Compendium
CVS II
Baroreflex
• Inotropic
• Chronotropic
• Dromotropic
• Batmotropic
effect
Aferent pathway
Parasympathetic pathway
Sympathetic pathway
BP=HR x SV x R
R
HR
BP=HR x SV x R
Regulation of blood circulation upon
orthostasis
https://www.researchgate.net/publication/3
43407493_Addressing_Orthostatic_Hypote
nsion_in_Heart_Failure_Pathophysiology_
Clinical_Implications_and_Perspectives
RAAS
Natriuretic peptides
https://heart.bmj.com/content/103/20/1569
Valsalva maneuver
Pulse wave
Reflected wave
Forward systolic wave
t [s]
P[mmHg]
t [s]
P[mmHg]
SBP
DBP
PP=SBP – DBP
mBP=DBP+1/3PP
mBP
Higher arterial stiffness
Factors of arterial stiffness changes
̶ Elastin degradation
̶ Collagen deposition
̶ Endothelial dyfunction
Complications of the higher arterial
stiffness
̶ ↑SBP
̶ ↓DBP
̶ ↑PP
Ultrasound measurement
age IMTR (mm) IMTL (mm)
PWV
A highly compliant aorta has a relatively low PWV (< 6 m/s)
Methods of the arterial blood pressure
measurement
24-hour blood pressure
monitoring
Palpatory
(sphygmomanometer)
Auscultatory
(sphygmomanometer,
stethoscope)
Oscillometric
Photoplethysmographic
(volume-clamp method, Peňáz)
Photoplethysmography
Control
system
Constant finger volume
pressureControl system:
Correction of the pressure in the finger
cuff according to the arterial lumen
changes.
Aim: maintaining of constant arterial
lumen through pressure changes in
the cuff.
cuff
SBP
DBP
Variability of circulatory parameters
amplitude
time (s) frequency (Hz)
T=50 s
T=10 s
T=3 s
a=0.5
a=0.3
a=0.2
period T amplitude a frequency f = 1/T
f = 1/3 = 0.33 Hz
f = 1/10 = 0.1 Hz
f = 1/50 = 0.02 Hz
0.5
0.2
0.3
+
+
=
+
+
=
0.5
0.2 0.3
0.330.02 0.1
f = 0,02 Hzf = 0,1 Hzf = 0,33 Hz
Spectrum
Frequency domainTime domain
Elsevier, Boron and Boulpaep, Medical Physiology, Updated edition
Variability of circulatory parameters
Autoregulation of cardiac contraction
̶ Heterometric autoregulation
̶ Homeometric autoregulation
Resting filling Ideal filling Overstretch
time
Force of
contraction
Bowditch effect
Intracellular Ca
vs.
Extracellular Ca
Phlebogram
̶ Atrial systole (a)
̶ Isovolumetric contraction (c)
̶ Ejection phase (x)
̶ Isovolumetric relaxation (d)
̶ Filling phase (y)
Phlebogram
Determinnts of cardiac perfprmance
Determinnts of cardiac perfprmance
Contractility = Force of contraction
Contractility => Force of contraction
Contractility = ability for contraction
ATP, Ca, O2
Contractility
EF=
𝑆𝑉
𝐸𝐷𝑉
100%
EF>60%
𝑑𝑃
𝑑𝑡
=
𝐷𝐵𝑃 − 𝐸𝐷𝐵𝑃
𝐼𝑉𝐶
𝑑𝑃
𝑑𝑡
𝑚𝑎𝑥
dP
dt
max
dP
dt
P [mmHg]
t [s]
Contractility
Emax =
dP
dV
Index podle Sagawa-Suga
𝐄 𝐦𝐚𝐱 𝟏
A
B1
P [mmHg]
V [ml]
𝐄 𝐦𝐚𝐱 𝟐
A
B2
P [mmHg]
V [ml]
Thank you for your attention