PULMONARY

CIRCULATION

CARDIOVASCULAR
PHYSIOLOGY
SYSTEMIC
CIRCULATION

Wattana B. Watanapa, MD PhD

Physiology, Siriraj, Mahidol

CLOSED CIRCUIT
CVP

MAP

Ohm
Ohms Law
V=IR

Pressure
difference

P=QR
Pressure
difference
mmHg

V.R.

Venous return

Flow

l/min, ml/s

Flow (vol/time)
In a closed circuit,
flow must be the
same at all levels
.
. . C.O. = V.R.

= MAP - CVP

Resistance

mmHg.min/l

Central venous
pressure

Mean arterial
pressure

C.O.
Flow = Velocity x Area
m3/s =

m/s

m2

Cardiac output

Pulmonary vascular resistance

Electrical circuit :

Ohm
Ohms Law
Hydraulic circuit :

Resistance
=

V=IR

P=QR

P/Q

MAP - CVP = C.O. x TPR

Total peripheral resistance (TPR)
Systemic vascular resistance (SVR)

~ 0 mmHg

.
. . MAP = C.O. x TPR

Resistance
CARDIAC
OUTPUT
=

STROKE
VOLUME

1 1
(l/min, ml/min)

HEART
RATE

1
1
(l, ml)

1
(min-1)

Viscosity

Poiseuille Law

R = 8nL
r4 . ll

.
..R

n, R

1
r4

P=QR
MAP
C.O.
Stroke
volume

Heart
rate

TPR
Arteriolar
radius

compliance

Viscosity

P=QR

Blood
70-75 ml/kg bw
= + plasma
Hematocrit (Hct.)
= % rbc volume / total bl. vol.

= 42% 38%

Anemia < 40% < 36%

Polycythemia > 50%
hypovolemia

Arial systole

Isovolumic
relaxation

Isovolumic
contraction

Ventricular
filling

Semilunar valves

Atrium
Atria

Systole
Diastole

Aortic v.

Atrioventricular
valves
Mitral v.
Tricuspid v.

Ventricles

Ejection

Cardiac cycle

Pulmonic v.

End-diastolic
volume (EDV)

End-systolic
volume (ESV)

Stroke volume
SV = EDV - ESV
Ejection fraction (EF)
= (EDV-ESV)/ EDV
= SV/EDV

Systolic BP
Diastolic BP

Heart sound
S1 - AV valve
S2 - semilunar
valve
Murmurs

Pacemaker
SA node
atrial m.
AV node
common bundle
bundle branch
Purkinje fiber
ventricular m.

conducting system

fast vs slow
response AP

ectopic focus

Plateau phase

Plateau phase

SA & AV node

7.21
340

SA & AV node

diastolic depolarization

= pacemaker

symp

intrinsic parasymp

Phase 4 in SA
-> HR
Symp & Parasymp
modify

Heart rate
apex beat
Left 5th intercostal space, midclavicular line

Radial pulse


Carotid pulse

Chronotropic effects: +ve =
HR, -ve = HR

ECG

Tachycardia = HR > 100 /min, bradycardia = HR < 60/min

P=QR

>

>



HR


HR

HR

MAP
C.O.
Stroke
volume

Heart
rate
Parasymp.
Vagal tone

TPR
Arteriolar
radius

Symp.
& Adr.

stroke volume

FRANKFRANK-STARLING
MECHANISM
or Starling
Starlings law
of the heart

Venous return

Preload

Frank-Starling Mechanism
stroke volume

Contractility

Viscosity

PRELOAD
END-DIASTOLIC VOLUME (ml)

End-diastolic
volume (EDV)

Length-tension
relation
Sliding filament
mechanism
Stroke volume
SV = EDV - ESV

End-systolic
volume (ESV)

Ejection fraction (EF)

= (EDV-ESV)/ EDV
= SV/EDV

Ventricular function curves

preload = initial length

Preload
Venous return

Sympathetic venomotor tone

Some
indices of
ventricular
performance
e.g. SV, SW,
C.O., etc.

Skeletal muscle pump

Respiratory pump

Pericardium
Diastolic filling time
Some indices of initial length
e.g. LVEDV, LVEDP, etc.

CONTRACTILITY
Inotropic state

initial length (preload)

[Ca++]i,
++
Ca sensitivity, &
, myosin ATPase activity

Mitral tricuspid stenosis

Index for CONTRACTILITY

Ejection fraction

(SV/EDV)

ventricular function curve

shift upward & left

contractility
shift upward
& left

Contractility
= Inotropic effect
Positive inotropic effects

contractility

shift downward
& right

sympathetic, adrenaline
thyroid H.
increased [Ca++]ECF

Negative inotropic effects

Ca channel blocker
myocardial ischemia or infarct
heart failure

P=QR

Coronary a.

MAP
C.O.
Stroke
volume
Preload
(EDV)

Contractility

Heart
rate
Parasymp.
Vagal tone

V.R.

TPR
Arteriolar
radius

Viscosity

Symp.
& Adr.

Coronary blood flow

coronary a.
Metabolism
Metabolite
-> Coronary a.

Ischemia
Angina pectoris