Coronary circulation1903
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Coronary circulation basics
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Coronary circulation1903
- 4. Coronary Blood Flow •225 ml/min Normal CBF = 70mL/100g tissue/min 4-5% of CO 3 to 6 times increase in exercise O2 Consumption 8mL/min/100g at rest
- 5. Measurement of CBF Nitrous Oxide (Kety method) Radionuclides utilization techniques Coronary Angiographic technique Electromagnetic flowmeter technique Cardiac MRI
- 6. Factors That Influence Coronary Blood Flow Physical Factors Neural and Neurohumoral Factors Metabolic Factors
- 7. Physical Factors • Aortic pressure • Arteriolar resistance • Extravascular compression • Counterpulsation
- 8. Neural and Neurohumoral Factors • Sympathetic nerves – vasoconstriction • Vagus nerve - slight dilation
- 12. Factors affecting coronary blood flow Mean aortic pressure Muscular exercise Emotional excitement Hypotension Hormones Heart rate Effect of ions Metabolic factors Temperature
- 14. Coronary artery disease • Leading cause of death in the world • Atherosclerosis – Plaques
- 16. Angina Pectoris The sensation of chest pain, pressure, or squeezing, often due to ischemia of the heart muscle from obstruction or spasm of the coronary arteries
- 17. Myocardial Infarction Coronary occlusion leading to loss of function of myocardium
- 18. Causes of Death after Acute Coronary Occlusion Decreased Cardiac Output Damning of Blood in Pulmonary vessels Pulmonary edema Fibrillation of Heart Rupture of heart
- 19. ECG Changes in MI
- 20. ECG Changes in MI
- 21. Treatment of CAD Vasodilators – Nitroglycerine Beta Blockers CABG Coronary Angioplasty Balloon & Stent
- 23. PTCA
- 24. CABG
- 25. CEREBRAL CIRCULATION Measurement and regulation
- 27. Circle of Willis
- 28. Normal Blood Flow Continuous Blood Flow Stop 5-10 s Unconscious Stop 3-4 min Brain Damage 15% of Tot Blood flow 18mL/100g tissue Critical flow level
- 29. Normal O2 consumption • Total 50mL/min – 3.3mL/100 g/min • Gray matter has more O2 consumption
- 30. Measurement of Cerebral Blood Flow 1. Kety method 2. SPECT 1. Single Photon Emission Computed Tomography 3. PET 1. Positron Emission tomography 4. MRI 1. Magnetic Resonance Imaging
- 31. Kety method • Fick’s principle using 15 % N2O for 10 min • Cerebral blood flow (CBF) = – N2O taken by brain tissue per min / A-V diff of [N2O ]
- 32. • Single-Photon Emission Computed Tomography (SPECT) • PET • MRI
- 36. Regulation of Cerebral Blood Flow THE BRAIN CONSUMES 20% of total body oxygen 25% of total body glucose
- 37. REGULATION OF CEREBRAL BLOOD FLOW • Metabolic regulation • Auto-regulation of CBF • ICP in regulation of CBF – Monro Kellie Doctrine – Cushing reflex • Nervous regulation of CBF
- 38. Autoregulation Inspite of systemic pressure changes within 60-140 mmHg range BP CBF in brain is unchanged.
- 39. Monro-Kellie doctrine Brain tissue and spinal fluid are essentially incompressible, the volume of blood, spinal fluid, and brain in the cranium at any time must be relatively constant.
- 40. Cushing Reflex • Cushing's triad of – increased blood pressure, – irregular breathing, – reduction of the heart rate
- 41. Cushing reaction
- 42. Stroke Stroke, also known as cerebrovascular accident (CVA), cerebrovascular insult (CVI), or brain attack, is when poor blood flow to the brain results in cell death.