14 CARDIO VASCULAR PHYSIOLOGY FLASH

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By: kokololo (109 month(s) ago)

nice presentation thanks

By: trickydrashok (116 month(s) ago)

nice presentation. i need to download it for academic purpose DR ASHOK BADAMALI SR CARDIAC ANAESTHESIA PGI CHANDIGARH, INDIA

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Human Physiology : 

Human Physiology Cardiovascular Physiology

Blood Functions - Distribution : 

Blood Functions - Distribution Supplies Oxygen from lungs to cells Supplies nutrients from digestive system to cells Transports metabolic wastes from cells to disposal sites Transports hormones to target tissues/organs

Blood Functions - Regulation : 

Blood Functions - Regulation Regulates body temperature Regulates the pH of body fluids Regulates blood volume to support efficient circulation to cells, tissues, organs & systems

Blood Functions - Protection : 

Blood Functions - Protection Prevents blood loss Prevents infection through the activity of white blood cells, complement & antibodies

Plasma : 

Plasma Liquid part of blood Contains: Water Proteins Hormones Nutrients Electrolytes Respiratory Gases Wastes

Plasma Proteins : 

Plasma Proteins Include: Albumin (60%) Globulins (36%) (Antibodies & transport proteins) Clotting Proteins (4%) Enzymes & Hormones

Serum : 

Serum Albumin (60%) Globulins (36%) (Antibodies & transport proteins) Clotting Proteins (4%) Enzymes & Hormones Liquid part of blood without clotting proteins Serum X

Hematocrit : 

Hematocrit Percent of formed elements Hematocrit Normal Hematocrit is around 45%, depending on gender

Formed Elements - Cells/Components : 

Formed Elements - Cells/Components Erythrocytes (RBCs) Platelets Leucocytes (WBCs)

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250,000-500,000/mm3 4 - 6 million/mm3

Granulocyte - Neutrophil : 

Granulocyte - Neutrophil Nucleus with 3 to 6 lobes Phagocytize bacteria & some fungi Produced in bone marrow by myeloblasts Cytoplasmic granules fine, both basic & acidic

Granulocyte - Eosinophil : 

Granulocyte - Eosinophil Nucleus bilobed Cytoplasmic granules coarse & acidic (red/orange) Destroy parasitic worms & immune complexes Produced in bone marrow by myeloblasts

Granulocyte - Basophil : 

Granulocyte - Basophil Nucleus lobed - U or S shaped Cytoplasmic granules large & basic -(purplish/black) Cause vasodilation by the release of histamines Produced in bone marrow by myeloblasts

Agranulocyte - Lymphocyte : 

Agranulocyte - Lymphocyte Nucleus spherical-fills half or more of cell B lymphocytes - Humoral Immunity (antibodies) T lymphocytes - Cellular Immunity Produced in lymphatic tissues No visible granules in cytoplasm

Agranulocyte - Monocyte : 

Agranulocyte - Monocyte Nucleus U or kidney shaped -fills half or more of cell Differentiate into macrophages in tissues. Provide defense against viruses & intracellular bacteria in chronic infections. Activate lymphocytes Produced by monoblasts in lymphatic tissues. No visible cytoplasmic granules

Blood Clotting Process : 

Blood Clotting Process Platelets - Form temporary plug & release platelet factors which catalyze clot formation

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Platelet factors - React with Calcium (Ca2+) & other clotting factors in the plasma to initiate clot formation. Thromboplastin - a lipid (Tissue Factor) released from injured cell membranes which accelerates the clotting process. Lipids released from damaged cell membranes such as thromboplastin having a localized effect are called Prostaglandins.

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Platelet factors, Ca2+ & other clotting factors in plasma initiate clot formation A plasma protein (Prothrombin) is converted by prothrombin activator into an enzyme Thrombin.

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Thrombin converts the plasma protein Fibrinogen into the insoluble protein Fibrin.

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Fibrin forms a mesh which glues the platelets & RBCs together to form the clot.

Factors Affecting Clot Formation : 

Factors Affecting Clot Formation Vitamin K - Required by liver to produce prothrombin & several other clotting factors. Calcium - Necessary for prothrombin conversion into thrombin & fibrinogen conversion into fibrin. Thromboplastin - Speeds up clot formation from 3 - 6 minutes to 15 seconds.

Factors Affecting Clot Formation : 

Factors Affecting Clot Formation Heparin - A natural anticoagulant which prevents clot formation by inhibiting thrombin formation. Sodium Citrate - An agent used on glassware & instruments to prevent coagulation by tying up Calcium. Plasmin (Fibrinolysin) - Breaks down clots by dissolving the fibrin after the clot is no longer needed.

ABO & Rh Blood Groups (Types) : 

ABO & Rh Blood Groups (Types) Based on the presence of specific antigens (proteins) on the outer surface of cells. Many other antigens exist on cell membranes besides A, B, AB, O & Rh. Because A, B, AB, O & Rh antigens can cause severe transfusion reactions, blood typing is always done for these prior to transfusions. Other types are of medical or legal interest.

ABO Blood Types : 

ABO Blood Types Type A Type B Type AB Type O Type A Antigen on cells Type B Antigen on cells Type A & B Antigens Neither A nor B Antigens

ABO Antibodies In Plasma : 

ABO Antibodies In Plasma Type A blood Type B blood Type AB blood Type O blood Anti-B Antibodies Anti-A Antibodies No Anti-A or Anti-B Antibodies Both Anti-A & Anti-B Antibodies

Rh (Rhesus) Factor : 

Rh (Rhesus) Factor Up to 8 genes determine if a person is Rh positive. The most common of these are the C, D & E genes which determine if a person has C, D and/or E antigens on the walls of the cells. People who do not have Rh antigens on their cell membranes are Rh negative.

Rh Blood Groups : 

Rh Blood Groups Rh - Rh + No Rh Antigens on cell membranes Type Rh Antigens on cell membranes

Rh Antibodies in Plasma : 

Rh Antibodies in Plasma Rh - Rh + No Anti-Rh antibodies in plasma until sensitized to Rh antigens No Anti-Rh antibodies in plasma

Antibody/Antigen Reactions : 

Antibody/Antigen Reactions When antibodies in plasma react with antigens on cell membranes, they bind to the cells causing the cells to clump. The clumping of cells due to antigen/antibody reactions is called agglutination. Agglutinated cells block the flow of blood disrupting circulation and the distribution of O2, gases and nutrients.

Transfusion Considerations : 

Transfusion Considerations Type A blood Type B blood Type AB blood Type O blood Anti-B Antibodies Anti-A Antibodies No Anti-A or Anti-B Antibodies Both Anti-A & Anti-B Antibodies No A or B antigens Type O - Theoretical Universal Donor

Transfusion Considerations : 

Transfusion Considerations Type A blood Type B blood Type AB blood Type O blood Anti-B Antibodies Anti-A Antibodies No Anti-A or Anti-B Antibodies Both Anti-A & Anti-B Antibodies Type AB - Theoretical Universal Recipient

Inappropriate Physiological Applications : 

Inappropriate Physiological Applications ABO & Rh blood antigens represent only a few of many blood cell antigens. Estimates vary from more than a 100 to millions. Even though ABO & Rh blood typing is done, the possibility exists that persons receiving more than one transfusion could have a reaction to less common or currently unknown blood types. Cross matching may avoid reactions.

Erythroblastosis Fetalis : 

Erythroblastosis Fetalis No problem with first pregnancy. Maternal & fetal blood don’t mix. During delivery if mother becomes sensitized to Rh + blood, she will begin to produce anti-Rh antibodies. This may also occur due to placental abnormalities, prior tubal pregnancies, miscarriage, abortions or amniocentesis in which Rh + fetal blood may sensitize the Rh - mother. RH - Rh +

Erythroblastosis Fetalis : 

Erythroblastosis Fetalis In subsequent pregnancies with an Rh + fetus, mother’s anti-Rh antibodies will cross the placenta causing fetal blood cells to agglutinate & be destroyed. Effects on fetus may range from jaundice, to brain damage (anoxia), to possible death. RhoGAM shots at 28 weeks and after delivery may prevent sensitization. RhoGam offers no protection after a woman is sensititized.

Anemia - reduced O2 carrying capacity of the blood : 

Anemia - reduced O2 carrying capacity of the blood Insufficient number of RBCs: Hemorrhagic - due to blood loss associated with an injury, undiagnosed bleeding ulcer, etc. Hemolytic - due to blood loss due to transfusion reactions & certain bacterial and parasite infections. Aplastic - due to destruction or inhibition of red marrow by drugs, ionizing radiation or certain bacterial toxins.

Anemia - reduced O2 carrying capacity of the blood : 

Anemia - reduced O2 carrying capacity of the blood Insufficient hemoglobin content in RBCs: Iron Deficiency - inadequate intake or absorption of iron. Pernicious - dietary deficiency of Vitamin B12 or inadequate production of intrinsic factor for absorption of Vitamin B12.

Anemia - reduced O2 carrying capacity of the blood : 

Anemia - reduced O2 carrying capacity of the blood Abnormal hemoglobin in RBCs: Sickle Cell - one amino acid in the 287 forming the beta chains is wrong. In low O2 conditions the beta chains form stiff rods which cause RBCs to sickle blocking small vessels.

Other Blood Related Disturbances : 

Other Blood Related Disturbances Polycythemia - abnormally high number of RBCs (8 - 11 million/mm3). Increases blood viscosity & blood pressure. Cause - most often the result of bone marrow cancer. Lecuopenia - abnormally low number of WBCs (less than 5,000/mm3). Cause - drugs, steroids & anti-cancer agents.

Other Blood Related Disturbances : 

Other Blood Related Disturbances Leukemia - abnormally high numbers of immature WBCs that are mitotic & unspecialized. Named according to abnormal WBC type involved Myelocytic - derived from myeloblasts (chronic) Lymphocytic - involves lymphocytes (acute)

Other Blood Related Disturbances : 

Other Blood Related Disturbances Thrombus - a clot that forms & is stationary in an unbroken blood vessel. If sufficiently large, it may block the flow of blood downstream causing death of those tissues. Embolus - an abnormal object moving through a blood vessel, ie. Clot, air bubble, lipid droplet, etc. Embolism - a blockage of blood vessels caused by an embolus. May cause a stroke or heart attack depending on tissues affected.

Intrinsic Cardiac Conduction System : 

Intrinsic Cardiac Conduction System Approximately 1% of cardiac muscle cells are autorhythmic rather than contractile 75/min 40-60/min 30/min

Intrinsic Conduction System : 

Intrinsic Conduction System Function: initiate & distribute impulses so heart depolarizes & contracts in orderly manner from atria to ventricles. SA node AV node Bundle of His Bundle Branches

ECG Deflection Waves : 

ECG Deflection Waves (Pacemaker) Atrial repolarization

ECG Deflection Waves : 

ECG Deflection Waves 1st Degree Heart Block = P-Q interval longer than 0.2 seconds. 60 seconds ÷ 0.8 seconds = resting heart rate of 75 beats/minute

ECG Deflection Wave Irregularities : 

ECG Deflection Wave Irregularities Enlarged QRS = Hypertrophy of ventricles

ECG Deflection Wave Irregularities : 

ECG Deflection Wave Irregularities Prolonged QT Interval = Repolarization abnormalities increase chances of ventricular arrhythmias.

ECG Deflection Wave Irregularities : 

ECG Deflection Wave Irregularities Elevated T wave : Hyperkalemia

ECG Deflection Wave Irregularities : 

ECG Deflection Wave Irregularities Flat T wave : Hypokalemia or ischemia

Heart Blocks : 

Heart Blocks Normal ECG 3rd Degree Block No P waves. Rate determined by autorhythmic cells in ventricles 2nd Degree Block Not a QRS for each P wave P QRS T

Cardiac Cycle : 

Cardiac Cycle All events associated with a single heart beat including atrial systole & diastole followed by ventricular systole & diastole. (V. Systole) (V. Diastole) Systolic BP Diastolic BP

ECG Deflection Waves : 

ECG Deflection Waves 60 seconds ÷ 0.8 seconds = resting heart rate of 75 beats/minute

Frank Starling Law of the Heart : 

Frank Starling Law of the Heart The more cardiac muscle is stretched within physiological limits, the more forcibly it will contract. Rubber band analogy Increasing volumes of blood in ventricles increase the stretch & thus the force generated by ventricular wall contraction. Greater stretch means more blood volume is pumped out, up to physical limits.

Frank Starling Law of the Heart : 

Frank Starling Law of the Heart Increased blood volume = increased stretch of myocardium = Increased force to pump blood out.

Terms, Definitions & Units : 

Terms, Definitions & Units Blood Pressure - force generated against arterial walls per unit of area in mm Hg. Systolic Pressure - peak arterial pressure. Averages about 120 mm Hg in healthy adults. Diastolic Pressure - lowest arterial pressure. Averages between 70 - 80 mm Hg in healthy adults. Blood Volume - quantity of blood in cardiovascular system. Varies from 4-5 L. in females to 5-6 L. in males.

Terms, Definitions & Units : 

Terms, Definitions & Units Cardiac Output - the amount of blood pumped by a ventricle per minute. Units may be in milliliters or Liters per minute. Heart Rate - number of cardiac cycles per minute. Average for males = 64-72/min. Average for females = 72-80/min. Stroke Volume - amount of blood pumped out of a ventricle each beat. Average resting stroke volume = 70 ml.

Factors influencing blood pressure : 

Blood volume increases due to increased water retention from increased ADH production, IVs or transfusions = BP Blood volume loss due to injuries, hemorrhages, use of diuretics, etc. = BP Blood Pressure = Blood Volume × Peripheral Resistance Factors influencing blood pressure

Factors influencing blood pressure : 

Cardiac Output = circulating blood volume Blood Pressure = Blood Volume × Peripheral Resistance Factors influencing blood pressure Cardiac Output = Heart Rate × Stroke Volume Increased heart rate caused by the release of epinephrine into blood by the adrenal glands = increased cardiac output, which increases circulating blood volume, to increase blood pressure.

Factors influencing blood pressure : 

Vasodilation = diameter = resistance = BP Peripheral Resistance affected by: blood viscosity (thickness) diameter of vessels (vasoconstriction/vasodilation) Blood Pressure = Blood Volume × Peripheral Resistance Factors influencing blood pressure Vasoconstriction = diameter = resistance = BP Elastic Arterial Walls = BP (Polycythemia) elasticity of arterial walls

Homeostatic Blood Pressure Regulation Mechanisms : 

BP - Stimulates Cardioinhibitory center to heart rate & Vasomotor center to diameter. Homeostatic Blood Pressure Regulation Mechanisms Medullary Reflex Centers: Cardioacceleratory - increases heart rate Cardioinhibitory - decreases heart rate Vasomotor - changes diameter of vessels BP - Stimulates Cardioacceleratory center to heart rate & Vasomotor center to diameter. Baroreceptors in aortic arch & carotid sinuses: sensitive to changes in blood pressure.

Homeostatic Blood Pressure Regulation Mechanisms : 

in CO2 or in O2 stimulates Vasomotor center to diameter (vasoconstrict) of vessels to BP. Homeostatic Blood Pressure Regulation Mechanisms Medullary Reflex Centers: Cardioacceleratory - increases heart rate Cardioinhibitory - decreases heart rate Vasomotor - changes diameter of vessels in CO2 stimulates Vasomotor center to diameter (vasodilate) of vessels to BP. Chemoreceptors in aortic bodies & carotid bodies: sensitive to changes in CO2 & O2 in blood.

Aneurysm : 

Aneurysm Weakness of the wall of an artery causing an abnormal enlargment or bulge. The aorta or the arteries that supply the heart, brain, legs or kindeys are most commonly affected.

Angina Pectoris : 

Angina Pectoris Medical term for chest pain due to coronary heart disease. It occurs when the myocardium doesn’t get as much blood (Oxygen) as it needs. Insufficient blood supply is called ischemia. May initially occur during physical exercise, stress, or extreme temperatures. It is a sign of increased risk of heart attack.

Hypertension : 

Hypertension High blood pressure. Sustained arterial blood pressure of 140/90 mm Hg or above. Rising diastolic pressure generally indicative of progressive hardening of arteries. Since the heart must work harder to pump blood against higher pressures, there is increased risk of a cardiovascular accident.

Hypotension : 

Hypotension Abnormally low blood pressure. Sustained systolic blood pressure of below 100 mm Hg. Generally associated with lower risk of cardiovascular accidents & long life providing that the tissues are adequately perfused..

Circulatory Shock : 

Circulatory Shock Blood vessels inadequately filled to enable normal circulation & supply of O2 & nutrients. May result in death of cells & damage to organs. Common Types: Hypovolemic - severe blood loss Cardiogenic - heart (pump) failure Vascular - excessive vasodilation Septicemic - vasodilation due to bacterial toxins produced during an infection.

Atherosclerosis (Arteriosclerosis) : 

Atherosclerosis (Arteriosclerosis) Narrowing and hardening of arteries and impairment of blood flow due to the deposition of fatty materials and calcium in their walls. Risk factors include: smoking inactivity diabetes high blood cholesterol personal or family history of heart disease

Arteriosclerosis (Atherosclerosis): : 

Arteriosclerosis (Atherosclerosis):

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AcknowledgementsMost of the figures used in this presentation came from the Benjamin Cummings Digital Library Version 2.0 for Human Anatomy & Physiology, Fifth Edition. Thanks to pathology blogs for images

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