Beruflich Dokumente
Kultur Dokumente
o D= diffusion coefficient
Depends on the substance it is diffusing AND
through what substance
Flow= Flux x Area
C C
flow=D out
A
o
d
CARDIOVASCULAR
CARDIOVASCULAR
o Even when they are not moving (biggest organ)
Flow measurement
Volume
Flow=
Time
Pressure
Pressure=
Force
Area
Pressure gradient
CARDIOVASCULAR
P=P arterial
CARDIOVASCULAR
r
o v= viscosity of the fluid (only valid for laminar flow)
Control of vessel resistance
1
R
radius
Resistance
Series:
Parallel:
P=Flow ( R 1+ R 2)
P=Flow (
1 1
+ )
R1 R2
CARDIOVASCULAR
Dividers/walls
Inter-atrial septum (between atria)
Inter-ventricular septum (between ventricles)
Left ventricular free wall
Right ventricular free wall
Cardiac valves
Atrial ventricular values
o LEFT: mitral value (bicuspid)
o RIGHT: tricuspid value
Pulmonary value (semilunar) (right ventricle/pulmonary trunk)
Aortic value (left ventricle/aorta)
Values sit in a fibrous ring (NOT muscle)
Papillary muscles and chordae tendinae
Papillary muscle: cylinder of muscle that comes out of the wall
It attaches to leaflet of values by chordae tendinae
When ventricle contracts chordae tendinae pull down on
leaflets and prevent prolapsing in the atrium and keep value
closed
Papillary muscle rupture mitral regurgitation (value
replacement)
Other terms
CARDIOVASCULAR
CARDIOVASCULAR
Both
intra- and
extracellular
flow of
current is
necessary
Membrane is
an
insulator
No charge
= no potential
Local current is measured by ECG
* ALL positive ions (not just Na and K) AND ALL negative ions
Electrocardiogram (ECG)
Electrocardiogram: the printed graph
Electrocardiograph: the device that measures it
Voltmeter to measure extracellular voltage
o Measure the different in two points
Patient hooks up with the patient 5 leads (copper wire)
ECG waves and complexes
Amplitude= 1 mV in
interstitial space at the
surface (vs. 100 mV for an
intracellular recording)
ONLY local circuits: only
depolarization OR
repolarization
Waves
Before P wave= activation
of SA node (too small)
P wave= atrial excitation
(1/2 right, left)
Halfway through P = AD node (slowly)
Between P and Q= bundle of his, bundle branches, purkinje
Q= septum, R= left and right ventricular free walls
T= ventricular wave of depolarization
Leads
Electrode itself RA lead
CARDIOVASCULAR
CARDIOVASCULAR
NO resting membrane
potential
No Na current SO Ca generates
the upstroke
CARDIOVASCULAR
Block can get worse can become complete
atrioventricular block
Treatment= pacemaker that beats ventricles
CARDIOVASCULAR
QRS occurs
at the peak of the last T wave
o Ectopic beat in the ventricles probably from an ectopic
pacemaker
Ectopic means in the wrong place
Rapid
rhythm in
the
ventricles (V tach)
o QRS/T every 0.2 s 5 times/ second
o Cardiac output=0 because there is no time for ventricle to
pump
V. Fibrillation low amplitude cannot return to normal
o Use AED= automated external defribrillator
o Big shock can bring one back to normal sinus
CARDIOVASCULAR
Mechanical activity
Mechanical activity lags behind electrical activity
CARDIOVASCULAR
CARDIOVASCULAR
CARDIOVASCULAR
Abnormal valves
Stenotic valve: not completely open (calcium deposition)
Insufficient valve: leaky value (some backflow)
Some are pathologic, most are benign
Blood pressure LEFT arterial blood pressure
Maximum= systolic pressure (120)
Minimum= diastolic pressure (80)
Pulse pressure= systolic-diastolic= 40
Mean arterial pressure (MAP)= diastolic + (1/3) pulse pressure
1
MAP=diastolic pressure+ Pulse pressure
o
3
Measurement of BP
Direct
Indirect: palpation, auscultation, oscillometry
o All use aneroid sphygmomanometer
Inflating bulb, cuff, aneroid gauge, needle valve
Method of palpation
High pressure in cuff> artery= stop flow
First pulse: systolic blood pressure
Method of auscultation
Use stethoscope
High pressure in cuff> artery= no flow = no sounds
Systolic> cuff= open a bit= turbulent flow= Kirchhoff sounds
o Marks systolic pressure
CARDIOVASCULAR
Oscillometry
Little pulses = hit the cuff = pressure in cuff increases
These start before systolic and end after diastolic
o Algorithm can fix this
Don't need to be trained
Total peripheral resistance
Blood Pressure Mean =Cardiac output total peripheralresistance
Resistance
CARDIOVASCULAR
CARDIOVASCULAR
Sympathetic
control of
contractility
Same as
control of heart rate except it synapses with ventricles increase
of SA node
Increases the strength of contraction
o Duration of systole decreases
o SHIFT frank starling law to the LEFT
BOTH frank-starling and increase of contractility
occur when you exercise
Same drugs can be used
CARDIOVASCULAR
Baroreceptors
Reflex that senses pressure
In carotid sinus and aortic arch STRETCH receptors
Every heart beat it stretches action potentials
o Higher pressure= higher firing frequency= decrease BP
o Increase or decrease sympathetic/parasympathetic
Heart rate, contractility, vessel tone
IF you cut the nerve (baroreceptor denervation)
o Very high and very low pressures (labile)
o THUS baroreceptor reflex is called the buffer reflex
Long term MAP is unchanged
Kidney, blood volume and BP
Increase in BP= increase pressure diuresis (urinary loss)=
decrease plasma volume
Decrease end diastolic volume frank starling mechanism
Dcrease stroke volume, decrease cardiac output= decrease BP
Diuretic= reduce BP
CARDIOVASCULAR
Orthostasis
Arterial blood pressure: doesn't change much
o Slight rise in diastolic, slight drop in systolic (10 mmHg)
o For 10 s: immediate drop in BP
Due to hydrostatic pressure
o Mean arterial blood pressure remains the same
Central blood volume: from 1.2 0.9 L
o Blood is pooled in lower extremities
Right atrial pressure: 5.1 0.2 mmHg
o Right atrium not as filled, because blood in feet
Stroke volume: 100mL 50 mL
o Atrium is not as filled
o Frank starling mechanism AND there is less blood
o Despite increase in contractility (baroreceptor)
Cardiac output: 6L/min 4.5 L/min
Heart rate: 60 90
o To increase cardiac output after stroke volume is cut in half
o CO= HR x SV
TPR: increased (INCREASE constriction)
o Blood flow to forearm decrease (doesn't happen in
brain/heart)
o To maintain MAP MAP= CO x TPR
Orthostatic/postural hypothesion
If system does not work
BP falls enough faint
Muscle pump in orthostasis
Everything goes back to levels of lying flat
Constricting muscles in calf
o Effect is due to venous valves
o One way valve to prevent backflow
Pressure in vein increase opens next valve, closes
last valve
Very important in exercise
Venous pressure while standing
High pressure in veins water goes into interstitial space
Blood volume is reduced
Less frank-starling decrease TP
Muscle pump lowers venous pressure
o Less blood in veins (80 25)
CARDIOVASCULAR
Starling forces
Arterial end: net filtration pressure= 10 mmHg
Venous end= -10 mmHg
Lymph flow= 4L/day
Exercise
HR increases (linearly)
o Max heart rate= 220- age
o Increase by x3
o Due to sympathetic ervous system
Stroke volume: increase (due to contractility)
o SV decreases at high HR because heart is pumping too fast
for the ventricles to fill
Cardiac output increases by x 3
o Due to HR increase rather than SV
CO= HR x SV
Arterial pressure: increase by x 1.2
TPR: decreases by 0.4 because MAP= CO x TPR
o Using more of muscles waste products dialation
Oxygen consumption x 9
o Because CO x3 and arteriovenous oxygen dif increase by
x3
Arteriovenous oxygen difference: increase by 0.3
o Fick principle: V o 2=Cardiac output av O2
CARDIOVASCULAR
Endurance training
Can go to higher work load and a higher cardiac output
o CO= HR x SV
o Trained: lower heart rate for same work load
Can reach higher max work load before max heart
rate
o SV increase due to hypertrophy of ventricular muscle
Cardiac cells grow in size