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CHAPTER 17 CONTROL OF CARDIOVASCULAR FUNCTION Essentials of Pathophysiology.

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Presentation on theme: "CHAPTER 17 CONTROL OF CARDIOVASCULAR FUNCTION Essentials of Pathophysiology."— Presentation transcript:

1 CHAPTER 17 CONTROL OF CARDIOVASCULAR FUNCTION Essentials of Pathophysiology

2  The left side of the heart pumps blood to the lungs.  The venous side of the circulation contains a larger portion of the blood volume than the arterial side.  The rate of blood flow through a vessel is affected by pressure, resistance, and vessel radius.  The loose-fitting sac that surrounds the heart is called the myocardium.  The rhythmic impulse of the cardiac conduction system is generated at the AV node and is known as the pacemaker of the heart. PRE LECTURE QUIZ (TRUE/FALSE) F T T F F

3  _______________ is the result of disorganized electrical activity in the atrium or the ventricle.  Cardiac _______________ is the amount of blood the heart pumps each minute and is defined by the formula SV × HR.  The _______________ are thin-walled, distensible, and collapsible vessels that are capable of enlarging and storing large quantities of blood.  The ______________ period of the cardiac cycle is marked by ventricular relaxation and filling.  The heart valve that controls the direction of blood flow from the right atrium to the right ventricle is called the _________________ valve. PRE LECTURE QUIZ Diastolic Fibrillation output Tricuspid veins

4 PATH OF BLOOD FLOW Scenario:  You inject a medication into the client’s arm  Within a few minutes, some of that drug has reached the client’s liver and is being deactivated Question:  How did it get there?

5 SIMPLIFIED PATH OF BLOOD FLOW right heart lungs left heart body

6 HEART ANATOMY Lungs

7 QUESTION True or False. The pulmonary circulation moves blood through the left side of the heart.

8 ANSWER False Rationale: The right side of the heart pumps blood to the lungs through the pulmonary arteries, where gas exchange takes place. The left side of the heart is considered systemic circulation because blood is pumped to all body tissues.

9 THE HEART LAYERS

10 THE BASICS OF CELL FIRING  Cells begin with a negative charge: resting membrane potential  Stimulus causes some Na + channels to open  Na + diffuses in, making the cell more positive (less Negative) Threshold potential Resting membrane potential Stimulus

11 THE BASICS OF CELL FIRING (CONT.)  At threshold potential, more Na + channels open  Na + rushes in, making the cell very positive: depolarization  Action potential: the cell responds (e.g., by contracting) Threshold potential Resting membrane potential Stimulus Action potential

12 THE BASICS OF CELL FIRING (CONT.)  K + channels open  K + diffuses out, making the cell negative again: repolarization  Na + /K + ATPase removes the Na + from the cell and pumps the K + back in Threshold potential Resting membrane potential Stimulus Action potential

13 CARDIAC MUSCLE FIRING  Cells begin with a negative charge: resting membrane potential  Calcium leak lets Ca 2+ diffuse in, making the cell more positive Threshold potential Resting membrane potential Calcium leak

14 CARDIAC MUSCLE FIRING (CONT.)  At threshold potential, more Na + channels open  Na + rushes in, making the cell very positive: depolarization  Action potential: the cell responds (e.g., by contracting) Threshold potential Resting membrane potential Action potential Calcium leak

15 CARDIAC MUSCLE FIRING (CONT.)  K + channels open  K + diffuses out, making the cell negative again, but Ca 2+ channels are still allowing Ca 2+ to enter  The cell remains positive: plateau Threshold potential PLATEAU Action potential Calcium leak

16 CARDIAC MUSCLE FIRING (CONT.)  During plateau, the muscle contracts strongly  Then the Ca 2+ channels shut and it repolarizes Threshold potential PLATEAU Action potential Calcium leak

17 QUESTION Which ion channels allow cardiac muscle to fire without a stimulus? a. Na + b. K + c. Ca 2+ d. Cl -

18 ANSWER c. Ca 2+ Rationale: In the SA and AV nodes, resting cardiac muscle cells have open Ca 2+ channels. This allows Ca 2+ to leak into the cells, making them more positive (the cells reach threshold this way without the need for a stimulus).

19 THE CELL PASSES THE IMPULSE TO ITS NEIGHBORS Desmosomes link cells tightly together Gap junctions pass the electrical signal to the next cells

20 HEART CONTRACTION How would each of the following affect heart contraction:  A calcium channel blocker  An Na + channel blocker  A drug that opened Na + channels  A drug that opened K + channels

21 CARDIAC CYCLE—DIASTOLE  Ventricles relax  Blood entering atria  Blood flows through AV valves into ventricles  Semilunar valves are closed

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23 CARDIAC CYCLE—SYSTOLE  Ventricles contract  Blood pushes against AV valves and they shut  Blood pushes through semilunar valves into aorta and pulmonary trunk

24 Systole What happens in isovolumetric contraction?

25 QUESTION Which of the following statements is true about ventricular systole? a. Atria contract b. Ventricles contract c. AV valves are open d. Semilunar valves are closed

26 ANSWER b. Ventricles contract Rationale: During ventricular systole, the ventricles contract. Because blood is being forced from the ventricles, semilunar valves must be open and AV valves closed. The atria are in diastole (relaxation) during ventricular systole.

27 CARDIAC CYCLE Discussion:  Arrange these steps in the proper order: 8– Ventricles relax4– First heart sound 1– Systole5– Semilunar valves open 10–Diastole3– AV valves close 9– AV valves open6– Semilunar valves close 2– Ventricles contract7– Second heart sound

28 PRESSURE, RESISTANCE, FLOW  Fluid flow through a vessel depends on:  The pressure difference between ends of the vessel º Pressure pushes the fluid through º Pressure keeps the vessel from collapsing  The vessel’s resistance (R) to fluid flow º Small vessels have more resistance º More viscous fluids have greater resistance ΔP = P in - P out Flow, F= ΔP ÷ R

29 PRESSURE, RESISTANCE, FLOW OF BLOOD  Blood flow through a vessel depends on:  Heart creating pressure difference between ends of the vessel  Heart pushing the blood through  Blood pressure keeping the vessels open  The vessel’s resistance to fluid flow  Constricting arterioles increasing resistance  Increased hematocrit increasing resistance

30 DISCUSSION How will each of these factors affect arteriole size and peripheral resistance?  Lactic acid Low PO 2  Cold Histamine  Endothelin Heat  NO Adenosine

31 BLOOD PRESSURE BP = CO x PR Blood pressure = cardiac output × peripheral resistance How is this related to F=P/R ?

32 QUESTION Tell whether the following statement is true or false. In patients with hypertension (high blood pressure), peripheral resistance is increased. (Hint: P= F x R )

33 ANSWER True Rationale: In hypertension, blood vessels are constricted/narrowed. Smaller vessels increase resistance (it’s harder to push the same amount of fluid/blood through a tube that has become smaller).

34 FORCES MOVING FLUID IN AND OUT OF CAPILLARIES Higher Pressure from artery Lower Pressure of the veins

35 LYMPH VESSELS CARRY TISSUE FLUID BACK TO THE VEINS Interstitial fluid not recaptured in the capillaries enters the lymphatic system and ultimately reenters the blood at the subclavian vein


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