CARDIOVASCULAR SYSTEM

Functions The main function of the cardiovascular system is transportation. With the use of the blood as the transport vehicle, and the blood vessels as the pathways, the system carries oxygen, nutrients, cell wastes, hormones and other substances vital for body homeostasis to and from the cells. Functions Respiration - delivers oxygen to the cells and removing carbon dioxide from them Nutrition - carries digested food substances to the cells of the body Waste Removal - disposes of waste products and poisons that would harm the body if they accumulated Immunity - helps protect the body from disease Cellular Communication - the circulatory system provides a mode of transport for hormones Thermoregulation - the circulatory system transports heat (can both warm and cool body)

THE HEART
Location Lies in the mediastinum, or the middle of the thorax just behind the body of the sternum between the point of attachment of the second through the sixth rib. Approximately two thirds of the heart s mass is to the left of the midline of the body, one third to the right. Posteriorly, the heart rests against the bodies of the fifth to the eighth thoracic vertebrae. The apex of the heart lies on the diaphragm pointing to the left, approximately located between the fifth and sixth intercostal space, left midclavicular line. The base of the heart lies on the second rib Size and Shape Infant : 1/130 of the total body weight, appears transverse and large Adult: 1/300 Between puberty and 25 years, the heart attains its adult shape and weight: male 310g female 225g Dimensions: Coverings

Length: 12 cm (4.5 in) Width: 9 cm (3.5 in) Depth: 6 cm (2.5 in)

The coverings of the heart provide protection and reduces friction between the heart and the thoracic wall. Pericardium - loose-fitting inextensible sac. - though white fibrous tissue - consists of two parts: 1. Parietal layer

Lines the inside of the fibrous pericardium 2. Visceral layer (epicardium) Adhering to the outside of the heart Between the visceral and parietal layers is the pericardial space which contains pericardial fluid which allows the heart to beat easily in a relatively frictionless environment as the serous pericardial layers slide smoothly across each other.

Structure of the Heart

Wall of the Heart Consists of three layers of tissues. 1. Epicardium (visceral serous pericardium) - Outer layer of the heart wall 2. Myocardium a. Cardiac muscle b. Cardiac muscle tissue is composed of many branching cells that are foined into a continuous mass by intercalated disks. c. Large areas of cardiac muscle are electrically coupled into a single functional unit called a syncytium. d. Cardiac muscles are autorhythmic, and do not produce tetanus, thus do not fatigue 3. Endocardium Inner wall which is in direct contact with blood

Chambers of the Heart

FOUR CHAMBERS OF THE HEART a. 2 atria b. 2 ventricles The interventricular and the interatrial septums divides the heart longitudinally. The atria are mainly receiving chambers. The ventricles are the pumping or discharging chambers. Heart Valves The tricuspid valve regulates blood flow between the right atrium and right ventricle The pulmonary valve controls blood flow from the right ventricle into the pulmonary arteries, which carry blood to the lungs to pick up oxygen The mitral valve lets oxygen-rich blood from the lungs pass from the left atrium into the left ventricle The aortic valve opens the way for oxygen-rich blood to pass from the left ventricle into the aorta, the body's largest artery, where it is delivered to the rest of your body

Blood Pathway through the Heart

The heart functions as a double pump: the right side for pulmonary circuit pump and the left for the systemic circuit pump. While it is convenient to describe the flow of blood through the right side of the heart and then through the left side, it is important to realize that both atria contract at the same time and both ventricles contract at the same time. The heart works as two pumps, one on the right and one on the left, working simultaneously. Blood flows from the right atrium to the right ventricle, and then is

pumped to the lungs to receive oxygen. From the lungs, the blood flows to the left atrium, then to the left ventricle. From there it is pumped to the systemic circulation. Systemic Circuit Pump The systemic circulation provides the functional blood supply to all body tissue. It carries oxygen and nutrients to the cells and picks up carbon dioxide and waste products. Systemic circulation carries oxygenated blood from the left ventricle, through the arteries, to the capillaries in the tissues of the body. From the tissue capillaries, the deoxygenated blood returns through a system of veins to the right atrium of the heart. The coronary arteries are the only vessels that branch from the ascending aorta. The brachiocephalic, left common carotid, and left subclavian arteries branch from the aortic arch. Blood supply for the brain is provided by the internal carotid and vertebral arteries. The subclavian arteries provide the blood supply for the upper extremity. The celiac, superior mesenteric, suprarenal, renal, gonadal, and inferior mesenteric arteries branch from the abdominal aorta to supply the abdominal viscera. Lumbar arteries provide blood for the muscles and spinal cord. Branches of the external iliac artery provide the blood supply for the lower extremity. The internal iliac artery supplies the pelvic viscera. Cardiac Circulation Coronary Arteries Branch into left and right from the base of the aorta and encircle the heart in coronary sulcus (AV groove) at the junction of the atria and ventricles. The heart also includes a system of arteries that branch off the main coronary arteries and that assist in supplying the heart with essential oxygen and nutrients. The right coronary artery supplies the right atrium and right ventricle. It branches into the posterior descending artery and the right marginal artery. The left coronary artery branches into the circumflex artery and the left anterior descending (anterior interventricular) artery. The left coronary artery supplies the left atrium and the left ventricle. The blood returns from the heart muscle via 2 major veins 1. Great Cardiac vein: brings deoxygenated blood back from the anterior heart wall 2. Middle Cardiac vein: brings deoxygenated blood back from the posterior heart wall. Both vessels empty into the Coronary Sinus (a large vein on back of heart). It empties into Right Atrium. Only few anastomoses exist between the larger branches of the coronary arteries. Anastomosis consists one or more branches from th rpoximal part of an artery to a more distal part of itself or of another artery.

Physiology of the Heart

The heart s intrinsic conduction system Conduction System An electrical system. It determines the rate & rhythm of the heartbeat 1. Sinoatrial node (SA node, pacemaker) - Neurons fire at 70/80 beats per minute, causes atria to contract. It is called the heart s natural pacemaker. It is located at the right atrium.

2. Atrioventricular node (AV node) - neurons fire at 40-50 beats per minute; typically the SA node overrides it, but if SA node is not functioning it will ultimately cause ventricles to contract at a slower rate. 3. Atrioventricular Bundle (Bundle of His) - conducts impulses between ventricles 4. The AV Bundle divides into left & right Bundle Branches which go to the ventricles. 5. Purkinje fibers - deliver impulses directly to the myocardium of the ventricles. Each electrical signal in the heart begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the right atrium, which is the upper right chamber of the heart. In a healthy adult heart at rest, the SA node fires off an electrical signal to begin a new heartbeat 60 to 100 times a minute. From the SA node, the signal travels to the right and left atria. This causes the atria to contract and pump blood into the heart's two lower chambers, the ventricles. The signal passes between the atria and ventricles through a group of cells called the atrioventricular (AV) node. The signal slows down as it passes through the AV node. This slowing allows the ventricles time to finish filling with blood.

Cardiac Cycle and the Heart Sounds

Cardiac cycle refers to the events of one heart beat during which atria and ventricles have contracted and relaxed (0.8 s average length) Systole contraction Diastole relaxation Mid-to-late diastole Passive Ventricular Filling (0.1s) Diastasis(0.2s)- longer period of slow ventricular filling at the end of ventricular diastole. Atrial Systole Ventricular systole Isovolumetric Ventricular Contraction(S1) Ejection Rapid ejection Reduced ejection Residual volume Early diastole Isovolumetric Ventricular Relaxation(S2)

HEART SOUNDS
Characterized by two sounds : lubb and dupp (dubb) 1. Lubb systolic sound - caused by the contraction of the ventricles and the vibrations of the closing of the AV valves - low pitch 2. Dubb diastolic sound

- caused by the vibrations of the closing of the semilunar valves. - Short and sharp

Cardiac output
Cardiac Output is the amount of blood pumped by each side of the heart in 1 minute CO = Heart Rate (HR) X Stroke Volume (SV) Stroke Volume is the volume of blood pumped out by a ventricle with each heartbeat (70 ml/beat). Normal adult blood volume = 6000ml

Regulation of Stroke Volume

Starling s Law of the Heart the critical factor controlling stroke volume is how much the cardiac muscle cells are stretched before the contract. Venous return the amount of blood entering the heart through the veins, distending the heart Muscular pump affects venous return Factors Modifying Basic Heart Rate 1. Neural controls Autonomic Nervous System 2. Physical Factors 3. Electrolyte imbalance

Neural Control
The nerves of the sympathetic division (accelerator nerves) of the autonomic nervous system more strongly stimulate the SA and AV nodes and the cardiac muscle itself increasing the HR. Parasympathetic (inhibitory or depressor) Nerves(vagus) slow and steady the heart (digitalis). Epinephrine(mimics the sympathetic nervous sytem) and thyroxine increases HR

Electrolyte Imbalance
These may pose threat to the heart 1. Decreased calcium ion depresses the heart 2. Excessive calcium causes prolonged contractions that may stop the heart. 3. Decreased potassium causes feeble heart beat and abnormal rhythm while excess does otherwise 4. Excess or lack of Na Physical Factors 1. Age 2. Gender 3. Exercise 4. Body temperature

BLOOD VESSELS
TYPES OF BLOOD VESSELS 1. Arteries a. arterioles 2. Veins a. Venules- lacks tunica media b. sinuses 3. Capillaries

Structure of the blood vessels

Blood Vessel Walls Larger blood vessel walls have three layers: 1. tunica adventitia (outer) 2. tunica media (middle) 3. tunica intima (inner) Tunica Adventitia - made of strong, flexible fibrous connective tissue. - helps hold vessels open and prevents tearing of the vessel walls during body movements. Tunica Media - made up of smooth muscle sandwiched with a layer of elastic connective tissue - the smooth muscles permits changes in diameter - the smooth muscles are innervated by autonomic nerves and supplied by tiny vasa vasorum. Tunica Intima - made up of endothelium that is continuous to the heart s - in arteries, the endothelium forms a smooth lining. - in veins, it forms semilunar valves . Capillary Walls - the only layer of the wall of the caplillaries is the endothelium - Capillaries have fenestrations

Functions of the blood vessels

Capillaries Primary exchange vessels of the cardiovascular system Keeps the cells supplied with vital materials and rid of injurious wastes Microcirculation - blood flows at its slowest rate allowing maximum contact time between blood and the tissues. Arteries Serves mainly as distributors to arterioles then to the capillaries Maintains blood pressure and circulation

Veins Collectors (capacitance vessels) and reservoir vessels Return blood to the heart and accommodate varying amounts of blood. Capacitance - ease of stretch to accommodate blood volume

The individual smooth muscle in the walls of the arterioles serve as precapillary sphincters which function as regulatory valves Has lamina on each face of its tunica media

Major blood vessels

Systemic Circulation General Principles of Systemic Arteries 1. Main arteries are major pipelines distributing blood from the heart which rebranch forming arterioles. 2. End-arteries diverge into capillaries 3. Arterial anastomosis 4. Aorta is the major artery that serves as the main trunk of the entire systemic arterial system. a. Ascending b. Aortic arch c. Descending d. abdominal 5. Brachiocephalic artery 6. - supplies the right side of the head and neck which branches to right subclavian artery and right common carotid artery 7. Left subclavian artery and left common carotid artery 8. - branch directly from the aorta General Principles of Systemic Veins 1. Ultimate extension of capillaries 2. Large veins of the cranial cavity are called dural sinuses 3. Vein anastomosis 4. Many veins have corresponding arteries bearing the same name located nearby. 5. Vessels are considerably in location and branches. 6. Venous blood from the head, neck, upper extremities and thoracic cavity (except the lungs) drains into superior vena cava. 7. Venous blood from the lower extremities and the abdomen enters the inferior vena cava. Hepatic Portal Circulation Inferior mesenteric vein Drains the terminal part of the large intestine into the splenic vein Splenic vein Drains the spleen, pancreas and the lest side of the stomach Superior mesenteric vein Drains the small intestine and the first part of the colon Left gastric vein Drains the right side of the stomach directly into the hepatic portal vein

Fetal Circulation Two umbilical arteries and one vein (AVA) Placenta structure for nutrients and wastes exchange Three bypasses/detours: Ductus venosus bypasses liver Foramen ovale bypasses RV Ductus arteriosus blood bypasses the lungs

PHYSIOLOGY OF CIRCULATION
Principles of Circulation 1. Blood flows because of pressure gradients between different parts of its bed- Newton s 1st and 2nd laws of motion 2. Blood circulates from the left ventricle to the right atrium because blood pressure gradient exist between the two. ARTERIAL PULSE Pulse - a pressure wave created by the alternating expansion and recoil of an artery that occurs with each beat of the left ventricle - averages 70 to 76 (60 100) bpm Body sites for pulse assessment: Apical Temporal Facial Common carotid Brachial Radial Femoral Popliteal Posterior tibial Dorsalis pedis BLOOD PRESSURE - The pressure exerted by the blood against the walls of the blood vessels - BP is higher in the arteries that in veins - Blood flows continuously in a decreasing pressure gradient - BP = CO X Peripheral Resistance Factors that affect HR, PR and BP - Raas, age, anxiety, etc

CONTROL OF BLOOD VESSELS Vasomotor Control Mechanism - Control changes in the diameter of vessels/ arterioles Vasomotor center/ vasoconstrictor center - Found in medulla - Initiate an impulse outflow via sympathetic fibers to the blood vessels smooth muscles Vasomotor Pressoreflexes - Increase in arterial BP stimulates aortic and carotid baroreceptors (decreasing HR), inhibiting the vasoconstrictor center - Decrease in BP causes the aortic and carotid baroreceptors to send more impulse to the medulla s vasoconstrictor center Vasomotor Chemoreflexes - Located in the aortic and carotid bodies - Sensitive to excess CO2, hypoxia and decreased pH. - Transmits impulses to the medulla s vasoconstrictor center - Emergency mechanism when hypoxia or hypercapnia endangers the stability of the internal environment Local Control Of Arterioles - Several local mechanisms produce vasodilation in localized areas hyperemia