Moderator: DR - Anil Verma Speaker: Rajeev: Published by

CARDIAC PHYSIOLOGY
& ANAESTHETIC
CONSIDERATIONS
MODERATOR : DR.ANIL VERMA
SPEAKER : RAJEEV
PUBLISHED BY
www.medicalppt.blogspot.com
Heart
 Hollow
 Located within the mediastinum
of the thorax
 Distal end extends downward
to the left forming apex at the
fifth intercostal space.
HEART STRUCTURE
 ANATOMICALLY ONE ORGAN

 FUNCTIONALLY DIVIDE INTO
RT. & LT PUMPS
 FOUR VALVES WITH
UNIDIRECTIONAL FLOW
Pulmonary
and
Systemic
Bloodflow
The heart consists of three different layers
Coronary supply
Inferior Rt coronary
Anteroseptal Lt ant descening
Anteroapical Lt ant desceding(

distal)
Anterolateral Circumflex
Posterior Rt coronary artery

l
CARDIAC ACTION POTENTIAL
PHASE
Mechanical Response 0 = Rapid Depolarization
(inward Na+ current)
MEMBRANE POTENTIAL (mV)
1 1 = Overshoot
0 2
2 = Plateau
(inward Ca++ current)
3 = Repolarization
0 (outward K +
current)
3 4 = Resting Potential
4
-90
TIME
PACEMAKERS (in order
of their inherent rhythm)
• Sino-atrial (SA) node

• Atrio-ventricular (AV) node
• Bundle of His
• Bundle branches
• Purkinje fibers
Sinoatrial Node
AtrioVentricular Node
Atrioventricular Bundle
Purkinje Fibers
Heart Conduction System

INITIATION & CONDUCTION
OF THE CARDIAC IMPULSE
Heart Actions
• Atrial systole is when the atria

contract while the ventricles
relax which is called ventricular
diastole.
• Thus systolic and diastolic
blood pressure.
• This series of contraction and
relaxation is called a cardiac
cycle. www.medicalppt.blogspot.com
EVENTS IN CARDIAC
CYCLE LATE DIASTOLE
DIASTOLE
ISOMETRIC
VENTRICULAR ATRIAL
RELAXATION SYSTOLE
VENTRICULAR
ISOMETRIC VENTRICULAR
EJECTION www.medicalppt.blogspot.com
CONTRACTION
CYC LE
CAR DI AC
opens
Mitral
Aortic
Closes
Atrial
Isovolumic
Systolecontract.
S1
Rapid Ejection
Reduced Ejection
S2
Isovolumic Relax.
Rapid Ventricular
Filling
Reduced Ventricular
Filling
Atrial
Systole
opens
closes
Mitral
Aortic
CARDIAC OUTPUT
• DEFIND AS VOLUME OF BLOOD

PUMPED BY HEART/MIN
• CO = SV X HR
• SV IS VOLUME PUMPED PER
CONTRACTION
• average cardiac output would
be 5L.min-1 for a human male
and 4.5L.min-1 for a female.
CARDIAC OUTPUT AND THE FICK
PRINCIPLE
BODY O2 CONSUMPTION
Lungs
250mlO2/min
PULMONARY PULMONARY
ARTERY VEIN
PaO2 PvO2
190mlO2/l blood 140mlO2/l blood
Pulmonary capillaries
O2 CONSUMPTION (ml/min)
CARDIAC OUTPUT=
PaO2
-
PvO2
Pulse
• Pressure wave move along the artery wall

which are pliable
• usually measured in beats per
minute
• normal range from 60 to 100 beats
per minute
Factors Influencing the
Pulse
• Stroke volume
• Rate of ejection
• Distensibility of peripheral arteries
• Peripheral resistance
• Pulse rate
• Pulse pressure
• Size of the vessel
• Distance from the heart
Pulsus Parvus
• The pressure is diminished, and the pulse feels

weak and small, seen in - restrictive
pericardial disease, hypovolemia, mitral
stenosis
• Pulsus Parvus et Tardus (weak and delayed):
→Aortic Stenosis
Bisferiens Pulse
• Increased arterial pulse with a double systolic

peak.
• Causes : AR
• HCM
Bigeminal Pulse
• characterized by groups of two

heartbeats close together
followed by a longer pause. The
second pulse is weaker than the
first
• Causes: severe HF, hypovolemic shock,
cardiac tamponade)
Pulsus Alternans
arterial pulse waveform showing

alternating strong and weak
beats
• Causes:
• Left ventricular failure
• severe AR www.medicalppt.blogspot.com
Pulsus Paradoxus
• Pressure drop > 20 mmHg during inspiration.

• Normally, systolic arterial pressure falls 8-12 mmHg during
inspiration.
• Causes:
• Cardiac Tamponade
• COPD, hypovolemic shock
BLOOD PRESSURE
• DEFINE AS PRESSURE OF
BLOOD AGAINST THE WALL OF
MAIN ARTRIES
• HIGHEST DURING SYSTOLE N
LOWEST DURING DIASTOLE
• MEASURED BY
SPHYGMOMANOMETER @
BRACHIAL ARTERY OF ARM
Blood Pressure (BP):
Measurements
Figure 15-7: Measurement of arterial blood pressure
CLASSIFICATION
Category Systolic Diastolic

hypotension <90 <60
normal 90 – 119 60 - 79
prehypertes 120 - 139 80 - 89
ion
stage1ht 140 - 159 90 - 99
stage2ht >160 >100
Pulse and Mean Arterial
Pressures
• Pulse pressure = Systolic –

Diastolic
• Mean arterial pressure (MAP) =
Diastolic +
1/3 pulse pressure
EJECTION FRACTION
• Ejection fraction (Ef) is the

fraction of the end-diastolic
volume that is ejected with
each beat
• it is stroke volume (SV) divided
by end-diastolic volume (EDV):
EJECTION FRACTION
• In a healthy man, the SV is

approximately 70 ml and the left
ventricular EDV is 120 ml, giving
an ejection fraction of 70/120,
or 0.58 (58%).
• Healthy individuals typically
have ejection fractions between
50% and 65%
METHODS OF EF
MEASUREMENT
• CARDIAC CATHETRISATION
• RADIONUCLEOTIDE STUDIES
• ANGIOCARDIOGRAPHY
CARDIAC INDEX
• Cardi ac index (CI ) i s a
vasodynami c parameter that
rel ates the cardi ac output to
body surf ac e area
• uni t of measurement is
(l/mi n/m2 )
• normal range of cardiac index is
2.6 - 4.2 L/min per square meter.
ANAESTHETIC
CONSIDERATION
• Halothaane isoflurane and
enflurane depress SA node
automaticity.
• IV induction agent have limited
effect on usual clinical doses.
• Opioids can depress cardiac
conduction.
• LA associated with systemic
toxicity. www.medicalppt.blogspot.com
GOALS OF ANAESTHESIA
IN CVS DISEASES
• PREMEDICATE BY BZP’S
• BLUNT RESPONSE BY
LARYGOSCOPY N INTUBATION
• AVOID TACHYCARDIA
• AVOID HYPOCAPNIA
THANK YOU
FOR MORE MEDICAL PRESENTATIONS VISIT

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CARDIAC PHYSIOLOGY

MODERATOR : DR.ANIL VERMA

 ANATOMICALLY ONE ORGAN

Anteroseptal Lt ant descening

Anteroapical Lt ant desceding(

Posterior Rt coronary artery

• Sino-atrial (SA) node

Heart Conduction System

• Atrial systole is when the atria

• DEFIND AS VOLUME OF BLOOD

• Pressure wave move along the artery wall

• The pressure is diminished, and the pulse feels

• Increased arterial pulse with a double systolic

• characterized by groups of two

arterial pulse waveform showing

• Pressure drop > 20 mmHg during inspiration.

Category Systolic Diastolic

• Pulse pressure = Systolic –

• Ejection fraction (Ef) is the

• In a healthy man, the SV is

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