Basic Biomedical Sciences I Case Three: Path of the Heart
VELOCITY OF BLOOD FLOW AND CROSS-SECTIONAL AREA
Resistance in Parallel or Series:
DIFFERENCE BETWEEN LAMINAR AND TURBULENT FLOW
CAUSES OF TURBULENT BLOOD FLOW
FACTORS AFFECTING TURBULENT FLOW
MECHANISM OF CRITICAL CLOSING PRESSURE IN BLOOD VESSELS AND THE FACTORS AFFECTING IT
Basic Biomedical Sciences One
Methods for Measuring Venous Pressure
Effects of the following on venous pressure and flow
Factors that tend to collapse the veins entering the thorax:
Thoraco-Abdominal Pump (Respiratory Pump)
Functional relationship between cardiac output and central venous pressure (right atrial pressure)
Mean systemic filling pressure
. Slope of the venous return curve
. Combining Cardiac Output and Venous Return Curves
o Inotropic agents change the cardiac output curve
o Changes in total peripheral resistance change both the cardiac output and the venous return curves.
DYNAMICS OF THE MICROCIRCULATION
Substances that can cross the capillary wall and the mechanisms involved in their passage across the capillary wall
Factors that influence transcapillary movement (Starling
Humoral (Extrinsic) Control of blood flow
Lymph channels in the body
Terminal Lymphatic Capillaries and Their Permeability.
Factors that determine the rate of lymph flow
Lymphatic pump- increases lymph flow
Pumping Caused by External Intermittent Compression of the Lymphatics
Summary of Factors that Determine Lymph Flow
Case Five: Guard Your Heart CARDIOVASCULAR SYSTEM
Limitations of Blood Pressure reading
Effects of changes in cardiac output and total peripheral resistance on arterial blood pressure and pulse pressure
Effect of the following physiologic factors on the blood pressure:
Mechanisms involved in the regulation of blood pressure in reference to:
Hormonal control including autocrines.
Autoregulation or local control
Hemodynamics of Circulation
The Heart, Arteries, Capillaries, Veins, and Lymphatics
Arteries: Transport blood to tissues under high pressure
Arterioles: Control conduits to release blood into capillaries
Capillaries: Exchange substances between interstitium and blood
Venules: Collect blood from capillaries
Veins: Transport blood back to the heart and act as reservoir of blood
CROSS-SECTIONAL AREAS AND VELOCITIES OF BLOOD FLOW
NORMAL HEMODYNAMICS THE NORMAL CARDIAC STRUCTURES
How does the circulatory system manage to do what it does?
How are the intravascular and interstitial fluid kept separated?
PHYSICS OF FLUID MOVEMENT IN A CYLINDER
How does blood return to the heart?
Cardiovascular Adrenergic Receptors
Basic Biomedical Sciences one
ACTION POTENTIAL, ELECTRICAL STIMULATION, AND CARDIAC CONTRACTION
The ECG in relation to the Cardiac Cycle
What happens mechanically after
PR Interval -> AV Nodal Delay
QRS Complex -> Ventricular Depolarization -> Ventricular Contraction
What happens mechanically after
ST Segment -> Ventricles Fully Depolarized -> Plateau Phase
T Wave -> Ventricular Repolarization -> Ventricular Relaxation
What happens mechanically after
Relationship to Heart Sounds
The Cardiac Conduction System
SINOATRIAL NODE (SA NODE)
THE CARDIAC ACTION POTENTIALS
The Ventricular Myocyte Action Potential
Mechanism of excitation-contraction coupling and relaxation in cardiac muscle
Differences between Sinus-Nodal and Ventricular Muscle Action Potentials
TRANSMISSION OF CARDIAC IMPULSE THROUGH THE HEART
FUNDAMENTAL CARDIAC ELECTROPHYSIOLOGY PRINCIPLES
Depolarization versus Repolarization Waves
Conduction through the Bundle Branches and Ventricular Septum
THE STANDARD ELECTROCARDIOGRAM RECORDING, ECG PAPER
Three Unipolar Augmented Leads
Three Augmented Unipolar Limb Leads:
Six Precordial, Chest Leads
Limb Leads Axes, The Hexaxial System
Right-sided and Posterior Chest Leads, Non-standard.
Twelve-Lead ECG Recordings
Arrangement of Leads on the ECG
The Coronary Artery Distribution based on the Contiguous Lead Groupings.
Coronary Artery Territories and ECG Leads
VECTORIAL ANALYSIS AND DETERMINATION OF THE MEAN ELECTRICAL AXIS
DETERMINING THE ELECTRICAL AXIS (SHORTCUT METHOD)
One. PHYSIOLOGIC AXIS DEVIATIONS
Two. PATHOLOGIC AXIS DEVIATIONS
QRS Complexes in Left Ventricular Hypertrophy (LVH)
Four. CONDITIONS THAT CAUSE ABNORMAL VOLTAGES OF THE QRS COMPLEX
Four. CONDITIONS THAT CAUSE BIZARRE QRS COMPLEX MORPHOLOGIES
ELECTROCARDIOGRAMINATION OF HEART RATE
Calculating Heart Rate using a twelve-second rhythm strip:
Variable Shapes of ST-segment Elevations in Acute Myocardial Infarction
E. T WAVE (VENTRICULAR REPOLARIZATION)
F. QT INTERVAL (VENTRICULAR DEPOLARIZATION & REPOLARIZATION)
MYOCARDIAL INFARCTION LOCALIZATION
Anterior Myocardial Infarction
Localize the Myocardial Infarction:
ELECTROCARDIOGRAMOSIS OF BUNDLE BRANCH BLOCKS (BBB) - NORMAL IMPULSE CONDUCTION
Complete Right Bundle Branch Block (CRBBB)
MISCELLANEOUS DISORDERS (CONTD.)
o Ventricular Tachycardia (VTach)
o Ventricular Fibrillation
o SINUS RHYTHM WITH FIRST DEGREE AV BLOCK
o FUNCTIONS OF THE MICROCIRCULATION
o STRUCTURE OF THE MICROCIRCULATION AND CAPILLARY SYSTEM
Structure of the Capillary Wall
Special Types of Pores in Capillaries of Certain Organs
EXCHANGE OF WATER AND NUTRIENTS IN THE BLOOD AND INTERSTITIAL FLUID
Effect of Molecular Size on Passage Through the Pores
THE INTERSTITIUM AND THE INTERSTITIAL FLUID
Free Fluid in the Interstitium
Interstitial Fluid Pressures in Tightly Encased Tissues.
Interstitial Fluid Pressure in Loose Subcutaneous Tissue.
Interstitial Fluid Colloid Osmotic Pressure.
Fluid Volume Exchange through the Capillary Membrane.
Effect of Abnormal Imbalance of Forces at the Capillary Membrane.
Lymph Channels of the Body.
Effect of Interstitial Fluid Pressure on Lymph Flow.
Factors that increase lymph flow.
Pumping Caused by External Intermittent Compression of the Lymphatics.
Lymphatic Capillary Pump.
Where do we see hemoglobin?
TYPES AND STRUCTURE OF HEMOGLOBIN
Major forms of hemoglobin in adults:
ALLOSTERIC BEHAVIOR AND POSITIVE COOPERATIVITY
• Hemoglobin also demonstrates POSITIVE COOPERATIVITY
• HEMOGLOBIN SYNTHESIS REQUIREMENTS:
PATHWAY FOR THE SYNTHESIS OF HEME
First step of heme synthesis.
Structure of porphobilinogen.
Formation of uroporphyrinogen.
• Defects in heme synthesis are called porphyrias.
• Review on protein synthesis:
DNA, genes, and translation of globins.
Chromosomal location of globin genes.
Two major types of adult globins.
Combining heme and globin.
· Lifespan of patients with sickle cell anemia:
SUMMARY OF HEMOGLOBIN SYNTHESIS.
REGULATORS OF HEMOGLOBIN SYNTHESIS.
One. Systemic regulators:
Two. Metabolic cofactors:
VON WILLEBRAND FACTOR (VWF).
TRANS: AREA fifteen to nineteen.
C. secondary hemostasis ; formation of platelet clot.
CLOT STABILIZATION AND RESORPTION.
CELL MEMBRANE OF PLATELETS.
FACTORS THAT LIMIT COAGULATION
ANTITHROMBOTIC PROPERTIES OF ENDOTHELIUM
Basic Biomedical Sciences One Cardiovascular System Video Correlates VIDEO ONE: CARDIOVASCULAR SYSTEM: ANATOMY OF THE HEART BY LECTURIO
Circulation through the heart:
A more anatomically correct diagram
Return of venous blood to the heart.
VIDEO four: COMPONENTS OF THE HEART BY LECTURIO The heart has six important components.
VIDEO SIX: THE CARDIAC CYCLE ANIMATION BY ALILA MEDIA
Basic Biomedical Sciences One Case One: "Do I need a CBC?"
DIFFERENTIATION AS TO SITE OF PRODUCTION BEFORE AND AFTER BIRTH
DIFFERENTIATION BETWEEN INTRAMEDULLARY AND EXTRAMEDULLARY HEMATOPOIESIS
MECHANISM OF PRODUCTION AND RELEASE
ERYTHROCYTIC, RED CELL SERIES GENERAL DESCRIPTION
Basophilic Normoblast, Prorubricyte.
Polychromatophilic Normoblast, Rubricyte.
Orthochromaphilic Normoblast (Metarubricyte)
LEUKOCYTIC (WHITE CELL) SERIES GENERAL DESCRIPTION
GRANULOCYTES (NEUTROPHILS, EOSINOPHILS, BASOPHILS)
The mature eosinophils contain two types of granules:
AGRA-NULOCYTES, MONOCYTES, MACROPHAGES, LYMPHOCYTES
MEGAKARYOCYTIC, THROMBOCYTIC SERIES GENERAL DESCRIPTION
COMPLETE BLOOD COUNT DEFINITION
SIGNIFICANCE OF ABNORMAL VALUES
White Blood Cell Differential Count
Relative versus Absolute Values
Mechanisms: The primary factors influencing the neutrophil count are:
Mechanisms by which neutropenia occur include:
Basic Biomedical Sciences One Case Two: "This Oozing Makes Me Woozy"
Physical and Chemical Characteristics of Platelets
Mechanism of the Platelet Plug
TISSUE FACTOR (FACTOR THREE)
PROACCELERIN (FACTOR FIVE)
PROCONVERTIN (FACTOR SEVEN)
ANTIHEMOPHILIC B (FACTOR NINE)
STUART FACTOR (FACTOR TEN)
PLASMA THROMBOPLASTIN ANTECEDENT (FACTOR ELEVEN)
HAGEMAN FACTOR (FACTOR TWELVE)
FIBRIN STABILIZING FACTOR (FACTOR THIRTEEN)
PREKALLIKREIN (FLETCHER FACTOR)
HIGH MOLECULAR WEIGHT KININOGEN (FITZGERALD FACTOR)
· Initiation of Coagulation: Formation of Prothrombin Activator
CONVERSION OF PROTHROMBIN TO THROMBIN
ACTION OF THROMBIN ON FIBRINOGEN TO FORM FIBRIN
CLOT RETRACTION AND EXPRESSION OF SERUM
INTRAVASCULAR ANTICOAGULANTS THAT PREVENT BLOOD CLOTTING IN THE NORMAL VASCULAR SYSTEM ENDOTHELIAL SURFACE FACTORS
ANTITHROMBIN ACTION OF FIBRIN AND ANTITHROMBIN THREE
MECHANISMS AND FACTORS BEHIND FIBRINOLYSIS
Activation of Plasminogen to Form Plasmin, Then Clot Lysis
TESTS TO ASSESS DIFFERENT SYSTEMS INVOLVED IN HEMOSTASIS
EMBRYOLOGY OF THE HEART AND BLOOD VESSELS
DERIVATIVES OF THE PHARYNGEAL ARCH ARTERIES
DERIVATIVES OF LYMPH SACS AND DUCTS
COMPONENTS OF THE PERICARDIUM
GREAT BLOOD VESSELS AT THE BASE OF THE HEART ARTERIES
o Descending thoracic aorta
LARGE VEINS OF THE THORAX
BORDERS AND SURFACES OF THE HEART
CHAMBERS OF THE HEART MAIN CHAMBERS
ANATOMICAL FEATURES OF THE MAIN CHAMBERS
Right and Left Ventricles
ATRIOVENTRICULAR OPENINGS
LOCATION OF VALVES CLINICAL LOCATION
CORONARY CIRCULATION RIGHT CORONARY ARTERY
SUMMARY OF OVERALL ARTERIAL SUPPLY TO THE HEART IN MOST INDIVIDUALS
VENOUS DRAINAGE CORONARY SINUS
RESTING MEMBRANE POTENTIAL
ABSOLUTE REFRACTORY PERIOD
EFFECTIVE REFRACTORY PERIOD
RELATIVE REFRACTORY PERIOD
COMPONENTS OF THE IMPULSE CONDUCTING SYSTEM SINOATRIAL NODE
One. Anterior internodal pathway (Anterior Internodal Tract of Bachman)
Two. Middle Internodal Pathway (Middle Internodal Tract of Wenkeback)
Three. Posterior Internodal Pathway (Posterior Internodal Tract of Thorel)
AV BUNDLE (BUNDLE OF HIS)
AUTOMATICITY AND RHYTHMICITY
MECHANISM OF AUTOMATICITY AND RHYTHMICITY EXHIBITED BY PACEMAKER TISSUE
SA NODE AS THE PRIMARY PACEMAKER OF THE HEART
FACTORS AFFECTING IMPULSE DISCHARGES OF THE SA NODE
Effects of acetylcholine on the heart:
CHANGES IN IONIC CONCENTRATION
NORMAL PATHWAY OF CARDIAC IMPULSE
TRANSMISSION OF CARDIAC IMPULSE IN THE VENTRICULAR MUSCLE
COMPONENTS OF THE NORMAL ECG AND ITS ELECTROPHYSIOLOGIC BASIS
"ALL OR NONE" RESPONSE OF THE CARDIAC MUSCLE
PHASES OF THE CARDIAC CYCLE
Four. Fourth heart sound (S4)
NORMAL CARDIAC OUTPUT AND REGULATION MECHANISM
FACTOR CONTROLLING CARDIAC OUTPUT
MECHANISMS OF REGULATION OF HEART PUMPING
MECHANISMS IN CARDIAC INTRINSIC REGULATION FRANK-STARLING LAW
LENGTH-TENSION RELATIONSHIP
FACTORS AFFECTING CARDIAC CONTRACTILITY
Sympathetic and Parasympathetic Nerve Impulses.
Cardiac Glycosides (Digitalis) and Other Inotropic Agents.
Other Pharmacologic Agents.
EFFECT OF TEMPERATURE ON CARDIAC FUNCTION.
MECHANISMS IN CARDIAC EXTRINSIC REGULATION NERVOUS CONTROL OF CARDIAC ACTIVITY.
Sympathetic stimulation via beta receptor:
Parasympathetic stimulation via muscarinic receptor:
CHEMICAL CONTROL OF CARDIAC ACTIVITY.
SOURCE OF ENERGY REQUIRED FOR CARDIAC CONTRACTILITY
FACTORS THAT INCREASE CARDIAC OXYGEN CONSUMPTION