous System

CARDIAC MUSCLE - Functional Syncytium - Automaticity

STRIATED MUSCLE

SKELETAL MUSCLE - Motor Units - Stimulated by Motor Nerves

STRUCTURE OF A MYOCARDIAL CELL Sarcolemma

Mitochondria

T-tubule SR Fibrils

Normal Heart Rate

Ca++

Ca++

Fast Heart Rate

Ca++

Ca++

Ca++

Ca++

LENGTH-TENSION CURVE TOTAL TENSION

TENSION

ACTIVE TENSION

PASSIVE TENSION EQUILIBRIUM LENGTH LENGTH LENGTH OPTIMAL LENGTH (Lo) RESTING LENGTH

TENSION

SARCOMERE LENGTH (Q)

CARDIAC MUSCLE
TOTAL TENSION ACTIVE TENSION TENSION

PASSIVE TENSION MUSCLE LENGTH

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase After-load PRESSURE Isovolumetric Phase Stroke Volume DIASTOLIC PRESSURE CURVE End Diastolic Volume

Pre-load End Systolic Volume

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase After-load PRESSURE Isovolumetric Phase Stroke Volume DIASTOLIC PRESSURE CURVE End Diastolic Volume

Pre-load End Systolic Volume

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase After-load PRESSURE Isovolumetric Phase Stroke Volume DIASTOLIC PRESSURE CURVE End Diastolic Volume

Pre-load End Systolic Volume

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase After-load PRESSURE Isovolumetric Phase Stroke Volume DIASTOLIC PRESSURE CURVE End Diastolic Volume

Pre-load End Systolic Volume

Cardiac Output = Stroke Volume x Heart Rate STROKE VOLUME If: Constant Then: o CO reflects oSV

DIASTOLIC FILLING Right Atrial Pressure (RAP) reflects Diastolic Filling

THE FRANK- STARLING LAW OF THE HEART CARDIAC OUTPUT (L/min) 15-

10Pressure Volume -4 0 +4 RAP mmHg +8

5-

THE FRANK- STARLING LAW OF THE HEART CARDIAC OUTPUT (L/min) 15-

10-

5-

-4

0 +4 RAP mmHg

+8

THE FRANK- STARLING LAW OF THE HEART CARDIAC OUTPUT (L/min) 15-

10-

5-

-4

0 +4 RAP mmHg

+8

THE FRANK- STARLING LAW OF THE HEART CARDIAC OUTPUT (L/min) 15-

10-

5-

-4

0 +4 RAP mmHg

+8

THE FRANK- STARLING LAW OF THE HEART CARDIAC OUTPUT (L/min) 15-

10-

5-

-4

0 +4 RAP mmHg

+8

BY ALTERING THE CARDIAC FUNCTION CURVE - CHANGING CONTRACTILITY - CHANGING HEART RATE BY ALTERING THE VASCULAR FUNCTION CURVE - CHANGING MEAN CIRCULATORY PRESSURE Blood Volume Venous Capacity - CHANGING TOTAL PERIPHERAL RESISTANCE

Chemosensitive Area

MOTOR CORTEX HYPOTHALAMUS

Glossopharyngeal Nerve

VASOMOTOR CENTER PRESSOR AREA DEPRESSOR AREA CARDIOINHIBITORY AREA Vagus HEART Arterioles

Sympathetic Nervous System

Baroreceptors Carotid Sinus Aortic Arch Chemoreceptors Carotid Bodies Aortic Bodies Atrial Receptors

Veins

Adrenal Medulla

Bainbridge Reflex (o Heart Rate) Volume Reflex (o Urinary OUTPUT) a. q Vascular Sympathetic Tone b. q ADH Secretion c. q Aldosterone Secretion

CARDIAC 15OUTPUT or 10Response to Hemorrhage o HR & Contractility Venoconstriction (o MCP) Vasoconstriction (o TPR)

PERIPHERAL BLOOD FLOW [Venous Return] 5(L/min) -4

0 +4 RAP mmHg

+8

o Sympathetic tone via baroreceptor reflex

o Heart rate and contractility Venoconstriction (o MCP) Vasoconstriction (o arterial BP & direct blood to vital organs)

Restore Blood Volume

Capillary fluid shift (q BP favors reabsorption) q Urinary output (q Arterial BP, ADH, ReninAngiotensin-Aldosterone)

Restore plasma proteins & hematocrit

CARDIAC 15OUTPUT or 10Response to Syncope (Fainting o HR & Contractility Venoconstriction (o MCP) Vasoconstriction (o TPR)

PERIPHERAL BLOOD FLOW [Venous Return] 5(L/min) -4

0 +4 RAP mmHg

+8

CAUSES:

Impairment of electrical activity Muscle damage Valvular defects Cardiomyopathies Result of drugs or toxins

PROBLEM: Maintaining circulation with a weak pump (q Cardiac output & cardiac reserve; o RAP) SOLUTIONS: o Sympathetic tone via baroreceptor reflex -o Heart rate and contractility -Venoconstriction (o MCP) -Vasoconstriction (o Arterial BP) Fluid retention (o MCP) -Capillary fluid shift -ADH -Renin-angiotensin-aldosterone

CARDIAC 15OUTPUT or 10-

SYMPTOMS: Systemic Edema Pulmonary Congestion Enlarged Heart Adjustments to Failure Cardiac Failure

PERIPHERAL BLOOD FLOW [Venous Return] 5(L/min) -4

0 +4 RAP mmHg

+8

HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase After-load PRESSURE Isovolumetric Phase Stroke Volume DIASTOLIC PRESSURE CURVE End Diastolic Volume

Pre-load End Systolic Volume