Pulmonary Circulation Pulmonary valve: right, left and anterior Pulmonary brancharteriolescapillaries Left Atrium Larger than RA Mitral valve: anterior and posterior
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
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 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
CI = CO / BSA
Normal 2,5-3,5 ltr/minute m2
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
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.
Thank You