oct 2009dr nyoman w / dr denny agustiningsih1 the cardiac cycle what is the cardiac cycle. the...
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1OCT 2009 Dr Nyoman W / Dr DENNY AGUSTININGSIH
THE CARDIAC CYCLEWhat is the cardiac cycle.
The cardiac cycle is the sequence of events that occur when the heart beats. There are two phases of this cycle:
Diastole - Ventricles are relaxed. Systole - Ventricles contract.
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DENNY AGUSTININGSIH 2OCT 2009
Electrocardiography
Atria
Ventricles
TWO SEPARATE PUMPS
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DENNY AGUSTININGSIH 3OCT 2009
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DENNY AGUSTININGSIH 4OCT 2009
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DENNY AGUSTININGSIH 5OCT 2009
Heart Sounds• are Produced by the Closing of the Valves• Normal heart sounds are produced when valves snap
closed: LUB-DUP • LUB = closing of AV valves: beginning of systole • DUP = closing of semilunar valves: end of systole • Abnormal valve sounds: – Leakage of valve -> swishing sound (murmur) – Narrowing of valve (stenosis) -> high pitched sound
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DENNY AGUSTININGSIH 6OCT 2009
Heart sounds:
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DENNY AGUSTININGSIH 7OCT 2009
Ventricular Volumes
• End Diastolic Volume-(EDV)– volume in ventricles at the end of filling
• End Systolic Volume- (ESV)– volume in ventricles at the end of ejection
• Stroke volume (EDV-ESV)– volume ejected by ventricles
• Ejection fraction– % of EDV ejected (SV/EDV X 100%)– normal 50-60%
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DENNY AGUSTININGSIH 8OCT 2009
Cardiac Output• Normally about 5 liters/min • The cardiac output per minute (CO) is the product of
the size of a single output, the stroke volume (SV), and the heat rate (HR) in beats/minute: – CO = HR X SV – = 70 beats/min X .07 liters/beat = 5 liters/min
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DENNY AGUSTININGSIH 9OCT 2009
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DENNY AGUSTININGSIH 10OCT 2009
Factors Affecting Cardiac Output
• Rate:– Factors affecting HR– Last topics
• Rhythm– Sinus rhythm from SA node– Arrhythmia
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DENNY AGUSTININGSIH 11OCT 2009
Factors Affecting Cardiac Output
• Preload– Equal to EDV– Depends on Venous Return– Frank-Starling Law– Contractility
• Afterload– TPR
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DENNY AGUSTININGSIH 12OCT 2009
VENOUS RETURN
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DENNY AGUSTININGSIH 13OCT 2009
Muscle pump
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DENNY AGUSTININGSIH 14OCT 2009
Frank-Starling Law of the Heart
• Relationship between EDV, contraction strength, and SV.
• Within physiologic limits the heart will pump all the blood that returns to it without allowing excessive damming of blood in veins
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DENNY AGUSTININGSIH 15OCT 2009
Mechanism of Frank-Starling
• Increased venous return causes increased stretch of cardiac muscle fibers. (Intrinsic effects)– increased cross-bridge formation– increased calcium influx• both increases force of contraction
– increased stretch on SA node• increases heart rate
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DENNY AGUSTININGSIH 16OCT 2009
Extrinsic Control of Contractility
• Contractility:– Strength of contraction at
any given fiber length.
• Depends upon sympathoadrenal system:– NE and Epi produce an
increase in contractile strength. • + inotropic effect:
– More Ca2+ available to sarcomeres.
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DENNY AGUSTININGSIH 17OCT 2009
TPR
• Total Peripheral Resistance:– Impedance to the ejection of blood from ventricle.– Afterload.
• In order to eject blood, pressure generated in the ventricle must be greater than pressure in the arteries.
– Pressure in arteries before ventricle contracts is a function of TPR.
• SV inversely proportional to TPR.– Greater the TPR, the lower the SV.
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DENNY AGUSTININGSIH 18OCT 2009
RV wallcerscent
LV wall3x thickercylindricalInterventricular
septum
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DENNY AGUSTININGSIH 19OCT 2009
Cardiac output distribution