Cardiovascular Physiology

Heart and Circulation

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Structure of the Heart

The human heart has 4 chambers.

2 atria (top) 2 ventricles (bottom)

When blood leaves a chamber it must pass through a valve.

4 valves in the heart total

Tricuspid valve Pulmonary semi-lunar valve Bicuspid valve (aka. mitral) Aortic semi-lunar valve (not seen in this picture)

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Pulmonary and Systemic Circulations

Pulmonary circulation:

De-oxygenated blood is pumped by the right ventricle, to the lungs, and back to the heart at left atrium.

Systemic circulation:

Oxygenated blood is pumped to organs and tissues (then back to the right atrium) by the left ventricle.

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Normal Intracardiac Pressures:

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Know the Flow!

Vena cava R. Atrium TCV R. Ventricle PSLV Pulmonary Artery Lung Pulmonary Vein L. Atrium BCV L. Ventricle ASLV Aorta capillaries in tissues Vena cava

TCV=tricuspid valve, PSLV=pulmonary semilunar valve, BCV=bicuspid valve, ASL=aortic semilunar valve

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Heart Valves

Atrioventricular valves (AV valves)

Bicuspid (mitral) Tricuspid Pulmonary semilunar valve Aortic semi-lunar valve

Semilunar valves

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Heart Sounds

Heart sounds are produced by the Closing of the AV and Semilunar valves. Lub (first sound):

Produced by closing of the AV valves during ventricular contraction. Produced by closing of the semilunar valves when pressure in the ventricles falls below pressure in the arteries.

Dub (second sound):

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Summary of Heart Beat: Electrical, Pressure and Chamber Volumes

Figure 14-27: The Wiggers diagram

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Cardiac Cycle

TERMS

Systole: Phase of contraction. Diastole: Phase of relaxation. End-diastolic volume (EDV): Total volume of blood in the ventricles at the end of diastole. Stroke volume (SV): Amount of blood ejected from ventricles during systole. End-systolic volume (ESV): Amount of blood left in the ventricles at the end of systole. EDV-SV=ESV

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Cardiac Cycle

(continued)

Step 1: Isovolumetric contraction: Contraction of the ventricle causes ventricular pressure to rise, but ventricular pressure is less than aortic pressure. AV valves close (lub) Semilunar valves are still closed at this point Step 2: Ejection: Contraction of the ventricle causes ventricular pressure to rise above aortic pressure. Semilunar valves open AV valves remain closed Step 3: Aortic pressure rises above ventricular pressure Semilunar valves snap shut (dub)

Step 4: Isovolumetric relaxation: Back pressure causes semilunar valves to close. AV and semilunar valves are both closed. Step 5: Rapid filling of the ventricles

Atrial pressure rises above ventricular pressure .

AV valves open

Step 6: Atrial contraction/systole

Empties the final amount of blood into the ventricles immediately prior to the next phase of isovolumetric contraction of the ventricles.

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Heart Murmurs

Abnormal heart sounds produced by abnormal patterns of blood flow in the heart. Defective heart valves:

Valves become damaged by antibodies (rheumatic endocarditis) made in response to an infection, or congenital defects. Mitral valve becomes thickened and calcified.

Mitral stenosis:

Impairs blood flow from left atrium to left ventricle. Accumulation of blood in left ventricle may cause pulmonary HTN.

Incompetent valves:

Damage to papillary muscles (Ex: Mitral Valve prolapse)

Valves do not close properly.

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Conducting Tissues of the Heart

APs spread through myocardial cells through gap junctions. Impulses cannot spread to ventricles directly because of fibrous tissue. Conduction pathway:

SA node. AV node. Bundle of His. Purkinje fibers.

Stimulation of Purkinje fibers cause both ventricles to contract simultaneously.

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Conducting Tissues of the Heart

(continued)

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Electrocardiogram (ECG/EKG)

The body is a good conductor of electricity.

Tissues have ion concentrations that fluctuate in response to differences in electrical potential. Measures of the electrical activity of the heart per unit time.

Electrocardiogram:

Potentials generated by heart are conducted to skin where they can be measured by electrodes.

Does NOT measure the flow of blood through the heart.

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EKG Waves

P wave:

Atrial depolarization Ventricular depolarization Atrial repolarization Ventricular repolarization

QRS complex:

T wave:

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Arrhythmias Detected on ECG

Flutter:

Fibrillation:

Extremely rapid (200-300 bpm), but coordinated, contraction of atria or ventricles.

Rapid, uncoordinated contractions of atria or ventricles.

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Arrhythmias Detected on ECG

Bradycardia:

Tachycardia:

HR slower < 60 beats/min.

HR > 100 beats/min.

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AV Blocks

Firstdegree AV nodal block:

Rate of impulse conduction through AV node is extended. P-R interval>0.2 seconds

Second-degree AV nodal block:

Only 1 out of 2-4 atrial APs can pass to the ventricles. P wave without QRS.

Third-degree (complete) AV nodal block:

None of the atrial waves can pass through the AV node. Atria paced by SA node Ventricles paced by ectopic pacemaker cells.

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Myocardial Ischemia

S-T segment is depressed

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Arteries

Elastic: expand and recoil with the pumping of the left ventricle. The left ventricle is the strongest chamber of the heart, since it must overcome the pressure to move blood through muscular arterioles. Pulse: felt by pressing a palpable artery against a bone.

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Veins

Valves

The presence of valves makes for a one-way flow direction

Skeletal muscle pump

Venous return to right atrium is assisted by skeletal muscle contractions

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Blood Pressure

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Blood Pressure

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Sounds of Korotkoff

Turbulent blood flow resulting from a constricted artery. Sounds like tapping First sound-cuff pressure is equal to systolic pressure
Last sound- cuff pressure is equal to diastolic pressure The sounds of Korotkoff are NOT the lub-dub sounds produced by the closing of heart valves, which can only be heard at the chest.

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THE END