Cardiovascular Physiology

Dr. Nicole Burns

February 14, 2013
The Heart
Aorta
Superior vena cava
Pulmonary veins
Right atrium
Right ventricle
Inferior vena cava
Pulmonary artery
Pulmonary veins
Left atrium
Left ventricle
Interventricular septum
Sherwood Fig. 9-4a, p. 303
The Heart Wall
Endocardium (inner)
Layer of endothelial cells
Myocardium (middle)
Cardiac muscle
Epicardium (outer)
Pericardium
Double-walled membranous sac
Cardiac Muscle (myocardium)
Aerobic muscle
99% contractile cells
1% autorhythmicity cells
Self-excitate
Intercalated discs
Anatomy of
conduction
system
Sinoatrial
(SA) node
Internodal
pathway
Right
branch
of bundle
of His
Right
ventricle
Purkinje
fibers
Left
branch
of bundle
of His
Atrioventricular
(AV) node
Interatrial
pathway
Sherwood Fig. 9-8, p. 306
Atrioventricular
(AV) bundle
Pacemaker cells
All cardiac pacemaker cells display a
spontaneous electrical rhythm
Rate is dependent on location within the heart and
speed of the membrane potential drift to threshold
Sinoatrial (SA) node
Cardiac pacemaker
Intrinsic rate of 80-100 A.P./min
Conduction speed of 0.05m/sec

Atrioventricular (AV) node
Intrinsic rate of 40-60 A.P./min
Conduction speed of 0.05m/sec
Bundle of His
Intrinsic rate of 20-40 A.P./min
Conduction speed of 1m/sec

Purkinje fibres
Intrinsic rate of 15-40 A.P./min
Conduction speed of 4m/sec
Electrical Activity in Pacemaker Cell
Autorhythmic cells are leaky to Na+ and therefore have a unstable
membrane potential
Pacemaker potential- membrane potential drifts towards threshold
Initiates action potential and ultimately cardiac contraction
Electrical Activity in Contractile
Cells
Contractile cells have a stable membrane potential and require
an electrical stimulus from the autorhythmic cells to contract
Excitation-Contraction Coupling
Electrical Activity in Contractile Cells
Refractory period means tetanus of
cardiac muscle is impossible.
Cardiac contractile cells APs exhibit a
prolonged plateau phase
accompanied by a prolonged period
of contraction.
Summary: An effective heart
All achieved by the electrical properties of the cardiac muscle
Regular contractions at appropriate rate for metabolism (ANS control)
Guaranteed time for ventricular filling after atrial and ventricular contractions
(refractory period)
Contraction duration long enough for physical movement of fluid (plateau phase)
Contractile strength sufficient to generate appropriate pressures (plateau phase)
Ventricular pressure directed towards exit valves (intrinsic conduction system)
Coordination of left & right, and atrial & ventricular contractions (intrinsic conduction
system)
Matched volume of emptying and filling (intrinsic conduction system)
Electrocardiogram
Recording of the surface electrical activity of
the heart from electrodes placed on skin
Body fluids are conductors
Non-invasive
Comparison of voltages detected by electrodes
at two points
Reflects the cardiac cycle
SUM of activity in ALL cardiac muscle
Exact pattern of activity depends on orientation of
electrodes
The ECG
Waves reflect
depolarization and
repolarization events
Baseline reflects when
there is no overall
depolarization or
repolarization
Occurs when muscle is at
rest, and during sustained
contraction
Spread of depolarization
General direction of
spread of depolarization
Cardiac Vector
(normally between -10
o
and +100
o
)
0
o
180
o
ECG Timing
P wave
80-100ms

PR interval
120-200ms

QRS Complex
80-120ms

ST segment
70-80ms

T wave
~200ms
RR interval reflects entire duration of each heart beat
Clinical ECG
1 horizontal box= .2s (small box 0.04s), 5 boxes = 1sec
10 small division upward or downward= 1millivolt
http://library.med.utah.edu/kw/ecg/image_index/index.html
Assessment of
orientation of the
heart
Localisation of areas
that do not conduct
electrical activity
normally
Assessment of
myocardial
hypertrophy or
atrophy
Accurate
measurement of
heart rate (60/RR
interval)
Respiratory Sinus Arrhythmia
Marquette Electronics Copyright 1996
http://library.med.utah.edu/kw/ecg/image_index/index.html
Normal

HR with inspiration

HR with expiration

Expressed more in
young and fit
Bradycardia & Tachycardia
Bradycardia !60bts/min
Chronic exercise training
Vagal stimulation
Tachycardia " 100 bts/min
Increased body
temperatures
Sympathetic stimulation
Exercise
Breakdown of SA node pacemaker
authority
Impulse from SA node is blocked before it enters atria
Latent pacemakers pick up authority
No/small p-waves clue: Atrial fibrillation
Heart block
1
st
degree: delay in
conduction, prolonged P-R
interval >0.2s, QRS same
2
nd
degree: incomplete
heart block, P-R interval
between .25-.45sec, atria
beating faster than
ventricles- dropped beats
Compete AV block: P-wave
regular frequency
completely unrelated to
ventricular firing,
Ventricular QRS followed
by T wave normal.
Breakdown of ventricular
coupling or refractory period
Breakdown of left/right
ventricular coupling-
Same mechanisms that cause
AV block
QRS may be considerable
abnormal
Breakdown of refractory safety
period
Hypertrophy can cause different
refractory periods in epicardium &
endocardium
(Ectopic beats)
Left Ventricular Hypertrophy
High blood pressure

In exercise-
adaptation to
increased preload/
afterload

Enhances pumping
capacity
http://library.med.utah.edu/kw/ecg/image_index/index.html
Exercise Hyperkalaemia
Elevated potassium-
speeds recovery of
action potentials

Often seen in athletes
http://library.med.utah.edu/kw/ecg/image_index/index.html
Summary: ECG

An ECG tracing records the electrical activity
of the heart
Waves reflect depolarization and repolarization events
Intervals reflect timing
Both have diagnostic value