ANATOMY AND PHYSIOLOGY

OF THE
CARDIOVASCULAR SYSTEM
 HEART
LOCATED ON THE DIAPHRAGM
NEAR THE MIDLINE OF THE THORACIC CAVITY
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The heart=a muscular double pump with 2 functions

Overview
 The right side receives oxygen-
poor blood from the body and
tissues and then pumps it to the
lungs to pick up oxygen and dispel
carbon dioxide
 Its left side receives oxygenated
blood returning from the lungs
and pumps this blood throughout
the body to supply oxygen and
nutrients to the body tissues

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 Heart’s position in thorax
In mediastinum – behind sternum and pointing left, lying on
the diaphragm
It weighs 250-350 gm (about 1 pound)
Feel your heart beat at apex

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(this is of a person lying down)
 Location and Surface Projection
The heart is hollow, cone-shaped, about the size of a closed
fist .
Lies in the mediastinum between the lungs and rests upon the
diaphragm
Two-thirds of its mass lies to the left of the midline
Apex - lower, pointed end
Base - broader, superior portion

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 Heart’s position in thorax

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 Layers of Heart Wall
Pericardium - membrane (sac) that surrounds and protects the
heart, it has two layers:
(a) Fibrous pericardium - superficial layer, tough, inelastic,
prevents overstretching, provides protection, and anchors the
heart in place
(b) Serous pericardium - deeper layer, thin;
(i) parietal layer - fused to the fibrous pericardium, and (ii)
visceral layer (or epicardium) adheres to the heart itself
Pericardial cavity (between the two layers) is filled with
pericardial fluid which reduces friction.

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 Layers of Heart Wall

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 PERICARDIUM

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 FIBROUS:THIN INELASTIC, DENSE IRREGULAR
CONNECTIVE TISSUE
---HELPS IN PROTECTION, ANCHORS HEART TO
MEDIASTINUM
SEROUS: THINNER, MORE DELICATE DIVIDED INTO
PARIETAL AND VISCERAL

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EPICARDIUM: COMPOSED OF MESOTHELIUM AND
DELICATE CONNECTIVE TISSUE (IMPARTS A SLIPPERY
TEXTURE TO THE OUTER SURFACE OF THE HEART).
 MYOCARDIUM:RESPONSIBLE FOR PUMPING

ENDOCARDIUM: THIN LAYER OF ENDOTHELIUM

WHICH IS CONTINOUS WITH THE LINING OF THE
LARGE BLOOD VESSELS ATTACHED TO THE HEART.

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CHAMBERS OF THE HEART
 Chambers of the heart

Two atria
Right atrium
Left atrium

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Two ventricles
Right ventricle
Left ventricle

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 Chambers of the heart
divided by septae:
Two atria-divided by
interatrial septum
Right atrium
Left atrium
Two ventricles-divided by
interventricular septum
Right ventricle
Left ventricle

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 Myocardial Thickness and Function
The atria are thin-walled as they deliver blood under less
pressure
The ventricles have thick walls since they pump blood at a
higher pressure and over greater distances
The right and left ventricles eject equal amounts of blood
The left ventricle is thicker because it pumps under higher
pressure and over a greater distance than the right ventricle
(Fig. 14.4c)

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ATRIOVENTRICULAR &
SEMILUNAR VALVES
 Heart Valves - Atrioventricular
The four valves prevent backflow of blood in the heart after
blood passes through them
Atrioventricular (AV) valves
- tricuspid valve between the right atrium and the right
ventricle
- bicuspid (mitral) valve - between the left atrium
and the left ventricle
 Chordae tendineae and associated papillary muscles permit
flow but prevent backflow

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 Heart Valves - Semilunar
Two semilunar (SL) valves each having three semilunar
cusps
Allow ejection of blood from the ventricles into the
pulmonary trunk and aorta
Prevent backflow of blood into the heart
Pulmonary valve - between the pulmonary trunk and the
right ventricle
Aortic valve - between the aorta and the left ventricle

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 SYSTEMIC AND PULMONARY
CIRCULATION
LEFT SIDE IS A PUMP
TO THE SYSTEMIC
CIRCULATION.
RIGHT SIDE IS A PUMP
TO THE PULMONARY
CIRCULATION.
 Circulation of Blood
The heart pumps blood into two circuits arranged in series
(connected end to end)
Systemic circulation - left side of heart receives
oxygenated blood from the lungs
Pumps this blood into the aorta which branches into
systemic arteries that carry blood to all organs except
alveoli of the lungs
Arteries branch into arterioles and eventually into
systemic capillaries where nutrients, gases, wastes, etc.
are exchanged with the surrounding cells; venules and
subsequently systemic veins return the deoxygenated
blood to the right atrium

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 Circulation of Blood
Pulmonary circulation - the right ventricle pumps blood
into the pulmonary trunk which branches into the
pulmonary arteries
This blood goes to the pulmonary capillaries where the
blood becomes oxygenated
Pulmonary veins carry the oxygenated blood to the left
atrium

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 Coronary (Cardiac) Circulation
Two coronary arteries, the left and right coronary
arteries branching from the ascending aorta supply the
myocardium
Left coronary artery divides into the anterior
interventricular branch (or left anterior descending
artery) and the circumflex branch
Right coronary artery divides into the posterior
interventricular branch and marginal branch

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 Coronary Arteries

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 Cardiac Conduction System
Sinoatrial (SA) node - the heart’s natural pacemaker,
initiates each heartbeat
Other components of of the conduction system include:
Atrioventricular (AV) node, Atrioventricular
bundle or bundle of His, right and left bundle
branches, Purkinje fibers
The nervous system and certain hormones can alter the pace
of contractions but the nervous system does not initiate
contractions

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Electrical conduction system:

specialized cardiac muscle cells that carry

impulses throughout the heart
musculature, signaling the chambers to
contract in the proper sequence

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Conduction system

SA node (sinoatrial)

In wall of RA
Sets basic rate: 70-80
Is the normal pacemaker
Impulse from SA to atria
Impulse also to AV node via internodal pathway
AV node
In interatrial septum

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 Conduction continued
SA node through AV bundle (bundle of His)
Into interventricular septum
Divides
R and L bundle branches
become subendocardial
branches (“Purkinje
fibers”)
Contraction begins
at apex

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CARDIAC CYCLE
 ATRIAL SYSTOLE
LASTS FOR 0.1 SEC
ATRIAL DEPOLARIZATION CAUSES ATRIAL
SYSTOLE
IT CONTRIBUTES A FINAL 25mL OF BLOOD
TO EACH VENTRICLE
END OF ATRIAL SYSTOLE IS ALSO END OF
VENTRICULAR DIASTOLE
END-DIASTOLIC VOLUME IS 130 mL
 VENTRICULAR SYSTOLE
LASTS FOR 0.3 SEC
IT IS CAUSED BY VENTRICULAR
DEPOLARIZATION
ISOVOLUMETRIC CONTRACTION LASTS
FOR 0.05 SECONDS WHEN BOTH THE
SEMILUNAR AND ATRIOVENTRICULAR
VLAVES ARE CLOSED.
THE SL VALVES OPEN WHEN
-THE LEFT VENTRICULAR PRESSURES SURPASSES AORTIC
PRESSURE(80 MM OF MERCURY)
-THE RIGHT VENTRICULAR PRESSURE RISES ABOVE
PULMONARY PRESSURE (20 mmHg)
SL VALVES OPEN FOR 0.25 SEC
THE LEFT VENTRICLE EJECTS ABOUT 70 ML INTO
THE AORTA
THE RIGHT VENTRICLE EJECTS THE SAME VOLUME
INTO THE PULMONARY TRUNK.
END SYSTOLIC VOLUME IS 60mL IN EACH
VENTRICLE .
 HEART SOUNDS
PRODUCED FROM BLOOD
TURBULENCE CAUSED BY
CLOSING OF HEART VALVES
S1 – ATRIOVENTRICULAR VALVE
CLOSURE
S2 – SEMILUNAR VALVE CLOSURE
S3- RAPID VENTRICULER FILLING
S4- ATRIAL SYSTOLE
 CARDIAC OUTPUT

CO = SV X HR
mL/min mL/beat (Beats/min)

FOR A RESTING ADULT

CO = 70mL/beat x75beats/min
= 5250 mL/min
= 5.25 L/min
HEMODYNAMIC MONITORING OF HEART
CVP
PAP
SWAN-GANZ CATHETER
INSERTION OF CATHETER
CHEST X RAY
MRI
TRADE MILL STRESS TESTING
BRONCHOSCOPY
PFT
SPIROMETERY
ECG
OTHER BLOOD TEST
PACEMAKER
PACEMAKER LOCATION
DEFIBRILLATORS
THANK YOU