CardioVascular

Physiology

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Objectives:
 At the end of the course, students will be able to:
– Describe functional anatomy of the heart.
– Appreciate the electrical activity of the heart.
– Correlate the electrical activity with mechanical
events of the heart.
– Describe the concept of cardiac output and its control.
– Apprehend hemodynamics and vascular physiology.

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1. Over view of cardiovascular system
Three basic components:
1. Heart

2. Vascular system
3. Blood

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Division of the Circulation:
• Pulmonary circulation

– The flow of blood between heart and lungs.

• Systemic circulation
– The flow of blood between heart and the
body systems.

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The Heart Wall
•The Heart wall consists of three layers

1. Epicardium (visceral pericardium)

2. Myocardium

3. Endocardium.

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Myocardium:
– The thick muscular part of the heart which
produces the force to pump blood.
– Made up of 3 types of muscles.
1. Contractile unit
2. Pacemaker unit
3. Conducting unit

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Heart Chambers:
• It is made up of 4 chambers – 2 atria & 2 ventricles.
• The two upper chambers, which receive blood
returning to the heart, are called atria (singular,
atrium).
• The two lower chambers are called ventricles, which
pump blood out of the heart.
– Ventricular muscle is more thicker than atria.
– The left ventricle is two to four times as thicker
than the right(10-15mm).

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Valves of the Heart:
1. Atrioventricular valves
 Tricuspid valve – between right atrium
and right ventricle
 Bicuspid Valve (Mitral valve) -
between left atrium and left ventricle

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 2. Semilunar valves:
 Pulmonary valve – between the opening
of pulmonary artery & right ventricle.
 Aortic valve – between the opening of
aorta & left ventricle.

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• The main function of valves are to ensure one way blood flow.

– Tricuspid valve : prevent back flow of blood from

right ventricle to right atrium.
– Mitral/bicuspid valve: prevent back flow of blood
from left ventricle to left atrium.
– Pulmonary Semilunar valve: Prevents back-flow of
blood from the pulmonary artery into the right
ventricle.
– Aortic Semilunar Valve: Prevents backflow of blood
from aorta into left ventricle.

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 Fig .Blood flow through heart
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Innervations to the Heart:
 Parasympathetic fibers:
 Arise from the medulla & pass through the
vagus nerve.
 Parasympathetic mainly innervates SA node,
atria and AV node.
 No direct Ventricular innervations - Vagal escape
(Ventricular escape).
 Cardioinhibitory effect

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 The Sympathetic Fibers:
– Arise from the upper thoracic segments of
spinal cord & pass through the sympathetic
nerves.
– Innervate all parts of the heart.
– Cardioacceleration effect

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 Electrical Activity of the Heart:
Two specialized types of cardiac muscle cells:
1. Contractile cells:
• 99% of cardiac muscle cells
• Do mechanical work of pumping
• Normally do not initiate its own action potentials
2. Auto rhythmic cells:
• Do not contract
• Specialized for initiating and conducting action potentials,
responsible for contraction of working cells.
• Pacemakers and conducting fibers

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Pacemaker Cells:
• Is a strip of modified muscle located on the
posterior wall of the right atrium.
• Contains small myocytes with only scanty
myofibrils.
• These cells are responsible for a unique property
of the heart: its ability to contract without any
outside signal.
• The Sinoatrial node(SA node) in the right atrium
is the primary pacemaker of the heart.
• The Atrioventricular node(AV node) located b/n
Rt atrium and Rt ventricle is the secondary
pacemaker.

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Intrinsic Properties of Cardiac cells:
• Cardiac function is not fully dependent on intact
nervous pathways.
• Heart continues to beat after full denervation
because of the intrinsic properties it has.
1.Automaticity:
• Ability to generate action potentials(pace
making).
 Rhythmicity: The regular generation of these
action potentials

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Rate of autorhythmicity:
• SA Node: 60-100 beats/min

• AV Node: 40-60 beats/min

• Bundle of His: 30 beats /min

• Purkinje fibers: 15 beats/min(incompatible with

life)

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2. Conductivity:
- Ability to transduce a signal/action potential
3. Contractility/:
- Ability to contract
- Atrial & ventricular muscles
4. Excitability
- The ability to respond to certain stimuli.

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Spread of Cardiac Excitation:

SA node AV node

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 Electrocardiogram ( ECG )
• Defn : Graphical representation of electrical
activities of the heart during each cardiac cycle
recorded from the surface of the body.
 Biophysical Basis:

– The electrical events of the heart are conducted

through out the body in all directions, as the body
fluids acts as volume conductor. It is also
conducted to the surface of the body.

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• Information obtained from ECG:

– Relative size of chambers

– Rhythm and conduction disturbance.

– Extent, location and progress of ischemic damage.

– Electrolyte disturbance.

– Influence of drugs.

– Heart rate

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 Electrocardiogram ECG

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• P Wave

Atrial depolarization
• QRS complex Wave
ventricular depolarization
• T wave
Ventricular repolarization

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Pacemaker abnormalities:

• Sinus tachycardia: HR above 100bpm

• Sinus bradycardia: HR below 60bpm
• Is normal phenomenon in well trained
people.

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 Discussion
• Does our heart contract without any external
stimuli? why?
• What is plateau phase of the cardiac action
potential?
• Draw ECG wave and indicate the deflections?
• What are the function of AV node?
• Where is the source of Ca++ for cardiac muscle
contraction?

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 Cardiac Cycle:
 The sequence of cyclical events that takes
place as a heart works to pump blood through
the body.
 The frequency of the cardiac cycle is the heart
beat.
• An average normal heart beat is 70-80
beats/minute
• Has two phases: Systole and Diastole.

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 Heart Sounds:
 Heart sounds (lub-dup) are associated with closing of
heart valves.
• First heart sound -Closure of AV valves. signifies
beginning of systole (contraction).
• Second heart sound -Closure of Aortic & Pulmonic
valves (Semilunar valves).
• Third heart sound (sometimes) -due to rapid
ventricular filling.
• Fourth heart sound (occasionally)- during atrial
contraction.

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The Cardiac Output (CO)
• Is the amount of blood pumped by each ventricle in one minute.
• Is the product of Heart Rate (HR) and Stroke Volume (SV)
• HR is the number of heart beats per minute
• SV is the amount of blood pumped out by a ventricle with each
beat.
 E.g {CO (ml/min) = HR (75 beats/min) x SV(70 ml/beat)}

 CO = 5250 ml/min (5.25 L/min)

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Stroke volume is determined by:
I. End diastolic volume(EDV): volume of
blood in the ventricles at end of diastole.
II. Total peripheral resistance(TPR): impedance
to blood flow through arteries.
III.Contractility: strength of ventricular
contraction

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Factors affecting Cardiac output:
• Exercise
• Position
• Sleep
• Emotions
• Venous return/blood volume
• Peripheral resistance
• Contractility
• Neuronal and hormonal…

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 Stroke volume

Strength of cardiac contraction

•An increase venous
return, increase EDV, so
End-diastolic volume
that increase SV.

Venous return

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36
 Estimated distribution of cardiac output at rest

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 Discussion
1. Define Cardiac Output?

2. Define stroke volume?

3. State the relation between cardiac output and

blood volume?

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Biophysics of blood flow (hemodynamic)
• Hemodynamic: is the relationship between blood flow, pressure
and resistance.
 Blood flow (Q) is determined by two factors:
1. Pressure difference (P)
• Q depends on P1-P2 (P) (pressure gradient)
2. Vascular resistance (R) acting along blood vessels
• R= measure of friction between blood vessel and moving fluid:
• Q = P (Ohm’a law)
R

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Determinant of Resistance (R):
• Fluid viscosity: Resistance is directly
proportional to the viscosity of the blood.
• Tube length (L): Constant in body, resistance
is directly proportional to the length of the
vessel.
• Tube radius (r): Resistance is inversely
proportional to the fourth power of the vessel
radius.

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 The Vascular System:

• Functions of blood vessels:

 Distribution of blood

 Exchange of materials with tissues

 Return of blood to the heart

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Classification of Vessels:
1. Elastic vessels:
– Example: Aorta, big arteries
– Pressure storing components
– High ability of stretching and recoiling
2. Resistance Vessels
– Example: small arteries and arterioles
– High muscular component
– Develop high resistance
– Regulate blood flow

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3. Exchange vessels:
• Capillaries
• Made up of endothelium
• Thin enough for exchange
• 3 types: Continuous, Discontinuous and Fenestrated
capillaries
4. Capacitance vessels (big to small veins)
– Very high capacity of distension
– Can accommodate large volume of blood (65% of
blood volume).

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Fig: Flow velocities, blood volumes, blood pressures, and vascular
resistances in the peripheral vasculature from aorta to right atrium.44
 Arterial Blood Pressure (ABP)
 Blood pressure in the aorta and other big arteries.
 ABP is the lateral pressure exerted by the blood on the
arterial walls.
 It oscillates during each cardiac cycle between a maximum
called systolic BP and a minimum called diastolic BP.
 ABP is conventionally written as systolic (peak, ejection
pressure)/diastolic (minimum) blood pressure.

In normal adult  120/80 mmHg.

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Mean Arterial Pressure:
• It is the average pressure in the arteries throughout
cardiac cycle.
• MAP is the average effective pressure that drives blood
through the systemic organs.
• It is calculated by the following formula:
• MAP = DBP + (SBP - DBP)
3

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Importance of arterial BP
1. Maintains tissue perfusion.
2. Produces the capillary hydrostatic pressure.

3. The Diastolic BP:

• Assures continuous blood flow to tissues even in the
diastolic phase.
• Is essential for the normal coronary blood flow
• Prevents blood stasis in the arteries during ventricular
diastole

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General factors that affect arterial BP:
• Gravitational effect
• Age/Sex
• Exercise
• Body weight
• Emotion
• Deep sleep
• Race

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 Blood Pressure Measurement
• Direct measurement/ invasive
• Indirect measurement /non invasive=
sphygmomanometer

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Auscultatory method 51
 Factors that determine and maintain
ABP

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Regulation of the Overall Circulation:
 Crucial mechanism:
 Adjustment of TPR and CO to maintain pressure
gradient for flow through vascular system.
 Adjust vessel capacity and blood volume.
• Regulatory processes:
1.Short term Control mechanisms( e.g baroreceptors
reflex)

2.Long-term Control mechanisms

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Short-term control mechanisms:
• Predominantly vasomotor adjustment
and neuronal control.
Baroreceptor reflexes:
– Location of receptors:
• Aortic arch
• Carotid sinus

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• Neural components of the arterial baroreceptor reflex.
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2. Long Term Regulation:
– A slow, hormonal regulation
– Is used in long term blood pressure
regulation by adjustment of blood volume
via renin-angiotensin aldosterone system.

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Pathophysiology of blood pressure
 Hypertension
 140/90 = 18-49yrs
– 160/95 = over 50yrs
• Hypotension

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 Types of Hypertension
• Primary or essential hypertension (95%).
• If cause of hypertension can’t be determined
• Secondary hypertension (5%)
• Hypertension due to identifiable cause
• Renal, endocrine, cardiovascular diseases are
main causes.

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Therapeutic Principles:
• Systemic hypertension treated through one of
the following strategies.
1.Reduction of the total blood volume (and thus
stroke volume).
2.Reduction of the cardiac frequency(and reduce
cardiac output.
3.Reduction of the TPR with vasodilators

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Circulatory Shock:
• Generalised inadequacy of blood flow through the
body.
• Hypoperfusion compromises the delivery of oxygen
and nutrients and the removal of metabolites.
• Tissue hypoxia shifts metabolism to anaerobic
pathways with production of lactic acid.

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Causes:
I. Hypovolemic
II. Cardiogenic
III. Septic
IV. Anaphylactic
V. Neurogenic

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