Dewi Irawati MD, MS

Dept.of Physiology
FMUI

Everyday Activities

High concentration
work
White collar
Routine activities

Sedentary Life

Heavy physical
work

Special conditions

Pregnancy

Obesity

Exercise

Extreme conditions

Deep-sea diving

High-altitude

Starvation

What the .........

Stressful situation

Cardiovascular Adjustment
To meet Oxygen demand
Maintain Homeostasis

Transport System

Cardiovascular Function
Rapid convective transport of O2, glucose, amino

acids, fatty acids, vitamin, drugs and water.

Rapid washout of waste products
Part of a control system distribution/secretion
of hormones
Temperature regulation
Role in reproduction hydraulic mechanism for
penile erection

How does the Heart function?

Act as a pump
Contraction - Relaxation

Excitable tissue
Electrical event
Mechanical event

Life style

Coffee & alcohol

Food

Smoking

Influences the cardiovascular response

Case illustration:

Wake-up Call (part 1)

It was 4:30 a.m. She was in cold sweat and having
difficulties breathing. She felt as though she had run a
marathon. Fear swept through her-something terrible was
going to happen. Panic-stricken, she woke up her
husband, Jeremy.
Denise, what is it? Is it a nightmare?
No, its like Im having an asthma attack. I feel
lightheaded and I cant catch my breath. My heart feels
like its beating irregularly a thousand times a minute.

Questions
1. How likely is this to be a heart problem? Asthma?

Panic attack?
2. What are the symptoms that are consistent with
your preliminary diagnosis?
3. What are the underlying mechanisms of those
symptoms?
Keywords:
lightheaded, difficulty in breathing, increased heart
rate, irregular heart beat

Knowledge needed:
How is the normal heart beat conducted?
Electrical events of the heart

Action potential of autorhythmic cells

Action potential of contractile cells
Spread of action potential throughout the heart

What influences frequency of the heart beat?

Neural regulation of the heart
Others.......??
What are the consequences of irregular heart beat?
Regulation of normal cardiac output

Knowledge needed:
Distribution of normal blood flow
Hemodynamic laws
Characteristics/properties of various blood vessels
Vascular regulation:

Central regulation
Local/peripheral regulation

HEART ANATOMY & HISTOLOGY

Functional Anatomy of the Heart

Chambers

4 chambers
2 Atria
2 Ventricles

2 systems
Pulmonary
Systemic

Functional Anatomy of the Heart

Valves

Function is to prevent backflow

Atrioventricular Valves
Prevent backflow to the atria
Prolapse is prevented by the chordae
tendinae
Tensioned by the papillary muscles
Semilunar Valves
Prevent backflow into ventricles

Functional Anatomy of the Heart

Intrinsic Conduction System
Consists of

pacemaker cells
and conduction
pathways
Coordinate the
contraction of the
atria and ventricles

Conduction System of the Heart

Coordinating the pump:

Electrical signal flow

Myocardial Physiology
Autorhythmic Cells (Pacemaker Cells)

Characteristics of Pacemaker Cells

Myocardial Physiology
Autorhythmic Cells (Pacemaker Cells)

Altering Activity of Pacemaker Cells

Sympathetic activity
NE and E increase If channel activity

Binds to 1 adrenergic receptors which activate cAMP and

increase If channel open time
Causes more rapid pacemaker potential and faster rate of action
potentials

Sympathetic Activity Summary:

increased chronotropic effects
heart rate
increased dromotropic effects
conduction of APs
increased inotropic effects
contractility

Myocardial Physiology
Autorhythmic Cells (Pacemaker Cells)

Altering Activity of Pacemaker Cells

Parasympathetic activity
ACh binds to muscarinic receptors

Increases K+ permeability and decreases Ca2+ permeability =

hyperpolarizing the membrane
Longer time to threshold = slower rate of action potentials

Parasympathetic Activity
Summary:
decreased chronotropic effects
heart rate
decreased dromotropic effects
conduction of APs
decreased inotropic effects
contractility

Myocardial Physiology
Contractile Cells

Skeletal Action Potential vs Contractile Myocardial

Action Potential

Myocardial Physiology
Contractile Cells

Plateau phase prevents summation due to the

elongated refractory period

No summation capacity = no tetanus
Which would be fatal

Summary of Action Potentials

Skeletal Muscle vs Cardiac Muscle

YOUR TASK
MAKE COMPARISON OF ACTION POTENTIAL BETWEEN
SKELETAL AND CARDIAC MUSCLE
(CONTRACTILE AND AUTORHYTHMIC MYOCARDIUM)

Excitation-Contraction Coupling

The Cardiac Cycle

Coordinating the activity

The sequence of events

as blood enters the atria,

leaves the ventricles and
then starts over
Synchronized by the
Intrinsic Electrical
Conduction System
Influenced by the
sympathetic and
parasympathetic divisions
of the ANS

Seven phases

The Cardiac Cycle

Coordinating the activity

Electrical

Conduction
Pathway

The Cardiac Cycle

Coordinating the activity

The electrical system gives

rise to electrical changes

(depolarization/
repolarization) that is
transmitted through isotonic
body fluids and is recordable
The ECG!
A recording of electrical
activity
Can be mapped to the cardiac
cycle

The Cardiac Cycle

Phases

Systole = period of contraction

Diastole = period of relaxation
Cardiac Cycle is alternating periods of systole and

diastole
Phases of the cardiac cycle
1.
2.
3.
4.
5.

Atrial filling (Rapid and Late phase), both atrium and ventricle
are relaxed (diastole)
Atrial Systole
Isovolumetric Ventricular Contraction
Ventricular ejection (Rapid and Late phase)
Isovolumetric Ventricular Relaxation

Back to Atrial & Ventricular Diastole

Wiggers
Curve
Correlation between:
Electrical events
Mechanical events
Heart sounds
Ventricular volume
During One Cycle

Autonomic
innervation of
the heart

Characteristic of various blood

vessels

Regulation of blood vessels

Case illustration:

Wake-up Call (part 2)

No, Denise thought to herself. Theres no way this was

a sign of heart troubles. I didnt have any pain in my

chest, Im physically fit, and I have no family history.
Theres just no way.
After assuring herself of this, Denise immediately stood
up to get a glass of water. Suddenly Denise felt faint and
passed out on the floor. Her face was as pale as a ghost.

Questions
Why didnt Denise feel any pain?
What causes Denise to faint upon standing up?
Why was her face pale?

Keywords:
Suddenly stood up, felt faint, passed out, pale

Knowledge needed:
Coronary circulation normal, disturbances
Parameters of the cardiovascular system
Heart rate
Stroke volume
Cardiac output
Cardiac index
Blood-pressure
Factors influencing cardiac output and blood pressure
Factors influencing blood flow abnormalities of the

blood vessels
Compensation mechanism of the cardiovascular system

Case illustration:

Wake-up Call (part 3)

Denise was in the early stages of menopause. She had

been on a strict diet since she gained weight, and doing
exercise as well. She only ate apples and water melon,
and drank nothing but water.
Jeremy, 48 years old, was diagnosed with coronary artery
disease. The scare had encouraged him to gradually end
years of chain smoking and adopt a healthier lifestyle. He
was currently working on giving up the occasional
cigarette for good.
I think you its about time you consult a doctor Jeremy
said.

Questions
What are the characteristics of Denises lifestyle/risk

factors that might lead to a heart problem?

What laboratory & supplementary diagnostic
examination should be conducted?

Keywords:
menopause, strict diet, exercise, chain smoking
husband, cardiovascular examination

Knowledge needed:
Factors influencing cardiovascular regulation
Hormonal
Dietary
Other
Cardiovascular risk factor
Exposure to harmful conditions
Cardiovascular examination
Non-invasive
Invasive

The Heart Sound

Electrocardiogram

Summary
What should be studied:
Electrical events of the heart
Mechanical events of the heart
Special properties of the heart
Regulation of the cardiovascular system
Parameters of the cardiovascular system
Laboratory & supplementary diagnostic examination
of the cardiovascular system

Websites
http://www.gwc.maricopa.edu/class/bio202/

cyberheart/cardio.htm
http://www.mic.ki.se/MEDIMAGES.html

ELECTROCARDIOGRAPH
Recording of electrical activity of the heart

(depolarization and repolarization of the

myocardial cells) through special electrodes
Human body: volume conductor ability to
conduct electrical activity in all direction
Significancy:
Overview of spread of action potential (action

potential summation of active cells), variates with

time, spread of impulse during one cycle.
Recording of electrical potential (voltage) difference
between two electrodes

ECG Recorder
Galvanometer, sensitive to electrical potential

changes
Active/recording electrode at 2 different points/site
Amplification of electrical potential difference
Recording apparatus - speed
Specific curve: amplitude (mV) and duration
(seconds)

Technique of recording an ECG

Special Graphic Paper:
Distance between 2 thin lines = 1 mm
Distance between 2 thick lines = 5 mm
Paper speed 25 mm/sec. ( 1 mm = 0.04 sec.)
Sensitivity: , 1 and 2 (1 mV = 5, 10 or 20 cm)

ECG Leads
Bipolar:
Potential difference between 2 active electrodes
Einthoven: I, II and III

Unipolar:
Potential diference between 1 active electrode and

indifferent electrode
Augmented extremity leads GOLDBERGER: aVR,
aVL and aVF
Precordial leads WILSON: V1, V2, V3, V4, V5 dan V6

ECG Curve

ECG Analysis
Normal rhythm: sinus rhythm
Every P wave is followed by QRS complex and T wave
All 12 lead

ECG Analysis
Heart rate:
60
P-P (R-R) interval (mm) X 0.04

ECG Analysis
P wave Lead II
Amplitude: < 0.25 mV
Duration: < 0.11 sec.

ECG Analysis

P-R interval Lead II

Amplitude: < 0.25 mV
Duration: < 0.2 sec.

ECG Analysis
QRS complex Lead V2 V3
Duration: < 0.12 sec.

QRS configuration: V1 V6
rS Rs
Transitional zone

ECG Analysis
QRS electrical heart axis
QRS T angle: < 70
I
Lead I: - 1 + 8 = +7

III
Lead III: - 2 + 12 = +10

ECG Analysis
S-T segment all leads
Iso-electric
Important clinical significance

ECG Analysis
T wave configuration all leads
Positive deflection except aVR and sometimes

V1

ECG Analysis
U wave
Late Purkinje cells depolarization
Unknown significance