1. Introduction to the Course
These courses are going to cover four major topics: cardiovascular physiology, respiratory physiology,
renal physiology, and then digestive physiology.
1A. Cardiovascular Physiology
We're going to start out with lectures looking at thefunction of the cardiovascular system, so today, we'll
begin by looking at electrical activity in the heart: we'll look at how electrical activity is conducted
through the heart from the endogenous pacemaker through to contractile cells - you've all heard of
implantable pacemakers, but there is an endogenous groupof cells in the heart thatfunction as the normal
pacemaker in normal, non-pathological situations.
In the next lecture, we're going to look at the ECG (electrocardiogram), which produces that generally
familiar heartbeat pattern, and we'll see what the various deflections, and periods between deflections,
represent; as well, we'll see how you can use an ECG to determine whether a heart is functioning
normally, or to diagnose disease or abnormal states.
We'll then look at what's called the electrical axis of the heart, which is the general, overall direction that
electrical activity flows in the heart; again, this is a very useful diagnostic tool that can tell you whether
there are various disease states in the heart. The axis can deviate from its normal direction, either to the
left or the right, and which direction it goes and the extent to which it deviates can assist you in
The cardiac cycle, the focus of the next lecture, tells about the various pressure and volume changes, the
opening and closing of valves, and the contraction of atria and ventricles that occur during a single beat
of the heart (or cardiac cycle).
We're then going to look at regulation of cardiac output (cardiac output refers tothe amount of blood the
heart puts out per unit of time), and regulation of blood flow, and then heart failure and blood pressure.
1B. Respiratory Physiology
When we come to respiratory physiology, we'll begin by looking at pulmonary mechanics, i.e., the
pressure and volume changes, muscle contraction, and other factors that are associated with a single
inspiration and expiration. We'll look at a technique of spirometry, which is used to measure lung
volumes and capacities. Again, these are important diagnostic tests, and can be used to diagnose, for
instance, whether someone has an obstructive lung disease, a restrictive lung disease, or whether the lung
is functioning normally.
Alveolar ventilation looks at how the air that we breathe in actually gets into the gas exchange site, the
alveoli, and how this can be modified by changing breathing rate and tidal volume and how they are
Blood-gas transport looks at the linkage between oxygen and carbon dioxide transport in the red blood
cell; everyone knows that hemoglobin in the red bloodcells carries oxygen, but it is also critical for CO 2
transport in the blood as well - and you cannot separate oxygen and CO trans2ort.
Ventilation-perfusion matching looks at how we keep the volume of air that we breathe in, and the
volume of blood pumped to our lungs relatively constant in order to allow for optimal gas transfer.
Control of breathing looks at mechanisms in the brainthat produce breathing: just as there is a pacemaker
in the heart to control heart rate, there is what could be called a pacemaker in the brainstem that controls
breathing without any conscious thought.
And then, we'll look in one lecture at various sleep-related breathing disorders.
1C. Renal Physiology
In the renal system, we're going to look at kidney function, the regulation of various ions, the role of
different hormones in regulating kidney function, and then at how we have an osmotic gradient going
from the outside to the inside of our kidney, which allows us to form a concentrated urine (without this
gradient, we can't produce anything but the most dilute of urine).
We'll spend about a lecture and a half looking at acid-base balance, which brings into play the renal,
respiratory and cardiovascular systems - so it is a good integrated topic.
1D. Digestive Physiology
And then finally, we'll spend the last four lectures looking at the digestive system. We'll look at the
functions of the various components of the GI tract, as well as the various accessory organs that provide
enzymes and other substances to facilitate gut functi on. Then we'll look at the digestion and absorption of
various nutrients, and the neural and hormonal regulation of the digestive system.
2. The Cardiovascular System
I've already alluded to the various topics that we're going to cover; and throughout our study of the
cardiovascular system, we're always going to come back to some basic principles and equations that can
really help in your understanding of cardiovascular control.
The amount of blood pumped out of the heart per unit of time is called cardiac output, and it is a
function of heart rate, and stroke volume. Stroke volume is the volume of blood pumped per beat.
Thus, cardiac output is produced by the equation CO = HR x SV.
All of the cardiovascular regulatory systems we're going to look at have, at their core, one basic, critical
function: and that is to prevent blood pressure from falling too low. High bloodpressure will kill, but it
will take years; low blood pressure will kill in minutes . So every adjustment we see in the heart and blood
vessels throughout cardiovascular function ultimately boils down to keeping blood pressure up so blood
flow can occur to organs that are critically sensitive to low oxygen levels. 3
We can calculate blood pressure by multiplying cardiac output by what is called peripheral resistance.
This refers to the resistance to blood flow within the circulatory system. We'll see that this resistance
occurs primarily in small vessels, particularly small arteries called arterioles.
So, cardiovascular regulatory mechanisms are going to impinge on these three factors: heart rate, stroke
volume, and peripheral resistance. Whether it’s a nervous mechanism or a hormonal mechanism, all
adjustments that occur in the cardiovascular system are going to affect one or more of these three
variables with the ultimate goal of keeping blood pressure levels up.
2A. Heart Anatomy
Before we start looking at electrical activity, I just want to cover some basic heart anatomy to place
everything into perspective, and then look at some ba sic patterns of blood flow. The human heart, like the
hearts of other mammals, is a four-chambered heart. There is a left side and a right side; with both an
atria and ventricle on either side. Blood comes back from circulation via the vena cava, with the
inferior vena cava coming from the lower body and asuperior vena cava coming from the upper body:
they empty into theright atria, and then blood flows through anatrioventricular valve, in this case the
tricuspid valve to theright ventricle. When the right ventricle contracts, it pumps blood up through the
pulmonary arteries, up to the lungs.
Oxygenated blood returns to the heart via the pulmonary veins and enters the left atria, and moves
from there to the left ventricle, and then up to the aorta, into systemic circulation. The atria and the
ventricles are separated by several septa - there is an interatrial septum that separates the atria, and an
interventricular septum that separates the two ventricles. The left ventricle is the ventricle that pumps
blood to the systemic circulation, which has rather high resistance; thus the left ventricle's muscles are
substantially greater than those of the right. When we look at blood flow, we'll see how the pulmonary
circuit (which is supplied by the right ventricle) has substantially less pressure in it: and so the right
ventricle doesn't need to pump with such force, as it faces far less resistance.
To reiterate the pattern of blood flow, then, we have deoxygenated blood from the systemic circulation
coming into the right side of the heart, and then being pumped through the pulmonary arteries to the 4
lungs. The blood is oxygenated, returns to the heart via the pulmonary veins, goes into the left ventricle
and then is pumped via the aorta back to the systemic circulation. Thepulmonary circuit isthe only place
where we see an artery carrying deoxygenated bloodand a vein carrying oxygenated blood; the opposite
is true throughout the rest of the body. This is because the designation of artery/vein has nothing to do
with oxygenation, but rather whether it is carrying blood towards or away from the heart. Red and blue
colours are generally used to designate oxygenated and deoxygenated blood, respectively.
2B. The Conduction System of the Heart
So next, let's look at the electrical conduction system of the heart. The electrical activity that will
eventually cause the heart to polarize and contract isgenerated in a little region in the right atria called the
sinoatrial (SA) node. It consists of a group of cells that have no resting membrane potential, and will
spontaneously depolarise, thereby sending a wave of electrical activity through this conduction system;
where it will go to the contractile muscle cells, and cause the heart to contract.
Everything, then, begins in the sinoatrial node. We have action potentials fired in the sinoatrial node
cells, in the pacemaker cells, and this electrical activity spreads throughout the atria, through what are
termed internodal pathways. The pathways travel out from the nodes throughout the atria, carrying
waves of depolarisation. These waves of depolarisation cause the heart to contract; they travel through
the atria, to the ventricle, through a single pathway: theAV (atrioventricular) node. The septa, between
the atria and the ventricles, prevent any electrical activity from simply going anywhere in the heart -
instead, all electrical activity must, at some point, go through the AV node. So we have these waves of
depolarisation, going from the SA node, through the atria, to the AV node, where they pass on to the
From there, these waves of depolarisation travel through an AV bundle, or what is called the Bundle of
His, and then through two branch bundles, a left and a right, which go through the interventricular
septum. From there, the activity goes through what are known asPurkinje fibres, which originate at the
bottom (apex) of the heart and move upward into the contractile muscle. This pattern of activity has the
effect of causing the heart to contract starting at the bottom, easing theflow of blood up into the aorta or
the pulmonary artery. The cells in this internodal pathway system are modified muscle cells, not
contractile cells - the job of these cells is instead topass waves of depolarisation onto the contractile cells,
thereby triggering their contraction. 5
Cells within the heart are electrically coupled via gap junctions. From the SA nod