제2장 심혈관계 구조와 기능

(1)

제 2장 심혈관계 구조와 기능

(Anatomy and Physiology of Cardiovascular system) 심 호 흡 계 물 리 치 료

부산가톨릭대학교 물리치료학과

김 난 수

(2)

1. 심장의 구조와 기능

(3)

심장 혈관

3

(4)

태아의 혈액순환

태아의 혈액순환 (국가건강정보포털 의학정보) http://terms.naver.com/entry.nhn?docId=2099364&cid=51004&categoryId=51004

(5)

팔로 4징후(tetralogy of fallot, TOF)

5

(6)

2. 혈관의 구조

(7)

3. 심장의 기능

7

(8)

내부 전도계

(INTRINSIC CONDUCTION SYSTEM)

(9)

9

(10)

Action potentials of typical cardiac muscle cell

(심실근과 심방근세포의 활동전압)

(11)

심근세포의 활동전위

11

(12)

70 140

4. 심장의 박출량 조절

(13)

13

(14)

Cardiac Cycle

(15)

Stroke volume

• Stroke volume depends on several factors such as heart size, contractility, duration of contraction, preload (end- diastolic volume), and afterload.

• Exercise: Prolonged aerobic exercise training may also increase stroke volume, which frequently results in a lower (resting) heart rate. Reduced heart rate prolongs ventricular diastole (filling), increasing end-diastolic volume, and ultimately allowing more blood to be ejected.

15

(16)

Stroke volume

• Preload: Stroke volume is intrinsically controlled by preload (the degree to which the ventricles are stretched prior to contracting).

An increase in the volume or speed of venous return will increase preload and, through the Frank–Starling law of the heart, will increase stroke volume. Decreased venous return has the opposite effect, causing a reduction in stroke volume.

• Afterload: Elevated afterload (commonly measured as the aortic pressure during systole) reduces stroke volume. Though not usually affecting stroke volume in healthy individuals, increased afterload will hinder the ventricles in ejecting blood, causing reduced stroke volume. Increased afterload may be found in aortic stenosis and arterial hypertension.

16

(17)

Extrinsic Control of the Heart

 PNS acts through the vagus nerve to decrease heart rate and force of contraction.

 SNS is stimulated by stress to increase heart rate and force of contraction.

 Epinephrine and norepinephrine—released due to sympathetic stimulation—increase heart rate.

Intrinsic Control of the Heart

 Frank-Starling’s law

 Baroreceptor & Chemoreceptor

 Cortex & Propriocetor

17

(18)

Reference

• 심장호흡계 물리치료 중재학. 대한심장호흡물리치료 학회. 범문에듀케이션. 2014

• 김경 외. 심장호흡물리치료. 정담미디어. 2013

• 심폐물리치료학. 이석민 외. 현문사. 2014

• http://terms.naver.com/entry.nhn?docId=2099364&cid=51 004&categoryId=51004

• https://en.wikipedia.org/wiki/Stroke_volume