CARDIOVASCULAR SYSTEM
By,
Jitendra Mourya
Mayur Gupta
Sameer Patil
Sanjeev Kumar

Guide
Prof. Prashant Sir
 What is the cardiovascular system?
 Parts of cardiovascular system ?
Functions of the Heart
• Generates blood pressure
• Routes blood
– Heart separates pulmonary and systemic
circulation

• E...
Functions of the Heart
• Regulates blood supply
– Changes in contraction rate and force match
blood delivery to changing m...
Chambers of the heart; valves
HEART




Deoxygenated blood returns to
the heart via the superior and
inferior vena cava, enters the
right atrium, pass...
The double pump
Serous membrane

Continuous with
blood vessels
Coordination of chamber contraction, relaxation
The Heart: Cardiac Output
• Cardiac output (CO)
• Amount of blood pumped by each side of the
heart in one minute
• CO = (h...
Conduction system of the heart
Heart contracts as a unit
Atrial and ventricular syncytia help conduct
electrical signals t...
Electrocardiogram (ECG) can trace conduction
of electrical signals through the heart
Electrocardiograms (EKG/ECG)
(cont.)
Aberrant ECG patterns indicate damage
More cells

constriction of blood
vessel walls
Characteristics of blood vessels
Arteries and arterioles carry blood away from
heart
Capillaries- site of exchange
Venules...
Endothelium- prevents platelet aggregation
secretes substances that control diameter
of blood vessel
Tunica media- smooth ...
KIDNEYS AND BLOOD PRESSURE RUGULATION
THE “RENIN-ANGIOTENSIN SYSTEM”
Antihypertensive
Definition of Hypertension- Hypertension is very common disorder
particularly past middle age.
Hypertensi...
Types of Hypertension: Mild Hypertension- 90-99 mmHg/140-159 mmHg
 Moderate hypertension- 100-109 mmHg/160-179 mmHg
 Se...
Risk factor:Age, alcohol, cigarette smoking, diabetes mellitus, elevated serum
lipids, excess Na ⁺ in diet, gender, family...
Drug Therapy
DIURETICS- First line therapy for HT, promotes salt-water excretion
thereby relaxing the vascular constrictio...
ANGIOTENSIN CONVERTING ENZYME INHIBITORS– Enalapril,
lisinopril, captopril.
Mechanism of action- blocks conversion of angi...
FACTS WITH HYPERTENSION
 One fifth of the deaths in India are from coronary heart disease. By the

year 2020, it will acc...
ARRYTHMIA
An Arrhythmia is an abnormal rhythm of the heart and is caused
by problems with Hearts electrical impulse genera...
Types of Arrhythmias
The arrhythmias are basically into following categories
depending upon there impact on rate of heartb...
Types of Bradycardia
•

Sinus bradycardia : The heart rate is less than 60 beats per min and it is considered as
normal an...
Types of Tachycardia
•

Atrial or Supraventricular tachycardia (SVT) is a fast heart rate that starts in the upper
chamber...
Physical causes of arrhythmia
•
•
•
•
•
•

Mechanical injury
Smoking.
Heart attack .
Drug influences.
Antiarythmatic drugs...
Actual causes
•
•
•
•
•
•

Abnormal atomaticity.
Impaired conduction.
Combination of above two.
Ischemia.
Electrolyte and ...
Mechanism of Arrythmias
•

Ectopic Pacemakers

When the SA node is suppressed the other specialized conduction tissues lik...
Reentry Mechanism
Antiarrythmatic Drugs
•

Vaughan Williams and Singh in 1969 divided
the antiarrythmatic drugs into four classes
according ...
Class I Drugs
• They are further classified into IA, IB, IC
•

IA : They moderately decrease dv/dt (electrical potential) ...
Additional Drugs
•

Adenosine, Digitalis : For PSVT (Paroxysmal Supraventricular Tachycardia)

•

Sympathomomimetics-Isopr...
Important Drugs Used for Arrythmia
Drugs

Class

Brand
Name

T½

Dosage

Used for

Excretion

Disopyramide

I

Norpace

6-...
Adverse effects of
antiarrythmatic Drugs
•

The major adverse effect of antiarrythmatic drugs are they themselves cause ar...
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
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Cardiovascular system

  1. 1. CARDIOVASCULAR SYSTEM By, Jitendra Mourya Mayur Gupta Sameer Patil Sanjeev Kumar Guide Prof. Prashant Sir
  2. 2.  What is the cardiovascular system?  Parts of cardiovascular system ?
  3. 3. Functions of the Heart • Generates blood pressure • Routes blood – Heart separates pulmonary and systemic circulation • Ensures one-way blood flow – Heart valves ensure one-way flow 3
  4. 4. Functions of the Heart • Regulates blood supply – Changes in contraction rate and force match blood delivery to changing metabolic needs – Most healthy people can increase cardiac output by 300–500%
  5. 5. Chambers of the heart; valves
  6. 6. HEART   Deoxygenated blood returns to the heart via the superior and inferior vena cava, enters the right atrium, passes into the right ventricle, and from here it is ejected to the pulmonary artery. Oxygenated blood returning from the lungs enters the left atrium via the pulmonary veins, passes into the left ventricle, and is then ejected to the aorta.
  7. 7. The double pump
  8. 8. Serous membrane Continuous with blood vessels
  9. 9. Coordination of chamber contraction, relaxation
  10. 10. The Heart: Cardiac Output • Cardiac output (CO) • Amount of blood pumped by each side of the heart in one minute • CO = (heart rate [HR]) x (stroke volume [SV]) • Stroke volume • Volume of blood pumped by each ventricle in one contraction
  11. 11. Conduction system of the heart Heart contracts as a unit Atrial and ventricular syncytia help conduct electrical signals through the heart Sinoatrial (S-A) node is continuous with atrial syncytium S-A node cells can initiate impulses on their own; activity is rhythmic
  12. 12. Electrocardiogram (ECG) can trace conduction of electrical signals through the heart
  13. 13. Electrocardiograms (EKG/ECG) (cont.)
  14. 14. Aberrant ECG patterns indicate damage
  15. 15. More cells constriction of blood vessel walls
  16. 16. Characteristics of blood vessels Arteries and arterioles carry blood away from heart Capillaries- site of exchange Venules, veins- return blood to heart
  17. 17. Endothelium- prevents platelet aggregation secretes substances that control diameter of blood vessel Tunica media- smooth muscle and connective tissue. Innervated by sympathetic nerves (vasoconstriction) Missing in smallest arteries Tunica externa- connective tissue; is vascularized
  18. 18. KIDNEYS AND BLOOD PRESSURE RUGULATION THE “RENIN-ANGIOTENSIN SYSTEM”
  19. 19. Antihypertensive Definition of Hypertension- Hypertension is very common disorder particularly past middle age. Hypertension could be that level of BP (blood pressure) at or above which long term antihypertensive treatment will reduce cardiovascular mortality.  Blood Pressure- The force exerted by the blood against the walls of the blood vessels.  Normal blood pressure- 140/90 mmHg (systolic/diastolic)
  20. 20. Types of Hypertension: Mild Hypertension- 90-99 mmHg/140-159 mmHg  Moderate hypertension- 100-109 mmHg/160-179 mmHg  Severe Hypertension- 110mmHg or more/180 mmHg or more Classification: Primary hypertension- elevated BP without known cause, accounts for over 95% of hypertension cases.  Secondary hypertension- cause of hypertension can be identified accounts for 5% of hypertension cases.
  21. 21. Risk factor:Age, alcohol, cigarette smoking, diabetes mellitus, elevated serum lipids, excess Na ⁺ in diet, gender, family history, obesity, sedentary lifestyle & socioeconomic stress. Medical management Lifestyle modification:• Nutritional therapy • Avoid tobacco, smoking • Reduce alcohol consumption • Physical activity
  22. 22. Drug Therapy DIURETICS- First line therapy for HT, promotes salt-water excretion thereby relaxing the vascular constriction.  Thiazide diuretics- Hydrochlorthiazide, Chlorthalidone Mechanism of action- act on DCT To inhibit Na/Cl Co-transport ADR- Hypokalemia, hypoglycemia, hypercalcaemia Marketed Products- Hydrazide Tab( cipla), Aquazide(Sun)  Loop diuretics- Furosemide, buetanide, torasemide Mechanism of action- act on ascendind loop of henle by inhibiting Na/K/2Cl co-transport. Used in only severe HT with cardiac and renal insuffiency ADR- Hyperuricaemia, hypercalciuria, hyperemagnesaemia, hypokalaemia Marketed Products- Lasix (SANOFI AVENTIS)
  23. 23. ANGIOTENSIN CONVERTING ENZYME INHIBITORS– Enalapril, lisinopril, captopril. Mechanism of action- blocks conversion of angiotensin 1 to ang. 2 which is vasoconstrictor and stimulates aldosterone release and thus promotes Na retention, also inhibit degradation of bradykinin which is vasodilator. ADR- hypotension after first dose, dry cough, angioneuratic oedema, hyperkalaemia, fatal during pregnancy Marketed products- Aceten tab(WOCKHARDT), Angiopril(TORRENT), Acinopril(NICHOLAS), Ciprol(CIPLA) ANGIOTENSIN RECEPTOR ANTAGONIST CALCIUM CHANNEL BLOCKER VASODILATORS BETA ADRENERGIC BLOCKER ALPHA BLOCKER
  24. 24. FACTS WITH HYPERTENSION  One fifth of the deaths in India are from coronary heart disease. By the year 2020, it will account for one third of all deaths. Sadly, many of these Indians will be dying young.  there appears to be a steady increase in hypertension prevalence over the last 50 years, more in urban than in rural areas. Hypertension is 2530% in urban and 10-15% in rural subjects.  Current projections suggest that India will have the largest cardiovascular disease burden in the world.
  25. 25. ARRYTHMIA An Arrhythmia is an abnormal rhythm of the heart and is caused by problems with Hearts electrical impulse generation or conduction or both. The electrical impulses may occur too fast or too slow or irratically causing the heart to beat very fast or very slow . The normal rate of heart beat in a healthy person ranges between 60-80 beats per second
  26. 26. Types of Arrhythmias The arrhythmias are basically into following categories depending upon there impact on rate of heartbeat. 1) Bradycardia :In which the rate of heart beat is very low i.e. less than 60pulse /min. 2) Tachycardia : In which the rate of heart beat is very high i.e. more than 100 pulse /min 3)Atrial Fibrillation (AF or AFib) :AF is a quivering or irregular heartbeat that can lead to stroke and other heart-related complications. 4)Ventricular fibrillation: is life-threatening Ventricular fibrillation (v-fib for short) is the most serious cardiac rhythm disturbance. The lower chambers quiver and the heart can't pump any blood, causing cardiac arrest
  27. 27. Types of Bradycardia • Sinus bradycardia : The heart rate is less than 60 beats per min and it is considered as normal and not needed tobe treated. • Sinus pause (also called sinus arrest) : During a sinus pause, the heart may miss one or more beats because its natural pacemaker. Sick sinus syndrome :Sick sinus syndrome happens when the normal pacemaker of the heart (the sinus node) does not work properly • • Heart block :Heart block refers to an abnormality in the way electricity passes through the normal electrical pathways of the heart. The abnormality "blocks" the electrical impulse from continuing through the normal pathways and usually results in a slower heart rate.
  28. 28. Types of Tachycardia • Atrial or Supraventricular tachycardia (SVT) is a fast heart rate that starts in the upper chambers of the heart. some forms are called paroxysmal atrial tachycardia (PAT) or paroxysmal supraventricular tachycardia (PSVT). • Sinus tachycardia = fast but steady Sinus tachycardia is a normal increase in the heart rate The sinoatrial (SA) node --- the heart's natural pacemaker - sends out electrical signals faster than usual. The heart rate is fast, but the heart beats properly. • Ventricular tachycardia is a fast heart rate that starts in the heart's lower chambers (ventricles). It often occurs in life-threatening situations that dictate rapid diagnosis and treatment
  29. 29. Physical causes of arrhythmia • • • • • • Mechanical injury Smoking. Heart attack . Drug influences. Antiarythmatic drugs Congenital heart defects (present at the time of birth) e.g. Wolff-Parkinson-White syndrome . • Strong emotions, anger and other feelings may cause imbalance in heart beats.
  30. 30. Actual causes • • • • • • Abnormal atomaticity. Impaired conduction. Combination of above two. Ischemia. Electrolyte and pH imbalance. Altering electrophysiological properties of cardiac fibres.
  31. 31. Mechanism of Arrythmias • Ectopic Pacemakers When the SA node is suppressed the other specialized conduction tissues like artrial fibres, artrioventricular nodal tissue, bundle if HIS, pirkinje fibres takes up the role of pacemakers and develop automaticity.such conditions occur in the cases of myocardial ischaemia,hypopotassaemia circulating cathecoalmines. • Electrophisiological Actions This phenomenon occurs when the slope of depolarization in phase 1 increase causing premature ventricular beats,ventricular tachycardias,ventricular,rhythm escape. • Reentry or Altered Impulse Propagation or Conductivity Defect In this type of mechanism heart may transmit impulses slowly or act as a conduction blocks.simply slowing the rate of transmission of impulses through ventricals causing ventricular tachycardias, A-V blocks, ventricular premature beats.this can occur in case of
  32. 32. Reentry Mechanism
  33. 33. Antiarrythmatic Drugs • Vaughan Williams and Singh in 1969 divided the antiarrythmatic drugs into four classes according to their actions on the heart cells. Antiarrythmatic Drugs Class I Na+ channel blocker Class II Beta-Adrenergic blockers Propanolol,Esmolol,Sotalol Class III Prolong Repolaraization Class IV Ca channel blocker Amiodarone,Bretylium, Dofelitide,Ibulitide Verapamil,Diliatizem
  34. 34. Class I Drugs • They are further classified into IA, IB, IC • IA : They moderately decrease dv/dt (electrical potential) of 0 phase. Drugs: Quninidine, Procanamide, Disopyramide, Moricizine • IB : They make a little decrease in dv/dt of 0 phase. Drugs : Lidocaine, Mexiletine • Ic : They markably decrease in dv/dt of 0 phase. Drugs : Propafenone, Flecainide
  35. 35. Additional Drugs • Adenosine, Digitalis : For PSVT (Paroxysmal Supraventricular Tachycardia) • Sympathomomimetics-Isoprenaline Anticholinergics-Antropine : for A-V Blocks(Artrio-Ventricular blocks) Anti arrythmatic Drugs can only reset the heart beat by monitoring or controlling the flow of ions or elements such as Na+,Ca2+.Cl-,K+ in the cardial cells. Or they can Prolong the ERP(effective refractory period) and ADP(action potential duration). Simply antiarrythmatic drugs are used only for resseting or prolonging the action potential. The important Drugs which are used freqently are tabulised as follows
  36. 36. Important Drugs Used for Arrythmia Drugs Class Brand Name T½ Dosage Used for Excretion Disopyramide I Norpace 6-7 hrs Oral 100-150 mg Anti chlorinergic renal Propranolol II Idneral 3-4 hrs i.v. 40-80 mg Fillbration and toxication renal Amiodarone III Cordarone, Pacerone 3-8 weeks Orally 400-600mg i.v. 100-300 mg Ventricular arrythmias Hepatic and biliary Verapamil IV Calan, veralan I.V. 5 mg PSVT Urine and faeces Adenosine new Adenocar,Ade noscan I.V. 6-12 mg PSVT and nearly all above urine 5-12 hrs < 10 sec
  37. 37. Adverse effects of antiarrythmatic Drugs • The major adverse effect of antiarrythmatic drugs are they themselves cause arrythmia. • Major part of these drugs are toxic if not administered accurately .e.g. lidocaine • They can cause fall or rise in blood pressure. • Other adverse effect seen in most antiarrythmatic drugs is nausea,bradyarrythmia,drowsiness,pulmonary aveoltis and fibrosis. • Photosensitization

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