ENDOCRINE SYSTEM • 2pancreatic juice secretion
PAGE 1750/ p. 1420
ENDOCRINE SYSTEM- The endocrine system works with
the nervous system to maintain internal homeostasis and to
integrate the body’s response to the external environment
• The activities and functions are closely related that it
refers to them as neuroendocrine system
KEY TERMS
Anterior pituitary: lobe of the pituitary gland that produces
stimulating hormones as well as growth hormone, prolactin and
melanocyte stimulating hormone
Diurnal rhythm: response of the hypothalamus and then the
pituitary and adrenals to wakefulness, sleeping and light
exposure
Glands: organized groups of specialized cells that secrete
hormone or chemical messengers directly into the bloodstream
to communicate within the body
Hormones: chemical messengers working within the endocrine
system to communicate within the body
Hypothalamic-pituitary axis: interconnection of the
hypothalamus and pituitary gland to regulate levels of certain
endocrine hormones through a complex series of feedback
systems
Hypothalamus: “master gland of the neuroendocrine system;
regulates both nervous and endocrine responses to internal and
external stimuli
Negative feedback system: control system in which increasing
levels of a hormone lead to decreased lebels of releasing and
stimulating hormones, leading to decreased hormone levels,
which stimulates release of releasing and stimulating
hormones; allows tight control of the endocrine system
Neuroendocrine system: the combination of the nervous and
endocrine systems, which work closely together to maintain
regulatory control and homeostasis in the body
Pituitary gland: gland found in the sella turcica of the brain;
produces hormones, endorphins and enkephalins and stores two
hypothalamic hormones
Posterior pituitary: lobe of the pituitary that receives
antidiuretic hormone and oxytocin via nerve axons from the
hypothalamus and stores them to be released when stimulated
by the hypothalamus
Releasing hormone or factors: chemicals released by the
hypothalamus into the anterior pituitary to stimulate the release
of anterior pituitary hormones
GLANDS
Adrenal cortex- cortisol aldosterone (hormones produced)
• Increases glucose levels, suppresses inflammatory and
immune reactions
Intestine- secretin, cholestocytokinin (hormones produced)
Kidney (juxtaglomerular cells)- erythropoietin renin (hormones
produced)
• Increases red blood cell production
• Stimulates increase in blood pressure and vascular
volume
Ovaries- estrogen, progesterone (hormones produced)
• Promotes secondary sex characteristics, prepares
female body for pregnancy
Pancreas- insulin, glucagon, somastostatin (hormones
produced)
• Regulation of glucose, fat metabolism (islet of
Langerhans)
Parathyroid glands- parathyroid hormone (hormones produced)
• Increases serum calcium levels
Pineal gland- melatonin (hormones produced)
• Affects secretion of hypothalamic hormones,
particularly gonadotropin-releasing hormone
Placenta- estrogen, progesterone (hormones produced)
• Maintain fetal growth and development, prepares the
body for delivery
Stomach- gastrin (hormones produced)
• Stimulates stomach acid production
Testes- testosterone (hormones produced)
• Stimulates secondary sex characteristics in males
Thyroid- thyroid hormone, calcitonin (hormones produced)
• Stimulates basal metabolic rate (how the body uses
energy)
• Decreases serum calcium levels
HORMONES
• Chemicals that are produced in the body that meet
specific criteria
• Produced in very small amounts
• Secreted directly in to the bloodstream
• Travel through the blood to specific receptor sites
throughout the body
• Act to increase or decrease the normal metabolic
processes of cells when they react with their specific
receptor sites
• Are immediately broken down
• Some hormones react with specific receptor sites on a
cell membrane to stimulate the nucleotide cyclic
adenosine monophosphate (cyclic AMP) within the
cell to cause an effect
Key points:
• The endocrine system and the nervous system regulate
body functions and maintain homeostasis largely with
the help of hormones, which are chemicals produced
 within the body. Hormones increase or decrease
cellular activity
• The endocrine system regulates growth and
development, reproduction, energy use in the body
and electrolyte balance
• Hormones can react with receptors on the cell
membrane to cause an immediate effect on a cell by
altering systems near the cell membrane, or they may
enter the cell and react with receptor sites on
messenger RNA, which then enters the nucleus and
alters cell function.
HYPOTHALAMUS
• Coordinating center for the nervous and endocrine
responses to internal and external stimuli
• Monitors the body’s homeostasis by analyzing input
from the periphery and the CNS and coordinating
responses through autonomic, endocrine and nervous
systems
• Responsible for regulating a number of body
functions, including body temperature, thirst, hunger,
water retention, blood pressure, respiration,
reproduction, and emotional reactions
• Maintains internal homeostasis by sensing blood
chemistries and by stimulating or suppressing
endocrine, autonomic and CNS activity.
• Known as the master switchboard of the
neuroendocrine system
• Produces: GHRH, TRH, GnRH, CRH, PRH, ADH,
oxytocin
• The hypothalamus is connected to the pituitary gland
by two networks:
• A vascular capillary network carries the hypothalamic-
releasing factors directly into the anterior pituitary
• A neurological network delivers two other hypothalamic
hormones—Antidiuretic hormone (ADH) and
oxytocin—to the posterior pituitary to be stored
Other controls
• Glucose levels
• Calcium levels
• Renal blood flow
• Local GI stimuli
• Potassium levels
• Other local stimuli
HYPOTHALAMIC RELEASIC FACTORS
• Growth hormone releasing hormone (GHRH)
• Thyrotropin releasing hormone (TRH)
• Gonadotrophin releasing hormone (GnRH)
• Corticotropin releasing hormone (CRH)
• Prolactin releasing hormone (PRH)
Key Points:
• The hypothalamus produces stimulating and inhibiting
factors that travel to the anterior pituitary through a
capillary system to stimulate the release of pituitary
hormones or block the production of certain pituitary
hormones when levels of target hormones get too high
PITUITARY GLAND
• Located in the skull in the bony Sella turcica under a
layer of dura mater.
• Divided into three lobes:
• Anterior lobe
• A posterior lobe
• Intermediate lobe
ANTERIOR PITUITARY- produces six major hormones
✓ GH
✓ Adrenocorticotropic hormone (ACTH)
✓ Follicle-stimulating hormone (FSH)
✓ Luteinizing hormone (LH)
✓ PRL
✓ Thyroid stimulating hormone (TSH/thyrotropin)
• These hormones are essential for the regulation of
growth reproduction and some metabolic processes
• The anterior pituitary hormones are released in a
rhythmic manner called diurnal rhythm
• Diurnal rhythm occurs when the hypothalamus begins
secretion of corticotropin-releasing factor (CRF) in
the evening, peaking at about midnight; adrenocortical
peak response is between 6 and 9 am; levels fall during
the day until evening, when the low level is picked up
by the hypothalamus and CRF secretion begins again
• produces melanocyte-stimulating hormone (MSH)
and various lipotropins.
• MSH plays an important role in animals that use skin
color changes as an adaptive mechanism.
GROWTH HORMONE ANTAGONISTS
Gigantism: response to excess kevels of growth hormone
before the epiphyseal plates close; heights of 7 to 8 feet are not
uncommon
Acromegaly: thickening of bony surfaces in response to excess
growth hormone after the epiphyseal plates have closed
Pegvisomant is a GH receptor antagonist
• it binds to the GH receptor but does not activate or
stimulate IGF-1 secretion
• approved by the FDA for the treatment of acromegaly
• administered SC
• based on serum IGF-1 levels, the dose is titrated at 4–
6-week intervals
STOMASTOTIN- it inhibits the release of GH, glucagon,
insulin, and gastrin has limited therapeutic usefulness
OCTEOTIDE- reduced symptoms caused by a variety of
hormone-secreting tumors
• acromegaly; the carcinoid syndrome; gastrinoma;
glucagonoma; nesidioblastosis
• the watery diarrhea, hypokalemia and achlorhydria
(WDHA) syndrome; and diabetic diarrhea
POSTERIOR PITUITARY HORMONES
• stores two hormones that are produced by the
hypothalamus and deposited in the posterior lobe via
the nerve axons where they are produced.
 • antidiuretic hormone (ADH), also known as
vasopressin and oxytocin
• oxytocin stimulates milk ejection or let down in
lactating women
• ADH is directly released in response to increased
plasma osmolarity or decreased blood volume.
• Osmoreceptors stimulate the release of ADH
• ADH acts in the kidneys to increase retention of water
in order to decrease the osmolarity of the blood
volume.
ADH DISORDERS
hypothalamus secretes releasing factors to cause the
anterior pituitary to release stimulating hormones,
which act with specific endocrine glands to cause the
release of hormone
• GH and PRL are released by the anterior pituitary and
directly influence cell activity. These hormones are
regulated by the release of the hypothalamic-
inhibiting factors somatostatin and PIF in response to
the levels of the pituitary hormones GH and PRL
CHAPTER 35: HYPOTHALAMIC AND
PITUITARY AGENTS

• diabetes insipidus (DI): results from insufficient Key Terms:

secretion of ADH
• syndrome of inappropriate antidiuretic hormone
(SIADH) occurs with excessive secretion of ADH
VASOPRESSIN AND DESMOPRESSIN- treatments of
choice for antidiuretic replacement therapy in central diabetes
A. vasopressin (synthetic vasopressin)
Diabetes insipidus- vasodilatory shock, effective in some cases
of esophageal variceal bleeding and colonic diverticular
bleeding
B. desmopressin
diabetes insipidus- nocturnal enuresis, hemophilia A, von
willebrand’s disease (Vwd) (Type 1)
INTERMEDIATE LOBE
• produces endorphins and enkephalins, which are
released in response to severe pain or stress and
occupy specific endorphin receptor sites in the
brainstem to block the perception of pain.
Key points:
The pituitary gland has three lobes:
Acromegaly: thickening of bony surfaces in response to excess
growth hormone after the epiphyseal plates have closed
Diabetes insipidus: condition resulting from a lack of
antidiuretic hormone, which results in the production of
copious amounts of glucose-free urine
Dwarfism: small stature, resulting from lack of growth
hormone in children
Gigantism: response to excess levels of growth hormone before
the epiphyseal plates close; heights of 7 to 8 are not uncommon
Hypopituitarism: lack of adequate function of the pituitary;
reflected in many endocrine disorders
DRUGS AFFECTING HYPOTHALAMIC HORMONES
AGONISTS
• Goserelin
• Histrelin
leuprolide
• Nafarelin
• Tesamorelin

• the anterior lobe produces stimulating hormones in ANTAGONISTS

response to hypothalamic stimulation
• Cetrorelix
• the posterior lobe stores ADH and oxytocin, which are
• Degarelix
two hormones produced by the hypothalamus
• Ganirelix
• the intermediate lobe produces endorphins and
enkephalins to modulate pain perception DRUGS AFFECTING ANTERIOR PITUITARY
HORMONES
HYPOTHALAMIC-PITUITARY AXIS

• uses series of negative feedback system works muck GROWTH HORMONE AGONISTS
like the law of supply and demand in business • somatropin
• when the hypothalamus senses a need for a particular • Somatropin rDNA origin
hormone such as thyroid hormone where it secretes the
releasing hormone or factor TRH directly into the GROWTH HORMONE ANTAGONISTS
anterior pituitary.
• The anterior pituitary secretes TSH which stimulates • bromocriptine mesylate
thyroid gland to produce thyroid hormone. • Lanreotide
• When the hypothalamus senses the rising levels of • Octeotide acetate
thyroid hormone, It stops secreting TRH, resulting in • Pegvisomant
decreased TSH production DRUGS AFFECTING OTHER ANTERIOR PITUITARY
Key points: HORMONES

• The hypothalamus and pituitary operate by a series of • Chorionic gonadotropin

negative feedback mechanisms called the HPA. The • Chorionic gonadotropin alpha
 • Cosyntropin
• Pasireotide
• Thyrotropin alpha
DRUGS AFFECTING POSTRIOR PITUITARY
HORMONES
• Conivaptan
• Desmopressin
• Tolvaptan
DRUGS AFFECTING HYPOTHALAMIC HORMONES
Stimulate the release of hormones
• Growth hormone-releasing hormone (GHRH)
• Thyrotropin-releasing hormone (TRH)
• Gonadotropin-releasing hormone (GnRH)
• Corticotropin-releasing hormone (CRH)
• Prolactin releasing hormone (PRH)
Inhibit the release of hormone
• Stomastotin
• Prolactin-inhibiting factor (PIF)
Hypothalamic releasing hormones
• Goserelin (zoladex) (synthetic GnRH)
• Histrelin (Vantas) (antineoplastic agent)
• Leuprolide (Lupron)
• Nafarelin (synarel)
• Tesamorelin (Egrifta)
Antagonists that block the effects of hypothalamic-releasing
hormones
• Cetrorelix (cetrotide) (GnRH antagonist and fertility
drug)
• Degarelix (Firmagon) (Blocks GnRH and is used as
an antineoplastic agents)
• Ganirelix acetate (antagon) (blocks GnRH)
CHAPTER 36: ADRENOCORTICAL AGENTS
(P. 1836/ p. 1478)
ADRENAL GLANDS
• adrenal medulla: inner layer of the adrenal gland:
sympathetic ganglia, releases norepinephrine and
epinephrin into circulation in response to sympathetic
stimulation
• adrenal cortex: layer of the adrenal gland; produces
glucocorticoids and mineralocorticoids in response to
ACTH stimulation; also responds to sympathetic
stimulation
DIURNAL RHYTHM
• Secretion of CRH, ACTH and cortisol are high in the
morning in day-oriented people those who have
regular cycle of wakefulness during the day and sleep
during the night. In such individuals, the peak levels
of cortisol usually come between 6 and 8 am. The
levels then fall off slowly (with periodic spurts) and
reach a low in the late evening, with the lowest levels
around midnight
GLUCOCORTICOIDS
• Enter target cells and bind to cytoplasmic receptors,
initiating many complex reactions that are responsible
for anti-inflammatory and immunosuppressive effects
• Indicated for the short-term treatment of many
inflammatory disorders, to relieve discomfort and to
give the body a chance to heal from the effects of
inflammation
• Adverse effects: fluid retention, congestive heart
failure, increased appetite, weight gain, fragile skin,
loss of hair, weakness, muscle atrophy, increased
susceptibility to infections, development of cancers
• Adverse effects on children: risk for growth
retardation associated with suppression of the
hypothalamic pituitary system
MINERALCORTICOIDS
• Increase sodium reabsorption in the renal tubules and
increase potassium and hydrogen excretion, leading to
water and sodium retention
• Indicated in combination with a glucocorticoid, for
replacement therapy in primary and secondary adrenal
insufficiency, treatment of salt-wasting adrenogenital
syndrome
• Adverse effects: increased fluid volume seen with
sodium and water retention, headache, edema,
hypertension, CHF, arrythmias, weakness,
hypokalemia
CHAPTER 37: THYROID AND PARATHYROID
AGENTS
HYPOTHYDOIDISM
• Absence of thyroid gland
• Lack of sufficient iodine in the diet to produce the
needed level of thyroid hormone
• Lack of sufficient functioning thyroid tissue due to
humor or autoimmune disorders
• Lack of TSH due to pituitary diseases
• Lack of TRH related to a tumor or disorder of the
hypothalamus
CRETINISM: lack of thyroid hormone in the infant; if
untreated, leads to mental retardation
MYXEDEMA: severe lack of thyroid hormone In adults
Treatment:
• Levothyroxine (levoxyl, Synthroid, tirosint, unithroid,
unithroid direct), a man-made version of the thyroid
hormone thyroxine (T4). It acts just like the hormone
your thyroid gland normally makes. The right dose can
make you feel a lot better
HYPERTHYROIDISM
• Excess levels of thyroid hormone
• Graves’ disease is thought to be an autoimmune
problem
 • Treatments: surgical removal of the gland or portions
of the gland; treatment with radiation to destroy parts
or all of the gland; or drug treatment to block the
production of thyroxine in the thyroid gland or to
destroy parts or all of the gland
ANTITHYROID AGENTS
• Thioamides
• propylthiouracil,
• methimazole
• iodine solutions
PAGET’S DISEASE- of bone interferes with your body’s
normal recycling process, in which new bone tissue gradually
replaces old bone tissue. Over time, the disease can cause
affected bones to become fragile and misshapen. PAGET’S
DISEASE of bone most commonly occurs in the pelvis, skull,
spine and legs
ANTIHYPERCALCEMIC AGENTS
• BISPOSPHONATES- patient must stay upright for
at least 30 minutes after taking the drug on an empty
stomach
• CALCITONINS
BISPOHSPONATES- are a class of drugs that prevent the loss
of bone density, used to treat osteoporosis and similar diseases.
They are the most commonly prescribed drugs used to treat
osteoporosis.
Side effects for all the bisphosphonates
• Alendronate, ibandronate, risedronate and zoledronic
acid
• Bone, joint or muscle pain, nausea, difficult
swallowing, heartburn, irritation of the esophagus
(tube connecting the throat to the stomach) and
gastric ulcer
CALCITONIN- is a hormone that is produced in humans by
the parafollicular cells (commonly known as c-cells) of the
thyroid gland
• Is involved in helping to regulate levels of calcium
and phosphate in the blood, opposing the action of
parathyroid hormone
CHAPTER 38: ANTIDIABETIC AGENTS
DIABETES MELLITUS
• Most common of all metabolic disorders
• Affects many end organs and causes numerous clinical
complications
• Treatment is aimed at tightly regulating the blood
sugar level through the use of insulin or insulin
stimulating drugs
HYPERGLYCEMIA
• Glycosuria: presence of glucose in the urine
• Polyphagia: increased hunger, sign of diabetes when
cells cannot use glucose for energy and feel that they
are starving, causing hunger
• Polydipsia: increased thirst, seen in diabetes when loss
of fluid and increased tonicity of the blood lead to
hypothalamic thirst center to make the patient feel
thirsty
• Ketosis: breakdown of fats for energy, resulting in an
increase in ketones to be excreted from the body
DIABETES RELATED DISORDERS
• Atherosclerosis: heart attacks and strokes
• Retinopathy: loss of vision
• Neuropathies: motor and sensory changes in the feet
and legs and progressive changes in other nerves
• Nephropathy: renal dysfunction
KETOACIDOSIS
• Fruity breath as the ketones builds up in the system
and are excreted through the lungs
• Dehydration as fluid and important electrolytes are
lost through the kidneys
• Slow, deep respirations as the body tries to rid itself of
high acid levels
• Loss of orientation and coma
Diabetic ketoacidosis- is a serious complication of diabetes that
occurs when your body produces high levels of blood acids
called ketones. The condition develops when your body can’t
produce enough insulin
Ketoacidosis vs nonketotic hyperosmolar syndrome
• Although both conditions can occur at ant age,
diabetic ketoacidosis typically develops in younger
patients, less than 45 years, who have little or no
endogenous insulin production, whereas HHS usually
occurs in much older non-insulin-dependent patients
( who are often greater than 60 years old)
HYPOGLYCEMIA
• Blood sugar level below 40 mg/dl, occurs in a number
of clinical situations, including starvation and when
treatment of hyperglycemia with insulin or oral agents
lowers the blood sugar too far
• Sympathetic response to lower blood sugar
THE TYPE OF INSULIN INCLUDE:
• Rapid-acting
• Short-acting
• Intermediate-acting
• Long-acting
• Pre-mixed
SULFONYLUREAS
• Bind to potassium channels on pancreatic beta cells to
increase insulin secretion
• May improve insulin binding to insulin receptors and
increase the number of insulin receptors
• Increase the effect of ADH on renal cells
• Effective only in patients who have functioning beta
cells
NONSULFONYLUREAS CHAPTER 43: DRUGS AFFECTING BLOOD
PRESSURE
• Acarbose
• Metformin
• Miglitol
• Pioglitazone CATEGORIES RATING THE SEVERITY OF
• Repaglinide HYPERTENSION
• Rosiglitazone BP RANGE CATEGORY
• Nateglinide
Systolic pressure Diastolic pressure
CHAPTER 42: INTRODUCTION TO THE
CARDIOVASCULAR SYSTEM
<130 mmHg <85 mmHg Normal blood
CARDIAC CYCLE pressure

Diastole: resting phase of the heard; blood is returned to the 130-139 85-89 High normal
heart during this phase blood pressure

Systole: contracting phase of the heart; blood is pumped out of 140-159 90-99 Stage 1 (mild)
the heart during this phase hypertension
160-179 100-109 Stage 2
Cardiac cycle: a period of cardiac muscle relaxation followed (moderate)
by a period of contraction in the heart hypertension
180-209 110-119 Stage 3 (severe)
Deoxygenated blood: right atrium through tricuspid valve to hypertension
the lungs
>210 >120 Stage 4 (very
Oxygenated blood: through the pulmonary veins to the left severe)
atrium through the mitral valve to the left ventricle, through the hypertension
aortic valve to the aorta ANTIHYPERTENSION

Membrane potential: refers to the difference in charge • Diuretics

between the inside and outside of a neuron, which is created
due to the unequal distribution of ions on both side of the cell
Action potential: refers to the electrical signaling that occurs
within neurons
MECHANICAL ACTIVITY
Sarcomere: functional unit of a muscle cell, composed of actin
and myosin molecules arranged in layers to give the unit a
striped or striated appearance
Actin: thin filament that makes up a sarcomere or muscle unit
Myosin: thin filament with projections that makes up a
sarcomere or muscle unit
Troponin: chemical in heart muscle that prevents actin and
myosin from reacting, leading to muscle relaxation, inactivated
by calcium during muscle stimulation to allow actin and myosin
to react, causing muscle contraction
• beta blockers
• alpha and beta blockers
• alpha adrenergic blockers
• alpha1 blockers
• alpha2 agonists
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS
(ACE)
• prevent angiotensin-converting enzymes from
converting angiotensin I to angiotensin II, a powerful
vasoconstrictor and stimulator of aldosterone release,
leading to a decrease in blood pressure and in
aldosterone secretion with a resultant slight increase in
serum potassium and a loss of serum sodium and fluid
• indicated for the treatment of hypertension, alone or in
combination with other drugs

Hydrostatic pressure (HP): driving force of heart ends to push

fluid out of capillary ANGIOTENSIN II RECEPTOR BLOCKERS (ARB)

Oncotic pressure (OP): pressure exerted by plasma proteins
ends to pull fluid into capillary
Filtration pressure: net force on fluid, determined by the
balance between HP and OP
• selectively bind with angiotensin II receptor sites in
vascular smooth muscle and in the adrenal gland to
block vasoconstriction and the release of aldosterone
• indicated to be used alone or in combination therapy
for the treatment of hypertension

CALCIUM CHANNEL BLOCKERS

• inhibit the movement of calcium ions across the

membranes of myocardial and arterial muscle cells,
altering the action potential and blocking muscle cell
contraction; depressing myocardial contractility,
 slowing cardiac impulse formation in the conductive diuretics alone or who have poor response to digoxin,
tissues, and relaxing and dilating arteries, causing a diuretics and vasodilators
fall in blood pressure and a decrease in venous return
• indicated for treatment of hypertension and angina CHAPTER 45: ANTIARRHYTHMIC AGENTS

VASODILATORS Membrane potential: refers to the difference in charge

• act directly on vascular smooth muscle to cause
muscle relaxation, leading to vasodilation and drop in
blood pressure
• indicated for the treatment of severe hypertension that
has not responded to other therapy
ANTIHYPOTENSIVE AGENTS
• sympathetic adrenergic agonists
• midodrine
CHAPTER 44: CARDIOTONIC AGENTS
between the inside and outside of a neuron, which is created
due to the unequal distribution of ions on both sides of the cell
Action potential: refers to the electrical signaling that occurs
within neurons
CARDIAC ARRHYMIAS
Tachycardia- more than 100 heart bpm
Bradycardia- less than 60 heart bpm
Premature atrial contraction (PACs)- Caused by an ectopic
focus in the atria stimulating an atrial response

Premature ventricular contractions (PVCs)- an ectopic

Congestive heart failure: a condition in which the heart
muscle fails to adequately pump blood around the
cardiovascular system leading to a backup or congestion of
blood in the system
Pulmonary edema: severe left-sided congestive heart failure
with backup of blood into the lungs, leading to loss of fluid into
the lung tissue
Inotropic agents, or inotropes: are medicines that change the
force of your heart’s contractions. There are 2 kinds of
inotropes. Positive inotropes strengthen the force of the
heartbeat. Negative inotropes weaken the force of the heartbeat
Chronotropic effects (from chrono- time, and tropos- a turn) are
those that change the heart rate
focus in the ventricles stimulating the cells and causing an early
contraction
Heart blocks- blocks conduction of an impulse
CAUSES OF CARDIAC ARRHYTHMIAS
• electrolyte disturbances
• decreases in the oxygen delivered to the cells
• structural damage
• acidosis or the accumulation of waste products
ANTIARRHYTHMIC DRUGS
Antiarrhythmics- drugs that can affect the action potential of
cardiac cells and are used to treat arrhythmias and return normal
rate and rhythm

Digitalis glycosides exert a positive inotropic effect, i.e. an Proarrhythmic- tending to cause arrhythmias; many of the
increase in myocardial contractility associated with a drugs used to treat arrhythmias have been found to generate
prolongation of relaxation period, and glycosides lower the arrhythmias
heart rate (negative chronotropic), impede stimulus conduction
Cardiac arrhythmia suppression trial (CAST)- a large research
(negative dromotropic) and promote myocardial excitability
study, basis for current indication for antiarrhythmics- used for
CARDIAC GLYCOSIDES short term to treat life threatening ventricular arrhythmias, not
long term.
• increase intracellular calcium and allow more calcium
to enter myocardial cells during depolarization, NORMAL SINUS RHYTHM
causing the following effects
• increased force of myocardial contraction
• increased cardiac output and renal perfusion
• slowed heart rate by slowing the rate of cellular
repolarization
• decreased conduction velocity through the AV node

PHOSPHODIESTERASE INHIBITORS

• block the enzyme phosphodiesterase leading to an

increase in myocardial cell cAMP, which increases
calcium levels in the cell causing a stronger
contraction and prolonged effects of sympathetic
stimulation, leading to vasodilation, increased
oxygen consumption and arrhythmias
• indicated for the short-term treatment of CHF in
patients who are not responding to digoxin or
SINUS TACHYCARDIA
SINUS BRADYCARDIA
PREMATURE ATRIAL CONTRACTION
PREMATURE VENTRICULAR CONTRACTION
3RD DEGREE HEART BLOCK
CHAPTER 46: ANTIANGINAL AGENTS
CORONARY ARTERY DISEASE
Atheromas: fatty tumors in the intima of the vessels
Atherosclerosis: narrowing of the arteries caused by build up of
atheromas, swelling and acculation of platelets; leads to a loss
of elasticity and responsiveness to normal stimuli
Angina pectoris: “suffocation of the chest”; pain caused by the
imbalance between oxygen being supplied to the heart and
muscle and demand for oxygen by the heart muscle
Myocardial infarction: end result of vessel blockage in the
heart, leads to ischemia and then necrosis of the area cut off
from the blood supply; can heal, replacing the dead cells with
scar tissue
Prinzmetal’s angina: drop in blood flow through the coronary
arteries caused by a vasospasm in the artery, not by
atherosclerosis
NITRATES
• caused direct relaxation of smooth muscle with a
resultant decrease in venous return and decrease in
arterial pressure, which reduces cardiac workload and
decreases myocardial oxygen consumption
• indicated for the prevention and treatment of attacks
of angina pectoris
• adverse effects are related to the vasodilation and
decrease in blood flow that occurs
BETA BLOCKERS
• competitively block beta-adrenergic receptors in the
heart and juxtaglomerular apparatus, decreasing the
influence of the sympathetic nervous system on these
tissues and thereby decreasing the excitability of the
heart, cardiac output, and cardiac oxygen
compensation, and lowering blood pressure
• indicated for the long-term management of angina
pectoris caused by atherosclerosis
• adverse effects are related to their blockade of the
sympathetic nervous system
CALCIUM CHANNEL BLOCKERS
• inhibit the movement of calcium ions across the
membranes of myocardial and arterial muscle cells,
altering the action potential and blocking muscle cell
contraction
• indicated for the treatment of prinzmetal’s angina,
chronic angina, effort-associated angina, and
hypertension
• adverse effects are related to their effects on cardiac
output and on smooth muscle
CHAPTER 47: LIPID LOWERING AGENTS
CORONARY ARTERY DISEASE RISK FACTORS
Unmodifiable risk factors
• genetic predispositions, age, gender
modifiable risk factors
• gout, cigarette smoking, sedentary lifestyle, high
stress levels, hypertension, obesity, diabetes,
bacterial infections
METABOLISM OF FATS
Bile acids: cholesterol-containing acids found in the bile, which
act like detergents to break up fats in the small intestine
Cholesterol: necessary component of human cells and the
formation of steroid hormones; produced in the body and found
in dietary fats
Chylomicron: carrier for lipids in the blood stream, consists of
proteins and lipids, cholesterol and so forth
Low density lipoproteins (LDL): tightly packed fats that are
thought to contribute to the development of CAD when
remnants left over from the LDL are processed in the arterial
lining
High density lipoproteins (HDL): loosely packed chylomicron
containing fats, able to absorb fats and fat remnants in the
periphery; thought to have a protective effect, decreasing
development of CAD
HMG CoA reductase: enzyme that regulates the last step in
cellular cholesterol synthesis
BILE ACID SEQUESTRANTS
• bind with bile acids in the intestine to form a complex
that is excreted in the feces
• used to reduce serum cholesterol in patients with
primary hypercholesterolemia (with high LDLs) as an
adjunct to diet and exercise
• adverse effects include: direct GI irritation, including
nausea, and constipation that may progress to fecal
impaction
HMG CoA REDUCTASE INHIBITORS
• block the formation of cellular cholesterol, leading to
a decrease in serum cholesterol and a decrease in
serum LDLs, with a slight increase or no change in
the levels of HDLs
• indicated as adjuncts with diet and exercise for the
treatment of elevated cholesterol and LDL levels in
patients unresponsive to dietary restrictions alone; to
slow the progression of CAD in patients with
document CAD; to prevent first MI in patients who
are at risk for MI development
• the most common adverse effect associated with
these drugs reflect their effects on the GI system
OTHER DRUGS USED TO AFFECT LIPID LEVELS
Clofibrate- inhibits liver synthesis of LDL and cholesterol,
lowers serum lipids, and has an antiplatelet effect
Fenofibrate- inhibits triglyceride synthesis in the liver, resulting
in the reduction of LDLs; increases uric acid secretion; and may
stimulate triglyceride breakdown
Gemfibrozil- inhibits peripheral breakdown of lipids, reduces
triglyceride production and LDL production, and increases
HDL concentrations
Vitamin niacin- inhibits the release of free fatty acids rom
adipose tissue, increases the rate of triglyceride removal from
plasma, and generally reduces LDL and triglyceride levels and
increases HDL levels
CHAPTER 48: DRUGS AFFECTING BLOOD
COAGULATION
Factor XI/ plasma thromboplastin antecedent: is the zymogen
form of factor XLa, one of the enzymes of the coagulation
cascade
Partial thromboplastin Time (PTT): a blood test that measures
the time it takes your blood to clot. A PPT test can be used to
check for bleeding problems. Blood clotting factors are needed
for blood to clot (coagulation)
• The reference range of the aPTT is 30-40 seconds. The
reference range of the PTT is 60-70 seconds. In
patients receiving anticoagulant therapy, the reference
range is 1.5-2.5 times the control value in seconds
Prothrombin time: test measures how quickly your blood clots.
Sometimes called a PT or pro time test, a prothrombin time test
uses a sample of your blood. Prothrombin is a protein produced
by your liver. It is one of many factors in your blood that help
it to clot appropriately.
• Most of the time, results are given as what is called
INR (international normalized ratio). If you are not
taking blood thinning medicines, such as warfarin, the
normal range for your PT results is: 11 to 13.5
seconds
ANTIPLATELET DRUGS
• Inhibit platelet adhesion and aggregation by blocking
receptor sites on the platelet membrane, preventing
 platelet-platelet interaction or the interaction of • Tranexamic acid
platelets with other clotting chemicals • Aprotinin
• Used to decrease the risk of fatal MI, to prevent • Diamino arginine vasopressin
reinfarction after MI, to prevent thromboembolic
stroke, and to maintain the patency of grafts CHAPTER 49: DRUGS USED TO TREAT ANEMIAS
• Most common adverse effects seen with these drugs is
bleeding BLOOD

Antiplatelets include Plasma: the liquid part of blood

• ASA: aka acetylsalicylic acid (aspirin, asaphen, Erythrocytes: RBC

entrophen, novasen) clopidogrel (Plavix) Erythropoiesis: RBC production
• Prasugrel (effient)
• Ticagrelor (brilinta) Anemia: decrease in the number of RBCs

ANTICOAGULANTS • Megaloblastic anemia: bone marrow contains large

number of large immature RBCs
• Interfere with the normal cascade of events involved • Iron deficiency anemia: low amounts of iron available
in the clotting process in the blood
• Used to treat thromboembolic disorders such as atrial • Pernicious anemia: gastric mucosa cannot produce
fibrillation, MI, pulmonary embolus, and evolving intrinsic factor and vitamin B12 cannot be absorbed
stroke, and to prevent the formation of thrombi in such
disorders LARGE, STRUGCTURALLY ABNORMAL,
• Most commonly encountered adverse effect is IMMATURE RBC
bleeding
• Oral-warfarin
• Parenteral- heparin: low molecular weight heparins

THROMBOLYTIC AGENTS

• Work by activating plasminogen to plasmin, which in

turn breaks down fibrin threads in a clot to dissolve a
formed clot
• Indicated for the treatment of acute MI; to treat
pulmonary emboli and ischemic stroke; and to open
clotted IV catheters
• Most common adverse effect is bleeding

The most commonly used clot-busting drugs aka Thrombolytic ERYTHROPOIETIN

agents include
• Act like natural glycoprotein erythropoietin to
• Eminase (anistreplase) stimulate the production of RBC in the bone marrow
• Retavase (reteplase) • Indicated for the treatment of anemia associated with
• Streptase (streptokinase, kabikinase) renal failure or for patients on dialysis; to decrease the
• T-PA (class of durgs that include activase) need for blood transfusions in surgical patients, for the
• TNKase (Tenecteplase) treatment of anemia associated with AIDS treatment,
• Abbokinase, kinlytic (rokinase) and for the treatment of anemia associated with cancer
chemotherapy
BLEEDING DISORDERS

• Hemophilia
• Liver disease
• Bone marrow disorders

DRUGS USED TO CONTROL BLEEDING

• Antihemophilic agents
• Systemic hemostatic agents
• Topical hemostatic agents

Substances- hemostatic agents

• Aminocaproic
• Antifibrinolytic agents IRON DEFICIENCY ANEMIAS
• Estrogens, conjugated (USP)
• Hemostatics • Menstruating women who lose RBCs monthly
 • Pregnant and nursing women who have increased • Produced by C (parafollicular) cells
demands for iron
• Rapidly growing adolescents, especially those who do
not have nutritious diet
• Persons with GI bleeding; even individuals with slow
bleeding associated with NSAIDs may develop this
disorder

IRON PREPARATIONS

• Elevate the serum iron concentration

• Indicated for the treatment of iron deficiency anemias,
may also be used for adjunctive therapy in patients
receiving epoetin alfa
• Most common adverse effects associated with oral
iron are related to direct GI irritation

Megaloblastic anemia treatments PARATHYROID GLANDS

• Folic acid derivatives • Tiny masses on the posterior of the thyroid
• Vitamin B12

ENDOCRINE AND CIRCULATORY SYSTEM

• Found at the base of the throat

• Consists of two lobes and a connecting isthmus
• Produces two hormones
• Thyroid hormone
• calcitonin

THYROID HORMONE

• Major metabolic hormone • Secrete parathyroid hormone

• Composed of 2 active iodine-containing hormones • Stimulate osterclasts to remove calcium from bone
• Thyroxine (T4)- secreted by thyroid follicles • Stimulate the kidneys and intestine to absorb more
• Triiodothyronine (T3)- conversion of T4 at calcium
target tissues • Raise calcium levels in the blood

ADRENAL GLANDS
CALCITONIN • Two glands
• Cortex- outer glandular region in three layers
• Decreases blood by calcium levels by causing its
• Medulla- inner neural tissue region
• Sits on top of the kidneys

HORMONES OF THE ADRENAL CORTEX

Mineralocorticoids (mainly aldosterone)

• Produced in outer adrenal cortex

• Regulate mineral content in blood, water and
electrolyte balance
• Target organ is the kidney
deposition on bone • Production stimulated by renin and aldosterone
• Antagonistic to parathyroid hormone
 • Production inhibited by atrial natriuretic peptide • The islets of the pancreas produce hormones
- Insulin: allows glucose to cross plasma membranes
into cells from beta cells
- Glucagon: allows glucose to enter the blood from
alpha cells
- These hormones are antagonists that maintain blood
sugar homeostasis

Glucocorticoids (including cortisone and cortisol)

• Produced in the middle layer of the adrenal cortex

• Promote normal cell metabolism
• Help resist long-term stressors
• Released in response to increased blood levels of ACTH

Sex hormones

- Produced in the inner layer of the adrenal cortex

- Androgens (male) and some estrogen (female)

HORMONES OF THE ADRENAL MEDULLA

• Produces 2 similar hormones (catecholamines)

- Epinephrine
- Norepinephrine
• These hormones prepare the body to deal with short
term stress

ROLES OF THE HYPOTHALAMUS AND ADRENAL

GLANDS IN THE STRESS RESPONSE

Short term stress response (catecholamines) EPI/NOREPI PANCREATIC HORMONES AND BLOOD SUGAR

1) Increased HR PINEAL GLAND

2) Increased BP
3) Liver converts glycogen to glucose and releases
glucose to blood
4) Dilation of bronchioles
5) Changes in blood flow patterns, leading to increased
alertness and decreased digestive and kidney activity
6) Increased metabolic rate
Long term stress response (Mineralocorticoids)
1) Retention of sodium and water by kidneys
2) Increased blood vol and BP
• Fond on the 3rd ventricle of the brain
• Secretes melatonin
- Helps establish the body’s wake and sleep cycles
- May have other as yet unsubstantiated functions
THYMUS
• Located posterior to the sternum
• Largest in infants and children
• Produces thymosin
- Matures some types of WBC
- Important in developing the immune system

HORMONES OF THE OVARIES

Estrogen- produced by graafian follicles/ placenta

Glucocorticoids

1) Proteins and fats converted to glucose or broken down

for energy
2) Increased blood sugar
3) Suppression of immune system

PANCREATIC ISLETS

• The pancreas is a mixed gland

 - Stimulates the development of secondary female
characteristics
- Matures female reproductive organs
- Helps prepare the uterus to receive a fertilized
egg
- Helps maintain pregnancy
- Prepares the beast to produce milk

Progesterone- produced by the corpus luteum

- Acts with estrogen to bring about the menstrual

cycle
- Helps in the implantation of an embryo in the
uterus

HORMONES OF THE TESTES

- Interstitial cells of tester are hormone producing - Classified as a connective tissue

- Produce several androgens - Living cells- formed elements
- Testosterone is the most important androgen - Non living matrix- plasma
✓ Responsible for adult male secondary sex
characteristics PHYSICAL CHARACTERISTICS OF BLOOD
✓ Promotes growth and maturation of male
- Color range:
reproductive system
✓ Oxygen- rich blood is scarlet red
✓ Required for sperm cell production
✓ Oxygen poor blood is dull reed
OTHER HORMONE-PRODUCING TISSUES AND - pH must remain between 7.35-7.45
ORGANS - blood temperature is slightly higher than body
temperature
- Parts of the small intestine
- Parts of the stomach BLOOD PLASMA
- Kidneys
- composed of approximately 90% water
- Heart
- includes many dissolved substances
- Many other areas have scattered endocrine cells
✓ nutrients
ENDOCRINE FUNCTION OF THE PLACENTA ✓ salts (metal ions)
✓ respiratory gases
- Produces hormone that maintain the pregnancy ✓ hormones
- Some hormones play a part in the delivery of the baby ✓ proteins
✓ waste products

PLASMA PROTEINS

Albumin: regulates osmotic pressure

Clotting proteins- help to stem blood loss when a blood vessel

is injured

Antibodies- help protect the body from antigens

FORMED ELEMENTS

Erythrocytes: RBC

- Produces HCG in addition to estrogen, progesterone Leukocytes: WBC

and other hormones Platelets: cell fragments
DEVELOPMENTAL ASPECTS OF THE ENDOCRINE ERYTHROCYETS (RBC)
SYSTEM
- the main function is to carry oxygen
- Most endocrine organs operate smoothly until old age - outnumber WBC 1000:1
✓ Menopause is brought about by lack of efficiency
of the ovaries anatomy of circulating erythrocytes:
✓ Problems associated with reduced estrogen are
common - biconcave disks
✓ Growth hormone production declines with age - essentially bags of hemoglobin
✓ Many endocrine glands decrease output with age - anucleate (no nucleus)
- contain very few organelles
BLOOD- the only fluid tissue in the human body
HEMOGLOBIN
- iron-containing protein
- binds strongly, but reversibly, to oxygen
- each hemoglobin molecule has four oxygen binding
sites
- each erythrocyte has 250 mil hemoglobin molecules
LEUKOCYTES (WBC)
- crucial in the body’s defense against diseases
- these are complete cells, with a nucleus and organelles
- able to move into and out of blood vessels (diapedesis)
- can move by ameboid motion
- can respond to chemicals release by damaged tissues
LEUKOCYTE LEVELS IN THE BLOOD
- normal levels are between 4000 and 11,000 cells/ml
abnormal leukocyte levels:
leukocytosis: above 11,000 leukocytes/ml
- indicates an infection
leukopenia: abnormally low leukocyte level
- commonly caused by certain drugs
TYPES OF LEUKOCYTES
Granulocytes: granules in their cytoplasm can be stained
- include neutrophils, eosinophils and basophils
agranulocytes: lack visible cytoplasmic granules
- include lymphocytes and monocytes
GRANULOCYTES
neutrophils: multilobed nucleus with fine granules
- act as phagocytes at active sites of infection
eosinophils: large brick red cytoplasmic granules
- found in response to allergies and parasitic worms
basophils: have histamine containing granules
- initiate inflammation
AGRANULOCYTES
Lymphocytes: nucleus fills most of the cell
- play an important role in the immune response
monocytes: largest of the WBC
- function as macrophages
- important in fighting chronic infection
PLATELETS
- derived from ruptured multinucleate
(megakaryocytes)
- needed for the clotting process
- normal platelet count= 300, 000/mm3
HEMATOPOIESES
- blood cell formation
- occurs in red bone marrow
- all blood cells are derived form a common stem cell
(hemocytoblast)
- hemocytoblast differentiation
✓ lymphoid stem cell produced lymphocytes
✓ myeloid stem cell produced other formed
elements
FATE OF ERYTHROCYTES
• unable to divide, grow, or synthesize proteins
• wear out in 100 to 1200 days
• when worn out, are eliminated by phagocytes in the
spleen or liver
• lost cells are replaced by division of hemocytoblasts
CONTROL OF ERYTHROCYTE PRODUCTION
- rate is controlled by a hormone (erythropoietin)
- kidneys produce most erythropoietin as a response to
reduced oxygen levels in the blood
- homeostasis is maintained by negative feedback from
blood oxygen levels
HEMOSTASIS
- stoppage of blood flow
- result of a break in a blood vessel
- hemostasis involves three phases
✓ platelet plug formation
✓ vascular spasms
✓ coagulation
PLATELET PLUG FORMATION
- collagen fibers are exposed by a break in a blood
vessel
- platelet become “sticky” and cling to fibers
- anchored platelets release chemical to attract more
platelets
- platelets pile up to form a platelet plug
VASCULAR SPASMS
- anchored platelets release serotonin
- serotonin causes blood vessel muscles to spasm
cells - spasms narrow the blood vessel, decreasing blood loss
COAGULATION
- injured tissues release thromboplastin
 - PF3 (a phospholipid) interacts with thromboplastin,
blood protein clotting factors, and calcium ions to
trigger a clotting cascade
- Prothrombin activator converts prothrombin to
thrombin (an enzyme)
- Thrombin joins fibrinogen proteins into hair-like
fibrin
- Fibrin forms a meshwork (the basis for a clot)
BLOOD CLOTTING
- Blood usually clots within 3-6 min
- The clot remains as endothelium regenerates
- The clot is broken down after tissue repair
UNDESIRABLE CLOTTING
Thrombus: a clot in an unbroken blood vessel
- Most Americans are Rh+
- Problems can occur in mixing Rh+ blood into a body
with Rh- blood
Rh DANGERS DURING PREGNANCY
- Danger is only when the mother is Rh- and the father
is Rh+ and the child inherits the Rh+ factor
- The mismatch of an Rh- mother carrying an Rh+ baby
can cause problems for the unborn child
- The first pregnancy usually proceeds without
problems
- the immune system is sensitized after the first
pregnancy
- in a second pregnancy, the mother’s immune system
produces antibodies to attack the Rh+ blood
(hemolytic disease of the newborn)

- Can be deadly in areas like the heart BLOOD TYPING

Embolus: a thrombus that breaks away and floats freely in the - blood samples are mixed with anti-A and anti-B serum
bloodstream - coagulation or no coagulation leads to determining
blood type
- Can later clog vessels in critical areas such as the brain - typing for ABO and Rh factors is done in the same
manner
BLEEDING DISORDERS
cross matching: testing for agglutination of donor RBCs by the
Thrombocytopenia: platelet deficiency
recipient’s serum and vice versa
- Even normal movements can cause bleeding form
DEVELOPMENTAL ASPECTS OF BLOOD
small blood vessels that require platelets for clotting
- fetal hemoglobin differs from hemoglobin produced
Hemophilia: hereditary bleeding disorder
after birth
- Normal clotting factors are missing
Sites of blood cell formation:
BLOOD GROUPS AND TRANSFUSIONS

- Large losses of blood have serious consequences

- Loss of 15-30% causes weakness
- Loss of over 30% causes shock which can be fatal
- Transfusions are the only way to replace blood quickly
- Transfused blood must be of the same blood group

HUMAN BLOOD GROUPS

- Blood contains genetically determined proteins

- A foreign protein (antigen) may be attacked by the
immune system
- Blood is “types” by using antibodies that will cause
- the fetal liver and spleen are early sites of blood cell
blood with certain proteins to clump (agglutination)
formation
- There are over 30 common RBC antigen
- bone marrow takes over hematopoiesis by the seventh
- The most vigorous transfusion reactions are caused by
month
ABO and Rh blood group antigens
HbA: refers to adult hemoglobin which a α2β2 tetramer
ABO blood groups
HbF: refers to fetal hemoglobin, which is an α2γ2 tetramer that
- Based on the presence or absence of two antigens
can bind to oxygen with greater affinity than HbA.
- Type a
- Type b - HbF has a higher affinity for oxygen than HbA
- The lack of these antigens is called type O
- The presence of both A and B is called type AB
- The presence of either A or B is called types A and B
THE CARDIOVASCULAR SYSTEM
respectively
- A closed system of the heart and blood vessels
Rh blood groups
- The heart pumps blood
- Named because of the presence or absence of one of - Blood vessels allow blood to circulate to all parts of
eight Rh antigens (agglutinogen D) the body
 - The function of the cardiovascular system is to deliver
oxygen and nutrients and to remove CO2 and other
waste products

THE HEART

Location:

- Thorax between the lungs

- Pointed apex directed towards left hip
- About the size of your fist

THE HEART: VALVES

- Allow blood to flow in only one direction

THE HEART: COVERINGS - Four valves
Pericardium: a double serous membrane - Valves open as blood is pumped through
- Help in place by chordae tendineae (heart strings)
Visceral pericardium: next to heart - Close to prevent backflow
Parietal pericardium: outside layer Atrioventricular valves- between atria and ventricles
- Serous fluid fills the space between the layers of - Bicuspid valve (left) and tricuspid valve (right)
pericardium
Semilunar valves- between ventricle and artery
THE HEART: HEART WALL
- Pulmonary semilunar valve
Three layers: - Aortic semilunar valve
1) Epicardium- outside layer OPERATION OF HEART VALVES
- This layer is the parietal pericardium
- Connective tissue layer
2) Myocardium- middle layer
- Mostly cardiac muscle
3) Endocardium- inner layer
- Endothelium

THE HEART: CHAMBERS

- Right and left side act as separate pumps

four chambers:

1) Atria- receiving chambers

- Right and left atrium
2) Ventricles- discharging chambers
- Right and left ventricle

THE HEART: ASSOCIATED GREAT VESSELS

Aorta: leaves left ventricle

Pulmonary arteries: leaver right ventricle

Vena cava: enters right atrium

Pulmonary veins (four): enter left atrium

CORONARY CIRCULATION
 - Blood in the heart chambers does not nourish the THE HEART: CARDIAC OUTPUT
myocardium
- The heart has its own nourishing circulatory system Cardiac output (CO)- amount of blood pumped by each side of
- Coronary arteries the heart in one minute
- Cardiac veins - CO= (heart rate (HR)) x (stroke volume (SV))
- Blood empties into the right atrium via the coronary
sinus Stroke volume: volume of blood pumped by each ventricle in
one contraction

THE HEART: REGULATION OF HEART RATE

THE HEART: CONDUCTION SYSTEN
- Stroke volume usually remains relatively constant
- Intrinsic conduction system (nodal systems) - Starling’s law of the heart- the more that the cardiac
- Heart muscle cells contract, without nerve impulses, muscle is stretched, the stronger the contraction
in a regular continuous way - Changing heart rate is the most common way to
- Special tissue sets the pace change cardiac output
- Sinoatrial node: pacemaker
- Atrioventricular node Increased heart rate
- Atrioventricular bundle - Exercise
- Bundle branches - Decreased blood volume
- Purkinje fibers 1) Sympathetic nervous system
HEART CONTRACTIONS - Crisis
- Low blood pressure
- Contraction is initiated by the sinoatrial node 2) Hormones
- Sequential stimulation occurs at other autorhythmic - Epinephrine
cells - Thyroxine

DECREASED HEART RATE

- Parasympathetic nervous system

- High blood pressure or blood volume
- Decreased venous return

BLOOD VESSELS: THE VASCULAR SYSTEM

- Taking blood to the tissues and back

- Arteries
- Arterioles
- Capillaries
- Venules
THE HEART: CARDIAC CYLE - Veins

- Atria contract simultaneously

- Atria relax, then ventricles contract
- Systole= contraction
- Diastole= relaxation

Cardiac cycle: events of one complete heart beat

Mid to late diastole: blood flows into ventricles

Ventricular systole- blood pressure builds before ventricle

contracts, pushing out blood

Early diastole: atria finish re-filling, ventricular pressure is low

THE VASCULAR SYSTEM

BLOOD VESSELS: ANATOMY PULSE

Three layers (tunics)

- Tunic intima (endothelium)

- Tunic media (smooth muscle): controlled by
sympathetic nervous system
- Tunic externa: mostly fibrous connective tissue

DIFFERENCE BETWEEN BLOOD VESSEL TYPES

BLOOD PRESSURE
MOVEMENT OF BLOOD TRHOUGH VESSELS

MEASURING ARTERIAL BLOOD PRESSURE

CAPILLARY BEDS
BLOOD PRESSURE: EFFECTS OF FACTORS
VARIATIONS IN BLOOD PRESSURE

CAPILLARY EXCHANGE

CAPILLARY EXCHANGE: MECHANISMS

DEVELOPMENTAL ASPECTS OF THE

CARDIOVASCULAR SYSTEM