CHAPTER ICARDIOVASCULAR

5 SySTEM

Q. Heart sounds. May.2010, Oct. 2009, April 2003,

Nov. 2002, June 2000, Nov. 1997

ANSWER:

Features First Second Third Fourth

Occurs during | Isometric Protodiastole Rapid filling Atrial sys-
contraction and part of phase tole
period and isometric
part of ejec- relaxation
tion period

Cause Closure of Closure of Rushing of Contraction

atrioven- semilunar blood into of atrial
tricularvalve| valve ventricle musculature

Characteristic long.softand Shortsharp Lowpitched Inau. le

low pitched, andhigh sound
LUBB pitched,DUB
Duration 0.10-0.17 0.10-0.14 0.07-0.10 0.02-0.04

Frequency 25-45 50 1-6 1-4

ECG Coincides Appears 0.09 Between Between
with R wave sec after T T and P wave P and Q
wave
wave
Number of 9-13 4-6 1-4 1-2
vibrations in
phonocardio-
8ram

Q. Blood pressure regulation.

May 2010, Oct 2006, Oct 2005, April 2004
ANSWER:
Blood pressure is the lateral pressure exerted by the con-
tained column of blood on the wall of arteries.
PHYSIOLOGY -
 42 CARDIOVAScuLAR SySTEM
Normal value =
120/80 mm hg
Regulation:
1. Nervous mechanism : Short term regulation via vasom
tor system which include vasomotor center vasoconstri
tor fibres and vasodilator fibres.
Mechanism of action is by 4 ways as
(a) Baroreceptor mechanism situated in carotid sin
and wall of aorta.
Increase in blood pressure
stimulation
Baroreceptor
Impulses via IX and X cranial nerves

Nucleus of tractus solitarius

Inhibition of stimulation of
vasoconstrictor area vasodilator area

in vasomotor tone fin vagal area

Dilatation of blood vessel Bradycardia and reduction in

Cardiac output
Normal blood pressure
Normal blood pressure
(b) Chemoreceptor mechanism-situated in carotid boc
and aortic body. When the pressure decreases the 07
ygen content decreases which stimulate the recepte
and vasoconstrictor centre.
(c) Higher centers cerebral cortex and
-

hypothalam
stimulate the vasomotor center.
(d) Respiratory centers

PHYSIOLOGY
 CARDIOVASCULAR SYSTEM 43
2. Renal mechanism:
lin blood pressure
Jstimulation
Juxta glomerular apparatus
Renin

Angiotensinogen angiotensin 1
LACE
Angiotensin 11 >angiotensin 111angiotensin 1V

Vasoconstriction adrenal cortex

Normal BP aldosterone

Kidneys
Reabsorption of water and sodium
Increase in ECF volume

Increase in blood volume

Normal BP
3. Hormonal regulation: Hormones which increase the pres-
sure.

adrenaline
noradrenaline
thyroxine
aldosterone
vasopressin
angiotensin
serotonin

PHYSIOLOGY
 44| CARDIOVAScULARSySTEM
Hormones which decrease the pressure
Vasoactive intestinal polypeptide
Bradykinin
Prostaglandin
.Histamine
Acetylcholine
Atrial natriuretic peptide
Brain natriuretic peptide
Ctype natriuretic peptide
4. Local mechanism:
Local vasoconstrictors are endothelins produced by stretch-
ing of blood vessels.
Local vasodilators of metabolic origin are carbondioxide,
lactate, adenosine . nitric oxide is endothelium derived va-
sodilator factor.
Q. Cardiac cycle. Mar. 2009, Dec. 2000

ANSWER
Defination : the sequence of coordinated events which
take place during heart beat. It includes -

Systole: Contraction of cardiac muscle and pumping ot

blood through arteries
Diastole: Relaxation of cardiac muscle and filling of blood
Duration = 0.27+0.53 0.8 sec

Events
1. Atrial systole: Last phase of ventricular diastole. Durin5
this 10% of blood is forced from atria into ventricle.
2. Isometric contraction period: Type of muscular con
traction characterised by increase in tension without ay
change in the length of muscle fibres.

PHYSIOLOGY
 CARDIOVASCULAR SYSTEM 45
3. Ejection period :It includes 2 stages
(a) Rapid ejection: Immediately after opening of semi-
lunar valves large amount of blood is ejected from
ventricles.

(b) Slow ejection

4. Protodiastole: it is the end of systole and beginning of dias-
tole. The pressure in aorta and pulmonary artery increases
and pressure in ventricles drops.
5. Isometric relaxation period: Muscular relaxation char-
ecterised by decrease in tension without change in length
of ventricular muscle fibres. All the valves are closed dur-
ing this and ventricular pressure decreases.
6. Rapid filling phase: AV valves open and the blood flows
from atria to ventricles.
7. Slow filling phase/diastasis: Pressure changes during car-
diac cycle:
Area Maximum pressure Minimum pressure
Left atrium 7-8 mm hg 0-2 mm hg
Right atrium 5-6 mm hg 0-2 mm hhg
|Left ventricle 120 mm hg 5 mm hg
Right ventricle 25 mm hg 2-3 mm hhg
Systemic aorta 120 mm hg_ 80 mm hg
Pulmonary artery 25 mm hg 7-8 mm hg

Q. Factors regulating the action of Heart. March 2009

ANSWER
The actions of the heart are classified into four types.
1. Chronotropic Action: Is the frequency of heartbeat or heart
rate.
2. Intropic Action: Force of contraction of heart is called ino-
tropic action. It is of two types.
PHYSIOLOGY
 46| cARDIOVAscuLAR SySTEM
Positive inotropic action or increase in the force of
contrac-
tion
Negative inotropic action or decrease in the force of con-
traction.
3. Dromotropic Action: Is the conduction of
heart. It is two types. impulse through
Positive Dromotropic action or increase in the
conduction velocity of
Negative Dromotropic action or decrease in the velocity of
conduction
4.
Bathmotropic Action: Is the excitability of cardiac muscle.
It is also of two
types.
Positive Bathmotropic action or increase in the excitability
of cardiac muscle
Negative Bathmotropic action or the decrease in the excit-
ability of cardiac muscle.
Regulation of actions of the heart
All the of the heart are
tial for the heart to copecontinuously
with
regulated. It is essen
the needs of the
up body. All
the actions are altered
by
the stimulation of nerves supply-
ing the heart or some hormones or hormonal
secreted in the body. substances
Q. Cardiac output. Oct. 2008, May 2008, April 2005

ANSWER
Cardiac output is
expressed in three ways:
1. Stroke Volume: Is defined as the
amount of blood
out by each ventricle during each beat. pumped
Normal value: 70 mL
(60-80) when the heart rate is norma
(72/minute).
2. Minute Volume: Is amount of
ventricle in one minute. It is blood pumped out by ea
and heart rate the product of stroke volune
PHYSIOLOGY
 CARDIVASCULAR SYSTEM47
Minute volume = Stroke volume x Heart rate

Normal value: 5 liters/ ventricle/minutes.

3. Cardiac Index: Is the minute volume expressed in rela-
tion to square meter of body surface area. It is defined as
the amount ot blood out per
pumped ventricle/minute/
square meter of the body surface area.

Normal value: In an adult, with average body surface area

of 1.734 square meter and normal minute volume surface
area/minute.
Ejection Fraction: Is the fraction of end diastolic volume
that is ejected out by each ventricle. Normally, it is 60-65%.
Cardiac Reserve: is the maximum amount of blood that
can be pumped out by the heart above normal value. Car-
diac reserve plays important role in increasing the essen-
tial to withstand the stress of exercise.
Cardiac reserve is usually expressed in percentage. In nor-
mal young healthy adult, the cardiac reserve is 300-400%.
In old age it is about 200-250%. It increases to 500-600%
in athletes. In cardiac diseases, the cardiac reserve is mini-
mum or nil.

VARIATIONS IN CARDIAC OUTPUT:

Physiological:
Age: In children, cardiac output is less because of less blood
volume. The cardiac index is more than in adults because
of less body surface area.
Sex: In females, cardiac output is less. Cardiac index is
more than in males, because of less body surface area.

Body build: Greater the body build, more is the cardiac

output.
Diurnal variation: Cardiac output is low in early morning
and increases in day time. It depends upon the basal condi-
tions of the individuals.
PHYSIOLOGY
 48 CARDIOVASCULAR SYSTEM
Environmental Temperature: Moderate changes in tem
perature doe» .ot affect cardiac output. Increase in tem
perature above 300°C raises cardiac output.
Emotional conditions: Anxiety, apprehension and excite
ment increase cardiac output about 50-100% through the
release of catecholaomines which increase the heart rate
and force of contractions.
After meals: During the first one hour after taking meals
cardiac output increases.
Exercise: Cardiac output increases during exercise because
of increase in heart rate and force of contraction. Howeve
it depends upon the severity of exercise.
High altitude: In high altitude, the cardiac output increases
because of increase in secretion of adrenaline. Adrenaline
secretion is stimulated by hypoxia (lack of oxygen).
Posture: While changing from recumbent to upright posi
tion, the cardiac output decreases.
Pregnancy: During the later months of pregnancy, cardiac
output increases by 40%.
Sleep: Cardiac output is slightly decreased or unaltered
during sleep.
Pathological Variations:
Cardiac output increases in the following conditions:
Fever: Due to increased oxidative processes
Anemia: Due to hypoxia
Hyperthyroidism: Due to increased basal metabolic rate
Cardiac output decreases in the following conditions:
Hypothyroidism: Due to decreased basal metabolic rate
Atrial fibrillation: Because of
incomplete filling
Incomplete heart block with coronary sclerosis or my o c a r

dial degeneration: Due to defective pumping

PHYSIOLOGY
 CARDIOVASCULAR SYSTEM49
Congestive cardiac failure: Because of weak contractions
of heart
Shock: Due to poor pumping and circulation
Hemorrhage: Because of decreased blood volume.
FACTORS MAINTAINING CARDIAC OUTPUT:
1. Venous Return: Is the amount of blood, which is returned
to the heart from different
parts of the body. cardiac out-
put is directly proportional to venous return provided the
other factors (force of contraction, heart rate and
eral resistance) remain constant.
periph-
Venus return in turn depends upon five factors.
(a) Respiratory: Pump is the respiratory activity that
helps of the blood back to heart
return
during inspi-
ration also called abdominothoracic
pump. During
inspiration, thoracic cavity expands and makes the
intrathoracic pressure more negative. It increases
the diameter of inferior vena cava
resulting in in-
creased venous return. At the same time, descent of
diaphragm increases the intra-abdominal pressure
which compresses abdominal veins and pushes the
blood upward towards the heart and hereby the ve-
nous return is increased.Respiratory pump is much
stronger in forced respiration and in severe muscular
exercise.
(b) Muscle pump: Is the muscular activity that helps re
turn of the blood back to heart. During muscular ac-
tivities, the veins are compressed or squeezed. Due to
the presence of valves in veins, during compression
the blood is moved towards the heart. When muscu-
lar activity increases the venous return is more
When the skeletal muscles contract the veins locat-
ed in between the muscles is compressed. The valve
of the vein proximal to the contracting muscles is
opened and the blood is propelled towards the heart.
PHYSIOLOGY
50 cARDIOVASCULARSysTEM
The valve of the vein distal to the muscles is closed
by the back flow of blood.
During the relaxation of the muscles, the valve proxi.
mal to the muscles closes and prevents the back flow
of the blood. And the valve distal to the muscles
opens and allows the blood to flow upwards.
(c) Gravity: Gravitational force reduces the venous re
turn. When a person stands for a long period, gravity
causes pooling of blood in the legs, which is called
venous pooling. Because of venous pooling, the
amount of blood returning to heart decreases.
(e) Venous Pressure: Venous pressure also affects the
venous return. The pressure in the venules is 12-18
mm. Hg. In the smaller and larger veins, the pressure
gradually decreases. In the great veins, i.e. inferior
vena cava and superior vena cava, the pressure fals
to about 5.5 mm Hg. At the junction of vena cave and
right atrium, it is about 4.6 mm Hg.
The pressure in the right atrium is still low and it alters
during cardiac action. It falls to zero during atrial dias-
tole. This pressure gradient at every part of venous free
helps as a driving force for venous return.
( Sympathetic Tone: The venous return is aided by sym-
pathetic or vasomotor tone also. The sympathetic
tone takes blood towards heart.
2. Force of Contraction: The cardiac output is directly pro-|
portional to the force of contraction provided the other
three factors remain constant. Force of contraction depends
upon diastolic period and ventricular filling.
According to Frank-Starling law, the force of contractiono
heart is directly proportional to the initial length of muscle
fibers before the onset of contraction.
The force of contraction also depends upon preload and
after load.
PHYSIOLOGY
 CARDIOVASCULAR SYSTEM| 51
3. Heart Rate: Cardiac output is directly proportional to heart
rate provided the other three factors remain constant. Mod-
erate change is heart rate does not alter the cardiac out-
put.
4. Peripheral Resistance: Peripheral resistance is the resis-
tance offered to blood flow at the peripheral blood vessels.
Against which the heart has to pump the blood. The car-
diac output is inversely proportional to peripheral resis-
tance.

The resistance is offered at arterioles called resistant ves-

sels. In the body the maximum peripheral resistance is of-
fered at the splanchnic region.
Measurement of Cardiac Output:
Cardiac output is measured by direct methods and indirect
methods. Direct methods are used only in animals. Indirect
methods are used both in animals and human beings.
By Direct Methods: Direct methods which are used to
measure cardiac output in animals are:
1. By using cardiometer
2. By using flowmeter
Mechanical flowmeter
Electromagnetic flowmeter
Ultrasonic Doppler Flowmeter
Disadvantages of Direct methods
The blood vessel has to be cut open at the risk of anima>'s
life
While using cardiometer, the size of the cardiometer must
be suitable for the size of the heart

While using mechanical flowmeter, diameter of inlet and

the outlet of the flowmeter must be equivalent to the diam-
eter of the blood vessel.

PHYSIOLOGY
 52 CARDIOVAscULAR sySTEM
of cardiac output by methods:
indirect
Measurement
methods. Along with mea
invasive and n o n invasive
has
surement of cardiac output,
the methods provide other he
the structure and movements
modynamic data and about
heart.
of valves and chambers of the
Noninvasive Methods: Invasive method re
Invasive and
invasion or penetration
fers to procedure which involves
a
the body by meang
of healthy tissues, organs or part of
or catheterization
perforation, puncture, incision, injection
Noninvasive method means the procedure
that does not
involve invasion or penetration of tissues, organs or par

of the body
Different Indirect methods

By Fick's principle
Indicator (dye) dilution technique

Thermo dilution technique

Ultrasonic Doppler transducer technique

Doppler echocardiography
Ballostocardiographt.
Q. Electrocardiogram. Oct. 2006, April 200

Q. P-R interval. Oct. 200

ANSWER
Electrocardiogram is the record or graphical registrau
ation

of electrical activities of the o the

heart, which occur prior
onset of mechanical
activities. It is the summed elecctrica
activity of all the cardiac
surface of the body.
muscle fibers recorded tron t
PHYSIOLOGY -
 CARDIoVASCULAR SYSTEM 53
Uses of ECG:
ECG is useful determining and diagnosing the following.
Heart rate
Heart rhythm
Abnormal electrical conduction
Poor blood flow to heat muscle (ischemia)
Heart attack
Coronary artery disease
Hypertrophy of heartchambers.
Waves of normal ECG:

Wave/segment From-To Duration Amplitude

Cause
(second) (mv)
(P wave Atrial depolari- 0.1 0.1-0.12
zation
QRS complex Onset of 'Q Ventricular 0.08-0.10 Q 0.1-0.2 |
wave to he depolarization R 1
end of 'S5 S 0.4
wave
T wave Ventricular repo- 0.2 0.3
larization
'P-'R' interval Onset of P Atrial depolari- 0.18 (0.12-0-2)
wave to Onset |zation and Con-
of 'Qwave duction through
AV Node
9-T interval Onset of 'QElectrical activity 0.4-0.42
wave and end lin ventricles
of 'T wave
'S'T segment End of "S Isoelectric 0.08
wave and
Onset of 'T
wave

- PHYSIoLOGY
 54 CARDIOVAscULARsySTEM
Q. Heart Rate. Nov. 199

ANSWER
Normal rate - 72/min( 60-80)

which includes
Regulation by nervous mechanism
-

1. Vasomotor center-cardiaccenter: situated in reticularfor

mation of medulla and pons.it has other areas as
(a) Vasoconstrictor area- it increases the rate and con
trolled by hypothalamus ,cerebral cortex.
(b) Vasodilator area- it decreases the rate and controled
by hypothalamus ,cerebral cortex
() Sensory area- it controls the above areas.
2. Motor nerve fibres to heart :they include
(a) Parasympathetic fibres - via vagus and are cardioin
hibitory.
(6) Sympathetic fibres from upper thoracic region od
spinal cord and are cardioaccelerator.
3. Sensory nerve fibres to heart pass via inferior cervica
sympathetic nerve which carry the sensations from heart
to brain.

Applied Physiology:
Tachycardia - increase in heart rate - children, exercise, fe

ver,anemia, hypoxia, hyperthyroidism,valvular problems

of heart
Bradycardia - decrease in heart rate - sleep, hypothyroid

ism, heart attack, obstructivejaundice, drugs.

Q. Describe the physiological basis for the cardio
respiratory changes during exercise.
Oct. 2008, April 2007, April 2004, Nov. 2003, May 199
ANSWER:
Pulmonary ventilation is the amount of air that enters an
leaves the lungs in one minute. It is the product of tid
PHYSIOLOGY
 CARDIOVASCULAR SYSTEM 55
volume and respiratory rate. It is the about 6 liters/ minute
with a normal tidal volume of 500mL and the respiratory
rate of 12/minute.

During exercise, hyperventilation, which includes increase

in rate and force of respiration occurs. In moderate exer-
cise, respiratory rate increases to about 30/minute and
tidal volume increases about 2000mL. Thus, the palmary
ventilation increases to about 60 liters/ minute during
moderate exercise. In severe muscular exercise, it rises still1
further up to 100 liters/ minute.
Various factors are involved in increasing the pulmonary
ventilation during exercise.
1. Higher centers
2. Chemoreceptor's
3. Proprioceptors
4. Body temperature
5. Acidosis.
1. Higher centers:
The rate and depth of respiration increase during the on-
set of exercise, sometimes, before starting the exercise, the
thought or anticipation of exercise itself increases the rate
and force of respiration. It is a
psychic phenomenon due to
the activation of higher center like
tor cortex of brain.
Sylvian cortex and mo-
The higher centers in turn accelerate the
cesses
respiratory pro-
by stimulating respiratory centers.
2. Chemoreceptor's:
The
chemoreceptor's
which are stimulated by exercise in-
duced hypoxia and hyper apnea, send impulses to the re
spiratory centers. The respiratory centers in turn increase
the rate and force of
respiration.
PHYSIOLOGY
 56 CARDIOVAscULAR SySTEM

3. Proprioceptors:
Proprioceptors, which are activated during exercise, send
cortex through the
somatic afferent
impulses to cerebral
nerves. Cerebral cortex
in turn c a u s e s hyperventilation by
respiratory centers.
sending impulses to the medullary
4. Body temperature:
muscular activity,
Body temperature, which increases by
increases the ventilation by stimulating the respiratory
centers.

5. Acidosis:
stimulates the
developed during exercise also
re-
Acidosis
spiratory centers resulting in hyperventilation
Diffusing Capacity For Oxygen:
During exercise, blood flow through the pulmonary capil-
laries is increased. Because of this the diffusing capacity ot
alveoli for oxygen is increased. The diffusing capacity for
oxygen is about 21mL/minute at resting condition. It rises
to 45-50mL. Minute during moderate exercise.
Consumption of Oxgyen:
The oxygen consumed by the tissues, particularly the skel-
etal muscles is greatly enhanced during exercise because
of vasodilatation the amount of oxygen utilized by the
muscles is directly proportional to the amount of oxygen
available.

PHYSIOLOGY