Cardiac Anatomy & Physiology 2025 PDF

Welcome to DPT 611 Cardiovascular Rehabilitation! Overview of course - What you should learn! Communication Preferences FNIBBLE due by the end of week 3 Cardiovascular Risk Factors, CV Anatomy & Physiology DPT 611 Cardiovascular Rehabilitation Lora Packel PT, PhD Spring 2025 Learning Objec...

Welcome to DPT 611 Cardiovascular Rehabilitation! Overview of course - What you should learn! Communication Preferences FNIBBLE due by the end of week 3 Cardiovascular Risk Factors, CV Anatomy & Physiology DPT 611 Cardiovascular Rehabilitation Lora Packel PT, PhD Spring 2025 Learning Objectives At the end of this module, students should be able to: State the normal anatomy and physiology of the cardiovascular and lymphatic system (as it relates to CV disease) State risk factors for cardiovascular disease Interpret/Categorize risk factors State fundamental principles in exercise physiology related to the cardiovascular system Define the movement system and utilize it to direct examination of a mock patient with cardiovascular disease Cardiovascular Anatomy With a classmate, draw the heart inclusive of valves, and the branches of the aorta. We will discuss coronary arteries soon, so leave these off your diagram for now. Do not scroll ahead in the presentation Heart – Gross Anatomy Three layers ○ Epicardium – outermost layer (visceral pericardium and parietal pericardium) ○ Myocardium – middle muscular layer responsible for contraction Myocardial cells have: Automaticity – ability to contract in the absence of a stimuli Rhythmicity – ability to beat in a “pattern” Conductivity –ability to transmit nerve impulses. ○ Endocardium – innermost layer Heart – Gross Anatomy BASE of the heart is the cephalad (cranial) portion and tilted posteriorly APEX is the most inferior portion around the 5th intercostal space 2/3rds of the heart lies to the left of the sternum Blood Flow and the Cardiac Cycle Pair & Share – with your classmate, discuss and draw how blood flow moves through the heart and be ready to report out!! Don’t look ahead! https://www.quora.com/What-type-or-types-of-blood-flow-through-the-heart Base of the heart APEX of the Heart  Nervous System Influence on the Heart The ANS influences heart rate and contractility through: ○ Vagus nerve – parasympathetic input Influences the sinoatrial (SA) node to decrease heart rate ○ Sympathetic trunk (T1-T5) – sympathetic input Influences the SA node to increase heart rate (Chronotropy) Influences the myocardium to increase contractility (Inotropy) ○ Beta1 receptors where epinephrine and norepinephrine bind to increase HR and contractility Coronary Circulation Aortic Sinuses of Valsalva give rise to the Right Coronary Artery and the Left Coronary artery. ○ Arteries are epicardial (lie on heart surface) and have endocardial branches that feed the myocardium. Left Main coronary artery splits into ○ Left anterior descending (LAD) Feeds anterior wall of LV ○ Left circumflex (LCX) Feeds LA, lateral and posterior wall of LV Anterior view of the heart depicting major vessels and coronary circulation. Citation: Chapter 4 Anatomy of the Cardiopulmonary System, DeTurk WE, Cahalin LP. Cardiovascular and Pulmonary Physical Therapy: An Evidence-Based Approach, 3e; 2017. Available at: https://login.ezproxy.sju.edu/ Accessed: June 09, 2022 Copyright © 2022 McGraw-Hill Education. All rights reserved  Coronary Arteries Right Coronary Artery ○ Feeds the right side of the heart ○ In the majority of people, RCA feeds both SA and AV node “Right dominant” Arteries are compressed during systole, so myocardium is fed during diastole ○ Diastolic blood pressure is the key determinant of coronary artery perfusion There is a high rate of oxygen extraction/delivery in the coronaries so if the heart needs more oxygen, this primarily happens by increasing the rate of blood moving through the coronaries (heart rate) Anatomy of Peripheral Arteries, arterioles, capillaries, venules, veins, and lymphatics! Arterial system – three layers ○ Intima – innermost layer ○ Media – middle layer that contains contractile tissue; important for blood pressure, oxygen delivery ○ Adventitia – outer layer Large arteries (like aorta) have more elastic https://en.wikipedia.org/wiki/Artery properties whereas smaller arterioles and capillaries have more muscular properties Venules and Veins Veins carry deoxygenated blood back to the heart Veins have little muscular layer, but have valves for one-way flow Lymphatics are one-way vessels with valves that help with fluid balance and are part of the immune system ○ Lymphatics carry excess fluid and large proteins back to the heart ○ More details in the medical management courses Fundamentals of cardiovascular physiology Movement is dependent upon the cardiovascular system! therapy https://clinicalgate.com/oxygen-transport-the-basis-of-cardiovascular-and-pulmonary-physical- / Neural and hormonal input to heart Electrical system Mechanical system ○ Pumping ability ○ Relaxation ability ○ Valve function Coronary artery function Lungs – ability to exchange gas Hemoglobin concentration and function Peripheral artery function Myoglobin function Cardiac Cycle Systole & Diastole During ventricular systole…. The AV valves are open/closed? The Semilunar vales are open/closed? You should be able to answer this question if I ask about valves during ventricular diastole…. Fundamentals of Cardiac Physiology Cardiac output (CO) – volume of blood ejected from the heart to the periphery each minute ○ CO = SV x HR ○ @ 4-8 L/min Stroke volume (SV)– volume of blood ejected from the heart with each contraction Ejection fraction (EF)– the percentage of blood in the LV ejected with each beat ○ 50-75% is normal Preload – volume of blood returning to the heart and placing a stretch on the LV Afterload – pressure against which the heart has to pump Peripheral Circulation Resistance in the peripheral circulation makes it harder for the heart to pump effectively ○ Increases myocardial oxygen demand Skeletal muscle ○ At rest, there is resistance to blood flow as the muscle doesn’t need a lot ○ During activity, metabolism increases which triggers hemoglobin to release oxygen Oxygen diffuses into muscle and attaches to myoglobin Myoglobin can release oxygen to the mitochondria to fuel the electron transport chain to make ATP for muscle contraction A-vO2 arterial – venous difference ○ Indicates how much oxygen is being used by the system Risk Factors for Heart Disease How many can you name? Risk Factors Review from exercise physiology and know normative values and recommended levels! This content will appear on your next assessment! Major Risk Factors for Heart Disease and Stroke Hypertension ○ *know stages of HTN (Clinical Practice 1) High cholesterol ○ Total cholesterol is HDL + LDL + 20%Triglyceride level ○ Elevated low-density lipoprotein (LDL), Low HDL, or high triglycerides increase risk Diabetes Obesity and Overweight ○ Know criteria (exercise physiology) Smoking (first or second hand) HDL targets: > 40 mg/dL MEN > 50 mg/dL WOMEN Major Risk Factors Continued Physical inactivity Male gender ○ After the age of 65, risk of heart disease is equal between males and females ○ Around age 50, women’s risk increases as estrogen decreases Heredity & Race ○ Parents or siblings with heart or circulatory problems before age 55 increases your risk ○ Higher prevalence of HTN in blacks ○ Higher prevalence of obesity and smoking in Mexican—Americans, AI, Hawaiians, and some Asian-Americans Age ○ Older age increases risk  Diabetes and Heart Disease Full pathophysiology of diabetes will be covered in medical management courses. There are two main types of diabetes: Diabetes Type I (auto-immune) and Diabetes Type II (acquired) Key to both is insulin resistance or absence. Insulin brings glucose into the cell for metabolism. When this isn’t available, the body harnesses fats for energy. Higher glucose levels are found in the blood as glucose can’t enter the cells effectively.  Diabetes High blood glucose damages blood vessels, nerves that control blood vessels as well as most other organ/body systems. Those with diabetes have 2x risk for: ○CAD ○MI ○CVA ○Heart failure ○Tend to have higher: Total cholesterol LDL Triglycerides Blood pressure  Diabetes: Macrovascular Changes Coronary artery disease in people with diabetes: ○Develops earlier – look for signs in younger patients ○CAD tends to be more widespread in multiple vessels Cardiovascular autonomic neuropathy ○Damages autonomic nerves that innervate heart and blood vessels Orthostasis Exercise intolerance due to lower cardiac output and resting tachycardia SILENT myocardial infarction Contributing Risk Factors Stress ○ Raises BP, increases myocardial oxygen demand ○ Increased adrenaline which elevates BP and damages lining of vessels ○ Increases blood clotting Birth Control pills ○ Risk increased if older than 35, smoke, or if have HTN Alcohol Intro to Simulation What happens in Vegas, stays in Vegas On Thursday ½ of class will go up to the SIM center and ½ will come to class for a lecture. After about 50 minutes, you’ll swap places. BEFORE THURSDAY: 1) Check posted schedule 2) View 3 minute video of Sim Space 3) View quick PP of simulation introduction 4) Goals for simulation exposure a) Familiarize yourself with sim center to lessen anxiety about sims! b) Familiarize yourself with the room, control center, sim principles, feedback, and general sequence of simulations c) Begin to gain comfort with typical lines and monitoring in an acute care setting d) Begin to gain comfort with a hospital bed and how to mobilize an acute care patient