St. Luke’s College of Medicine – William H.

Quasha Memorial
PHYSIOLOGY BLOCK 2

Lecture: 1 - Overview of Cardiovascular Physiology Date: September 11, 2015

Lecturer: Antonio C. Pasco III, M.D. Trans Team: Ang C, Ang T, Apara, Ausan

Topic Outline
I. Objectives The heart – valves, septa
*Intercalated disks – are gap junctions where ions can pass from
II. The Cardiovascular System
one cardiac cell to another (permeable to ions), impulses can
A. Components of the Cardiovascular System
pass easily; contracts in the same principle as skeletal muscles
B. Conductive System
*cardiac muscle contraction has longer duration than skeletal
III. The Heart and Blood Vessels *fibrous ring- separates ventricular muscles from fibrous muscles
A. Heart - Blood Supply, Drainage, and Innervation
B. Blood Flow
 Cardiac Muscle Physiology (Guyton)
C. The Normal Heart
o Latticework, with the fibers dividing, recombining and then
D. Blood Vessels
spreading again
IV. Blood
o Striated
V. Quiz
 Typical myofibrils that contain actin and myosin
filaments
LEGEND  Filaments lie side by side and slide during contraction
PPT Trans Audio Trans Book Trans in the same manner as occurs in skeletal muscle
o Syncytium(the tissue contracts as one unit)
I. OBJECTIVES  Intercalated discs - cell membranes that separate
individual cardiac muscle cells from one other
1. Understand overall physiology of the cardiovascular
system.  GAP JUNCTIONS which allow rapid diffusion of
2. Enumerate and describe the roles and general ions
functions of the components of the cardiovascular system.  When one cell becomes excited, the action potential
3. Discuss the role of the heart as a pump. rapidly spreads to all of them
4. Discuss the blood volume distribution, pressure,  Syncytium of the heart
resistance, diameter, cross section, velocitydifference in o Atria are separated from the ventricles by fibrous tissue
the heart and the vascular system. that surround the atrio-ventricular (A-V) valvular openings
5. Describe the pulmonary and systemic circulation o Action potentials are NOT conducted through the fibrous
and their characters. tissue
 Potentials are conducted ONLY by way of a
II. THE CARDIOVASCULAR SYSTEM specialized conductive system called the Atrio-
1. Heart– central pump; right side pumps blood through ventricular (A-V) Bundle
the lungs (pulmonary circulation) while left side o This division of the heart allows the atria to contract a short
pumps blood through the rest of the body (systemic time ahead of ventricular contraction
circulation)  Atrial Syncytium: constitutes the walls of the two atria
2. Blood vessels– series of distributing (arteries) and  Ventricular Syncytium: constitutes the walls of the
collecting tubes (veins) towards a network of two ventricles
Capillaries – thin walled vessels for rapid exchange
of substances through
Blood – a complex fluid,serves asmedium of
exchange
3. Overall goal: to get adequate blood flow through the
capillaries tissues
4. Functions:
a. Transport (e.g. oxygen, CO2, hormones)
b. Regulatory/homeostatic
c. Protective (immunity)

A. THE HEART
1. Layers
a. Pericardium(outermost)
Figure 3. Conductive system of the heart
b. Myocardium
c. Endocardium (innermost)

Figure 1. Heart Layers

2. Cardiac Muscle Types
a. Atrial
b. Ventricular
c. Excitatory and Conductive

Figure 4. The heart: an overview

Figure 2. The heart; cardiac muscle

Page 1 of 6 1 – OVERVIEW OF CARDIOVASCULAR PHYSIOLOGY

 PHYSIOLOGY BLOCK 1

III. THE HEART AND BLOOD VESSELS

A. Supply, Drainage, Innervation

Figure 5. Heart valves. Triscupid valve separates right ventricle from right
atrium while Bicuspid/ Mitral valve separates left ventricle to left atrium

2 major differences between the membrane properties of

cardiac and skeletal muscle (Guyton)
 The differences in the membranes accounts for the prolonged
action potential and the plateau in cardiac muscle as
compared to skeletal muscle (further discussed in later
transes)
1. Action potential
 Skeletal Muscle: Sudden openings of large numbers of
fast sodium channels
 Cardiac Muscle:
i. Voltage activated fast sodium channels
ii. L-type calcium channels (slow calcium channels) Figure 7.Overview of blood circulation
 Calcium-sodium channels
 Systemic circulation
 Close at the end of 0.2-0.3 sec
LEFT ATRIUM
Large quantities of both calcium and sodium ions flows through
these channels to the interior of the cardiac muscle fiber which MITRAL VALVE
maintains the plateau in the action potential
 After the onset of action potential CAPILALRIES, VEINS,
SUPERIOR VENA CAVA
o Permeability for potassium decreases (TO PULMONARY
LEFT VENTRICLE
CIRCULATION)
o Excess calcium influx
o Depolarization
AORTIC VALVE
B. CONDUCTIVE SYSTEM of the HEART
1. Rhythmical electrical impulses
a. Cardiac Rhythmicity – continuous succession of heart
REST OF THE BODY AORTA
muscle contractions
2. Rapid conduction
3. Atria contract ahead of vesicles  Pulmonary circulation
4. Total delay of 0.16 seconds – from SA node- AV node- AV
bundles- Purkinje fibers RIGHT ATRIUM

*atrium contracts ahead than ventricle

TRICUSPID VALVE
SUPERIOR VENA
 Ventricular muscle potential: 105mV CAVA
o Intracellular potential rises RIGHT VENTRICLE
 Between beats: very negative value (-85mV)
 During each beat: positive value (20mV) PULMONARY VEINS
 Plateau: forms after each spike when the membrane remains (RIGHT AND LEFT) - to PULMONARY VALVE
left atrium (then
depolarized for at least 0.2 seconds SYSTEMIC
o Causes ventricular contraction to last as much as 15 times CIRCULATION) PULMONARY
as long as in cardiac muscle as in skeletal muscle ARTERIES (RIGHT
AND LEFT)

LUNGS

Figure 6. Force of ventricular heart muscle contraction, showing also

duration of the refractory period and relative refractory period, plus
the effect of pre-mature contraction. Note that pre-mature
contractions do not cause wave summation, as occurs in skeletal Figure 8. Overview of coronary circulation (red: coronary arteries; blue:
muscle. coronary veins)

Page 2 of 6 1 – OVERVIEW OF CARDIOVASCULAR PHYSIOLOGY

 PHYSIOLOGY BLOCK 1

Note: for now, just know that the main coronary arteries supplying the
heart are the right coronary artery and the circumflex artery; for the
venous drainage, it’s the great cardiac vein anteriorly and the coronary B. Blood Flow
sinus posteriorly (it communicates directly with the right atrium)
- Passive (from high to low pressure area – arterial to venous)
- Continuous (systolic ejection distend arteries-heart
contraction, elastic recoil during diastole- relaxation)
- Pulsatile first then steady flow (intermittent ejection then
damping effect of distention and resistance)
- Unidirectional- because of the valves

Pulmonary artery- carries deoxygenated blood

Pulmonary vein- carries oxygenated blood

*Opening of valves are PASSIVE

The heart - Unidirectional blood flow

Figure 11. Intracardiac Pressure (from ppt)

Figure 9. Extrinsic innervations of the heart

Nerve supply: comes from Autonomic Nervous System

Increasing conduction of Sympathetic NS – Increases contraction

300- 400%

Parasympathetic NS stimulationby Cranial Nerve X (Vagus Nerve)

– decreases cardiac muscle responsiveness to stimuli (as
acetylcholine makes the conductive fibers permeable to potassium
ions)

TWO PUMPS IN A SERIES

 2-chamber pump
o Atrium - weak primer pump
 Contraction adds 20% filling of the ventricles
 80% goes directly to ventricle because valves are
open
 Damaging atrium: heart can still work Figure 12. Cardiac flow and pressure diagram
o Ventricle – main pumping force *Pressure inside the right atrium is almost 0 mmHg
 60% ejection fraction (of blood) *Right side of the heart has lower pressure compared to left side
Implication: hole between two ventricles – blood flows towards the
A. Supply, Drainage, Innervation right side

C. THE NORMAL HEART

- Contraction of individual muscle cells must occur at regular
interval and must be synchronized
- Valves fully opened and must not leak
- Contraction must be forceful
- Ventricles must fill adequately
Actions of the heart
- Bathmotropic action or excitability or irritability of cardiac
muscle (positive- increase excitability; negative- decrease)
- Dromotropic action or conductivity (positive and negative)
- Chronotropic action or heart rate (tachycardia and
bradychardia)
- Inotropic action or contractility (positive and negative)

*Sympathetic stimulation to the heart – positive chronotropic

and ionotropic action

Review of concepts:
If the atria lose its function, what happens to the conductive
system?

What would happen if…

- the aortic valve fuses?
- the mitral valve fuses?
- the pulmonic valve fuses?
- the tricuspid valve fuses?
Figure 10. Pulmonary and systemic circulation - the Papillary muscles rupture?
 Pulmonary circulation – refers to the blood flow between the - there is a hole in the interventricular septum
right side of the heart and the lungs - we prick the heart with a pin? What property will be
 Systemic circulation – refers to the blood flow between the exhibited?
left side of the heart and the rest of the body - there are 2 pacemakers functioning?

Page 3 of 6 1 – OVERVIEW OF CARDIOVASCULAR PHYSIOLOGY

 PHYSIOLOGY BLOCK 1

- increase sympathetic activity? What property is exhibited? – large cross sectional area
-very thin
D. Blood vessels – slow velocity of blood
Components – site of exchange (nutrient, gas and waste)
– not more than 0.1 mm from most cells

“from aorta to capillaries the number of vessels increased by 3

billion fold, the cross sectional area increased by 500 fold”

Figure 15.Diagram of movement of substances across a capillary

4. Veins
–capacitance vessels (blood reservoir)
–low resistance tubes with valves

*contraction of skeletal muscles pushes blood upward and the

Figure 13. Artery, vein and capillary valves prevent it from flowing back downwards
* when blood reaches the thorax (with negative pressure) it sucks
Physical Characteristics the blood towards the heart

Figure 16. Role of skeletal muscle in venous blood flow

Circulatory distribution

Figure 14. Overview of blood vessel characteristics

Arterial System
1. Aorta (arteries)
– elastic transport blood under high pressure
(pressure reservoir)
-high blood flow velocity
2. Arterioles
- muscular, resistant vessels – control conduits (control
points in maintaining blood pressure)
-participate in regulation of tissue flow and blood pressure
-pulsatile flow in the arterial system because of intermittent Figure 17. Blood distribution
ejection from heart is dampened by:
a. Distensibility of the arteries
b. frictional resistance
3. Capillaries

Page 4 of 6 1 – OVERVIEW OF CARDIOVASCULAR PHYSIOLOGY

 PHYSIOLOGY BLOCK 1

rr – relative resistance

Blood vessels: Cross sectional area and velocity “normal circulation… the total blood volume is constant, an
increase in one area … decreases in other area/s ….
distribution is determined by cardiac output and contractile state of
resistance”

Review of concepts
Discuss briefly what happens if we:
- Squeeze the veins
- Put a connection between the veins and the arteries
- Vasodilate the arterioles
- Increase the pressure in the right atrium
- Vasoconstrict the arteries

IV. BLOOD
-20% of extracellular flud (ECF), 8% of Total Body Weight (TBW)
-5 to 6 liters
-slightly alkaline
-components:

Figure 18. Overview of blood vessel cross sectional area and velocity

 An increase in total area of the vascular bed corresponds to a lower

velocity of blood flow. Why? With increasing tissue area
coverage, you have to sacrifice the diameter of the blood vessel,
to the point that RBCs can only pass one cell at a time Figure 21. Blood: components
(capillaries), thus significantly slowing blood flow.

Blood Vessel Pressure Differences

Blood components and function

Figure 19. Normal blood pressures in the different portions of the

circulatory system when a person is lying in the horizontal position; this
also demonstrates the difference in pressures between pulmonary (far
right) and systemic circulations (far left)

Blood Vessel Vascular Resistance Normal values of erythrocytes, leukocytes and platelets in
adult human blood
large
arteries veins -7%
19%

small
capillaries
arteries -
27%
47%

veins -7% small arteries -47%

capillaries 27% large arteries 19% Figure 22. Blood components and function

Figure 20. Vascular resistance

*cross sectional area of all the capillaries are higher than the
overall cross sectional areas of arteries and veins
* vena cava has a smaller cross sectional area than artery; thus
blood flow is slower

Summary
ta – total cross sectional area

Page 5 of 6 1 – OVERVIEW OF CARDIOVASCULAR PHYSIOLOGY

 PHYSIOLOGY BLOCK 1

Normal Constituents of Adult Human Plasma END OF TRANSCRIPTION

Class Constituent Amount/normal
concentration range
Electrolytes (inorganic)
+
Cations Sodium (Na ) 136–145 mEq/L
+
Potassium (K ) 3.5–5.0 mEq/L
2+
Calcium (Ca ) 4.3–5.2 mEq/L
2+
Magnesium (Mg ) 1.2–1.8 mEq/L
3+
Iron (Fe ) 60–160 μg/dL
2+
Copper (Cu ) 70–155 μg/dL
+
Hydrogen (H ) 35–45 nmol/L (pH =
7.35–7.45)
− The feeling after first block exams:
Anions Chloride (Cl ) 98–106 mEq/L
−
Bicarbonate (HCO3 ) 23–28 mEq/L
Lactate 0.67–1.8 mEq/L
2−
Sulfate (SO4 ) 0.9–1.1 mEq/L
2−
Phosphate (HPO4 3.0–4.5 mg/dL
mostly)
Proteins Total (7% of plasma 6–8 g/dL
weight)
Albumin 3.4–5.0 g/dL
Globulins 2.2–4.0 g/dL
Fibrinogen 0.3 g/dL
Nutrients Glucose 80–120 mg/dL
Total amino acids 40 mg/dL
Cholesterol 150–200 mg/dL
Phospholipids 150–220 mg/dL
Triglycerides 35–160 mg/dL
Waste Uric acid (from 2.6–7.2 mg/dL
products nucleic acids)
Blood urea nitrogen 8–25 mg/dL
(from protein)
Creatinine (from 0.2–0.9 mg/dL
creatine)
Bilirubin (from heme) 0.1–1.2 mg/dL

Blood functions
- Transport Answers:
Respiratory gases, nutrients, metabolites, hormones
- Regulation 1. Gap junctions (specifically
Acid-base, body temperature, fluid and electrolyte intercalated discs)
2. Arterioles
- Protection
3. AV (atrioventricular) bundle
Blood clotting, immunity, phagocytosis against infection 4. Inotropic
Summary topics and correlation with topics 5. Left atrium and ventricle
I. Physiology of the heart
A. Properties of the heart:
1. Irritability and excitability – cardiac muscle physiology
2. Conductivity and rhythmicity – pacemaker potential,
conductive sytem, ecg
3. Contractability – heart as a pump, heart sounds, cardiac
cycle, myocardiac contractility and its regulaton
4. Intropism – cardiac output and its regulation
B. Coronary circulation
II. Physiology of the peripheral circulation
1. Hemodynamics
2. Blood flow and its regulation
3. Arterial and venous function
4. Arterial pressure and its regulation
5. Microcirculation and lymphatics
III. Blood and its component
1. Blood physiology
2. immunity
IV. Correlation
1. Aging and the cardiovascular system
2. Clinical – physiology of heart failure and shock

V. QUIZ
1.What feature of cardiac tissue enables it to operate as a
syncytium?

2.What blood vessels serve as control points for blood pressure in

systemic circulation?

3. Which specialized cardiac tissue serves as the connection

between the atrial and ventricular conductive system?

4. What property of the heart refers to its contractility?

5. The mitral valve separates what chambers of the heart?

Page 6 of 6 1 – OVERVIEW OF CARDIOVASCULAR PHYSIOLOGY