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CARDIOVASCULAR SYSTEM
BY
Dr. A.R. JOSHI
PROFESSOR OF PHYSIOLOGY
CARDIOVASCULAR SYSTEM
Properties of Cardiac Muscle
1. Autorhythmicity
2. Conductivity
3. Contractility
4. Excitability
5. ...
 Electrodes (leads).
 Amplifier
 Recording unit
 Bipolar leads – I, II, III.
 Unipolar leads –
Limb leads – aVR , aVL , aVF
Chest leads – V1 to V6.
 P-Wave- Depolarization of atria
 QRS Complex- Depolarization of
ventricles
 T-Wave – Repolarization of ventricles
 PR interval – AV conduction time
• (0.12 – 0.16 Sec.)
 QT interval – Ventricular systole
• (0.26 – 0.30 Sec)
 TP inter...
 Diagnosis of arrhythmias & heart
blocks.
 Diagnosis of hypertrophy.
 Diagnosis of IHD.
 Diagnosis of other diseases l...
NERVE SUPPLY OF HEART
Autonomic Nervous System
Sympathetic supply( T1 to T5 )
Effects of stimulation
(Due to Noradrenalin ...
PARA SYMPATHETIC SUPPLY
(Lt. & Rt. Vagus)
Effects of Stimulation :
(Due to Acetyl Choline )
1. Decrease in Heart rate
2. D...
CARDIAC CYCLE
Total time – 0.8 sec when HR -75/min.
Events :
Atrial events :
1. Atrial systole 0.1 sec
2. Atrial diastole ...
VENTRICULAR SYSTOLE
(contraction)
Events :
1. Isovolumetric contraction phase
2. Maximum ejection phase
3. Reduced ejectio...
VENTRICULAR DIASTOLE
(relaxation)
Events :
1. Protodiastole
2. Isovolumetric relaxation phase
3. First rapid filling phase...
FIRST HEART SOUND
Causes :
1. Closure of A-V valves
2. Contraction of Ventricles
3. Ejection of blood in big vessels
Pecul...
SECOND HEART SOUND
Causes :
1. Closure of S-L valves
2. Relaxation of Ventricles
3. Regurgitation of blood in big vessels
...
REGULATION OF HEART RATE
1. Nervous factors
2. Hormonal factors
3. Local factors
4. Reflexes : Cardio acceleratory reflex
...
CLINICAL EXAMINATION OF
ARTERIAL PULSE
1. Rate
2. Rhythm
3. Volume
4. Force
5. Tension
6. Equality
7. Condition of vessel ...
CARDIAC OUTPUT
1. Stroke Volume (70 ml)
2. Minute volume=S.V x H.R.(5 litres/min.)
3. End systolic volume (60 ml)
4. End d...
FACTORS AFFECTING
STROKE VOLUME
Venous return (Input factors) :
1. Muscle pump
2. Respiratory pump
3. Blood volume
4. Pres...
FORCE OF CONTRACTRION
(Output factors)
1. Nervous factors
2. Hormonal factors
3. Frank-Starling’s law
4. Coronary perfusio...
CAUSES OF CARDIAC FAILURE
1. Ischaemic
2. Hypertensive
3. Valvular
4. Cardiomyopathies
RIGHT HEART FAILURE
Causes : COPD
Ischaemia
Pulmonary valve diseases
Secondary to chronic LVF
Effects: Pitting oedema over...
LEFT HEART FAILURE
Causes : Hypertension
Ischaemia
Aortic valve diseases
Effects : Pulmonary oedema
Basal crepitations
Pul...
(Preferably with hospitalization)
1. Treat the basic cause
2. Oxygenation
3. Salt restricted diet
4. Cardiotonic drugs lik...
PHYSIOLOGICAL VARIATION
1. Age
2. Sex
3. Exercise
4. Posture
5. Diurnal
6. Mental stress
7. High altitude
FACTORS AFFECTING B.P.
Systolic B.P. depends upon Cardiac output
Diastolic B.P. depends upon Peripheral
Resistance, which ...
REGULATION OF B.P.
Short term regulation :
Nervous regulation
1. Baroreceptors
2. Chemoreceptors
3. CNS ischemic response
...
REGULATION OF B.P.(cont.. )
Intermediate :
1. Vascular stress relaxation
2. Capillary fluid shift mechanism
Long term :
1....
HYPERTENSION
Definition :
Types : 1. Primary
2. Secondary
Predisposing factors for primary hypertension :
1. Age
2. Sex
3....
HYPERTENSION (cont.. )
Symptomatology :
● Asymptomatic
● Classical symptoms
● Complications
LVF
Encephalopathy and stroke
...
TREATMENT OF PRIMARY
HYPERTENSION
● Mild hypertension :
Life style modification
Salt, fat and sugar restriction
Tranquilli...
ANTIHYPERTENSIVE DRUGS
1. Beta blockers e.g.atenolol
2. Calcium channel blockers e.g.amlodipine
3. ACE inhibitors e.g.capt...
SHOCK
Persistent hypotension leading to
inadequate tissue perfusion.
Types :
1. Hypovolemic
2. Cardiogenic
3. Anaphylactic...
STAGES OF HYPOVOLEMIC
SHOCK
1. Compensatory : Blood loss upto 500ml
(All B.P.regulating mechanisms working to maximum)
2. ...
PRINCIPLES OF TREATMENT
1. Hospitalization
2. Replacement therapy
3. Drugs e.g dopamine
4. Treatment of complications
e.g ...
PECULARITIES OF CORONARY
CIRCULATION
(Normal flow –250 ml per min )
1. End arteries
2. Filled in diastole
3. High capillar...
PECULARITIES OF PULMONARY
CIRCULATION
( Normal flow –5lits per min )
1. Low pressure system
2. No tissue fluid formation
3...
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
Cardiovascular system
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This PPT is on Cardiovascular System ,prepared By Dr.A.R.Joshi & uploaded by Prof.Dr.R.R.Deshpande on 25-8-13

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Cardiovascular system

  1. 1. CARDIOVASCULAR SYSTEM BY Dr. A.R. JOSHI PROFESSOR OF PHYSIOLOGY
  2. 2. CARDIOVASCULAR SYSTEM Properties of Cardiac Muscle 1. Autorhythmicity 2. Conductivity 3. Contractility 4. Excitability 5. All or none law 6. Long refractory period
  3. 3.  Electrodes (leads).  Amplifier  Recording unit
  4. 4.  Bipolar leads – I, II, III.  Unipolar leads – Limb leads – aVR , aVL , aVF Chest leads – V1 to V6.
  5. 5.  P-Wave- Depolarization of atria  QRS Complex- Depolarization of ventricles  T-Wave – Repolarization of ventricles
  6. 6.  PR interval – AV conduction time • (0.12 – 0.16 Sec.)  QT interval – Ventricular systole • (0.26 – 0.30 Sec)  TP interval – Ventricular diastole • (0.46 – 0.50 Sec)  ST- Segment should be iso-electric   
  7. 7.  Diagnosis of arrhythmias & heart blocks.  Diagnosis of hypertrophy.  Diagnosis of IHD.  Diagnosis of other diseases like electrolyte imbalance, pericarditis etc.
  8. 8. NERVE SUPPLY OF HEART Autonomic Nervous System Sympathetic supply( T1 to T5 ) Effects of stimulation (Due to Noradrenalin and Adrenalin ) 1. Increase in Heart rate 2. Increase in Force of contraction 3. Increase in Excitability 4. Increase in Conductivity (Effects blocked by alpha & beta blockers)
  9. 9. PARA SYMPATHETIC SUPPLY (Lt. & Rt. Vagus) Effects of Stimulation : (Due to Acetyl Choline ) 1. Decrease in Heart rate 2. Decrease in Force of contraction 3. Decrease in Excitability 4. Decrease in Conductivity (All effects reverted by Atropine which blocks muscarinic 2 receptors)
  10. 10. CARDIAC CYCLE Total time – 0.8 sec when HR -75/min. Events : Atrial events : 1. Atrial systole 0.1 sec 2. Atrial diastole 0.7 sec Ventricular events : 1. Ventricular systole 0.3 sec 2. Ventricular diastole 0.5 sec
  11. 11. VENTRICULAR SYSTOLE (contraction) Events : 1. Isovolumetric contraction phase 2. Maximum ejection phase 3. Reduced ejection phase (First Heart sound occurs at beginning of Iso-volumetric contraction phase)
  12. 12. VENTRICULAR DIASTOLE (relaxation) Events : 1. Protodiastole 2. Isovolumetric relaxation phase 3. First rapid filling phase 4. Diastasis 5. Last rapid filling phase (Second heart sound occurs at beginning of Isovolumetric relaxation phase )
  13. 13. FIRST HEART SOUND Causes : 1. Closure of A-V valves 2. Contraction of Ventricles 3. Ejection of blood in big vessels Peculiarities 1. Like LUBB 2. Intensity high & pitch low 3. More duration 4. Best heard at apex 5. Best heard with diaphragm 6. Coincides with carotid pulse
  14. 14. SECOND HEART SOUND Causes : 1. Closure of S-L valves 2. Relaxation of Ventricles 3. Regurgitation of blood in big vessels Peculiarities : 1. Like DUP 2. Intensity low & pitch high 3. Short duration 4. Best heard at base 5. Best heard with bell 6. Comes after carotid pulse
  15. 15. REGULATION OF HEART RATE 1. Nervous factors 2. Hormonal factors 3. Local factors 4. Reflexes : Cardio acceleratory reflex Cardio inhibitory reflex 5. Miscellaneous factors like body temp.
  16. 16. CLINICAL EXAMINATION OF ARTERIAL PULSE 1. Rate 2. Rhythm 3. Volume 4. Force 5. Tension 6. Equality 7. Condition of vessel wall 8. Peripheral pulsations 9. Apex–pulse co-relation
  17. 17. CARDIAC OUTPUT 1. Stroke Volume (70 ml) 2. Minute volume=S.V x H.R.(5 litres/min.) 3. End systolic volume (60 ml) 4. End diastolic volume (130 ml) 5. Ejection systolic fraction (0.55) =Stroke volume/End diastolic volume (Criterion of cardiac fitness )
  18. 18. FACTORS AFFECTING STROKE VOLUME Venous return (Input factors) : 1. Muscle pump 2. Respiratory pump 3. Blood volume 4. Pressure gradient 5. Venous tone
  19. 19. FORCE OF CONTRACTRION (Output factors) 1. Nervous factors 2. Hormonal factors 3. Frank-Starling’s law 4. Coronary perfusion 5. Diastolic period
  20. 20. CAUSES OF CARDIAC FAILURE 1. Ischaemic 2. Hypertensive 3. Valvular 4. Cardiomyopathies
  21. 21. RIGHT HEART FAILURE Causes : COPD Ischaemia Pulmonary valve diseases Secondary to chronic LVF Effects: Pitting oedema over feet Prominent neck veins Liver enlargement & ascitis Hepato-jugular reflex present
  22. 22. LEFT HEART FAILURE Causes : Hypertension Ischaemia Aortic valve diseases Effects : Pulmonary oedema Basal crepitations Pulsus alternans
  23. 23. (Preferably with hospitalization) 1. Treat the basic cause 2. Oxygenation 3. Salt restricted diet 4. Cardiotonic drugs like digitalis 5. Drugs to reduce load on heart like diuretics TREATMENT OF CARDIAC FAILURE
  24. 24. PHYSIOLOGICAL VARIATION 1. Age 2. Sex 3. Exercise 4. Posture 5. Diurnal 6. Mental stress 7. High altitude
  25. 25. FACTORS AFFECTING B.P. Systolic B.P. depends upon Cardiac output Diastolic B.P. depends upon Peripheral Resistance, which depends upon- ● Diameter of blood vessel ● Elasticity of blood vessel ● Viscosity of blood ● Velocity of blood ● Length of blood vessel
  26. 26. REGULATION OF B.P. Short term regulation : Nervous regulation 1. Baroreceptors 2. Chemoreceptors 3. CNS ischemic response Hormonal regulation 1. Renin angiotensin 2. Catecholamines 3. ADH
  27. 27. REGULATION OF B.P.(cont.. ) Intermediate : 1. Vascular stress relaxation 2. Capillary fluid shift mechanism Long term : 1. Role of aldosterone 2. Role of kidney
  28. 28. HYPERTENSION Definition : Types : 1. Primary 2. Secondary Predisposing factors for primary hypertension : 1. Age 2. Sex 3. Heredity 4. Life style(Diet,sedentary work,stress,habits) 5. D.M. and obesity
  29. 29. HYPERTENSION (cont.. ) Symptomatology : ● Asymptomatic ● Classical symptoms ● Complications LVF Encephalopathy and stroke Nephropathy Retinopathy
  30. 30. TREATMENT OF PRIMARY HYPERTENSION ● Mild hypertension : Life style modification Salt, fat and sugar restriction Tranquillizers if required ● Moderate hypertension : All above Diuretics ● Severe hypertension: All above Anti hypertensives
  31. 31. ANTIHYPERTENSIVE DRUGS 1. Beta blockers e.g.atenolol 2. Calcium channel blockers e.g.amlodipine 3. ACE inhibitors e.g.captopril 4. Angiotensin receptor blockers e.g.losartan 5. Alpha receptor blockers e.g.doxazocin
  32. 32. SHOCK Persistent hypotension leading to inadequate tissue perfusion. Types : 1. Hypovolemic 2. Cardiogenic 3. Anaphylactic 4. Neurogenic 5. Septic
  33. 33. STAGES OF HYPOVOLEMIC SHOCK 1. Compensatory : Blood loss upto 500ml (All B.P.regulating mechanisms working to maximum) 2. Progressive : Blood loss upto 1 litre (External help in form of fluid or blood transfusion ) 3. Irreversible : Blood loss more than 1 litre (Harmful positive feedback sets in )
  34. 34. PRINCIPLES OF TREATMENT 1. Hospitalization 2. Replacement therapy 3. Drugs e.g dopamine 4. Treatment of complications e.g renal failure
  35. 35. PECULARITIES OF CORONARY CIRCULATION (Normal flow –250 ml per min ) 1. End arteries 2. Filled in diastole 3. High capillary density 4. A-V difference of oxygen is high 5. Local factors regulate blood flow 6. Presence of beta receptors 7. Energy derived from fatty acids
  36. 36. PECULARITIES OF PULMONARY CIRCULATION ( Normal flow –5lits per min ) 1. Low pressure system 2. No tissue fluid formation 3. Distensible 4. Nerves and hormones have no effect 5. Hypoxia causes vasoconstriction 6. Less blood flow to apex and more to base 7. Rich lymphatic supply

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