‫‪Cardiovascular system‬‬

‫‪review‬‬

‫‪Ahmed Omer Lak‬‬

‫)‪M . B.C H.B, F K BMS ( M E DIC INE), FK BMS ( C ARD IOLOGY‬‬
‫ا ﺧ ﺘﺼﺎص ا ﻻﻣﺮا ض ا ﻟ ﺒﺎﻃﻨ ﻴﺔ و ا ﻻﻣﺮاض ا ﻟ ﺼﺪ ﻳ ﺔ‬

‫ﻣ ﻌ ﺎﻟﺠﺔ ا ﻻ ﻣﺮاض ا ﻟ ﻘ ﻠﺒﻴﺔ ﺑ ﺘﺪاﺧﻞ ا ﻟﻘ ﺴ ﻄ ﻳﺔ‬ ‫ا ﺧ ﺘﺼﺎص ا ﻟ ﺪ ﻗﻴﻖ‬

 CARDIOVASCULAR SYSTEM (C.V.S)

1- Heart
2- Arteries
3- Capillaries
4- Veins
5- Blood
6- lymphatics
 The primary function of CVS divides into two major divisions

- Pulmonary circulation:
1). carries blood to the lungs
2). Eliminates CO2 via the lungs and
3). returns blood to the heart

- Systemic circulation:
1). Supplies blood to the rest of the body
2). Delivers O2 to all the body
3). And carries away wastes.
The Heart

The heart is a cone-shaped, hollow, muscular pump.

Size: the adult heart has a mass of between 250- 350 gram and is about the size
of a clenched fist, around 14 cm long and 9 cm wide.
Location: the heart lies in the mediastinal area of thoracic cavity between the
lungs.
Base, Apex, and Surfaces of the heart

Base: is formed by left and right atria. Mostly the left atrium found beneath the 2nd rib.
mainly
Apex: lies in the left 5th intercostal space, Formed by the left ventricle.

Inferior/ diaphragmatic: It formed by left and right ventricles.

Anterior/ Sternocostal: lies just behind the sternum and the ribs. Formed mostly by the right
ventricle.

Left/ pulmonary: formed mostly by left ventricle.

Right/pulmonary: RV only
not ation
t.ie
 Heart wall Structure

The heart wall consists of three layers:

1. The epicardium (epi = upon or above): is the outer layer of the heart, composed mainly of simple
squamous epithelium and connective tissue.
2. The myocardium (myo= muscle): Is the middle layer of the heart wall .and, is composed of
cardiac muscle tissue.
The myocardium is the thickest of the three heart wall layers.
3. The endocardium (endon= within): is the inner layer of the heart wall and it composed of simple
squamous epithelium and a layer of connective tissue.
The endocardium also covers the surface of valves and continues as the endothelium of blood
vessels.
Pericardium EIE.IE t

A sac called pericardium covers the heart.

The pericardium restricts excessive heart movements in the thoracic cavity and prevents
overfilling with blood.

The pericardium is composed of 2 parts:

1. Fibrous pericardium: is the outer part of pericardium and it composed of tough dense
connective tissue.

2. Serous pericardium: is the inner part of pericardium and it composed of 2 subdivisions

 a). parietal layer: that lines the inner surface of the fibrous pericardium.

b). visceral layer (epicardium): that covers the outside of the heart.
pericardial cavity: a thin space between the parietal and visceral layers of pericardium which
contains a serous fluid about 20-50ml.
The serous fluid lubricates the membranes to reduce and prevent the friction during heartbeat.
Pericardium & cardiac wall structure 1
 Chambers of the Heart

Heart consists 4 chambers, the 2 superior chambers are known as atria (right atrium and left atrium).
The 2 inferior chambers are known as ventricles (right ventricle and left ventricle).
Right Atrium: it receives deoxygenated blood and passes it the right ventricle.
Opening into the right atrium:
1. Superior vena cava (blood comes from head neck, upper limbs and superior regions of the trunk and
enters into right atrium)
2. Inferior vena cava (blood comes from lower limbs, and trunk and enters into right atrium.
3. Coronary sinus (blood comes from the heart wall and enters into right atrium).
4. Right atrioventricular opening (blood leaves right atrium and enters into right ventricle). This
opening is guarded by tricuspid valve.
Interatrial septum forms a thin wall between the right and left atria.
Fossa ovalis: is an oval depression in the interatrial septum.

It represents a remnant of fetal foramen ovale.

Right Ventricle: The right ventricle forms most of the anterior surface of the heart. Deoxygenated
blood flows into the right ventricle from the right atrium.
Opening of the right ventricle:

1. Right aterioventricular opening (via tricuspid valve) blood enters ventricle

2. Pulmonary trunk (blood leaves the right ventricle and enters into pulmonary artery.

An interventricular septum forms a thick wall between the right and left ventricles its about 9-11mm
1cm
Left Atrium: oxygenated blood enters the left atrium from the pulmonary veins.
Opening of the left atrium:

1. Pulmonary veins ( 4 viens 2 RT and 2 LT . blood comes from lungs and enters left atrium).
2. Left atrioventricular opening: blood leaves left atrium and enter the left ventricle.this opening
is guarded by mitral (bicuspid) valve.
Left Ventricle: oxygenated blood flows into the left ventricle from the left atrium.
The wall of left ventricle is 2-3 times as thick as right ventricle.

Opening in the left ventricle:

1. Left atrioventicular opening (blood comes from the left atrium).

2. Aortic (blood leaves left ventricle to flows into aortic artery). It is guarded by aortic valve.
 mitral
tricuspidexcept valve
anofthemare
Cardiac valves
The valves: are connective tissue flaps that lined by epithelial tissue.
Their function is to permit the passage of the blood in one direction and prevent backflow.

In the heart, there are 4 valves; two as atriovanticular and two as semilunar
Atrioventricular valves:
1. Right atriovantricular valve (tricuspid) is made of three cusps.

2. Left atriovantricular valve (mitral or bicuspid) is made of two cusps.

The free edges of the cusps are attached to papillary muscles through the cord like structures
called cordae tendineae.
Papillary muscles: these muscles are cone shaped which originated from the ventricular wall.
There apex are connected to cordae tendineae.
Cordae tendineae: are fine tendinous cords which are attached from papillary muscles to the
border of cusps.

This attachment is to prevent the bulging of the valves into the atria during ventricles contract.
Semilunar Valves:
1. Aortic valve: present at the opening the aorta in left ventricle. (has 3 cusps).

2. Pulmonary valve: present at the opening of pulmonary trunk. (has 3 cusps).

These valves open when ventricles contract to allow the blood to flow from right ventricle to
pulmonary artery and from left ventricle to aorta.

They close when ventricle relax.

Right left
posterior
Externally:

Sulci of the Heart

1. Coronary sulcus = ateriovantricular sulcus: is a relatively deep groove that extends around
the heart and separates atria and ventricles.

2. Anterior interventricular sulcus

3. Posterior interventricular sulcus located between the left and right ventricles.
Fibrous skeleton of the Heart:

Is located between the atria and ventricles.

Functions:
1. Separate atria and ventricles.
2. Anchors heart valves.
3. Provides electrical insulation between atria and ventricles. (so prevent contraction
of all chambers at the same time).
 Blood supply to the heart

Arteries

Left and right coronary arteries: their origin is ascending aorta.

- Right coronary artery it gives two branches: right

marginal
artery

1. Right marginal artery: it supplies the right border of the heart.

per arposterior
interventricular
artery

02. Posterior interventricular artery: it supplies the right and left ventricles.
- Left coronary artery it gives the following branches:
L I.liaexaney
O1. Anterior interventricular artery (left anterior descending artery): it supplies the anterior surface of both ventricles.

O2. Circumflex artery: supplies the left atrium and ventricle.

0
Connections among smaller arteries are called anastomoses.
Anastomoses may delay appearance of ischemic heart symptoms.

itsEndartery
Veins

Coronary sinus: receive blood from:

1.great cardiac vein

2. middle cardiac vein

3. small cardiac vein

The coronary sinus opens directly into the right atrium

am ow aucdmap a
Nerve Supply to the heart

1. Sympathetic: derived from thoracic spinal cord T1-T2.

Stimulation of the heart by sympathetic nervous system leads to

increase heart rate (tachycardia),

 increase force of contraction, and
notcontractionforceofcontraction
 dilation of coronary arteries.
Nerve Supply to the heart

2. Parasympathetic: branches of vagus nerve (cranial nerve X)

Stimulation of the heart by parasympathetic nervous system leads to:

Slowing of the heart (bradycardia),

 reduction in the force of contraction, and

 constriction of coronary arteries.

Cardiac cycle

It is the inclusive period of time from the start of one heartbeat to the
initiation of the next.
In each cardiac cycle, there are alternate contractions and relaxation
of all chambers.
Each contraction is called systole and each relaxation is called
diastole
 The events at single cardiac cycle:
afterother
one
1. Atrial systole: contraction of both atria (left and right) simultaneously leads to move blood
(20%) from atria to the ventricles (from right atrium to the right ventricle through tricuspid valve.
EE.es
And from left atrium to the left ventricle through mitral valve).

2. Atrial diastole: in this phase it acts as a reservoir ( storage)

3. Ventricular systole: In this period, the tricuspid and mitral valves are closed, and the blood
forced into the blood vessels through semilunar valves (from left ventricle to the pulmonary
Montaminant

artery. And from left ventricle to the aorta).

4. Ventricular diastole: most of blood (80%) flows passively from relaxing atria into the
ventricles through the open aterioventricle valves.
p QRS T

idiot as
A
Passive

SI

S
 PulmonaryPressure2030mmg
E a

15 c

I 0

127 onebeat
Wigger diagram
Cardiac Output

It means the amount of blood ejected by each ventricle per minute.

Stroke volume: is the amount of blood ejected by each ventricle per beat

Cardiac output = stroke volume x heart rate

SV HR
Heart Sounds

1. Labb Sound: Made by contraction of ventricles and closure of tricuspid and mitral valves.
2. Dupp Sound: Made by closure of pulmonary and aortic valves. When ventricles relax.
Cardiac Muscle
 Conducting System of the Heart

The heartbeat originates in a specialized cardiac muscle cells (cardiac conducting system) and
spreads via this system to all parts of the myocardium.
Parts of conducting system:
1. Sinoatrial (SA) node is located in the posterior wall of right atrium (at the junction of the
superior vena cava with the right atrium).
2. Atrioventricular (AV) node is located in the right posterior portion of interaterial septum

3. Bundle of His: located in the interventricular septum and divided into branches right and left.

4. Purkinje fibers: begin within the apex of the heart and extend through the walls of the ventricles.
This system has ability to stimulate cardiac contraction without any innervations.
Electricity and Action potential of the cardiac muscle
- Myocardial fibers have a resting membrane potential of approximately (-90) mV.
The action potential in the stimulated cardiac myocyte is divided into
5 phases:

- Phase 0 :
rapid depolarization: occurs due to rapid Na+ influx, so the inner membrane gradually
becomes less negative, and when the membrane potential becomes (- 40)mV (reaches
the threshold for initiating action potential),
the Ca++ influxes leads to produce the rapidly rising phase of action potential
depolarization.
The membrane potential reaches to the +30 mV.
- Phase 1: initial rapid repolarization. It is a short phase.
The membrane potential in this phase reaches to (-10) mV.
This phase occurs due to closure of Na+ channel and opening of K+ channel.

- Phase 2: plateau. It occurs due to slow influx of Ca++.

- Phase 3: repolarization. during this phase complete repolarization and the
membrane reaches to approximately resting value.
- Phase 4: resting potential. The membrane potential is maintained at (-90)mV.
At resting membrane potential the Na+ channel Ca++ channel are
closed.
While some leakage of K+ through K+ channel.
Action potential causes the release Ca++ into cytoplasm (from sarcoplasm) which
causes the muscle contraction.
All heart cells are electrically joint one to another by intercalated disc (gap junction), so
one cardiac muscle generate action potential it just spread to the other.
.

Duration of action potential: is about 250 msec.

at a heart rate 75 beats/ minute.
The duration of action potential decrease when
heart rate increases
 Normal Electrocardiogram (ECG or EKG)

It refers to the record of the potential fluctuation during the cardiac cycle.
Due to sequential spread of the excitation in the:
1. Atria
2. Interventricular septum.
3. Ventricular wall
4. Repolarization of the myocardium
These events appear in the ECG as a series of positive and negative waves (P, Q,
R, S, and T).
Waves of ECG
P wave: atrial depolarization
QRS complex wave: ventricular depolarization
T wave: ventricular repolarization.
Intervals and segments

P-R interval: it measured from the onset of P wave to the onset QRS complex.
It measures the AV conduction time. Its duration varies from 0.12- 0.2sec.

QT interval: it is the time from the start of the QRS complex to the end of T wave.
It indicates total systolic time of ventricle (ventricular depolarization and repolarization).

PQ segment:
ST segment: it is an isoelectric period between the end of QRS and beginning of T wave.

Its duration is about 0.32 sec.

Ventricularsystole
Clinical application of ECG:

It is important in the diagnosis, prognosis, and planning treatment of the cardiac disorders e.g.:
1. Cardiac arrhythmias

2. Myocardial infarction
3. Cardiac hypertrophy

4. Changes in the ionic composition of the heart

Good luck