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The volume of blood pumped by each ventricle per minute is called cardiac output Cardiac output = Stroke Volume X Heart Rate Normal value = 5 Liters /Minute Cardiac output = Stroke Volume X Heart Rate The factors which regulate stroke volume and Heart rate are basically regulating Cardiac output Volume of blood ejected by each ventricle in single systole; Normal Value = 70 ml/beat Stroke Volume = End diastolic Volume – End Systolic Volume So stroke volume is mainly controlled by EDV ESV VENOUS RETURN: What ever blood volume returns to the heart, same is pumped forward through the Frank’s Starlings Law. According to this law 13- 15 liters of blood volume can be pumped out without cardiac stimulation. DURATION OF DIASTOLE OR FILLING TIME: ventricular filling occurs during diastole, so there must be adequate ventricular filling time. DISTENSIBILITY OF THE VENTRICLES: Normally ventricles are distensible to accommodate adequate blood volume. Infarction decreases the distensibility which decreases the EDV. ATRIAL CONTRACTION: There must be adequate atrial contraction to have adequate EDV. If atrial function is not adequate then EDV will decrease. E.S.V is basically CONTROLLED BY MYOCARDIAL CONTRACTION FORCE OF MYOCARDIAL CONTRACTION: It depends upon the initial length of muscle fibers according to frank’s starlings law. PRELOAD: The effect of EDV on initial length is called preload. So EDV also effects the ESV. AFTER LOAD: Force of contraction is also dependant upon the resistance against which the ventricles have to pump CONDITION OF THE MYOCARDIUM : It also effects the force of contraction. AUTONOMIC NERVES : Sympathetic stimulation increases and parasympathetic stimulation decreases force of contraction HORMONES: Catecholamines, thyroxine, glucagon, digitalis, calcium, increased temp, caffeine, theophyline increase the force. Force decreases by hypoxia, acidosis, barniturates, procainamide and quinidine decrease the force of contraction.
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The volume of blood pumped by each ventricle per minute is called cardiac output Cardiac output = Stroke Volume X Heart Rate Normal value = 5 Liters /Minute Cardiac output = Stroke Volume X Heart Rate The factors which regulate stroke volume and Heart rate are basically regulating Cardiac output Volume of blood ejected by each ventricle in single systole; Normal Value = 70 ml/beat Stroke Volume = End diastolic Volume – End Systolic Volume So stroke volume is mainly controlled by EDV ESV VENOUS RETURN: What ever blood volume returns to the heart, same is pumped forward through the Frank’s Starlings Law. According to this law 13- 15 liters of blood volume can be pumped out without cardiac stimulation. DURATION OF DIASTOLE OR FILLING TIME: ventricular filling occurs during diastole, so there must be adequate ventricular filling time. DISTENSIBILITY OF THE VENTRICLES: Normally ventricles are distensible to accommodate adequate blood volume. Infarction decreases the distensibility which decreases the EDV. ATRIAL CONTRACTION: There must be adequate atrial contraction to have adequate EDV. If atrial function is not adequate then EDV will decrease. E.S.V is basically CONTROLLED BY MYOCARDIAL CONTRACTION FORCE OF MYOCARDIAL CONTRACTION: It depends upon the initial length of muscle fibers according to frank’s starlings law. PRELOAD: The effect of EDV on initial length is called preload. So EDV also effects the ESV. AFTER LOAD: Force of contraction is also dependant upon the resistance against which the ventricles have to pump CONDITION OF THE MYOCARDIUM : It also effects the force of contraction. AUTONOMIC NERVES : Sympathetic stimulation increases and parasympathetic stimulation decreases force of contraction HORMONES: Catecholamines, thyroxine, glucagon, digitalis, calcium, increased temp, caffeine, theophyline increase the force. Force decreases by hypoxia, acidosis, barniturates, procainamide and quinidine decrease the force of contraction.
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In the heart there is Atrial muscle and Ventricular muscle which are separated from each other by the fibrous AV Rings containing Valves. ATRIAL MUSCLE: thin walled. There are two sheets, superficial and deep sheet. Superficial sheet is common over both atria. Deep sheet is separate for each atrium. Muscle fibers in the deep sheet are at right angle to the muscle fibers in the superficial sheet. FUNCTIONS OF THE ATRIUM: 1. Receive venous blood from large veins. So atria act as reservoir. 2. Conduct the blood into the ventricles. 3. Atrial contraction is responsible for last 25 % of ventricular filling. 4. In the right atrium there is SA Node(Pace maker) and AV node. 5. In the wall of the atria, there are low pressure stretch receptors and these are involved in various reflexes like brain bridge reflex and left atrial reflex. 6. Atria also produce a hormone i.e. Atrial Natriuretic Hormone. Whenever NaCl increases in ECF, it causes release of ANH which causes natriuresis. VENTRICULAR MUSCLE: Much thicker than atrial muscle. Thickness of right ventricle wall is 3-4 mm and thickness of left ventricle is 8 – 12 mm. 1.Involuntary 2.Has cross striations 3.Each cardiac muscle fiber consists of a number of cardiac cells, united at ends in series. Where as in skeletal muscle each muscle fiber is individual cell. 4.Cardiac muscle cells are branching and interdigitate. 5.Single central nucleus in each cell. 6. Atrial muscle and ventricular muscle act as separate functional syncytium and impulses from atria are conducted to ventricles through the AV Node and AV Bundle. 7. Sarcoplasmic system is present. In skeletal muscle triad is at the junction of A and I bands. In cardiac muscle T Tubules are much large and thus in cardiac muscle if we take a section it may form a diad or a triad. And these diads and triads are present at the level of Z Disks. 8.Between adjacent cardiac cells there are side to side and end to end connections and these are the intercellular junctions. These junctions are Gap Junctions. Or intercalated discs 9.When one part of myocardium is excited the whole muscle is excited. 10.Whole myocardium obeys all or none law as a whole. 11.No spike potential but action potential with plateau. 12.Has got long refractory period. Absolute refractory period in ventricular muscle is 250 – 300 milli sec. In atrial muscle Absolute refractory period is 150 milli sec Because of long refractory period cardiac muscle cannot be tetanized.
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Sequence of events from the beginning of one systole to the beginning of next consecutive systole. One heart beat consists of one systole and one diastole. Each cardiac cycle is initiated by the cardiac impulse which originates from the SA node. During each cardiac cycle, certain events occur in the heart and these include pressure changes, volume changes, production of heart sounds, closure and opening of heart valves and electrical changes in the heart.
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In the heart there is Atrial muscle and Ventricular muscle which are separated from each other by the fibrous AV Rings containing Valves. ATRIAL MUSCLE: thin walled. There are two sheets, superficial and deep sheet. Superficial sheet is common over both atria. Deep sheet is separate for each atrium. Muscle fibers in the deep sheet are at right angle to the muscle fibers in the superficial sheet. FUNCTIONS OF THE ATRIUM: 1. Receive venous blood from large veins. So atria act as reservoir. 2. Conduct the blood into the ventricles. 3. Atrial contraction is responsible for last 25 % of ventricular filling. 4. In the right atrium there is SA Node(Pace maker) and AV node. 5. In the wall of the atria, there are low pressure stretch receptors and these are involved in various reflexes like brain bridge reflex and left atrial reflex. 6. Atria also produce a hormone i.e. Atrial Natriuretic Hormone. Whenever NaCl increases in ECF, it causes release of ANH which causes natriuresis. VENTRICULAR MUSCLE: Much thicker than atrial muscle. Thickness of right ventricle wall is 3-4 mm and thickness of left ventricle is 8 – 12 mm. 1.Involuntary 2.Has cross striations 3.Each cardiac muscle fiber consists of a number of cardiac cells, united at ends in series. Where as in skeletal muscle each muscle fiber is individual cell. 4.Cardiac muscle cells are branching and interdigitate. 5.Single central nucleus in each cell. 6. Atrial muscle and ventricular muscle act as separate functional syncytium and impulses from atria are conducted to ventricles through the AV Node and AV Bundle. 7. Sarcoplasmic system is present. In skeletal muscle triad is at the junction of A and I bands. In cardiac muscle T Tubules are much large and thus in cardiac muscle if we take a section it may form a diad or a triad. And these diads and triads are present at the level of Z Disks. 8.Between adjacent cardiac cells there are side to side and end to end connections and these are the intercellular junctions. These junctions are Gap Junctions. Or intercalated discs 9.When one part of myocardium is excited the whole muscle is excited. 10.Whole myocardium obeys all or none law as a whole. 11.No spike potential but action potential with plateau. 12.Has got long refractory period. Absolute refractory period in ventricular muscle is 250 – 300 milli sec. In atrial muscle Absolute refractory period is 150 milli sec Because of long refractory period cardiac muscle cannot be tetanized.
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CARDIAC CYCLE, ECG AND HEART SOUNDS: BY Wincy Thirumurugan.. “Cardiac cycle refers to the series of events that take place when the heart beats.” Each cycle is initiated by spontaneous contraction in the SA node and then transmit through the A-V bundle and branches into the ventricles results completion of one cycle. EVENTS OR PHASES OF CARDIAC CYCLE: Diastolic phase (Diastole) in this phase the heart chamber are in the state of relaxation and fills with blood that receives from the veins [IVC, SVC,PULMONARY VEINS] Systolic phase (Systole) in this the heart chambers are contracting and pumps the blood towards the periphery via the arteries. [ Pulmonary artery and aorta] PHASES OF THE CARDIAC CYCLE The different phases of the cardiac cycle involve: Atrial diastole - Atrial relaxation Atrial systole -Atrial contraction Isovolumic relaxation -ventricular relaxation in the early phase but blood will not move and the Atrio ventricular valves will be closed Ventricular filling - ventricular relaxation, the Atrio ventricular valves will be open allows filling blood in the ventricles Isovolumic contraction of ventricle – ventricular systole in the early phase but no movement of the blood. The semilunar valves will be closed. Ventricular ejection -ventricular contraction and send blood out of the ventricles through opened semilunar valves. 6. Ventricular Filling Stage: second phase. Rapid Filling, Slow Filling & Last Rapid Filling Duration of Cardiac Cycle: In a normal person, a heartbeat is 72 beats/minute. An Electrocardiogram (ECG) is a medical test that detects cardiac (heart) abnormalities by measuring the electrical activity generated by the heart as it. The machine that records the patient’s ECG is called an electrocardiograph. contracts. PLACEMENT OF ECG LEADS ECG WAVES: The P wave is caused by spread of depolarization through the atria, After the onset of the P wave, The QRS waves Occurs as a result of electrical depolarization of the ventricles, the ventricular T wave represents the stage of repolarization of the ventricles, The 'U' wave is a wave comes after the T wave of ventricular repolarization and may not always be observed. HEART SOUNDS: First Heart Sound (S1) The first heart sound results from the closing of the mitral and tricuspid valves. Second Heart Sound (S2): The second heart sound is produced by the closure of the aortic and pulmonic valves. Third Heart Sound (S3): The third heart sound, also known as the “ventricular gallop,” occurs just after S2 when the mitral valve opens, allowing passive filling of the left ventricle. The S3 sound is actually produced by the large amount of blood striking a very compliant LV. [Compliance heart means how easily the chamber of heart or the lumen of blood vessels expands when it is filling with the blood] Fourth Heart Sound (S4): The fourth heart sound, also known as the “atrial gallop,” occurs just before S1 when the atria contract to force blood into the LV.
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1.
THE CARDIAC CYCLE
Lecture 3
2.
3.
4.
5.
6.
ATRIAL SYSTOLE
The end of diastole
7.
8.
9.
10.
11.
ISOVOLUMETRIC CONTRACTION The
Beginning of systole
12.
13.
14.
15.
16.
RAPID EJECTION
17.
18.
19.
20.
REDUCED EJECTION
The end of systole
21.
22.
23.
24.
ISOVOLUMETRIC RELAXATION
The beginning of Diastole
25.
26.
27.
28.
RAPID VENTRICULAR FILLING
29.
30.
31.
32.
REDUCED VENTRICULAR FILLING
(Diastasis)
33.
34.
35.
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