CARDIOVASCULAR CONTROL

DURING EXERCISE
MUHAMMAD FATHI BIN OTHMAN
MUHAMMAD AFIF BIN NASIR
LEARNING OUTCOME
Review the structure and function of the heart,
vascular system, and blood.
Find out how the cardiovascular system
responds to increased demands during
exercise.
Explore the role of the cardiovascular
system in delivering oxygen and nutrients to
active body tissues.

STRUCTURE AND FUNCTION OF
THE CARDIOVASCULAR SYSTEM
The cardiovascular system is impressive in its ability to
respond immediately to your bodys many and ever-
changing needs.

Any system of circulation requires three components :
1. A pump (the heart)
2. A system of channels ( the blood vessels)
3. A fluid medium ( the blood)
Heart
Has two atria that act as receiving chambers.
Has two ventricles acting as sending units.
Located in the center of thoracic cavity.
Pump that circulates blood through the entire
vasular system
Enclosed in a tough membranous sac called the
pericardium


Heart
Myocardium

Muscle thickness varies directly with stress placed
on chamber walls.
Left ventricle has the larger muscle mass and can
develop the highest pressures
With vigorous training, the left ventricle size
increases.
Due to intercalated disks impulses travel from
muscle fiber to muscle fiber in the heart (unlike
skeletal muscle fibers)

Cont.
Intercalated disks allow the myocardium to act as a
syncytium, i.e., it acts as one large muscle fiber so all
fibers contract together.
Skeletal Muscle
Heart Muscle
Intercalated disk
CARDIAC CONDUCTION SYSTEM
Sinoatrial (SA) nodepacemaker
Atrioventricular (AV) node
AV bundle (bundle of His)
Purkinje fibers6 times faster
transmission than conduction from heart
muscle cell to heart muscle cell

EXTRINSIC CONTROL OF HEART
ACTIVITY
Parasympathetic nervous system acts through the vagus nerve to decrease
heart rate and, to a lesser extent, the force of contraction (PNS predominates
at restvagal tone); ACh is the parasympathetic neurotransmitter.

Sympathetic nervous system is stimulated by stress to increase heart rate
(chronotropic effect) and force of contraction (inotropic effect);
norepinephrine (NE) is the sympathetic neurotransmitter.

The endocrine system (hormones) which is epinephrine and
norepinephrinereleased from adrenal medulla due to sympathetic nervous
system activity

Cardiac Arrhythmias

Bradycardia (slow heart)resting heart rate below 60 beats/min;
normal in trained persons (Peter Snell = 28 beats/min)

Tachycardia (fast heart)resting heart rate above 100 beats/min

Premature ventricular contractions (PVCs)feel like skipped or extra
beats; ectopic origin, i.e., they originate outside the SA node all heart
tissue has an intrinsic rhythm; that generated by the SA node is usually
fastest

Ventricular tachycardiathree or more consecutive PVCs that can
lead to ventricular fibrillation in which contraction of the ventricular
tissue is uncoordinated

Electrocardiogram (ECG or EKG)

Printout shows the heart's electrical activity and can be used
to monitor cardiac changes and pathologies
The P waveatrial depolarization
The QRS complexventricular depolarization and
atrial repolarization
The T waveventricular repolarization

PHASES OF A RESTING ECG


TAKING AN EXERCISE ECG


Cardiac Cycle

Events that occur between two consecutive heartbeats (systole to
systole)
Diastolerelaxation phase during which the ventricles fill with blood
(T wave to QRS)62% of cycle duration
Systolecontraction phase during which the ventricles expel blood
(QRS to T wave)38% of cycle duration
Wiggers Diagram Cardiac Cycle


BRAIN TEASER
There is a room with no doors, no widows, nothing and a
man is hung from the ceiling and a puddle of water is on
the floor. How did he die?



Answer
He was standing on a block of ice
and melted!



Stroke Volume and Cardiac Output

Stroke Volume (SV)

Volume of blood pumped by each ventricle per contraction
End-diastolic volume (EDV)volume of blood in ventricle
before co
End-systolic volume (ESV)volume of blood in ventricle
after contraction
SV = EDV ESV, e.g., SV = 125 ml 50 ml = 75 ml
Cardiac Output (Q)

Total volume of blood pumped by each ventricle per minute
Q = HR SV, e.g., Q = 60 beats/min x 75 ml/beat = 4,500
ml/min, or 4.5 l/min

Ejection Fraction (EF)

Proportion of blood pumped out of the left ventricle each beat
EF = SV/EDV x 100
Averages 60% at rest, e.g., EF = 75 ml/125 ml x 100 = 60%

CALCULATIONS OF SV, EF, AND Q

Vascular System: Closed System

Arteries
Arterioles: control blood flow through tissue by
vasoconstriction and vasodilation
w Capillaries: where exchange between blood and tissues
occurs, e.g., oxygen, carbon dioxide, glucose, FFA, etc.
Venules
Veins: possess valves to assist unidirectional flow of the
blood

Vascular System: Closed System

Blood flows because of
A pressure difference, i.e.,
a P

Flow is unidirectional
because of valves in the
heart and the veins

Blood Pressure

Systolic blood pressure (SBP) is the highest arterial pressure
and diastolic blood pressure (DBP) is the lowest arterial
pressure in the cardiac cycle
Mean arterial pressure (MAP)average pressure exerted by
the blood as it travels through arteries usually what is
considered in physiological studies
Estimated MAP = DBP + [0.333 (SBP DBP)]

Blood Pressure

Average systemic arteriolar constriction increases blood pressure;
dilation reduces blood pressure
Recall Ohms law: V = IR, or
voltage (electromotive force) = current (flow) x resistance
Similarly, in the cardiovascular system,
P = Q x TPR, or pressure = cardiac output x total peripheral resistance
Mean arterial blood pressure is the primary regulated variable in the
cardiovascular system, assuring sufficient blood flow to the brain in an
upright bipedal human
Monitored by baroreceptors located in the aorta and carotid arteries:
increased mean pressure decreased sympathetic vasoconstriction;
decreased pressure increased sympathetic vasoconstriction

Functions of the Blood

Transports gas, nutrients, wastes, and hormones
Regulates temperature
Buffers and balances acid-base

COMPOSITION OF TOTAL BLOOD
VOLUME

Blood Formed Elements and
Hematocrit

Blood formed elements
w White blood cellsprotect body from disease organisms
Blood plateletscontribute to blood coagulation
Red blood cells >99% of the total blood cells contain hemoglobin, which
binds and carries oxygen to tissues, and to a lesser extent, carbon dioxide to the
lungs from the tissues
Hematocrit
w Ratio of formed elements to the total blood
volume
w HematocritFormed elements/total blood
volume

Blood Viscosity

Thickness of the blood
The more viscous, the more resistant to flow
Higher hematocrits result in higher blood viscosity; the higher
the hematocrit, the greater the oxygen carrying capacity;
however, the greater viscosity requires greater cardiac work
to pump the blood

Cardiovascular Response to Acute
Exercise

Heart rate (HR) increases as exercise intensity increases up to maximal heart
rate.
Stroke volume (SV) may increase up to 40% to 60% VO
2
max in untrained
individuals and up to maximal levels in trained individuals, but the SV response
is highly variable.
Increases in HR and SV during exercise allow cardiac output (Q) to increase
Blood flow increases to the active muscles, and decreases to the inactive
tissue, e.g., visceral organs
Mean arterial pressure increases, but not to near the same extent as Q; thus,
TPR decreases nearly proportionally to the increase in Q to maintain a constant
MAP

Resting Heart Rate

Averages 60 to 80 beats/min; can range from 28 to above
100 beats/min
Tends to decrease with age and with increased
cardiovascular fitness
Is affected by environmental conditions such as altitude and
temperature

Maximum Heart Rate

The highest heart rate value one can achieve in an all-out
effort to the point of exhaustion
Remains relatively constant day-to-day but decreases with
aging
wCan be estimated: HRmax = 220 age in years or 226-age
for women


BRAIN TEASER
A boy and a doctor was fishing. The boy
is the doctor's son but the doctor is not
the boy's father. Who is the doctor?
Answer
His Mother!
Stroke Volume

Determinant of cardiorespiratory endurance capacity at maximal
rates of work because maximal HRs dont vary much in persons
of the same age
May increase with increasing rates of work up to intensities of
40% to 60% of max or higher when starting from upright position
May continue to increase up through maximal exercise intensity,
generally in highly trained athletes
Magnitude of changes in SV depends on
position of body before and during exercise

Stroke Volume

STROKE VOLUME INCREASES
IN CYCLISTS


Stroke Volume Increases During
Exercise

Frank Starling mechanism increase in venous return (i.e.,
increased pre-load) from muscle and respiratory pumps
results in more blood in the ventricle causing it to stretch
more and contract with more force according to the length-
tension relationship.
Increased ventricular contractility (without end-diastolic
volume increases) from sympathetic stimulation.
Decreased total peripheral resistance due to increased
vasodilation of blood arterioles in active muscles.

Left Ventricular Volumes vs.
Exercise Intensity

Supine
Upright
CHANGES IN Q AND SV WITH
INCREASING RATES OF WORK


Cardiac Output

Resting value is approximately 5.0 L/min (70 kg male).
Increases linearly with increasing exercise intensity to
maximal values of between 20 to 40 L/min.
The magnitude of cardiac output varies with body size
When exercise intensity exceeds 40% to 60%, further
increases in Q may be more a result of increases in HR than
SV since SV tends to plateau at higher work rates.

CARDIAC OUTPUT AND INTENSITY

CHANGES IN HR, SV, AND Q
WITH CHANGES IN POSITION
AND EXERCISE INTENSITY









A B C
RELATIVE DISTRIBUTION OF Q
DURING EXERCISE


ABSOLUTE DISTRIBUTION OF
Q DURING EXERCISE


BRAIN TEASER
What ends in a 'w' but
has no end?
Answer
A rainbow!
Cardiovascular Drift

In the heat, blood flow to the skin increases to promote
cooling. Blood tends to pool in skin vessels, decreasing
venous return to the heart (decreasing pre-load).
Gradual decrease in stroke volume and systemic and
pulmonary arterial pressures and an increase in heart rate,
which allows maintenance of cardiac output.
Occurs to some extent even with steady-state prolonged
exercise in a thermoneutral environment, but particularly in
exercise in a hot environment.

CARDIOVASCULAR DRIFT


BLOOD PRESSURE
pressure exerted by blood against the blood vessels

Systolic = highest pressure in the artery
Diastolic = lowest pressure in the artery

Systolic BP = 120 mmHg at rest
As exercise increases = systolic BP increases because Q increases,
but diastolic BP not change.
But, if a submax steady-state endurance exercise is prolonged,
systolic BP decreases because increased arteriole dilation in active
muscles.



BLOOD PRESSURE
OXYGEN CONTENT
Amount of oxygen extracted from the blood as it travels through the
body
Calculated as the difference between the oxygen content of arterial
blood and right atrial blood
Increases with increasing rates of exercise as more oxygen is
taken from blood
w The Fick equation represents the relationship of the bodys oxygen
consumption (VO
2
) to the arterial-mixed venous oxygen difference
(a-vO
2
diff) and cardiac output (Q); VO
2
= Q a-vO
2
diff.
e.g., if Q = 25 l blood/min and a-vO
2
diff = 100 ml O
2
/l blood,
VO
2
= 2.5 l O
2
/min


CHANGES IN a-vO
2
diff


Blood Plasma Volume

Reduced <10% with onset of exercise (goes to interstitial fluid space
from squeezing effects of contracting muscles)
More is lost if exercise results in sweating; countered by aldosterone
and ADH
Excessive loss can result in dehydration and impaired performance
Reduction in blood plasma volume results in hemoconcentration

HEMOCONCENTRATION


All the change in cardiovascular function that take
place when you start to exercise, the cardiovascular
system is extremely complex.
INTEGRATION OF THE
EXERCISE RESPONSE
THANK YOU