Cardiac Physiology (I)

A. Rhan Akar Ankara University School of Medicine

December- 2003

Cardiovascular System
Primary function: convection mass movement of fluid caused by pressure difference

Heart- driving force Arteries- distribution Microcirculation- exchange Veins- reservoir

The Heart

central part of the circulatory system driving blood through

systemic (high pressure system) pulmonary circulations (low pressure system)

RV wall

LV wall

Interventricular septum

Left ventricular wall is three times thicker than right ventricle Right ventricle crescent-shaped Left ventricle- cylindrical Conducting tissue ( Purkinje fibers) in the septum

Left Ventricle
ejects blood primarily by reducing the
cross-sectional area of the cylinder

changes in volume are a function of

changes in the radius squared

area= . r2

Cardiac Output
volume of blood ejected by one ventricle per minute

CO
~5L

= stroke volume x heart rate

= (70-80 ml) x (65-75 beats/min)

CO

= Stroke volume . Heart rate

Preload Afterload Contractility

Sympathetic activity Parasympathetic (vagal) activity Catecolamines

Haemodynamics
study of factors that determine blood flow and blood pressure in the body

Pressure = force per unit area (dynes/cm2)

1 mmHg = 1.36 cmH2O = 1330 dynes/cm2

Total energy = Kinetic energy + Potential energy

Momentum that blood gains because of its mass (m) and velocity

Hydrostatic pressure Lateral pressure

m . v2 2

Flow (Q) Mass movement of a volume of fluid per unit time ml/sec L/min
Continuity principle: flow through each vascular component must be equal to each other To keep the flow rate equal, the velocity of flow must vary inversely with the cross-sectional area

Narrow segment represents an area of increased velocity which results in a Bernoulli effect (conversion of potential energy into kinetic energy)

Poiseuilles Law
(for laminar flow)

P . . r4 Q= 8..L
P= pressure gradient r= radius of the tube = viscosity of the fluid L= length of the tube Resistan ce

8..L . r4

Ohms Law

Voltage (pressure gradient) Current (flow) = Resistance

Law of Flow (Darcy)

Q= P R
flow is proportional to driving pressure inversely proportional to resistance

SVR = P/Q

(mmHg/L/min)

1 peripheral resistance unit (PRU) = 1 mmHg/ml/sec

Systemic circulation resistance= 1 PRU Pulmonary circulation resistance= 0.1-0.2 PRU

Frank Starling effect

Energy produced by the heart when it contracts is a function of the end-diastolic length of the muscle fibers

Direct linear relationship Tension in an individual fiber Pressure development in the ventricle

Frank curve for isolated muscle

Preload
depends volume of blood before contraction (LVEDV) physiologically determined by the venous return wall stress at the end of diastole LVEDP determines the LVEDV and hence the resting length of the ventricular muscle fibers

Frank Starling Increased ventricular

end-diastolic volume and pressure increases the force of contraction The time required to generate peak pressure is unchanged

Contractility (Inotropism)
increased contractile force at a constant preload or ventricular volume
Activation of 1 receptors
Sympathetic nerve stimulation Epinephrine, norepinephrine

Digitalis

Contractility
Contractility alter the peak force developed and the duration of the contractile process

Frank Starling Ventricular function curve

(venous pressure)

Contractility @ Maximal velocity of shortening

Positive inotropism can be defined as an increase in the maximal velocity of shortening (Vmax)

Force velocity curve for isolated muscle

(afterload)

Negative Inotropic Mechanisms

Hypoxia Acidosis Myocardial ischaemia or infarct

Law of Laplace
Wall stress (T)= pressure x radius (r) 2 thickness (h)

The increase in the radius-to-thickness ratio increases wall stress (or afterload) (maladaptive) at any given radius (LV size), the greater the pressure developed by the LV, the greater the wall stress

A practical application of Law of Laplace.

In a sphere; V = 4/3r3
V= volume r= radius Left ventricle has three axes; Antero-posterior (DA) Lateral diameter (DL) Maximal length (LM)

V = 4/3 (DA/2) x (DL/2) x (LM/2)