Human Anatomy and Physiology

CCST4083

Part 3 (The Cardiovascular System)

Chapter 10: Physiology of Cardiovascular System

Lecturer:

HKU SPACE Community College

http://www.sads.org.uk/heart.jpg
 Chapter Outline

1. Cardiac Physiology
Define Stroke Volume, End-diastolic Volume, Heart Rate
and Cardiac Output
Factors Affect Stroke Volume, Heart Rate and Cardiac
Output

2. Vascular Physiology
Define Blood Flow in a Blood Vessel
Factors affect Blood Flow in a Circulation
Control of Blood Flow to a Special Circulation

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 Part 1: Cardiac Physiology
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1. Stroke Volume (SV) : blood volume (mL) ejected by a ventricle

during one heartbeat (one ventricular systole)
The left and right ventricles have the same SV
The left ventricular wall is thicker and thus generates
greater pressure to give the SV

2. HR is the number of heartbeats (contractions) per minute

Determined by the firing rate of the SA node (pacemaker)

Stroke Volume (SV) (unit: mL) x Heart rate (HR)

= Blood volume pumped by each ventricle per minute

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= Cardiac Output (CO) [Unit: mL/min]
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Not all the output by both ventricles
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http://cardiovascularconduction.weebly.com/uploads/8/7/5/5/8755439/5927463.png?362
 The Cardiac Cycle
(a complete heartbeat)
When the cardiac (heart) muscles contract (called systole), the heart pumps blood out of it.

The myocardium at different chambers work in a corporative sequence of systole and diastole:
1.Relaxation of the whole heart (Diastole)
Reduces the pressures in the atria and ventricles
Lower the pressure in the heart chambers for refilling blood

2.Contraction of the atria (Atrial Systole)

Squeezes the blood inside the atria into the ventricles (ventricular walls remain diastole)
Allows the blood in ventricles to reach the max. volume [called the end-diastolic
volume (EDV)]

3.Contraction of the ventricular walls (Ventricular Systole)

Blood is forced out and goes into the aorta/pulmonary artery
The volume of blood pumped out per one contraction = Stroke Volume
* Not all blood in ventricles is ejected (~60% of the end-diastolic volume)

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http://www.phschool.com/science/biology_place/biocoach/images/cardio1/beatnhrt.gif
 Measurement of Cardiac Function
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Cardiac Output (CO) = Stroke Volume (SV) x Heart Rate (beats/min) Healthy
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Cardiac Output:

e.g. In a normal healthy adult,

Stroke volume of left ventricle =70mL Heart Rate = 60-80 beats per min

Cardiac output (CO) = 70 mL/beat (SV) x ~72 beats/ min (HR) = ~ 5000 mL/min (5L/min)

** Cardiac output represents heart function

1. Stroke volume (SV): If the heart weakens or the blood volume drops, then SV declines.
2. Heart rate (HR): When SV declines, HR may increase. It is a compensation. CO may not change.
If SV keeps dropping and then CO is less than 5000 mL/ min, it is the case of heart failure.
Less blood supplies to body cells.

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 Stroke Volume (SV)
Stroke volume is controlled by
1.Preload
the degree of ventricular wall is stretched by filled blood
before contraction
It is affected by the venous return and the filling time
And preload can be represented by the end-diastolic
volume (EDV)
The greater the EDV, the greater the SV

2.Afterload (= arterial blood pressure)

Back pressure exerted by pumped blood
Higher arterial blood pressure = more resistance
(friction) = harder to squeeze out blood

3.Contractility of ventricular heart muscles

- The stronger the contraction, the more the blood will be
squeezed out
-
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http://www.gcrweb.com/HeartDSS/animation/heartbeat.gif
 Preload- degree of ventricles are Afterload- back pressure exerted by blood in the
stretched by filled blood (initial stretching large arteries (pressure against blood ejection)
of the cardiocmyocytes prior to
contraction) 7
http://classconnection.s3.amazonaws.com/248/flashcards/430248/jpg/preload&afterload1314773421818.jpg
 - st Factor Affects the Stroke Volume (SV)
1. Preload and Frank-Starling law
It is an Intrinsic factor
Preload is the degree to which the
cardiomyocytes are stretched BEFORE
contraction
Preload is represented by EDV
The more the blood in the ventricle , the
greater the EDV, the greater the stretch
of the ventricular wall (preload)
There is an optimal length/tension relationship
EDV is determined by the venous return (the for maximal force generation (when EDV is
amount of blood returns to the right atrium) from 100-380mL )
and filling time of ventricle

-
The greater the end-diastolic volume (the
greater the venous return), the greater the
stretch of ventricular wall (preload) and
the greater the stroke volume
8
P.373, Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
 Stroke Volume and Ejection Fraction

Ejection fraction (EF) is the percentage of blood of the

ventricle pumps out per contraction

Ejection fraction (%) = The ratio of SV/EDV

EDV is usually about 130 mL (filled blood in a ventricle)
Normal SV is around 70 ml (70 ml of blood is ejected per
contraction)
EF = (70/130) x 100%
i.e. An ejection fraction of 54% means that 54% of the
filed blood (i.e. EDV) is pushed out in a contraction

-
preload does NOT increase EF
Increases EDV just increases SV without increasing EF
(the power of contraction)
No change in contractility https://www.youtube.com/watch?v=YEvm-Otmpw4
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http://www.nismat.org/data/images/eject_fract1668712067.gif
 (I) What are the factors that affect the stroke volume?

2. Afterload (= arterial blood pressure)

Afterload is the arterial (aortic) pressure that

blocks the flow of blood to leave the heart

Higher arterial blood pressure = Greater resistance

= the ventricle has to work harder to squeeze
blood out
Therefore, increase in arterial blood pressure
increases afterload a greater resistance
reduces stroke volume

Ventricular systole. Red arrow is

Anything that increases the arterial pressure can path from left ventricle to aorta.
increase afterload Afterload is largely dependent
(i.e. Hypertension) upon arterial/ aortic pressure.
This increases the workload of the heart

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http://upload.wikimedia.org/wikipedia/commons/3/34/Heart_systole.svg
(I) What are the factors that affect the stroke volume?

3. Contractility of the heart muscle

Increase contractility means a greater ejection fraction (increases the percentage of

blood be pumped out)

There are TWO extrinsic factors determine the Stroke Volume:

1. Sympathetic innervation from the autonomic nervous system

Sympathetic stimulation acts on ventricular muscles
increases contractility
Parasympathetic innervation does NOT affect ventricular muscles

2. Hormone from the adrenal glands

Epinephrine (EP; adrenaline) increases the contractility

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 Extrinsic stimulation

12
P.374, Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
 Innervation of the Heart
Autonomic Nervous System [ANS]
The ventricles are innervated by the sympathetic nerve only
The atria are innervated by both the sympathetic and parasympathetic nerves

The right atrium has

The SA node (determines the heart rate)

The left and right ventricular walls have cardiomyocytes (for contraction)
http://www.mayoclinic.com/images/image_popup/mcdc7_adrenal_glands.jpg 13
P.361, Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
 (I) What are the factors that affect the stroke volume?

Sympathetic stimulation
Leads to a stronger contraction (and a
little bit faster) at any end-diastolic
cejatonklmr
volumes Increase contractility
Neurotransmitter of sympathetic
nerves= Noradrenaline (Norepinephrine)
Acting on 1-adrenergic receptor on the
ventricular cardiomyocytes àmnd
就
Hormones
Adrenaline (Epinephrine) from the
adrenal glands Even without increasing ventricular EDV,
acting on 1- adrenergic receptor increased contractility can also increase
same as sympathetic stimulation the stroke volume

14
P.374 and 375, Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
 Sympathetic Stimulation leads to a
Greater Contractility ( Ejection Fraction)

15
P.374, Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
 (II) What are the factors that affect the heart rate (HR)?

Factors affect the activity of the SA node (Pacemaker)

1. Autonomic nervous system (extrinsic factor)

I. Sympathetic stimulation on SA node (Right atrium)

Neurotransmitter = Noradrenaline [Norepinephrine (NE)]
Receptor = 1-adrenergic receptor in the SA node

Result: ,
II. Parasympathetic stimulation
Neurotransmitter = Acetylcholine
Receptor = M receptor (muscarinic cholinergic receptor) in the SA node

Result:
More parasympathetic stimulation to the
SA node in the resting state
Thus, the normal HR: 60-80 beats/ min

16
P.372, Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
 Pacemaker Potentials (SA Node)

Heart rate is affected by the sympathetic and parasympatheic nervous systems

Sympathetic stimulation: increases SA node firing rate increases HR
parasympathetic stimulation: decreases SA node firing rate decreases HR

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 What are the factors that affect the Heart Rate (HR)?

2. Hormone Mniiige
Adrenaline (Epinephrine) from the adrenal glands
Acting on the SA node same as norepinephrine from sympathetic neurons
Therefore, the outcome is similar to the sympathetic stimulation
i.e. increases the heart rate

3. Body temperature, plasma electrolyte concentration, hormones other than

epinephrine and a metabolite (adenosine) produced by myocardial cells
Less important

18
P.372, Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
 Something more than sympathetic regulation of
very important!!
Sympathetic stimulation increases cardiac output (CO) in 2 ways
1.
BUT = decrease blood filling time to the ventricles
i.e. lower end-diastolic volume (lower the stroke vol.)

If heart rate is very high (beyond a certain value) i.e. > 200 per minute
- diastole is very short
- little time for ventricular filling
- end-diastolic volume becomes very low
- stoke volume is greatly reduced
Final outcome: Cardiac output reduces significantly

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 Summary: CO= SV x HR
Cardiac output is affected by

1. Stroke volume = Blood pumped per contraction

reduced stroke volume reduces cardiac output
a. Blood volume and End-diastolic volume (EDV)
Preload (amount of blood filled in ventricle at the end of diastole)

b. Afterload (= arterial blood pressure)

- higher arterial blood pressure = more resistance
= harder to squeeze out blood

c. Contractility of ventricular heart muscles

- the stronger the contraction, higher % (more) of EDV of blood squeezed out

2. Heart rate
I. Autonomic nervous system (SNS, PSNS)
II. Hormonal control (e.g. epinephrine from adrenal glands)
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III. Other factors
 Cardiac Output

21
P.374 and 375, Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
 Cardiac function is the ability for the heart to
pump blood in a period of time

Cardiac output (CO) indicates the amount of

blood pumped out in ONE minute from each
ventricle

Stroke volume just indicates the amount of

blood pumping out in a single contraction
Another factor of cardiac output is heart rate
(no. of beat in a minute)
For example:
If a person has a great stroke volume but a very
low heart rate Cardiac output is still low
the amount of blood pumping out in a period of
time may be less than usual
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http://image.slidesharecdn.com/cardiacoutput-131211223430-phpapp02/95/cardiac-output-1-638.jpg?cb=1386822931
 i

4
blood
ejection

http://highered.mheducation.com/sites/0073378100/student_view0/chapter12/animations.html
 Cardiac Function Measurement
Human cardiac output can be measured by
medical scanning.

Echocardiogram or cardiac (functional)

MRI: noninvasive techniques that uses
ultrasonic or magnetic waves.
Both techniques can detect the
abnormal functioning of cardiac valves
or contractions of the cardiac walls,
and can also be used to measure
ejection fraction.

Cardiac angiography: requires the

temporary threading of a thin, flexible tube
called a catheter through an artery or vein
into the heart.
This technique is useful for evaluating
cardiac function and for identifying
narrowed coronary arteries
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http://nurseslabs.com/wp-content/uploads/2014/04/Cardiac-Output.jpg http://www.nhlbi.nih.gov/health//dci/images/echo_setup.jpg
 absorption
digestion

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 Part 2:
Vascular Physiology and
Control of Blood Flow to a Special
Circulation

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http://www.teachpe.com/images/circulatory_system.jpg
 Vascular Physiology and Blood Flow
(mL/min)
Blood flow can be defined as the
volume of blood that passes
a given point in the circulation
system
within a given amount of time

(mL/min)

During exercise, there is an increase

flows to the skeletal muscles
dilation of arteries and arterioles
Arteriole is a blood vessel
regulates blood flow of a particular
organ or tissue

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http://assets.openstudy.com/updates/attachments/53a78337e4b0ffdda15e37f1-praetorian.10-1403488117737-answer.jpg
 Special Circulation
To control the amount of blood flow into a particular organ

Why is it necessary?
To distribute blood efficiently for optimum usage
e.g. When exercise, muscles need more O2 (produce energy), therefore more
blood is needed to flow to the muscles to supply O2

How to achieve it?

Controls the radius of arteriole by the smooth muscle
Using some local chemicals/factors (mainly metabolites and acid)
using extrinsic factors (including hormone, nerve impulse)
using endothelial cells (using paracrine signaling)
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http://figures.boundless.com/16829/full/capillary.png
 Blood Flow (F, unit: mL/min)

Consider 2 connected syringes with 2 elastic tubes that one is larger and one is smaller.
If you apply the same force (pressure) on the piston, more fluid flows to the syringe
with bigger radius. i.e. Less resistance

Same force

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 Controlling the Radius of a Blood Vessel

Arteriole contains smooth muscle

Blood flow (Q) to a given organ is directly related to
the pressure (P) of the blood as it enters its
capillaries and inversely related to the vascular
resistance (R) applied by its arterioles.
Any factors act on the smooth muscle of an arteriole
results in either vasodilation / vasoconstriction
Floworgan=MAP/Resistance organ
The greater the pressure, the
And resistance 4
greater the blood flow; the
lower the pressure, the less the
changing the arteriolar radii in individual organs blood flow
P= Mean arterial pressure (MAP) which is the The greater the vascular
constant throughout the body resistance, the less the blood
Since venous pressure is normally close to flow; the lower the vascular
resistance, the more the blood
zero
flow.

http://www.biosbcc.net/doohan/sample/images/CO%20and%20MAP/blood%20flow.jpg
What are the factors that control the radius of
blood vessels?
Local Factors self-regulation of blood flow
regulated by local chemical mediators
independent of extrinsic factors (nerve impulses and hormones)
Examples:
- metabolites, oxygen , electrolytes, substances in the tissue fluid secreted by nearby
cells under certain conditions due to
I. Increased metabolism
II. Change in local blood flow
III. Occlusion (Blockage)
IV. Injury

Extrinsic Factors
1. Sympathetic nervous system
2. Hormones
3. Autonomic neurons (endothelial cells)
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Encouraging more blood flow when? Local factors
In response to increased metabolism

e.g. When a tissue has been working hard (e.g. exercise), what changes in
tissue fluid would occur to the amount of the following substance ?
decreases
1. The amount of O2 _______________
increases
2. The amount of CO2 ______________
increases
3. H+ concentration _______________
: production of lactic acid due to anaerobic respiration
: CO2 + H2O H2CO3 (carbonic acid) H+ + HCO3-
increases (repeated repolarization)
4. K+ concentration _______________

Vasodilation Active Hyperemia (increase in blood flow)

increase in organ blood flow (hyperemia) associated with increased
metabolic activity of an organ or tissue

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 Flow Autoregulation in Response to
Reduced Blood Flow

A reduction in blood flow/blood pressure result in

decreases
1. The amount of O2 _______________
increases
2. The amount of CO ______________
2

increases
3. H+ concentration _______________

These factors in tissue fluid cause autoregulation

Arteriole of that region will dilate automatically
Restoration of blood flow toward normal in to that tissue or organ

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 34
P.392, Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
 Extrinsic Controls of Vasoconstriction and
Vasodilation
Extrinsic controls
1. Sympathetic nervous system (SNS):
Neurotransmitter: Noradrenaline
(Norepinephrine)
2. Hormones: adrenaline (epinephrine)

SNS (Fight and flight response) leads to

1. Vasoconstriction in most internal organs
Due to the presence of -adrenergic
receptor ( -AR)

2. Vasodilation in the arterioles that supplying

blood to the skeletal muscle Vasomotor center
Due to the presence of 2-adrenergic innervates blood vessels by
receptor ( 2-AR) the sympathetic nerves
(release Norepinephrine)
More blood flows to the skeletal muscle
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http://www.rci.rutgers.edu/~uzwiak/AnatPhys/Blood_Vessels_files/image008.jpg
 Similar to sympathetic nervous

There are some hormones that control diameters of arterioles

(they are also extrinsic factors)

Epinephrine (adrenaline) excreted by adrenal medulla binds to

Activation of
sympathetic
nervous system

Sympathetic nervous system sends a nerve impulse to the adrenal glands

(adrenal medulla) to secrete epinephrine

Do you remember the action of adrenaline on heart?

http://www.biosbcc.net/doohan/sample/images/CO%20and%20MAP/epi_vessels.jpg
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 Other Chemicals that Regulate Vasoconstriction
and Vasodilation

Endothelial cells can act as autonomic neurons

to secrete several paracrine agents
Autonomic neurons
diffuse to the adjacent vascular smooth
DO NOT release
muscle and induce either relaxation or
acetylcholine and
contraction
norepinephrine
vasodilation in the presence of vasodilators
Release nitric oxide (NO) and
other vasodilators
Example:
Arterioles in the penis are sensitive to nitric
oxide
vasodilation and increases blood flow for
erection

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 Controlling the Radius of a Blood Vessel
1. Vasodilation = relaxation of (arteriolar) smooth muscle = increase in radius
2. Vasoconstriction = contraction of (arteriolar) smooth muscle = decrease in radius

Vasodilation Vasoconstriction

F = P/R By changing resistance (vasoconstriction or vasodilation) and

keep pressure the same, then blood flow to a particular tissue changes

Some vasoconstrictors you may learn later

1. Angiotensin II
2. Vasopressin (Antidiuretic hormone)
END