Cardiovascular System

CARDIOVASCULAR
SYSTEM
Finals Lecture Session 1
First Semester, A.Y. 2021-2022
COLLEGE OF MEDICAL LABORATORY SCIENCE – VALENZUELA CAMPUS / ANTONIO C. PASCUA JR, RMT, MSMT/ JOSHUA LUIGI D. RAMEL, RMT
UNIT OUTLINE
At the end of this Unit, the student must be able to:
1. Discuss the synergistic efforts of the blood, blood vessels and the heart as vital
components in the maintenance of all body processes
2. Compare and contrast the structure and function of arteries, arterioles, capillaries,
venules, and veins
3. Explain the factors that regulate the volume of blood flow and how blood
pressure changes throughout the cardiovascular system
4. Describe how blood pressure is being regulated by different body processes
5. Define pulse, and define systolic, diastolic, and pulse pressures
6. Describe and compare the major routes that blood takes through various regions
of the body
THE CARDIOVASCULAR SYSTEM
• A closed system of the heart and blood vessels
• The heart pumps blood
• Blood vessels allow blood to circulate to all
parts of the body
• The function of the cardiovascular system is to
deliver oxygen and nutrients and to remove
carbon dioxide and other waste products
The Heart
• Location
• Thorax between the lungs
• Pointed apex directed toward left hip
• About the size of your fist
COLLEGE OF MEDICAL•LABORATORY
Less than SCIENCE
1 – VALENZUELA CAMPUS / ANTONIO C. PASCUA JR, RMT, MSMT/ JOSHUA LUIGI D. RAMEL, RMT
THE HEART: COVERINGS
Pericardium – a double serous
membrane
Visceral pericardium - Next to heart
Parietal pericardium - Outside layer
Serous fluid fills the space between

the layers of pericardium
THE HEART: HEART WALL
Three layers
1. Epicardium
• Outside layer
• This layer is the parietal pericardium
• Connective tissue layer
2. Myocardium
• Middle layer
• Mostly cardiac muscle
3. Endocardium
• Inner layer
• Endothelium
THE HEART: HEART WALL
Layers of the heart Location Description Function
Thin, serous(watery)
membrane that is Covers the heart and
Outer layer of the
Epicardium continuous with the attaches to the
heart
lining of the pericardium
pericardium
Contracts to pump
Middle layer of the Thick layer of cardiac
Myocardium blood into the arteries
heart muscle
Thin layer of epithelial

Inner layer of the cells that is continuous Lines the interior
Endocardium
heart with the lining of the chambers and valves
blood vessels
EXTERNAL HEART ANATOMY
THE HEART: CHAMBERS
• Right and left side act as separate pumps
• Four chambers
Atria
• Receiving chambers
• Right atrium
• Left atrium
Ventricles
• Discharging chambers
• Right ventricle
• Left ventricle
THE HEART: CHAMBERS
Chamber of the Heart Location Function
Right Atrium Upper right chamber Receives deoxygenated blood from the body via both the
Superior(upper) vena cava and inferior (lower) vena cava
and pumps into the right ventricle
Right Ventricle Lower right chamber Receives blood from the right atrium and pumps it into
the pulmonary artery, which carries it to the lungs to be
oxygenated.
Left Atrium Upper left chamber Receives oxygenated blood from the lungs via the
pulmonary veins and pumps it into the left ventricle.
Left Ventricle Lower left chamber Receives blood from the left atrium and pumps it into
the aorta. The cell walls of the left ventricle are nearly
three times as thick as those of the right ventricle owing
to the force required to pump the blood into the arterial
system.
BLOOD CIRCULATION
The Heart: Valves
- Allow blood to flow in only one direction
- Four valves
Atrioventricular valves – between atria
and ventricles
•Bicuspid valve (left)
•Tricuspid valve (right)
Semilunar valves between ventricle and
artery
•Pulmonary semilunar valve
•Aortic semilunar valve
The Heart: Valves
Valves Location Description Function
Right AV valve or Between the right Has three cusps hence the Closes when the right vent. Contracts
tricuspid valve atrium and right name tricuspid and prevents blood from flowing back
ventricle into the right atrium
Left valve or Between the left Has two cusps, hence the Closes when the left vent. Contracts and
Bicuspid or mitral atrium and left name bicuspid prevents blood from flowing back into
valve ventricle the left atrium
Right semilunar Ate the entrance Has three half-moon- Closes when the right vent. Relaxes and
valve or pulmonic/ to the pulmonary shaped cusps prevents blood from flowing back into
pulmonary valve artery the right ventricle
Left semilunar valve At the entrance to Has three half shaped Closes when the left ventricle relaxes
or aortic valve the aorta cusps and prevents blood from flowing back
into the left ventricle
OPERATION OF HEART VALVES
Valve Pathology
• Incompetent valve = backflow and repump
• Stenosis = stiff= heart workload increased
• May be replaced
• Lup Dub Heart Sound
The Heart: Associated Great Vessels
Aorta
- Leaves left ventricle
Pulmonary arteries
- Leave right ventricle
Vena cava
- Enters right atrium
Pulmonary veins (four)
- Enter left atrium
CORONARY CIRCULATION
• Blood in the heart chambers does not
nourish the myocardium
• The heart has its own nourishing circulatory
system
• Coronary arteries
• Cardiac veins
• Blood empties into the right atrium via the
coronary sinus
CARDIAC PATHOLOGY
Rapid heart beat
• = Inadequate blood
• = Angina Pectoris
THE HEART: CONDUCTION SYSTEM
• Intrinsic conduction system
(nodal system)
• Heart muscle cells contract, without
nerve impulses, in a regular, continuous
way
THE HEART: CONDUCTION SYSTEM
- Special tissue sets the pace
1. Sinoatrial node (right atrium)
“Pacemaker”
2. Atrioventricular node (junction of
right and left atria and ventricles)
3. Atrioventricular bundle (Bundle
of His)
4. Bundle branches (right and left)
5. Purkinje fibers
ELECTROCARDIOGRAMS (EKG/ECG)
Three formations
– P wave: impulse across atria
– QRS complex: spread of impulse
down septum, around ventricles
in Purkinje fibers
– T wave: end of electrical activity
in ventricles
PATHOLOGY OF THE HEART
• Damage to AV node = release of ventricles from control = slower heart beat
• Slower heart beat can lead to fibrillation
• Fibrillation = lack of blood flow to the heart
• Tachycardia = more than 100 beats/min
• Bradychardia = less than 60 beats/min
THE HEART: CARDIAC CYCLE
• Atria contract simultaneously
• Atria relax, then ventricles contract
• Systole = contraction
• Diastole = relaxation
FILLING OF HEART CHAMBERS – CARDIAC CYCLE
THE HEART: CARDIAC OUTPUT
Cardiac output (CO)
• Amount of blood pumped by each side of the
heart in one minute
• CO = (heart rate [HR]) x (stroke volume [SV])
Stroke volume
• Volume of blood pumped by each ventricle in
one contraction
THE HEART: CARDIAC OUTPUT
CO = HR x SV
5250 ml/min = 75 beats/min x 70 mls/beat
Norm = 5000 ml/min
Entire blood supply passes through body once per minute.
CO varies with demands of the body.
CARDIAC OUTPUT REGULATION
THE HEART: REGULATION OF HEART RATE
Stroke volume usually remains relatively
constant
• Starling’s law of the heart – the more that the
cardiac muscle is stretched, the stronger the
contraction
Changing heart rate is the most common way
to change cardiac output
REGULATION OF HEART RATE
Increased heart rate
1. Sympathetic nervous system
• Crisis
• Low blood pressure
2. Hormones
• Epinephrine
• Thyroxine
3. Exercise
4. Decreased blood volume
THE HEART: REGULATION OF HEART RATE
• Decreased heart rate
• Parasympathetic nervous system
• High blood pressure or blood volume
• Dereased venous return
• In Congestive Heart Failure the heart is
worn out and pumps weakly. Digitalis
works to provide a slow, steady, but
stronger beat.
CONGESTIVE HEART FAILURE (CHF)
• Decline in pumping efficiency of heart
• Inadequate circulation
• Progressive, also coronary atherosclerosis, high blood pressure
and history of multiple Myocardial Infarctions
• Left side fails = pulmonary congestion and suffocation
• Right side fails = peripheral congestion and edema
VASCULAR SYSTEM
BLOOD VESSELS: THE VASCULAR SYSTEM
• Taking blood to the tissues and back
• Arteries
• Arterioles
• Capillaries
• Venules
• Veins
THE VASCULAR SYSTEM
Figure 11.8b
BLOOD VESSELS: ANATOMY
Three layers (tunics)
1. Tunic intima
• Endothelium
2. Tunic media
• Smooth muscle
• Controlled by sympathetic nervous system
3. Tunic externa
• Mostly fibrous connective tissue
DIFFERENCES BETWEEN BLOOD VESSEL TYPES
• Walls of arteries are the thickest

• Lumens of veins are larger
• Skeletal muscle “milks” blood in veins
toward the heart
• Walls of capillaries are only one cell layer
thick to allow for exchanges between blood
and tissue
MOVEMENT OF BLOOD THROUGH VESSELS
• Most arterial blood is

pumped by the heart
• Veins use the milking
action of muscles to
help move blood
CAPILLARY BEDS
• Capillary beds
consist of two types
of vessels
• Vascular shunt –
directly connects an
arteriole to a venule
CAPILLARY BEDS
True capillaries – exchange vessels

• Oxygen and nutrients cross to
cells
• Carbon dioxide and metabolic
waste products cross into blood
DIFFUSION AT CAPILLARY BEDS
VITAL SIGNS
• Arterial pulse
• Blood pressure
• Repiratory Rate
• Body Temperature
• All indicate the efficiency of the system
Pulse
• Pulse – pressure wave of
blood
• Monitored at “pressure
points” where pulse is
easily palpated
BLOOD PRESSURE
Measurements by health professionals are made on the
pressure in large arteries
• Systolic – pressure at the peak of ventricular contraction
• Diastolic – pressure when ventricles relax
Pressure in blood vessels decreases as the distance away
from the heart increases
MEASURING ARTERIAL BLOOD PRESSURE
BLOOD PRESSURE: EFFECTS OF FACTORS
Neural factors
Autonomic nervous system adjustments
(sympathetic division)
Renal factors
Regulation by altering blood volume
Renin – hormonal control
BLOOD PRESSURE: EFFECTS OF FACTORS
Temperature
Heat has a vasodilation effect
Cold has a vasoconstricting effect
Chemicals
Various substances can cause increases or
decreases
Diet
VARIATIONS IN BLOOD PRESSURE
Human normal range is variable
Normal
140–110 mm Hg systolic
80–75 mm Hg diastolic
Hypotension
Low systolic (below 110 mm HG)
Often associated with illness
Hypertension
High systolic (above 140 mm HG)
Can be dangerous if it is chronic
CIRCULATORY ROUTES
There are two basic postnatal (after birth) routes for blood flow;
• Pulmonary circulation -when blood returns to the heart from the

systemic route, it is pumped out of the right ventricle through the
pulmonary circulation to the lungs.
• Systemic circulation- carries oxygen and nutrients to body tissues and

removes carbon dioxide and other wastes and heat from the tissues.
PULMONARY CIRCULATION
The pulmonary circulation carries deoxygenated blood

from the right ventricle to the air sacs (alveoli) within the
lungs and returns oxygenated blood from the air sacs to
the left atrium
SYSTEMIC CIRCULATION
The systemic circulation carries oxygen and nutrients to body

tissues and removes carbon dioxide and other wastes and heat
from the tissues.
PATHWAY OF SYSTEMIC CIRCULATION
1. Oxygen-rich blood from the lungs leaves the pulmonary circulation when
it enters the left atrium through the pulmonary vein.
2. The blood is then pumped through the mitral valve into the left ventricle.
3. From the left ventricle, blood is pumped through the aortic valve and into
the aorta.
PATHWAY OF SYSTEMIC CIRCULATION
4. The aorta arches and branches into major arteries to the upper body before
passing through the diaphragm, where it branches further into arteries which
supply the lower parts of the body.
5. The arteries branch into smaller arteries, arterioles, and finally capillaries.
THE HEPATIC PORTAL CIRCULATION
Hepatic portal circulation -carries venous blood from the gastrointestinal organs
and spleen to the liver.
Portal vein - vein that carries blood from one capillary network to another
Hepatic portal vein- receives blood from capillaries of gastrointestinal organs and
the spleen and delivers it to the sinusoids of the liver.
Superior mesenteric vein -drains blood from the small intestine and portions of the
large intestine, stomach, and pancreas
Splenic vein -drains blood from the stomach, pancreas, and portions of the large
intestine
THE HEPATIC PORTAL CIRCULATION
Inferior mesenteric vein- which passes into the splenic vein, drains portions of the large intestine
Right and left gastric veins- which open directly into the hepatic portal vein,
drain the stomach.
Cystic vein-which also opens into the hepatic portal vein, drains the gallbladder.
Hepatic portal vein -the liver is receiving nutrient-rich but deoxygenated
blood .
Hepatic artery, the liver also receiving oxygenated blood ,a branch of the celiac trunk.
Sinusoids- the oxygenated blood mixes with the deoxygenated blood

Eventually, blood leaves the sinusoids of the liver through the hepatic veins, which drain into the
inferior vena cava.
REFERNCES
Keller, S.;Marieb, E. (2017) - Essentials of Human Anatomy & Physiology-Pearson, 12th edition
Lecture Notes, Salazar, Romaenia S. RMT, MAT (2019)
MACROSCOPIC AND
MICROSCOPIC ANALYSIS OF
THE CARDIOVASCULAR
SYSTEM
Finals Laboratory Session 1
First Semester
Our Lady of Fatima University
COLLEGE OF MEDICAL LABORATORY SCIENCE – VALENZUELA CAMPUS / JOSHUA LUIGI D. RAMEL, RMT / jdramel@fatima.edu.ph
UNIT OUTLINE
1. Differentiate blood vessels of the body both macroscopically and microscopically
MACROCSCOPIC ANALYSIS
Image Source: Lecture Notes, Ramel, Jonas Mikko D., MD (2017)
I. MACROSCOPIC ANALYSIS
CORONARY ARTERIES
1. Right Coronary Artery (RCA)

- supplies the: Right Atrium, Right Ventricle, parts of Left
Ventricle (posterior side, by the posterior interventricular
artery)
2. Left Coronary Artery (LCA )– Left Ventricle and a

small portion of the Right Ventricle (via the Left Anterior
Descending Artery), LA auricle – nonmuscular extension
of the atria, adds volume to chambers of heart
CORONARY ARTERIES
2.a.) Left Anterior Descending Artery (LAD)

- Passes along the IV groove to the apex of the heart
- Supplies adjacent part of the ventricles; gives rise to a
lateral branch that descend on the anterior surface of the
heart
2.b.) Circumflex artery

- Runs through the left border of the heart to its posterior
surface
- Left marginal branch: follows the left margin of the
heart; supplies the left ventricle
- Terminates in the coronary sulcus in the posterior
aspect of the heart
CARDIAC VEINS
1.) Coronary sinus
- Venous drainage of most of the coronary circulation
- Empties into the RA, via the coronary sinus
Major veins draining into the coronary sinus:

a.) Great cardiac vein
- Drains the areas of the heart supplied by the LCA
b.) Middle cardiac vein

– Accompanies posterior IV artery
c.) Small cardiac vein

– Accompanies right marginal artery
d.) Anterior cardiac vein

– Drains directly into the right atrium
AORTIC BRANCHES
Main branches of the arch of the aorta:
1. Brachiocephalic trunk
- Arises posterior to the manubrium
- Anterior to the trachea and posterior to the left of the
brachiocephalic vein
- Branches into right subclavian and right common carotid arteries
2. Left common carotid

- Arises posterior to the manubrium, slightly posterior and to the
left of the brachiocephalic trunk
- Enters the neck by passing posterior to the left SC joint
3. Left subclavian
- Arises from the posterior part of the arch, just posterior to the left
common carotid artery
Thoracic Aorta
- Begins on the left side of the inferior border of the body of
the T4 vertebra
- Descends in the posterior mediastinum on the left sides of
T5- T12 vertebrae
- Branches of descending aorta
AMDOMINAL AORTA
1.) Inferior phrenic artery – First branch of abdominal

aorta; supplies inferior portion of diaphragm
2.) Coeliac artery – Supplies stomach and liver, first half

of duodenum
3.) Superior mesenteric artery

- Last half of duodenum, small intestine, parts of large
intestine, pancreas
- Supplies part of the gastrointestinal tract derived from
midgut
4.) Inferior mesenteric artery

- Large intestine: distal third of transverse colon up to the
rectum
- Supplies part of gastrointestinal tract derived from the
hindgut
AMDOMINAL AORTA
5. ) Renal artery
- Kidney
- Arise at the level of the IV disc between L1 and L2
vertebrae
6.) Gonadal artery
- Supply blood to gonads;
- Male: testicular artery; transverses inguinal canal and
enters scrotum; supplies abdominal ureter, and
epididymis
- Female: ovarian artery; supplies abdominal and /or
pelvic ureter, ovary, and ampullary end of uterine tube
7.) (Four to five) Lumbar arteries – supplies blood to

posterior abdominal wall
8.) Common iliac arteries – branches off into internal and

external iliac arteries
VEINS IN THE ABDOMINAL CAVITY
2.) Right, middle, and left hepatic veins

- Drains blood from the liver into the IVC just inferior the
diaphragm
3.) Renal veins

- Drains each kidneys into the IVC
- Lie anterior to the right and left renal arteries
4.) Right gonadal vein – empties directly into IVC

5.) Left gonadal vein – empties into renal vein; testicular /
ovarian vein
6.) Varicosyl – worm-like structure found more commonly
in the veins of the left scrotum, because of higher pressure
in the left renal vein
7.) Common internal and external iliac veins
II. TISSUES OF THE VASCULAR WALLS
3 Concentric Layers of Blood Vessels:
1. Tunica Intima
2. Tunica Media
3. Tunica Adventitia
1. Tunica Intima - includes the endothelium,

connective tissue, and an internal elastic lamina
2. Tunica Media - contains alternating layers of
smooth muscle and collagen or elastic lamellae
3. Tunica Adventitia - contains connective tissue,
small vessels and nerves and vasa vasorum
III. VASCULATURE
Arteries:
1.Elastic
2.Muscular
3.Small
Microvasculature
1. Arteioles
Veins: 2. Capillaries
1. Small 3. Venules
2. Medium
3. Large
III. VASCULATURE
Arteries:
1. Large Elastic Arteries
- aka Conducting Arteries
- with fenestrated elastic laminae in the thick tunica media
- Contains Vasa Vasorum
2. Muscular Arteries
-less elastic material than Elastic Artery
- Distribute blood to all organs and maintain steady blood
pressure and flow with vasodilation and constriction
III. VASCULATURE
Arteries:
3. Small Arteries
- no vasa vasourm
- Distribute blood to arterioles, adjusting flow
with vasodilation and constriction
III. VASCULATURE
Microvasculature
1. Arterioles
-Endothelium; no connective tissue / smooth
muscle
- Resist and control blood flow to capillaries;

major determinant of systemic blood pressure
III. VASCULATURE
Microvasculature
2. Capillaries
- Endothelium only
- No Tunica Adventitia
- Exchange metabolites by diffusion to and
from cells
III. VASCULATURE
Microvasculature
2. Capillaries
Types of Capillaries
A. Continuous Capillaries – tight junctions; allow cellular
exchange
B. Fenestrated Capillaries – small pores (fenestrations)

C. Discontinuous Capillaries
- AKA Sinusoids
- Large Lumen
- Discontinued Basal Lamina
III. VASCULATURE
Microvasculature
3. Venules
- Endothelium; no valves
- No Tunica Adventitia
- Drain capillary beds; site of leukocyte exit
from vasculature
III. VASCULATURE
Veins
1. Small Veins
- Connective tissue, thicker than media
- Collect blood from venules
2. Medium Veins
- Thicker than media; longitudinal smooth muscle
may be present
- Carry blood to larger veins, with no backflow
III. VASCULATURE
Veins
3. Large Veins
- Thickest layer, with bundled longitudinal
smooth muscle
- Return blood to heart
REFERNCES
Lecture Notes, Ramel, Jonas Mikko D., MD (2017)
Lecture Notes, Ramel, Joshua Luigi D., RMT (2019)
Lecture Notes, Tan, Christine Faith, MD (2020)
Mescher, Anthony L (2018) , Junqueira’s Basic Histology Text and Atlas 15th Edition

Cardiovascular System

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CARDIOVASCULAR

Parietal pericardium - Outside layer

Serous fluid fills the space between

Thin layer of epithelial

• Walls of arteries are the thickest

• Most arterial blood is

True capillaries – exchange vessels

• Pulmonary circulation -when blood returns to the heart from the

• Systemic circulation- carries oxygen and nutrients to body tissues and

The pulmonary circulation carries deoxygenated blood

The systemic circulation carries oxygen and nutrients to body

Sinusoids- the oxygenated blood mixes with the deoxygenated blood

Image Source: Lecture Notes, Ramel, Jonas Mikko D., MD (2017)

Image Source: Lecture Notes, Ramel, Jonas Mikko D., MD (2017)

1. Right Coronary Artery (RCA)

2. Left Coronary Artery (LCA )– Left Ventricle and a

Image Source: Lecture Notes, Ramel, Jonas Mikko D., MD (2017)

2.a.) Left Anterior Descending Artery (LAD)

2.b.) Circumflex artery

Image Source: Lecture Notes, Ramel, Jonas Mikko D., MD (2017)

Major veins draining into the coronary sinus:

b.) Middle cardiac vein

c.) Small cardiac vein

d.) Anterior cardiac vein

2. Left common carotid

Image Source: Lecture Notes, Ramel, Jonas Mikko D., MD (2017)

Image Source: Lecture Notes, Ramel, Jonas Mikko D., MD (2017)

Image Source: Lecture Notes, Ramel, Jonas Mikko D., MD (2017)

1.) Inferior phrenic artery – First branch of abdominal

2.) Coeliac artery – Supplies stomach and liver, first half

3.) Superior mesenteric artery

4.) Inferior mesenteric artery

7.) (Four to five) Lumbar arteries – supplies blood to

8.) Common iliac arteries – branches off into internal and

2.) Right, middle, and left hepatic veins

3.) Renal veins

4.) Right gonadal vein – empties directly into IVC

Image Source: Lecture Notes, Ramel, Jonas Mikko D., MD (2017)

1. Tunica Intima - includes the endothelium,

- Resist and control blood flow to capillaries;

B. Fenestrated Capillaries – small pores (fenestrations)

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