The Heart Part 2 Circulatory System:
Cardiac Cycle <ul><li>One complete contraction and relaxation of all 4 chambers of the heart </li></ul><ul><li>Atrial syst...
Principles of Pressure and Flow <ul><li>Pressure causes a fluid to flow  </li></ul><ul><ul><li>___________________________...
Heart Sounds <ul><li>____________________ - listening to sounds made by body </li></ul><ul><li>First heart sound (S 1 ), l...
Phases of Cardiac Cycle <ul><li>________________ period </li></ul><ul><ul><li>all chambers relaxed </li></ul></ul><ul><ul>...
___________________  of Ventricles <ul><li>Atria repolarize and relax </li></ul><ul><li>Ventricles depolarize </li></ul><u...
Ventricular Ejection <ul><li>Pressure opens ________________ valves </li></ul><ul><li>Blood ejected </li></ul><ul><li>Stro...
Ventricles-  Isovolumetric  Relaxation <ul><li>Ventricles repolarize and relax (begin to expand) </li></ul><ul><li>_______...
Ventricular Filling - 3 phases <ul><li>Rapid ventricular filling  </li></ul><ul><ul><li>AV valves first open </li></ul></u...
Major Events of Cardiac  Cycle <ul><li>__________ period </li></ul><ul><li>__________ filling </li></ul><ul><li>Isovolumet...
Rate of Cardiac Cycle <ul><li>Atrial systole, 0.1 sec </li></ul><ul><li>Ventricular systole, 0.3 sec </li></ul><ul><li>Qui...
Ventricular Volume  Changes at Rest <ul><li>End-systolic volume (ESV)  60 ml </li></ul><ul><li>Passively added to ventricl...
________________ (CO) <ul><li>Amount ejected by ventricle in 1 minute </li></ul><ul><li>Cardiac Output = ____________ x __...
Heart Rate <ul><li>___________ = surge of pressure in artery </li></ul><ul><ul><li>infants have HR of 120+ bpm  </li></ul>...
Chronotropic Effects <ul><li>____________ chronotropic agents    HR  </li></ul><ul><li>____________ chronotropic agents  ...
Chronotropic Chemicals <ul><li>_______________ </li></ul><ul><li>Neurotransmitters - cAMP 2 nd  messenger </li></ul><ul><u...
<ul><li>Electrolytes </li></ul><ul><ul><li>_____ has greatest effect </li></ul></ul><ul><ul><ul><li>hyperkalemia  </li></u...
Sympathetic Nervous System <ul><li>_______________________- center </li></ul><ul><ul><li>stimulates sympathetic nerves to ...
Parasympathetic Nervous System <ul><li>Cardioinhibitory center stimulates _________ nerves </li></ul><ul><ul><ul><li>right...
Inputs to Cardiac Center <ul><li>Higher brain centers affect HR </li></ul><ul><ul><li>cerebral cortex, limbic system, hypo...
Inputs to Cardiac Center <ul><li>____________________________ </li></ul><ul><ul><li>sensitive to blood pH, CO 2  and oxyge...
Stroke Volume (SV) <ul><li>Governed by three factors: </li></ul><ul><ul><li>_________________ </li></ul></ul><ul><ul><li>c...
Preload <ul><li>_________________________________________ </li></ul><ul><li>________________________________________ </li>...
Contractility <ul><li>Contraction force for a given preload </li></ul><ul><li>______________ inotropic agents  </li></ul><...
Afterload <ul><li>Pressure in arteries above semilunar valves opposes opening of valves </li></ul><ul><li>   afterload  ...
Exercise and Cardiac Output <ul><li>Proprioceptors </li></ul><ul><ul><li>HR ____ at beginning of exercise due to signals f...
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PowerPoint: Part 2

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PowerPoint: Part 2

  1. 1. The Heart Part 2 Circulatory System:
  2. 2. Cardiac Cycle <ul><li>One complete contraction and relaxation of all 4 chambers of the heart </li></ul><ul><li>Atrial systole, Ventricle diastole </li></ul><ul><li>Atrial diastole, Ventricle systole </li></ul><ul><li>Quiescent period </li></ul>
  3. 3. Principles of Pressure and Flow <ul><li>Pressure causes a fluid to flow </li></ul><ul><ul><li>____________________________ - pressure difference between two points </li></ul></ul><ul><li>Resistance opposes flow </li></ul><ul><ul><li>great vessels have positive blood pressure </li></ul></ul><ul><ul><li>ventricular pressure must rise above this resistance for blood to flow into great vessels </li></ul></ul>
  4. 4. Heart Sounds <ul><li>____________________ - listening to sounds made by body </li></ul><ul><li>First heart sound (S 1 ), louder and longer “_______”, occurs with closure of _______ valves </li></ul><ul><li>Second heart sound (S 2 ), softer and sharper “_______” occurs with closure of __________________ valves </li></ul><ul><li>S 3 - rarely heard in people > 30 </li></ul>
  5. 5. Phases of Cardiac Cycle <ul><li>________________ period </li></ul><ul><ul><li>all chambers relaxed </li></ul></ul><ul><ul><li>AV valves open and blood flowing into ventricles </li></ul></ul><ul><li>_____________ systole </li></ul><ul><ul><li>_____ node fires, depolarize </li></ul></ul><ul><ul><li>atria contract, force additional blood into ventricles </li></ul></ul><ul><ul><li>ventricles now contain ____-___________________ (____) of about 130 ml of blood </li></ul></ul>
  6. 6. ___________________ of Ventricles <ul><li>Atria repolarize and relax </li></ul><ul><li>Ventricles depolarize </li></ul><ul><li>Ventricles contract </li></ul><ul><li>Rising pressure closes AV valves - ___________________ </li></ul><ul><li>No ejection of blood yet (no change in volume) </li></ul>
  7. 7. Ventricular Ejection <ul><li>Pressure opens ________________ valves </li></ul><ul><li>Blood ejected </li></ul><ul><li>Stroke volume: amount ejected, _____ ml at rest </li></ul><ul><li>SV/EDV= ejection fraction, at rest ~ ____%, during vigorous exercise as high as ____%, diseased heart < ______% </li></ul><ul><li>___________________: amount left in heart </li></ul>
  8. 8. Ventricles- Isovolumetric Relaxation <ul><li>Ventricles repolarize and relax (begin to expand) </li></ul><ul><li>_______________ valves close (__________ notch of aortic press. curve) - h eart sound S 2 occurs </li></ul><ul><li>AV valves remain closed </li></ul><ul><li>Ventricles expand but do not fill (no change in volume) </li></ul>
  9. 9. Ventricular Filling - 3 phases <ul><li>Rapid ventricular filling </li></ul><ul><ul><li>AV valves first open </li></ul></ul><ul><li>________________ </li></ul><ul><ul><li>sustained lower pressure, venous return </li></ul></ul><ul><li>______________ </li></ul><ul><ul><li>filling completed </li></ul></ul>
  10. 10. Major Events of Cardiac Cycle <ul><li>__________ period </li></ul><ul><li>__________ filling </li></ul><ul><li>Isovolumetric contraction </li></ul><ul><li>_______________ ejection </li></ul><ul><li>_______________ relaxation </li></ul>
  11. 11. Rate of Cardiac Cycle <ul><li>Atrial systole, 0.1 sec </li></ul><ul><li>Ventricular systole, 0.3 sec </li></ul><ul><li>Quiescent period, 0.4 sec </li></ul><ul><li>Total 0.8 sec, heart rate 75 bpm </li></ul>
  12. 12. Ventricular Volume Changes at Rest <ul><li>End-systolic volume (ESV) 60 ml </li></ul><ul><li>Passively added to ventricle during atrial diastole +30 ml </li></ul><ul><li>Added by atrial systole +40 ml </li></ul><ul><li>End-diastolic volume (EDV) 130 ml </li></ul><ul><li>Stroke volume (SV) ejected by ventricular systole -70 ml </li></ul><ul><li>End-systolic volume (ESV) 60 ml </li></ul><ul><li>Both ventricles must eject same amount of blood </li></ul>
  13. 13. ________________ (CO) <ul><li>Amount ejected by ventricle in 1 minute </li></ul><ul><li>Cardiac Output = ____________ x ________________ </li></ul><ul><ul><li>~ 4 to 6L/min at rest </li></ul></ul><ul><ul><li>_____________________  CO to 21 L/min for fit person and up to 35 L/min for world class athlete </li></ul></ul><ul><li>____________________: difference between a persons maximum and resting CO </li></ul><ul><ul><li> with fitness,  with disease </li></ul></ul>
  14. 14. Heart Rate <ul><li>___________ = surge of pressure in artery </li></ul><ul><ul><li>infants have HR of 120+ bpm </li></ul></ul><ul><ul><li>young adult females avg. _______ bpm </li></ul></ul><ul><ul><li>young adult males avg. ________ bpm </li></ul></ul><ul><ul><li>HR rises in the elderly </li></ul></ul><ul><li>____________: resting adult HR above 100 </li></ul><ul><ul><li>stress, anxiety, drugs, heart disease or  body temp. </li></ul></ul><ul><li>_____________: resting adult HR < 60 </li></ul><ul><ul><li>in sleep and endurance trained athletes </li></ul></ul>
  15. 15. Chronotropic Effects <ul><li>____________ chronotropic agents  HR </li></ul><ul><li>____________ chronotropic agents  HR </li></ul><ul><li>____________ of medulla oblongata </li></ul><ul><ul><li>an autonomic control center with two neuronal pools: a cardioacceleratory center (sympathetic), and a cardioinhibitory center (parasympathetic) </li></ul></ul>
  16. 16. Chronotropic Chemicals <ul><li>_______________ </li></ul><ul><li>Neurotransmitters - cAMP 2 nd messenger </li></ul><ul><ul><li>catecholamines (NE and epinephrine) </li></ul></ul><ul><ul><ul><li>______________________ </li></ul></ul></ul><ul><li>_______________ </li></ul><ul><ul><li>caffeine inhibits cAMP breakdown </li></ul></ul><ul><ul><li>nicotine stimulates catecholamine secretion </li></ul></ul><ul><li>_______________ </li></ul><ul><ul><li>TH  adrenergic receptors in heart,  sensitivity to sympathetic stimulation,  HR </li></ul></ul>
  17. 17. <ul><li>Electrolytes </li></ul><ul><ul><li>_____ has greatest effect </li></ul></ul><ul><ul><ul><li>hyperkalemia </li></ul></ul></ul><ul><ul><ul><ul><li>myocardium less excitable, HR slow and irregular </li></ul></ul></ul></ul><ul><ul><ul><li>______________________ </li></ul></ul></ul><ul><ul><ul><ul><li>cells hyperpolarized, requires increased stimulation </li></ul></ul></ul></ul><ul><ul><li>___________ </li></ul></ul><ul><ul><ul><li>______________________ </li></ul></ul></ul><ul><ul><ul><ul><li>decreases HR </li></ul></ul></ul></ul><ul><ul><ul><li>hypocalcemia </li></ul></ul></ul><ul><ul><ul><ul><li>____________________ </li></ul></ul></ul></ul>Chronotropic Chemicals
  18. 18. Sympathetic Nervous System <ul><li>_______________________- center </li></ul><ul><ul><li>stimulates sympathetic nerves to SA node, AV node and myocardium </li></ul></ul><ul><ul><li>nerves secrete _________________, binds to  -adrenergic receptors in the heart (positive chronotropic effect) </li></ul></ul><ul><ul><li>CO peaks at HR of 160 to 180 bpm </li></ul></ul><ul><ul><li>Sympathetic n.s. can  HR up to 230 bpm, (limited by refractory period of SA node), but SV and CO  (less filling time) </li></ul></ul>
  19. 19. Parasympathetic Nervous System <ul><li>Cardioinhibitory center stimulates _________ nerves </li></ul><ul><ul><ul><li>right vagus nerve - SA node </li></ul></ul></ul><ul><ul><ul><li>left vagus nerve - AV node </li></ul></ul></ul><ul><ul><li>secretes ACH which binds to receptors </li></ul></ul><ul><ul><ul><li>nodal cells hyperpolarized, HR slows </li></ul></ul></ul><ul><ul><li>vagal tone: background firing rate holds HR to sinus rhythm of 70 to 80 bpm </li></ul></ul><ul><ul><ul><li>severed vagus nerves (intrinsic rate-100bpm) </li></ul></ul></ul><ul><ul><ul><li>maximum vagal stimulation  HR as low as 20 bpm </li></ul></ul></ul>
  20. 20. Inputs to Cardiac Center <ul><li>Higher brain centers affect HR </li></ul><ul><ul><li>cerebral cortex, limbic system, hypothalamus </li></ul></ul><ul><ul><ul><li>sensory or emotional stimuli (rollercoaster, IRS audit) </li></ul></ul></ul><ul><li>___________________ </li></ul><ul><ul><li>inform cardiac center about changes in activity, HR  before metabolic demands arise </li></ul></ul><ul><li>________________ signal cardiac center </li></ul><ul><ul><li>aorta and internal carotid arteries </li></ul></ul><ul><ul><ul><li>pressure  , signal rate drops, cardiac center  HR </li></ul></ul></ul><ul><ul><ul><li>if pressure  , signal rate rises, cardiac center  HR </li></ul></ul></ul>
  21. 21. Inputs to Cardiac Center <ul><li>____________________________ </li></ul><ul><ul><li>sensitive to blood pH, CO 2 and oxygen </li></ul></ul><ul><ul><li>aortic arch, carotid arteries and medulla oblongata </li></ul></ul><ul><ul><li>primarily respiratory control, may influence HR </li></ul></ul><ul><ul><li> CO 2 (hypercapnia) causes  H + levels, may create acidosis (pH < 7.35) </li></ul></ul><ul><ul><li>Hypercapnia and acidosis stimulates cardiac center to  HR </li></ul></ul>
  22. 22. Stroke Volume (SV) <ul><li>Governed by three factors: </li></ul><ul><ul><li>_________________ </li></ul></ul><ul><ul><li>contractility </li></ul></ul><ul><ul><li>_________________ </li></ul></ul><ul><li>Example </li></ul><ul><ul><li> preload or contractility causes  SV </li></ul></ul><ul><ul><li> afterload causes  SV </li></ul></ul>
  23. 23. Preload <ul><li>_________________________________________ </li></ul><ul><li>________________________________________ </li></ul><ul><li>____ preload causes ___ force of contraction </li></ul><ul><ul><li>exercise  venous return, stretches myocardium (  preload ) , myocytes generate more tension during contraction,  CO matches  venous return </li></ul></ul><ul><li>______________________________ - SV  EDV </li></ul><ul><ul><li>_____________________________________ </li></ul></ul><ul><ul><ul><li>_________ they are stretched (  preload) the ______ they contract </li></ul></ul></ul>
  24. 24. Contractility <ul><li>Contraction force for a given preload </li></ul><ul><li>______________ inotropic agents </li></ul><ul><ul><li>factors that ____ contractility </li></ul></ul><ul><ul><ul><li>hypercalcemia, catecholamines, glucagon, digitalis </li></ul></ul></ul><ul><li>_____________ inotropic agents </li></ul><ul><ul><li>factors that ____ contractility are </li></ul></ul><ul><ul><ul><li>hyperkalemia, hypocalcemia </li></ul></ul></ul>
  25. 25. Afterload <ul><li>Pressure in arteries above semilunar valves opposes opening of valves </li></ul><ul><li> afterload  SV </li></ul><ul><ul><li>any impedance in arterial circulation _____ afterload </li></ul></ul><ul><li>Continuous  in afterload (____________, atherosclerosis, etc.) ________________ of myocardium, may lead it to weaken and fail </li></ul>
  26. 26. Exercise and Cardiac Output <ul><li>Proprioceptors </li></ul><ul><ul><li>HR ____ at beginning of exercise due to signals from joints, muscles </li></ul></ul><ul><li>Venous return </li></ul><ul><ul><li>muscular activity ____ venous return causes ______ SV </li></ul></ul><ul><li> HR and  SV cause  CO </li></ul><ul><li>Exercise produces ventricular hypertrophy </li></ul><ul><ul><li>_______ allows heart to beat more slowly at rest </li></ul></ul><ul><ul><li> cardiac reserve </li></ul></ul>
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