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University of BaghdadCollege of Nursing
Department of Basic Medical Sciences
Overview ofAnatomy and Physioloy –II
Second Year Students
Asaad Ismail Ahmad , Ph.D.Asaad Ismail Ahmad , Ph.D.Electrolyte and Mineral Physiology
[email protected] - 2013
ANATOMY AND PHYSIOLOGY - II
Brief Contents1- Cardiovascular System1- Cardiovascular System2- Blood3- Lymphatic System4- Urinary System5- Male Reproductive System6- Female Reproductive System7- Sensory Function7- Sensory Function
Asaad Ismail Ahmad, Ph.D in Electrolyte and Mineral PhysiologyCollege of Nursing – University of Baghdad / 2012 – [email protected]
Text bookText book
Martini FH. Fundamentals of Anatomy and Physiology, 5th ed. Prentice Hall, New Jersey, 2001. 2001.
References:1.Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong's Review of Medical
Physiology, 23rd ed. McGraw Hill, Boston, 2010.2.Drake RL, Vogl W, Mitchell AWM. Gray's Anatomy for Students. Elsevier,
Philadelphia, 2005.3.Goldberger ,E. 1975.A Primer of Water Electrolyte and Acid-Base Syndromes. 5th ed., 3.Goldberger ,E. 1975.A Primer of Water Electrolyte and Acid-Base Syndromes. 5th ed.,
Lea and Febiger ,Philadelphia.
4. Martini, FH and Welch K. Applications Manual Fundamentals of Anatomy andPhysiology,4th ed., Prentice Hall, NewJersey, 1998.
5.Maxwell, MH and Kleeman CR. 1980.Clinical Disorders of Fluid and Electrolyte Metabolism. McGraw-Hill Book Company, New York.
6.McKinley M, and O'Loughlin VD. Human Anatomy, McGraw Hill, Boston, 2006.2006.
7.Nutrition Foundation.1984.Present Knowledge in Nutrition. 5th ed., Nutrition Foundation, Inc , Washington, D.C.
8.Vander A, Sherman J, Luciano D., Human Physiology, 7th ed., McGraw Hill, Boston, 1998.
Contents:
CARDIOVASCULARSYSTEMSYSTEMI- ANATOMY OF THE HEARTII- ANATOMY OF BLOOD VESSELSIII- PHYSIOLOGY OF THE HEARTIV- PHYSIOLOGY BLOOD VESSELSIV- PHYSIOLOGY BLOOD VESSELS
Asaad Ismail Ahmad, Ph.D in Electrolyte and Mineral PhysiologyCollege of Nursing – University of Baghdad / 2012 – [email protected]
THIRD LECTURE
Physiology of the Heart
1. Functional Properties of CardiacMuscle1. Functional Properties of CardiacMuscle2. Action Potential and Conducting System3. Cardiac Cycle4. Electrocardiogram5. Arrhythmia 6. Cardiodynemic6. Cardiodynemic
Asaad Ismail Ahmad, Ph.D in Electrolyte and Mineral PhysiologyCollege of Nursing – University of Baghdad / 2012 – [email protected]
PHYSIOLOGY OF HEART AND BLOOD VESSELS
Maintaining Blood Flow( Tissue Perfusion )
Contents:1- Functional Properties of
CardiacMuscleCardiacMuscle
FUNCTIONAL PROPERTIES OFCARDIAC MUSCLE
I- EXCITABILITYII- CONDUCTIVITYIII- RHYTHMICITYIV- CONTRACTILITYIV- CONTRACTILITY
I- EXCITABILITY
I- EXCITABILITY
Response of the tissue to stimuli, Response of the tissue to stimuli, are created and conducted by development action potential( example of excitable cells arenerve cell and muscle cell) nerve cell and muscle cell)
Action Potential ofCardiac Muscle
Voltmeter for Measuring Potentials
STEPS OF ACTION POTENTIAL IN CARDIAC MUSCLE FIBER 668-669
1- DEPOLARIZATION (Na+ entry)
2- PLATEAU (Ca++ entry)
3- REPOLARIZATION (K+ loss)
ACTION POTENTIAL OF CARDIAC MUSCLE 669
Action Potential of Nerve Cell (Neuron)
II- CONDUCTIVITY
II- CONDUCTIVITY 670-671Ability of cardiac muscle to transmitelectrical signal (impulse) produce byelectrical signal (impulse) produce bySA node to all cardiac muscle cell by special conducting system
CONDUCTING SYSTEM 670CONDUCTING SYSTEM 670A network of specialized cardiac musclecells that initiates and distributes electrical impulses
STRUCTURES OFCONDUCTING SYSTEM 670
1- SA node1- SA node2- Internodal fiber3- AV node4- AV bundle5- Bundle branches6- Purkinje fiber
RESTING MEMBRANE POTENTIAL
1- Cardiac muscle fiber = - 90 mV2- SA node = - 60 mV2- SA node = - 60 mV3- Perkinje fiber = - 95 mV
Threshold membrane potentialMembrane potential at which an action Membrane potential at which an action
potential (electrical signal) begins
CONDUCTION PATHWAY
Sinus nodal action potential is compared with that of a ventricular muscle fiber 670
III- RHYTHMICITY
III- RHYTHMICITYAbility of the tissue to produce its own impulses regularly, also called autorhythmicity or self excitationautorhythmicity or self excitation
RHYTHMICITY OF DIFFERENT PART OFTHE HEART
SA node 75 / minuteSA node 75 / minuteAV node 50 / minuteAtrial muscle 50 / minuteVentricular muscle 30 / minute
PACEMAKER
Cardiac pacemakerCardiac pacemakeris part of the heart which impulses for the
heart beat are produced normally. SA node is the cardiac pacemaker where the electrical activity start first. electrical activity start first.
AUTONOMIC INNERVATION OF SA node (PACEMAKER) 684
1- Parasympathetic stimulation releasesAcetylcholine which extends repolarization and Acetylcholine which extends repolarization and decrease the rate of spontaneous depolarization. (Slow the heart rate )2- Sympathetic stimulation release norepinephrine which shortens repolarizationAnd increased the rate of spontaneous And increased the rate of spontaneous depolarization, as a result, (Increase heart rate )
AUTONOMIC INERVATION OF THE HEART 684
CONTROL of PACEMAKER FUNCTION685
IMPLANTED PACEMAKERS
When there is marked bradycardiaWhen there is marked bradycardiain patients implanted pacemaker are useful in patients with sinusnode dysfunction, AV block andthird-degree heart block.third-degree heart block.
ARTIFICIAL PACEMAKER
An electronic cardiac pacemaker thatgenerates an extrinsic electrical impulse, generates an extrinsic electrical impulse, which cause the heart muscle to depolarize and then contract.Its rate is preset regardless of the heartintrinsic activity, it can be either temporary (transcutaneous, transvenous, or epicardial) or implantated
IV- CONTRACTILITY
Ability of the tissue to contract after receiving a stimulus (action potential).
REFRECTORY PERIOD 669Period in which the muscle does not show any response to stimulus. There are two types of refractory period:types of refractory period:
a- Absolute refractory periodb- Relative refractory period
PHYSIOLOGICAL HEART PARAMETERSNormal RangeHeart rate (pulse):60–80 bpm
Stroke volume:
DescriptionGenerated by the SA node, propagated through the conduction pathway; parasympatheticimpulses (vagus nerves) decrease the rate; sympathetic impulses increase the rateThe amount of blood pumped by a ventricle in one beatStroke volume:
60–80 mL/beat
Cardiac output:5–6 L/min
Ejection fraction:60%–70%
The amount of blood pumped by a ventricle in one beat
The volume of blood pumped by a ventricle in one minute = stroke volume x pulse
The percentage of blood within a ventricle that is pumped out per one beat
Cardiac reserve:15 liters or more
ECG
Echo
The difference between resting cardiac out putand maximum cardiac output during exercise
ELECTROCARDIOGRAM , Recorded or graphical registration of electrical activities of the heart
HEART RATE (PULSE) 668
Number of heart contraction per minute.Both sympathetic and parasympatheticBoth sympathetic and parasympatheticFrom cardiac plexus innervate SA nodeAnd AV nodes, atrial and ventricular muscle cells.CHRONOTROPIC ACTION: Effect on heart rate
either a- Tachycardia (+ chro.trop)either a- Tachycardia (+ chro.trop)b- Bradycardia (- chro.trop)
CONTROLCONTROLHEART
RATERATE
FACTRS AFFECTING HEART RATE 683
I- AUTONOMIC INNERVATION1- Sympathetic release NE bind to beta-1 receptor,lead to opening Ca++ influx, Ca++ influx increase rate of depolarization and shortens period of lead to opening Ca++ influx, Ca++ influx increase rate of depolarization and shortens period of repolarization. SA node reach the threshold more quickly, this result in increase heart rate.
2- Parasympathetic release Ach lead to opening K+ efflex channels which prolonge repolarizationand slow spontaneous depolarization, and thiseresult in decrease heart rate.
II- HORMONESII- HORMONES1- Epinephrine2- Norepinephrine3- Thyroxine
CARDIAC CYCLE 674
One complete heartbeat, include atrialand ventriculars systole and diastoleand ventriculars systole and diastolelasting for 0.8 second (800 msec).SYSTOLE: period of cardiac contractionlasting for 0.3 second (300 msec).DIASTOLE: period of cardiac relaxationDIASTOLE: period of cardiac relaxationlasting for 0.5 second (500 msec).
HEART SOUND 677
Sound produce during mechanical activity of each cardiac cycle (systole activity of each cardiac cycle (systole and diastole). These are:LUBB: The first sound due to suddenclosure of atrioventricular valvesDUPP: The second sound due to sudden closure DUPP: The second sound due to sudden closure
of semilunar valves in aorta and pulmonary artery
CARDIAC MURMUR
ABNORMAL HEART SOUNDABNORMAL HEART SOUND
1- Systolic murmur2- Diastolic murmur3- Continuous murmur3- Continuous murmur
Contents:4. Electrocardiogram
(ECG)(ECG)
ELECTROCARDIOGRAM“ ECG “ 673Recorded or graphical registration ofelectrical activities of the heart (the sumelectrical activities of the heart (the sumof extracellular electrical activity of allcardiac muscle cells
ELECTROCARDIOGRAPHELECTROCARDIOGRAPHMachine used in ECG
ELECTROCARDIOGRAM 673
LEADS IN ECG “electrocardiogram”Lead is a pair of electrodes used in recording changes in electric potential ( action potential)of the heart (electrocardiography) or the brain (electroencephalography).(electroencephalography).TYPES OF LEAD1- Lead I (between two arms)2- Lead II (btween right arm and left leg)3- Lead III (between left arm and left leg)3- Lead III (between left arm and left leg)4- Leads V 1-6 (over the heart)5- Others
Normal Electrocardiogram (ECG)
WAVES, SEGMENT AND INTERVAL OF NORMAL “ECG”
P wave : Atrial depolarizationP wave :QRS complex :T wave :P-R interval :QRS duration:
Atrial depolarizationVentricular depolarizationVentricular repolarizationAtr.depo. = 0.18 secondVen.depo. = 0.1 secondQRS duration:
QT interval :S-T interval :
Ven.depo. = 0.1 secondVen,Elec.Act.=0.4 secondVen.Repo. =0.08 second
Basic ECG Assessment
Follow these steps for basic electrocardiogram interpretation.interpretation.
1. Determine ventricular rate.2. Determine QRS duration and shape.3. Identify P waves and determine if a P wave precedes every
QRS complex.4. If more than 1 P wave precedes a QRS complex, determine
the ratio of P waves to QRS complex (ex., 4:1, 3:1, 2:1).the ratio of P waves to QRS complex (ex., 4:1, 3:1, 2:1).5. Is P wave shape consistent?6. Determine atrial rate and rhythm.7. Determine P-R intervals and if they are consistent.
Contents:5. Arrhythmia
CARDIAC ARRHYTHMIAAbnormal or irregular heartbeat
CAUSES OF CARDIAC ARRHYTHMIA1- Electrolyte imbalance2- Hypoxia3- Trauma4- Inflammation4- Inflammation5- Drugs
TYPES OF ARRHYTHMIA
I- NORMOTROPIC ARRHYTHMIAI- NORMOTROPIC ARRHYTHMIAAbnormality in SA node (the normal cardiac pacemaker)
1- Sinus tachycardia1- Sinus tachycardia2- Sinus brady cardia3- Sinus arrhythmia
Continue: TYPES OF ARRHYTHMIAII- ECTOPIC ARRHYTHMIA
(ECTOPIC BEATS)In this abnormalities, the cardiac In this abnormalities, the cardiac pacemaker is any cardiac tissue other than SA node.1- Extrasystole2- Paroxysmal tachycardia3- Heart block3- Heart block4- Atrial fibrillation5- Atrial flutter6- Ventricular fibrillation
ECTOPIC FOCI OF EXCITATION(ECTOPIC BEATS)
Normally myocardial cells, his bundle and purkinje system are low spontaneously discharge, becaus the normal pacemaker discharge of SA node is more rapid than their pacemaker discharge of SA node is more rapid than their rate of spontaneous discharge. In excited ectopic focus, the abnormal dischrge of cardiac muscle cells and purkinjesystem occur before the expected next normal beat and transiently interrupts the cardiac rhythm (atrial nodal or ventricular extrasystole or premature beat). If the focus discharges are higher rate than SA node produce ( atrial, discharges are higher rate than SA node produce ( atrial, ventricular, or nodal paroxysmal tachycardia or atrial flutter)
Application of electrical current to the chest to stop ventricular fibrillation
CARDIODYNAMICSCARDIODYNAMICSSTROKE VOLUMECARDIAC OUTPUTCARDIAC OUTPUTCARDIAC RESERVE( productivity of the heart)
CARDIODYNAMICS 680Movements and forces generated during cardiac
contraction.End-diastolic volume (EDV): volume of blood in each ventricle at the end of ventricular diastolin each ventricle at the end of ventricular diastolEnd-systolic volume (ESV): volume of blood remaining in each ventricle at the end of ventricular systoleStroke volume (SV): volume of blood pumped of each ventricle during single beat, expressed as: SV = EDV - ESVexpressed as: SV = EDV - ESVNote: stroke volume is the most important factor in an examination of a single cardiac cycle
CARDIAC OUTPUT
Blood volume pumped by each ventricle in one minuteone minute
(ventricular efficiency).
CO = SV X HRCARDIAC STROKE HEART CARDIAC STROKE HEART OUTPUT VOLUME RATE ml / min. ml / beat beats / min.
FACTORS AFFECTING CARDIACOUTPUT 681
FACTORS AFFECTING CARDIAC OUTPUT686
FACTORS AFFECTING CARDIAC OUTPUT 681
1- Autonomic innervation Heart 2- Hormones Rate3- End-diastolic volume (EDV) Stroke4- End –systolic volume (ESV) Volume
CONDITION INCREASECARDIAC OUTPUT
1- Fever ( oxidative process )1- Fever ( oxidative process )2- Anemia ( hypoxia )3- Hypothyroidism ( BMR )
CONDITION DECREASEDCARDIAC OUTPUT1- Hypothyroidism2- Atrial fibrilation2- Atrial fibrilation3- Coronary stenosis4- Myocardial infarction (MI)5- Congestive heart failure6- Incomplete heart block7- Shock7- Shock8- Hemorrhage
ABNORMAL ELECROLYTE DISORDERS AFFECTING CARDIAC OUTPUT 686
1- Hyperkalemia2- Hypokalemia2- Hypokalemia3- Hypercalcemia4- Hypocalcemia5- Abnormal body temperature5- Abnormal body temperature
FACTORS AFFECTING STROKE VOLUME “EDV and ESV” 681
Factors affecting EDVFactors affecting EDV1- Filling time2- Venous return
Factors affecting ESV1- Preload1- Preload2- Contractility of ventricle3- After load
FACTORS INFLUENCE “ESV” 681Definitions:Preload: degree of stretching experience
during ventricular diastoleduring ventricular diastoleContractility ( inotropic ): amount of force
produced during a contraction at a given preload
Afterload: amount of tension (force) the Afterload: amount of tension (force) the contracting ventricle must produce to force open the semilunar valve and eject blood
CARDIAC RESERVE
The difference between resting and The difference between resting and Maximal cardiac outputs during heavyexercise (increase SV and HR). Heavyexercise can raise CO by 300 – 500 % to 18 – 30 liters / minute. Trained athletswith maximum exercise increase CO by 700 % to 40 liters / minute.
FACTORS AFFECTING FORCE OF CONTRACTILITY (INOTROPIC)
1- Autonomic innervation2- Hormones3- Drugs4- Change in ion concentration 4- Change in ion concentration
in ECF
TYPES OF IONTROPICS
Positive inotroic1- Sympathetic stimulation1- Sympathetic stimulation2- Epinephrine and norepinephrine3- Thyroid hormones4- Glucagon5- Agents stimulate influx of Ca++ 5- Agents stimulate influx of Ca++
into cardiac muscle cells
CONTINUE: TYPES OF INOTROPIC
Negative inotropic1- Parasympathetic (Ach)1- Parasympathetic (Ach)2- Agents block Ca++ channels
( e.g. verapamil – antiarhythmia )3- Drugs block alpha and beta
receptors ( drugs used for treatreceptors ( drugs used for treathypertension e.g. propranolol,atenolol, timolol,metoprolol …
