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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 17
Control of Cardiovascular Function
Chapter 17
Control of Cardiovascular Function
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Path of Blood FlowPath of Blood Flow
Scenario:
• You inject a medication into the client’s arm
• Within a few minutes, some of that drug has reached the client’s liver and is being deactivated
Question:
• How did it get there?
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Simplified Path of Blood FlowSimplified Path of Blood Flow
right heart
lungs
left heart
body
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Heart AnatomyHeart Anatomy
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Question
Tell whether the following statement is true or false:
The pulmonary circulation moves blood through the left side of the heart.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer Answer
False
The right side of the heart pumps blood to the lungs through the pulmonary arteries, where gas exchange takes place. The left side of the heart is considered systemic circulation because blood is pumped to all body tissues.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Heart LayersThe Heart Layers
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Basics of Cell FiringThe Basics of Cell Firing
• Cells begin with a negative charge: resting membrane potential
• Stimulus causes some Na+ channels to open
• Na+ diffuses in, making the cell more positive
Threshold potential
Resting membrane potential Stimulus
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Basics of Cell Firing (cont.)The Basics of Cell Firing (cont.)
• At threshold potential, more Na+ channels open
• Na+ rushes in, making the cell very positive: depolarization
• Action potential: the cell responds (e.g., by contracting)
Threshold potential
Resting membrane potential Stimulus
Action potential
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Basics of Cell Firing (cont.)The Basics of Cell Firing (cont.)
• K+ channels open
• K+ diffuses out, making the cell negative again: repolarization
• Na+/K+ ATPase removes the Na+ from the cell and pumps the K+ back in
Threshold potential
Resting membrane potential Stimulus
Action potential
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiac Cell FiringCardiac Cell Firing
• Cells begin with a negative charge: resting membrane potential
• Calcium leak lets Ca2+ diffuse in, making the cell more positive
Threshold potential
Resting membrane potential Calcium
leak
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiac Muscle Firing (cont.)Cardiac Muscle Firing (cont.)
• At threshold potential, more Na+ channels open
• Na+ rushes in, making the cell very positive: depolarization
• Action potential: the cell responds (e.g., by contracting)
Threshold potential
Resting membrane potential
Action potential
Calcium leak
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiac Muscle Firing (cont.)Cardiac Muscle Firing (cont.)
• K+ channels open
• K+ diffuses out, making the cell negative again, but Ca2+ channels are still allowing Ca2+ to enter
• The cell remains positive: plateau
Threshold potential
PLATEAU
Action potential
Calcium leak
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiac Muscle Firing (cont.)Cardiac Muscle Firing (cont.)
• During plateau, the muscle contracts strongly
• Then the Ca2+ channels shut and it repolarizes
Threshold potential
PLATEAUAction potential
Calcium leak
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Question
Which ion channels allow cardiac muscle to fire without a stimulus?
a. Na+
b. K+
c. Ca2+
d. Cl-
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer Answer
c. Ca2+
In the S-A node and A-V node, resting cardiac muscle cells have open Ca2+ channels. This allows Ca2+ to leak into the cells, making them more positive (the cells reach threshold this way without the need for a stimulus).
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Heart ContractionHeart Contraction
How would each of the following affect heart contraction:
• A calcium-channel blocker
• A Na+ channel blocker
• A drug that opened Na+ channels
• A drug that opened K+ channels
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiac Cycle—DiastoleCardiac Cycle—Diastole
• Ventricles relaxed
• Blood entering atria
• Blood flows through AV valves into ventricles
• Semilunar valves are closed
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiac Cycle—SystoleCardiac Cycle—Systole
• Ventricles contract
• Blood pushes against AV valves and they shut
• Blood pushes through semilunar valves into aorta and pulmonary trunk
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Question
Which of the following statements is true about ventricular systole?
a. Atria contract
b. Ventricles contract
c. AV valves are open
d. Semilunar valves are closed
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer Answer
b. Ventricles contract
During ventricular systole, the ventricles contract. Because blood is being forced from the ventricle, semilunar valves must be open and AV valves, closed. The atria is in diastole (relaxation) during ventricular systole.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cardiac CycleCardiac Cycle
Discussion:
• Arrange these steps in the proper order:
– Ventricles relax – First heart sound
– Systole – Semilunar valves open
– Diastole – AV valves close
– AV valves open – Semilunar valves close
– Ventricles contract – Second heart sound
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pressure, Resistance, FlowPressure, Resistance, Flow
• Fluid flow through a vessel depends on:
– The pressure difference between ends of the vessel
º Pressure pushes the fluid through
º Pressure keeps the vessel from collapsing
– The vessel’s resistance to fluid flow
º Small vessels have more resistance
º More viscous fluids have greater resistance
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pressure, Resistance, Flow of BloodPressure, Resistance, Flow of Blood• Blood flow through a vessel depends on:
– Heart creating pressure difference between ends of the vessel
• Heart pushing the blood through
• Blood pressure keeping the vessels open
– The vessel’s resistance to fluid flow
• Constricting arterioles increasing resistance
• Increased hematocrit increasing resistance
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Discussion:Discussion:
How will each of these factors affect arteriole size and peripheral resistance?
• Lactic acid • Low PO2
• Cold • Histamine
• Endothelin • Heat
• NO • Adenosine
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Blood PressureBlood Pressure
BP = CO x PRBlood Pressure = Cardiac Output × Peripheral Resistance
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Question
Tell whether the following statements is true or false:
In patients with hypertension (high blood pressure), peripheral resistance is increased.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer Answer
True
In hypertension, blood vessels are constricted/narrowed. Smaller vessels increase resistance (it’s harder to push the same amount of fluid/blood through a tube that has become smaller).
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Lymph Vessels Carry Tissue Fluid Back to the VeinsLymph Vessels Carry Tissue Fluid Back to the Veins
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