Cardiac function

and control

Physiology 2016

TheHeart

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Heart:theconductingsystem
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Cardiacexcitation

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Different cardiac cells; different action potential

A:ventricularmusclecells;B:pacemakercells

Theventricularactionpotential

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The intrinsic conduction system is made up of specialized cardiac cells that initiate and distribute
impulses, ensuring that the heart depolarizes in an orderly fashion.

The autorhythmic cells have an unstable or drifting resting potential, called a pacemaker potential,
which results in a slow depolarization. When the resting potenital "drifts up" to threshold the cells
rapidly generate an action potential. Depolarization is followed by repolarization, although the
inward flux of Ca++ extends the absolute refractory period and inhibits rapid sequential
depolarizations.

Excitationcontractioncoupling
contraction

depolarization

relaxation

Action potential

Excitationcontractioncoupling

reflux of positive ions

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 Excitationcontractioncoupling

CardiacOutput

Thecardiacoutput(CO)isequaltothevolume
ofbloodpumpedbytheheartperbeat(stroke
volume,SV)timestheheartrate(HR).

CO=SVxHR

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 HeartRate:
contractilerhythmoftheheartanditsregulation

Neuralregulationofheartrate

slow down depolarization

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 Factoraffectingheartrate

StrokeVolume:
Volumeofbloodejectedduringoneheartbeat
anditsregulation

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 RegulationofSV

Strokevolumeisregulatedby3variables:

EDV:Volumeofbloodintheventriclesat
theendofdiastole.
Totalperipheralresistance (TPR):Frictional
resistanceorimpedancetobloodflowin
thearteries.
Contractility:Strengthofventricular
contraction.

EDV
Workloadontheheartpriortocontraction
(preload).

o IncreaseinEDVresultsinanincreaseinSV.

o StrengthofcontractionvariesdirectlywithEDV.

o Ejectionfraction:SV/EDV.Normallyis60%.

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 FrankStarlingLawoftheHeart:
RelationshipbetweenEDV,contractionstrength,andSV.

AsEDVincreases:
Myocardiumis
increasingly
stretched
Thisincreasesthe
numberof
interactions
betweenactin
andmyosin
Thisallowsmore
forcetodevelop

Theventricularfunctioncurve:FrankStarling
lawoftheheart

SV/EDV = 60%

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 TPR
TotalPeripheralResistance:Impedancetotheejectionof
bloodfromventricle.
Afterload.
Inordertoejectblood,pressuregeneratedinthe
ventriclemustbegreaterthanpressureinthe
arteries.
Pressureinarteriesbeforeventriclecontractsisa
functionofTPR.
SVinverselyproportionaltoTPR.
GreatertheTPR,thelowertheSV.

ExtrinsicControlofContractility
Sympathoadrenalsystem:
NEandEpiproduceanincreaseincontractile
strength.
+inotropiceffect:
MoreCa2+ availabletosarcomeres.

Parasympatheticstimulation:
Doesnotdirectlyinfluencecontractionstrength.

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 Sympatheticstimulationandventricular
functioncurve

Effectofsympatheticstimulationonventricular
contraction

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Controlofstrokevolume

Summary:
Controlofcardiacoutput

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