Cardiovascular Physiology

PhD PT Raphael Martins de Abreu

2024
[email protected]
Heart
The Heart

➢ Primary organ of the circulatory system

➢ Made up of cardiac muscle, cardiac nervous

tissue, with protective epithelial and connective
tissues

➢ Double-sided pump:
Pump blood to the lungs

Pump blood to the body

Electrical Activity
Pacemaker of the Heart (intrinsic)
• Sinoatrial Node
Generate the sinus rhythm of the heart
3 conduct pathways – posterior, middle and anterior
Contract the atrium down the way

• Atrioventricular Node
“Collecting node” - Collects the impulse from the atria

• Atrioventricular Bundle (HIS)

Takes the impulse down the way

• Purkinje Fibers
Small fibers taking the impulses into the ventricular
myocardium
 Neural Activity

Intrinsic regulation
(autorhythmic cells)

Extrinsic regulation
Neural Activity
Sympathetic Division

ACh: acetylcholine
NE: norepinephrine
EPI: epinephrine
Neural Activity
Parasympathetic Division

ACh: acetylcholine
M - Muscarinic receptors
Neural Activity
Main Differences

Rest, heal & digest Fight or Flight

Parasympathetic activity Sympathetic activity
dominates dominates
Cardiac Output (Q)
Cardiac Performance

How efficiently the heart meets the body's Q HR SV

demands

Maintain good tissue perfusion

Q 70 70
Cardiac Output (Q)

Definition: Amount of blood (L) pumped by the

heart minute (min): 4 to 6 L/min at rest (↑ 4 to 6 Q 4900mL
times)
Q - Determinants
Echocardiography

Information: velocity, direction, character of blood

flow.

Just as police radar monitors traffic

Q - Determinants

Blood flowing toward the transducer = its velocity is encoded as red

Blood flowing away the transducer = its velocity is encoded as blue

Q - Determinants
Cardiac Output (Q)
SV EDV ESV
Q - Determinants
Heart Rate

Chronotropic Effects
HR
Time “a turn”

+ Chronotropes

Sympathetic stimulation

- Chronotropes

Parasympathetic stimulation
Q - Determinants
Preload

Amount of blood
entering the ventricle Venous Blood Atrial
during diastole return volume contraction

Determines the End

Diastolic Volume Increased: Hypervolemia,
(EDV) Regurgitation (Valves), Heart Failure
Q - Determinants
Boyle’s Law

States that the volume of gas is inversely

proportional to pressure.
Q - Determinants
During inspiration – Rib cage expands (↑ volume)
Respiratory Pump diaphragm contracts and is lowered
Expiration
Inspiration Inspiration
Intrathoracic
pressure

Abdominal
pressure
Circulation
Structure
 Q - Determinants
Muscle Pump

These valves permit blood to move forward

towards the heart (counteracting the
gravitational effects of the upright posture)

Valves prevent backflow

during venous return

Affected by muscle pump

(rhythmic exercises)
Muscle pump: Skeletal muscles surround veins,
and when they contract or relax, they can have a
significant impact on blood flow
Q - Determinants
Venous Return

Skeletal Respiratory

Venous Return

Preload
Q - Determinants
Afterload
SV EDV ESV

Resistance ventricles must

overcome to circulate blood

Vasoconstriction Hypertension

Determines the End

Systolic Volume (ESV) Increase AL

Afterload ∝ 1/SV
Q - Determinants
Contractility

How hard the myocardium contracts for a given preload;

Inotropic - Mechanisms that change the force of your heart's

contractions.

+ Inotropes

Strengthen the force of the heartbeat (sympathetic

stimulation)

- Inotropes

Weaken the force of the heartbeat (parasympathetic)

Q - Determinants
Frank-Starling’s Law

Correlation between filling and ejection fraction of

the heart

Increased venous return (pre-load) => increased

blood filling of the atria and ventricle

Increase stretch of cardiac muscles => increased

force of contraction => increased stroke volume
Q - Determinants
Q - Physical Activity
Q Responses

Increases from 5 to 20-25 L/min

Ejection Fraction
Measure of the pumping efficiency of the heart and is used to
classify heart failure;

Amount of blood Total blood volume ejected from the ventricle during each
pumped out of the contraction.
ventricle
SV 70mL 0.58 mL 100
EDV 120mL
EF = 58%

Total amount of
blood in ventricle
~Half the blood volume
in the LV should get
pumped out during each
heartbeat
Circulation
Blood Pressure
MAP
SBP - Pressure when heart is contracting
The average arterial pressure throughout one
cardiac cycle, systole, and diastole

DBP - Pressure when heart is relaxed Ex. 83x50mmHg

MAP = SBP + 2 (DBP)/3

MAP = 83 + 2 (50)/3 To perfuse vital
MAP = 83 + 100/3
organs
MAP = 183/3
MAP = 61 mmHg
(60-100mmHg)

Low MAP: inadequate blood flow to organs,

syncope, and shock.

Elevated MAP: ventricular remodeling, vascular

injury, end organ damage, and stroke.
Circulation
Tasks of the Circulatory System

Main task
Perfuse and maintain function of the brain

Transport - Supply
O2 and nutrition to the cells and organs

Transport – Removal
CO2 and metabolic products

Defense
Clotting, antibodies
 Fick’s Law
Rate of Diffusion
Fick's law of diffusion provides a
quantitative framework for understanding T
how molecules move through biological
tissues

T
A
A

T = Membrane thickness MW = Molecular weight

A = Membrane área P = Partial pressures of the gas
Circulation
Tissue Perfusion

Pressure exerted by blood against the wall of a

capillary is called capillary hydrostatic pressure
(CHP)

Colloid osmotic-pressure, is a form of osmotic

pressure induced by the proteins,
notably albumin
Tissue Perfusion
Circulation
Total Peripheral Resistance
Vascular Resistance

Viscosity
Friction between blood and the blood vessel
wall

Blood Flow
TPR

Radius
Resistance to flow throughout entire systemic
vasculature
Total Peripheral Resistance
Blood Viscosity

Polycythaemia Anemia

Low oxygen Internal Bleeding

Plasma

Total Blood Volume

Dehydration Menstruation
Smoking Trauma
Ulcer
Red Blood

Cancer
Cells

TPR - INCREASED TPR - DECREASED

Poiseuille's Law
Vasoconstriction

Increased contraction of circular smooth muscle in the arteriolar wall

Poiseuille’s Law: ↑ Resistance and ↓ Blood Flow

Cased by: ↑Sympathetic Stimulation, Cold

Vasodilation

Decreased contraction of circular smooth muscle in the arteriolar wall

Poiseuille’s Law: ↓ Resistance and ↑ Blood flow

Cased by: ↓ Sympathetic Stimulation, Heat

Arteriolar Radius
Intrinsic Control

Local control: Ability of an organ to regulate its

own blood flow regardless of what may be
happening elsewhere in the body.

Local metabolic changes!!

For example, if a muscle is actively being utilized

it will require more O2 than if it was at rest, so the
blood vessels supplying that muscle
will vasodilate, to increase the amount of blood,
and therefore O2, being delivered to that muscle.
Arteriolar Radius
Exercise Pressor Reflex

The “exercise pressor reflex”, as it is known

today, is activated during muscle contraction

Stimulation of receptors that respond to either

mechanical distortion or the metabolic by-
products of exercising skeletal muscle.

Signals are transmitted to the central nervous

system via group III (mechanically sensitive)
and group IV (metabolically sensitive) afferent
fibers.

Inputs Outputs
Circulation
Arteries have low capacitance, meaning they
Structure cannot store a significant amount of blood. Veins
have high capacitance, allowing them to store
blood and release it gradually when needed.
Arteriolar Radius
Extrinsic Control
Arteriolar Radius
Extrinsic Control Renin-Angiotensin-Aldosterone System

SBP ≤ 100 mmHg - Kidneys release the enzyme

renin into the bloodstream

Renin splits angiotensinogen (protein) into pieces

(angiotensin I)

Angiotensin I (inactive), is split into pieces by

angiotensin-converting enzyme (ACE). One piece is
angiotensin II (hormone active)

Angiotensin II = vasoconstriction + triggers the

aldosterone (hormone) release

Blood volume + vasoconstriction = BP

BP Determinants
BP Determinants
Baroreceptors After central processing, the arterial baroreflex regulates
MAP by altering efferent PNS and SNS to the heart and
blood vessels

NTS: nucleus tractus solitarius

NA: nucleus ambiguous
RVLM: rostral ventrolateral medulla
CVLM: caudal ventrolateral medulla
BP Determinants
Baroreceptors

Standing

Central blood volume

Venous return
Stroke volume

Cardiac output

Blood pressure

Baroreflex counter-regulation
(SNS and PNS)
Coronary Arteries
Coronary Flow

80% Myocardial nutrition - Ventricular

Diastole
Cardiovascular Physiology
PhD PT Raphael Martins de Abreu
2024
[email protected]