!"#$%&"'()*'How is the heart regulated?
What causes atherosclerosis & heart disease?'
•!
•!
•!
•!
P3'3,*'<%*'.+'2+/%/7@@4<%
;</.342=%>%&2*/.342=%1-%
3K<A+,%.3%D+*'.%
1433?%@'+//7'+%A'*?2+,.%
1*'3'[email protected]'/%>%1433?%-'+//7'+%
1433?%B43C%-D</2=*4%B*=.3'/E%
•! -'+//7'+%A'*?2+,.%
•! F*?27/%3G%H+//+4%
•! 1433?%I2/=3/2.<%
•! JK+'=2/+%
•! ;D3'.L.+'8%=D*,A+/%
•! 1433?%M3C%>%N433?%@'+//7'+%
•! O3,AL.+'8%=D*,A+/%
•! PQ0%;I0%RF0%N433?%@'+//7'+%
•! ;83S2,A%>%&2*N+.+/E%R+*'.%'2/S%
•! 6.D+'3/=4+'3/2/%
&'(%)*'+,%-+.+'/+,0%1234(%!!50%67.78,%9:!$%
CD5?23E'$,"'F2&/&"#5$/&0'G',/A'$,"-'&"H%?2$"'>I'
R3C%C374?%.D+/+%/U8742%*V+=.%1-E%
Stimulus!
G+*'0%?+@'+//23,0%D<@3.D+'82*%
Sensor/receptor!
Efferent pathway!
Change in
blood
pressure!
Effector!
Parasympathetic
neurons!
Sympathetic
neurons!
I+,.'2=74*'%1-%87/.%N+%
T%&2*/.342=%1-%.3%3@+,%
/+8247,*'%H*4H+/%
J"0#&3F"',/A'#2&.32#'/%$5%$'30'&"H%?2$".K'
-'+?2=.%.D+%+V+=.%3G%&"H%?2&%*+'3N2=%+K+'=2/+%3,%;I0%RF%>%PQ%
Medullary
cardiovascular
control
center!
Integrating center!
+,-'./"0'12&.32#'4%$5%$'678'9':;<'='>?//.'@?/AB'
Carotid and aortic
baroreceptors!
SA node!
Ventricles!
Veins!
Arterioles!
DW@E""=H@D</2343A<(=38"1433?Z9:-'+//7'+"1-:!9(D.8%%
DW@E""D2AD+'+?(8=A'*CLD244(=38"/2.+/"::#9$:#X#:"/.7?+,.YH2+C:"=D*@.+'9!"*,28*U3,YYN*'3'[email protected]'Y'+M+KY=3,.'34Y3GYN433?Y@'+//7'+(D.84%
+,2$'5,-03#2?'L2&32F?"0'2M"#$'F?//.'N/AB'
7/A'./"0'F?//.'N/A'#,2EH"'.%&3EH'"D"&#30"B'
B'2=U3,^%
B43C%]%`-'+//7'+%?2V(%a%'*?27/Xb"%
H2/=3/2.<%a%4+,A.D%
F*?27/%2,='+*/+/%!%M3C%2,='+*/+/%
cD+'+%2/%M3C%=3,/.*,.d%%
B43C%]%'*?27/X%
_3<,+'%>%P*/+<0%9:!$%
DW@/E""8<(N@==(+?7"=3,.+,."N4A<99$"P*'?2*=;</.+8"P*'?2*=;</.+8Y@'2,.(D.84%>%%
DW@E""[4.(=\"+,"/S'2@.*"KL/'?=+L*L3N+DLS'H+"9LS'+H,2L3N+D"%%
4..0'82P/0'Q/&'."2$,'Q&/R'#/&/E2&-'
,"2&$'.30"20"'3E'SK:K'
+,-'./"0'0-0$/?3#'>I'3E#&"20"'A3$,'"D"&#30"B'
+,-'./"0EO$'.320$/?3#'>I'3E#&"20"'A3$,'"D"&#30"B%
PQ%f%1433?%B43C%
`RF%a%;Ib%f%g6H+(%`&2*/.342=b%1-%"%F+/2/.*,=+h%
F+*''*,A+?%+i7*U3,%!%6H+(%`&2*/.342=b%1-%f%`RF%a%;Ib%a%F+/2/.*,=+%
cD*.%G*=.3'%D*/%.D+%N2AA+/.%+V+=.%3,%'+/2/.*,=+%.3%N433?%M3Cd%
$%
X($%
X%
k($%
l+,%$$%<'%
k%
8+,%T%$$%<'%
9($%
9%
;</.342=%1-%
c38+,%m$%
!($%
c38+,%T%m$%
!%
&2*/.342=%1-%
:($%
:%
;83S2,A%
&2*N+.+/%
c3'S37.%e,.+,/2.<%
DW@E""CCC(D78*,S2,+U=/(=38"+K=+'@./"+K=+'@./"*==7'*.+LN433?L@'+//7'+L
8+*/7'+8+,.L='2U=*4L.3L+K+'=2/+L@'+/='2@U3,%%
P*@+C+440%B3'?0%P'3j0%+.%*4(%9:!:%
7/A'./"0'.32F"$"0'3E#&"20"0'$,"'&30T'/Q'
2$,"&/0#?"&/030'3E'$,30'R/."?B'
7/A'./"0'2$,"&/0#?"&/030',255"EB''
O2NN<0%9::9%
JK=+//%O&O%+,.+'/%*'.+'2*4%C*44/%
l*='3@D*A+/%+*.%O&O%%
JF%f%+,?3@4*/82=%'+U=7478%
l*='3@D*A+%!%G3*8=+44%
;833.D%87/=4+%!%G3*8%=+44/(%%%
l3'+%/833.D%87/=4+%2,H*?+/%%
B2N'37/%=*@%G3'8/(%
;UV+'0%,*''3C+'%C*44/%'*2/+%
'+/2/.*,=+%.3%N433?%M3C(%%
e,M*88*.3'<%=D+82=*4/%?2A+/.%
=*@%3H+'%@4*i7+%
[email protected]'+%2,?7=+/%*%N433?%=43.%
%
http://www.hhmi.org/biointeractive/obesity/heart_attack.html
http://www.nytimes.com/packages/html/health/20070408_HEART_FEATURE/index.html
o+*?2,0%-+.47'*0%>%c+'/.7=S0%9:!k%
When does blood flow decrease dramatically?
% of Normal Blood Flow
% Blood Flow
Things to Understand & Review:
!(!
9(!
100
k(!
80
60
X(!
40
$(!
20
0
m(!
0%
20%
40%
60%
% Blockage
80%
100%
#(!
5(!
JK@4*2,%.D+%A'*?2+,.%2,%N433?%@'+//7'+%G'38%.D+%*3'.*%.3%.D+%H+,*%=*H*%2,%.D+%/</.+82=%
=2'=72.(%%R3C%>%CD<%C244%.D+%@'+//7'+/%2,%.D+%@7483,*'<%=2'=72.%?2V+'d%%&+p,+%>%+K@4*2,%
/</.342=%>%?2*/.342=%N433?%@'+//7'+(%
cD<%2/%=*'?2*=%37.@7.%+i7*4%.3%N433?%M3Cd%%cD*.%=*7/+/%'+/2/.*,=+%.3%N433?%M3Cd%%
&+/='2N+%D3C%H2/=3/2.<0%'*?27/%3G%*%H+//+4%>%2./%/833.D,+//%*V+=.%N433?%M3C(%cD<%?3+/%
H+//+4%'*?27/%D*/%.D+%N2AA+/.%+V+=.%3,%'+/2/.*,=+%.3%N433?%M3Cd%%n'*@D%.D+%'+4*U3,/D2@%
N+.C++,%H+//+4%'*?27/%3,%.D+%qL*K2/%>%N433?%M3C%3,%.D+%rL*K2/(%
cD*.%*'+%N*'3'[email protected]'/d%%cD+'+%*'+%.D+<%43=*.+?d%%R3C%?3+/%.D+2'%p'2,A%'*.+%`s%*=U3,%
@3.+,U*4/b%=D*,A+%*/%.D+%/+,/3'<%2,@7.%=D*,A+/d%R3C%?3+/%D<@+'.+,/23,%*V+=.%.D+2'%
'+/@3,/+/d%B3443C%3'%?2*A'*8%.D+%/.+@/%2,%.D+%,+A*UH+%G++?N*=S%D38+3/.*/2/%433@%2G%*b%
N433?%R-%2/%*N3H+%,3'8*4%>%Nb%N433?%R-%2/%N+43C%,3'8*4(%%JK@4*2,%D3C%+83U3,/%`G+*'0%
?+@'+//23,0%*,A+'b%*,?%D<@3.D+'82*%=*,%*4.+'%,3'8*4%N433?%@'+//7'+%D38+3/.*/2/(%
cD<%?3+/%/</.342=%N433?%@'+//7'+%2,='+*/+0%N7.%?2*/.342=%@'+//7'+%'+8*2,%/.*N4+%C2.D%
+K+'=2/+d%R3C%=*,%?2*/.342=%1-%N+%,+*'4<%=3,/.*,.%CD24+%N433?%M3C%2,='+*/+/%C2.D%+K+'=2/+d%%
cD<%?3+/%N433?%M3C%2,='+*/+%.3%D+*'.0%/S2,%>%/S+4+.*4%87/=4+/%?7'2,A%+K+'=2/+d%%cD<%?3+/%
N433?%M3C%.3%.D+%N'*2,%'+8*2,%=3,/.*,.%?7'2,A%+K+'=2/+d%%JK@4*2,%CD<%8*,<%H2/=+'*4%3'A*,/%
'+=+2H+%4+//%N433?%M3C%?7'2,A%+K+'=2/+(%%
JK@4*2,%.D+/+%43,AL.+'8%=D*,A+/%2,%.D+%*+'3N2=%*.D4+.+/E%43C+'%'+/U,A%RF0%D2AD+'%;I0%D2AD+'%
8*K(%=*'?2*=%[email protected]%D2AD+'%IQ9%8*K(%
R3C%87=D%?3+/%/83S2,A%*,?%?2*N+.+/%2,='+*/+%<37'%'2/S%3G%?+*.D%G'38%D+*'.%?2/+*/+d%
&+/='2N+%D3C%?2*N+.+/%=*,%2,='+*/+%.D+%'2/S%3G%?+H+43@2,A%*.D+'3/=4+'3/2/(%%%
&+/='2N+%.D+%@'3A'+//23,%4+*?2,A%.3%/+H+'+%*.D+'3/=4+'3/2/(%%JK@4*2,%D3C%*.D+'3/=4+'3/2/%
2,='+*/+/%<37'%'2/S%3G%=43.%G3'8*U3,(%6.%CD*.%4+H+4%3G%N43=S*A+%?3+/%N433?%M3C%
?'*8*U=*44<%?+='+*/+d%%
U..3P/E2?'8"0/%&#"0'
!(! 1'3C,%c_0%-*H+<%t0%1*78*,%6J(%`9:!$b%P38@*'2,A%@3@74*U3,%*W'2N7.*N4+%'2/S/%G3'%D+*'.%
?2/+*/+%*='3//%.D+%*?74.%42G+/@*,%2,%C38+,(%1'%_%;@3'./%l+?%XuE!:muv!:#m(%
9(! P*@+C+44%;0%B3'?%J;0%P'3j%_10%+.%*4(%`9:!:b%P*'?23H*/=74*'%'2/S%G*=.3'%.'+,?/%*,?%@3.+,U*4%G3'%
'+?7=2,A%=3'3,*'<%D+*'.%?2/+*/+%83'.*42.<%2,%.D+%w,2.+?%;.*.+/%3G%68+'2=*(%1744+U,%3G%.D+%
c3'4?%R+*4.D%Q'A*,2\*U3,%55`9bE!9:L!k:(%
DW@E""CCC(CD3(2,."N744+U,"H3478+/"55"9":5L:$#55$"+,"%%
k(! _3<,+'%l_0%>%P*/+<%&-(%`9:!$b%F+A74*U3,%3G%2,='+*/+?%N433?%M3C%`D<@+'+82*b%.3%87/=4+/%
?7'2,A%+K+'=2/+E%*%D2+'*'=D<%3G%=38@+U,A%@D</2343A2=*4%,++?/%-D</2343A2=*4%F+H2+C/%u$`9bE%
$XuLm:!(%DW@E""@D</'+H(@D</2343A<(3'A"=3,.+,."u$"9"$Xu%%
X(! O2NN<%-(%`9::9b%6.D+'3/=4+'3/2/E%tD+%x+C%I2+C(%;=2%68+'(%95m`$bEX#L$$(%
$(! ;2+A+4%F0%+.%*4(%`9:!!b%P*,=+'%;.*U/U=/0%9:!!E%tD+%28@*=.%3G%+4282,*U,A%/3=23+=3,382=%*,?%
'*=2*4%?2/@*'2U+/%3,%@'+8*.7'+%=*,=+'%?+*.D/(%P6%P*,=+'%_%P42,%m!E9!9L9km%
m(! o+*?2,%ln00%-+.47'*%Pe0%>%c+'/.7=S%nR(%`9:!kb%l34+=74*'%8+=D*,2/8/%42,S2,A%?2*N+.+/%.3%
.D+%*==+4+'*.+?%?+H+43@8+,.%3G%*.D+'3/=4+'3/2/(%P*,%_%&2*N+.+/%k#EkX$Lk$:(%