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The Cardiovascular System

LORD IZON O. SANTOS, MDRN


The Cardiovascular System

• A closed system of the heart and blood


vessels
• The heart pumps blood
• Blood vessels allow blood to circulate to all
parts of the body
• The function of the cardiovascular
system is to deliver oxygen and
nutrients and to remove carbon dioxide
and other waste products
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The Heart

• Location
• Thorax between the lungs
• Pointed apex directed toward left hip
• About the size of your fist

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The Heart

Figure 11.1

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The Heart: Coverings

• Pericardium – a double serous


membrane
• Visceral pericardium
• Next to heart
• Parietal pericardium
• Outside layer
• Serous fluid fills the space between the
layers of pericardium
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The Heart: Heart Wall
• Three layers
• Epicardium
• Outside layer
• This layer is the parietal pericardium
• Connective tissue layer
• Myocardium
• Middle layer
• Mostly cardiac muscle
• Endocardium
• Inner layer
• Endothelium
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External Heart Anatomy

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 11.2a Slide 11.5


The Heart: Chambers
• Right and left side act as separate pumps
• Four chambers
• Atria
• Receiving chambers
• Right atrium
• Left atrium
• Ventricles
• Discharging chambers
• Right ventricle
• Left ventricle
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Blood Circulation

Figure 11.3
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The Heart: Valves
• Allow blood to flow in only one direction
• Four valves
• Atrioventricular valves – between atria and
ventricles
• Bicuspid valve (left)
• Tricuspid valve (right)
• Semilunar valves between ventricle and
artery
• Pulmonary semilunar valve
• Aortic semilunar valve
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The Heart: Valves

• Valves open as blood is pumped


through
• Held in place by chordae tendineae
(“heart strings”)
• Close to prevent backflow

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Operation of Heart Valves

Figure 11.4
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The Heart: Associated Great Vessels
• Aorta
• Leaves left ventricle
• Pulmonary arteries
• Leave right ventricle
• Vena cava
• Enters right atrium
• Pulmonary veins (four)
• Enter left atrium
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 11.11
Coronary Circulation

• Blood in the heart chambers does not


nourish the myocardium
• The heart has its own nourishing
circulatory system
• Coronary arteries
• Cardiac veins
• Blood empties into the right atrium via the
coronary sinus
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The Heart: Conduction System

• Intrinsic conduction system


(nodal system)
• Heart muscle cells contract, without nerve
impulses, in a regular, continuous way

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The Heart: Conduction System

• Special tissue sets the pace


• Sinoatrial node
• Pacemaker
• Atrioventricular node
• Atrioventricular bundle
• Bundle branches
• Purkinje fibers
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Heart Contractions

• Contraction is initiated by the sinoatrial


node
• Sequential stimulation occurs at other
autorhythmic cells

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Heart Contractions

Figure 11.5

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Filling of Heart Chambers –
the Cardiac Cycle

Figure 11.6

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The Heart: Cardiac Cycle

• Atria contract simultaneously


• Atria relax, then ventricles contract
• Systole = contraction
• Diastole = relaxation

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The Heart: Cardiac Cycle

• Cardiac cycle – events of one complete


heart beat
• Mid-to-late diastole – blood flows into
ventricles
• Ventricular systole – blood pressure builds
before ventricle contracts, pushing out
blood
• Early diastole – atria finish re-filling,
ventricular pressure is low
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The Heart: Cardiac Output

• Cardiac output (CO)


• Amount of blood pumped by each side of
the heart in one minute
• CO = (heart rate [HR]) x (stroke volume
[SV])
• Stroke volume
• Volume of blood pumped by each ventricle
in one contraction
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Cardiac Output Regulation

Figure 11.7

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The Heart: Regulation of Heart Rate
• Increased heart rate
• Sympathetic nervous system
• Crisis
• Low blood pressure
• Hormones
• Epinephrine
• Thyroxine
• Exercise
• Decreased blood volume
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 11.21
The Heart: Regulation of Heart Rate
• Decreased heart rate
• Parasympathetic nervous system
• High blood pressure / blood volume
• Dereased venous return

Slide 11.22
Blood Vessels: The Vascular
System

• Taking blood to the tissues and back


• Arteries
• Arterioles
• Capillaries
• Venules
• Veins

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•BLOOD VESSEL: ANATOMY
•Three layers (tunics)
•Tunic intima
•Endothelium
•Tunic media
•Smooth muscle
•Controlled by sympathetic nervous
system
•Tunic externa
•Mostly fibrous connective tissue
The Vascular System

Figure 11.8b

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Differences Between Blood Vessel
Types
• Walls of arteries are the thickest
• Lumens of veins are larger
• Skeletal muscle “milks” blood in veins
toward the heart
• Walls of capillaries are only one cell
layer thick to allow for exchanges
between blood and tissue
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Movement of Blood Through
Vessels

• Most arterial blood is


pumped by the heart
• Veins use the milking
action of muscles to
help move blood

Figure 11.9

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Capillary Beds

• Capillary beds
consist of two
types of vessels
• Vascular shunt –
directly connects an
arteriole to a venule

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 11.10 Slide 11.28a


Capillary Bed
Diffusion at Capillary Beds
• True capillaries –
exchange vessels
• Oxygen and
nutrients cross to
cells
• Carbon dioxide
and metabolic
waste products
cross into blood

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 11.10 Slide 11.28b


Major Arteries of Systemic Circulation

Figure 11.11

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Major Veins of Systemic Circulation

Figure 11.12

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Arterial Supply of the Brain

Figure 11.13

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Hepatic Portal Circulation

Figure 11.14

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Circulation to the Fetus

Slide 11.34
Highly oxygenated blood from the placenta
enters the fetus via the umbilical vein. A
large proportion of this blood passes into
the liver to supply the hepatic sinusoids.
The remainder bypasses the liver in the
ductus venosus, drains into caudal vena
cava and mixes with poorly oxygenated
blood returning from the fetal body. The
blood in the caudal vena cava, which,
although mixed is still well oxygenated,
drains into the right atrium of the heart.
Most of the blood entering the right atrium
from the caudal vena cava is directed
through the foramen ovale into the left
atrium where it is mixed with a small
amount of deoxygenated blood returning
from the lungs. The contents of the left
atrium enter the left ventricle and are
expelled from the heart into the aorta.
The contents of the right atrium (which consist of some well
oxygenated blood from the caudal vena cava and poorly
oxygenated blood returning from the head and forelimbs via the
cranial vena cava) enter the right ventricle and are expelled
from the heart via the pulmonary artery. Only approximately 5
-10% of the blood in the pulmonary artery enters the lungs in the
fetus due to the high resistance of their collapsed, non-aerated
state. The remainder enters the ductus arteriosus which is a
shunt linking the pulmonary artery and the aorta. The
convergence of the poorly oxygenated pulmonary blood and the
well-oxygenated aortic blood occurs after the main supply to the
head and forelimbs have branched off the aortic arch. This
ensures that the blood richest in oxygen reaches the developing
brain.
The abdominal aorta supplies the rest of the body and gives off
two umbilical arteries (branches of the internal iliac arteries)
which carry poorly oxygenated blood back to the placenta.
Changes at birth
At birth the lungs can inflate and perform their true function
meaning that the fetal bypass systems are no longer required.
•Umbilical vein - Constricts to form the ligamentum teres,
which extends from the umbilicus to the liver. The mesentery
that surrounded the umbilical vein becomes the falciform
ligament.
Ductus venosus - A sphincter in the ductus venosus
constricts so that all blood entering the liver passes through
the hepatic sinusoids.
Foramen ovale - Due to aeration of the lungs, pulmonary
resistance decreases and pulmonary blood flow increases.
The increase in pulmonary blood flow causes the
pressure in the left atrium to raise above that of the right
which results in the valve of the foramen ovale being
pushed against the septum secundum. This closes the
foramen ovale and its vestge is known as the fossa ovale.
Ductus arteriosus - The change in the partial pressure of
oxygen in the blood once the lungs become functional
controls the constriction of the ductus arteriosus. Closure
of the duct is usually complete soon after birth and its
remnant is known as the ligamentum arteriosus.
Umbilical arteries - The intra-abdominal portions of the
umbilical arteries constrict. Some parts remain patent
supplying the urinary bladder and these are contained
within the lateral vesicle ligaments which are vestiges of
the mesetery surrounding the umbilical arteries.
Pulse

• Pulse –
pressure wave
of blood
• Monitored at
“pressure
points” where
pulse is easily
palpated
Figure 11.16
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Blood Pressure
• Measurements by health professionals
are made on the pressure in large
arteries
• Systolic – pressure at the peak of
ventricular contraction
• Diastolic – pressure when ventricles relax
• Pressure in blood vessels decreases as
the distance away from the heart
increases
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Blood Pressure: Effects of Factors

• Neural factors
• Autonomic nervous system adjustments
(sympathetic division)
• Renal factors
• Regulation by altering blood volume
• Renin – hormonal control

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Blood Pressure: Effects of Factors

• Temperature
• Heat has a vasodilation effect
• Cold has a vasoconstricting effect
• Chemicals
• Various substances can cause increases or
decreases
• Diet
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Factors Determining Blood Pressure

Figure 11.19
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Variations in Blood Pressure
• Human normal range is variable
• Normal
• 140–110 mm Hg systolic
• 80–75 mm Hg diastolic
• Hypotension
• Low systolic (below 110 mm HG)
• Often associated with illness
• Hypertension
• High systolic (above 140 mm HG)
• Can be dangerous if it is chronic
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 11.41
Developmental Aspects of the
Cardiovascular System

• A simple “tube heart” develops in the


embryo and pumps by the fourth week
• The heart becomes a four-chambered
organ by the end of seven weeks
• Few structural changes occur after the
seventh week

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 11.44


Heart Attack (Myocardial Infarction)

Description
This image shows clearly the damage caused by a heart attack.
To the right of the image, you can see the back wall of the left
ventricle where there is an extensive area of dead tissue
(infarct).
The central part of the infarct shows the yellow appearance of
dead tissue (necrosis), and bordering on this is an outer reddish
area which suggests partial healing by early scar tissue. The
front wall of the left ventricle (on the left of the image) appears
normal.
Where the reddish area curves around the yellow dead tissue at
the top, you can see the right coronary artery, which is
considerably narrowed due to artherosclerosis (hardening of the
artery walls). A blood clot has formed in this narrowed area and
was responsible for the heart attack.
Atherosclerosis is responsible for the majority of
deaths in our society. It is also responsible for a
huge amount of morbidity.
If one studies insurance tables, atherosclerosis
causes a large contribution to years of potential life
lost.
Atherosclerosis is predominantly a disease of
arteries – both large and medium-sized.
It affects elastic and muscular vessels.
Atherosclerosis may also involve veins when they
become vein grafts and are exposed to arterial
pressure.
Risk factors for atherosclerosis include those, which
are modifiable, and those, which are not.
  
 
 

Age - in general, atherosclerosis increases with


  
   age. The earliest lesions of atherosclerosis are
 
   present after the age of 10 years old and some
  
  believe that this is a disease present since infancy
  
  
 
Gender – atherosclerosis is present more in males,
  
  
however females catch up after menopause. Some
 
  
old dated thinking regarded females as having less
   atherosclerosis than males. However, it is
 
   recognized now that females do develop significant
  
  atherosclerosis. Estrogen is protective as it has
  
  
multiple effects including effects on lipids, nitric
 
oxide, vascular tone and antioxidant properties.
Smoking causes multiple malignancies and
accelerates and initiates atherosclerosis. Many
effects on the endothelial cell including poor
vascular tone with vasoconstriction, oxidation, and
prothrombotic products.

Inactivity and obesity


Diabetes – affects endothelium and lipids
Hypertension - accelerates the development of
atheroma
Hyperlipidemia
Family history – probably multifactorial based on
many of the above factors
ARTERIOSCLEROSI
S OF THE
EXTREMITIES

Arteriosclerosis of the extremities is a disease of the peripheral blood


vessels that is characterized by narrowing and hardening of the
arteries that supply the legs and feet. The narrowing of the arteries
causes a decrease in blood flow. Symptoms include leg pain,
numbness, cold legs or feet and muscle pain in the thighs, calves or
S1 closure of AV valves (lub)
S2 closure of SL valves (dup)
S3 & S4 diastolic filling sound
S3 is heard after S2, if present
suspect CHF
S4 is heard prior to S1,
if present suspect non-
compliant ventricles although
this is common among
elderly
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Thromboangitis obliterans Buerger’s 
disease
• Obstructive inflammatory process affecting the 
peripheral arteries
• male, 20 to 40 years old
• intermittent claudication, numbness and 
tingling, thrombophlebitis
• may require amputation of the affected digits
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Coronary artery disease (CAD) is caused by a
narrowing or constriction of the arteries that supply
the heart muscle with blood. This narrowing is a
result of atherosclerosis—the buildup of
cholesterol and other fatty substances in the
arteries.

When the arteries narrow, blood flow is reduced.


The reduced blood flow (ischemia) causes the
heart muscle to receive less oxygen in certain
areas. If the blood flow is completely cut off, a
heart attack (myocardial infarction) will
occur, and the heart muscle will be permanently
damaged.
•ANGINA

•Duration of pain – In general, anginal pain lasts for


only a few minutes and is relieved by rest or
nitroglycerin.

•MYOCARDIAL INFARCTION (HEART ATTACK)


•Heart attack pain is usually more severe than
anginal pain, and may last longer, often 15 minutes
or more.

•Pain that lasts less than 30 seconds and goes away


with a few deep breaths or a change in position is
usually not angina.
•External factors –
•Anginal pain is often brought on by exercise or
activity, emotional tension, dreams, cold or windy
weather, low blood sugar, or even eating.
•Your symptoms can subside when you alter the
behavior or environmental trigger.

•Heart attack pain will usually not subside with


rest and may be accompanied by other symptoms
such as shortness of breath, nausea, or sweating.

•The elderly or people with diabetes may have less


typical or more subtle symptoms signaling angina
or heart attack. Some people may have “silent
ischemia” and experience no symptoms.
Types of Angina
There are three primary types of angina:
•Stable angina – The attacks are predictable, and
the triggers that cause them can be identified. They
do not occur when you are resting or relaxed, and
symptoms will usually disappear after a few minutes
of rest.
•Unstable angina – The symptoms are less
predictable. Chest pain may occur while resting or
even sleeping (nocturnal angina), and the discomfort
may last longer and be more intense. Stable angina
becomes unstable when symptoms occur more
frequently, last longer, or are precipitated more
easily. You should call your doctor immediately if you
experience symptoms at rest, or a worsening pattern
of symptoms.
Variant or Prinzmetal's angina – This is usually
caused by the spasm of a coronary vessel. It occurs
when you are at rest, and often in the middle of the
night. It can be quite severe. It may indicate that you
have one of the following conditions:
•Coronary artery disease
•Extremely high blood pressure
•Hypertrophic cardiomyopathy (disease of the heart
muscle)
•Diseases of the heart valves