Overall plan and functions of the cardiovascular

system (CVS). Functional anatomy of the heart:

Recapitulation of cardiac muscle properties;
Med & Surg 200, Nursing 200, Med Lab 200,
Opt 300.
 INTRODUCTION
• Cardiovascular system is the system of heart and blood vessels that circulate
blood throughout the body. It constitutes one of the coordinating and integrating
systems of the body.
• It consists of the heart, blood and blood vessels (arteries, veins, and capillaries).
The arteries carry blood (oxygenated) from the heart to the rest of the body, and
the veins carry deoxygenated blood back to the heart with the exception of the
pulmonary vessels.
• The heart works continuously without a break throughout the life span of an
individual. Cessation of 3-5mins is called cardiac arrest and leads to sudden death
without resuscitation. The heart beats an average of 70beats/minute.
The heart works as a pump that pushes blood to the organs,
tissues, and cells of the body. Blood performs the following
functions:
Delivery of oxygen and nutrients to the tissues.
Transport of waste products of metabolism to the excretory
organs.
 Circulation of electrolytes and hormones.
Body temperature regulation- thermoregulation.
Transport of immune substances for body defense
mechanisms.
 THE HEART
• The heart is located between the lungs in the middle of the
chest, behind and slightly to the left of the sternum (breast
bone).

• The heart weighs between 200 and 425g, a little larger than the
fist.

• The heart beats about 72 times in a minute pumping about

5liters of blood and 100,000 times a day, pumping about 7,571
liters( 2 gallons) of blood.
 Functional anatomy of the Heart
• The heart is a muscular organ that pumps blood throughout the
circulatory system. It is situated between the 2 lungs in the
mediastinum.
• The heart itself is made up of 4 chambers, 2 atria and 2 ventricles. The
musculature is thicker in the ventricles, than the atria. The wall of the
L ventricle is 3 times thicker than the R ventricle.
• The heart is made up of 3 layers: outer pericardium, middle
myocardium and Inner endocardium.
• The pericardium is made of 2 layers; outer parietal pericardium and
inner visceral pericardium.
• The 2 layers are separated by a space called the pericardial cavity
which is just a potential space.
 SEPTA OF THE HEART
• Atria are separated from one another by a
fibrous septum called interatrial septum.

• The ventricles are separated by the

interventricular septum which is muscular.
 Valves of the heart
There are 4 heart valves
• The two atrioventricular (AV) valves, the
mitral valve (bicuspid valve), and the tricuspid valve, which are
between the upper chambers (atria) and the lower chambers
(ventricles). They control blood flow from the atria to the
ventricles.

• The two semilunar (SL)valves namely the aortic valve and the
pulmonary valve, which are in the arteries leaving the heart.
These control blood flow out of the ventricles.
 Vessels of the Cardiovascular system
• Aorta
• Arteries
• Arterioles
• Capillaries
• Venules
• Veins
• Venae Cavae
S/N CHARACTERISTICS ARTERIES VEINS
1 Arteries carry blood Veins carry blood
away from the heart from the tissues of
Blood Circulation
to the tissues of the the body back to the
body. heart.
2 Arteries carry Veins carry
oxygenated blood deoxygenated blood
Blood Type
expect pulmonary except pulmonary
artery. vein.
3 Arteries have thick Veins have thin non
Thickness elastic muscular elastic less muscular
walls. walls.
4 Veins are usually
Arteries are usually
positioned closer
Position positioned deeper
beneath the surface
within the body.
of the skin.
5 Valves Valves are absent. Valves are present.
6 These possess These possess wide
Lumen
narrow lumen. lumen
7 Blood flows under Blood flows under
Pressure
high pressure. low pressure.
8 These are reddish in These are bluish in
Color
color. color.
9 Superficial veins,
Pulmonary and deep veins,
Types
systemic arteries. pulmonary veins and
systemic veins.
10 Internal Diameter Narrower (4mm) Wider (5mm)
11 Volume Low (15%) High (65%)
12 These show spurty
These show sluggish
Movement movement of blood
movement of blood.
giving pulse.
13 Pulse is detectable in Pulse not detectable
Pulse
the arteries. in the veins.
14 Arterial walls are Veins have
Walls
more rigid. collapsible walls.
•The cardiovascular system is composed of two
circulatory paths: pulmonary circulation, the circuit
through the lungs where blood is oxygenated; and
systemic circulation, the circuit through the rest of
the body to provide oxygenated blood. The two
circuits are linked to each other through the heart,
creating a continuous cycle of blood through the
body.
 PULMONARY CIRCULATION
• Pulmonary circulation is the movement of blood from the heart to
the lungs for oxygenation, then back to the heart again. Oxygen-
depleted blood from the body leaves the systemic circulation when it
enters the right atrium through the superior and inferior venae cavae.
The blood is then pumped through the tricuspid valve into the right
ventricle. From the right ventricle, blood is pumped through the
pulmonary valve and into the pulmonary artery. The pulmonary
artery splits into the right and left pulmonary arteries and travel to
each lung.
• At the lungs, the blood travels through capillary beds on the alveoli
where gas exchange occurs, removing carbon dioxide and adding
oxygen to the blood. The oxygenated blood then leaves the lungs
through pulmonary veins, which returns it to the left atrium,
completing the pulmonary circuit. As the pulmonary circuit ends, the
systemic circuit begins.
 SYSTEMIC CIRCULATION
• Systemic circulation is the movement of blood from the
heart through the body to provide oxygen and nutrients
to the tissues of the body while bringing deoxygenated
blood back to the heart. Oxygenated blood enters the
left atrium from the pulmonary veins. The blood is then
pumped through the mitral valve into the left ventricle.
From the left ventricle, blood is pumped through the
aortic valve and into the aorta, the body’s largest artery
to other parts of the body.
• The arteries branch into smaller arteries, arterioles, and finally
capillaries. Gas and nutrient exchange with the tissues occurs within
the capillaries that run through the tissues. Metabolic waste and
carbon dioxide diffuse out of the cell into the blood, while oxygen and
glucose in the blood diffuses out of the blood and into the cell.
Systemic circulation keeps the metabolism of every organ and every
tissue in the body alive, with the exception of the parenchyma of the
lungs, which are supplied by pulmonary circulation.

• The deoxygenated blood continues through the capillaries which

merge into venules, then veins, and finally the venae cavae, which
drain into the right atrium of the heart. From the right atrium, the
blood will travel through the pulmonary circulation to be oxygenated
before returning again to the system circulation, completing the cycle
of circulation through the body.
 CARDIAC MUSCLE
• Cardiac muscle (heart muscle) is an involuntary, striated
muscle that is found in the walls and histological foundation of
the heart, specifically the myocardium. Cardiac muscle is one of
three major types of muscle, the others
being skeletal and smooth muscle. The cells that constitute
cardiac muscle, called cardiomyocytes or myocardiocytes.

• The myocardium is the muscle tissue of the heart, and forms a

thick middle layer between the outer epicardium layer and the
inner endocardium layer.
• Coordinated contractions of cardiac muscle cells in the
heart pump blood out of the atria and ventricles to the
blood vessels.
• Although it is striated, cardiac muscle differs from skeletal
muscle in that it is highly branched with cells connected by
overlapping projections of the sarcolemma called
intercalated discs. These discs contain desmosomes and
gap junctions
• These cross striations are formed by rotating segments
of thick and thin protein filaments. Like skeletal muscle,
the primary structural proteins of cardiac muscle are
myosin and actin
 Cardiac Muscles are made up of
Intercalated discs
• Intercalated discs are small connections that join cardiac muscle cells (cardiomyocytes)
to each other.
Gap junctions
• Gap junctions are part of the intercalated discs. When one cardiac muscle cell is
stimulated to contract, a gap junction transfers the stimulation to the next cardiac cell.
This allows the muscle to contract in a coordinated way.
Desmosomes
• Like gap junctions, desmosomes are also found within intercalated discs. They help hold
the cardiac muscle fibers together during a contraction.
Nucleus
• The nucleus is the “control center” of a cell. It contains all of the cell’s genetic material.
While skeletal muscle cells can have multiple nuclei, cardiac muscle cells typically only
have one nucleus.
 ELECTROPHYSIOLOGIC PROPERTIES OF THE HEART/
CARDIAC MUSCLE
1. Automaticity – the ability to spontaneously generate and discharge an
electrical impulse.
2. Rhythmicity; the ability to send electrical impulses in a regularly, evenly
manner.
3. Excitability – the ability of the cell to respond to an electrical impulse.
4. Conductivity – the ability to transmit an electrical impulse from one cell to the
next.
5. Contractility – the ability of the cell to shorten and lengthen its fibers.
6. Refractoriness; Cells inability to respond to another electrical impulse.
 AUTOMATICITY/RHYTHMICITY
• Ability of a tissue to produce its own impulses regularly- also called
autorhythmicity or self excitation.
• This property is present in all tissues of the heart. However, the heart
has specialized excitatory structure from which discharge of impulses is
rapid. This specialized structures are called pacemakers.
Pacemaker; defined as part of the heart from which impulses for
heartbeat are produced normally.
In mammalian heart , the pacemaker is the Sinoatrial (SA)node named
by Lewis Sir Thomas in 1918.
 Location of the SA node
• SA node, is a small strip of modified cardiac muscle situated in
the superior part of the R atrium just below the opening of the
SVC.
Rhythmicity of other parts
• SA node 70-80/minute
• AV node 40-60/minute
• Atrial muscle 40-60/min
• Ventricular muscle 20-40/min
• Purkinje fibers 35-40/min
 CONDUCTIVITY
• It is the ability of cardiac muscle to spread excitatory impulses in the
heart tissue through a specialized conductive system in the cardiac
muscle namely SA node, AV node, Bundle of His, Right & Left bundle
branches and the Purkinje fibres.
Conductive pathway of the heart
• Sinoatrial (SA) node normally generates the action potential, i.e. the electrical
impulse that initiates contraction.
• The SA node excites the right atrium (RA), travels through Bachmann’s
bundle to excite left atrium (LA).
• The impulse travels through internodal pathways in RA to the atrioventricular
(AV) node.
• From the AV node, the impulse then travels through the bundle of His and down
the bundle branches, fibers specialized for rapid transmission of electrical
impulses, on either side of the interventricular septum.
• Right bundle branch (RBB) depolarizes the right ventricle (RV).
• Left bundle branch (LBB) depolarizes the left ventricle (LV) and
interventricular septum.
• Both bundle branches terminate in Purkinje fibers, millions of small fibers
projecting throughout the myocardium.
Velocity of Impulse at Different Parts of the
Conductive System
• Atrial muscle 0.3meter/second
• AV node 0.05m/s
• Bundle of His 0.12m/s
• Purkinje fibers 4m/s
• Ventricular muscle 0.5m/s
 EXCITABILITY
• In all tissues, the initial response to a stimulus is the
development of action potential. It is followed by the
physiologic action, in this case contraction, secretion etc.
 Cardiac Membrane potential
• The transmembrane potential (TMP) is the electrical potential
difference (voltage) between the inside and the outside of a
cell. When there is a net movement of +ve ions into a cell, the
TMP becomes more +ve, and when there is a net movement of
+ve ions out of a cell, TMP becomes more –ve.
• Ion channels help maintain ionic concentration gradients and
charge differentials between the inside and outside of the
cardiomyocytes.
 Properties of cardiac ion channels
• Selectivity: they are only permeable to a single type of ion based on their
physical configuration.
• Voltage-sensitive gating: a specific TMP range is required for a particular channel
to be in open configuration; at all TMPs outside this range, the channel will be
closed and impermeable to ions. Therefore, specific channels open and close as
the TMP changes during cell depolarization and repolarization, allowing the
passage of different ions at different times.
• Time-dependence: some ion channels (importantly, fast Na+ channels) are
configured to close a fraction of a second after opening; they cannot be opened
again until the TMP is back to resting levels, thereby preventing further excessive
influx.
Action potential: electrical stimulation created by a sequence of
ion fluxes through specialized channels in the membrane
(sarcolemma) of cardiomyocytes that leads to cardiac
contraction.
Action potential in cardiomyocytes
• The action potential in typical cardiomyocytes is composed of 5
phases (0-4), beginning and ending with phase 4.
Phase 4: The resting phase
• The resting potential in a cardiomyocyte is −90 mV due to a
constant outward leak of K+ through inward rectifier channels.
• Na+ and Ca2+ channels are closed at resting TMP.
Phase 0: Depolarization
• An action potential triggered in a neighbouring cardiomyocyte or pacemaker cell
causes the TMP to rise above −90 mV.
• Fast Na+ channels start to open one by one and Na+ leaks into the cell, further
raising the TMP.
• TMP approaches −70mV, the threshold potential in cardiomyocytes, i.e. the point
at which enough fast Na+ channels have opened to generate a self-sustaining
inward Na+ current.
• The large Na+ current rapidly depolarizes the TMP to 0 mV and slightly above 0
mV for a transient period of time called the overshoot; fast Na+ channels close
(recall that fast Na+ channels are time-dependent).
Phase 1: Early repolarization
• TMP is now slightly positive.
• Some K+ channels open briefly and an outward flow of K+ returns the TMP to
approximately 0 mV.
Phase 2: The plateau phase
• L-type Ca2+ channels are still open and there is a small, constant inward current of
Ca2+. This becomes significant in the excitation-contraction coupling process
described below.
• K+ leaks out down its concentration gradient through delayed
rectifier K+ channels.
• These two countercurrents are electrically balanced, and the TMP is maintained
at a plateau just below 0 mV throughout phase 2.
Phase 3: Repolarization

• Ca2+ channels are gradually inactivated.

• Persistent outflow of K+, now exceeding Ca2+ inflow, brings TMP back
towards resting potential of −90 mV to prepare the cell for a new cycle
of depolarization.
• Normal transmembrane ionic concentration gradients are restored by
returning Na+ and Ca2+ ions to the extracellular environment, and
K+ ions to the cell interior. The pumps involved include the
sarcolemmal Na+-Ca2+ exchanger, Ca2+-ATPase and Na+-K+-ATPase.
CONTRACTILITY
• The ability of the cell to shorten and lengthen its fibers(contraction) after
receiving a stimulus.
• Factors affecting the contractile properties of the cardiac muscle are;
i. All or none law; If strength of stimulus is below threshold level, no response.
ii. Staircase phenomenon; gradual increase in the force of contraction.
iii. Summation of subliminal stimuli; stimulus with sublingual strength no
response but few stimuli with same sublingual strength in succession, response
thru contraction.
iv. Refractory period; period in which the muscle does not respond to stimulus.
All or none law
• When a stimulus is applied, whatever may be the strength, the whole
cardiac muscle gives maximum response or it does not give any
response at all.
• Below the threshold level, (strength of the stimulus not adequate),
the muscle does not give response.
• All or None Law is applicable to whole cardiac muscle. It is because of
syncytial arrangement of cardiac muscle. In the case of skeletal
muscle, all or none law is applicable only to a single muscle fiber.
Staircase Phenomenon
• Gradual increase in the force of contraction.
• It occurs because of the beneficial effect which facilitates the force of successive
contraction. So there is a gradual increase in force of contraction.

Summation of Subliminal Stimuli

• When a stimulus with a sublimal strength is applied, the quiescent heart does not
show any response. When few stimuli with same subliminal strength are applied
in succession, the heart shows response by contraction. It is due to the
summation of the stimuli.
Refractory period

• Defined as the time from phase 0 until the next possible

depolarization of a myocyte, i.e. once enough fast Na+ channels have
recovered (as TMP decreases below −50 mV).

• Cardiomyocytes have a longer refractory period than other muscle

cells given the long plateau from slow Ca2+ channels (phase 2). This is
a physiological mechanism allowing sufficient time for the ventricles
to empty and refill prior to the next contraction. Total duration is
0.53s
• Absolute refractory period (ARP): the cell is completely
unexcitable to a new stimulus. Duration 0.27sec.

• Relative refractory period (RRP): a greater than normal stimulus

will depolarize the cell and cause an action potential. Duration is
0.26 sec

• Supranormal period: a hyperexcitable period during which a

weaker than normal stimulus will depolarize the cells and cause an
action potential. Cells in this phase are particularly susceptible to
arrhythmias when exposed to an inappropriately timed stimulus,
which is why one must synchronize the electrical stimulus during
cardioversion to prevent inducing ventricular fibrillation.
Significance of long refractory period in cardiac
muscle

1. Summation of contractions does not occur

2. Fatigue does not occur
3. Tetanus does not occur
 CARDIAC CYCLE
• The cardiac cycle is the sequence of coordinated events that occurs
when the heart beats. As the heart beats, it circulates blood
through pulmonary and systemic circuits of the body.
• One cardiac cycle is completed when the heart chambers fill with blood
and blood is then pumped out of the heart.
• The cardiac cycle comprises a complete relaxation and contraction of
both the atria and ventricles, and lasts approximately 0.8 seconds.
• Thus, cardiac cycle is the period of time between the onset of atrial
contraction (atrial systole) and ventricular relaxation (ventricular
diastole).
• The cardiac cycle integrates pressure, volume, and electrocardiographic
and valvular movements during the systolic and diastolic periods
 CARDIAC CYCLE PHASES
• At the beginning of the cardiac cycle, both the atria and ventricles are
relaxed (diastole). Blood is flowing into the right atrium from the
superior and inferior venae cavae and the coronary sinus.
• Blood flows into the left atrium from the four pulmonary veins. The
two atrioventricular valves, the tricuspid and mitral valves, are both
open, so blood flows unimpeded from the atria and into the ventricles.
Approximately 70–80 percent of ventricular filling occurs by this
method. The two semilunar valves, the pulmonary and aortic valves,
are closed, preventing backflow of blood into the right and left
ventricles from the pulmonary trunk on the right and the aorta on the
left.
 Seven (7) events of the cardiac cycle

1. Atrial contraction
2. Isovolumetric ventricular contractions
3. Rapid ventricular ejection
4. Reduced ventricular ejection
5. Isovolumetric ventricular relaxation
6. Rapid ventricular filling(ventricular gallop and S3
7. Reduced ventricular filling (atrial gallop and S4
Atrial contraction (A-V Valves Open; Semilunar Valves
Closed) Phase 1
• Atrial depolarization initiates contraction of the atrial musculature. As
the atria contract, the pressure within the atrial chambers increases,
which forces more blood flow across the open atrioventricular (AV)
valves, leading to a rapid flow of blood into the ventricles.

• Atrial contraction (atrial kick) normally accounts for about 10- 20% of
left ventricular filling. It lasts for about 0.11s.

• Atrial contraction does produce a small increase in venous pressure

that can be noted as the "a-wave" of the left atrial pressure (LAP). Just
following the peak of the a-wave is the x-descent.
• After atrial contraction is complete, the atrial pressure begins to fall
causing a pressure gradient reversal across the AV valves. This causes
the valves to float upward (pre-position) before closure. At this time,
the ventricular volumes are maximal, which is termed the end-diastolic
volume (EDV). The left ventricular EDV (LVEDV), which is typically
about 120 ml, represents the ventricular preload and is associated with
end-diastolic pressures of 8-12 mmHg and 3-6 mmHg in the left and
right ventricles, respectively.

• A heart sound is sometimes noted during atrial contraction (fourth

heart sound, S4). This sound is caused by vibration of the ventricular
wall during atrial contraction. Generally, it is noted when the ventricle
compliance is reduced ("stiff" ventricle) as occurs in ventricular
hypertrophy and in many older individuals.
Pressure Changes in the Atria (The a, c, and v Waves)
• The a wave is caused by atrial contraction. Ordinarily, the right atrial
pressure increases 4 to 6 mm Hg during atrial contraction, and the left atrial
pressure increases about 7 to 8 mm Hg.
• The c wave occurs when the ventricles begin to contract; it is caused partly
by slight backflow of blood into the atria at the onset of ventricular
contraction but mainly by bulging of the A-V valves backward toward the
atria because of increasing pressure in the ventricles.
• The v wave occurs toward the end of ventricular contraction; it results from
slow flow of blood into the atria from the veins while the A-V valves are
closed during ventricular contraction. Then, when ventricular contraction is
over, the A-V valves open, allowing this stored atrial blood to flow rapidly
into the ventricles and causing the v wave to disappear.
Isovolumetric ventricular contractions (All Valves Closed)
(Phase 2)
• This phase of the cardiac cycle begins with the appearance of
the QRS complex of the ECG, which represents ventricular
depolarization. This triggers excitation-contraction coupling,
myocyte contraction and a rapid increase in intraventricular
pressure. Early in this phase, the rate of pressure development
becomes maximal. This is referred to as maximal dP/dt.
• The AV valves close when intraventricular pressure exceeds
atrial pressure.
• Closure of the AV valves results in the first heart sound (S1).
This sound is normally split (~0.04 sec) because mitral valve
closure precedes tricuspid closure.
• During the time period between the closure of the AV valves
and the opening of the aortic and pulmonic valves, ventricular
pressure rises rapidly without a change in ventricular volume
(i.e., no ejection occurs).
• Ventricular volume does not change because all valves are
closed during this phase. Contraction, therefore, is said to be
"isovolumic" or "isovolumetric.“
• The rate of pressure increase in the ventricles is determined by
the rate of contraction of the muscle fibers, which is determine
by mechanisms governing excitation-contraction coupling. The
maximal rate of pressure change during this phase is termed
"dP/dtmax."
 Rapid ventricular ejection (Aortic and Pulmonic Valves
Open) Phase 3
• Rapid ejection: This phase represents initial, rapid ejection of blood into the aorta
and pulmonary arteries from the left and right ventricles, respectively. Ejection
begins when the intraventricular pressures exceed the pressures within the aorta
and pulmonary artery, which causes the aortic and pulmonic valves to open.

• No heart sounds are ordinarily noted during ejection because the opening of
healthy valves is silent. The presence of sounds during ejection (i.e., systolic
murmurs) indicate valve disease or intracardiac shunts.

• Left atrial pressure initially decreases as the atrial base is pulled downward,
expanding the atrial chamber. Blood continues to flow into the atria from their
respective venous inflow tracts and the atrial pressures begin to rise. This rise in
pressure continues until the AV valves open at the end of phase 5.
Isovolumetric Relaxation (Phase 5)-All Valves Closed
• When the intraventricular pressures fall sufficiently at the end of phase 4, the
aortic and pulmonic valves abruptly close (aortic precedes pulmonic) causing the
second heart sound (S2) and the beginning of isovolumetric relaxation. Valve
closure is associated with a small backflow of blood into the ventricles and a
characteristic notch (incisura or dicrotic notch) in the aortic and pulmonary artery
pressure tracings.
• After valve closure, the aortic and pulmonary artery pressures rise slightly
(dicrotic wave) following by a slow decline in pressure.
• Although ventricular pressures decrease during this phase, volumes do not
change because all valves are closed. The volume of blood that remains in a
ventricle is called the end-systolic volume and is ~50 ml in the left ventricle. The
difference between the end-diastolic volume and the end-systolic volume is ~70
ml and represents the stroke volume.
• Left atrial pressure (LAP) continues to rise because of venous return from the
lungs. The peak LAP at the end of this phase is termed the v-wave.
 Rapid Filling (Phase 6)- A-V Valves Open
• As the ventricles continue to relax at the end of phase 5, the
intraventricular pressures will at some point fall below their respective
atrial pressures. When this occurs, the AV valves rapidly open and
passive ventricular filling begins.
• The opening of the mitral valve causes a rapid fall in LAP. The peak of
the LAP just before the valve opens is the "v-wave." This is followed by
the y-descent of the LAP. A similar wave and descent are found in the
right atrium and in the jugular vein.
• Ventricular filling is normally silent. When a third heart sound (S3) is
audible during rapid ventricular filling, it may represent tensing of
chordae tendineae and AV ring during ventricular relaxation and filling.
This heart sound is normal in children; but is often pathological in
adults and caused by ventricular dilation.
 Reduced Filling (Phase 7)-A-V Valves Open
• As the ventricles continue to fill with blood and expand, they become
less compliant and the intraventricular pressures rise. The increase in
intraventricular pressure reduces the pressure gradient across the AV
valves so that the rate of filling falls late in diastole.

• In normal, resting hearts, the ventricle is about 90% filled by the end of
this phase. In other words, about 90% of ventricular filling occurs
before atrial contraction (phase 1) and therefore is passive.

• Aortic and pulmonary arterial pressures continue to fall during this

period.
 Volume changes in the cardiac cycle
• End diastolic volume ( EDV): Maximum volume of blood in each ventricle after
filling(ie at the end of diastole). It is about 130—150mL
• End Systolic volume (ESV): Minimum volume of blood in each ventricle at the end
of ejection(ie at the end of Systole) . It is about 70-90mL
• Stroke volume (SV): Amount of blood ejected from the ventricles per beat.
SV=EDV-ESV. It is usually about 70 mL
• Ejection fraction (Ef): Is the fraction (or portion) of end diastolic volume that is
ejected out by each ventricles per beat. It is expressed in %tage. Ef= SV/EDV%
• Cardiac output (CO) is the total volume of blood pumped by the heart per
minute. It is the product of blood pumped by each heart beat (stroke volume or
SV) and the number of beats (heart rate). CO=HRxSV
Actions of the Heart
FOUR TYPES

1. Chronotropic action
2. Inotropic action
3. Dromotropic action
4. Bathmotropic action
CHRONOTROPIC ACTION
• Is the frequency of heart beat or heart rate. There are 2 types
Tachycardia- increase in HR
Bradycardia- decrease in HR

INOTROPIC ACTION
• Is the force of contraction of the heart. There are 2 types
Positive ionotropi- Increase in the force of contraction
Negative ionotropic- Decrease in the force of contraction
DROMOTROPIC ACTION
• Is the conduction of impulse through the heart. There are 2 types
Positive dromotropic action : Increase in velocity of conduction
Negative dromotropic action: Decrease in Velocity of conduction

BATHMOTROPIC ACTION
• Is the excitability of cardiac muscle. There are 2 types
Positive bathmotropic action: Increase in the excitability of cardiac
muscle
Negative bathmotropic action: Decrease in the excitability of cardiac
muscle
• Preload can be defined as the initial stretching of the cardiac
myocytes prior to contraction. Preload, therefore, is related to
muscule sarcomere length. Because sarcomere length cannot
be determined in the intact heart, other indices of preload are
used such as ventricular end-diastolic volume or pressure.

• Afterload is related to the pressure that the ventricle must

generate in order to eject blood into the aorta. An increase in
afterload (e.g., increased aortic pressure) decreases SV, and
causes ESV to increase. Conversely, a decrease in afterload
augments SV and decreases ESV.
Factors that increase Preload
 Electrocardiogram (ECG)
• Electrocardiography is the technique by which the electrical activities of the heart
are studied. This technique was discovered by Dutch physiologists, Einthoven
Willem who is considered the father of ECG.
• Electrocardiograph is the instrument (ECG machine) by which the electrical
activities of the heart are recorded.
• Electrocardiogram is the record or graphical registration of electrical activities of
the heart, which occur prior to the onset of mechanical activities. ECG is recorded
in 12 leads.
• The paper used for recording ECG is called ECG paper. ECG grid refers to the
markings (lines) on ECG paper.