BODYFLUI

DSANDCI
RCULATI
ON
Def
ini
ti
on-Bl
oodi
sanopaquesl
ight
lyal
kal
iner
eddi
shcol
our
edv
iscousf
lui
dconnect
ive
ti
ssuewherev ar
iousty
pesofcorpuscl
esaresuspendedi
nthef
lui
dmat
ri
x(Pl
asma)and
ci
rcul
atedt
hroughthebl
oodvessel
sandhear
t.

Bl
oodmaybedef
inedasmesoder
malor
igi
n,mobi
lef
lui
dconnect
ivet
issue.

 Whybl
oodi
scal
ledaconnect
ivet
issue?

(i
)Ast heconnect ivetissueint heembr yoorigi
natesf r
om mesoder mall ay er,si
mi l
arlythe
bloodisalsoorigi
natedf r
om themesoder mallayer.
(i
i)Asinconnectivetissuet heint ercell
ular
fl
uidismor ethant hecel l
ularpart,simil
arlyinbloodt heplasma( i
ntercell
ularf l
uid)i smor e
(55%)thanthecellularpart(corpuscles)(45%).(i
ii
)Ast hereisnobasementmembr anei nthe
connecti
vet i
ssue,similarl
ynobasementmembr anei salsopresentint hebl ood.( i
v )Ast he
connecti
vet i
ssueconnect sdifferentpar t
soft hebody ,simil
arl
ybl ood byi tsci rculati
on
connectsdiff
erentorgansanddi f
ferentpartsofthebody .

React
ionofbl
ood:Bl
oodi
sanal
kal
inef
lui
d.I
tspHi
s7-
4.

Buff
erofblood:Buf
feristhechemicalcompoundsthatcanconv ertstr
ongacidsorbasesint
o
weakones.Thebufferofbloodare(i
)Bicarbonat
ebuff
er-f
ormedbyt hehydrol
ysi
sofcarboni
c
aci
dintowaterandbufferbicar
bonate.(
ii
)Haemoglobi
npr esentinRBC.(i
ii)Bl
oodprotei
nand
phosphat
e,etc.

[1]Erythrocytes:(i
)Tr anspor
tofoxy gen-Er
ythrocy
tescarryhugeamountofoxy genfrom
l
ungsi svariousthetissuecell
sasoxy haemoglobincomplex.
( i
i)Tr
ansportofcar
bondioxide-
Eryt
hrocytes carrya mi nute amountofcar bon dioxi
de from tissue cel
lstothe lungs.
(i
i)Maintenanceofaci d-basebalance-
Eryt
hrocyteswit
hthehaemogl obi
nconsti
tut
eabuf fer
syst
em whi chmai nt
ainst hepHbalanceoftheblood.

[2]Leucocy t
es:(a)Def ensiveaction( 1)Phagocy t
osi s:Neut rophi l
sandMonocy tesdef endt he
bodyf rom infecti
onsbyengul f
ingt heinvadedmi cro-or ganisms.Theyal sophagocy t
izet he
dead cel l
st o prot ectt hebody .(i
)Ant ial
lergi
cact i
on- Eosinophi lsdetoxif
yt hei nf
lamat ion
i
nduci ngsubst ancesandt oxi
nsr eleasedbymi crobs.Theyal soi nhibi
ttheall
ergicreact i
ons.
Thel argepar asiteswhi char et oobi gt ophagocy t
ized,eosi nophilskil
lthem byr eleasing
l
y sosomesandot herchemi cal
s.(i
i)Ant i
bodypr oduct i
onLy mphocy tesareresponsibl
ef orthe
product i
onofant ibodi esint hebody .Theyar eal sor esponsi blef orthedevelopmentofcel l
medi atedandhumor alimmuni t
yoft hebody .Prev ent iv
eact i
on- Heparinsecreti
on:Basophi l
s
sy nt
hesisandsecr etet hi
sant i
coagulantwhi chprev entsi ntr
av ascularbloodclott
ing

[
3] Platelet
s: (a) Blood Coagul
ati
on-I
ft he pl
atel
ets are di
sint
regated,they li
berate
t
hrombopl asti
n(Pl
atel
etfactor
.(
b)Clotretr
acti
on:Plat
elet
ssecretefibr
in-st
abi
li
zing f
actor
whichhelpsinretr
acti
onofclott
edblood.
PLASMA-

(
a)Def
ini
ti
on:Theplasmaisafai
ntyel
low,
sli
ght
lyal
kali
ne,
fibr
eless,
viscousi
nter
cel
lul
arf
lui
d
mat
ri
xinwhichthebloodcor
puscl
esremai
nsuspended.

(b)Functi
onsofPlasma:(i
)Plasmaactsasr eser
verofprot
einsoftheti
ssuecel
ls.(
ii
)Plasma
servesasacid-
basebuffersandmai nt
ainsthepHoftheblood.(i
ii
)Pl
asmat r
anspor
tsvarious
essenti
alaswellaswast emat er
ial
sandgases.(iv
)Plasmapl ay
sani mport
antrol
einblood
coagulat
ionandprevent
stheexcessivelossofbl
ood.

 Adv
ant
ageofabsenceofnucl
eusi
nRBC

Inhuman( mammal ian)RBC,t heabsenceofnucl eusi sofgr eatadv antage.Absenceof

nucleus,theci
rcularRBCbecomebi concaveinshape.Thi sbiconcaveshapemakesmany
advantagessuch as-( i)to accommodat e mor e haemogl obi
n.( i
i)Itallowsconsi der
able
alt
erati
oncellvolumewi t
houtincreasingtensi
onoft hecellmembr ane.(ii
i)Ital
lowseasy
fol
dingofRBCwheni tpassthrought henarr
owcapi l
lari
eswhichisofshor t
erdiameterthan
RBC.

BLOODGROUPS:ABOSy
stem

(a)Defi
nit
ion:Thecl
assi
fi
cat
ionofbl
oodofdi
ff
erenti
ndi
vi
dual
sont
hebasi
soft
heant
igeni
c
natur
eofther edbl
oodcel
lsi
stermedasbl
oodgroup.

Si
gni
fi
canceofbl
oodgr
oup-
-

1.
Toav
oidr
eact
ionsduet
oincompat
ibl
etr
ansf
usi
ons,
thebl
oodgr
oupmustbedet
ermi
ned.

2.St
udyofbl
oodgr
oupshast
hrownl
ighti
ntot
her
emot
easwel
lasr
ecentor
igi
nofman.

3.Forestabl
ishmentofi
denti
tyofasubj
ectbl
oodgroupi
ngissomet
imeshel
pful
.Thi
sist
aken
advantageofintraci
ngmissi
ngbabiesi
namat er
nit
yward.

Erythroblastosi
sf oetal
is:Itisahemol yti
cdi seaseoft hefoetusandnew bor nbaby .Itis
charact er
ized byaggl utinat
ion ofRBCs f ol
lowed byhemol ysisand appear
ence ofl arge
number sofnucl eatedRBCsi nthebl
ood.Er ythrobl
ast
osisfoetal
ismainl
yoccur s,whent he
mot heri sRh- veandf oetusisinher
it
edRh+v ef r
om thefather
,thentheantigen-
Doft he
foetussl owlyinducedt heanti-
Rhantibodiesi nthemot her
'sblood.Thisanti
bodieseasi l
y
crosst heplacentabydi ffusi
onandhemol yzetheRBCsoff oetusornewlybornbaby.
COAGULATI
ONOFBLOOD-

(a)Def
ini
ti
on:The physio-
chemicalpr
ocess whi
ch tr
ansf
ormed t
he f
lui
d bl
ood i
ntoa
semi
sol
idj
ell
y-l
ikemass,
iscall
edcoagul
ati
onorcl
ott
ingofbl
ood.

(b)Mechani
sm ofbloodcoagul
ati
on:Accordingt othemoder nconcept,coagul
ati
onofbl
ood
i
sacascadeofenzy meacti
vechemi calreactions.Whereoncet heinacti
veenzymesof
plasmaareact
ivat
ed,hosei
nturnact
ivetheot herinact
iveenzymes.

Thewhol
epr
ocesst
akespl
acei
nthr
eemaj
orst
eps:

[1]Format i
onofPr ot
hrombi nactivat
or(1ststep):Prot
hrombi
n act i
vatorisami xt
ureof
protei
n,phospholi
pidandCai on.I
tiscall
edprothr
ombinaseorthromboki nase.Nor
mallyitis
notpresentinthebloodv esselsorfort
hecontactofbl
oodwi t
hextravasculardamagedtissue
elements,iscal
ledextr
insicblood.I
tcanbef or
medbyt hetwodif
ferentpat hways-

Ext ri
nsicandIntri
nsi
cpat hways.Whent hepr othr
ombi nactiv
atorformat i
oni ni
tiatedforthe
rupt ur
eofbl oodv esselsorf ort hecont actofbloodwi thextrav asculardamagedt i
ssue
element s,iscal
ledextrinsicpathway .Wher eas,whent hepr ot
hrombi nact i
vatorf or
mat i
on
i
nit i
atedfordamagedbl oodcel l
s(platel
ets)orcontactofbloodwithcollagenandr oughwat er
wet tablesurf
aces,iscalledintri
nsicpathway .Theprothr
ombi nacti
v at
orf ormedi next r
insic
pat hwaycont ai
nst i
ssuet hr
ombopl asti
n( fact
orI I
I)
,acti
v efactorV , acti
vef actorX and
2+
Ca ( f
actorI
V).

[2]Formati
onofThrombi
n from Prothr
ombin( f
act
orII
)(2ndstep)
:Pr ot
hrombi
nacti
vat
or
whichisf
ormedintwodif
fer
entpathways,wit
hinafewseconds,i
npresenceofCaspl
it
sthe
plasmaprot
einpr
othr
ombin(
fact
orII)i
ntothr
ombin.

[3]For mat i
onofFi bri
nf r
om Fi bri
nogen( Fact
orI)( 3rdstep):Final
ly,thrombin( I
la)actson
fibrinogenpr otei
nandconv ertsitintosolublefibri
nmonomer .Fibrinmonomer shav ethe
aut omat i
ccapabi l
it
yt opolymer i
zewi t
heachot herandf ormf i
bri
npol ymer sori
nsol ubl
efibri
n
fibres.Initi
all
y,thenewl yf ormedf ibr
inpolymersar ev er
yweak,notcr oss-
li
nkedwi t
heach
ot herbutwi t
hinaf ewmi nutest heyarecrossli
nkedandconv ertedintoadense, rigi
d, i
nsolubl
e
ret i
culum bytheact ivat
edf i
brin-stabil
izi
ngfactor(XII
Ia).Allbl
oodcor puscles,l
argepr otei
ns
oft hebl oodgetent r
appedi nthef i
bri
nmesh- workandar edgl l
ati
nusmass( clot)isformed.
RBCFi brinstr
ands

Benef
ici
alaspect
sorSi
gni
fi
canceofbl
oodcoagul
ati
on:

(i
)Coagulati
onstopshaemor r
hage,Whenbleedingoccurs,t
hesheddedbloodcoagulat
esand
thevesselsgetpluggedoffbyt hecl
ot.Retr
actionofclotcompressestheruptur
edvessel
s
fur
therandstopsbleedi
ng.(i
i)Coagul
ati
onblockst heent
ryofger
mst hroughthewounds.(
ii
i)
Coagulat
ionhelpsinmaint
ainingnor
malbloodvol ume.
Extr
avascul
arclot
ti
ngThepr ocessofbl
oodclot
ti
ngout
sidet
her
upt
uredbl
oodv
essel
sis
knownasextrav
ascul
arcl
ott
ingorcoagul
ati
on.

Intr
avascularcl
ott
ingorthrombosisTheprocessofbloodclott
ingi
nsi
detheunbrokenblood
vessel(usuall
yinv ei
n)iscal
ledthrombosi
se.g..coronaryt
hrombosi
s(f
or mat
ionofclotor
plug withi
n coronary art
ery
).The clotitselfis call
ed thr
ombus which may dissol
ve
spontaneously.

Thr
ombosis-Thepr ocessbywhi chabloodclotknownast
hrombusi
sfor
medwi
thi
nthe
bl
oodvessel(
int
rav
ascularcl
ott
ing)i
scal
ledt
hrombosis

Ant
icoagul
ant
s:

(
a)Def i
nit
ion:Thechemicalsubst
anceswhichi
nhi
bitbl
oodcoagul
ati
onandmai
ntai
nthe
l
iqui
dit
yofblood,ar
eknownasant i
coagul
ant
s.

(b) Types-- Ant

icoagul
ants ar et wo t
ype - Natural ar
e Hepar
in,Hirudi
n. Ar
ti
cif
ical
anti
coagulant
s ar e ant
icoagulant
s sodi
um citrat
e,potassium ci
tr
ate,sodi
um oxalate,
potassi
um oxalat
e,EDTA( et
hylenediami
netet
raacet
icaci
d)

WhyNa-
cit
rat
epr
efer
redmor
esui
tabl
eant
icoagul
anti
nbl
oodbank?

Na-citr
ateisoft
enusedi nthebloodbankasant i
coagul
antt okeepthebloodi nli
qui
dstate.
Thesodi um ci
trater
eactswithCa2+i nvbl
oodplasmatof orminsolublecalci
um ci
tr
ateand
therebyremovet hei
oniccal
cium (Ca2+)from t
heblood.InabsenceofCa2+coagul ati
onof
blooddoesnott akepl
aceInbloodbanksthestor
edbloodwhent ransfer
redintoapati
entt
hen
thecitr
ateiseasil
ymetaboli
zedthroughTCAcycl
eintherecipi
ent'
sbodycausi ngnoharm.

I
mpor
tanceorSi
gni
fi
canceofant
icoagul
ant
:

Thosepat i
entwhoar eatincr
easedriskofformingbloodclotsmayreceiveanti
coagul
ants.
Examplesar eheparin.Hepari
ni soft
enadmi ni
ster
eddur i
nghaemodi al
ysi
sandopenhear t
surgery.To preventclott
ing i
n donated bl
ood,blood banks,and l
aborat
ori
es oft
en add
substancethatremov eCa2+Examplesare-EDTA(ethyl
enedeaminetet
raacet
icaci
d)andCPD
(ci
trat
ephosphat edextr
ose).

Rol
eofv i
taminKinclot
ti
ng:Normalcl
otti
ngrequi
resadequat
eamountofv
itami
nK.Because
i
srequi
redforthesy
nthesi
soffourcl
ott
ingfact
ors(l
l,
VII,
I
XandX).
Whybl
ooddoesnotcl
otwi
thi
nthev
essel
s?

Factorswhichpr eventint r
avascularclot
tingare--1.Absenceoft hromboplasti
n,Smoothness
oft he innerlining oft he vessels prevent
sr upture ofplatelets.Hence formation of
thromboplasti
n does nott ake place.2.Pr esence ofheparin Li tt
le amountofhepar in
(anti
coagulant
)i ssecret edf r
om t hemastcel l,l
ivercellandbasophi lsofWBC.I tinhibi
ts
coagulat
ionofbl oodbyi nhibit
ingtheacti
onofact i
v ethr
omboplastin.

LYMPHATI
CSYSTEM-

Component
sofl
ymphat
icsy
stem:Thel
ymphat
icsy
stem consi
stsl
ymphat
iccapi
l
lar
ies,
l
ymphduct
s,l
ymphat
icgl
ands(
nodes)andofl
ymph.

Ly
mphat
icsorLy
mphv
essel
s-Thev
essel
sthr
oughwhi
chl
ymphi
sci
rcul
atedt
hroughout
t
hebodyi
scal
ledt
hel
ymphat
icsorl
ymphv
essel
s.

St
ruct
ureofLy
mphat
ics:Fr
om t
het
issuespacet
hel
ymphat
icsorl
ymphv
essel
sbegi
nas
bli
ndendsandf orm smal ltubeswhichfor m networkcall
edt hel
ymphati
ccapill
aries.These
capill
ariesj
oinandf ormlargervessel
scalledlymphduct swhichcontai
nvalv
es.Vessel spass
throughsmal lgl
andscal l
edl ymphnodes( glands).Sev
erallymphat
icscombineandf or
mt he
thoracicductatthel ef
tsideandr i
ghtly
mphat i
cductatther i
ghtsi
deofthebody .Theset wo
duct sopeninthesubcl avi
anv ei
nsoftheirrespectiv
esides.Lymphductsaresimilartothose
ofv einsandcontainsv al
ves.

Ly
mph gl
ands orLy
mph nodes:Ovalorbean shaped masses ofl
ymphoi
dti
ssue
surroundedbydisti
nctcapsulear
ecall
edlymphnodesorl ymphgl
ands.
Thel
ymphgl
ands
producelymphocyt
esandantibodi
es,
whichdi
sposesbact
eri
a.

For
mat
ionofl
ymph:Lymphi
sabsol
utel
yder
ivedf
rom t
heexcessf
lui
doft
het
issuespaces
Whent hereabsor
ptionoftissuef lui
datthev enousendsoft hebloodcapil
lari
esislessthan
thedif
fusionandf i
ltr
ati
onofpl asmaatt hear teri
alends,theexcessflui
dent ersintot he
peri
pherally
mphaticcapil
lari
esf rom theintersti
tium.Itf
lowst hr
oughthely mphati
cv essels
andlymphnodesgr aduallyabsor beddiff
erentpr otei
nsandot hermateri
alsfrom i
ntersti
tum
andtchangedintolymph.Atl astlymphisdai nedintothevenousblood.

Composi
ti
onofl
ymph:Li
ket
issuef
lui
d,t
hecomposi
ti
onofl
ymphi
smor
eorl
esssameas
t
hatofpl
asma.Ly
mphcont
ainsl
argenumber
sofl
ymphocy
tesandmonocy
tes.

Noncell
ularpart
:1.Wat er-
95% 2.Sol i
ds- 5% (
a)Or gani
c-(i
)Pr ot
eins:2-3-4-5gm% (albumi
n,
globul
inandf i
bri
nogen)(ii
)Car bohydrates:glucose(ii
i)Lipi
ds:5- 15% (afteramealr i
chi
n
fatt
yfoods)(i
v)Otherconst
ituents:ur
ea,creati
ne,aminoacids,
enzymes, antibodi
es,
etcetc

(
b)I
nor
gani
c-Chl
ori
des(
asNaCl
),
phosphor
us,
cal
cium ,
etc
Cel
lul
arpar
t:Ly
mphcont ains1000-
2000leucocy
tes/Cumm.Mai nl
ylymphocyteoccasi
onal
monocyt
es,macrophagesareseen,
granul
ocyt
esareseenneart
hesi
teofi
nfect
ion.

HUMANCI
RCULATORYSYSTEM
Ci
rcul
ati
onofbl
oodt
hroughhear
t-
-

Ci
rcul
ati
onofbl
oodt
hroughhear
tisuni
dir
ect
ionalduet
opr
esenceofv
alv
esi
nsev
eral
places

1.Atfir
stthev enousblood( i
.e.lessO2andmor eCO2cont aini
ngbl ood)comesfr
om the
upperpartoft
hebodyt hroughsuper i
orv
enacavaandfrom thelowerpar toft
hebodyt
hrough
i
nferi
orvenacavat other i
ghtat r
ium oftheheart
.Ther ightat r
ium alsorecei
vesr
educed
(v
enous)bloodfrom t
hehear tmusclethr
oughthecoronar
ysi nus.

2.Duri
ngatr
ialsyst
olethevenousbloodfrom ri
ghtat
rium passesintot
herightventr
icleby
val
vesopeni
ngt hetr
icuspi
dvalve(
atri
oventr
icul
arval
ve)presentattheri
ghtatri
ovent
ricul
ar
ori
fi
ce.

3.Af
terfi
ll
ing,syst
oleofr
ightventr
icleexpelst
hev enousbl
oodint
othelungsbypul
monar
y
tr
unk(ar
ter
y )t
hroughther
ightatr
ioventr
icul
arri
fi
ce.Iti
sguar
dedbythesemil
unarv
alv
e.

Inthelungst hepul monaryart

erydi v
idesintonumerouscapil
lari
esnet
wor k.Astheblood
cir
culat
es thr
ough t he pulmonar y(lungs)capi
ll
ari
es,the blood i
s broughtinto cl
ose
rel
ati
onshipwi t
hthei nspi
redairintothelungsal
veoli
.Theti
ssuecellgi
vesof fsomeofi t
s
carbondioxi
deandacqui r
esaf reshsupplyofoxygen.Thi
sprocessiscommonl yknownas
oxygenati
on(purif
icati
on)ofbl
ood.

4.Afteroxygenat
iont
hevenousbloodconv
ert
sintot
heart
eri
albl
oodwhich.cont
ainsmor
eO,
andl essCO,.Thisbl
oodthenreturnstot
heleftat
ri
um t
hroughfourpul
monaryv ei
ns(
two
ari
singfrom eachPul
monaryvei
nlung).

5.Fr
om leftat
ri
um thebloodpassesintothel
eftvent
ri
clebyopeni
ngt
hebi
cuspi
dval
ve
(Mi
tr
alv
alve)pr
esentatt
helef
tatr
iovent
ri
cul
aror
if
ice.

6.Duringcont r
acti
onoftheventr
icl
es,theoxy
genat
edbloodfr
om thelef
tvent
ri
clefl
owsinto
thelargearterycal
ledaort
abyopeni ngtheaort
icv
alve(si
mil
unarval
ves)pr
esentatthel
eft
atr
ioventr
icularor
ifi
ceTheaortadivi
desandsubdivi
destofor
m anetworkofextremelyf
ine
vesselscall
edcapill
ari
es.

Thear t
erialbl
ood whi
lefl
owing thr
oughcapi
ll
ari
essuppl
iesnut
ri
ti
onand oxygen t
ot he
ti
ssuesandt akeswasteproductsandcar
bondioxi
defr
om theti
ssuesandconver
tedinto
venousblood(al
socall
eddeoxygenat
edbl
ood).
STRUCTUREOFHUMANHEARTANDBLOODVESSELS

In1616,Engl
ishphysici
anWil
li
am Harvey
,fi
rstdescr
ibedt
hef
unct
ionalact
ivi
ti
esofhuman
hear
tandthecircul
ati
onofbl
oodinthebody.

I
nter
nalst
ruct
ureofhear
t-
--

Atri
a:Thebot hat ri
um ( atri
a)actasr eceivingchamber sforthebloodofal lveins.
Theyar e
parti
ti
onedbyt hei ntraatrialseptum whi chi sf ibr
ousi nnature.Ther i
ghtat r
ium.receiv
es
bl
oodf r
om thewhol ebodyt hr
ought wol argev eins,superi
orvenacavaandi nferi
orvenacav a
Superiorvenacav adr ainsdeoxy genatedbl oodi ntorightatr
ium,coll
ecti
ngt hebl oodfrom t
he
headandupperr egionoft hebody .Wher easi nf
eriorvenacav abri
ngst hedeoxy genat
ed
bloodf um thel owerr egionoft hebodyt other i
ghtatti
um.Ther i
ghtat r
ium alsobeing
connectedwi t
hsomeot hersmal lveinst hroughcor onarysinus.Ital
sodr ainsdeoxy genat
ed
bloodf r
om cardi
acmuscl es(heartwall)i
ntot heat ri
um.

Vent
ri
cles-Thev ent
ri
clesaredi
str
ibut
ingchambrrsforbloodwhi
chent
ersf
rom at
ri
a.Ri
ght
andl
eftventr
icl
esareparti
ti
onedbyint
ravent
ri
cul
arseptum.

Thewal l
softheventr
icl
esarethi
ckert
hanthatofatr
ia.Theinnersurfaceoftheventr
icl
esis
unev
en, t
hrownint
otrabecul
ae,
knownascol umnaecarneaeortrabeculaecar
neae.Fewlarge
coni
calmuscularproj
ecti
onsarealsopresentintheinnersurfaceoft heventr
icl
es,call
ed
papi
ll
arymuscles.

Inbet weenri
ghtatri
um andr i
ghtventr
iclether ei
sabigov alaper
turecalledr
ightatri
oventr
icul
orif
icewhichisguardedbyaone- wayt r
icuspidv al
ueThev alv
econsistsofthreeendot hel
ium
coveringfibr
ouscuspsorf l
aps,andt hef reemar gi
nsoft hecuspsf acingtherightventr
icle
whichar eat t
ached wi t
hpapi l
lar
ymuscl esofr i
ghtventri
clebyanumberoff i
ne,tough
tendinouswhi t
et hreads,call
ed chordaet endi
neaeThesechor daet endi
neaepr eventt he
pushingoft hecuspst owardstheat r
ium aswel lascheckthebackf low ofbloodfrom ri
ght
ventri
cletoatri
um duringtheventr
icul
arsy stole.

Thepul monar
yaor t
a( tr
unk)isder i
vedfrom theupperl ef
tcorneroft heri
ghtv ent
ricle.
Thereaft
erthe tr
unk is di
vi
ded intorightand lef
tpul monar
y arter
ies whi
ch carryt he
deoxygenat
edbloodofrightvent
ri
cletothecor
respondingl
ungforoxygenati
on.Theapertur e
atthesit
eofori
ginofthepulmonaryaort
aisdulyguardedbyaone-wayvalvecal
ledsemilunar
val
v eorpul
monaryvalv
e.

Leftventr
icl
ei scone-shapedandmor emuscul arthanther i
ghtvent r
icle.Inbet weent helef
t
atr
ium andl eftventri
clether
eisal argepassage,theleftatri
ovent r
icularaper t
urewhi chis
guardedbyaone- waybicuspi
d(twoflaps)val
veormi tr
alvalve.Thef r
eeedgesoft heflapsof
bi
cuspidv al
vear ealsoremainconnectedbychordaetendineaetot hel eftventr
icularpapil
lar
y
muscles,whichal sopreventt
hebackf l
owofbloodf r
om leftventr
icletocor respondingatri
um
duri
ngv entr
icularsyst
ole.
Thesystemi caort
aisderiv
edf r
om theupperr ightcornerofthelef
tv entr
icl
e.Thesyst
emic
aort
acarriesandsuppl
iestheoxygenatedbloodt othedif
fer
entti
ssuecel l
softhewholebody
.
Theapertureofthesystemicaort
aisal soguardedbyasemi l
unarval
veoraor ti
cvalv
ewhich
prev
entsthebackf l
owofbloodfrom aor t
atoventri
cleduri
ngtheventri
culardi
astol
e.

Bef
orel
eavi
ngtheheartt
hesyst
emicaortaproducestwocor
onar
yar
ter
ies(
ri
ghtandl
eft
)
whi
chsuppl
ytheoxy
genat
edbl
oodtothehear
ttissues.

Ti
ssuesoft
hehear
twal
l
:

The wallofthe hear

tis made up oft
hree di
ff
erentl
ayer
s:Out
erepi
car
dium.mi
ddl
e
myocardi
um,andi
nnerendocar
dium.

(i
)Epi
car
dium:Thisi
sat hinlay
erconst
it
utestheout
ermostpar
tofthehear
t.
Act
ual
lyi
tvf
used
witht
heinnerl
ayer(
v i
sceral
)ofperi
car
dium.Itismadeupofat hi
nfibr
ousandel
ast
iclay
er
cover
edbymesothel
ium (squamousepit
heli
um).

(
ii
)Myocardi
um:Thisisthemiddlel
ayeroft
hehear
t,madeupofst
ri
atedbr
anchi
ngcar
diac
muscl
efi
bresandconnecti
vet
issue.

(i
ii
)Endocar dium:Thi
sistheinnermostlay
eroftheheartandfor
msthesur
faceoftheheart
cavi
ties.Itismadeupofat hi
nl ay
eroflooseconnect
iveti
ssueonwhi
chasingl
elay
erofflat
epit
helialcell
s(endot
hel
ium)arepresent
.

Aper
tur
esandv
alv
esoft
hehear
t:

The mai
n purpose ofthe pr
esence ofdi
ff
erentv
alv
es i
nthe hear
tist
o mai
ntai
na
uni
dir
ect
ionalf
lowofthebl
oodwithi
nit
.

(i
)Ri
ghtat
riov
ent r
icularaper
tur
eorRightA.V.-aper
tur
e-pr
esencei
nbet
weent
her
ightat
ri
um
andr
ightv
entri
cle-guardedbytr
icuspi
dval
ve.

(
ii
)Leftat
rioventr
icul
arapertur
eorLeftA.V.aper
tur
epr
esencei
nbet
weent
hel
eftat
ri
um and
l
eftv
entri
cle-guardedbybicuspidormi
tralval
ve.

(i
ii
)Sy st
emicaortaandpulmonar
yaortaaper
tur
espresenceinbetweent hel
eftv
entr
icl
eand
outgoingsystemicaor
ta;andinbetweentheri
ghtventri
cleandoutgoingpulmonar
yaorta,
respecti
vel
y-guar
dedbylef
tandri
ghtsemil
unar(
S,L.
)valves.r
espect
ivel
y.

(i
v)Inf
eriorvenacav
aapertur
e-presenceinbet
weent
hei
ncomi
ngi
nfer
iorv
enacav
aandr
ight
atr
ium guardedbycavalv
alveorEustachi
anval
ve.
Car
diacexci
tat
oryandconduct
ivesy
stem (
Junct
ionalTi
ssuesofHear
t)

(a)Defi
nit
ion:Thespecial
isedmy ocardi
alfi
breswhichareresponsi
blefort
hespont
aneous
generat
ionandconductionoft herhythmiccardi
acimpulsesintheheartmuscl
eknownas
cardi
acexcitat
oryandconducti
vesystem orj
uncti
onalti
ssuesofthehear
t.

I
nt his syst
em t he f
oll
owi
ng component
s ar
e pr
esent
-(
i)Si
noatr
ialnode (
SA node)
,(ii
)
I
nternodalpathways.(
ii
i)At
ri
ovent
ri
cul
arnode(
AVnode)(iv
)Bundl
eofHisorAVbundle,and
(
v)Pur ki
njefi
bres.

(i
)Sinoart
ri
alnode-
Thesinoat
ri
al(SA)nodeislocat
edinthepost
eri
olat
eralwal
loft
her
ight
atr
ium j
ustbel
lowtheopeni
ngofthesuperi
orvenacava.

(i
ii
)Atri
oventr
icul
arnode-
Theat
ri
ovent
ri
cul
ar(AV)nodeisl
ocat
edi
nthepost
eri
orwal
loft
he
ri
ghtatri
um justbehindthel
owerpartoftheint
erat
ri
alsept
um,neart
heopeni
ngofthe
coronar
ysinus.

i
v )Bundl
eofHisorAVbundle-
Thebundl
eofHi sorAVbundl eisor i
ginatedfrom AVnodeand
thenpasseddownwardthroughtheri
ghtsideoft hefibr
ousi nterventri
cul
arseptum.Aft
er
reachi
ngatthemuscul
arpartoft
heseptum i
tdivi
dedintorightandl eftbundleupt
otheapex
oftheheartandt
henspr
eadedint
othewall
soft hevent
ri
cles.

(v
)Pur ki
njefi
bres-
Thepur ki
njef
ibr
esareder
ivedfrom therightandlef
tbranchesofthe
bundle ofHis oft he v
entri
cul
arwall
s and then scat
ter
ed int
ot he ent
ir
ev ent
ri
cul
ar
my ocar
dium.

Or
igi
nandconduct
ionofcar
diaci
mpul
se:

Rhythmi
cself-
exci
tati
on,duetot
hespont
aneousgener
ati
onofi
mpulsesandtheconducti
on
ofthati
mpulsesthroughoutt
hecar
diacmuscl
es,ar
etheuni
quepr
operti
esofthejunct
ional
ti
ssuesoft
heheart.

TheSAnodei sconsi deredast hepacemakeroft hehear t

,sinceitsaut omati
cr hythmi cal
dischar
geismai nl
yr esponsi
bl efort henormalbeatingoft hehear t.Conti
nuousandr hy thmi c
depolari
sat
ionoft heSAnodei scauseoft hegenerationofi mpulses.Whenev ertheimpul ses
reachinat hresholdanact ionpot ent i
alisgenerated.Theact i
onpot enti
ali st
henspr eads
spontaneouslyi nt
ot he adjacentat ri
almuscl efibres as wel las i nt
ot he enti
re atr i
al
my ocar
dium andcausescont racti
onoft hebot hat
ri
um.I nthemeant i
met hisact
ionpot ent i
al
ofSAnodei salsoreacht ot heAVnodet hroughtheint er
nodalpat hways.Thenor malr ateof
generati
onofi mpul sesoft heSAnodei s70t o80t imespermi nute.TheAVnodei sal so
generatesi
mpul sesatanr hy
t hmicr ateof40t o60ti
mespermi nute.
WhenSAnodeunabletomai nt
aini
tsrateofdi
schar
get hentheAVnodecont r
olsthebeatof
thehear
tati
tsownr hyt
hm.Thus,AVnodei sconsideredasar eserve-pacemaker.Li
keSA
andAVnodes,pur
kinjefi
bresarealsoenabl
etodischargeatar at
eof30t o40t i
mesper
minut
eandabl
etocontrolt
heventr
icul
arbeat
saccordingl
y.

Sincetherateofrhyt
hmicaldi
schargeofSA nodeisfasterthanthatofotherjuncti
onal
ti
ssuesandastheproducedimpulsesofSAnodereachtothem bef
orethei
rself
-exci
tati
on,
thusthenormalrhyt
hmici
tyofthehear ti
sactual
lycont
roll
edbyt heSA nodeornor mal
spacemaker.

CARDI
AC(
HEART)MUSCLE-Pr
oper
ti
es

1.Excitabi
li
ty-
Exci
tabi
li
tyi
s an import
antpropert
yofal lli
ving t
issues i
ncludi
ng cardi
ac
muscularti
ssue.Whenacardiacmuscleissti
mulat
edbythresholdsti
mulus,itisexci
tedand
theexci
tati
onisshownbytheresponsei.
e.,
bythecont
ract
ionofthemuscl efi
bres.

2.Cont
racti
l
ity-Contr
act
il
it
yist
hemostchar
acter
ist
icpr
oper
tyofal
lty
pesofmusculart
issues.
I
tisduet opr esenceoftwotypesofcont
ract
il
eelement
s,act
inandmy osi
ninthemuscl e
fi
bres(
my ofi
bril
s).

3.Conducti
vi
ty-
Whent hecardi
acmusclefibreisst
imul
atedbyathreshol
dst i
mulus,
anact
ion
potent
iali
ssetatthesiteofexci
tat
ion.Thisimpul
seisthenconductedalongthemembrane
ofthemusclefi
brethr
oughoutthewholelengthofthemuscl
e(fi
bre)
.

4.All
-or-
nonelaw-I
tistheeventofcontracti
onofmuscl efi
bret
hateitheroccursmaximal
lyor
i
tdoesnotoccuratal l
.Thi
spr opert
yisappliedforsingl
emusclefibre.Sincehear
tmuscleis
syncyti
um,heartact
sasawhol e.I
not herwordswi thanadequatest i
mul ust
hewholeheart
contr
actstoitsutmostandift hesti
mul usisinadequat
ethencontractionofheartdoesnot
takeplaceatall
.

BLOODVESSELS

Theelast
icandmuscul
artubesthr
oughwhi
cht
hebl
oodci
rcul
atesuni
dir
ect
ional
lyal
lov
ert
he
body
,arecall
edbl
oodvessels.

Ther
ear
ethr
eet
ypesofbl
oodv
essel
s:ar
ter
y,v
einandcapi
ll
ary
.

Hi
stol
ogi
calst
ruct
ureofbl
oodv
essel
s:

[
1]Arter
y:Thewallofarter
yismadeupofi sthreedist
inctcoatsorlayers.Outer
mostlayer
t
unicaadvent
it
iaortuni
caexterna,middl
elayeri
stunicamedi aandinnermostlayeri
stunica
i
ntimaortuni
cainter
na.Thetunicaadvent
it
iaisathicklayerandconsistoflooseconnect
ive
t
issuewhichi
slongit
udi
nall
ywrappedupbyt hewhiteandy el
lowclast
icfibr
es.
[2]Vei
n:Thewallofvei
ni sal
somadeupoft hesamet hreecoatsorlayer
sli
keasanar t
ery
.
However,t
hetuni
cainti
maandt uni
camedi aarer
elati
velythi
nnerbecauseofl
esselast
icand
muscul
arfibr
esinthem.Thusthewallofavei
nisthinnerandlessclast
icbutver
yri
giddueto
t
hepresenceofexcessi
vecoll
agenfi
bres.

Sometimesthefol
dingsoft
hetuni
caint
imaofthev
einscr
eateval
veswit
hint
helumenwhi ch
pr
eventthebackfl
owofthevenousbl
ood.Thel
umenofthevei
niswidert
hanthatofar
ter
y.

[3]Capil
lar
y:Thewal l
sofcapill
ari
esarev er
ythi
n and consi
stofa unicel
lul
arlay
erof
elongat
edandf l
att
enendot
hel
ialcel
lsr
est
ingonabasementmembr anel
ocatedontheout
er
sidesofthecapi
ll
ari
es.

Thus,nut
ri
ent
s,wasteproduct
s,respi
rat
orygases,hor
mones,et
c.ar
eeasi
lyexchangedi
n
bet
weenthebloodandt
issuefl
uidthr
oughthecapi
ll
arywal
ls.

HEARTRATE-Thenumberofbeat
ingofhear
t(i
e.,sy
stol
eanddi
ast
ole)occurpermi
nut
eis
cal
ledhear
trat
e.

Nor
malv
alues:Theav
eragenor
malhear
trat
einadul
tmal
eis72t
imespermi
nut
e.

CARDI
ACCYCLE-
(
a)Defi
niti
on:Thecycl
icr
epetat
ionofsequent
ialmechani
calchanges(
event
s)t
akepl
acei
n
t
heheartduri
ngeachbeat
,isr
eferr
edascardi
accycl
e.

(b)Eventsofcar
diaccycle:Thesequenceofeventsduri
ngcar di
accy cl
ecanbedi vi
dedinto
twomaj orcomponents-
(1)Atri
alevent
sand(2)v ent
ri
cularevents.Thedur at
ionofoccur
ing
event
sinatri
aorinventr
iclesi
sassameast hedurati
onofcardiaccycle,i
.e.0-
8second.

At
ri
alev
ent
s:At
ri
alev
ent
sconsi
stsofat
ri
alsy
stol
eandat
ri
aldi
ast
ole.

(1)Artrialsystol
eThecar diaccyclestar t
swi ththecont racti
on(syst
ole)ofatr
ia.Thedurati
on
ofatrialsystoleis0.1second.Int hi
sev entbot htheatriacontractal
mostsimultaneousl
y.The
forceofcont r
actioninfi
rsthalfofat r
ialsystoleishighert hanthatofthesecondhalf.Duri
ng
theatr i
alcontractiontheintr
a-at
r i
alpressurer i
seswhi chr ushesoutthestor
edbl oodofatri
a
i
ntot her especti
v eventri
clesthrought heAVv alves.
Att histi
meAVv alv
esalsor emainopen
becauseoft hecont i
nuati
onofv entri
culardiastoli
cphase.

Thustheri
sesofint
ra-at
ri
alpressur
eduringatr
ialsy
stoleisnotreasonofAVvalvesopening
buti
tsqueezest
heatri
albloodint
otheventr
icl
esatthelastpartofthevent
ri
cul
ardiast
ole.

(2)Art
rialdi
astol
e-Attheendofsy st
ole,t
heat ri
aldiast
olestar
tsandcont i
nuesuptothe
begi
nningoft henextatr
ialsystol
e.Atri
aldiast
olelastfor0.7second.Dur
ingthediast
oli
c
condi
ti
ont hebothatri
astartr
elaxi
ngsimultaneousl
yandi nt
ra-
atr
ialpr
essur
ef al
lsgr
adual
ly.
Thus,thedeoxy genat
edbl oodeasil
yentersintother i
ghtatr
ium throughvenacav aand
coronarysi
nus,andtheoxygenatedbloodenter
sint
otheleftat
ri
um throughpulmonar
yv ei
ns.
Att heendofthedi astol
icphase,theatri
alsyst
olestart
sagain.Sot heatr
ialcycl
e(atri
al
systol
eandatri
aldiast
ole)i
scompl et
edwithi
n0.8second.

Vent
ri
cul
arEv
ent
sst
art
sjustaf
tert
heat
ri
alsy
stol
e.

I
tal
soconsi
stsofv
ent
ri
cul
arsy
stol
eandv
ent
ri
cul
ardi
ast
ole.

Ventr
icularEvents -The dur at
ion ofv entr
icularsy stol
ei s 0.8 second and syst
ole and
vent
ri
cularbotht hev ent
riclescontractsi
mul taneously.Now,att hi
st i
mevent r
icl
escontr
act
l
ikeclosedcavit
ies,sincetheAVv alv
esandt hesemi lunarvalvesar eremai
nclosed.Theref
ore
i
nt hi
s phase the v entr
icularmuscl es are contracti
ng.Thisty pe ofcontracti
on i
s call
ed
i
somet ri
ciscall
edisomet riccontracti
onperi
odandi tlastsfor0.05second.

Int hi
sper i
odtheint
ravent
ri
cularpressur
eri
sessharpl
yandassoonast hepressureexceeds
theexi st
ing pr
essureinaortaand pul monaryar
tery
,t hesemil
unarvalv
esopenand t he
ejecti
onofbl oodf r
om contracti
onofv entr
icl
eascl osedlef
tventr
icl
etoaor t
aandr i
ght
ventri
cletopulmonaryart
ery,
start
s

Theej ect
ionperi
odlastsfor0.25second.Thisperi
odcanbedividedint
ot woparts-
maximum
ejecti
onperiodandreducedejecti
onper i
od.Inmaximum ej
ect
ionperiodthebl
oodr ushesi
nto
theempt yaortaandpulmonar yart
ery.Assoonast hesemil
unarv al
vesareabout80%oft he
storedbloodoft heventri
clesisejectedoutwithi
n0.11second.Thus,t hefi
rstpartofthe
ejecti
onperiodisknownasmaxi mum ej ect
ionasmaximum amountofbloodisejectedwit
ha
highspeedinashor tt
imeper i
od.

Inthelastpartoft
heejectionperi
odtheremaini
ng20%oft hestoredbloodisej
ectedout.The
durati
onis0.14second.Since,themaximum amountofej ectionperi
odt hebl
oodpressurein
aortaandpulmonaryarterybecomehigh,thusinthelastpartoftheej
ectionper
iodtherateof
eject
ionofbloodisreduced.Hence,i
tiscall
edthereducedejecti
onperiod.

Thedurati
onofv ent
ri
cul
ardi
astolei
s0.5secondandbotht hevent
ri
clesrel
axsi
mult
aneousl
y.
Vent
ri
culardiast
olecanbedi
videdintot
hefollowi
ngsuccessiv
eperiods-
prot
odi
ast
oli
cperi
od,
i
sometricrel
axati
onperi
odandv ent
ri
cul
arfi
ll
ingperi
od.

(i
)Protodiastoli
cperiod-Wi ththeonsetofventr
icul
ardiastol
ethei nt
ravent
ri
cul
arpr
essure
star
tstof al
l.
Thisshortesti
nterv
albetweentheonsetofventr
icul
ardiastol
eandthecl
osureof
semilunarvalvesisknownaspr otodi
ast
oli
cperi
od.Thedur at
ionofthisperi
odis0-
04second.

(i
i)Isomet r
icrelaxati
onper iod-
Witht heclosureoft hesemi lunarvalv
est hev ent
ri
clesst i
ll
rel
axingascl osedcav i
ti
esf oramomentbecauseoft hei nt
raventri
cul
arpr essureissti
llhi
gher
thant hatofat ri
alpr essureand theAV v al
vesar ey etto beopened.I nthisperiodt he
ventri
cularmuscl esarer el
axingbyr educi
ngt hetensionnotbyenhanci ngt hei
rlength.This
peri
odi sknownasi somet r
icrel
axat
ionperiodanditsdur at
ionis0.08second.
(i
ii
)Vent r
icul
arfil
li
ngper iod:Thetimeperi
odi nwhi cht
heempt yandr el
axingventri
clesar e
fi
ll
ingupr api
dlybyt hebloodofrespect
iveatr
ium.Thedur at
ionoft
hev entr
icul
arfi
lli
ngper i
od
i
s0. 38second.Att heendoft heisometr
icrel
axationper
iodbelowtheintr
aatri
alpressure,the
AVv al
vesopened.Consequent lythest
oredat r
ialbl
oodrushesint
ot herespecti
vev entri
cles
ast heyar
estil
lrel
axi ng,

Hear
tSounds-Thesoundswhicharepr
oduceddur
ingt
hecont
ract
ionandr
elaxat
ionofhear
t
i
neachbeatar
ecall
edheartsound.

Ty
pesofhear
tsound:

[1]Firstheartsound:Firstheartsound L-U-
U-B devel
op due tothe sudden closure of
atr
ioventr
icul
arvalvesandthei
rvibrat
ion,
dur
ingtheonsetofvent
ri
cul
arsystol
e(ie,beginni
ng
ofisometriccont
racti
onofventr
icles)
.

[2]Secondheartsound:Secondhear
tsoundDUPi
sv er
ysharpandappear
sduetothesudden
closur
eofsemi l
unarvalvesduri
ngtheonsetofventr
icul
ardi
astol
e(i.
e.begi
nni
ngoft he
i
somet ri
crel
axati
onofv entr
icl
es)
.

CARDI
ACOUTPUT-

Theamountofbloodpumpedoutbyeachvent
ri
clei
ntot
hesy
stemi
corpul
monar
yci
rcul
ati
on
i
napart
icul
arti
mei scal
ledcar
diacout
put
.

Thet
ermsofcar
diacout
putcanbeexpr
essedi
ndi
ff
erentway
s-

[1]St
rokevol
ume:Theamountofbl
oodpumpedoutbyeachventr
icl
eineachst
rokeorbeat
i
scall
edstr
okevol
ume.Innor
malheal
thyadul
tst
heav
eragest
rokevolumei
s70ml .

[
2]Minutevolume:Theamountofbloodpumpedoutbyeachventr
icl
eineachminuteiscall
ed
minut
ev ol
ume.I nnor
malhealthyadul
tstheaver
ageminut
ev ol
umei sabout5lit
res.Since,
t
hestrokev olumeis70mlandnor mal
lyhear
tbeat
s72t i
mespermi nut
e,t
husthemi nute
vol
umeis70mlx72( hear
trat
e)=5040mli.
e.appr
oxi
matel
y5lit
res.