Continuing Medical Education Programs Dr. Anika Niambi Al-Shura, Lecturer Copyright 2014 Niambi Wellness. All rights reserved

Integrative Anatomy and Patho-Physiology in TCM Cardiology Copyright 2014 Niambi Wellness. All rights reserved

This course is approved by the following agencies: National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for 14 PDA points and Florida State Board of Acupuncture for 15 CEUs. The companion textbook: Integrative Anatomy and Patho-Physiology in TCM Cardiology must be ordered at Copyright 2014 Niambi Wellness. All rights reserved

This course examines of the structure, function and pathology of the heart from the western medicine and Chinese medicine perspectives. Copyright 2014 Niambi Wellness. All rights reserved Course Description

Course Objectives Review the normal anatomy and physiology of the cardiovascular system. Evaluate the disease characteristics found in sections of the heart sections. Analyze the inter-relationship between western medicine and TCM theory in cardiology. Copyright 2014 Niambi Wellness. All rights reserved

Course Modules Copyright 2014 Niambi Wellness. All rights reserved

Module 1: Cardiovascular Anatomy Module 2: Physiology Module 3: Pathology Copyright 2014 Niambi Wellness. All rights reserved

Module 2 Cardiovascular Physiology Copyright 2014 Niambi Wellness. All rights reserved

Chapter 4: Cardiac Rhythm Chapter 5: Pumping Actions Chapter 6: Vascular Function and Circulation Contents Copyright 2014 Niambi Wellness. All rights reserved

Chapter 7: Humeral Control Chapter 8: Nervous System Regulation Contents Copyright 2014 Niambi Wellness. All rights reserved

Chapter 4: Cardiac Rhythm Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Cardiac Muscle Structure Part 2: Cardiac Muscle Contractility Part 3: Electrical Activity Contents Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Cardiac Muscle Structure Copyright 2014 Niambi Wellness. All rights reserved

Cardiac myocyte: Sarcomere Look in the textbook and label each myocyte section. Copyright 2014 Niambi Wellness. All rights reserved

Part 2: Cardiac Muscle Contractility Copyright 2014 Niambi Wellness. All rights reserved

Look in the textbook and label each section. Copyright 2014 Niambi Wellness. All rights reserved Cardiac muscle contractility

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Part 3: Electrical Activity Copyright 2014 Niambi Wellness. All rights reserved

Resting potentials Copyright 2014 Niambi Wellness. All rights reserved

Nernst equation Copyright 2014 Niambi Wellness. All rights reserved

Goldman equation Copyright 2014 Niambi Wellness. All rights reserved

Action Potentials Copyright 2014 Niambi Wellness. All rights reserved

Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

1.Describe the sarcomere. 2.Discuss the role of ATP. 3.Explain Resting potentials. 4.Explain action potentials. 5.Describe the site of transmission. Copyright 2014 Niambi Wellness. All rights reserved According to the textbook

1.What are types of lines and bands of a sarcomere? 2.What are the three types of troponin in muscle contractility? 3.Which two ions are crossing the cell membrane during resting potentials? 4.What does the Nernst equation describe about ions? 5.Which three ions are part of the Goldman equation? Copyright 2014 Niambi Wellness. All rights reserved According to the course

Copyright 2014 Niambi Wellness. All rights reserved

Chapter 5: Pumping Actions Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Cardiac Cycle Part 2: Regulation Part 3: Preload on Stroke Volume Contents Copyright 2014 Niambi Wellness. All rights reserved

Part 4: Inotropy (Contractility) Part 5: Afterload on Stroke Volume Contents Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Cardiac Cycle Copyright 2014 Niambi Wellness. All rights reserved

Wiggers Diagram/ Heart Qi The cardiac cycle includes to the events related to the flow and pressure of blood through the heart from one heartbeat to the next. Copyright 2014 Niambi Wellness. All rights reserved

Phase 1: Atrial Systole Copyright 2014 Niambi Wellness. All rights reserved

P wave represents the atrial electrical depolarization.This phase is ventricular diastole. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

During filling, pressure within the right atrium increases, pushing blood across the AV valves into the right ventricle. Copyright 2014 Niambi Wellness. All rights reserved

At the end of the phase the ventricles are completely filled to about 140mL. This is the EDV (end diastolic volume). Copyright 2014 Niambi Wellness. All rights reserved

The S 4 (fourth heart sound) is sound heard during this phase. It’s usually heard in ventricular hypertrophy. Copyright 2014 Niambi Wellness. All rights reserved

Phase 2: Isovolumetric Ventricular Systole Copyright 2014 Niambi Wellness. All rights reserved

QRS wave represents the beginning of systole. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

This phase represents ventricular depolarization. The rise in pressure in the ventricles exceeds the pressure in the atrium causing the AV valves to close. Copyright 2014 Niambi Wellness. All rights reserved

The S 1 (first heart sound) is sound heard during this phase. Copyright 2014 Niambi Wellness. All rights reserved

Phase 3: Ventricular Ejection Copyright 2014 Niambi Wellness. All rights reserved

This section represents the S and T wave. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

The pressure in the ventricle exceeds the pressure within the pulmonary arteries and the aorta. The pulmonic valves open to allow blood flow. Copyright 2014 Niambi Wellness. All rights reserved

No heart sound is heard in healthy valves. A sound heard at this phase is called an ejection murmur. Copyright 2014 Niambi Wellness. All rights reserved

Phase 4: Ventricular Relaxation Copyright 2014 Niambi Wellness. All rights reserved

This section represents the T wave after the QRS wave. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

The pressure in the ventricle decreases due to emptying. Atrial pressure is rising. Copyright 2014 Niambi Wellness. All rights reserved

No heart sound is heard in healthy valves. A sound heard at this phase is called an ejection murmur. Copyright 2014 Niambi Wellness. All rights reserved

Phase 5: Isovolumetric Relaxation Copyright 2014 Niambi Wellness. All rights reserved

Phase 5: Isovolumetric Relaxation This section represents the end of the T wave. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

The volume of blood which remains in the left ventricle which is = 70mL is called the ESV (end systolic volume). EDV-ESV=SV ( =70) Copyright 2014 Niambi Wellness. All rights reserved

S 2 sound is heard as the valve closes. Copyright 2014 Niambi Wellness. All rights reserved

Phase 6: Diastolic Copyright 2014 Niambi Wellness. All rights reserved

This section represents the end of the T wave to the middle of the P phase. Circle this in your textbook. Copyright 2014 Niambi Wellness. All rights reserved

The atria fills with blood, the pressure causes the AV valves open to release the blood into the ventricles. Copyright 2014 Niambi Wellness. All rights reserved

No sound is heard in healthy AV valves. If S 3 sound is heard, it is considered normal in children, but ventricular dilation in adults. Copyright 2014 Niambi Wellness. All rights reserved

Part 2: Regulation Copyright 2014 Niambi Wellness. All rights reserved

The Fick prinicple C A = arterial blood C V = venous blood Copyright 2014 Niambi Wellness. All rights reserved

In 1870 Adolf Eugen Fick in 1870 calculated the oxygen consumption rate as it flows through blood. Copyright 2014 Niambi Wellness. All rights reserved

The principle calculates the rate of blood flow and the rate of oxygen picked up by the red blood cells. Copyright 2014 Niambi Wellness. All rights reserved

The Fick principle involves measuring oxygen concentration in the veins and arteries, however this collection and analysis can be difficult to obtain. Copyright 2014 Niambi Wellness. All rights reserved

The Oxygen Content Equation Record this information in your textbook. C a O 2 =(S a O 2 xHbx1.34)+.003(P a O 2 ) Copyright 2014 Niambi Wellness. All rights reserved

Physicians consider that the measurement of oxygen content in hemoglobin is a simpler process. Hemoglobin carries oxygen and deficiency (anemia) can lead to hypoxemia. Each gram of hemoglobin carries 1.34 mL of O 2. Copyright 2014 Niambi Wellness. All rights reserved

Part 3: Preload Copyright 2014 Niambi Wellness. All rights reserved

Frank-Starling mechanism

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Part 4: Inotropy (contractility) Copyright 2014 Niambi Wellness. All rights reserved

cAMP (cyclic adenosine monophosphate ATP is cellular energy and is used in signal transduction. Adenylate cyclase uses ATP to produce cyclic AMP. Copyright 2014 Niambi Wellness. All rights reserved

cAMP is a second messenger, as it regulates the function of ion channels and assists the passage of ions and certain hormones into cells. Copyright 2014 Niambi Wellness. All rights reserved

It is also involved in glycogen and adrenaline regulation and lipid metabolism. Copyright 2014 Niambi Wellness. All rights reserved

Part 5: Afterload on Stroke Volume Copyright 2014 Niambi Wellness. All rights reserved

Afterload Afterload is the pressure generated in the ventricles to eject blood out of the heart. Copyright 2014 Niambi Wellness. All rights reserved

The pressure must be greater than pulmonic and systemic pressure for valve opening. Copyright 2014 Niambi Wellness. All rights reserved

As afterload increases, cardiac output decreases. Copyright 2014 Niambi Wellness. All rights reserved

Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

1.Describe heart qi. 2.List the phases of the cardiac cycle on the Wiggers diagram. 3.Discuss the rule of Discuss how blood volume affects stroke volume. 5.Describe contractility 6.Describe afterload. Copyright 2014 Niambi Wellness. All rights reserved According to the textbook

1.Discuss the Fick principle 2.Discuss the oxygen content equation. 3.What 4 factors are described in the Frank- Starling mechanism ? 4.What is cAMP? 5.What is afterload? Copyright 2014 Niambi Wellness. All rights reserved According to the course

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Chapter 6: Vascular Function and Circulation Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Calcium Channels Part 2: Contraction of Smooth Muscle Contents Copyright 2014 Niambi Wellness. All rights reserved

Part 3: Endothelial Factors Part 4: Metabolites Contents Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Calcium Channels Copyright 2014 Niambi Wellness. All rights reserved

Calcium Channel Blocker A calcium channel is a gate on the cell surface which allows calcium ions to pass. Copyright 2014 Niambi Wellness. All rights reserved

There are 2 kinds of calcium channels: high voltage low voltage Copyright 2014 Niambi Wellness. All rights reserved

Voltage gated: L-type P-type N-type R-type Copyright 2014 Niambi Wellness. All rights reserved High voltage

L-type Myocytes (ventricle) Skeletal and smooth muscle Osteoblasts Dendrites Copyright 2014 Niambi Wellness. All rights reserved

P-type Certain neural cells Copyright 2014 Niambi Wellness. All rights reserved

N-type Certain neural cells Copyright 2014 Niambi Wellness. All rights reserved

R-type Certain neural cells Copyright 2014 Niambi Wellness. All rights reserved

T-type Certain neural cells Pacemaker (SA nodal cells) Copyright 2014 Niambi Wellness. All rights reserved Low voltage

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Part 2: Contraction of Smooth Muscle Copyright 2014 Niambi Wellness. All rights reserved

The pressure in blood vessels can contract and neurotransmitters can cause more or less contraction or relaxation. Copyright 2014 Niambi Wellness. All rights reserved

ATP can be an important neurotransmitter. It is released with noradrenaline and neuropeptide from peri-vascular sympathetic nerves. Copyright 2014 Niambi Wellness. All rights reserved

ATP can assist at P2 receptors to cause smooth muscle contraction in vessels. Copyright 2014 Niambi Wellness. All rights reserved

Part 3: Endothelial Factors Copyright 2014 Niambi Wellness. All rights reserved

Endothelial cells form the linings of the blood vessels. Endothelin-1(ET-1) is involved in tissue production and repair throughout the body. Copyright 2014 Niambi Wellness. All rights reserved

ET-1 also repairs and extend capillaries in a spontaneous process called sprouting. In this process, endothelial cells may act similarly to hyphae in fungus. Copyright 2014 Niambi Wellness. All rights reserved

Nitric oxide is produced by endothelial cells and can serve as a neurotransmitter by relaxing smooth muscle tissue such as in vessels. Copyright 2014 Niambi Wellness. All rights reserved

Part 4: Metabolites Copyright 2014 Niambi Wellness. All rights reserved

Adenosine regulated by ATP. Also it is involved with vasodilation. It causes relaxation of smooth muscle as is found inside the artery walls. Copyright 2014 Niambi Wellness. All rights reserved

K+ channel activity is an important determinant of vascular tone and functioning. Copyright 2014 Niambi Wellness. All rights reserved

Endothelial cell dysfunction may be due to problems with nitric oxide which could also cause changes in K+ channel activity which will affect vasodilation. Copyright 2014 Niambi Wellness. All rights reserved

Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

1.Explain the significance of Ca++ and H+ on smooth muscle contraction. 2.Describe Ca++ affect on smooth muscle contraction. 3.Which endothelin is associated with vascular functioning? How? 4.What is the role of prostaglandins in vasodilation? 5.Which four metabolites are involved with increase in vasodilation? Copyright 2014 Niambi Wellness. All rights reserved According to the textbook

1.What are the two kinds of calcium channels? 2.Which kinds are involved with cardiac functioning? 3.Describe the role of ATP in vascular contraction. 4.What is ET-1? 5.What is the role of nitric oxide (NO) in vascular functioning? 6.What is the role of adenosine and K+ activity in vascular functionin Copyright 2014 Niambi Wellness. All rights reserved According to the course

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Chapter 7: Humoral Control Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Local Hormones Part 2: System Hormones Contents Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Local Hormones Copyright 2014 Niambi Wellness. All rights reserved

Bradykinin This is a kinin which is part of inflammation, and is formed in locally around the site of an injury, which causes vasodilation and edema. Copyright 2014 Niambi Wellness. All rights reserved

Serotonin This is a neurotransmitter which causes vasoconstriction and smooth muscle contraction. Copyright 2014 Niambi Wellness. All rights reserved

Part 2: System Hormones Copyright 2014 Niambi Wellness. All rights reserved

Renin-angiotensin-aldosterone The renin-angiotensin-aldosterone system (RAAS) is involved in regulating vascular resistance, blood volume, cardiac output and arterial pressure. Copyright 2014 Niambi Wellness. All rights reserved

Adrenals Epinephrine causes constriction in many networks of minute blood vessels but dilates the arteries and bronchus. Norepinephrine constricts blood vessels. Copyright 2014 Niambi Wellness. All rights reserved

Chapter Assessment Copyright 2014 Niambi Wellness. All rights reserved

1.Explain bradykinin as part of pathogenic issues. 2.Explain serotonin as part of pathogenic issues. 3.Explain renin-angiotensin. 4.Explain adrenal hormones. Copyright 2014 Niambi Wellness. All rights reserved According to the textbook

1.Define bradykinin. 2.Define serotonin. 3.Explain the renin-angiotensin-aldosterone system. 4.Explain the role of epinephrine. 5.Explain the role of norepinephrine. Copyright 2014 Niambi Wellness. All rights reserved According to the course

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Chapter 8: Humoral Control Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Autonomic Nervous System Part 2: Sympathetic Reflexes Part 3: Parasympathetic Reflexes Contents Copyright 2014 Niambi Wellness. All rights reserved

Part 1: Autonomic Nervous System Copyright 2014 Niambi Wellness. All rights reserved

The sympathetic and parasympathetic are part of the autonomic nervous system. The sympathetic reflexes cause vasoconstriction. The parasympathetic reflexes cause vasodilation. Copyright 2014 Niambi Wellness. All rights reserved

Part 3: Parasympathetic Reflexes Copyright 2014 Niambi Wellness. All rights reserved

The sympathetic reflexes accelerates the heart beat. Copyright 2014 Niambi Wellness. All rights reserved

The sympathetic reflexes relaxes the bronchus. Copyright 2014 Niambi Wellness. All rights reserved

Part 2: System Hormones Copyright 2014 Niambi Wellness. All rights reserved

The parasympathetic reflexes slows the heart beat. Copyright 2014 Niambi Wellness. All rights reserved

The parasympathetic reflexes constricts the bronchus. Copyright 2014 Niambi Wellness. All rights reserved

Module 1 Review Questions

Complete the Module 2 review interactive practice quiz. Copyright 2014 Niambi Wellness. All rights reserved

Please continue on to Module 3 Copyright 2014 Niambi Wellness. All rights reserved