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Cardiac physiology
The document summarizes cardiac physiology, including: 1) The circulatory system consists of the heart, blood vessels, and blood, with the heart serving as a pump that establishes blood pressure. 2) The heart has two main functions - generating blood pressure and routing blood flow between the pulmonary and systemic circulations to ensure one-way flow. 3) An electrocardiogram (ECG) provides a non-invasive record of the heart's electrical activity and can help identify conditions like arrhythmias.
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Overview of cardiac physiology and anatomy review.
Heart, blood vessels, and blood are crucial components of the circulatory system.
Heart generates blood pressure, routes blood, and regulates blood supply.
Processes involved in blood flow and pump action of the heart.
Myocardial autorhythmic and contractile cells, their functions, and characteristics.
Mechanisms and pacemaker potentials in the heart's intrinsic conduction system.
Detailed description of the pacemaker potential and action potentials in cardiac cells.
Characteristics of action potentials in cardiac contractile cells and their refractory periods.
Ca2+ dynamics during cardiac contraction and the conduction pathways in the heart.
Recording of electrical activity during heart cycles through electrocardiogram (ECG).
Phases of cardiac cycle including systole, diastole, and Wiggers diagram.
Definition of cardiac output, its components, and calculation methods.
Intrinsic and extrinsic factors influencing cardiac output and stroke volume.
Preload impacts stroke volume within the Frank-Starling law framework.
Influence of sympathetic stimuli and hormones on myocardial contractility.
Role of medulla oblongata and autonomic nervous system in regulating heart rate.
Causes and risk factors associated with congestive heart failure (CHF).
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Cardiac physiology
- 1.
- 2. FISIOLOGIA CARDIOVASCULAR Robson A.S. Santos
- 3. Cardiac Physiology -Anatomy Review
- 4. Circulatory System • Threebasic components – Heart • Serves as pump that establishes the pressure gradient needed for blood to flow to tissues – Blood vessels • Passageways through which blood is distributed from heart to all parts of body and back to heart – Blood • Transport medium within which materials being transported are dissolved or suspended
- 5. Functions of theHeart • Generating blood pressure • Routing blood – Heart separates pulmonary and systemic circulations – Ensuring one-way blood flow • Regulating blood supply – Changes in contraction rate and force match blood delivery to changing metabolic needs
- 6. Circulatory System • Pulmonarycirculation – Closed loop of vessels carrying blood between heart and lungs • Systemic circulation – Circuit of vessels carrying blood between heart and other body systems
- 7. Blood Flow Throughand Pump Action of the Heart
- 8. Blood Flow ThroughHeart
- 9. Cardiac Muscle Cells • MyocardialAutorhythmic Cells – Membrane potential “never rests” pacemaker potential. • Myocardial Contractile Cells – Have a different looking action potential due to calcium channels. • Cardiac cell histology – Intercalated discs allow branching of the myocardium – Gap Junctions (instead of synapses) fast Cell to cell signals – Many mitochondria – Large T tubes
- 10. Electrical Activity ofHeart • Heart beats rhythmically as result of action potentials it generates by itself (autorhythmicity) • Two specialized types of cardiac muscle cells – Contractile cells • 99% of cardiac muscle cells • Do mechanical work of pumping • Normally do not initiate own action potentials – Autorhythmic cells • Do not contract • Specialized for initiating and conducting action potentials responsible for contraction of working cells
- 11. Intrinsic Cardiac ConductionSystem Approximately 1% of cardiac muscle cells are autorhythmic rather than contractile 70-80/min 40-60/min 20-40/min
- 12. Electrical Conduction • SAnode - 75 bpm – Sets the pace of the heartbeat • AV node - 50 bpm – Delays the transmission of action potentials • Purkinje fibers - 30 bpm – Can act as pacemakers under some conditions
- 13. Intrinsic Conduction System • Autorhythmiccells: – Initiate action potentials – Have “drifting” resting potentials called pacemaker potentials – Pacemaker potential - membrane slowly depolarizes “drifts” to threshold, initiates action potential, membrane repolarizes to -60 mV. – Use calcium influx (rather than sodium) for rising phase of the action potential
- 14. Pacemaker Potential • • • • • • • Decreased effluxof K+, membrane permeability decreases between APs, they slowly close at negative potentials Constant influx of Na+, no voltage-gated Na + channels Gradual depolarization because K+ builds up and Na+ flows inward As depolarization proceeds Ca++ channels (Ca2+ T) open influx of Ca++ further depolarizes to threshold (-40mV) At threshold sharp depolarization due to activation of Ca2+ L channels allow large influx of Ca++ Falling phase at about +20 mV the Ca-L channels close, voltage-gated K channels open, repolarization due to normal K+ efflux At -60mV K+ channels close
- 15. AP of ContractileCardiac cells PX = Permeability to ion X PNa 1 +20 Membrane potential (mV) – Rapid depolarization – Rapid, partial early repolarization, prolonged period of slow repolarization which is plateau phase – Rapid final repolarization phase 2 PK and PCa 0 -20 -40 3 0 PNa -60 -80 PK and PCa 4 4 -100 0 Phase 100 200 Time (msec) 300 Membrane channels 0 Na+ channels open 1 Na+ channels close 2 Ca2+ channels open; fast K+ channels close 3 Ca2+ channels close; slow K+ channels open 4 Resting potential
- 16. AP of ContractileCardiac cells • Action potentials of cardiac contractile cells exhibit prolonged positive phase (plateau) accompanied by prolonged period of contraction – Ensures adequate ejection time – Plateau primarily due to activation of slow L-type Ca2+ channels
- 17. Why A LongerAP In Cardiac Contractile Fibers? • • • We don’t want Summation and tetanus in our myocardium. Because long refractory period occurs in conjunction with prolonged plateau phase, summation and tetanus of cardiac muscle is impossible Ensures alternate periods of contraction and relaxation which are essential for pumping blood
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- 19. Membrane Potentials inSA Node and Ventricle
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- 21. Excitation-Contraction Coupling inCardiac Contractile Cells • Ca2+ entry through L-type channels in T tubules triggers larger release of Ca2+ from sarcoplasmic reticulum – Ca2+ induced Ca2+ release leads to cross-bridge cycling and contraction
- 22. Electrical Signal Flow- Conduction Pathway • • • • • • • Cardiac impulse originates at SA node Action potential spreads throughout right and left atria Impulse passes from atria into ventricles through AV node (only point of electrical contact between chambers) Action potential briefly delayed at AV node (ensures atrial contraction precedes ventricular contraction to allow complete ventricular filling) Impulse travels rapidly down interventricular septum by means of bundle of His Impulse rapidly disperses throughout myocardium by means of Purkinje fibers Rest of ventricular cells activated by cell-to-cell spread of impulse through gap junctions
- 23. Electrical Conduction inHeart • Atria contract as single unit followed after brief delay by a synchronized ventricular contraction SA node AV node 1 2 THE CONDUCTING SYSTEM OF THE HEART 1 SA node depolarizes. SA node 3 Internodal pathways 3 Depolarization spreads more slowly across atria. Conduction slows through AV node. AV node A-V bundle Bundle branches 2 Electrical activity goes rapidly to AV node via internodal pathways. 4 Purkinje fibers 5 4 Depolarization moves rapidly through ventricular conducting system to the apex of the heart. 5 Depolarization wave spreads upward from the apex. Purple shading in steps 2–5 represents depolarization.
- 24. Electrocardiogram (ECG) • • Record ofoverall spread of electrical activity through heart Represents – Recording part of electrical activity induced in body fluids by cardiac impulse that reaches body surface – Not direct recording of actual electrical activity of heart – Recording of overall spread of activity throughout heart during depolarization and repolarization – Not a recording of a single action potential in a single cell at a single point in time – Comparisons in voltage detected by electrodes at two different points on body surface, not the actual potential – Does not record potential at all when ventricular muscle is either completely depolarized or completely repolarized
- 25. Electrocardiogram (ECG) • Differentparts of ECG record can be correlated to specific cardiac events
- 26. Heart Excitation Relatedto ECG P wave: atrial depolarization START P The end R PQ or PR segment: conduction through AV node and A-V bundle T P P QS Atria contract. T wave: ventricular Repolarization Repolarization R T P ELECTRICAL EVENTS OF THE CARDIAC CYCLE QS P Q wave Q ST segment R R wave R P QS P R Ventricles contract. Q P S wave QS
- 27. ECG Information Gained • • • • • (Non-invasive) HeartRate Signal conduction Heart tissue Conditions
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- 29. Ventricular Fibrillation: major causeof death in heart attack
- 30. Cardiac Cycle -Filling of Heart Chambers • • • Heart is two pumps that work together, right and left half Repetitive contraction (systole) and relaxation (diastole) of heart chambers Blood moves through circulatory system from areas of higher to lower pressure. – Contraction of heart produces the pressure
- 31. Cardiac Cycle -Mechanical Events 1 START 5 4 Isovolumic ventricular relaxation: as ventricles relax, pressure in ventricles falls, blood flows back into cups of semilunar valves and snaps them closed. Ventricular ejection: as ventricular pressure rises and exceeds pressure in the arteries, the semilunar valves open and blood is ejected. Late diastole: both sets of chambers are relaxed and ventricles fill passively. Atrial systole: atrial contraction forces a small amount of additional blood into ventricles. 2 3 Isovolumic ventricular contraction: first phase of ventricular contraction pushes AV valves closed but does not create enough pressure to open semilunar valves. Figure 14-25: Mechanical events of the cardiac cycle
- 32. Wiggers Diagram 0 100 200 Time (msec) 300 400 QRS complex Electrocardiogram (ECG) P 500 600 700 800 QRS complex Cardiaccycle T P 120 Aorta 90 Pressure (mm Hg) Dicrotic notch Left ventricular pressure 60 30 Heart sounds Left ventricular volume (mL) Atrial systole Left atrial pressure S1 S2 EDV 135 ESV 65 Atrial systole Isovolumic ventricular contraction Ventricular systole Ventricular systole Ventricular diastole Early ventricular diastole Atrial systole Late ventricular diastole Atrial systole Figure 14-26
- 33. Cardiac Cycle • Leftventricular pressure-volume changes during one cardiac cycle KEY EDV = End-diastolic volume ESV = End-systolic volume Stroke volume 120 Left ventricular pressure (mm Hg) D ESV 80 C One cardiac cycle 40 EDV B A 0 65 100 Left ventricular volume (mL) 135 Figure 14-25
- 34. Heart Sounds • Firstheart sound or “lubb” – AV valves close and surrounding fluid vibrations at systole • Second heart sound or “dupp” – Results from closure of aortic and pulmonary semilunar valves at diastole, lasts longer
- 35. Cardiac Output (CO)and Reserve • CO is the amount of blood pumped by each ventricle in one minute • CO is the product of heart rate (HR) and stroke volume (SV) • HR is the number of heart beats per minute • SV is the amount of blood pumped out by a ventricle with each beat • Cardiac reserve is the difference between resting and maximal CO
- 36. Cardiac Output =Heart Rate X Stroke Volume • Around 5L : (70 beats/m × 70 ml/beat = 4900 ml) • Rate: beats per minute • Volume: ml per beat – SV = EDV - ESV – Residual (about 50%)
- 37. Factors Affecting CardiacOutput • Cardiac Output = Heart Rate X Stroke Volume • Heart rate – Autonomic innervation – Hormones - Epinephrine (E), norepinephrine(NE), and thyroid hormone (T3) – Cardiac reflexes • Stroke volume – Starlings law – Venous return – Cardiac reflexes
- 38. Factors Influencing CardiacOutput • • Intrinsic: results from normal functional characteristics of heart contractility, HR, preload stretch Extrinsic: involves neural and hormonal control – Autonomic Nervous system
- 39. Stroke Volume (SV) –Determined by extent of venous return and by sympathetic activity – Influenced by two types of controls • Intrinsic control • Extrinsic control – Both controls increase stroke volume by increasing strength of heart contraction
- 40. Intrinsic Factors AffectingSV • Contractility – cardiac cell contractile force due to factors other than EDV • Preload – amount ventricles are stretched by contained blood - EDV • Venous return - skeletal, respiratory pumping • Afterload – back pressure exerted by blood in the large arteries leaving the heart Stroke volume Strength of cardiac contraction End-diastolic volume Venous return
- 41. Frank-Starling Law • Preload, ordegree of stretch, of cardiac muscle cells before they contract is the critical factor controlling stroke volume
- 42. Frank-Starling Law • Slowheartbeat and exercise increase venous return to the heart, increasing SV • Blood loss and extremely rapid heartbeat decrease SV
- 43. Extrinsic Factors InfluencingSV • Contractility is the increase in contractile strength, independent of stretch and EDV • Increase in contractility comes from – – – – Increased sympathetic stimuli Hormones - epinephrine and thyroxine Ca2+ and some drugs Intra- and extracellular ion concentrations must be maintained for normal heart function
- 44. Contractility and Norepinephrine •Sympathetic stimulation releases norepinephrine and initiates a cAMP secondmessenger system Figure 18.22
- 45. Modulation of CardiacContractions Figure 14-30
- 46. Factors that AffectCardiac Output Figure 14-31
- 47. Medulla Oblongata CentersAffect Autonomic Innervation • Cardio-acceleratory center activates sympathetic neurons • Cardio-inhibitory center controls parasympathetic neurons • Receives input from higher centers, monitoring blood pressure and dissolved gas concentrations
- 48. Reflex Control ofHeart Rate Figure 14-27
- 49. Modulation of HeartRate by the Nervous System Figure 14-16
- 50. Establishing Normal HeartRate • • SA node establishes baseline Modified by ANS – Sympathetic stimulation • Supplied by cardiac nerves • Epinephrine and norepinephrine released • Positive inotropic effect • Increases heart rate (chronotropic) and force of contraction (inotropic) – Parasympathetic stimulation Dominates • Supplied by vagus nerve • Acetylcholine secreted • Negative inotropic and chronotropic effect
- 51. Regulation of CardiacOutput Figure 18.23
- 52. Congestive Heart Failure(CHF) • Congestive heart failure (CHF) is caused by: – Coronary atherosclerosis – Persistent high blood pressure – Multiple myocardial infarcts – Dilated cardiomyopathy (DCM)
Editor's Notes
- #12 Approximately 1% of the cardiac muscle cells are autorhythmic rather than contractile. * These specialized cardiac cells don’t contract but are specialized to initiate and conduct impulses through the heart to coordinate its activity. * These constitute the intrinsic cardiac conduction system. These autorhythmic cells constitute the following components of the intrinsic conduction system: * the sinoatrial (SA) node, just inferior to the entrance of the superior vena cava into the right atrium, * the atrioventricular node (AV) node, located just above the tricuspid valve in the lower part of the right atrium, * the atrioventricular bundle (bundle of HIS), located in the lower part of the interatrial septum and which extends into the interventricular septum where it splits into right and left bundle branches * which continue toward the apex of the heart and the purkinje fibers * which branch off of the bundle branches to complete the pathway into the apex of the heart and turn upward to carry conduction impulses to the papillary muscles and the rest of the myocardium. Although all of these are autorhythmic, they have different rates of depolarization. * For instance, the SA node * depolarizes at a rate of 75/min. * The AV node depolarizes at a rate of 40 to 60 beats per minute, * while the rest have an intrinsic rate of around 30 depolarizations/ minute. * Because the SA node has the fastest rate, it serves as the pacemaker for the heart. *