CARDIOVASCULAR SYSTEM

The cardiovascular system is types of circulatory system. The system supply oxygen, nutrients
and other essential substances to the tissue of the body and remove carbon dioxide and other
metabolic end products from the tissues. The cardiovascular system is composed of heart, blood
vessels and blood, it is also known as blood vascular system.

HEART
The heart is hollow, blunt, cone-shaped (conical) muscular pumping organ. Its size is about
closed fist of the owner i.e. approximately 12cm × 9cm.It is pinkish in colour .Its weight is
about 250gm in female and 300 gm in male.

LOCATION (POSITION) OF HEART

The heart is situated obliquely in middle mediastinum between two lungs in the thoracic cavity,
the base extends up to the 2nd ribs while the apex lies at the level of the 5th intercostal space i.e.
just below the left from the midline of the body so that 2/3 rd mass of the heart lies on left side
and 1/3 of right side.
STRUCTURE OF HEART
1. External Structure:
 The Apex is formed by the lower end of the left ventricle, lies in the 5th intercostal space.
 The base of the heart is formed by its broad upper end.
 Two surfaces:
 Sternocostal surface (Anterior surface)
 Diaphragmatic surface (Inferior surface)
 Three borders:
 Right border
 Left border
 Inferior border
2. Layers of the Heart wall
The heart consists of three layers of tissue:
 Pericardium
 Myocardium
 Endocardium
a. Pericardium: - Heart is externally covered by a double layered membrane called
pericardium. It consists of fibrous and serous pericardium.
 Fibrous pericardium:-It is made up of fibrous connective tissue. It prevents the heart
from over distension (overstretching).
 Serous pericardium:-It is a double layered:
o Parietal pericardium: - Lining of fibrous pericardium.
o Visceral pericardium: - Lining of myocardium.
Between these two layers a narrow space is present called pericardial space filled with
pericardial fluid. This fluid reduces the friction, protects the heart from shocks and injuries and
allows it’s free movement.

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b. Myocardium:-Myocardium is a specialized muscle present in the middle layer of heart. It is
also known as cardiac muscle or heart muscle which is only found in the heart. It performs
the work of the heart.
c. Endocardium:-Endocardium is the inner layer of heart, made up of squamous epithelial
cells. The endocardium contains Purkinje fibers, specialized muscle cells that convey the
electrical impulses that cause the heart to contract, and collagen fibers, which give the
endocardium elasticity.
Pericardial
Parietal Visceral
space with
pericardium pericardium
fluid

Fibrous Serous Myocardium Endocardium

Pericardium
Fig. Layers of the heart wall
3. Internal Structure of Heart
The internal structure of heart is consists of:
 Chambers of heart
 Valves of heart
(i) Chambers of heart
Heart is made up of four chambers. The upper two chambers are known as atrium and lower
two chambers are kwon as ventricles.

Fig. Internal Structure of Heart

a. Atrium: The right and left atrium together forms the upper thin walled chambers. They are
separated by inter-atrial septum. Right atrium receives the opening of superior venacava,
inferior venacava and coronary sinus and left atrium receives the opening of four pulmonary
veins (2-right &2-left pulmonary veins), there is a small concave structure on the right side
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 of inter-atrial septum which is called “fossae ovalis”which is ruminant of foramen ovale
(The opening of interatrial septum of the fetal heart).
b. Ventricles: They are lower chambers of heart internally separated by inter ventricular
septum (left & right). Left and right ventricles have muscular projection or ridges on their
inner lining they are called papillary muscle. The left ventricle is thicker than right ventricle
because it has to pump blood to all over the body.
(ii) Valves of the Heart
Valves

Atrioventricular valves Semi lunar valves

Right Left Pulmonary Aortic

Artioventricular Artioventricular valve valve
valve valve

Chart. Valves of the Heart

(i) Atrioventricular valves:
 Right Atrioventricular valve:-It lies between right atrium and right ventricle. It is also
known as tricuspid valve as it has 3 flaps.
 Left Atrioventricular valve: - It lies between left atrium and left ventricle. It is also
known as bicuspid valve and mitral valve.
(ii) Semi lunar valves:
There are two types of valve found on the main branch of arteries:
 Pulmonary valve: - It lies in the opening of pulmonary artery.
 Aortic valve: - It lies in the opening of aorta.
Note -The function of valve is to allow free forward and unidirectional flow of the blood.
Blood supply to the heart
 Arterial supply: The heart is supplied with arterial blood by the right and left coronary
arteries. They are first branches from the aorta.
 Venous drainage: Venous blood is collected into several small veins that join to form the
coronary sinus, which opens into the right atrium.
Nerve supply to the heart
The cardiovascular centre is in the medulla oblongata .The nerve supply to the heart is by
sympathetic and parasympathetic nerves. It is a branch of autonomic nervous system. The
sympathetic stimulation increases heart rate and parasympathetic stimulation decreases heart rate.
FUNCTION OF HEART
 The function of the heart is to maintain constant circulation of blood throughout the body.
The heart acts like a pump and its action consists of a series of events known as the cardiac
cycle.
CIRCULATION OF BLOOD THROUGH THE HEART
The right atrium receives deoxygenated blood from the superior venacava and inferior
venacava

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 Right atrium
 Through Tricuspid valve
Right ventricle
 Through pulmonary artery
Lungs
 Through 4 pulmonary veins
Left atrium
 Through bicuspid valve
Left ventricle

Aorta

Systemic circulation

Fig. Circulation of Blood Through the Heart

CONDUCTIVE SYSTEM OF HEART
The small groups of specialized neuromuscular cells in the myocardium initiate and conduct
impulses causing co-ordinate and synchronised contraction of the heart muscle. The conduction
includes following structure:
 Sinoatrial node (SA node)
 Atrioventricular node (AV node)
 Atrioventicular bundle (Bundle of His or AV bundle)
 Purkinje fibres
A. Sinoatrial node (SA node):- SA node is a collection of neuromuscular tissues on a posterior
wall of right atrium near the opening of superior venacava. It can initiate and spread the action
potential or impulse in the form of electric wave, thus it is called pacemaker of the heart.
B. Atrioventricular node (AV node): -It is situated in the interatrial septum towards the right
atrium near the atrioventricular valves (AV valve). It to some extent, can initiate the wave of
contraction but at a very slower rate than SA node. It is not a pacemaker, its main function is to
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pick up the wave of contraction from myocardium of right atrium. It is known as pace setter.
C. Atrioventricular bundle (Bundle of His or AV bundle): -AV node gives a bundle of
cardiac muscle fiber in the interatrial septum. It divides into right and left branches which run
along the interventricular septum.
D. Purkinje fibres: -Right and left branches of bundle of His from the openend of the ventricle
give rise to thin fibers of myocardium called purkinje fibers.
SV node AV node AV bundle
(bundle of His)

Purkinje's fibers

Left/Right bundle branches

Fig. Conductive System of Heart

HEART BEAT
One complete sequence of contraction and relaxation of the heart is called heart beat. Normal
heart rate is 72/minute. Its average is between 60 -70 /minute.
FACTOR CONTROLLING HEART BEAT
1. Intrinsic control: The heart beat originates and is controlled by the SA node present within
the heart.SA node rhythmically generates the impulses throughout the life time.
2. Extrinsic control: Though cardiac impulse is self generated and controlled, it can be
changed extrinsically (out side the heart) by hormones and neural impulses.
 Hormonal control:-Various hormones like thyroxin, insulin, adrenalin, nor adrenalin and
sex hormones directly act on the SA node stimulating or inhibiting the cardiac impulse.
 Nervous system:- The cardiovascular area is situated in the medulla. Heart is under the
control of autonomic nervous system.ANS has two groups of nerve fibers sympathetic
and parsympathetic.vagus nerve from parasympathetic system, slow the heart rate while
sympathetic nerves accelerate the heart beat.
FACTOR AFFECTING HEART BEAT
There are many factors that affect the heart beat.
1. Sex:-Women have a slightly faster pulse rate than man.
2. Age: - The heart beat gradually decreases from birth to adulthood then increases with
advancing old age.

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3. Body temperature: - The heart beat generally increases 7-10 beats for each degree of
temperature elevation.
4. Digestion: - The increased metabolic rate during digestion will increase the pulse rate
slightly
5. Pain: - Pain increased pulse rate.
6. Emotion:-Fear, anger, anxiety and excitement increase the pulse rate.
7. Exercise: - The heart must be faster during exercise to meet the increased demand for
oxygen.
8. Blood pressure: - In general, heart rate and blood pressure have an inverse relationship.
When the blood pressure is low, there is an increase in pulse rate as the heart attempts to
increase the output of blood from the heart (cardiac output).
CARDIAC CYCLE
The rhythmic contraction and relaxation of heart chamber in cyclic pattern is called cardiac
cycle. During each heart beat or cardiac cycle the heart contract and then relax. The period of
contraction is called systole and relaxing period is called diastole. The complete cardiac cycle is
of 0.8second.
DIFFERENT PHASES OF CARDIAC CYCLE
i. Atrial systole = 0.1 sec.
ii. Ventricular systole = 0.3 sec.
iii. Complete cardiac diastole = 0.4 sec.

Fig. Cardiac Cycle

i. Atrial systole:
 Simultaneous contractions of both atria.
 Opens AV valves (Tricuspid & Bicuspid valves).
 Blood flows within the ventricles of respective sides.
 No heart sound is produced.
 Completes with in 0.1 sec.
ii. Ventricular systole:
 Simultaneous contraction of both ventricles.
 Bicuspid valve and tricuspid valves (AV valves) get closed so that first heart sound
(LUBB) is produced.
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  Blood is forced into pulmonary artery and aorta.
 It completes within 0.3sec.
iii. Complete cardiac diastole:
 Relaxation of both atria and ventricles together.
 Both atria get filled with blood.
 Pulmonary and aortic valves get closed to prevent back flow of blood so that second
heart sound (DUBB) is produced.
 It completes within 0.4 sec.
HEART SOUND
The vibratory motion of the heart produced during the different events of the cardiac cycle
conducts through the structure surrounding the heart and produces special audible sound called
the heart sound.
CLASSIFICATION OF HEART SOUND
 First heart sound (LUBB):- Produced during ventricular systole due to closure of bicuspid
valve and tricuspid valve (AV valves).It is low pitched and prolonged duration of 0.10-0.17
second like the word "LUBB".
 Second heart sound (DUBB):-Produced during complete cardiac diastole due to closure
pulmonary and aortic valve. It is high pitch short and sharp sound like the word "DUBB"
duration of about 0.10-0.14 second.
 Third heart sound:-It is produced due to the first rapid filling of ventricular diastole. It
occurs by the sudden rush of atrial blood into ventricles when atrioventricular valves open.
It has low frequency and is not audible by stethoscope and is recorded only by
phonocardiograph. Duration about 0.07- 0.10 second.
 Forth heart sound: - It occurs during atrial contraction due to inrush of blood form atria
to ventricle. It occurs just before first heart sound and indicates the end of ventricular filling.
It is also not audible by stethoscope and is recorded only by phonocardiograph. Duration
0.02-0.04 second.
CARDIAC OUTPUT
The amount of blood pumped from each ventricle in per minute is called cardiac output.
Cardiac output = Stroke volume × Heart rate
Normal value: 5 liter/ventricle/minute
Stroke volume: The amount of blood pumped out by each ventricle during each beat is known
as stroke volume. Normal value:-70ml (60-80 ml) when the heart rate is normal 72/minute.
FACTORS MAINTAINING CARDIAC OUTPUT
Cardiac output is maintained by four factors:
i. Venous return
ii. Force of contraction
iii. Heart rate
iv. Peripheral resistance
BLOOD PRESSURE
Blood pressure is the force of blood exerted by the wall of arteries. The normal blood pressure
is 120/80 mm of Hg or 16/11 kpa.

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TYPES OF BLOOD PRESSURE
a. Systolic blood pressure: This is the maximum pressure exerted in the arteries during the
systole of heart. The normal systolic blood pressure is 120 mm of Hg or 16kpa.
b. Diastolic blood pressure: This is the minimum pressure in the arteries during the diastole
of the heart. The normal diastolic blood pressure is 80 mm of Hg 0r 11kpa.
c. Pulse pressure: This is the difference between the systolic pressure and diastolic pressure.
Normally, it is 40 mm of Hg.
d. Mean pressure: It is the average pressure existing in the arteries. It is not the arithmetic
mean of systolic and diastolic pressures. It is the diastolic pressure plus one – third of
pulse pressure. To determine the mean pressure, the diastolic pressure is considered than
the systolic pressure. It is because the diastolic period of cardiac cycle is longer than the
systolic period. Normal mean pressure is 93 mmHg (80+13=93).
REGULATION OF BLOOD PRESSURE
Regulation of Blood Pressure

Nervous Renal Hormonal

mechanism mechanism mechanism
Baroreceptor Rennin Angiotensin mechanism Vasoconstrictor
Chemoreceptor Renal body fluid mechanism Vasodilator

Chart. Regulation of Blood Pressure

 Nervous Mechanism: - Short term control
 Renal Mechanism: - Long term control
1. NERVOUS MECHAISM
Baroreceptor and chemoreceptor are found on the aortic arch and carotid sinus, the
cardiovascular centre is situated in medulla.
 Baroreceptor:
During increased blood pressure:
Raised blood pressure in artery

Stimulates Baroreceptor

Signals conveyed by cardiovascular centre

Increase parasympathetic nerve activity

Causes: vasodilation
Slow heart rate
Decrease myocardial contraction

Decrease peripheral resistance

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 Falling blood pressure

Decrease blood pressure

During low blood pressure:
Decrease blood pressure

Stimulate Baroreceptor

Signal conveyed by cardiovascular centre

Increase sympathetic stimulate activity

Causes: Increase heart rate

Increase force of cardiac contraction

Increase peripheral resistance

Increase blood pressure

 Chemoreceptor
Decrease arterial pressure

Increase blood flow to chemoreceptors

Decreased O2,increased Co2,increased H+

Stimulates chemoreceptors

Signal go to vasomotor centre

Activated vasomotor centre

Inreased blood pressure

2. RENAL MECHANISM
 Rennin Angiotensin mechanism
Decreased arterial blood pressure

Decreased blood flow of the kidney

Rennin secretion from kidney

Rennin converts angiotensinogen of blood to Angiotensin I

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 In lungs, Angiotensin I is converted to Angiotensin II

Angiotensin II

Causes vasoconstriction Stimulates secretion of aldosterone which

increases absorption of salt and water from
distal Nephron.
Increased blood pressure
Increased blood volume

Increased blood pressure

 Renal body fluid mechanism
Increase arterial blood pressure

Increase cardiac output of kidney

Kidneys excrete more amounts of water and salt, particularly sodium

Decrease extra cellular fluid and blood volume

Decrease arterial pressure

3. HORMONAL MECHANISM
Many hormones are involved in the regulation of blood pressure:
 Hormones, which increase the blood pressure:
 Adrenaline
 Thyroxin
 Aldosterone
 Vasopressin
 Angiotensin
 Serotonin
 Hormones, which decrease the blood pressure
 Histamine
 Acetylcholine
 Atrial natriuretic peptide
FACTORS AFFECTING BLOOD PRESSURE
 Cardiac output
 Peripheral resistance
 Age: - Blood pressure rise with age
 Sex: - 10-20% less in female
 Posture in recumbent position Blood pressure is lower than in sitting of standing posture
 Exercise: - Blood pressure increase
 Emotion and Excitement:-It increases

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 BLOOD CIRCULATION
The transport and movement of water, nutrients, oxygen, hormones and waste products through
the blood is known as circulation.
TYPES OF CIRCULATION
 Pulmonary circulation
 Systemic circulation
 Portal circulation
Lungs

Pulmonary
Circulation
Left side of
Right side
the heart
of the heart

Systemic Circulation

All body tissues

Fig. Blood Circulation
 Pulmonary circulation: The passage of blood flow from right ventricle to the lungs & from
lungs to the left atrium is called pulmonary circulation.
 Systemic circulation: The passage of blood from left ventricle to the tissues and from the
tissues to the right atrium is called systemic circulation.
 Portal circulation: The blood from one organ is first transported to another organ through
the portal vein is known as portal circulation.
o Hepatic portal circulation-The nutrient rich blood from the intestinal tract is
directly transmitted to liver for metabolism.
o Hypothalamic portal circulation- Hormone released from hypothalamus is
directly transmitted to pituitary gland.
IMPORTANCE OF CIRCULATION
 To supply the O2, nutrition, vitamins to the tissues.
 To carry away different metabolic waste products and Co2 from tissues for elimination.
 To prevent intravascular coagulation of blood.
 Helps to maintain thermal balance thought the body.
BLOOD VESSELS
The blood vessels are the part of the circulatory system that transports blood throughout the
body. There are three major types of blood vessels:
 Artery
 Vein
 Capillary
i. Artery: The artery is the blood vessel, which carry blood away from the heart to different
organs. Its diameter is 4 mm.The smallest parts of arteries are called arteriole.

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ii. Vein: The vein is the blood vessels, which carry blood towards the heart from different parts
of the body. Its diameter is 5 mm.The smallest parts of vein are called venule.
iii. Capillary: Capillary is network of microscopic endothelial tubes. Capillary wall consist of
single layer of endothelial cells sitting on a very thin basement membrane. The average
diameter of capillaries is 6-8 micron.
STRUCTURE OF BLOOD VESSELS
The wall of arteries and veins consists of three layers:
i. Tunica adventitia: It is outer layer of blood vessels, composed of fibrous tissue.
ii. Tunica media: It is middle layer of blood vessels, composed of smooth muscle and elastic
tissue.
iii. Tunica interna: It is inner layer of blood vessels, composed of squamous epithelium called
endothelium.
Tunica
adventitia
Tunica
Media
Tunica
Interna
Lumen

Artery Vein

Elastic
Membran
Fig.: Structure of Blood Vessels
e

 Blood supply to the blood vessels:-The outer layers of tissue of thick-walled blood vessels
receive their blood supply via a network of blood vessels called the vasa vasorum. Vessels
with thin walls and the endothelium of the others receive oxygen and nutrients by diffusion
from the blood passing through them.
 Controls of blood vessels:-The controls of blood vessels are the autonomic nervous system.
These nerves arise from the vasomotor centre in the medulla oblongata and they change the
diameter of the lumen of the blood vessels, controlling the volume of blood.
DIFFERENCE BETWEEN ARTERIES AND VEINS
No. ARTERIES VEINS
Arteries carry oxygenated blood, Veins carry deoxygenated blood, towards the
1. away from the heart except heart except pulmonary veins.
pulmonary artery.
These are mostly deeply situated These are superficial and deep in location.
2.
in the body.
3. These are thick walled. These are thin walled.
4. These pass narrow lumen. These pass wide lumen.
5. These are reddish in colour. These are bluish in colour.
6. Arteries blood pressure is high. Veins blood pressure is low.
7. High elasticity. Low elasticity.
8. Internal valves are absent. Internal valves are present.
ELECTROCARDIOGRAM
This is the record or graphical representation of electrical activities of the heart, which occur
prior to the onset of mechanical activities. The summed electrical activity of all the cardiac
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muscle fibers when recorded extracellularly is called electrocardiogram. This technique was
discovered by Dutch physiologist, Einthoven willem who is called the father of ECG.

Fig. Normal ECG

WAVE OF NORMAL ECG
The waves of ECG recorded by limb Lead II are considered as the typical waves. Normal ECG
has the following waves namely P, Q, R, S and T
 P wave is the atrial complex.
 QRST complex is the ventricular complex.
 QRS complex is the initial ventricular complex.
 T wave is the final ventricular complex.
USES OF ECG
ECG is useful in determining and diagnosing the following:
 Heart rate
 Heart rhythm
 Abnormal electrical conduction
 Poor blood flow to heart muscle
 Heart attack
 Coronary artery disease
 Hypertrophy of heart

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