RBM1528 Human

Physiology 2

Week 1
Session 2
 Session 2 outline:

• Cardiovascular system
1. Anatomy
• Kahoot- Check out your knowledge
2. Cardiac cycle
• Activity
3. Cardiac conduction system and ECG
• Activity
https://cdn.pixabay.com/photo/2014/05/18/00/44/heart-
346715_960_720.png
Learning Objectives
1. State the major structures of the heart and the
function of each.

2. Describe the route of blood flow through the heart and

body, naming the chambers and structures the blood
passes through.

3. Name the structures that make up the conduction

system of the heart and trace the conduction pathway
in the heart.

4. Describe the cardiac cycle by relating contraction of the

chambers, pressure in the chambers, blood flow and
heart sounds.

5. Describe what event in the cardiac cycle is initiated by

each of the electrocardiogram (ECG) waves.

Image Source: https://upload.wikimedia.org/wikipedia/commons/2/27/2003_Dual_System_of_Human_Circulation.jpg

https://kahoot.it/ 10 min

Revision Anatomy of the heart!

LO1: State the major structures of the heart and the function of each.
POP-UP questions:
The Cardiovascular System - Structure the Heart
Answer on the paper provided- the first 5 answers earn “brownie
points”

1. What are the four chambers of the heart?

2. How is an atrium different from a ventricle?

3. How the bicuspid valve different from the tricuspid valve?

4. Why is the left side of the heart more muscular?

5. How is the endocardium different from the myocardium and

the pericardium?

Image Source: https://commons.wikimedia.org/wiki/File:1022_Muscle_Fibers_(small).jpg

 Activity 10 min: The Set-up of the Cardiovascular
System
TASK:
You work in a groups in breakout rooms
Use the video to answer questions below:
Watch Video: https://www.youtube.com/watch?v=7XaftdE_h60

1. What blood vessels take blood towards the heart?

2. What blood vessels take blood away from the heart?
3. What is the function of the superior and inferior vena cava?
4. Which chamber does deoxygenated blood first enter into?
5. What is the function of the right and left pulmonary arteries?
6. Which chamber does oxygenated blood first enter into?
7. Why are the pulmonary arteries and veins an exception?

Image Source: https://upload.wikimedia.org/wikipedia/commons/2/27/2003_Dual_System_of_Human_Circulation.jpg

Key Concepts: 20 min
1. Describe the route of blood flow through
the heart and body, naming the chambers
and structures the blood passes through.

2. Describe the cardiac cycle by relating:

1. contraction of the chambers,
2. pressure in the chambers,
3. heart sounds.
Cardiovascular system
Heart (cardiac muscle)
Blood vessels
◦ Arteries
◦ Veins
◦ Capillaries
◦ Lymph vessels
Blood & lymph

Function
 To deliver nutrients to the cells

 To deliver waste to the excretion units

POP UP Question:
1. In which order the two
erythrocytes will go
through the heart and
body- put numbers in
order

2. Name structures A, B C
and D
What is/What it does
• Heart is double muscle pump
• 24/7 work for 80 odd years
• Pumps between 5-35 l/min
• Has to be able to work as an unit
• Has to be resilient to fatigue
• Has to be immune to tetanic (spastic)
contraction
• Has to be able to adapt to change in
demands
• Has to be self sufficient
Cardiac muscle
• Macroscopic Structure
• Heart Fibre Orientation
• Connective tissue
• Endomysium/epimysium-
connected to a intercalated
discs
 Cardiac Muscle: microscopic
structure
Striated.
◦ short, fat, branched, one central
nucleus.
Connected in series by
intercalated discs.
The connective tissue
endomysium acts as both
tendon and insertion
Complete lattice work of
cardiac muscle is a
syncytium.
◦ Assists in the conduction of
action potentials
Marieb; Figure 18.11
The Cardiac Cycle
• One cycle is defined as the beginning of one beat to
the start of the next.
• Contraction = systole (ejection of blood)
 Atrial systole
 Ventricle systole
• Relaxation= diastole (filling)
• Atrial diastole
• Ventricle diastole
 Major Events of the Cardiac Cycle

 Atrial systole
 Isovolumetric contraction
 Ventricular ejection
 Isovolumetric relaxation
 Ventricular filling
Major Events of the Cardiac Cycle
Quiescent
period

Stroke volume: about 70 End-systolic

ml volume
End-Diastolic SV/EDV= ejection
volume (EDV) of (ESV):
fraction, (% of EDV
about 130 ml of amount left in
ejected)
blood at rest ~ 54%,to 90%, heart
diseased heart < 50%
Marieb
http://www.youtube.c
om/watch?v=kcWNjt
77uHc
3. Cardiac Auscultation
• Listening to the sounds of the heart.
• The sounds are created by vibrations due to the
closing of the heart valves.
• Different sounds are best heart in different regions
of the chest.
• Aortic Semilunar:
• Pulmonary Semilunar:
• Tricuspid Valve:
• Mitral Valve:
Guyton & Hall (2006) Fig 23-2 p 270
Atrioventricular Valve Function

Figure 18.9
Basic Heart Sounds
S1- closure of AV valves –
◦ indicates the beginning of the systole [ “LUBB”}
◦ Best heard at the apex and louder than S2
◦ One sound (despite some asynchrony in closure of tricuspid and mitral
valve)
S2 is result of the closure of the semilunar valves
◦ Indicates end of systole
◦ Higher pitch and shorter duration [ “DUBB”]
◦ S2 is actually 2 sounds in inspiration that merge in one in
expiration (often labelled as A2 and P2)
◦ Aortic valve closes First – component of A2 more prominent
◦ P2 occurs slightly later in inspiration = 2 distinctive sounds (despite
lower pressure in pulmonary circulation)
Rate of Cardiac Cycle
• Atrial systole, 0.1 sec
• Ventricular systole, 0.3 sec
• Quiescent period, 0.4 sec
• Total 0.8 sec, heart rate 75 bpm
POP-UP Questions: The Cardiac Cycle

1. What is the Cardiac Cycle?

2. What do systole and diastole refer to?

3. How is contraction and relaxation related to pressure?

4. What is the meaning of isovolumetric?

5. What is the sequence of events in relation to the

opening and closing of different heart valves?

6. What does the first heart sound S1 represent?

7. What does the second heart sound S2 represent?

Watch Video:
http://library.med.utah.edu/kw/pharm/hyper_heart1.html
Image Source: http://ib.bioninja.com.au/standard-level/topic-6-human-physiology/62-the-blood-system/cardiac-cycle.html
Circulatory
circuits
• Pulmonary
• Systemic
• Coronary
• Cerebral
• Mesenteric
• Renal
• Peripheral
Activity: 30 min
• Students work in pairs
• Use the following resources
• H5P interactive video
“Cardiovascular system Cardiac
cycle, conduction & ECG (H5P)
to complete questions from H5P
interactive “Cardiovascular system
module 2 and 3”
https://kahoot.it/ 20 min
How it does it:
• Electrical cardiac system conducts electrical
impulse to contracting muscles
• Pacemaker SA node initiated heart impulse
• AV node delays impulse entrance into ventricles
• Electrocardiogram (ECG) is a record of all action
potentials generated in heart
 Figure 18.15a Intrinsic cardiac conduction system and action potential succession during one heartbeat.

Superior vena cava Right atrium

1 The sinoatrial (SA)

node (pacemaker)
generates impulses.

Internodal
pathway
2The impulses Left atrium
pause (0.1 s) at the
atrioventricula
r (AV) node.

3The Subendocardial
atrioventricula conducting
r (AV) bundle network
connects the atria (Purkinje fibers)
to the ventricles.
4 The bundle branches
conduct the impulses Inter-
through the ventricular
interventricular septum. septum

5 The subendocardial
conducting network
depolarizes the contractile
cells of both ventricles.

Anatomy of the intrinsic conduction system showing the sequence

© 2013
of electrical excitation
Pearson
Education, Inc.
 Pacemaker SA Potential

1Pacemaker potential This slow

depolarization is due to both opening of
Na+ channels and closing of K+ channels.
Notice
that the membrane potential is never a
flat line.

+10 Action 2Depolarization The action

potential Threshold potential begins when the pacemaker
0 2 2 potential reaches threshold.
–10 Depolarization is due
3 2 3
Membrane potential

–20 2 to Ca2+ influx through Ca2+ channels.

–30 Ca helps to
2+ K+ exits cell=
generate repolarisation 3 Repolarization is due
–40 depoalrisaton
1 1
Pacemaker to Ca channels inactivating and
2+
–50 K+ channels opening. This allows K+
1 1 potential
–60 efflux, which brings the membrane
–70 Na+ leaks potential back to its most negative
voltage.
(mV)

into cell

Time (ms)
© 2013 Pearson
Figure 18.14 Pacemaker and action potentials of pacemaker cells in the heart.
Education, Inc.
 Figure 18.15 Intrinsic cardiac conduction system and action potential succession during one heartbeat.

Superior vena cava Right atrium

1 The sinoatrial (SA)

node (pacemaker)
generates impulses. Pacemaker potential

Internodal pathway

2The impulses Left atrium SA node

pause (0.1 s) at the
atrioventricular
(AV) node.
Atrial muscle
3The Subendocardial
atrioventricular conducting
(AV) bundle network
connects the atria AV node
(Purkinje fibers)
to the ventricles.
4 The bundle branches Pacemaker Ventricular
conduct the impulses Inter- potential muscle
through the ventricular
interventricular septum. septum Plateau

5 The subendocardial
conducting network
depolarizes the contractile 0 100 200 300
cells of both ventricles.
400
Anatomy of the intrinsic conduction system showing the sequence of
electrical excitation Milliseconds
Comparison of action potential shape at
various locations

© 2013 Pearson
Education, Inc.
Pacemakers

Sherwood Fig. 9-13

 POP UP Questions: The Electrical System of the Heart
.

1. What is depolarization and what is its significance?

2. What is the function of the SA node?

3. What is the function of the AV node?

4. Why can’t the atria and ventricles squeeze simultaneously?

5. Summarize the sequence of events in relation to the electrical

system of the heart.

WATCH VIDEO: https

://www.youtube.com/watch?v=RYZ4daFwMa8
Image Source: https://www.youtube.com/watch?v=7K2icszdxQc
 Electrocardiogram (ECG)
• The ECG records the electrical activity of the
heart
R

ventricular repolarisation
atrial depolarisation T
P

Q S
ventricular depolarisation
Electrocardiogram (ECG)
P wave:
• excitation (depolarization) of both atria
followed by contraction
QRS complex:
• excitation (depolarization) of both
ventricles followed by contraction;
•& relaxation (repolarization) of both atria
T wave:
• relaxation (repolarization) of both
ventricles
Electrocardiogram (ECG)

Marieb: Fig 18.17

Electrocardiogram (ECG)

Sherwood
Fig. 9-
Electrocardiogram (ECG)
• The ECG records the electrical activity of the
heart

• ECG:
• Standard limb leads
• I II III

Sherwood
Fig. 9-
POP-UP question: The Key features of an ECG

1. What is an ECG?

2. What does the P wave represent?

3. What does the QRS segment represent?

4. What does the T wave represent?

5. What does the first heart sound correspond to?

6. What does the second heart sound correspond to?

Watch Video: https://www.youtube.com/watch?v=0sogXvxxV0E

Watch Video: https://www.youtube.com/watch?v=RYZ4daFwMa8&t

Image Source: https://superscienceblogme.tumblr.com/post/131605587049/wiggers-diagram-to-use-in-my-proforma
 Activity: 30 min
• You work in groups of 4
• Role play:
• Each student takes role of one
diagram
• Ventricular volume
• Ventricular pressure
• Aortic pressure
• ECG tracing and heart sounds
• Write on A4 paper list of
events that happen during each
phase of cardiac cycle across
https://kahoot.it/ 20 min
Class summary: 5 min

https://www.youtube.com/watch?v=nSyldEm26Lo