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The Cardiovascular System
William Harvey (1628) demonstrated that
the circulatory system forms a circle so
that blood is continuously pumped out
of the heart by way of another set of
vessels.
(i.e. Arteries and Veins)
The Cardiovascular System
Heart attacks are, perhaps, the number one
killer in the USA. In middle age and older
persons, the probability of developing a
coronary disease increases with:
1. Smoking
2. Obesity
3. Cholesterol/triglycerides
4. Abnormal ECG
5. Hypertension
The Cardiovascular System
I. Blood Vascular II. Lymphatic Vascular
A. Heart
A. Lymphatic Capillaries
B. Arteries
B. Lymphatic Vessels
C. Capillaries
Thoracic Duct
D. Veins
Right Lymphatic Duct
Impulse Conduction
A-V Node
Atrionodal
Nodal
Nodal His
Junctional fibers (0.01m/s)
Node (0.1m/s)
Transitional (0.4m/sec)
Bundle of His
Branches of bundle of
His E Purkinje fibers
rate L5 to 4.0 m/sec
Cardiac Action Potentials
Pace-maker
40
-90
-60
Atrial Myocradial cell
2
No+
Co 4K+
1 in set
in
-90
3
1. Resting potential
2. Spike (rapid depolarization)
3. Plateau (Ca++ perinmeability )
4. Repolarization
Ventricular
Myocradial cell
Electrocardiogram (ECG)
The ECG is the algebraic sum of the electrical events
which occur during a heart beat. These signals are
transmitted via the body fluids to the body surface
where they are recorded by electric amplifiers.
The series of pikes and depressions have arbitrarily
been labeled
R
T
P
I. Unipolar (V) leads
(9 locations)
QS
A. Chest leads
(precordial)
II. Bipolar Limb Leads
V 1- 6
I. from RA to LA
B. Limb leads
II. from RA to LL
VR (right arm)
III. from LA to LL
VL (left arm)
VF (left foot)
Relationship between Monophasic
Action Potential and Ventricular
Activity
Depolarization
Repolarization
R
T
Q S
R
ECG
T
P
Q
PR
interval
PR segment
S
ST
segment
QT interval
QRS Duration
Duration
Ave. Range
PR interval
0.18 0.12-0.20
QRS duration 0.08 0.006-0.10
QT interval
0.40 0.37-0.43
ST interval
0.32
Event
Atrial Dep. Through AV
Aent. Dep.
Vent. Dep + Repol.
Vent. Repolarization
Pathological Conditions
Mean Electrical Axis
(mark changes in current flow)
Left Axis Deviation
(hypertrophy of left ventricle)
1. Hypertension
(muscle mass on left side of heart)
2. Aortic Valvular stenosis
3. Aortic Valvular regurgitation
4. Several congenital heart conditions
Right Axis Deviation
1. Hypertrophy of right ventricle
(pulmonary stenosis)
2. Tetralogy of Fallot
(congenital right to left shunt )
Cardiac Arrhythmias
I. Correlation of Plasma K+ Level
Noraml (plasma K+ 4 - 5.5 mEq/l)
a.
b.
c.
p
u
t
Hypokalemia (plasma K+ + 2.5 mEq/l)
u
t
Hypokalemia (plasma K+ + 2.3 mEq/l)
d.
Hyperkalemia (K+ + 7.0)
e.
Hyperkalemia (K+ + 8.5
II. Atrial Enlargement
a.
“p” pulmonale
b.
“p” mitrale
Origin of the heartbeat & the electrical activity of the heart
Cardiac Rhythms & Arrhytmias
Cardiovascular
Pressures & Sounds
aortic valve
opens
120 100 80 60 40 20 0-
closes
Dicrotic notch
a
Key (color)
1. Left ventricular P.
2. Aortic pressure
3. Left atrial p.
v
c
closes opens
mitral valve
Electrocardiogram
4 1
2
3
Phonocardiogram
1. Lub
2. Dub
3. Rapid ventricular filling
4. Atrial contraction
40
20
0
100
80
60
Diastolic
Pressure
Systolic Pressure
Vena cava
Large veins
Main venous branch
Terminal veins
Venale
capilleries
Arteriale
Terminal arteries
Main arterial branch
120
Large arteries
Aorta
Comparison of Pressures Within
the Circulatory System
Heart
Sounds
Time seconds
120-
0
0.2
0.4
0.6
0.8
10080-
Ventricle
60-
Pressure (mmHg)
40-
200
120-
Volume (ml)80-
Disstole
Systole
1
6
5
2
3
40-
4
1st
2nd 3rd
Heart sounds
Heart Murmurs
(Bruits - Outside the heart)
Types:
A Innocent (functional)
B pathogenics (non-functional)
1. Stenosis - narrowing of valve
2. Regurgitant (insufficient)
3. Prolaspse
C. Congential
2. Patent ductus arteriosis
2. Interventricular septal defect
Heart Murmurs
(Bruits - Outside the heart)
Valve Name
Aortic or
Pulmonary
Mitral or
Tricuspid
Abnormality
Stenosis
Regurgitation
Timing of Murmur
Systolic
Diastolic
Stenosis
Regurgitation
Diastolic
Systolic
Rheumatic Vascular lesions cause an autoimmune disease in
which the heart valves are likely to be damaged .
It is caused by a group A streptococcal toxin such as the ones
which cause sore throat, scarlet fever, or middle ear infection.
Heart & Circulation
1.Blood
Blood cells become packed at the
bottom of the tube when whole
blood is centrifuged, leaving the
fluid at the top of the tube. Red
blood cells are the most abundant
of the blood cells -- white cells &
platelets float ?? Only a thin, lightcolored “buffy coat” at the interface
between the packed red blood cells
and the plasma.
Representative normal plasma values
Measurement
Normal Range
Blood volume
80-85 ml/kg body weight
Blood osmoiality
280-296 mOsm
Blood pH
7.35-7.45
Enzymes:
Creatine
Female: 10-79 U/L
phosphokinase (CPK)
Male : 17-148 U/L
Lactic Dehydrogenase
45-90 U/L
(LDH)
Phosphate (acid)
Female: 0.01-0.56
Sigma U/ml
Male: 0.13-0.63 Sigma
Representative normal plasma values
Measurement
Hematology Values:
Hematocrit
Hemoglobin
Red blood cell count
White blood cell count
Hormones
Testosterone
Adrenocorticotropic (ACTH)
Growth hormone
Insulin
Normal Range
Female: 37%-48%
Male: 45%-52%
Female: 12-15 g/100ml
Male: 13-18 g/100ml
4.2-5.9 million/mm3
4,300-10,880/mm3
Male: 300-1,100ng/100ml
15-70 pg/ml
Children: over 10ag/ml
Adult male: below 5 mg/ml
6-26 * U/ml (fasting)
Representative normal plasma values
Measurement
Normal Range
Ions
Bicarbonate
Calcium
Chloride
Potassium
Sodium
24-30mmol/l
2.1-2. 6mmol/l
100-106mmol/l
3.5-5.0mmol/l
135-145mmol/1
Representative normal plasma values
Measurement
Normal Range
Organic Molecules (other)
Cholesterol
Glucose
(fasting)
Lactic acid
Protein (total)
Triglyceride
Urea nitrogen
Uric acid
120-220mg/100ml
70-110mg/100ml
0.6-1.6mmol/l
6.0-8.4g/100ml
40-150mg/100ml
8-25mg/100ml
3-7 mg/100ml
Hemostasis
Mechanisms
1. Vascular Spasms
(vasoconstricitions)
2. Formation of Platelet Plug
3. Blood Coagulation
Table 13.4 Plasma Clotting Factors
*
*
*
*
+
+
+
* Require Vitamin K
+ Antihemophilic factors
Table 13.5 Some acquired and
inherited defects in the clotting
mechanism
Extrinsic
pathway
Common
pathway
Intrinsic
pathway
Extrinsic pathway
Activator:
tissue thromboplastin
VII
VII activated
VII complex
(VII, tissue
thromboplastin,
calcium,
phospholipids)
Common
pathway
Intrinsic pathway
Activators:
collagen,gas, and others
XII
XII activated
XI
XI activated
IX
Common
pathway
IX activated
VIII complex
(VIII, (X activated,
calcium, phospholipids)
Extrinsic
pathway
X
Common pathway
X activated
V complex
(V, X activated,
calcium,
phospolipids
Prothrombin
Fibrinogen
Intrinsic
pathway
Thrombin
Fibrin
XIII
Fibrin
polymer
Prevention of Blood Clotting
A. In-Vivo
1. Endothelial Surface Factors
(Prostocyclin)
2. Heparin: A conjugated
polysaccharide produced by mast cells
(basophils)
3. Coumarin(Warfarin) & Phenindione:
orally administered; blocks the
synthesis of Vit.-K dependent clotting
factors
4. Aspirin
Prevention of Blood Clotting
B. In-Vitro
1. Removal of Ca++
a. Oxalates
b. Citrates
c. Chelating agents (EDTA)
2. Inhibition of vitamin-K
Dicumarol (coumarin)
 3. Aspirin
Inhibits platelet aggregation
O
EDTA
A chelate of
ethylenediamine
tetraacetate with a
divalent metal
cation (Me2+).
O
The shaded
portion represents C
the plane of the O
coordination
bonds
C
O
O
C
O
CH2
CH2
N
Me 2+
CH2
N
CH2O
C
O
CH2
CH2
Causes for Excessive Bleeding
1. Vitamin-K Deficiency
Factors II, VII, IX & X
2. Hemophilia
Factors VII (75%), IX (15%),
& XI (5-10%)
3. Thrombocyopenia
Extrinsic Pathway
Vessel Damage
Intrinsic Pathway
Vessel Damage
Exposed Collagen
Subendothelial Cells
Exposed to Blood
Contact
Activation
XII
Tissue Factor
XIIa
VIIa
XIa
XI
VII
Ixa
IX
VIII
XIIIa
IX
Activated
Platelets
Xa
X
V
Prothrobin
Va
X
Activated
Platelets
Thrombin