Module IV

Cardiovascular System
ECG
Blood
Circulatory System
Lymphatic System
 Module 4
• Cardiovascular system-heart- structure of heart and major blood vessels,
• rhythmic excitation heart-cardiac cycle,
• ECG – origin, waveform–cardiac rhythm & rate – normal & abnormal,
myocardial ischemia & infarction, atherosclerosis – definitions Heart sounds
& murmurs, cardiac outputs.
• Circulatory systems-Systemic circulation and pulmonary circulation, blood
pressure, arterial pulse, blood flow,
• Blood-the composition of blood, function, blood groups, lymphatic systems.
Cardiovascular System
•To maintain homeostasis, essential materials such as O2 and
nutrients must continually be picked up from the external
environment and delivered to the cells, and waste products must
continually be removed.
•Furthermore, excess heat generated by muscles must be
transported to the skin where it can be lost from the body surface
to help maintain body temperature. Homeostasis also depends on
the transfer of hormones, which are important regulatory chemical
messengers, from their site of production to their site of action.
Cardiovascular System
•The circulatory system, which contributes to homeostasis by
serving as the body’s transport system, consists of the heart,
blood vessels, and blood.
•All body tissues constantly depend on the life-supporting blood
flow the heart provides them by contracting, or beating.
•The heart drives blood through the blood vessels for delivery to
the tissues in sufficient amounts, whether the body is at rest or
engaging in vigorous exercise.
Cardiovascular System
•From just days following conception until death, the beat goes
on.
•Throughout an average human life span, the heart contracts
--------- ? times, never stopping except for a fraction of a second
to fill between beats.
•Within about 3 weeks after conception, the heart of the
developing embryo starts to function. It is the first organ to
become functional.
•At this time, the human embryo is only a few millimeters long
Cardiovascular System
•The heart develops so early and is so crucial throughout life
because the circulatory system is the body’s transport system.
•A human embryo, having little yolk available as food, depends on
promptly establishing a circulatory system that can interact with
the mother’s circulation to pick up and distribute to the
developing tissues the supplies needed for survival and growth.
•Thus begins the story of the circulatory system, which serves
throughout life as a vital pipeline for transporting materials on
which the cells of the body absolutely depend.
 The cardiovascular system has three components
1. The heart is the pump that imparts pressure to the blood to establish the
pressure gradient needed for blood to flow to the tissues. Like all
liquids, blood flows down a pressure gradient from an area of higher
pressure to an area of lower pressure.
2. The blood vessels are the passageways through which blood is directed
and distributed from the heart to all parts of the body and subsequently
returned to the heart. The smallest of the blood vessels are designed for
rapid exchange of materials between the surrounding tissues and the
blood within the vessels.
3. Blood is the transport medium within which materials being transported
long distances in the body, such as O2, CO2, nutrients, wastes,
electrolytes, and hormones, are dissolved or suspended.
Anatomy and Location of Heart
•The heart is located in the thoracic cavity between the lungs.
•This area is called the mediastinum.
•The base of the cone-shaped heart is uppermost, behind the
sternum, and the great vessels enter or leave here.
•The apex (tip) of the heart points downward and is just above
the diaphragm to the left of the midline.
•This is why we may think of the heart as being on the left side,
because the strongest beat can be heard or felt here.
 Pericardium
• The membrane that surrounds and protects the heart is the pericardium
• It confines the heart to its position in the mediastinum, while allowing sufficient
freedom of movement for vigorous and rapid contraction.
• The pericardium consists of two main parts:
• (1) the fibrous pericardium and
• (2) the serous pericardium
• The superficial fibrous pericardium is composed of tough, inelastic, dense irregular
connective tissue.
• The deeper serous pericardium is a thinner, more delicate membrane that forms a
double layer around the heart
• The outer parietal layer of the serous pericardium is fused to the fibrous
pericardium.
• The inner visceral layer of the serous pericardium, also called the epicardium
 Pericardium
• The heart is enclosed in the pericardial membranes, of
which there are three layers.
• The outermost is the fibrous pericardium, a loose fitting
sac of strong fibrous connective tissue that extends
inferiorly over the diaphragm and superiorly over the
bases of the large vessels that enter and leave the heart.
• The serous pericardium is a folded membrane; the fold
gives it two layers, parietal and visceral.
• Lining the fibrous pericardium is the parietal
pericardium. On the surface of the heart muscle is the
visceral pericardium, often called the epicardium.
• Between the parietal and visceral pericardial membranes
is serous fluid, which prevents friction as the heart beats.
 Pericardium
• Between the parietal and visceral layers of the serous pericardium is a thin
film of lubricating serous fluid.
• This slippery secretion of the pericardial cells, known as pericardial fluid,
reduces friction between the layers of the serous pericardium as the heart
moves.
• The space that contains the few milliliters of pericardial fluid is called the
pericardial cavity.
Pericardium
Pericardium
Heart view
CHAMBERS, VESSELS AND VALVES
•The walls of the four chambers of the heart are made of cardiac
muscle called the myocardium.
•The chambers are lined with endocardium, simple squamous
epithelium that also covers the valves of the heart and continues
into the vessels as their lining (endothelium).
•The important physical characteristic of the endocardium is not
its thinness, but rather its smoothness.
•This very smooth tissue prevents abnormal blood clotting,
because clotting would be initiated by contact of blood with a
rough surface.
 CHAMBERS
• The upper chambers of the heart are the right and left atria (singular: atrium),
which have relatively thin walls and are separated by a common wall of
myocardium called the interatrial septum.
• The lower chambers are the right and left ventricles, which have thicker walls
and are separated by the interventricular septum
• The atria receive blood, either from the body or the lungs, and the ventricles
pump blood to either the lungs or the body
 RIGHT ATRIUM
• The two large caval veins return blood from the body to the right atrium
• The superior vena cava carries blood from the upper body, and the inferior vena
cava carries blood from the lower body.
• From the right atrium, blood will flow through the right atrioventricular (AV) valve,
or tricuspid valve, into the right ventricle.
• The tricuspid valve is made of three flaps (or cusps) of endocardium reinforced with
connective tissue.
• The general purpose of all valves in the circulatory system is to prevent backflow of
blood.
• The specific purpose of the tricuspid valve is to prevent backflow of blood from the
right ventricle to the right atrium when the right ventricle contracts.
• As the ventricle contracts, blood is forced behind the three valve flaps, forcing them
upward and together to close the valve.
 LEFT ATRIUM
• The left atrium receives blood from the lungs, by way of four pulmonary veins.
• This blood will then flow into the left ventricle through the left atrioventricular (AV)
valve, also called the mitral valve or bicuspid (two flaps) valve.
• The mitral valve prevents backflow of blood from the left ventricle to the left atrium
when the left ventricle contracts.
• Another function of the atria is the production of a hormone involved in blood
pressure maintenance.
• When the walls of the atria are stretched by increased blood volume or blood
pressure, the cells produce atrial natriuretic peptide (ANP), also called atrial
natriuretic hormone (ANH).
• (The ventricles of the heart produce a similar hormone called B-type natriuretic
peptide, or BNP, but we will use ANP as the representative cardiac hormone.)
 LEFT ATRIUM
• ANP decreases the reabsorption of sodium ions by the kidneys, so that more
sodium ions are excreted in urine, which in turn increases the elimination of
water.
• The loss of water lowers blood volume and blood pressure.
• You may have noticed that ANP is an antagonist to the hormone aldosterone,
which raises blood pressure.
 RIGHT VENTRICLE
• When the right ventricle contracts, the tricuspid valve closes and the blood is
pumped to the lungs through the pulmonary artery (or trunk).
• At the junction of this large artery and the right ventricle is the pulmonary
semilunar valve (or more simply, pulmonary valve).
• Its three flaps are forced open when the right ventricle contracts and pumps
blood into the pulmonary artery.
• When the right ventricle relaxes, blood tends to come back, but this fills the
valve flaps and closes the pulmonary valve to prevent backflow of blood into
the right ventricle.
 RIGHT VENTRICLE
• Projecting into the lower part of the right ventricle are columns of
myocardium called papillary muscles
• Strands of fibrous connective tissue, the chordae tendineae, extend from the
papillary muscles to the flaps of the tricuspid valve.
• When the right ventricle contracts, the papillary muscles also contract and
pull on the chordae tendineae to prevent inversion of the tricuspid valve.
• If you have ever had your umbrella blown inside out by a strong wind, you
can see what would happen if the flaps of the tricuspid valve were not
anchored by the chordae tendineae and papillary muscles.
 LEFT VENTRICLE
• The walls of the left ventricle are thicker than those of the right ventricle, which
enables the left ventricle to contract more forcefully.
• The left ventricle pumps blood to the body through the aorta, the largest artery of the
body.
• At the junction of the aorta and the left ventricle is the aortic semilunar valve (or
aortic valve)
• This valve is opened by the force of contraction of the left ventricle, which also
closes the mitral valve.
• The aortic valve closes when the left ventricle relaxes, to prevent backflow of blood
from the aorta to the left ventricle.
• When the mitral (left AV) valve closes, it prevents backflow of blood to the left
atrium; the flaps of the mitral valve are also anchored by chordae tendineae and
papillary muscles.
• All of the valves are shown in figure which also depicts the fibrous skeleton of the
heart.
 LEFT VENTRICLE
• This is fibrous connective tissue that anchors the outer edges of the valve flaps and
keeps the valve openings from stretching.
• It also separates the myocardium of the atria and ventricles and prevents the
contraction of the atria from reaching the ventricles except by way of the normal
conduction pathway.
• As you can see from this description of the chambers and their vessels, the heart is
really a double, or two-sided, pump.
• The right side of the heart receives deoxygenated blood from the body and pumps it
to the lungs to pick up oxygen and release carbon dioxide.
• The left side of the heart receives oxygenated blood from the lungs and pumps it to
the body.
• Both pumps work simultaneously; that is, both atria contract together, followed by
the contraction of both ventricles.
Valves
 Systemic and Pulmonary Circulations
• In postnatal (after birth) circulation, the heart pumps blood into two closed
circuits with each beat—systemic circulation and pulmonary circulation
(pulmon- lung).
• The two circuits are arranged in series: The output of one becomes the input
of the other, as would happen if you attached two garden hoses
• The left side of the heart is the pump for systemic circulation; it receives
bright red oxygenated (oxygen-rich) blood from the lungs.
• The left ventricle ejects blood into the aorta.
• From the aorta, the blood divides into separate streams, entering progressively
smaller systemic arteries that carry it to all organs throughout the
body—except for the air sacs (alveoli) of the lungs, which are supplied by
pulmonary circulation.
 Systemic and Pulmonary Circulations
• In systemic tissues, arteries give rise to smaller-diameter arterioles, which finally lead into
extensive beds of systemic capillaries.
• Exchange of nutrients and gases occurs across the thin capillary walls. Blood unloads O2
(oxygen) and picks up CO2 (carbon dioxide).
• In most cases, blood flows through only one capillary and then enters a systemic venule.
• Venules carry deoxygenated (oxygen-poor) blood away from tissues and merge to form
larger systemic veins. Ultimately the blood flows back to the right atrium
• The right side of the heart is the pump for pulmonary circulation; it receives all the dark-red
deoxygenated blood returning from the systemic circulation.
• Blood ejected from the right ventricle flows into the pulmonary trunk, which branches into
pulmonary arteries that carry blood to the right and left lungs.
• In pulmonary capillaries, blood unloads CO2, which is exhaled, and picks up O2 from
inhaled air.
• The freshly oxygenated blood then flows into pulmonary veins and returns to the left atrium
 Coronary Circulation
• The right and left coronary arteries are the first branches of the ascending
aorta, just beyond the aortic semilunar valve
• The two arteries branch into smaller arteries and arterioles, then to capillaries.
• The coronary capillaries merge to form coronary veins, which empty blood
into a large coronary sinus that returns blood to the right atrium.
• The purpose of the coronary vessels is to supply blood to the myocardium
itself, because oxygen is essential for normal myocardial contraction.
• If a coronary artery becomes obstructed, by a blood clot for example, part of
the myocardium becomes ischemic, that is, deprived of its blood supply.
• Prolonged ischemia will create an infarct, an area of necrotic (dead) tissue.
• This is a myocardial infarction, commonly called a heart attack
 Coronary Circulation
• Nutrients are not able to diffuse quickly enough from blood in the chambers
of the heart to supply all the layers of cells that make up the heart wall.
• For this reason, the myocardium has its own network of blood vessels, the
coronary or cardiac circulation (coron- crown).
• The coronary arteries branch from the ascending aorta and encircle the heart
like a crown encircles the head
• While the heart is contracting, little blood flows in the coronary arteries
because they are squeezed shut.
• When the heart relaxes, however, the high pressure of blood in the aorta
propels blood through the coronary arteries, into capillaries, and then into
coronary veins
 Coronary Circulation - Anastomoses
• Most parts of the body receive blood from branches of more than one artery,
and where two or more arteries supply the same region, they usually connect.
• These connections, called anastomoses, provide alternate routes, called
collateral circulation, for blood to reach a particular organ or tissue.
• The myocardium contains many anastomoses that connect branches of a given
coronary artery or extend between branches of different coronary arteries.
• They provide detours for arterial blood if a main route becomes obstructed.
Thus, heart muscle may receive sufficient oxygen even if one of its coronary
arteries is partially blocked.
 Blood pressure
• Blood pressure is the pressure of circulating blood against the walls of blood
vessels.
• Pressure exerted by the column of blood to the walls of blood vessels
• Systolic blood pressure refers to the pressure inside arteries when heart is
pumping
• Diastolic pressure is the pressure inside arteries when heart is resting between
beats
 Arterial pulse
• Pulse, rhythmic dilation of an artery generated by the opening and closing of
the aortic valve in the heart.
• A pulse can be felt by applying firm fingertip pressure to the skin at sites
where the arteries travel near the skin's surface; it is more evident when
surrounding muscles are relaxed.
Arterial pulse
 Cardiac Cycle
• The cardiac cycle is the sequence of events in one heartbeat.
• In its simplest form, the cardiac cycle is the simultaneous contraction of the two
atria, followed a fraction of a second later by the simultaneous contraction of the
two ventricles.
• Systole is another term for contraction. The term for relaxation is diastole.
• You are probably familiar with these terms as they apply to blood pressure readings.
• If we apply them to the cardiac cycle, we can say that atrial systole is followed by
ventricular systole.
• There is, however, a significant difference between the movement of blood from the
atria to the ventricles and the movement of blood from the ventricles to the arteries.
• A single cardiac cycle includes all the events associated with one heartbeat. Thus, a
cardiac cycle consists of systole and diastole of the atria plus systole and diastole of
the ventricles.
• In each cardiac cycle, the atria and ventricles alternately contract and relax, forcing
blood from areas of higher pressure to areas of lower pressure.
• As a chamber of the heart contracts, blood pressure within it increases.
• Figure (next slide) the relation between the heart’s electrical signals (ECG) and
changes in atrial pressure, ventricular pressure, aortic pressure, and ventricular
volume during the cardiac cycle.
• The pressures given in the figure apply to the left side of the heart; pressures on the
right side are considerably lower.
• Each ventricle, however, expels the same volume of blood per beat, and the same
pattern exists for both pumping chambers.
• When heart rate is 75 beats/min, a cardiac cycle lasts 0.8 sec.
• To examine and correlate the events taking place during a cardiac cycle, we will
begin with atrial systole.
ECG associated with one heartbeat
Pressure (mmHg) associated with one heartbeat
ECG
• Cardiovascular system-heart- structure of heart and major blood vessels,
• rhythmic excitation heart-cardiac cycle,
• ECG – origin, waveform–cardiac rhythm & rate – normal & abnormal,
myocardial ischemia & infarction, atherosclerosis – definitions Heart sounds
& murmurs, cardiac outputs.
• Circulatory systems-Systemic circulation and pulmonary circulation, blood
pressure, arterial pulse, blood flow
• Blood-the composition of blood, function, blood groups, lymphatic systems.