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CARDIAC REGULATION EXTRINSIC AND INTRINSIC MECHANISMS Guido E. Santacana Ph.D. Professor Dept. of Physiology Control of Cardiac Activity CARDIAC OUTPUT = HEART RATE X STROKE VOLUME Pacemaker Activity Myocardial Performance TWO POINTS TO REGULATE EXTRINSIC REGULATION AUTONOMIC NERVES BARORECEPTOR REFLEX BAINBRIDGE REFLEX RESPIRATORY EFFECTS CHEMORECEPTOR REFLEXES VENTRICULAR RECEPTOR REFLEX HORMONAL REGULATION EXTRINSIC REGULATION HEART AND BLOOD VESSELS EXTRINSIC INNERVATION OF THE HEART THORACIC CERVICAL MEDULLA OBLONGATA R VAGUS SAN EPICARDIAL PLEXUS L CORONARY VESSELS AVN MYOCARDIUM SYMPATHETIC VS VAGAL STIMULATION AND DECAY VAGAL SYMPATHETIC PARASYMPATHETIC / SYMPATHETIC REASONS FOR STIMULATION/DECAY DIFFERENCES VAGUS SYMP. Ach NPY NE K+ Ach M REUPTAKE ATROPINE NE B BLOCKERS AchE DIFUSSION B1 cAMP EFFECTS OF CATECHOLAMINES EPINEPHRINE NOREPINEPHRINE BARORECEPTOR REFLEX AORTIC ARCH CAROTID SINUS 200 HEART RATE B/M 50 ARTERIAL PRESSURE mmHg 150 BAINBRIDGE VS BARORECEPTOR REFLEXES VOLUME LOAD INCREASED RA PRESSURE + CO + ARTERIAL PRESSURE + ATRIAL RECEPTORS BARORECEPTOR REFLEX + BAINBRIDGE REFLEX + + HEART RATE RESPIRATORY REGULATION OF CARDIAC ACTIVITY INSPIRATION BARORECEPTOR REFLEX + + ARTERIAL PRESSURE INTRATHORACIC PRESSURE CO + + VENOUS RETURN BAINBRIDGE PERIPHERAL CHEMORECEPTORS AND HEART RATE PERIPHERAL CHEMORECEPTORS + MEDULLA + RESPIRATORY ACTIVITY DAMPENING OF CARDIAC EFFECT HEART RATE VENTRICULAR RECEPTOR REFLEX VASOVAGAL SYNCOPE STANDING VENTRICULAR CONTRACTION VENOUS POOLING VENOUS RETURN SYMPATHETIC ACTIVITY CO MAP BARO REFLEX HUMORAL REGULATION INSULIN THYROID GLUCAGON dP/dt CATECHOLAMINES POTENTIATION STEROIDS RENIN-ANGIOTENSIN ATRIAL NATRIURETIC PEPTIDE ENDOTHELIN ANTIDIURETIC HORMONE INTRINSIC REGULATION FRANK STARLING HEART RATE AND FORCE INTRINSIC REGULATION OF THE HEART FRANK STARLING LAW OF THE HEART AND BACK TO THE VENTRICULAR FUNCTION CURVE :>) LVP EDV FORCE DEVELOPED(G) FORCE DEVELOPMENT .32 1.6 180 INTERVAL BETWEEN CONTRACTIONS(SEC) REGULATION OVERVIEW