curs 8 - mgsii.files. · pdf filecurs 8 ciclul cardiac (revolutia cardiaca) zgomote cardiace...
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CURS 8 CICLUL CARDIAC (REVOLUTIA CARDIACA) ZGOMOTE CARDIACE SOC APEXIAN
DEBIT CARDIAC
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CICLUL CARDIAC
• DEFINITIE sistola- contractie Diastola- relaxare Ciclul cardiac- toate evenimentele derulate pe parcursul unei batai cardiace
- perioada intre inceputul unei contractii cardiace si debutul contractiei urmatoare
Activitatea mecanica urmeaza evenimentelor electrice de
pe ECG.
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CICLUL CARDIAC
• 1. sistola atriala
• 2. sistola ventriculara
- contractie izovolumetrica
- contractie izotonica- ejectie rapida
- ejectie lenta
• 3. diastola ventriculara
- relaxarea izovolumetrica
- umplere rapida
- umplere lenta
!!!! SISTOLA ATRIALA
!!!! ATENTIE PROTODIASTOLA
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CICLUL CARDIAC
• DIASTOLA VENTRICULARA-
- relaxare izovolumetrica - EARLY DIASTOLA
- umplere rapida
- umplere lenta (diastaza) MID TO LATE DIASTOLA
- contractie atriala
SISTOLA VENTRICULARA-
- contractie izovolumetrica
- ejectie rapida
- ejectie lenta
!!!!! ATENTIE PROTODIASTOLA
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DIASTOLA VENTRICULARA DV (MID-to-LATE)
• A si V- faza de relaxare (presiune redusa in cord)
• - prin valvele AV deschise- curgere pasiva a sangelui prin atrii si prin valvele AV spre V
• Presiunea in A este usor peste cea din V – deoarece A contin sange adus de vene
• Valve Aortica si Pulmonara inchise
• peste 80% din umplerea V
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1.SISTOLA ATRIALA SA
• Restul de 20% - prin contractie atriala spre sfarsitul diastolei
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1.SISTOLA ATRIALA SA
• 0.1 sec • Atriile se contracta • Ventricule relaxate • 1 Depolarizarea NSA determina depolarizarea A- unda P
• 2 Depolarizarea A- determina SA – exercita presiune
asupra sangelui-forteaza sangele prin valvele AV spre V • determina cresterea presiunii intraatriale – impinge sangele rezidual spre V
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1.SISTOLA ATRIALA SA
• 3. SA- contribuie cu 25 mL volum sg in fiecare V
Sfarsitul SA= sfarsitul DV Ventriculele contin 130 mL la sf diastolei = volum
diastolic final In acest moment- V- finalul diastolei- au vol maxim de sange
Apoi relaxare atriala- si V se depolarizeaza (QRS complex). • 4 complex QRS marcheaza inceputul depolarizarii
ventriculare
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Vander’s Human Physiology, 13th edition, 2014
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2.SISTOLA VENTRICULARA SV
• 0.3 sec • VENTRICULE SE CONTRACTA • ATRIILE SE RELAXEAZA- DIASTOLA ATRIALA
• 5 DEPOLARIZARE VENTRICULARA determina sistola ventriculara - CRESTE PRESIUNEA intraventriculara- IMPINGE
SANGELE SI FORTEAZA INCHIDEREA VALVELOR AV- 0.05 s valvele SL (semilunare) si AV sunt inchise=
CONTRACTIE IZOVOLUMETRICA – punere in tensiune
M cardiac se contracta- dar nu se scurteaza
CONTRACTIE este izometrica volum cardiac nemodificat= izovolum
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2. SISTOLA VENTRICULARA
Presiunea V continua sa creasca
• Cand ajunge superioara P din artere- se incheie faza izovolumetrica
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2.SISTOLA VENTRICULARA SV
• 6. CONTRACTIA V izotonica-
- deschiderea valvelor are loc atunci cand -P Vstg >Pao (80 mmHg)
- P Vdr >Pao pulmonara (20 mmHg)
- creste presiunea rapid
P Vstg creste- ajunge la- la 120 mmHg
P V dr ajunge la 25–30 mmHg.
P aorta atinge 120 mmHg
FAZA DE EJECTIE- VENTRICULARA 0.25 sec.
RAPIDA- pana in momentul in care presiunea in V atinge valoarea maxima
LENTA- sincrona undei T pe ECG
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2.SISTOLA VENTRICULARA SV
• 7 EJECTIE- Vstg- ejectie 70 mL in aorta
Vdr- ejectie 70 ml in a pulmonara
60 mL= VOLUM SISTOLIC FINAL- ventriculii nu se golesc complet!!!!!
VOLUM BATAIE = VOLUL DIASTOLIC FINAL- VOLUM SISTOLIC FINAL
• VOLUM BATAIE IN REPAUS este 130 mL -60 mL= 70 mL
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2.SISTOLA VENTRICULARA SV
• Presiunea in V si aorta incep sa scada inaintea sfarsitului sistolei V- deoarece forta de contractie scade spre finalul acestei faze
• 8 unda T – marcheaza inceputul repolarizarii ventriculare
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SISTOLA
Vander’s Human Physiology, 13th edition, 2014
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3. DIASTOLA VENTRICULARA DV
• 9 Repolarizarea V determina DV 0.4 s
are loc relaxarea V si presiunea scade
RELAXARE IZOVOLUMETRICA Sangele din aorta si pulmonara reflueaza spre zonele cu
presiune redusa din ventriculi- inchid valvele semilunare
Valva AO se inchide la o presiune de 100 mm Hg.
Refluxul sangelui spre valva Ao inchisa- determina- UNDA DICROTA
• DUPA inchiderea valvelor semilunare- toate 4 valvele sunt inchise • Valvele AV sunt inchise deoarece presiunea din V este mai mare fata
de cea din A
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Vander’s Human Physiology, 13th edition, 2014
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3. DIASTOLA VENTRICULARA
10. PRESIUNEA SCADE RAPID-
• Cand atinge o valoare sub cea atriala- se deschid valvele AV
- Umplere ventriculara- 0.3
- umplere rapida - presiunea intraatriala scade rapid
- presiunea V creste
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3. DIASTOLA VENTRICULARA
- umplere lenta- DIASTAZA- incepe in momentul in care presiunile A-V s-au egalizat
- dureaza pana la o noua SA
curgere lenta-
la sfarsitul perioadei de relaxare- ventriculii sunt 80% plini
• Unda P- semnaleaza inceputul unui nou ciclu cardiac
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Vander’s Human Physiology, 13th edition, 2014
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• FIZIOLOGIC- SV- incepe odata cu inchiderea valvelor AV
- se termina- odata cu deschiderea lor
CLINIC- SV- interval de timp intre inchiderea valvelor Av si a celor sigmoide
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Silverthorn’s Human Physiology, 2013
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Fox SR. Human Physiology 2011
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Marieb EN, Hoehn K. Anatomy and Physiology 2013
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Marieb EN, Hoehn K. Anatomy and Physiology 2013
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Marieb EN, Hoehn K. Anatomy and Physiology 2013
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Silverthorn’s Human Physiology, 2013
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MODIFICARI DE PRESIUNE SI VOLUM IN TIMPUL CICLULUI CARDIAC
• (1) CURGEREA CARDIACA A SANGELUI este controlata de modificarile de presiune
• (2) sangele curge de-alungul unui gradient de presiune PRINCIPIU CURGERII SANGELUI- curge de la presiune
crescuta spre presiune redusa • Modificarile de presiune- reflecta alternarea contractiei cu
relaxarea miocardului si determina deschiderea valvelor permitand curgerea sangelui
• 75/min- 0.8 sec
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MODIFICARI DE PRESIUNE SI VOLUM IN TIMPUL CICLULUI CARDIAC
• INIMA DREAPTA/INIMA STANGA- presiuni diferite
- Presiuni sistolice si diastolice- artera pulmonara- sunt 24 si 10 mm Hg
- Presiuni sistolice si diastolice in aorta- 120 si 80 mm Hg
VOLUM DE SANGE EJECTAT ACELASI!!!!!
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Silverthorn’s Human Physiology, 2013
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MODIFICARI DE PRESIUNE SI VOLUM IN TIMPUL CICLULUI CARDIAC
• Punct A- sfarsitul contractiei V
- V contine minim cant de sange
- este relaxat
- presiunea este la valoarea minima
- sangele curge in atrii din venele pulmonare
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MODIFICARI DE PRESIUNE SI VOLUM IN TIMPUL CICLULUI CARDIAC
Punct A- !!!! CAND presiunea in A> PRESIUNE V- deschiderea valvei mitrale
• Punct A-B- sangele curge din A in V si creste volumul V
Volumul V- creste dar presiunea creste foarte putin
• A’-B- Ultima faza a umplerii V- prin contractie atriala
• Punct B- Ventriculul contine cantitatea maxima de sange- volum diastolic final
• 70-kg- 130-135 mL cresterea frecventei cardiace foarte mult- volumul diastolic final
scade
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MODIFICARI DE PRESIUNE SI VOLUM IN TIMPUL CICLULUI CARDIAC
• CONTRACTIA V- se inchide valva mitrala si tricuspida
!!!! valve AV si semilunare- inchise-
• V se contracta- CRESTE PRESIUNEA – CONTRACTIE IZOVOLUMETRICA (B-C)
• Atingerea unei P V>P Aorta- deschiderea valvei aortice (C)
• Presiunea continua sa cresca pe masura ce V se contracta dar volumul V scade pe masura ce sangele este impins in aorta (C-D)
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MODIFICARI DE PRESIUNE SI VOLUM IN TIMPUL CICLULUI CARDIAC
• VOLUM SISTOLIC FINAL- cantitatea minima de sange continuta in V pe parcursul ciclului cardiac (D)
ESTE DE 60-65 mL
- Dupa contractie- relaxare cu Reducerea presiunii
- Reducerea P V<P aorta- se inchid valvele semilunare- V devine o incapere inchisa
- Relaxare IZOVOLUMETRICA- fara modificari ale volumului (D-A)
• Cand presiunea V stg scade sub cea atriala- se deschide valva mitrala- ciclul se reia
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• Cresterea frecventei cardiace-reducerea perioadei
de relaxare- durata SA si a SV- se scurteaza usor
• BRADICARDIE- sportivi, somn, clinostatism
• TAHICARDIE- effort, emotii, perioada digestiei
• BRADICARDIE- hipotiroidism
• TAHICARDIE- hipertiroidism
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ZGOMOTE CARDIACE
• lub-dup-
• Turbulenta sangelui asociata cu inchiderea valvelor • ZGOMOT I- lung, tonalitate joasa, intensitate crescuta
• ZGOMOT II- scurt, inalt, intensitate redusa
• Zg III, IV
• Pauza mica intre zg I si II si mai mare intre zg II si zg I
• Inregistrare grafica- fonocardiograma
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ZGOMOTE CARDIACE
• ZGOMOT I- inchiderea valvelor AV- punctul la care Pres V creste peste cea atriala
- marcheaza inceputul SV
DETERMINAT DE :
1. vibratia sangelui data de inchiderea valvelor AV
2. reverberatia sangelui intre valvele supradestinse AV si perete V
3. deschiderea valvelor sigmoide- vibratia pereti aorta si sigmoida
4. turbulenta sangelui ejectat in aorta si pulmonara
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ZGOMOTE CARDIACE
• Zgomot I- bicuspida- intensitate maxima
- tricuspida- intensitate maxima
Intensitate variaza
-Efort fizic
-Insuficienta cardiaca
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ZGOMOTE CARDIACE
ZGOMOT II • Marcheaza debutul diastolei V
DETERMINAT DE : - turbulenta sangelui asociata cu inchiderea valvelor
sigmiode aortice si pulmonare la sf sistolei (inceputul diastolei ventriculare) - vibratia valvelor sigmioide si a peretilor arteriali
- reverberatia sangelui intre valve si peretele arterial - Dedublare fiziologice- copii, adolescenti
- Intensitate maxima- aorta- sp II intercostal drept pulmonara- sp II intercostal stg Intensitatea variaza – HTA, HTP
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ZGOMOTE CARDIACE
• Valva mitrala se inchide inaintea celei tricuspide
• Valva aortica- inaintea celei pulmonare-
• ZG I si II se aud la suprafata toracelui- in locatii care sunt usor diferite fata de cele ale valvelor- !!!! Sunetul este “indepartat” fata de valve de catre curgerea sangelui
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Marieb EN, Hoehn K. Anatomy and Physiology 2013
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Tortora G, Derrikson B. Principles of anatomy and physiology 12th edition, 2009
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ZGOMOTE CARDIACE
• ZGOMOT III- diastolic
- determinat de incetinirea brusca a curgerii sangelui- umplerea rapida- umplere lenta- vibratia valvelor AV si a peretilor V
- la tineri- cu perete toracic subtire- la vf inimii
- se intensifica- la marirea flux sg- effort fizic
- patologic in insuficienta cardiaca
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ZGOMOTE CARDIACE
• ZGOMOT IV- neperceput fiziologic
- patologic
- datorat turbulentei sangvine din timpul sistolei atriale
- produs de atriu hipertrofiat
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SOCUL APEXIAN
• Senzatia de izbitura la nivelul vf inimii in timpul SV
• Datorata modificarilor de forma, consistenta si pozitie a inimii
• SISTOLA- inima sferica, globuloasa
- consistenta crescuta
- torsionare de la stg la dr dispre posterior spre anterior
DIASTOLA- con flasc
- moale- ramane urma coastelor pe suprafata ei
Sp V IC LMC
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DEBITUL CARDIAC
• Cantitatea de sange pompata in mica si marea circulatie de fiecare V/minut
• DC= Frecventa cardiaca X volum sistolic (bataie)
Volum sistolic (bataie VB)- volum de sange pompat de un ventricul pe o bataie cardiaca
- se coreleaza cu forta de contractie V EXEMPLU • DC= FC 75 /min X70 ml/bataie= 5.25 l/min
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DEBITUL CARDIAC
• VALORI NORMALE= aprox. 5 L/min
• VARIATII
Fiziologice- femei vs barbati 10%
CRESTERI-
1. EFORT FIZIC - creste DC, consum O2, dif AV
controlat prin mec nervoase si umorale
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DEBITUL CARDIAC
1. EFORT FIZIC
- Mecanisme NERVOASE- scoarta- SN adrenergic- creste ritm cardiac, forta de contractie, vasoconstrictie in zonele depozit de sange- creste intoarcerea venoasa
-scoarta- Nervii simpatici colinergici- vasodilatatie in musculatura scheletica- creste intoarcerea venoasa
!!!!! F IMP- vasodilatatia in muschiul care se contracta
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DEBITUL CARDIAC
• 1. EFORT FIZIC
• Mecanisme UMORALE-
cataboliti- acid lactic, acid piruvic, CO2:
- actioneaza direct- determina dilatarea capilarelor
- stimuleaza receptorii- declanseaza reflexul de nutritie al lui Hess- vasodilatatie
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DEBITUL CARDIAC
• 2. DIGESTIE cu 30% in primele ore
• 3. TERMOREGLARE- cald- crestere cu 30% - frig- creste- faza de frison termic
• 4. GRAVIDE- creste vol plasmatic - creste cu 30-40%
• 5. EMOTII/ANXIETATE- adrenalina creste cu 50%-100%
• 6. POST TRANSFUZII
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DEBITUL CARDIAC
SCADERI- inaintarea in varsta
PATOLOGICE- CRESTERI-
hipertiroidism, febra, anemie, fistule Arterio-venoase
SCADERI
hipotiroidism, soc, Insuficienta cardiaca decompensata