Download - ChapterIV Cardiovascular Physiology.2(2012)
![Page 1: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/1.jpg)
Chapter IV
Cardiovascular Physiology (2)
![Page 2: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/2.jpg)
Section B
Pump function of the heart
![Page 3: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/3.jpg)
1. Concept : The cardiac events that occur from the
beginning of one heartbeat to the beginning of the next are called the
cardiac cycle. 60 (s/min) Duration (s/beat) = ——————— HR (beats/min)
Normal range of HR: 60-100 bpm (75bpm)
I. Cardiac Cycle
![Page 4: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/4.jpg)
2. The Cardiac Cycle
• If the heart rate is 75 bpm, each
cardiac cycle takes for 0.8s.
• The cardiac cycle is composed of d
iastole and systole.
![Page 5: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/5.jpg)
2. The Cardiac Cycle
0.1s
0.3s
0.5s
0.7s
![Page 6: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/6.jpg)
3.Mechanical events in cardiac cycle
a. Atrial systoleb. Isovolumic ventricular contractionc. Rapid ejection d. Reduced ejection e. Isovolumic ventricular relaxationf. Rapid filling g. Reduced filling
Ventricular ejection
Ventricular filling
![Page 7: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/7.jpg)
pressure volume valves blood flow
What happen in the heart during each cardiac cycle
![Page 8: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/8.jpg)
i. Before atrial systole , A-V valves are open and blood flows into the ventricles (about 75% of the blood).
ii. Atrial contraction causes an additional 25% of filling of the ventricles, so the atria simply function as primer pumps.
iii. During atrial systole, A-V valves open and semilunar valves close.
iv. The ventricular pressure is lower than pressures in the atrium and the aorta.
v. 0.1s
a. Atrial systole
![Page 9: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/9.jpg)
![Page 10: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/10.jpg)
b. Isovolumic (isovolumetric) ventricular contraction
Interval between the start of ventricular systole and the opening of the semilunar valves is called isovolumic ventricular contraction. i. The ventricular pressure is higher than atrial press
ure and lower than aortic pressure. ii. A-V valves are closed and semilunar valves are n
ot open. iii.The ventricular pressure rises rapidly but does no
t reach the peak. iv.The ventricular volume has no change. v. 0.05s
![Page 11: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/11.jpg)
![Page 12: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/12.jpg)
c. Rapid ejection phasei. The ventricular pressure is higher than aorti
c pressure and much higher than atrial pressure , and reaches the peak at the end
of rapid ejection.ii. A-V valves are closed and semilunar valves are open. iii. The blood is rapidly ejected from ventricle to aorta. iv. The volume of ventricle decreases rapidly .
![Page 13: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/13.jpg)
![Page 14: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/14.jpg)
d. Reduced ejection phase During the next two thirds of ejection
phase, about 30% of emptying occurs. This period is called reduced
ejection phase. Although the ventricular pressure is
slightly lower than the aortic pressure during this phase, the blood is still leaving the ventricles. Momentum keeps
the blood moving forward.
![Page 15: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/15.jpg)
![Page 16: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/16.jpg)
e. Isovolumic (isovolumetric) ventricular relaxation The period between closure of the semil
unar valves and opening of the A-V valves is called isovolumic ventricular
relaxation.
i. Ventricular pressure falls back to the diastolic pressure level at the end of reduced ejection phase, but it is till higher than atrial pressure.
ii.Seminlunar valves are closed and A- V valves are not yet open. iii. Blood remains in the atria. iv.A sharp fall in ventricular pressure without a change in ventricular volume. v. 0.06-0.08s
![Page 17: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/17.jpg)
![Page 18: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/18.jpg)
f. Rapid filling (inflow) phase
i. When ventricular pressure is lower than atrial pressure , A-V valves are open and blood flow rapidly into the
ventricle. ii. The ventricular volume increases rapidly, the ventricular pressure decreases .
![Page 19: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/19.jpg)
![Page 20: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/20.jpg)
g. Reduced filling (inflow) phase
• During the last 2/3 of filling
phase, only a small amount of blood
flows into the ventricles at a much
slower rate.
![Page 21: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/21.jpg)
![Page 22: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/22.jpg)
Ventricular state
Atrial pressure
Ventricular pressure
Aortic pressure
A-V valves
Semilunar valves
Ventricular volume
Blood flow
Duration
Atrial systole
Isovolumic contraction
Rapid ejection
Reduced ejection
Isovolumic relaxation
Rapid filling
Reduced filling
Begin to contract
Continue to
contract
Continue to
contract
Begin to relax
Continue to relax
Continue to relax
Relax ﹥ ﹤↑
﹤ ↑Sharply﹤﹤↑↑peak ﹥﹤ ↓ ﹤﹤↓Sharply ﹤﹥ ﹤﹥ ↓ ﹤
Open Close
CloseClose
Close
Close Open
CloseClose
Open Close
Open Close
-↓Sharply
↓
-↑Sharply
↑
↑
-V→Aorta
(rapidly)
V→Aorta (slowly)
-Atrium→V (rapidly)
Atrium→V (slowly)
Atrium→V
0.1s
0.05s
0.1s
0.15s
0.06-0.08s
0.11s
0.22s
Open
↓↓
![Page 23: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/23.jpg)
4. Function of valves
To ensure a uni
directional flow o
f the blood.
![Page 24: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/24.jpg)
5. Heart sound
Concept: The sounds produced
by the heart during a cardiac cycle
are called heart sounds. Cause: closure of valves turbulence of blood vibration of ventricles and large vessels.
![Page 25: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/25.jpg)
A.First Heart sounda. Its tone is lower and duration is longer.
b. Its intensity reflects the contractility of the myocardia. The stronger the cardiac muscle contraction, the louder the first sound.
c. It marks the beginning of ventricular systole.
d. It is mainly caused by the closure of mitral and tricuspid valves just after the start of ventricular systole.
![Page 26: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/26.jpg)
B.Second heart sounda. Its tone is higher and duration is shorter.
b. Its intensity reflects the aortic or pulmonary pressure. The higher the arterial blood pressure, the louder the second sound.
c. It indicates the beginning of ventricular diastole.
d. It is mainly caused by the closure of aortic and pulmonary valves just after the end of ventricular systole.
![Page 27: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/27.jpg)
C. Third heart sound Third heart sound coincides with the period of rapid ventricular filling and is probably due to vibrations set up by inrush of blood.
D. Fourth heart sound (atrial heart sound)
Fourth heart sound may be due to ventricular filling and is rarely heard in normal adults.
![Page 28: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/28.jpg)
II. Cardiac Output
![Page 29: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/29.jpg)
• End-diastolic pressure (EDP) is the pressure in the ventricle at the
end of ventricular diastole. (5mmHg)
• End-diastolic volume (EDV) is the volume of blood in the ventricle that reaches a maximum at the end
of ventricular diastole. (135ml)
![Page 30: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/30.jpg)
65 130 195 220 275Period of filling Left ventricular volume (ml)
EDPEDV
![Page 31: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/31.jpg)
• End-systolic pressure (ESP) is the pressure in the ventricle at the end
of the ejection phase.
• End-systolic volume (ESV) is the volume of blood that remains in the ventricle at the end of the ejection
phase. (65ml)
![Page 32: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/32.jpg)
65 130 195 220 275Period of filling Left ventricular volume (ml)
ESPESV
![Page 33: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/33.jpg)
II. Cardiac Output1. Stroke volume and ejection fraction A. Stroke volume(SV) i. Concept : The volume of blood pumped out of
each ventricle each beat is called stroke volume. SV=EDV-ESV
ii. Normal range: 60-80ml(70ml)
![Page 34: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/34.jpg)
B. Ejection fraction(EF)
i. Concept : The ratio of SV to end–diastolic volume is called theejection fraction.
EF=(SV/EDV) ×100% ii. Normal range: 55%-65%
![Page 35: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/35.jpg)
2. Cardiac output and cardiac index
A. Cardiac output (CO) i. Concept : The quantity of blood pumped by
each ventricle per minute is called cardiac output. CO=SV×HR ii. Normal range: 4.5-6L/min
(5.0L/min)
![Page 36: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/36.jpg)
B. Cardiac index
![Page 37: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/37.jpg)
B. Cardiac index
i. Concept : Cardiac index is the cardiac output per square meter of
body surface area.
ii. Resting cardiac index Normal range: 3.0-3.5L/min/m2
iii. 10 years: 4 L/min/m2 80 years: 2.4 L/min/m2
![Page 38: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/38.jpg)
3. Cardiac Reserve
A. Concept: The ability of heart to increase
its cardiac output from the resting cardiac output is called cardiac reserve.
![Page 39: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/39.jpg)
B.Heart can increase output by different ways
① By increasing HR (60 ~ 180 beats /min) ② By increasing SV
a. By decreasing ESV b. By increasing EDV
![Page 40: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/40.jpg)
4.Regulation of Cardiac Output(Factors affecting cardiac output) A. Control of Heart Rate
40 ~ 180 beats/min HR↑→CO↑
> 180 beats/min cardiac cycle↓→ relaxation period↓↓ →
amount of ventricular filling(EDV)↓→ preload ↓ → SV↓→CO↓ < 40 beats/min cardiac cycle↑→ relaxation period↑→ a
mount of ventricular filling reaches its maximum, and HR is too low→CO↓
![Page 41: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/41.jpg)
c
The factors that affect the heart rate
![Page 42: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/42.jpg)
①Sympathetic nerve, Adr, NA, Ca2+, increased body temperature → HR↑
②Parasympathetic nerve, Ach, ischemia, toxin → HR ↓
The factors that affect the heart rate
![Page 43: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/43.jpg)
B. Control of stroke volume
★ Preload ★ Afterload
★ Contractility
i. Effects of preload
The preload of the ventricle is the ventricular
end-diastolic pressure (EDP).
The initial length of the ventricle is the
ventricular end-diastolic volume (EDV).
![Page 44: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/44.jpg)
Intrinsic regulation of heart pumping ——the Frank –Starling mechanism Within physiologic limit, the more the
heart fills with blood during diastole, the greater the force of contraction during systole and the greater the quantity of
blood pumped into the aorta.
![Page 45: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/45.jpg)
Stroke Volume
Preload (EDV)
Preload↑( EDV ↑ ) ↓
Initial length of myocardium↑
↓ Force of contraction↑
↓SV↑
↓ CO↑
It is also called heterometric autoregulation. Significance: to adjust the stroke volume subtly.
![Page 46: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/46.jpg)
Factors determining EDV
(1) Duration of ventricular diastole (2) Venous return
![Page 47: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/47.jpg)
ii. Changes in myocardial contractility (homometric autoregulation)
Definition: myocardium’s intrinsic ability to efficiently contract and empty the ventricle independent of preload & afterload
Significance: to adjust SV dramatically.
![Page 48: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/48.jpg)
Low
Stroke Volume
Preload (End-Diastolic Volume)
Increase inCardiacContractility
At a given EDV, SV increases With cardiac contractility
Normal
High
![Page 49: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/49.jpg)
Positive inotropic agents: sympathetic nerve, Adr, NA, and digitalis drug
Negative inotropic agents: vagus nerve, anoxia, acidosis, and Ach
![Page 50: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/50.jpg)
iii. Effects of afterload • The arterial pressure is the afterload.• Resistance to ventricular ejection
![Page 51: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/51.jpg)
Stroke volum↓
Ejection period↓ + ejection speed↓
Isovolumic contraction phase↑ + contraction speed↓
Afterload(arterial pressure)↑
Residual blood(ESV)↑
Preload(EDV)↑
Heterometric and homometric autoregulation
Restore the SV
![Page 52: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/52.jpg)
![Page 53: ChapterIV Cardiovascular Physiology.2(2012)](https://reader036.vdocuments.us/reader036/viewer/2022081417/577cca1f1a28aba711a56b8b/html5/thumbnails/53.jpg)