The coronary circulation supplies blood to the heart muscle. The right and left coronary arteries branch to form a dense capillary network around each cardiac muscle cell. Coronary blood flow is regulated by metabolic demand of the heart as well as mechanical factors related to the cardiac cycle. During systole, compressive forces within the heart reduce coronary flow, while flow increases during diastole when the vessels dilate. Multiple chemical and neural factors also control resistance within the coronary vasculature to match blood supply with myocardial oxygen requirements. Imbalances can lead to ischemia if demand outpaces supply.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
A patient with pacemaker presents a complex challenge to the attending anaesthesiologist. The mode of management will be according to the type of pacemaker implanted. This presentation discusses in brief the peri-operative consideration in a patient with pacemaker.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
A patient with pacemaker presents a complex challenge to the attending anaesthesiologist. The mode of management will be according to the type of pacemaker implanted. This presentation discusses in brief the peri-operative consideration in a patient with pacemaker.
THE CORONARY CIRCULATION of the heart in the bodyAsiiAyodimeji
Coronary circulation of the heart the heart is supply by two artery On the side of the heart :Right coronary artery and left coronary artery the Right coronary artery supply the Right portion of the heart the Right ventricle and Right auricle
USMLE CVS 004 Coronary circulation and venous drainage heart.pdfAHMED ASHOUR
The blood supply to the heart is crucial for its function as a muscular organ that pumps blood to the rest of the body.
The coronary circulation provides oxygen and nutrients to the heart muscle (myocardium).
Understanding the blood supply to the heart is crucial for diagnosing and treating cardiovascular conditions, and interventions such as coronary artery bypass grafting (CABG) may be performed to restore blood flow to the heart muscle in certain cases.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
3. Coronary Vascular
Resistance
Epicardial conductance vessels
Only a small % of resistance normally
Stenotic lesions
Intramyocardial vessels (arterioles)
Contribute most to total coronary vascular
resistance
5. CORONARY CIRCULATION
BLOOD SUPPLY OF THE HEART:
Arterial supply:
- The cardiac muscle is supplied by the first two branches
of the aorta i.e. right & left coronary arteries.
- The coronary arteries branch freely to form a rich
capillary network.
- There is about one capillary for each cardiac muscle
fiber.
6. Coronary arteries are functional end arteries.
Anastomatic connections bet. the small branches of
the two coronary arteries and bet. the coronary
arterioles and extra cardiac arterioles.
These anatomizes are not sufficient to supply the
cardiac muscle with blood if one of the coronary
arteries is occluded.
Thus, occlusion of a large branch of the coronary
artery e.g. by coronary thrombosis necrosis
(=death) of the muscle supplied by that branch.
7. Venous Drainage:
Coronary venous drainage occurs through two
systems:
1) Superficial system: It is formed of coronary sinus
and anterior cardiac veins that open into the right
atrium.
2) Deep system: which drains the rest of the heart. It is
formed of thebasian veins and arterio-sinusoidal
vessels that open directly into the heart chamber.
8. CHARACTERISTICS OF THE
CORONARY CIRCULATION
1) It is very short and very rapid (so it is essential to the
heart).
2) The blood flow in this circulation occurs mainly during
cardiac diastole (75%)
3) There is no efficient anastomoses between the coronary
vessels.
4) It is a rich circulation (5% of the CO while the heart
weight is 300gm).
9. 5) Its regulation is mainly by metabolites and not
neural
6) The capillary permeability is high (the cardiac lymph
is rich in protein)
7) The coronary vessels are susceptible to
degeneration and atherosclerosis.
10. CORONARY BLOOD FLOW
Under resting conditions coronary blood flow
(CBF) in the human heart is about 250 ml/ minute
(=5% of the cardiac output).
In severe muscular exercise, the work of the
heart increased and the CBF may be increased
up to 2 liters/ minute.
11. Coronary Inflow (arterial) occurs mainly during
diastole, because during systole the coronary
arteries are mechanically compressed by the
contracting myocardium, i.e.
Systole of the heart coronary inflow
Diastole of the heart coronary inflow
12. Coronary Outflow (venous) occurs mainly
during systolic due to compression of the
coronary veins by the contracting myocardium.
During diastole coronary outflow and veins are
filled.
Normal diastolic blood pressure is important for
coronary filling because filling of coronary
arteries occurs mainly during ventricular
diastolic.
14. RIGHT CORONARY ARTERY
Arises from the ant. Coronary sinus of valsalva just above the
ant. Cusp of aortic valve .
Passes bet. Pulmonay trunk & rt. Atrium.
Desends in the rt. Part of AV groove/sulcus.
In 80% continues as post. Inter-ventricular artery (PDA).
And anastamosis with ant. Inter-ventricular artery (br. Of LCA)
15. Before entering the AV groove gives SA nodal artery in
60%.
AV nodal branch in 90% (br. Of PDA)
Acute Marginal Branch – runs to the apex –ant. Wall of
right ventricle
PDA gives of Septal branches– Post. 1/3 inter-ventricular
septum
PDA gives off br. to post. Of right ventricle.
PDA gives off anastamotic br. with LCX & ant. Inter-
ventricular A.
Brach to Post. Medial papillary muscle of left ventricle.
16. LEFT CORONARY ARTERY
Arises from the Post. Aortic sinus of valsalva.
Passes behind the Pulmonary trunk & left atrial
appendage (1-2cm).
Divides in the space between Aorta & pulmonary
artery into:-
1) Left ant. Inter-ventricular (LAD)
2) Circumflex Artery
17. LAD- Left Ant. Descending Artery :-----
Runs in Ant. Inter-Venticular Sulcus.
Turns sharply at the apex to anastomose with PDA.
Supplies apical portion of both ventricles.
Gives off Diagonal Braches – Left ventricular lateral wall.
Gives off a branch to Antero-lateral papillary muscle of R
ventricle
Gives off Septal Branches–Ant. 2/3 inter-ventricular septum
( In 1%Left coronary artery is absent – both branches originate from the aorta
via separate Ostia)
18. LCX- Circumflex Artery:----
Arises at right angle to LCA near the base of left atrial
appendage.
Runs in the left part of AV groove around the left border of heart.
Ends on the post surface of heart by anastamosing with RCA.
In Av groove lies close to the annulus of mirtal valve.
Gives off Atrial circumfles artery – Left atrium.
Gives off Obtuse Marginal Br. At left border –Post surface LV
In less than 40% SA Nodal br. Arises from LCX.
19.
20. VENOUS DRAINAGE OF HEART
- Veins follow the arteries but different names.
- 2/3 of venous return via Coronary sinus & Ant. Cardiac
Vein.
- Remaining by small veins – Venae Cordae Minimae-
directly into the cavity of heart.
21.
22. Coronary Sinus
2.25 cm wide channel – continuation of Great Cardiac
Vein
Runs L-R in the Post. Portion of coronary groove on the
Post. Surface of heart.
Opening located bet. Right AV orifice & IVC.
Receives blood from ---
Great cardiac vein, Oblique vein, Post. Vein of left
ventricle from the left side.
23. Great Cardiac Vein
Begins at the apex
Ascends in Ant.inter-ventricular groove along with LAD artery
Drains areas supplied by LCA
Receives tributaries –
Left ventricular surface via Ant. Inter-ventricular Vein
Left marginal vein (follows marginal branch of the
circumflex artery)
Left posterior vein
24. Middle & Small Cardiac Vein
Middle cardiac vein :- begins at apex – Ascends in the post.
Inter-ventricular groove along with PDA.
Empties into the right side of coronary sinus.
Small Cardiac Vein :- is a continuation of right marginal vein.
Runs along the lower border of heart.
Empties into coronary sinus but may drain directly into right
atrium.
Both drain areas supplied by Right Coronary Artery
25. Oblique vein –
Descends on the back of left atrium.
Opens into the left side of coronary sinus.
Remnant of left superior vena cava.
Anterior Cardiac Vein –
Crosses the ant. Inter-venticular groove over RCA.
Opens directly into right atrium.
Drains most of ant. Surface of heart.
26. Venae Cordae Minimae / "lesser" venous system
Thebesian veins drain blood from the capillary bed into
the ventricular cavity.
Arterioluminal vessels drain blood directly from the
arteries into ventricles without traversing capillary beds.
Venoluminal vessels form direct communications with the
coronary veins, shunting blood from these vessels into
the ventricular cavities.
(this coronary venous blood draining directly into LV
contributes to fixed shunt & to dilution of oxygenated
blood)
28. The amount of blood passing through
the coronary vessels (CBF) is directly
proportional to the work done by the heart
i.e.
cardiac work CBF
and
cardiac work CBF.
29. The following factors modify the CBF:
1) Nervous Factors:
The effect of the autonomic nerves to the heart on the
coronary arteries is indirect through their effect on cardiac
metabolism i.e.
a) Stimulation of sympathetic
cardiac metabolism coronary vasodilatation
CBF.
b) Stimulation of parasymp cardiac metabolism
coronary vasoconst. CBF.
30. 2) Chemical Factors:
a) Metabolic factors:
cardiac metabolism O2 tension (local hypoxia),
CO2, K+, lactic acid & adenosine in the cardiac muscle
coronary vasodilatation CBF.
cardiac metabolites active hyperemia during
cardiac activity = auto regulation of CBF.
O2 lack (hypoxia) is the most effective coronary
vasodilator. It produces coronary vasodilatation through:
• Direct action on coronary blood vessels and
• Release of chemical substances such as adenosine
(from ATP) which is a potent coronary vasodilator.
32. 3) Mechanical factors (=effect of cardiac cycle):
-Ventricular systole of the intra-myocardial
pressure compression of the coronary
vessels CBF mainly in the left coronary
artery (due to stronger cont of the left vent.)
-CBF during ventricular diastole (maximal at
the end of isometric relaxation).
33. 4) Other Factors:
a) Heart Rate:
Excessive in the heart rate diastolic period
coronary filling (as it occurs mainly during
ventricular diastole) CBF.
b) Cardiac Output:
CBF is directly proportional to COP i.e.
COP CBF
COP CBF
34. c) Blood Pressure:
CBF is directly proportional to aortic BP
especially diastolic
diastolic pressure CBF
and
diastolic aortic pressure (as in aortic
regurgitation) CBF
35. Determinants of coronary blood
flow
- Coronary perfusion pressure
- Perfusion Time
- Vessel wall diameter
36. Coronary Perfusion Pressure
Pressure gradient that drives blood through
the coronary circulation.
Coronary Perfusion Pressure =
Diastolic BP – LVEDP (or PCWP)
41. Coronary Blood Flow
1) Metabolic control
2) Autoregulation
3) Endothelial control of coronary
vascular tone
4) Extravascular compressive forces
5) Neural control
44. Metabolic Control
Coronary circulation is exquisitely sensitive
to myocardial tissue oxygen tension
Increased oxygen demand results in a
lower tissue oxygen tension. This causes
vasodilation and increased blood flow via-
Adenosine
Nitric oxide
Prostaglandins
K+
ATP channels
45. Metabolic Control of Blood Flow
Lack of oxygen?
Formation of vasodilators?
Combination of both??
Metarteriole
Precapillary
Sphincter
Capillary
Relaxation of smooth muscle
Increased Blood Flow
46. Auto regulation
Ability of a vascular network to maintain constant
blood flow over a range of arterial
pressures.( 60–140 mm Hg)
Beyond this range flow becomes pressure- dependent
Autoregulation is an independent determinant of
CBF
The set point at which CBF is maintained
depends on MVO2
50. When Damage to Endothelium Occurs--
Damage to endothelial cells will lead to:
Decreased Nitric Oxide and Prostacyclin
production
Increased Endothelin production
This will lead to:
Vasoconstriction
Vasospasm
Thrombosis
51. Neural Control
Coronary blood flow is controlled
predominantly by local
metabolic, autoregulatory, and
endothelial factors
Neural control of the coronary circulation
complements the above local effects
52. Neural Control
Sympathetic Control
Alpha = constrict coronary vessels
Beta = dilate coronary vessels
Beta1 in conduit arteries
Beta2 in resistance arterioles
Parasympathetic Control
Acetylcholine
Vasodilation in healthy subjects
Vasoconstriction in patients with atherosclerosis
53.
54. Extravascular Compressive Forces
The heart influences its blood supply by
the squeezing effect of the contracting
myocardium on the blood vessels
coursing through the heart.
55. Extravascular Compressive Forces
Left Ventricle
Early Systole > Initial Flow Reversal
Remainder of Systole > Flow follows aortic
pressure curve, but at a much reduced pressure
Early Diastole > Abrupt pressure rise (80-90% of
LV flow occurs in early diastole)
Remainder of Diastole > Pressure declines
slowly as aortic pressure decreases
57. Extravascular Compressive Forces
Right Ventricle
Lower pressure generated by thin right
ventricle in systole.
No reversal of blood flow during early
systole.
Systolic blood flow constitutes a much
greater proportion of total blood flow.
58.
59. Transmural Distribution of Myocardial Blood
Flow
Extravascular compressive forces are greater in the
subendocardium (inner) and least near the subepicardial
layer (outer)
Under normal resting conditions this does not impair
subendocardial blood flow as increased flow during diastole
compensates
Subendocardial to subepicardial ratio: 1.25/1
Due to preferential dilatation of the subendocardial vessels
secondary to increased wall stress and, therefore, increased
MVO2 in the subendocardium
60. Transmural Distribution of Myocardial Blood
Flow
The subendocardium is more susceptible
to ischemia than the mid-myocardium or
subepicardium.
Epicardial coronary stenoses are
associated with reductions in the
subendocardial to subepicardial flow
ratio.
61. Coronary Flow Reserve
Difference between baseline blood flow
and maximal flow
Usually measured following pharmacologic
coronary vasodilation
In the absence of coronary artery
disease, maximal flow is 4 – 5 times as
great as at rest.
Coronary flow reserve decreases with
increasing severity of coronary artery
disease.
62.
63. Myocardial Oxygen Supply
Determined by –
1) Coronary Perfusion Pressure.
2) Oxygen Carrying Capacity of Blood
3) Heart rate - diastolic time
4) Coronary artery diameter
65. Myocardial Oxygen Supply
Oxygen Content of Blood
O2 Content =
(1.36 x Hb x % Saturation) + (pO2 x 0.003)
O2 delivered to myocardium =
O2 content x coronary blood flow
66. Myocardial Oxygen Supply
Oxygen Extraction
The heart extracts oxygen to a greater extent
than any other organ
Coronary sinus pO2 value is normally in range
of 20-22 mmHg (% sat = 32-38%)
Can only minimally increase O2 extraction
Increases in O2 demand must be met by
increased coronary blood flow
70. Factors Increasing
Myocardial Oxygen Consumption
Increased Heart Rate
Increased Inotropy (Contractility)
Increased Afterload
Increased Preload
Changes in preload affect myocardial oxygen
consumption less than do changes in the other factors
71. Oxygen Cost of Myocardial
Work
Pressure work is much more costly than
volume work for the heart
Pressure work = increasing arterial pressure
at a constant cardiac output
Volume work = increasing cardiac output
while maintaining a constant pressure
72. Volatile anaesthetics & coronary circulation
Volatile anesthetics cause direct coronary artery
vasodilation in vitro.
myocardial oxygen consumption (MVO2 )--heart
rate, preload, afterload, and inotropic state, cause
coronary vasoconstriction in vivo via metabolic
autoregulation
Direct and indirect actions ultimately determines the net
effect.
Halothane produces coronary artery dilation in arteries
larger than 2000 um.
73. Halothane – direct myocardial depression – dec.BP
Coronary Blood flow dec. coz of low BP
But O2 demand also decreases so CPP maintained
Isoflurane causes vasodilation of predominantly small
(<900 um) canine epicardial coronary arteries.
Isoflurane, desflurane, and sevoflurane little cardiac
depression.
Enflurane – same profile as Halothane.
74. Coronary Artery Steal
Absolute decrease in collateral dependent myocardial
perfusion at the expense of an increase in blood flow to a
normally perfused area of myocardium, as may follow the
drug-induced vasodilation of coronary arterioles
WHAT DO YOU UNDERSTAND BY THIS ???