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Introduction to the Cardiovascular System

Applied Biological Science

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Aim of Session
To introduce the structure and function of the heart and blood vessels Introduce relevant terms and cardiac measures in the context of nursing such as SV, CO, CI and relationship to CPR.

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Learning Outcomes
Describe the location and general features of the heart. Describe structure an explain the functions of the pericardium. Identify the layers of the heart wall. Trace the flow of blood through the heart, identifying the major blood vessels, chambers, and heart valves. Describe the components and function of the conducting system of the heart. Describe the events of the cardiac cycle including systole, diastole and the heart sounds. Describe the different types of blood vessels and their function

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Key Concepts
Heart Blood vessels Blood Pump Pipes Transport medium

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Effectiveness of system
You heart started beating by the 6th week of embryonic development and continues for the rest of your life. How many heart beats is that in a lifetime?
Years Days Hours Minutes Beats per minute ∴ 80 x 365.25 x 24 x 60 x 80 = ? 80 365.25 24 60 80

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Years in a lifetime Days in a lifetime

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80 x 365.25 = 40 x 730.5 = 20 x 1461 = 10 x 2922 24 x 29220 = 12 x 58440 = 6 x 116880 60 x 701280 = 6 x 7012800 = 3 x 14025600 80 x 42076800 = 8 x 420768000 = 4 x 841536000 = 2 x 1683072000

= 29220

Hours in a lifetime

= 701280

Minutes in a lifetime

= 42076800

Heartbeats in a lifetime

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= 3,366,144,000

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An Overview of the Cardiovascular System

Heart Size and Position
The heart is approximately the size of your clenched fist. Located in the thoracic cavity posterior to the sternum and anterior to the thoracic vertebrae, superior to the diaphragm and medial to the lungs Mediastinal space.
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Protection of the heart
Surrounded by protective cage of the ribs. Located directly behind the sternum. In front of the thoracic spine. Hence sandwiched inbetween various bony structures

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Location of the Heart to other soft tissues/structures

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Layers of the heart
Pericardium (Visceral and Parietal) Myocardium Endocardium

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Pericardium

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The Layers of the Myocardium

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Properties of Cardiac Muscle
Cardiac muscle is amitotic Similar to skeletal muscle but has additional properties. Cardiac muscle cells are short, fat, branched and interconnected. Loose connective tissue allows the cardiac cells something to pull against. A functional Syncytium
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Syncytium
A syncytium is a large region of cytoplasm that contains many nuclei. The syncytium of cardiac muscle is important because it allows rapid coordinated contraction of muscles along their entire length. Action potentials propagate along the surface of all the muscle fibres leading to contraction.
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Myocardial tissue

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Myocardium

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Ventricular Wall Thickness

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Cardiac valves
Four fibrous valves separate the atria from the ventricles and ventricles from the arteries Function is to stop retrograde blood flow when the heart contracts Valve leaflets attached to chordae tendinae which attach to papillary muscles which stop the valves flapping backwards when heart contracts
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Valve layout
Right side of the heart Tricuspid

Left side of the heart Bicuspid (mitral)

Separates right atria from right ventricle Separates right ventricle from pulmonary artery

Separates left atria from left ventricle Separates left ventricle from aorta

Pulmonary

Aortic

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The Valves: controlling direction of flow

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Heart sounds are caused by valves closing and can be heard through a stethescope

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Coronary circulation
Very active tissue – needs lots of energy Extensive blood supply to myocardium Very effective at extracting oxygen from blood

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Cardiac conducting system
Has specialised clumps of cells which are able to initiate an electrical discharge which causes myocardial cells to contract Specialise electrical pathway ensures that transmission of the impulses through the heart ensures that cardiac contraction is of maximal effectiveness Ability to contract on it’s own in the absence of hormonal and neural stimulation.
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Electrical Conduction
SA Node – Pacemaker AV Node – Co-ordinates convergence of electrical stimuli passing down towards the ventricles. Bundle of His - passes impulse down into the venticles Bundle branches – ensure that all areas of the heart receive the impulse Purkinjee fibres – pass impulse into the muscle cells

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Electrical Activity of the Heart

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Origins and Pathway of Electrical Activity

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Neural Control of the Heart

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Terminology
Stroke Volume The volume of blood ejected from the heart at each contraction The volume of blood ejected from the heart each minute Pressure generated by ventricular contraction Pressure generated by elastic recoil of the arteries

Cardiac Output Systolic pressure Diastolic pressure

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Cardiac Output
CO (ml/min) = SV (ml/beat) X HR (beats/min) Cardiac Output is therefore about how much blood is ejected from the left ventricle particularly. CO consequently effects BP.
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Cardiac index
This is a parameter that relates the cardiac output (CO) to body surface area (BSA), thus relating heart performance to the size of the individual. The unit of measurement is litres per minute per square metre (l/min/m2). The normal range of cardiac index is 2.6 - 4.2 L/min per square metre. The index is calculated using the following formula:

CI = CO = SV x HR BSA BSA
CI=Cardiac Index BSA=Body Surface Area SV=Stroke Volume HR=Heart Rate

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Adaptability of heart
Resting Heart Heart rate 70 bpm Stroke volume 70ml Cardiac output = 5 litres per minute Exercising heart Heart rate 170 bpm Stroke volume 140ml Cardiac output = 25 litres per minute

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Frank Starling mechanism
The greater the end-diastolic fibre length, and the greater the end-diastolic pressure, the greater the force of contraction. Contractility

If from any given end-diastolic fibre length there is an increased power of contraction, then an increase in contractility has occurred.

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Frank Starling mechanism

The more the heart stretches the harder it pumps.

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Blood vessels
Extensive network of vessels which transport blood to nearly all tissues in the body.
– – – – –

Arteries Arterioles Capillaries Venules Veins

40.000 km !

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Anatomical structure
Basic anatomical structure in arteries and veins similar. 3 layers
Tunica adventitia Tunica media Tunica intima

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Layers of the blood vessels
Tunica adventitia – Tough fibrous coat to protect blood vessel from damage Tunica media – Muscle layer of varying thickness Tunica media – Very smooth epithelial lining to the blood vessel

Elastic membrane found each side of the muscle layer

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Arteries
Always take blood away from the heart Thick muscle layer Under autonomic nervous control Stretches under force of blood pressure then elastic recoil maintains pressure wave Large arteries have their own little arteries – vaso vasorum
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Arterioles
Smaller than arteries Basic structure the same (minimal adventitia in small arterioles) Arteriolar network important in the maintenance of blood pressure, temperature control

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Capillaries
The walls of capillaries are composed of only a single layer of cells, the endothelium. This layer is so thin that molecules such as oxygen, water and lipids can pass through them by diffusion and enter the tissues. Waste products such as carbon dioxide and urea can diffuse back into the blood to be carried away for removal from the body. Capillaries are so small the red blood cells need to partially fold into bullet-like shapes in order to pass through them in single file.

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Capillary bed
The "capillary bed" is the network of capillaries supplying an organ. The more metabolically active the cells, the more capillaries it will require to supply nutrients. The capillary bed usually carries no more than 25% of the amount of blood it could contain, although this amount can be increased through autoregulation by inducing relaxation of smooth muscle. The capillaries do not possess this smooth muscle in their own walls, and so any change in their diameter is passive. Any signalling molecules they release (such as endothelin for constriction and nitric oxide for dilation) act on the smooth muscle cells in the walls of nearby, larger vessels, e.g. arterioles.

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Capillary types
Capillaries come in three types:

Continuous - Continuous capillaries have a sealed endothelium and only allow small molecules, water and ions to diffuse. Fenestrated - Fenestrated capillaries (derived from "fenestra," the Latin word for "window") have openings that allow small molecules to diffuse. Sinusoidal - Sinusoidal (discontinuous) capillaries are special forms of fenestrated capillaries that have larger openings in the epithelium allowing red blood cells and serum proteins to enter

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Venules
Small veins collecting blood from capillary network. Very little muscle therefore dependent on external muscle activity to return blood towards heart Contains valves to prevent backflow

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Veins
Larger vessels Thinner layer of muscle therefore external muscle activity helps return blood to the heart. Valves to prevent back flow Thoracic “suck” assists

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Summary
The goal of the cardiovascular system is regulation of adequate blood flow to all the body tissues. This is achieved using a highly effective pump, plumbing and transport system. If any of these become damaged it will affect tissue survival in the long term and hence homeostasis.
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