Functional Classification of Heart Failure

Representative heart conditions detectable

through electrocardiography

Atrial flutter is characterized by a rapid but regular

sequence of atrial depolarization at rates between 200
and 380 beats per minute.

Atrial fibrillation is characterized by rapid, irregular,

uncoordinated depolarization of the atria with no
definite P waves.

Ventricular fibrillation is a very serious rhythmic

abnormality in which multiple impulses travel
erratically in all directions around the ventricles.

Heart block arises from defects in the cardiac

conducting system. The atria still beat regularly, but
the ventricles occasionally fail to be stimulated and
thus do not contract following atrial contraction.
 Cardiac cycle

This diagram depicts various

events that occur concurrently
during the cardiac cycle. Follow
each horizontal strip across to
see the changes that take place
in the electrocardiogram; aortic,
ventricular, and atrial pressures;
ventricular volume; and heart
sounds throughout the cycle. The
last half of diastole, one full
systole and diastole (one full
cardiac cycle), and another
systole are shown for the left side
of the heart. Follow each vertical
strip downward to see what
happens simultaneously with
each of these factors during each
phase of the cardiac cycle.
Left-ventricular pressure–volume
loop for a single cardiac cycle
 Comparison of laminar and
turbulent flow
Abnormal heart sounds, or
murmurs, are usually (but not
always) associated with cardiac
disease. Blood normally flows in
a laminar fashion—that is,
layers of the fluid slide smoothly
over one another (lamina means
“layer”). Laminar flow does not
produce an audible sound.
When blood flow becomes
turbulent, however, a sound can
be heard. eg. stenotic valve is a
stiff, narrowed valve that does
not open completely.
Cardiac output depends on heart rate
and stroke volume
Cardiac Hypertrophy
Physiological and Pathological
Cardiac Hypertrophy
The heart is innervated by
both divisions of the
autonomic nervous system,
which can modify the rate
(and the strength) of
contraction, even though
nervous stimulation is not
required to initiate
contraction of the heart
muscle.
 Autonomic control of SA node activity and
heart rate
(a) Parasympathetic stimulation
decreases the rate of SA nodal
depolarization so that the membrane
reaches threshold more slowly and
has fewer action potentials, whereas
sympathetic stimulation increases the
rate of depolarization of the SA node
so that the membrane reaches
threshold more rapidly and has more
frequent action potentials. (b)
Because each SA node action
potential ultimately leads to a
heartbeat, increased parasympathetic
activity decreases the heart rate,
whereas increased sympathetic
activity increases the heart rate.
Intrinsic and extrinsic control of stroke volume
Effect of sympathetic stimulation
on stroke volume
Control of cardiac output
Coronary Arteries; supplying
blood to heart muscle
Coronary Blood Flow
Atherosclerosis and Coronary
heart disease
Plaque rupture one of the biggest
challenge
Organization of the cardiovascular system
 Distribution of cardiac output (CO) at rest

The lungs receive all the blood

pumped out by the right side of
the heart, whereas the systemic
organs each receive some of the
blood pumped out by the left side
of the heart. The percentage of
pumped blood received by the
various organs under resting
conditions is indicated. This
distribution of CO can be adjusted
as needed.
Relationship of flow to the pressure
gradient in a vessel
(a) As the difference in pressure (DP)
between the two ends of a vessel
increases, the flow rate increases
proportionately.

(b) Flow rate is determined by the

difference in pressure between the
two ends of a vessel, not the
magnitude of the pressures at each
end.
Relationship of resistance and flow to the
vessel radius
Features of Blood Vessels
 Arteries as a pressure reservoir
Because of their elasticity, arteries act as a pressure reservoir.
(a) The elastic arteries distend during cardiac systole as more
blood is ejected into them than drains off into the narrow, high-
resistance arterioles downstream. (b) Elastic recoil of arteries
during cardiac diastole continues driving blood forward when
the heart is not pumping.
Arterial blood pressure and its measurement
Mean arterial pressure (MAP) is the main
driving force for blood flow
Arteriolar vasoconstriction and vasodilation
Comparison of blood flow rate and velocity of
flow in relation to total cross-sectional area

The flow rate refers to the volume of blood per unit

of time flowing through a given segment of the
circulatory system.

The velocity of flow is the speed, or distance per

unit of time, with which blood flows forward through
a given segment of the circulatory system.
 Point to Remember

The blood flow rate is identical

through all levels of the circulatory
system and is equal to the cardiac
output (5 L/min at rest). The velocity
of flow varies throughout the
vascular tree and is inversely
proportional to the total cross-
sectional area of all the vessels at a
given level.
Exchanges across a continuous
capillary wall
Percentage of total blood volume in different
parts of the circulatory system
Function of venous valves
Respiratory pump enhancing venous return
As a result of respiratory activity, the pressure surrounding the
chest veins is lower than the pressure surrounding the veins in
the extremities and abdomen. This establishes an externally
applied pressure gradient on the veins, which drives blood
toward the heart.
Location of the arterial baroreceptors
Firing rate in the afferent neuron from the carotid
sinus baroreceptor in relation to the magnitude of
mean arterial pressure
Baroreceptor reflexes to restore blood
pressure to normal