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CHAPTER 15 CARDIOVASCULAR SYSTEM www.sirinet.net.

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1 CHAPTER 15 CARDIOVASCULAR SYSTEM www.sirinet.net

2 Information 7,000L/day 7,000L/day Beats 2.5 billion times/ lifetime Beats 2.5 billion times/ lifetime Cardiovascular system Cardiovascular system

3 HEART SIZE: 14cm X 9cm SIZE: 14cm X 9cm

4 HEART LOCATION www.cayuga-cc.edu

5 HEART LOCATION en.wikipedia.org

6 PULMONARY CIRCUIT invest-trial.org

7 SYSTEMIC CIRCUIT http://classes.midlandstech.com/carterp/Courses/bio211/chap18/Slide7.jpg

8 PERICARDIUM en.wikipedia.org

9 PERICARDIUM www.cayuga-cc.edu

10 PERICARDIUM

11 PERICARDIUM FIBROUS PERICARDIUM FIBROUS PERICARDIUM OUTER; TOUGH; DENSE CONNECTIVE TISSUE; FOR PROTECTION; OUTER; TOUGH; DENSE CONNECTIVE TISSUE; FOR PROTECTION; PARIETAL PERICARDIUM PARIETAL PERICARDIUM INNER LINING OF FIBROUS PERICARDIUM INNER LINING OF FIBROUS PERICARDIUM VISCERAL PERICARDIUM VISCERAL PERICARDIUM COVERS THE HEART COVERS THE HEART PARICARDIAL CAVITY PARICARDIAL CAVITY FILLED WITH FLUID? FILLED WITH FLUID?

12 PERICARDIUM www.cayuga-cc.edu

13 HEART WALL EPICARDIUM EPICARDIUM THE VISCERAL PERICARDIUM THE VISCERAL PERICARDIUM PROTECTS HEART (REDUCES FRICTION) PROTECTS HEART (REDUCES FRICTION) CONNECTIVE TISSUE COVERED BY EPITHELIAL TISSUE; CAPILLARIES AND NERVES; MAY HAVE FAT CONNECTIVE TISSUE COVERED BY EPITHELIAL TISSUE; CAPILLARIES AND NERVES; MAY HAVE FAT MYOCARDIUM MYOCARDIUM MIDDLE LAYER MIDDLE LAYER CARDIAC MUSCLE; MUSLCE FIBERS SEPARATED BY CONNECTIVE TISSUE; HAS BLOOD VESSELS; LYMPH VESSELS AND NERVES CARDIAC MUSCLE; MUSLCE FIBERS SEPARATED BY CONNECTIVE TISSUE; HAS BLOOD VESSELS; LYMPH VESSELS AND NERVES ENDOCARDIUM ENDOCARDIUM CONNECTIVE TISSUE COVERED BY EPITHELIAL TISSUE; ; BLOOD VESSELS; PERKINJIE FIBERS; CONNECTIVE TISSUE COVERED BY EPITHELIAL TISSUE; ; BLOOD VESSELS; PERKINJIE FIBERS; LINES HEART CHAMBERS AND STRUCTURES LINES HEART CHAMBERS AND STRUCTURES

14 PERICARDIUM en.wikipedia.org

15 HEART

16 MYOCARDIUM radiology.uchc.edu

17 INTERNAL HEART en.wikipedia.org CHAMBERS

18 PARTS ATRIA HAVE AURICLES ATRIA HAVE AURICLES ATRIOVENTRICULAR ORIFICE HAS A-V VALVE ATRIOVENTRICULAR ORIFICE HAS A-V VALVE ATRIOVENTRICULAR SULCHUS ATRIOVENTRICULAR SULCHUS INTERVENTRICULAR SULCHUS INTERVENTRICULAR SULCHUS TRICUSPID VALVE TRICUSPID VALVE RIGHT SIDE RIGHT SIDE BICUSPID VALVE/MITRAL VALVE BICUSPID VALVE/MITRAL VALVE LEFT SIDE LEFT SIDE CHORDAE TENDONAE CHORDAE TENDONAE PAPILLARY MUSCLES PAPILLARY MUSCLES SEMI LUNAR VALVES SEMI LUNAR VALVES

19 www.pbs.org

20 SKELETON OF HEART DENSE CONECTIVE TISSUE RINGS DENSE CONECTIVE TISSUE RINGS FROM AORTA AND PULMONARY TRUNK THROUGH HEART FROM AORTA AND PULMONARY TRUNK THROUGH HEART DENSE CONNECTIVE TISSUE IN SEPTUM DENSE CONNECTIVE TISSUE IN SEPTUM VALVE ATTACHMENTS; MUSCLE ATTACHMENTS; KEEP ORIFICES FROM EXPANDING VALVE ATTACHMENTS; MUSCLE ATTACHMENTS; KEEP ORIFICES FROM EXPANDING

21 BLOOD FLOW www.pbs.org

22 BLOOD SUPPLY TO HEART CORONARY ARTERIES OFF AORTA CORONARY ARTERIES OFF AORTA BRANCHES TRAVEL ALONG ATRIOVENTRICULAR SULCHUS, POSTERIOR INTERVENTRICULAR SULCHUS AND ANTERIOR INTERVENTRICULAR SULCHUS BRANCHES TRAVEL ALONG ATRIOVENTRICULAR SULCHUS, POSTERIOR INTERVENTRICULAR SULCHUS AND ANTERIOR INTERVENTRICULAR SULCHUS MANY CAPLILLARIES TO MYOCARDIUM MANY CAPLILLARIES TO MYOCARDIUM ANASTOMOSES BETWEEN SMALL ARTERIOLS PROVIDE ALTERNATE BLOOD FLOW ? ANASTOMOSES BETWEEN SMALL ARTERIOLS PROVIDE ALTERNATE BLOOD FLOW ?

23 HEART ACTIONS ATRIA CONTRACT = ATRIAL SYSTOLE AS VENTRICLES RELAX = VENTRICULAR DIASTOLE ATRIA CONTRACT = ATRIAL SYSTOLE AS VENTRICLES RELAX = VENTRICULAR DIASTOLE THEN: VENTRICLES CONTRACT = VENTRICULAR SYSTOLE AND ATRIA RELAX = ATRIAL DIASTOLE THEN: VENTRICLES CONTRACT = VENTRICULAR SYSTOLE AND ATRIA RELAX = ATRIAL DIASTOLE = CARDIAC CYCLE = CARDIAC CYCLE

24 HEART SOUNDS LUBB= AV VALVES CLOSING LUBB= AV VALVES CLOSING DUBB= SEMILUNAR VALVES CLOSING DUBB= SEMILUNAR VALVES CLOSING HEART MURMUR HEART MURMUR

25 CARDIAC MUSCLE www.siumed.edu

26 CARDIAC MUSCLE FIBERS INTERCALATED DISC/3D/INTERWOVEN INTERCALATED DISC/3D/INTERWOVEN FUNCTIONAL SYNCYTIUM FUNCTIONAL SYNCYTIUM ATRIAL SYNCYTIUM ATRIAL SYNCYTIUM VENTRICULAR SYNCYTIUM VENTRICULAR SYNCYTIUM

27 HEART CONTRACTION SPECIALIZED MYOFIBRILS FOR SENDING CARDIAC IMPULSES SPECIALIZED MYOFIBRILS FOR SENDING CARDIAC IMPULSES SA NODE: PACEMAKER SA NODE: PACEMAKER BENEATH EPICARDIUM OF RT ATRIUM NEAR SUPERIOR VENA CAVA BENEATH EPICARDIUM OF RT ATRIUM NEAR SUPERIOR VENA CAVA REACH THRESHOLD SPONTANEOUSLY AND BY SELF REACH THRESHOLD SPONTANEOUSLY AND BY SELF INCREASED PERMEABILITY TO SODIUM AND CALCIUM AND DECREASED PERMEABILITY TO POTASSIUM INCREASED PERMEABILITY TO SODIUM AND CALCIUM AND DECREASED PERMEABILITY TO POTASSIUM RHYTHMIC: 80 IMPULSES/MINUTE; PARASYMPATHETIC INHIBITS CONTRACTIONS TO ~70/MINUTE RHYTHMIC: 80 IMPULSES/MINUTE; PARASYMPATHETIC INHIBITS CONTRACTIONS TO ~70/MINUTE

28 SA NODE /hyperphysics.phy-astr.gsu.edu

29 INTERNODAL ATRIAL MUSCLE FIBERS CONDUCT IMPULSES TO DISTANT REGIONS OF ATRIA GAP JUNCTIONS ALLOW IMPULSE TO SPREAD THROUGH MYOCARDIUM GAP JUNCTIONS ALLOW IMPULSE TO SPREAD THROUGH MYOCARDIUM BOTH ATRIA CONTRACT BOTH ATRIA CONTRACT ATRIA AND VENTRICLES SEPARATED BY FIBROUS SKELETON OF HEART ATRIA AND VENTRICLES SEPARATED BY FIBROUS SKELETON OF HEART ONLY CONDUCTION TO VENTRICLES IS THROUGH JUNCTIONAL FIBERS ONLY CONDUCTION TO VENTRICLES IS THROUGH JUNCTIONAL FIBERS

30 JUNCTIONAL FIBERS TO AV NODE JUNCTIONAL FIBERS TO AV NODE INFERIOR PART OF SEPTUM UNDER ENDOCARDIUM INFERIOR PART OF SEPTUM UNDER ENDOCARDIUM ONLY CONNECTION BETWEEN ATRIA AND VENTRICLES ONLY CONNECTION BETWEEN ATRIA AND VENTRICLES JUNCTIONAL FIBERS HAVE SMALL DIAMETERS: SPEED? IMPORTANCE? JUNCTIONAL FIBERS HAVE SMALL DIAMETERS: SPEED? IMPORTANCE? IMPULSE TO AV BUNDLE/BUNDLE OF HIS IMPULSE TO AV BUNDLE/BUNDLE OF HIS LARGE FIBERS LARGE FIBERS BUNDLE ENTERS INTERVENTRICULAR SEPTUM; BRANCHES TO BOTH SIDES TO LARGE PURKINJE FIBERS BUNDLE ENTERS INTERVENTRICULAR SEPTUM; BRANCHES TO BOTH SIDES TO LARGE PURKINJE FIBERS

31 BUNDLE OF HIS radiology.uchc.edu

32 HEART ELECTRICAL PHENOMENA /hyperphysics.phy-astr.gsu.edu

33 PERKINJIE FIBERS www.siumed.edu

34 PURKINJE FIBERS CARRY IMPULSE THROUGH VENTRICLES FASTER THAN CELL TO CELL CONDUCTION: WHY NOT IN ATRIA? PURKINJE FIBERS CARRY IMPULSE THROUGH VENTRICLES FASTER THAN CELL TO CELL CONDUCTION: WHY NOT IN ATRIA? MUSCLES ARANGED IN WHORLS SO CONTRACT IN TWISTING MOTION MUSCLES ARANGED IN WHORLS SO CONTRACT IN TWISTING MOTION FIBERS GO TO APEX FIRST SO APEX CONTRACTS FIRST MOVING BLOOD UP FIBERS GO TO APEX FIRST SO APEX CONTRACTS FIRST MOVING BLOOD UP WHERE ARE THE PULMONARY ARTERY AND AORTIC OPENINGS? WHY? WHERE ARE THE PULMONARY ARTERY AND AORTIC OPENINGS? WHY?

35 ELECTROCARDIOGRAM ELECTRICAL CHANGES IN MUSCLE P WAVE: SA NODE TRIGGERS IMPULSE FOR ATRIAL CONTRACTION QRS WAVES: DEPOLARIZATION OF VENTRICLES BEFORE CONTRACTION; THICKER SO MORE CHANGE T WAVE: VENTRICLE REPOLARIZATION INDICATES PROBLEMS WITH HEART PQ INTERVAL: SA NODE THROUGH AV NODE

36 HEART CONTRACTION hyperphysics.phy-astr.gsu.edu

37 REGULATION OF CARDIAC CYCLE CONTROLLED BY PARASYMPATHETIC AND SYMPATHETIC NS EFFECTS? CONTROLLED BY PARASYMPATHETIC AND SYMPATHETIC NS EFFECTS? PARASYMPATHETIC SEND VIA VAGUS NERVES CONTINUALLY WHICH RELEASE ACETYLCHOLINE TO SA AND AV NODE TO BRAKE HEART ACTION PARASYMPATHETIC SEND VIA VAGUS NERVES CONTINUALLY WHICH RELEASE ACETYLCHOLINE TO SA AND AV NODE TO BRAKE HEART ACTION SYMPATHETIC SEND VIA VAGUS NERVES OCCAISIONALLY TO SA AND AV NODE RELEASE EPINEPHRINE TO INCREASE CONTRACTIONS SYMPATHETIC SEND VIA VAGUS NERVES OCCAISIONALLY TO SA AND AV NODE RELEASE EPINEPHRINE TO INCREASE CONTRACTIONS CONTROL BY BOTH ORIGINATES IN MEDULLA OBLONGATA CONTROL BY BOTH ORIGINATES IN MEDULLA OBLONGATA HAS CARDIOINHIBITOR AND CARDIOACCELERATOR REFLEX CENTERS HAS CARDIOINHIBITOR AND CARDIOACCELERATOR REFLEX CENTERS RECEIVE INFO FROM CARDIOVASCULAR SYSTEM RECEIVE INFO FROM CARDIOVASCULAR SYSTEM

38 BLOOD PRESSURE EFFECT BARORECEPTORS OF AORTA AND CAROTID ARTERIES DETECT BLOOD PRESSURE CHANGES BARORECEPTORS OF AORTA AND CAROTID ARTERIES DETECT BLOOD PRESSURE CHANGES HIGHER PRESSURE STIMULATES IMPULSE TO CARDIOINHIBITOR REFLEX CENTER AND PARASYMPATHETIC NS DECREASES HEART RATE HIGHER PRESSURE STIMULATES IMPULSE TO CARDIOINHIBITOR REFLEX CENTER AND PARASYMPATHETIC NS DECREASES HEART RATE STRETCH RECEPTORS OF VENA CAVA DETECT HIGH PRESSURE STRETCH RECEPTORS OF VENA CAVA DETECT HIGH PRESSURE SEND IMPULSE TO CARDIOACCELERATOR REFLEX CENTER AND SYMPATHETIC NS STIMULATES HEART SEND IMPULSE TO CARDIOACCELERATOR REFLEX CENTER AND SYMPATHETIC NS STIMULATES HEART

39 OTHER CONTROLS CEREBRUM AND HYPOTHALAMUS CAN INCREASE OR DECREASE IT CEREBRUM AND HYPOTHALAMUS CAN INCREASE OR DECREASE IT TEMPERATURE: TEMPERATURE: HIGHER INCREASES IT HIGHER INCREASES IT LOWER DECREASES IT LOWER DECREASES IT SURGERY? SURGERY?

40 IONS MOST IMPORTANT: K+ Ca++ MOST IMPORTANT: K+ Ca++ K: K: HIGH: DECREASES RATE & FORCE, MAY BLOCK CONDUCTION (CARDIAC ARREST) HIGH: DECREASES RATE & FORCE, MAY BLOCK CONDUCTION (CARDIAC ARREST) LOW: ARRHYTHMIA LOW: ARRHYTHMIA Ca: Ca: HOW DOES SA DIFFER FROM SKELETAL MUSCLE? HOW DOES SA DIFFER FROM SKELETAL MUSCLE? SO WHERE DOES Ca COME FROM? SO WHERE DOES Ca COME FROM? HIGH: INCREASES CONTRACTION; TETANIC HIGH: INCREASES CONTRACTION; TETANIC LOW: SLOWS HEART CONTRACTION LOW: SLOWS HEART CONTRACTION

41 BLOOD VESSELS TYPES: TYPES: ARTERIES; ARTERIOLES; CAPPILLARIES; VENULES; VEINS ARTERIES; ARTERIOLES; CAPPILLARIES; VENULES; VEINS DIRECTIONS? DIRECTIONS? FUNCTION? FUNCTION?

42 ARTERIAL & VENOUS PATHWAYS www.accessexcellence.org

43 ARTERY & VEIN ANATOMY www.accessexcellence.org

44 ARTERY www.cayuga-cc.edu

45 ENDOTHELIUM SMOOTH SURFACE ? ALSO RELEASE ? RELEASE CHEMICALS TO DILATE OR CONSTRICT BLOOD FLOW NITRIC OXIDE

46 TUNICA MEDIA ELASTIC CONNECTIVE TISSUE ? ELASTIC CONNECTIVE TISSUE ?

47 TUNICA ADVENTIA/EXTERNA ATTACHES TO TISSUE ATTACHES TO TISSUE VASO VASORUM ? VASO VASORUM ?

48 REGULATION OF DIAMETER SYMPATHETIC NS  VASOMOTOR FIBERS  STIMULATE SMOOTH MUSCLE TO CONTRACT: VASOCONSTRICTION SYMPATHETIC NS  VASOMOTOR FIBERS  STIMULATE SMOOTH MUSCLE TO CONTRACT: VASOCONSTRICTION INHIBITED: VASODILATION INHIBITED: VASODILATION

49 BLOOD FLOW ARTERIES  ARTERIOLES  METARTERIOLES  CAPILLARIES ARTERIES  ARTERIOLES  METARTERIOLES  CAPILLARIES ARTERIOVENOUS SHUNTS ARTERIOVENOUS SHUNTS

50 ARTERIOLE www.siumed.edu

51 CAPILLARIES STRUCTURE ? STRUCTURE ? FUNCTION ? FUNCTION ? PERMEABILITY: SLITS WHERE CELLS OVERLAP/THROUGH CELLS PERMEABILITY: SLITS WHERE CELLS OVERLAP/THROUGH CELLS SIZE VARIES ? SIZE VARIES ?

52 http://www.youtube.com/watch?feature=player _detailpage&v=Q530H1WxtOw http://www.youtube.com/watch?feature=player _detailpage&v=Q530H1WxtOw http://www.youtube.com/watch?feature=player _detailpage&v=Q530H1WxtOw http://www.youtube.com/watch?feature=player _detailpage&v=Q530H1WxtOw

53 CAPILLARY BED www.accessexcellence.org

54 www.cayuga-cc.edu

55 CAPILLARY TYPES CONTINUOUS: UNINTERRUPTED HAVE INTERCELLULAR CLEFTS BETWEEN TIGHT JUNCTIONS FENESTRATED SMALL PORES IN ENDOTHELIUM SINUSOIDAL: LARGER PORES DISCONTINUOUS SINUSOIDAL: SINUSOID, NO TIGHT JUNCTIONS

56 CONTINUOUS CAPILLARY www.cayuga-cc.edu

57 FENESTRATED CAPILLARY www.cayuga-cc.edu

58 SINUSOID CAPILLARY www.cayuga-cc.edu

59 DISCONTINUOUS SINUSOIDAL CAPILLARIES www.bu.edu/histology

60 BLOOD BRAIN BARRIER HOW? WHY? HOW? WHY?

61 BLOOD BRAIN BARRIER users.ahsc.arizona.edu

62 BLOOD BRAIN BARRIER www.angiochem.com

63 web.sfn.org/content

64 PRECAPILLARY SPHINCTER www.lib.mcg.edu

65 CAPILLARY EXCHANGE DIFFUSION; LIPID SOLUBLE/INSOLUBLE DIFFUSION; LIPID SOLUBLE/INSOLUBLE FILTRATION FILTRATION HYDROSTATIC PRESSURE DUE TO CONTRACTION OF VENTRICLES CLOSER TO ARTERIOLE END OF BED: FILTRATION HYDROSTATIC PRESSURE DUE TO CONTRACTION OF VENTRICLES CLOSER TO ARTERIOLE END OF BED: FILTRATION OSMOTIC PRESSURE: OSMOTIC PRESSURE: DUE TO IMPERMEANT SOLUTE ONE SID EOF CELL MEMBRANE: PLASMA PROTIENS: PLASMA COLLOID OSMOTIC PRESSURE: REABSORPTION; CLOSER TO VENOUS END DUE TO IMPERMEANT SOLUTE ONE SID EOF CELL MEMBRANE: PLASMA PROTIENS: PLASMA COLLOID OSMOTIC PRESSURE: REABSORPTION; CLOSER TO VENOUS END USUALLY MORE FLUID LEAVES THAN RETURNS (NEXT CHAPTER) USUALLY MORE FLUID LEAVES THAN RETURNS (NEXT CHAPTER) WHEN WOULD MORE EXIT ? WHEN WOULD MORE EXIT ?

66 CAPILLARY TRANSPORT users.ahsc.arizona.edu

67 CPPILARY TRANSPORT Figure 3 Transport mechanisms at the BBB. 1 = paracellular diffusion (sucrose), 2 = transcellular diffusion (ethanol), 3 = ion channel (K+ gated), 4 = ion-symport channel (Na+/K+/Cl- cotransporter), 5 = ion-antiport channel (Na+/H+ exchange), 6 = facilitated diffusion (Glucose via GLUT-1), 7 = active efflux pump (P-glycoprotein), 8 = active-antiport transport (Na+/K+ ATPase), 9 = receptor mediated endocytosis (transferrin & insulin)

68 VEIN www.cayuga-cc.edu

69 ARTERY vs. VEIN www.siumed.edu

70 ARTERY vs. VEIN www.siumed.edu

71 VEINS VALVES ? VALVES ? BLOOD RESERVOIRS: (25%) BLOOD RESERVOIRS: (25%)

72 ARTERIAL BLOOD PRESSURE SYSTOLIC PRESSURE: SYSTOLIC PRESSURE: VENTRICLES CONTRACT VENTRICLES CONTRACT DIASTOLIC PRESSURE DIASTOLIC PRESSURE ATRIA CONTRACT ATRIA CONTRACT ARTERIAL WALLS RECOIL AFTER BLOOD ENTERS: PULSE ARTERIAL WALLS RECOIL AFTER BLOOD ENTERS: PULSE

73 FACTORS AFFECTING BLOOD PRESSURE STROKE VOLUME STROKE VOLUME 70 ml 70 ml CARDIAC OUTPUT= STROKE VOLUME X HEART RATE CARDIAC OUTPUT= STROKE VOLUME X HEART RATE IF STROKE VOLUME OR HEART RATE INCREASE IF STROKE VOLUME OR HEART RATE INCREASE BLOOD VOLUME: ~5L; 8% BODY WT BLOOD VOLUME: ~5L; 8% BODY WT PERIPHERAL RESISTANCE: BLOOD VS. WALLS: ARTERIAL RECOIL LESSENS PRESSURE/PULSE PERIPHERAL RESISTANCE: BLOOD VS. WALLS: ARTERIAL RECOIL LESSENS PRESSURE/PULSE

74 VICOSITY: RESISTENCE TO FLOW OF BLOOD MOLECULES VICOSITY: RESISTENCE TO FLOW OF BLOOD MOLECULES INCREASED VISCOSITY ? INCREASED VISCOSITY ?

75 CONTROL OF BLOOD PRESSURE DETERMINED BY CARDIAC OUTPUT x PERIPHERAL RESISTANCE DETERMINED BY CARDIAC OUTPUT x PERIPHERAL RESISTANCE LIMITED BY HOW MUCH RETURNS TO THE VENTRICLES LIMITED BY HOW MUCH RETURNS TO THE VENTRICLES USUALLY ONLY 60% IS PUMPED OUT OF VENTRICLE SO SYMPATHETIC STIMULATION CAN INCREASE USUALLY ONLY 60% IS PUMPED OUT OF VENTRICLE SO SYMPATHETIC STIMULATION CAN INCREASE MYOCARDIAL FIBERS STRETCH WHEN BLOOD ENTERS VENTRICLES MORE THEY STRETCH, HARDER THEY CONTRACT: FRANK-STARLING LAW OF THE HEART MYOCARDIAL FIBERS STRETCH WHEN BLOOD ENTERS VENTRICLES MORE THEY STRETCH, HARDER THEY CONTRACT: FRANK-STARLING LAW OF THE HEART

76 PRELOAD: BLOOD ENTERING VENTRICLES AND STRETCHING FIBERS PRELOAD: BLOOD ENTERING VENTRICLES AND STRETCHING FIBERS AFTERLOAD: FORCE NEEDED TO OPEN SEMILUNAR VALVES FOR EJECTION AFTERLOAD: FORCE NEEDED TO OPEN SEMILUNAR VALVES FOR EJECTION HYPERTENSION INCREASES AFTERLOAD HYPERTENSION INCREASES AFTERLOAD CARDIOINHIBITOR AND CARDIOACCELERATOR CARDIOINHIBITOR AND CARDIOACCELERATOR

77 THINGS THAT INCREASE HEART RATE: THINGS THAT INCREASE HEART RATE: EPINEPHRINE;EMOTIONS: FEAR, ANGER; EXERCISE; BODY TEMPERATURE RISE EPINEPHRINE;EMOTIONS: FEAR, ANGER; EXERCISE; BODY TEMPERATURE RISE ARTERIOLE CONSTRICTION VASOMOTOR CENTER OF MEDULLA: CONTROLS VASODILATION OR CONSTRICTION BY SYMPATHETIC SYSTEM VASOMOTOR CENTER OF MEDULLA: CONTROLS VASODILATION OR CONSTRICTION BY SYMPATHETIC SYSTEM BARORECEPTORS OF AORTA SEND TO VASOMOTOR CENTER; ALSO PICKS UP PRESSURE LOSS: RELEASES EPINEPHRINE BARORECEPTORS OF AORTA SEND TO VASOMOTOR CENTER; ALSO PICKS UP PRESSURE LOSS: RELEASES EPINEPHRINE IMPORTANT CONTROL OF ARTERIOLES TO ABDOMINAL VISCERA: COULD CONTAIN MOST OF THE BLOOD OF BODY IMPORTANT CONTROL OF ARTERIOLES TO ABDOMINAL VISCERA: COULD CONTAIN MOST OF THE BLOOD OF BODY

78 CHEMICALS OF CONTROL INCREASING CO2; DECREASING O2; LOWERING pH; RELAXES SMOOTH MUSCLE  INCREASED BLOOD FLOW INCREASING CO2; DECREASING O2; LOWERING pH; RELAXES SMOOTH MUSCLE  INCREASED BLOOD FLOW VASODILATORS: NITRIC OXIDE FROM ENDOTHELIAL CELLS AND BRANDYKININ FROM BLOOD VASODILATORS: NITRIC OXIDE FROM ENDOTHELIAL CELLS AND BRANDYKININ FROM BLOOD VASOCONSTRICTION: ANGIOTENSIN AND ENDOTHELIN FROM ENDOTHELIUM VASOCONSTRICTION: ANGIOTENSIN AND ENDOTHELIN FROM ENDOTHELIUM

79 VENOUS BLOOD FLOW BLOOD PRESSURE IS LOWER BLOOD PRESSURE IS LOWER BLOOD FLOW: BLOOD PRESSURE; SKELETAL MUSCLE CONSTRICTION; RESPIRATORY MOVEMENTS; VASOCONSTRICTION BLOOD FLOW: BLOOD PRESSURE; SKELETAL MUSCLE CONSTRICTION; RESPIRATORY MOVEMENTS; VASOCONSTRICTION VASOCONSTRICTION: LOW PRESSURE SYMPATHETIC REFLEXES STIMULATE SMOOTH MUSCLE CONTRACTION VASOCONSTRICTION: LOW PRESSURE SYMPATHETIC REFLEXES STIMULATE SMOOTH MUSCLE CONTRACTION

80 CENTRAL VENOUS PRESSURE PRESSURE IN RIGHT ATRIUM ? PRESSURE IN RIGHT ATRIUM ? HIGH: INCREASES AND MORE PRESSURE IN VEINS HIGH: INCREASES AND MORE PRESSURE IN VEINS HIGH BLOOD VOLUME OR VASOCONTRICTION INCREASES CVP HIGH BLOOD VOLUME OR VASOCONTRICTION INCREASES CVP HIGH CVP= EDEMA HIGH CVP= EDEMA

81 PULMONARY CIRCUIT RIGHT VENTRICLE CONTRACTS WITH LESS POWER SO LESS ARTERIAL PRESSURE HELPS WITH DIFFUSION OF O2 AND CO2 RIGHT VENTRICLE CONTRACTS WITH LESS POWER SO LESS ARTERIAL PRESSURE HELPS WITH DIFFUSION OF O2 AND CO2

82 LIFE SPAN CHANGES PLAQUE (FAT) BUILD UP ON ATERIES ? PLAQUE (FAT) BUILD UP ON ATERIES ? INCREASES WITH AGE INCREASES WITH AGE CARDIAC OUTPUT STAYS THE SAME FOR MOST CARDIAC OUTPUT STAYS THE SAME FOR MOST DECREASES WITH THOSE HEART DISEASE DECREASES WITH THOSE HEART DISEASE CARDIAC MUSCLE DECLINES, DON’T DIVIDE: REPLACED BY FIBROUS CONNECTIVE TISSUE AND ADIPOSE TISSUE CARDIAC MUSCLE DECLINES, DON’T DIVIDE: REPLACED BY FIBROUS CONNECTIVE TISSUE AND ADIPOSE TISSUE LEFT VENTRICLE 25% THICKER AT 80 LEFT VENTRICLE 25% THICKER AT 80

83 SLOWS A LITTLE SLOWS A LITTLE 8 ML LESS/YEAR 8 ML LESS/YEAR VALVES THICKEN, BECOME MORE RIGID, MAY CALCIFY VALVES THICKEN, BECOME MORE RIGID, MAY CALCIFY SA AND AV NODE AND BUNDLE OF HIS BECOME MORE ELASTIC SA AND AV NODE AND BUNDLE OF HIS BECOME MORE ELASTIC SYSTOLIC BLOOD PRESSURE INCREASES: DECREASING SIZE AND ELASTICITY OF ARTERIES SYSTOLIC BLOOD PRESSURE INCREASES: DECREASING SIZE AND ELASTICITY OF ARTERIES ARTERIES: TUNICA INTERNA THICKENS; MORE MUSCLE, MORE COLLAGEN, CALCIUM AND FAT: MORE RIGID ARTERIES: TUNICA INTERNA THICKENS; MORE MUSCLE, MORE COLLAGEN, CALCIUM AND FAT: MORE RIGID

84 ARTERIOLES HALF THEIR ELASTICITY AT 70; DON’T RESPOND WELL TO CHANGES IN TEMPERATURE ARTERIOLES HALF THEIR ELASTICITY AT 70; DON’T RESPOND WELL TO CHANGES IN TEMPERATURE VEINS: MORE CAOLLAGEN, MAY CALCIFY BUT NOT AS MUCH, USUALLY NOT AFFECTED OR OTHER VEINS TAKE OVER VEINS: MORE CAOLLAGEN, MAY CALCIFY BUT NOT AS MUCH, USUALLY NOT AFFECTED OR OTHER VEINS TAKE OVER ENDOTHELIUM: LESS SMOOTH ENDOTHELIUM: LESS SMOOTH LESS CAPILLARIES LESS CAPILLARIES EXERCISE HELPS SLOW MANY OF THESE CHANGES EXERCISE HELPS SLOW MANY OF THESE CHANGES


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