Cardiovascular

System
• The circulatory system, also called the cardiovascular
system or the vascular system, is an organ system that
permits blood to circulate and transport nutrients,
oxygen, carbon dioxide, hormones, and blood cells in the
body to provide nourishment and help in fighting
diseases, stabilize temperature and pH, and
homeostasis.
 The Heart
• Approximately the size of a person’s fist, the hollow,
cone-shaped heart weighs less than a pound.
• Enclosed in the mediastinum, the middle cavity of
the thorax
• Apex, the pointed part, levels the fifth intercostal
space
• Base, the broader part, from which the great vessels
emerge, lies beneath the second rib.
 Coverings and Walls
• The heart is enclosed by a double sac of serous
membrane, the pericardium.
• The thin epicardium, or visceral pericardium,
tightly hugs the external surface of the heart and is
actually a part of the heart wall.
• It is continuous at the base with the loosely applied
parietal pericardium, which is reinforced on its
superficial face by dense connective tissue, the
fibrous pericardium.
 Heart Walls
• Three layers:
1. Epicardium ( described earlier)
2. Myocardium ( the layer that actually contracts)
3. Endocardium
• Myocardium consists of thick bundles of cardiac muscle
twisted and whorled into ringlike arrangement.
− Reinforced internally by a dense, fibrous connective
tissue called “ skeleton of the heart”
• Endocardium is a thin, glistening sheet of endothelium that
lines the heart chambers
Chambers and Associated Great Vessels

• The heart has four hollow chambers or

cavities:
a. 2 atria – primarily receiving chambers
b. 2 ventricles – discharging chambers
 Pulmonary Circulation
• The right side of the heart receives a relatively oxygen-
poor blood from the veins of the body through the large
superior and inferior vena cava and pumps it out
through the pulmonary trunk. The pulmonary trunk
splits into the right and left pulmonary arteries which
carry blood into the lungs, where oxygen is picked up
and carbon dioxide is unloaded. Oxygen-rich blood
drains from the lungs and is returned to the left side of
the heart through the four pulmonary veins.
 Systemic Circulation
• Blood returned to the left side of the heart is pumped out of
the heart into the aorta from which the systemic arteries
branch to supply essentially all body tissues. Oxygen-poor
blood circulates from the tissue back to the right atrium via
the systemic veins, which finally empty their cargo into
either superior or inferior vena caca.
 Heart Valves
• The heart is equipped with four valves, which allow blood to
flow in one direction through the heart chambers.
• The atrioventricular valve or AV valves are located between
the atrial and ventricular chambers on each side. AV valves
prevents backflow into the atria when the ventricles
contract.
• The left AV valve, the bicuspid, or mitral valve consists of
two flaps
• The right AV valve, the tricuspid valve has three flaps.
 • Chordae tendineae “tendinous cords”, anchor
the flaps to the walls of the ventricles.
• The semilunar valves guard the bases of the two large
arteries leaving the ventricular chambers.
• Thus thy are known as the pulmonary and aortic
semilunar valves.
• Each semilunar valves has three leaflets that fits
tightly together when the valves are closed.
 Cardiac Circulation
• The blood supply that oxygenates and
nourishes the heart is provided by the right
and left coronary arteries.
• The coronary arteries branch from the base of
the aorta and encircle the heart in the coronary
sulcus at the junction of the atria and
ventricles.
GROSS ANATOMY OF THE HEART
Physiology of the
Heart
 Intrinsic Conduction System
of the Heart
• The heart pumps 6L of blood in a day through spontaneous
contractions that occur in a regular, unifying rhythm.
• Two systems act to regulate heart activity.
1. Autonomic nervous system – “breaks and accelerator”
2. Intrinsic conduction system, or the nodal system – built into the
heart tissue and sets its basic rhythm.
− Composed of a special tissue; a cross between muscle and nervous
tissue.
− Enforces a contraction rate of approximately 75 beats per minute
on the heart; thus the heart beats as a coordinated unit.
 • Sinoatrial (SA) node – located at the right atrium
− It has the highest rate of depolarization so it starts
each heartbeat and sets the pace
− Often called the pacemaker
• Atrioventricular (AV) node – junction of the atria and ventricles.
− The impulse set by the SA node is delayed briefly to give the atria
time to finish contracting. It then passes rapidly to the
atrioventricular bundle (Bundle of His) and the right and left
bundle branches located in the interventricular septum and the
purkinje fibers which spreads within the muscles of the ventricle
walls.
− This results in a “wringing” contractions of the ventricles that
begins from the apex moving towards the atria.
• Heart block – results from any damage on the AV node that
partially or totally releases the ventricles from the control of
the SA node, thus the ventricles begin to beat on its own
rate, which is much slower.
• A pacemaker is surgically installed when the SA node is
damaged
• Ischemia, or lack of adequate blood supply to the heart
• Fibrillation – a rapid, uncoordinated shuddering of the heart
muscle
• Tachycardia – is a rapid heart rate (over 100 bpm)
• Bradycardia – is a heart rate that is substantially slower than
the normal (less than 60 bpm).
 Cardiac Cycle and Heart Sounds
• Systole means the heart is contracting.
• Diastole means the heart is relaxing.
• Cardiac cycle refers to the event of one complete heartbeat, during
which the atria and ventricles contract and then relax.
3 Periods in the Cardiac Cycle
1. Mid-to-late diastole
− Pressure in the heart is low, and blood is flowing into and through
the atria into the ventricles from the pulmonary and systemic
circulation.
− Semilunar valves closed, AV valves open.
− Then the atria contract and force the blood remaining in their
chambers into the ventricles.
2. Ventricular systole
− Ventricular contraction begins and the pressure within
the ventricles increases rapidly, closing the AV valves.
− Semilunar valves open, blood rushes through them out
of the ventricles
− Atria are relaxed, chambers are again filling with blood.
3. Early diastole
− Ventricles relax, semilunar valves shut (preventing
backflow)
− Intraventricular pressure drops below the pressure in
the atria
− AV valves forced open and the ventricles again begin to
refill rapidly with blood, completing the cycle.
 Heart Sounds
• By using a stethoscope, you can hear the heart sounds
described as “lub” and “dub” (lub-dub pause, lub-dub
pause, and so on)
• The “lub” is caused by the closing of the AV valves (longer,
louder)
• The “dub” occurs when the semilunar valves closed at the
end of systole (short and sharp)
• Murmurs are abnormal or unusual heart sounds due to
interruptions or obstructions of blood flow or problems of
any of the valves of the heart.
 Cardiac Output
• Cardiac Output (CO) is the amount of blood pumped out by
each side of the heart in 1 minute.
• It is the product of the heart rate (HR) and the stroke volume
(SV)
• Stroke volume is the volume of blood pumped out by a
ventricle with each heartbeat. Stroke volume increases ad
the force of ventricular contraction increases.
HR = 75 bpm (normal)
SV = 70 ml/beat (normal)
CO = HR (75bpm) x SV (70ml/beat)
CO = 5250 ml/min
Blood Vessels
• As the heart beats, blood is
propelled into the large arteries
leaving the heart. It then moves
into successively smaller and
smaller arteries and then into the
arterioles, which feed the capillary
beds in tissues.
• Capillary beds are drained by
venules which in turn empty into
veins.
• Tunica intima lines the lumen on interior of the
vessels, is a thin layer of endothelium (squamous
epithelial cells) resting on a basement membrane.
• Tunica media is the bulky middle coat. It is mostly
smooth muscle and elastic tissue. Some of the larger
arteries have elastic laminae, complete sheet of
elastic tissue.
• Tunica externa is the outermost tunic; it is
composed largely of fibrous connective tissue. Its
function is to support and protect the vessels.
Structural Difference Between
Arteries, Veins, and Capillaries
Arteries
• Carry blood away from the heart
• Walls of arteries are usually much thicker than the
walls of veins to withstand the pressure produced
when the heart pumps blood
• Elastic fibers allows the artery to stretch under
pressure.
• Aorta is he largest artery
• Arterioles are the smallest artery vessels that
connect arteries to capillaries
Veins
• Carry blood toward the heart
• Have thinner walls because pressure of blood in the
veins tend to be lower
• Have valves that prevent the backflow of blood and
prevent blood from going into wrong direction
• Skeletal muscles surrounding the veins contracts and
relax squeezing the vein to allow pushing of blood to
the heart.
• When we inhale, the drop in pressure that occurs in
the thorax causes the large veins to expand and fill.
Capillaries
• The transparent walls are only one cell layer thick-
just the tunica intima.
• Connects arteries and veins
• Contact tissue cells and directly serve cellular needs
• Exchange between blood and tissue cells occurs
− Drop off oxygen and nutrients from the heart by
arteries
− Pick up CO2 and other waste products and send
to the heart by veins
Gross Anatomy of
Blood Vessels
 Major Arteries of the Systemic
Circulation
• Aorta
− Largest artery of the body
− About the size of a garden hose
− Springs upward from the left ventricle of the heart
as the ascending aorta
− Arches to the left as the aortic arch
− Then plunges downward through the thorax
following the spine, thoracic aorta
− Into the abdominopelvic cavity as the abdominal
aorta
Major Veins of the Systemic
Circulation
• Major veins converge on the vena cava, which
enter the right atrium of the heart.
• Veins draining the head and the arms empty
into the superior vena cava
• Those draining from the lower body empty
into the inferior vena cava
Special Circulation – Arterial Supply of the Brain
Fetal Circulation
• The umbilical cord contain three blood vessels; One
large umbilical vein and two smaller umbilical
arteries (AVA).
• The umbilical vein carries blood rich in nutrients and
oxygen to the fetus.
• The umbilical arteries carry carbon dioxide and
debris-laden blood from the fetus to the placenta.
• As blood flows toward the heart of the fetus, it
bypasses the immature liver through the ductus
venosus and enters the inferior vena cava
• Foramen ovale - a flap-like opening in the interatrial
septum
• Ductus arteriosus - a short blood vessel that connect
the aorta and the pulmonary trunk.
• The aorta carries blood to the tissues of the fetal body
and back to the placenta through the umbilical arteries.
• At birth, the foramen ovale closes and the ductus
arteriosus collapses and is converted to the fibrous
ligamentum arteriosum.
• Umbilical vessels become obliterated and the circulatory
pattern converts to that of an adult.
Arterial Pulse

• Pulse – a pressure wave

created by the
alternating expansion
and recoil of an artery
with each beat of the
left ventricle.
• Pressure point – areas
where pulse is easily
palpated.
Blood Pressure
• Blood pressure is the pressure the blood exerts
against the inner walls of the blood vessels, and it is
the force that keeps blood circulating continuously
even between heartbeats.
• Systolic pressure – the pressure in the arteries at
the peak of ventricular contractions
• Diastolic pressure – the pressure when ventricles
are relaxing
• Measured in millimetres of mercury (mmHg)
Factors Affecting Blood
Pressure
• Peripheral resistance – is the amount of friction
encountered by the blood as it flows through the
blood vessels.
• Any factors that increases cardiac output and
peripheral resistance, increases the blood pressure
1. Neural factors – vasoconstriction
2. Renal factors – renin-angiotensin II mechanism
3. Temperature
4. Chemicals - (epinephrine, nicotine, alcohol)
5. Diet
Developmental Aspects of
the Cardiovascular System
• The heart begins as a simple tube in the embryo
• Is starts beating and busily pumping blood by the fourth
week of pregnancy
• Patent Ductus Arteriosus (PDA) – is a condition in which the
ductus arteriosus does not closes and cause deoxygenated
blood to flow in the wrong direction, weakening the heart
muscle and causing heart failure and other complications.
• Coronary artery disease is the buildup of plaque in the
arteries that supply oxygen-rich blood to your heart
(Cleveland Clinic, 2021).