Cardiovascular

Respiratory System
KING DANIEL M. BARCE
 TheCardiovascular Respiratory System
consists of heart and blood vessels,
which work with the respiratory system
(the lungs and the airways). These body
system carry oxygen to the muscles and
organs of the body and remove waste
products, including carbon dioxide.
Anatomy of the Heart
Objectives:

- Describe the location of the heart

- Describe the structure of the pericardium and the heart wall

- Discuss the external and internal anatomy of the chambers of the

heart
Location of the Heart

 The heart is relatively small, roughly the same size (but not the
same shape) as your closed fist. It’s about 12 cm (5 in.) long, 9
cm (3.5 in.) wide as it broadest point and 6 cm (2.5 in.) thick
with an average mass of 250 g (8 oz) in adult females and 300 g
(10 oz) in adult males.

 The heart rests on the diaphragm, near the midline of the

thoracic cavity. It lies in the mediastinum, a mass of a tissue
that extend from the sternum to the vertebral column between
the lungs. About two thirds of the mass of the heart lies to the
left of the body’s midline. You can visualize the heart as a cone
lying on it’s side. The pointed apex is directed anteriorly,
inferiorly and to the left. The broad base is directed posteriorly,
superiorly and to the right.
Pericardium
 The membrane that surrounds and protects the heart is called
pericardium
 The pericardium consist of two main parts: The Fibrous pericardium
and the Serous pericardium.

 The Fibrous Pericardium is composed of tough, inelastic, dense

irregular connective tissue. It resemble a bag that rests of the
attaches to the diaphragm; its open is fused to the connective
tissues of the blood vessels entering and leaving the heart.

 The Serous Pericardium is a thinner, more delicate membrane that

forms a double layer around the heart. The outer parietal layer of
the serous pericardium is fused to the fibrous pericardium. The inner
visceral layer of the serous pericardium, also called the epicardium.
Layers of the Heart Wall
 The wall of the heart consists of three layers: the
epicardium (external layer), the myocardium (middle
layer) and the endocardium (inner layer). As noted
earlier, the outermost epicardium, the thin,
transparent outer layer of the heart wall is also called
the visceral layer of the serous pericardium. It is
composed of mesothelium and delicate connective
tissue that imparts a smooth, slippery texture to the
outermost surface of the heart. The middle
myocardium which is cardiac muscle tissue, make up
the bulk of the heart and is responsible for its
pumping action.
Chambers of the Heart
 The Heart has a four chambers. The two
superior chambers are the atria (= entry halls
or chamber), and the two inferior chambers
are the ventricle (= little bellies.) On the
anterior surface of each atrium is wrinkled
pouchlike structure called an auricle, so
named because of its resemblance to a dog
ear. Each auricle slightly increases the
capacity of an atrium so that it can hold the
greater volume of blood.
 The right atrium receives oxygen-poor blood from the body and
pumps in to the right ventricle.

 The right ventricle pumps the oxygen-poor blood to the lungs.

 The left atrium receives oxygen-rich blood from the lungs and
pumps it to the left ventricle.

 The left ventricle pumps the oxygen-rich blood to the body.

Heart Valves and Circulation of
Blood
Objectives
 Describe the structure and function of the valves
of the heart. Outline the flow of blood through
the chamber of the heart and through the
systemic and pulmonary circulations.

Discuss the coronary circulation.

Operation of the Atrioventricular
Valves
 Because they are located between an atrium and a
ventricle, the tricuspid and bicuspid valves are termed
atrioventricular (AV) valves. When an AV valve is
open, the pointed of the cusps project into the
ventricle. When the ventricle are relaxed, the papillary
muscle are relaxed, the chordae and tendineae are
slack , and blood moves from a higher pressure in the
atria to a lower pressure in the ventricles through
open AV valves. When the ventricles contract, the
pressure of the blood drives the cusps upward until
their edge meet and close the opening.
Operation of the Semilunar Valves

 The aortic and pulmonary valves are known as the semilunar (SL)
valves because they are made up of three crescent moon-shaped
cusps. Each cusps attaches to the arterial wall by its convex outer
margin. The SL valves allow ejection of blood from the heart into
arteries but prevent backflow of blood into the ventricles. The free
borders of the cusps project into the lumen of the artery. When the
ventricles contract, pressure builds up within the chambers. The
semilunar valves open when pressure in the ventricle exceeds the
pressure I the arteries, permitting ejection of blood from the
ventricles into the pulmonary trunk and aorta. As the ventricle relax,
blood starts to flow back toward the heart. This back flowing blood
fills the valve cusps, which causes the semilunar valves to close
tightly.
Heart Valve Disorders

 Allfour valves can be stenotic

(hardened, restricting blood flow); the
conditions are called tricuspid stenosis,
pulmonic stenosis, mitral stenosis or
aortic stenosis. Valvular insufficiency
also called regurgitation, incompetence
or “leaky valve” this occurs when a valve
does not close tightly.
Systemic and Pulmonary
Circulations
 There are two types of Circulations:
Pulmonary circulations and Systemic
circulation. Pulmonary circulation moves blood
between the heart and the lungs. Systemic
circulation moves blood between the heart and
the rest of the body. It sends oxygenated
blood out cells and return deoxygenated blood
to the heart.
Coronary Circulation
 Coronary circulation is the circulation of
blood in the blood vessels that supply
the heart muscles. Coronary arteries
supply oxygenated blood to the heart
muscle, and cardiac veins drain away
the blood once it has been
deoxygenated.
Coronary Arteries
 The coronary arteries are the blood
vessels (arteries) of coronary circulation,
which transports oxygenated blood to
the substance of the heart. The heart
requires a continuous supply of oxygen
to function and survive, much like any
other tissue or organ of the body.
Coronary Veins

After blood passes through the arteries of the coronary

circulation, it flows into capillaries, where it delivers
oxygen and nutrients to the heart muscle and collects
carbon dioxide and waste and then moves into coronary
veins. Most of the deoxygenated blood from the
myocardium drains into a large vascular sinus in the
coronary sulcus in the posterior surface of the heart,
called the coronary sinus. (A vascular sinus is a thin-
walled vein that has no smooth muscles to alter its
diameter.) The deoxygenated blood in the coronary
sinus empties into the right atrium.
 Great cardiac vein in the anterior interventricular sulcus, which
drains the areas of the heart supplied by the left coronary artery (left
an right ventricles and left atrium.)

 Middle cardiac vein in the posterior interventricular sulcus, which

drains the areas supplied by the posterior interventricular branch of
the right coronary artery (left and right ventricles)

 Small cardiac vein in the coronary sulcus, which drains the right
atrium and right ventricle

 Anterior cardiac veins which drains the right ventricle and open
directly into the right atrium.
Myocardial Ischemia and Infarction

 Myocardial Ischemia occurs when blood

flow to the heart muscle (myocardium)
is obstructed by a partial or complete
blockage of a coronary artery by a build
up of plaques (atherosclerosis). If the
plaques rupture, you can have a heart
attack (myocardial infarction).
Cardiac Muscle Tissue and The
Cardiac Conduction System
Objectives
-Describe the structural and functional
characteristics of cardiac muscle tissue and the
conduction system of the heart.
-Describe how an action potential occurs in
cardiac contractile fibers.
-Describe the electrical events of a normal
electrocardiogram (ECG).
Histology of Cardiac Muscle Tissue

 Compared with skeletal muscles fibers, cardiac

muscle fibers are shorter in length and less
circular in transverse section. They also
exhibit branching, which gives individual
cardiac muscle fibers a “stair-step”
appearance. A typical cardiac muscle fiber is
50--100 um long and has a diameter of about
14 um.
Regeneration of Heart Cells

 During human development, cardiac myocytes

are made by progenitor stem cells and
proliferate to form the heart. Once the heart is
formed, the myocytes transform from
immature cells into mature cells that cannot
proliferate then myocytes would become
mature again and aid in contracting the
regenerated heart muscle.
Autorhythmic Fibers: The
Conduction System
 Network of specialized cardiac muscle
fibers called “äutorhythmic fibers”
because they are self excitable form of
conduction system, a network of
specialized cardiac muscle fibers that
provide a path for each cycle of cardiac
excitation to progress through the heart.
Action Potential and Contraction
of Contractile Fibers
 The action potential initiated by the SA
mode travel along the conduction system
and spreads out to excite the “working”
atrial and ventricular muscle fibers is
called contractile fibers.
Depolarization

 Unlike autorhythmic fibers, contractile fibers

have a stable resting membrane potential that
is close to –90 mV. When a contractile fiber is
brought to threshold by and action potential
from neighboring fibers, its voltage gated
fast Na+ channel. These sodium ion
channels are referred to as “fast” because
they open very rapidly in response to a
threshold-level depolarization.
Plateau

 The next phase of an action potential in a

contractile fiber is plateau, a period of
maintained depolarization. It is due in part to
opening of voltage-gated slow channels in the
sarcolemma. When these channels opens
calcium, ions move from the interstitial fluid
(which has a higher Ca2+ concentration) into
cytosol.
Repolarization

 The recovery of the resting membrane potential

during the repolarization phase of a cardiac action
potential resembles that in other excitable cells. After
a delay (which is particularly prolonged in cardiac
muscles). Voltage-gated K+ channels open. Outflow of
K+ restore the negative resting membrane potential
(-- 90 mV). At the same time the calcium channels in
the sarcolemma and the sarcoplasmic reticulum are
closing, which also contributes to repolarization.
The Cardiac Cycle

Objectives:
- Describe the pressure and volume changes that
occur during a cardiac cycle.
- Relate the timing of heart sounds to the ECG
waves and pressure changes during systole and
diastole.
Pressure and Volume Changes
During the Cardiac Cycle
 In each cardiac cycle, the atria and ventricles alternately contract
and relax, forcing blood from areas of higher pressure to areas of
lower pressure. As a chamber of the heart contracts, blood pressure
within it increases shows the relation between the heart’s electrical
cignal (ECG) and changes in atrial pressure, ventricular pressure,
aortic pressure, and ventricular volume during the cardiac cycle.
The pressure given in Figure 20.14 apply to the left side of the heart;
pressures on the right side are considerably lower. Each ventricle,
however expels the same volume of blood per beat, and the same
pattern exists for both pumping chambers. When heart rate is 75
beats/mins a cardiac cycle lasts 0.8 sec. To examine and correlate
the events taking place during a cardiac cycle, we will begin with
atrial systole.
Atrial Systole
 During atrial systole, which last about 0.1 sec the atria are
contracting. At the same time the ventricle are relaxed.

 Depolarization of the SA node causes atrial depolarization marked

by the P wave in the ECG
 Atrial depolarization causes atrial systole. As the atria contract, they
exert pressure on the blood within, which forces blood through the
open AV valves into the ventricles.
 Atrial systole contributes a final 25 ml of blood to the volume already
in each ventricle (about 150 mL). The end of atrial systole is also the
end of ventricular diastole (relaxation). Thus, each ventricle contains
about 130 mL at the end of its relaxation period (diastole). This blood
volume is called the end-diastole volume (EDV).
 The QRS complex in the ECG marks the onset of ventricular
depolarization.
Ventricular Systole

 During ventricular systole, which last about 0.3 sec the ventricles are
contracting. At the same time, the atria are relaxed in atrial
diastole.
Relaxation Period

 During the relaxation period, which lasts about

0.4 sec, the atria and the ventricles are both
relaxed. As the heart beats faster and faster,
the relaxation period becomes shorter and
shorter.
Heart Sounds

 Auscultation (aws-kul-TA-shun; ausculta- = listening), the act of

listening to sounds within the body, is usually done with a
stethoscope. The sounds of the heartbeat comes primarily from
blood turbulence caused by the closing of the heart valves.
Smoothly flowing blood is silent. Recall the sounds made by white-
water rapids or a waterfall as compared with the silence of smoothly
flowing river. During each cardiac cycle, there are four heart
sounds, but in a normal heart only the first and the second heart
sounds (S1 and S2) are loud enough to be heard by listening
through a stethoscope.
Heart murmurs

 Heartmurmur is an abnormal sound

consisting of a clicking, rushing or
gurgling noise that is heard before,
between or after the normal heart
sound, or that may mask the normal
heart sounds. Heart murmur in children
are extremely common and usually do
not represent a health condition.
Cardiac Output
Objectives :
- Define cardiac output

- Describe the factors that affect regulation

of stroke volume

- Outline the factors that affect the

regulation of the heart rate
Cardiac Output
 Cardiac output (CO) is the volume of blood ejected from the left
ventricle for the right ventricle) into the aorta (pulmonary trunk)
each minute. Cardiac output equals the stroke volume (SV), the
volume of blood ejected by the ventricle during each contraction,
multiplied by the heart rate (HR), the number of heartbeats per
minute:

CO= SV x HR
(mL/min) (mL/beat) (beats/min)
In a typical resting adult male, stroke volume average 70 mL beat,
and heart rate is about 75 beats/min. Thus, average cardiac output is
CO = 70 mL/beat x 75 beats/min
= 5252 mL/min
= 5.25 L/min
Cardiac Reserve

 Cardiac reserve is the difference between a

person’s maximum cardiac output and cardiac
output at rest. The average person has a
cardiac reserve of four or five times the
resting value. The endurance athletes may
have a cardiac reserve seven o eight times
their resting CO. People with the severe heart
disease may have little or no cardiac reserve,
with their limits their ability to carry out even
the simple tasks of daily living.
Regulation of Stoke Volume
 A healthy heart will pump out the blood that entered
its chambers during the previous diastole. In other
words, if more blood returns to the heart during
diastole, then more blood is ejected during the next
systole. At rest, the stroke volume is 50-60 % of the
end diastolic volume because 40-50% of the blood
remains in the ventricles after each contraction (end-
systolic volume). Three factors regulate stroke volume
and ensure that the left and right ventricles pump
equal volumes of blood. (1) preload, the degree of
stretch on the heart before it contracts. (2)
contractility, the forcefulness of contraction of
individual ventricular muscle fibers; and (3)
afterload, the pressure that must be exceeded before
ejection of blood from the ventricles can occur.
Regulation of the Heart Rate

 Heart rate is controlled by the two branches of

the autonomic (involuntary) nervous system.
The sympathetic nervous system (SNS) and
the parasympathetic nervous system (PSN).
The sympathetic nervous system (SNS)
release the hormones (catecholamines –
epinephrine and norepinephhine) to accelerate
the heart rate.
Exercise of the Cardiovascular
Fitness
 Activities like walking, jogging, running,
cycling, swimming, aerobics, rowing, stair
climbing, hiking, cross country skiing and
many types of dancing are “pure” aerobics
activities. Sports such as soccer, basketball,
squash and tennis may also improve your
cardiovascular fitness.