Cardiovascular Physiology

by

H. Khorrami Ph.D.

http://khorrami1962.spaces.live.com
http://www.scribd.com/khorrami4
khorrami4@yahoo.com
 Objectives
• Action potential
• Conductive system
• Heart pump
• Electrocardiogram
• Control of heart
• Circulation
 Pericardial sac
• Protection
• Lubrication
• Nourishment
• Anchoring
 Cardiac Muscle
• Cardiac Muscle
• Atrial muscle
• Ventricular muscle
• Specialized excitatory & conductive muscle fibers
• Cardiac Muscle as a Syncytium
• Intercalated disc “communicating” junctions (gap junctions) - totally
free diffusion of ions
• Atrial syncytium
• Ventricular syncytium
Conductive System
 Cardiac Muscle Action Potential
• Depolarization
• Fast Na+ channels
• Plateau
• Slow Ca++ channels
– Slow to open
– Slow to close
• After depol. cardiac muscle
membrane permeability to K+
decreases
• Ca++ thus pumped in –
excitation-contraction coupling
• Repolarization
• Slow K+ channels
• Refractory Periods
• 0.25 - 0.3 sec (Absolute)
– Corresponds to plateau
• 0.05 sec (Relative)
AP Comparison
Cardiac Muscle Action Potential
Cardiac Muscle Action Potential
Action potential
Step2
Step3
Refractory period
 Cardiac Cycle
• Cardiac events occurring from beginning of one
heartbeat to the beginning of the next beat
• Each cycle – INITIATED by SA node
– Spontaneous generation of AP in SA node
– AP travels through both atria
– Through A-V bundle into the ventricles
» AV node delay (more than 0.1 second)
» Hence atria contract ahead of ventricles

• Diastole and Systole

– Period of relaxation – Diastole
» Heart fills with blood
– Period of contraction – Systole
» Ejection of blood
 FACTS TO REMEMBER
• SYSTOLE IS CONTRACTION
-THE RISE IN PRESSURE IN THE CONTRACTING
CHAMBER
-BLOOD BEING EJECTED BY THE CONTRACTING
CHAMBER
• DIASTOLE IS RELAXATION
- A FALL IN PRESSURE OF THE RELAXING
CHAMBER
- FILLING OF THE RELAXING CHAMBER
 CARDIAC CYCLE

• The normal duration of the cardiac cycle is 0.8 sec

• Each beat of the heart consists of systole and diastole
of atria and ventricles.
• Systole is the contraction of the heart during which
blood is ejected out from the heart
• Diastole is the relaxation of the heart during which
the chambers of the heart are filled with blood
 Cardiac Cycle
ATRIAL EVENTS:
• Atrial Systole 0.1 sec
• Atrial Diastole 0.7 sec

VENTRICULAR EVENTS:
• Ventricular systole 0.3 sec
• Ventricular diastole 0.5 sec

• Diastasis 0.4 sec

 Ventricular systole
Duration 0.3 sec. It has 3 phases.

1. Isovolumetric contraction phase: 0.05 sec

2. Rapid ejection phase: 0.10 sec

3. Reduced ejection phase: 0.15 sec

 Events in the cardiac cycle

• Initially, during diastole, all chambers are

relaxed and filled with blood due to venous

return
ATRIAL SYSTOLE
The end of diastole

• Atrial systole: 0.1 sec.

• Atrial pressure rises.

• Right atrium : 4-6 mmHg

• Left atrium : 7-8 mmHg
ISOVOLUMETRIC CONTRACTION
The Beginning of systole
After the ventricles have filled by atrial
contraction, AV (Atrio-ventricular) valves
close as the ventricles begin their
contraction and intraventricular pressure
increases
The semilunar valves remain closed and this
makes ventricle a closed cavity
The volume in the ventricles remains
unchanged throughout the contraction,
hence the name isovolumetric
Closure of the AV valves in this phase causes
the first heart sound
RAPID EJECTION
The semilunar valves (aortic and
pulmonary) open at the
beginning of this phase.

2/3rd of stroke volume ejected

Aortic pressure increases but

slightly less than ventricles
REDUCED EJECTION
The end of systole
The continued contraction of the
ventricles pushes the remaining blood
into the blood vessels ( Aorta and
pulmonary artery) slowly

At the end of this phase the ventricles

begin to relax
 PROTODIASTOLIC PHASE
• When ventricles begin to relax, the AV valves
close and the semilunar valves remain open.
• As the intra ventricular pressure decreases
below the pressure in the aorta and
pulmonary artery, the blood tries to come
back into the ventricles.
• This is prevented by closure of semilunar valve
which produces the second heart sound
ISOVOLUMETRIC RELAXATION
The beginning of Diastole

In this phase, the ventricle is in a

closed cavity, which is relaxing
During this phase the intra ventricular
pressure goes below the atrial
pressure
FIRST RAPID VENTRICULAR FILLING

Since there is reduced intra

ventricular pressure in this phase,
causing the semilunar valves to
close

The AV valves open and there is

sudden rush of blood into the
ventricles from the atria
REDUCED VENTRICULAR FILLING
(Diastasis)

During this phase both atria

and ventricles are relaxing
,the AV valve is open
The blood entering the
atria,fill the ventricles
passively
 PRESSURE CHANGES DURING CARDIAC
CYCE
• Chambers of the heart show different pressures during the
various phases of the cardiac cycle.

• Left ventricle will have higher pressure than right ventricle

and both atria have lower pressures.

• During ventricular systole, LV pressure reaches a maximum of

120-140 mm Hg and RV pressure reaches a maximum of 25-30
mm Hg.

• During ventricular diastole, LV pressure drops to about 15-20

mm Hg and RV pressure drops to 0 mm Hg.
https://www.youtube.com/watch?v=IS9TD9fHFv0
Cardiac Chamber Pressures
 HEART SOUNDS
• First heart sound :
It is due to the closure of AV valves ( mitral and
tricuspid valves) .
Heard as LUB
Duration is 0.09 to 0.15 seconds
It is characterized by prolonged ,loud sound
and best heard at mitral and tricuspid areas
 Heart Sounds
• Second heart sound:
It is due to the closure of semilunar valves.
Heard as DUP,
Duration is 0.10 seconds
It is characterized by short, sharp sound and
best heard at aortic and pulmonary areas
 END DIASTOLIC VOLUME 110 - 150 ml

 STROKE VOLUME 70 - 90 ml
END SYSTOLIC VOLUME 40 - 70 ml
SV = EDV-ESV
Ejection Fraction(EF): SV/EDV 50-60%

DURATION OF CARDIAC CYCLE α 1/HR

 Cardiac Cycle
• End-diastolic volume (110-150 ml)
• End-systolic volume (50-70 ml)
• Stroke volume (70-90ml at rest)
• Ejection fraction
– % of end-diastolic ventricular volume that is ejected with each
stroke
– Is about 65%
– Valuable index of ventricular function
• Preload
• Afterload
 LEFT VENTRICULAR PRESSURE/VOLUME P/V
LOOP
LEFT VENTRICULAR PRESSURE (mmHg)

120 F
E

80 D

40

A B
C
0
50 100 150
LEFT VENTRICULAR VOLUME (ml)
PRESSURE/VOLUME RELATIONSHIPS UNDER
DIFFERENT CONDITIONS

PRELOAD AFTERLOAD CONTRACTILITY

 Heart
• At birth: appears large in proportion to the chest
• In infants it is 1/130 of the total body weight
compared to 1/300 in an adult
• Between puberty and 25 yrs the heart attains its
adult shape and weight
– About 300 g is average male and 225 g for females
• In adults the shape tends to resemble that of the
chest
 Heart rate
• https://www.thevisualmd.com/read_videogui
de/?idu=1083625201
 Heart rate
• Resting HR: 50-90 bpm
• Tachycardia, resting HR>100
– Sinus
– Atrial
– Ventricular
• Bradycardia, HR<50
• Ectopic pacemaker
• Arrhythmia
• Flutter 180-280
• Fibrillation >300
 Heart rhythm
• https://www.youtube.com/watch?v=EqUfgffJx
_8
 Training Heart Rate
• THR with intensity %a= (220- age)x %a*
• THR = ((HRmax − HRrest) × % intensity) + HRrest

*Usually 50%-85%
HRmax
 Heart control
• Nervous system
– Sympathetic
– Parasympathetic
• Hormonal
• Humoral
• Physical
 Heart beat
• Lack of innervation( transplant): 105 bpm
• Lack of sym. 25 bpm
• Lack of parasym. 125
 Circulatory system
• Consists of the heart, arteries, veins, and capillaries
 Its appearance reaches a functional state long
before any other major organ system
 Heart begins to beat in the 4th week after
fertilization
Histological Structure of Blood Vessels
Capillary Structure

• Continuous
Capillary

• Fenestrated
Capillary
The Distribution of Blood
 Cardiovascular Physiology
• Pressure-
– Blood pressure

– Hydrostatic pressure

– Venous pressure
 Cardiovascular Physiology
• Resistance (total peripheral resistance)

– Vascular resistance

– Viscosity

– Turbulence
 Blood
pressures
and the
vascular
system
Blood pressures
and the vascular
system

Arterial
Pressure-

Venous Pressure-
 Capillary Exchange

Diffusion:

Filtration:

Reabsorption:
Capillary Exchange/Lymphatic system
 Venus return
• Varicose vein
Aneurysm
 Aneurysm
• Any individual experiencing some or all of the following
symptoms, regardless of age, should undergo
immediate and careful evaluation by a physician

• Localized Headache
• Dilated pupils
• Blurred or double vision
• Pain above and behind eye
• Weakness and numbness
• Difficulty speaking
 Ruptured Aneurysm
• Seek Medical Attention Immediately If You Are Experiencing Some
Or All Of These Symptoms:

• Sudden severe headache, the worst headache of your life

• Loss of consciousness
• Nausea/Vomiting
• Stiff Neck
• Sudden blurred or double vision
• Sudden pain above/behind the eye or difficulty seeing
• Sudden change in mental status/awareness
• Sudden trouble walking or dizziness
• Sudden weakness and numbness
• Sensitivity to light (photophobia)
• Seizure
• Drooping eyelid
Regulation of Cardiovascular System

Overview-
Regulation of Cardiovascular System
 Regulation of Cardiovascular System
• Neural Mechanisms
– Vasoconstriction
– Vaosdilation

– Baroreceptors

– Chemoreceptors
Control of Cardiovascular Function - Hormones

ADH-

Angiotensin-

Erythropoietin-

ANP-
Control of Cardiovascular Function – Hormones
Decreased Blood Pressure
Control of Cardiovascular Function – Hormones
Increased Blood Pressure
 THE CONCEPT OF THE HYDRAULIC FILTER
SYSTOLE DIASTOLE

COMPLIANT

RIGID
 MEAN ARTERIAL PRESSURE (MAP)

REMEMBER OHMS LAW?

CARDIAC OUTPUT PERIPHERAL RESISTANCE

INSTANTANEOUS
INCREASE

STEADY STATE
INCREASE