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MODULE 4
Cardio-Vascular System

BLOOD

Functions of Blood
1. keep the internal cellular environment of the body tissues in the state of dynamic
equilibrium
2. transports oxygen from the lungs to the tissues
3. transports carbon dioxide from the tissues to the lungs
4. carries food materials to all parts of the body
5. returns waste to the kidneys to be excreted
6. transports internal secretion from the glands in which they are produced to the
tissues
7. the buffers in the blood help maintain acid-base balance
8. involved in the immunity to disease and protecting the body against invading
bacteria

Characteristics of Blood
1. color
- artery > bright scarlet red due to increased oxygen content
vein > dark red blue due to decreased oxygen content

2. quantity
- 7-8% of total body weight
volume in males – 6 liters

3. pH
- slightly alkaline

4. temperature
- 38% always slightly higher than body temperature

Blood Cells
1. erythrocytes
- carry oxygen from the lungs to the tissues and carbon dioxide back from
the tissues to the lungs
- lack mitochondria; make ATP by anaerobic mechanisms; they do not use
up any of the oxygen they transport
- hemoglobin > iron-containing protein; transport back oxygen carried in
the blood
- normal hemoglobin > 12-18 g / 100 ml
female 12-16 g / 100 ml
male 13-18 g / 100 ml
- life span > 120 days

2. leukocytes
- less numerous the erythrocytes around 1 %
- bigger size
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- life span: 14 hours

- capable of slipping into and out of the blood vessels ( diapedesis )
- respond to chemicals that diffuse from the damaged cell (chemotaxis)
- amoeboid movement
- leukocytosis > increased or more than 11,000 cell / mm 3
may be due to infection
- leukopenia > decreased due to drugs

a. granular
neutrophils > most common; mobile defense against acute infection
eosinophils > 1-3%; detoxify foreign proteins that enter the body;
increased during allergy and infection

basophils > least numerous; contains histamine-containing granules;

histamine is an inflammatory chemical that makes blood
vessels leaky and attract other leukocytes to the inflammation
sites

b. agranular
lymphocytes > defense against disease; replaced 2-3x daily; for
immune response
monocytes > largest of all blood cells; for removal of larger particles;
change into macrophages when they migrate into the tissues
which help fight against chronic infection

3. thrombocytes
- smallest, oval-shaped, granular; they are fragments of megakaryocytes
- normal value > 300,000 / mm3
- prevents blood loss; when blood vessel is damaged, its lining loses its
smoothness and the platelets begin to stick to the walls forming a plug
- contain platelet factor which initiates blood clotting; substances involved in
the clotting process are released and thus can initiate the formation of
a clot at the site of injury; once a blood clot has formed, platelets
make it shrink or contract during which process the clot is changes
from a soft mass to a firm one; thus the bleeding stops
- platelets store serotonin; serotonin is liberated as platelets disintegrate,
causes constriction of some of the small blood vessels and thereby
further helps to control bleeding
- life cycle > live only a few days in the blood stream and are completely
replaced about every 4 days

Plasma

1. water
- 91-92 %

2. proteins
- 6-8% of plasma
- mostly found in the liver
a. albumin
- most abundant; formed by the liver; colloid osmotic pressure helps
to regulate the volume of plasma within the blood vessels by
pulling in water from the tissue fluid
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- used in burn patients

b. gamma globulin
- produced by plasma cells; develops immunity e.g. measles

c. protrombin
- produced in the liver; responsible for coagulation of blood; if lacking,
clotting disturbances occur

d. fibrinogen
- produced in the liver; liquid in circulating blood but when blood
clots, it changes to solid state called fibrin; used in surgery

3. carbohydrates
- present in blood as glucose; energy supply

4. lipids
- neutral fats; cholesterol, phospholipids
- supply energy
- vitamins

5. inorganic salts
- chlorides of sodium, potassium, calcium and magnesium

6. gases
- oxygen, carbon dioxide, nitrogen

7. waste products
- urea, uric acid, lactic acid and creatinine

BLOOD VESSELS

1. artery
- large vessel where blood is propelled away from the heart as it beats

2. arteriole
- smaller artery

3. capillary bed
- microscopic blood vessel

4. venule
- drained by capillaries

5. vein
- empty into the heart

Microscopic Anatomy of Blood Vessels

- tunics or coats

1. tunica interna
- lines the lumen or interior of the blood vessels
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- its cells fit closely together and form a slick surface that decreases friction
as blood flows through the vessel lumen

2. tunica media
- bulky middle coat
- mostly smooth muscle and elastic tissue

3. tunica externa
- outermost tunic
- support and protect the muscle

MAJOR ARTERIES OF THE BODY

1. ascending aorta
a. right coronary
b. left coronary
- these two arteries supply the myocardium

2. aortic arch and thoracic aorta

a. brachiocephalic
- 1st branch of the aortic arch
b. left common carotid
c. left subclavian
d. right common carotid
e. rightsubclavian

3. arteries serving the head and neck

a. internal carotid
– serves the brain
b. external carotid
– supplies the tissue external to the skull in the neck and head
c. vertebral
– supply the cerebellum, brain stem and posterior cerebral
hemisphere

4. arteries serving the thorax and upper limbs

a. axillary artery
– serves the upper limbs; branch off supplying the chest wall
and shoulder girdle
b. brachial
– branches into radial and ulnar arteries which supply the
forearm and hand
c. anterior intercostal
– supplies the thorax wall and the anterior intercostal structure
d. posterior intercostals
– supplies the posterior intercostals structure
e. phrenic
– serve the diaphragm
f. esophageal
– serve the esophagus
g. bronchial
– bronchi
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5. abdominal aorta
a. celiac trunk
– unpaired artery that divides into 3 branches
left gastric – somach
splenic – spleen
common hepatic – gives off branches to the stomach,
small intestine, pancreas
hepatic – liver
b. superior mesenteric
– supplies most of the small intestine and first half of the large
intestine
c. renal
– kidney
d. gonadal
– ovarian and testicular
e. inferior mesenteric
– supplies the distal half of the large intestine
f. common iliac
– serves the pelvis, lower abdominal wall and the lower limbs
g. internal iliac
– gluteal muscles, adductor muscles of the medial thigh,
genitals
h. external iliac
– anterior wall and lower limbs
i. femoral
– femur
j. popliteal
– knee, leg, foot
k. dorsalis pedis
– terminal; palpated in patients with circulation problem;
dorsum of the foot
l. arcuate
– extension of the dorsalis pedis

MAJOR SYSTEMIC VEINS OF THE BODY

1. superior vena cava
- where veins draining the head and upper extremities empty
2. inferior vena cava
- where veins draining the lower body empty
3. veins of the lower limb
a. anterior and posterior tibial
- serve the calf and foot
b. popliteal
- crosses the back of the knee
c. femoral
- thigh
d. great saphenous
- superficial vein, longest vein in the body
e. small saphemous
- extends up the medial side of the leg, knee, and thigh to empty into
the femoral vein; drains the calf muscle and then empties into
the popliteal vein at the knee
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4. veins of the abdomen

a. lumbar
- where through which the inferior vena cava receives blood from the
posterior abdominal wall

b. left gonadal
c. right gonadal
d. renal
– drain the kidneys
e. right and left hepatic
– liver

f. hepatic portal veins

– carries blood to the liver to be processed before it enters the
systemic venous system

5. veins draining into the superior vena cava

a. right and left brachiocephalic
– drain the head, neck and upper extremities
b. internal jugular
– large veins that drain the dural sinuses of the brain and they receive
blood from the head and neck as they move inferiorly
c. vertebral
– drain the posterior aspect of the head and neck
d. subclavian
– receive venous blood from the upper limb
e. external jugular vein
– returning venous drainage of the extracranial tissues of the
head and neck, joins the subclavian vein near its origin

6. veins of the upper limb and thorax

a. axillary
– subclavian vein at the axilla
b. brachial
– runs the course of the humerus
c. radial and ulnar
– forearm
d. cephalic
– superficial drainage of the arm which empties into the axillary vein
e. medial basilic
– medial; enters into the brachial vein
f. medial cubital vein
– runs between the cephalic and basilica veins in the anterior elbow
g. azygous
– drains the right side of the thorax, enters the dorsal aspect of the
superior vena cava just before that vessel enter the heart

HEART

- size of a person fist

- hollow, cone-shaped, weigh less than a pound
- located within the bony thorax
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- apex > pointed; directed toward the left hip and rests in the diaphragm
approximately at the level of the 5th intercostals space
- base > broader; postero-superior; where the great vessels of the body
emerge points toward the right shoulder and lies
beneath the 2nd rib

Properties of Cardiac Muscle

- blood pump
- propel blood to all tissues of the body
- involuntary ensuring a constant blood supply
- cells are arranged in spiral or figure-8-shaped bundles
- where heart contracts, its internal chambers become smaller forcing blood
upward into the large arteries leaving the heart

Circulation of Blood
1. pulmonary
- supplies blood only to the lungs; carries oxygen-poor blood from the heart
to the lungs where carbon dioxide is removed, oxygen is added

2. systemic
- supplies all the cells, tissues and organs of the body with oxygen-rich blood
and returns the oxygen-poor blood to the heart

Layers of the Heart Wall

1. epicardium
- visceral pericardium

2. myocardium
- consists of thick bundles of cardiac muscle twisted and whorled into ring-
like arrangements
- layer that contracts

3. endocardium
- thin, glistening sheet of endothelium that lines the heart chambers

Cardiac Output
- amount of blood pumped out by each side of the heart (each ventricle) in
1 minute
- heart rate X stroke volume = cardiac output

Stroke Volume
- volume of blood pumped out by a ventricle with each heartbeat

Example: 75 x 70 = 5250 ml/min

Venous Return
- amount of blood entering the heart and distending its ventricles

Regulation of Stroke Volume

- Starling’s Law of the Heart
- the critical factor controlling stroke volume is how much the cardiac
muscles are stretched just before they contract
- the more they are stretched, the stronger the contraction will be
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- venous return > amount of blood entering the heart and distending its
ventricles
> most important factor stretching the heart muscle
- increased volume or speed of venous return
- increased stroke volume and force of contraction

Regulation of Heart Rate

- when blood volume drops suddenly or when the heart has been seriously
weakened, stroke volume declines and cardiac output is maintained by a
faster heartbeat
- most important external influence on heart rate is the activity of the
autonomic nervous system
- others: hormones, chemicals, ions

physical and emotional stress

the nerves of the sympathetic division of the autonomic nervous system stimulate
the SA and AV nodes and the cardiac muscle itself

heart beats rapidly (e.g. frightened, catching a bus)

heart rate speeds up when special demands are placed on it

faster blood flow increased the rate at which fresh blood reaches body cells, more
oxygen and glucose are made available to them during periods of stress

when demand declines, the heart adjusts

parasympathetic nerves, primarily the vagus nerve, slow and steady the heart,
giving it more time to rest during non-crisis times

The Intrinsic Conducting System of the Heart

The depolarization wave is initiated by the sino-atrial (SA) node

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Wave passes successively through the atrial myocardium to the atrio-ventricular

(AV) valve

AV bundle

right and left bundle branches

Purkinje fibers in ventricular walls

Electrocardiography (ECG)

P atrial depolarization immediately before they contract

QRS ventricular depolarization; precedes the contraction of the ventricles
T ventricular repolarization

Cardiac Cycle

Mid-to-late Diastole
- relaxation
- pressure in the heart is low
- blood flows passively into and through the atria into the ventricles from
the pulmonary and systemic circulation
- semilunar valves are closed
- AV valves are open
- Atria contract and force the blood remaining in their chambers into the
ventricles

Ventricular Systole
- ventricular contraction begins
- pressure within the ventricles increases rapidly
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- AV valves are closed

- semilunar valves are open (due to higher intraventricular pressure than
the pressure in the large arteries leaving the heart)
- blood rushes through them out of the ventricles
- atria are relaxed
- chambers are again filling with blood

Early Diastole
- end of systole
- ventricles relax
- semilunar valves snap shut
- ventricles are completely closed chambers
- intraventricular pressure drops
- AV valves are forced open (intraventricular pressure drops below pressure
in the atria)
- ventricles begin to refill rapidly with blood

Practical Considerations:
1. murmur
- heart sounds are due to valvular action therefore, murmur are due to
abnormal heart sounds
a. valves fail to perform properly due to disease
b. valves fail to close tightly and blood leaks back
c. valve orifice is stenosed or narrowed

2. disorders of the blood pressure

hypertension
- BP > 140 mmHg at rest; renal or unknown
- Obesity; nervous strain

Hypotension
- BP < 100 mmHg; frequent fatigue and lack of physical endurance

3. pulse
tachycardia - HR > 100 / min thready – very rapid but weak
bradycardia – HR < 100 / min

4. hot and cold compress

hot compress
- used to relieve pain
- increase the blood flow to the part involved by dilating the blood vessels
- temperature of the skin of the extremities may be increased from about
24 – 44 0C

cold compress
- cause a constriction of blood vessels in the skin
- reduces swelling of an infected area and may relieve pain this way

rvmarcelo@spuqc.edu.ph

rochivm@yahoo.com