| 00:14 | Okay. I think we are ready get going. You guys ready to |
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| 00:18 | going? You learn about the Only one person is nodding their |
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| 00:25 | So what you wanna talk about Yeah. No ideas. Meston. |
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| 00:36 | talk about calibration real quick. And what we're gonna do after calibration. |
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| 00:39 | it's like a literally three minutes talking calibration because it's really hard to do |
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| 00:43 | 123456 people here. Okay. Eso gonna talk to the six people |
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| 00:49 | If you want to shout out your , you can. What do you |
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| 00:51 | ? Good paper. Bad paper. paper. Good paper. Good, |
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| 00:57 | , good. It was a good . I like that. That's the |
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| 01:02 | . This was a good paper. right, So you probably figured that |
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| 01:06 | . If the first time you went it, you scored it. You've |
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| 01:08 | a crappy great. It's like, a second. Maybe I was a |
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| 01:11 | bit too harsh, because on the paper, I was a little bit |
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| 01:15 | easy, and so I gave them sorts of Oh, I'm so sad |
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| 01:18 | you grades. And then now you Wait a second. Ah, So |
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| 01:22 | had to go the other direction, ? So they did a really good |
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| 01:27 | . I don't have again. I have the scores in front of me |
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| 01:29 | up in my office. But I I scored the overall paper, like |
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| 01:34 | a 93 or 94. And I , there are flaws in the |
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| 01:38 | I'm not gonna pretend like the perfect . And the odds of you coming |
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| 01:41 | the perfect paper is pretty much like odds of you come across a four |
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| 01:45 | clover on a highway. It's just gonna happen. All right, perfect |
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| 01:50 | just don't exist. But what you do with something like this is you |
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| 01:54 | kind of see Alright. Well, they accomplishing the goals? Are they |
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| 01:59 | the rubric scores? And if they , award them for doing so. |
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| 02:04 | again, you don't have to be . You don't have to be |
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| 02:07 | You're just sticking to the rubric. we have a couple things coming |
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| 02:12 | right? We have one mawr So you've had an easy one. |
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| 02:15 | mean, a bad paper. I need to a bad paper, |
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| 02:19 | That was the first one, you a good paper. So what do |
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| 02:24 | think the third calibration is going to ? Who knows? It could be |
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| 02:30 | good one. It could be another one. Could be someplace in the |
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| 02:32 | . You've got to figure that And then on Friday, what do |
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| 02:35 | have? Rough draft, Which means final paper that gets to be reviewed |
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| 02:40 | you can come back and fix All right. So, um, |
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| 02:44 | know they're gonna be some of you are perfectionists who think that you're not |
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| 02:47 | turn into perfect paper and air You're not gonna turn in anything, |
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| 02:51 | let me just say if you turn something, you're getting scored on |
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| 02:56 | right? So if you get ones the way across the board, that's |
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| 03:00 | than zeros all the way across the , right? What's the lowest grade |
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| 03:04 | get on the paper? Do you if you turn in something, just |
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| 03:09 | what's low is great? Well, one's equal. You want to read |
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| 03:12 | instructions? E didn't think so, there was a lot of a lot |
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| 03:16 | words in those instructions, and Lord it might say, You know, |
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| 03:19 | you send Doctor wanted a six pack his favorite beer, it might might |
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| 03:24 | have to turn in My paper. be in there. Go read the |
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| 03:28 | . You never know. There might some secret loophole that you can get |
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| 03:31 | of doing something. Who knows? really isn't. All right? I |
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| 03:38 | even know where I was going. brains all for what was talking |
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| 03:49 | Oh, yes. So what does mean? One is the lowest grade |
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| 03:52 | can get. If you get all all the way across word, you |
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| 03:54 | a 50 50. Right now, you turn in a title, I'm |
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| 04:01 | come hunt you down at your I'm gonna breathe on you, and |
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| 04:03 | gonna get cove It and die. scared some people. I think right |
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| 04:12 | it's but that's it. But I've students who are like, Well, |
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| 04:15 | didn't want them to see that I have my conclusion done, so I |
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| 04:17 | turn in a paper. Oh, you got a zero instead of a |
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| 04:23 | . That was smart. Don't be student. Turn something in. All |
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| 04:28 | , So that's the key thing. what does that paper do? Friday |
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| 04:32 | what time? Midnight. After you start losing points. Okay? |
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| 04:37 | just get it on on time. take care of. And then you |
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| 04:40 | pure views that are gonna look a like these calibrations. Alright. So |
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| 04:44 | what I'm gonna talk about there. there any questions about what's coming |
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| 04:48 | Any questions about the test right Who? I discovered something new |
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| 04:52 | All right, so one of your emailed me or came to office hours |
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| 04:56 | I know you guys love coming officer said, Hey, I don't know |
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| 04:59 | to see my scores or blah, , blah, but the test I |
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| 05:01 | , All right, well, I'm . Why don't you tell me what |
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| 05:03 | see? So I know what I right and wrong, but I can't |
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| 05:06 | the answers to the questions. So changed the setting and I said, |
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| 05:09 | can you see? Now? Said could see the answers, but I |
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| 05:12 | see what I put in. I All right, click another button. |
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| 05:14 | said, Now, what could you ? So I could see what my |
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| 05:17 | is that I could see what all answers are. And so now I |
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| 05:20 | what I got right and what I wrong. And now I can actually |
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| 05:24 | exam. So you could do that for both of the exams. That's |
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| 05:26 | what's gonna happen? Moving forward? did not know I had the wrong |
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| 05:29 | , so I apologize for that. you can now go in and |
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| 05:32 | What the hell? All right, that's the other thing. Are they |
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| 05:38 | fun in the chat? No. , not at all. All |
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| 05:41 | let's talk about some actual biology. talk about the heart. All |
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| 05:46 | So I think you're gonna find Um, like I said in my |
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| 05:50 | , this is kind of the This is, like, the highlight, |
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| 05:53 | high point of the class where everything now we're going to start coming back |
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| 05:58 | in terms of the amount of work you're gonna do is going to slow |
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| 06:00 | a little bit after turning in the and doing the peer reviews. That |
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| 06:04 | all you gotta do is just work the paper. In terms of the |
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| 06:07 | , I think it's even gonna get as Well, with one exception, |
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| 06:11 | think the hardest class we're gonna have here moving forward is probably the, |
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| 06:16 | I can't remember the first or the lecture in the renal. Siri's |
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| 06:20 | there's two of them. One because system, it's one of those things |
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| 06:23 | is not hard, but the first you go through it, it's kind |
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| 06:25 | like, you know, confusing. once you get past the confusing, |
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| 06:29 | like, Okay, this is not bad as a sui get. And |
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| 06:33 | think this stuff is a little bit interesting than the brain, right? |
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| 06:37 | I think you're gonna find this a more fun. And and also, |
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| 06:39 | easier to understand rather than these nebulous of how you have these neural systems |
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| 06:46 | the circulatory system is simple. We already understand that there's three parts to |
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| 06:50 | , right? We've got our We got our blood vessels. Then |
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| 06:53 | got the blood that's circulating through That is a circulatory system in a |
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| 06:57 | . Thank you very much. You go home now. No, you |
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| 07:02 | more. Okay. Yeah, I about 30 more slides, so |
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| 07:07 | All right. So the heart is pump, all right. And with |
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| 07:11 | circulatory system is basically these blood vessels allow you to move a fluid the |
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| 07:17 | through and allows you to carry nutrients materials to the different parts of your |
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| 07:22 | . In fact, we're gonna look blood vessels a little bit later. |
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| 07:25 | blood vessels there's not a single cell your body that is more than 10 |
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| 07:30 | away from a blood vessel. All , so, in other words, |
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| 07:34 | order for yourselves to survive, they to receive the nutrients that they're that |
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| 07:38 | going to get from the from the system. They need that in order |
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| 07:43 | survive. And so the circulatory system responsible for doing that. The process |
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| 07:48 | moving blood through the blood vessels is perfusion. It's measured in terms of |
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| 07:54 | per sorry per unit time program of . I get that right mils per |
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| 07:58 | program. Alright, I'm not gonna some sort of strange for me to |
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| 08:02 | . Tell me what this is, in essence, when you hear the |
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| 08:05 | perfusion, you should think blood is through a blood vessel. Alright, |
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| 08:09 | that's what we're shooting for their All , So the heart is responsible for |
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| 08:14 | the force that drives that blood through blood vessels. And we're gonna be |
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| 08:18 | at all of those, uh, characteristics. What? The force is |
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| 08:23 | the Star Wars force, but the that drives blood. All right, |
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| 08:26 | gonna be looking at some of the that govern this process. Now, |
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| 08:32 | is simply water plus stuff, all , It's the materials that are being |
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| 08:38 | . So there's includes and nutrients the gasses that you breathe in and out |
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| 08:43 | gonna be in the blood. And what we're doing is we're taking those |
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| 08:47 | and moving to them to where they to be all right. Also sells |
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| 08:52 | waste, and we want to get of waste. So the blood is |
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| 08:55 | means by which we move waste. it's basically just a system to move |
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| 09:00 | around the body efficiently. All now, in a very general |
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| 09:05 | these were the three blood vessels. gonna have a whole lecture on the |
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| 09:08 | vessels in a little while. Not lecture, but the next one, |
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| 09:11 | believe. And so these are the vessels. If you memorize these three |
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| 09:15 | , you're pretty good going forward Arteries always blood vessels that carry blood away |
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| 09:20 | the heart. On the other we have blood returning back towards the |
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| 09:24 | . We refer to those veins and between those two types of vessels, |
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| 09:28 | have things that are called capital. capital areas are the vessels of |
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| 09:32 | Arteries do not exchange nutrients. Veins not exchange nutrients or waste Onley |
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| 09:39 | Aries Capital years or itsy bitsy teeny . And they allow for the movement |
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| 09:43 | materials from the plasma into the interstitial and vice versa. The other two |
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| 09:50 | and veins are simply conduits to move fluid very quickly between the heart and |
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| 09:56 | tissue where the exchange is taking Our focus, then, is gonna |
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| 10:02 | on the heart today. All The heart sits in your chest. |
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| 10:06 | doesn't look like this. Or however do heart hands. Sorry, you |
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| 10:10 | see this online. Guys alright. actually does have that kind of shape |
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| 10:14 | it, but it's basically it's fallen to its side and it's jammed into |
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| 10:17 | chest and you can kind of see up there in that top left picture |
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| 10:21 | it says two pumps. You can it has the apex, that pointy |
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| 10:25 | pointing down towards the left hip. right, now the heart is a |
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| 10:31 | chambered organ. It's hollow, And it has three basic anatomical features |
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| 10:36 | you should be aware of to help understand the physiological functions. First |
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| 10:40 | it's a two pump structure. You see the points up there in the |
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| 10:44 | as well. All right, there vessels what we refer to as the |
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| 10:47 | vessels that deliver fluid or blood to heart and then are leaving the heart |
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| 10:53 | allow the blood to be moved throughout body. All right, so they |
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| 10:57 | and propel blood. And lastly, are valves located within their two pairs |
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| 11:02 | valves that are located within the heart govern where that blood is going to |
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| 11:06 | during this pumping process. And so I want to do is I want |
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| 11:10 | kind of walk through this and I make sure before we go any |
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| 11:13 | do we all know are right from left. Everyone, I want you |
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| 11:17 | raise your right hand if you're even though I can't see you raise |
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| 11:20 | right hand. Excellent. Alright. , the reason I'm asking you to |
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| 11:25 | your right hand is because on an , what's gonna happen is you're gonna |
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| 11:29 | very confused with left and right. right, Because if you look at |
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| 11:33 | , which side is my right? side relative to you, is |
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| 11:38 | It's on your left, right, you see, left, right, |
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| 11:41 | , right. So if you're sitting on examine, you get confused. |
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| 11:45 | . Here's my right hand. If were born in America and you learned |
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| 11:48 | pledge of Allegiance, where do you you Raise your right hand? You |
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| 11:51 | it on your heart. If you born in America, you learn to |
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| 11:55 | your hand and solemnly swear something. ? So know which side we're always |
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| 12:00 | start on our right hand side. right, so that's important. So |
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| 12:05 | first thing that I have up here that it is a two pump |
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| 12:08 | We have a left pump and a pump, and you'll even hear me |
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| 12:11 | the lecture. Sometimes where I get two things confused because start talking. |
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| 12:15 | fast. So if I start going . Oh, wait a second. |
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| 12:18 | doesn't sound right. Yeah, I'll down. So you're right. This |
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| 12:23 | my right hand side. We're starting the right hand side. We moved |
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| 12:26 | our left. The right pump. right hand side is going to be |
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| 12:31 | the oxygen blood from the systemic You're systemic. Circulation is basically everything |
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| 12:37 | your body except for your chest. lungs. Okay. So it doesn't |
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| 12:42 | if it's coming from your head or your toes. That would be systemic |
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| 12:46 | . And so blood turning from the goes to the right hand side. |
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| 12:51 | you see how I'm starting over On the right hand side, It's |
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| 12:54 | blood I'm drawing. It blew because , that is the oxygenated is always |
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| 12:59 | blue. If you cut a person and look at their blood, is |
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| 13:02 | ever blue? No, it's red really, really dark red. All |
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| 13:08 | . But the blue is because if look at a vein through the skin |
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| 13:12 | of the tinting of the skin, makes that vain look blue. And |
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| 13:16 | that's why the oxy is painted Okay, if you cut open the |
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| 13:21 | , it's still gonna be read. right, now, what it's doing |
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| 13:26 | it's going to take that blood. first pump takes that blood and propels |
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| 13:31 | into the pulmonary. Circulation of pulmonary is the circulatory system that is going |
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| 13:37 | the lungs. And so what we're is we're propelling dioxide blood into an |
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| 13:42 | so that it could become oxygenated, so that blood coming from the pulmonary |
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| 13:48 | then enters into the second bump. would be the left side of the |
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| 13:53 | . So the right side propels to pulmonary system. The left side of |
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| 13:57 | heart receives that blood. It's oxygen oxygenated now, and we can now |
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| 14:02 | it to the rest of the body from the left side. So the |
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| 14:08 | pump is to the systemic circulation, then that blood that's being pushed |
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| 14:13 | The systemic circulation is being pushed back the right hand side. It's now |
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| 14:17 | oxygenated because gone throughout the body and the oxygen has gone to your big |
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| 14:21 | because your big toe needs all that for all the hard work it's |
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| 14:25 | And then we just repeat the process and over and over again. Right |
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| 14:29 | pumps into the lungs with left pump out into the systemic circulation. All |
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| 14:36 | , Now, if you look at pump, what we have is we |
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| 14:39 | an upper and a lower chamber. upper chambers refer to as an |
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| 14:42 | If you don't know what that term , it means the entrance or the |
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| 14:47 | first room you enter into a When you came into this building, |
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| 14:51 | walk into the atrium, all And so that's the receiving chamber. |
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| 14:58 | now there is muscle. The heart made up of muscles and the atrium |
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| 15:02 | muscles. But it doesn't play a role in propelling fluid into the |
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| 15:11 | um, circulatory system. Right? the right side of the heart is |
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| 15:15 | blood into the pulmonary circulation. The plays very little. Hart has a |
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| 15:21 | small role in propelling that blood Alright, it's job is to just |
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| 15:26 | of collect blood and then move it the second chamber, which is the |
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| 15:31 | . And frankly, 90% if not of the blood that enters into the |
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| 15:36 | just naturally flows into the ventricle. all right, Because it's like |
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| 15:41 | These doors were opened. You just of wander in because this is the |
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| 15:46 | it goes. And so blood interest the second chamber, that ventricle in |
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| 15:50 | ventricle plays the major role of All right, so the H M |
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| 15:56 | blood and then kind of allows it be delivered to the ventricle. The |
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| 16:01 | then does the pumping portion to propel blood out in the circulation. So |
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| 16:06 | occurs both on the right hand side on the left hand side. See |
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| 16:14 | else we got here? Oh, . Now talk about valves. |
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| 16:19 | the two chambers air separated from each bivalves. And the purpose of a |
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| 16:24 | in the circulatory system is to create of flow. All right, the |
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| 16:29 | are one way valves. That means the pressure on the backside of that |
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| 16:35 | for well is greater than the than the front side. That causes the |
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| 16:40 | open. So the flow moves from back to the front. But when |
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| 16:44 | pressure on the front side becomes greater the backside than the valve closes and |
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| 16:49 | the backflow of that blood or that in the opposite direction. So the |
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| 16:56 | of the valves is to drive the in one direction. Now we have |
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| 17:01 | pairs of valves. We have what call the atrial ventricular valves, cleverly |
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| 17:05 | because they lie between the atria and . Right? So, atrial |
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| 17:10 | Now they do have very specific You can you refer to him. |
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| 17:14 | ask if you're like me and lazy the right and the left atrial ventricular |
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| 17:19 | , right and left a V Right? That's the abbreviation. But |
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| 17:22 | do have names. Anatomically speaking, right a V valve is called the |
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| 17:26 | cuss, but it has three You can look in there and you |
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| 17:30 | kind of see how they're kind of off to each other. Let me |
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| 17:33 | if I could just circle that for . So there's one. There's |
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| 17:38 | There's the third one over there. the name. Try cusp it all |
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| 17:43 | . The other valve, the left V valve is the bicuspid, and |
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| 17:48 | has to custom. You can see kind of tied off if I don't |
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| 17:52 | in both at the same time, one that sits over there and one |
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| 17:58 | kind of sits up like that, right, but it also the another |
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| 18:01 | . It's called the mitral valve. name, the mitral valve. Because |
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| 18:05 | you look at the valves, they like a bishop's miter. All |
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| 18:09 | Now, again, I'm not gonna you. That's just I like tribute |
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| 18:12 | that. It helps me remember All right, So how do you |
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| 18:15 | ? Right versus left. If which which will, Right? Has an |
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| 18:18 | . I try Cusp, it has I and and that's why I've underlined |
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| 18:22 | and highlighted it for you. All , so these valves, it's between |
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| 18:26 | atrium, the ventricles. So when ventricle is contracting, it has more |
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| 18:31 | than on the than the atrium And we don't want the flow of |
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| 18:35 | to go out back into the We wanted to go out towards the |
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| 18:39 | system, and so this valve, it closes, prevents that backflow into |
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| 18:45 | atrium. All right, so that's purpose of the A V valve. |
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| 18:48 | prevents the backflow of fluid from the into the atrium when the pressure is |
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| 18:54 | than the in the atrium. than the ventricle than you have forward flow |
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| 18:57 | blood moving from the atria to the . That kind of makes sense. |
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| 19:02 | a door that opens one way from back side of the door. You |
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| 19:06 | to go in. If you're on front side door, you don't get |
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| 19:08 | go back. The other two valves the semi lunar valves. Why do |
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| 19:12 | call them semi lunar now? semi half lunar half moon valves. |
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| 19:19 | do you think they're called half moon ? Because they only work at night |
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| 19:24 | the half moon is there. you're right. They look like half |
|
| 19:29 | . All right, You're not gonna this stuff When you see here at |
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| 19:32 | dump stuff, it's like, yeah, that was when he said |
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| 19:34 | stupid, which is like 80% of class right now. The nice thing |
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| 19:41 | thes simulator valves is there, named where they're located between the ventricle and |
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| 19:48 | part the sorry, the next vessel you're gonna enter into. So between |
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| 19:54 | right ventricle and the pulmonary circulation, to the vessels that are coming out |
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| 20:00 | called the pulmonary arteries. And so vow between the pulmonary artery and the |
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| 20:06 | is the pulmonary valve between the aorta the left ventricle. You have the |
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| 20:13 | or sorry. You have the order the left ventricle. If you have |
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| 20:16 | aortic valve, that's where the name from. And once again, once |
|
| 20:20 | push blood out of the heart, don't want that blood coming back |
|
| 20:23 | This is like kicking a kid out the house. You don't want them |
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| 20:26 | come back after you kicked him out the house. So you slam the |
|
| 20:29 | shut and you lock it. And what these valves air doing. This |
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| 20:33 | what your parents are plotting right That's funny. You're supposed to laugh |
|
| 20:38 | that. Especially you guys online. right, so what we're doing is |
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| 20:43 | driving the blood in a very specific . From the heart to the circulation |
|
| 20:49 | circulation back around to the heart. right, now, not on |
|
| 20:53 | Are we doing this? But we're what I want to point out here |
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| 20:57 | notice that we don't need a valve the atrium and the circulatory system, |
|
| 21:04 | right? And the reason for that when the atria contracts. What is |
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| 21:08 | to do is it's actually going to that vessel close, so it kind |
|
| 21:12 | serves as a false valve. All , so what? I'm creating massive |
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| 21:16 | in the atria. I'm actually uh, you know, pressing on |
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| 21:20 | squeezing close the vein that's entering into atrium. But the other reason is |
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| 21:28 | really, we're gonna learn. Learn over the course of the next three |
|
| 21:32 | is that in order for flow toe in the circulatory system, we have |
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| 21:35 | have a point of high pressure and point of low pressure. The highest |
|
| 21:42 | . If you consider your whole one big giant, giant circle is |
|
| 21:45 | be on the on the left ventricle the heart. Right, Because left |
|
| 21:51 | is going in the systemic circulation and lowest point of pressure in order for |
|
| 21:55 | to return back to the heart has beware. I want you to think |
|
| 21:59 | a second if the highest pressures and I want to get blood back |
|
| 22:02 | the point. Remember, we're going You know this about great. It's |
|
| 22:05 | go from an area of high pressure an area of low pressure. If |
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| 22:08 | wanna get back to the left or the right atrium, where is the |
|
| 22:11 | pressure gonna be? It is not trick question where the blood comes in |
|
| 22:17 | the right atrium. They're good. heard it. So the highest pressure |
|
| 22:24 | in the heart and on the opposite . That's the lowest pressure and even |
|
| 22:29 | so on the side. I think now it doesn't. Sorry. So |
|
| 22:34 | one of the reasons we don't need valve because there's gonna be greater pressure |
|
| 22:38 | the Vienna Cavell, which is the vein back to the heart is greater |
|
| 22:44 | in the atrium. If it wasn't than blood, wouldn't return to the |
|
| 22:47 | and go to the place where the pressure happens to be all right. |
|
| 22:51 | in the grand scheme of things, need to think of this as one |
|
| 22:54 | giant circle, all right, where high pressures on one side low pressures |
|
| 22:58 | the other side. If that wasn't case where the lowest pressure is, |
|
| 23:01 | where the blood would go. So why the left atrium Excuse me? |
|
| 23:05 | right atrium is the lowest pressure So this kind of is what the |
|
| 23:10 | flow looks like. And this is of those things that you should just |
|
| 23:13 | of commit to memory. And you see. Where do I start? |
|
| 23:16 | here on the right hand side. ? I pledge allegiance, right. |
|
| 23:20 | , right atrium. The blood that's to the right atrium member is oxygen |
|
| 23:25 | . So it's blue, right? blood flows into the right ventricle. |
|
| 23:30 | I should circle this so you guys see where we are. Right. |
|
| 23:33 | here's the right. Uh, do where I hold the back of the |
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| 23:37 | . So here's your right atrium. you go into the right ventricle, |
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| 23:41 | ventricle pumps out into the lungs. . So that would be an artery |
|
| 23:46 | the pulmonary arteries and then through the circulation. So you'll have capital |
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| 23:51 | and then you'll come out through the veins. Your turn back to the |
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| 23:55 | atrium, then you move to the ventricle. Notice that at this |
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| 23:58 | the blood is oxygen rich when it lungs. And what you're doing is |
|
| 24:03 | pumping out into circulation once again. way you could look at this if |
|
| 24:09 | really wanna be truly truly lazy and capital areas for a moment, all |
|
| 24:13 | , I'm just gonna ignore the capital Look at what happened. We go |
|
| 24:16 | the atrium to the ventricle into an , got capital areas in there that |
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| 24:21 | ignoring. Then we go to veins then you return to an atrium, |
|
| 24:25 | then you go to a ventricle and you go back out to an artery |
|
| 24:28 | ignoring the capital areas and notice what do here is we come all the |
|
| 24:32 | back around and we have veins. enter into the atrium again. You |
|
| 24:37 | what we got here? A V V A V A V. And |
|
| 24:39 | you want to, you can throw right in there. There's your capital |
|
| 24:43 | and there's your atria ventricle arteries. your Kapler's. You see how that |
|
| 24:49 | works. It's pretty simple in terms anatomy and in terms of nomenclature. |
|
| 24:59 | right, so the anatomy portion, think it's simple. Are there any |
|
| 25:06 | about the anatomy of the heart? We didn't name the parts of the |
|
| 25:11 | , just the big stuff, because all sorts of little crazy tiny things |
|
| 25:16 | there that when you take anatomy, point every single solitary thing out. |
|
| 25:20 | you're just like, Okay, time . I give questions, comments, |
|
| 25:27 | . Okay, on the on the there. Where you actually Yeah, |
|
| 25:34 | looks like it's from blue to Yeah. Become Yeah. So I'm |
|
| 25:39 | to circle here, and you're you're right here, right? Yeah. |
|
| 25:44 | . So what you're doing is you're from D oxy blood. There's gonna |
|
| 25:46 | capital areas in there, right? those your capital areas, which I've |
|
| 25:50 | out there, right, notice when see the purple that's showing you there |
|
| 25:55 | exchange taking place. So you're making transition. And when we talk about |
|
| 26:00 | , a couple lectures, it's gonna what we're learning today into what we're |
|
| 26:04 | learn with respiration and its role in that blood. All right, but |
|
| 26:09 | that's that's the oxygenation taking place. when you come back out on the |
|
| 26:13 | side, what you have is you oxygenated blood. All right, so |
|
| 26:19 | what it's trying to show you. six. It says that some of |
|
| 26:23 | automated blood roll go and mix with oxygenated Yes, yes. And so |
|
| 26:33 | have to kind of look at this this figure a little bit more carefully |
|
| 26:35 | see what their what they're trying to here. Um, um we'll see |
|
| 26:44 | got a part of me. This , like, two point fun to |
|
| 26:46 | . Maybe even one point front. , s. So the idea |
|
| 26:51 | I think, is what they're trying say is, Look, you we |
|
| 26:54 | guarantee that everything is gonna be 100% anymore than we can promise that everything |
|
| 26:58 | gonna be 100% detox. In what we're going to see a little |
|
| 27:02 | later is that it's never 100%. if you started watching those apple watch |
|
| 27:08 | , what do they keep showing you oxygenated. And we're gonna understand what |
|
| 27:13 | means when we start talking about that we do the respiratory system. So |
|
| 27:18 | understand that yes, there is a bit of mixing. It's not 100% |
|
| 27:21 | , but the the principle is the that we're going from deok stocks. |
|
| 27:27 | . Served, um, after we're a systemic quarters of gas exchange. |
|
| 27:34 | any place where you see these types things that they're gonna be the capital |
|
| 27:39 | and what they're saying is, and circling a whole bunch of that aren't |
|
| 27:42 | well in there. So when you're at portal systems, ignore the portal |
|
| 27:46 | for a moment. But the idea that what you do is when you're |
|
| 27:50 | with gas exchange, it's occurring at level of the capital Aries. So |
|
| 27:53 | you're doing is you're going from an down to a smaller structure till you |
|
| 27:57 | get down to the capital areas. areas is where the material exchange takes |
|
| 28:02 | . And this is when I say you're no more than 10 microns |
|
| 28:05 | You're really dealing with capital, every , and that's not gonna be part |
|
| 28:08 | this lecture. If if we want pursue that, you just gotta wait |
|
| 28:11 | lecture or two before I go into depth about that. Okay, because |
|
| 28:16 | story I wanna tell you now is how we get the blood toe where |
|
| 28:19 | goes. All right, that's that's story. Any other questions? All |
|
| 28:27 | , let's deal with blood flow alright dealing with pressure. Now, |
|
| 28:33 | in that very first unit. I you need to know about Grady INTs |
|
| 28:35 | you need to start thinking great. because we're gonna see Grady. It's |
|
| 28:38 | and over and over again. This the first time we're going to see |
|
| 28:40 | again. All right, So what is showing you is that blood flow |
|
| 28:45 | gonna be dependent upon a pressure grading pressure. Grading simply is the difference |
|
| 28:49 | pressure between two points. And in little cartoon up here, what they're |
|
| 28:53 | is Look, here's point number one so we can do pressure number |
|
| 28:56 | Here's pressure number two. I can and measure what those pressures are, |
|
| 29:00 | the difference between them is the Delta or the difference in pressure. If |
|
| 29:04 | think about the circulatory system, as I said, I create a high |
|
| 29:08 | over here in the ventricle. My pressure is over here. I could |
|
| 29:12 | the measure between those two points, that would be the Delta P. |
|
| 29:16 | right. That's the difference in pressure the entire length of the systemic |
|
| 29:21 | Alright, so the movement or blood is gonna be dependent on that |
|
| 29:27 | Grady int. Alright, and simply blood flows just like every other liquid |
|
| 29:31 | an area of high pressure to an of low pressure. Well, that's |
|
| 29:35 | , right? And I say, you ever have to do math in |
|
| 29:38 | class? There is the math on of the exams. Nope, but |
|
| 29:42 | do have to know some formulas every and then. We're going to see |
|
| 29:44 | couple of them here. Alright, this is a real simple one |
|
| 29:48 | Part of the reason pressure drops over length of a tube is because when |
|
| 29:53 | fluid is moving through, that tube rubbing against the sides of the |
|
| 29:57 | and that friction causes resistance or is . And so it causes flow loss |
|
| 30:05 | we're going to see that resistance has impact in terms of flow. Now |
|
| 30:09 | already know this right? Think of floor. This floor is horribly carpeted |
|
| 30:14 | really, really gross. All but can you imagine taking a running |
|
| 30:18 | across this carpet? How far would slide? Not very right, because |
|
| 30:22 | resistance. Now imagine if we ripped this carpet this ugly, nasty mustard |
|
| 30:28 | think it's mustard yellow. I'm just That's the color, right? And |
|
| 30:33 | it being tile now. And you a running dive and you went |
|
| 30:37 | Could you go further than you did the carpet? Yes, but you |
|
| 30:40 | stop after a certain distance right Imagine what I used to do when |
|
| 30:45 | was in your shoes in college, we would go take soap and we |
|
| 30:49 | soap down the dorm room halls. then what we would do is we'd |
|
| 30:55 | and take us diving, you dive to see how far we could |
|
| 30:59 | . So imagine, you know, floor, Soapy. Would I go |
|
| 31:05 | ? What did I do? I reduced the resistance, right? And |
|
| 31:08 | I increase the rate of flow. , I'm not encouraging you to go |
|
| 31:12 | that, but make sure you have while you're in college because you can't |
|
| 31:14 | that when you're an adult. Yes. We throw each other to |
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| 31:19 | who could go the furthest, and put little pins up at the end |
|
| 31:23 | the thing to see if we could them down. We did stupid stuff |
|
| 31:25 | the time. We didn't wear helmets we rode our bikes. You |
|
| 31:30 | some of us grew up with all teeth, but yeah, we had |
|
| 31:35 | , I think. No, I know if I've told this class |
|
| 31:37 | When I was when I was 15 17 years old, we all had |
|
| 31:41 | bikes because that was the thing. I grew up in El Paso, |
|
| 31:44 | I had a friend who had a that had a shallow sloping. They |
|
| 31:46 | a swimming pool. We got our up onto his house and we would |
|
| 31:50 | a bike off into the swimming We didn't think twice about that. |
|
| 31:56 | know, I had a friend who practice the table top. You |
|
| 31:59 | the tabletop isn't on the dirt bike you take the bike and you make |
|
| 32:03 | flat, right, and then you back out on your land, |
|
| 32:06 | But you have to learn how to that. And I remember my friend |
|
| 32:10 | how to do that. You got up into the tabletop. He was |
|
| 32:12 | excited, but he didn't come back . He went to the hospital, |
|
| 32:16 | his four stitches. And then the day we were riding our bikes because |
|
| 32:19 | didn't just go home and say that the end of the day or the |
|
| 32:22 | and you were writing down. We're without writing without our hands on the |
|
| 32:26 | . And he's just going on and a rock that caused that front wheel |
|
| 32:30 | start spinning and he flipped over his and reopen Those stitches had to go |
|
| 32:34 | to the hospital to get it And then we rode our bikes the |
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| 32:38 | day. Just make sure we had hands on the handlebars. You learn |
|
| 32:42 | quickly when you make mistakes, not do them again. Right? |
|
| 32:47 | Just went down a fun little rat . Alright, Rabbit hole. All |
|
| 32:53 | , so they're different kinds of Alright. And here what I want |
|
| 32:58 | to understand is that we're primarily going be dealing with this driving pressure, |
|
| 33:02 | ? This first pressure and the driving simply is the pressure that moves the |
|
| 33:07 | forward in the vessel. And so , um and again, we're not |
|
| 33:11 | math here, But in the when your physicians and you're doing, |
|
| 33:15 | have to kind of think about these . Notice here that they're showing you |
|
| 33:19 | leg that's at a 45 degree angle notice that you have. There's a |
|
| 33:23 | a calculation that you need to make order to create that driving pressure, |
|
| 33:28 | ? But we usually work in one , right? Were there in the |
|
| 33:31 | Why, uh, this So if if you're in a vessel that is |
|
| 33:36 | just along the X axis, you basically calculate All right, whatever the |
|
| 33:41 | is between point A and point that's the driving pressure that moves that |
|
| 33:45 | forward. All right, so one the things I point out here says |
|
| 33:49 | circulation, it's a difference between the and venous ends of the systemic |
|
| 33:54 | So it would be the pressure and aorta versus the pressure and the Vienna |
|
| 33:59 | . That would be the whole systemic . But if you're looking at a |
|
| 34:02 | vessel, you might just be looking two little points across that vessel. |
|
| 34:06 | would be the driving pressure, but other pressures that we need to be |
|
| 34:10 | of. So from the outside, inward is what is called trans mural |
|
| 34:16 | . It's the pressure across the wall that vessel, so remember we have |
|
| 34:22 | inside the vessel. Right. So my blood vessel. We have pressure |
|
| 34:27 | inward. That fluid is interstitial and it's trying to get into the |
|
| 34:34 | . Right? And that fluid inside vessel is trying to get out of |
|
| 34:38 | of the vessel. That would be hydrostatic pressure. So notice that this |
|
| 34:43 | is perpendicular to the driving pressure. ? So I'm just gonna draw this |
|
| 34:49 | , make it simple for you. this is the driving pressure, trans |
|
| 34:55 | pressure is moving this way. Hydrostatic is moving that way. And this |
|
| 35:01 | be the wall of the vessel I'm sorry. There's two colors there |
|
| 35:05 | one color there, but you can of get this idea. All |
|
| 35:10 | Now, the hydrostatic pressure is important this shows you the relative effect of |
|
| 35:16 | on a blood vessel, right? if I'm sitting in a chair like |
|
| 35:19 | been doing my entire week right, at your desk, watching your |
|
| 35:24 | watching your doing your schoolwork, doing , and you don't ever move from |
|
| 35:28 | chair, you notice that your feet swelling. Why? Because gravity is |
|
| 35:33 | downward, right? And that hydrostatic that water is just going. I'm |
|
| 35:38 | to figure out the fastest way out these vessels. Well, if gravity |
|
| 35:41 | pulling me down, this must be way to go. And so |
|
| 35:43 | like, tries to escape through your . Now it's not trying to escape |
|
| 35:48 | your feet is just being pulled down gravity crime. And then the trans |
|
| 35:52 | pressure is trying to drive into and that external pressure. So if you |
|
| 35:58 | ah, strong trans mural pressure but hydrostatic or week driving pressure, we |
|
| 36:04 | pressure. You end up with a of fluid, basically pressing those veins |
|
| 36:08 | driving fluid even further out, creating larger transmittal pressures. Which is when |
|
| 36:12 | see people with the Dema and their and they look like they have these |
|
| 36:16 | , swollen feet. That's what's kind going on, all right, but |
|
| 36:20 | are the three different pressures that air . All right, so trans mural |
|
| 36:26 | vessel diameter, it's pushing in hydrostatic is pulling downwards. It's going that |
|
| 36:33 | , not in this vessel. It's to get out there like that. |
|
| 36:41 | cardiac output, What is this? , this is the flow of blood |
|
| 36:44 | by the heart. Real simple Cardiac output It equal to the heart |
|
| 36:48 | times a stroke volume stroke volume is amount of blood being ejected per, |
|
| 36:53 | , per stroke or pump of the . The heart rate is how many |
|
| 36:57 | it pumps per minute. Right, you can put your hands try to |
|
| 37:01 | it. So I've got 60 heartbeats a minute. All right, so |
|
| 37:05 | your heart rate, 60 beats per . And then how much blood your |
|
| 37:08 | is ejecting? That would be your volume. Multiply those two numbers |
|
| 37:12 | You got your cardiac output. That's much blood you're pumping per minute. |
|
| 37:17 | , so it's a real simple So instead of doing some math, |
|
| 37:20 | just do some hypothetical math. What if I increase my heart rate? |
|
| 37:24 | happens to my cardiac output? It up. It's a direct correlation. |
|
| 37:32 | happens if I increase increase my stroke , the amount of blood I'm pumping |
|
| 37:36 | beat? It goes up. So of a sudden, now it's a |
|
| 37:39 | simple way to look at this, ? If I increase either heart rate |
|
| 37:43 | stroke volume, I'm increasing cardiac output my body has one of two choices |
|
| 37:48 | increase how much blood the heart is . I can either pump more blood |
|
| 37:52 | beat or I can increase the rate which I'm beating. Okay, so |
|
| 37:58 | one of two strategies your body is to do when it needs to get |
|
| 38:02 | blood circulating through Now. There's also we're not gonna go into right |
|
| 38:06 | But based on your size, your is trying to maintain more or less |
|
| 38:10 | constant cardiac output, regardless of if a big person or a small |
|
| 38:16 | So if you go look at the rate of a child, their heart |
|
| 38:19 | is really, really fast. It's hummingbirds, right? But their cardiac |
|
| 38:25 | is roughly equal to that of an , and vice versa. If you |
|
| 38:28 | a very large person, they have ah heart rate that's rather slow. |
|
| 38:33 | trying to maintain a constant cardiac so your body has kind of this |
|
| 38:37 | point that it's trying to maintain. if you're exercising, do you think |
|
| 38:41 | your body is gonna need a greater output? Yeah, so it's gonna |
|
| 38:45 | what it's gonna increase heart rate and gonna increase stroke volume is going to |
|
| 38:50 | both and is trying to just ensure blood is flowing much mawr quickly to |
|
| 38:56 | organs. All right, but this a simple idea that we're gonna be |
|
| 39:01 | with over and over and over What I want to deal with right |
|
| 39:05 | is I want to deal with this of flow. All right, we're |
|
| 39:09 | to see that there's this relationship between said flow is dependent upon the pressure |
|
| 39:13 | int on. We also know that is dependent upon resistance. Right? |
|
| 39:17 | know, I just talked about me across the floor here, you |
|
| 39:21 | Or you can picture yourself sliding whichever you want to. All right, |
|
| 39:25 | what is resistance if you've taken You've learned this resistance is simply the |
|
| 39:30 | or opposition to blood flow due to losses, alright or due to |
|
| 39:36 | All right. And if you've ever why, Because I know many of |
|
| 39:39 | are planning on health, health Have you ever wondered why you have |
|
| 39:42 | take physics one and physics to it's that you understand this little equation right |
|
| 39:48 | ? This resistance Alright. No. what we have is an inverse |
|
| 39:55 | Oh is inversely proportional to resistance. right. So as I increased resistance |
|
| 40:02 | goes down. If I decreased, flow goes up. That's nice. |
|
| 40:07 | . Now resistance is dependent upon three factors. The first is vessel |
|
| 40:13 | Alright, that's an inverse relationship. actually it's expressed. As you see |
|
| 40:17 | there, resistance is inversely proportional Toe over are to the fore. In |
|
| 40:22 | words, as I increase my radius , my resistance drops dramatically. So |
|
| 40:30 | think about this. If resistance is are sorry, Radius is one Whatever |
|
| 40:33 | unit is, If I double I've really gone from one to the |
|
| 40:39 | Power which is 1 to 2 to fourth power, which is 16 |
|
| 40:45 | So there's this dramatic change. if you don't see that if you |
|
| 40:50 | want to do the math because math your head sometimes All right, let's |
|
| 40:53 | just do it this way. You like coffee and milk shakes? Maybe |
|
| 40:57 | together, like coffee milkshakes. Don't call those, like, Frappuccinos or |
|
| 41:02 | ? I don't know. All so when you get a coffee, |
|
| 41:05 | give you that little tiny swizzle right? The purpose of that swizzle |
|
| 41:08 | is literally to stir something. But you could suck the coffee through |
|
| 41:12 | little tiny straw, right? Like molecule at a time, right? |
|
| 41:16 | like, you know, a little of caffeine, a little bit of |
|
| 41:19 | . You know, you'll get all stuff eventually, right? Now, |
|
| 41:22 | you ever gotten a milkshake, what of started they give you big old |
|
| 41:26 | straw, right? A straw like ? Because what they want you to |
|
| 41:29 | is they don't want you to fight that milkshake. Because if you get |
|
| 41:32 | little tiny straw, you start It's You're basically have to create such |
|
| 41:36 | great force that if you aren't you might actually suck your head the |
|
| 41:39 | way into the straw. So I you to picture these 22 items, |
|
| 41:43 | ? I want you to picture that milkshake straw and putting it into a |
|
| 41:49 | cup and then taking a suck like would trying to go through that little |
|
| 41:52 | straw. What are you gonna You're gonna burn every ounce of your |
|
| 41:57 | and then probably things that you didn't were inside your body, right? |
|
| 42:01 | the coffee is just going to come the bigger the radius, right, |
|
| 42:06 | would be the radius. The bigger radius, the less resistance, the |
|
| 42:09 | the flow. Now take that little swizzle straw. Put it in your |
|
| 42:12 | of your ever, ever going to a drop of milk Shake in your |
|
| 42:15 | . Never, right, because it's same sort of issue. I'm taking |
|
| 42:19 | radius. I'm making it smaller. increasing the resistance. The flow is |
|
| 42:23 | to become next to nothing. All , now, you also vessel length |
|
| 42:30 | the vessel, the more surface area have more surface area, have them |
|
| 42:34 | resistance. I'm going to come right? So in essence, it's |
|
| 42:39 | ah longer period. Are ah, area on which I'm going to come |
|
| 42:45 | contact with something, so that's gonna a direct relationship. So there's a |
|
| 42:49 | relationship to resistance in length and lastly that's determined primarily in blood by the |
|
| 42:55 | of red blood cells. And so more red blood cells you have in |
|
| 42:59 | in the thick of your blood is that's, you know, think about |
|
| 43:02 | this. Water versus ketchup, which better water, right? Ketchup. |
|
| 43:06 | know, that's actually used to be ad. Was ketchup there like you're |
|
| 43:10 | down the thing and they'd sing the from the seventies Anticipation. And you'd |
|
| 43:14 | like, Come on, ketchup, on. All right. But that's |
|
| 43:16 | idea is so the thicker, the , the slower flow, the greater |
|
| 43:20 | all right? And so that's That's three factors. And in fact, |
|
| 43:24 | you could do is you could do math, which don't do right, |
|
| 43:28 | it shows you the relationship. This what is called castles law, and |
|
| 43:31 | can see there's constant in there. an eight and a pie, but |
|
| 43:35 | you can see there's your viscosity. length and your radius are all in |
|
| 43:41 | to this to this resistance, and what passes Law says. So just |
|
| 43:48 | real quick. Visa constriction is when vessel gets smaller. All right, |
|
| 43:53 | we're decreasing the radius. If I the radius, I'm increasing resistance, |
|
| 43:59 | ? Faizo dilation. It's gonna get and big. I'm reducing resistance. |
|
| 44:05 | right, so these are some of characteristics of resistance and remember resistance is |
|
| 44:12 | related to flow. So what this us, then if we know that |
|
| 44:19 | is dependent upon the pressure, And it's gonna be a direct |
|
| 44:23 | right? And we know that there an inverse relationship with resistance. Then |
|
| 44:28 | can come up with what is called laws of hydrodynamics. And this for |
|
| 44:32 | vessel that flow is equal to the in pressure divided by the resistance. |
|
| 44:39 | , again, I'm not gonna make do math. I'm not gonna ask |
|
| 44:41 | to calculate flow. I'm not gonna you to calculate the difference in pressure |
|
| 44:47 | anything like that, but you do to know the relationship. So if |
|
| 44:51 | increase pressure, what's going to Toe flow? If I write, |
|
| 44:57 | gonna increase. If I decrease the , great. And what's gonna happen |
|
| 45:01 | going to decrease flow yada, yada. Alright, that is what's |
|
| 45:05 | . But then you need to also able to translate that. What happens |
|
| 45:08 | I increase the length? What's gonna to flow? It's going to |
|
| 45:13 | right? So that's that's the idea you need to be able to think |
|
| 45:17 | those lines. All right, so the relationships that I want you to |
|
| 45:21 | able to, um, to And that's showing you up. There |
|
| 45:24 | Passos Law with regard to blood Now, I was in here for |
|
| 45:34 | hurricane. That wasn't the one that last weekend. This last weekend. |
|
| 45:39 | the hurricane that missed us, But we did get a little bit |
|
| 45:42 | rain. But have you ever noticed you go down to the bios and |
|
| 45:45 | during a rainstorm that if you look the flow in the bayou, the |
|
| 45:49 | nearest the shore is slow, the in the middle of the bayou or |
|
| 45:53 | river is fastest. Alright? And is because fluid flow, um has |
|
| 46:00 | this relationship, it basically flows in laminar fashion. Three only laminar means |
|
| 46:05 | a straight line. What interrupt straight is if there's something in the way |
|
| 46:09 | causes it to become turbulent, all ? And if you look at it |
|
| 46:13 | a tube so you can think of bayou as kind of a half |
|
| 46:17 | But if you have a full you'd actually be able to see that |
|
| 46:20 | flow through that tube actually has a of concentric rings like a bull's |
|
| 46:26 | So the fastest flow, what we V Max is at the very center |
|
| 46:31 | this. This cone of movement and lowest or weakest flow or velocity is |
|
| 46:38 | what we're looking at. The slowest of flow is gonna be nearest the |
|
| 46:42 | . Now, why would that be , right? If I'm up against |
|
| 46:46 | and I'm rubbing against, it's let down now the next layer in is |
|
| 46:52 | slowed down because of the layer that's to It's right, but it's going |
|
| 46:56 | keep getting progressively progressively less resistance as move towards the center. And so |
|
| 47:00 | center is gonna be the fastest. this is going on in your |
|
| 47:06 | Now, if you think of that that I just showed you F equals |
|
| 47:10 | P over our, you'd say, , mathematically, I love mathematical |
|
| 47:14 | This is why we thought that we're have 60 million deaths, you |
|
| 47:17 | because of code, because they never , Oh, wait a second In |
|
| 47:21 | , things change over time. This why you take calculus and never used |
|
| 47:24 | because it's very, very complicated math no one gets it except for |
|
| 47:27 | six people. And they're the ones teach, and they do a poor |
|
| 47:30 | of it, right? And so happens is is we look at an |
|
| 47:35 | like Delta we look at f equals p over are we could say, |
|
| 47:38 | , as I increase, uh, P then flow is naturally gonna go |
|
| 47:42 | , and it's gonna keep going like forever. But then you go examine |
|
| 47:45 | the real world, it doesn't That's actually what This little graphic on |
|
| 47:48 | bottom and says, Look, we this nice, clean laminar flow And |
|
| 47:52 | at a certain driving pressure, it goes to hell in a handbasket. |
|
| 47:56 | all starts decreasing. And the reason that is because of there's this dramatic |
|
| 48:02 | of kinetic energy. Basically, those layers get kind of all wobbly, |
|
| 48:07 | then they start colliding into each and it causes all this things |
|
| 48:11 | And that's what turbulent flow is. , in a clean system, that |
|
| 48:16 | flow is gonna be down the line ways. Right? But if you're |
|
| 48:19 | me and you lived in apartment, when I was in grad school, |
|
| 48:22 | in an apartment that was built in seventies, which was like, 20 |
|
| 48:24 | 30 years old at the time. you could listen toe water flowing through |
|
| 48:29 | pipes. And it's like you could whenever anyone upstairs did anything if they |
|
| 48:33 | turning on the water there, flushing toilets. Because you can just think |
|
| 48:37 | all the stuff that has collected over in that tube, right? And |
|
| 48:42 | causes turbulence in the tube, even it's a solid flow of fluid through |
|
| 48:48 | . And that's what you hear. that turbulence? All right, so |
|
| 48:53 | you hear things in the blood you hear turbulent flow that's telling you |
|
| 48:58 | something wrong with your tubes. Write wrong with the article in the |
|
| 49:04 | Laminar flow, make no noise. right. Turbulent flow does. All |
|
| 49:13 | now we're not gonna have to worry what that critical velocity is. We |
|
| 49:16 | need to understand that our blood is in a laminar fashion right that there |
|
| 49:22 | a maximum velocity towards the center and resistance towards the edges. Now, |
|
| 49:29 | regard to blood pressure, you've heard these terms. You've heard of systolic |
|
| 49:32 | diastolic. Haven't you you don't know they are. But you've heard those |
|
| 49:36 | . You might know what they I don't know. I mean, |
|
| 49:39 | a lot of people, uh, in class. What? Why did |
|
| 49:46 | not change? Alright, let's try I go back and see what |
|
| 49:52 | Okay. Now its okay. All . So systolic pressure. Systolic pressure |
|
| 49:59 | defined as the highest point of pressure ventricular contraction is what is called ventricular |
|
| 50:06 | . Hence the name systolic pressure. right. And so typically, what |
|
| 50:11 | doing is we're measuring in the All right? So what is the |
|
| 50:15 | pressure in the artery after the hardest diastolic pressure is the lowest pressure in |
|
| 50:23 | artery after the heart has gone through pressure is now is relaxed, so |
|
| 50:28 | going through diastolic. So Sicily is heart contracting diastolic is the heart relaxing |
|
| 50:34 | really, the ventricle is the thing we're looking at here. All |
|
| 50:38 | so systolic pressure when you go get your blood pressure measured. What |
|
| 50:44 | be the what should be the systolic in a perfect healthy human when you |
|
| 50:48 | your blood pressure. What are you for? 1 20. What's the |
|
| 50:52 | pressure? You're looking for 80. , well, if you're healthy and |
|
| 50:57 | an athlete is gonna be a little lower for the rest of the human |
|
| 51:03 | , and then you get old and goes the wrong direction. And then |
|
| 51:07 | doctor still thinks that she should have heart of a 20 year old. |
|
| 51:11 | right, anyway, so 120 80 those two numbers. So when they |
|
| 51:15 | my blood pressure is 1 20/80 your the systolic and diastolic pressure. So |
|
| 51:21 | the high pressure and low pressure between two points. The pulse pressure simply |
|
| 51:26 | difference between those two. So what's difference between 1 2080 40? |
|
| 51:31 | that's simple math. Okay? We have what is called the mean arterial |
|
| 51:35 | on the graph up there in the top, you can see it's that |
|
| 51:38 | line, so the mean arterial pressure an average pressure. But it's not |
|
| 51:43 | taking those two numbers, adding them and dividing by two. Because we |
|
| 51:48 | these two conditions of the heart, have sisterly and diastolic, and you |
|
| 51:51 | more time and joyously than you do , right. So that means there's |
|
| 51:55 | greater amount of of of not pressure of time spent in die asleep. |
|
| 52:01 | that means you have to calculate for greater time. So what it really |
|
| 52:05 | , it's roughly equivalent to the diastolic . So that would be 80 in |
|
| 52:09 | healthy person, plus a third of post pressure. What do you |
|
| 52:13 | The post pressure was 40. So divided by three is 13.3 that I |
|
| 52:22 | the class every year, but also math. So 80 plus 13.3 is |
|
| 52:29 | . So your body is trying to a map, right? I |
|
| 52:35 | arterial pressure of roughly 93.3 millimeters of . Now is your heart actually your |
|
| 52:41 | doing any sort of calculations? Alright. Do these numbers even matter |
|
| 52:46 | the to the brain at all? . All right. It's just looking |
|
| 52:49 | when we're physiologist, this is what measuring. And so we're kind of |
|
| 52:53 | engineering into something that we understand. right, now, in the bottom |
|
| 53:00 | here, this is showing you You see here in the left ventricle we |
|
| 53:03 | . Here's what's going on. A and diastolic pressure. Look how widespread |
|
| 53:08 | is. So you can imagine what's heart doing? Its contracting. And |
|
| 53:10 | it's relaxing and contracting. That's so it's really going through these massive |
|
| 53:15 | of pressure. But when you get the artery, you have blood out |
|
| 53:19 | in that artery and the aorta. while you're reaching that same high |
|
| 53:24 | you're not pushing all the blood out the artery. There's still blood in |
|
| 53:27 | trying to go backwards into the so you're maintaining a diastolic pressure that's |
|
| 53:32 | higher than what's in the actual ventricle . Alright, But as that blood |
|
| 53:37 | to travel through the body, you see here it's kind of going, |
|
| 53:39 | , it's going to the arteries. these were the named arteries. You |
|
| 53:42 | see that the pressures are going down , and part of the reason that |
|
| 53:48 | is going down is because you're coming greater and greater resistance, and one |
|
| 53:53 | the things your body is trying to is maintain constant flow. Alright, |
|
| 53:58 | if I'm maintaining constant flow and my P is changing well, really, |
|
| 54:04 | resistance is increasing. That my delta has to modify. And that's what |
|
| 54:08 | seeing is that you're seeing a loss that pressure. And so the mean |
|
| 54:12 | pressure decreases over time or really over notice here at the bottom. Remember |
|
| 54:22 | I said over here in the right . What's that pressure gonna be? |
|
| 54:27 | the lowest point. So this also that blood is returning all the way |
|
| 54:31 | to the heart. The lowest point pressure is always gonna be the right |
|
| 54:36 | . All right, that's where the is trying to return to. So |
|
| 54:41 | do we measure blood pressure? the proper way to do that is |
|
| 54:44 | take somebody take this big, freaking needle, stick it into their neck |
|
| 54:49 | in their crowded artery, and then this little structure into that needle that's |
|
| 54:54 | a line or in a or And you put that right there into |
|
| 54:58 | aorta and you measure the blood directly you look at the pressure directly. |
|
| 55:02 | anyone want to do that? When you go to the doctor or |
|
| 55:07 | , say please stick me with the needle that could get your hands |
|
| 55:10 | What you say is Please, please that thing on my arm. What's |
|
| 55:13 | thing called? That's hanging over That thing. And that's when the |
|
| 55:16 | looks at you and goes, It's single man. Manama. Nominal phenomena |
|
| 55:20 | . No, it's a blood pressure . Let's all try to stay |
|
| 55:24 | Single man. E hate this Finger. Oh, moment. |
|
| 55:28 | ma mature moment. Um, can say it online? Finger moment, |
|
| 55:37 | . No one can say it. it. That I should just make |
|
| 55:41 | an aural exam. Say that It's a blood pressure cuff. And |
|
| 55:49 | you do is you stick that blood cuff on your arm, and what |
|
| 55:51 | does is it sits over the artery your upper arm, okay? And |
|
| 55:57 | you do is you put pressure into cuff you put air, and that |
|
| 56:01 | inside that cup is gonna become, gonna pump air into it. It's |
|
| 56:04 | become greater and greater than the pressure the fluid inside your artery. And |
|
| 56:11 | is gonna ultimately do because the transmitter , because I'm pressing up against that |
|
| 56:15 | is gonna call cause that artery to . All right, And then once |
|
| 56:21 | artery closes. What I'm doing is listening for sound. So as I'm |
|
| 56:25 | area, I'm listening to see when don't hear any sounds. And then |
|
| 56:29 | I don't hear a sound, I go of the pressure inside the |
|
| 56:33 | Just let us or not the artery that blood pressure cuff and allow the |
|
| 56:37 | to escape slowly And now what I'm I'm listening for the first sound right |
|
| 56:42 | . Awash sound because when the pressure the artery is greater than the pressure |
|
| 56:47 | the cuff blood can kind of push where that occlusion is taking place. |
|
| 56:51 | when I hear that first sound, the point where I've discovered the systolic |
|
| 56:56 | , the highest pressure, right. as I let that air out, |
|
| 57:00 | gonna keep hearing e push. And I stopped hearing the sound, I |
|
| 57:09 | the point where now the pressure is in the artery than it is in |
|
| 57:13 | blood pressure cuff and is now Lamine Eri in a laminar fashion Once |
|
| 57:19 | , that's the diastolic pressure thes two and the sounds that you're hearing are |
|
| 57:23 | the Karate cough sounds. All That's what you're looking for. And |
|
| 57:27 | you take the physiology lab next you get to do that to each |
|
| 57:33 | . Or if you go work in hospital, you could do that to |
|
| 57:35 | Well, Or if your parents are the health professions or if you just |
|
| 57:38 | to have a blood pressure cup at and of stethoscope, you could do |
|
| 57:42 | to yourself a lot of fun. that's where we get those two values |
|
| 57:45 | systolic and diastolic pressures. We can it indirectly. So this finger Mammon |
|
| 57:51 | e I can see it when I think about it. The single man |
|
| 57:54 | management See now I started to think it again. Alright, When you're |
|
| 57:58 | that, you're not measuring blood pressure . You're doing so indirectly. |
|
| 58:04 | If you want to do it directly ? We have to dio a line |
|
| 58:08 | the atrium or into the orders. not the atrium All right, moving |
|
| 58:17 | Got about 20 minutes here to get the rest. What we wanna do |
|
| 58:20 | wanna ask the question How does the actually pump? Alright, it actually |
|
| 58:26 | an electrical circuitry to it. It's really cool during development. The cells |
|
| 58:31 | are responsible for driving the heart's pumping are, um, show up first |
|
| 58:38 | you can actually see them. There's even a heart. There is just |
|
| 58:40 | clump of cells, and they're already and they form and create a heart |
|
| 58:47 | . Um, um, over the of development, all right. And |
|
| 58:52 | what we have here is we're looking this conduction system now. I want |
|
| 58:56 | pause here for a second. This system is not nerve. Okay? |
|
| 59:02 | conduction system are muscle cells, all . Typically in a textbook when you're |
|
| 59:10 | about nerves, nerves or colored yellow , air red veins or blue cap |
|
| 59:16 | or purplish nerves or yellow. And this cartoon, what do you |
|
| 59:22 | This is the blackest which highlighted in . So they were just like we |
|
| 59:26 | know what to color these things. right, so these air muscle |
|
| 59:30 | right? So when we hear the system, think these are muscle cells |
|
| 59:36 | there's two different types of muscle cells we'll get to in just a |
|
| 59:38 | One are called the auto rhythmic cells the nodal cells, which is what |
|
| 59:43 | looking at right now. And then other type are the contract I'll |
|
| 59:46 | which we'll get to. So there four different areas where you're gonna see |
|
| 59:50 | auto rhythmic cells. We have what called the Sino atrial node. |
|
| 59:54 | The Sino atrial node is found in upper regions of the atrium. |
|
| 59:58 | so here you go. There's the a note. I've just circled it |
|
| 60:01 | you. All right, so it's the upper right? Hmm. Near |
|
| 60:04 | Vienna Kaveh. This structure is ultimately for creating the electrical pulse in these |
|
| 60:13 | cells that are then conducted through the of these structures, including the contraction |
|
| 60:18 | the contract ourselves. All right. , again, these air auto rhythmic |
|
| 60:22 | , they produce their own action potential they drive everything else. Now they're |
|
| 60:27 | to the next, which is called A V. The atrial ventricular |
|
| 60:32 | It tells you where it's located near atrium, the ventricles. All |
|
| 60:36 | And so that's that green dot in middle of our little picture here. |
|
| 60:39 | right, so it's showing you where located, and so it's kind of |
|
| 60:44 | that junction, and then you have Siris of these cells That kind of |
|
| 60:48 | like nerve fibers. Now they're They're traveling down through the septum of |
|
| 60:52 | heart. This is called the bundle hiss. And then that's when you |
|
| 60:57 | down to the apex. The bundle hiss then splits into a series of |
|
| 61:00 | that project outward towards the ventricular walls around the edges. And these air |
|
| 61:04 | the Preqin Gee fibers. Alright. , collectively, this is the conduction |
|
| 61:11 | . Now of all of these, please ignore the blue. Apparently what |
|
| 61:15 | did when I remodeled this this little right here was supposed to be sitting |
|
| 61:19 | top of that. And this thing here is supposed to be sitting over |
|
| 61:21 | top of that. I apparently never him when I remodeled this life. |
|
| 61:27 | , but the s a note. I said, this is the one |
|
| 61:30 | ultimately determines the rate at which the of the heart is gonna work. |
|
| 61:34 | if I damage the S a then now the conductive system is gonna |
|
| 61:39 | dependent upon the next structure that is dominant. It's not necessarily the A |
|
| 61:44 | note. It's just it's gonna be of them. Alright, so it's |
|
| 61:48 | gonna be the next fastest. So s a node is responsible for driving |
|
| 61:53 | rate of all the other ones regardless you know, they're all weaker than |
|
| 61:58 | one. So it basically, when fires, the other ones fire alongside |
|
| 62:02 | it. So once he s a , fires what it does the action |
|
| 62:06 | that air going from muscle cell, muscle cell, a muscle cell. |
|
| 62:09 | this is an electrical system, not electrical system. Basically, what it |
|
| 62:14 | is it travels down first to can we get all the ink |
|
| 62:19 | This slide goes from the S, node to the other atrium, but |
|
| 62:24 | travels along the length of the right down to the Amy note. And |
|
| 62:29 | this does is it causes the two to contract at the same time. |
|
| 62:36 | , remember what we say the heart It's a two pump system, |
|
| 62:39 | So left pumping the right pump. the left pumping the right pump aren't |
|
| 62:42 | sync, they're gonna fight each and it's gonna cause problems. So |
|
| 62:46 | you wanna do is you want to both the Atria to fire at the |
|
| 62:49 | time and contract at the same time send blood down to the ventricles at |
|
| 62:53 | same time. And you want the ventricles to contract at the same |
|
| 62:57 | So they send their blood out through the to the pulmonary circulation, the |
|
| 63:03 | circulation at the same time. This kind of like ring around the |
|
| 63:07 | right? If anyone part of people hands going ring around the rosy. |
|
| 63:11 | guys playing ring around the rosy, ? Remember that? I mean, |
|
| 63:14 | might have been six years old, remember doing it. If you stop |
|
| 63:17 | one of those people, the circle move. That's what we're saying here |
|
| 63:21 | We want everything to be moving in So the two Atria have to contract |
|
| 63:25 | . Two ventricles contract together so that fluid moves out to the systemic and |
|
| 63:30 | circulation at the same time so blood be returned back to the atria. |
|
| 63:34 | atria at the same time. That's the S a note is doing. |
|
| 63:39 | the action potential from the essay no to both Atria and then also travels |
|
| 63:46 | to the A V note this little right here is just trying to show |
|
| 63:51 | what this connection This is those electrical that I referred to Ah, long |
|
| 63:55 | ago, I said, we're not talk about thes because where you're going |
|
| 63:58 | see them in the heart. here we are at the heart. |
|
| 64:00 | is what it looks like. you're moving ions from cell to cell |
|
| 64:05 | cell. And that's causing that action to progress from one cell down to |
|
| 64:09 | next song and so forth. So I mentioned, there are two types |
|
| 64:18 | cells. I call them the Auto Cells. You can see there's also |
|
| 64:21 | the nodal cell. So the cell we're looking at right now is this |
|
| 64:25 | rhythmic sell. Its sole job is produce this pacemaker activity to produce action |
|
| 64:31 | that will be transferred from muscle seldom cell and then every other cell outside |
|
| 64:36 | this conducted system. Outside of the . A note a V note |
|
| 64:40 | his burkini fibers. These are the . I'll sell these the worker |
|
| 64:44 | Right. So 99% of the muscle of the heart are contract. I'll |
|
| 64:49 | . The rest are these little tiny that are found that are all the |
|
| 64:53 | cells that are found inside the A note the essay notes on and so |
|
| 64:57 | . All right, so algorithmic cells conduct action potentials. And they're telling |
|
| 65:07 | contract ourselves to do the muscle car do the work of the pump. |
|
| 65:15 | , it wouldn't be physiology if we have these ugly little tiny graphs in |
|
| 65:19 | . Alright, What we're looking at we're looking at an action potential produced |
|
| 65:24 | a pacemaker cells or auto rhythmic cell nodal sell whichever one you want to |
|
| 65:28 | . All right, same name or names, Same self. All |
|
| 65:33 | Does this picture this big, large right here? Does it look like |
|
| 65:36 | actual potential that you've seen before? not 100% but it kind of |
|
| 65:42 | But it doesn't look like that action 100% that we saw when we looked |
|
| 65:46 | neurons. It's got the peak but it sure doesn't look the |
|
| 65:50 | Looks kind of weird. And the it looks weird is because there are |
|
| 65:55 | ions that are involved, and we different types of channels that are |
|
| 66:00 | All right, So remember when we about action potentials in the neurons, |
|
| 66:04 | had two primary ions that we're dealing . What were the two ions do |
|
| 66:08 | guys remember sodium and potassium? great. They're still there. They're |
|
| 66:13 | our friends. We're just gonna add other we're gonna add in calcium. |
|
| 66:17 | right. So, calcium, you already say it is important for the |
|
| 66:21 | . Okay, so what do we ? We have a bunch of different |
|
| 66:24 | of channels. The first channel is The Funny Channel. I'm not |
|
| 66:29 | All right, What we have here a channel that is dependent upon a |
|
| 66:36 | nucleotide, um, that is responsible opening it. And it's a hyper |
|
| 66:41 | channel so that H c n stands hyper polarization. Something something cyclic nucleotide |
|
| 66:48 | channel. It is like the longest ever. So that's why I just |
|
| 66:50 | HCM channel, all right. And what this does is when it opens |
|
| 66:55 | , it opens up in response to polarization. Okay, so this is |
|
| 67:00 | it's a funny channel channel. When hit really, really low. That's |
|
| 67:04 | it opens up, and it allows the inflow of sodium and the outflow |
|
| 67:09 | potassium. And so what you do you see this slow increase, All |
|
| 67:16 | , you start rising towards threshold, then that's gonna open up some voltage |
|
| 67:21 | sodium channels. There's not a lot them, but they're there, so |
|
| 67:24 | going to continue to rise. And what we're gonna do is we're gonna |
|
| 67:27 | opening up some other types of calcium . These are the tea type channels |
|
| 67:32 | called transient type. And so all here, that rise is dependent upon |
|
| 67:39 | three different channels. And then you threshold. When threshold happens. When |
|
| 67:44 | do that, that's when you're gonna the L type channels. All |
|
| 67:49 | So in essence, what you're doing you're opening one thing after the |
|
| 67:52 | and it's gonna cause what is a rise to become a fast arise. |
|
| 67:55 | eventually it's gonna be shooting up like rocket, and then all those channels |
|
| 68:00 | . And then finally, what you is you see, uh, potassium |
|
| 68:04 | open and allow the channel to, mean, allow the of expertise to |
|
| 68:09 | back down to I'm a put in . Here. Rest there is no |
|
| 68:13 | rest, okay? And that's when when they close again, and then |
|
| 68:18 | I funny channels open up and you repeat the action. So what you |
|
| 68:22 | up with is something that looks a like this. So not too |
|
| 68:29 | right? I mean, there's some in here, but I'm not gonna |
|
| 68:33 | all mean and evil, right? idea here is I've got sodium and |
|
| 68:40 | coming in over here. I got coming in and over here, I |
|
| 68:45 | potassium coming in. That's not too , is it? And so this |
|
| 68:53 | what's going on in the nodal Ready for some fun? Of course |
|
| 68:59 | are. So here's the contract. sell action potential. Does that look |
|
| 69:05 | same? Nope. Very different, same ions. Similar type of |
|
| 69:15 | Alright, so here you can see are the atrial cells. There's a |
|
| 69:18 | injury fibers. There's a ventricular muscle . They're just trying to show you |
|
| 69:22 | you're going to see these things. what you can see is I basically |
|
| 69:25 | three steps, right? I'm at . Then here's step number one. |
|
| 69:31 | rising phase. Something happens, and I get sustained high plateau and then |
|
| 69:40 | falling phase. So it kind of kind of like a weird table or |
|
| 69:44 | chair. All right, so what in the rapid rising phase? I've |
|
| 69:49 | sodium, and some calcium channels that opening up appear in the top. |
|
| 69:55 | sodium channels close, but the calcium stay open. So that helps me |
|
| 70:01 | sustain the plateau. And when the channels close, the potassium channels |
|
| 70:07 | and that causes me to return back . So it's kind of all you |
|
| 70:13 | do is kind of draw it out say there is a three different |
|
| 70:16 | All right, So the idea here that I'm going through these three different |
|
| 70:23 | to create this really weird looking action . So your question at this point |
|
| 70:28 | be So why should I care? that your question? Why do I |
|
| 70:33 | ? All right. This is why care is has to do with refractory |
|
| 70:40 | . Remember the refractory period fracture By definition is the period of time |
|
| 70:45 | which an action potential can't occur in cell. If you look over |
|
| 70:49 | this is what a skeletal muscle looks . You can see there's a little |
|
| 70:52 | action potential over there. There's a tiny, refractory period, and |
|
| 70:55 | there's the muscle contraction that follows the potential. Notice. The two events |
|
| 71:00 | separate from each other. Fracture periods small. So if I get a |
|
| 71:05 | of actual tension of trying really, quick, I could get a |
|
| 71:08 | really strong summation and create a muscle in the heart. Do I want |
|
| 71:16 | really strong muscle contraction? I'm glad guys are shaking your hands. |
|
| 71:21 | What do we call that? my heart goes and just sits |
|
| 71:27 | Contracted heart attack is a good right? That's tetanus of the |
|
| 71:33 | Tetanus of the heart is bad. don't want to sustain contraction. So |
|
| 71:38 | do we avoid sustained contractions? Have long refractory period. Well, how |
|
| 71:42 | we ensure that we have a really refractory period? Well, why don't |
|
| 71:45 | keep the state of the action Why don't we stretch it out? |
|
| 71:49 | that's what we do here. We the rapid rising face. Oh, |
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| 71:53 | let's go ahead and just stretch that with our plateau. And then now |
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| 71:57 | can have our rapid falling phase, our contraction occurs over that period of |
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| 72:02 | while we're maintaining the plateau. So the plateau ensures for an elongated period |
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| 72:10 | contraction or a long period of so that contraction goes through a period |
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| 72:16 | contraction and relaxation. So now what your heart do? Bump, |
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| 72:21 | bump, bump, bump, bump, bump, contraction, |
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| 72:24 | contract. Relax, contract. contract. Relax over and over and |
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| 72:28 | again. It never goes contract and there. It can't because the action |
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| 72:34 | doesn't allow it because it creates a long refractory period. So let's look |
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| 72:44 | this action potential. The action potential we're interested in is one that's the |
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| 72:48 | a node. So we said, two different types of contractions. There's |
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| 72:52 | in the auto rhythmic cells. There's in the contract ourselves. So this |
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| 72:56 | that's on the S a node. type of of action potential we're seeing |
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| 73:01 | it's like the algorithmic or one that's the contract. Oh, at a |
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| 73:05 | . Alright, that's what we're looking . So the first thing it's gonna |
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| 73:09 | it's going to move from left are . From right to left, this |
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| 73:14 | what is referred to as the inter pathway. It ensures that both sides |
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| 73:19 | gonna contract at the same time. then it also moves to the A |
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| 73:24 | note. Now, when this action being projected, it's being projected to |
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| 73:30 | points. But then along the that's when you're gonna come into the |
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| 73:33 | . I'll cells. So the contract cells are being stimulated simultaneously, which |
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| 73:37 | why they're going to contract as The inter nodal pathway just ensures that |
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| 73:43 | moved from point A to point B then at the point be the A |
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| 73:49 | note. We have what is called , um a V nodal delay. |
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| 73:56 | right, so what this does it that the A V know that the |
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| 74:02 | contraction of the atria, uh, forward and is completed before the signal |
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| 74:08 | sent down to the ventricles? we said we have. We have |
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| 74:12 | timing issue. We want the left right to contract at the same |
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| 74:16 | But we also want to make sure the atria contract before the ventricles contract |
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| 74:21 | right, so that's what the A nodal delay is for. Alright, |
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| 74:25 | you don't delay ensures that the next is act the a V note that |
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| 74:32 | conducts down the bundle of hiss. it's basically moving down the bundle of |
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| 74:37 | and then back out up around the Gee fibers. Alright again these air |
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| 74:42 | the auto rhythmic cells and then along length, moving away from the Perkin |
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| 74:46 | fibers and moving away from the bundle hiss. There's a contract I'll |
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| 74:50 | So while the signals traveling down and , it's also stimulating all those contract |
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| 74:55 | . And eventually what's gonna happen is the contract ourselves all contracts simultaneously so |
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| 75:00 | you get to two ventricles to contract the same time, all right. |
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| 75:05 | so this ensures that were in ejecting simultaneously into the pulmonary circulation and into |
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| 75:12 | systemic circulation. So s a no no delay. Bundle his pro Kinji |
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| 75:19 | . Eight year contracts together. Ventricles together. Everything is hunky Dorry. |
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| 75:24 | heart's working just fine. And that's this slide basically shows you right |
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| 75:29 | It's basically showing you the full right? If you could start up |
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| 75:33 | at the say no to the A note, you move down back around |
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| 75:37 | edges and you get this massive, polarization to cause a contraction. We |
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| 75:45 | one last slide. Does your heart work at the same rate? |
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| 75:55 | no. Someone. You have your forward and come up to you, |
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| 76:00 | they look atyou deep in your eyes say, You know, you're pretty |
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| 76:04 | . I wanna take you out for Boba tea. Just trying to come |
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| 76:10 | with something silly. What do your do? Goes faster? That's |
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| 76:16 | It's like, All right, I , it's a boba tea. Someone |
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| 76:19 | I'm cute, right? Yours are , How does that happen? |
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| 76:26 | it has to do with the sympathetic the parasympathetic acting on those activities that |
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| 76:32 | already described so you can see appear the very top. The gray represents |
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| 76:37 | auto rhythmic cells and that that pacemaker down here in the bottom same thing |
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| 76:43 | gray represents that pacemaker potential. When activity happens, what you do is |
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| 76:49 | increased sodium and calcium permeability. And do we see sodium and calcium permeability |
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| 76:54 | the front end of that, action potential, right? So instead |
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| 77:00 | taking my sweet time getting up to threshold. If I increased permeability, |
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| 77:04 | going to increase that slope. And what this is trying to show you |
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| 77:08 | that Here's my normal slope right Look at my slope Steeper. So |
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| 77:16 | spend less time below threshold on dime a threshold a lot faster. So |
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| 77:23 | why I increase my rate. The thing that happens is I decrease potassium |
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| 77:29 | . So that means I don't go a Sfar. So you can see |
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| 77:32 | here. This is where my rest . And again, I'm gonna put |
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| 77:34 | in quotations. Look where my rest quotations is here, so I don't |
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| 77:40 | quite as far away from threshold. it doesn't take me as long to |
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| 77:43 | back to threshold. So I spend time below threshold, more time above |
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| 77:49 | . And my slopes, even as move up and move back down, |
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| 77:54 | steeper than they were before. Sympathetic . The results. Sympathetic stimulation. |
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| 78:01 | heart beats faster because of those three , right? Increasing sodium, potassium |
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| 78:07 | sodium calcium permeability decreasing. Protect our permeability. Alright, three other thing |
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| 78:13 | happens. Your heart also beats stronger we're going to get to that a |
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| 78:16 | bit. That's actually it's basically as result of the increase in calcium |
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| 78:21 | We're gonna talk about that a little later. Aziz. Well, I |
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| 78:25 | with regard to sympathetic, it's just opposite. If this is increasing sodium |
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| 78:29 | , you're gonna be decreasing it If you're decreasing potassium, you're enhancing |
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| 78:33 | increasing potassium under para sympathetic, and that means you go down further. |
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| 78:39 | here's your rest. Normally, look where rest is down there. You're |
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| 78:42 | more time below, and then your , which was like this is now |
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| 78:46 | little bit longer. And so you're more time below threshold, so your |
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| 78:52 | beats slower. And that's how the nervous system changes. Heart rate. |
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| 79:00 | right, so I've just spent an and 20 minutes talking as fast as |
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| 79:06 | can about the heart. Are there questions about the heart? Anyone want |
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| 79:12 | ask me about what heartbreak is? fun. It's a fun class, |
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| 79:19 | ? Good. I'm glad you don't . You don't wanna know about |
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| 79:23 | There's plenty of songs out there for to learn about heartbreak. Any questions |
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| 79:31 | ? Did they all log off? . Okay, All right. |
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| 79:36 | with that, you guys can go and do other fun things. I |
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| 79:40 | know what other fun things are there do at home, you know? |
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| 79:44 | forget. Flied on the There you . That's it. Yep. If |
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| 79:48 | if you're in the dorms, go some dishwashing liquid. You know, |
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| 79:54 | it up with some water, put out all over the floor, and |
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| 79:57 | just start sliding. It is But remember, there's a hazard to |
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| 80:03 | . There's inherent risk in sliding face across a dorm room hallway. If |
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| 80:10 | don't know that, don't come back sue me. I just explained |
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| 80:14 | All right, you guys have a week. I'm planning on, uh |
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| 80:18 | will get the great stuff posted here soon as I can. Just let |
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| 80:22 | know. I had a freshman class took their test today, and they're |
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| 80:26 | little bit more panicky than you So when anything goes wrong, they |
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| 80:30 | me. And so my entire day has been putting out fires that didn't |
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| 80:35 | to be putting out like their their . It's OK. There, |
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| 80:39 | you know your score. Don't worry blackboard, You got to get, |
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| 80:42 | know, so question Online? Oh, so what? Yes. |
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| 80:55 | . Uh, it's It's, um honestly I don't know the answer, |
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| 81:00 | it's been explained to me that it's whatever happens to be the next |
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| 81:04 | So sometimes it could be the Jeez, sometimes it could be the |
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| 81:08 | of hiss. I guess it's person . I don't know. Uh, |
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| 81:13 | what? What that state is. Thio, it's false to state that |
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| 81:17 | will automatically be the A V That's all I know. So |
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| 81:22 | Don't know the exact answer to Anything else? Did everyone have fun |
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| 81:29 | the football game? No, but right. We want to |
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