HEART AND CIRCULATION

Humans have a double circulation system. This is helpful in maintaining the pressure. For every one
time the blood goes around the body, it gets pumped twice.
However, we have one heart instead of two as it is more efficient and requires less energy. And also, if
we had two hearts we would have a increased risk of heart disease.
 Pressure is being lost when the blood passes through the lungs which is why a double
circulation is needed.
THE CARDIAC CYCLE
Contraction:
 Atrial Systole:
1. pressure increases in the atria
2. presure in the atria is higher than the pressure in the ventricles
3. Atrio-ventricular valve opens
4. Blood pours into the ventricles

 Ventricular Systole:
1. Pressure in the ventricles increases
2. Pressure in the ventricles is higher than that in the artia
3. Atrio-ventricular valve closes
4. Semi-lunar valve opens
5. Pressure in the ventricles is greater than in the arteries
6. Blood is forced out

Relaxation:
 Diastole
1. Blood enters the atria
2. Pressure in the atria increases
3. Ventricles relax
4. Elastic recoil of arteries
5. Pressure in arteries is greater than in the ventricles
6. Semi-Munar valves close

PASSAGE OF ELECTRICAL IMPULSES AROUND THE HEART.

Electrocardiology (ECG / EKG)

An ECG is a transthoraic (through the chest cavity) interpretation of electrical heart activity.
The ECG works by detecting tiny electrical changes on the surface of the body that are caused by the
depolarisation of the heart muscle.
 At rest, the heart muscle cells have a charge across their cell membrane.
 Reducing this charge towards zero is called depolarisation.
 Depolarisation causes the muscle to contract.
 The Sinoatrial node sends electrical impulses that cause depolarisation.
 ECG's can indicate weakness in different parts of the heart muscle.
ELECTRICAL IMPULSES ACROSS THE HEART
1. SAN initiates heartbeat / acts as a pacemaker myogenic;
2. (SAN) sends wave of electrical activity / impulses (across atria) causing atrial contraction;
3. AVN delays (electrical activity / impulses);
4. (Allowing) atria to empty before ventricles contract / ventricles to fill before they contract;
5. (AVN) sends wave of electrical activity / impulses down Bundle of His / Purkyne fibres;
6. (Causing) ventricles to contract (from base up) / ventricular systole;

CORONARY HEART DISEASE

 CHD is any condtion that interferes with the coronary arteries.

 The heart muscles requires a continuous supple of oxygen and glucose.
 The coronary arteries are supplied via the aorta.

ATHEROMA
 Fatty deposits that build up and form in arterial walls.

1. Endothelium damages - inflames - This usually happens at a junction where a smaller artery
branches off.
2. The white blood cells form a rough surface while the lipids build up beneath that surface.
3. This rough surface may age; die; then break down, causing platelets to stick to that damaged
surface.
4. The platelets cause the blood to clot. This condition is called THROMBOSIS.
5. The blood clot may grow and cause the lumen to become blocked and stop blood flow to the
heart --> HEART ATTACK.

COMPLICATIONS:
a. Bits of the clot may break away and get stuck in some of the smaller aterioles where they cut off
the blood supply to small secions of the heart muscle.
b. The artery may be weakened by damaged wall and begin to bulge because of the accumilating
blood pressure. This swelling is called an ANEURYSM. In a small number of situations the
aneurysm can actually burst and become fatal.
c. Aneurysms and throbosis can form anywhere in the body (in the brain is causes a stroke).

MYOCARDIAL INFARCTION

It s possible to survive for many years with atheroma and not be aware of it's existence or being
seriously incapacitated.
ANGINA: Pain in the center of the chest brought on by vigourous exercise - The pain normally dies
away when the exercise stops. The pain is caused by the atheroma preventing certain areas of the
heart muscle from getting the increased blood supply needed during exercise. Regular aspirin
treatment can reduce blood clots.

 Most mycardial infarctions are caused when a clot blocks a coronary artery at the site of an
atheroma.
 This causes severe chest pains, breathlessness, sickness and a rapid (but weak) pulse.
 The seriousness of the condition depends on the location of the blockage and how much of the
heart is being deprived.
 Affected muscle will stop working and this disrupts the heartbeat.
 The impulses that make muscle fibres contract together become uncoordinated - The left ventricle
hasn't got enough force to pump the blood out into the aorta and no pulse can be felt in the neck.
 Emergency defibrilation is needed before much damage can occur i.e. brief electric shocks until
the heart beat stabalizes.
 Most victims die within an hour otherwise.
 CPR and chest pumping can help in emergency.

RISK FACTORS OF CHD

 AGE AND SEX - rarely occurs in young adults - risk increases with age due to increased damage
- men are more susceptible than women but after a certain age they are almost equally at risk.
 GENETIC FACTORS: CHD tends to run in families, mainly due to similarity in lifestyle - risk in
higher is identical twins than in non-identical twins.
 SMOKING: Increases risk - likely to damage both heart and lungs - nicotine makes ateries
constrict = increased blood pressure.
 HIGH BP: Thick arterial walls = narrower lumen = even higher BP = development of an atheroma
due to damage = irregular heartbeat.
 HIGH CONCENTRATIONS OF LDL's: LDL's are involved in atheroma formation - cholesterol is
needed for synthesis of cell membrane. Lipoproteins are made by fats and cholesterol in the diet.
Increased fats = increased no. of LDL's = increased chance of CHD
 HDL's: absorb cholesterol and return it to the liver where iit is emulsified and removed = LESS
CHANCE OF CHD!