CVS mod2 physiology

23topics

**1. Structure & Properties of the Heart and its Muscles**

a. **Explain the Structure of the Heart:**

- The heart is a muscular organ comprised of four chambers – two atria and two
ventricles.
- It is divided into the left and right sides, with each side responsible for specific
circulatory tasks.

b. **Enlist the Properties of the Heart:**

- The heart is a vital organ that exhibits properties such as rhythmic contraction
(systole) and relaxation (diastole).
- It has the ability to pump blood efficiently throughout the circulatory system,
maintaining blood pressure.

c. **Explain the Structure of Heart Muscles:**

- The heart muscles, or myocardium, form the bulk of the heart wall.
- These muscles are striated and possess unique features such as intercalated
discs for synchronized contractions.

d. **Restate the Properties of Heart Muscles:**

- Heart muscles exhibit involuntary contractions driven by electrical impulses.
- They are highly resistant to fatigue due to continuous and rhythmic pumping
throughout a lifetime.
**2. Cardiac Cycle, its Events, Pressures & Volume Changes**

a. **Define Cardiac Cycle:**

- The cardiac cycle refers to the complete sequence of events that occur during
one heartbeat, involving both contraction and relaxation phases of the heart.

b. **Illustrate Different Events Involved in Cardiac Cycle:**

- **Atrial Contraction (Atrial Systole):** Atria contract, pushing blood into the
ventricles.
- **Ventricular Contraction (Ventricular Systole):** Ventricles contract, ejecting
blood into the pulmonary and systemic circulations.
- **Isovolumetric Relaxation:** Brief period when all valves are closed, and no
blood enters or leaves the ventricles.
- **Ventricular Filling:** Blood flows from atria to ventricles, facilitated by open AV
valves.

c. **Summarize Changes in Volume and Pressure During Cardiac Cycle:**

- **Atrial and Ventricular Volume Changes:** Volumes fluctuate as blood moves
between atria and ventricles and then into the pulmonary and systemic circulations.
- **Pressure Changes:** Pressure increases during systole and decreases during
diastole, ensuring unidirectional blood flow through the heart.

**3. Cardiac Cycle Regulation (Intrinsic & Extrinsic Mechanisms)**

a. **Explain Cardiac Cycle Regulation:**

- Cardiac cycle regulation involves a series of mechanisms that ensure the heart
beats at an appropriate rate and force, adapting to the body's needs.

b. **Summarize the Mechanisms on Which Cardiac Cycle Regulation is Controlled:**

- **Intrinsic Mechanisms (Autoregulation):**

1. **Cardiac Conduction System:** Includes the sinoatrial (SA) node,
atrioventricular (AV) node, and Purkinje fibers, regulating the heart's electrical
impulses.
2. **Frank-Starling Law:** Within limits, the greater the volume of blood in the
heart during diastole, the greater the force of contraction during the next systole.

- **Extrinsic Mechanisms (Neural and Hormonal Control):**

1. **Sympathetic Nervous System Activation:** Releases norepinephrine,
increasing heart rate and force of contraction (positive chronotropic and inotropic
effects).
2. **Parasympathetic Nervous System Activation:** Through the vagus nerve,
releases acetylcholine, reducing heart rate (negative chronotropic effect).
3. **Hormonal Regulation:** Hormones like epinephrine and norepinephrine from
the adrenal medulla can influence heart rate and contractility, while hormones like
angiotensin II can impact blood volume and pressure.

**4. Cardiac Muscle, Ventricular & Pacemaker Potentials**

a. **Define Cardiac Muscle:**

- Cardiac muscle is a specialized type of muscle found in the heart. It is striated,
involuntary, and possesses unique features like intercalated discs for coordinated
contractions.
b. **Define Ventricular Potentials:**
- **Resting Potential:** The electrical charge across the cardiac cell membrane
when the cell is not stimulated.
- **Depolarization:** Sodium influx causes a rapid change in membrane potential,
leading to muscle contraction.
- **Plateau Phase:** A transient period of maintained depolarization due to
calcium influx, prolonging the contraction and preventing tetany.
- **Repolarization:** Potassium efflux restores the cell to its resting state.

c. **Define Pacemaker Potentials:**

- Pacemaker cells in the sinoatrial (SA) node generate spontaneous
depolarizations.
- **Pacemaker Potential:** Gradual depolarization caused by a mixed sodium and
potassium current.
- **Threshold:** Once a certain potential is reached, an action potential is
initiated, leading to atrial contraction and the propagation of electrical signals
through the heart.

**5. Excitatory-Conductive System (Tissues) of the Heart**

a. **Summarize Specialized Conductive System of Heart Muscles:**

- The excitatory-conductive system of the heart comprises specialized tissues
that coordinate and propagate electrical signals for rhythmic heart contractions.
- **Sinoatrial (SA) Node:** Located in the right atrium, the primary pacemaker
initiates electrical impulses.
- **Atrioventricular (AV) Node:** Delays impulses, allowing atria to contract before
ventricles.
- **Bundle of His:** Conducts signals to the interventricular septum.
- **Purkinje Fibers:** Distribute signals throughout the ventricles, ensuring
synchronized contraction.
- This system ensures an organized and sequential contraction, facilitating
efficient blood pumping through the heart.

**6. Normal ECG-Waves & the Mechanism of Their Positive & Negative
Recordings**

a. **Enlist Normal ECG Waves:**

- **P Wave:** Represents atrial depolarization.
- **QRS Complex:** Indicates ventricular depolarization.
- **T Wave:** Signifies ventricular repolarization.

b. **Summarize the Mechanism of Positive Recording of ECG Wave:**

- **Positive Deflection:** Occurs when the electrical impulse moves toward a
positive electrode.
- **P Wave:** Positive deflection as atrial depolarization moves toward the
positive electrode (usually leads I and II).
- **QRS Complex:** Positive deflection as ventricular depolarization progresses
toward positive electrodes (different leads show variations).
- **T Wave:** Positive deflection as ventricular repolarization moves toward
positive electrodes.

c. **Summarize the Mechanism of Negative Recording of ECG Waves:**

- **Negative Deflection:** Results when the electrical impulse moves away from a
positive electrode.
- **P Wave:** Negative deflection in leads where atrial depolarization moves away
from the positive electrode.
- **QRS Complex:** Negative deflection in leads where ventricular depolarization
moves away from the positive electrode.
- **T Wave:** Negative deflection as ventricular repolarization moves away from
positive electrodes.M

**7. ECG Recording Paper, Leads, Einthoven's Law & Calculation of

Heart Rate by ECG**

a. **Define ECG Recording Paper:**

- ECG recording paper is a graph paper used to record the electrical activity of the
heart. Each small square represents a specific time and voltage, aiding in the
analysis of cardiac events.

b. **Enlist ECG Leads:**

- **Bipolar Limb Leads (I, II, III):** Record electrical activity between two limbs.
- **Unipolar Limb Leads (aVR, aVL, aVF):** Record electrical activity between one
limb and a virtual central point.
- **Chest Leads (V1-V6):** Record electrical activity in the horizontal plane across
the chest.

c. **Explain Einthoven's Law and How It Implements ECG:**

- **Einthoven's Law:** The sum of the electrical potentials in any ECG lead equals
the sum of the potentials in the other two leads.
- This law aids in understanding the relationship between different leads,
facilitating a comprehensive view of cardiac electrical activity.

d. **Restate How Heart Rate is Calculated by ECG:**

- Calculate the number of R waves in a specific time segment (e.g., 6 seconds) on
the ECG strip.
- Multiply this count by 10 to obtain the heart rate per minute.
- This method provides a quick and accurate assessment of heart rate based on
the R-R interval.

**8. Cardiac Arrhythmias - Tachycardia, Bradycardia, Paroxysmal

Tachycardia, Ectopic Pacemakers & Premature Beats**

a. **Describe Cardiac Arrhythmias:**

- Cardiac arrhythmias are abnormalities in the rhythm of the heartbeat. These can
manifest as irregular heartbeats, either too fast (tachycardia) or too slow
(bradycardia), disrupting the normal cardiac cycle.

b. **Define Tachycardia, Bradycardia, Paroxysmal Tachycardia:**

- **Tachycardia:** Abnormally fast heart rate, usually above 100 beats per minute.
- **Bradycardia:** Abnormally slow heart rate, typically below 60 beats per
minute.
- **Paroxysmal Tachycardia:** Sudden, intermittent episodes of rapid heart rate,
often originating from the atria.
c. **Define Ectopic Pacemaker and Premature Beats:**
- **Ectopic Pacemaker:** A region outside the normal pacemaker (usually the SA
node) that initiates electrical impulses, potentially causing arrhythmias.
- **Premature Beats:** Early heartbeats originating from locations other than the
SA node, disrupting the regular heart rhythm. They can be atrial (premature atrial
contractions) or ventricular (premature ventricular contractions).

**9. Cardiac Arrhythmias - Heart/AV Blocks, Atrial/Ventricular Flutter &

Fibrillation, Cardio-Pulmonary Resuscitation (CPR)**

a. **Enlist Different Types of Heart Block:**

- **First-Degree Heart Block:** Prolonged conduction from atria to ventricles.
- **Second-Degree Heart Block:** Intermittent failure of atrial impulses to reach
ventricles.
- **Third-Degree (Complete) Heart Block:** No impulses from atria reach
ventricles, and ventricles initiate their own impulses.

b. **Define Atrial/Ventricular Flutter and Fibrillation:**

- **Atrial Flutter:** Rapid, regular atrial contractions (usually 250-350 beats/min)
causing a fluttering sensation.
- **Atrial Fibrillation:** Chaotic, irregular atrial contractions, compromising
effective blood pumping.
- **Ventricular Flutter:** Rapid, regular ventricular contractions.
- **Ventricular Fibrillation:** Chaotic, irregular ventricular contractions, a medical
emergency requiring immediate intervention.
c. **Summarize Cardio-Pulmonary Resuscitation (CPR):**
- CPR is an emergency life-saving technique that combines chest compressions
and rescue breaths to maintain blood flow and oxygenation when a person's heart
has stopped beating.
- The steps involve assessing responsiveness, activating emergency services,
performing chest compressions at an adequate rate and depth, and providing
rescue breaths until professional help arrives.

**10. Vectorial Analysis of Normal & Abnormal ECG**

a. **Explain How Normal ECG is Analyzed by Vector:**

- Vectorial analysis in ECG involves understanding the direction and magnitude of
electrical currents during cardiac depolarization and repolarization.
- The normal vectorial analysis considers the coordinated depolarization from the
atria to the ventricles, producing recognizable P, QRS, and T waves.

b. **Summarize the Conditions that Cause Abnormal ECG:**

- Various conditions can lead to abnormal ECG, including myocardial infarction,
ischemia, electrolyte imbalances, heart failure, and structural heart diseases.

c. **Enlist the Conditions that Cause Bizarre, Prolonged QRS Complex:**

- **Bundle Branch Blocks (BBB):** Interruption in the normal conduction of
electrical impulses through the bundle branches, leading to delayed ventricular
depolarization.

d. **Enlist the Causes that Cause T-Wave Inversion:**

 - T-wave inversion can result from various conditions, including myocardial
ischemia, infarction, ventricular hypertrophy, and electrolyte imbalances. It is
essential to consider the clinical context for accurate interpretation.

**11. Revision of Heart Topics**

1. **Structure & Properties of Heart & its Muscles:**

- a. Explained the four-chamber structure of the heart and its division into left and
right sides.
- b. Listed properties of the heart, including rhythmic contraction, efficient blood
pumping, and maintenance of blood pressure.
- c. Described the myocardium as the heart muscle and its unique features like
intercalated discs.
- d. Restated properties of heart muscles, emphasizing involuntary contractions
and resistance to fatigue.

2. **Cardiac Cycle, its Events, Pressures & Volume Changes:**

- a. Defined the cardiac cycle as the sequence of events during one heartbeat.
- b. Illustrated events like atrial and ventricular contraction, isovolumetric
relaxation, and ventricular filling.
- c. Summarized changes in volume and pressure during the cardiac cycle,
ensuring unidirectional blood flow.

3. **Cardiac Cycle Regulation (Intrinsic & Extrinsic Mechanisms):**

- a. Explained cardiac cycle regulation involving intrinsic mechanisms (conduction
system, Frank-Starling Law) and extrinsic mechanisms (sympathetic,
parasympathetic, hormonal).
4. **Cardiac Muscle, Ventricular & Pacemaker Potentials:**
- a. Defined cardiac muscle and highlighted features of ventricular potentials.
- b. Described ventricular potentials, including resting potential, depolarization,
plateau phase, and repolarization.
- c. Defined pacemaker potentials and threshold, explaining their role in initiating
action potentials.

5. **Excitatory-Conductive System (Tissues) of the Heart:**

- a. Summarized the specialized conductive system involving the SA node, AV
node, Bundle of His, and Purkinje fibers.

6. **Normal ECG-Waves & the Mechanism of Their Positive & Negative

Recordings:**
- a. Enlisted normal ECG waves (P, QRS, T).
- b. Summarized the mechanism of positive recording for each wave.
- c. Summarized the mechanism of negative recording for each wave.

7. **ECG Recording Paper, Leads, Einthoven's Law & Calculation of Heart Rate by
ECG:**
- a. Defined ECG recording paper and enlisted leads (limb, chest).
- b. Explained Einthoven's Law and its application in ECG.
- c. Restated how heart rate is calculated using R-R intervals on the ECG strip.

8. **Cardiac Arrhythmias - Tachycardia, Bradycardia, Paroxysmal Tachycardia,

Ectopic Pacemakers & Premature Beats:**
- a. Described cardiac arrhythmias as abnormalities in heart rhythm.
- b. Defined tachycardia, bradycardia, and paroxysmal tachycardia.
- c. Defined ectopic pacemakers and premature beats.
9. **Cardiac Arrhythmias - Heart/AV Blocks, Atrial/Ventricular Flutter & Fibrillation,
Cardio-Pulmonary Resuscitation (CPR):**
- a. Enlisted different types of heart blocks (first-degree, second-degree, third-
degree).
- b. Defined atrial/ventricular flutter and fibrillation.
- c. Summarized cardio-pulmonary resuscitation (CPR) as an emergency life-
saving technique.

10. **Vectorial Analysis of Normal & Abnormal ECG:**

- a. Explained how normal ECG is analyzed by vector, considering direction and
magnitude.
- b. Summarized conditions causing abnormal ECG.
- c. Enlisted conditions causing bizarre, prolonged QRS complex.
- d. Enlisted causes of T-wave inversion.

This revision provides a comprehensive overview of key topics related to the heart
and its functions.

**12. Introduction to Circulation & Structure of Blood Vessels,

Pressures & Resistance**

a. **Define Circulation, Blood Pressure, Blood Resistance:**

- **Circulation:** The continuous movement of blood through the heart and blood
vessels, delivering oxygen and nutrients while removing waste products.
 - **Blood Pressure:** The force exerted by blood against the walls of arteries
during circulation, measured in millimeters of mercury (mmHg).
- **Blood Resistance:** Opposition to blood flow in blood vessels, influenced by
vessel diameter, length, and blood viscosity.

b. **Explain Structure of Blood Vessel:**

- **Arteries:** Thick-walled vessels carrying oxygenated blood away from the
heart.
- **Veins:** Thinner-walled vessels returning deoxygenated blood to the heart.
- **Capillaries:** Tiny vessels facilitating the exchange of nutrients and gases
between blood and tissues.
- Understanding the layers (tunica intima, tunica media, tunica externa) and
structural differences between arteries and veins is crucial for comprehending
blood vessel function.

**13. Capillary Circulation & Starling Forces/Pressures Causing Fluid

Exchanges Across the Capillaries**

a. **Describe Capillary Circulation:**

- Capillary circulation involves the smallest blood vessels, capillaries, connecting
arterioles and venules.
- Capillaries facilitate the exchange of nutrients, gases, and waste products
between blood and surrounding tissues.

b. **Summarize Starling Forces/Pressures Causing Fluid Exchange Across Capillary

Membrane:**
- **Capillary Hydrostatic Pressure (Pc):** Pushes fluid out of capillaries into
interstitial spaces.
- **Interstitial Fluid Hydrostatic Pressure (Pif):** Opposes capillary hydrostatic
pressure, favoring fluid reabsorption.
- **Capillary Colloid Osmotic Pressure (πc):** Draws fluid into capillaries due to
proteins in the blood.
- **Interstitial Fluid Colloid Osmotic Pressure (πif):** Opposes capillary colloid
osmotic pressure, favoring fluid reabsorption.
- The balance between these forces regulates fluid movement.

c. **Describe Vascular Expandability:**

- Vascular expandability refers to the ability of blood vessels, particularly arteries,
to stretch and accommodate changes in blood volume.
- This property helps maintain blood pressure and ensures continuous blood flow.

d. **Summarize Function of Arterial and Venous System:**

- **Arterial System:** Carries oxygenated blood away from the heart. Arteries
have thicker walls to withstand higher pressure and maintain blood flow during
ventricular contraction.
- **Venous System:** Returns deoxygenated blood to the heart. Veins have
thinner walls and contain valves to prevent backflow, aiding blood return against
gravity.
- Together, these systems maintain a continuous and regulated circulation
throughout the body.
**14. Lymphatics**

a. **Define Lymphatic System:**

- The lymphatic system is a network of vessels, nodes, and organs that transport
lymph throughout the body. It plays a crucial role in immune function by filtering and
transporting lymph, a fluid containing white blood cells, proteins, and waste
products.

b. **Explain Interstitial Fluid Lymph Flow:**

- Interstitial fluid, the fluid found between cells, is collected by lymphatic
capillaries.
- Lymphatic vessels transport this fluid, now called lymph, through lymph nodes,
filtering and removing impurities.
- The movement of lymph is aided by skeletal muscle contractions, respiratory
movements, and the presence of one-way valves in lymphatic vessels.

**15. Local Control of Blood Flow**

a. **Explain How Circulation is Regulated to Increase Body Demands:**

- **Metabolic Autoregulation:** Tissues release metabolic byproducts (e.g.,
adenosine) during increased activity or oxygen demand.
- **Local Vasodilation:** Metabolic byproducts cause vasodilation in arterioles,
increasing blood flow to meet tissue needs.
- **Local Vasoconstriction:** Decreased metabolic byproducts lead to
vasoconstriction, conserving blood flow in resting conditions.

b. **Explain Humoral Control of Blood Flow:**

- **Vasoactive Substances:** Hormones and local chemicals influence blood
vessel diameter.
- **Vasodilators:** Substances like nitric oxide (NO) cause vasodilation, increasing
blood flow.
- **Vasoconstrictors:** Hormones like angiotensin II cause vasoconstriction,
regulating blood pressure.
- **Endothelin:** Released by endothelial cells, promoting vasoconstriction.
- **Prostaglandins:** Can have both vasodilatory and vasoconstrictive effects
depending on the context.
- These humoral factors contribute to systemic blood pressure regulation and
distribution of blood flow.

**16. Vasomotor Center**

a. **Define Vasomotor Center:**

- The vasomotor center is a region in the medulla oblongata of the brainstem that
plays a crucial role in regulating blood vessel diameter and, consequently, blood
pressure.

b. **Summarize How Vasomotor Center Regulates Blood Pressures:**

- **Sympathetic Nervous System Influence:** The vasomotor center, part of the
sympathetic nervous system, releases norepinephrine.
- **Vasoconstriction:** Norepinephrine causes vasoconstriction, increasing
systemic vascular resistance.
- **Blood Pressure Regulation:** By adjusting the degree of vasoconstriction, the
vasomotor center regulates blood pressure to meet the body's demands.
- **Baroreceptor Reflex:** Baroreceptors in blood vessels detect changes in
pressure, providing feedback to the vasomotor center to adjust vascular tone
accordingly.
- **Integration with Other Regulatory Mechanisms:** Works in coordination with
hormonal factors and local control mechanisms to maintain homeostatic blood
pressure levels.

**17. Arterial Blood Pressure & Its Short-Term Regulation**

a. **Define Arterial Blood Pressure:**

- Arterial blood pressure is the force exerted by blood against the walls of arteries,
primarily generated by the contraction of the left ventricle during systole and
maintained during diastole.

b. **Define Different Phases of Arterial Blood Pressure:**

- **Systolic Pressure:** The highest pressure during ventricular contraction
(systole).
- **Diastolic Pressure:** The lowest pressure during ventricular relaxation
(diastole).
- **Pulse Pressure:** The difference between systolic and diastolic pressure,
reflecting the force of each heartbeat.
c. **Explain Short-Term Regulation of Blood Pressure:**
- **Baroreceptor Reflex:** Baroreceptors in arterial walls detect changes in
pressure.
- **Rapid Adjustment:** Baroreceptors signal the vasomotor center in the medulla
oblongata.
- **Sympathetic Nervous System Activation:** Increased sympathetic activity
causes vasoconstriction and increased heart rate.
- **Parasympathetic Nervous System Activation:** Activated in response to
decreased blood pressure, slowing the heart rate.
- **Hormonal Regulation:** Short-term adjustments involve hormones like
epinephrine and norepinephrine, enhancing cardiac output and vasoconstriction.
- **Renin-Angiotensin-Aldosterone System (RAAS):** Activation helps retain
sodium and water, increasing blood volume and pressure.
- These mechanisms collectively contribute to rapid adjustments in blood
pressure to maintain homeostasis.

**18. Arterial Blood Pressure Long-Term Regulation**

a. **Summarize the Events for Long-Term Regulation of Blood Pressure:**

- **Renal Regulation:** The kidneys play a crucial role in long-term blood pressure
regulation.
- **Renal Blood Flow and Filtration:** Changes in renal blood flow influence
filtration and fluid balance.
- **Renin-Angiotensin-Aldosterone System (RAAS):** Responds to low blood
pressure by releasing renin, initiating a cascade leading to the production of
angiotensin II.
 - **Angiotensin II:** Causes vasoconstriction, stimulates aldosterone release, and
triggers thirst, leading to increased blood volume and pressure.
- **Aldosterone:** Acts on the kidneys to retain sodium and water, further
increasing blood volume.
- **Antidiuretic Hormone (ADH):** Released by the pituitary gland in response to
low blood pressure, promoting water retention by the kidneys.
- **Atrial Natriuretic Peptide (ANP):** Released by the atria in response to high
blood pressure, promoting sodium and water excretion.
- **Fluid Balance and Blood Volume:** These mechanisms collectively regulate
fluid balance, blood volume, and, consequently, long-term arterial blood pressure.

**19. Hypertension, Types, Causes & Effects on the Human Body -

Basics**

a. **Define Hypertension with its Types:**

- **Hypertension:** Also known as high blood pressure, hypertension is a
condition where the force of blood against the arterial walls is consistently too high.
- **Types:**
1. **Primary (Essential) Hypertension:** The most common type with no
identifiable cause.
2. **Secondary Hypertension:** Caused by an underlying condition, such as
kidney disease or hormonal disorders.

b. **Enlist Causes of Hypertension:**

- **Risk Factors:**
1. **Age:** Risk increases with age.
2. **Family History:** Genetic predisposition.
 3. **Obesity:** Excess weight increases the workload on the heart.
4. **Lack of Physical Activity:** Inactivity contributes to hypertension.
5. **Tobacco Use:** Smoking and chewing tobacco can elevate blood pressure.
6. **Excessive Salt Intake:** High sodium consumption can lead to fluid
retention.
7. **Excessive Alcohol Consumption:** Heavy drinking can raise blood pressure.

c. **Summarize the Effect of Increased Blood Pressure on the Human Body:**

- **Cardiovascular System:** Prolonged hypertension can damage arteries,
leading to atherosclerosis, increasing the risk of heart disease and stroke.
- **Kidneys:** High blood pressure can damage the kidneys, reducing their ability
to filter waste and maintain fluid balance.
- **Brain:** Hypertension increases the risk of cognitive decline, stroke, and other
brain-related issues.
- **Eyes:** Chronic high blood pressure can damage blood vessels in the eyes,
leading to vision problems.
- **Other Organs:** Hypertension can affect various organs and contribute to
overall cardiovascular and organ system damage. Regular monitoring and
management are crucial.

**20. Cardiac Output, Cardiac Index, Factors Regulating Cardiac

Output & Methods of Measurement**

a. **Define Cardiac Output and Cardiac Index:**

- **Cardiac Output (CO):** The volume of blood ejected by the heart per minute.
CO = Stroke Volume × Heart Rate.
 - **Cardiac Index (CI):** Cardiac output adjusted for body surface area, providing
a standardized measure. CI = Cardiac Output ÷ Body Surface Area.

b. **Summarize Factors Regulating Cardiac Output:**

- **Stroke Volume (SV):**
1. **Preload:** Volume of blood in the ventricles before contraction.
2. **Contractility:** Force of ventricular contraction.
3. **Afterload:** Resistance against which the heart pumps blood into the aorta.

- **Heart Rate (HR):**

1. **Autonomic Nervous System:** Sympathetic stimulation increases heart rate,
while parasympathetic stimulation decreases it.
2. **Hormones:** Epinephrine and norepinephrine influence heart rate.

c. **Illustrate the Method of Measuring Cardiac Output:**

- **Thermodilution:** A catheter with a temperature sensor is placed in the
pulmonary artery. Cold saline is injected, and the change in blood temperature is
measured to calculate cardiac output.
- **Fick Method:** Oxygen consumption is measured, and the difference in
oxygen content between arterial and mixed venous blood is used to calculate
cardiac output.
- **Electromagnetic Flowmetry:** Measures blood flow using electromagnetic
principles in specialized catheters.
- **Doppler Ultrasound:** Measures blood flow velocities in specific vessels, and
stroke volume is calculated to determine cardiac output.
- **Impedance Cardiography:** Measures changes in thoracic impedance during
the cardiac cycle, estimating stroke volume and cardiac output.
- These methods provide insights into the effectiveness of the heart's pumping
action and are essential in assessing cardiac function.
**21. Heart Sounds, Heart Valves & Valvular Diseases**

a. **Define Different Heart Sounds:**

- **S1 (Lub):** The first heart sound occurs during the closure of the
atrioventricular valves (tricuspid and mitral) and marks the beginning of systole.
- **S2 (Dub):** The second heart sound occurs during the closure of the
semilunar valves (aortic and pulmonary) and marks the beginning of diastole.
- **S3 (Kentucky):** Often considered pathological, occurs during rapid filling of
the ventricles.
- **S4 (Tennessee):** Also considered pathological, occurs at the end of diastole
when the atria contract.

b. **Enlist Different Heart Valves and Their Morphology:**

- **Atrioventricular (AV) Valves:**
1. **Tricuspid Valve:** Between the right atrium and right ventricle.
2. **Mitral (Bicuspid) Valve:** Between the left atrium and left ventricle.
- **Semilunar Valves:**
3. **Aortic Valve:** Between the left ventricle and the aorta.
4. **Pulmonary Valve:** Between the right ventricle and the pulmonary artery.
- Valves are composed of leaflets or cusps, supported by chordae tendineae and
papillary muscles.

c. **Summarize Valvular Diseases, Their Causes and Effects on the Human Body:**
- **Stenosis:** Narrowing of the valve, impeding blood flow.
- **Regurgitation (Insufficiency):** Incomplete closure of the valve, causing
backflow.
- **Causes:**
- **Rheumatic Fever:** Common cause of mitral stenosis.
- **Congenital Defects:** Malformed valves present from birth.
- **Aging:** Degenerative changes affecting valve function.
- **Infections:** Endocarditis can damage valves.
- **Effects on the Human Body:**
- **Reduced Cardiac Output:** Valve dysfunction compromises the heart's
pumping efficiency.
- **Congestion:** Backflow of blood can lead to congestion in the associated
chambers.
- **Risk of Infection:** Damaged valves are more susceptible to infections.
- Timely diagnosis and intervention are crucial to managing valvular diseases and
preventing complications.

**22. Coronary Circulation & Ischemic Heart Diseases - Brief**

a. **Explain Coronary Blood Flow:**

- Coronary circulation is the network of blood vessels supplying the heart muscle
(myocardium) with oxygen and nutrients.
- Coronary arteries, originating from the aorta, branch into smaller vessels,
ensuring adequate blood supply to meet the heart's metabolic demands.

b. **Explain Events Occur Due to Ischemia to the Heart:**

- **Ischemia:** Inadequate blood supply to the myocardium.
- **Events:**
1. **Angina Pectoris:** Chest pain or discomfort due to reduced blood flow and
oxygen supply to the heart muscle.
2. **Myocardial Infarction (Heart Attack):** Prolonged ischemia leading to
irreversible damage or death of heart muscle cells.
3. **Arrhythmias:** Ischemia can disrupt the heart's electrical conduction
system, leading to abnormal rhythms.
4. **Heart Failure:** Chronic ischemic damage can weaken the heart, impairing
its ability to pump effectively.
5. **Complications:** Ischemia contributes to various heart-related
complications, emphasizing the importance of preventing and managing coronary
artery diseases.

**23. Congenital Heart Defects - Patent Ductus Arteriosus & Tetralogy

of Fallot**

a. **Define Congenital Heart Defects:**

- Congenital heart defects are structural abnormalities present in the heart at
birth, often affecting its chambers, valves, or blood vessels.

b. **Explain Patent Ductus Arteriosus (PDA) & Tetralogy of Fallot:**

- **Patent Ductus Arteriosus (PDA):**
- **Description:** Failure of the ductus arteriosus, a fetal blood vessel
connecting the pulmonary artery and aorta, to close after birth.
- **Effect:** Causes abnormal blood flow between the aorta and pulmonary
artery, increasing the workload on the heart.
- **Symptoms:** May vary from none to significant respiratory distress and poor
growth.
- **Treatment:** Medications or surgical closure.
 - **Tetralogy of Fallot:**
- **Description:** A complex congenital heart defect consisting of four
abnormalities:
1. **Ventricular Septal Defect (VSD):** Hole in the wall separating the heart's
lower chambers.
2. **Pulmonary Stenosis:** Narrowing of the pulmonary valve and artery.
3. **Right Ventricular Hypertrophy:** Thickening of the right ventricle due to
increased workload.
4. **Overriding Aorta:** The aorta is positioned over the VSD.
- **Effect:** Leads to mixing of oxygenated and deoxygenated blood, causing
cyanosis (bluish tint).
- **Symptoms:** Cyanosis, difficulty in feeding, poor growth.
- **Treatment:** Surgical intervention to correct the defects.

**24. Atherosclerosis, Myocardial Infarction, & Cardiac Failure**

a. **Define Atherosclerosis:**
- **Atherosclerosis:** A chronic inflammatory condition characterized by the
buildup of plaque (composed of cholesterol, fatty substances, cellular waste,
calcium) in the walls of arteries.
- **Effect:** Narrowing and hardening of arteries, leading to reduced blood flow.

b. **Define Myocardial Infarction (Heart Attack):**

- **Myocardial Infarction (MI):** Occurs when blood flow to a part of the heart
muscle is blocked, usually by a blood clot. This leads to damage or death of the
affected heart tissue.
- **Symptoms:** Chest pain, shortness of breath, sweating, and nausea.
 - **Complications:** Can lead to heart failure, arrhythmias, or other life-
threatening conditions.

c. **Define Cardiac Failure:**

- **Cardiac Failure:** Also known as heart failure, it is a condition where the heart
is unable to pump blood effectively to meet the body's demands.
- **Types:**
1. **Left-Sided Heart Failure:** Inadequate pumping of oxygenated blood to the
body.
2. **Right-Sided Heart Failure:** Inability to effectively pump deoxygenated
blood to the lungs for oxygenation.
- **Symptoms:** Shortness of breath, fatigue, fluid retention (edema).
- **Causes:** Result from conditions such as coronary artery disease,
hypertension, or myocardial infarction.
- **Treatment:** Medications, lifestyle changes, and in severe cases, heart
transplant.

**25. Circulatory Shock, Syncope/Fainting**

a. **Explain Circulatory Shock with its Stages and Types:**

- **Circulatory Shock:** A life-threatening condition where there is insufficient
blood flow to meet the body's metabolic demands.
- **Types:**
1. **Hypovolemic Shock:** Due to reduced blood volume (e.g., hemorrhage,
dehydration).
2. **Cardiogenic Shock:** Caused by heart failure or inadequate pumping of
blood.
 3. **Distributive Shock:** Widespread vasodilation leading to decreased blood
pressure. Subtypes include septic, anaphylactic, and neurogenic shock.
4. **Obstructive Shock:** Due to mechanical obstruction of blood flow (e.g.,
pulmonary embolism, cardiac tamponade).
- **Stages:**
1. **Compensatory Stage:** Initial response to maintain blood pressure.
2. **Progressive Stage:** Compensatory mechanisms fail, and vital organ
perfusion decreases.
3. **Refractory Stage:** Irreversible damage to organs, often fatal.

b. **Enlist the Causes of Circulatory Shock:**

- **Hypovolemic Shock Causes:**
- Hemorrhage (internal or external bleeding).
- Severe dehydration (vomiting, diarrhea).
- **Cardiogenic Shock Causes:**
- Heart attack (myocardial infarction).
- Severe heart failure.
- **Distributive Shock Causes:**
- Septicemia (severe infection).
- Anaphylaxis (severe allergic reaction).
- Neurogenic shock (spinal cord injury).
- **Obstructive Shock Causes:**
- Pulmonary embolism.
- Cardiac tamponade (fluid accumulation around the heart).

c. **Explain How Circulatory Shock is Managed in Clinical Setup:**

- **Treatment Goals:**
- Restore and maintain blood flow to vital organs.
- Address underlying causes.
 - **Therapies:**
- Intravenous fluids to increase blood volume.
- Vasopressors to constrict blood vessels.
- Inotropic medications to improve heart function.
- Treatment of underlying conditions (e.g., antibiotics for sepsis).
- Surgical interventions (e.g., for obstructive causes).
- Continuous monitoring and supportive care.

d. **Define Syncope/Fainting with its Causes:**

- **Syncope (Fainting):** A temporary loss of consciousness due to a sudden
drop in blood flow to the brain.
- **Causes:**
- Vasovagal syncope (common fainting triggered by emotions or stress).
- Orthostatic hypotension (sudden drop in blood pressure upon standing).
- Cardiac issues (arrhythmias, structural heart problems).
- Neurological causes (seizures, neurological disorders).
- Dehydration, medications, or blood loss.
- **Management:** Identifying and addressing underlying causes, lifestyle
modifications, and, if necessary, medication adjustments.

**26. Revision - Circulation**

In this revision, let's recap key points about circulation:

- **Circulation Overview:**
- Continuous movement of blood through the heart and blood vessels.
- Facilitates the delivery of oxygen, nutrients, and removal of waste products.
- **Blood Vessels:**
- **Arteries:** Carry oxygenated blood away from the heart.
- **Veins:** Return deoxygenated blood to the heart.
- **Capillaries:** Allow exchange of substances between blood and tissues.

- **Blood Pressure:**
- **Arterial Blood Pressure:** Force exerted by blood against arterial walls.
- **Systolic Pressure:** Highest during ventricular contraction.
- **Diastolic Pressure:** Lowest during ventricular relaxation.

- **Blood Flow Regulation:**

- **Local Control:** Autoregulation based on tissue needs.
- **Humoral Control:** Hormones influencing vessel diameter.
- **Autonomic Nervous System:** Sympathetic and parasympathetic regulation.

- **Long-Term Blood Pressure Regulation:**

- **Renal Regulation:** Kidneys influence blood volume and pressure.
- **RAAS System:** Responds to low blood pressure.
- **Hormonal Factors:** ADH, aldosterone, and natriuretic peptides.

- **Vasomotor Center:**
- Located in the medulla oblongata.
- Regulates blood vessel diameter through sympathetic activity.

- **Cardiac Output:**
- **Definition:** Volume of blood ejected by the heart per minute.
- **Factors:** Stroke volume and heart rate.
- **Regulation:** Autonomic nervous system and hormonal factors.
- **Heart Sounds & Valves:**
- **S1 (Lub):** Closure of AV valves (tricuspid, mitral).
- **S2 (Dub):** Closure of semilunar valves (aortic, pulmonary).
- **Valves:** Tricuspid, mitral, aortic, pulmonary.

- **Cardiovascular Diseases:**
- **Atherosclerosis:** Plaque buildup in arteries.
- **Myocardial Infarction:** Heart attack due to blocked blood flow.
- **Cardiac Failure:** Inability of the heart to pump effectively.

- **Circulatory Shock:**
- **Types:** Hypovolemic, cardiogenic, distributive, obstructive.
- **Stages:** Compensatory, progressive, refractory.
- **Causes:** Hemorrhage, heart failure, infection, obstruction.

- **Syncope/Fainting:**
- **Definition:** Temporary loss of consciousness due to reduced blood flow to the
brain.
- **Causes:** Vasovagal, orthostatic hypotension, cardiac or neurological issues.

This revision covers essential aspects of circulation, blood pressure regulation,

cardiac function, and common cardiovascular conditions.