ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY

LECTURER: Dr. Sarah De Luna

SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

The Cardiovascular System – Stores excess iron

Function: Materials Transport and Heat Distribution – Produces hepcidin, a key regulator of iron balance
• The Cardiovascular System is like a network of highways Spleen
connecting muscles and organs through an extensive system of
vessels that transport blood, nutrients, and waste. • Functions can be classified as
 Hematopoietic: Able to produce RBCs during fetal
development
 Filtration

 Remove old and damaged RBCs from circulation

 Removes hemoglobin from RBCs and returns iron
component to the bone marrow for reuse
 Filters out bacteria, especially encapsulated
organisms
 Immunologic: Contains a rich supply of lymphocytes,
monocytes, and stored immunoglobulins
Different Types of Molecules Move Through the
Cardiovascular System  Storage: Stores RBCs and approximately 30% of total mass
of platelets
• Nutrients from digested food to cells
Blood
• Oxygen from lungs to cells
Blood is a Type of Connective Tissue
• Metabolic wastes from cells to excretory organs.
• Blood transports substances between body cells and the
• Hormones that regulate body activities external environment.
• Distributes heat to maintain body temperature (constrict or • A liquid connective tissues
dilate)
• A mixture
Three interrelated components of the Cardiovascular System
 the formed elements
1. Blood (transport vehicle)  living blood cells & platelets
2. Heart (pump)  the plasma – the fluid matrix

3. Blood vessels (network of tubes) Physical Characteristics of Blood

Other Components of the Hemovascular System • More viscous than water

• Bone marrow -red and yellow • Temperature about 1 degree Celsius higher than oral or rectal
body temperature
• Liver
• Alkaline pH (7.35 to 7.45)
• Spleen
• ~8% of total body weight
• Lymph system
• 5-6 L in adult male
Liver
• 4-5 L in adult female
– Acts as a filter
Functions of Blood
– Produces all the procoagulants essential to hemostasis and
blood coagulation (PROTHROMBIN and CLOTTING ➢Transport and Distribution
FACTORS)
– delivery of O2, nutrients, and hormones
– critical to formation of Vitamin K
– removal of CO2 and metabolic wastes
V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

➢Regulation of Internal Homeostasis

– body temperature
– pH
– fluid volume
– composition of the interstitial fluid/lymph

➢Protection
– necessary for inflammation and repair
– prevents blood loss by hemostasis (coagulation)
– prevents infection
Composition of Blood

➢ Blood sample ➢ 1.5% OTHER SOLUTES

– spin it -> separates into 2 parts – Waste products - carried to various organs for removal

• Plasma – Nutrients – glucose and other sugars, amino acids, lipids,

vitamins and minerals
 ~55% of the volume
 straw colored liquid on top – Electrolytes (ions)

• Formed elements - ~45% of the volume – Regulatory substances

 red blood cells (99%)  enzymes

 buffy coat - white blood cells and platelets (1%)  hormones

Components of Blood – PLASMA – Gases - O2 , CO2 , N2

➢ 92% WATER

➢ 7% PROTEINS

➢Important for osmotic balance

• Albumin (60%)

 transports lipids
 steroid hormones
• Fibrinogen (4%) – blood clotting
• Globulins (35%) – many different proteins with a wide
variety of functions

 globulin classes α, β, and γ

• 1% other regulatory proteins

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

Components of Blood – FORMED ELEMENTS Leukocytes/White Blood Cells (WBCs)

➢>99% RED BLOOD CELLS - protect the body from invading pathogens and other foreign
substances.
➢LIVING CELLS
- There are several types of WBCs: neutrophils, basophils,
➢Erythrocytes, or Red Blood Cells (RBC’s), for O2 and CO2 eosinophils, monocytes, and lymphocytes. Lymphocytes are
transport further subdivided into B lymphocytes (B cells), T lymphocytes
(T cells), and natural killer (NK) cells.
➢RBCs’ hemoglobin also helps buffer the blood
Granular Leukocytes
Erythrocytes/Red Blood Cells (RBCs)
- transport oxygen from the lungs to the body cells and deliver
carbon dioxide from body cells to the lungs.

Agranular Leukocytes
➢<1% WHITE BLOOD CELLS and THROMBOCYTES
(platelets)

➢Leukocytes (White Blood Cells)

 Granular leukocytes (granulocytes)

- neutrophils
- eosinophils
- basophils

 Agranular leukocytes (agranulocytes) Thrombocytes/ Platelets

- lymphocytes - T cells, B cells
- monocytes → tissue, macrophages
➢Thrombocytes (platelets)
- the final type of formed element, are fragments of cells that
do not have a nucleus. Among other actions, they release
chemicals that promote blood clotting when blood vessels are
damaged. Platelets are the functional equivalent of
thrombocytes, nucleated cells found in lower vertebrates that
prevent blood loss by clotting blood.

The Heart

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

Fascinating Facts
• It is a fact that the heart, when taken out of the body, will
continue to beat. Even when cut into parts, the muscles in the
heart will continue to beat.
• The heart pumps over 300 quarts of blood an hour.
• Heart beats about 100,000 times every day or about 35
million beats per year. Your heart will beat approximately
2,700,000,000 times in a lifetime.
Pericardium
• The aorta, the largest artery in the body, is almost the
diameter of a garden hose. Capillaries, on the other hand, are • Pericardium- surrounds heart, keeps your heart in it’s place
so small that it takes ten of them to equal the thickness of a (like a father-in-law with the gun collection)
human hair.
• Allows heart to beat without friction, room to expand and
• Your body has about 5.6 liters (6 quarts) of blood. This 5.6 resists excessive expansion
liters of blood circulates through the body three times every
minute. In one day, the blood travels a total of 19,000 km • Pericardium
(12,000 miles)--that's four times the distance across the US A. Fibrous Pericardium – Superficial, tough, elastic
from coast to coast.
B. Serous Pericardium – Thinner, delicate, double layer
Heart Anatomy
• 1.) Parietal Layer – fused to the fibrous pericardium
• As big as 2 closed fists in adults, males have bigger
anatomical hearts PERICARDIAL FLUID, PERICARDIAL CAVITY
• Located in the mediastinum, like a cone on its side between • 2.) Visceral Layer
the lungs
– Also called the epicardium
• Base - broad superior portion of heart
Heart Wall
• Apex - inferior end, tilts to the left, tapers to point
1.) Epicardium- outside slippery layer
Great Blood Vessels of the Heart
• Also called the visceral pericardium (just to be confusing)
• Pulmonary Arteries
2.) Myocardium- muscle of heart
– Carry blood from the right ventricle to the lungs
3.) Endocardium- inside the heart
– Blood is deoxygenated
Myocardium
• Pulmonary Veins
• Atrial walls are thinnest
– Carry blood from the lungs to the left atrium
• Right ventricle thinner than left ventricle
– Blood is oxygenated
– pumps blood shorter distance
• Superior & Inferior Vena Cava
• Left ventricle walls thickest
– Carries blood from the body to the right atrium
• Right and left ventricles pump same volume of blood with
– Blood is deoxygenated each beat
• Aorta
– Carries blood from the left ventricle to the body
– Blood is oxygenated

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

Clinical Correlation
• Pericarditis – inflammation of the pericardium Acute –
sudden, no known cause; viral
-chest pain
-pericardial friction rub (creaking sound) Chronic – gradual,
long-lasting
-pericardial fluid accumulates—compress heart
-Cardiac tamponade -fluid in the pericardial cavity
compressing the heart, can stop the heart beat
-cancer and tuberculosis
• Myocarditis – inflammation of the myocardium – viral
Endocardium infection, rheumatic fever, exposure to radiation or certain
chemicals, medications
• Interatrial septum
-fever, fatigue, chest pain, irregular or rapid heartbeat, joint
– wall that separates atria pain, breathlessness-mild and recover
• Pectinate muscles • Endocarditis – inflammation of the endocardium
– internal ridges of myocardium in right atrium and both Heart Chambers
auricles
• 4 chambers
• Interventricular septum
• Right and left atria (= entry halls)
– wall that separates ventricles
– 2 superior, posterior chambers
• Trabeculae carneae
– receive blood returning to heart
– internal ridges in both ventricles walls
• Right and left ventricles (= little bellies)
• Chordae tendineae- cords connecting to the tricuspid and
mitral valves – 2 inferior chambers

• Heart Valves – pump blood into arteries

Internal Anatomy Anterior Aspect – Left ventricle is thicker, why?

Pathway of Blood Through the Heart
• The heart is two side-by-side pumps
– Right side is the pump for the pulmonary circuit
• Vessels that carry blood to and from the lungs
• Pulmonary circuit is a short, low-pressure circulation
– Left side is the pump for the systemic circuit
• Vessels that carry the blood to and from all body tissues
• Systemic circuit blood encounters much resistance in the
long pathways
• Anatomy of the ventricles reflects these differences

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

 rat lamb
– chordae tendineae - cords connect AV valves to papillary
muscles (on floor of ventricles)

Blood Flow in the Heart

Heart Valves and Circulation of Blood

Pathway of Blood Through the Heart ▪ The valves of the heart open and close in response to
pressure changes as the heart contracts and relaxes
Right atrium → tricuspid valve → right ventricle →
pulmonary semilunar valve → pulmonary trunk → pulmonary
arteries → lungs → pulmonary veins → left atrium →
bicuspid valve → left ventricle → aortic semilunar valve →
aorta→ systemic circulation
Heart Valves
• Ensure one-way blood flow
• Semilunar valves - control flow into great arteries
– pulmonary: from right ventricle into pulmonary trunk
– aortic: from left ventricle into aorta
• Atrioventricular (AV) valves ▪ When one set of valves is open, the other set is closed
Because they are located between an atrium and a ventricle,
the tricuspid and bicuspid valves are termed
– right AV valve has 3 cusps (tricuspid valve)
– left AV valve has 2 cusps (mitral, bicuspid valve)

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

• Insufficient/Incompetent valve = failure of valve to close

completely backflow and repump
• Lup Dub Heart Sound
EXAMPLES
• Mitral stenosis – scar formation; congenital anomaly
• Mitral insufficiency – left ventricle→left atrium; mitral valve
AV Valve Mechanics prolapse

• Ventricles relax, pressure drops, semilunar valves close, AV
valves open, blood flows from atria to ventricles
• Ventricles contract, AV valves close (papillary m. contract
and pull on chordae tendineae to prevent prolapse), pressure
rises, semilunar valves open, blood flows into great vessels
• Aortic stenosis, aortic insufficiency (aorta→left ventricle)
• Rheumatic fever – streptococcal infection of throat; bacteria
trigger an immune response in which antibodies produced
attack and inflame connective tissues in joints, heart valves
(aortic, mitral)

NOTE: SYSTOLE, DIASTOLE • Can be replaced

Operation of Heart Valves

Heart Sounds
• Auscultation
– act of listening to heart sounds
Location of Heart Valves • Due to vibrations in the blood caused by valves closing and
opening
• Four sounds but only two loud enough to hear by
stethoscope (S1 and S2)
• S1 = lub = long, booming sound AV valves closing (mitral
and tricuspid)
• S2 = dub = short, sharp sound SL valves closing (aortic and
pulmonary)
• S3 blood turbulence during ventricular filling (relaxed)
• S4 blood turbulence during atrial systole/ventricular filling
(active)
Valve Pathology
• Stenosis = narrowing of heart valve opening that restricts
blood flow; stiff= heart workload increased

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

Heart Murmurs
• A heart murmur is a swishing sound heard when there is
turbulent or abnormal blood flow across the heart valve.
• Innocent murmurs – murmurs present without any medical
or heart conditions (childhood murmurs, pregnancy)
Heart Sounds – Timing
• Causes – Valvular heart diseases – most common;
cardiomyopathy; septal defect
• Functional causes – anemia, hyperthyroidism
Systolic Murmurs
Derived from increased turbulence associated with:
1. Increased flow across normal SL valve or into a dilated
great vessel
2. Flow across an abnormal SL valve or narrowed ventricular
outflow tract - e.g. aortic stenosis
3. Flow across an incompetent AV valve - e.g. mitral
regurgitation
4. Flow across the interventricular septum
Diastolic Murmurs
• Almost always indicate heart disease
• Two basic types:
1. Early decrescendo diastolic murmurs
– signify regurgitant flow through an incompetent semilunar
valve
• e.g. aortic regurgitation
2. Rumbling diastolic murmurs in mid- or late diastole
Heart Sounds:
– suggest stenosis of an AV valve
The Heartbeat

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

• Atria and ventricles contract in coordinated manner

– Ensures correct blood flow
• 2 types of cardiac muscle cells involved:
– Conducting system – electrical events
• Control and coordinate activity of contractile cells
– Contractile cells – mechanical events
• Produce powerful contractions that propel blood
Microscopic Anatomy of Cardiac Muscle Review: Action Potential of Skeletal Muscle and Nerve
• Cardiac muscle cells are striated, short, fat, branched, and
interconnected
• Connective tissue matrix (endomysium) connects to the
fibrous skeleton
• T tubules are wide but less numerous; SR is simpler than in
skeletal muscle
• Numerous large mitochondria (25–35% of cell volume)

Contractile Myocardium vs Conducting Myocardium

• Intercalated discs: junctions between cells anchor cardiac

cells
– Desmosomes prevent cells from separating during
contraction
Action Potentials and Contraction for Contractile
– Gap junctions allow ions to pass; electrically couple adjacent Myocardium
cells
1. Depolarization – contractile fibers have stable resting
• Heart muscle behaves as a functional syncytium membrane potential
• Voltage-gated fast Na+ channels open – Na+ flows in
• Then deactivate and Na+ inflow decreases

2. Plateau – period of maintained depolarization

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

• Due in part to opening of voltage-gated slow Ca2+ channels Pacemaker and Action Potentials of the Conducting
– Ca2+ moves from interstitial fluid into cytosol Myocardium
• Ultimately triggers contraction
• Depolarization sustained due to voltage-gated K+ channels
balancing Ca2+ inflow with K+ outflow
3. Repolarization – recovery of resting membrane potential

❑ Resembles that in other excitable cells

❑ Additional voltage-gated K+ channels open

❑ Outflow K+ of restores negative resting membrane

potential The Conducting System
❑ Calcium channels closing Made up of two types of cells that do not contract:
❑ Refractory period – time interval during which second »Nodal cells (responsible for establishing rate of
contraction cannot be triggered contraction)

– Lasts longer than contraction itself »Conducting cells (distribute the contractile stimulus
to general myocardium)
– Tetanus (maintained contraction) cannot occur
Contractile Myocardium vs Conducting Myocardium
❑ Blood flow would cease
The Contractile Myocardium

The Conducting Myocardium

• Cardiac muscle tissue contracts on its own
– Does not need hormonal or neural stimulation
• These will change the force
– Called automaticity or autorhythmicity
• Repeatedly generate action potentials that trigger heart
contractions
– Have unstable resting potentials called pacemaker potentials
– Use calcium influx (rather than sodium) for rising phase of
the action potential

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

Sinus Rhythm
• Sinoatrial node is cardiac pacemaker
• Normal sinus rhythm 60- 100 beats/min
• Cardiac arrhythmia is an abnormality of the heart rhythm

Sequence of Excitation
Clinical Classification of Arrhythmias
• Sinoatrial (SA) node generates impulses about 90-100 action
• Heart rate (increased/decreased) Bradycardia – heart rate
potentials per minute
slow (<60 beats/min) Tachycardia – heart rate fast (>100
• Atrioventricular (AV) node delays the impulse beats/min)
approximately 0.1 second; 40-50 action potentials per minute
• Heart rhythm (regular/irregular)
• Impulse passes from atria to ventricles via the
• Site of origin (supraventricular / ventricular)
atrioventricular bundle (bundle of His);20-40 action potentials
per minute • Complexes on ECG (narrow/broad)
– AV bundle splits into two pathways in the interventricular Electrocardiogram (ECG or EKG)
septum (bundle branches)
• Composite record of action potentials produced by all the
1. Bundle branches carry the impulse toward the apex of the heart muscle fibers
heart
• Electrodes placed on body surface
2. Purkinje fibers carry the impulse to the heart apex and
ventricular walls – arms and legs and six positions on chest

Electrical Conduction in Heart • Graphed as series of up and down waves produced during
each heartbeat
• Atria contract as single unit followed after brief delay by a
synchronized ventricular contraction • Instrument called electrocardiograph
– produces 12 different tracings
ECG WAVES
• P wave
– atrial depolarization
• QRS complex
– ventricular depolarization
– onset of ventricular contraction
• T wave
– ventricular repolarization

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

– just before ventricles start to relax 3. Action potential enters AV bundle and out over ventricles
• atrial repolarization usually not visible • QRS complex
– masked by larger QRS complex • Masks atrial repolarization
• Different parts of ECG record can be correlated to specific 4. Contraction of ventricles/ ventricular systole
cardiac events
• Begins shortly after QRS complex appears and continues
during S-T segment
5. Repolarization of ventricular fibers
• T wave
6. Ventricular relaxation/ diastole

HEART EXCITATION RELATED TO ECG

Correlation of ECG Waves and Systole

– Systole – contraction/ diastole – relaxation
1. Cardiac action potential arises in SA node
• P wave appears
Clinical Classification of Arrhythmias Based on Heart
2. Atrial contraction/ atrial systole Rate
V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

Sinus Bradycardia and Junctional Rhythm Sinus Tachycardia and Supraventricular Tachycardia

Idioventricular Rhythm and 3rd Degree AV Block Multifocal Atrial Tachycardia and Atrial Fibrillation

Atrial Fibrillation Atrial Flutter and Ventricular Tachycardia

Clinical Classification of Arrhythmias Based on Heart

Rate The Cardiac Cycle

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

• Cardiac cycle: period between the start of one heartbeat and

the beginning to the next
• Systole: contraction
• Diastole: relaxation
• All events associated with one heartbeat
• In each cycle, atria and ventricles alternately contract and
relax
– During atrial systole, ventricles are relaxed
– During ventricle systole, atria are relaxed
• Forces blood from higher pressure to lower pressure
• During relaxation period, both atria and ventricles are
relaxed
– The faster the heart beats, the shorter the relaxation period
– Systole and diastole lengths shorten slightly Cardiac Output and Cardiac Reserve
• Cardiac Output (CO) = volume of blood ejected from left (or
right) ventricle into aorta (or pulmonary trunk) each minute
• CO = stroke volume (SV) x heart rate (HR)
• HR is the number of heart beats per minute
• SV is the amount of blood pumped out by a ventricle with
each beat; ml per beat
• In typical resting male
– 5.25L/min = 70mL/beat x 75 beats/min
• Entire blood volume flows through pulmonary and systemic
circuits each minute
• Cardiac reserve – difference between maximum CO and CO
at rest
– Average cardiac reserve 4-5 times resting value
Factors Influencing Cardiac Output
• Heart rate – rate of depolarization in autorhythmic cell
• Positive chronotropic factors increase heart rate
• Negative chronotropic factors decrease heart rate
• Stroke volume usually remains relatively constant. Changing
heart rate is the most common way to change cardiac output

Regulation of Heart Rate

• Increased heart rate
V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

• Sympathetic nervous system – Positive inotropic agents increase contractility

• Crisis • Often promote Ca2+ inflow during cardiac action potential
• Low blood pressure • Increases stroke volume
• Hormones • Epinephrine, norepinephrine, digitalis
• Epinephrine – Negative inotropic agents decrease contractility
• Thyroxine • Anoxia, acidosis, some anesthetics, and increased K+ in
interstitial fluid
• Exercise
Afterload
• Decreased blood volume
– Pressure that must be overcome before a semilunar valve
• Decreased heart rate can open
• Parasympathetic nervous system – Increase in afterload causes stroke volume to decrease
• High blood pressure or blood volume • Blood remains in ventricle at the end of systole
• Dereased venous return – Hypertension and atherosclerosis increase afterload
• In Congestive Heart Failure the heart is worn out Preload and Afterload
and pumps weakly. Digitalis works to provide a slow,
steady, but stronger beat.
Factors Influencing Cardiac Output
• Stroke volume – force of contraction in ventricular
myocardium
1. Preload
2. Contractility
3. Afterload
Preload
– Degree of stretch on the heart before it contracts
– Greater preload increases the force of contraction
Regulation of Heart Beat
– Frank-Starling law of the heart – the more the heart fills with
blood during diastole, the greater the force of contraction – Autonomic Regulation
during systole
–Nervous System Control
• Preload proportional to end-diastolic volume (EDV)
– Chemical Regulation
– 2 factors determine EDV
1. Duration of ventricular diastole
2. Venous return – volume of blood returning to right
Autonomic regulation
Ventricle
– Originates in cardiovascular center of medulla oblongata
Contractility
– Increases or decreases frequency of nerve impulses in both
– Strength of contraction at any given preload sympathetic and parasympathetic branches of ANS

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

– Noreprinephrine has 2 separate effects

• In SA and AV node speeds rate of spontaneous
depolarization
• In contractile fibers enhances Ca2+ entry increasing
contractility
– Parasympathetic nerves release acetylcholine which
decreases heart rate by slowing rate of spontaneous
depolarization
MEDULLA OBLONGATA CENTERS AFFECT Chemical regulation of heart rate
AUTONOMIC INNERVATION
– Hormones
• Cardio-acceleratory center activates sympathetic neurons
• Epinephrine and norepinephrine increase heart rate
• Cardio-inhibitory center controls parasympathetic neurons and contractility
• Thyroid hormones also increase heart rate and
contractility
– Cations
• Ionic imbalance can compromise pumping
effectiveness
• Relative concentration of K+, Ca2+ and Na+
important

Nervous System Control of the Heart

Congestive Heart Failure (CHF)

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

Definition • Left ventricular and atrial end-diastolic pressures increase

and cardiac output decreases
• Abnormality of cardiac function that leads to the inability of
the heart to pump blood to meet the body’s basic metabolic • Impaired left ventricular filling results in congestion and
demands or when it can do so only with an elevated filling increased pulmonary vascular pressures
pressure
• REMEMBER: “L”eft and “L”ung, the fluid “backs up” to
• Causes a decreased tissue perfusion as a result of decreased lungs
CARDIAC OUTPUT
Right-sided failure
• Clinical presentation of a disease
• Caused by pulmonary hypertension and left heart failure
• NOT a diagnosis in itself
• Pulmonary hypertension causes increased pressure that right
• Congestive heart failure (CHF) is caused by: ventricle must pump against, so right ventricle cannot empty;
hypertrophy and dilatation result
– Coronary atherosclerosis
• Right ventricle distention leads to blood accumulation in
– Persistent high blood pressure systemic veins
– Multiple myocardial infarcts • REMEMBER: “R”ight and “R”est of the body, the fluid
– Dilated cardiomyopathy (DCM) – main pumping “backs up” to rest of body
chambers of the heart are dilated and contract poorly Systolic versus Diastolic
– Valve disorders
– Congenital defects
Classifying Heart Failure
• Anatomically
– Left versus Right
• Physiologically
– Systolic versus Diastolic
• Functionally
– How symptomatic is your patient?
Left versus Right Failure

Left-sided failure
• Results from LEFT ventricular wall damage or dilatation

V. L. PANTI
 ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY
LECTURER: Dr. Sarah De Luna
SCHOOL OF NURSING, ALLIED-HEALTH, AND BIOLOGICAL SCIENCES - SAINT LOUIS UNIVERSITY, BAGUIO CITY

UNIT 5: TRANSPORT

Treatment of CHF
• Treat Precipitating Factor(s)!!!!
• Adjust Heart Rate
• Decrease Preload
• Decrease Afterload
• Increase Contractility
• Increase Oxygenation
UNLOAD ME
• U – upright position
Evaluation of Heart Failure • N – Nitrates
• HEART SOUNDS!!! • L - Lasix
• Systolic Murmurs • O - Oxygen
– Mitral Regurg • A - ACEi
– Aortic Stenosis • D - Digoxin
• Diastolic Murmurs • M - Morphine
– Mitral Stenosis • E - ECG
– Aortic Insufficiency
• S3: Rapid filling of a diseased ventricle
• CXR
– Kerley’s lines : A and B
– Pulmonary Edema
– Cephalization
– Pleural Effusions (bilateral)
• EKG
– Left atrial enlargement
– Arrhythmias
– Hypertrophy (left or right)

V. L. PANTI