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Cardiovascular Anatomy and Physiology

Anatomy of the Heart

Right Atrium Systemic drain through SVC, IVC and Coronary Sinus Tricuspid valve: anterior, posterior and medial Papillary muscles and chordae tendineae Right Ventricle 1/3 LV Anterosuperior outflow to the pulmonary circulation

Pulmonary Circulation Pulmonary valve: right, left and anterior Pulmonary brancharteriolescapillaries Left Atrium Larger than RA Mitral valve: anterior and posterior

Left Ventricle 8-15 mm thick and 4.5-5.5 cm diameter

Coronary circulation
Left main Branch Left Anterior Decending Anterior left ventricle wall, V3-V5 Circumflex branches Posterior LV and part of RV, lead I and VL Right Coronary Artery AV node and common Bundle of His II, V and VF, conduction abnormalities

Sinoatrial (SA) node Junction of the SVC with RA 100-110 beats / minute Anterior, middle and posterior internodal Atrioventricular (AV) node Near the ostium of coronary sinus Bundle of His Membranous interventricular to the apex of the septum Right and Left bundle branch Endocadium of the ventricle Purkinje system

Cardiac Conduction system

Cardiac electrophysilogy SA node

spontaneous generation of action potentials 100-110 action potentials ("beats") per minute. vagal tone" brings the resting heart rate down to 60-80 beats/minute. The normal range for sinus rhythm is 60-100 beats/minute. sinus bradycardia , sinus tachycardia. Controls both atrial and ventricular rhythm.

SA node causing atrial contraction. The impulse travels into the ventricles via the atrioventricular node (AV node).

Specialized conduction pathways (bundle branches and Purkinje fibers) within the ventricle rapidly conduct the wave of depolarization throughout the ventricles to elicit ventricular contraction.

Cardiac and vascular Nerves

Sympathetic system Parasympathetic system Cerebral vasomotor system Cardiac receptor Neural supply of the peripheral vasculature Pericardium

Cardiac cycle
RA and LA filling TV and MV are closed Isovolumetric relaxation of the LV AV has close but LV pressure still higher than LA Open of the AV valves LV and RV relaxation, rapid filling Atrial contraction, P wave AV valves close Atrial filling CVP and PA catheter

Electrocardiograph (ECG)
P wave represents atrial depolarisation Q wave represents depolarisation at the bundle of His R wave represents the main spread of depolarisation, from the inside out, through the base of the ventricles S wave shows the subsequent depolarisation of the rest of the ventricles upwards from the base of the ventricles T wave represents repolarisation of the myocardium after systole is complete

Coronary autoregulation
Coronary perfusion constant at BP 50-120 mmHg Coronary arteriole (diameter <150um) dilatation Oxygen demand alter the autoregulation (Myocardial oxygen tension ) Most important regulator metabolic

Cardiac output
Volume of blood pumped by the heart each minute CO = HR x SV
SV ratio = EF = (EDV-ESV) / EDV
Normal 0.6-0.7

Preload, afterload, contractility, heart rate and ventricular compliance

Normal 2,5-3,5 ltr/minute m2

Contractility of the heart

Contractility inotropic state independent of changes in preload, afterload, or heart rate Compliance nonlinear change in ventricular enddiastolic volume/change in end-diastolic pressure

Myocardial metabolism
Energy source: lactate and fatty acid Linier uptake of fatty acid 90% of myocardial oxygen comsumption Fasting priod : FFA Myocardial lactate Arterial lactate and pyruvate oxidation Glugose, pyruvate, acetate and triglyceride Myocardial Oxygen Consumption 8-10 ml O2 per 10 mg myocardium per minute HR, wall tension, myocardial contractility

Myocardial Supply-Demand ratio

Supply-demand balance to avoid ischemia Oxygen Supply Diameter of coronary artery, LV EDP, Aortic Diastolic Pressure, Arterial Oxygen content Coronary perfusion pressure = ADP - LV EDP Oxygen content PaO2, Hb, 2-3 DPG pH, PCO2 and temperature in oxygen dissociation Oxygen Demand

Distribution of Cardiac Output

brain 12%, heart 4%, liver 24%, kidneys 20%, muscle 23%, skin 6%, and intestines 8%. About 15% of the blood volume remains in the heart and pulmonary circulation, with the remainder in the systemic circulation. Of the blood in the systemic circulation, about 64% is in the veins Volume management

Blood Pressure
Mean arterial pressure is the product of the cardiac output and the systemic vascular resistance. Arterial pressure varies with the respiratory cycle. decreases 6 mm Hg or less during inspiration because pulmonary venous capacitance increases pericardial tamponade

Arterial Pulse
wave of vascular distention the pulse wave depends on the elasticity of the vessel aortic arch, 35 m/sec subclavian, 710 m/sec small nondistensible peripheral arterial 1530 m/sec

Pulmonary Circulation
low-pressure, high-flow system Functions metabolic transport of humoral substances and drugs Transport of blood through the lungs reservoir for the left ventricle PA catheter filtration of venous drainage transport of gas, fluid, and solutes across the walls of exchanging vessels.

Physiology of the Venous System

60% of the systemic blood volume is in small veins and venules (diameters 20 m to 2 mm) Venous return (VR), the rate of flow of blood from the periphery to the heart ~ cardiac output is equal to venous return

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