Tutorial

NFNF3022
What happens in valve disease &
treatment?
• the heart can’t effectively pump blood
throughout the body
- blood is leaking back into the chamber
- Pump blood against a narrowed
opening.
• The heart has to work harder to pump
• lead to heart failure, sudden cardiac
arrest and death.

• Medicine and surgery (in severe cases)

What went wrong in heart attack?
• A heart attack occurs when an artery supplying your heart with blood
and oxygen becomes blocked.
What does it mean by angioplasty &
coronary by-pass?
• a tiny balloon in inserted at
the site of the blockage and
expands it, which widens the
narrowed artery.
• In most cases, a small metal
coil called a stent is placed in
the clogged artery to help
keep the artery open and
reduce the risk of it narrowing
again.
What does it mean by angioplasty &
coronary by-pass?
• During bypass surgery, a
section of healthy blood vessel
— often taken from inside the
chest wall or the lower leg — is
attached above and below the
blocked artery. This lets blood
flow around the blocked area
to the heart muscle.
What went wrong in heart failure?

• Heart failure, sometimes known as

congestive heart failure, occurs
when your heart muscle doesn't
pump blood as well as it should.
Certain conditions, such as narrowed
arteries in your heart (coronary
artery disease) or high blood
pressure, gradually leave
your heart too weak or stiff to fill
and pump efficiently.
Describe how does the heart obtain its nutrients and
oxygen?

• The right coronary artery mainly supplies the muscle of the

right ventricle.
• The left coronary artery quickly splits into two and supplies the
rest of the heart muscle.
• The main coronary arteries divide into many smaller branches
to supply all the heart muscle.
A B:d
B C: b
C  D: a
D  A: c

A-B: b
B-C: d
C-D: a
D-A: c
What is viscosity?

• A measure of fluid’s resistance to flow.

State TWO (2) determinants of blood pressure.

• Cardiac output (heart rate and stroke volume)

• Total peripheral resistance
 Describe electrical conduction system in the heart.
• Electrical conduction starts from SA node which contain natural pacemaker cell that
doesn’t rely on nervous system.
• It incorporates several component on heart region. SA node which located posterior
right atrium, produce action potential that conduct through intermodal pathway to
larger AV node which located near right AV valve.
• As the action potential is passing along the way, the conducting cells pass the
stimulus to contractile cells of both atria.
• The action potential then spreads across the atrial surfaces by cell-to-cell contact.
• The impulse arrived at AV node but enter it slowly as the nodal cell of AV node is
smaller than conducting cell of intermodal pathway.
• The impulse relaying within nodal cell is less efficient than in conducting cell.
• These produce a delay, allowing both atria contract completely before ventricle
contract and blood rush from atria to ventricle.
• After this brief delay, signal at AV node conducted to Bundle of His (aka
atrioventricular bundle) then branches to left and right bundle branches, Purkinje
Fibre at sides of ventricles and papillary muscle.
• Purkinje fibres then distribute the impulse to the ventricular myocardium, and
ventricular contraction begins
The rising phase of action potential in contractile myocardium and
autorhythmic myocardium is due to sodium ion and calcium ion entry,
respectively.
Describe how our body restored its normal blood pressure when there is an
increase in blood pressure?

• When the arterial blood pressure rises above the normal, the baroreceptors in
carotid sinuses and aortic arc stimulated.
• The impulse from the baroreceptors travels along the afferent nerves and
stimulate cardio-inhibitory centre which inhibit the cardio-acceleratory centre.
• This impulse also inhibit vasomotor centre.
• Stimulation of cardio-inhibitory centre will then causes the decreasing sympathetic
impulses to heart which eventually decrease heart rate and heart contractility.
• The inhibition of the vasomotor centre will decrease the rate of vasomotor
impulses which allow vasodilation.
• Both of these effects will causing the blood pressure to return to homeostatic
range.
How to ensure unidirectional blood
flow?
• The heart valves lie at the exit of each of your four heart chambers and maintain oneway blood flow
through your heart.
• The four heart valves make sure that blood always flows freely in a forward direction and that there is no
backward leakage.
• Blood flows from right and left atria into ventricles through the open tricuspid and mitral valves
respectively.
• When the ventricles are full, the tricuspid and mitral valves shut.
• This prevents blood from flowing backward into the atria while the ventricles contract.
• As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped
out of the ventricles.
• Blood from the right ventricle passes through the open pulmonic valve into the pulmonary artery, and
blood from the left ventricle passes through the open aortic valve into the aorta and the rest of the body.
• When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves shut. These
valves stop blood from flowing back into the ventricles.
• This pattern is repeated over and over with each heartbeat, causing blood to flow continuously to the
heart, lungs, and body.
How to minimise friction in the
heart?
• To minimize friction in the heart, the heart is encased with
pericardium which is the membranous fluid-filled sac. Pericadium
consist of fibrous pericardium, pericardial space and serous
pericardium (parietal layer, visceral layer and myocardium).
How does the heart contract (cellular & molecular)?

• Action potential in cardiac contractile cell will travel down T-tubules.

• This causes the entry of small amount of Ca2+ from extracellular fluid (ECF) through L-type
Ca2+ channels.
• The entry of this small amount of Ca2+ will trigger release of large amount of Ca2+ from
sarcoplasmic reticulum through ryonidine Ca2+ reease channels. These will increase cystolic
Ca2+.
• Ca2+ will bind at troponin causes troponin to change and shape and troponin-tropomyosin
complex in thin filament to pulled aside.
• This expose actin (myosin binding site) to myosin head in thick filament.
• The binding of actin and myosin will from cross bridge between thin filament and thick
filament.
• This will leads to thin filament slide inward between thick filament and cause contraction.
The heart will contract.
Describe homeostasis of blood
pressure.
Describe ion movements and state of ions channels in the action
potentials of autorhythmic and cardiac cells during depolarization,
repolarization and rapid repolarization.

Action potential Phase Autorythmic cell Cardiac cell

Depolarization Ca2+ channel opens and If Voltage –gated Na+
channel closes. Ca2+ enter channels open. Na= enter
the cell. the cells.
Repolarization Initial Repolarization:Na+
channel closes and K+
channels open causing Na+
cannot enter the cells and
K+ move out from cell.
Plateau: Ca2+ channel
opens and K+ channel close
causes Ca2+ enter the cells
and K+ do not move out
from cell. This lead to
plateau in membrane
potential.
Rapid Repolazation Ca2+ channel close and K+ Ca2+ channel close and K+
channels open. Ca2+ cannot channels open. Ca2+ cannot
enter the cells and K+ move enter the cells and K+ move
out from cell. out from cell.
Describe how heart rate can be reduced and
increased.

• Heart rate can increased be sympathetic nerve stimulation. Sympathetic nerve stimulation will
stimulate B1 receptor and causes influx of Ca2+ and Na+ into autorythmic cells. This will lead to
increase in depolarization and thus increase heart rate.
• Heart rate can be reduced by parasympathetic nerve stimulation. Stimulation of paraysmthetic nerve
will stimulate muscuranic receptor. Thus will cause efflux of K+ into autorythmic cell and causes
hyperpolarization. This will reduce rate of depolarization and lead to reduce in heart rate.
Explain how conduction system is physically
represented as an ECG.

• P wave indicate atrial depolarization, P-R segment indicate conduction

of impulse to AV node and AV bundle. QRS complex indicate
ventricular depolarization and T wave indicate ventricular
repolarization.
How ECG can be used to detect problems in the
conduction system.

• Problems in conduction system include second degree heart block,

atrial fibrillation and ventricular fibrillation. In second degree heart
block, conduction of atrial impulse through the AV node and/or His
bundle is delayed or blocked. The patient ECG will have many P
waves. In atrial fibrillation, the P complex can only be seen as coarse
wave because the action potentials fire very rapidly in a chaotic
manner. In ventricular fibrillation, the will be absent in P, QRS or T
wave because coordinated contraction of the ventricular myocardium
is replaced by high-frequency, disorganized excitation, resulting in
failure of the heart to pump blood.
A: (b) aortic valve opens
B: (d) aortic valve closes
C: (e) mitral valve closes
D: (c) mitral valve opens E: (a) end-diastolic
volume F: (f) end-systolic volume