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Suhartini drg., M.Biotech

Physiology-Biomedic Department Dentistry Faculty of Jember University

The Cardiovascular System

consists of the heart plus all the blood vessels transports blood to all parts of the body in two 'circulations':
pulmonary systemic


The Functions of Circulatory system

1. Transport of nutrients, wastes, essential gases 2. Buffers body pH 3. Transports hormones 4. Assists in temperature regulation 5. Urine formation 6. Assists in response to infections
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Circulation Reviewed
Blood Vessels "closed circulation"
Arteries from heart Capillaries cell exchange Veins to heart

Heart "four chambered"

Right atrium & ventricle
Pulmonary circuit

Left atrium & ventricle

Systemic circuit
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Sirculation & Distribution of Blood in the Body Organs


The Blood Vessels

The cardiovascular system has three types of blood vessels: 1. Arteries (and arterioles) carry blood away from the heart 2. Capillaries where nutrient and gas exchange occur 3.Veins (and venules) carry blood toward the heart.
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The Arteries
Arteries and arterioles take blood away from the heart. The largest artery is the aorta. The middle layer of an artery wall consists of smooth muscle that can constrict to regulate blood flow and blood pressure. Arterioles can constrict or dilate, changing blood pressure.
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The Veins
Venules drain blood from capillaries, then join to form veins that take blood to the heart. Veins have much less smooth muscle and connective tissue than arteries. Veins often have valves that prevent the backward flow of blood when closed. Veins carry about 70% of the bodys blood and act as a reservoir during hemorrhage.
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The Capillaries
Capillaries have walls only one cell thick to allow exchange of gases and nutrients with tissue fluid. Capillary beds are present in all regions of the body but not all capillary beds are open at the same time. Contraction of a sphincter muscle closes off a bed and blood can flow through an arteriovenous shunt that bypasses the capillary bed.


The Capillaries



Make Up of Blood Vessels: Capillaries



Capillary exchange



Osmotic Pressure in Capillaries



The heart
The heart is a cone-shaped, muscular organ located between the lungs behind the sternum. The heart muscle forms the myocardium, with tightly interconnect cells of cardiac muscle tissue. The pericardium is the outer membranous sac with lubricating fluid.
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The heart has four chambers: two upper, thin-walled atria, and two lower, thick-walled ventricles. The septum is a wall dividing the right and left sides. The tricuspid valve on the right and the bicuspid valve on the left; both valves are reenforced by chordae tendinae attached to muscular projections within the ventricles.
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Passage of Blood Through the Heart

Blood follows this sequence through the heart: superior and inferior vena cava right atrium tricuspid valve right ventricle pulmonary semilunar valve pulmonary trunk and arteries to the lungs pulmonary veins leaving the lungs left atrium bicuspid valve left ventricle aortic semilunar valve aorta to the body.
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volume of blood pumped by each ventricle CO = HR (heart rate) (x/mnt) x SV (stroke volume) (mL/beat)
Heart rate is the number of heart beats per

minute; normally it is about 70 beat/ minute Stroke volume is the volume of blood pumped by each ventricle per beat; normally it is about 70 ml/ beat



Regulation Stroke Volume

Intrinsic control:
End-diastolic volume (ventricle relax) = stroke volume Mechanism : strength of contraction End-diastolic volume (the volume of blood in the heart just before the ventricles begin to contract) is called the Frank-Starling law of the heart:
end-diastolic volume = stretching of of cardiac muscle = strength of contraction = stroke volume

Extrinsic control:
Sympathetic stimulation strength of contraction of cardiac muscle Mechanism : sympathetic stimulation release of norepinephrine increased permeability of muscle cell membranes to calcium calcium diffuses in more crossbridges are activated stronger contraction
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Regulators of the Heart:



The Heartbeat
Each heartbeat is called a cardiac cycle. When the heart beats, the two atria contract together, then the two ventricles contract; then the whole heart relaxes. Systole is the contraction of heart chambers; diastole is their relaxation. The heart sounds, lub-dup, are due to the closing of the atrioventricular valves, followed by the closing of the semilunar valves.
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Intrinsic Control of Heartbeat

The SA (sinoatrial) node, or pacemaker, initiates the heartbeat and causes the atria to contract on average every 0.85 seconds. The AV (atrioventricular) node conveys the stimulus and initiates contraction of the ventricles. The signal for the ventricles to contract travels from the AV node through the atrioventricular bundle (His) to the smaller Purkinje fibers.



Conduction system of the heart



The Hearts Electrical System

Most of the muscle cells in the heart are contractile cells. The autorhythmic cells are located in these areas: Sinoatrial (SA), or sinus, node Atrioventricular (AV) node Atrioventricular (AV) bundle (also sometimes called the bundle of His) Right & left bundle branches Purkinje fibers Various automatic cells have different 'rhythms': SA node 60 - 100 per minute (usually 70 - 80 per minute) AV node & AV bundle 40 - 60 per minute Bundle branches & Purkinje fibers - 20 - 40 per minute the SA node is commonly referred to as the PACEMAKER.



Extrinsic Control of Heartbeat

A cardiac control center in the medulla oblongata speeds up or slows down the heart rate by way of the autonomic nervous system branches: parasympathetic system (slows heart rate) and the sympathetic system (increases heart rate). Hormones epinephrine and norepinephrine (simpt) from the adrenal medulla also stimulate faster heart rate.



The Electrocardiogram
An electrocardiogram (ECG) is a recording of the electrical changes that occur in the myocardium during a cardiac cycle. Atrial depolarization creates the P wave, ventricle depolarization creates the QRS wave, and repolarization of the ventricles produces the T wave.






Blood Flow
The beating of the heart is necessary to homeostasis because it creates pressure that propels blood in arteries and the arterioles. Arterioles lead to the capillaries where nutrient and gas exchange with tissue fluid takes place.



Blood Flow: Pressure Changes

Flows down a pressure gradient Highest at the heart, decreases over distance Hydrostatic (really hydraulic) pressure in vessels Decreases 90% from aorta to vena cava
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Some Physic of Fluid Movement: Blood Flow



Mean Arterial Pressure (MAP)

MAP = Cardiac Output X Total Peripheral Resistance Factors effecting MAP are:
total peripheral resistance (TPA)
TPA refers to the sum total of vascular resistance to the flow of blood in the systemic circulation. Because of their small radii, arterioles provide the greatest resistance to blood flow in the arterial system TPA MAP

cardiac output blood volume



Baroreceptor Reflexes in Short-term Regulation of MAP

Blood pressure is contolled by baroreceptor reflexes Blood Pressure BP The cardiovascular control center (CCC) responds by decreasing sympathetic input and increasing parasympathetic input to the heart.
The CCC sympathetic input to the blood vessels vasodilation
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Regulators of the Heart: Reflex Baroreceptors



Blood Volume in Long Term Regulation of MAP

Chemical controls
Act directly on muscle (tunic media) or interact with neural Epinephrine - BP Nicotine vasoconstriction (BP) Alcohol vasodilation (BP) Histamine vasodilation (BP) Antidiuretic hormone (ADH) (volume BP)

Kidneys control long term BP

Regulate blood volume Renin/angiotensin II mechanism (vasoconstriction)

Cold vasoconstriction Heat vasodilation



Summary of Factors that Effect Mean Arterial Pressure



Summary of Factors that Effect Blood Flow during Exercise



Blood Pressure Measurement



The Average of Blood Pressure




Cardinal symptoms of Cardiac Disease

chest pain neck and/or UE pain and discomfort cool clammy skin palpitation dyspnea syncope fatigue cough cyanosis edema claudication
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1. Reduced concentration of plasma proteins.
Factor that reduce plasma proteins include:
Kidney disease can result in the loss of plasma proteins in the urine. Liver disease can decrease the synthesis of plasma proteins. A protein-deficient diet will decrease plasma proteins. Severe burns result in a loss of plasma proteins (albumin) at the burn site

2. Increased capillary permeability 3. Increase in venous pressure

Left heart failure Standing still

4. Blocked Lymphatics.
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Risk Factors
Non Modifiable
age male sex family history Race

physical inactivity cigarette smoking hypertension elevated serum cholesterol levels

most at risk personality: hostility associated with anger

4 known triggers
vigorous exercise or exertion exposure to cold or wind psychological or emotional stress eating a big meal
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Contributing Factors
obesity diabetes response to stress personality

Cardiovascular Disorders
Cardiovascular disease (CVD) is the leading cause of death in Western countries. Modern research efforts have improved diagnosis, treatment, and prevention. Major cardiovascular disorders include atherosclerosis, stroke, heart attack, aneurysm, and hypertension.
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Atherosclerosis is due to a build-up of fatty material (plaque), mainly cholesterol, under the inner lining of arteries. The plaque can cause a thrombus (blood clot) to form. The thrombus can dislodge as an embolus and lead to thromboembolism.



Stroke, Heart Attack, and Aneurysm

A cerebrovascular accident, or stroke, results when an embolus lodges in a cerebral blood vessel or a cerebral blood vessel bursts; a portion of the brain dies due to lack of oxygen. A myocardial infarction, or heart attack, occurs when a portion of heart muscle dies due to lack of oxygen.
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Partial blockage of a coronary artery causes angina pectoris, or chest pain. An aneurysm is a ballooning of a blood vessel, usually in the abdominal aorta or arteries leading to the brain. Death results if the aneurysm is in a large vessel and the vessel bursts. Atherosclerosis and hypertension weaken blood vessels over time, increasing the risk of aneurysm.
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Coronary Bypass Operations

A coronary bypass operation involves removing a segment of another blood vessel and replacing a clogged coronary artery. It may be possible to replace this surgery with gene therapy that stimulates new blood vessels to grow where the heart needs more blood flow.
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Coronary bypass operation



Clearing Clogged Arteries

Angioplasty uses a long tube threaded through an arm or leg vessel to the point where the coronary artery is blocked; inflating the tube forces the vessel open. Small metal stents are expanded inside the artery to keep it open. Stents are coated with heparin to prevent blood clotting and with chemicals to prevent arterial closing.
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Heart Transplants and Artificial Hearts

Heart transplants are routinely performed but immunosuppressive drugs must be taken thereafter. There is a shortage of human organ donors. Work is currently underway to improve selfcontained artificial hearts, and muscle cell transplants may someday be useful.



About 20% of Americans suffer from hypertension (high blood pressure). Hypertension is present when systolic pressure is 140 or greater or diastolic pressure is 100 or greater; diastolic pressure is emphasized when medical treatment is considered. A genetic predisposition for hypertension occurs in those who have a gene that codes for angiotensinogen, a powerful vasoconstrictor.
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Variety of causes/ risk factors of hypertension are known - sedentary lifestyle - smoking - obesity - diet (excess sodium; cholesterol; calories in general) - stress - arteriosclerosis - genetic factors