Cardiac

physiology
Dr Anam baig
Dr Sushma mutthineni
Functions of cardiovascular
system
Components of cvs
Structure and chambers of heart
 Right atrium
 Right ventricle
 Left atruim
 Left ventricle
 Av valves
 Semilunar valves
 Aorta and pulmonary
artery
Cardiac action potential
 Action potential is defined as rapid changes in the membrane potential that spreads
rapidly along the cell membrane of excitable tissue.
 Nerve signals are transmitted by action potential
 Cardiac action potential is of two types

1.SA NODAL AP- Sa node pacemaker of heart. It has ability too generate electrical
impulse[chronotropy]
It has restless membrane potential which oscillates between -60 to -40 Mv this occurs
before generation of action potential
membrane potential is the electrical potential difference accrss the plasma
membrane when the cell is in non exited statewhich is not stable here hence
restless.
2. Ventricular AP —concerned with contractiblity of heart[ ionotropy]
It is resting membrane potential of -90 mV
SA nodal action potential
Ventricular action potential
CONDUCTING
SYSTEM OF HEART
CONDUCTING SYSTEM OF
HEART
 The property of heart to conduct impulse is called DROMOTROPY
 COMPONENTS OF CONDUCTING SYSTEM-
1.SA NODE- generates impulse – firing rate 100/min
resting HR is 72/min due to vagal inhibition [parasympathic effevct]
in a person with transplanted heart [denervated heart HR is100/min
2. AV NODE- physiological delay in conduction of 0.1second to allow vent relaxation.it is
known as gatekeeper of heartlowest no. of gap junctions and slowest conduction
3.BUNDLE BRANCHES- Rt and Lt bundle branches going to respective ventricles
4-BUNDLE OF HIS
5-PURKINGE FIBRES- innervates every single ventricular myocardial cell highest no. of
gap junctions hense highest conduction speed.
CARDIAC CYCLE
CARDIAC CYCLE EVENTS
 CARDIAC CYCLE HAS 2 PHASES:
 Atrial systole- 0.1s
 Atrial diastole- 0.7s
 Ventricular systole- 0.3s
 Ventricular diastole- 0.5s
 ATRIAL SYSTOLE
 Duration 0.1sec.It is seen following the imoulse
generation in the SAN node
 Atrial muscle contracts and atrial pressure rises
with ventricular pressure following it
 It propels approximateley 30percent additional
blood into the ventricles
 VENTRICULAR systole
1. ISOVOLUMIC CONTRACTION
 Mitral valve closes
 First heart sound heard
 No change in volume
 Pressure increases
 Ends at the opening of aortic valve

2. RAPID EJECTION PHASE

 Two third of ventricular volume is ejected

3. SLOW EJECTION PHASE

 Remaining one third ofblood is ejected
 ATRIAL DIASTOLE
 Duration 0.7sec
 During this phase,atrial muscle relax and atrial
pressure gradually increases due to continuous
venous return
 VENTRICULAR DIASTOLE
1. Prodiastole
 Aortic valve closure
 Second heart sound heard

2.Isovolumic relaxtion phase

 Volume remains same as the ventricles is relaxing

3.Rapid filling phase: 80% filling happens (passive filling)

4.Slow filling phase: 80% filling happens (passive filling)
5.Filling due to atrial contraction
 Last 20% filling
 Also called atrial kick
 Ventricular filling is both active and passive.
 Slow filling phase is also called diastasis.
 STROKE VOLUME AND
EJECTION FRACTION
 STROKE vOLUME= EDV-ESV
= 120-50
=70ML

 EJECTION FRACTION= SV/EDV X 100

=70/120 X 100
EF= 55 to 65%
CARDIAC OUTPUT
 CO= Heart rate x Stroke volume
1. Heart rate is directly proportional to cardiac
output
 Parameters affecting heart rate

- Sympathetic nervous system increases HR

- Parasympathetic nervous system decreases HR
2. Stroke volume is directly
proportional to cardiac output.
 Parameters affecting stroke volume
-Increased Contractility increases the
stroke volume
-Increased afterload decreases the
stroke volume
-Increased preload increases the stroke
volume
PRESSURE VOLUME LOOP
IMPORTANCE OF PV GRAPH
 CARDIAC INDEX RATIO
Cardiac index is expressing CO per square meter of
body surface area.

 FICKS PRINCIPLE
- Amount of O2 consumption = Arteriovenous O2
difference times blood flow i.e. CO
- O2 consumption = (Arterial O2-Venous O2)X CO
WIGGERS DIAGRAM
BARORECEPTOR REFLEX
 Afferent pathway: Afferent nerve which carry impulse
from carotid sinus Ⅸ is [Glassophyrangeal] and from
aortic arch is Ⅹ [vagus].
 Center: Cardiac center is located in medulla [brain stem].
 Efferent pathway: From Cardiac center, we get Efferent
ANS, Sympathetic and Parasympathetic fibers to heart
and blood vessels.
 Effector Organ: Sympathetic causes increase heart rate
and force of contraction of heart, vasoconstriction,
therefore, increase CO and BP.
 Parasympathetic causes decrease heart rate, decrease
force of contraction of heart, therefore, decreased cardiac
output and decreased BP.
 BRADYCARDIC REFLXES
1.Bezold jarisch reflex
• Profound hypotension and bradycadia seen in
patients with myocardial infarction
• This is because infarcted tissue releases serotonin
that activates bradycardic reflex
2.Cushings reflex
• Seen in trauma patients with head injury,having
elevated intracranial tension characterised by
decrease in heart rate and bradycardia
TACHYCARDIC REFLEX
1.Bainbridge Reflex
• In patients of congestive heart failure,edema or
fluid overload seen,which ends up at the right
atrium
• The excess fluid stimulates the SA node and
increases its firing thereby increases the heart rate
NORMAL ECG WAVEFORM
ECG WAVES

late repolarisation of purkinje

fibres and papillary muscles
EINTHOVEN’S TRIANGLE
einthovn’s triangle aka limb leads
It describes the position of bipolar leads in
respective limbs it is based on enthoven’s
law – which states lead 1+ lead 3 = lead 2

LIMB LEADS
AUGMENTED LEADS
Also known as goldberger leads
3 in number aVR, aVL, Avf
Here the action potential is augmented 1.5 times
One limb acts as positive end other two acts as neg ends
SURFACE LEADS
ECG PAPER
ECG SEGMENTS
Ecg segments and intervals
 ECG SEGMENTS
LINES ORE SEGMENTS
REPRESENTING NO CURRENT
FLOW[ ISOELECTRICLINES]
There are two segments-
1.PR seg- 0.1 sec , no current flows after
the end of p wave and before onset of
QRS complex. Denotes AV nodal delay
2.ST SEG -End of QRS to before onset
of T wave . Aka J point of ventricular
depolarisation and repolarisation. Any
current flow in this segment denotes
pathological cause [MI] hence aka
injury current
 ECG INTERVALS
INTERVAL= I WAVE+ISEG
1] PR INTERVAL- denotes total atrial
activity.
2] RR INTERVAL- Betweentwo
successive R waves used to calculate heart
rate
HR=1500/no of small squares
Or 300/ no of large boxes.
3] QT- QRS Cx+ST seg +T wave
Denotes total ventricular activity. 0.4 sec.
changes according to HR.
CORRECTED QTc=QT interval/under
root of RR int
JUGULAR VENOUS PRASSURE

 JVP has 3 positive

waves a,c and v
 Two neg decents X
deScent and Y descent
 These denote the
changes in the atrial
pressure as reflects in
internal jugular vein
WAVEFORMS OF JVP AND ITS
CAUSES
THANK YOU