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Anatomy of the Cariovascular System

Shiela Marie C. Calano BS pharmacy IV Saint Paul University Philippines

System carries oxygen, nutrients, cell wastes, hormones and many others substances vital for body homeostasis to and from the cells. The force to move the blood around the body is provided by the beating heart.

Major function: Transportation Functions of the heart: Generating blood pressure Routing blood Ensuring one- way blood flow Regulating blood supply

Cardiovascular system: The Heart Location and size Size: Approximately the size of the persons fist, the hollow, cone shaped heart weighs less than a pound. Location: the heart is located within the bony thorax and is flanked on each side by the lungs.

Apex (more pointed) Directed toward the left hip and rest on the diaphragm, approximately at the level of the fifth intercoastal space. Base (broader posterosuperior aspect) Great vessels of the body emerge points toward the right shoulder and lies beneath the second rib.

Coverings and Wall

Pericardium Double sac of serous membrane Encloses the heart Visceral pericardium/ epicardium tightly hugs the external surface of t he heart and is actually part of the heart wall

Parietal pericardium Fibrous layer helps protect the heart and anchors it to surrounding structures, such as the diaphragm and sternum. Serous fluid Slippery lubricating fluid Produced by the serous pericardial membranes Allows the heart to beat easily in or relatively frictionless environment as the pericardial layers slide smoothly across each other.

Pericarditis Inflammation of the pericardium results in a decrease in the amount of serous fluid Causes the pericardial layers to bind and stick to each other, forming painful adhesions that interfere with heart movements.

Heart walls: composed of three layers

Epicardium Myocardium Endocardium

1. Epicardium 2. Myocardium Consists of thick bundles of cardiac muscle twist and whorled into ring like arrangements Layer that usually contracts Reinforced internally by a dense, fibrous connective tissue network called skeleton of the heart

3. Endocardium Thin, glistening sheet of endothelium that lines the heart chambers. Continuous with the linings, of the blood vessels leaving and entering the heart.

Chambers and associated Great vessels

The heart has four hollow chambers or cavities Each of these chambers is lines with endocardium ( help blood flow smoothly through the heart) Superior atria: Receiving chambers Located at the base of the heart They are not important in the pumping activity of the heart

Inferior, thick walled ventricles : discharging chambers : actual pumps of the heart When they contract, blood is propelled out of the heart and into the circulation Interventricular septum or interatrial septum Septum that divides the heart longitudinally (depending on which chamber it divides and separates)

Heart: function as a double pump Right side: works as a pulmonary circuit pump Receives 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. Pulmonary trunk splits into the right and left pulmonary arteries, which carry blood to the lungs, where oxygen is picked up and carbon dioxide is unloaded. Oxygen rich blood drains from the lungs and is returned into the left side of the heart through the four pulmonary veins.

Pulmonary circulation
Circulation from the right side of the heart into the lungs and back to the left side of the heart Function: carry blood to the lungs for gas exchange and then return it to the heart. 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 tissues back to the right atrium via the systemic veins, which finally empty their cargo into either the superior or inferior vena cava.

Systemic circulation From the left side of the heart through the body tissues and back to the right side of the heart Supplies oxygen and nutrient- rich blood to all body organs.

Valves The heart is equipped with four valves Allow blood to flow in only one direction through the heart chambers- from the atria through the ventricles and out the great arteries leaving the heart.

Atrioventricular or AV valves Located between the atrial and ventricular chambers on each side Prevent backflow into the atria when the ventricles contract Bicuspid/ mitral valve Left AV valve Consists of two cusps or flaps of endocardium Tricuspid valve Right AV valve Has three cusps

Chordate tendinae heart strings Tiny white cords Anchor the cusps to the walls of the ventricles. Semilumar valves Second set of valves Guards the bases of the two large arteries leaving the ventricular chambers Known as pulmonary and aortic semilunar valves(3)

The AV valves are open during heart relaxation and closed when the ventricles are contracting The semilunar valves are closed during heart relaxation and are forced open when the ventricles contract.

Operation of the AV valves

Blood returning to the heart fills atria, putting pressure against atrioventricular valves; the atrioventricular valves are forced open. As the ventricles fill, atrioventricular valve flaps hang limply into ventricles. Atria contract, forcing additional blood into ventricles. AV valves open

Ventricles contract forcing blood against atrioventricular valve cusps Atrioventricular valves close Chordate tendinae tighten, preventing valve flaps from everting into atria. AV valves closed

Route of blood flow through the heart

Blood supply to the heart

Cardiac muscle in the wall of the heart is thick and metabolically very active. Two coronary arteries supply blood to the wall of the heart.

Coronary arteries Originate from the base of the oarta, just above the aortic semilunar valves. Left coronary artery Originates on the left side of the aorta Three major branches: Anterior interventricular artery Lies in the anterior interventricular sulcus

Circumflex artery Extends around the coronary sulcus on the left to the posterior surface of the heart Left marginal artery Extends inferiorly along the lateral wall of the left ventricle from the circumflex artery Right coronary artery Originates on the right side of the aorta. Extends around the coronary sulcus on the right to the posterior surface of the heart and gives rise to the posterior interventricular artery, which lies in the posterior interventricular sulcus.

Right marginal artery Extends inferiorly along the lateral wall of the right ventricle. Cardiac veins Drain blood from cardiac muscle Coronary sinus Large vein located within the coronary sulcus on the posterior aspect of the heart.

Angina pectoris Situations in which the myocardium is deprived of oxygen often result in crushing chest pain

Action potential

1. Depolarization phase Na+ channels open. K+ channels close. Ca2+ channels begin to open.

2. Early repolarization phase (rapid) and Plateau phase (longer period) Na+ channels close. Some K+ channels open, causing early repolarization. Ca2+ channels are open, producing the plateau by slowing further repolarization.

3. Final repolarization phases Ca2+ channels close. Many K+ channels open.

Physiology of the heart

Two types of controlling systems act to regulate heart activity. 1. Nerves of the autonomic nervous system that act like brakes and accelerators to decrease or increase the heart rate depending on which division is activated. 2. Intrinsic conduction system or nodal system Built in the heart tissue Composed of special tissue found nowhere else in the body Causes heart muscle depolarization in only one directionfrom the atria to the ventricles. It enforces a contraction rate of approximately 75 beats per minute on the heart, thus the heart beats as a coordinated unit.

Sinoatrial/ SA node
Crescent shaped node of tissue Located in the right atrium Highest rate of depolarization in the whole system Called pacemaker From the SA node, the impulse spreads through the atria to the AV node, and then the atria contract. At the AV node, the impulse is delayed briefly to give the atria time to finish contracting. It then passes rapidly through the AV bundle branches, and the Purkinje fibers. Results in a wringing contraction of the ventricles ejects blood superiorly into the large arteries leaving the heart.

Atrioventricular/ AV node Junction of the atria and ventricles Atrioventricular (AV) bubdle (bundle of His) the right and left bundle branches located in the interventricular septum, Purkinje fibers Spread within the muscle of the ventricle walls

Electrocardiography Clinical procedure for mapping the electrical activity of the heart. Heart block Atria and ventricles (separated from one another by insulating connective tissue-> depolarization waves can reach the ventricles only by traveling through the AV node. Any damage to the AV node partially or totally release the ventricles from the control of the SA node. When this occurs, the ventricles (thus the heart) begin to beat at their own rate, which is much slower.

Ischemia lack of an adequate blood supply to the heart muscle May lead to fibrillation- a rapid uncoordinated shuddering of the heart muscle Makes the heart totally useless as a pump and is a major cause of death from heart attacks in adult. Tachycardia Rapid heart rate ( over 100 beats per minute) Bradycardia Heart rate that is substantially slower than normal (less than 60 beats per minute)

Cardiac cycle and heart sounds

Systole Heart contraction Diastole Heart relaxation contraction and relaxation of the ventricles

Cardiac cycle Events of one complete heartbeat, during which both the atria and ventricles contract then relax. Average heart beat: approximately 75 times per minute Length of cardiac cycle: normally about 0.8 second

Mid - to- late diastole Heart in complete relaxation-> the pressure in the heart is low-> blood is flowing passively into and through the atria into the ventricles from the pulmonary and systemic circulations -> semilunar valves are closed-> AV valves are open-> then atria contract and force the blood remaining in their chambers into the ventricles

Entricular systole
Ventricular contraction begins ->pressure within the ventricles increases rapidly, closing the AV valves-> when intraventricular pressure is higher than the pressure in the large arteries leaving the heart, the semilunar valves are forced open-> blood rushes out through them out of the ventricles. During the ventricular systole, the atria are relaxed, and their chambers are again filling with blood.

Early diastole
At the end of the systole-> ventricles relax-> semilunar valves snap shut (preventing backflow) -> ventricles are completely closed chambers. Intraventricular pressure drops-> (when it drops below the pressure in the atria)-> the AV valves are forced open, and the ventricles again begin to refill rapidly with blood, completing the cycle.

Heart sounds
lub caused by the closing of the AV valves dup occurs when semilunar valves close at the end of the systole murmurs abnormal heart sounds

cardiac output (CO)

amount of blood pumped out by each side of the heart in 1 minute. Product of the heart rate(HR) and stroke volume (SV)

stroke volume (SV)

Volume of blood pumped out by a ventricle with each heartbeat increases as the force of ventricular contraction increase

Congestive heart failure

Progressive condition that reflects weakening of the heart by coronary artherosclerosis, persistent high blood pressure, or multiple myocardial infarcts

Pulmonary congestion
If the left heart fails-> right side of the heart continues to propel blood to the lungs but the left side is unable to eject the returning blood into the systemic circulation As the blood vessels within the lungs become swollen with blood, the pressure within them increases, the fluid leaks within the circulation into the lung tissue, causing pulmonary edema.

Peripheral congestion

Right side of the heart fails Occurs as the blood backs up in the systemic circulation. Edema is most noticeable in the distal pasts of the body.

Failure of one side of the heart puts a greater strain on the opposite side and eventually the whole heart fails.