Blood path: RA to RV to lungs to LA to LV to body; the left ventricle is thickest because it pumps against systemic resistance. S1 marks AV valve closure, S2 semilunar closure.
Conduction: SA node (pacemaker) to AV node (0.1 s delay) to bundle of His to Purkinje fibers. On the ECG, P is atrial depolarization, QRS ventricular depolarization, T ventricular repolarization.
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CO
ร
TPR
Poiseuille: resistance scales as RโฮทL/r4, so halving a vessel radius raises resistance 16-fold โ arterioles are the resistance vessels controlling blood pressure.
Frank-Starling: more preload stretches the ventricle and raises stroke volume; afterload is the pressure it must overcome; sympathetic tone raises contractility independently. Ejection fraction is SV/EDV.
Capillary Exchange
Starling forces: Jvโโ(PcโโPiโ)โ(ฯcโโฯiโ) Hydrostatic pressure filters fluid out at the arteriolar end; albumin's oncotic pull reabsorbs it at the venular end. Low albumin or blocked lymphatics produces edema.
Key Takeaways
CO and TPR jointly set blood pressure; exercise raises both HR and SV.
The r4 dependence makes arteriolar tone the dominant BP lever.
Preload up means SV up; afterload up means SV down.
Starling force imbalance explains edema in liver, kidney, and lymphatic disease.