BIO 1414 Human Anatomy & Physiology II

Unit 5 - Cardiovascular Physiology By: Robert F. Allen, Professor of Biology

Blood Functions - Distribution

Supplies Oxygen from lungs to cells Supplies nutrients from digestive system to cells Transports metabolic wastes from cells to disposal sites Transports hormones to target tissues/organs

Blood Functions - Regulation

Regulates body temperature Regulates the pH of body fluids Regulates blood volume to support efficient circulation to cells, tissues, organs & systems

Blood Functions - Protection

Prevents blood loss Prevents infection through the activity of white blood cells, complement & antibodies

Plasma
Liquid part of blood Contains:
Water Proteins Hormones Nutrients Electrolytes Respiratory Gases Wastes

Plasma Proteins
Include: Albumin (60%) Globulins (36%) (Antibodies & transport proteins) Clotting Proteins (4%) Enzymes & Hormones

Plasma

Serum
Liquid part of blood without clotting proteins

Albumin (60%) Globulins (36%) (Antibodies & transport proteins) Clotting Proteins (4%) Enzymes & Hormones

Serum Plasma

Clot

Hematocrit
Percent of formed elements Normal Hematocrit is around 45%, depending on gender

Hematocrit

Formed Elements Cells/Components

Erythrocytes (RBCs) Platelets Leucocytes (WBCs)

250,000500,000/mm3

4 - 6 million/mm3

Granulocyte - Neutrophil
Nucleus with 3 to 6 lobes Cytoplasmic granules fine, both basic & acidic

Phagocytize bacteria & some fungi Produced in bone marrow by myeloblasts

Granulocyte - Eosinophil
Nucleus bilobed Cytoplasmic granules coarse & acidic (red/orange)

Destroy parasitic worms & immune complexes Produced in bone marrow by myeloblasts

Granulocyte - Basophil
Nucleus lobed - U or S shaped Cytoplasmic granules large & basic (purplish/black)

Cause vasodilation by the release of histamines Produced in bone marrow by myeloblasts

Agranulocyte - Lymphocyte
Nucleus spherical-fills half or more of cell No visible granules in cytoplasm

B lymphocytes - Humoral Immunity (antibodies) T lymphocytes - Cellular Immunity Produced in lymphatic tissues

Agranulocyte - Monocyte
Nucleus U or kidney shaped -fills half or more of cell No visible cytoplasmic granules

Differentiate into macrophages in tissues. Provide defense against viruses & intracellular bacteria in chronic infections. Activate lymphocytes Produced by monoblasts in lymphatic tissues.

Blood Clotting Process

Platelets - Form temporary plug & release platelet factors which catalyze clot formation

 Platelet factors - React with Calcium (Ca2+) & other clotting factors in the plasma to initiate clot formation.

Thromboplastin - a lipid (Tissue Factor) released from injured cell membranes which accelerates the clotting process. Lipids released from damaged cell membranes such as thromboplastin having a localized effect are called Prostaglandins.

 Platelet factors, Ca2+ & other clotting factors in plasma initiate clot formation A plasma protein (Prothrombin) is converted by prothrombin activator into an enzyme Thrombin.

 Thrombin converts the plasma protein Fibrinogen into the insoluble protein Fibrin.

 Fibrin forms a mesh which glues the platelets & RBCs together to form the clot.

Factors Affecting Clot Formation

Vitamin K - Required by liver to produce prothrombin & several other clotting factors. Calcium - Necessary for prothrombin conversion into thrombin & fibrinogen conversion into fibrin. Thromboplastin - Speeds up clot formation from 3 - 6 minutes to 15 seconds.

Factors Affecting Clot Formation

Heparin - A natural anticoagulant which prevents clot formation by inhibiting thrombin formation. Sodium Citrate - An agent used on glassware & instruments to prevent coagulation by tying up Calcium. Plasmin (Fibrinolysin) - Breaks down clots by dissolving the fibrin after the clot is no longer needed.

ABO & Rh Blood Groups (Types)

Based on the presence of specific antigens (proteins) on the outer surface of cells. Many other antigens exist on cell membranes besides A, B, AB, O & Rh. Because A, B, AB, O & Rh antigens can cause severe transfusion reactions, blood typing is always done for these prior to transfusions. Other types are of medical or legal interest.

ABO Blood Types

Type A Type A Antigen on cells

Type B

Type B Antigen on cells

Type AB

Type A & B Antigens

Type O

Neither A nor B Antigens

ABO Antibodies In Plasma

Type A blood Anti-B Antibodies

Type B blood

Anti-A Antibodies No Anti-A or Anti-B Antibodies Both Anti-A & Anti-B Antibodies

Type AB blood

Type O blood

Rh (Rhesus) Factor
Up to 8 genes determine if a person is Rh positive. The most common of these are the C, D & E genes which determine if a person has C, D and/or E antigens on the walls of the cells. People who do not have Rh antigens on their cell membranes are Rh negative.

Rh Blood Groups
Rh No Rh Antigens on cell membranes

Rh +

Type Rh Antigens on cell membranes

Rh Antibodies in Plasma
Rh No Anti-Rh antibodies in plasma until sensitized to Rh antigens No Anti-Rh antibodies in plasma

Rh +

Antibody/Antigen Reactions
When antibodies in plasma react with antigens on cell membranes, they bind to the cells causing the cells to clump. The clumping of cells due to antigen/antibody reactions is called agglutination.

Agglutinated

cells block the flow of blood disrupting circulation and the distribution of O2, gases and nutrients.

Transfusion Considerations
Type A blood Anti-B Antibodies

Type B blood

Anti-A Antibodies No Anti-A or Anti-B Antibodies Both Anti-A & Anti-B Antibodies

Type AB blood

Type O blood No A or B antigens

Type O - Theoretical Universal Donor

Transfusion Considerations
Type A blood Anti-B Antibodies

Type B blood

Anti-A Antibodies No Anti-A or Anti-B Antibodies Both Anti-A & Anti-B Antibodies

Type AB blood

Type O blood

Type AB - Theoretical Universal Recipient

Inappropriate Physiological Applications

ABO & Rh blood antigens represent only a few of many blood cell antigens. Estimates vary from more than a 100 to millions. Even though ABO & Rh blood typing is done, the possibility exists that persons receiving more than one transfusion could have a reaction to less common or currently unknown blood types. Cross matching may avoid reactions.

Erythroblastosis Fetalis
No problem with first pregnancy. Maternal & fetal blood dont mix. During delivery if mother becomes sensitized to Rh + blood, she will begin to produce anti-Rh antibodies. This may also occur due to placental abnormalities, prior tubal pregnancies, miscarriage, abortions or amniocentesis in which Rh + fetal blood may sensitize the Rh - mother.

RH Rh +

Erythroblastosis Fetalis
In subsequent pregnancies with an Rh + fetus, mothers anti-Rh antibodies will cross the placenta causing fetal blood cells to agglutinate & be destroyed. Effects on fetus may range from jaundice, to brain damage (anoxia), to possible death. RhoGAM shots at 28 weeks and after delivery may prevent sensitization. RhoGam offers no protection after a woman is sensititized.

RH Rh +

Anemia - reduced O2 carrying capacity of the blood

Insufficient number of RBCs:
Hemorrhagic - due to blood loss associated with an injury, undiagnosed bleeding ulcer, etc. Hemolytic - due to blood loss due to transfusion reactions & certain bacterial and parasite infections. Aplastic - due to destruction or inhibition of red marrow by drugs, ionizing radiation or certain bacterial toxins.

Anemia - reduced O2 carrying capacity of the blood

Insufficient hemoglobin content in RBCs:
Iron Deficiency - inadequate intake or absorption of iron.

Pernicious - dietary deficiency of Vitamin B12 or inadequate production of intrinsic factor for absorption of Vitamin B12.

Anemia - reduced O2 carrying capacity of the blood

Abnormal hemoglobin in RBCs:
Sickle Cell - one amino acid in the 287 forming the beta chains is wrong.

In low O2 conditions the beta chains form stiff rods which cause RBCs to sickle blocking small vessels.

Other Blood Related Disturbances

Polycythemia - abnormally high number of RBCs (8 - 11 million/mm3). Increases blood viscosity & blood pressure. Cause - most often the result of bone marrow cancer. Lecuopenia - abnormally low number of WBCs (less than 5,000/mm3). Cause - drugs, steroids & anti-cancer agents.

Other Blood Related Disturbances

Leukemia - abnormally high numbers of immature WBCs that are mitotic & unspecialized. Named according to abnormal WBC type involved
Myelocytic - derived from myeloblasts (chronic) Lymphocytic - involves lymphocytes (acute)

Other Blood Related Disturbances

Thrombus - a clot that forms & is stationary in an unbroken blood vessel. If sufficiently large, it may block the flow of blood downstream causing death of those tissues. Embolus - an abnormal object moving through a blood vessel, ie. Clot, air bubble, lipid droplet, etc. Embolism - a blockage of blood vessels caused by an embolus. May cause a stroke or heart attack depending on tissues affected.

Intrinsic Cardiac Conduction System

Approximately 1% of cardiac muscle cells are autorhythmic rather than contractile 75/min 40-60/min

30/min

Intrinsic Conduction System

Function: initiate & distribute impulses so heart depolarizes & contracts in orderly manner from atria to ventricles.
SA node AV node Bundle of His Bundle Branches Purkinje fibers

ECG Deflection Waves

(Pacemaker)

Atrial repolarization

ECG Deflection Waves

60 seconds 0.8 seconds = resting heart rate of 75 beats/minute

1st Degree Heart Block = P-Q interval longer than 0.2 seconds.

ECG Deflection Wave Irregularities

Enlarged QRS = Hypertrophy of ventricles

ECG Deflection Wave Irregularities

Prolonged QT Interval = Repolarization abnormalities increase chances of ventricular arrhythmias.

ECG Deflection Wave Irregularities

Elevated T wave : Hyperkalemia

ECG Deflection Wave Irregularities

Flat T wave : Hypokalemia or ischemia

Heart Blocks
P T Normal ECG QRS

2nd Degree Block

Not a QRS for each P wave

3rd Degree Block

No P waves. Rate determined by autorhythmic cells in ventricles

Cardiac Cycle
All events associated with a single heart beat including atrial systole & diastole followed by ventricular systole & diastole.
(V. Systole) Systolic BP Diastolic BP (V. Diastole)

ECG Deflection Waves

60 seconds 0.8 seconds = resting heart rate of 75 beats/minute

Frank Starling Law of the Heart

The more cardiac muscle is stretched within physiological limits, the more forcibly it will contract. Rubber band analogy Increasing volumes of blood in ventricles increase the stretch & thus the force generated by ventricular wall contraction. Greater stretch means more blood volume is pumped out, up to physical limits.

Frank Starling Law of the Heart

Increased blood volume = increased stretch of myocardium

Increased force to pump blood out.

Terms, Definitions & Units

Blood Pressure - force generated against arterial walls per unit of area in mm Hg. Systolic Pressure - peak arterial pressure. Averages about 120 mm Hg in healthy adults. Diastolic Pressure - lowest arterial pressure. Averages between 70 - 80 mm Hg in healthy adults. Blood Volume - quantity of blood in cardiovascular system. Varies from 4-5 L. in females to 5-6 L. in males.

Terms, Definitions & Units

Cardiac Output - the amount of blood pumped by a ventricle per minute. Units may be in milliliters or Liters per minute. Heart Rate - number of cardiac cycles per minute. Average for males = 64-72/min. Average for females = 72-80/min. Stroke Volume - amount of blood pumped out of a ventricle each beat. Average resting stroke volume = 70 ml.

Factors influencing blood pressure

Blood Pressure = Blood Volume Peripheral Resistance

Blood volume loss due to injuries, hemorrhages, use of diuretics, etc. =

BP

Blood volume increases due to increased water retention from increased ADH production, IVs or transfusions = BP

Factors influencing blood pressure

Blood Pressure = Blood Volume Peripheral Resistance

Cardiac Output =

circulating blood volume

Cardiac Output = Heart Rate Stroke Volume Increased heart rate caused by the release of epinephrine into blood by the adrenal glands = increased cardiac output, which increases circulating blood volume, to increase blood pressure.

Factors influencing blood pressure

Blood Pressure = Blood Volume Peripheral Resistance

Peripheral Resistance affected by: blood viscosity (thickness)

(Polycythemia)

diameter of vessels (vasoconstriction/vasodilation) Vasoconstriction = diameter = resistance = BP Vasodilation = diameter = elasticity of arterial walls Elastic Arterial Walls = BP resistance = BP

Homeostatic Blood Pressure Regulation Mechanisms

Medullary Reflex Centers: Cardioacceleratory - increases heart rate Cardioinhibitory - decreases heart rate Vasomotor - changes diameter of vessels Baroreceptors in aortic arch & carotid sinuses: sensitive to changes in blood pressure.

BP - Stimulates Cardioinhibitory center to heart rate & Vasomotor center to diameter. BP - Stimulates Cardioacceleratory center to heart rate & Vasomotor center to diameter.

Homeostatic Blood Pressure Regulation Mechanisms

Medullary Reflex Centers: Cardioacceleratory - increases heart rate Cardioinhibitory - decreases heart rate Vasomotor - changes diameter of vessels Chemoreceptors in aortic bodies & carotid bodies: sensitive to changes in CO2 & O2 in blood.

in CO2 or in O2 stimulates Vasomotor center to diameter (vasoconstrict) of vessels to BP. in CO2 stimulates Vasomotor center to diameter (vasodilate) of vessels to BP.

Aneurysm
Weakness of the wall of an artery causing an abnormal enlargment or bulge. The aorta or the arteries that supply the heart, brain, legs or kindeys are most commonly affected.

Angina Pectoris
Medical term for chest pain due to coronary heart disease. It occurs when the myocardium doesnt get as much blood (Oxygen) as it needs. Insufficient blood supply is called ischemia. May initially occur during physical exercise, stress, or extreme temperatures. It is a sign of increased risk of heart attack.

Hypertension
High blood pressure. Sustained arterial blood pressure of 140/90 mm Hg or above. Rising diastolic pressure generally indicative of progressive hardening of arteries. Since the heart must work harder to pump blood against higher pressures, there is increased risk of a cardiovascular accident.

Hypotension
Abnormally low blood pressure. Sustained systolic blood pressure of below 100 mm Hg. Generally associated with lower risk of cardiovascular accidents & long life providing that the tissues are adequately perfused..

Circulatory Shock
Blood vessels inadequately filled to enable normal circulation & supply of O2 & nutrients. May result in death of cells & damage to organs. Common Types: Hypovolemic - severe blood loss Cardiogenic - heart (pump) failure Vascular - excessive vasodilation Septicemic - vasodilation due to bacterial toxins produced during an infection.

Atherosclerosis (Arteriosclerosis)
Narrowing and hardening of arteries and impairment of blood flow due to the deposition of fatty materials and calcium in their walls. Risk factors include:
smoking inactivity diabetes high blood cholesterol personal or family history of heart disease

Arteriosclerosis (Atherosclerosis):

All images copyright Camera M.D. Studios. Special thanks to Gregory Curfman, M.D..

Acknowledgements Most of the figures used in this presentation came from the Benjamin Cummings Digital Library Version 2.0 for Human Anatomy & Physiology, Fifth Edition. Other figures came from public domain internet sources and software in the possession of the author.