Professional Documents
Culture Documents
PHYSIOLOGY
Dr. Poland
Room 3-007, Sanger Hall
Phone: 828-9557
E-mail: poland@hsc.vcu.edu
HEART
(PUMP)
AUTOREGULATION
REGULATION
CARDIOVASCULAR
SYSTEM NEURAL
HORMONAL
VESSELS
(DISTRIBUTION SYSTEM) RENAL-BODY FLUID
CONTROL SYSTEM
PULMONARY
CIRCULATION
1. LOW RESISTANCE
2. LOW PRESSURE
(25/10 mmHg)
SYSTEMIC
CIRCULATION
1. HIGH RESISTANCE
2. HIGH PRESSURE
(120/80 mmHg)
PARALLEL
SUBCIRCUITS
UNIDIRECTIONAL
FLOW
ARTERIES (LOW COMPLIANCE)
HEART
DIASTOLE
VEINS
80 mmHg 120 mmHg
CAPACITY
VESSELS
SYSTOLE
CAPILLARIES
THE SYSTEMIC CIRCULATION
CAPACITY VESSELS
NORMAL
AUTOMATICITY
Na +
K+
Gradually
increasing PNa
Na+
K+
-70 mV -0
THRESHOLD
RESTING
Atrio-ventricular (AV) node
Sino-atrial
(SA) node
BUNDLE
BRANCHES
PURKINJE FIBERS
INTERCALATED DISC (TIGHT JUNCTION)
PACEMAKERS (in order of
their inherent rhythm)
• Sino-atrial (SA) node
• Atrio-ventricular (AV) node
• Bundle of His
• Bundle branches
• Purkinje fibers
PHASE
Mechanical Response 0 = Rapid Depolarization
(inward Na+ current)
MEMBRANE POTENTIAL (mV)
1 1 = Overshoot
0 2
2 = Plateau
(inward Ca++ current)
3 = Repolarization
0 (outward K+ current)
4 = Resting Potential
3
-90 4
TIME
ACTION POTENTIALS
VENTRICULULAR
MEMBRANE POTENTIAL (mV)
SAN
CELL
1
0 2
0
0 3
0 3 4
-50 -50
4
-100 -100
SINGLE VENTRICULAR ACTION POTENTIAL
1 mV
ECG T
P
QS Repolarization of ventricles
Depolarization of ventricles
Depolarization of atria
ECG Recordings (QRS Vector pointing leftward, inferiorly
& posteriorly)
3 Bipolar Limb Leads:
RA LA
I = RA vs. LA (+)
LL
ECG Recordings (QRS Vector pointing leftward, inferiorly
& posteriorly)
3 Bipolar Limb Leads:
RA LA
I = RA vs. LA (+)
II = RA vs. LL (+)
LL
ECG Recordings (QRS Vector pointing leftward, inferiorly
& posteriorly)
3 Bipolar Limb Leads:
RA LA
I = RA vs. LA (+)
II = RA vs. LL (+)
LL
ECG Recordings (QRS Vector pointing leftward, inferiorly
& posteriorly)
3 Bipolar Limb Leads:
RA LA
I = RA vs. LA (+)
II = RA vs. LL (+)
Spine
V6
V5
Sternum V4
V1 V2 V3
ECG Recordings: (QRS vector---leftward, inferiorly and posteriorly
3 Bipolar Limb Leads
I = RA vs. LA(+)
II = RA vs. LL(+)
III = LA vs. LL(+)
3 Augmented Limb Leads
aVR = (LA-LL) vs. RA(+)
aVL = (RA-LL) vs. LA(+)
aVF = (RA-LA) vs. LL(+)
6 Precordial (Chest) Leads: Indifferent electrode (RA-LA-LL) vs.
chest lead moved from position V1 through position V6.
THE CARDIAC CYCLE
LATE DIASTOLE
DIASTOLE
ISOMETRIC
VENTRICULAR ATRIAL
RELAXATION SYSTOLE
VENTRICULAR
EJECTION ISOMETRIC VENTRICULAR
CONTRACTION
EJECTION
ISOVOLUMETRIC RELAXATION
RAPID INFLOW
ISOVOLUMETRIC DIASTASIS
CONTRACTION ATRIAL SYSTOLE
PRESSURE (mmHg)
AORTIC
PRESSURE
ATRIAL
PRESSURE
VENTRICLE
PRESSURE
VOLUME (ml)
ECG
PHONO-
CARDIOGAM
SYSTOLE DIASTOLE SYSTOLE
MEASUREMENT OF CARDIAC OUTPUT
VENOUS RETURN
PERIPHERAL
BLOOD FLOW
. VO2
CARDIAC OUTPUT (Q) =
[O2]a - [O2]v
= 250 ml/min
20 ml% - 15 ml%
= 5 L/min
.
Q = HR x SV .
.
Q CARDIAC INDEX = Q 2
SV = m body surface
HR
area
5 L/min
= 5 L/min
70 beats/min =
1.6 m2
= 0.0714 L or 71.4 ml
= 3.1 L/min/m2
THE HEART AS A PUMP
• REGULATION OF CARDIAC OUTPUT
– Heart Rate via sympathetic & parasympathetic nerves
– Stroke Volume
• Frank-Starling “Law of the Heart”
• Changes in Contractility
• MYOCARDIAL CELLS (FIBERS)
– Regulation of Contractility
– Length-Tension and Volume-Pressure Curves
– The Cardiac Function Curve
Autoregulation
(Frank-Starling “Law of the Heart”)
Sympathetic
Nervous System
Parasympathetic
Nervous System
CARDIAC MUSCLE
- Functional Syncytium
- Automaticity
STRIATED MUSCLE
SKELETAL MUSCLE
- Motor Units
- Stimulated by Motor Nerves
STRUCTURE OF A MYOCARDIAL CELL
Mitochondria Sarcolemma
T-tubule
SR
Fibrils
SARCOLEMMA
20% Mitochondria
T-tubule 10%
80%
Ca++
SR
THICK
MYOFILAMENT
THIN MYOFILAMENT
REGULATAION OF
CONTRACTILITY
Fast
Heart Rate Ca++ Ca++ Ca++ Ca++
SERIES ELASTIC
ELEMENTS
CONTRACTILE
PARALLEL ELASTIC COMPONENT
ELEMENTS
(ACTIVE TENSION)
(PASSIVE TENSION)
TOTAL
TENSION
LENGTH-TENSION CURVE
TOTAL TENSION
ACTIVE
TENSION TENSION
PASSIVE TENSION
OPTIMAL LENGTH (Lo)
EQUILIBRIUM LENGTH RESTING LENGTH
LENGTH
LENGTH
TENSION
TOTAL TENSION
ACTAIVE TENSION
TENSION
PASSIVE
TENSION
MUSCLE LENGTH
HEART
SYSTOLIC PRESSURE CURVE
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE
G D
I N SE
LL A
SYSTOLIC PRESSURE CURVE
FI RE
C
IN
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE
DIASTOLIC FILLING
Right Atrial Pressure (RAP) reflects Diastolic Filling
CARDIAC FUNCTION CURVE
THE FRANK- STARLING “LAW OF THE HEART”
10-
Pressure
5-
Volume
-4 0 +4 +8
RAP mmHg
CARDIAC FUNCTION CURVE
THE FRANK- STARLING “LAW OF THE HEART”
5-
-4 0 +4 +8
RAP mmHg
CARDIAC FUNCTION CURVE
THE FRANK- STARLING “LAW OF THE HEART”
5-
-4 0 +4 +8
RAP mmHg
CARDIAC FUNCTION CURVE
THE FRANK- STARLING “LAW OF THE HEART”
5-
-4 0 +4 +8
RAP mmHg
CARDIAC FUNCTION CURVE
THE FRANK- STARLING “LAW OF THE HEART”
5-
-4 0 +4 +8
RAP mmHg
P1 > P2
P1 FLOW P2
mm Hg
P = FLOW x R
FLOW = P
R
R= P
FLOW
L/min
or mm Hg
ml/sec ml/sec
P1 P2
P1 > P2
RESISTANCES IN PARALLEL
FlowT = Flow1 + Flow2 + Flow3
P P
= + P + P R1
RT R1 R2 R3
PV PA
1 = 1 + 1 + 1 R2
RT R1 R2 R3
R3
RT = 1
1 + 1 + 1
R1 R2 R3
If: R1 = 2; R2 = 4; R3 = 6 PRU’s
RT = R1 + R2 + R3
RT = 12 PRU’s
v = Pr2 /8l
P
Flow = R
Q = vr2
Pr4
Q = 8l
R = 8l/r4
TOTAL PERIPHERAL RESISTANCE
SYSTEMIC CIRCULATION:
TPR = Aortic Pressure - RAP
FLOW
100 - 0 mmHg = 1.2 PRU’s
TPR =
83.3 ml/sec (5 L/min)
PULMONARY CIRCULATION:
Cv = 300 ml = 60 ml/mmHg
5 mmHg
Sym
Cv = 24 x Ca
Veins
Sym
Sym
1 2 3 4
VOLUME (L)
MEAN CIRCULATORY PRESSURE
Unstressed
PRESSURE (mmHg)
Volume
Stressed Volume
7-
MCP = 7 mmHg
1 2 3 4 5 6
VOLUME (L)
CAPILLARIES
• Pressure inside is 35 to 15 mmHg
Precapillary
Capillaries
Sphincters ?
Metarteriole
Venule
VASOMOTION = Intermittent flow due to constriction-
relaxation cycles of precapillary shpincters
or arteriolar smooth muscle (5 - 10/min)
AUTOREGULATION OF VASOMOTION:
2. Vasodilator Theory
Vasodilator substances produced (via O2)
e.g. Adenosine Heart
CO2 Brain
Lactate, H+, K+ Skeletal Muscle
3. Myogenic Activity
DIFFUSION BETWEEN BLOOD & INTERSTITIAL FLUID
Plasma Proteins
BLOOD
INTERSTITIAL
FLUID O2 CO2 Glucose
active transport
CELL
FLUID BALANCE
Filtration vs. Reabsorption
40- Outward Forces:
1. Capillary blood pressure
(Pc = 35 to 15 mmHg)
PRESSURE (mmHg)
30-
2. Interstitial fluid pressure
(PIF = 0 mmHg)
20- 3. Interstitial fluid colloidal
osmotic pressure
(IF = 3 mmHg)
10- TOTAL = 38 to 18 mmHg
Inward Force:
1. Plasma colloidal osmotic
pressure (C = 28 mmHg)
0-
CAPILLARY FLUID SHIFT
Pout > c Pout < c
Pc Pc
30-
Via
lymphatics
20-
Filtration Reabsorption
10-
RADIAL FLOW
0-
LYMPHATIC CAPILLARY
“PUMP”
Compression
Smooth muscle contraction
Anchoring Filaments
Effects of gravity on arterial and venous pressures.
Each cm of distance produces a 0.77 mmHg change.
Veins Arteries
0 100 mm Hg
190 mm Hg
Sphincters protect
capillaries
VENOUS PUMP keeps PV < 25 mm Hg
HEART
Art. BP
VEINS CO = PBF ARTERIES
(RAP) RAP
7 mmHg 7 mmHg
7 7 7 0 1.2 0
6 31 25 1.2 20.8
5 55 50 1.2 41.7
4 79 75 1.2 62.5
0 3 103 100 1.2 83.3 (5 L/min)
THE VASCULAR FUNCTION CURVE
10-
PBF
or
VENOUS
RETURN 5-
(L/min)
0-
-4 0 +4 +8
RAP (mmHg)
WAYS TO ALTER THE
VASCULAR FUNCTION CURVE
Hemorrhage VOLUME
MCP
1 2 3 4 5 6
BLOOD VOLUME (L)
MEAN CIRCULATORY PRESSURE
VENOCONSTRICTION
Unstressed Stressed Volume
PRESSURE (mmHg)
Volume
7- Normal
1 2 3 4 5 6
BLOOD VOLUME (L)
MEAN CIRCULATORY PRESSURE
VENODILATION
Unstressed Stressed Volume
PRESSURE (mmHg)
Volume
7- Normal
1 2 3 4 5 6
BLOOD VOLUME (L)
RELATIONSHIP BETWEEN RAP and PBF
Cv = 24 x Ca P
RAP Pv Pa P= Pa - Pv TPR PBF=TPR
(mmHg) (mmHg) (mmHg) (mmHg) (PRU’s) (ml/sec)
7 7 7 0 1.2 0
6 31 25 1.2 20.8
5 55 50 1.2 41.7
4 79 75 1.2 62.5
0 3 103 100 1.2 83.3 (5 L/min)
MCP 8 8 8 0 1.2 0
7 32 25 1.2 20.8
6 56 50 1.2 41.7
5 80 75 1.2 62.5
4 104 100 1.2 83.3 (5 L/min)
0 3 128 125 1.2 104.2 (6.25 L
min
THE VASCULAR FUNCTION CURVE
7 7 7 0 1.2 0
6 31 25 1.2 20.8
5 55 50 1.2 41.7
4 79 75 1.2 62.5
0 3 103 100 1.2 83.3 (5 L/min)
TPR 7 7 7 0 2.0 0
6 31 25 2.0 12.5
5 55 50 2.0 25.0
4 79 75 2.0 37.5
0 3 103 100 2.0 50.0 (3 L/min)
THE VASCULAR FUNCTION CURVE
Vasodilation
10-
PBF TPR
or
VENOUS
RETURN 5-
(L/min)
TPR
Vasoconstriction 0-
-4 0 +4 +8
RAP (mmHg)
CARDIAC & VASCULAR
FUNCTION CURVES
15-
CARDIAC
OUTPUT
or 10-
PERIPHERAL
BLOOD FLOW
[Venous Return] 5-
(L/min)
-4 0 +4 +8
RAP mmHg
CHANGES IN
CARDIOVASCULAR
PERFORMANCE
BY ALTERING THE CARDIAC FUNCTION CURVE
- CHANGING CONTRACTILITY
- CHANGING HEART RATE
Baroreceptors Vagus
Carotid Sinus HEART
Aortic Arch
Arterioles
Chemoreceptors Veins
Adrenal
Carotid Bodies
Aortic Bodies Medulla
Bainbridge Reflex ( Heart Rate)
Atrial Receptors Volume Reflex ( Urinary OUTPUT)
a. Vascular Sympathetic Tone
b. ADH Secretion
c. Aldosterone Secretion
RENIN-ANGIOTENSIN-ALDOSTERONE MECHANISM
Angiotensin
Vasoconstriction Aldosterone
Venoconstriction Kidney
Hypothalamic
Osmoreceptors
50 100 150
ARTERIAL BLOOD PRESSURE (mmHg)
HYPERTENSION (140/90 mmHg)
Secondary Hypertension (10%) [e.g., Pheochromocytoma]
Essential Hypertension (90%)
- Normal cardiac output
- Cardiac hypertrophy [left ventricle]
- “Resetting” of the baroreceptors
- Thickening of vascular walls
or CO
PBF BP
1 2 3 4 5 (L/min)
Blood Volume (L)
-4 0 +4 +8
RAP (mmHg)
CARDIAC & VASCULAR
FUNCTION CURVES
15-
CARDIAC
OUTPUT
or 10-
Response to Hemorrhage
PERIPHERAL HR & Contractility
BLOOD FLOW Venoconstriction ( MCP)
[Venous Return] 5- Vasoconstriction ( TPR)
(L/min)
-4 0 +4 +8
RAP mmHg
RESPONSE TO HEMORRHAGE
Sympathetic tone via baroreceptor reflex
Heart rate and contractility
– Venoconstriction ( MCP)
– Vasoconstriction ( arterial BP & direct blood to
vital organs)
• Restore Blood Volume
– Capillary fluid shift ( BP favors reabsorption)
Urinary output ( Arterial BP, ADH, Renin-
Angiotensin-Aldosterone)
• Restore plasma proteins & hematocrit
SYNCOPE (FAINTING)
Postural syncope
(Blood pooling in the extremities)
Vasovagal syncope
Volume
7- Normal
Unstressed Vol.
Syncope (Fainting) Stressed Vol.
MCP
1 2 3 4 5 6
BLOOD VOLUME (L)
SYNCOPE (FAINTING)
Blood pooling in the extremities
7-
MCP CO
Pressure
or CO
PBF BP
1 2 3 4 5 (L/min)
Blood Volume (L)
-4 0 +4 +8
RAP (mmHg)
CARDIAC & VASCULAR
FUNCTION CURVES
15-
CARDIAC
OUTPUT
or 10-
Response to Syncope (Fainting
PERIPHERAL HR & Contractility
BLOOD FLOW Venoconstriction ( MCP)
[Venous Return] 5- Vasoconstriction ( TPR)
(L/min)
-4 0 +4 +8
RAP mmHg
CARDIAC FAILURE
CAUSES: Impairment of electrical activity
Muscle damage
Valvular defects
Cardiomyopathies
Result of drugs or toxins
-4 0 +4 +8
RAP mmHg
HEART
I AC
RD RE SYSTOLIC PRESSURE CURVE
CA ILU
FA
Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE
PHYSICAL ACTIVITY
-Exercise (20 x BMR)
-Shivering (5 x BMR)
HEAT LOSS
COOL HOT
RADIATION
CONDUCTION 70%
CONVECTION
VAPORIZATION 30%
Insensible Water Loss * *
Sweating *
SKIN HYPOTHALAMUS
Preoptic Area
W Sweating
Set Vasodilation
Warm W
Receptors
point Vasoconstriction
W C Shivering
Cold
Receptors
Interaction Between
Peripheral & Central Sensors
Cooling the skin raises the set point above which sweating begins.
Warm skin--sweating occurs above 36.7C
Cold skin--sweating occurs above 37.4 C
Warming the skin lowers the set point below which shivering begins.
Cold skin: shivering occurs at 37.1C
Warm skin: shivering occurs at 36.5C
PYROGEN WBC
bacterial toxins, leukocytes,
viruses, pollen, + monocytes = endogenous pyrogen
proteins, dust
Arachidonic Acid
Prostaglandins Aspirin
Reference
Temperature Actual Core
or Set Point
Temperature
Onset of Fever
Fever Breaks