AL-Iraqia university/ College of Medicine Lect.

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Dr.Mahasen Mohammed CVS Physiology
Cardiovascular innervations
Objectives;
1. Identify morphologically differences between types of cardiovascular centers.
2. What are the Functions of cardiac sympathetic& parasympathetic nerves
3. Illustrate the mechanisms that control blood flow to the organs
There are 2 main centers:
 Vasomotor center (VMC).
 Cardioinhibitory center (CIC).
Vasomotor center:
This center located bilaterally in the reticular substance of the
lower pons and medulla. The center transmits
parasympathetic impulses through the vagus nerves to the
heart and sympathetic impulses through the spinal cord and
peripheral sympathetic nerves to the heart and to the blood
vessels of the body. It includes the following areas or centers:
I- Vasomotor center (VMC).
1-Vasoconstrictor center (VCC):
Its neurons secrete norepinephrine to excite the
vasoconstrictor neurons of the sympathetic system throughout
the spinal cord. Stimulation of the VCC increases the
sympathetic discharge to:
 The heart (increasing heart rate β1&β2).
 The blood vessels (leading to generalized
vasoconstriction (VC) through α1 adrenergic receptors).
 The adrenal medullae (leading to secretion of
Catecholamines).
2-Vasodilator center (VDC):
Its fibers ascend upward to the vasoconstrictor center,
inhibiting the activity of this area (VCC), thus causing vasodilation. Stimulation of
this center leads to generalized vasodilatation (VD) by inhibiting the activity of the
VCC.
II- Cardioinhibitory centre (CIC).
 The dorsal motor nucleus of the vagus. It sends inhibitory signals to the heart via
the vagus nerve through cholinergic receptors).

OTHER areas include Sensory area:

Its neurons receive sensory nerve signals from the vagus and glossopharyngeal
nerves. This area controls the activities of the vasoconstrictor and vasodilator centers,
an example are the baroreceptor reflex that controls the blood pressure.

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Innervation of the heart:
The heart receives sympathetic and parasympathetic nerve supply. The sympathetic
nerve supply to the heart is connected to, and controlled
by, the vasoconstrictor center. The parasympathetic
vagal supply to the heart is connected to, and controlled
by, the cardioinhibitory center. There are also afferent
nerve fibers from the heart join the sympathetic and
parasympathetic nerves to the CNS.
The sympathetic cardiac nerves
The preganglionic fibers arise from the lateral horn
cells of the upper five thoracic spinal segments. They
relay in the three cervical and upper five thoracic
sympathetic ganglia. Postganglionic fibers arise from
the cervical and thoracic ganglia and proceed to supply the atria, ventricles, the
conducting system, and the blood vessels of the heart.
Functions of the cardiac sympathetic nerves
The sympathetic nerves supply all parts of the heart (atria, ventricles, conduction system
and the coronary vessels). When activated, they lead to the following:
A- An increase in:
1. Heart rate (+ve chronotropic effect).
2. Contractility (+ve inotropic effect).
3. Excitability (causing extrasystole or paroxysmal tachycardia)
4. Conductivity (+ve dromotropic effect = decreasing the AV nodal delay).
B- An increase of the cardiac output.
C- Vasodilation of the coronary vessels (by the effect of the metabolites formed as a
result of the increased myocardial activity).
The parasympathetic cardiac nerves
The preganglionic fibers arise from the cardioinhibitory center in the medulla. The
fibers proceed as vagal fibers to relay in terminal ganglia in the wall of the atria.
Short postganglionic fibers arise from terminal ganglia & proceed to supply the atria,
SA node, & AV node, and the blood vessels of the heart. but the ventricles are not
supplied by vagus nerve.
Functions of the cardiac parasympathetic nerves
They supply atria, SA & AV nodes and coronary vessels but not the ventricles. When
activated, they lead to depression of all cardiac properties, resulting in a decrease of:
- Rhythmicity i.e. the heart rate (-ve chronotropic effect).
- Atrial contractility (-ve inotropic effect).
- Atrial excitability (terminate an attacks of atrial tachycardia or extrasystole).
- Conductivity (-ve dromotropic effect= prolongs AV nodal delay).
2- A decrease of the cardiac output.
3- Vasoconstriction of the coronary vessels (secondary to decreased metabolite
formation due to the decreased cardiac activity).

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The resting tones to the heart:
The VCC and CIC are normally continuously active during rest leading to tonic
discharge to the heart known as the sympathetic and vagal tones respectively.
* The resting sympathetic tone to the heart
This is positively inotropic (increasing the ventricular pumping power 20-25 %) and
positively chronotropic (tending to increase the heart rate to about 120 beats /minute).
* The resting parasympathetic tone to the heart (vagal tone)
The inhibitory vagal tone is the continuous discharge of impulses in the vagus nerves at
the SA node during rest, reducing its rhythmicity; decreasing the heart rate to about 72
beats/min. which is well below the inherent rate of SA node rate that is of 100
beats/minute. It doesn't affect the ventricular pumping power (because the vagi don't
supply the ventricles). Thus, vagotomy increases the heart rate to about 120 beats per
minute (because of the dominance of sympathetic tone). In other words, in resting state,
there is more parasympathetic activity (vagal tone) to the heart than sympathetic, so the
normal resting heart rate is of 72 beats/minute.
Autonomic control the coronary circulation:
Sympathetic stimulation has a direct vasoconstrictor effect on the coronary vessels by
stimulating the α-adrenergic receptors. In vivo, however, sympathetic stimulation
increases the metabolic activity of the heart which has a strong dilator effect on the
coronaries. So, the net effect of sympathetic stimulation is coronary vasodilation.
Parasympathetic vagal stimulation dilates the coronaries, but because it decreases the
heart rate, metabolic activity decreases and coronary flow decreases.

Innervation of the blood vessels:

The vessels which are most affected by the vasoconstrictor nerve fibers are:
 The high resistance vessels (the arterioles).
 The capacitance vessels (mainly the big veins).
The vasoconstrictor nerves
All the blood vessels of the body except the capillaries are supplied with sympathetic
vasoconstrictor fibers. These fibers are connected under control of the medullary VCC.
The chemical transmitter of all the sympathetic vasoconstrictor fibers is noradrenaline.
It acts on the (alpha); α1-adrenergic receptors on the smooth muscles of the blood
vessels leading to their constriction.
Vasomotor tone: (the resting tone to the blood vessel)
Under normal conditions, the vasoconstrictor area of the vasomotor center transmits a
continuous discharge of impulses to the vasoconstrictor neurons in the lateral horn of
the spinal cord and in turn to the sympathetic vasoconstrictor nerve fibers, maintaining
a partial state of contraction in the blood vessels, keeping the normal level of arterial
pressure.
The vessels constrict when the sympathetic discharge to them increases and dilate
when the sympathetic discharge decreases.

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The vasodilator nerves
The vasodilator nerves include sympathetic, parasympathetic, and somatic nerves. None
of them is under the control of the vasomotor center.
A- The sympathetic vasodilator system
These are sympathetic vasodilator cholinergic nerves which supply
1- the blood vessels of skeletal muscle. The activity is centrally controlled by the
motor cerebral cortex in the frontal lobe of the brain. Descending fibers from the
motor cortex proceed downwards, relay in the anterior hypothalamus and midbrain.
Fibers from their end on specific lateral horn cells in the spinal cord sends
preganglionic fibers which activate the postganglionic sympathetic vasodilator
fibers. Thus, this sympathetic vasodilator system is not under the control of the
vasomotor center. It helps to increase the blood flow through skeletal muscles during
exercise.
In addition, this system is activated by sudden strong emotions which may lead to
widespread vasodilation → severe hypotension → brain ischemia → syncope
(transient loss of consciousness).
2-Other sympathetic cholinergic vasodilator fibers are those which supply sweat
glands. Their activity is controlled by the heat loss center in the anterior
hypothalamus.
3-Another example of sympathetic cholinergic fibers is those which supply
piloerector muscles of the hairs.
B- The parasympathetic vasodilator system
The vasodilator fibers in the vagus are generally weak, but parasympathetic
stimulation has almost no effects on most blood vessels. However, parasympathetic
nerves do innervate salivary glands, gastrointestinal glands, and genital erectile
tissue where they cause vasodilation.
C- The smooth muscles of blood vessels supplying the skeletal muscles are unique
because, in addition to α1 receptors, they also have β 2 receptors. These receptors are
inhibitory indicating that, when activated, they cause relaxation of the muscle.