CARDIOVASCULAR SYSTEM

MYOCARDIAL INFRACTION
 Coronary heart disease is the greatest single cause for

death in most cases in the Universe.  The most frequent cause is the myocardial infarction.  Therefore, it is important to understand the cardiovascular system thoroughly, so as to take subsequent prevention against the heart disease.  The metabolism process of the cell needs nutrients and excretes waste products; the circulatory system provides these nutrients and removes these waste products.

Function of the HEART
 HEART is the major component of Circulatory system.

 Heart supplies the power required to circulate the blood throughout the body.
 Heart—two pumps in series.

 RHS – provides the power required to force blood through the lungs.
 LHS – provides the power required to force blood

throughout body via capillaries.

Simplified block diagram of the circulatory system

HEART

Cell revitalization  The aorta curves in an arch up from the heart. branch billions of tiny capillaries. These channels are only about 10 microns in diameter. By the time blood has reached the capillaries. the digestive organs. . From these arteries branch the smaller arterioles and from these. the arms and the legs. Here the blood discharges its load of dissolved food and oxygen to the body cells. down     along the back bone and into the abdomen. from it other large arteries lead to the head. it is moving slowly along channels.

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Functional model of the cardiovascular system .

. In yielding oxygen and taking on the waste.  The venules converge into larger veins and then into the two largest veins just above and below the heart.  The blood now starts back to the heart passing from the capillaries into the venules. the blood turns colour form bright red to dull ‘red’ or “blue”. known as “venacava”. These cells in turn deposit waste materials such as carbon-di-oxide into the blood stream.

HEART .

 The lungs then supply the blood with fresh oxygen. then is pumped into the left ventricle and passes via the aorta.  This is done for repeating the circulation process.  It is pumped into the right ventricle and then moves out through the pulmonary artery to the lungs. The blood empties into right atrium. .  The blood passes form the lungs to the left atrium.

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5 L/min . The average quantity of blood in a man’s body is about five liters. This is completely circulated through the body in approximately one minute. The waste products contained in the blood are removed by the kidneys and liver. This general flow throughout the body is known as the     “systemic circulation”. the flow to and from the lungs is known as the “pulmonary circulation”.

 Its covering. consists of three layers of fibrous tissues with a small space in between.THE HEART: Anatomy  The heart is a hollow. cm long at its maximum dimension.  The heart itself weighs less than half a kilogram. muscular pump located within the mediastinum of the thorax & resting upon the diaphragm. is almost about 15  The heart lies pointed downward to the chest cavity to the left of the mid-center body line. . filled with a thin film of pericardial fluid.  The heart has a covering as well as lining. the pericardium. cone-shaped.

Septum .

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a left and right receiving chamber (atrium) and below them a left and right pumping chamber (ventricle). or dividing wall of tissue.  The entire walls of the heart are made of muscle. within these walls are four hollow chambers.THE HEART  The left and right sides of the heart are separated by the septum. .

The Heart Valves  The tricuspid valve regulates blood flow between the right atrium and right ventricle.  The aortic valve lets oxygen-rich blood pass from the left ventricle into the aorta. then to the body. .  The mitral valve lets oxygen-rich blood from your lungs pass from the left atrium into the left ventricle.  The pulmonary valve controls blood flow from the right ventricle into the pulmonary arteries.

Cardiac cycle or the Mechanical activity  It is characterized by the following events. the heart beats (or contracts) about 70 times per minute. . a quantity of blood is driven through the heart.  With a person in a sitting position.  With each beat.

 The heart’s period of mechanical activity is known as “systole”. the heart assumes its maximum size and fills with oxygenated blood returning from the lungs and venous blood returning from the body.  During diastole. the heart mechanically rests and this is known as the period of “diastole”. .SYSTOLE and DIASTOLE  Between beats.

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 This propels additional blood into the ventricles.  This increased pressure shuts two “atrioventricular” valves (Tricuspid and Bicuspid).  The ventricles then begin to contract.  With further contraction. the pressure continues to rise. thereby causing a rise in pressure within the ventricles.Cardiac cycle or the Mechanical activity  The onset of systole is initiated by contraction of the muscles surrounding the atria. .

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Electrophysiology of the cardiac muscle cell .

HEART .

 The aortic valve is forced to open.Systemic circulation  Once the pressure of the systemic and pulmonary circulations are exceeded. with a peak pressure about 120 mmHg (called the systolic pressure) and a low pressure about 80 mmHg (called the diastolic pressure). a phase of ventricular ejection is begun.  Then the blood is squeezed into aorta and thence into the ‘systemic circulation’. .  This blood flow leading in to the aorta can be considered as a wave.

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Arterial blood pressure waveform Systolic pressure Pressure (mmHg) Dicrotic notch-represents a reflected pulse due to slight back pressure built up as the mitral valve closes Diastolic pressure Time .

 As soon as these pressures fall below the pressures sustained in the circulatory systems. .  After the ventricular contents are partially ejected. the aortic and pulmonary valves close. signaling the onset of diastole. the pulmonary valve is forced open and blood is supplied to the ‘pulmonary circulation’. the muscles surrounding the ventricles relax and the ventricular pressure falls.Pulmonary circulation  Similarly.

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 The right atrium consists of a bundle of nerves known as the “Sinoartrialnode” (SA node).  Its function is to start the heart beat and set its rhythm or pace.  This type of nerve system is found nowhere else in the body. . this node is also called as “cardiac pacemaker or natural pacemeaker” and generate impulses at a normal rate of the heart. about 70bpm at rest.Electrical potentials generated with in the HEART  The muscle contraction is initiated by stimulation.

The Conduction System .

 These impulses also travel along conducting fibers in the atrium to the “Atrioventricular node” (AV Node). .  Impulses generated by the SA Node stimulate contraction of the muscles comprising the atria. The electrical and mechanical output from the heart is initiated by stimulation from this node which results in contraction of the various heart muscles. stimulating the depolarization of this node.

. and acts as a delay line to provide timing between the action of the Atria and Ventricles. which arborize in the ventricular muscle. The AV Node is located in the lower part of the heart- wall between the two atria on the septum.  Stimulation of the AV Node causes impulses to be sent to the myocardium or muscles comprising the ventricles via the “bundle of his”. two bundle branches on each of the septums and the fine “purkinje fibers”.

The Conduction System .

.  So. Thus the Atria and Ventricles are functionally linked only by the AV Node and the conduction system.  The AV delay is provided so that the atrial contraction is complete the ventricular filling before the contraction of the ventricles. the muscular contractions necessary to maintain the heart’s pumping action are initiated by depolarization and repolarization of the SA Node and then depolarization and subsequent repolarization of the AV Node.

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the atria are repolarizing.  These external potentials generated from within the heart are known as the electrocardiogram or ECG. When the ventricles are depolarizing. .  These depolarizations and repolarizations generate external action potentials which can be recorded at the surface of the body.

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 However.Heart Electrical Activity (ECG)  1)Depolarization of the SA node and a resulting contraction of the muscles surrounding the atria. for some reason. .  This potential is known as the TA wave and is rarely observed in practice. this does not generate a pronounced action potential.  This results in external action potential known as “P wave”. repolarization of the atria occurs.  2)Immediately following this depolarization.

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. Electrical activity produced by depolarization of the SA node travels through fibers within the atrium to the AV node.  The time taken for this electrical stimulation to travel form the SA node to the AV node is known as the “atrioventricular conduction time” and is typically between 120ms and 220ms.

. this node depolarizes and the depolarization is conducted down through the ‘bundle of His’ to the myocardium muscle causing “ ventricular depolarization”. the cells concerned repolarize.  Immediately following this depolarization.  The external action potential is referred to as “QRS complex”. When this stimulation reaches the AV node.  This results in ventricular repolarization or the “ T wave”.

. Many ECG waveforms also show an additional wave occurring after the “T wave”.  This is designated the “U wave” (after potentials) and its origin is unknown.

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Electrophysiology of the heart Different waveforms for each of the specialized cells .

ECG WAVEFORM .

5 mv .wave 0.25 mv 1.ECG parameters: Amplitude P-wave R-wave 0.1-0.60 mv Q-wave T-wave 25% R.

11 s QRS 0.10 s .22 s Q-T 0.12-0.35-0.15 s P-wave 0.09-0.ECG parameters: Duration P-R interval 0.44 s S-T 0.05-0.

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Detail of the QRS complex. showingventricular activation time (VAT) and amplitude .

gif .org/wiki/File:ECG_priciple_slow.http://en.wikipedia.

The PR interval reflects the time the electrical impulse takes to travel from 120 to 200ms the sinus node through the AV node and entering the ventricles. and spreads from the 80ms rightatrium to the left atrium. therefore. PR segment The PR segment connects the P wave and the QRS complex. The impulse vector is from the AV node to the bundle of His to the bundle branches and then to the Purkinje fibers.6 to 1. the main electrical vector is directed from the SA node towards the AV node.2s P wave During normal atrial depolarization. and this shows up flat on the ECG. This electrical activity does not produce a 50 to 120ms contraction directly and is merely traveling down towards the ventricles. PR interval The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. The PR interval is more clinically relevant. . The PR interval is.Feature Description The interval between an R wave and the next R wave: Normal resting heart rate is between 60 and 100 bpm. Duration RR interval 0. This turns into the P wave on the ECG. a good estimate of AV node function.

QRS complex The QRS complex reflects the rapid depolarization of the right and left ventricles. it is used to measure the degree of ST elevation or depression present. The ST segment represents the period when the ventricles are depolarized. N/A ST segment The ST segment connects the QRS complex and the T wave. They have a large muscle mass compared to the atria. 80 to 120ms . It is isoelectric. 80 to 120ms J-point The point at which the QRS complex finishes and the ST segment begins. so the QRS complex usually has a much larger amplitude than the P-wave.

The interval from the beginning of the QRS complex to the apex of the T wave is 160ms referred to as the absolute refractory period. Up to 420ms in heart rate of 60 bpm .T wave The T wave represents the repolarization (or recovery) of the ventricles. The last half of the T wave is referred to as the relative refractory period (or vulnerable period). ST interval The ST interval is measured from the J point to the end of the T wave. It varies with heart rate and for clinical relevance requires a correction for this. giving the QTc. 320ms QT interval The QT interval is measured from the beginning of the QRS complex to the end of the T wave. A prolonged QT interval is a risk factor for ventricular tachyarrhythmias and sudden death.

elevated J-point or Osborn wave appears as a late delta wave following the QRS or as a small secondary R wave.U wave The U wave is hypothesized to be caused by the repolarization of the interventricular septum. They always follow the T wave and also follow the same direction in amplitude. hypercalcemia or hyperthyroidism usually. It is considered pathognomonic of h ypothermia or hypocalcemia. If they are too prominent.[30] . They normally have a low amplitude. suspect hypokalemia. and even more often completely absent.[29] J wave The J wave.

A Wiggers diagram. showing the cardiac cycle events occuring in the left ventricle. .

wave "c" corresponds to an increase in pressure from the mitral valve bulging into the atrium after closure. waves "QRS" correspond to ventricular depolarization. .  In the electrocardiogram: wave "P" corresponds to atrial  In the phonocardiogram: The sound labeled 1st contributes to the S1 heart sound and is the reverberation of blood from the sudden closure of the mitral valve (left A-V valve) and the sound labeled "2nd" contributes to the S2 heart sound and is the reverberation of blood from the sudden closure of the aortic valve. depolarization. In the atrial pressure plot: wave "a" corresponds to atrial contraction. and wave "v" corresponds to passive atrial filling. and wave "T" corresponds to ventricular repolarization.

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