Myocardial Contvactili By: Zakirullah youss}2si uscle Contraction , ~ Elect col activity start {wm sf-Nede , Aes over abtia diag athwugh Av-nede gees te ventricles auhen ik yeahs first cetry Elected activity goes to And Cell = low vesistomce — Cennection present: Bio Myocrdial cells there is Gop-yunction unction Gap-Tuncti when me cell undergo depolarization t means this cat acyuive alot of Catims, These Cations frickle to next cell thrugh these Gap-Junctios. (windows for Cahons Passage) Pyecandiat sing cab intra cellecudor store f 2-line : pep reach From fare when Cell yeceive Cations ~af RMP to Threshe Tivesheld is a special type of vltte ot ana sheng depolanzation Gurrent will stort Ge: here Ws ~Jorv) Here veltage gated Not~ channels will eRen, which allow Ne be come iw (usually Cancentrated outs’), & KT Concert yation tie rmere iw ca Se Kes cut For more high quality medical notes contact with whatsapp:+93728888256when RMP reach to thesheld, thyesheld j adtivabin ef Voltage gated Na channel weeoy, anced sand channels open Yor very short time, But in this Heme heavy amount of No& shift ‘to inside As Cations move in electro negostwvity being neutralized. (Meves toward positivity — +10) +> Channels mow — Closed So, Fivst electicol event: 1 cell trickeled Cations thwug Gap -qunction. Sal ” o tented cations took RMP to thresheld ard 4 y At threshold voltage fated No channels briskly apened (Na enter) +N@ come in, cell ‘ne gotive Polavity lost» Depelavized — aftey NO channel closed, Kt channels opend- > Gi chomnds also open at the Same time. aK Loves to move out, go after depslanration, voitage gated Kechamnels allow Kt -Leakage- SAL the same time Veltage Gated Gi chanel open for Passive — tran spat NOTE: Ct Concent rahion outside the ced is Much higher Compare to cyfosole (loco times move outside tram msidé) Remembers scive transport things against utelized when we move electro chemical gradiant- # Fer KW to move out & Cat to move in —> Passive the opposite —————> Active + For No te move in ee to thaw oof ————> Pietive* Cell Simultaneously besing ave los ag it & gaimy ave tens as Gt yo significant Change occur im Potential Called « Plat eau” + Duvation ef plateau 15 dependant on how long this exchange of Cations is quing ome > Even thought KT Gt channels beth of them ave depelari s akion sensitive, ag soon as depeloriration commpletel K-chamnes werking —slowely 4 progressively they start opening frequently aK boss occur mere — Prequently (Hug less ef 6) 5 GE wor is unitially move, tham less & evertvally least: + eventually No GE Ceme in bot efflux WS Yast, se the rmembssane Come back te electronegative: L REPOLARIZED ~ electricat event occuring om the sorface of Cell sweepivyy evey surface actually - wwhen Ist part of membrane depclanzed, some cations Come im & trickle te vert Point, 2nd part RMP Gres te threshold. NE Coming iw, into Part 2, goest te port 3 & fake it foy RMP~» Te threshold ~_, Depolari zation — wave of Depolarization && Repolavization sweeps ovev Vembrome of yetardium- For more high quality medical notes contact with whatsapp:+93728888256 ®@Myocardial cals develepe special — invaginations on tmemb yane These invaginations are callal Transverse Tubules /TTWwblules, function of fa Tetst 4 = Take action Potential wapidely te deeper Parts of the call. > deepest port of call even Yeceive Electrical Phenomena. whenever Cardiac action Potential Call, te beings im some Gt dusing Platawr Phate, amoves, along, MyeGurdiak % To kubules trigger GF te qe inte deeper farts of he cel (extvacelleculay Got). of ERC Sarce plasmic Reticuluw) found = Special tyPe special Active fyamsporters Myocardiak they Use ATP Ctrey ? frvomsfortey on SR: Function ef active a Take Gt — From — mbracyteselic owen te Inbrasarceplasimic aver. sarceplasmic Reticulum ave éxtremely with Gris is TITRA celecwlay cd But Tot tntracgteselic) Maintaimed — well tw Cells, very vich in iw Gt. Twtyacetleculay store of cat ig Myoavdial cells cat channels = SR have cat sensitive hits SR; these channels Ofer F Let of when sxtyacelileculay at co Release from sR te extosel povpese_of plateau: STe bing vextvacelecslav cat into wnfracelleculay environment cated “Tye ot Triyter Gt is at frm — extyacelleculaw, which shift te tner iw Yo Cavdium duning ploteaw Phase @ For more high quality medical notes contact with whatsapp:#93728888256Tagger Gt triggers . intra celteculow a of — Gt yeleose rom Massive yelease ef Go mow participates Mechanical Contvaction- NOTE sa shift of co Jom sR to cytosel is alto Tom high — + low (Passive proces) > Recaptuving ef Gt is active tvonsport. Muscle will ge tte Contraction If Gt net controlled (Fovevey ——> Rigey moctis) iw + T-ftubules ove very neay to Z-Lines mayesin heads act with actin Gilament fer Contvaction purPese “r Myosin globilay heads act with tyosin—binding sites em actin which ave protected ky Tropemysin- + ovhen Gt bind with —trfonin C, troponin yatates,, pulling Tropomy sin awoy Pom interference sa myosin binding site Exposed when binding eccurs, ATP brken down bg ATPase activity present. im Pyosin heads, Centys) Cress bridges Jermad whith side actin Ylament te enter of Say Comere emi’ es a od te mechanical Force of Cont action when Gt gtark Coming in (from extyvo cellacwo) % Platesn ended, ee Paageny te yrigger Gt sensitive Got~ channel 15 cat ATPase mw SR activated a Ca Pulled back in so Gt iw a aaainy Jom Troponin | Tropenin leses GE & become angry. Release Trpemgcine te ele. ae binding activily a (Diastele) For more high quality medical notes contact with whatsapp:+93728888256 ©step by step How electrical activity head te Mechanicat activily im A myocardial Celh Stimulus fer — Depelanization 19) cess bridges oe Od ee \) Cel repolarized (completed) DN dependant ae “eit 13) Ethacelleadar Gt thrown back ppiateon CK efflvy te Sxtraceleculay side, 5) K efflux only 4 Repelartration 13) Released cat actively pumped OG Myers SR velense back to SR: 1) Gt bind wilh troponin 1) Ct on treponin detaches YT repomin pull awoy trepemycine. 15) Tropomysin interfevs a) Myecin binding actin sites exPesed — 12) onget of Diastole IP heat bak — Bo beats/minute Levery minute ge electrical events, Bo times — Extacelleculay Cot trigger ins Betimes S-R release co. Bo times contractim , go times cal from cyteset taken to sR. (higger GT jaken back te ecF- How Does tigger ct Jo back? > similoy Gt ATPase in call membrane Pull them vt iw Membrane Not /KT ATPare take Incoming Not out & bring Kt in again. > Special changer — present membrane | winich bring, BN (which goes out throug NA/K ATRose) S| takes cot Gein, aft 02 Ce Exiting Mechamisms: O Cot ATPase Cprmay active Transpext) @ anc/cz uxchanger. Aso special Proteins present called (phospholamban) , which help Gt Atpase te take Gat Pom cytescl—,to SR — Superactivatkes Gt ATPase © For more high quality medical notes contact with whatsapp:+93728888256Effect of ANS om contyactili — Symphate mimetic activity produce Positive tmetrophty (increase in strength ef Contraction) Ie tes intracellecutay lead of ct strength of Contyaction o Frequency of Cross bridging made Biy myocin head & actin Cvessbndging XX Ct Cencentrabin Cintra calleculor Ct) Tatracelleculay Gt of Actin—Myesin Cassbidging & Contractility > @ Inctwrhy IF ave wotwphic dyug used , Strength ef — Centyaction Tes, and obviously fes Actin—myosin Cressbndg ng. athis dg operates by — mcrensing GX (ead = —ve motmphy im Contrast, des it i spwhen — sympathetic N-s activated, Nor- Cpine Ph eg een act on heart & 7 Contractility. Defined Ase> ave imctrepic action How does epinephnne §& Nov-Epimephvm — IMCrease intracellecuay lead of Gr im myecardiok Celt — Br Advenergic —-Fecepters present in heart, when rif epi bind & Stimulate By AR > BL Receptor Coupled — wills CG stimulatory, which — sthmulate Ademylyl cyclase which Convert ATP -t cAMP. — Nov- pi or Epi —> 1 cAMP. , _ caMp > stimulate patein Kinase A @ For more high quality medical notes contact with whatsapp:+93728888256—Profem Kinase A lead te Phosphosylatim of channels responsible Yor Trgger Gi. ~ when these channels phosphorylated, they become widely open & allow Tt cat entrance. epi/w ees as ag he és Fink Remember: pump PY present te take cytosel ca’ Concent vote it inte S-R- (fF these pomps werk — These pumps awe sevely te shift Gt Slowely , Intiasarceplasmic Gt bes influenced by prtem a inte SR become high = if protein Work well, theve ste & Massive Got power of fumes (every sigrificiently mawtamed yelens@ ashen bigzered > Prtein Kinase A also stimulate this Protein by phesphorlstin Se tmbyasarcoplasmic Steves of ct te $Oy Karine action of moe at (tigger) Ontvance & super-Por? actin Produce Shenger Contractility. I) Release of Epi & Nor Epi 2) Stimulation of BL AR VG; Protein Stimulated W) Aderyi cyclase stimulated jt came © mnetwpby 6)Prtein Kinase A activity T Mt) t activity on Troponin 1) T Trepemycin remeval WT Actin-tyosin Cress-loridging, yt strength ef Conctractien DT phosphoryralation of Vellege @ Jt CB chawnels & PUMPS ay t bigger Gt IT Gt yelease from massive stores For more high quality medical notes contact with whatsapp:+93728888256Hew acely( Choline apPose this process? eplerpiime Tes Heert woe Acetyl choline — through Para sympathetic (vagal) system decrease heart vate. Howceme IF Gretid ines massage applica Carer of Vogal insist) Than How does Parasympathetic occur? ~ SA-nede imhibtted , Av-nede mhibited mo significant change in tnetyephic actvily- Acetyl cholin Cavse © Inctuphy , © drenoberhy — Vagus system —elease Ach. a tusconnic-Q -vecepter present (serpentine receptors) which ove Coupled with — Ginhibitery (i, Bi, i), the stimolation RG lead te mhibition of Adenyl cyclase; 50 ATP 38 _, cAMP at CAMP.) ~ Protein, Kinase A activity ves NoTE: —< ——- sympathetic N-s is activator of PKA. Poasympathic 5 is imhibitey of P-KRe Less Phosphovylation of Ne — Channels x Notes in SA-nede, nat current was taking RMP to thresheid + Notes No & Gt Channels ave phosphorylatad. by PKR Fer more tnbromee of Nt Gt. sympathetic owes act om myocardial Cells, Iw Such a way of all Myotardial Cells (S$A-nede, Av-nede, atrial cells, yentviculow Cells, Purkinje Cells) have Phosphosylation in Gf Channel & Nat- Chammels. Se cationic Leads Tes Epinephwin, Nor- Epinephrin , Depamin —» are Cation leaden. For mere high quality medical notes contact with whatsapp-93720888256 @— If Cations over Loaded: aNoymat sympathetic geod — 4 aot entvactility Co chance of Tachy arrhythmias t we see how sympathetic N-S acts m (sa-nodal cells) re. AS a © chronotropic agent a — ~ loads SA & AV-nede (specially 5A) ‘549 epalacization wilk not & cot en a. SR-node ~ RMP Yeach to T-P mere rapidly Av-nede CAP mare freyvently) —> Rapid depolarization — HR Tes In AV-nede cells everleaded—> Conduction tmhanced >® Yemetwric action bro sa-node @ chonotets) |] ater ale Av-node (@ drome frepts) | Electvicok By Purkinje (@ Bathmotiepy) | Activity aineten myocar dive (© Lntrpic) eee ov- Epimephvin : Sisapioy Mow- aphwer when —-symmPalhetic Nis everactive , Chance ef tachyarythmia T = Cations, txtva GE, Not (after Epimephin Daan . te thvesheld ie & Nev= Sgimephrin activity) take RMP near _ under adyener9ic ivflvence hove mere Gionic . byacavdial Cells te te threshold current, so RMP wen under sympathetic ontluence, evew RMP camnot vest — dumping avound and Hoy auto-five- = Edepic foci formed > Risk cf tachyanythmia Tes. ~ Normal awomaticity is im sA-node - Bot if ectopic foci Porm elseush ear —> Abnormal ey, For more high quality medical notes contact with whatsapp:+93728888256~ Under whlvence of sympathetic system, nemal automaticity is Ewhanced Cchrnetyephy) Bot when abnewmal automaticity is Enhanced ~> © Bathmebepy) ecco =Rbnomal excitability — sympathetic Ns is Cabin Leader on anyocavdial system Qyvren it lead Gti on sa-node, 7 its antematicy @ chownctrepic actin ore overload Cations on Av- node Conduction thavuyh Av-nede Tes © drometwyic action) 3) when everlsads yenbicular cell, payticularly purkinje cat (osvally (mitable cells) excessive tendency t spentemecvs five depelarired @Batkrmot ory A when Gtios loaded im Contvactile Myc aydiat cells, Strength Contyaction 1. a (@ Imctropic action.) Under sympathetic Newous we have ved electri Nee eters ee Al ave due be each tes Gatim Lead. $O, sympathetic nes Leads Cations im $A-node, Av-mede, porkinje cells Sy in Myocardial cells & produce alteration in electrical & Mechomical Properties. How ave all these ropevties opposed by Povas'ympatheti = Obviously this Hime Cee dae => Parvosympathetic ns (Ach) should Cavse © chronotverhy © Dremetrry & © Balkwrotophy ¥ Not © Motwphy since Contractile cells dont usvally have chelinergic Yeceptors * Advemerqic yecePters present ont candi. one Av-nede | Atvia, Purkinje system & Cmbractile mye dies Cholinergic receptas ave present int * Meeavelp on SAE AV-Kode Flite Zon Atria'(nearly) absent on ventricle For more high quality medical notes contact with whatsapp:+93728888256+ Advenergic present uniformly while chelinevaic present selective? Depolavizatio in AV-node = Cholinergic syst > beading of cations Slow clr a Phesphrery lation @* FR w onits — bind with mtermal side of Ke channel, so kK Rushes out > Catiens in Av-Mode being Lost ap Cakions not being leaded easily Cations alse being yushed cut — since slope very slow, depclarization very Slow ~ Heavt whe + $0, Cholinergic activity —9 less of i hyper polanization reduced wtle of ct & No es pifficult te depolavrrzed cell; electyically cells mhibited- gh-nede Inhibited —> O chvonetyoP) - Av-node inhibited — © Dremefyophy - Purkenje Cols inhibited © Bathmstorhy But Muscarinic (chelmergic) vecefters ave net — Present im Contractile Myetardium 5 No © Tenohephy For more high quality medical notes contact with whatsapp:+93728888256Effect of heart vole om Contyactili HAR heart beat mere —y every beat will be stronger. — during fast heot ake +Tachy cardia, you get shower heat bet. — Iw this diofvam ,we see heart yoke oe \nikially mederate “Zobpmn strength nrewmal oe os Het yor 9130, ne sigvificant tmeveose in Strength + > Gradually Strength T strciyn, « Sout Const vaca treet = Duvation emom ema, sTncresse heart yale + Increase strength Ph Coed Staiy Case effect Reason #4: ' + when heart besting slowely, less Ap for fiven time = Fast Heat beating s Mave Ap /unit Hime a when HRT, Ap pey unit Hme fT, nombey of plateau t > Total cot rey) te cell Tes. 7 SR vecoptoving mot all = so with vepeoted trictcting of Govt of SR, amd less, complete ve capturing mere Cot available Contvectilii Se. fow y » beer: SR Gam yeaplore previous lead ef veleased Co nent lead Come im, omount ef Gt wwerking on troponin 1 pagressiny until hevt veach -marimern activity Reasen #25 Af heart vote due te sympathetic activity —mot only is tetol mumber of plakeau 7 Cveasen #1) but alse, due te Phosphorylation of — Ca- channels, cat ameunt t © For more high quality medical notes contact with whatsapp:+93728888256Role of Extya- systole = normally gA-nede Living af veaulay tnlevvels, suppose trnitabble Gocos present, Myocardial cai, which Tired unsxpectedly Contractility due te Ivvilable Focus called Extya systole. usvally exdvasystele has strengh less than usual stvength but strength of post-extva systole 7 Reason: ysvally cat vested to SR dam cack vatevval But when extva-systele was Pairtidly Yecevering the Jallosens Game ~Simce Cot shll present : Strength T colted; “post extra~systelic Petenciation” SG extes stole ‘ oi, te SN 38 we HR Failing Heart . ae JD pisitolis Covgex) RY vate aT ese Bringing No bring RMP neov threshold | Digitaliring patients emeams leading cells with Cotions : patient tend te develope Atrial & ventneuloy Tackyarry thmias. SPonede sUPgieRiAt Vagus Digitalis Load : node supflied by left vayys Cations ‘tm Atrias Venticle Hyocardi_ Coie Inhibit this Rt vagus —> SA-rede left ~ —> Av-nede Digitalis Leads Gains tw Attiat Vent Myo curdium Advantages ¢ © inctropic ogent pisadvantojes: T Risk ef Tadryarritimnia — pigitalis also hes action om vagus — since vagus is hibit ef sA-nede + AV- ede; ge strange stimulation pre duced ~ sh-nede_ AV-rede mhibited, Atvia + ventvicles stim lai sinus g Nedat_Byody cardia Abia Wrentvicitay Tachy.evdia Heart block -\R Patient Comes with abil Tachycardia (fibsilation) with modal blecks Wy this will be te effet of pigitalis Cusvally) > \P Patient has abtial Plotter (e3 Seobtm) & Av-nede Very achve, so you werty tho foo mods impulses Joan down 9, yentviaday Tachyorytori mos ctant, You "may slow down Av-nede, pessibaly by giving them Digitalis which blocks Av-nede % stimulate abvia , (gee —Uor) -y out of Boo may be [Se weve Fer down now my be ovt of Yoo ~275 Ferg down ~ ventviculay yote avrythmia is what Con Kill patient. For more high quality medical notes contact with whatsapp:+93728888256 ©Length & Tentim Relatimship in Cavdiac muscle less volume = less stvetch on Myocaydium = length ef fibey is Less before Contraction. As blocd im lett ventricle Ts left venbvicle stretching \ 3] optimum length of Myocardial saycomeve: -— > ™ Muscle 1 emough Cat Pre sent, Toa oom away Trepamysin, myosin heads Gm all interact with myosin binding site on action > To get best Contractility Tam myocardium first veyvest is appropriate § optimum length ef myocardial Savcomene 1" length of SavCcomeve is less oy move than optimum ; theve will be no good Contraction. 7 IF vewticle — Gilled mae, Length, strech Left ventricle has jooml bleod ; in diastole & systele, this same Volume of bleed has different pressures. — when left ventricle is Tlled ie Keeps illing at certain level dunng diastele, j_ pressure ee Ea Yorker Filing Gases Significant prehore Sh pressuve elevation —_— Reason it Is so Slow 1s be ventricle is velox durny diastele — suppese there is iGeml im diastole im Lengt, /presure ctveteh) /EDV ventricle, baremeters will measure Low oe Pressure, since ventyicle s velaxed if suddenly — systel hos stated (me ‘ejection yet)-tSer)), pyessu “ ® For more high quality medical notes contact with whatsapp:+93728888256~ Suppose ot IYoml thevefer full systole pressuve may ge upte Fommily 04 opposed te Swmig tm diastele - At leoml diastole may be omml , systole with be less than emmy ~1f Weert 1s over-Jilled — systole yma) Yall down again Review Diastclic pressuve curve: ~ventyicle velaxed as you put mae volume Pressure gvadually t systolic pressuve Curve : — less volume less Pressuve slight mevease im volume, pressure rapidly 1, until optimum length pressure ame very high , theve fev, pressuve genevaled decveases = AL optimom Length during systele maximum cress-bndging made. Bot haw many will veallyFmade depend on cs. awhen ventricle volume is very Lew; underfilled, so litfle stretch om mye cardidmd cells? that Some aves Yer Cress-bridje wasted: = when ventricles — abnormally diatitad "Patleloyic Condition” eg: ventviculev Jaivre, ventricles become globuiated oy diakaed . when ventricles dialated become very big, but net efficient sever Stretching. Tn wormal (sitting) Person | heave is not userkin] at optimal: —supfese IP we give & Potient — Veme ~ Constrictey dug, which soyveezes his ves lots of — bleed will ge syveez im vein be ventricle 4 veins Eypended } EDVT “2 Contractility 1, Cot theveattey——> falling Pvessuve (¥ Co). For more high quality medical notes contact with whatsapp:+93728888256 _ in Person increosing EDV, means Increasing Co until certo @~Pre-loads Load on heorl that ventricle DV/eop Werk om tt ~ EP ve-load 1 Tention- — Aftey certain Gand 41 pre-load — 4 pressure ~ Move Pre-lead means amore cusiut , upte , until physieleyict lived — Inhonsic Regulation of Heart, Adjust Co with veneus iwpot ~ SVt Amount of bleed gyected pey systally has te pct c ie 2 Roms phar —As EDV Continues i Caiithin physictogneal Gmit) output will tes poe! “ Nrenacenstier sve TIN Mevrnal Person pe SV= Fowl Co: be Co= Secomfrin (12x10 = 5000) : EDV= [Uoml Tye Due ev /eop + Relationship By EDV Co: (Frank sterling lows) Lone way te stale. within physiclogical Limits, emtion developed by oe tow mypavelial cells. is divectly — proportional be the \nifial Stretch - ancther way te stote: within physiological Lmits, Sv, or Co generated by ventricle (hear) ic divectly Proportional te the EDV. How they found : Heart of 0 fro§—y Move they Hove you fill For more high quality medical notes contact with whatsapp:+93728888256 ® ed led wy moe ejected, an grengjey Contraction -- if a dng —mtyavenously given to patient ew, svt » for vem ah for same length —s 1 Contractility cat st have been added te coe- =r wuld be any sympathomimetic diy: > @ imetwphic dwg means Yor amy que volume mee Contraction more Sv & het more efficiert: Remembev : sv = Er? epv- ESV sv ev = 507.@5) = qt @1) a7. (3) heart Potient 1: EF Te patient 2: EF patient 3: EF = loo tuo uo ue efficiency of dvugs Patient evi & Gol EF shows A— motwpic sv x CO » Hepvi simply given change Co Co when venoconstvicters 9 WRT since EDVT, length of Savcomere by estore actin — ryosin optimum given bot. Smotwyic agent Ee veme binding 3 More D- ig comstaicter- Potient EDVS svt cet te Bt FoOCct c— Dt po ct B— FP: For more high quality medical notes contact with whatsapp:+93728888256 tye — 240 poe tt o oincterhy vemediohakey yeno Con stricter @ wotwrhy stopped @ rotwphy © mottry stepped ©Left ventviculay Volume —pressure Loop & Exection acitic da mitral valve open Rertic Closed Ad ae 1-25 Ventricular Tiling, SUE 2: left ventricle starts Conhactiy & mitved valve clesed 2.-3% Ragid Pressure twild up. ‘ one 4 Aertic valve opened. ~ mityal a i: =Egecion start - ee sme ais aa i a cede Gel —- oe oe Us ISo-velumetvic Relaration stats agsive C a Tung aN Fay — During ventyiculoy diastole ne sign ficont increase (very Little) im pressure ventricle = during ver olny systele thought, pressure vapidly mcvents, where as Velume Initially stable _uwhen Pressure eXCeeds that of anrta aertic vane Pens, se Volume loss mow take Place: : Marimum Energy used in Tsovelumetvic phase (23) Maximum serk done in Ejection phase. (34) summary 1342 % pene 0 ~ Isevel = {govelum etvic ie eal ENiaaien qo 34 & - ISovelymernic Relaxation - iPentive graph meves—> (Rit) Grfinue tte tks means mere vent: filling, cpen. For more high quality medical notes contact with whatsapp:+93728888256-\$ Tb qraph Corvard) — its means gragh needs tT Pressure te Contract- — afterload is mare. -Te open acrtic valve more Pressure ye wired wits meoms theve is: ~systemic hypevtention 6 sovtflow ebstruction = 1B gph — Celt) Us menns more ejection = positive Tnotvophic action Clinical Applications pre-load Mecleod eve EDVT fem Ibo— 2ooml we reload cy Venous Yetum — Nemo constviction Here heart (ventids) only ge ab tlommty st Becks ak higher vesistomce > stepped yecting gorliey (werk is tos mock for ik te hondle) Te. (se — FT cutflow yesistance =Aaertic Stenosis ey systemic HTN Mey be Atiecenstictor we tue ae somenlf —Heve venticle opens ak rermal Point Re sistance Newmal ~ sqyveez move tham nommal amet af bleed tected: contraction excessive wee _ after isavelumerric 4 volumes (Yow! — thereafter; nermmally Jeml ected we teow tected since EFT — Positive oiatare dovug Used: im ventricle ayamst blood Present Hust pomp. EDV: EDP lett atrial Pressuvet As Pre-lad T, EDPT ‘ cw ruby pre-load means, left ventacle Tin) “ea ° END of MyoCARDIAL ContRACTIN For more high quality medical notes contact with whatsapp:+93728888256 Remember: pre-load > ammount of which heart