Pharmacology Notes

Owner: Samantha Anne Nicole S. Sanchez

DO NOT DISTRIBUTE WITHOUT MY CONSENT!!
○​ Pumps blood to the
CHAPTER 21: Review of Cardiac entire body (systemic
Physiology and Pathology circulation)
○​ Thickest wall →

🔹 Overall Function of the Circulatory

System
generates
pressure
highest

🔹 Myocardium (Cardiac Muscle)

●​ Responsible for continuous blood
flow throughout the body
●​ Maintains homeostasis by:
○​ Delivering oxygen (O₂) and ●​ Middle layer of the heart wall
nutrients ●​ Composed of specialized striated
○​ Removing carbon dioxide muscle cells
(CO₂) and metabolic ●​ Responsible for forceful
wastes contraction
○​ Transporting hormones
and immune components 📌 Key Functions:
●​ Works closely with respiratory,
renal, and endocrine systems ●​ Produces arterial blood pressure
●​ Ensures forward flow of blood
●​ Works in a synchronized manner

🔹 Heart: Structure and Function

(functional syncytium)

📌 Important Concept:
●​ A muscular organ that acts as a
pump ●​ Strength of contraction affects
●​ Generates the pressure gradient cardiac output (CO)
needed for blood circulation ●​ Damage to myocardium → ↓
●​ Located in the mediastinum of pumping ability
the thoracic cavity

📌 Chambers of the Heart 🔹 Coronary Circulation

1.​ Right Atrium (RA)
○​ Receives deoxygenated ●​ The heart has its own blood
blood from systemic supply system
circulation
2.​ Right Ventricle (RV) 📌 Coronary Arteries:
○​ Pumps blood to the
●​ Arise from the ascending aorta
lungs (pulmonary
●​ Supply oxygen and nutrients to
circulation)
myocardium
3.​ Left Atrium (LA)
○​ Receives oxygenated
blood from lungs
📌 Key Idea:
4.​ Left Ventricle (LV)
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
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●​ Coronary blood flow occurs ○​ Previous damage (e.g.,
mainly during diastole MI)
●​ Blockage → ischemia → can ●​ Results in:
lead to infarction ○​ Fluid accumulation
(edema)
○​ Reduced tissue

🔹 Cardiac Conduction System perfusion

●​ Network of specialized
electrical cells in the heart Coronary Artery Disease (CAD)
●​ Ensures coordinated
contraction of atria and ●​ Caused by atherosclerosis
ventricles (plaque buildup in arteries)

📌 Major Components: ●​ Leads to:

○​ Narrowed
arteries
coronary

1.​ SA Node (Sinoatrial Node) ○​ Reduced blood flow to

○​ “Pacemaker” of the myocardium (ischemia)
heart
○​ Initiates electrical
impulse
2.​ AV Node (Atrioventricular Myocardial Infarction (MI)
Node)
○​ Delays impulse → allows ●​ Occurs when coronary artery is
ventricular filling completely blocked
3.​ Bundle of His → Bundle ●​ Leads to:
Branches → Purkinje Fibers ○​ Death of myocardial tissue
○​ Rapidly conduct ●​ Commonly caused by:
impulses to ventricles ○​ Ruptured atherosclerotic

📌 Function:
plaque + thrombosis

Cardiac Muscle (Myocardium)

●​ Maintains rhythmic heartbeat
●​ Coordinates atria contract first,
then ventricles
🔹 Basic Concept
🔹 Major Cardiovascular
(VERY HIGH YIELD)
Diseases
●​ The myocardium (cardiac
muscle) is responsible for the
pumping ability of the heart
●​ Organized into 4 chambers:
Chronic Heart Failure (CHF) ○​ 2 atria (receiving
chambers)
●​ Condition where the heart ○​ 2 ventricles (pumping
cannot pump enough blood chambers)
●​ Causes:
○​ Weak myocardium 📌 Key Function:
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
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●​ Contraction → ↑ pressure in
chambers → blood is pushed
📌 Function:
forward ●​ Prevent backflow of blood
●​ Ensures unidirectional blood ●​ Maintain efficient forward flow
flow through valves

🔹 Role of Myocardial Contraction

🔹 Step-by-Step Blood Flow (VERY
HIGH YIELD – memorize sequence!) ●​ Ventricular contraction

📍
(systole) generates:
Systemic → Pulmonary → ○​ High pressure → drives
Systemic Cycle blood into circulation
●​ Strength of contraction
1.​ Body → Right Atrium determines:
○​ Blood returns via: ○​ Cardiac output (CO)
■​ Superior vena ○​ Tissue perfusion
cava
■​ Inferior vena cava
○​ Blood is deoxygenated
2.​ Right Atrium → Right Ventricle 🔹 Coronary Circulation
Supply of the Heart)
(Blood
○​ Through tricuspid valve
3.​ Right Ventricle → Lungs
○​ Via pulmonary arteries ●​ Myocardium is supplied by
○​ Function: gas exchange coronary arteries
(CO₂ out, O₂ in) ●​ These arteries:
4.​ Lungs → Left Atrium ○​ Branch from the aorta
○​ Via pulmonary veins immediately after it
○​ Blood is now leaves the heart
oxygenated
5.​ Left Atrium → Left Ventricle 📌 Important Concept:
○​ Through bicuspid
●​ Coronary perfusion depends
(mitral) valve
on:
6.​ Left Ventricle → Aorta → Body
○​ Adequate blood flow
○​ Blood pumped into aorta
○​ Proper myocardial
○​ Distributed to entire
function
body (systemic
circulation)

🔹 Ischemia (VERY HIGH YIELD)

🔹 Key Valves (Direction Control) ●​ Ischemia​
= Reduced blood supply to the
●​ Tricuspid valve → RA → RV
myocardium
●​ Bicuspid/Mitral valve → LA →
LV
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
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📌 Causes: ⚡ Cardiac Conduction
High Yield Notes
System –

●​ Decreased coronary blood flow

●​ Obstruction (e.g., plaque, clot)

📌 Effects: 🔹 Basic Concept

●​ ↓ Oxygen delivery ●​ The cardiac conduction system
●​ ↓ ATP production is made of specialized cardiac
●​ ↓ Contractility of myocardium cells (modified muscle cells)
➡️ Leads to: ●​ Functions as the electrical
control system of the heart
●​ Located in specific regions
●​ Weak pumping ability within the heart walls
●​ Possible progression to:
○​ Myocardial Infarction

🧠 Quick Flow Mnemonic 🔹 Key Property: Autorhythmicity

👉 “Body → RA → RV → Lungs → LA
→ LV → Body”
(VERY HIGH YIELD)

●​ Ability of cardiac cells to

generate electrical impulses
spontaneously
●​ The heart does NOT need
external nerve stimulation to
beat

📌 Controlled by:
●​ Intrinsic pacemaker activity
●​ Modulated (not initiated) by
autonomic nervous system

Sequence of Electrical Conduction

📍 Step-by-Step Pathway:
1.​ SA Node (Sinoatrial Node)
○​ Located in right atrium
○​ Known as the natural
pacemaker
○​ Initiates electrical
impulse
2.​ Impulse spreads through atria
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
DO NOT DISTRIBUTE WITHOUT MY CONSENT!!
○​ Causes atrial

3.​ AV
depolarization → atrial
contraction
Node (Atrioventricular
🔹 Functional Importance
Node) ●​ Maintains rhythmic heartbeat
○​ Located between atria ●​ Ensures synchronization of
and ventricles cardiac cycle
○​ Delays impulse briefly ●​ Prevents inefficient or chaotic

📌 Importance of delay: contractions

●​ Allows ventricles to fill with

blood before contraction 🔹 Clinical Correlation (HIGH YIELD)
⚠️ Conduction Problems Can Cause:
4.​ AV Bundle (Bundle of His) ●​ Arrhythmias (irregular
○​ Only electrical heartbeat)
connection between ●​ Delayed or blocked impulses
atria and ventricles
5.​ Right & Left Bundle Branches 📌 Examples:
○​ Conduct impulse down
the interventricular ●​ SA node dysfunction →
septum abnormal heart rate
6.​ Purkinje Fibers ●​ AV node block → impaired
○​ Distribute impulse atrial-ventricular conduction
throughout ventricular
walls
○​ Cause rapid,
coordinated ventricular 🔹 Key Relationships (Exam Focus!)
contraction
●​ SA node = initiates impulse
●​ AV node = delay (critical for
filling)
🔹 Overall Result of Conduction ●​ Purkinje
conduction
fibers = fastest

●​ Atria contract first, then ●​ Electrical activity →

ventricles contract mechanical contraction
●​ Ensures:
○​ Efficient blood filling
○​ Strong blood ejection
🧠 Quick Mnemonic
📌 Both sides of the heart: 👉 “SA → AV → Bundle of His →
●​ Contract simultaneously Bundle Branches → Purkinje”
●​ Pump equal amounts of blood
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
DO NOT DISTRIBUTE WITHOUT MY CONSENT!!
○​ Conduction
abnormalities
○​ Ischemia or infarction

🔹 Key ECG Waves & What They

Represent

📈 P Wave
●​ Represents atrial
depolarization
●​ Corresponds to:
⚡🫀 Electrocardiogram
High Yield Notes
(ECG) –
○​ Atrial contraction

📉 QRS Complex
🔹 Basic Concept ●​ Represents
depolarization
ventricular

●​ An electrocardiogram (ECG) is ●​ Impulse travels:

a recording of the electrical ○​ AV node → Bundle of His
activity of the heart → Purkinje fibers
●​ Reflects:
○​ Depolarization
(activation/contraction)
📌 Important:
○​ Repolarization ●​ Largest waveform (ventricles
(recovery/relaxation) have more muscle mass)

🔹 12-Lead ECG System 📈 T Wave

(IMPORTANT)
●​ Represents ventricular
●​ Standard ECG uses 12 leads repolarization
(views) ●​ Ventricles return to resting
●​ Each lead provides a different state
electrical perspective of the
heart

📌 Importance: 🔹 Key Intervals (VERY HIGH YIELD)

●​ Helps detect: ⏱️ PR Interval
○​ Arrhythmia
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
DO NOT DISTRIBUTE WITHOUT MY CONSENT!!
●​ From start of P wave → start of ●​ QRS = ventricular activity
QRS (most important clinically)
●​ Represents: ●​ PR interval = AV conduction
○​ Time for impulse to time
travel from SA node → ●​ QT interval = total ventricular
AV node activity

📌 Clinical relevance:
●​ Prolonged PR → possible AV
block
🔹 Clinical Significance
●​ ECG is used to detect:
○​ Arrhythmia (irregular
⏱️ QT Interval rhythms)
○​ Conduction delays or
blocks
●​ From start of QRS → end of T ○​ Myocardial damage (e.g.,
wave infarction)
●​ Represents:
○​ Total time for ventricular
depolarization +
📌 Abnormal findings:
repolarization ●​ Changes in wave shape, size,
📌 Important: or timing
●​ Values outside normal ranges
→ indicates pathology
●​ Prolonged QT → risk of
dangerous arrhythmias

🔹 Lead II (Common Reference)

🔹 Sequence of Electrical
(Link to Conduction System)
Events ●​ Often used for:
○​ Demonstrating classic
ECG waveform
1.​ SA node fires → P wave ●​ Shows clear:
2.​ Impulse delayed at AV node → ○​ P wave
PR interval ○​ QRS complex
3.​ Rapid conduction through ○​ T wave
ventricles → QRS complex
4.​ Ventricles recover → T wave

Quick Mnemonic
🔹 Key Concepts (Exam Favorites!) 👉 “P = Atria, QRS = Ventricles, T =
Recovery”
●​ Depolarization = contraction
●​ Repolarization = relaxation
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
DO NOT DISTRIBUTE WITHOUT MY CONSENT!!
Cardiac Nerve Supply (Autonomic ○​ ↑ Conduction velocity
Control) – High Yield Notes (positive dromotropic
effect)
3.​ Myocardium

🔹 Basic Concept ○​ ↑ Contractility (positive

inotropic effect)

●​ The heart is innervated by the

autonomic nervous system
(ANS):
○​ Sympathetic division
📌 Overall Effect:
○​ Parasympathetic ●​ ↑ Cardiac output (CO)
division ●​ Prepares body for increased

📌 Key Idea: energy demand

●​ The heart has autorhythmicity

(can beat on its own)
●​ ANS function = modulate
🔹 Parasympathetic Nervous System
(PNS)
(regulate), NOT initiate
heartbeat ●​ Dominant during:
○​ Rest
○​ Digestion

🔹 Sympathetic
(SNS)
Nervous System
○​ Sleep

📌 Neurotransmitter:
●​ Activated during: ●​ Acetylcholine (ACh)
○​ Stress ●​ Acts on muscarinic receptors
○​ Exercise (M₂ receptors)
○​ Fight-or-flight response

📌 Neurotransmitter: 📌 Effects on the Heart:

●​ Norepinephrine (NE)
●​ Acts on adrenergic receptors 1.​ SA Node
(mainly β₁ receptors) ○​ ↓ Heart rate (negative
chronotropic effect)
2.​ AV Node

📌 Effects on the Heart: ○​ ↓ Conduction velocity

(negative
effect)
dromotropic

1.​ SA Node 3.​ Myocardium

○​ ↑ Heart rate (positive ○​ Minimal effect on
chronotropic effect) contractility
2.​ AV Node
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
DO NOT DISTRIBUTE WITHOUT MY CONSENT!!
🔹 Pathophysiology
📌 Overall Effect: ●​ Blood accumulates in heart
chambers → dilatation
●​ ↓ Cardiac activity (enlargement)
●​ Promotes energy conservation ●​ ↓ Blood flow to organs → poor
(“rest-and-digest”) perfusion

Integration with Conduction System 📌 Kidneys response:

●​ SA node = primary target for HR ●​ Detect ↓ blood flow
control
●​ AV node = controls conduction
timing
➡️
●​ Retain water + electrolytes​
Leads to:
●​ Fluid retention
●​ Myocardium mainly affected by ●​ Edema
sympathetic stimulation
🔹 Types of Heart Failure
Clinical Correlation (HIGH YIELD)

●​ Excess sympathetic activity →

🫁 Left-Sided Heart Failure
○​ Tachycardia ●​ Blood backs up into lungs
○​ Increased workload of ●​ Causes:
heart ○​ Pulmonary edema
●​ Excess parasympathetic activity ○​ Shortness of breath
→ (dyspnea)
○​ Bradycardia ○​ Impaired gas exchange
○​ Possible
delays
conduction
🦵 Right-Sided Heart Failure
●​ Drugs often target these systems:
○​ β-blockers → ↓ HR & ●​ Blood backs up into systemic
contractility circulation
○​ Anticholinergics → ↑ HR ●​ Causes:
○​ Ascites (fluid in abdomen)

🫀
○​ Peripheral edema (legs,
Main Diseases of the Heart – High feet)
Yield Notes
📌 Key Concept:
●​ Left failure → Right failure →
🔴 Chronic Heart Failure (CHF) Total heart failure

🔹 Basic Concept 🔹 Treatment (General)

●​ Diuretics → ↓ fluid overload
●​ Heart has ↓ contractile ability ●​ Vasodilators → ↓ workload
●​ Pumps less blood than it
receives
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
DO NOT DISTRIBUTE WITHOUT MY CONSENT!!
●​ Beta blockers → ↓ cardiac ●​ Chest pain due to reduced
stress coronary blood flow
●​ Cardiac
contractility
glycosides → ↑
🔹 Causes
🔴 Coronary Artery Disease (CAD) ●​ Atherosclerosis
●​ Arteriosclerosis
🔹 Basic Concept ●​ Coronary artery spasm

●​ Reduced blood flow through 🔹 Triggers

coronary arteries
●​ Leads to myocardial ischemia ●​ Physical exertion
●​ Emotional stress

🔹 Relief
🔹 Major Underlying Conditions ●​ Rest
🧱Arteriosclerosis ●​ Antianginal drugs

●​ Hardening & narrowing of 🔹 Key Idea

arteries (aging-related)
●​ ↓ Elasticity → ↓ blood flow ●​ Temporary ischemia (no
permanent damage)
Atherosclerosis (VERY HIGH YIELD) ●​ Warning sign for possible MI

●​ Type of arteriosclerosis
●​ Caused by:
○​ Cholesterol-rich plaque Myocardial Infarction (MI)

🔹 Basic Concept
buildup

📌 Effects:
●​ Death of heart muscle due to
●​ Narrowed arteries lack of blood supply
●​ ↓ Coronary blood flow
●​ ↑ Risk of clot formation 🔹 Cause
🔹 Clinical Importance ●​ Complete blockage of coronary
artery
●​ CAD is a major cause of: ●​ Usually due to:
○​ Angina Pectoris ○​ Blood clot (thrombus)
○​ Myocardial Infarction ○​ Forms on atherosclerotic

🔴 Angina Pectoris plaque

🔹 Pathophysiology
🔹 Definition
Pharmacology Notes
Owner: Samantha Anne Nicole S. Sanchez
DO NOT DISTRIBUTE WITHOUT MY CONSENT!!
●​ ↓ Blood flow → ↓ oxygen → cell
death (necrosis)

🔹 Outcomes
Severe MI:

●​ Sudden death

Less Severe MI:

●​ Healing occurs:
○​ Dead tissue replaced by
fibrous (connective)
tissue
○​ ↓ Contractile ability

🔹 Complications
YIELD)
(VERY HIGH

●​ Heart failure (CHF)

●​ Arrhythmias (conduction system
damage)

🔹 Treatment
●​ Anticoagulants → prevent clot
formation
●​ Fibrinolytics → dissolve clot
●​ Supportive care:
○​ Rest
○​ Monitoring
○​ Rehabilitation