Physiological changes during exercise

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Physiological changes during exercise

Cardio

Cardio

Introduction to the cardiovascular system
Anatomy of the heart
Anatomy of the coronary circulation
Anatomy clinical correlates: Heart
Anatomy of the superior mediastinum
Anatomy of the inferior mediastinum
Anatomy clinical correlates: Mediastinum
Development of the cardiovascular system
Fetal circulation
Cardiac muscle histology
Artery and vein histology
Arteriole, venule and capillary histology
Cardiovascular system anatomy and physiology
Lymphatic system anatomy and physiology
Coronary circulation
Blood pressure, blood flow, and resistance
Pressures in the cardiovascular system
Laminar flow and Reynolds number
Resistance to blood flow
Compliance of blood vessels
Control of blood flow circulation
Microcirculation and Starling forces
Measuring cardiac output (Fick principle)
Stroke volume, ejection fraction, and cardiac output
Cardiac contractility
Frank-Starling relationship
Cardiac preload
Cardiac afterload
Law of Laplace
Cardiac and vascular function curves
Altering cardiac and vascular function curves
Cardiac cycle
Cardiac work
Pressure-volume loops
Changes in pressure-volume loops
Physiological changes during exercise
Cardiovascular changes during hemorrhage
Cardiovascular changes during postural change
Normal heart sounds
Abnormal heart sounds
Action potentials in myocytes
Action potentials in pacemaker cells
Excitability and refractory periods
Cardiac excitation-contraction coupling
Cardiac conduction system
Cardiac conduction velocity
ECG basics
ECG rate and rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG normal sinus rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement
Baroreceptors
Chemoreceptors
Renin-angiotensin-aldosterone system
Arterial disease
Angina pectoris
Stable angina
Unstable angina
Myocardial infarction
Prinzmetal angina
Coronary steal syndrome
Peripheral artery disease
Subclavian steal syndrome
Aneurysms
Aortic dissection
Vasculitis
Behcet's disease
Kawasaki disease
Hypertension
Hypertensive emergency
Renal artery stenosis
Coarctation of the aorta
Cushing syndrome
Conn syndrome
Pheochromocytoma
Polycystic kidney disease
Hypotension
Orthostatic hypotension
Abetalipoproteinemia
Familial hypercholesterolemia
Hypertriglyceridemia
Hyperlipidemia
Chronic venous insufficiency
Thrombophlebitis
Deep vein thrombosis
Lymphedema
Lymphangioma
Shock
Vascular tumors
Human herpesvirus 8 (Kaposi sarcoma)
Angiosarcomas
Persistent truncus arteriosus
Transposition of the great vessels
Total anomalous pulmonary venous return
Tetralogy of Fallot
Hypoplastic left heart syndrome
Patent ductus arteriosus
Ventricular septal defect
Atrial septal defect
Atrial flutter
Atrial fibrillation
Premature atrial contraction
Atrioventricular nodal reentrant tachycardia (AVNRT)
Wolff-Parkinson-White syndrome
Ventricular tachycardia
Brugada syndrome
Premature ventricular contraction
Long QT syndrome and Torsade de pointes
Ventricular fibrillation
Atrioventricular block
Bundle branch block
Pulseless electrical activity
Tricuspid valve disease
Pulmonary valve disease
Mitral valve disease
Aortic valve disease
Dilated cardiomyopathy
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy
Heart failure
Cor pulmonale
Endocarditis
Myocarditis
Rheumatic heart disease
Pericarditis and pericardial effusion
Cardiac tamponade
Dressler syndrome
Cardiac tumors
Acyanotic congenital heart defects: Pathology review
Cyanotic congenital heart defects: Pathology review
Atherosclerosis and arteriosclerosis: Pathology review
Coronary artery disease: Pathology review
Peripheral artery disease: Pathology review
Valvular heart disease: Pathology review
Cardiomyopathies: Pathology review
Heart failure: Pathology review
Supraventricular arrhythmias: Pathology review
Ventricular arrhythmias: Pathology review
Heart blocks: Pathology review
Aortic dissections and aneurysms: Pathology review
Pericardial disease: Pathology review
Endocarditis: Pathology review
Hypertension: Pathology review
Shock: Pathology review
Vasculitis: Pathology review
Cardiac and vascular tumors: Pathology review
Dyslipidemias: Pathology review
Sympatholytics: Alpha-2 agonists
Adrenergic antagonists: Presynaptic
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
Thiazide and thiazide-like diuretics
Calcium channel blockers
cGMP mediated smooth muscle vasodilators
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Positive inotropic medications
Cardiomyopathies: Clinical
Congenital heart defects: Clinical
Valvular heart disease: Clinical
Infective endocarditis: Clinical
Pericardial disease: Clinical
Chest trauma: Clinical
Hypertension: Clinical
Pulmonary hypertension
Aortic aneurysms and dissections: Clinical
Raynaud phenomenon
Peripheral vascular disease: Clinical
Heart failure: Clinical
Coronary artery disease: Clinical
Deep vein thrombosis and pulmonary embolism: Pathology review
Fascia, vessels and nerves of the upper limb
Vessels and nerves of the forearm
Vessels and nerves of the hand
Anatomy of the abdominal viscera: Blood supply of the foregut, midgut and hindgut
Fascia, vessels and nerves of the lower limb
Vessels and nerves of the gluteal region and posterior thigh
Anatomy of the popliteal fossa
Ventilation
Ventilation-perfusion ratios and V/Q mismatch
Gas exchange in the lungs, blood and tissues
Oxygen binding capacity and oxygen content
Oxygen-hemoglobin dissociation curve
Carbon dioxide transport in blood
Trypanosoma cruzi (Chagas disease)
Yellow fever virus
Rickettsia rickettsii (Rocky Mountain spotted fever) and other Rickettsia species
Arteriovenous malformation
Cerebral circulation

Transcript

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During physical exercise, our organs and tissues are working hard to keep us moving; or, technically speaking, for our musculoskeletal system to do its job.

Now it’s fairly obvious that during exercise, skeletal muscles work, or contract, harder and faster than when we’re at rest, so they use a lot of energy in a short time, so they need a lot more blood and oxygen to keep going.

So organ systems like the cardiovascular and respiratory system have to make some quick physiological adjustments, to meet the skeletal muscles demand.

Moreover, the endocrine system also kicks things into high gear, by secreting hormones like cortisol and adrenaline, that speed up intracellular processes to keep us going.

But before we delve into the specifics of that, let’s remember how muscle contraction works on a microscopic level.

So, skeletal muscles are made up of muscle fibers which are actually the skeletal muscle cells.

We just call them “fibers” because they are long, multinucleated cells, meaning they have more than one nucleus.

Their structure also differs from other cells because their cytoplasm, sometimes also called sarcoplasm, is filled with stacks of long filaments called myofibrils, which are made up of contractile units called sarcomeres.

And finally, sarcomeres are made up of the thick myosin filaments, and thin actin filaments, which can slide over one another, shortening the sarcomeres.

So when all the sarcomeres in a muscle fiber do that in sync, that results in shortening of the muscle as a whole, or muscle contraction.

And this process is powered by energy in the shape of ATP molecules, where adenosine-triphosphate.

The three phosphates in the molecule are linked in a chain, and between two adjacent phosphate molecules, there are high-energy phosphate bonds.

ATP molecules attach to a part of the myosin filament called the myosin head.

The myosin head is actually an ATPase, or an enzyme that can cleave an ATP molecule into ADP and phosphate ion, releasing the energy stored in the bonds.

After the energy is released, ADP detaches from the myosin head, so myosin can bind to actin filaments, forming cross-bridges that result in shortening of the muscle fiber.

Now, ATP molecules come from two sources: first, there’s a small stash spread out between myofibrils, which is just about enough to sustain muscle contraction for a single bout of exercise - like hitting a tennis ball with a racket.

But these ATP stores get depleted quickly, so if you want to keep playing tennis after the serve, muscle cells need to generate some more ATP.

ATP can be generated through a number of biochemical pathways.

First one is substrate phosphorylation - which means a phosphate is added to a molecule, in this case, the leftover ADP. In muscles, the phosphate comes from creatine phosphate, which splits into phosphate and creatine under the action of an enzyme called creatine phosphokinase.

Unfortunately, creatine phosphate also runs out rather quickly.

So 10 to 30 seconds after the onset of exercise, ATP needs to be generated through anaerobic glycolysis, or the breakdown of glucose into pyruvate and lactic acid.

This process happens in the cytoplasm, and it doesn’t require oxygen but it only yields about 2 ATP molecules per molecule of glucose.

What’s more, in the absence of oxygen, pyruvate is converted to lactic acid in the cytoplasm, so this causes a buildup of lactic acid, which causes muscle fatigue after about 1 minute of intense exercise.

Lactic acid can also spill into the bloodstream, making blood PH take a dip.

This is detected by peripheral chemoreceptors, which are specialized neurons located in the walls of the carotid arteries and the aortic arch.

When they register that blood PH dropped, these neurons fire more impulses, notifying the respiratory centers in the brainstem that they have to increase the respiratory rate and depth of breathing, all together called hyperventilation.

So more air, and, in turn, more oxygen reaches the alveoli, which are the tiny air sacs where gas exchange occurs.

More oxygen in the alveoli leads to pulmonary vasodilation, meaning these tiny vessels of the pulmonary capillary bed start to widen, reducing the pulmonary vascular resistance, so more blood flows through.

A decrease in pulmonary vascular resistance and an increase in pulmonary blood flow in all three zones the lungs; the upper, the middle and the lower ones, allow blood to reach all of these zones almost equally.

As a result, we get a more even distribution of pulmonary perfusion, and the physiological dead space, or the number of alveoli that were not actively used for gas exchange, also decreases.

This increases efficiency in gas exchange between the alveoli and the pulmonary capillaries, so more oxygen gets in the blood, and more carbon dioxide leaves the blood.

At the same time, when chemoreceptor firing rate increases, it also notifies the cardiac centers in the nucleus tractus solitarius located in the medulla oblongata, which signal the brain to turning down the parasympathetic stimulation to the heart, while increasing sympathetic stimulation - aka the fight or flight response.

Part of the fight or flight response is that brain signals the adrenal glands above the kidneys to release epinephrine, and when epinephrine gets to the heart, it binds to the adrenergic receptors of the heart muscle, making heart rate and contractility increase.

This means heart muscle fibers contract faster and stronger and the amount of blood the heart pumps out in a minute, increases as well.

Finally, epinephrine also causes systemic vasoconstriction, which means visceral blood vessels contract, so there’s reduced blood flow to the kidneys, liver and the gastrointestinal system.

Sources

  1. "Medical Physiology" Elsevier (2016)
  2. "Physiology" Elsevier (2017)
  3. "Principles of Anatomy and Physiology" Wiley (2014)
  4. "Effects of exercise on hematological parameters, circulating side population cells, and cytokines" Experimental Hematology (2008)
  5. "Cardiovascular Physiology Concepts" Lippincott Williams & Wilkins (2011)
  6. "Glucose-sensing mechanisms in pancreatic β-cells" Philosophical Transactions of the Royal Society B: Biological Sciences (2005)
  7. "Human Anatomy & Physiology" Pearson (2018)