1. Physical Therapy for Cardiovascular disorders
RHPT 482
Credit hours: 2T+1C
Course Instructor: Ahmad Osailan

2. Course Description
The course is designed to teach and perform clinical practice for the management of CVD.

3. Anatomy and physiology of the cardiovascular system
Objectives :
Be familiar with the anatomy of the heart and vascular system
Size of the heart
Location of the heart
Layers of the heart
Chambers of the heart
Vascular system and its layers
Brief physiology of cardiovascular system

4. Cardiovascular system
Consist of :
Heart
Blood vessels
Lymphatic

5. Overview of the heart
Heart Definition: “a pump that moves the entire body volume to and from the lungs and tissues.”
In Humans, Heart is 250 g in Male to 350 in Female. (Size of a fist)
It produces ~ 5 Litres of Blood every minute
Myogenic: ability to generate its own contraction

6. Location of the heart posterior to sternum medial to lungs
anterior to vertebral column
base lies beneath 2nd rib
apex at 5th intercostal space
lies upon diaphragm

7. posterior to sternum
medial to lungs
anterior to vertebral column
base lies beneath 2nd rib
apex at 5th intercostal space
lies upon diaphragm

8. Heart Structure Consist of : Pericardium Walls of the heart
Four champers
Four valves

9. Covering of the Heart Pericardium:
Def: Is a fibrous sac surrounds the heart and roots of great vessels.
Divided to :
Serous pericardium: smooth inner
Fibrous pericardium: Tough fibrous tissue outer

10. pericardiun
Serous pericardium
Parietal layer
Visceral layer
Fibrous pericardium

11. Pericardium Serous pericardium
Parietal layer: lines the inside of fibrous pericardium
Visceral layer: adheres to the surface of the heart.
Fibrous pericardium: Protects the heart and serous membrane

13. Heart Wall layers Epicardium: outer layer Myocardium: Middle layer
Endocardium: Inner layer

14. Endocardium Inner lining
Smooth (Endothelial) surface that permits blood to move easily through the heart
Continuous with lining of blood vessels

15. Myocardium Middle layer made of cardiac muscle (Myocardium)
Forms the bulk of the heart wall
Contains the septum- a thick muscular wall that completely separates the blood in the right side of the heart from the blood in the left side.

16. Epicardium Protective, outer layer of the heart wall
same as the visceral pericardium
The coronary blood vessels that nourish
the heart wall are located here

18. Champers of the Heart Heart has Four Champers
2 atria (atrium) 2 ventricles
2 atria separated by interatrial septum
2 ventricles separated by interventricular septum.

20. Champers Right Atrium Thinner wall than ventricles
Receives deoxygenated blood from vena cava
Passes blood through tricuspid valve into right
ventricle

21. Right Ventricle Thicker wall than atria
Comprises most of anterior surface of heart
Circulates deoxygenated blood to lungs through the pulmonic valve into pulmonary trunk

22. Left atrium Receives freshly oxygenated blood from pulmonary vein
Passes blood to left ventricle through mitral valve

23. Left ventricle Receives blood from left atrium
Thickest myocardial wall
Forms apex of heart
Sends blood to systemic circulation via aorta

24. Valves of the heart Function- prevent blood from flowing backwards
Responds to changes in pressure
Two types of valves in heart
Atrioventricular valves (AV)
Semi-lunar valves

25. Semilunar valves
Located at exit of ventricles, originiate from endothelial lining of veins
Heart contains two semilunar valves
Pulmonic
Aortic (Frequently damaged by Htn)

26. Atrioventricular Valves
Valve cusps are connected to papillary muscles
Chordae tendineae tiny collagen cords
that anchor cusps of valve to papillary muscles

27. Atrioventricular Valves
Left AV valve (Mitral, bicuspid)
Contains 2 cusps
Subject to abuse
Right AV valve (Tricuspid)
Contains 3 cusps
Not subjected to great abuses

28. Blood circulation There are 2 circulatory pathways: Pulmonary circuit
Systemic circuit

29. Blood circulation Pulmonary circuit:
Deoxygented Blood received by Right Atrium from Superior and inferior vena cava-> pass through Tricuspid V-> Right Ventricle -> through Pulmonary V -> pulmonary trunk -> pulmonary arteries -> R + L Lung.

30. Blood Circulation Systemic Circuit:
Oxygenated blood returns from lungs to heart through -> pulmonary veins -> Left Atrium -> pass through Mitral V -> Left ventricle -> pass through Aortic V -> aortic arch -> whole body

32. Blood Vessels Function: Distribution of blood
Exchange of materials with tissues
Return of blood to heart
Structure:
Most have 3 layers surrounding a hollow lumen

33. Blood Vessels
Arteries Veins
Arteriole Venule
Capillary network

34. General structure of Blood Vessels
Arteries and Veins Have 3 Tunics:
Tunica Externa ( Adventetia )
Tunica Media
Tunica Intema
Capillaries composed of endothelium ( tunica intema)

37. Blood vessels Tunica Intema: Inner smooth layer
Simple squamous epithelium
Continous with endocardium
Present in all vessels

38. Blood Vessels Tunica Media: Layer of smooth Muscles Contain Elastin
Supplied by Sympathetic division of ANS
Area of vasoconstriction and Vasodilatation

39. Blood Vessels Tunica Externa Layer of Connective tissue
Elastic and has collagen fibres

40. Arteries Characteristics: Thick walled Lots of Elastin in all tunics
Stretchable wall to recoil and propel blood
Withstand and regulate BP Fluctuations

41. Veins Characteristics: Thin walled Lumen is larger than arteries
Less stretchable than arteries

42. Capillaries Characteristics : Smallest vessel
Large enough for 1red cell
One tunica only (tunica intema)
Very thin, Why?

43. Blood supply to heart

44. Coronary arteries 2 Main Coronary Arteries
•Right CA- branches into some marginal arteries; supplies RV and posterior of heart
•Left CA- branches into
AIA (LAD) and
circumflex; supplies LV

45. Arterial supply to heart
Originates from the base of aortic artery
Only 5% of ejected blood is received through to innervate the heart (Myocardium)
Many branches directed to the Left ventricle, Why?
Coronary arteries traverse the heart forming a vast network of capillaries

46. Venous drainage Transport deoxygenated blood to coronary sinus
Coronary Sinus drains into RA

47. Discussion Which chamber among ventricles is thicker?
Which one is thicker among blood vessels?
How many layers surrounding the heart?
How many valves and what is the type of each one?
How many Circuit in cardiovascular system?

48. Physiology of cardiovascular system

49. Mainly the heart is a pumping machine.
To pump it require force to generate contraction.
Since the heart is mainly composed of cardiac muscles (myocyte),
it has similar functions and structure like skeletal muscles with some variations

50. Myocyte Characteristics: Striated cells Short cells
Mononucleus (one nucleus only)
Very large mitochondria (Many ATP)
Has intercalated disks

51. Types of cells in the heart
Contracting cells (Myocytes)
- concept of Actin and myosin for contraction
- depends on presence of Ca
- action potential is 30X longer than skeletal Muscles
2. Conducting cells (intercalated disks, SA node…)

52. Conduction system Non-contractile cells, self-excitable,
generate spontaneous action potentials,
Trigger heart contractions.
Conduction system is located in:
SA node
AV node
AV bundle
Purkinje fibres

54. Conduction system
Three potential areas capable of beginning cardiac conduction
SA Node- Located in right atria; bpm
AV Node- Located at AV junction; bpm
Ventricular System- Ventricles; < 40

55. How Heart beat is initiated
Through Action potential of SA node

56. How the myocardium is contracting
Through action potential of cardiac muscles

57. Cardiac cycle What is cardiac cycle:
Is a series of events occur when heart beats
Mainly consist of:
Systole period: Ventricles contract
Diastole Period: Ventricles relaxed
Duration: last for 0.8 Seconds

58. Cardiac Cycle

59. Cardiac output
Cardiac output: is the amount of blood pumped by each ventricle in one minute
CO= HR x SV
Heart rate: is the number of beats per minute
Stroke volume: is the amount of blood pumped by one ventricle with each beat.

60. Stroke Volume SV= End Diastolic volume – End systolic volume
EDV= amount of blood in a ventricle during diastole before contraction
ESV= amount of blood remaining in a ventricle after contraction.
Ejection Fraction (EF): percentage of blood ejected from a ventricle.

61. Regulation of Heart rate
Chemicals. Na, K
Autonomic nervous system
Positive chronotropic factors. HR
Atropine Dopamine Epinephrine
Negative chronotropic factors. HR
Beta blockers such as Acetylcholine
Digoxin

62. Discussion
How the blood is travelling through Heart chambers? What is Early filling and atrial filling? How to detect the electrical activity of the heart?