Escolar Documentos
Profissional Documentos
Cultura Documentos
Dept.of Physiology
FMUI
Everyday Activities
High concentration
work
White collar
Routine activities
Sedentary Life
Heavy physical
work
Special conditions
Pregnancy
Obesity
Exercise
Extreme conditions
Deep-sea diving
High-altitude
Starvation
Stressful situation
Cardiovascular Adjustment
To meet Oxygen demand
Maintain Homeostasis
Transport System
Cardiovascular Function
Rapid convective transport of O2, glucose, amino
Excitable tissue
Electrical event
Mechanical event
Life style
Food
Smoking
Case illustration:
Questions
1. How likely is this to be a heart problem? Asthma?
Panic attack?
2. What are the symptoms that are consistent with
your preliminary diagnosis?
3. What are the underlying mechanisms of those
symptoms?
Keywords:
lightheaded, difficulty in breathing, increased heart
rate, irregular heart beat
Knowledge needed:
How is the normal heart beat conducted?
Electrical events of the heart
Knowledge needed:
Distribution of normal blood flow
Hemodynamic laws
Characteristics/properties of various blood vessels
Vascular regulation:
Central regulation
Local/peripheral regulation
4 chambers
2 Atria
2 Ventricles
2 systems
Pulmonary
Systemic
pacemaker cells
and conduction
pathways
Coordinate the
contraction of the
atria and ventricles
Myocardial Physiology
Autorhythmic Cells (Pacemaker Cells)
Myocardial Physiology
Autorhythmic Cells (Pacemaker Cells)
Myocardial Physiology
Autorhythmic Cells (Pacemaker Cells)
Parasympathetic Activity
Summary:
decreased chronotropic effects
heart rate
decreased dromotropic effects
conduction of APs
decreased inotropic effects
contractility
Myocardial Physiology
Contractile Cells
Action Potential
Myocardial Physiology
Contractile Cells
YOUR TASK
MAKE COMPARISON OF ACTION POTENTIAL BETWEEN
SKELETAL AND CARDIAC MUSCLE
(CONTRACTILE AND AUTORHYTHMIC MYOCARDIUM)
Excitation-Contraction Coupling
Seven phases
Electrical
Conduction
Pathway
diastole
Phases of the cardiac cycle
1.
2.
3.
4.
5.
Atrial filling (Rapid and Late phase), both atrium and ventricle
are relaxed (diastole)
Atrial Systole
Isovolumetric Ventricular Contraction
Ventricular ejection (Rapid and Late phase)
Isovolumetric Ventricular Relaxation
Wiggers
Curve
Correlation between:
Electrical events
Mechanical events
Heart sounds
Ventricular volume
During One Cycle
Autonomic
innervation of
the heart
Case illustration:
Questions
Why didnt Denise feel any pain?
What causes Denise to faint upon standing up?
Why was her face pale?
Keywords:
Suddenly stood up, felt faint, passed out, pale
Knowledge needed:
Coronary circulation normal, disturbances
Parameters of the cardiovascular system
Heart rate
Stroke volume
Cardiac output
Cardiac index
Blood-pressure
Factors influencing cardiac output and blood pressure
Factors influencing blood flow abnormalities of the
blood vessels
Compensation mechanism of the cardiovascular system
Case illustration:
Questions
What are the characteristics of Denises lifestyle/risk
Keywords:
menopause, strict diet, exercise, chain smoking
husband, cardiovascular examination
Knowledge needed:
Factors influencing cardiovascular regulation
Hormonal
Dietary
Other
Cardiovascular risk factor
Exposure to harmful conditions
Cardiovascular examination
Non-invasive
Invasive
Electrocardiogram
Summary
What should be studied:
Electrical events of the heart
Mechanical events of the heart
Special properties of the heart
Regulation of the cardiovascular system
Parameters of the cardiovascular system
Laboratory & supplementary diagnostic examination
of the cardiovascular system
Websites
http://www.gwc.maricopa.edu/class/bio202/
cyberheart/cardio.htm
http://www.mic.ki.se/MEDIMAGES.html
ELECTROCARDIOGRAPH
Recording of electrical activity of the heart
ECG Recorder
Galvanometer, sensitive to electrical potential
changes
Active/recording electrode at 2 different points/site
Amplification of electrical potential difference
Recording apparatus - speed
Specific curve: amplitude (mV) and duration
(seconds)
ECG Leads
Bipolar:
Potential difference between 2 active electrodes
Einthoven: I, II and III
Unipolar:
Potential diference between 1 active electrode and
indifferent electrode
Augmented extremity leads GOLDBERGER: aVR,
aVL and aVF
Precordial leads WILSON: V1, V2, V3, V4, V5 dan V6
ECG Curve
ECG Analysis
Normal rhythm: sinus rhythm
Every P wave is followed by QRS complex and T wave
All 12 lead
ECG Analysis
Heart rate:
60
P-P (R-R) interval (mm) X 0.04
ECG Analysis
P wave Lead II
Amplitude: < 0.25 mV
Duration: < 0.11 sec.
ECG Analysis
ECG Analysis
QRS complex Lead V2 V3
Duration: < 0.12 sec.
QRS configuration: V1 V6
rS Rs
Transitional zone
ECG Analysis
QRS electrical heart axis
QRS T angle: < 70
I
Lead I: - 1
+
8
=
+7
III
Lead III: - 2
+
12
=
+10
ECG Analysis
S-T segment all leads
Iso-electric
Important clinical significance
ECG Analysis
T wave configuration all leads
Positive deflection except aVR and sometimes
V1
ECG Analysis
U wave
Late Purkinje cells depolarization
Unknown significance