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cardiovascular_physiology_concepts

cardiovascular_physiology_concepts

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LEARNING OBJECTIVES
THE NEED FOR A CIRCULATORY SYSTEM
THE ARRANGEMENT OF THE

CARDIOVASCULAR SYSTEM
THE FUNCTIONS OF THE HEART AND
BLOOD VESSELS
Heart
Vascular System
Interdependence of Circulatory and
Organ Function
THE REGULATION OF CARDIAC AND
VASCULAR FUNCTION
THE CONTENT OF THE FOLLOWING
CHAPTERS
SUMMARY OF IMPORTANT CONCEPTS
REVIEW QUESTIONS
chapter
Introduction to the Cardiovascular
System
LEARNING OBJECTIVES
Understanding the concepts presented in this chapter will enable the student to:
1. Explain why large organisms require a circulatory system, while single-cell and small multi-
cellular organisms do not.
2. Describe the series and parallel arrangement of the cardiac chambers, pulmonary circula-
tion, and major organs of the systemic circulation.
3. Describe the pathways for the \ufb02ow of blood through the heart chambers and large vessels

associated with the heart.
4. Describe, in general terms, the primary functions of the heart and vasculature.
5. Explain how the autonomic nerves and kidneys serve as a negative feedback system for

the control of arterial blood pressure.
1
THE NEED FOR A CIRCULATORY
SYSTEM

All living cells require metabolic substrates (e.g., oxygen, amino acids, glucose) and a mechanism by which they can remove by- products of metabolism (e.g., carbon dioxide, lactic acid). Single-cell organisms exchange these substances directly with their environ- ment through diffusion and cellular transport systems. In contrast, most cells of large organ- isms have limited or no exchange capacity with their environment because their cells are not in contact with the outside environment. Nevertheless, exchange with the outside envi- ronment must occur for the cells to function. To accomplish this necessary exchange, large organisms have a sophisticated system of blood vessels that transports metabolic sub- stances between cells and blood, and between blood and environment. The smallest of these blood vessels, capillaries, are in close proxim- ity to all cells in the body, thereby permitting exchange to occur. For example, each cell in skeletal muscle is surrounded by two or more capillaries. This arrangement of capillaries around cells ensures that exchange can occur between blood and surrounding cells.

Exchange between blood and the outside environment occurs in several different or- gans: lungs, gastrointestinal tract, kidneys and skin. As blood passes through the lungs, oxy- gen and carbon dioxide are exchanged be- tween the blood in the pulmonary capillaries and the gases found within the lung alveoli. Oxygen-enriched blood is then transported to the organs where the oxygen diffuses from the blood into the surrounding cells. At the same time, carbon dioxide, a metabolic waste prod- uct, diffuses from the tissue cells into the blood and is transported to the lungs, where exchange occurs between blood and alveolar gases.

Blood passing through the intestine picks up glucose, amino acids, fatty acids, and other ingested substances that have been trans- ported from the intestinal lumen into the blood in the intestinal wall by the cells lining the intestine. The blood then delivers these substances to organs such as the liver for ad- ditional metabolic processing and to cells

throughout the body as an energy source. Some of the waste products of these cells are taken up by the blood and transported to other organs for metabolic processing and \ufb01- nal elimination through either the gastroin- testinal tract or the kidneys.

Cells require a proper balance of water and electrolytes (e.g., sodium, potassium, and cal- cium) to function. The circulation transports ingested water and electrolytes from the in- testine to cells throughout the body, including those of the kidneys, where excessive amounts of water and electrolytes can be eliminated in the urine.

The skin also serves as a site for exchange of water and electrolytes (through sweating), and for exchange of heat, which is a major by- product of cellular metabolism that must be removed from the body. Increasing blood \ufb02ow through the skin enhances heat loss from the body, while decreasing blood \ufb02ow diminishes heat loss.

In summary, the ultimate purpose for the cardiovascular system is to facilitate exchange of gases, \ufb02uid, electrolytes, large molecules and heat between cells and the outside envi- ronment. The heart and vasculature ensure that adequate blood \ufb02ow is delivered to or- gans so that this exchange can take place.

THE ARRANGEMENT OF THE
CARDIOVASCULAR SYSTEM

The cardiovascular system has two primary components: the heart and blood vessels. A third component, the lymphatic system, does not contain blood, but nonetheless serves an important exchange function in conjunction with blood vessels.

The heart can be viewed functionally as two pumps with the pulmonary and systemic circu- lations situated between the two pumps (Fig. 1-1). The pulmonary circulation is the blood \ufb02ow within the lungs that is involved in the ex- change of gases between the blood and alveoli. The systemic circulation is comprised of all the blood vessels within and outside of organs excluding the lungs. The right side of the heart comprises the right atrium and the right ventri- cle. The right atrium receives venous blood from the systemic circulation and theright

2
CHAPTER 1
ventriclepumps it into the pulmonary circula-

tion where oxygen and carbon dioxide are ex- changed between the blood and alveolar gases. The left side of the heart comprises the left atrium and the left ventricle. The blood leaving the lungs enters the left atrium by way of the pulmonary veins. Blood then \ufb02ows from the left atrium into the left ventricle. The left ven-

tricleejects the blood into the aorta,which

then distributes the blood to all the organs via the arterial system. Within the organs, the vas- culature branches into smaller and smaller ves- sels, eventually forming capillaries, which are the primary site of exchange. Blood \ufb02ow from the capillaries enters veins, which return blood \ufb02ow to the right atrium via large systemic veins (the superior and inferior vena cava).

As blood \ufb02ows through organs, some of the fluid, along with electrolytes and small amounts of protein, leaves the circulation and enters the tissue interstitium (a process termed \ufb02uid \ufb01ltration). The lymphatic ves-

sels,which are closely associated with small

blood vessels within the tissue, collect the ex- cess \ufb02uid that \ufb01lters from the vasculature and transport it back into the venous circulation by way of lymphatic ducts that empty into large veins (subclavian veins) above the right atrium.

It is important to note the overall arrange- ment of the cardiovascular system. First, the right and left sides of the heart, which are sep- arated by the pulmonary and systemic circula-

tions, are in series with each other (see Fig. 1-1). Therefore, all of the blood that is pumped from the right ventricle enters into the pul- monary circulation and then into the left side of the heart from where it is pumped into the sys- temic circulation before returning to the heart. This in-series relationship of the two sides of the heart and the pulmonary and systemic cir- culations requires that the output (volume of blood ejected per unit time) of each side of the heart closely matches the output of the other so that there are no major blood volume shifts be- tween the pulmonary and systemic circulations. Second, most of the major organ systems of the body receive their blood from the aorta, and the blood leaving these organs enters into the venous system (superior and inferior vena cava) that returns the blood to the heart. Therefore, the circulations of most major organ systems are in parallel as shown in Figure 1-2. One major exception is the liver, which receives a large fraction of its blood supply from the ve- nous circulation of the intestinal tract that drains into the hepatic portal system to supply the liver. The liver also receives blood from the aorta via the hepatic artery. Therefore, most of the liver circulation is in series with the intesti- nal circulation, while some of the liver circula- tion is in parallel with the intestinal circulation.

This parallel arrangement has signi\ufb01cant hemodynamic implications as described in Chapter 5. Brie\ufb02y, the parallel arrangement of

INTRODUCTION TO THE CARDIOVASCULAR SYSTEM
3
RA
LA
RV
LV
Ao
PA
Pulmonary
Circulation
Systemic Circulation
FIGURE 1-1 Overview of the cardiovascular system. The right side of the heart, pulmonary circulation, left side of the
heart, and systemic circulation are arranged in series.RA, right atrium;R V, right ventricle;PA, pulmonary artery;Ao,
aorta;LA, left atrium;LV, left ventricle.

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