1/29/2016

• Thoracic Wall (review)

• Pulmonary Anatomy
• Pulmonary Physiology
• Cardiovascular Anatomy
• Cardiovascular Physiology
• Circulatory Physiology
Kenneth Mutia, PTRP

• Boundaries
• Post: Thoracic
Vertebrae
• Lat: Ribs 1-12
• Ant: Sternum
• Sup: Suprapleural
membrane/
thoracic outlet
• Inf: Diaphragm

• Ribs ACTION MOVEMENT DIMENSION ↑D

• 12 pairs Pump Handle Forward & Upward; ↑ AP diameter

• TRUE RIBS sternum & upper
• FALSE RIBS ribs;
• FLOATING RIBS
Bucket Handle Upward & Outward; ↑Transverse
• Sternum – dorsally concave by 160
degrees midshaft of ribs; diameter
• Flat bone that lies in the midline Caliper action Flaring/ Outward; ↑subcostal angle
• 3 parts lower ribs;
• Manubrium
• Body Piston action Descent of Central ↑Vertical
• Xiphoid process Tendon of Dimension
Diaphragm;

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Relaxed Inspiratory Relaxed Expiratory Forceful Inspiratory Forceful Expiratory

Diaphragm Passive recoil of the lung Diaphragm Abdominals
External intercostals External intercostals
Levatores Costarum Levatores Costarum
+
Scalenes
Upper Traps
Pectorals
Serratus Anterior
SCM

• Most important muscle for inspiration • Functions

• Dome shaped and separates the thoracic cavity • Inspiration
from the abdominal cavity
• Abdominal straining
• Openings
• Weight lifting muscle
• Aortic opening – T12 (aorta, thoracic duct, azygos
vein) • Thoracoabdominal pump
• Esophageal opening – T10 (esophagus, R & L
vagus nn)
• Caval opening – T8 (IVC, terminal brances of R
phrenic nerve)

• External Intercostal
• Superficial
• Fibers run downward and forward
• Internal Intercostal
• Intermediate layer
• Fibers run dowward and backward
• Innermost Intercostal
• Deepest
• Correspond with transversus abdominis mm

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• Serratus Posterior
Superior
• Downward and
laterally
• Elevates the ribs
• Serratus Posterior
Inferior
• Upward and Upper Respiratory Tract
laterally Lower Respiratory Tract
• Depresses the ribs

• NOSE
• External nose
• Nostrils
• Ala nasi
• Nasal Septum
• Nasal Cavity
• Nasal Septum
• Septal cartilage, vertical plate of ethmoid & vomer

• Walls of the Nasal Cavity • Nasal Cavity

• Floor – palatine process • Nasal Vestibule: modified skin & coarse hairs
• Superior part: Olfactory mucous membrane with
• Roof – nasal & frontal bones, cribiform plate, nerve endings
sphenoid
• Inferior part: Respiratory mucous membrane +
• Lateral wall – Conchae venous plexus
• Superior, Inferior, Middle • Function of ?
• Medial Wall – Nasal Septum • Conchae & paranasal sinuses
• Venous Plexus
• Mucus

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• Pharynx • Larynx
• Common passageway of food, water & air • Provides protective sphincter at the inlet of the
• Behind the nasal cavities, mouth & larynx air passages
• Resonating chamber for speech sounds • Voice production
• Tonsils • Cartilages
• Divided into 3 parts • Thyroid
• Nasopharynx • Cricoid
• Auditory tube • Aretynoid
• Oropharynx • Cornuculate
• Laryngopharynx • Cuneiform
• Epiglottis • Epiglottis

• Though, thick
movable partition in
the median portion
of the thoracic cavity
• Divided into
• Superior
mediastinum
• Inferior mediastinum

• Superior Mediastinum • Inferior Mediastinum • Lie on either side of the mediastinum

• Thymus • Thymus
• 2 parts
• Large veins • Heart*
• Parietal layer
• Large arteries • Esophagus & thoracic
• Trachea duct • Visceral layer
• Esophagus & thoracic • Descending aorta • Become continuous with one another at
duct • Sympathetic trunks the hilum of each lung via pleural cuff
• Sympathetic trunks

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• Separates the parietal & visceral pleural • Sensitive to pain, temperature, touch &
layer pressure?
• Contains a small amount of pleural fluid • Sensitive to stretch only?
• Normal amount?

• Trachea • Trachea
• Mobile cartilaginous & membranous tube • Sensation – vagus nerve & recurrent laryngeal
• Continuation of larynx at the lower border of nerve
cricoid cartilage • Trachealis muscle – SNS
• Ends below at?
• Patency
• Anteriorly by U-shaped bars of hyaline cartilage
• Posteriorly by trachealis muscle

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• The Bronchi • Segmental bronchus

• Principal or Main Bronchi • After entering a bronchopulmonary segment,
• Right – wider, shorter & more vertical than the left it divides into smaller bronchi – Bronchioles
• Superior Lobar Bronchus – branches out before entering • No cartilage, lined with columnar cilliated
the hilum epithelium
• Midddle Lobar Bronchus
• Brochioles give rise to terminal bronchioles &
• Inferior Lobar
respiratory bronchioles
• Left – narrower, longer & more horizontal (2 in
long) • End by branching into alveolar ducts
• Superior Lobar Bronchus • Lead into alveolar sacs – several alveoli opening
• Inferior Lobar Bronchus
into a single chamber

• Main Bronchi
• Lobar
RIGHT LEFT Bronchi
• Segmental
narrower, longer Bronchi
wider, shorter &
MAIN BRONCHI & more
more vertical • Terminal
horizontal
Bronchioles
Superior • Respiratory
Superior
LOBAR BRONCHI Middle Bronchioles
Inferior
Inferior
• Alveolar Duct
SEGMENTAL • Alveolar Sac
10 8
BRONCHI
• Alveoli

• Hilum • Lungs
• point of entry of bronchus, vessels & nerves into the
lungs • Conical, covered with visceral pleura &
• Root of the Lung suspended free on its own pleura
• Formed by structures that are entering or leaving the • Attached to the mediastinum via the root
lung
• Covered by tubular sheath of pleura
• Mediastinal parietal pleura & visceral pleura are
continuous
• Bronchi
• Pulmonary vessels
• Bronchial vessels
• nerves

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• Lungs • Right Lung

• Parts • Slightly larger than the
left
• Apex – projects to neck for
about 1 in above the clavicle • Divided by
• Base • Oblique fissure – T4
vertebrae to 6th
• Costal surface chondrosternal junction
• Mediastinal surface • Horizontal fissure – Sternal
end of 4th rib to T4
vertebrae
• 10 Bronchopulmonary
Segments

• Left Lung • Bronchopulmonary

Segment
• Divided by an Oblique
• Subdivision of a lung lobe
fissure into 2 lobes
• Pyramid shaped
• Anterior border surrounded by
possesses a Cardiac connective tissue
Notch • Contains:
• 8 bronchopulmnary • Segmental bronchus
segments • Segmental artery
• Lymph vessels
• Autonomic nerves

• Bronchopulmonary Segment
• Alveoli
RIGHT LUNG LEFT LUNG
• 2 or more share a
Apical Apical
common aveolar sac
Posterior Posterior
SUPERIOR SUPERIOR
Anterior Anterior basal • Walls
LOBE LOBE
Lateral basal • Type 1 alveolar cells
Posterior basal • Type 2 alveolar cells or
MIDDLE Lateral Superior/ Apical septal cells
LOBE Medial Medial basal • Alveolar macrophages
Superior/ Apical Anterior basal
INFERIOR • Fibroblasts – reticular &
Medial basal Lateral basal elastic fibers
INFERIOR LOBE Posterior basal
Anterior basal
LOBE
Lateral basal
Psoterior basal

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• Respiratory Unit • Respiratory Membrane

• Layer of type I and type II
• Respiratory bronchiole alveolar cells and associated
alveolar macrophages that
• Alveolar ducts constitutes the alveolar wall
• Epithelial basement
• Alveoli membrane underlying the
alveolar wall
• Capillaries
• Capillary basement
membrane that is often
fused to the epithelial
basement membrane
• Capillary endothelium

• Blood Supply & Drainage of the Lungs

• Bronchial Arteries
• Bronchi
• Lung connective tissue
• Visceral pleura
• Pulmonary Arteries
• Alveoli

• Inflow and outflow of air between

the atmosphere and the lung alveoli
• Lung Expansion & Contraction
• Downward/ Upward movement of the
diaphragm
Pulmonary Ventilation • Elevation/depression of the ribs
Volumes & Capacities
Principles of Gas Exchange
Principles of Gas Transport
• Continually renew the air in the gas
Regulation of Respiration exchange areas of the lungs

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• Pleural/ Intrapleural Pressure • Process of Inhalation

• Subatmospheric pressure that maintains the
close relationship of the 2 layers of the lung
pleurae
• Alveolar/Intrapulmonic Pressure
• Pressure inside the lungs
• Lowers as the person inhales air
• Contraction of diaphragm, external
intercostals & levatores costarum
• Contraction of accessory muscles
• Increase in Lung Volume
• Process of Exhalation
• Elastic Recoil
• Recoil of elastic fibers
• Inward pull of surface tension

• Factors Affecting Pulmonary Ventilation

• Lung compliance
• The extent to which the lungs will expand for each
unit increase in transpulmonary pressure
• Transpulmonary pressure = difference between Pleural
Pressure & Alveolar Pressure
• 200ml/cmH20
• 2 principal factors
• Tissue Elastic Forces
• Surface Tension

• Factors Affecting Pulmonary Ventilation • Spirometry

• Airway Resistance • Method of measuring the volume movement of
• Airflow = (Alveoli Pressure – Atmospheric air in & out of the lungs
Pressure)/Resistance
• Pulmonary Volumes
• Equal to the maximum volume to which the
lung can be expanded
• Pulmonary Capacities
• Combinations of two or more lung volumes

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• Tidal Volume – volume of air inspired or
expired with each normal breath
• Inspiratory Reserve Volume – volume of
air that can be inspired after normal
inspiration
• Expiratory Reserve Volume – volume of
air that can be expired after normal
expiration
• Residual Volume – volume of air
remaining in the lungs after forceful
expiration
• Pulmonary Capacities
• Inspiratory Capacity
• IRV + TV
• Functional Residual Capacity
• ERV + RV
• Vital Capacity
• IRV + TV + ERV
• IC + ERV
• Total Lung Capacity
• IRV + TV + ERV + RV
• IC + FRC
1/29/2016
• Inspiratory Capacity – amount of air that can
inspire after a resting expiration
• Functional Residual Capacity – amount of air
that remains in the lungs after normal
expiration
• Vital Capacity – maximum amount of air a
person can expel from the lungs after
maximum inspiration
• Total Lung Capacity - total amount of air
contained in the lungs after maximum
inspiration
• Minute Respiratory Volume
• Total amount of new air moved into the
respiratory passages each minute
• MRV = TV x Respiratory Rate
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• Alveolar Ventilation • Cough Reflex

• Rate at which new air reaches the respiratory • Sensitive Areas
unit • Light touch – bronchi, trachea, carina & larynx
• Physiologic Dead Space – Amount of air not • Corrosive chemical stimuli – terminal bronchioles
involved in gas exchange & carina
• Afferent nerve impulses via the Vagus nerve to
• Alveolar Ventilation Rate the Medulla
• Normal AVR = 4200ml/min

• Sneeze Reflex • Blood flow is essentially equal to the

• Applies to the nasal passageways
• Stimuli – irritation of the nasal passageways
• Afferent nerve impulses from the CNV to the
medulla
cardiac output
• Alveoli with low O2 concentration
• Vasoconstriction of adjacent blood vessels
• Effect of Hydrostatic Pressure
• Pressure of blood is greatest at the lowest
portions
• Effect of Alveolar Air Pressure
• Compresses the capillaries

• Zone 1 – No blood flow during all portions of • Diffusion – from an area of high pressure to
the cardiac cycle an area of low pressure
• Alveolar capillary pressure < alveolar air pressure • Pressure is directly proportional to the
• Zone 2 – Intermittent blood flow during peak concentration of gas molecules
pulmonary arterial pressure ATMOSPHERIC AIR ALVEOLAR AIR
• Systolic pressure > alveolar air pressure > 78.6% N 13.6% O2
Diastolic pressure 20.9% O2 5.2% CO2
0.04 % CO2
• Zone 3 – Continuous blood flow 0.06% Other gases
Variable – water vapor
• Alveolar capillary pressure > alveolar air pressure

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• Rate of Diffusion depends on •V/Q = 0

• Dalton’s Law
• Henry’s Law •V/Q = ∞
• Diffusion Coefficient
• CO2 can diffuse 20x more rapidly than O2 •V/Q = Normal
• Cross-sectional area of the fluid
• Distance
• Temperature of the fluid

• Law of Diffusion applies

• At the respiratory membrane
• Alveolar PO2 > Arterial PO2
• Alveolar PCO2 < Arterial PCO2
• At the peripheral tissues
• Arterial PO2 > Insterstitial Fluid PO2
• Arterial CO2 < Interstitial Fluid PCO2

• Factors affecting Interstitial Fluid O2 & CO2 • 4 O2 molecules can LOOSELY bind with 1
• Increase in Tissue Blood Flow Hgb molecule
• Increase in Tissue Metabolism • When PO2 is high – O2 binds with Hgb
• When PO2 is low – O2 is released from Hgb

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• Hemoglobin as a Buffer to Tissue PO2 • Oxygen- Hemoglobin Dissociation Curve

• Hemoglobin sets an upper limit of PO2 in the • As blood PO2 increases, there is an increase
tissues in % of hemoglobin bound with oxygen
• During Exercise, tissue PO2 is constant d/t
• As PO2 decreases, the % of Oxygenated
• Steep slope of the dissociation curve
hemoglobin decreases
• Increase tissue blood flow d/t decreased in PO2
• Hemoglobin maintains constant tissue PO2
during
• High altitude
• Deep sea or pressurized chambers

• Factors that affect affinity of HGB to O2

• pH level of blood
• Partial pressure of CO2
• Temperature
• 2,3-biphosphoglycerate

• CO2 is transported in the blood in 3 forms • Carbon Dioxide

• Dissolved CO2 Dissociation Curve
• Carbamino compounds • Haldane Effect
• Bicarbonate ions • Increase acidity of
Hemoglobin

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• Respiratory Centers
• Dorsal Respiratory Group
• Dorsal portion of medulla
• Receives sesnory impulses from CN9 & CN10
through Tructus Solitarius
• Functions
• Basic rhythm of respiration
• Inspiratory ramp signal

• Respiratory Centers • Respiratory Centers

• Pneumotaxic Center • Ventral Respiratory Group
• nucleus parabrachialis of the dorsal pons • Each side of the medulla
• Transmits signals to the inspiratory area • Pre-Botzinger Complex – rhythm generator
• Limit inspiration • Functions
• Controls the “switch-off” point of inspiratory ramp, • Expiration
controlling the filling phase of the lungs • Contributes to respiratory drive
• Increases rate of breathing • Stimulation to neurons can cause inspiration & expiration
• Provide powerful signals to the abdominals

Hering-Breuer Inflation Reflex • Chemical Control of Breathing

Cause/ • Stimulation of Respiratory Centers
TV increases 3x than normal
Stimulus
• Chemosensitive Area beneath the ventral surface of
Afferent Stretch Receptors from muscular medulla
Impulse portions of bronchi & bronchioles • Highly senstive to blood changes in PCO2 & H+ ion
Afferent Nerve Vagus Nerve concentration
Integrating • Excitation is great for the first few hours
DRG
Center • Increases Alveolar Ventilation
Activation of a feedback response that
Effect “SWITCHES OFF” the inspiratory ramp
signal

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• Chemical Control of Breathing • Other Factors that Affect Respiration

• Peripheral Chemoreceptor System • Voluntary Control
• Carotid Bodies • Irritant Receptors in the Airways
• Aortic Bodies • Coughing & sneezing reflex
• Bronchial constriction
• J receptors
• Feeling of dyspnea when pulmonary edema or
increase blood in the pulmonary capillaries occur
• Brain Edema
• Respiratory depression

• Fibrous sac that encloses

the heart & the roots of
the great vessels
• Prevents excessive
movements
Pericardium • Decreases friction
Boundaries of the Heart
Chambers of the Heart
Heart Valves
Blood Supply & Drainage of the Heart
Nerve Supply of the Heart

• Layers • Nerve Supply

• Fibrous Pericardium • Fibrous Pericardium & Parietal Layer of
• Attached to the central tendon Serous Pericardium
• Attached to the sternum via sternopericardial • Phrenic Nerves
ligaments
• Serous Pericardium • Visceral Layer of Serous Pericardium
• Parietal Layer • Sympathetic trunks
• Visceral Layer or ? • CN10
• Pericardial Cavity
• Normal amount of Pericardial Fluid?

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• Lies within the pericardium in the SURFACES OF THE HEART

mediastinum Sternocostal Right Atrium & Right
• 2/3rds of its mass lies to left of the midline Surface Ventricle
• Apex directed anteriorly, inferiorly and Diaphragmatic Right & Left Ventricles
to the left Surface Right Atrium
• 5th intercostal space in the midclavicular line Base of the Left Atrium
• 9cm from the midline Heart/ Posterior
Aspect
• Anterior to T5-T9 vertebrae
Apex of the Heart Left Ventricle

BORDERS OF THE HEART • Epicardium

Right Border Right Atrium • 2 layers
Left Border Left Auricle • Visceral layer of Serous
Left Ventricle Pericardium
Lower Border Right Ventricle • Adipose tissue
Right Atrium • Myocardium
Superior Border Right & Left Atria & Auricles
• Endocardium
• endothelium

• Right Atrium • Fetal Remnants in

• Main cavity and an the Right Atrium
Auricle
• Rudimentary valve
• Sulcus Terminalis
of IVC
• Crista Terminalis
• Musculi Pectinati • Fossa Ovalis –
• Openings
foramen ovale
• SVC & IVC • Annulus Ovalis –
• Coronary Sinus lower edge of
• Right AV Orifice septum secundum
• Guarded by Tricuspid Valve

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• Right Ventricle • Left Atrium

• Infundibulum • Main Cavity & Auricle
• Walls are thicker than • Inferior part is smooth, but also possess
the right atrium muscular ridges as in the right auricle
• Trabeculae Carnae • Openings
• Papillary muscles – • 4 pulmonary veins
Chordae Tendinae • Left AV orifice guarded by mitral valve
• Moderator band – ®
branch of AV bundle
• Prominent ridges

• Left Ventricle RIGHT LEFT

• Walls are 3 times thicker than the Right Right Border Base
Ventricle Pectinate muscle Smooth muscle
• No moderator band Inner: Crista Terminalis
• Aortic vestibule Outer: Sulcus Terminalis
SVC, IVC, Coronary Sinus, Pulmonary veins
® AV Orifice (L) AV Orifice

RIGHT LEFT • Atrial Septum

Crescentic Circular
Thin wall 3x Thicker Wall
• Ventricular Septum
Low Pressure 6x Higher Pressure • Membranous part
Trabeculae Carnae • Muscular part
(+) Moderator Band (-) Moderator band
• Skeleton of the Heart
3 papillary muscles 2 papillary muscle
3 chordae tendinae 2 chordae tendinae • Fibrous rings that surround the orifices and
(+) prominent ridges
continuous with the membranous part of
ventricular septum
Tricuspid Mitral
Infundibulum Aortic Vestibule

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Valve Auscultation Location

• Right Coronary Artery
2ndRight Intercostal 3rd Left Intercostal
Aortic • Right Conus Artery – infundibulum & upper
Space Space
part of anterior wall of right ventricle
2nd Left Intercostal 3rd Left Costal
Pulmonary Space • Anterior ventricular branches – anterior
Cartilage
surface of right ventricle
4th Left Intercostal 4th Right Intercostal • Marginal branches – largest
Tricuspid Space Space
• Posterior ventricular branches –
5th Left Intercostal 4th Left Costal diaphragmatic surface of right ventricle
Mitral Space Cartilage

• Right Coronary Artery • Left Coronary Artery

• Posterior Descending Artery • Anterior Descending Artery (LAD)
• AV node • Right & left ventricles, anterior part of the
• Posterior heart ventricular septum
• Atrial Branches • Circumflex Artery
• Anterior & lateral surface of the right atrium • Left Marginal Artery – Left margin of the Left
Ventricle to the Apex
• SA nodal artery – SA Node & right and left atria
• Anterior & Posterior Ventricular Branches – Left
ventricle
• Atrial Branches – Left Atrium

RIGHT CORONARY LEFT CORONARY ARTERY

ARTERY
• All Right Ventricle
• Variable part of
diaphragmatic surface of Left
Ventricle
• Posteroinferior 1/3 of
Ventricular Septum
• Right Atrium
• Part of Left Atrium
• SA node
• AV node
• AV bundle of His
• LBB
• Left ventricle (most)
• Small area of right ventricle
to right of the
interventricular groove
• Anterior 2/3 of the
ventricular septum
• Left atrium (most)
• RBB
• LBB

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• Coronary sinus • Cardiac Plexus

• Posterior part of the
atrioventricular • Sympathetic Supply
groove • Cervical & upper thoracic portions of the
• Continuation of the sympathetic trunks
Great Cardiac Vein
• Left of IVC in the Right • Parasympathetic supply
Atrium • Vagus Nerves
• Tributaries
• Small and middle
cardiac veins
• Anterior Cardiac Vein

• The cardiac muscle is

• Striated,
mononucleated,
involuntary
• Syncytium
Cardiac Muscle Physiology • Atrial syncytium
Rhythmical Excitation of the Heart
Cardiac Cycle • Ventricular syncytium
Normal Heart Sounds • Automaticity
Work Output
Regulation of Heart Pumping • Rhythmicity

• 3 major types • Action Potential

• Atrial muscles • RMP? Initial Spike?
• Ventricular muscle • Depolarization -> Plateau -> Repolarization
• Excitatory & conductive muscles fibers • Function of the Plateau?
• Caused by
• Opening of 2 types of ion channels
• Rapid decrease in permeability to Potassium ions

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• Excitation-Contraction Coupling • Phase 4 - Resting

Stage
• Release of Ca++ ions from the Sarcoplasmic
Reticulum • RMP/Baseline
• Release of extra Ca++ ions from the T Tubules • -80mV
• Phase 0 - Rapid
Depolarization
Stage
• Opening of FAST Na
Channels

• Phase 1 - Initial • Phase 3 - Rapid

Repolarization Repolarization
Stage Stage
• Closing of FAST Na • Closing of Slow Ca++
Channels channels
• Efflux of Na & Cl ions • Efflux of K ions
• Phase 2 - Plateau
Stage
• Opening of SLOW
Ca++ Channels

• Sinuatrial Node
• Upper part of sulcus terminalis, ® of SVC
opening
• Cause impulses to travel throughout the atria
• Controls the rate of beat of the entire heart
• Lower RMP = -55 to -60mv
• Self-excitable
• 60-100bpm

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• Sinuatrial Node • Atrioventricular Node

• Sends impulses through internodal fibers
• Rapidly stimulates atria to contract
• Posterior wall of the right atrium behind he tricuspid
valve
• Delays the transmission of impulses to the ventricles
• Decreased numbers of gap junctions between the cells in
the conducting pathway
• 40-60bpm

• Atrioventricular Bundle of His • Ventricular Purkinje Fiber System

• From tricuspid valve to membranous part of • From the AV node through the AV bundles into
the interventricular septum the ventricles
• Only connection of the atria to the ventricles • Large fibers that penetrate about 1/3 the way
• Divides into 2 branches into the muscle mass
• Right Bundle Branch
• Left Bundle Branch
• Action Potentials are unable to travel back to
AV node

• Ventricular Purkinje Fiber System

• Very rapid transmission of impulses
• Very high permeability of gap junctions at the
intercalated discs
• Provides synchronous ventricular contraction
• 20-40 bpm

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• Cardiac events that occur from the • Rapid Ventricular Filling

beginning of one heart beat to the • 80% of blood flows directly through the atria into
beginning of the next the ventricles
• Parts: • Atrial Systole
• Atrial Systole • First 1/3 of Ventricular Diastole – Rapid Filling
• Ventricular Systole • Middle 1/3 of Ventricular Diastole – small amount
• Isovolumetric Contraction of blood empty
• Ejection • Final 1/3 of Ventricular Diastole – Atrial Kick
• Relaxation • End-Diastolic Volume – 130mL

• Atrial Systole • Ventricular Systole

• Atrial Depolarization – contraction of the • Simultanoeus with atrial diastole

atrial muscles • Isovolumetric Contraction

• Primer Pump function
• Forces blood into the ventricles through the open
AV valves
• Contributes the final 20% of blood into the
ventricles (Atrial Kick)
• Ends when Ventricular Systole begins
• After ventricular contraction begins
• Ventricular pressure rises abruptly
• Causes he AV valves to close
• Ventricles builds up sufficient pressure to push the
semilunar valves to open
• Contraction is occurring but no emptying

• Ventricular Systole • Ventricular Diastole

• Ejection • Isovolumetric Relaxation
• Sufficient pressure has been built up to open the SL • Relaxation of the ventricles
valves – PRELOAD • Decrease in intraventricular pressures
• >80mmHg on the Left Ventricle • Pressure in the arteries closes the SL valves
• >8mmHg on the Right Ventricle • AV Valves are still closed
• Ventricular Systole – Overcomes the AFTERLOAD • When ventricular pressure drops below atrial
• Period of Rapid Ejection pressure
• Period of Slow Ejection • AV valves open
• End-Systolic Volume – 60ml • Ventricular Filling Begins

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S1 S2
Lub Dub
Contraction of the ventricles Ventricular filling
Closing of AV valves Closing of Semilunar Valves
Low Pitch, Long Rapid Snap
S3 S4
Lub Dub Dub La Lub Dub
Ventriclar gallop; Atrial gallop;
Rapid blood turbulence during Blood turbulence during atrial
ventricular filling systole
Congestive Heart Failure Myocardial Infarction/
Coronary Artery Disease

• Volume of blood ejected from the • Ejection Fraction

ventricles into the arteries/ aorta each • Percent of blood ejected
minute • Efficiency of ventricles in pumping blood
• CO = Stroke Volume x Heart Rate • EF = SV / Preload x 100%
• Normal Stroke Volume – 70ml per heart beat • EF = (EDV-ESV) / EDV x 100%
• Normal Heart Rate – 75 bpm • Normal Percentage = 55-75%
• Normal Cardiac Output is?

• Factors that directly affect the cardiac output • Vagal Stimulation

• Person’s age • Release of Acetylcholine
• Body size
• Sympathetic Stimulation
• Cardiac index – Cardiac Output/m2 of body surface area
• Release of Norepinephrine
• Venous Return
• CO = Mean Arterial Pressure/ Total Peripheral
Resistance
• Heart Pumping
• Nervous System Control

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• Frank-Sterling Mechanism • Chemical Regulation of Heart Rate

• Intrinsic ability of the heart to adapt to • Hormones
increasing volumes of inflowing blood • Epinephrine & Norepinephrine
• Thyroid Hormones
• Bainbridge Reflex
• Cations
• Atrial Reflex control
• Hyperkalemia & Hypernatremia
• Hypercalcemia

• Cardiac Output
• Temperature • CO = HR x SV
• Increased body temperature increases heart • Blood Pressure
rate • BP = CO x PVR

• Increase permeability to ions • Ejection Fraction

• SV / Preload x 100%
• Increase contractile strength
• (EDV-ESV) / EDV x 100%

• Arterial Pressure Load • Mean Arterial Pressure

• DBP + [(SBP-DBP) / 3]
• No change unless it rises above to 160mmHg • DBP x 1/3 Pulse Pressure

• Pulse Pressure
• SBP-DBP

• Tunica interna
• Inner lining of the
blood vessel & is in
direct contact with the
blood
• Layers
Blood Vessel Anatomy • Endothelium
Pressure, Flow & Resistance • Continuous with the
Vascular Distensibility endocardium
Local & Humoral Control of Blood Flow
Nervous Control of Circulation • Basement Membrane
Control of Arterial Blood Pressure • Internal Elastic Lamina
Cardiac Output, Venous Return & Regulation

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• Tunica Media • Tunica Externa

• Muscular & connective • Outermost layer
tissue layer
• Greatest variation among • Elastic & collagen
different blood vessels fibers
• Regulation of blood flow • Numerous nerves
• Vasodilation &
vasoconstriction • Small blood vessels
• Limit blood loss
• Vessels stretch & recoil

• Arteries • Arterial Anastomosis

• Union of the branches of 2 or more arteries supplying
• Tunica media contains more smooth muscles the same body region
• High compliance • Collateral Circulation – Provide alternative routes
for blood
• Types • End Arteries – arteries that do not anastomose
• Elastic Arteries
• Largest
• Conducting Arteries
• Muscular Arteries
• Distributing Arteries
• Vascular tone

• Arterioles • Arterioles
• Microscopic vessels • Function –
regulating Blood
• Layers Flow Resistance
• Thin tunica interna • Resistance –
• Tunica media has 1 or 2 layers of smooth muscle opposition to blood
flow d/t friction
• Tunica Externa – abundant Sympathetic nerves between the blood
• Parts & blood vessel wall
• Vasoconstriction &
• Metarteriole – terminal end Vasodilation
• Precapillary Sphincter – monitors blood flow

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• Veins • Veins
• Very thin walls relative to their total diameter • Movement of venous blood
• Thinner tunica intima & media • Pumping action of the heart
• Skeletal muscle contraction in the lower limbs
• Thickest layer is the tunica externa
• Valves
• Larger lumen
• Folds of tunica interna
• Distensible enough to adapt to variations in the
volume & pressure of blood passing through • Project into the lumen pointing to the heart
• Not designed to withstand pressure • Important function?

• Venules
• Capillaries
• Thin walls that do not readily maintain their
• Smallest of blood vessels
shape
• Exchange Vessels
• Drain the capillary blood & begin the return of
• Connect arterial outflow to venous return
blood flow back toward the heart
• Branched, interconnecting vessels that course
• Parts among the individual cells of the body
• Postcapillary vessels – initially receive blood from
capillaries
• Exchange of substances between the blood
and interstitial fluid
• Smallest venules
• Porous endothelium • Lack tunica media & tunica externa
• Muscular Venules

• 2 ways • HEART • Postcapillary Venule

• Capillaries • Elastic Arteries • Venule
• Vasomotion
• Muscular Arteries • Veins
• Thoroughfare channels
• Arterioles • HEART
• Metarterioles
• Precapillary
sphincters
• CAPILLARIES

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• Basic Theory of Circulatory Function

• Rate of blood flow in each tissue is controlled
in relation to tissue need
• Cardiac Output is controlled mainly by local
tissue flows
• General arterial pressure is controlled
independently of either
• Local blood flow control
• Cardiac output control

• Determined by • Resistance to Blood Flow - Ohm’s Law

• Pressure Difference • Size of the Lumen
• Vascular Resistance • Blood Viscosity
• Rate of blood flow is equal to the rate of • Total Blood Vessel Length
blood pumping by the heart • Conductance to Blood Flow
• Normal is 100ml/sec or 6L/min • Poiseuille’s Law
• Arterial Pressure

• Hydrostatic pressure exerted by the blood • Cardiovascular center

on the walls of the blood vessel • Medulla Oblongata
• Mean Arterial Pressure • Controls neural, hormonal & local negative
• Average BP in the arteries feedback mechanisms
• MAP = DPB + 1/3 (SBP-DBP) • Receives inputs from
• Higher centers
• Depends on • Sensory receptors
• Cardiac Output • Proprioceptors
• Baroreceptors
• Total Volume of blood • Chemoreceptors

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• Baroreceptors • Renin-Angiotensin-Aldosterone System

• Carotid Sinus Reflex • Antidiuretic Hormone
• Aortic Reflex
• Epinephrine & Norepinephrine
• Chemoreceptors
• Atrial Natriuretic Peptide
• Carotid Bodies
• Endothelin
• Aortic Bodies
• Proprioceptors • Histamine

• CNS Ischemic Repsonse

• Control of BP by the brain’s vasomotor center
in response to decrease in brain blood flow
• Cushing Reaction
• Results from increase in CSF pressure
• Abdominal Compression Reflex
• Skeletal Muscle Contraction

• Vasoconstriction • Acute Regulation

• Calcium ions • Tissue Metabolism
• Oxygen Availability
• Vasodilation • Vasodilator Theory
• Potassium ions • Oxygen Lack Theory
• Autoregulation of Blood Flow
• Magnesium ions
• Metabolic Theory
• Hydrogen ions • Myogenic Theory
• Anions • Long Term Regulation – increase tissue
• Carbon Dioxide Vascularity with increase in metabolism

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THANK YOU!!!

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