1 - 2020-Cardiovascular Physiology

Chapter 4
Cardiovascular Physiology
Zhang Jing （张静）
Email: jiyizhangjing@163.com
1
Chapter 4 Cardiovascular Physiology
Section A Electrical Activity of the Heart
Section B Pump Function of the Heart
Section C The Vascular System
Section D Integration of Cardiovascular Function
Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

Chapter 4 Cardiovascular Physiology



Section B Pump Function of the Heart

Section C The Vascular System

Section D Integration of Cardiovascular Function:

◆ KEY POINTS
1. Innervation of the heart.

2. AP of the ventricular muscle cells.
3. AP of the SA.
4. ECG
5. Refractory period of cardiac muscle cells.
6. the process of cardiac ejection and filling
7. Heart sound(S1,S2)

◆ KEY POINTS
8. Basic concepts: CO; SV; EF; Cardiac index; Blood

flow; Blood resistance; Blood pressure
9. Factors maintaining cardiac output
10. Windkessel Vessel
11. Formation of the BP
12. HOW to measure BP
13. Three channels of microcirculation
14. Formation of the Interstitial Fluid

◆ KEY POINTS
15. Innervation of the heart and blood vessels

16. Baroreceptors of reflex
17. Humoral regulation

Ⅱ Cardiac muscle→Innervation
◆ The heart is dominated by:
Sympathetic nerves
Parasympathetic nerves
(Vagus nerves)

Sympathetic nerves
Norepinephrine(NE)
+β-R(beta-adrenergic receptor)
Force of Rate of
Heart rate
contraction conduction
13
Parasympathetic nerves
Acetylcholine(ACh)
+M-R(muscarinic receptor)
Force of Rate of
Heart rate
contraction conduction
14
◆ Ventricle→AP
the ventricular muscle cell

Phase 0: Depolarization: Na+ inward current rapidly
Phase 1: Early phase of rapid repolarization: K+ outward current
Phase 2: Plateau: Ca2+ inward current and K+ outward current
Phase 3: Late phase of rapid repolarization : K+ outward current
Phase 4: Resting phase: Na+-K+ pump

and Na+-Ca2+ exchangers

SA node
Phase 0: Depolarization: Ca2+ inward current (L-type)
Phase 3: repolarization: K+ outward current
Phase 4: spontaneous depolarization: K+ outward current
Na+ inward current
Ca2+ inward current (T-type)
16
3.5 The electrocardiogram(ECG)
P wave
QRS complex
T wave
P-R interval
Q-T interval
S-T segment

❖ Refractory Period
➢In skeletal muscle, the refractory period is short.
➢Cardiac muscle has a long refractory period

compared to skeletal muscle.
18
❖ Refractory Period
In this period, regardless of the strength of

stimulus, the cardiac muscle cells can’t be
depolarized.
➢Long refractory period

prevent the summation of the
contraction. So it makes sure
that the contraction and
relaxation can occur
alternately.
19
◆ Properties of Cardiac Muscle
➢ Excitability
➢ Automaticity electrophysiological properties
➢ Conductivity
➢ Contractility -----→Mechanical property

Ⅰ→Cardiac cycle
➢ Each heartbeat consists of two major periods ：

1. Systole：heart contracts and pumps
the blood through arteries.
2. Diastole：heart relaxes and blood is filled in the heart.
All these changes are repeated during every

heartbeat, in a cyclic manner.

Ⅱ→ the process of cardiac ejection and filling
◆Take the left heart as an example to discuss the process
of cardiac ejection and filling.
1. Isovolumetric ventricular contraction

2. Ventricular ejection period
3. Isovolumetric ventricular relaxation
4. Ventricular filling period
5. Atrial contraction period
Atrium
Ventricle

2.1 Isovolumetric ventricular contraction
➢ Pressure: ventricle＞atria,
AV valve is closed.
➢ Pressure: ventricle＜artery,
aortic valve is still also closed.
◆ when ventricle contracts:

➢ AV valve is closed, aortic valve is also closed.
➢ The ventricle is a closed chamber.
2.2 Ventricular ejection period
➢ Pressure: ventricle＞atria,
AV valve is closed.
➢ Pressure: ventricle＞artery,
aortic valve is open.
◆ when ventricle contracts:

➢ Aortic valve is open, AV valve is also closed.
➢ The blood flows into the artery from the ventricle.

2.3 Isovolumetric ventricular relaxation
➢ Pressure: ventricle＜artery,
aortic valve is closed.
➢ Pressure: ventricle＞atrium,
AV valve is still closed.
◆ when ventricle relaxes:

➢ AV valve is closed, aortic valve is also closed.
➢ The ventricle is a closed chamber.
2.4 Ventricular filling period
➢ Pressure: ventricle＜atrium,
AV valve is open.
➢ Blood: atrium to ventricle

2.5 Atria contract: last rapid filling phase
➢ Atrium contraction occurs at the end of diastole; the

duration is 0.1s.
➢ The AV valve is still open;
➢ The blood continuously flows into ventricle from
atrium.
➢when atria contract and pump 10 %
blood into ventricles.
Atrium
Ventricle

3.1 Heart sounds
The first heart sound (S1)
1. S1 is caused by the closure of the AV valves.

2. It is a sign of the beginning of ventricular contraction.
3. It is a soft low pitched lub.

3.3 Heart sounds
The second heart sound (S2)
1. S2 is caused by the closure of the aortic and pulmonary

valves.
2. It is a sign of the beginning of ventricular relaxation.
3. It is a louder dup.

1.1 SV
• SV: is the amount of blood pumped out by each
ventricle during each beat.
SV = EDV -ESV
Ejection Fraction (EF):
➢ It refers to the percentage of the blood that is ejected

out of the ventricle with each contraction.

1.3 CO
➢Minute volume is the amount of blood pumped out by

each ventricle in one minute.
Minute volume = Stroke volume × Heart rate
➢ CO = HR×SV
• HR: the number of beats of per minute.
• SV: is the amount of blood pumped out by each
ventricle during each beat.

1.4 Cardiac index
➢ Cardiac index is the minute volume expressed in relation

to square meter of body surface area.
➢ It is defined as the amount of blood pumped out per

ventricle/minute/ square meter of the body surface area.

Ⅱ Basic Concept of Hemodynamics: Blood Flow,
Blood Flow Resistance and Blood Pressure
➢ Blood flow: volume of blood flowing through any

tissue in a given period of time. (volume velocity)
➢ Blood resistance: Resistance is the measure of the

friction that impedes flow.
➢ Blood pressure: means the pressure the blood exerts

against the inner walls of the blood vessels.

2. Factors maintaining cardiac output
➢ Cardiac output is maintained (determined) by following

factors:
Preload
1. Stroke volume Afterload
Myocardial contraction
➢ Preload: the volume of blood in the ventricles just before

the contraction
➢ Afterload: the arterial pressure that the ventricle have to
overcome while it contracts
➢ Contractility: the intrinsic ability of the myocardium
1. Windkessel Vessel aorta, pulmonary artery
and the biggest branch
➢Characteristics:
a. Wall thicker.
b. Rich in elastic fibers.
c. Obvious flexibility and expansibility.
➢Function:
a. Convert the intermittent ventricular ejection into

continuous blood in the vessels.
b. Buffer blood pressure ,fluctuation in a relatively
constant range.
1. Basic concepts of BP
➢ Systolic pressure (SP) – the maximum pressure

during systole.
➢ Diastolic pressure (DP) – the minimum pressure
during diastole .
➢ Pulse pressure=SP-DP

2. The formation of arterial BP
(1) Plenty of blood filling in the cardiovascular system.

(2) Cardiac ejection.
(3) Peripheral resistance.
(4) Elasticity of Windkessel vessel.

3.2.4 Step of measurement of BP
◆Here's everything you need to know about measuring

your own blood pressure, and a simple five-step guide.

◆ thoroughfare channel
Its diameter is larger than others.
Its resistance is smaller. (R = ΔP / F = 8 η l/ π r4)
The blood flow is faster.
The blood may quickly return to the

heart through the thoroughfare
channel and increase venous return .

◆ Circuitous channel (Nutrition channel)
✓ They are lined by only a single layer of endothelial cells.
✓ There are junctions or pores between endothelial cells.

✓ With greater surface area.
✓ Blood flows very slowly and at a very low pressure in
order to allow for maximal material exchange
◆ exchange of nutrients and

metabolites between blood
and interstitial fluid.

➢ Anastomosis shunt arteriole – venule
Arteriovenous shunt
Plays a role in thermoregulation.

5.3 Formation of the Interstitial Fluid
➢Capillary pressure(HPc)
➢Plasma colloid osmotic pressure(OPc)
➢Interstitial fluid hydrostatic pressure(HPif)
➢Interstitial fluid colloid osmotic pressure(OPif)
Net filtration pressure

-
Net reabsorption pressure
=
EFP=(HPc +OPif )-(OPC + HPIF)

1. Innervation of the heart
Sympathetic nerve
Decrease HR
Weaken myocardial contractivity
Decrease atrioventricular Increase HR
conduction Enhance myocardial contractivity
Speed up atrioventricular
conduction
2. Innervation of the blood vessels
➢ Except the true capillaries, the vascular walls have

smooth muscle distribution
➢ Divided into:
vasoconstrictor fibers
vasodilator fibers

2.1 vasoconstrictor fibers
➢ When the α-Rs are activated and leading to

contraction of blood vessels;
➢ when the β receptors are activated and leading to
relaxation of blood vessels.

2.1 vasoconstrictor fibers
➢ The affinity of NE binding to the α-Rs prevails over
the β-Rs.
➢ Therefore, when the sympathetic nerve is excited,

mainly leading to the contraction of the blood
vessels.
vasoconstrictor fiber

2.2 vasodilator fibers
➢ Divided into the sympathetic vasodilator fiber and

the parasympathetic fiber.
➢ Release the ACh.
➢ The ACh can bind the M-Rs and lead the blood
vessels relaxation.

3. Cardiovascular center
➢ Medulla oblongata is the most essential to

cardiovascular center —“Center of life”.
➢ The other cardiovascular centers contribute to

functional integration of the whole organism.

4. Process of baroreceptor reflex
➢ Carotid sinus baroreceptors ➢ Aortic arch baroreceptors
sinus nerve aortic nerve
➢ Nervous center
Cardiac sympathetic Cardiac vagus

nerve center Sympathetic
nerve center vasoconstictor
center
Cardiac sympathetic Cardiac vagus
nerve nerve Sympathetic
➢ Maintain the vasoconstictor nerve
relative stability of
arterial BP. Heart
Blood vessels
Ⅱ Humoral regulation
➢ Depending on the nature of action of these substances,

they are classified into two groups:
HORMONES WHICH INCREASE BP
HORMONES WHICH DECREASE BP
E
Vasoactive Intestinal Polypeptide
NE
Prostaglandins
Renin-angiotensin system
Acetylcholine
Vasopressin

◆ Epinephrine and norepinephrine
Heart β1-R The positive reactions(++++)

E
Blood α-R Vasoconstriction(++)
β2-R vasodilation
Heart β1-R The positive reactions(+++)
NE
Blood α-R Vasoconstriction(+++)
➢E: BP↑, HR↑ HR ↑ BP ↑ ↑

➢NE : BP↑, HR↑or↓ Baroreceptor reflex
➢E: cardiotonic drug
BP ↓
➢NE: vasopressor drug HR ↓
◆ Renin-angiotensin system
➢ I is physiologically inactive
and serves only as the
precursor of II.

◆ Vasopressin
hypothalamus ：
◆Formation：supraoptic nucleus and paraventricular nucleus
◆Secretion： posterior pituitary

Vasopressin or ADH
◆Effect： vasoconstriction
and antidiuresis
 Vasopressin is even more

powerful than angiotensin
as a vasoconstrictor.

1 - 2020-Cardiovascular Physiology

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Chapter 4

Section A Electrical Activity of the Heart

Section B Pump Function of the Heart

Section C The Vascular System

Section D Integration of Cardiovascular Function

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

1. Innervation of the heart.

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

8. Basic concepts: CO; SV; EF; Cardiac index; Blood

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

15. Innervation of the heart and blood vessels

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

◆ The heart is dominated by:

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

the ventricular muscle cell

Phase 1: Early phase of rapid repolarization: K+ outward current

Phase 2: Plateau: Ca2+ inward current and K+ outward current

Phase 3: Late phase of rapid repolarization : K+ outward current

Phase 4: Resting phase: Na+-K+ pump

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

➢In skeletal muscle, the refractory period is short.

➢Cardiac muscle has a long refractory period

In this period, regardless of the strength of

➢Long refractory period

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

➢ Each heartbeat consists of two major periods ：

All these changes are repeated during every

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

1. Isovolumetric ventricular contraction

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

◆ when ventricle contracts:

◆ when ventricle contracts:

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

◆ when ventricle relaxes:

➢ Blood: atrium to ventricle

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

➢ Atrium contraction occurs at the end of diastole; the

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

The first heart sound (S1)

1. S1 is caused by the closure of the AV valves.

3. It is a soft low pitched lub.

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

The second heart sound (S2)

1. S2 is caused by the closure of the aortic and pulmonary

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

➢ It refers to the percentage of the blood that is ejected

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

➢Minute volume is the amount of blood pumped out by

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

➢ Cardiac index is the minute volume expressed in relation

➢ It is defined as the amount of blood pumped out per

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings

➢ Blood flow: volume of blood flowing through any

➢ Blood resistance: Resistance is the measure of the

➢ Blood pressure: means the pressure the blood exerts

Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings