The Cardiovascular System

The Heart

1
 Microscopic Anatomy of Heart Muscle
Cardiac muscle is striated, short, fat, branched, and interconnected
The connective tissue endomysium acts as both tendon and insertion
Intercalated discs anchor cardiac cells together and allow free passage of ions
Heart muscle behaves as a functional syncytium

2
 Cardiac Muscle Contraction
Heart muscle

• Is stimulated by nerves and is self-excitable

(automaticity)
• Contracts as a unit
• Has a long (200 ms) absolute refractory period

Cardiac muscle contraction is similar

to skeletal muscle contraction

3
 Electrical activity of the heart
Automomacity
Many regions within the heart have been shown to be capable of
originating action potentials and functioning as peacemaker.
However, in a normal heart, only one region demonstrates spontaneous
electrical activity and by this means functions as a pacemaker.
This pacemaker region is called the sinoatrial node, or SA node.

4
 Pacemaker Potential-1
The membrane potential begins at about -60 mV and gradually depolarizes to -40 mV, which
is the threshold for producing an action potential in these cells.
This spontaneous depolarization is produced by the diffusion of Ca through openings in the
membrane called slow calcium channels ( T-Type) and Na channels,

After that, fast Ca ( L-type ) channels.

Repolarisation is produced by the opening of K gates.

The rate of spontaneous depolarization of ectopic pacemaker/ ectopic focus are slower than
that of SA node.

5
Sinoatrial (SA) node generates impulses about 75 times/minute

Atrioventricular (AV) node delays the impulse approximately 0.1 second

Impulse passes from atria to ventricles via the atrioventricular bundle
(bundle of His)

0.8-1 m/sec

0.03-0.05 m/sec

5 m/sec

Ventricular contraction begins 0.1 to 0.2 second after the contraction of the atria 6
AV bundle splits into two pathways in the
interventricular septum (bundle branches)
• Bundle branches carry the impulse toward the
apex of the heart
• Purkinje fibers carry the impulse to the heart apex
and ventricular walls

7
 Myocardial Action Potential
Resting membrane potential -90 mV.

The plateau phase results from a slow inward diffusion Ca

Rapid repolarization is achieved by opening of rapid K channels

8
 Heart Anatomy
Approximately the size of your fist

Location
• Superior surface of diaphragm
• Left of the midline
• Anterior to the vertebral column
• posterior to the sternum

9
Coverings of the Heart: Anatomy
Pericardium – a double-walled sac around the heart
• A superficial fibrous pericardium
• A deep two-layer serous pericardium
• The parietal layer lines the internal surface of the fibrous
pericardium
• The visceral layer or epicardium lines the surface of the heart
• They are separated by the fluid-filled pericardial cavity

10
11
Coverings of the Heart: Physiology
The pericardium:
• Protects and anchors the heart
• Prevents overfilling of the heart with blood
• Allows for the heart to work in a relatively friction-free environment

12
 Heart Wall
Pericardium

Epicardium – visceral layer of the serous pericardium

Myocardium – cardiac muscle layer forming the bulk of the heart

Endocardium – endothelial layer of the inner myocardial surface

13
 Heart Wall
Epicardium – visceral layer of the serous pericardium

Myocardium – cardiac muscle layer forming the bulk of the heart

Endocardium – endothelial layer of the inner myocardial surface

14
Gross Anatomy of Heart: Frontal Section

15
 Atria of the Heart
Atria are the receiving chambers of the heart
• Each atrium has a protruding auricle
• Pectinate muscles mark atrial walls

16
 Atria of the Heart

Blood enters right atria from superior and inferior

venae cavae and coronary sinus

Blood enters left atria from pulmonary veins

17
 Each atrium has a protruding auricle / Pectinate muscles mark atrial walls

enters right atria from superior and inferior venae cavae and coronary sinus / enters left
atria from pulmonary veins

18
 Ventricles of the Heart
Ventricles are the discharging chambers of the heart

Papillary muscles and trabeculae carneae muscles mark ventricular walls

19
Right ventricle pumps blood into the pulmonary trunk

Left ventricle pumps blood into the aorta

20
 Heart Valves
Heart valves ensure
unidirectional blood flow
through the heart

Atrioventricular (AV) valves

lie between the atria and the
ventricles

AV valves prevent backflow

into the atria when ventricles
contract

Chordae tendineae anchor

AV valves to papillary
muscles
21
 Heart Valves
Aortic semilunar valve lies between left ventricle and aorta

Pulmonary semilunar valve lies between the right ventricle

and pulmonary trunk
Semilunar valves prevent backflow of blood into the
ventricles

22
Heart Valves

23
Atrioventricular Valve Function

24
Semilunar Valve Function

25
 External Heart: Major Vessels of the Heart
(Anterior View)

Vessels returning blood to the heart include:

• Superior and inferior venae cavae
• Right and left pulmonary veins
Vessels conveying blood away from the heart include:
• Pulmonary trunk, which splits into right and left pulmonary arteries
• Ascending aorta (three branches) – brachiocephalic, left common
carotid, and subclavian arteries

26
Superior and inferior venae cavae Pulmonary trunk, splits into right and left
pulmonary arteries

Right and left pulmonary veins Ascending aorta (three branches) – brachiocephalic,
left common carotid, and subclavian arteries

27
External Heart: Vessels that Supply/Drain the
Heart (Anterior View)

Arteries – right and left coronary (in atrioventricular groove),

marginal, circumflex, and anterior interventricular arteries

Veins – small cardiac, anterior cardiac, and great cardiac

veins

28
Arteries – right and left coronary (in atrioventricular groove), marginal, circumflex, and
anterior interventricular arteries

Veins – small cardiac, anterior cardiac, and great cardiac veins

29
 External Heart: Major Vessels of the Heart
(Posterior View)
Vessels returning blood to the heart include:
• Right and left pulmonary veins
• Superior and inferior venae cavae
Vessels conveying blood away from the heart include:
• Aorta
• Right and left pulmonary arteries

30
Vessels returning blood to the heart include:
• Right and left pulmonary veins / Superior and inferior venae cavae

Vessels conveying blood away from the heart include:

• Aorta / Right and left pulmonary arteries

31
External Heart: Vessels that Supply/Drain the
Heart (Posterior View)
Arteries – right coronary artery (in atrioventricular groove) and
the posterior interventricular artery (in interventricular groove)

Veins – great cardiac vein, posterior vein to left ventricle,

coronary sinus, and middle cardiac vein

32
Arteries – right coronary artery (in atrioventricular groove) and the posterior
interventricular artery (in interventricular groove)

Veins – great cardiac vein, posterior vein to left ventricle, coronary sinus, and
middle cardiac vein

33
AV bundle splits into two pathways in the
interventricular septum (bundle branches)
• Bundle branches carry the impulse toward the
apex of the heart
• Purkinje fibers carry the impulse to the heart apex
and ventricular walls

34
Sinoatrial (SA) node generates impulses about 75 times/minute

Atrioventricular (AV) node delays the impulse approximately 0.1 second

Impulse passes from atria to ventricles via the atrioventricular bundle
(bundle of His)

0.8-1 m/sec

0.03-0.05 m/sec

5 m/sec

Ventricular contraction begins 0.1 to 0.2 second after the contraction of the atria 35
 Pathway of Blood Through the Heart and Lungs

Right atrium  tricuspid valve  right ventricle

Right ventricle  pulmonary semilunar valve  pulmonary
arteries  lungs
Lungs  pulmonary veins  left atrium

Left atrium  bicuspid valve  left ventricle

Left ventricle  aortic semilunar valve  aorta

Aorta  systemic circulation

36
Pulmonary and Systemic circulations

37
 Coronary Circulation

Coronary circulation is the functional

blood supply to the heart muscle itself

Collateral routes ensure blood delivery to

heart even if major vessels are occluded

38
Coronary Circulation: Arterial Supply

39
Coronary Circulation: Venous Supply

40
 Electrocardiogram (ECG)
Potential differences generated by the heart are conducted to the body surface,
where they can be recorded by surface electrodes placed on the skin.

The recording thus obtained is called electrocardiogram;

The recording device is called an electrocardiograph

41
Heart Excitation Related to ECG

42
 Electrocardiography
Electrical activity is recorded by electrocardiogram (ECG)

P wave corresponds to depolarization of SA node

QRS complex corresponds to ventricular depolarization

T wave corresponds to ventricular repolarization

Atrial repolarization record is masked by the larger QRS complex

43
 Electrocardiogram (ECG)-2
There are two types of ECG recording electrodes or ``leads``.
The bipolar limb leads record the voltage between electrodes placed on
the wrists and legs.
Lead I, II, and III.

The right leg is used as a ground lead

44
 Electrocardiogram (ECG)-3
In the unipolar leads, voltage is recorded between a single ``exploratory
electrode`` placed on the body and an electrode that is built into the ECG
and maintained at zero or ground potential.

AVR, AVL, and AVF

45
 Electrocardiogram (ECG)-4
The unipolar chest leads are labelled 1 through 6.

Total 12 standard ECG leads view the changing pattern of the heart`s electrical
activity from different perspectives

This is important because certain abnormalities are best seen with particular
leads and may not be visible at all other leads.

46
Electrocardiogram (ECG)-5
Each cardiac cycle produces 3 distinct ECG waves:
P - QRS - T
Cardiac cycle

47
 Heart Sounds

Heart sounds (lub-dup) are associated

with closing of heart valves
• First sound occurs as AV valves close and
signifies beginning of systole
• Second sound occurs when SL valves close at
the beginning of ventricular diastole

48
Correlation of the ECG with heart sounds

49
Extrinsic Innervation of the Heart
Heart is stimulated
by the sympathetic
cardioacceleratory
center

Heart is inhibited by
the parasympathetic
cardioinhibitory
center

50
 Cardiac Cycle

Cardiac cycle refers to all events associated

with blood flow through the heart

• Systole – contraction of heart muscle

• Diastole – relaxation of heart muscle

51
 Phases of the Cardiac Cycle

Ventricular filling –
mid-to-late diastole

• Heart blood pressure is

low as blood enters atria
and flows into ventricles
• AV valves are open, then
atrial systole occurs

52
Ventricular filling –
mid-to-late diastole

• Heart blood pressure is

low as blood enters atria
and flows into ventricles
• AV valves are open, then
atrial systole occurs

53
 Phases of the Cardiac Cycle
Ventricular systole

• Atria relax
• Rising ventricular
pressure results in
closing of AV valves
• Isovolumetric
contraction phase
• Ventricular ejection
phase opens
semilunar valves

54
 Phases of the Cardiac Cycle

Isovolumetric relaxation –
early diastole

• Ventricles relax
• Backflow of blood in aorta and
pulmonary trunk closes semilunar
valves

Dicrotic notch – brief rise in

aortic pressure caused by
backflow of blood
rebounding off semilunar
valves
55
 Cardiac Output (CO) and Reserve

CO is the amount of blood pumped by each ventricle in one minute

CO is the product of heart rate (HR) and stroke volume (SV)

HR is the number of heart beats per minute

SV is the amount of blood pumped out by a ventricle with each beat

Cardiac reserve is the difference between resting and maximal CO

For example: CO (ml/min) = HR (75 beats/min) x SV (70 ml/beat)

CO (ml/min) = 5250 ml/min (5.25 L/min)

56
Normal Values for Cardiac Output at Rest and During Activity

Cardiac Output varies widely with the level of activity of the body.

The following factors, among others, directly affect cardiac output:

• The basic level of body metabolism
• Exercise
• Age
• Size of the body

57
Effect of Age on Cardiac Output

The Cardiac Output is regulated throughout life almost

directly in proportion to overall bodily metabolic activity.

58
Regulation of Stroke Volume

SV = end diastolic volume (EDV)

minus end systolic volume (ESV)

EDV = amount of blood collected in a

ventricle during diastole

ESV = amount of blood remaining in

a ventricle after contraction
59
 Factors Affecting Stroke Volume
Preload – amount ventricles are stretched by
contained blood

Contractility – cardiac cell contractile force due to

factors other than EDV

Afterload – back pressure exerted by blood in the

large arteries leaving the heart

60
Frank-Starling Law of the Heart

Preload, or degree of stretch, of cardiac

muscle cells before they contract is the
critical factor controlling stroke volume

Slow heartbeat and exercise increase venous

return to the heart, increasing SV

Blood loss and extremely rapid heartbeat

decrease SV

61
Extrinsic Factors Influencing Stroke Volume

Contractility is the increase in contractile

strength, independent of stretch and EDV

Increase in contractility comes from:

• Increased sympathetic stimuli

• Certain hormones
• Ca2+ and some drugs

62
Extrinsic Factors Influencing Stroke Volume

Agents/factors that decrease contractility include:

• Acidosis
• Increased extracellular K+
• Calcium channel blockers

63
 Regulation of Heart Rate
Positive chronotropic factors increase
heart rate

Negative chronotropic factors decrease

heart rate

64
65
66
 Regulation of Heart Rate:
Autonomic Nervous System

Sympathetic nervous system (SNS) stimulation is

activated by stress, anxiety, excitement, or exercise

Parasympathetic nervous system (PNS) stimulation

is mediated by acetylcholine and opposes the SNS

PNS dominates the autonomic stimulation, slowing

heart rate and causing vagal tone

67
 Regulation of heart rate
Without the neural influences, the heart will continue to beat according to the
rhythm set by the SA node.
The effects of autonomic nerves on the pacemaker potentials in the SA node

Cronotropic, Dromotropic, and Inotropic effects

The activity of the autonomic innervation of the heart is coordinated by the
cardiac control center in the medulla oblongata of the brain stem
Baroreceptors

68
69
Chemical Regulation of the Heart

The hormones epinephrine and thyroxine

increase heart rate

Intra- and extracellular ion

concentrations must be maintained for
normal heart function

70
 Regulation of stroke volume
The stroke volume is regulated by three variables:

• The end diastolic volume/ preload of blood (110-130 ml)

• Total peripheral resistance (-)
• Contractility

The ejection fraction about 60%, relatively constant

The heart has a built-in mechanism that normally allows it to pump automatically
whatever amount of blood that flows into the right atrium from the veins.
• This mechanism, called the Frank-Starling law of the heart.
• When increased quantities of blood flow into the heart, the increased blood
stretches the heart walls of the heart chambers.
• As a result of the stretch, the cardiac muscle contracts with increased force,
and empties the extra blood.
71
 Regulation of stroke volume
A-Intrinsic control of contraction strength

As the EDV rises within the physiological range, the myocardium is increasingly
stretched and, as a result, contracts

72
B-Extrinsic control of contraction
strength
Positive inotropic effect of NE and
sympathetic nerves
Positive cronotropic effect

73
 Venous return - 1
The EDV and thus the stroke volume and cardiac output- is
controlled by factors that affect the venous return,

Which is the return of blood to the heart via veins.

Venous return serves as the driving force for the return of blood to
the heart.

Veins have a higher compliance.

2/3 blood are in the veins/ capacitance vessels

Muscular arteries/ resistance vessels

Mean venous pressure is only 2 mm Hg

Mean arterial pressure is 90-100 mm Hg

74
Venous return - 2

75
 Blood volume
Blood volume represents one part of the total body water

The distribution of body water between the intracellular and

extracellular compartments. The EC compartment includes the
blood plasma and the interstitial fluid. 76
 Exchange of fluid between capillaries and tissues

The distribution of ECF between the

plasma and interstitial compartments is in
a state of dynamic equilibrium.

Interstitial fluid is a continuously

circulating medium

The net filtration pressure=

37 mm Hg 17 mm Hg
hydrostatic pressure-blood (-) –tissue fluid

Oncotic pressure: 25 mm Hg

P= hydrostatic pressure

Π= colloid osmotic pressure

77
 Edema
Causes of edema
• High arterial blood pressure
• Venous obstruction
• Leakage of plasma proteins
into interstitial fluid
• Myxedema: the excessive
production of particular
Glycoproteins (mucin) in
ECF/ hypothyroidism

78
The Cardiovascular System
Blood Vessels

79
 Blood Vessels
Blood is carried in a closed system of vessels
that begins and ends at the heart

The three major types of vessels are arteries,

capillaries, and veins

Arteries carry blood away from the heart, veins

carry blood toward the heart

Capillaries contact tissue cells and directly

serve cellular needs
80
 Generalized Structure of Blood Vessels

Arteries and veins are

composed of three tunics
– tunica interna, tunica
media, and tunica externa

Lumen – central blood-

containing space
surrounded by tunics

Capillaries are composed

of endothelium with
sparse basal lamina
81
 Tunics
Tunica interna (tunica intima)
• Endothelial layer that lines the lumen of all vessels
• In vessels larger than 1 mm, a subendothelial connective tissue
basement membrane is present
Tunica media
• Smooth muscle and elastic fiber layer, regulated by sympathetic
nervous system
• Controls vasoconstriction/vasodilation of vessels
Tunica externa (tunica adventitia)
• Collagen fibers that protect and reinforce vessels
• Larger vessels contain vasa vasorum

82
Elastic (Conducting) Arteries

Thick-walled arteries near the heart; the

aorta and its major branches
• Large lumen allow low-resistance conduction of
blood
• Contain elastin in all three tunics
• Withstand and smooth out large blood pressure
fluctuations
• Allow blood to flow fairly continuously through the
body

83
 Muscular (Distributing) Arteries and Arterioles

Muscular arteries – distal to elastic arteries; deliver

blood to body organs
• Have thick tunica media with more smooth muscle and less
elastic tissue
• Active in vasoconstriction

Arterioles – smallest arteries; lead to capillary beds

• Control flow into capillary beds via vasodilation and
constriction

84
 Capillaries
Capillaries are the smallest blood vessels

• Walls consisting of a thin tunica interna, one cell thick

• Allow only a single RBC to pass at a time
• Pericytes on the outer surface stabilize their walls

There are three structural types of capillaries:

continuous, fenestrated, and sinusoids
85
 Continuous Capillaries
Continuous capillaries are abundant in the
skin and muscles, and have:
• Endothelial cells that provide an uninterrupted lining
• Adjacent cells that are held together with tight
junctions
• Intercellular clefts of unjoined membranes that allow
the passage of fluids

86
 Continuous Capillaries
Continuous capillaries of the brain:
• Have tight junctions completely around the endothelium
• Constitute the blood-brain barrier

87
 Fenestrated Capillaries
Found wherever active capillary absorption or filtrate
formation occurs (e.g., small intestines, endocrine glands,
and kidneys)
Characterized by:
• An endothelium riddled with pores (fenestrations)
• Greater permeability to solutes and fluids than other capillaries

88
 Sinusoids
Highly modified, leaky, fenestrated capillaries with large lumens

Found in the liver, bone marrow, lymphoid tissue, and in some endocrine organs

Allow large molecules (proteins and blood cells) to pass between the blood and
surrounding tissues

Blood flows sluggishly, allowing for modification in various ways

89
 Capillary Beds
A microcirculation of interwoven networks of capillaries,
consisting of:
• Vascular shunts – metarteriole–thoroughfare channel connecting an
arteriole directly with a postcapillary venule
• True capillaries – 10 to 100 per capillary bed, capillaries branch off the
metarteriole and return to the thoroughfare channel at the distal end of
the bed

90
 Venous System: Veins

Veins are:
• Formed when venules converge
• Composed of three tunics, with a thin tunica media and a
thick tunica externa consisting of collagen fibers and elastic
networks
• Capacitance vessels (blood reservoirs) that contain 65% of
the blood supply

91
 Venous System: Veins
Veins have much lower blood pressure and thinner walls than arteries

To return blood to the heart, veins have special adaptations

• Large-diameter lumens, which offer little resistance to flow

• Valves (resembling semilunar heart valves), which prevent backflow of blood

Venous sinuses – specialized, flattened veins with extremely thin walls

(e.g., coronary sinus of the heart and dural sinuses of the brain)

92
 Vascular Anastomoses
Merging blood vessels, more common in veins than
arteries

Arterial anastomoses provide alternate pathways

(collateral channels) for blood to reach a given body
region
• If one branch is blocked, the collateral channel can supply the
area with adequate blood supply

Thoroughfare channels are examples of

arteriovenous anastomoses

93
 Blood Flow

Actual volume of blood flowing through a vessel, an

organ, or the entire circulation in a given period:

• Is measured in ml per min.

• Is equivalent to cardiac output (CO), considering the entire
vascular system
• Is relatively constant when at rest
• Varies widely through individual organs, according to immediate
needs

94
 Blood Pressure (BP)

Force per unit area exerted on the wall of a blood

vessel by its contained blood

• Expressed in millimeters of mercury (mm Hg)

• Measured in reference to systemic arterial BP in large arteries
near the heart

The differences in BP within the vascular system

provide the driving force that keeps blood moving
from higher to lower pressure areas

95
 Resistance

Resistance – opposition to flow

• Measure of the amount of friction blood encounters as it

passes through vessels
• Generally encountered in the systemic circulation
• Referred to as peripheral resistance (PR)

The three important sources of resistance are

blood viscosity, total blood vessel length, and
blood vessel diameter
96
 Systemic Blood Pressure
The pumping action of the heart generates blood flow through the
vessels along a pressure gradient, always moving from higher- to lower-
pressure areas

Pressure results when flow is opposed by resistance

Systemic pressure:

• Is highest in the aorta

• Declines throughout the length of the pathway
• Is 0 mm Hg in the right atrium

The steepest change in blood pressure occurs in the arterioles

97
Systemic Blood Pressure

98
 Arterial Blood Pressure

Arterial BP reflects two factors of the

arteries close to the heart

• Their elasticity (compliance or distensibility)

• The amount of blood forced into them at any
given time

Blood pressure in elastic arteries near

the heart is pulsatile (BP rises and falls)
99
 Arterial Blood Pressure
Systolic pressure – pressure exerted on arterial walls during
ventricular contraction

Diastolic pressure – lowest level of arterial pressure during a

ventricular cycle

Pulse pressure – the difference between systolic and diastolic

pressure

Mean arterial pressure (MAP) – pressure that propels the blood

to the tissues

MAP = diastolic pressure + 1/3 pulse pressure

100
 Capillary Blood Pressure

Capillary BP ranges from 20 to 40 mm Hg

Low capillary pressure is desirable because high

BP would rupture fragile, thin-walled capillaries

Low BP is sufficient to force filtrate out into

interstitial space and distribute nutrients, gases,
and hormones between blood and tissues

101
 Venous Blood Pressure
Venous BP is steady and changes little
during the cardiac cycle

The pressure gradient in the venous

system is only about 20 mm Hg

A cut vein has even blood flow; a

lacerated artery flows in spurts

102
Controls of Blood Pressure

Short-term controls:

• Are mediated by the nervous system and

bloodborne chemicals
• Counteract moment-to-moment fluctuations in
blood pressure by altering peripheral resistance

Long-term controls regulate blood volume

103
Baroreceptor Reflexes

104
105
106
Long-Term Mechanisms: Renal Regulation

Long-term mechanisms control BP by altering

blood volume

Baroreceptors adapt to chronic high or low blood

pressure

• Increased BP stimulates the kidneys to eliminate water, thus

reducing BP
• Decreased BP stimulates the kidneys to increase blood
volume and BP

107