Circulatory System

Mrs. Quratulain
Lecturer (Physiology)
Objectives
• Basic components of circulatory system
• Physiology of human heart
• Cardiac cycle and its events
• Cardiac action potential
• Electrocardiogram
• Heart sounds
• Regulation of blood pressure
• Anomalies related to circulatory system
Reference
• Guyton and Hall : Chapter 9
What is Circulatory system?

System which help us maintain an

appropriate
environment
in all the tissue fluids of the body for
optimal
survival and function
of the cells.
 Circulatory
system

The The blood

Lymphatic Circulatory
system system

Arterial Venous
Blood Heart
system system
The Heart
 Physiology of Cardiac Muscle
• Atrial muscle,
• Ventricular muscle,
• and Specialized excitatory and
conductive muscle fibers.
Cardiac Muscle as a Syncytium
• intercalated discs, “communicating” junctions
• Atrial and Ventricular syncitiums

Properties of cardiac
muscle:
• Contractile.
• Rhythmicity.
• Excitability.
• Conductivity.
• Contractility
Cardiac Cycle

• The cardiac events that occur from the beginning of one heartbeat to the beginning

of the next are called the cardiac cycle

• Each cycle is initiated by spontaneous generation of an action potential in the sinus

node

• The cardiac cycle consists of a period of relaxation called diastole, during which the

heart fills with blood, followed by a period of contraction called systole.

Cardiac Cycle Cont…..
Atrial diastole
• Passive filling of right and left
atrium via SVC + IVC and
pulmonary veins respectively

• Atrial Systole.
• Contraction of the atria.
• Remaining 20% of ventricular filling is
completed
Cardiac Cycle Cont…..
Ventricular diastole
• Passive filling of LV and RV from respective atrium
due to pressure and volume gradient
• AV valve open
• 70% ventricular filling
• Ventricular pressure gradually rises

• Ventricular Systole

• Closure of AV valves.

• Shortening of ventricular muscles

• Sharp rise in ventricular

pressure
Cardiac Cycle Cont…..
Isovolumetric ventricular contraction
cardiac muscle tension is increasing but
little or no shortening of the muscle fibers
is occurring. Isovolumetric ventricular relaxation
Sharp rise in atrial pressure due to At the end of systole, ventricular relaxation
bulging of AV valve into atria begins suddenly, allowing both the right and
left intraventricular pressures to decrease
rapidly but no change in ventricular volume
Ventricular ejection
pressures in the left and right ventricles
exceed the pressures in the aorta (80 mm
Hg) and pulmonary artery (10 mm Hg).
• End-Diastolic (ventricular) Volume
• 110 to 120 milliliters
• End-Systolic (ventricular) Volume
• 40 to 50 milliliters
• ejection fraction—
• 60 per cent
• Stroke Volume Output
• 70 milliliters
• Cardiac Output
• Volume of blood pumped by LV each minute
Cardiac Action Potential

is a brief change in voltage (membrane potential) across the cell membrane of heart

cells. This is caused by the movement of ions(Na, K and Ca) between the inside and

outside of the cell, through ion channels.

Action Potentials in Cardiac Muscle.
Fast sodium channels/ Slow Calcium + Decrease in permeability for K +

Velocity of Signal Conduction in Cardiac Muscle.

• 0.3 to 0.5 m/sec in muscles while Around 4 m/sec in Purkinje fibers.

• Refractory Period of Cardiac Muscle.

• Of the ventricle is 0.25 to 0.30 second

• with an additional refractory period of about 0.05 second

• During this the muscle is more difficult than normal to excite but nevertheless can
be excited by a very strong excitatory signal
• Of the Atria is about 0.15 second
Origin of the Heartbeat & the
Electrical Activity of the Heart
• The conduction system,
• Sinoatrial node (SA node)- cardiac pacemaker
• The normal

• The Internodal atrial pathways

• Anterior internodal tract of Bachman
• Middle internodal tract of Wenckebach
• Posterior internodal tract of Thorel

• The Atrioventricular node (AV node)

• The Bundle of His and its branches

The Electrocardiogram
• The record of Potential fluctuations during the cardiac cycle is the
electrocardiogram (ECG)
Characteristics of the Normal Electrocardiogram
• P wave
• Generated when the Atria depolarize before atrial
contraction begins.

• QRS complex
• Caused by potentials generated when the ventricles
depolarize before contraction

• T wave
• Known as a Repolarization wave.
• Potentials generated as the ventricles recover from
the state of depolarization.
Characteristics of the Normal Electrocardiogram
cont….
• P-Q or P-R Interval The PQ
interval (PR interval) represents the time for
conduction from the SA node across the AV
node and His-Purkinje system

• Q-T Interval represents the duration of

ventricular electrical systole, which includes
ventricular activation and recovery.
• ST interval
• represents ventricular repolarization
 Voltage and Time Calibration of the ECG
• The horizontal calibration lines are arranged so that
10 of the small line divisions upward or downward in
the standard electrocardiogram represent 1 millivolt.

• Each inch in the horizontal direction is 1 second,

• and each inch is usually broken into five segments by

dark vertical lines; the intervals between these dark
lines represent 0.20 second.

• The 0.20 second intervals are then broken into five

smaller intervals by thin lines, each of which
represents 0.04 second.

• Rate of Heartbeat as Determined from the

Electrocardiogram.
 Murmurs

Heart murmurs are heart sounds

produced when blood is pumped across a
heart valve and creates a sound loud
enough to be heard with a
stethoscope. Murmurs are of various
types and are important in the detection
of cardiac and valvular pathologies
Nerve supply of the Heart
• Excitation of the Heart by the Sympathetic Nerves.

• Importance of Tonic strength.

• Increase in cardiac output.

• Positively Inotropic (contraction force)

• Positively Chronotropic (heart rate)

• Parasympathetic (Vagal) Stimulation of the Heart.

• The Vagal fibers are distributed mainly to the atria

and not much to the ventricles.
• Vagal stimulation mainly to decrease heart rate
rather than to decrease greatly the strength of
heart contraction.
Vasomotor area
• Receives input from,

• Peripheral sensory nerves from

baroceptors

• From other parts of nervous system

• Also from Aortic and carotid

chemoceptors

• Some stimuli act directly on the

Blood pressure

• pressure exerted by the blood on the walls of the vessels.

• Systolic vs Diastolic blood pressure.

• Factors maintaining blood pressure,

• Contractile force of heart.
• Cardiac output.
• Elasticity of blood vessels wall.
• Volume of blood.
• Peripheral vascular resistance
Regulation of Arterial Blood Pressure.
• The Baroreceptor system.

• Present in the carotid artery and aorta.

• Stimulated by stretch of the arterial wall.

• Nerve impulses to the medulla of the brain.

• And Vice Versa.

Arterial Pulse
• As the blood is forced into the aorta during systole a
pressure wave travels along the arteries.

• And the expansion is palpable as the pulse.

• The Arterial pulse reflects the dynamics of the Left side of

the Heart
 Venous pulse
• Changes in flow and pressure caused Right
Atrial and Right Ventricular filling produce
sensations in the central veins and then
transmitted to the peripheral veins (e.g.
Jugular vein).

• JVP (jugular venous pressure) reflects the

dynamics of right heart.
COMMON PATHOLOGICAL
CONDITIONS
• Hypotension.
• Low pressures (hypotension) result in inadequate organ perfusion and can
lead to dysfunction or tissue death.

• Hypertension.
• High pressures (hypertension) can cause vessel and end-organ damage.
• Arteriosclerosis.
• Literally means “hardening of the arteries”; it is a generic
term reflecting arterial wall thickening and loss of
elasticity

• Atherosclerosis.
• Is characterized by intimal lesions called atheromas that
protrude into vessel lumens
Ischemic Heart Disease
“An imbalance between the supply (perfusion) and demand of the
heart for oxygenated blood”.

• IHD usually presents as one or more of the following clinical syndromes:

• Myocardial infarction,
• The most important form of IHD, in which ischemia causes the death of heart muscle.
• Angina pectoris,
• In which the ischemia is of insufficient severity to cause infarction, but may be a harbinger of MI.
• Chronic IHD with heart failure.
• Sudden cardiac death,
• Unexpected death from cardiac causes in individuals without symptomatic heart disease or early after
symptom onset.
• usually the consequence of a lethal arrhythmia.
CIRCULATORY SHOCK
• Shock is characterized by systemic hypotension due either to reduced cardiac
output or to reduced effective circulating blood volume.
• The consequences are impaired tissue perfusion and cellular hypoxia