1. Continuing Medical Education Programs Dr. Anika Niambi Al-Shura, Lecturer Copyright 2014 Niambi Wellness. All rights reserved

2. Integrative Anatomy and Patho-Physiology in TCM Cardiology Copyright 2014 Niambi Wellness. All rights reserved

3. This course is approved by the following agencies: National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for 14 PDA points and Florida State Board of Acupuncture for 15 CEUs. The companion textbook: Integrative Anatomy and Patho-Physiology in TCM Cardiology must be ordered at www.elsevier.com Copyright 2014 Niambi Wellness. All rights reserved

5. This course examines of the structure, function and pathology of the heart from the western medicine and Chinese medicine perspectives. Copyright 2014 Niambi Wellness. All rights reserved Course Description

6. Course Objectives Review the normal anatomy and physiology of the cardiovascular system. Evaluate the disease characteristics found in sections of the heart sections. Analyze the inter-relationship between western medicine and TCM theory in cardiology. Copyright 2014 Niambi Wellness. All rights reserved

8. Course Modules Copyright 2014 Niambi Wellness. All rights reserved

9. Module 1: Cardiovascular Anatomy Module 2: Physiology Module 3: Pathology Copyright 2014 Niambi Wellness. All rights reserved

11. Module 2 Cardiovascular Physiology Copyright 2014 Niambi Wellness. All rights reserved

12. Chapter 4: Cardiac Rhythm Chapter 5: Pumping Actions Chapter 6: Vascular Function and Circulation Contents Copyright 2014 Niambi Wellness. All rights reserved

13. Chapter 7: Humeral Control Chapter 8: Nervous System Regulation Contents Copyright 2014 Niambi Wellness. All rights reserved

15. Chapter 4: Cardiac Rhythm Copyright 2014 Niambi Wellness. All rights reserved

17. Part 1: Cardiac Muscle Structure Part 2: Cardiac Muscle Contractility Part 3: Electrical Activity Contents Copyright 2014 Niambi Wellness. All rights reserved

19. Part 1: Cardiac Muscle Structure Copyright 2014 Niambi Wellness. All rights reserved

20. Cardiac myocyte: Sarcomere Look in the textbook and label each myocyte section. Copyright 2014 Niambi Wellness. All rights reserved

22. Part 2: Cardiac Muscle Contractility Copyright 2014 Niambi Wellness. All rights reserved

23. Look in the textbook and label each section. Copyright 2014 Niambi Wellness. All rights reserved Cardiac muscle contractility

24. Copyright 2014 Niambi Wellness. All rights reserved

25. Part 3: Electrical Activity Copyright 2014 Niambi Wellness. All rights reserved

26. Resting potentials Copyright 2014 Niambi Wellness. All rights reserved

27. Nernst equation Copyright 2014 Niambi Wellness. All rights reserved

28. Goldman equation Copyright 2014 Niambi Wellness. All rights reserved

29. Action Potentials Copyright 2014 Niambi Wellness. All rights reserved

31. Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

32. 1.Describe the sarcomere. 2.Discuss the role of ATP. 3.Explain Resting potentials. 4.Explain action potentials. 5.Describe the site of transmission. Copyright 2014 Niambi Wellness. All rights reserved According to the textbook

33. 1.What are types of lines and bands of a sarcomere? 2.What are the three types of troponin in muscle contractility? 3.Which two ions are crossing the cell membrane during resting potentials? 4.What does the Nernst equation describe about ions? 5.Which three ions are part of the Goldman equation? Copyright 2014 Niambi Wellness. All rights reserved According to the course

34. Copyright 2014 Niambi Wellness. All rights reserved

35. Chapter 5: Pumping Actions Copyright 2014 Niambi Wellness. All rights reserved

36. Part 1: Cardiac Cycle Part 2: Regulation Part 3: Preload on Stroke Volume Contents Copyright 2014 Niambi Wellness. All rights reserved

37. Part 4: Inotropy (Contractility) Part 5: Afterload on Stroke Volume Contents Copyright 2014 Niambi Wellness. All rights reserved

38. Part 1: Cardiac Cycle Copyright 2014 Niambi Wellness. All rights reserved

39. Wiggers Diagram/ Heart Qi The cardiac cycle includes to the events related to the flow and pressure of blood through the heart from one heartbeat to the next. Copyright 2014 Niambi Wellness. All rights reserved

40. Phase 1: Atrial Systole Copyright 2014 Niambi Wellness. All rights reserved

41. P wave represents the atrial electrical depolarization.This phase is ventricular diastole. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

42. During filling, pressure within the right atrium increases, pushing blood across the AV valves into the right ventricle. Copyright 2014 Niambi Wellness. All rights reserved

43. At the end of the phase the ventricles are completely filled to about 140mL. This is the EDV (end diastolic volume). Copyright 2014 Niambi Wellness. All rights reserved

44. The S 4 (fourth heart sound) is sound heard during this phase. It’s usually heard in ventricular hypertrophy. Copyright 2014 Niambi Wellness. All rights reserved

45. Phase 2: Isovolumetric Ventricular Systole Copyright 2014 Niambi Wellness. All rights reserved

46. QRS wave represents the beginning of systole. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

47. This phase represents ventricular depolarization. The rise in pressure in the ventricles exceeds the pressure in the atrium causing the AV valves to close. Copyright 2014 Niambi Wellness. All rights reserved

48. The S 1 (first heart sound) is sound heard during this phase. Copyright 2014 Niambi Wellness. All rights reserved

49. Phase 3: Ventricular Ejection Copyright 2014 Niambi Wellness. All rights reserved

50. This section represents the S and T wave. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

51. The pressure in the ventricle exceeds the pressure within the pulmonary arteries and the aorta. The pulmonic valves open to allow blood flow. Copyright 2014 Niambi Wellness. All rights reserved

52. No heart sound is heard in healthy valves. A sound heard at this phase is called an ejection murmur. Copyright 2014 Niambi Wellness. All rights reserved

53. Phase 4: Ventricular Relaxation Copyright 2014 Niambi Wellness. All rights reserved

54. This section represents the T wave after the QRS wave. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

55. The pressure in the ventricle decreases due to emptying. Atrial pressure is rising. Copyright 2014 Niambi Wellness. All rights reserved

56. No heart sound is heard in healthy valves. A sound heard at this phase is called an ejection murmur. Copyright 2014 Niambi Wellness. All rights reserved

57. Phase 5: Isovolumetric Relaxation Copyright 2014 Niambi Wellness. All rights reserved

58. Phase 5: Isovolumetric Relaxation This section represents the end of the T wave. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

59. The volume of blood which remains in the left ventricle which is = 70mL is called the ESV (end systolic volume). EDV-ESV=SV (140- 70 =70) Copyright 2014 Niambi Wellness. All rights reserved

60. S 2 sound is heard as the valve closes. Copyright 2014 Niambi Wellness. All rights reserved

61. Phase 6: Diastolic Copyright 2014 Niambi Wellness. All rights reserved

62. This section represents the end of the T wave to the middle of the P phase. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

63. The atria fills with blood, the pressure causes the AV valves open to release the blood into the ventricles. Copyright 2014 Niambi Wellness. All rights reserved

64. No sound is heard in healthy AV valves. If S 3 sound is heard, it is considered normal in children, but ventricular dilation in adults. Copyright 2014 Niambi Wellness. All rights reserved

65. Part 2: Regulation Copyright 2014 Niambi Wellness. All rights reserved

66. The Fick prinicple C A = arterial blood C V = venous blood Copyright 2014 Niambi Wellness. All rights reserved

67. In 1870 Adolf Eugen Fick in 1870 calculated the oxygen consumption rate as it flows through blood. Copyright 2014 Niambi Wellness. All rights reserved

68. The principle calculates the rate of blood flow and the rate of oxygen picked up by the red blood cells. Copyright 2014 Niambi Wellness. All rights reserved

69. The Fick principle involves measuring oxygen concentration in the veins and arteries, however this collection and analysis can be difficult to obtain. Copyright 2014 Niambi Wellness. All rights reserved

70. The Oxygen Content Equation Record this information in your textbook. C a O 2 =(S a O 2 xHbx1.34)+.003(P a O 2 ) Copyright 2014 Niambi Wellness. All rights reserved

71. Physicians consider that the measurement of oxygen content in hemoglobin is a simpler process. Hemoglobin carries oxygen and deficiency (anemia) can lead to hypoxemia. Each gram of hemoglobin carries 1.34 mL of O 2. Copyright 2014 Niambi Wellness. All rights reserved

73. Part 3: Preload Copyright 2014 Niambi Wellness. All rights reserved

74. Frank-Starling mechanism 12 4 3

75. Copyright 2014 Niambi Wellness. All rights reserved

76. Part 4: Inotropy (contractility) Copyright 2014 Niambi Wellness. All rights reserved

77. cAMP (cyclic adenosine monophosphate ATP is cellular energy and is used in signal transduction. Adenylate cyclase uses ATP to produce cyclic AMP. Copyright 2014 Niambi Wellness. All rights reserved

78. cAMP is a second messenger, as it regulates the function of ion channels and assists the passage of ions and certain hormones into cells. Copyright 2014 Niambi Wellness. All rights reserved

79. It is also involved in glycogen and adrenaline regulation and lipid metabolism. Copyright 2014 Niambi Wellness. All rights reserved

81. Part 5: Afterload on Stroke Volume Copyright 2014 Niambi Wellness. All rights reserved

82. Afterload Afterload is the pressure generated in the ventricles to eject blood out of the heart. Copyright 2014 Niambi Wellness. All rights reserved

83. The pressure must be greater than pulmonic and systemic pressure for valve opening. Copyright 2014 Niambi Wellness. All rights reserved

84. As afterload increases, cardiac output decreases. Copyright 2014 Niambi Wellness. All rights reserved

86. Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

87. 1.Describe heart qi. 2.List the phases of the cardiac cycle on the Wiggers diagram. 3.Discuss the rule of 70. 4.Discuss how blood volume affects stroke volume. 5.Describe contractility 6.Describe afterload. Copyright 2014 Niambi Wellness. All rights reserved According to the textbook

88. 1.Discuss the Fick principle 2.Discuss the oxygen content equation. 3.What 4 factors are described in the Frank- Starling mechanism ? 4.What is cAMP? 5.What is afterload? Copyright 2014 Niambi Wellness. All rights reserved According to the course

89. Copyright 2014 Niambi Wellness. All rights reserved

90. Chapter 6: Vascular Function and Circulation Copyright 2014 Niambi Wellness. All rights reserved

91. Part 1: Calcium Channels Part 2: Contraction of Smooth Muscle Contents Copyright 2014 Niambi Wellness. All rights reserved

92. Part 3: Endothelial Factors Part 4: Metabolites Contents Copyright 2014 Niambi Wellness. All rights reserved

94. Part 1: Calcium Channels Copyright 2014 Niambi Wellness. All rights reserved

95. Calcium Channel Blocker A calcium channel is a gate on the cell surface which allows calcium ions to pass. Copyright 2014 Niambi Wellness. All rights reserved

96. There are 2 kinds of calcium channels: high voltage low voltage Copyright 2014 Niambi Wellness. All rights reserved

97. Voltage gated: L-type P-type N-type R-type Copyright 2014 Niambi Wellness. All rights reserved High voltage

98. L-type Myocytes (ventricle) Skeletal and smooth muscle Osteoblasts Dendrites Copyright 2014 Niambi Wellness. All rights reserved

99. P-type Certain neural cells Copyright 2014 Niambi Wellness. All rights reserved

100. N-type Certain neural cells Copyright 2014 Niambi Wellness. All rights reserved

101. R-type Certain neural cells Copyright 2014 Niambi Wellness. All rights reserved

102. T-type Certain neural cells Pacemaker (SA nodal cells) Copyright 2014 Niambi Wellness. All rights reserved Low voltage

103. Copyright 2014 Niambi Wellness. All rights reserved

104. Part 2: Contraction of Smooth Muscle Copyright 2014 Niambi Wellness. All rights reserved

105. The pressure in blood vessels can contract and neurotransmitters can cause more or less contraction or relaxation. Copyright 2014 Niambi Wellness. All rights reserved

106. ATP can be an important neurotransmitter. It is released with noradrenaline and neuropeptide from peri-vascular sympathetic nerves. Copyright 2014 Niambi Wellness. All rights reserved

107. ATP can assist at P2 receptors to cause smooth muscle contraction in vessels. Copyright 2014 Niambi Wellness. All rights reserved

109. Part 3: Endothelial Factors Copyright 2014 Niambi Wellness. All rights reserved

110. Endothelial cells form the linings of the blood vessels. Endothelin-1(ET-1) is involved in tissue production and repair throughout the body. Copyright 2014 Niambi Wellness. All rights reserved

111. ET-1 also repairs and extend capillaries in a spontaneous process called sprouting. In this process, endothelial cells may act similarly to hyphae in fungus. Copyright 2014 Niambi Wellness. All rights reserved

112. Nitric oxide is produced by endothelial cells and can serve as a neurotransmitter by relaxing smooth muscle tissue such as in vessels. Copyright 2014 Niambi Wellness. All rights reserved

114. Part 4: Metabolites Copyright 2014 Niambi Wellness. All rights reserved

115. Adenosine regulated by ATP. Also it is involved with vasodilation. It causes relaxation of smooth muscle as is found inside the artery walls. Copyright 2014 Niambi Wellness. All rights reserved

116. K+ channel activity is an important determinant of vascular tone and functioning. Copyright 2014 Niambi Wellness. All rights reserved

117. Endothelial cell dysfunction may be due to problems with nitric oxide which could also cause changes in K+ channel activity which will affect vasodilation. Copyright 2014 Niambi Wellness. All rights reserved

119. Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

120. 1.Explain the significance of Ca++ and H+ on smooth muscle contraction. 2.Describe Ca++ affect on smooth muscle contraction. 3.Which endothelin is associated with vascular functioning? How? 4.What is the role of prostaglandins in vasodilation? 5.Which four metabolites are involved with increase in vasodilation? Copyright 2014 Niambi Wellness. All rights reserved According to the textbook

121. 1.What are the two kinds of calcium channels? 2.Which kinds are involved with cardiac functioning? 3.Describe the role of ATP in vascular contraction. 4.What is ET-1? 5.What is the role of nitric oxide (NO) in vascular functioning? 6.What is the role of adenosine and K+ activity in vascular functionin Copyright 2014 Niambi Wellness. All rights reserved According to the course

122. Copyright 2014 Niambi Wellness. All rights reserved

123. Chapter 7: Humoral Control Copyright 2014 Niambi Wellness. All rights reserved

124. Part 1: Local Hormones Part 2: System Hormones Contents Copyright 2014 Niambi Wellness. All rights reserved

125. Part 1: Local Hormones Copyright 2014 Niambi Wellness. All rights reserved

126. Bradykinin This is a kinin which is part of inflammation, and is formed in locally around the site of an injury, which causes vasodilation and edema. Copyright 2014 Niambi Wellness. All rights reserved

127. Serotonin This is a neurotransmitter which causes vasoconstriction and smooth muscle contraction. Copyright 2014 Niambi Wellness. All rights reserved

129. Part 2: System Hormones Copyright 2014 Niambi Wellness. All rights reserved

130. Renin-angiotensin-aldosterone The renin-angiotensin-aldosterone system (RAAS) is involved in regulating vascular resistance, blood volume, cardiac output and arterial pressure. Copyright 2014 Niambi Wellness. All rights reserved

131. Adrenals Epinephrine causes constriction in many networks of minute blood vessels but dilates the arteries and bronchus. Norepinephrine constricts blood vessels. Copyright 2014 Niambi Wellness. All rights reserved

133. Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

134. 1.Explain bradykinin as part of pathogenic issues. 2.Explain serotonin as part of pathogenic issues. 3.Explain renin-angiotensin. 4.Explain adrenal hormones. Copyright 2014 Niambi Wellness. All rights reserved According to the textbook

135. 1.Define bradykinin. 2.Define serotonin. 3.Explain the renin-angiotensin-aldosterone system. 4.Explain the role of epinephrine. 5.Explain the role of norepinephrine. Copyright 2014 Niambi Wellness. All rights reserved According to the course

136. Copyright 2014 Niambi Wellness. All rights reserved

137. Chapter 8: Humoral Control Copyright 2014 Niambi Wellness. All rights reserved

138. Part 1: Autonomic Nervous System Part 2: Sympathetic Reflexes Part 3: Parasympathetic Reflexes Contents Copyright 2014 Niambi Wellness. All rights reserved

139. Part 1: Autonomic Nervous System Copyright 2014 Niambi Wellness. All rights reserved

140. The sympathetic and parasympathetic are part of the autonomic nervous system. The sympathetic reflexes cause vasoconstriction. The parasympathetic reflexes cause vasodilation. Copyright 2014 Niambi Wellness. All rights reserved

142. Part 3: Parasympathetic Reflexes Copyright 2014 Niambi Wellness. All rights reserved

143. The sympathetic reflexes accelerates the heart beat. Copyright 2014 Niambi Wellness. All rights reserved

144. The sympathetic reflexes relaxes the bronchus. Copyright 2014 Niambi Wellness. All rights reserved

145. Part 2: System Hormones Copyright 2014 Niambi Wellness. All rights reserved

146. The parasympathetic reflexes slows the heart beat. Copyright 2014 Niambi Wellness. All rights reserved

147. The parasympathetic reflexes constricts the bronchus. Copyright 2014 Niambi Wellness. All rights reserved

149. Module 1 Review Questions

150. Complete the Module 2 review interactive practice quiz. Copyright 2014 Niambi Wellness. All rights reserved

151. Please continue on to Module 3 Copyright 2014 Niambi Wellness. All rights reserved