The Autonomic nervous system and the circulation

The main efferent limb of all cardiovascular reflexes. Can change resistances and volumes of vessels Can change rate and force of contraction of heart Can alter renal excretion of salt and water

Circulation
Bulk transport Diffusion, limited by distance, gradient and molecular mass Circulation ensures exchange vessels in all tissues provided with nutrients All cells linked via the capillary exchange vessels

The Roles of the Circulation

Respiration Nutrition Excretion Homeostasis (regulation of the constancy of the milieu interieur of Claude Bernard) Thermoregulation Defence Reproduction Communication (e.g. endocrine regulation)

Brain Head and arms

Ductus arteriosus

Lung s
Foramen Ovale

Liver

Ductus venosus

Splanchnic circulation

Kidneys

Placenta

Trunk and legs

Physiological Overview
Bulk flow system with variable demand Components are pump, fluid and vessels, potentially each of these can change properties to meet the bodies needs Flow created by energy differences Heart creates flow by creating energy differences, vessel properties modify the flow and this is reflected in the pressure gradients.

LV

Large arteries Arterioles

Llandis diagram

Capillaries Veins and venules RV

Pulmonary artery Pulmonary arterioles Pulmonary capillaries Pulmonary veins

Regional blood flow and cardiac output

Rest Blood flow ml/min Brain Cardiac muscle Skeletal muscle Kidneys Skin Splanchnic bed Other Cardiac output 750 150 750 1250 150 1250 700 5000 % of total 15 3 15 25 3 25 14 Exercise Oxygen consumption ml/min % of total 50 20 25 10 50 20 8 40 57 250 20 7 3 15 23 Blood flow ml/min 800 1000 14700 1200 1000 800 500 20000 % of total 4 5 74 6 5 4 2.2 Oxygen consumption ml/min 50 230 2080 20 10 40 70 2500 % of total 2 9 83 0.8 0.4 2 3

The heart

The cardiac cycle

Simple observation of the heart shows an orderly sequence of contraction Ventricles empty (ventricular systole) Ventricles fill rapidly Atria contract (atrial systole) Ventricles pump again

The cardiac cycle

Heart is a good pump because
Orderly sequence of contraction Low impedance to filling One way flow (valves) Variable output Autonomous

The cardiac cycle

Ventricles relax ventricular diastole
Isovolumetric relaxation

The cardiac cycle

Ventricles relax ventricular diastole
Rapid ventricular filling

The cardiac cycle

Ventricles relax ventricular diastole
Isovolumetric relaxation Rapid ventricular filling Atrial contraction

The cardiac cycle

Ventricles contract ventricular systole
Isovolumetric contraction

The cardiac cycle

Ventricles contract ventricular systole
Ventricular ejection

Auscultation
First and second sounds First (mitral and tricuspid)
Normal Split

Second (aortic and pulmonic)

Normal Split

Split both

Auscultation
3rd and 4th heart sounds 3rd (often normal in young, pathological in older ones rushing in) 4th (ventricular malfunction in older people a stiff wall)

Auscultation
Murmurs
Characterised by timing, duration and localisation

AS MS MI ASD Patent Ductus

ECG

ECG

Parasternal Long Axis

Volumes during the cardiac cycle

Heart rate and cardiac phases

Heart rate Duration of cardiac cycle Duration of ventricular systole Duration of ventricular diastole

75bts/min 0.8s 0.3s 0.5s

200bts/min 0.30s 0.16s 0.14s

Pressures during the cardiac cycle

E.H.Starling
The heart-lung preparation. Effectively an isolated heart preparation.

Heart lung apparatus

Key Features of the Preparation *.

The flow of blood into the heart (pre-load) and the resistance against which the heart has to pump (after-load) can be varied independently

Key Features of the Preparation*

Ventricular volume, and therefore SV, and CO, and arterial and venous pressures can be measured.

Key Features of the Preparation *

The heart is isolated from the central nervous system so that there is no reflex control, heart rate therefore does not change significantly The chest is open so that intrathoracic pressure is constant at atmospheric pressure and does not vary with respiration

Heart lung apparatus

S
Increasing volume of heart

Starling, Paterson and Piper pre-load experiments.

Varied the preload by changing venous return. After a number of beats the heart was expelling all the blood returning to it but from a greater diastolic volume. The output of the heart was now increased and this increased the cardiac work rate (power) At this point the balance between venous return and cardiac output was restored On returning the venous input to previous level the heart went back to initial state

Observation s1

Starling, Paterson and Piper S after-load experiments.

Varied the afterload by changing the pressure against which the heart had to pump After a number of beats the heart was expelling all the blood returning to it but from a greater diastolic volume. The cardiac output was restored but the work rate (power) was increased because the heart was pumping against a greater pressure. Repeated in up and down directions

Increasing volume of heart

Observations 2

Starling Stated His Law in the Linacre Lecture of 1915:

"The law of the heart is thus the same as the law of muscular tissue generally, that the energy of contraction, however measured, is a function of the length of the muscle fibre."