Cardiovascular Physiology:

Circuitry, Hemodynamics, Electrophysiology

Overview: Cardiovascular System

Functions of CV system
Deliver blood to tissues
Provides nutrients to cells for metabolism Removes wastes from cells

Components:
Blood Vessels Heart

Blood vessels:
Arteries Arterioles Capillaries Venules Veins

Divisions: Systemic circulation: Left heart Left ventricle pumps blood to all organs EXCEPT lungs Pulmonary circulation: Right heart Right ventricle pumps blood to lungs

Overview: The Heart

Two functional halves
Atria Ventricles

Wall of heart
Myocardium
Cardiac muscle

Inside pericardium Valves

Atrioventricular:
Tricuspid valve (right) Bicuspid valve (left)

Semilunar:
Pulmonary valve (right) Aortic valve (left)

Circuitry

Circuitry of Blood Flow

Sequential blood flow:
Left heart systemic circulation right heart pulmonary circulation left heart

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Blood oxygenated in lungs returns to left atrium via pulmonary vein Blood flows from left atrium to left ventricle through mitral valve (AV valve) Oxygenated blood fills left ventricle

Blood leaves left ventricle through aortic valve into aorta Blood flows through arterial system

Circuitry of Blood Flow

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Cariac output distributed among organs

Blood flow from organs collected in veins vena cava Vena cava carriers blood to right heart

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Right atrium fills with blood (venous return)

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Venous blood flows from fight atrium to right ventricle via tricuspid valve (AV valve) Blood ejected from right ventricle into pulmonary artery through pulmonary valve Blood flows through pulmonary artery to lungs, where blood is oxygenated (CO2 removed) Oxygenated blood returned to left atrium via pulmonary veins

Left and Right Heart

Cardiac output
Rate blood is pumped from either ventricle Cardiac output of left ventricle = cardiac output of right ventricle

Venous return
Rate blood is returned to atria from veins Venous return to left heart = venous return to right heart

Cardiac output from heart = venous return to heart

Hemodynamics

Blood Flow, Pressure, & Resistance

Similar to current, voltage, and resistance in electrical circuits
Ohms Law: I = V/R

Q = P/R
Q = flow (mL/min) P = pressure difference (mm Hg) R = resistance (mm Hg/mL/min)

Direction of blood flow determined by direction of pressure gradient (high to low pressure) Major mechanism for changing blood flow: changing R in blood vessels R = P/Q

Resistance to Blood Flow

Poiseuille equation:
R = resistance = viscosity of blood L = length of blood vessel r4 = most important relationship to R

4 Pr Q= 8nl

Series Resistance
Arteries, arterioles, capillaries, venules, and veins are arranged in series Total R = sum of individual Rs

Parallel Resistance
Arteries branch to serve many organs
Each organ can regulate its own blood flow

Total R in parallel < any individual Rs

Flow through each organ is a fraction of total flow Adding another R to circuit decrease in total R

Viscosity of Blood

Primarily due to RBCs

Hematocrit
% of blood that is cells

Greater % greater viscosity

Laminar Flow
Laminar flow:
Parabolic profile of velocity Layer of blood next to wall adheres to it Velocity of flow at vessel wall is 0, velocity flow at center is maximal

Turbulent flow
Irregularity in blood vessel Requires more energy to move

Reynolds Number
Predicts whether blood flow will be turbulent
= blood density d = blood vessel diameter v = blood flow velocity = blood viscosity

If NR < 2000 laminar flow

Example: Anemia

Pressure Profile of Vasculature

Aorta: high P
Cardiac output Low compliance of arterial wall

Arterioles: dramatic decrease in P

High resistance to flow

Capillaries: further decease in P

Frictional resistance to flow Filtration of fluid out

Large arteries: high P

High elastic recoil of arterial walls

Small arteries: decreasing arterial P

Venules & veins: further decrease in P

High compliance and large diameters

Cardiac Electrophysiology

Cardiac Muscle
All contractile cardiac muscle cells contract on every heart beat Excitable Excitation-contraction coupling Cardiac muscle as a syncytium

Innervation
Sympathetic
Innervates entire heart Releases norepinephrine
Binds B receptors

Parasympathetic
Innervates only specific parts of heart Releases ACh
Binds muscarininc Rs

Blood supply:
Coronary blood supply (from systemic arteries)

Gap junctions: cells so interconnected that when one cell becomes excited, the AP spreads to all of them

Cardiac Electrophysiology: General Review

Heart as a pump ventricles must be electrically activated to contract: Initiation of action potentials from SA node APs then conducted to entire myocardium Contraction
Gap junctions: cells so interconnected that when one cell becomes excited, the AP spreads to all of them
Cardiac muscle as a syncytium

Cardiac Action Potentials

Two kinds of heart cells:
1. Contractile
Atria and ventricles APs lead to contraction and generation of force/pressure

2.

Conducting
SA node, AV node, bundle of His, Purkinje system Rapidly spread APs over entire myocardium

Sequence of Excitation
Pathway of action potentials in heart: 1. SA node
Where AP is initiated Self-excitable Pacemaker

2.

Internodal tracts
Conducts impulse from SA node to AV node and throughout atria

3.

AV node
Slow conduction delay Diminished number of gap junctions

4.

Bundle of His
Conducts impulse from atria to ventricles

5.

Purkinje system
Conducts impulse to all parts of ventricles Fast conduction Increased gap junctions

Normal Sinus Rhythm

Three requirements
AP must originate in SA node SA nodal impulses must occur regularly at a rate of 60-100 impulses per minute Activation of myocardium must occur in correct sequence and with correct timing

APs in Ventricles and Atria

Long duration Long refractory period Stable resting membrane potential Plateau
Sustained period of depolarization

Phases of Action Potentials:

Ventricles and Atria
Phase O, Upstroke
Rapid depolarization Na+ inward current through fast Na+ channels

Phase 1, Initial Repolarization

Inactivation gates close on fast Na+ channels K+ moves out due to electrochemical gradient (leak channels)

Phase 2, Plateau
Activation of slow Ca2+ channels Ca2+ moving in balances K+ moving out

Phase 3, Repolarization
Inactivation of slow Ca2+ channels Opening of voltage-gated K+ channels

Phase 4, Resting Membrane Potential

Voltage-gated K+ channels close

Action Potentials in SA Node

Differences:
Automaticity Unstable resting membrane potential No sustained plateau
Na+ Ca2+ K+

Phases:
Phase 0: upstroke
Activation of voltage-gated Ca2+ channels

Phase 3: repolarization
Opening of voltage-gated K+ channels Inactivation of voltage-gated Ca2+ channels

Phase 4: spontaneous depolarization (Pacemaker potential)

Slow closing of voltage-gated K+ channels Inward Na+ current = If (slow movement of Na+ to inside)

The rate of Phase 4 sets the heart rate

Latent Pacemakers
Automaticity (phase 4 depolarization)
AV node Bundle of His Purkinje fibers
Location
SA Node AV node Bundle of His

Firing Rate (impulses/min)

70-80 40-60 40 15-20

Overdrive suppression

SA node has fastest firing rate Purkinje fibers SA node drives other firing rates Spontaneous depolarization is suppressed

Ectopic pacemaker:
SA node firing rate decreases or stops Latent pacemaker firing rate increases Conduction of APs from SA node is blocked

ExcitationContraction Coupling
AP initiated in myocardial cell membrane Depolarization spreads to interior of cell via T-tubules Inward Ca2+ current from T-tubules (through L-type channels) Calcium-Induced Calcium Release:
Inward Ca2+ current Initiates release of more Ca2+ from SR
Through Ca2+ release channels (ryanodine receptors)

Ca2+ binds troponin C tropomyosin moved cross-bridge formation Cross-bridge cycling

Continues as long as there is enough intracellular Ca2+