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Cardiovascular System--Blood Vessels

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  • Cardiac tamponade: compression of heart via fluid accum. In pericardial cavity Ventricles can’t fill properly
  • The fossa ovalis is a prominent depression in the interatrial septum. This is where there was an opening in the septum of the fetal heart. This allowed blood to by-pass circulation through the non-functioning fetal lungs and be circulated through the umbilical cord to the placenta instead.
  • MVP can cause chest paint, fatigue and shortness of breath. Often, however, it is not dangerous. Much more common in women, particularly those between 20 and about 40. Link is to an animation of stenosis.
  • Cor pulmonale: right ventricular failure due to high afterload in the pulmonary circuit (emphysema, chronic bronchitis, black lung disease).
  • Nine risk factors for CAD: heredity, age, gender (these three you can’t change!); obesity, diabetes, smoking, inactivity, hypertension (also, some researchers argue high cholesterol), stress.
  • “ Fig. 1. Figure 1. Initial arteriogram shows lefi common iliac artery (CIA) occlusion (arrows) and stenosis of left extrenal iliac artery (EIA) (arrow). Fig. 2. Appearance after placement of Palamz stent in the CIA and angioplasty of the EIA.” From: http://www.scvir.org/members/caseclub/1298/1298_04/1298_04.htm, 7/30/04.
  • NE and E act through cAMP to open Ca2+ gates. This increases contractility and thus has a positive inotropic effect. Glucagon stimulates cAMP formation and is sometimes used for emergency heart attack treatment in combination with calcium chloride. Digitalis treat congestive heart failure by inhibiting Na/K pumps, thus raising intracellular Na concentration and increasing Ca in sarcoplasm. Hypercalcemia causes excess Ca flow into sarcoplasm = strong, prolonged contraction. Hyperkalemia has a negative inotropic effect by decreasing the myoaction potentials and reduing Ca in sarcoplasm. Afterload is like adding more weight (hypertension) behind a door (aortic valve) that’s being slammed by a battering ram (blood in the left ventricle).
  • Acetylcholine opens K channels to cause hyperpolarization, and fewer heart beats. Foxglove (digitalis): positive inotropic and negative chronotropic
  • Transcript

    • 1. The Heart: Did you know?
      • the size of your heart is equal to that of your fist
      • the human heart creates enough pressure in the left ventricle to squirt blood 9.1 metres
      • According to German researchers, the risk of heart attack is higher on Monday than any other day of the week.
      • human heart rate = 100,800 beats/day
      • fetal heart starts beating during fourth week of pregnancy
      • lowest blood pressure is in right atrium
    • 2. What does the heart do?
      • 100,000 hb/day
      • ~3B hb/lifetime
      • 4,000 gallons (15,000 L) blood pumped/day
      • ~60% of blood in veins at any given time
    • 3. What are the heart parts?
      • In thoracic cavity: mediastinum
        • Apex points slightly to left
        • Base at “top” of heart
      • Around heart: pericardium
      • Heart: three layers
        • Epicardium
        • Myocardium
        • Endocardium
    • 4. What is the pericardium?
      • Parietal pericardium
        • Fibrous layer: dense irregular c.t. (outside)
        • Serous layer: moist (inside)
          • Turns inward at base (top of heart) to form visceral pericardium
      • Visceral pericardium
        • Covers heart surface (epicardium)
      • Pericardial cavity
        • Between parietal and visceral pericardium
        • Contains pericardial fluid
      • Pericarditis
          • Cardiac tamponade
    • 5. What are the three layers of the heart?
      • Epicardium = visceral pericardium
        • Contains fat deposits in sulci
        • Other areas: thin and transparent
    • 6. What are the three layers of the heart?
      • Myocardium
        • Cardiac muscle fibers
        • Held together by fibrous skeleton (collagenous and elastic fibers)
        • Recall: intercalated discs which contain gap junctions, desmosomes
    • 7.
      • Endocardium
        • Endothelium
          • Continuous with vascular endothelium
      What are the three layers of the heart?
    • 8. What’s inside the heart?
      • Four chambers
        • Two atria + auricles
          • Interatrial septum
            • Fossa ovalis
        • Two ventricles
          • Interventricular septum
    • 9.
      • Four valves
        • Atrioventricular valves
          • Right: tricuspid
          • Left: bicuspid (mitral)
          • Chordae tendinae
          • Papillary muscles
          • Prolapse
        • Semilunar valves
          • Right: pulmonary semilunar
          • Left: aortic semilunar
      What’s inside the heart?
    • 10. What’s inside the heart?
      • Valve disorders
        • Stenosis
          • Stiffened cusps; scar tissue occludes opening
          • http://www.heartcenteronline.com/myheartdr/common/articles.cfm?ARTID=187
          • Often rheumatic fever causes
            • Autoimmune disease attacks mitral valve: scarring and more heart work
            • Incompetent valve causes regurgitation and turbulence = heart murmur
        • Mitral valve prolapse (MVP)
      From: http://www.healthatoz.com/healthatoz/Atoz/images/ency/00042848.jpg
    • 11. What blood vessels lead to/from the heart ?
      • Superior/inferior vena cava
        • Empty into R atrium
      • Pulmonary trunk
        • At pulmonary semilunar valve: R/L pulmonary arteries
      • R/L pulmonary veins empty into L atrium
      From: http://connection.lww.com/products/sadler/images/figurelarge11-46.jpg
    • 12.
      • Ascending aorta
        • Brachiocephalic trunk
          • R common carotid artery and R subclavian artery
        • L common carotid artery
        • L subclavian artery
      • Ductus arteriosus: pulm. a. to aorta in fetus
      • Systemic vs. pulmonary circuit
      • Cor pulmonale: next slide
      What blood vessels lead to/from the heart? From: http://connection.lww.com/products/sadler/images/figurelarge11-46.jpg
    • 13. From: http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18131.jpg
    • 14. What are the coronary arteries?
      • Heart doesn’t get blood from chambers
      • Has its own vessels
      • Two stem immediately from ascending aorta
      • Left coronary artery (two branches)
        • Anterior interventricular branch
        • Circumflex branch
      • Right coronary artery (two branches)
        • Posterior interventricular branch
        • Marginal branch
    • 15. What are the coronary arteries?
      • Anastomoses
        • Prevent myocardial infarction
      From: http://www.clevelandclinic.org/heartcenter/images/guide/disease/cad/artery7.JPG
    • 16. What are the coronary veins?
      • Coronary sinus
        • 20% of blood directly into right atrium
        • 80% dumps into:
          • Greater cardiac vein
          • Middle cardiac vein
          • To coronary sinus to right atrium
    • 17. What path does blood take through the heart?
      • Trace the blood flow through the heart, systemic and pulmonary circuits beginning at the right atrium. Be sure to include all valves, chambers and major blood vessels connected to the heart .
    • 18. What are some coronary diseases?
      • Coronary artery disease (atherosclerosis)
        • Risk factors (9)
        • Atherosclerotic plaque
        • Thrombus and embolism
          • Heparin
          • Coumadin (warfarin) (blocks synth. Of II, VII, IX, X)
          • Coronary artery bypass grafting
          • Angioplasty with or without stent (next page)
    • 19. Figure 1 (common iliac a.) Figure 2
    • 20. What are some coronary diseases?
      • Ischemia
      • Angina pectoris
      • Myocardial infarction
      From: http://www.yourheart.org.uk/images/myocardial_infarction.jpg
    • 21. How does the heart beat?
      • Myogenic cells
      • Sinoatrial (SA) node: innate rate: ~100 b/min
        • Right atrial myocardium
        • Primary pacemaker; slow Na+ inflow
        • ANS regulates
      • Atrioventricular (AV) node (Bundle of His)
        • Single point of electrical connection bet. atria and ventricles
          • 40-50 bpm = nodal rhythm
          • Damage = total heart block
        • 100 msec delay
        • ANS regulates
    • 22. How does the heart beat?
      • AV bundle (right and left)
      • Purkinje fibers (conduction fibers)
      • heart conduction animation
      • Ectopic focus
    • 23. How do myocytes create a potential?
      • Myogenic cells
        • -60 mV potential
        • “ leak” to generate pacemaker potential
          • Slow Na + leak w/no K + outflow
          • -40 mV threshold
            • Fast Ca 2+ gates open (depolarize)
            • Then repolarization = K + gates open
        • Every 0.8 sec
    • 24. How do myocytes create a potential?
      • Myocytes
        • Slow Ca 2+ channels prolong contraction
    • 25. What is the cardiac cycle?
      • Terminology
        • Systole
        • Diastole
        • Normal sinus rhythm: 60-100 b/min; 70 ave.
        • Tachycardia; >100
        • Bradycardia; < 60
        • palpitations
      From: http://www.chez.com/deuns/ps/pression/p506.png
    • 26. What is an electrocardiogram (ECG)?
      • Wrists, ankles, six chest locations
      • Basic ECG waves
        • P wave: atrial depolarization and systole
          • When SA fires
        • QRS complex: ventricular depolarization
          • When AV node fires
          • Note: this masks atrial repolarization and diastole
          • S-T segment: beginning of ventricular systole
        • T wave: ventricular repolarization and diastole
      • Let’s look at it another way…
    • 27.  
    • 28. How do we interpret ECGs?
      • Size and timing of waves
      • Significance of large waves
        • P wave: mitral valve stenosis
        • Q wave: MI
        • R: ventricular hypertrophy
      • Arrhythmias
        • AV block
        • Fibrillation
    • 29. What are the phases of the cardiac cycle?
      • All this happens in less than a second!
      • cardiac cycle animation
      • Relaxation phase (quiescent period)
        • T wave initiates at end of heart beat
        • All chambers: diastole
        • Ventricular pressure falls below atrial pressure
          • Causes AV valve to open and ventricles to begin filling
    • 30.
      • Ventricular filling
        • SA node fires (P wave begins)
        • Atrial systole follows
        • End-diastolic volume (EDV) pushed into ventricles (~25 ml)
      What are the phases of the cardiac cycle?
    • 31.
      • Ventricular systole
        • AV node sends impulse to Purkinje fibers
        • Ventricles begin to depolarize and contract = isovolumetric contraction
        • Ventricular ejection (~70 ml ejected = stroke volume)
        • Blood remaining in ventricles (end systolic volume, ESV ~60 ml)
      What are the phases of the cardiac cycle?
    • 32.
      • Isovolumetric relaxation
        • Early ventricular diastole
      • Ventricular filling
        • Further relaxation of ventricles lowers pressure to below that of atria
        • AV valves open and blood pours in
      • Murmur = turbulence
      • Incompetent = swish sound from not closing completely
      • Stenotic = whistle b/c stiff
      What are the phases of the cardiac cycle?
    • 33. What is stroke volume?
      • Stroke volume
        • SV = EDV – ESV (amt of blood in one cycle)
    • 34. What 3 things affects stroke volume?
      • Preload
        • Stretch on ventricles before contraction
        • Starling’s law (think of rubber bands)
        • Ventricles eject as much as they receive
        • Keep both sides equal
          • Congestive heart failure if sides not equal
    • 35. What is stroke volume and what affects it?
        • Contractility ; determined by other factors than preload
          • Force of the contraction
          • ANS controls
            • Sympathetic and epinephrine (E)
            • Parasympathetic: vagal tone
              • Abnormal electrolytes can affect
          • Inotropic agents (vs. chronotropic agents)
            • Hyperkalemia = negative inotropic agent
            • NE/E = positive inotropic agents
        • Afterload
          • Pressure in aorta and pulmonary trunk
      From: http://www.magiclibrary.net/rarities/introductory-two-player-set-battering-ram-italian.jpg
    • 36. What is cardiac output?
      • CO (ml/min) = SV (ml/beat) X HR (beat/min)
        • Total amount ejected from right OR left ventricle in one minute
      • Auscultation
        • Lubb: blood turbulence from AV valve closure
        • Dubb: blood turbulence from closure of semilunar valves
      From: http://medicine.ucsd.edu/clinicalmed/cardiac-auscultation.jpg
    • 37. What regulates the heart?
      • Chronotropic effects and agents
      • Nervous system doesn’t initiate heart beat
        • Instead modifies its rate and force via autonomic innervation
      positive inotropic and negative chronotropic From: http://www.huntingtonbotanical.org/Shakespeare/gallerypicslg/Foxglove.jpg
    • 38.
      • Medullary Cardiovascular Center (CV)
        • Cardioacceleratory center (sympathetic): NE
        • Cardioinhibitory center (parasympathetic): acetylcholine
          • Vagus nerve to SA and AV node
          • ACh opens K + channels = hyperpolarization
        • NE and acetylcholine action
          • Beta adrenergic receptors on cardiac fibers
            • Use of beta blockers to control hypertension
      What regulates the heart? From: http://www.mc.uky.edu/pharmacology/instruction/decor/ar/bhkbbl.jpg
    • 39. What regulates the heart?
        • Baroreceptors: animation
        • Potassium
          • Hyperkalemia: slows beat, may arrest in diastole
            • Too much potassium raises membrane potential making repolarization difficult
          • Hypokalemia: leaves cells hyperpolarized
            • Need more stimulus to reach threshold
      • Hormonal regulation of bp
        • Kidneys: renin production (raises bp)
        • Hypothalamus: ADH production
        • Adrenals: aldosterone production
      From: people.eku.edu/ritchisong/ baroreceptors.jpg