CARDIOVASCULAR

SYSTEM

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Heart Anatomy

Approximately the size of your fist

Location
Superior surface of diaphragm
Left of the midline
Anterior to the vertebral column,
posterior to the sternum

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Layers of the Heart

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Heart Wall

Epicardium visceral layer of the serous

pericardium
Myocardium cardiac muscle layer forming the
bulk of the heart
Fibrous skeleton of the heart crisscrossing,
interlacing layer of connective tissue
Endocardium endothelial layer of the inner
myocardial surface

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 Vessels returning blood to the heart include:
1. Superior and inferior vena cava

2. Right and left pulmonary veins

Vessels conveying blood away from the heart

include:
1. Right and left pulmonary arteries

2. Aorta

Arteries

Veins
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External Heart

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External Heart: Posterior View

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Heart: Frontal Section

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Myocardial Thickness and Function

Thickness of myocardium varies according to the

function of the chamber
Atria are thin walled, deliver blood to adjacent ventricles
Ventricle walls are much thicker and stronger
right ventricle supplies blood to the lungs (little flow
resistance)
left ventricle wall is the thickest to supply systemic
circulation
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Myocardium of left ventricle is much thicker
than the right.
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Blood Flow

Right atrium tricuspid valve right ventricle

Right ventricle pulmonary semilunar valve

pulmonary arteries lungs
Lungs pulmonary veins left atrium

Left atrium bicuspid valve left ventricle

Left ventricle aortic semilunar valve aorta

Aorta systemic circulation

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Heart Valves
Heart valves ensure unidirectional blood flow
through the heart
Atrioventricular (AV) valves lie between the
atria and the ventricles
AV valves prevent backflow into the atria when
ventricles contract
Semilunar valves prevent backflow of blood into
the ventricles
Aortic semilunar valve lies between the left
ventricle and the aorta
Pulmonary semilunar valve lies between the
right ventricle and pulmonary trunk

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Heart Valves

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Circulation routs

Pulmonary (right side)

Systemic (left side)

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Heart beat: The cardiac cycle

Contraction: systole

Relaxation: Diastole

The heart sounds

lub closing of AV valves

dub closing of semilunar valves

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Cardiac Muscle Contraction

Heart muscle:
Is stimulated by nerves and is self-
excitable (automaticity)
Has a long (250 ms) absolute refractory
period

Cardiac muscle contraction is similar

to skeletal muscle contraction
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Heart Physiology: Intrinsic Conduction System

Autorhythmic cells:
Initiate action potentials
Have unstable resting potentials called
pacemaker potentials
Use calcium influx (rather than sodium)
for rising phase of the action potential

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Pacemaker and Action Potentials of the Heart

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Heart Physiology: Sequence of Excitation

Sinoatrial (SA) node generates impulses

about 75 times/minute. Sinoartial node is the
cardiac pacemaker
SA node generates 80-100 action potential per minute

Atrioventricular (AV) node delays the

impulse approximately 0.1 second.
Atrioventricular node stimulated by SA node
AV node generates 40-60 action potential per minute

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 SA node: cardiac
pacemaker
AV node: relay
impulse
AV bundle and
Purkinje fibers:
carry impulse to
ventricles

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 Heart Physiology: Sequence of Excitation

Impulse passes from atria to ventricles via the

atrioventricular bundle (bundle of His)
AV bundle splits into two pathways in the
interventricular septum (bundle branches)
1. Bundle branches carry the impulse toward the
apex of the heart
2. Purkinje fibers carry the impulse to the heart
apex and ventricular walls

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Sequence of Excitation

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Heart Excitation Related to ECG

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 Other control (nervous)

Heart is stimlated by
the sympathetic
cardioacceleratory
center - increase heart
rate

Heart is inhibited by the

parasympathetic
cardioinhibitory center -
decrease heart rate

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Electrocardiography
Electrical activity is recorded by
electrocardiogram (ECG)

P wave corresponds to depolarization of SA node

QRS complex corresponds to ventricular

depolarization

T wave corresponds to ventricular repolarization

Atrial repolarization record is masked by the

larger QRS complex

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Summary of the parts and waves of a cardiac cycle as seen in
an ECG signal

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Cardiac Cycle

Cardiac cycle refers to all events

associated with blood flow through the
heart
Systole contraction of heart muscle
Diastole relaxation of heart muscle

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Heart Sounds
Heart sounds (lub-dup) are associated with closing
of heart valves
First sound occurs as AV valves close and
signifies beginning of systole (contraction)
Second sound occurs when SL valves close at
the beginning of ventricular diastole (relaxation)

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PHONOCARDIOGRAM

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 First heart sound has four component
Initial component in S1: first myocardial
contractions in the ventricles move blood
toward the atria, closing the AV valves
Second component in S1: abrupt tension of the
closed AV valves, blood is ejected out of the
ventricles. Because of semilunar valve opens.
Third component of S1: caused by oscillation of
blood between the root of the aorta and the
ventricular walls
Fourth component of S1: vibrations caused by
turbulence in the ejected blood flowing rapidly
through Aorta and pulmonary artery

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 S2 has two components:
one due to closure of the aortic valve (AV) and
another due to closure of the pulmonary valve
(PV).
The aortic valve normally closes before the
pulmonary valve.

S3: sudden termination of the ventricular

rapidfilling phase.
S4: atrial contractions displacing blood into the
distended ventricles.
Murmurs.

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ECG ELECTRODES

Color codes
used in ECG
Electrodes

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Clinical practice: standard 12channel ECG
obtained using
Four limb leads

and chest leads in six positions.

Left arm, right arm, left leg: leads I, II, and

III.

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 LEADS
Lead I: Left Arm (LA) and Right Arm (RA)

Lead II: Left Leg (LL) and right Arm (RA)

Lead III: Left Leg (LL) and Left Arm (LA)

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 Wilsons central terminal: combining
left arm, right arm, and left leg leads;
reference for chest leads.
Augmented limb leads known as
aVR, aVL, and aVF
aV for augmented lead,
R for right arm, L for left arm, and F
for left foot

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BIPOLAR LIMB LEADS

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 BIPOLAR LIMB LEADS

Hypothetical equilateral triangle formed by

leads I, II, and III: Einthovens triangle.

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UNIPOLAR LIMB LEADS

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UNIPOLAR LIMB LEADS

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Einthovens triangle and the axes of the six ECG leads formed by using four
 UNIPOLAR CHEST LEADS

Six chest leads (V1 V6) obtained from six

standardized positions on the chest with Wilsons
central terminal as the reference.

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UNIPOLAR CHEST LEADS

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 UNIPOLAR CHEST LEADS
The six chest leads permit viewing the cardiac
electrical vector from different orientations in a
cross sectional plane:

V5 and V6 most sensitive to left ventricular activity;

V3 and V4 depict septal activity best;

V1 and V2 reflect activity in the right half of the

heart.

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 The 12 lead system serves as the basis of
the standard clinical ECG.

Some of the lead interrelationships are:

II = I + III

aVL = ( I - III) / 2.

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VECTORIAL RELATIONS BETWEEN
ECG LEADS I, II, AND III

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 Important features of standard clinical ECG:
Rectangular calibration pulse, 1 mV and 200 ms:
pulse of 1 cm height on the paper plot.
Speed 25 mm/s: 0.04 s/mm or 40 ms/mm.
Calibration pulse width: 5 mm.
ECG signal peak value normally about 1 mV .
Amplifier gain: 1,000.
Recommended sampling rate: 500 Hz for diagnostic ECG.
ECG for heart rate monitoring: reduced bandwidth
0.5 50 Hz.
High resolution ECG: greater bandwidth of 0.05 500
Hz.
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