Cardiovascular a p s10
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  • More ATP needed for cardia than skeletal, b/c never sleeps. \n
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  • Force behind blood flow is pressure. FLow is passive \n
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  • all because of Pressure.\n
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  • More murmurs in diastlole than systale.\nOrder an echo.\n
  • Gallum - blood hitting a non-compliant ventricle. \n
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  • Right output is the inflow of the left.\n
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  • Coronary circ is hier in diastole and lower in systole. \n
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  • pr interval represents the AV conduction --> important\n
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  • Look at this and understand. \nStep 1 - fast Na\nStep 2 - slow Ca\nStep 3 - K out. \n
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  • Leaky K channels. ?\n
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  • Kintuckee - S3 \nTennisee - S4 - blood hitting an uncompliant ventricel\n
  • SV is for each contraction.\nCO is per minute.\n
  • SV and Ejection Fraction.\nEDV and ESV\n
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  • NE --> increase HR and contractility\nNE on beta 1, \nNE on alpha cause constriction of the peripheral vessels. \n
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  • A big sloppy heart will have to generate more tension on the same amount of blood to generate the same pressure. \n
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  • Normally Parasym is the dominant neural control, stim beta 2 (1?)on heart, causing increased HR and contractility. \nSym NE and Epi\nEpi from adrenal goes on beta 2 on vessels causing dilation (coronary circ).\n
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  • Flow is = Pressure \n resistance\n
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  • Myoglobin, in the heart, allows heart to survive systole as circulation will only happen during diastole.\n
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Transcript

  • 1. Cardiovascular Anatomy and Physiology Reference: Pathophysiology by Kathryn McCance Mindy Milton, MPA, PA-C July 13, 2010 1Mosby items and derived items © 2006 by Mosby, Inc.
  • 2. Objectives Brief review of the structure of the heart and vascular system  Blood flow through the heart and body  Chambers  Valves  Pulmonary circulation  Systemic circulation  Coronary circulation  Electrical conduction through the heart  Specialized cells  Automaticity  Rhythmicity 2Mosby items and derived items © 2006 by Mosby, Inc.
  • 3. Objectives Cardiac Action Potential  Four phases 0-4  ECG Cardiac cycle  Diastole  Systole Cardiac Workload  Cardiac Output  ANS, Hormones  Frank-Starling Law  LaPlace’s Law 3Mosby items and derived items © 2006 by Mosby, Inc.
  • 4. Objectives Cardiac Workload  Preload - blood coming back to the heart.  Afterload Structure of blood vessels Blood flow  Capillary exchange Blood pressure  C.O.  Stroke Volume  PVR 4Mosby items and derived items © 2006 by Mosby, Inc.
  • 5. Cardiovascular System Heart is a four chambered pump Blood vessels are the tubes Purpose is life – supplies oxygen and nutrients to every cell and clears C02 and wastes 5Mosby items and derived items © 2006 by Mosby, Inc.
  • 6. Cardiac Muscle Cell  Bundles of myofibrils  Junctions – intercalated discs  Rapid syncytial contraction  Sacromere – functional unit  Z line to Z line  Actin and myosine bands  Optimum length 2.2 – 2.4 µm  T-tubules  Communicates with ECF  Majority of Ca++  Sarcoplasm Reticulum  Ca++ storage  Mitrochondria  Energy = ATP  Aerobic respiration  Oxygen 6Mosby items and derived items © 2006 by Mosby, Inc.
  • 7. Myocardial Cells Nearly identical to skeletal muscle cells Intercalated disks - desmosomes, Actin, myosin, and the troponin-tropomyosin complex troponin - tested for  Troponin T, I, and C with MI Myocardial metabolism  Myocardial oxygen consumption 7Mosby items and derived items © 2006 by Mosby, Inc.
  • 8. Myocardial Contraction andRelaxation 8Mosby items and derived items © 2006 by Mosby, Inc.
  • 9. Circulatory System Heart  Right heart  Pumps blood through the lungs (pulmonary circulation)  Left heart  Pumps blood through the systemic circulation 9Mosby items and derived items © 2006 by Mosby, Inc.
  • 10. Circulatory System Heart  Mediastinum  Heart wall  Pericardium  Parietal and visceral  Pericardial cavity and fluid  Myocardium  Endocardium 10Mosby items and derived items © 2006 by Mosby, Inc.
  • 11. The Heart Wall 11Mosby items and derived items © 2006 by Mosby, Inc.
  • 12. The Chambers of the Heart Right atrium Left atrium Right ventricle Left ventricle 12Mosby items and derived items © 2006 by Mosby, Inc.
  • 13. The Chambers of the Heart 13Mosby items and derived items © 2006 by Mosby, Inc.
  • 14. Normal Intracardiac Pressures 14Mosby items and derived items © 2006 by Mosby, Inc.
  • 15. The Valves of the Heart Atrioventricular valves  Tricuspid valve  Bicuspid valve (Mitral) Semilunar valves  Pulmonic semilunar valve  Aortic semilunar valve 15Mosby items and derived items © 2006 by Mosby, Inc.
  • 16. The Valves of the Heart 16Mosby items and derived items © 2006 by Mosby, Inc.
  • 17. The Great Vessels Superior and inferior venae cavae Aorta Pulmonary artery (trunk)  Right and left pulmonary arteries  Blood from right ventricle Pulmonary veins  Four, two from left and right lung fields  Blood enters left atrium 17Mosby items and derived items © 2006 by Mosby, Inc.
  • 18. Blood Flow Cardiac cycle Diastole - 70 % of the blood comes in passively. Then last filling from atrial kick. Systole Phases of the cardiac cycle 18Mosby items and derived items © 2006 by Mosby, Inc.
  • 19. Phases of the cardiac cycle 1 – Systole with isovolumetric contraction  AV closed and SL not open yet  Increased intraventricular pressure  Blood volume unchanged 2 – LV pressure > aortic pressure  SL open and blood ejected  Rapid ventricle pressure and volume decrease 3 – Diastole with isovolumetric relaxation  SL close and AV not open yet  Decreased intraventricular pressure  Blood volume unchanged 4- LV pressure < LA pressure  AV open and ventricle fills 19Mosby items and derived items © 2006 by Mosby, Inc.
  • 20. Blood Flow 20Mosby items and derived items © 2006 by Mosby, Inc.
  • 21. Normal Intracardiac Pressures 21Mosby items and derived items © 2006 by Mosby, Inc.
  • 22. The Coronary Vessels Right coronary artery (RCA)  Conus  Right marginal branch  Posterior descending branch Left coronary artery (LCA)  Left anterior descending artery (LAD)  Circumflex artery (LCX) 22Mosby items and derived items © 2006 by Mosby, Inc.
  • 23. The Coronary Vessels Collateral arteries Coronary capillaries Coronary veins  Coronary sinus  Great cardiac vein  Posterior vein of the left ventricle Coronary lymphatic vessels 23Mosby items and derived items © 2006 by Mosby, Inc.
  • 24. The Coronary Vessels 24Mosby items and derived items © 2006 by Mosby, Inc.
  • 25. Structures That Control HeartAction Cardiac action potentials Conduction system  Sinoatrial node (SA) - 60-100  Intranodal pathways  DELAY  Atrioventricular node (AV)  Bundle of His (AV bundle)  Right and left bundle branches  Purkinje fibers 25Mosby items and derived items © 2006 by Mosby, Inc.
  • 26. Conduction System of the Heart 26Mosby items and derived items © 2006 by Mosby, Inc.
  • 27. Structures That Control HeartAction Cardiac excitation Propagation of cardiac action potentials  Depolarization – Na and Ca  Repolarization - K Electocardiogram Automaticity  Spontaneous depolarization = no stimulus  SA node, AV node, ventricles Rhythmicity  Regular AP generation by conduction system 27Mosby items and derived items © 2006 by Mosby, Inc.
  • 28. Cardiac Action Potential Four phases  Resting phase (4) cell membrane is relatively impermeable to sodium. Electrical differences are maintained by NA and K pump  Phase 0: rapid depolarization with increase permeability to NA with increasing positive potential  Phase 1: Rapid decrease in Na movement  Phase 2: increased calcium movement  Phase 3: rapid repolarization with movement of K out of the cell 28Mosby items and derived items © 2006 by Mosby, Inc.
  • 29. Ventricle Action Potential 29Mosby items and derived items © 2006 by Mosby, Inc.
  • 30. Comparison of Action Potential Skeletal AP Skeletal force Cardiac AP  Allows ventricle filling Cardiac force 30Mosby items and derived items © 2006 by Mosby, Inc.
  • 31. Action Potential 31Mosby items and derived items © 2006 by Mosby, Inc.
  • 32. SA Node depolarization 32Mosby items and derived items © 2006 by Mosby, Inc.
  • 33. ECG Tracing 33Mosby items and derived items © 2006 by Mosby, Inc.
  • 34. Cardiac Cycle Concepts:  Systole: contraction phase of the heart  Diastole: relaxation and filling phase of the heart  Blood moves from areas of higher to lower pressure  Valves between cardiac chambers also respond to pressure changes  Heart rate will impact the length of each phase of the cardiac cycle. (Increased heart rate all phases will be shortened 34Mosby items and derived items © 2006 by Mosby, Inc.
  • 35. 35Mosby items and derived items © 2006 by Mosby, Inc.
  • 36. Cardiac Cycle  Systole  Aortic and pulmonic valves are open  Contraction phase of the heart  Responsible for stroke volume  Stroke volume 70-80 cc with residual volume of 50-60cc 36Mosby items and derived items © 2006 by Mosby, Inc.
  • 37. Cardiac Cycle 37Mosby items and derived items © 2006 by Mosby, Inc.
  • 38. CARDIAC WORKLOAD 38Mosby items and derived items © 2006 by Mosby, Inc.
  • 39. Control of Cardiac Output 39Mosby items and derived items © 2006 by Mosby, Inc.
  • 40. Autonomic Control of CO 40Mosby items and derived items © 2006 by Mosby, Inc.
  • 41. Cardiac Workload Frank-Starling Law of the heart  Increased stretch, increase force of contraction  The amount of blood in the ventricle at end of diastole (EDV) is directly related to the contraction force of the next systole assuming function of heart remains constant 41Mosby items and derived items © 2006 by Mosby, Inc.
  • 42. Cardiac Workload Laplace’s Law  Amount of ventricle wall tension to produce a certain pressure depends on size/radius of chamber and wall thickness. 42Mosby items and derived items © 2006 by Mosby, Inc.
  • 43. Cardiac Workload Afterload - systemic blood pressure.  PVR  Resistance to left ventricular ejection of blood Heart rate  Neural control mechanisms  Thyroid Hormones  Increased HR will increase Oxygen demand. 43Mosby items and derived items © 2006 by Mosby, Inc.
  • 44. Structures That Control HeartAction Cardiac innervation  Sympathetic nerves  Parasympathetic nerves Adrenergic receptor function  α- or β-adrenergic receptors  Norepinephrine or epinephrine 44Mosby items and derived items © 2006 by Mosby, Inc.
  • 45. Autonomic Innervation of theCardiovascular System 45Mosby items and derived items © 2006 by Mosby, Inc.
  • 46. Systemic Circulation  Macrocirculation  Arteries  High pressure  Elastin  Smooth muscle  Veins  Thin walled  Low pressure  valves  Microcirculation  Arterioles  Metarterioles – pre-capillary sphincter  Capillaries Microcirc are the major  Hydrostatic and oncotic pressures contributors the the  Venules peripheral vascular resistance 46Mosby items and derived items © 2006 by Mosby, Inc.
  • 47. Factors Affecting Blood Flow Poiseuille law Pressure  Force of walls exerted on a liquid per unit area Resistance  Opposition to force  Diameter and length of the blood vessels contribute to resistance 47Mosby items and derived items © 2006 by Mosby, Inc.
  • 48. Factors Affecting Blood Flow Velocity Laminar vs. turbulent flow Vascular compliance  C=VP  If there is an increase in volume, there is a compliance of the vessel to accommodate an increase in pressure. 48Mosby items and derived items © 2006 by Mosby, Inc.
  • 49. Laminar vs. Turbulent Flow 49Mosby items and derived items © 2006 by Mosby, Inc.
  • 50. Regulation of Blood Pressure Arterial pressure  Mean arterial pressure (MAP)  MAP = DP + 1/3(SP-DP) --> 90. High is 120-60.  Effects of cardiac output (CO)  Effects of total peripheral resistance (TPR)  Effects of hormones and Peptides  Epinephrine and norepinephrine - constriction.  Antidiuretic hormone, renin-angiotensin-aldosterone system, and  natriuretic peptides(opposite of Angiotensin II, Aldo) 50Mosby items and derived items © 2006 by Mosby, Inc.
  • 51. Regulation of Coronary Circulation Coronary perfusion pressure (CPP)  Difference in the aorta pressure and the pressure in the right atrium coronary vessels Autoregulation  Metabolic overrides neurogenic  Systemic and coronary Autonomic regulation  SNS/PNS 51Mosby items and derived items © 2006 by Mosby, Inc.
  • 52. Lymphatic System Special vascular system that picks up excess fluid and returns it to the bloodstream Lymphatic fluid Lymphatic veins and venules - pick up a lot of fluid. Right lymphatic duct Thoracic duct 52Mosby items and derived items © 2006 by Mosby, Inc.
  • 53. Lymphatic System 53Mosby items and derived items © 2006 by Mosby, Inc.
  • 54. Questions? Thanks for your attention.. 54Mosby items and derived items © 2006 by Mosby, Inc.