Human Physiology Dr.

Ananda
Chandrasekara
(NTN 1224 ) Senior Lecturer
 The Cardiovascular System

• Cardio – heart
• Vascular -relating to, affecting, or consisting of a
vessel or vessels, especially those which carry blood.
The Cardiovascular
System
• A closed system of the heart and blood
vessels
• The heart pumps blood
• Blood vessels circulate to all parts of
the body
• Lungs exchange gasses
• The function of the cardiovascular system is
to deliver oxygen and nutrients and to
remove carbon dioxide and other waste
products
https://www.youtube.com/watch?v=_lgd03h3te8
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
The Heart Wall: 3 layers
• Pericardium
• Outside layer
• Connective tissue layer
• Myocardium
• Middle layer
• Mostly cardiac muscle
• Endocardium
• Inner layer
• Endothelium
Pericardial Layers of the Heart

8
https://www.youtube.com/watch?v=pte5wO5ZB2Q
Anatomy of
the heart
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
 Blood
Circulation

Figure 11.3
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
 • Valves open as blood is pumped
The Heart: through
Valves • Close to prevent backflow
Operation of Heart Valves
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
 • 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

Coronary Circulation
 The Heart: Conduction System

Intrinsic conduction system (nodal system)

Heart muscle cells contract, without nerve
impulses, in a regular, continuous way

• Special tissue sets the pace

• Sinoatrial node (SA) -
Pacemaker
• Atrioventricular node
(AV)
• Atrioventricular bundle
• Bundle branches
• Purkinje fibers
 The Heart’s Cardiac
Cycle

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

• Contraction is initiated by the sinoatrial node

• Sequential stimulation occurs at other autorhythmic cells
Filling of Heart Chambers – the Cardiac
Cycle

Figure 11.6
Heart Excitation Related to ECG

Chapter 18, Cardiovascular System

Figure 18.17 23
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
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
Cardiac Output Regulation

Figure 11.7
Regulation of Heart Rate
• Stroke volume usually remains relatively constant
• Starling’s law of the heart – the more that the cardiac muscle is stretched, the
stronger the contraction
• Changing heart rate is the most common way to change cardiac
output
 Regulation of Heart
Rate

• Increased heart rate

• Sympathetic nervous
system
• Activated in a Crisis
• Low blood pressure
• Hormones
• Epinephrine
• Thyroxine
• Exercise
• Decreased blood volume
Blood Vessels: The Vascular System
• Taking blood to the tissues and back
• Arteries
• Arterioles
• Capillaries
• Venules
• Veins

Figure 11.8a
The Vascular System

Figure 11.8b
Differences Between Blood Vessel Types
• Walls of arteries are the thickest
• Lumens (inside space) 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
Capillary Beds
• True capillaries –
exchange vessels
• Oxygen and nutrients cross
to cells
• Carbon dioxide and
metabolic waste products
cross into blood

Figure 11.10
Diffusion at Capillary Beds

Figure 11.20
Capillary Exchange
• Substances exchanged due to concentration
gradients
• Oxygen and nutrients leave the blood
• Carbon dioxide and other wastes leave the cells
Capillary Exchange: Mechanisms

• Direct diffusion across

plasma membranes
• Endocytosis or exocytosis
• Some capillaries have gaps
(intercellular clefts)
• Plasma membrane not joined
by tight junctions
• Fenestrations of some
capillaries
• Fenestrations = pores
Arterial Supply of the Brain

Figure 11.13
Hepatic Portal Circulation
Circulation to the Fetus
 Pulse
• Pulse – pressure wave
of blood
• Monitored at
“pressure points”
where pulse is easily
palpated

Figure 11.16
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
Measuring Arterial Blood Pressure

Figure 11.18
Blood Pressure: Effects of Factors
• Neural factors
• Autonomic nervous system adjustments (sympathetic division)
• Renal factors
• Regulation by altering blood volume
• Renin – hormonal control
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
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
Thickness of Cardiac Walls

Myocardium of left ventricle is much thicker than the right.

Chapter 18, Cardiovascular System 46

Atrial Septal Defect

Chapter 18, Cardiovascular System 47

Ventricular Septal Defect

Chapter 18, Cardiovascular System 48

Pathway of Blood Through the Heart and
Lungs
• Right atrium  tricuspid valve  right ventricle
• Right ventricle  pulmonary semilunar valve  pulmonary arteries
 lungs
• Lungs  pulmonary veins  left atrium
• Left atrium  bicuspid valve  left ventricle
• Left ventricle  aortic semilunar valve  aorta
• Aorta  systemic circulation

Chapter 18, Cardiovascular System 49

Pathway of Blood Through the Heart and
Lungs

Chapter 18, Cardiovascular System

Figure 18.5 50
Coronary Circulation
• Coronary circulation is the functional blood supply to the heart
muscle itself
• Collateral routes ensure blood delivery to heart even if major vessels
are occluded

Chapter 18, Cardiovascular System 51

Coronary Circulation: Venous Supply

Chapter 18, Cardiovascular System 52

Figure 18.7b
Heart• Heart valves ensure unidirectional blood flow through
Valves
the heart
• Atrioventricular (AV) valves lie between the atria and
the ventricles
• AV valves prevent backflow into the atria when ventricles
contract
• Chordae tendineae anchor AV valves to papillary
muscles

Chapter 18, Cardiovascular System 53

Heart Valves
• Semilunar valves prevent backflow of blood into the ventricles
• Aortic semilunar valve lies between the left ventricle and the aorta
• Pulmonary semilunar valve lies between the right ventricle and
pulmonary trunk

Chapter 18, Cardiovascular System 54

Heart Valves

Chapter 18, Cardiovascular System

Figure 18.8a, b 55
Heart Valves

Chapter 18, Cardiovascular System

Figure 18.8c, d 56
Atrioventricular Valve Function

Chapter 18, Cardiovascular System

Figure 18.9 57
Semilunar Valve Function

Chapter 18, Cardiovascular System

Figure 18.10 58
Mitral Valve Prolapse

Chapter 18, Cardiovascular System 59

Microscopic Anatomy
• Cardiac muscle is striated,of Heart
short, Muscle
fat, branched, and
interconnected
• The connective tissue endomysium acts as both tendon
and insertion
• Intercalated discs anchor cardiac cells together and
allow free passage of ions
• Heart muscle behaves as a functional syncytium

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Cardiovascular System: Anatomy Review: The Heart
Chapter 18, Cardiovascular System 60
Microscopic Anatomy of Heart Muscle

Chapter 18, Cardiovascular System 61

Figure 18.11
The Cardiovascular System: The Heart
Physiology

62
Cardiac Muscle Contraction
• Heart muscle:
• Is stimulated by nerves and is self-excitable (automaticity)
• Contracts as a unit
• Has a long (250 ms) absolute refractory period
• Cardiac muscle contraction is similar to skeletal muscle contraction

Chapter 18, Cardiovascular System 63

Heart Physiology: Intrinsic Conduction System
• Autorhythmic cells:
• Initiate action potentials
• Have unstable resting potentials called pacemaker potentials
• Use calcium influx (rather than sodium) for rising phase of the action
potential

Chapter 18, Cardiovascular System 64

Pacemaker and Action Potentials of the Heart

Chapter 18, Cardiovascular System 65

Figure 18.13
Heart Physiology: Sequence of Excitation
• Sinoatrial (SA) node generates impulses about 75 times/minute
• Atrioventricular (AV) node delays the impulse approximately 0.1
second

Chapter 18, Cardiovascular System 66

Heart Physiology: Sequence of Excitation
• Impulse passes from atria to ventricles via the atrioventricular
bundle (bundle of His)
• AV bundle splits into two pathways in the interventricular septum (bundle
branches)
1. Bundle branches carry the impulse toward the apex of the heart
2. Purkinje fibers carry the impulse to the heart apex and ventricular walls

Chapter 18, Cardiovascular System 67

Heart Physiology: Sequence of Excitation

Chapter 18, Cardiovascular System 68

Figure 18.14a
Extrinsic Innervation of the Heart
• Heart is stimulated by
the sympathetic
cardioacceleratory
center
• Heart is inhibited by
the parasympathetic
cardioinhibitory
center

Chapter 18, Cardiovascular System 69

Figure 18.15
 • Electrical activity is recorded by electrocardiogram (ECG)
Electrocardiography
• P wave corresponds to depolarization of SA node
• QRS complex corresponds to ventricular depolarization
• T wave corresponds to ventricular repolarization
• Atrial repolarization record is masked by the larger QRS
complex

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Cardiovascular System: Intrinsic Conduction System
Chapter 18, Cardiovascular System 70
Electrocardiography

Chapter 18, Cardiovascular System

Figure 18.16 71
Heart Sounds
• Heart sounds (lub-dup) are associated with closing of heart valves
• First sound occurs as AV valves close and signifies beginning of systole
(contraction)
• Second sound occurs when SL valves close at the beginning of ventricular
diastole (relaxation)

Chapter 18, Cardiovascular System 72

Cardiac Cycle
• Cardiac cycle refers to all events associated with blood flow through
the heart
• Systole – contraction of heart muscle
• Diastole – relaxation of heart muscle

Chapter 18, Cardiovascular System 73

 • Ventricular
Phases of the filling – mid-to-late
Cardiac Cycle diastole
• Heart blood pressure is low as blood enters atria (passively)
and flows into ventricles
• AV valves are open, then atrial systole occurs

Chapter 18, Cardiovascular System 74

 • Ventricular
Phases of the systole
Cardiac(contraction)
Cycle
• Atria relax
• Rising ventricular pressure results in closing of AV valves
• Isovolumetric contraction phase
• Ventricular ejection phase opens semilunar valves

Chapter 18, Cardiovascular System 75

 • Isovolumetric relaxation – early diastole
Phases• of the Cardiac Cycle
Ventricles relax
• Backflow of blood in aorta and pulmonary trunk closes
semilunar valves
• Dicrotic notch – brief rise in aortic pressure caused by
backflow of blood rebounding off semilunar valves

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Cardiovascular System: Cardiac Cycle
Chapter 18, Cardiovascular System 76
Phases of the Cardiac Cycle

Chapter 18, Cardiovascular System

Figure 18.20 77
Cardiac Output (CO) and Reserve
• Cardiac Output is the amount of blood pumped by each ventricle in
one minute
• CO is the product of heart rate (HR) and stroke volume (SV)
• HR is the number of heart beats per minute
• SV is the amount of blood pumped out by a ventricle with each beat
• Cardiac reserve is the difference between resting and maximal CO

Chapter 18, Cardiovascular System 78

Cardiac Output:
• CO (ml/min) = HRExample
(75 beats/min) x SV (70 ml/beat)
• CO = 5250 ml/min (5.25 L/min)

Chapter 18, Cardiovascular System 79

Regulation of Stroke Volume
• SV = end diastolic volume (EDV) minus end systolic volume (ESV)
• EDV = amount of blood collected in a ventricle during diastole
• ESV = amount of blood remaining in a ventricle after contraction

Chapter 18, Cardiovascular System 80

Factors Affecting Stroke Volume
• Preload – amount ventricles are stretched by contained blood
• Contractility – cardiac cell contractile force due to factors other than
EDV
• Afterload – back pressure exerted by blood in the large arteries
leaving the heart

Chapter 18, Cardiovascular System 81

 • Preload, or degree of stretch, of cardiac muscle cells
Frank-Starling Law of
before they contract the
is the Heart
critical factor controlling
stroke volume
• Slow heartbeat and exercise increase venous return to
the heart, increasing SV
• Blood loss and extremely rapid heartbeat decrease SV

Chapter 18, Cardiovascular System 82

Preload and Afterload

Chapter 18, Cardiovascular System 83

Figure 18.21
Extrinsic Factors Influencing Stroke Volume
• Contractility is the increase in contractile strength, independent of
stretch and EDV
• Increase in contractility comes from:
• Increased sympathetic stimuli
• Certain hormones
• Ca2+ and some drugs

Chapter 18, Cardiovascular System 84

Extrinsic Factors Influencing Stroke Volume
• Agents/factors that decrease contractility include:
• Acidosis
• Increased extracellular K+
• Calcium channel blockers

Chapter 18, Cardiovascular System 85

Contractility and Norepinephrine
• Sympathetic
stimulation
releases
norepinephrine
and initiates a
cyclic AMP second-
messenger system

Chapter 18, Cardiovascular System 86

Figure 18.22
Regulation of Heart Rate
• Positive chronotropic factors increase heart rate
• Caffeine
• Negative chronotropic factors decrease heart rate
• Sedatives

Chapter 18, Cardiovascular System 87

Regulation of Heart Rate: Autonomic Nervous
System
• Sympathetic nervous system (SNS) stimulation is activated
by stress, anxiety, excitement, or exercise
• Parasympathetic nervous system (PNS) stimulation is
mediated by acetylcholine and opposes the SNS
• PNS dominates the autonomic stimulation, slowing heart
rate and causing vagal tone
• If the Vagus Nerve was cut, the heart would lose its
tone. Thus, increasing the heart rate by 25 beats per
minute.

Chapter 18, Cardiovascular System 88

Atrial (Bainbridge) Reflex
• Atrial (Bainbridge) reflex – a sympathetic reflex initiated by increased
blood in the atria
• Causes stimulation of the SA node
• Stimulates baroreceptors in the atria, causing increased SNS stimulation

Chapter 18, Cardiovascular System 89

Chemical Regulation
• The hormones of and
epinephrine thethyroxine
Heartincrease heart
rate
• Intra- and extracellular ion concentrations must be
maintained for normal heart function

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Cardiovascular System: Cardiac Output
Chapter 18, Cardiovascular System 90
Factors Involved in Regulation of Cardiac
Output

Chapter 18, Cardiovascular System

Figure 18.23 91
Congestive Heart Failure (CHF)
• Congestive heart failure (CHF) is caused by:
• Coronary atherosclerosis
• Persistent high blood pressure
• Multiple myocardial infarcts
• Dilated cardiomyopathy (DCM) – main pumping chambers of the heart are
dilated and contract poorly

Chapter 18, Cardiovascular System 92

Developmental Aspects of the Heart

Chapter 18, Cardiovascular System

Figure 18.24 93
Developmental Aspects of the Heart
• Fetal heart structures that bypass pulmonary circulation
• Foramen ovale connects the two atria
• Ductus arteriosus connects pulmonary trunk and the aorta

Chapter 18, Cardiovascular System 94

Examples of Congenital Heart Defects

Chapter 18, Cardiovascular System

Figure 18.25 95
Age-Related Changes Affecting the Heart
• Sclerosis and thickening of valve flaps
• Decline in cardiac reserve
• Fibrosis of cardiac muscle
• Atherosclerosis

Chapter 18, Cardiovascular System 96

Congestive Heart Failure
• Causes of CHF
• coronary artery disease, hypertension, MI, valve disorders,
congenital defects
• Left side heart failure
• less effective pump so more blood remains in ventricle
• heart is overstretched & even more blood remains
• blood backs up into lungs as pulmonary edema
• suffocation & lack of oxygen to the tissues
• Right side failure
• fluid builds up in tissues as peripheral edema

Chapter 18, Cardiovascular System 97

Coronary Artery Disease
• Heart muscle receiving
insufficient blood supply
• narrowing of vessels---
atherosclerosis, artery
spasm or clot
• atherosclerosis--smooth
muscle & fatty deposits in
walls of arteries

• Treatment
• drugs, bypass graft,
angioplasty, stent

Chapter 18, Cardiovascular System 98

Clinical Problems
• MI = myocardial infarction
• death of area of heart muscle from lack of O2
• replaced with scar tissue
• results depend on size & location of damage
• Blood clot
• use clot dissolving drugs streptokinase or t-PA & heparin
• balloon angioplasty
• Angina pectoris
• heart pain from ischemia (lack of blood flow and oxygen )
of cardiac muscle

Chapter 18, Cardiovascular System 99

https://www.youtube.com/watch?v=3Nf6Q2skGOM
By-pass Graft

Chapter 18, Cardiovascular System 101

Percutaneous Transluminal Coronary
Angioplasty

Chapter 18, Cardiovascular System 102

https://www.youtube.com/watch?v=p3z9FLYijrQ
Artificial Heart

Chapter 18, Cardiovascular System 104