Cardiovascular Physiology

Objectives
• Review the basic anatomy and
physiology of the cardiovascular
system.
• Describe the electrical and mechanical
events involved in the cardiac cycle.
 Objectives
• Discuss the factors that alter or impact the
electrical and mechanical events of the
cardiac cycle.
• Explain the physiology of circulation and
perfusion.
Anatomy
 Did you know???
Your heart is about the size of your clenched fist

It beats about 4000 times an hour and about

100,000 times a day

It will beat over 2 billion times in a lifetime

Each heartbeat pumps half a cup of blood

The force of your heartbeat is sufficient to shoot

blood 30 feet into the air
 Anatomy Review - The Heart
Right atrium
• Incoming blood supply
• Tricuspid valve
• Chordae tendinae and
papillary muscles
• Right Ventricle
• Pulmonary artery
 Anatomy Review - The Heart
Left atrium
• Receives supply
from the pulmonary
vein
• Left ventricle
• Bicuspid (mitral) valve
• Aorta
 Anatomy Review - The Heart
Heart wall
• Endocardium
• Myocardium
• Epicardium
Splits into another
outside layer – the
pericardium
 The Pericardium
• Fixates the heart to the
thoracic cavity
• Relatively inflexible tissue
• Pericardial sac holds
30-50mL of serous
fluid between the
pericardium and
epicardium,prevents
friction during contraction
 Valves of The Heart
Pulmonic

Aortic

Mitral

Tricuspid
 Circulation through Heart
Pulmonary
Right side of the heart
Blood from the body, low O2 high CO2,
right atrium→right ventricle→lungs
via pulmonary trunk.
Unloading of CO2 pick up O2 to left
side of the heart.
Arteries carry De-Oxygenated blood
Veins carry oxygen rich blood
Systemic
Left side of heart
Oxygen rich blood - lungs- left atrium-
left vent. - aorta
Blood transported via systemic
arteries to body tissues, gas and
nutrient exchange across capillary
walls
Blood is then returned to the right side
of the heart through superior and
inferior venae cavae.
 Circulation through Heart
Although equal volumes of blood are flowing in the
pulmonary and systemic circuits, the two
ventricles have uneven workloads.

Pulmonary Circuit: right, short low pressure

circulation.

Systemic Circuit: left, long pathway, five times as

much resistance to blood flow, high pressure
 Coronary Circulation
The functional supply of the heart, is the
shortest circulation in the body.

The arterial supply of coronary circulation is

provided by the right and left coronary
arteries arising from the base of the aorta,
and encircle the heart in the
atrioventricular groove.
 Coronary Arteries
• The coronary arteries provide an
intermittent, pulsating blood flow to the
myocardium.
• Actively deliver blood when the heart is
relaxed, ineffective when the ventricles are
contracting because:
– compressed by contracting myocardium
– entrances to the coronary arteries is
blocked by the open Aortic valve.
Coronary Artery Supplies
Right C.A.

Right atrium and

ventricle

Inferior portion of
the left ventricle

Interventricular
septum

Conduction
system
Coronary Artery Supplies
Left Main C.A.

Left atrium

Nearly all of the

left ventricle

Circumflex
and LAD Branch

AV node in half
of the population
 Cardiac Physiology
• Electrical components
• Electrophysiology
• The Cardiac Cycle
• Mechanical Events of the Cardiac Cycle
• Influences of Electrical and Mechanical
• Heart Function
Electrical Conduction System
 Action Potential
Early repolarisation
Notch Plateau

Upstroke → Late rapid

depolarisation Repolarisation

Resting
potential

Intracellular

Extracellular

Ref: Woods et al (2005) Cardiac Nursing 5th ed Lippincott, Wilkins & Williams: Philadelphia p 23
 Cardiac Cell Types
Electrical cells
• Generate and
conduct impulses
rapidly
• SA and AV nodes
• Nodal pathways
• Interventricular
septum
• No contractile
properties
 Cardiac Cell Types
Muscle (myocardial) cells
• Main function is
contraction
• Atrial muscle
• Ventricular muscle
• Able to conduct
electrical impulses
• May generate its own
impulses with certain
types of stimuli
 Unique Properties of Cardiac Cells
• Automaticity • Conductivity (all cells)
SA and AV nodes Points of stimulation
• Excitability (all cells) • Nervous system
Points of stimulation • Electrolytes

• Nervous system Slowing of conductivity

• Physical cell damage • Ischemia
• Ischemia • Calcification of nodal
• Electrolytes pathways
Contraction
• Muscle cells
Mechanical Function
of the Heart
 The Cardiac Cycle
2 components

Diastole
Filling of the chamber
Systole
Contraction of the chamber and ejection of blood
 Cardiac Output
• The amount of blood ejected from the
ventricle in one minute
• Elements of cardiac output
Stroke volume CO = SV x HR
• Amount of blood ejected from the
ventricle in one contraction
Heart rate
• The number of cardiac cycles in one minute
Determination of Stroke Volume
Preload
Amount of blood delivered to the chamber.
Depends upon venous return to the heart.
Also dependent upon the amount of blood delivered
to the ventricle by the atrium.
Contractility
The efficiency and strength of contraction
Frank Starling’s Law
Afterload
Resistance to forward blood flow by the vessel walls
 Cardiac Feedback Loops
• Master controller: the medulla
Incoming input
• Chemoreceptors
Sense changes in pH, PaCO2 and PaO2
• Baroreceptors
Sense changes in arterial pressure
Response of the medulla
• Stimulate the autonomic nervous system
 Autonomic Nervous System
Sympathetic Nervous System
Extensively innervates the SA node and ventricular cells
• Increase in heart rate
• Increase in conduction and contractility in the
ventricles
Parasympathetic Nervous System
Innervates the SA and AV nodes
• Decreases heart rate
• Decreases conduction times through the AV node
 Chemical Factors
• Hormones
Adrenaline
• Stimulation of beta receptors in the
myocardium
• Increase in contractility of the
ventricles
• Increase in conduction throughout the
ventricles
 Chemical Factors
Electrolyte Concentrations
Calcium
• Impacts the strength of contractions
• High calcium may cause irritability of
electrical cells
 Chemical Factors
Potassium
Impacts the rates of firing and recovery of the
cardiac cells
• High potassium
• Irregular firing of cardiac cells
• Dysrhythmias and ventricular fibrillation
potentials
• Low potassium
• Longer delays in the firing of cardiac cells
• May be caused by diuretic use
• Bradycardia
• Hypotension (systemic complication)
• Poor cardiac output results
The Vascular System
 The Vascular System
• The vascular system is composed of the
systemic and pulmonary circulation.
• Both systems consist of arteries,
capillaries and veins.
• Arterial system: away from the heart
• Venous system: capillary beds to heart
• Anatomical differences of arteries and
veins
 Factors Contributing to Arterial
Blood Pressure
BP = CO x TPR
• Cardiac Pump
• Blood Volume
• Peripheral Resistance
• Elasticity of Arterial Walls
• Viscosity of Blood
 Factors Aiding Venous Return

1) Cardiac Pump

2) Respiratory Pump

3) Muscular Pump
 Control Of Blood Pressure
• Cardioacceleratory & Cardioinhibitory
centres in the Medulla.
• Chemicals, Temperature, Sex, Emotions
and age, effect heart rate
• Vasomotor centre, pressoreceptors
(baroreceptors), chemoreceptors -
chemical and autoregulation
Pathophysiology

When it all goes wrong

 Pathophysiology – Pericardial,
Myocardial and Endocardial
Disease
• Pericarditis – inflammation of the pericardium
• Effusion – excess fluid/blood/pus in the pericardial sac
• Tamponade – significant compression of the heart due
to pericardial effusion
• Myocarditis – inflammation of the myocardium
• Cardiomyopathies – dilatation, hypertrophy or non-
compliance of the myocardium
• Infective Endocarditis – infective organisms invade
the endothelial lining of the heart involving the valves,
causing vegetation
 Pathophysiology - Valvular Heart
Disease
• Stenotic
– unable to open fully ∴ restricting forward blood flow
↑ afterload and cause hypertrophy (enlarged muscle)
• Regurgitant, incompetent or insufficient
– Unable to close fully ∴ permit backward blood flow
– ↑ volume load and cause dilation of chambers
• Rheumatic Heart Disease
– extensive inflammatory changes → scarring of the
valves
• Infective Endocarditis
– Endovascular infection → vegetation on a heart valve
• Degenerative Changes
Physiology of Ischaemia
Atherosclerosis – Hardening
Atheroma (plaque) builds up in
the coronary arteries and reduces
blood flow and O2 supply to the
heart muscle, resulting in angina
pain. Prolonged ischaemia or
plaque rupture leads to
myocardial infarction and loss of
myocardial function (heart failure).
The extent of damage depends
on which artery is affected and
time to treatment.
 References
• Darovic, G. (2002). Hemodynamic Monitoring invasive and
noninvasive clinical application 3rd ed. W.B. Saunders Company.
• Marieb, E.N. (2001). Human Anatomy and Physiology 2nd ed. The
Benjamin/Cummings Publishing Company: California.
• Stinson Kidd, P.& Dorman, Wagner, K. (2001). High Acuity Nursing
3rd ed. Prentice Hall: New Jersey.
• Thelan, L.A., Urden, L.D., Lough, M.E. & Stacy, K.M. (1998).
Critical Care Nursing Diagnosis and Management 3rd ed. Mosby: St
Louis.
• Tortora, G.J. & Grabowski, S.R. (1993). Principles of Anatomy &
Physiology 7th Ed. Harper Collins: New York