Cardiovascular system

E. Abindau

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 Cardiovascular system
• Cardiovascular system consist of:
– The heart
– Blood vessels
• Arteries
• Veins
• Capillaries
– Blood

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 Functions of the cardiovascular system
• Transport and distribute essential substances to the
tissues
• Remove metabolic byproducts

• Adjustment of oxygen and nutrient supply in different

physiologic states

• Regulation of body temperature

• protect the body from infection through blood

components especially white blood cells 3
 The heart
• Cone-shaped organ
about the size of a loose
fist
• In the mediastinum
• Extends from the level
of the second rib to
about the level of the
sixth rib
• Slightly left of the
midline

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 The heart
 Heart is bordered:
 Laterally by the lungs
 Posteriorly by the
vertebral column
 Anteriorly by the
sternum

 Rests on the
diaphragm inferiorly

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The heart

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 Cardiac muscle
• Heart coverings • Heart walls:
– Pericardium
• Covers the heart and
large blood vessels
attached to the heart
• Visceral pericardium
– Innermost layer
– Directly on the heart
• Parietal pericardium
– Layer on top of the
visceral pericardium
– Epicardium
• Outermost layer
• Fat to cushion heart
– Myocardium
• Middle layer
• Primarily cardiac muscle
– Endocardium
• Innermost layer
• Thin and smooth
• Stretches as the heart
pumps
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 The heart chambers
• Four chambers – Two ventricles
– Two atria • Lower chambers
• Upper chambers • Left and right
• Left and right • Separated by
• Separated by interventricular
interatrial septum septum

Atrioventricular septum separates the atria from the

ventricles

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 The heart valves
• Tricuspid valve – prevents blood from flowing
back into the right atrium when the right ventricle
contracts
• Bicuspid (mitral) valve – prevents blood from
flowing back into the left atrium when the left
ventricle contracts
• Pulmonary semilunar valve – prevents blood
from flowing back into the right ventricle
• Aortic semilunar valve – prevents blood from
flowing back into the left ventricle
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 Cardiac cycle
One heartbeat = one cardiac cycle= The period from the
end of one heart contraction to the end of the next
 Atria contract and relax
 Ventricles contract and relax • Left atrium contracts
• Right atrium contracts – Bicuspid valve opens
– Tricuspid valve opens
– Blood fills right ventricle – Blood fills left ventricle

• Right ventricle contracts • Left ventricle contracts

– Tricuspid valve closes
– Pulmonary semilunar valve
opens
– Blood flows into pulmonary
artery
– Bicuspid valve closes
– Aortic semilunar valve opens
– Blood pushed into aorta

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 Cardiac cycle
Diastole is
longer than
systole

The
sequence of
systole and
diastole
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 The Phases of the Cardiac Cycle
• Isovolumetric or isovolumic contraction
• Events: ventricular contraction
– ventricular pressure rise 
– atrioventricular and semilunar valves closed 
– the ventricular pressure increase sharply
– Period: 0.05 sec
– Importance: enable the ventricular pressure to rise from 0
to the level of aortic pressure (after-load)

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 The Phases of the Cardiac Cycle
• Ventricular ejection
• Events: ventricular contraction continuously
• the ventricular pressure rise above the arterial pressure
semilumar valves open
blood pours out of the ventricles
 Rapid ejection period (0.10s, 60% of the stroke
volume)
 Reduced ejection period (0.15s, 40% of the stroke
volume)
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Period of isometric (isovolumic) relaxation
• Events:
• ventricular muscle relax
® the ventricular pressure fall
® lower than the aortic pressure
® aortic valve close
® the ventricular pressure fall sharply
• Period: 0.06-0.08 s
• Importance: Enable the ventricular pressure fall to the
level near the atrial pressure
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 Period of filling of the ventricles
• Events: Ventricular muscle relax continuously
•  the ventricular pressure is equal or lower than the atrial
pressure
•  atrioventricular valve open
•  blood accumulated in the atria rushes into the
ventricular chambers quickly from the atrium to the
ventricle.
 Period of rapid filling. (0.11s, amount of filling, 2/3)
 Period of reduced filling (0.22s, little blood fills into the
ventricle)
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 Atrial systole
 Significance, 30% of the filling
 Be of major importance in determining the final
cardiac output during high output states or in the
failing heart

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Cardiac cycle

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Cardiac cycle

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 S1- first sound
Heart sounds
 Atrioventricular valves and surrounding fluid vibrations as valves close at
beginning of ventricular systole
 S2- second sound
 closure of aortic and pulmonary semilunar valves at
beginning of ventricular diastole
 S3- third sound
 vibrations of the ventricular walls when suddenly
distended by the rush of blood from the atria
 S4-4th heart sound
 Left or right atrium vigorously contracting against a
stiffened ventricle
 A murmur – abnormal heart sound from the cusps
not completely closing
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Cardiac conduction system
Conduction system
Sinoatrial node,

Atrioventricular node,

Atrioventricular bundle
(bundle of His),

Purkinje system.

Special property: automaticity

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 Cardiac conduction system
• Group of structures that send electrical
impulses through the heart
• Sinoatrial node (SA node) Bundle of His
– Wall of right atrium Between ventricles
– Generates impulse Two branches
Sends impulse to Purkinje
– Natural pacemaker fibers
– Sends impulse to AV node
Purkinje fibers
• Atrioventricular node (AV Lateral walls of ventricles
Ventricles contract
node)
– Between atria just above ventricles
– Atria contract
– Sends impulse to the bundle of His
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 Delay in transmission at the A-V node (150 –
200 ms) – sequence of the atrial and
ventricular contraction – physiological
importance

 Rapid transmission of impulses in the Purkinje

system – synchronize contraction of entire
ventricles – physiological importance

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 Cardiac conduction system
• Characteristics of Pacemaker Cells
– Unstable membrane potential
• “bottoms out” at -60mV
• “drifts upward” to -40mV, forming a pacemaker potential
– Myogenic
• The upward “drift” allows the membrane to reach threshold potential (-
40mV) by itself
• This is due to
1. Slow leakage of K+ out & faster leakage Na+ in
» Causes slow depolarization
» Occurs through If channels (f=funny) that open at negative membrane
potentials and start closing as membrane approaches threshold potential
2. Ca2+ channels opening as membrane approaches threshold
» At threshold additional Ca2+ ion channels open causing more rapid
depolarization
» These deactivate shortly after and
3. Slow K+ channels open as membrane depolarizes causing an
efflux of K+ and a repolarization of membrane

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Myocardial physiology

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 Myocardial Physiology
• Altering Activity of Pacemaker Cells
– Sympathetic activity
• NE and E increase If channel activity
– Binds to β1 adrenergic receptors which activate cAMP and increase I f
channel open time
– Causes more rapid pacemaker potential and faster rate of action
potentials

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 Myocardial Physiology
• Altering Activity of Pacemaker Cells
– Parasympathetic activity
• ACh binds to muscarinic receptors
– Increases K+ permeability and decreases Ca2+ permeability =
hyperpolarizing the membrane
» Longer time to threshold = slower rate of action potentials

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 Myocardial physiology
• Special aspects
– The action potential of a contractile cell
• Ca2+ plays a major role again
• Action potential is longer in duration than a “normal” action potential due to
Ca2+ entry
• Phases
4 – resting membrane potential @ -90mV
0 – depolarization
» Due to gap junctions or conduction fiber action
» Voltage gated Na+ channels open… close at 20mV
1 – temporary repolarization
» Open K+ channels allow some K+ to leave the cell
2 – plateau phase
» Voltage gated Ca2+ channels are fully open (started during initial
depolarization)
3 – repolarization
» Ca2+ channels close and K+ permeability increases as slower activated K+
channels open, causing a quick repolarization

• The plateau prevents tetanus

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 Myocardial physiology

Skeletal Action Potential vs Contractile

Myocardial Action Potential

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 Ecg
+25 1 RRP
0
Transmembrane Potential

-25 2
3
-50 0
ARP
-75 4
-100

-125
0 0.1 0.2 0.3
Time (msec)
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 Electrocardiogram (ECG)

P wave: atrial depolarization

P-R segment: conduction through AV
node and AV bundle
QRS complex: ventricular
depolarization
T wave: ventricular repolarization

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CARDIAC PERFORMANCE

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VENOUS RETURN & CONTRACTILITY
SV=EDV–ESV

EDV (preload) depends on

venous return (ventricular
filling) and the resistance
of the ventricle to
expansion.

Force of contraction
(ejection volume, SV)
increases with stretching
(Frank-­Starling effect).
Venous Return = Preload39
 Regulation of arterial Blood pressure
 Baroreceptor reflexes
 Reflex involving arterial chemoreceptors/
ischemic
 Hormonal Control
– Vasopressin [antidiuretic hormone (ADH)]
– Atrial natriuretic peptide (ANP)
– Renin–angiotensin–aldosterone system

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 Carotid sinus
 At the bifurcation of the common carotid arteries
 the root of internal carotid artery shows a little bulge
 has stretch receptors in the adventitia
 are sensitive to arterial pressure fluctuations
 Afferent nerves travel in the carotid sinus nerve
 a branch of the glossopharyngeal nerve. (IXth cranial
nerve)

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 Aortic arch.
baroreceptors
in the adventitia of the arch of aorta
Function
 similar to the carotid sinus receptors.
afferent nerve fibers travel in the aortic
nerve,
a branch of the vagus nerve. (Xth cranial
nerve)
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 Chemoreceptors in the carotid and aortic bodies

• are located near the bifurcation of the common

carotid arteries and along the aortic arch.
• have very high rates of O2 consumption and are
very sensitive to decreases in the partial
pressure of oxygen (PO2).
• Decreases in PO2 activate vasomotor centers
that produce vasoconstriction, an increase in
TPR, and an increase in arterial pressure.
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Renin–angiotensin–aldosterone system

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 BLOOD VESSELS
• The blood vessels are organs of the cardiovascular system
• The blood vessels form a closed circuit to and from the
heart
• The blood vessels include:
• Arteries - carry blood away from the ventricles of the heart
• Arterioles - receive blood from the arteries and carry blood
to the capillaries
• Capillaries - sites of exchange of substances between the
blood and the body cells
• Venules - receive blood from the capillaries
• Veins - carry blood toward the atria of the heart

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 Blood vessels
• Arteries:
• Thick strong wall (three layers or tunics)
• Endothelial lining
• Middle layer of smooth muscle and elastic tissue
• Outer layer of connective tissue
• Carries blood under relatively high pressure
• Arterioles:
• Thinner wall than an artery (three layers or tunics)
• Endothelial lining
• Middle and outer layers are thinned
• Some smooth muscle tissue
• Small amount of connective tissue
• Helps control blood flow into a capillary
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 Blood vessels
• Capillaries are the smallest diameter blood
vessels
• They connect the smallest arteriole and the
smallest venule
• They are extensions of the inner lining of
arterioles
• The walls are endothelium only
• They are semi-permeable

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 Blood vessels
• Venule:
• Microscopic vessels that continue from the capillaries and
merge to form veins
• Thinner walls than arterioles
• Less smooth muscle and elastic tissue than arteriole
• Veins:
• Thinner walls than arteries (three layers or tunics)
• Middle wall poorly developed
• Many have flap-like valves
• Carry blood under relatively low pressure
• Function as blood reservoirs
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Venous Blood Flow

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 Blood flow
1. Bulk flow from high to low pressure states.
2. Resistance opposes blood flow. Resistance depends on:
a. length of the tube (blood vessel)
b. radius of the tube (to 4th power!)- most important!
c. viscosity of the blood
3. Flow rate is the volume of blood that passes a given
point per unit time (L/min). This is determined by pressure
gradients and resistance.
4. Velocity of the blood is how far a volume of blood
travels per unit of time (mm/sec). This is determined by
cross sectional area, if the flow rate is constant.
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Blood pressure (BP) maintained in
diastole by compliance of elastic
arteries.

Pulsatility & blood pressure

diminishes in arterioles due to
resistance.

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• Mean Arterial (MAP): the driving pressure
• MAP = DP + 1/3 (SP – DP)
• Pulse Pressure (PP) = SP –DP
Where DP = diastolic pressure
SP = systolic pressure
• Arteries distribute blood to individual organs! FLOW (F)
= (P2-P1)/Resistance
• CO = Q = (MAP- P vena cava)/Total Peripheral Resistance
• = MAP/TPR
• Q organ = (MAP – Venous P)/Resistance of organ
• = MAP/R organ 57
 ARTERIOLES REGULATE BLOOD WITHIN
ORGANS
1. LOCAL CONTROL:
Myogenic response = change in wall tension
Hyperemia = change in ECF metabolites
active = increased metabolism increases ECF metabolites
(K+, CO2, H+)
reactive hyperemia = increased metabolites during ischemia
causes higher flow in reperfusion
2. REFLEX CONTROL: Sympathetic innervation
(NorEpi at α 1 AR)
Hormones (vasopressin, epinephrine)
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