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Cardiovascular disease
Cardiovascular disease is still Australias greteast health problem 55% of women and 45% of men
It kills more people than any other and contributes to significant illness, disability, poor quality of life
and premature death.
It is the most expensive disease group in Australia in terms of health expenditure ~10% of health
Overview of Cardiovascular Function
Atria > Ventricles > Arteries > Arterioles > Capillaries > Venules > Veins
Blood flows in a continuous loop through the cardiovascular system, systemic and pulmonary
circulations are in series.
Pulmonary circulation

All of the blood goes to the lungs

Right heart pump
Low pressure

Systemic circulation

Blood is shared between different organs and tissue (i.e. flow is parallel through different
Left heart pump
High pressure

What drives blood along the vessels?


Gradient of blood pressure

Pressure change in both circulation

systems are similar but the pulmonary
circulation is of much lower pressure than
the systemic.

Total blood volume and distribution

Blood volume = ~ 7-8% body weight
In a 70kg man = 70 x 0.075 = 5.25kg = ~5L
Where is the blood in the body?

Heart 7%
Pulmonary circulation 9%
Arteries 13%
Arterioles and capillaries 7%
Veins, venules and venous sinuses 64%

3 Fundamental Equations to Remember

Flow =

Blood flow (F)

Volume of blood flowing through vessel, organ or circulation, per unit of time (ml/min)
o Blood flows from high pressure to lower pressure

Blood pressure (BP)


Force per unit area exerted on the wall of a vessel by the blood (mean, systolic and diastolic
BP; mmHg)
o Contraction of the heart generates the pressure that drives flow of blood through
blood vessels

Resistance (to flow, R)


Amount of friction blood encounters as it passes through the vessels

How difficult is it for blood to flow between two points for any given pressure difference

Factors which determine the resistance to flow

1. Length of the tube
o Resistance is directly proportional to the length of the tube
o The longer the tube the greater the resistance
Pressure in pulmonary circulation is much lower than systemic circulation
(same FLOW but total LENGTH of blood vessels in pulmonary circulation is
2. Radius of the tube



Smaller diameter -> Higher resistance

Small changes in diameter -> Big changes in resistance

3. Viscosity of the fluid

o Blood viscosity is largely dependent on Haematocrit
^ Haematocrit = ^ Viscosity = ^ Resistance

Main factor controlling resistance to blood flow is DIAMETER

Diameter can change due to

Structural abnormalities
o Atherosclerotic plaques
Vasoconstriction and dilation
o Local chemical and physical factors
o Sympathetic nervous system
o Vasoactive hormones
o Factors released from the endothelium

The heart as a pump

Systole = period of contraction
Diastole = period between contractions (relaxation)

Heart valves
Atrioventricular valves

Tricuspid (Right atrium)

Mitral valve/bicuspid (Left atrium)
o Prevent backflow

Semilunar valves

Pulmonary (Right ventricle)

Aortic (Left ventricle)
o Prevent backflow

Cardiac cycle

Cardiac Output

Volume of blood pumped by each ventricle per minute

o Cardiac Output = Heart Rate x Stroke Volume
Average values at rest
o Heart rate
= ~70 beats/min
o Stroke volume = ~70 ml/min
o Cardiac output = 4.9 L/min
Cardiac output in different states
o Strenuous exercise: CO can increase 5-6 fold to 25-30 L/min
o Highly trained athletes: up to 35-45 L/min
o Pregnancy: CO increases by ~50%
o CO < 3L/min becomes life threatening

Stroke volume

Volume of blood pumped with each contraction (heart beat)

3 Major determinants
o End diastolic volume (degree of filling) = Preload
o Contractility Force of contraction of individual
ventricular muscle fibres
o Afterload: Pressure that must be exceeded before
ejection of blood from ventricles can begin

1. End-Diastolic Volume (Preload)

Influenced by
Duration of Ventricular Diastole (i.e. filing time)
Venous pressure (passive filling)
INCREASED Venous return (Preload) automatically in stroke volume
INCREASED Filling Of ventricles stretches the cardiac muscle cells
Ventricles contract with greater force as a result
Underlying basis is the length-tension relation of cardiac muscle
Frank-Starling Law of the Heart
2. Contractility
Contraction strength at the same muscle length (end-diastolic volume).
Changes in contractility are generally due to
I. Change in amount of Ca2+ being released in cardiac muscle cells
2. Change in affinity of the myofilaments for
3. Change in of myofilaments available to participate in contraction.
Influenced by
Certain drugs & hormones, & ionic changes in extracellular fluid
Increased by Sympathetic Stimulation
Noradrenaline & circulating Adrenaline
o act on cardiac muscle cells
o Increase Ca2+ entry into cell and evoke greater Ca2+ release
from the sarcoplasmic reticulum (Store)

Ejection Fraction (EF)

Important indicator Of cardiac health
Stroke volume expressed as a fraction of the end-diastolic volume.
Ejection Fraction = Stroke Volume / End-Diastolic Volume
Typical values at rest:
EDVZ 120ml. ESV-50ml
SV 120-50 70 ml
EF 120 -0.6
should be at least 55% in a healthy heart
EF increases when cardiac muscle contractility increases
can be as high as 90% in vigorous exercise

3. Afterload
Pressure in the arterial system (aorta or pulmonary artery) that resists ventricular ejection
For ventricles to be able to eject blood, ventricular pressure must rise higher than the pressure in
the respective arterial system. (Refer to Cardiac Cycle)
High arterial pressure (high afterload) can reduce stroke volume

Heart Rate
Controlled by autonomic nervous system acting on pacemaker cells of the sinoatrial (SA) node.
DECREASED by parasympathetic stimulation.
INCREASED by sympathetic stimulation & circulating adrenaline.
Other factors incl. K. imbalance in ECF & high body temperature, but these don't play a role in
normal control of heart rate.
Tachycardia = INCREASED Heart Rate
Bradycardia = DECREASED Heart Rate
Average Values
Normal Resting HR: ~70 beats/min
Athlete ~40 beats/min
Upper Limit ~200 beats/min
Maximum with age 220 - Age
Arterial Blood Pressure

Arterial pressure rises & falls with cardiac cycle

Pressure in large arteries essentially same bc of low resistance to flow
Key Definitions
Systolic Pressure
Diastolic Pressure
Pulse Pressure
Mean Arterial Pressure

Normal Values
Systolic over diastolic

Highest pressure during one cycle

Lowest pressure during one cycle
Systolic Diastolic pressure
Average pressure over one cycle
= diastolic + 1/3 pulse pressure

120/80 mmHg
~93 mmHg