![Page 1: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/1.jpg)
HeartPrepared by Dr F.NikbakhtAssistant professor of Medical school
![Page 2: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/2.jpg)
Cardiac muscle
![Page 3: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/3.jpg)
Cardiac Muscle
![Page 4: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/4.jpg)
![Page 5: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/5.jpg)
Sinus node and the Purkinje system of the heart, showing also the A-V node, atrial internodal pathways, and ventricular bundle branches
![Page 6: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/6.jpg)
Organization of the A-V node. The numbers represent the interval of time from the origin of the impulse in the sinus node. The values have been extrapolated
to human beings .
![Page 7: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/7.jpg)
Transmission of the cardiac impulse through the heart, showing the time of appearance (in fractions of a second after initial appearance at the sinoatrial
node) in different parts of the heart .
![Page 8: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/8.jpg)
Rhythmical action potentials (in millivolts) from a Purkinje fiber and from a ventricular muscle fiber, recorded by means of microelectrodes
![Page 9: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/9.jpg)
Rhythmical discharge of a sinus nodal fiber. Also, the sinus nodal action potential is compared with that of a ventricular muscle fiber .
![Page 10: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/10.jpg)
Force of ventricular heart muscle contraction, showing also duration of the
refractory period and relative refractory period, plus the effect of premature
contraction. Note that premature contractions do not cause wave summation, as
occurs in skeletal muscle.
![Page 11: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/11.jpg)
![Page 12: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/12.jpg)
Denervated HeartHeart Rate ~100/min (Intrinsic Heart Rate)
Parasympathetic Nervous System)PNS: Vagus Nerve(
Could Decrease HR to Zero (Cardiac Arrest)
Sympathetic Nervous System)SNS: Cardiac Nerves(
Could Increase HR by 300%
Normal HR (~72/min) Is dominated by PNS
![Page 13: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/13.jpg)
Parasympathetic NS,Inhibits cardiac APs
Sympathetic NS stimulates cardiac APs
![Page 14: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/14.jpg)
Vagal Nerve Terminals
Neurotransmitter = Acetylcholine
Muscarinic Receptors
K Channels
Hyperpolarization
Longer time to reach threshold (Slower Heart Rate)
![Page 15: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/15.jpg)
Sympathetic Nerve Terminals
Neurotransmitter = Norepinephrine
Beta-adrenergic Receptors
Leak Na Channels
Faster Rate of Spontaneous Depolarization
Faster to reach threshold (Faste Heart Rate)
![Page 16: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/16.jpg)
Conducting System of Heart
![Page 17: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/17.jpg)
![Page 18: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/18.jpg)
Cardiac CycleHeart is two pumps that work together,
right and left halfRepetitive contraction (systole) and
relaxation (diastole) of heart chambersBlood moves through circulatory system
from areas of higher to lower pressure.Contraction of heart produces the pressure
![Page 19: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/19.jpg)
The cardiac cycleThe cardiac cycle
![Page 20: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/20.jpg)
Cardiac cycle
![Page 21: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/21.jpg)
Ejection Fraction = Stroke Volume/End-Diastolic Volume
Ejection Fraction is a measure of cardiac contractility
![Page 22: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/22.jpg)
The pressure-volume loop
![Page 23: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/23.jpg)
![Page 24: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/24.jpg)
Heart SoundsFirst heart sound or “lubb”
Atrioventricular valves and surrounding fluid vibrations as valves close at beginning of ventricular systole
Second heart sound or “dupp”Results from closure of aortic and pulmonary semilunar valves at beginning of ventricular diastole, lasts longer
Third heart sound (occasional)Caused by turbulent blood flow into ventricles and detected near end of first one-third of diastole
![Page 25: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/25.jpg)
Sound Origin
1st sound Closure of mitral and tricuspid valves
2nd sound Closure of aortic and pulmonary valves
3rd sound Rapid ventricular filling in early diastole
4th sound Ventricular filling due to atrial contraction
![Page 26: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/26.jpg)
Regulation of stroke volume & heart rate
Measurement of cardiac outputRegulation of heart rate
neuralRegulation of stroke volume
PreloadAfterloadNeural
Control of cardiac output
![Page 27: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/27.jpg)
Sympathetic nervous system–sympathetic nerves release norepinephrine–plus circulating epinephrine from adrenal
medulla–both act on ß-receptors on sinoatrial node–increases slope of the pacemaker potential –increases heart rate = tachycardia
+25
0
-25
-50
-75
mV
![Page 28: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/28.jpg)
Parasympathetic nervous system–vagus releases ACh –acts on muscarinic receptors on sinoatrial
node–hyperpolarises cells and decreases slope of
pacemaker potential–decreases heart rate = bradycardia
+25
0
-25
-50
-75
mV
![Page 29: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/29.jpg)
Regulation of stroke volume - preload
Starlings Law states - the energy of contraction is proportional to the initial length of the cardiac
muscle fibre
Length
Ten
sion
=)preload(
![Page 30: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/30.jpg)
Regulation of stroke volume - preload
In vivo, preload is affected by the End Diastolic Volume
End Diastolic Volume
Str
oke
Volu
me
Increased venous return, increases EDV, and therefore increases stroke volume = self-
regulation
Resting EDV
![Page 31: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/31.jpg)
Regulation of stroke volume - afterload
Afterload is the load against which the muscle tries to contract
In vivo, afterload is set by the arterial pressure against which the blood is expelled (this in turn
depends on the Total Peripheral Resistance)If TPR increases, stroke volume will go down
![Page 32: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/32.jpg)
Regulation of stroke volume - neural
End Diastolic Volume
Str
oke
Volu
me +sympathetic stimulation
![Page 33: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/33.jpg)
Control of cardiac outputHR increases
via decrease vagal tone & increased sympathetic tone
Contractility increases via increased sympathetic tone alters inotropic state & shortens systole
Venous return increases via venoconstriction & skeletal/respiratory pumps maintains preload
Total peripheral resistance falls due to arteriolar dilation in muscle, skin & heart reduces afterload
CO increase 4-6 times
HR x SV = CO
![Page 34: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/34.jpg)
![Page 35: Heart Prepared by Dr F.Nikbakht Assistant professor of Medical school](https://reader036.vdocuments.net/reader036/viewer/2022062519/5697bfb51a28abf838c9ddd6/html5/thumbnails/35.jpg)