Physiology – CVS 2 - Similar effect to have Interventricular septum defect

Refractory Period
Heart - Normal: 0.25-0.30s
o Biggest complex in ECG
2 regions of circulation o If you hit the heart at just the right time, the
- Right circulation rhythmic action of the heart can cause it to
o Deoxygenated blood stop beating, common in children
o From superior and inferior vena cava into the - Relative: 0.05s
right atrium A regular heart rhythm is an utmost importance in the regulation of
o In severe blood delivery problem back to the the heart
heart, you can see blood going up and down
the neck because there is no valves in the The Cardiac Cycle
vena cava - Systole
o From right atrium to the AV valve to the o Pumping of blood outside the chamber
ventricle (right) to the pulmonary artery - Diastole
o Any disfunction of these valves will cause o Phase that involves the filling of the chamber
congestion of blood in the ventricle or the - Atrial systole
atrium o Activities that lead to the expulsion of blood
▪ Ex. Stenosis (valves) out of the atrium
▪ Reflux/regurgitates Diastolic dysfunction is non-fatal (chronic) compared to systolic
• Backflow dysfunction.
• Causes disturbance in
the flow of blood in Diastole
the circ. System - Correlate with ECG
o If there is a heart problem, lungs are - The depolarization of the atria
probably affected as well (directly or - 110-120mL of blood (doesn’t happen physiologically)
indirectly) - End-diastolic volume
- Left circulation o What is measured clinically
o Oxygenated blood o Potential blood that will come out of the
o Pulmonary vein heart
▪ Only vein that carries o Low volume – low volume coming out of the
oxygenated blood heart correlates with a poor pump
▪ Drains to the left atrium - The extra 20%
• Houses the mitral o Not really needed at rest
valve - The P in the PQRST in ECG
• Prevents backflow of - For it to happen, does not need the atria to contract
blood - It can happen without the help of the atrium contracting
• AV valve of the left - Excessive strenuous tasks, end diastolic volume is
side of the heart reduced because the extra 20% is not there anymore
• Most commonly - Happens during the relaxation after the heart pumps
damaged - Happens at isovolumetric relaxation
• Ex. Mitral valve - Drop in pressure in the ventricles, the AV valves will
prolapse open
• Rheumatic Heart - SA node gets to the atria, causing it to contract, the
disease extra 20% comes in and atrial contraction happens,
o Left ventricles causing the AV valves to open
▪ Exerts the most force because It - Closure of the AV valves marks the start of the Systole
delivers blood to the systemic - The negative pressure of the atrium causes the valve to
circulation close
▪ Pumps more strongly than the Systole
right side - Correlate with ECG is the QRS complex
▪ Also the reason why they are o Ventricular depolarization
separated to right and left - LV: 80mmHg threshold
▪ Because the pressure in the left is o Beyond 80, the blood will now pump blood
greater than the right - RV: 8mmHg threshold
▪ High pressure causes changes in - 60% is emptied
the lumen of the BV o 70/30 (duration)
▪ High pressure of the left side - 70mL ejected (60% of 110-120mL)
causes left ventricle failure o Stroke volume – amount of blood that comes
No clear cut because in the capillaries there is continuous exchange out of the heart
of oxygenated to deoxygenated ▪ Measures the function of the heart
▪ Lower end diastolic volume means
AV Valve
lower stroke volume
- Could be the o CO = SV x HR
o Tricuspid valve ▪ 70mL x 60beats/min
o Mitral valve ▪ 420 mL/min
Myocytes
o Cardiac output
- Conducting muscle fibers, almost lost their ability to ▪ Amount of blood the heart can
contract pump out in a minute
- Specialize only in conducting impulses ▪ Determine the blood flow
Atrial septum defect o Heart rate
- Congenital
 ▪ Amount of times the heart pumps - Increase in adrenaline can increase cardiac output
in a minute Potassium
▪ Increased cardiac output means - Intracellular electrolyte, involved in repolarization
increased HR - An increase or decrease will have an adverse cardiac
S1 effect, because cardiac cells are permeable to
- The first heart sound potassium, faster repolarization and depolarization
- Marks the start of systole leads to tachycardia
- Sound 1 - A lack in potassium, difficult to repolarize
- Blood hits the AV valves Calcium
S2 - Essential in beating, same with potassium
- Blood hits the aortic valve - Increase calcium increses HR
- Sound is due to the backflow Temperature
S3 and S4 - Increases permeability leading to tachycardia
- Filling of the ventricle Arterial pressure
- Are pathologic heart sounds - Afterload increased, will cause decreased cardiac
output becomes not enough blood will come out
A wave - Blood pumped per beat is decreased
- Atrial wave - Addressed thru vasodilation
- Pumping of the blood from atrium to ventricle causing an Septal wall holes
increase in atrial volume - Transition of pressure from the left to the heart which
C wave leads to permanent changes
- Closure of the AV valve Valve reflux
- As blood is pumped by the ventricles, blood hits the AV - Almost always ensures that the output is decreased
valve resulting to the ballooning out of the AV valve - Some of it will backflow to the AV valves isntread of
causing a slight increase in the atrial pressure going to the semilunar valves
- Depolarization Effect of valve stenosis
- Isovolumetric contraction Hypertension
V wave - Increased peripheral pressure which will increase the
- Venous wave afterload, heart will have a difficult time to pump to
fight the higher pressure in the peripheral
Semilunar valves
- Aortic valve
- Pulmonary valve
Papillary muscles
- Muscles found near the bottom of the heart
- Finger like projections
- Houses the chordae tendinae
o Keeps the av valves from prolapsing too
much, keeps them steadily in place
Preload
- Pressure that comes into the heart
- Exerted by the veins to the heart
- Beneficial in situations like, hypotensions
- Preload decreases when you lose blood, give fluids to
increase preload
Afterload
- Constrictions of the capillaries increases the afterload’
- Like ACE inhibitors
- Treat it with vasodilation of the arterial side, because in
the venous side it affects the preload.
Heart is metabolically active
- Needs oxygen and fatty acid
- Oxygen is used as the final electron acceptor in ATP
production thru cellular respiration
- The lack of oxygen will most definitely affect the heart,
it is very detrimental for the heart to receive oxygen
- Fatty acid as fuel during resting
- Heat is a reflection of the inefficiency of the system
- Heart is 20-25% efficient

Effect of parasympathetic function

- Vagus nerve to the SA node
- The higher the impulse of the vagus nerve is, the slower
the heart rate
- Vago-vagal syncope
o Transient sudden loss of consciousness
because of the low of flow in the brain
- Example if napupupu increases parasympathetic
stimulation
Sympathetic
Electrophysiology of the Heart - Increased afterload has a negative effect on cardiac
muscle shortening
The Heart - Limits the muscle shortening
- Heart muscle is syncytial - Increased in valvular closure, aortic valve stenosis, valve
- In series and in parallel embolism in the aorta, atherosclerosis in the major
The Conduction System arteries
- Supranodal - Increasing contractility increases the fraction of end
- Infranodal diastolic volume 55% of the end diastolic volume
- Relative to the AV node - Increase inotropy increases ejection fraction
- Findings in the ECG may reflect the areas above the AV - Ejection fraction
or Below the AV node o SV over the End diastolic volume
- 3 distinct nodes Digitalis
o Region of AV node - Given to patients with ventricular systolic pressure
o Region of SA node failure
o Bundle of His - Causes an increase in contractile force of myocytes
- Differ in how fast they fire impulses - Will block the action of the NaK ATPase pump, which
- Whoever fires the fastest, wins also inhibits Na-Ca exchanger
SA node o Na-Ca exchanger is responsible for 15% of
- Highest rate per minute (60-100/min) the recovery phase
- Normal HR 60-100ml/min (80mL/min) o Ca-Na exchanger 1 ion of calcium in
- Pacemaker of the heart exchange of 3 ions of sodiums go in
- Releases impulses at regular intervals - Blocking this will increase in trigger of calcium induced
AV node calcium increased
- Second fastest, the node found near the Tricuspid Valve - 85% is from the SERCA
- Fires 40-60mL/min - Increases HR, contractility,
- AV node will take over if the SA node dies, because it is - Increase rate of action potential conduction
second fastest o Altering the conductivity of the gap junction
Without the SA and AV node, the cells will conduct impulses - Decreases cardiac action potential duration
themselves but at slow speed (20-40mL/min) it is their inherent o By early activation of…
property. - Decreases cardiac relaxation
Bundle of His -

The right atria contracts with a little delay from the left atria tho its
only 0.01 ms

Low calcium and low sodium will affect the sinus node called funny
currents can cause the heart to stop beating.

Preload – end diastolic volume

During inspiration there will be a decrease in intrathoracic pressure,

there would be a decrease in right atrial and pulmonary pressure,
increased inflow, which will cause increased preload or venous
return.

Venous return is decreased in times of shock, blood loss, etc

Ventricular compliance is determinant of preload, which also

decreases. Ventricular stiffness in post MI, infiltrative disease like.
Pericarditis decreases compliance of ventricles, also pericardial
effusion, rhabdomyosarcoma, which impede the contraction of the
ventricles.

AV valve stenosis and/or regurgitations will decrease preload.

Semilunar valve diseases increase preload.
Increasing wall thickness will decrease preload, like in hypertrophy,
less capacity to accept the volume of the atria.

Afterload
- The load after the muscle exerts contractile force
- The load the muscle acts upon to exceed the tension
- Corresponds to the systolic pressure during the period of
ejection
- Increasing the afterload decreases the cardiac output.
Because the ventricle must eject higher mean arterial
pressure or diastolic pressure.
- Stroke volume is reduction because of the reduction of
muscle fiber shortening
- Increased afterload will increase the phase of
isovolumetric contraction