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    Heart

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    MaggieSam

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    © All Rights Reserved
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    of 36
    The Cardiovascular System: Heart In the last chapter we examined the composition and functions of blood. For blood to reach body calls and exchange materials with ‘them, it must be constantly purped bythe heart through the bodys blood vessels. The heartbeats about 100,00 times every day, which ‘adds up to about 35 milion beats in a yea. The let side ofthe hear ‘pumps blood through an estimated 200,009 km (60,000 mi of blood vessels. The right side of the heart pumps blood through the lung, ‘enabling blood to pick up oxygen and unload carbon dioxide. Even ‘wile you are sleeping. yourheert pumps 30timesits own weight each rmiute, which amountstoabout ites (3g tothelungs andthe same volume tothe resto the body At this rate, the heart pumps more than 114000 liters (850 gal) of blood ina day, oF 1 milion tes (26 milion ‘al) ina year. You don’t spend all your time sleeping, however, and your heart pumps more vigorously when you are active. Thus, the ‘actual blood volume the heart pumps ina single day is much larger. ‘Thischapter explores the design ofthe hear and the unique properties that permititto pump fr alifetime without a moment of rest Looking Back to Move Ahead... + Functions of Blood (Section 14.1) + Membranes (Section 44) + Muscular Tissue (Section 4.5) + Cardiac Muscle Tissue (Section 8.7) + Action Potentials (Section 9.3) + Free Radicals (Section 2.1) + ANS Neurotransmittrs (Section 11.3) [sa] Structure and Organization of the Heart onsecrves «Identify the location of the heart and the structure and functions of the pericardium. 350 @ | Araigram of an obstructed corenary artery (aro) Did you ever wonder how coronary artery disease develops and how its treated? You can find outin Section 35.2, Clinical Application: Coronary Artery Disease. + Describe the ayers of the heart wall and the chambers of the heat. + Identity the major blood vessels that enter and extthe heart, + Explain the structure and functions ofthe valves ofthe heart. Location and Coverings of the Heart ‘The scenic study ofthe normal heart and the diseases associated with itis cardiology (kar-d8-01-6¢ cardio: = heart; logy = study (of). The hearts situated between the two lungs inthe thoracic cavity, with about two-thirds ofits mass yingto the left ofthe body's midline (Figure 35.3) Your heart is about the size of your closed fst, The Scanned with CamScanner he stration, vessel that cary ongerated bod are colored re vessel deoxygenated blood ae colored ble, The borders othe medlastirum are inetd by a dashed ie. “The hears located brtwoon the lungs wih about wo tis of sass totheleh ol he mine, ‘Super vera cava Fight ng Pura cto ‘aval ng nie) Siaphagn 14 natin and Oration teat 38H ary (@)Artriorwaw o the heat Inthe thease cavty ANTERIOR, (© infor viow of wansverse section of horace eaity showing the hearin the mediastinum Q What forms the base of the heart? pointed end, the er, is formed by the tp ofthe left ventricle, alower chamber ofthe heart, and rests on the diaphragm. The base of the hheartis opposite the apex andis formed by the atria (upper chambers of the heart), mostly the left atrium, into which the four pulmonary veins open, and a portion ofthe right atrium that receives the supe- rior and inferior vena cavae (see Figure 15.38). ‘The membrane that surrounds and protects the heart and | itin place's the pericardium (peri-~ around). \tconsists of two} the fibrous pericardium and the serous pericardium (see Figure’: ‘The outer frous pericardium is a tough, inelastic, dense ire connective tissue layer. It prevents overstretching ofthe heart vides protection, and anchors the heart in place. Scanned with CamScanner a2 CHAPTER 18 thecardonaul Stem eat [clinical Connection Cardiopulmonary Resuscitation {ac compresion ad atiialvetiavon othe ling via mouth to month ‘espraton an, fr many year, ths combination was the soe method of {Com Recently however, hands cy CPR has bcc he peered hd. Because the he les Between two igi stivetures-hesternam and vertebral clumn-pressureonthe ces ompresion) ene usedtaforee Ulosdoutofthehaor and tothe cation Aker cling Rando {Pshoulabe administered, Inthe procedre, chest compression shuld te gen hard ane fst trate of 100 per minute and to inches deep TERETE] retcarsum and near wall “The percraum a she that surounds and protects the hear ‘numa Tha resid crtnee ust ined maces professors wee fra aomannd wnarra tain @ waite. Soren CPR 8 ‘commander wae ara. el as anyore who SOM thor fora forenapin, vetins of en omring, er Ore Of rtonmoronce posonet, Ts esumaced tha Pard-oty CPR saves about 20% mor We ‘an the ardurd method. oreo, ands ony CBR boot the wa ‘aterm Lh ta 3 compared taba tionl method ot nare a a Tei ano eave foram emerpncyagatcer to pistons mite te hands only CPR to Wghened,ronmaea bytes. Fy. 28 ‘ube la ol entactingcortapoun Gunmen wich a Pepa, FE {ubereuloss continues tore tanger are much mare elf ero hands ony CPR attr thantretmert nvhaing he ardaré Method. (0) Cerdac muscle thers Endocardlum Coronary bod vessels Myocardium (cardiac muscle) (a) Porton ot pereardum and right venticlar heat wall showing ‘the divisions ofthe peicardum and layers of the heart wall Q Which layer is both part of the pericardium and part of the heart wall? Scanned with CamScanner 1 €6 The inner serous perleardlum is 2 thinner, more delicate ‘membrane that forms a double layer around the heart. Th Parietal layer of the serous pericardium is fused to the fibrous Pericardium, and the inne vtceral layer ofthe serous pericardium, ‘also called the epleardium (epi. = on top of), adheres tightly to the surface ofthe heart. Between the parietal and visceral layers of the serous pericardium is a thin film of fluid. This ud, known 88 pericardial flud, reduces friction between the mem the heart moves. The pericardfal cavity is the space that the pericardial fluid. Inflammation of the pericardium is called pericarditis (per--kar-Oi-tis). Heart Wall ‘The wall ofthe heart (Figure 15.23) is composed of tree layers epicardium (external layer), myocardium (middle aye), and endocar 2. The forcefulness of contraction of individual ventricular mus- le ibers. Even ata constant depree stretch, the beartcan con tract more or les forefuly when certain substances ae present Stimulation ofthe sympathetie division ofthe autonomic nervous £ystem (ANS), hormones such 3 epinephrine and noepinephine, ‘increased Ca level the Intersil fui, and the drug diptls all increase the force of eontraction of cardiac muscle ier. In Contrast, inhibition ofthe sympathetic division ofthe ANS, anowa, acidosis, some anesthetics, and increased Kleven the extrac. lular lid decrease contraction fore ‘The pressure required to eject blood from the ventrices. The semilunarvalves open and ejection of blood rom te heart begins ‘when pressure nthe right vente exceeds the pressure inthe pul- monary rank and when the pressue inthe le entice exceeds the pressure inthe arta, When therequied pressure shigher than normal the valves pen later than normal, stoke volume dcreses, ‘and more blood remain nthe ventricles a the end of stole [¥ Clinical Connection Congestive Heart Failure In congestive heart fllure (CHF), the her i fang pum. k pumps blood ess ae less effectively, leaving more blood inthe ventricles atthe ‘end ofeach eye. The result i 9 polve feedback cyl: Less-fective pumping leads to even lower pumping capability Oten, one side ofthe heart stats to al before the other. the le venti fl rst, cant ump otal the blood it receives, and blood backs up in the lungs: The results pulmonary edema, uid accumulation inthe lungs that can ead ‘to suffocation I thei ventric isis, blend back up inthe temic blood vessels. in this case, the resulting perpherof edema is usually ‘most noticeable a sweling ithe fet and ankles. Common causes of ‘CAF are coronary artery disease longterm high Blood pressure, myocar Gjmpathetieand parasympathetic branches ofthe ANS (Figure 15.) 6 Cort oornt 308 ‘sing ram the CV center are sympathetic neurons that reach the heart via cordioe accelerotor nerve. They innervate the conduction system, ara, and ventricles. The novepinephvine released by cardiac ‘accelerator nerves increases the heart rate. Also arising from the CV Center are parasympathetic neurons that reach the heart via the vogus {@) nerves. these parasympathetic neurons extend tothe conduction system and aria, The neurotransmitter they release acetycholine (ACh) —decreases the heart rate by slowing the pacemaking activity of the SAnode. ‘Several typesof sensory receptors provide input tothe cardiovas cular center. For example, baroreceptors boro: ~ pressure), neurons sensitive to blood pressure changes, are strategically located in the arch ofthe aorta and carotid arteries (arteries in the neck that supply blood tothe brain. f there is a increase in blood pressure, the ba- roreceptors send nerve impulses along sensory neurons that are part of the glossopharyngeal (0X) and vagus (1) nerves to the CV center (Figure 15.9), The cardiovascular center responds by putting out ‘more nerve impulses along the parasympathetic (motor) neurons that are alzo part ofthe vagus (0) nerves and by decreasing cardiac accelerator output. The resulting decrease in heat rate lowers cardiac ‘output and thus lowers blood pressure. fblood pressure alls, barore- ceptors do net stimulate the cardiovascular center, Asa result ofthis lack of stimulation, heart rate increases, cardiac output increases, ‘and blood pressure increases tothe normal level Chemoreceptors, ‘neurons sensitive to chemical changesin the blood, detec changesin ‘blood levels f chemicals such as Oy, CO, and H”. Their relationship ‘tothe cardiovascular centerisconsideredin Chapter 16 with regard to blood pressure (see Section 16.2). Chemical Regulation of HeartRate certainchemicals influence both the basic physiology of cardiac muscle ands ate of contraction. chemicals with major effets on the heart fall nto one of | wo categories: Hormones, Epinephrine and norepinephrine (rom the adrenal rmedulle) enhance the heart's pumping effectiveness by increas- ing both heart rate and contraction force. Exercise, stress, and excitement cause the adrenal medulla to release more hormones. ‘Thyroid hormones alo increase heart rate. One sign of hyperthy- roidism (excessive levels of thyroid hormone) is tachycardia (ele vated resting heart ate). 2. tons. Elevatedblood levels of” ora” decreaseheartrateand.con- traction force. A moderate increase in extracellular and intracellular Ca level increases heartrate and contraction force. Other Factors in Heart Rate Regulation Age, gender, physical fines, and body temperature als influence resting heart rate. A newborn baby i likely to havea resting heat rate over 120 beats per minute; the rat then declines throughout childhood to the adult level of 75 beats per minute. Adut females generally have slightly higher esting heart rates than adult males, although regular ‘exercise tends to bring resting heart rate downin both sexes. As adults ge theicheat rates may increase Increased body temperature, such as occurs during fever or strenuous exercise, increases heart rate by causing the SA node to Scanned with CamScanner 364 CHAPTER 15 Theater ter Het FEERITEEEY tenon nervous sytem equation of heartrate- paranmpattinerves that enerite the eat The croatia center nthe mesula blngata conwos bon syratatc ard Spina ond Key: Sensory neurons anor <— sympanetcneres pacympatete renee > Inareh of ora What effect does acetylcholine, released by parasympatheticnerves, have on heart rate? lischarge more rapidly Decreased body temperature decreases heart ‘ate and free of contraction. During surgical repair of certain heart abnormalities it is helpful to slow a patients heart rate by deliber- ately cooling the body. Checkpoint 12, Desriba how stroke volume felted 13, How doestheautonomienenous system hep regulate hea ate? [157] Exercise and the Heart OBJECTIVE + Explain the relationship between exercise and the heat. ‘person's cardiovascular fitness canbe improved at any age with eg- ular exercise, Some types of exercise are more effective than others for improving the helt of the cardiovascular system, Aerob exercise, ‘any activity that works large body muscles for atleast 20 minutes, elevates cardiac output and accelerates metabolic rat. Three to five such sessions a week are usually recommended for improving the heath ofthe cardiovascular system. risk walking, runing bieyling, ‘ros-county sing and swimmingare examples of aerobic activites. Sustained exercise increases the oxygen demand ofthe muscles. ‘Winether the demand is met depends mainly onthe adequacy of ar- ac output and proper functioning ofthe respiratory system. Aer several weeks of taining, a healthy personincreeses maximal cardiac ‘output (the amount of blood ejected from the ventricles into there spective arteries per minute, thereby increasing the maximal rate of caygen delivery to the tissues. Onygen delvery aso rises because sheletal muscles develop more capilary networks in response to longterm taining. During strenuous activity, a welltrained athlete can achieve a cardiac output double that ofa sedentary person, in part because traning causes hypertrophy (enlargement) ofthe heart. This condi- tionisreerredtoas physiological cardiomegaly kar -dé-5 MEG-alé; ‘mega-= lage). Apathological cardiomegaly is elated to significant ‘heart disease. Eventhough theheartofa well-trained athletes larger, tasting cariac output is about the same asin a healthy untrained Scanned with CamScanner Person, because stroke velume (volume of blood pumped by each beat ofa ventricle) is increased while ear rateis decreased. The rest: ing heartrate of trained athlete ote is only 40-60 beats permite (esting bradycardia). Regular exercise also helps to reduce blood ‘ressure, anxiety, and depression; control weight; and increase the body's abit to lssolve blood clots. Checkpoint 14, whais aerobic errs? vy ae aerobic evercses beef? ‘The heart isthe blood pump forthe cardiovascular system, but its the blood vessels that distribute Blood to all parts of the body and collect blood from ther. the next cater we will ee how blood esses accomplish this essential task Common Disorders Myocardial Ischemia and Infarction Paria obstruction of blood flow in the coronary arteries may cause ‘myocardial ischemia s-KE-mé-3;sche-= toobstuct;-emio =inthe blood), a condition of reduced blood flow to the myocardium. Usu- ‘aly ischemia causes hypoxia (reduced oxygen supply), which may ‘weaken els without king them. Angin pectoris (asin or AN ra PEK), which erally means “strangled chest” isa severe ‘ain that usually accompanies myocardial ischemia. Typical, suffer ets describe it as a tightness or squeezing sensation, as though the chest wereina vise. The pin associated with angina pectrisisoften ‘refered tothe nec, chin, or down the let arm to the elbow. silent ‘myocardial ischemia, ischemic episodes without pain Ispartcularty dangerous because the person has no forewarning of an impending heart attack. ‘complete obstruction to blood flow ina coronary artery may result in a myocardial infarction (MI) (infARK-shen}, commonly called a hear attack. Infection means the death ofan area of tissue because of interrupted blood supply, Because the heart tsue cstal to the obstruction dies and is replaced by noncontrctlescartisue, the heart muscle loses some ofits strength, Depending on the size and location ofthe infarcted (dead) area an infarction may disrupt the conduction system of he heart and cause sudden death by ti: Bering ventricular fibilation, Treatment for 2 myocardial infarction ‘may involve injection ofa thrombalytc(clot-disolvng) agent such 25, streptokinase oA, pls heparin on anticoagulant), or performing coronary angoplasty or coronary artery bypas grafting Fortunately, heart muscle can remain aliveina resting person fitrecevesas ite 35 10t0 15% ofits normal blood supply. Congenital Defects A defect that exists at bit and usually before) sa congenital defect. ‘Among the several congenital defects that affect the heart are the following + Inpatent ductus ortrisus (PDA) the ducts arteriosus temporary blood vessel) between the 2ora andthe pulmonary trunk, which Scanned with CamScanner normaly closes shorty ake bith remains open (se Figure 16.17. ‘Closure ofthe ductus arteriosus leaves a remnant called the igaren ‘um arteriosum (ee Figure 15.33). + Arial septol defect (ASD) i caused by incomplete closure of the intertrial septum, The most common type involves the foramen ‘ovale, which normaly loss shortly after bith (see Figure 16.17) + Ventriewlarseptol defect (v8) is caused by an incomplete closure ofthe interventricular septum, + Valwiar stenosis anarroningofon ofthe ales associated with blood flow through the heart. + Tetralogy of Fallot (tet RAL} offal.) is 2 combination of four defects an interventricular septal defect, an aorta that emerges ‘rom beth entrlesinsteadof tom theleftventrle only, anarrowed pulmonary semilunae vale, and an enlarged right ventricle. Some congenital heart defects are being surgically corected prior to birth inorder to prevent complications atthe ime of birth or following the bith of n infor. Arrhythmias “The usual hythm of heartbeats, established by the SA nodes called ‘norm sinus rhythm, The term arthytheaa-RITH-mé-8;¢- = wth ‘ut) or dysrhythmia refers to an abnormal rythm as a result ofa defect in the conduction syst ofthe heart. The heart may best imegulny, t0 fat, of t00 slowly. Symptoms include chest pain, shortness ofbreath lightheadedness, izinss, and fainting. Arhyth- rmiasmay be caused by factors that stimulate the heat, suchasstres, ‘afeine,alohol, nicotine, cocaine, and certain drugs that contain ‘afeine or other stimulant, Arrhythmias may also be caused by 2 Congenital defect, coronary artery disease, myocardial infarction, hypertension, defective heat valves, rheumatic heat disease, hyper ‘hyroidism, and potassium deficiency. Following are some types of arrhythmias: + Supraventrcuor tachycordla (SVT) is 3 rapid but regular heart rate(160-200 beats per minute) that originatsin the ara. The ep- sodes begin and end suddenly and may ast fom afew minutes to ‘many hours. «+ Heart lockis an arrhythmia that occurs when the electrical path ways between the atria and ventricles are blocked, slowing the 366 CHAPTER 1S Tecardovaedar Str Heat transmission of neve impulses. The most common st of block ages the atioventrcuar node, a condition called avioventrcular (Av block + Atrial premature controction (APC) isa heartbeat that occurs ea ler than expected and briefly interrupts the normal heart rhythm. It ‘often causes a sensation of a skipped heartbeat followed bya more forceful heartbeat APCS originate inthe atrial myocardium and are ‘commen in healthy individuals + Atrio Mutter consist of rapid, regular arial contractions (240-360, beats/min) accompanied by an atrioventricular (AW) block which some ofthe nerve impulses from the SA node are not conducted ‘through the AV node. + Atrial fibrillation (AF) is @ commen arhythmia, affecting mostly ‘older adults, in which contraction ofthe ata fibers is asynchro ous (not in unison) so that atrial pumping ceases altogether. The atria may beat 30010600 beats per minute The ventricles may also speed up, resulting na rapid heartbeat (upto 160 beats/min). + Ventriculor premature contraction (VC). Another form of arhyth mia arises when an ectopic focus (eTOPAK) a region ofthe heart other than the conduction system, becomes more excitable than rormal and causes an occasional abnormal action potential to oc- Cut As a wave of depolarization spreads outward from the ectopic focus, it causes a ventricular premature controction (beat). The ‘contraction occurs early in diastole before the SA node is normally Scheduled to discharge its action potential. Ventricular premature contractions may be relatively benign and may be caused by emo- tonal stress, excessive intake of stimulants such as cafine, alcoho, cr ricoting, and lack of sep. tn other caves, the premature beats ‘may elect an underhying pathology + Ventrlelartachycerdia (VT oe Wtoch) isan aerthnia that rates inthe vertrcles and is characterized by four or more ventric lar premature contraction. lt eauses the ventricles to Beat 100 fast (atleset 120 beats/min. VT is slmost always associated with heat ‘disease ofa recent myocardial infarction and may develo ito 2 very serious arrhythmia called ventricular fibrilation (described ‘shorty, Sustained V1 i dangerous because the ventricles donot fil properly and thus donot pump sufficient blood, The result may below blood pressure and hear faire + Vontriculr Mbilation (VF or Wb) isthe most deadly arhythmis, In which contractions of the ventricular bers are completely asynchronous so thatthe ventricles quiver rather than contact n 2 coordinated way. Asa result, ventricular pumping stops, blood jection ceases, and circulatory failure and death occur unless there is immediate medical intervention, Ventricular fibilation ‘causes unconsciousness in seconds and, if untreated, seizures occur and irreversible brain damage may cur afer ive minutes. Death soon follows. Treatment involves cardiopulmonary resus Citation (CPR) and defibrillation. In defibrilation (46-b-r-Uk- shun), also called cardioversion (kar-4é-6-VER-shun), a strong, brief electrical currents passed tothe heart and often can stop the ventricular fibrillation. The electrical shock is generated by 2 device called a defibrilltor(de-I8--i-or) and applied via two large paddle shaped electrodes pressed against the skin of the chest Medical Terminology and Conditions ‘Anpocardlography (on j-Skar’-d6 06-6; ang0-= vessel cardi: = ‘hea %ay examination of the hear and gest blood vsels ater ire. tlon of raiopaque dye iniothe bloodstream. Asystole($-SISto:8;¢-= witha). Fae ofthe myocaréum to conract Cardia arrest KAR 8.9 REST) Aclnial term meaning cessation of “an effective heanbeat he here may be completely topped ora ver- tricular fiilation, Cardia catheterization hath-eterihshun) Procedure tats used to sole the heats coronary arteries, chambers valves and get vss Iemay also be used to measure pressre inthe heat ad blood vessel to acces care outpt and to meas the fw of blod through the beat ‘and blood vest, the rygen content ef Blaod, and the status ofthe ear valves and conductionsjten. The bas procedure nohesinsertingacath ‘eter ito a perperal vein for right hear catheeration or aero et heart catheterization) and gusing it under forescopy era obser) (Cardiac rehabilitation a-i--TAshun) Asuporised progam of pro gressive exercise, psychological suppor, education andtavingtoenables patient to resume normal atts folowing myocardial inreion Cardlomegaly iar 5-MEG-248:mego- larg) Heart enlarger Cor pulmonale (CP)(KORPuLmint;cr-= hearpulman tung) ight ventricular hypertopty caused by hypertension (igh bloodpressure in the pulmonary circulation. ndocardts (ed0-ar. 0) nlammaton of he endocardium tht ‘ypc involves th heart ales. ost cases are caused bacteria ba tealendcarts. Myocarditis Stars) tnlammaton ofthe myocardium tatu allyocurs a a complication of vl infection rheumatic fever, or exo: furetoraation or certsin chris or mediators. Papltatlon (palpi thshun) A tering ofthe heart or abnormal ate corchythmofthe heat. Paroxysmal tachycardia (par-ok S12. ak-¢KAR--) A period of rapid heartbeats that begins and ends suddeny. Rheumatic fever (coMAT:A)_ An acute systemic inflammatory disease ‘hat usualy cus aera sueptocccal infection ofthe throat. Te bac tea tiger animmune response inwhich antibodies that are produced to destroy the bacteria attack and inflmethe connective tisut ia ois, hear valves, and ther organs. ven though heumaticfever may weaken ‘theentrehear wall most en tdamagesthe bicuspid (mira andaonic vals Sudden cardiac death The unexpected casation of circulation and breathing due tosnunderjing heart lseasesuchasischemia, myocarcat infarction, ora dstrbarce in catia ehythm. Scanned with CamScanner Carerteten 361 Chapter Review Review 15.1 Structure and Organization of the Heart 2. The heart i stusted between the ngs, wh about woes ols mass totheleh ofthe mide. 2. The pericardium const of nose ius ayer Mbrous pererdtam) and an ner serous pericardium. The sou aadium compose of 2 Paietallayer and vcerallayer Swoon he paietal and visceral lyersof the serous percadiom isthe perearalal cavity, spac filed with periar- ‘lal Qui tat eguces ction beeen the wo membranes. 13. The wal ofthe heart has thee ayers: epleardlum, myo ‘endocardium. 4. The chambers include two upper aria and two lower ventricles. ‘5. Te blood flows though the heart fom the supelor ad Inferior venae ‘eavae and the coronary snus tothe ight atrium, trough height ventricle, and though the pulmonary trunk othe lungs. 6. From the lings, blood flows through the pulmonary vein into the lf atrium, through the et ventricle, nd ou though the 2, 7. Four valves prevent the bacllow of blood in the heat AtHoventricula (dy) valves, between the aa and their ventricles, are he tleuspid valve lon the right sie ofthe heat andthe Bleuspid (to) valve onthe et The ativenticulr ves, ehordaetendineae, and theirpaplary muscles sop blood from flowing back nto the stra Each ofthetwo arteries that ave the hearths 2 semitanar valve. 115.2 Blood Flow and Blood Supply of the Heart 4. Blood flows throug the heart from areas of higher pressure to areas of lower pressure. The pressures elated tothe size and volume ofa chamber, 2. The movement of blood through the hearts controll by the opeingand closing ofthe valves andthe contraction and relaxation ofthe myocardium. 13. Coronary (cord) creuatlon delivers ongenated blood tothe myocar ‘ium and removes carbon dioxide from it 4. Deoxygenated blood retursto the right atrium via the coronary sinus. 15.3 Conduction System of the Heart 4. The conduction system consis of specialized cardia muscle tissue thet generates and aistributes action potenti 2. Components of this system ae the sinoatial (SA) node (natural pace- maker), atrioventricular (av) node, atrioventricular (AV) bundle (bundle ‘of ie) bundle branches, and Purkinje ers. Scanned with CamScanner 154 Electrocardiogram 1. the record of lca changes ving each adic cc ferred to aneectrocarlogram (C6). 2 Anoxol ECG cori of P wave (depolarization), QRS complex (onset of vervicula éepolanzaton), and wave vertu repetition, 2. The ECG i used to diagnose abrormal cardiac mytims and conduction pater 15.5 The Cardiac Cycle 1 Acardlac eel const of systole contraction) and asa (lator ce chambers ofthe heart 2. The phase ofthe cardiac cc ae [athe relation pelo, (>) ata "ytol, ano verteeuar systole. 2. A complete cardiac ee takes 08s at an average heartbeat of TS beats ermine. |. The fist heat sound (bb) represents the osing ofthe atrivertriclar Valves. The second sound (dup) represents he closing of seminar aes. 15.6 Cardiac Output 2. cardiac output (Co) i the amount of blood ejected by thei vet int the arta each minute: CO = stoke volume x bess pe minute 2. stroke volume (SV) ithe amout of blood ejected by 2 verre Grin ‘enteulr systole related to stretch onthe hear Before i contract ferauinss of contraction, andthe amount of pressure require to ec blood fromthe vents. 2 Nervous contrl ofthe cardiovascular system originates in he eadiovay ‘ilar (Ev) center inthe medulla oblongata. Sympathetic impuses incre heart rate and force of contraction; parasympathetic impulses decrea ‘Heat ates affected by hormones (epinephrine, norepinephrine, thyry formones), fons (Na, K°, CA"), age, Bender, physical fess, and be temperature. 35.7 Exercise and the Heart 1. Sustained exercise increases oxygen demandon muscle. 2. Among the benef of aerobleexerelse are increased maximal car ‘output, decreased blood pressure, weight contrl, and increased abil dissolve clots, a The Cardiovascular System: Blood The focus of this chapteris blood; the next two chapters will examine the heart and blood vessels, respectively. Blood transports various Substances, helps regulate several life processes, and affords protec- tion against disease For all ofits similarities in origin, composition, {and functions, blood is 35 unique from one person to ancther 25 are skin, bone, and hair Health-car professionals routinely examine and analyze its differences through various blood tests when trying to determine the cause of different diseases. Looking Back to Move Ahead... We] = Blood Tissue section 4.3) + Positive Feedback Systems (Section 1.3) + Phagocytosis (Section 3.3) 14] Functions of Blood OBJECTIVE + List and describe the functions of blood. The cardiovascular system (cord. = heart; vascular = blood or blood vessels) consists of three interrelated components: blood, the heart, and blood vessels. The branch of science concemed with the study of blood, blood forming tissues, and the disorders associated with them is hematology (héma-TOL-6-6; hema- or hemato- = blood; logy = study of) ‘Bloodis aliquid connective tisue that consist ofcells surrounded byextraceliolar matrix. Blood has three general functions: transporta- tion, regulation, and protection. 1. Transportation, Slood transports orygen from the lungs to cells, throughout the body and carbon dioxide (2 waste product of Scanned with CamScanner CHAPTER 14 Q Did you ever wonder how and why blood samples are taken? You can find out in Section 14.2, Clinical Connection: Blood ‘Sampling Procedures and Reasons for Sampling. cellular respiration; see Section 20.1) from the cells to the lungs. It also carries nutrients from the gastrointestinal tract to body) cells, heat and waste products away from cells, and hormones from endocrine glands to other body cels. 12 Regulation, Blood helps regulate the pH of body fluids. The heat: absorbing and coolant properties ofthe water n blood plasma (see ‘Section 2.2) and its variable rate of flow through the skin help ad |ustbody temperature. Blood osmotic pressure also influences the water content feels. 3. Protection, Blood clots (becomes gel-like) in response to ann jury, which protects against its excessive loss from the cardio, vascular system, In addition, white blood cells protect agains, 2 304 CHAPTER 14 Thecorowcalr Sytem: Bact disease by carrying on phagocytosis and producing proteins called antibodies, Blood contains addtional proteins, called interferons and complement, that also help protect against disease, Checkpoint 2. name several substances transported by blood. 2. Hows bod protective 142 Components of Whole Blood ossective + Discuss the formation, components, and functions of whole blood. Blood isdenser and more viscous (thicker) than water. The temper ature of blood is about 38°C (1004F) ts pl is slighty allalin, ranging from 7.35 to 7.45. Blood constitutes about Bf the total ‘body weight. The blood volume is Sto liters (1.5 gal) nan average- sized adult male and 4 to 5 liters (1.2 gal) in an average-sized adult female. The difference in volume is due to differences in body size Whole blood is composed of two portions: (1) blood plasma, ‘liquid extracellolar matrix that contains dissolved substances, ‘and (2) formed elements, which ae cells and cell fragments. If 2 BY components of loadin s normal adult ‘ample of blood is centrifuged (spun at high speed) in small {lass tube, the cells (which are more dense sink to the bottom of the tube and thelighterweight blood plasma (whichistess dense) forms layer on top (Figure 14.28). Blood is about 45% formed clements and 55% platma, Normally, more than 99% of the formed elements are red blood cells (RBCS) since they are the ‘most dense The percentage of total blood volume occupied by ted blood cals is termed the hematocrit (he-MAT--kit). Pale Colorless white blood cells (W8Cs) and platelets occupy less than 1% of total blood volume. They form a very thin Layer, called the bufly coot, between the packed RBCs and blood plasma in cent: fuged blood. Figure 14.1b shows the composition of blood plasma and the numbers of the various types of formed elements in blood Blood Plasma When the formed elements are removed from blood, 9 stram- colored liquid called blood plasma (or simply plasm) remains Plasma is about 81.5% water, 76 proteins, and 1.5% solutes other than proteins Proteins inthe blood, te plasma proteins, ace sy. thesized mainly by the liver. The most plentiful plasma proteins are the elbumins (al -BU-mins), which account for about 54% of all, plasma proteins. Among other Functions, albumins help maintain proper blood osmotic pressure, which isan important facto inthe fexchange of fluids across capillary walls. Globulins (GLOB-O-tns), which compose 38% of plasma proteins, include antibodies, detensive proteins produced during certain immune responses. Fibrinogen (-8RIN-sen) makes up about T% of plasma proteins and is a key protein information of blood clots. Other solutes in plasma include electrolytes, nutrients, gases, regulatory sub- ances such as enzymes and hormones, vitamins, and waste products cals witeblood cl, andpatelets ood isa connective sue thot const of biood plasma qu) pus formed elements: re blood Functions of loed 4, Transpons ong, carbon oxide, tents hormones, heat, and wastes 2 Regulates pt, body temperature, and watercontemof cel. 23, Protects pant blood oss ‘roushclting and apsinst deena through phopocyticwhite Dood eels andpotenssuchas antbodies meters, and complement — Blood psa (55%) = Buty coat, composed of ‘hile ood cll Red bood els nd platelets aes) (a) Aopearance of cantehged blo Scanned with CamScanner ‘BLOOD PLASMA 7 on ther de ‘andtiaves, oe FORMED ELEMENTS 2 Components tele iad 335, esa et Ateomina $s — EZ trans 20 ee enone 7 we i cere 1% y emcvorpee tarts ance egatory cme Onerschie aad cao 1 , sures BLOOD PLASMA weight) = ‘WHITE BLOOD CELLS 15000-1000 we FORMED ELEWENTS WHITE BLOOD CELLS ‘tuber perl) (©) Componetso io Q Which formed elements of blood are most numerous? Formed Elements ‘The formed elements ofthe blood are the following sce Figure 14.2): 1. Red blood cells erythrocytes) 1M, White blood cells (leukocytes) [A Granular leukocytes (contain conspicuous granules that are visible undera light microscope after staining) 4, Neutrophils 2. Eosinophils 3. Basophis 1B, Agranular leukocytes (no granules are vsibleunder alight mi- croscope after staining) 4 Tand B yimphocytes and natural kilr cells 2, Monocytes Platelets Scanned with CamScanner Formation of Blood Cells the process by which the formed elements of blood develop is called hemopoiesis (hém-3- ‘oysis;-poiesls = making), also called hematopoiesis. Before birth, hhemopoiess fist occurs in the yolk sac of an embryo and later in the liver, spleen, thymus, and lymph nodes of a fetus. In the last three ‘months before bith, red bone marrow becomes the primary site of Ihemopoiesis and continues as thesource of blood cells afte birth and throughout if. Red bone marrow is a highly vascularized connective tissue located in the microscopic spaces between trabeculae of spongy bone tissue tis present chiefly in bones ofthe axial skeleton, pectoral and pelvic gidles, and the proximal epiphyses of the humerus and femur, About 0.05-0.1%4f red bone marrow cells are cells called plur. ‘potent stem cells (pioo-R-po-tent;plr- = several). Plripatent stem calls are cells that have the capacity to develop into many diffrent types of cells (Figure 14.22), 4386 CHAPTER 14 Thecorionascular Systeme lod In response to stimulation by specific hormones, pluripotent stem cals gnerate two other types of stem cells, which have the ca- pacty to develop into fewer types of cel: myelold stem cells and ‘ymphold stem cells (Figure 14.23). Myeloid stem cels begin their @09@ o [Rasies] | [Eeseoont] [Beso] [Revronl] Lint toot ote —— | L_‘rnte bonsai Tara te ot (a) vgn otto0d cal tom ppt stom cls Scanned with CamScanner 2 sate nelRon Vey Eosrepn Bescon pOo™ Byes Gr 6 reece, eSbon 208" 0.9 ae 355 9 ‘09 ea con aie wt Turcon: nonce) Coury pioaenomcunventyel eae EY Uymenooge (@) Protomerogaps Monoevie What percentage of body weight is made up of blood? large surface area forthe diffusion of gas molecules into and out of an RBC. ‘The percentage of total blood volume occupied by RBCs called the hematocrit (bé-MAT.S-th; a hematocrit of 40 indicates that 4096 ofthe volume of blood is composed of RBCs, The normal range ‘of hematocrit fr adult females is 38-468 (average = 42) for adult males, itis 40-54% (average = 47).A significant drop in hematocrit indicates anemia, a lowerthan-normal number of RBCS. In poly ‘eythemia (pol’-€-s-THE mé-2) the percentage of RECS is abnormally high, and the hematocrit may be 65% or higher. This rises the vis~ cosity of blood, which increases the resistance to flow and makes the blood more difficult forthe heart to pur. Increased viscosity also contributes thigh blood pressure andincreasedrskofstroke. Causes (of polyeythemia include abnormal increases in RBC production, Scanned with CamScanner 2 component tissue hypora, dehydration, or blood doping by athletes (described later. ROC LIFE CrELE Red blood cals ve only about 120 days because of wear and tear on ther plasma membranes as they squeeze through blood capillaries. Worn-out red blood calls are removed from crcl mn as follows (Figure 14.3): © sacrophopes inthe spleen, ver, and red bone marow phage: ‘jtiae ruptured and worn-out red bod cls, splitting apart the heme and obi portion of hemeglobin. © The rotenglobinis roken down nto amino acids whichcan be reused by body eas to synthesize ther proteins {© ton removed trom the here portion assccates withthe plasma protein transfer (tras-FER; tons ~ across fer = ior, wich acts a transporter © The ion-transterin complex i then cated to red bone marrow, were RC precursor calls we Rin bemoglbin synthesis rons needed forthe heme potion of the hemoglobin melecle, and “ino acids ae needed for he globin portion Vitamin Bis aso neededtorsythesisefhemeslobin.(Thelningofthe stomach must broduce a protein eal inte fcr for absorption of etary ‘tain, rom the Glvactinto the bod) © Entvopoiss in red bone marrow resus inthe production of redbload cel which enter the circulation. © When iron is removed from heme, the nomiton portion of heme is converted to blverdin (i-VERdin, a gren pigment, and then into blrubin(i--ROO-in), a yelow-orange pigment. lirbin enters the blood and is transported tothe iver. Within the live blrubin secreted by Iver ellsinto bl, which pases into the smalintesin and then nt the large intestine, © intntargeintesine baceriaconvertbilubininto urobilinogen (Gea-brLIN-ajen) Some uobinagenis absorbed back nt the blood, converted ta yellow pigment called urobilin (urn), and excreted in rine, Host urbilnogen is eliminated in feces in the form ofa brown pigment called streobilin (str -K0-8-in), ih ves fecesits characterisccolor. ‘Because fre ion ions bind to and damage molecules in cells or in the blood, tranterrin acts 2s a protective “protein escort” during transportof iron fons. Asa result, plasma contains virtually no freeiron, [RBC PRODUCTION. The formation of blood cells in general is called hhemopoiess; the formation of just RACS is termed erythropolesis (esith’r8-poy--sis) Near the end of enthropoess, an RBC precursor jects its nucleus and becomes reticulocyte (re-TIKo-0sitseeFig- ture 14.22), Loss the nucleus causes the center ofthe cell to indent, producing the RBCs distinctive biconcave shape. Reticulocytes, Uwbich are about 348 hemoglobin and retain some mitochondria, ribosomes, and endoplasmic reticulum, pass fom red bone marrow into the bloodstream. Reticulocytes usualy develop into mature BCs within to 2 days after their release from bone marrow. Normally, erythropoiesis and destruction of RBCs proceed at the same pace. Ifthe oxygen-carrying capacity ofthe blood falls 338 CHAPTER 14 Mecardonaelr Stem: ond (DIEIITETEE Formation and detrcton of ed bood cls, and the recyting ot hemeogcbin unre @ What substanceis responsible for the brown color of feces? because erythropoiesis is not keeping up with RBC destruction, BC production increases (Figure 14.4) The contelled condition inthis particular negative feedback loop is the amount of oxygen delivered to the kidneys (and thus to body tssues in general) Hypoxia hi-POKS-€-2), a deficiency of oxygen, stimulates increased release of erythropoletin (EPO) (eith'r0-POY-e-tin}, a hormone ‘made by the kidneys. EPO circulates through the blood tothe red bbone marrow, where it stimulates erythropoiesis. The larger the 01 RC oration redone marow equasterate of ROC destruction macophoprs ‘numberof RECsin the blood, the higher the oxygen delivery tothe tissues (Figure 14.4). A person with prolonged hypoxia. may

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