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Prepared By George Shafik Product Manager

Agenda

1 2

The Cardiovascular System Arterial Blood Pressure

3
4

The Urinary System

The Hypertension

The Cardiovascular System

The Cardiovascular System

The Heart
2

The Vessels
3

Endothelium

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The Cardiovascular System

The Heart
The heart is a hollow cone-shaped muscle located between the lungs and behind the sternum. The heart is a double pump organ. It contains 4 chambers:(2 atria + 2 ventricles). The right side receives deoxygenated blood from the tissues & pumps it to the lung. The left side receives oxygenated blood from the lung & pumps it to the body.

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The Cardiovascular System

The Heart
The heart has three layers.

Endocardium.

The smooth, inside lining of the heart.

Myocardium.

The middle layer of heart muscle. The sac filled with a fluid Surrounding the heart

Pericardium.

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The Cardiovascular System

The Heart
The Heart has 2 Ventricles & 2 Atria.

2 Atria

2 Chamber at the upper part of the heart (right & left).

2 Ventricles

2 Chamber at the lower part of the heart (right & left).

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The Cardiovascular System

The Heart
Each chamber has a sort of one-way valve at its exit that prevents blood from flowing backwards. When each chamber contracts, the valve at its exit opens. When it is finished contracting, the valve closes so that blood does not flow backwards.

The pulmonary valve

The mitral bicuspid valve

The exit of the left atrium.

The exit of the right ventricle.

The aortic valve The tricuspid valve

The exit of the left ventricle. The exit of the right atrium.

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The Cardiovascular System

The Heart
The Heart Beats

When the heart muscle contracts (Systole) Then the heart muscle relaxes (Diastole)
The heart contracts in two stages:

1. The 2 atria contract at the same time, pumping blood to the ventricles. 2. Then the 2 ventricles contract together to pump the blood out of the heart.

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The Cardiovascular System

The Heart The Cardiac Cycle

The Cardiac Cycle

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The Cardiovascular System

The Heart
The Cardiac Cycle

1. Blood returns to the heart fills the atria pressure against atrioventricular valves forced to be open. 2. Blood fills the ventricles (ventricular filling) [Mid diastole]. 3. Atria contract forcing additional blood into ventricles [late diastole].

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The Cardiovascular System

The Heart
The Cardiac Cycle
4. Blood returns to the heart fills the atria Ventricles contract (ventricular systole) forcing the blood against AV valves AV valves close [Isovolumetric ejection phase] papillary muscles contract & cordae tendinae tighten preventing valves from everting into atria intraventricular pressure rises blood is pushed against semiluner valves (aortic, pulmonary) forced to be open [Ventricular ejection phase] 5. As ventricles relax intraventricular pressure falls semilunar valves close [Early diastole].

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The Cardiovascular System

The Heart
The Cardiac Electrophysiology
Heart beats 60-80 times / min. Alternative contractions (systole) & relaxation (diastole). This is due to 3 fundamental electrophysiological properties:

Automotricity. Excitability (SA node, AV node) Conductivity (AV bundle, bundle branches,

Purkinje fibers). The cardiac muscle has an intrinsic ability to depolarize & contract. Nodal system initiates and distributes impulses through the heart, so that the myocardium depolarizes and contracts in an orderly sequential manner

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The Cardiovascular System

The Heart
The Cardiac Electrophysiology

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The Cardiovascular System

The Heart
The proper function of the cardiac muscle requires oxygen & nutrients. The Coronary Circulation
A very high flow Filling up occur during diastole. Any blockage of coronary arteries can be serious & in some cases fatal

Sympathetic innervations
Its stimulation lead to Positive actions (frequency, contraction, excitability & conduction)

Parasympathetic innervations
Its stimulation lead to Negative actions (frequency, contraction, excitability & conduction)
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1 2

The Cardiovascular System

The Vessels
The blood vessels (Arteries, Veins & capillaries).

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The Cardiovascular System

The Vessels
The Structure: Tunica Intima. Tunica Media. Tunica Adventitia.

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The Cardiovascular System

Endothelium
Form a selective barrier. Are metabolically active. Contain converting enzyme. Release vasoactive substances.

Agenda

1 2

The Cardiovascular System Arterial Blood Pressure

3
4

The Urinary System

The Hypertension

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Arterial Blood Pressure

Definition
The force of the blood against the walls of the artery. The force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries.

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Arterial Blood Pressure

Craniological Concepts

Peripheral resistance
The force applied against the walls of the arteries

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Arterial Blood Pressure

Physiological variation of arterial blood pressure

Blood pressure in arteries is greater than in veins & systemic blood pressure is higher than pulmonary blood pressure.

When we talk about blood pressure we mean systemic arterial blood pressure.
Systolic blood pressure refers to the pressure of blood in the artery when the heart contracts. It is the top (and higher) number in a blood pressure reading and it ranged between (90 140 mmHg). Diastolic blood pressure refers to the pressure of blood in the artery when the heart relaxes between beats. It is the bottom (and lower) number in a blood pressure reading and it ranged between (60 90 mmHg).

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Arterial Blood Pressure

Physiological variation of arterial blood pressure

Normal blood pressure is not fixed figure , there is normal variability between different individuals & varies in the same person under different circumstances

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Arterial Blood Pressure

Physiological variation of arterial blood pressure

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Arterial Blood Pressure

Physiological control of blood pressure

Nervous Regulation Humoral Regulation

Sympathetic (Hypertensive action). Parasympathetic (Hypotensive action). Baroreceptors

Hormones.

RAAS.
Bradykinin.

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Arterial Blood Pressure

Physiological control of high blood pressure

Baroreceptor
They are stretch-sensitive mechanoreceptors that form a part of the afferent arm of the baroreflex, which acts as a short-term regulator of heart rate and blood pressure.

Baroreceptor in the human body detect the pressure of blood flowing through them, and can send messages to the central nervous system to increase or decrease total peripheral resistance and cardiac output.

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Arterial Blood Pressure

Physiological control of high blood pressure

Agenda

1 2

The Cardiovascular System Arterial Blood Pressure

3
4

The Urinary System

The Hypertension

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The Urinary System

The Kidney
The kidneys are two beanshaped organs located in the posterior part of the abdomen filter wastes (such as urea) from the blood and excrete them, along with water, as urine. Above each kidney is an adrenal gland (also called the suprarenal gland)

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2

The Urinary System

The Nephron
The Nephron is the basic functional unit of the kidney ,there are more than a million within the cortex and medulla. Nephrons regulate water & solute (especially electrolyte). Nephrons reabsorb some necessary fluid and molecules back into the blood while secreting other.

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2

The Urinary System

The Nephron
Glomerular Capsule. Proximal tubule. Proximal convoluted tubule. Proximal straight (Descending) Loop of Henle. Descending limb (Thin segment). Ascending limb (Thick segment). Distal convoluted tubule.

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2

The Urinary System

The Nephron

Proximal Tubule
Responsible for re-absorption of: o2/3 Salts and water. oGlucose and organic acids 100%. oPotassium 65%. oUrea 50%.

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2

The Urinary System

The Nephron

Distal Tubule
Responsible for re-absorption of: oWater. oPotassium. oNa. oCl.

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2

The Urinary System

The Nephron

The loop of Henle

Is the portion of the Nephron that leads from the proximal convoluted tubule to the distal convoluted tubule. The main function of this structure is to reabsorb water and ions from urine. To do this, it uses a countercurrent multiplier mechanism in the medulla.

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2

The Urinary System

The Nephron

The loop of Henle

Divided into 4 parts:
1. 2. 3. 4. Descending limb. Thin ascending limb. Thick ascending limb. Cortical thick ascending limb.

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2

The Urinary System

The Nephron

The loop of Henle

Descending limb has low permeability to ions and urea, highly permeable to water.
Cortical thick as. limb drains urine into the distal convoluted tubule.

Thin ascending limb not permeable to water, but it is permeable to ions.

Thick ascending
(Na+), (K+) and (Cl-) ions are reabsorbed from the urine by active transport. The electrical gradient drives more Reabsorption of Na+, as well as (Mg2+) and importantly calcium Ca2+.

Agenda

1 2

The Cardiovascular System Arterial Blood Pressure

3
4

The Urinary System

The Hypertension

The Hypertension

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The Hypertension

Definition &Types of Hypertension

Hypertension: defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg a systolic pressure above 140 with a diastolic pressure above 90. The two major types are: Primary or essential hypertension, that has no known cause, is diagnosed in the majority of people. Secondary hypertension ,is often caused by reversible factors, and is sometimes curable.

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The Hypertension

Types of Hypertension
The other types include:
Malignant Hypertension. Pulmonary hypertension (hypertension occurring

in the heart-lung arteries). Gastrointestinal hypertension (early stages of

high blood pressure during pregnancy). Isolated Systolic Hypertension . White Coat Hypertension. Resistant Hypertension

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The Hypertension

Types of Hypertension

Primary Hypertension
Essential hypertension:
it is by far the most common type of hypertension, and is diagnosed in about 95 % of cases. Essential hypertension has no obvious or yet identifiable cause.

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The Hypertension

Types of Hypertension

Secondary Hypertension
Due to:
Kidney damage or impaired function (This accounts for most secondary forms of hypertension.) Tumors or over activity of the adrenal gland Thyroid dysfunction Coarctation* of the aorta Pregnancy-related conditions

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The Hypertension

Types of Hypertension Malignant Hypertension

The most severe and progressive form of hypertension,. It rapidly leads to organ damage. Malignant hypertension is becoming relatively rare, and is not caused by cancer or malignancy. Unless properly treated, it is fatal within five years for the majority of patients. Death usually comes from heart failure, kidney damage or brain hemorrhage.

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The Hypertension

Types of Hypertension Pulmonary hypertension

Hypertension occurring in the heart-lung arteries.

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The Hypertension

Types of Hypertension
Isolated Systolic Hypertension
In this case the systolic blood pressure, (the top number), is consistently above 160 mm Hg, and the diastolic below 90 mm Hg. This may occur in older people, and results from the age-related stiffening of the arteries. The loss of elasticity in arteries, like the aorta, is mostly due to arteriosclerosis. Treatment starts with lifestyle modification, and if needed, added drugs.

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The Hypertension

Types of Hypertension White Coat Hypertension

Anxiety-induced hypertension, it means blood pressure is only high when tested by a health professional. it does not need to be treated. However, regular follow- up is recommended to ensure that persistent hypertension has not developed. Lifestyle changes like more exercise, less salt and alcohol, no nicotine and weight loss, would be wise. A low fat, high fibre diet, with increased fruit and vegetable intake, will be beneficial.

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The Hypertension

Types of Hypertension Resistant Hypertension

If blood pressure cannot be reduced to below 140/90 mmHg, despite a tripledrug regime, resistant hypertension is considered.

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2

The Hypertension

Symptoms & Complications

1.Symptoms:
Most people with high blood pressure don't have any symptoms. People with severe high blood pressure or a rapid rise in blood pressure may also experience headaches, blurred or impaired vision, fits or blackouts. People with high blood pressure have an increased risk of major illnesses including: cardiovascular disease such as angina, stroke, heart attack or atrial fibrillation kidney damage damaged sight

2.Complications:

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2

The Hypertension

Symptoms & Complications

The Hypertension

Hypotension
Low blood pressure. May be a sign of severe disease and requires urgent medical attention. When blood pressure and blood flow decrease beyond a certain point, the perfusion of the brain becomes critically decreased (i.e., the blood supply is not sufficient), causing lightheadedness, dizziness, weakness and fainting. Sometimes the blood pressure drops significantly when a patient stands up from sitting. This is known as postural hypotension; gravity reduces the rate of blood return from the body veins below the heart back to the heart, thus reducing stroke volume and cardiac output.

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The Hypertension

Treatment of Hypertension

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The Hypertension

Treatment of Hypertension

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The Hypertension

Treatment of Hypertension

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The Hypertension

Treatment of Hypertension

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The Hypertension

Treatment of Hypertension

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The Hypertension

Treatment of Hypertension

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The Hypertension

Treatment of Hypertension

Prepared By George Shafik Product Manager