PHR 201 Physiology and Anatomy II

Chapter 2: Cardiovascular System

Kazi Milenur Rahman Prattay

Lecturer
School of Pharmacy
BRAC University
Cardiovascular System
- Also called the Circulatory System

Components of the circulatory/cardiovascular system

• Cardiovascular System consists of three components:
• The heart, which pumps blood
• The blood vessels, through which blood flows and
• The blood
The Heart
- The heart is a hollow, cone-shaped, muscular pump.

Size and Location of the Heart

• Heart size varies with body size. An average adult’s heart is about
14cm long (1 inch= 2.54 cm) and 9cm wide.
• The heart is located in the chest between the lungs behind the
sternum and above the diaphragm.
The Heart

Figure: Heart
The Heart
Covering of the Heart
• The pericardium is a double-layered sac that encloses the heart.
• The pericardium consists of an outer fibrous bag, the fibrous
pericardium, that surrounds a more delicate, double-layered serous
membrane.
• The innermost layer of this serous membrane, the visceral
pericardium (epicardium), covers the heart.
• At the base of the heart, the visceral pericardium turns back upon
itself to become the parietal pericardium, which forms the inner
lining of the fibrous pericardium.
The Heart

Figure: Covering of the Heart

The Heart
Covering of the Heart (cont.)
• Between the parietal and visceral layers of the pericardium is a space,
the pericardial cavity, that contains a small volume of serous fluid
that the pericardial membranes secrete.
• This fluid reduces friction between the pericardial membranes as the
heart moves within them.
• In pericarditis, inflammation of the pericardium due to viral or
bacterial infection produces adhesions that attach the layers of the
pericardium to each other. This condition is painful and interferes
with heart movements.
Layers of the Heart Wall
The heart wall is comprised of three layers.
They are the-
• Epicardium (outer),
• Myocardium (middle), and
• Endocardium (inner).
Layers of the Heart Wall
Epicardium
• The epicardium protects the heart by reducing friction.
• It is a serous membrane that consists of connective tissue
covered by epithelium, and it includes capillaries and nerve
fibers.

Myocardium
• The middle layer, or myocardium is thick and largely consists of
the cardiac muscle tissue that pumps blood out of the heart
chambers.
Layers of the Heart Wall
Endocardium
• The inner layer, or endocardium consists of epithelium and
underlying connective tissue.
• The endocardium also contains blood vessels and some
specialized cardiac muscle fibers called Purkinje fibers,
• The endocardium lines all of the heart chambers and covers the
structures, such as the heart valves, that project into them.
Layers of the Heart Wall
Chambers of the heart and their functions
The heart has four chambers: two atria and two ventricles.
1. The right atrium receives oxygen-poor blood from the body and
pumps it to the right ventricle.
2. The right ventricle pumps the oxygen-poor blood to the lungs.
3. The left atrium receives oxygen-rich blood from the lungs and
pumps it to the left ventricle.
4. The left ventricle pumps the oxygen-rich blood to the body.
Chambers of the heart and their functions
The Heart Valves and their functions
Four valves regulate blood flow through your heart:
1. The tricuspid valve regulates blood flow between the right atrium
and right ventricle.
2. The pulmonary valve controls blood flow from the right ventricle
into the pulmonary arteries, which carry blood to lungs to pick up
oxygen.
3. The mitral valve (also known as- bicuspid valve) lets oxygen-rich
blood from lungs pass from the left atrium into the left ventricle.
4. The aortic valve opens the way for oxygen-rich blood to pass from
the left ventricle into the aorta (body's largest artery).
The Heart Valves and their functions
The Heart Valves and their functions
Blood Vessels
• The blood vessels form a closed circuit of tubes that transports blood
between the heart and body cells.
• The tubes include arteries, arterioles, capillaries, venules, and veins.

Arteries and Arterioles

• The arteries are adapted to carry blood under relatively high pressure away
from the heart.
• The arterioles are branches of arteries.
• The walls of arteries and arterioles consist of layers of endothelium,
smooth muscle, and connective tissue.
Blood Vessels
Capillaries
• Found in the muscles and lungs
• Very low blood pressure
• Where exchange takes place.

Venules and Veins

• Venules continue from capillaries and merge to form veins.
• Veins carry blood to the heart.
• Venous walls are similar to arterial walls but are thinner and contain less
muscle and elastic tissue.
Three layers of tissue make up the walls of your great vessels:

• Tunica intima: This is the inner layer that directly comes into contact with your blood. It’s lined with
endothelial cells that help your blood flow smoothly.
• Tunica media: This is the middle layer. It’s made of elastic fibers that help your blood flow in the proper
direction. This layer also helps your blood vessels contract and relax. Healthcare providers call these
processes vasoconstriction and vasodilation.
• Tunica adventitia: This is the outer layer that provides structure to your vessels.
Blood Vessels
Difference Between Arteries and Veins
Functions of the Cardiovascular System
1. The primary function of the
cardiovascular system is to deliver blood
to the tissues, providing essential
nutrients to the cells for metabolism and
removing waste products from the cells.

2. The heart serves as the pump, which,

by contracting, generates the pressure to
drive blood through a series of blood
vessels.
Functions of the Cardiovascular System
3. The cardiovascular system also is involved in the regulation of
arterial blood pressure

4. It delivers regulatory hormones from the endocrine glands to

their sites of action in target tissues

5. It participates in the regulation of body temperature

Pathways/Circuits
The cardiovascular system has two closed pathways, or circuits, of
blood flow.

1. The pulmonary circuit

• The right side of the heart receives oxygen-poor blood from body
tissues and then pumps this blood to the lungs to pick up oxygen and
dispel carbon dioxide.

• The blood vessels that carry blood to and from the lungs form the
pulmonary circuit (pulmo = lung).
Pathways/Circuits
2. The systemic circuit
• The left side of the heart receives the
oxygenated blood returning from the lungs
and pumps this blood throughout the body to
supply oxygen and nutrients to body tissues.

• The blood vessels that carry blood to and

from all body tissues form the systemic
circuit.
Blood Flow Through the Heart
1. Blood low in oxygen and high in carbon dioxide enters the right atrium
through the venae cavae and the coronary sinus. (The right atrium receives
blood from two large veins: the superior vena cava and the inferior vena
cava. These veins return blood, low in oxygen, from tissues. A smaller vein,
the coronary sinus, also drains blood into the right atrium from the
myocardium of the heart.)

2. As the right atrial wall contracts, the blood passes through the tricuspid
valve and enters the chamber of the right ventricle.

3. When the right ventricular wall contracts, the tricuspid valve closes, and
blood passes through the pulmonary valve and into the pulmonary trunk and
its branches (pulmonary arteries).
Blood Flow Through the Heart
4. From the pulmonary arteries, blood enters the capillaries associated with
the alveoli of the lungs.
5. Gas exchange occurs between the blood in the capillaries and air in the
alveoli.
6. The oxygen-rich blood returns to the heart through the pulmonary veins
that lead to the left atrium.
7. The left atrial wall contracts, and blood moves through the mitral valve and
into the chamber of the left ventricle.
8. When the left ventricular wall contracts, the mitral valve closes, and blood
passes through the aortic valve and into the aorta and its branches.
Pathway of blood through the heart and
pulmonary circuit

Link: [Link]
 Cardiac cycle
The heart chambers function in a
coordinated fashion. Their actions are
regulated so that atria contract (atrial
systole), while ventricles relax (ventricular
diastole) and then ventricles contract
(ventricular systole) while atria relax
(atrial diastole).
Afterwards the atria and ventricles both
relax for a brief interval.
This series of events constitutes a
complete heartbeat, or cardiac cycle.
The cardiac cycle refers to the pattern of
contraction and relaxation of the heart
during one complete heartbeat.
 Heart sound/beat:

The first part of a heart

sound (lubb) originates
during ventricular systole,
when the mitral and
tricuspid valves are closing.

The second part (dupp)

occurs during ventricular
diastole, when the
pulmonary and aortic valves
are closing.

[Link]
Cardiac conduction system
The pumping action of the heart (heartbeat)
is controlled by the heart's electrical system
or the cardiac conduction system.

The conducting system of the heart is made

up of specialized cardiac muscle Fibers and
it is responsible for initiation and
conduction of cardiac impulse.

[Link]
Cardiac conduction system
SA node begins electrical impulse

This causes the atria to contract.

Impulse now reaches the AV node. From here it

travels through the bundle of His, divides into the
left and right bundle branches and through the
Purkinje fibres.

This causes the ventricles to contract.

Both ventricles do not contract at precisely the
same time, the left ventricle contracts slightly
before the right.

After contraction the ventricles relax (along with

the atria) and wait for the next electric impulse.

The atria fill with blood and an impulse from the

SA node starts the cycle over again.
 Electrocardiogram (ECG)
Also termed as EKG Why is ECG done?
• An electrocardiogram or ECG, is a recording of the
electrical changes in the myocardium during a An ECG gives two major kinds of information.
cardiac cycle.
• When a cardiac impulse passes through the heart, • First, by measuring time intervals on the ECG,
electrical current also spreads from the heart into a doctor can determine how long the
the adjacent tissues surrounding the heart. A electrical wave takes to pass through the
small portion of the current spreads all the way to heart. Finding out how long a wave takes to
the surface of the body. travel from one part of the heart to the next
• If electrodes are placed on the skin on opposite shows if the electrical activity is normal or
sides of the heart, electrical potentials generated slow, fast or irregular.
by the current can be recorded; the recording is
known as an electrocardiogram (ECG) • Second, by measuring the amount of
electrical activity passing through the heart
muscle, a cardiologist may be able to find out
if parts of the heart are too large or are
overworked.
 Figure: Relationship between the Cardiac Cycle and ECG
depolarization of the ventricles Initially, both the atria and ventricles are relaxed (diastole). The P wave
represents depolarization of the atria and is followed by atrial contraction
(systole). Atrial systole extends until the QRS complex, at which point, the
atria relax. The QRS complex represents depolarization of the ventricles
and is followed by ventricular contraction. The T wave represents the
repolarization of the ventricles and marks the beginning of ventricular
depolarization of relaxation.
the atria repolarization of the ventricles

Atrial Ventricular Ventricular

contraction contraction relaxation
 Blood Pressure

Blood pressure is the force blood exerts against the inner Difference between Systolic and Diastolic Blood
walls of the blood vessels. Pressure

Factors That Influence Arterial Blood

Pressure/Determinants of Blood Pressure
-Arterial blood pressure depends on a variety of factors.
These include-

1. cardiac output,
2. blood volume,
3. peripheral resistance, and
4. blood viscosity
Terms
• Cardiac output: The total volume of blood ejected per unit time is the
cardiac output. It is the quantity of blood pumped into the aorta each
minute by the heart. Cardiac output depends on stroke volume and
heart rate.
• Stroke volume: The volume of blood ejected on one ventricular
contraction/one single beat. Typically, stroke volume is about 70 mL.
• Heart rate: the number of beats per minute

Cardiac output is approximately 5000 mL/min in a 70-kg man (based on

a stroke volume of 70 mL and a heart rate of 72 beats/min).
 Blood pressure
What are the causes of high blood pressure?

Smoking
Being overweight or obese
Lack of physical activity
Too much salt in the diet
Alcohol consumption
Stress
Family history of high blood pressure
Chronic kidney disease
Adrenal and thyroid disorders

What are the causes of low blood pressure?

Heart diseases
Endocrine disorder
HOW IS BLOOD PRESSURE REGULATED? Dehydration
Blood loss
Lack of essential vitamins
 Renin-angiotensin system (RAS)
Angiotensin II causes the muscular
walls of small arteries (arterioles) to
constrict (narrow), which increases
blood pressure. Angiotensin II also
active hormone triggers your adrenal glands to release
aldosterone and your pituitary gland
to release antidiuretic hormone (ADH,
protein protein inactive inactive or vasopressin) (not shown here).

Together, aldosterone and ADH cause

the kidneys to retain sodium.
Aldosterone also causes your kidneys to
release (excrete) potassium through
urine. The increase in sodium in the
bloodstream causes water retention.

This increases blood volume and blood

pressure, thus completing the renin-
angiotensin-aldosterone system.
You can watch this video for more details : [Link]
Action Potentials in Cardiac Muscle
• The average action potential recorded in a ventricular muscle fiber (shown
in figure) is about 105 millivolts, which means that the intracellular potential
rises from a very negative value between beats, about −85 millivolts, to a
slightly positive value, about +20 millivolts, during each beat.
• After the initial spike, the membrane remains depolarized for about 0.2
second, exhibiting a plateau, followed at the end of the plateau by abrupt
repolarization.

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Action Potentials in Cardiac Muscle
Phases of Cardiac Action Potentials
Phase 0 (Depolarization): Fast Sodium Channels Open. When the cardiac cell
is stimulated and depolarizes, the membrane potential becomes more
positive. Voltage-gated sodium channels (fast sodium channels) open and
permit sodium to rapidly flow into the cell and depolarize it. The membrane
potential reaches about +20 millivolts before the sodium channels close.

Phase 1 (Initial Repolarization): Fast Sodium Channels Close. The sodium

channels close, the cell begins to repolarize, and potassium ions leave the cell
through open potassium channels.

TMZ
Action Potentials in Cardiac Muscle
Phases of Cardiac Action Potentials (Cont.)
Phase 2 (Plateau): Calcium Channels Open and Fast Potassium Channels
Close. A brief initial repolarization occurs and the action potential then
plateaus as a result of increased calcium ion permeability and decreased
potassium ion permeability. The voltage-gated calcium ion channels open
slowly during phases 1 and 0, and calcium enters the cell. Potassium channels
then close, and the combination of decreased potassium ion efflux and
increased calcium ion influx causes the action potential to plateau.

Phase 3 (Rapid Repolarization): Calcium Channels Close and Slow Potassium

Channels Open. The closure of calcium ion channels and increased potassium
ion permeability, permitting potassium ions to exit the cell rapidly, ends the
plateau and returns the cell membrane potential to its resting level.
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Action Potentials in Cardiac Muscle

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Electrocardiogram (ECG)
• Also termed as EKG
• An electrocardiogram or ECG, is a recording of the electrical changes in the
myocardium during a cardiac cycle.
• When a cardiac impulse passes through the heart, electrical current also
spreads from the heart into the adjacent tissues surrounding the heart. A
small portion of the current spreads all the way to the surface of the body.
• If electrodes are placed on the skin on opposite sides of the heart, electrical
potentials generated by the current can be recorded; the recording is known
as an electrocardiogram (ECG)

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Electrocardiogram (ECG)
• The following waves, intervals, and segments are seen on the ECG.
• It is composed of a P wave, a QRS complex, and a T wave.

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Electrocardiogram (ECG)
P wave
• The P wave represents depolarization of the atria.
• The duration of the P wave correlates with conduction time through the
atria; for example, if conduction velocity through the atria decreases, the P
wave will spread out.
QRS complex
• The QRS complex consists of three waves: Q, R, and S.
• Collectively, these waves represent depolarization of the ventricles.
T wave
• The T wave represents repolarization of the ventricles.

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Electrocardiogram (ECG)
PR (or PQ) interval
• The PR interval is the time from initial depolarization of the atria to initial
depolarization of the ventricles.
• So in other words, it starts at the P-wave and ends at the beginning of the
QRS complex.
QT interval
• The QT interval includes the QRS complex, the ST segment, and the T wave.
• It represents first ventricular depolarization to last ventricular repolarization.
ST segment
• The ST segment correlates with the plateau of the ventricular action
potential.
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Electrocardiogram (ECG)

Ref: [Link]
and-electrocardiogram-ECG-in-bottom-trace-Atrial_fig1_257286613
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