Cardiovascular System Physiology

Cardiovascular System
Physiology
Exercise Physiology - Day 04
Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

Learning Objectives
 Describe what constitutes the cardiovascular

system.
 Identify the functions of the cardiovascular
system.
 Explain how electrical excitation is spread
through the conduction system of the heart.
 Describe the factors that give rise to cardiac
output, particularly the variables that give rise
to what constitutes stroke volume.
Learning Objectives
 What is maximal oxygen uptake?

 What is the significance of a high cardiac
output of VO max? 2
 In what way does double product allow for an

estimate of myocardial oxygen consumption?
 Describe the vascular system from the aorta
to the muscle fiber.
 What are the factors that limit VO max? 2

Learning Objectives
 Identify the physiologic differences between

the parasympathetic and sympathetic
nervous systems.
 How do the coronary arteries differ from each
other in regard to blood flow to different parts
of the heart?

Learning Objectives
 Describe the effect of ventricular systole, the

training effect on submaximal exercise
coronary blood flow, and myocardial
adaptations.

Cardiovascular System
 Roles:
 It regulates body temperature.
 It removes excess heat through sweat, monitors
pH and water equilibrium.
 It distributes oxygen and nutrients to different
parts of the body.

Components of the Cardiovascular System
 Heart
 Enclosed in a fibrous sac called the pericardium
 Consists of four chambers with right and left
atrioventricular (AV) valves
 The AV valves allow blood to flow from the atria to
the ventricles but prevent flow in the opposite
direction.
 Ventricles:
 Outer layer is called the epicardium

 Middle layer is the muscular part of the ventricles called

the myocardium
 Inner layer is the endocardium

 The volume of blood in each ventricle at the end of

diastole (relaxation) is called the end-diastolic
volume (EDV), which averages about 130 mL at rest.
 The volume of blood left in the ventricles after
ventricular systole (contraction) is the end-systolic
volume (ESV), which is in this case 58 mL.
 During the transition from rest to exercise,
sympathetic postganglionic fibers release
noradrenaline to increase HR by increasing
the firing rate of the sinoatrial node.
 Noradrenaline also increases the conduction

velocity in the atria, the atrioventricular node,
and the Purkinje system.


 Arteries, Capillaries,
and Veins
 The systemic circuit
consists of nearly
60,000 miles of
arteries, arterioles,
capillaries, and veins.

 Responsible for the

delivery of O to the
2
periphery and the

removal of CO from the 2
periphery to the lungs

 The blood leaves the
left ventricle by way of
the aorta, which divides
into the left and right
subclavian arteries.

 The smallest arteries are called arterioles.

 The arterioles branch into smaller vessels called
metarterioles, giving rise to capillaries.
 Metarterioles are short vessels that link arterioles
and venules.
 Capillary bed: Microscopic blood vessels that
allow for blood and tissue gas exchange between
the arterioles and venules.

 Precapillary sphincters: Circular muscle that

when contracted closes off the flow of blood to
tissues. When the muscle is relaxed, it allows
blood to pass through to the tissues.

Coronary Arteries
 Myocardium is a muscle that requires a constant

blood flow and oxygen to maintain its cellular
integrity.
 About 33% of all deaths in the Western world
result from coronary artery disease.
 Coronary blood flow is the flow of blood through
the epicardial arteries to the myocardium.
 The major vessels of the coronary circulation are the left
main coronary artery, which divides into left anterior
descending and circumflex branches, and the right main
coronary artery.
Coronary Arteries
 The overall function of the heart depends upon its blood

flow and the degree to which it can increase the flow
under different metabolic conditions.

Coronary Arteries
 Coronary blood flow

 Right coronary artery
is an artery that arises
from the right aortic
sinus that supplies the
right side of the heart.
 Left coronary artery is
an artery that arises
from the left aortic
sinus that supplies the
left side of the heart.
Coronary Arteries
 Each cycle begins by

the spontaneous
generation of an
action potential in the
SA node.
 The action potential
travels through the
atria and to the AV
node.

Coronary Arteries
 The impulse
continues to the
bundle of His, to the
Purkinje fibers

Coronary Arteries
 Matching of Coronary Blood Flow to Cardiac

O2 Demand
 Compared to skeletal muscle, about 40% of the
cell volume of cardiac muscle cells is made up of
mitochondria.
 The lower the HR at rest and during exercise, the
more efficient the heart.

Coronary Arteries
 Sympathetic nervous system: The part of the

autonomic nervous system that is responsible for
increasing heart rate and ventricular contraction
among other physiological responses.

Calculating the Work of the Heart
 The oxygen consumption of the myocardium

at rest is higher than that in the resting
skeletal muscle
 It is critical that with mental and/or physical
stress (particularly during exercise), the CBF
can increase to ensure that more O is 2
available to the myocardium.

 Myocardial Oxygen Consumption

 It is the volume of oxygen used by the heart.
 It can be estimated by knowing the subject’s double product (i.e., heart
rate × systolic blood pressure).

 It is determined primarily by the intramyocardial

tension, contractile state of the myocardium, and
HR.
 Fick principle: A principle used to calculate
cardiac output as the quotient of total body
oxygen consumption divided by the difference in
oxygen content of the arterial blood and the mixed
venous blood.

 Regulation of Heart Rate and Stroke Volume

 The sinoatrial (SA) node is the pacemaker of the
heart
 An action potential is initiated in the SA node, it
spreads throughout the atria chambers
 This occurs about 70 times per minute.
 The heart is innervated by the two divisions of the
autonomic nervous system (ANS)

 Bradycardia is a decrease in heart rate as

evidenced by a slowing of the pulse rate to less
than 60 beats⋅min -1 or less.
 When there is a need for more O2 at the
tissues, HR is increased.
 The increase in HR is accomplished by the
sympathetic nervous system and its influence
on the SA and AV nodes.

 Pulse pressure: The pressure difference

between systolic blood pressure and diastolic
blood pressure.
 The activity of the PsNS and SNS is
coordinated by the cardiovascular center in
the ventrolateral medulla of the brain stem.
 Under conditions of stress, the center will increase
the activity of the SNS to ensure that the increase
in HR is sufficient to meet the metabolic demands
of the tissues.
 Frank-Starling law of the heart: It states that the

stroke volume of the heart increases in response
to an increase in the volume of blood filling the
heart.


Cardiovascular Training Effects
 Rest and submaximal and maximal exercise

 Aerobic exercise increases parasympathetic
activity and decreases the intrinsic rate of the SA
node.
 This adaptation is partly the reason for the lower HR at
rest and during submaximal exercise.
 Endurance athletes create a cardiovascular
difference between the trained subjects and the
nontrained subjects.

Cardiovascular Training Effects
 The primary difference between the trained subject and

the sedentary subject is the volume of blood pumped
per heartbeat.
 Partial pressure of oxygen: The pressure of
oxygen dissolved in the blood and how well
oxygen is able to move from the airspace of the
lungs and into the blood.

 Distribution of Cardiac Output

 At Rest
 A large percentage of cardiac output is distributed to the
digestive tract:
 To pick up nutrient supplies
 To the kidneys to eliminate metabolic wastes and adjust
water and electrolyte composition
 To the skin to eliminate heat
 The greater the level of activity, the higher the blood flow

 During Submaximal Exercise

 The changes in specific chemicals within each organ
help to define the magnitude and distribution of the Q
during exercise.
 Active hyperemia is the increase in blood flow that is
associated with the increase in metabolic activity of an
organ or tissue.

 Regular exercise results in peripheral vascular

adaptations that enhance perfusion.
 Type I fibers are the fibers that contain a large
quantity of oxidative enzymes.
 Electron transport system: Most of the ATP made in
the body comes from cellular respiration (i.e., a
series of oxidation–reduction reactions) in the
mitochondria.
 At maximal exercise, the larger blood flow to the Q
or blood flow to the active tissues is important to
increase extraction of oxygen.
Cardiovascular Perspective of VO2 max
 Being able to determine a client’s functional

capacity is an important part of the exercise
physiologist’s standards of professional
practice.
 Measuring VO max requires an all-out
2
mental and physical eff ort in accordance with

a strict exercise protocol that is usually
carried out on a treadmill or cycle ergometer.

 The exercise protocol involves a specific

increase in the intensity of the exercise while
VO2 is being measured.
 With each change in intensity, the increase in
VO is evaluated in terms of its linear relation
2
to the functional dynamics of the

cardiovascular system.

 Close to the end of the exercise test, there is

a point at which the VO begins to plateau 2
even if the exercise intensity is increased.

 This plateau identifies the maximal aerobic
capacity ( VO2 max) of the subject.

 VO max
2
 Maximal aerobic capacity is the highest rate of

oxygen consumption by the body during
exhausting aerobic exercise.
 At the tissue level, VO2 max refers to the
consumption of O2 by mitochondrial respiration
within the skeletal muscle fibers per unit of time.
 Another way of thinking about VO2 max is the
“power” to increase capacity to deliver more O2
per unit of time.
 The Oxygen transport system is designed to

transport oxygen from the lungs to the cellular
tissues.

 Preload is the volume of blood that stretches the

ventricular myocardium just before ventricular
contraction.
 Ejection fraction: Measurement of how much
blood is pumped out of the left ventricle of the
heart (the main pumping chamber) with each
contraction.

 Efficiency of the Heart

 The individual with a resting HR that is 10
beats⋅min lower than that before training
−1
demonstrates an increase in myocardial

efficiency.
 VO2 rest or during submaximal exercise remains
essentially unchanged or is decreased slightly
after training.
 The changes in VO2 mirror the changes in Q and
vice versa.
 Should there be a slight decrease in Q at rest or

during submaximal exercise, there should also be
a compensatory increase in a-vo diff (particularly 2
should VO2 remain essentially constant).

 The increased mitochondrial content and
respiratory capacity of the muscle fibers is
attributable to the body’s ability to perform at
increasingly higher percentages of VO2 max.

 Understanding What Limits VO max 2
 Central model
 The central model for understanding what limits VO 2 max
depends on maximum Q and maximum arterial O2
content.
 Arterial O2 content: The product of hemoglobin level in g
per 100 mL of blood, percent oxyhemoglobin saturation of
arterial blood, and Pao2 is arterial partial pressure of
oxygen.
 Arterial O2 content times Q equals the delivery of O 2 (Do2).
Using 5 L⋅min−1 as the resting Q, DO2 would be 985
mL⋅min−1.
 Hemoconcentration is the decrease in plasma volume

that results in an increase in the concentration of red
blood cells in the blood.

Cardiovascular System Physiology

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Cardiovascular System

Exercise Physiology - Day 04

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Describe what constitutes the cardiovascular

 What is maximal oxygen uptake?

 In what way does double product allow for an

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Identify the physiologic differences between

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Describe the effect of ventricular systole, the

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Middle layer is the muscular part of the ventricles called

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 The volume of blood in each ventricle at the end of

 Noradrenaline also increases the conduction

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Responsible for the

periphery and the

periphery to the lungs

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 The smallest arteries are called arterioles.

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Precapillary sphincters: Circular muscle that

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Myocardium is a muscle that requires a constant

 The overall function of the heart depends upon its blood

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Coronary blood flow

 Each cycle begins by

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Matching of Coronary Blood Flow to Cardiac

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Sympathetic nervous system: The part of the

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 The oxygen consumption of the myocardium

available to the myocardium.

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Myocardial Oxygen Consumption

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 It is determined primarily by the intramyocardial

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Regulation of Heart Rate and Stroke Volume

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Bradycardia is a decrease in heart rate as

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Pulse pressure: The pressure difference

 Frank-Starling law of the heart: It states that the

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Rest and submaximal and maximal exercise

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 The primary difference between the trained subject and

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Distribution of Cardiac Output

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 During Submaximal Exercise

Copyright©2015 by National Academy of Sports Medicine, an Ascend Learning Company

 Regular exercise results in peripheral vascular

 Being able to determine a client’s functional