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Structure and Function of the Cardiovascular System
A.
Structures of the heart 
 – a hallow organ, the hart lies in the mediastinum (i.e., space between the two lungs) and rests on thediaphragm.
1.
Pericardium 
 – the heart is encased in the pericardium, a thin, membranous sac that has a visceral layer in contactwith the heart and an outer parietal layer. The space between pericardial layers contains 20 to 30 ml of serous fluid,which protects the heart from trauma and friction.
2.
Heart wall  
 – the heart wall is specialized muscle tissue consisting of three tissue layers:
a.
Epicardium 
– the thin, serous outer layer
 b.
Myocardium 
– the thick, muscular middle layer
c.
Endocarium 
 – the smooth inner layer that comes in contact with blood.
3.
Heart chambers 
 – a membranous muscular septum divides the heart into two distinct sides. Each side contains twochambers an atrium and a ventricle
a.
The right atrium 
– a low-pressure chamber, receives systemic venous blood through the superior venacava, inferior vena cava, and coronary sinus.
 b.
The right ventricle 
 – another low-pressure chamber, receives blood from the right atrium through thetricuspid valve during ventricular diastole. It then ejects deoxygenated blood through the pulmonic valveinto the pulmonary artery and into pulmonary circulation during ventricular systole.
c.
The left atrium 
– a low-pressure chamber, receives oxygenated blood returning from the lung throughfour pulmonary veins.
d.
The left ventricle 
– a high-pressure chamber, receives blood from the left atrium through the mitral valveduring ventricular diastole. It then ejects oxygenated blood through the aortic valve into the aorta andinto systemic circulation during ventricular systole.4.Heart valves – connects the chambers and outflow tracts. The two types of heart valves are atrioventrivular valvesand semilunar valves.
a.
 Atrioventricular (AV) valves 
– separates the atria from ventricles.
-
The tricuspid valve 
(contains the cusps, or leaflets) is located between the right atrium andventricle.
-
The mitral valve 
(a bicuspid valve with two cusps) is located between the left atrium and ventricle
 b.
The semilunar valves 
(each containing three cusps) are located between each ventricle and itscorresponding artery.
-
The pulmonic valve 
is located between the right ventricle and pulmonary artery
-
The aortic valve 
is located between the left ventricle and aorta.
c.
 
Papillary muscles 
– muscle bundles on the ventricular walls, and
chordae tendinae
, fibrous bandextending from the papillary muscles to the valve cusps, keep the valves closed during systole. Thismaintains unidirectional blood flow through the AV valves and prevents backflow of blood5.The cardiac conduction system consists of specialized cardiac cells that initiate or propagate electrical impulsesthroughout the myocardium as a precursor to cardiac muscle contraction.a.Electrical pathways
-
The sinoatrial (SA) node 
, located at the junction of the right atrium and the superior vena cava,functions as the pacemaker for the myocardium, initiating rhythmic electrical impulses at anintrinsic rate of 60 to 100 impulses per minute.
-
The AV node 
, located in the septal wall of the right atrium, receives impulses from the SA node andrelays them to the ventricles
-
The Bundle of His 
, a bundle of specialized muscle fibers in the myocardial septum, conductsimpulses from the AV node. The bundle of His divides into right and left branches.
•
The right bundle branch 
(RBB) conducts impulses down the right side of the septum
•
The left bundle branch 
(LBB) conducts impulses into right and left fascicles that fan outinto the left ventricular muscle
•
The RBB and the LBB terminate in the
Purkinje fibers
, which propagate electricalimpulses into the endocardium and on to the myocardiumb.Electrical impulse activity. Electrical impulses traveling through the cardiac conduction system can bemeasured and recorded by electrocardiography.
-
Phases of the electrocardiogram (ECG) are labeled P, Q, R, S, and T.
•
The P wave represents atrial depolarization
•
The PR interval represents the time from the beginning of the atrial depolarization
•
The QRS complex represents ventricular depolarization
•
The T wave represents ventricular repolarization
 
-
Normal sinus rhythm
•
Heart rate is 60 to 100 beats per minute
•
P waves precede each QRS complex
•
PR interval is 0.12 to 0.2 second
•
QRS complex is 0.04 to 0.1 second
•
Conduction is forward and cyclical through the conduction system
•
Rhythm is regular with no abnormal delay6.The coronary arteries supply the heart with blood from branches that originate in the right or left sinus of Valsalva of the aortic valve cusps.
a.
The right coronary artery 
supplies blood to the right heart wall
 b.
The left main coronary artery 
, which divides into the left anterior descending coronary artery and thecircumflex artery, supplies most of the blood to the left heart wall.B.Functions of the heart – The heart has electrophysiologic, mechanical, and neurologic properties that coordinate to produceeffective myocardial contraction and pumping of blood.1.Cardiac Output (CO) is defined as the volume of blood ejected by each ventricle in 1 minute: CO = SV (Stroke Volume) x HR (heart rate)a.Stroke volume – is the amount of blood ejected by the left ventricle with each heartbeat. Several factorsinfluence CO indirectly by affecting the SV.
-
Preload, the end-diastolic filling volume of the ventricle, increases by increased returning volume toventricle
-
 Afterload, the resistance to left ventricular ejection, increases by increased systemic arterialpressure.b.Heart rate – is the number of heartbeats per minute. Normal is 60 to 100 beats/minute2.Cardiac cycle – each complete heartbeat, or cardiac cycle, consists of two phases in response to electricalstimulation.a.Systole – is the contraction phase. It is triggered by depolarization of cardiac muscle cells, which involvesa transient change in sodium and potassium ion concentration inside and outside the cell.b.Diastole – is the relaxation (filling) phase. Immediately after depolarization is completed, the processreverses itself, resulting in repolarization and a return to the resting state.3.Heart sounds result from vibrations caused by valve closure and ventricular fillinga.The first heart sound (S1) is associated with tricuspid and mitral valve closureb.The second heart sound (S2) is associated with aortic and pulmonic valve closurec.The third heart sound (S3) known as ventricular gallop, is often normal in persons younger than age 30but pathologic in older persons and occurs during the rapid ventricular filling stage of diastole.d.The fourth heart sound (S4) or atrial gallop, is linked to resistance to ventricular filling, as in hypertrophyor injury of the ventricular wall4.Neurologic factors regulating heart functiona.Sympathetic Nervous System stimulation – with release of norepinephrine, results in arteriolarvasoconstriction, increased heart rate, and a positive inotropic effectb.Parasympathetic Nervous System stimulation – with release of acetylcholine, results in decreased heartrate and slowed AV conductionc.The response of chemoreceptors, located in the carotid and aortic bodies, to decreased O2 and increasedCO2 concentrations is to increased the heart rated.The response of baroreceptors, located in the aortic arch, carotid sinus, vena cava, pulmonary arteries,and atria, is to decrease or increase heart rate, resulting in blood pressure changes.
DIAGNOSTIC AND LABORATORY STUDIES
1.White Blood Cell (WBC) count can detect signs of infection2.Lipid profile examines cholesterol (LDL and HDL) and triglycerides3.Cardiac enzymes examine the levels of creatinine phosphokinase, troponin, and lactate dehydrogenase4.Blood coagulation studies examine prothrombin time and partial thromboplastin time5.Chest radiograph can determine heart size and silhouette and visualize the pulmonary system6.ECG evaluates the heart’s electrical activity7.Holter monitoring (ambulatory ECG) allows for 24-hour continuous measurement of the heart’s electrical activity8.Exercise ECG (graded exercise test) evaluates electrical activity during physical stress; a chemical-induced ECG stress test isused if the client is unable to walk or bike for a long period of time9.Echocardiography yields information about cardiac structure (especially valvular) and function10.Radionuclide testing evaluates ventricular function and myocardial blood flow and detects areas of myocardial damage.Radionuclide testing includes positron emission tomography, multiple-gated acquisition, and thallium scanning11.Cardiac catheterization enables measurement of chamber pressures and oxygen saturation12.Arteriography visualizes coronary arteries with injections of radio opaque contrast media13.Ventriculography visualizes ventricles with injection of radio opaque media
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