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CV PHYSIOLOGY
Welcome to Cardiovascular Physiology Concepts. This site is a web-based resource of cardiovascular physiology concepts that has been written for students, teachers, and health professionals. The materials contained in this web site focus on physiological concepts that serve as the basis of cardiovascular disease.CV PHYSIOLOGY
CV PHYSIOLOGY
The higher frequency of SA nodal firing suppresses other pacemaker sites by a mechanism called overdrive suppression.If a latent pacemaker is being depolarized at a higher frequency than its intrinsic rate of automaticity by an adjacent cell that is driven by the primary pacemaker, then the increased frequency of depolarizations leads to an increase in intracellular sodium ions because moreCV PHYSIOLOGY
Cellular electrophysiological changes. When coronary blood flow is inadequate to support the oxygen needs of the myocardium (i.e., an ischemic state), tissue levels of oxygen fall, which leads to cellular hypoxia. Severe and prolonged hypoxia can ultimately lead toCV PHYSIOLOGY
The three augmented leads are depicted as shown to the figure using the axial reference system. The aV L lead is at -30° relative to the lead I axis; aV R is at -150° and aV F is at +90°. It is very important to learn which lead is associated with each axis. For a heart with a normal ECG and mean electrical axis of +60°, theaugmented leads
CV PHYSIOLOGY
The above tables show that the heart has a wide range of MVO 2 values that depends on the state of mechanical activity. Skeletal muscle, like the heart, has a wide range of values for oxygen consumption depending on its level of mechanical activity.CV PHYSIOLOGY
Venous pressure is a term that represents the average blood pressure within the venous compartment. The term "central venous pressure" (CVP) describes the pressure in the thoracic vena cava near the right atrium (therefore CVP and right atrial pressure are essentially the same).CVP is an important concept in clinical cardiology because it is a major determinant of the filling pressure andCV PHYSIOLOGY
Sodium-Calcium Exchange in Cardiac Cells. Intracellular calcium concentrations in both cardiac and vascular smooth muscle cells range from 10 -7 to 10 -5 M. Extracellular concentration of calcium is about 2 × 10 -3 M (2 mM). Therefore, there is a chemical gradient for calcium to diffuse into the cell.CV PHYSIOLOGY
As described elsewhere, cardiac output increases or decreases in response to changes in heart rate or stroke volume. When a person stands up, for example, cardiac output falls because a fall in central venous pressure leads to a decrease in stroke volume. As another example, limb movement (muscle pump) during exercise enhances venous return to the heart, which causes an increase in stroke volume.CV PHYSIOLOGY
Hemorrhagic shock is a clinical syndrome resulting from decreased blood volume (hypovolemia) caused by blood loss, which leads to reduced cardiac output and organ perfusion. Blood loss can be external (e.g., externally bleeding wound) or internal (e.g., internal bleeding caused by ruptured aortic aneurism). The severity of hemorrhagic shockand
CV PHYSIOLOGY
Welcome to Cardiovascular Physiology Concepts. This site is a web-based resource of cardiovascular physiology concepts that has been written for students, teachers, and health professionals. The materials contained in this web site focus on physiological concepts that serve as the basis of cardiovascular disease.CV PHYSIOLOGY
CV PHYSIOLOGY
The higher frequency of SA nodal firing suppresses other pacemaker sites by a mechanism called overdrive suppression.If a latent pacemaker is being depolarized at a higher frequency than its intrinsic rate of automaticity by an adjacent cell that is driven by the primary pacemaker, then the increased frequency of depolarizations leads to an increase in intracellular sodium ions because moreCV PHYSIOLOGY
Cellular electrophysiological changes. When coronary blood flow is inadequate to support the oxygen needs of the myocardium (i.e., an ischemic state), tissue levels of oxygen fall, which leads to cellular hypoxia. Severe and prolonged hypoxia can ultimately lead toCV PHYSIOLOGY
The three augmented leads are depicted as shown to the figure using the axial reference system. The aV L lead is at -30° relative to the lead I axis; aV R is at -150° and aV F is at +90°. It is very important to learn which lead is associated with each axis. For a heart with a normal ECG and mean electrical axis of +60°, theaugmented leads
CV PHYSIOLOGY
The above tables show that the heart has a wide range of MVO 2 values that depends on the state of mechanical activity. Skeletal muscle, like the heart, has a wide range of values for oxygen consumption depending on its level of mechanical activity.CV PHYSIOLOGY
Venous pressure is a term that represents the average blood pressure within the venous compartment. The term "central venous pressure" (CVP) describes the pressure in the thoracic vena cava near the right atrium (therefore CVP and right atrial pressure are essentially the same).CVP is an important concept in clinical cardiology because it is a major determinant of the filling pressure andCV PHYSIOLOGY
Sodium-Calcium Exchange in Cardiac Cells. Intracellular calcium concentrations in both cardiac and vascular smooth muscle cells range from 10 -7 to 10 -5 M. Extracellular concentration of calcium is about 2 × 10 -3 M (2 mM). Therefore, there is a chemical gradient for calcium to diffuse into the cell.CV PHYSIOLOGY
As described elsewhere, cardiac output increases or decreases in response to changes in heart rate or stroke volume. When a person stands up, for example, cardiac output falls because a fall in central venous pressure leads to a decrease in stroke volume. As another example, limb movement (muscle pump) during exercise enhances venous return to the heart, which causes an increase in stroke volume.CV PHYSIOLOGY
Hemorrhagic shock is a clinical syndrome resulting from decreased blood volume (hypovolemia) caused by blood loss, which leads to reduced cardiac output and organ perfusion. Blood loss can be external (e.g., externally bleeding wound) or internal (e.g., internal bleeding caused by ruptured aortic aneurism). The severity of hemorrhagic shockand
CV PHYSIOLOGY
Published by Wolters Kluwer, 2021ISBN-13: 9781975150075. The third edition of this popular textbook, authored by Dr. Klabunde, stresses the fundamental concepts of cardiovascular physiology. It was written to enable students to learn how the cardiovascular system functions to build a foundation for understanding cardiovascular disease, itsCV PHYSIOLOGY
What is the function of coronary arteries? The coronary arteries supply blood flow to the heart, and when functioning normally, they ensure adequate oxygenation of the myocardium at all levels of cardiac activity. Constriction and dilation of the coronary arteries, governed primarily by local regulatory mechanisms,regulate the amount of blood flow to the myocardium in a manner that matches theCV PHYSIOLOGY
Venous pressure is a term that represents the average blood pressure within the venous compartment. The term "central venous pressure" (CVP) describes the pressure in the thoracic vena cava near the right atrium (therefore CVP and right atrial pressure are essentially the same).CVP is an important concept in clinical cardiology because it is a major determinant of the filling pressure andCV PHYSIOLOGY
Patients may describe an arrhythmia as a palpitation or fluttering sensation in the chest. For some types of arrhythmias, a skipped beat might be sensed because the subsequent beat produces a more forceful contraction and a thumping sensation in the chest. A "racing" heart is another description. Proper diagnosis of arrhythmias requires anCV PHYSIOLOGY
The following summarizes important features of coronary blood flow: Flow is tightly coupled to oxygen demand. This is necessary because the heart has a very high basal oxygen consumption (8-10 ml O 2 /min/100g) and the highest A-VO 2 difference of a major organ (10-13 ml/100 ml). In non-diseased coronary vessels, whenever cardiac activity and oxygen consumption increases there is an increaseCV PHYSIOLOGY
General Terms: Normal sinus rhythm - heart rhythm controlled by sinus node at a rate of 60-100 beats/min; each P wave followed by QRS and each QRS preceded by a P wave. Bradycardia - a heart rate that is lower than normal. Tachycardia - a heart rate that is higher than normal. Paroxysmal - an arrhythmia that suddenly begins and ends.CV PHYSIOLOGY
The recorded tracing is called an electrocardiogram (ECG, or EKG). A "typical" ECG tracing is shown to the right. The different waves that comprise the ECG represent the sequence of depolarization and repolarization of the atria and ventricles. The ECG is recorded at a speed of 25 mm/sec (5 large squares/sec), and the voltages arecalibrated so
CV PHYSIOLOGY
Diminishing pressure within the vessel causes relaxation and vasodilation. This response is observed in vivo and in isolated, pressurized blood vessels. The myogenic mechanism may play a role in autoregulation of blood flow and in reactive hyperemia. Myogenic behavior has not been clearly identified in all vascular beds, but ithas been noted
CV PHYSIOLOGY
Venous Return - Hemodynamics. Venous return (VR) is the flow of blood back to the heart. Under steady-state conditions, venous return must equal cardiac output (CO) when averaged over time because the cardiovascular system is essentially a closed loop (see figure). Otherwise, blood would accumulate in either the systemic or pulmonarycirculations.
CV PHYSIOLOGY
Nitric Oxide. Nitric oxide (NO) is produced by many cells in the body; however, its production by vascular endothelium is particularly important in the regulation of blood flow. Because of its importance in vascular function, abnormal production of NO, as occurs in different disease states or following vascular injury, can adverselyaffect
CV PHYSIOLOGY
Welcome to Cardiovascular Physiology Concepts. This site is a web-based resource of cardiovascular physiology concepts that has been written for students, teachers, and health professionals. The materials contained in this web site focus on physiological concepts that serve as the basis of cardiovascular disease.CV PHYSIOLOGY
Published by Wolters Kluwer, 2021ISBN-13: 9781975150075. The third edition of this popular textbook, authored by Dr. Klabunde, stresses the fundamental concepts of cardiovascular physiology. It was written to enable students to learn how the cardiovascular system functions to build a foundation for understanding cardiovascular disease, itsCV PHYSIOLOGY
The higher frequency of SA nodal firing suppresses other pacemaker sites by a mechanism called overdrive suppression.If a latent pacemaker is being depolarized at a higher frequency than its intrinsic rate of automaticity by an adjacent cell that is driven by the primary pacemaker, then the increased frequency of depolarizations leads to an increase in intracellular sodium ions because moreCV PHYSIOLOGY
What is the function of coronary arteries? The coronary arteries supply blood flow to the heart, and when functioning normally, they ensure adequate oxygenation of the myocardium at all levels of cardiac activity. Constriction and dilation of the coronary arteries, governed primarily by local regulatory mechanisms,regulate the amount of blood flow to the myocardium in a manner that matches theCV PHYSIOLOGY
CV PHYSIOLOGY
Patients may describe an arrhythmia as a palpitation or fluttering sensation in the chest. For some types of arrhythmias, a skipped beat might be sensed because the subsequent beat produces a more forceful contraction and a thumping sensation in the chest. A "racing" heart is another description. Proper diagnosis of arrhythmias requires anCV PHYSIOLOGY
The following summarizes important features of coronary blood flow: Flow is tightly coupled to oxygen demand. This is necessary because the heart has a very high basal oxygen consumption (8-10 ml O 2 /min/100g) and the highest A-VO 2 difference of a major organ (10-13 ml/100 ml). In non-diseased coronary vessels, whenever cardiac activity and oxygen consumption increases there is an increaseCV PHYSIOLOGY
The three augmented leads are depicted as shown to the figure using the axial reference system. The aV L lead is at -30° relative to the lead I axis; aV R is at -150° and aV F is at +90°. It is very important to learn which lead is associated with each axis. For a heart with a normal ECG and mean electrical axis of +60°, theaugmented leads
CV PHYSIOLOGY
Cardiac Electrophysiology Tutorial. This tutorial provides a systematic approach to learning by using a sequence that is similar to how this topic would unfold in a traditional textbook. The student is encouraged to go not only to the initial link associated with each tutorial question, but also to use embedded hyperlinks to expand uponthe
CV PHYSIOLOGY
The following describes changes that occur in the left ventricular pressure-volume (PV) loop when there is aortic stenosis.In aortic stenosis (red loop in figure), left ventricular emptying is impaired because of high outflow resistance caused by a reduction in the valve orifice area when it opens.CV PHYSIOLOGY
Welcome to Cardiovascular Physiology Concepts. This site is a web-based resource of cardiovascular physiology concepts that has been written for students, teachers, and health professionals. The materials contained in this web site focus on physiological concepts that serve as the basis of cardiovascular disease.CV PHYSIOLOGY
Published by Wolters Kluwer, 2021ISBN-13: 9781975150075. The third edition of this popular textbook, authored by Dr. Klabunde, stresses the fundamental concepts of cardiovascular physiology. It was written to enable students to learn how the cardiovascular system functions to build a foundation for understanding cardiovascular disease, itsCV PHYSIOLOGY
The higher frequency of SA nodal firing suppresses other pacemaker sites by a mechanism called overdrive suppression.If a latent pacemaker is being depolarized at a higher frequency than its intrinsic rate of automaticity by an adjacent cell that is driven by the primary pacemaker, then the increased frequency of depolarizations leads to an increase in intracellular sodium ions because moreCV PHYSIOLOGY
What is the function of coronary arteries? The coronary arteries supply blood flow to the heart, and when functioning normally, they ensure adequate oxygenation of the myocardium at all levels of cardiac activity. Constriction and dilation of the coronary arteries, governed primarily by local regulatory mechanisms,regulate the amount of blood flow to the myocardium in a manner that matches theCV PHYSIOLOGY
CV PHYSIOLOGY
Patients may describe an arrhythmia as a palpitation or fluttering sensation in the chest. For some types of arrhythmias, a skipped beat might be sensed because the subsequent beat produces a more forceful contraction and a thumping sensation in the chest. A "racing" heart is another description. Proper diagnosis of arrhythmias requires anCV PHYSIOLOGY
The following summarizes important features of coronary blood flow: Flow is tightly coupled to oxygen demand. This is necessary because the heart has a very high basal oxygen consumption (8-10 ml O 2 /min/100g) and the highest A-VO 2 difference of a major organ (10-13 ml/100 ml). In non-diseased coronary vessels, whenever cardiac activity and oxygen consumption increases there is an increaseCV PHYSIOLOGY
The three augmented leads are depicted as shown to the figure using the axial reference system. The aV L lead is at -30° relative to the lead I axis; aV R is at -150° and aV F is at +90°. It is very important to learn which lead is associated with each axis. For a heart with a normal ECG and mean electrical axis of +60°, theaugmented leads
CV PHYSIOLOGY
Cardiac Electrophysiology Tutorial. This tutorial provides a systematic approach to learning by using a sequence that is similar to how this topic would unfold in a traditional textbook. The student is encouraged to go not only to the initial link associated with each tutorial question, but also to use embedded hyperlinks to expand uponthe
CV PHYSIOLOGY
The following describes changes that occur in the left ventricular pressure-volume (PV) loop when there is aortic stenosis.In aortic stenosis (red loop in figure), left ventricular emptying is impaired because of high outflow resistance caused by a reduction in the valve orifice area when it opens.CV PHYSIOLOGY
The following summarizes important features of coronary blood flow: Flow is tightly coupled to oxygen demand. This is necessary because the heart has a very high basal oxygen consumption (8-10 ml O 2 /min/100g) and the highest A-VO 2 difference of a major organ (10-13 ml/100 ml). In non-diseased coronary vessels, whenever cardiac activity and oxygen consumption increases there is an increaseCV PHYSIOLOGY
Venous pressure is a term that represents the average blood pressure within the venous compartment. The term "central venous pressure" (CVP) describes the pressure in the thoracic vena cava near the right atrium (therefore CVP and right atrial pressure are essentially the same).CVP is an important concept in clinical cardiology because it is a major determinant of the filling pressure andCV PHYSIOLOGY
Cellular electrophysiological changes. When coronary blood flow is inadequate to support the oxygen needs of the myocardium (i.e., an ischemic state), tissue levels of oxygen fall, which leads to cellular hypoxia. Severe and prolonged hypoxia can ultimately lead toCV PHYSIOLOGY
Kinetic energy and pressure energy can be interconverted so that total energy remains unchanged. This is the basis of Bernoulli's Principle. This principle can be illustrated by a blood vessel that is suddenly narrowed then returned to its normal diameter. In the narrowed region (stenosis), the velocity increases as the diameter decreases.CV PHYSIOLOGY
Angina is chest pain caused by an imbalance between oxygen supply (decreased coronary blood flow) and oxygen demand (increased myocardial oxygen consumption), which leads to a decrease in the oxygen supply/demand ratio and myocardial hypoxia.The decreased flow can result from coronary artery vasospasm, fixed stenotic lesions (chronic vessel narrowing), or from a blood clot (thrombus) thatCV PHYSIOLOGY
Abnormal Impulses. The normal pacemaker site for the heart is located within the SA node.Cells within this pacemaker region have an intrinsic firing rate that is modulated primarily by changes in autonomic nerve activity.If there is a high level of vagal tone on the SA node, then this will cause sinus bradycardia (an sinus rateDetails
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