Cardiac Physiology
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CARDIAC PHYSIOLOGY & ANAESTHETIC CONSIDERATIONS MODERATOR : DR.ANIL VERMA SPEAKER : RAJEEV PUBLISHED BY
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
Heart Hollow Located within the mediastinum of the thorax Distal end extends downward to the left forming apex at the fifth intercostal space.
www.medicalppt.blogspot.com
HEART STRUCTURE ANATOMICALLY ONE ORGAN FUNCTIONALLY DIVIDE INTO RT. & LT PUMPS FOUR VALVES WITH UNIDIRECTIONAL FLOW
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
Pulmonary and Systemic Bloodflow
www.medicalppt.blogspot.com
The heart consists of three different layers www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
Coronary supply Inferior
Rt coronary
Anteroseptal
Lt ant descening
Anteroapical Anterolateral
Lt ant desceding( distal) Circumflex
Posterior
Rt coronary artery www.medicalppt.blogspot.com
l
CARDIAC ACTION POTENTIAL
www.medicalppt.blogspot.com
MEMBRANE POTENTIAL (mV)
0
PHASE 0 = Rapid Depolarization Mechanical Response (inward Na+ current) 1 1 = Overshoot 2 2 = Plateau (inward Ca++ current) 3 = Repolarization + (outward K current) 0 3 4 = Resting Potential
4
-90 TIME
www.medicalppt.blogspot.com
PACEMAKERS (in order of their inherent rhythm) • • • • •
Sino-atrial (SA) node Atrio-ventricular (AV) node Bundle of His Bundle branches Purkinje fibers
www.medicalppt.blogspot.com
Sinoatrial Node
AtrioVentricular Node
Atrioventricular Bundle
Purkinje Fibers Heart Conduction System www.medicalppt.blogspot.com
INITIATION & CONDUCTION OF THE CARDIAC IMPULSE
www.medicalppt.blogspot.com
Heart Actions • Atrial systole is when the atria contract while the ventricles relax which is called ventricular diastole. • Thus systolic and diastolic blood pressure. • This series of contraction and relaxation is called a cardiac www.medicalppt.blogspot.com cycle.
EVENTS IN CARDIAC CYCLE DIASTOLE
ISOMETRIC VENTRICULAR RELAXATION
LATE DIASTOLE
ATRIAL SYSTOLE
VENTRICULAR ISOMETRIC VENTRICULAR EJECTION www.medicalppt.blogspot.com CONTRACTION
CAR DI AC CYC LE Mitral Closes
S1 S2
www.medicalppt.blogspot.com
Atrial Systole
Reduced Ventricular Filling
Rapid Ventricular Filling
Isovolumic Relax.
Reduced Ejection
Rapid Ejection
Atrial Systolecontract. Isovolumic
Aortic opens Aortic closes
Mitral opens
CARDIAC OUTPUT • DEFIND AS VOLUME OF BLOOD PUMPED BY HEART/MIN • CO = SV X HR • SV IS VOLUME PUMPED PER CONTRACTION • average cardiac output would be 5L.min-1 for a human male and 4.5L.min-1 for a female. www.medicalppt.blogspot.com
CARDIAC OUTPUT AND THE FICK PRINCIPLE BODY O2 CONSUMPTION Lungs PULMONARY ARTERY
250mlO2/min
PULMONARY VEIN
PaO2 190mlO2/l blood
PvO2 140mlO2/l blood
Pulmonary capillaries
CARDIAC OUTPUT=
O2 CONSUMPTION (ml/min)
-
www.medicalppt.blogspot.com 2
PaO
PvO2
Pulse
• Pressure wave move along the artery wall which are pliable • usually measured in beats per minute • normal range from 60 to 100 beats per minute www.medicalppt.blogspot.com
Factors Influencing the Pulse • • • • • • • •
Stroke volume Rate of ejection Distensibility of peripheral arteries Peripheral resistance Pulse rate Pulse pressure Size of the vessel Distance from the heart www.medicalppt.blogspot.com
Pulsus Parvus
• The pressure is diminished, and the pulse feels weak and small, seen in - restrictive pericardial disease, hypovolemia, mitral stenosis • Pulsus Parvus et Tardus (weak and delayed): →Aortic Stenosis www.medicalppt.blogspot.com
Bisferiens Pulse
• Increased arterial pulse with a double systolic peak. • Causes : AR •
HCM
www.medicalppt.blogspot.com
Bigeminal Pulse
• characterized by groups of two heartbeats close together followed by a longer pause. The second pulse is weaker than the first • Causes: severe HF, hypovolemic shock, www.medicalppt.blogspot.com cardiac tamponade)
Pulsus Alternans
arterial pulse waveform showing alternating strong and weak beats • Causes: • Left ventricular failure • severe AR www.medicalppt.blogspot.com
Pulsus Paradoxus
• Pressure drop > 20 mmHg during inspiration. • Normally, systolic arterial pressure falls 8-12 mmHg during inspiration. • Causes: • Cardiac Tamponade • COPD, hypovolemic shock
www.medicalppt.blogspot.com
BLOOD PRESSURE • DEFINE AS PRESSURE OF BLOOD AGAINST THE WALL OF MAIN ARTRIES • HIGHEST DURING SYSTOLE N LOWEST DURING DIASTOLE • MEASURED BY SPHYGMOMANOMETER @ BRACHIAL ARTERY OF ARM www.medicalppt.blogspot.com
Blood Pressure (BP): Measurements
www.medicalppt.blogspot.com
Figure 15-7: Measurement of arterial blood pressure
CLASSIFICATION Category
Systolic
Diastolic
hypotension <90
<60
normal
60 - 79
90 – 119
prehypertes 120 - 139 ion stage1ht 140 - 159
80 - 89
stage2ht
>100
>160
90 - 99
www.medicalppt.blogspot.com
Pulse and Mean Arterial Pressures • Pulse pressure = Systolic – Diastolic • Mean arterial pressure (MAP) = Diastolic + 1/3 pulse pressure
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
EJECTION FRACTION • Ejection fraction (Ef) is the fraction of the end-diastolic volume that is ejected with each beat • it is stroke volume (SV) divided by end-diastolic volume (EDV):
www.medicalppt.blogspot.com
EJECTION FRACTION • In a healthy man, the SV is approximately 70 ml and the left ventricular EDV is 120 ml, giving an ejection fraction of 70/120, or 0.58 (58%). • Healthy individuals typically have ejection fractions between 50% and 65% www.medicalppt.blogspot.com
METHODS OF EF MEASUREMENT • CARDIAC CATHETRISATION • RADIONUCLEOTIDE STUDIES • ANGIOCARDIOGRAPHY
www.medicalppt.blogspot.com
CARDIAC INDEX • Cardi ac index (CI ) i s a vasodynami c parameter that rel ates the cardi ac output to body surf ac e area • uni t of measurement is (l/mi n/m2 ) • normal range of cardiac index is 2.6 - 4.2 L/min per square meter. www.medicalppt.blogspot.com
ANAESTHETIC
• Halothaane isoflurane and CONSIDERATION
enflurane depress SA node automaticity. • IV induction agent have limited effect on usual clinical doses. • Opioids can depress cardiac conduction. • LA associated with systemic toxicity. www.medicalppt.blogspot.com
GOALS OF ANAESTHESIA IN CVS DISEASES • PREMEDICATE BY BZP’S • BLUNT RESPONSE BY LARYGOSCOPY N INTUBATION • AVOID TACHYCARDIA • AVOID HYPOCAPNIA
www.medicalppt.blogspot.com
THANK YOU www.medicalppt.blogspot.com
FOR MORE MEDICAL PRESENTATIONS VISIT www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
Heart Hollow Located within the mediastinum of the thorax Distal end extends downward to the left forming apex at the fifth intercostal space.
www.medicalppt.blogspot.com
HEART STRUCTURE ANATOMICALLY ONE ORGAN FUNCTIONALLY DIVIDE INTO RT. & LT PUMPS FOUR VALVES WITH UNIDIRECTIONAL FLOW
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
Pulmonary and Systemic Bloodflow
www.medicalppt.blogspot.com
The heart consists of three different layers www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
Coronary supply Inferior
Rt coronary
Anteroseptal
Lt ant descening
Anteroapical Anterolateral
Lt ant desceding( distal) Circumflex
Posterior
Rt coronary artery www.medicalppt.blogspot.com
l
CARDIAC ACTION POTENTIAL
www.medicalppt.blogspot.com
MEMBRANE POTENTIAL (mV)
0
PHASE 0 = Rapid Depolarization Mechanical Response (inward Na+ current) 1 1 = Overshoot 2 2 = Plateau (inward Ca++ current) 3 = Repolarization + (outward K current) 0 3 4 = Resting Potential
4
-90 TIME
www.medicalppt.blogspot.com
PACEMAKERS (in order of their inherent rhythm) • • • • •
Sino-atrial (SA) node Atrio-ventricular (AV) node Bundle of His Bundle branches Purkinje fibers
www.medicalppt.blogspot.com
Sinoatrial Node
AtrioVentricular Node
Atrioventricular Bundle
Purkinje Fibers Heart Conduction System www.medicalppt.blogspot.com
INITIATION & CONDUCTION OF THE CARDIAC IMPULSE
www.medicalppt.blogspot.com
Heart Actions • Atrial systole is when the atria contract while the ventricles relax which is called ventricular diastole. • Thus systolic and diastolic blood pressure. • This series of contraction and relaxation is called a cardiac www.medicalppt.blogspot.com cycle.
EVENTS IN CARDIAC CYCLE DIASTOLE
ISOMETRIC VENTRICULAR RELAXATION
LATE DIASTOLE
ATRIAL SYSTOLE
VENTRICULAR ISOMETRIC VENTRICULAR EJECTION www.medicalppt.blogspot.com CONTRACTION
CAR DI AC CYC LE Mitral Closes
S1 S2
www.medicalppt.blogspot.com
Atrial Systole
Reduced Ventricular Filling
Rapid Ventricular Filling
Isovolumic Relax.
Reduced Ejection
Rapid Ejection
Atrial Systolecontract. Isovolumic
Aortic opens Aortic closes
Mitral opens
CARDIAC OUTPUT • DEFIND AS VOLUME OF BLOOD PUMPED BY HEART/MIN • CO = SV X HR • SV IS VOLUME PUMPED PER CONTRACTION • average cardiac output would be 5L.min-1 for a human male and 4.5L.min-1 for a female. www.medicalppt.blogspot.com
CARDIAC OUTPUT AND THE FICK PRINCIPLE BODY O2 CONSUMPTION Lungs PULMONARY ARTERY
250mlO2/min
PULMONARY VEIN
PaO2 190mlO2/l blood
PvO2 140mlO2/l blood
Pulmonary capillaries
CARDIAC OUTPUT=
O2 CONSUMPTION (ml/min)
-
www.medicalppt.blogspot.com 2
PaO
PvO2
Pulse
• Pressure wave move along the artery wall which are pliable • usually measured in beats per minute • normal range from 60 to 100 beats per minute www.medicalppt.blogspot.com
Factors Influencing the Pulse • • • • • • • •
Stroke volume Rate of ejection Distensibility of peripheral arteries Peripheral resistance Pulse rate Pulse pressure Size of the vessel Distance from the heart www.medicalppt.blogspot.com
Pulsus Parvus
• The pressure is diminished, and the pulse feels weak and small, seen in - restrictive pericardial disease, hypovolemia, mitral stenosis • Pulsus Parvus et Tardus (weak and delayed): →Aortic Stenosis www.medicalppt.blogspot.com
Bisferiens Pulse
• Increased arterial pulse with a double systolic peak. • Causes : AR •
HCM
www.medicalppt.blogspot.com
Bigeminal Pulse
• characterized by groups of two heartbeats close together followed by a longer pause. The second pulse is weaker than the first • Causes: severe HF, hypovolemic shock, www.medicalppt.blogspot.com cardiac tamponade)
Pulsus Alternans
arterial pulse waveform showing alternating strong and weak beats • Causes: • Left ventricular failure • severe AR www.medicalppt.blogspot.com
Pulsus Paradoxus
• Pressure drop > 20 mmHg during inspiration. • Normally, systolic arterial pressure falls 8-12 mmHg during inspiration. • Causes: • Cardiac Tamponade • COPD, hypovolemic shock
www.medicalppt.blogspot.com
BLOOD PRESSURE • DEFINE AS PRESSURE OF BLOOD AGAINST THE WALL OF MAIN ARTRIES • HIGHEST DURING SYSTOLE N LOWEST DURING DIASTOLE • MEASURED BY SPHYGMOMANOMETER @ BRACHIAL ARTERY OF ARM www.medicalppt.blogspot.com
Blood Pressure (BP): Measurements
www.medicalppt.blogspot.com
Figure 15-7: Measurement of arterial blood pressure
CLASSIFICATION Category
Systolic
Diastolic
hypotension <90
<60
normal
60 - 79
90 – 119
prehypertes 120 - 139 ion stage1ht 140 - 159
80 - 89
stage2ht
>100
>160
90 - 99
www.medicalppt.blogspot.com
Pulse and Mean Arterial Pressures • Pulse pressure = Systolic – Diastolic • Mean arterial pressure (MAP) = Diastolic + 1/3 pulse pressure
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
EJECTION FRACTION • Ejection fraction (Ef) is the fraction of the end-diastolic volume that is ejected with each beat • it is stroke volume (SV) divided by end-diastolic volume (EDV):
www.medicalppt.blogspot.com
EJECTION FRACTION • In a healthy man, the SV is approximately 70 ml and the left ventricular EDV is 120 ml, giving an ejection fraction of 70/120, or 0.58 (58%). • Healthy individuals typically have ejection fractions between 50% and 65% www.medicalppt.blogspot.com
METHODS OF EF MEASUREMENT • CARDIAC CATHETRISATION • RADIONUCLEOTIDE STUDIES • ANGIOCARDIOGRAPHY
www.medicalppt.blogspot.com
CARDIAC INDEX • Cardi ac index (CI ) i s a vasodynami c parameter that rel ates the cardi ac output to body surf ac e area • uni t of measurement is (l/mi n/m2 ) • normal range of cardiac index is 2.6 - 4.2 L/min per square meter. www.medicalppt.blogspot.com
ANAESTHETIC
• Halothaane isoflurane and CONSIDERATION
enflurane depress SA node automaticity. • IV induction agent have limited effect on usual clinical doses. • Opioids can depress cardiac conduction. • LA associated with systemic toxicity. www.medicalppt.blogspot.com
GOALS OF ANAESTHESIA IN CVS DISEASES • PREMEDICATE BY BZP’S • BLUNT RESPONSE BY LARYGOSCOPY N INTUBATION • AVOID TACHYCARDIA • AVOID HYPOCAPNIA
www.medicalppt.blogspot.com
THANK YOU www.medicalppt.blogspot.com
FOR MORE MEDICAL PRESENTATIONS VISIT www.medicalppt.blogspot.com
www.medicalppt.blogspot.com
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