Cardiovascular system

Group II

Introduction

The cardiovascular system (cardio- - heart; vascular - blood vessels) consists of three interrelated components: blood, the heart, and blood vessels.

The Blood

Blood transports various substances, helps regulate several life processes, and affords protection against disease. For all of its similarities in origin, composition, and functions, blood is as unique from one person to another as are skin, bone, and hair. Health-care professionals routinely examine and analyze its differences through various blood tests when trying to determine the cause of different diseases. Hematology (he-m-a-TOL-oje-; hema- or hemato- blood; -logy - study of) The branch of science concerned with the study of blood, blood-forming tissues, and the disorders associated with them.

Blood is a connective tissue composed of a liquid extracellular matrix called blood plasma that dissolves and suspends various cells and cell fragments. Functions of blood: 1. Transports oxygen, carbon dioxide, nutrients, hormones, heat, and wastes. 2. Regulates pH, body temperature, and water content of cells. 3. Protects against blood loss through clotting, and against disease through phagocytic white blood cells and antibodies.

The Centrifuge

Components of blood

Components of blood

A. Blood Plasma
Plasma proteins - These proteins play a role in maintaining proper blood osmotic pressure which is an important factor in the exchange of fluids across capillary walls. - They are also called antibodies or immunoglobulins because they are produced during certain immune responses.

Plasma
- Consist of 90% water which dissolves and transport organic and inorganic. - And 10% dissolved solutes Dissolved Solutes: Electrolytes: Mostly sodium Nutrients: In varying amounts Organic wastes: In varying amounts Proteins: make up 7-9% of the plasma - Albumins: (80% of plasma) major contributor to osmotic concentration of blood. - Globulins: (16%) transport lipids and fat soluble vitamins. - Fibrinogen: (4%) converts insoluble fibrin in a blood clot.

B. Formed Elements 3 principal components: 1. Red Blood Cells (Erythrocytes) - transport oxygen and some carbon dioxide. 2. White Blood Cells (Leukocytes) - combat inflammation and infection. 3. Platelets (Thrombocytes) - help stop blood loss from damaged blood vessels by forming a platelet plug.

The shape of a red blood cell (RBC) and a hemoglobin molecule

Red blood cycle

Gas exchange by diffusion in lungs

White blood cells

2 types of WBC:

a) Granular Leukocytes include neutrophils, eosinophils, and basophils. b) Agranular Leukocytes include lymphocytes and monocytes.

Platelets

Platelets help stop blood loss from damaged blood vessels by forming a platelet plug. Their granules also contain chemicals that, once released, promote blood clotting. Platelets have a short life span, normally just 5 to 9 days. Aged and dead platelets are removed by fixed macrophages in the spleen and liver.

Stem Cell Transplants From Bone Marrow and Cord-Blood

Bone- marrow transplant The replacement of cancerous/ abnormal red bone marrow with healthy red bone marrow. Cancerous red bone marrow are destroyed by chemotherapy before transplant takes place. Treatment kills cancer cells and destroy patients immune system, this decreases the chances of transplant rejection

Red Bone Marrow

It

is removed from the iliac crest of the hip bone under general anesthesia with a syringe. It is then injected into the recipient's vein similar to blood transplant

Drawbacks
Patient is very vulnerable to infection due to the destruction of WBC. Transplanted Red-bone marrow may produce T-cells that can attack the recipient's tissue, this is called the graft-versus- host disease. Also, the recipients T-cells (which survived the treatment) can attack donors transplant cells. Patient must take immunosppresive drugs for life, this will cause higher risk of infection.

Cord- Blood Transplant

A more recent advance method for obtaining stem cells. Taken from umbilical cord after birth using a syringe.

Advantages:
easily collected following the permission of the newborn parents. More abundant than stem cells in red bone marrow. Less likely to cause graft-versus-host disease, thus this provides a larger number of potential donor. Less likely to transmit infections. Can be stored indefinitely in cord- blood banks.

Hemostasis
A sequence of responses that stops bleeding. This prevents hemorrhage, which is the loss of large amount of blood from the vessel.

There are three mechanisms

Vascular

Spasm Platelet Plug Formation Blood Clotting (coagulation)

Vascular Spasm

The contraction of smooth muscles around the damaged arteries/ arterioles. Reduces blood loss for several minutes to several hours.

Platelet Plug Formation

a.)Plateletssticktopartsofdamagedblood vessels.Thisiscalledtheplateletadhesion. b.)Plateletsbecomeactivated,duetoadhesion, andtheircharacteristicchanges.Theyextend manyprojectionsthathelptheminteractwith oneanother.Thisphaseiscalledplatelet releasereaction. c.)ReleaseofADPmakesplateletssticky, causingthenewlyrecruitedandactivated plateletstoadheretooriginallyactivated platelets.Thegatheringofplateletiscalled plateletaggregation. Eventuallytheattachmentoflargenumberof plateletsformamasscalledplateletplug.

Blood Clotting
Blood remains in its liquid form if it stays within its vessels, once it is drawn from the body, the blood will thicken and form into gel. Serumblood plasma minus the clotting proteins. Clot- the gel, which consist of network of insoluble protein fiber called fibrin which traps the formed elements.

Cont.

Clotting (Coagulation)- process of gel formation. Thrombosis- clotting in an undamaged blood vessel.

Clotting (Coagulation) Factors Calcium ions (Ca2+ ) Several Inactive enzymes

** Most clotting factors are identified by Roman numerals that indicate the order of their discovery.

Clot Retraction

Consolidation/ tightening of fibrin clot

Role of Vitamin K in Clotting

Required for the synthesis of four clotting factors.

Hemostatic Control Mechanism

Fibrinolytic System- dissolves small inappropriate clots. It also dissolve clot at site of damage once damage is repaired. Fibronolysis- Dissolution of a clot.

Cont.
Plasminogen- an inactive plasma enzyme incorporated to the clot. Plasmin (Fibrinolysin)- an active plasma enzyme. It dissolves clot by digesting fibrin threads and inactivating substances.

Intravascular Clotting

Thrombus- The clot itself. Embolus- a blood of clot, bubble of air, fate from broken bones or a piece of debris transported by blood. Pulmonary embolism- a condition where the embolus lodges in the lungs.

Blood Groups & Blood Types

Surface of erythrocytes (RBC) contains assortment of antigens composed of glycoprotein and glycolipids. These antigens are called agglutinogens. Blood group is based on the absence or presence of various antigens. Witin a blood group, there may be two or more different blood types.

ABO Blood Group

Transfusion

Transfer of whole blood or blood components.

What if an incompatible blood transfusion takes place?

Agglutination- clumping of the RBCs. Hemolysis- Rupture of RBCs and the release of hemoglobin in the blood plasma. This hemoglobin can cause kidney damage by clogging filtration membrane.

Rh Blood Group

The Heart

Cardiology - the scientific study of the normal heart and the diseases associated with it.

Anatomy of the heart

Location of the heart The heart is roughly the same size as your closed fist. It lies in the mediastinum.

Pericardium - It is the membrane that surrounds and protects the heart. It allows sufficient freedom of movement for vigorous and rapid contraction. - It consists of two main parts: A. Fibrous pericardium B. Serous pericardium

Layers of the Heart Wall - The wall of the heart consists of three layers:

A. The epicardium (external layer) - imparts a smooth, slippery texture to the outermost surface of the heart. B. The myocardium (middle layer) - is responsible for its pumping action. C. The endocardium (inner layer) - it provides a smooth lining for the chambers of the heart and covers the valves of the heart and it minimizes surface friction as blood passes through the heart and blood vessels.

Chambers of the Heart The heart has four chambers; the 2 superior receiving chambers, the atria and the 2 inferior pumping chambers, ventricles.

Right Atrium - receive blood from three veins: the superior vena cava, inferior vena cava, and coronary sinus. Right Ventricle - pumps blood a short distance to the lungs at lower pressure, and the resistance to blood flow is small. Left Atrium - receives blood from the lungs through four pulmonary veins. Left Ventricle - pumps blood great distances to all other parts of the body at higher pressure, and the resistance to blood flow is larger.

Auricle - slightly increases the capacity of an atrium so that it can hold a greater volume of blood. Septum divides the right and left sides of the heart.

Heart Valves & Blood Flow

Heart valves are flap-like structures that allow blood to flow in one direction. Below are the four valves of the heart: 1. Aortic Valve - prevents the back flow of blood as it is pumped from the left ventricle to the aorta. 2. Mitral Valve - prevents the back flow of blood as it is pumped from the left atrium to the left ventricle. 3. Pulmonary Valve - prevents the back flow of blood as it is pumped from the right ventricle to the pulmonary artery. 4. Tricuspid Valve - prevents the back flow of blood as it is pumped from the right atrium to the right ventricle.

Coronary Arteries are the network of blood vessels that carry oxygen- and nutrient-rich blood to the cardiac muscle tissue.

The coronary circulation provides blood flow to the myocardium. 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. The main arteries of the coronary circulation are left and right coronary arteries; the main veins are the cardiac veins and the coronary sinus

Comparedwithskeletalmuscle fibers,cardiacmusclefibersare:

Structural & Functional characteristics of cardiac muscle tissue

Shorterinlength. Lesscircularintransverse section. Exhibitbranching:stairstep. 1centrallylocatednucleus occasionallymayhave2nucleus. Theendsconnectstoneighboring fibersbyirregulartransversethickeningsofthesarcolemmacalledintercalated discs. Thediscscontainsdesmosomes,whichholdsthefiberstogetherandgapjunctions, which allowmuscleactionpotentialstoconductfromonemusclefibertoitsneighbors. Mitochondria(powergenerationcenter&siteofaerobicrespiration)arelargerand

Samearrangementofactinand myosin,andthesamebands,zones, andZdiscs. Actin&Myosinarethetwoprimary proteinsthatbuildthecardiac musclefiberswhicharecalledthe myofibrils. Theactinandmyosinfilamentsare responsibleformusclecontraction. Thebranchesinterlockwiththoseof adjacentfibersbyadherens junctions.Thesestrongjunctions enablethehearttocontractforcefully Thetransversetubuleplayanimportantroleinexcitationandcontractioncoupling withoutrippingthefibersapart. whichdrivestheheart.OneTtubulepersarcomereislocatedattheZdisc. Thesarcoplasmicreticulumissomewhatsmaller.Asaresult,cardiacmusclehasa smallerintracellularreserveofCa+. +.

ATP Production in Cardiac Muscle

produces little of the ATP it needs by anaerobic cellular respiration. it relies almost exclusively on aerobic cellular respiration in its numerous mitochondria. the needed oxygen diffuses from blood in the coronary circulation and released from myoglobin inside cardiac muscle fibers. produces some ATP from creatine phosphate.

Autorhythmic Fibers: The Conduction System

An inherent and electrical activity is the reason for the hearts lifelong beat. The source of this electrical activity is a network of specialized cardiac muscle called the autorhythmic fibers.

Autorhythmic Fibers:

-self excitable fibers. -repeatedly generate action potentials that trigger heart contractions. They continue to stimulate a heart to beat even after it is removed from the body.

Autorhythmic Fibers: two important functions: 1. they act as a pacemaker - setting the rhythm of electrical excitation that causes contraction of the heart. 2. they form the conduction system - a network of specialized muscle fibers that provide a path for each cycle of cardiac excitation to progress through the heart. Theconductionsystemensuresthatcardiacchambersbecomestimulatedto contractinacoordinatedmanner,whichmakestheheartaneffectivepump. It controls the generation and propagation of electrical signals or action potentialsthatcausetheheartsmusclestocontractandthehearttopump blood.

Cardiacaction potentials propagatethroughthe conductionsystem intheff.sequence:

1.

Cardiac excitation normally begins in the sinoatrial (SA) node. SA node cells dont have a stable resting potential.

Rather, they repeatedly depolarize to threshold spontaneously. The spontaneous depolarization is a pacemaker potential. When the pacemaker potential reaches threshold, it triggers an action potential. EachactionpotentialfromtheSAnodepropagatesthroughoutbothatria via gap junctions in the intercalated discs of atrial muscle fibers. Followingtheactionpotential,theatriacontract. 2.Theactionpotentialconductsalongatrialmusclefibersuntilitreachesthe atrioventricular(AV)node,locatedintheseptumbetweenthe2atria justanteriortotheopeningofthecoronarysinus.

3. From the AV node, the action potential enters the atrioventricular (AV) bundle. This bundle is the only site where action potentials can conduct from the atriatotheventricles. 4. The action potential then enters both the right and left bundle branches. Thebundlebranchesextendthroughtheinterventricularseptumtoward theapexoftheheart. 5. Finally, the large diameter Purkinje fibers rapidly conduct the action potential from the apex of the heart upward to the remainder of the ventricularmyocardium.Thentheventriclescontract,pushingtheblood upwardtowardthesemilunarvalves.

OntheirownautorhythmicfibersintheSAnodewouldinitiatean actionpotentialaboutevery0.6seconds,or100timesperminute. TheSAnodeactasthenormalpacemakeroftheheart. Nerve impulses from the autonomic nervous system (ANS) and bloodbornehormones(suchasepinephrine)modifythetimingand strength of each heartbeat, but they do not establish the fundamentalrhythm.

Artificial Pacemakers:
If the SA node becomes damaged or diseased, the slower AV nodecanpickupthepacemakingtask. Its rate of spontaneous depolarization is 40 to 60 times per minute. If the activity of both nodes is suppressed, the heartbeat may still be maintained by autorhythmic fibers in the ventricles theAVbundle,abundlebranch,orPurkinjefibers. However,thepacingrateissoslowatabout2035beatsper minutethatbloodflowtothebrainisinadequate. When this condition occurs, normal heart rhythm can be restoredandmaintainedbysurgicallyimplantinganartificial pacemaker, a device that sends out small electrical currents tostimulatethehearttocontract.

Action Potential and Contraction of Contractile Fibers

SA node initiates an action potential that travels along the conduction system and spreads to excite the working atrial and ventricular muscle fibers called contractile fibers.

Action potential occurs in a contractile fiber as follows: 1. Depolarization

have a resting membrane potential that is close to 90mV. whenbroughttothresholdby an action potential from neighboring fibers, its voltagegated fast Na+ they open very rapidly in response to a threshold level channelsopen. depolarization. allows Na+ inflow cytosol of contractile fibers is electrically more negative than interstitial fluid and Na+ concentration is higher ininterstitialfluid.

inflowofNa+downthe electrochemical gradientproducesa rapiddepolarization. withinfewmilliseconds, thefastNa+channels automatically inactivateandNa+ 2. Plateau inflowdecreases. aperiodofmaintaineddepolarization dueinparttoopeningofvoltagegatedslowCa+channelsinthesarcolemma whenthesechannelsopen,Ca+movefromtheinterstitialfluidintothe cytosol. inflowofCa+causesevenmoreCa+topouroutoftheSRintothecytosol. increasedCa+concentrationinthecytosoltriggerscontraction. severaldifferenttypesofvoltagegatedK+channelsarealsofoundin sarcolemma.

depolarizationsustainedCa+ inflowbalancesK+outflow. lastsabout0.25sec.andthe membranepotentialisclose to0mV. 3.Repolarization 4. afteradelay,voltagegatedK+channelsopen. outflowofK+restorestherestingmembranepotentialof90mVatthesame time,calciumchannelsinthesarcolemmaandSRareclosing. Refractoryperiod timeintervalduringwhichasecondcontractioncannotbetriggered. anothercontractioncannotbeginuntilrelaxationiswellunderway. preventstetanus(maintainedcontraction)incardiacmuscle

Electrocardiogram
As action potential propagate through the heart, they generate electrical currentsthatcanbedetectedatthesurfaceofthebody. An electrocardiogram (ECG or EKG) is a recording of these electrical signals. The ECGisa composite record of action potentials producedbyallheart musclefibersduringeachheartbeat. Theinstrumentusedtorecordthechangesisanelectrocardiograph.

Correlation of ECG Waves

The atria and ventricles depolarize and then contract at different times because the conduction system routes cardiac action potentials along a specificpathway. Thetermsystolereferstothephaseofcontractionoftheheartbywhichthe bloodisforcedonwardandthecirculationkeptup. Diastole is the phase of relaxation (the passive rhythmical expansion or dilationofthecavitiesoftheheartduringwhichtheyfillwithblood.)

THE CARDIAC CYCLE

Asinglecardiaccycleincludesalltheeventsassociatedwithoneheartbeat. Itconsistsofsystoleanddiastoleoftheatriaplussystoleanddiastoleofthe ventricles.

PressureandVolumeChangesDuringtheCardiacCycle Ineachcardiaccycle,theatriaandventriclesalternatelycontractandrelax, forcingbloodfromareasofhigherpressuretoareasoflowerpressure. Asachamberoftheheartcontracts,bloodpressurewithinitincrease. Each ventricle expels the same volume of blood per beat, and the same patternexistsforbothpumpingchambers.Whenheartrateis75beats/min, acardiaccyclelasts0.8sec.

Cardiac Cycle

Atrial Systole

- lasts about 0.1 sec. - atria are contracting - ventricles are relaxed Depolarization of the SA node causes atrial depolarization, marked 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 105 mL) The end of atrial systole is also the end of ventricular diastole (relaxation). Each ventricle contains about 130 mL at the end of relaxation period this blood volume is called the end-diastolic volume (EDV).

The QRS complex in the ECG marks the onset of ventricular depolarization. Ventricular Systole - lasts about 0.3 sec. - ventricles are contracting - atria are relaxed in atrial diastole Ventricular depolarization causes ventricular systole. As it begins, pressure rises inside the ventricles and pushes blood up against the atrioventricular (AV) valves, forcing them shut. For about 0.05 sec., both the SL (semilunar) and AV valves are closed the period of isovolumetric contraction. During this interval, cardiac muscle fibers are contracting and exerting force but are not yet shortening. Thus, the muscle contraction is isometric (same length). All the four valves are closed, ventricular volume remains the same (isovolumic). Continued contraction of the ventricles causes pressure inside the chambers to rise sharply.

Whenleftventriclepressuresurpasses aorticpressureatabout80mmHg andrightventricularpressurerises abovethepressureinthepulmonary trunk(about20mmHg)boththeSLvalvesopen. Atthispoint,ejectionofbloodfromtheheartbegins.Theperiodwhenthe SLvalvesareopenisventricularejectionadlastsforabout0.25sec. The pressure in the left ventricle continues to rise to about 120 mmHg, where as the pressure in the right ventricle climbs to about 25 30 mmHg. Theleftventricleejectsabout70mLofbloodintotheaortaandtheright ventricleejectsthesamevolumeofbloodintothepulmonarytrunk. Thevolumeremainingineachventricleattheendofthesystole,about60 mL,istheendsystolicvolume(ESV). Stroke volume, the volume ejected per beat from each ventricle, equals enddiastolicvolumeminusendsystolicvolume:SV=EDVESV Atrest,theSVisabout130mL60mL=70mL(alittlemorethan2oz.)

Relaxation Period - lasts about 0.4 sec. - atria and ventricles are relaxed - heart beats faster and faster, period becomes shorter and shorter. Ventricular repolarizationcausesventriculardiastole. Astheventriclesrelax,pressurewithinthechambersfallsandbloodinthe aortaandpulmonarytrunkbeginstoflowbackwardtowardtheregions oflowerpressureintheventricles. BackflowingbloodcatchesinthevalvecuspsandclosestheSLvalves. The aortic valve closes at a pressure of about 100 mmHg. Rebound of the bloodofftheclosedcuspsoftheaorticvalveproducesthedicroticwave ontheaorticpressurecurve. After the SL valves close, there is a brief interval when ventricular blood volume does not change because all four valves are closed this is the periodofisovolumetricrelaxation.

Astheventriclescontinues torelax,thepressurefalls quickly. Whenventricular pressuredropsbelow atrialpressure, theAVvalvesopen, andventricularfilling begins. Bloodthathasbeenflowing intoandbuildingupinthe atriaduringventricularsystole thenrushesrapidlyintotheventricles. Attheendoftherelaxationperiod,theventriclesareaboutfull.ThePwave appearsintheECGsignalingthestartofanothercardiaccycle.

CARDIACOUTPUT
Allbodycellsmustreceiveacertainamountofoxygenatedbloodeach minutetomaintainhealthandlife. Cardiacoutput(CO)isthevolumeofbloodejectedfromtheleftventricle(or therightventricle)intotheaorta(orpulmonarytrunk)eachminute. CO = (mL/min) SV x HR (mL/beat) (beats/min) (StrokeVolume) (HeartRate) thevolumeofbloodejected thenumberof ventricleduringeach heartbeats contraction perminute Typicalrestingadultmale: SV=70mL/beat HR=75beats/min CO = = = 70mL/beat x 75beats/min 5250mL/min 5.25L/min(volumeclosetototalbloodvolumeof5Lin

bythe

Heart Sounds
Auscultation act of listening to sounds within the body, usually done with a stethoscope. The sound of the heartbeat comes primarily from blood turbulence caused by the closing of the heart valves. (Smoothly flowing blood is silent.) During each cardiac cycle, there are 4 heart sounds, but in a normal heart only the 1st and 2nd heart sounds (S1 & S2) are loud enough to be heard by listening through a stethoscope. The 1st sound (S1) (lubb sound) is louder and a bit longer than the 2nd sound. The 1st sound is caused by blood turbulence associated with closure of the AV valves soon after ventricular systole begins. The 2nd sound (S2) (dubb sound) is caused by blood turbulence associated with the closure of the SL valves at the beginning of ventricular diatole.

Development of the Heart

Listening to a fetal heartbeat forthe1st timeisanexciting moment for prospective parents, but it is also an importantdiagnostictool. The cardiovascular system is oneofthe1st systemtoform in an embryo, and the heart isthe1st functionalorgan. This order of development is essentialbecauseoftheneed of the rapidly growing embryotoobtainoxygenand nutrients and get rid of wastes.

Development of the Heart:

Mesoderm day 18 or 19 following fertilization cardiogenic area from mesodermal cells(head end of embryo) cardiogenic cords a pair of elongated strands endocardial tubes hollow center in the cords primitive heart tube fuse into a single tube from the paired endocardial tubes on day 21 following fertilization Day 22 the primitive heart tube develops into 5 distinct regions and begins to pump blood. From tail end to head end (and the direction of blood flow) Sinus venosus: Initially receives blood from all the veins in the embryo. Contractions of the heart begin in this region. Develops into part of the right atrium, coronary sinus, and sinoatrial (SA) node. Atrium develops into part of the right atrium and the left atrium. Ventricle gives rise to the left ventricle. Bulbus cordis develops into the right ventricle. Truncus arteriosus gives rise to the ascending aorta and pulmonary trunk.

Day 23 the primitive heart tube elongates. (the bulbus cordis and ventricle growrapidlyandtheatrialandvenousendsofthetubeareconfinedby thepericardium,thetubebeginstoloopandfold). Atriaandventriclesarereorientedtoassumetheirfinaladultpositions. Day28 endocardialcushionsthickeningsofmesoderm(liningoftheheart wall) atrioventricularcanalregionbetweenatriaandventricles. foramenovaleinteratrialseptumandendocardialcushionsunite andanopeningintheseptum. interatrialseptumdividetheatrialregionintoarightatriumand aleftatrium. Beforebirth,theforamenovaleallowsmostbloodenteringtherightatriumto passintotheleftatrium. After birth, it normally closes so that the interatrial septum is a complete partition.

Formationoftheinterventricularseptumpartitionstheventricularregion intoarightventricleandaleftventricle. Partitionoftheatrioventricularcanal,atrialregionandventricularregion isbasicallycompletebytheendofthe5th week. Theatrioventricularvalvesformbetweenthe5th and8th weeks. Thesemilunarvalvesformbetweenthe5th and9th weeks.

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Blood Vessels

Basic Structure of a Blood Vessel Tunica Interna Endothelium Basement Membrane Internal Elastic Lamina Tunica Media Smooth Muscle External Elastic Lamina Tunica Externa

Arteries
carry blood away from the heart to other organs. Type of Arteries Elastic Arteries Muscular Arteries Anastomosis Collateral Circulation- The alternative route of blood flow to a body part through an anastomosis. Arteriole Metarteriole- end of the arteriole Precapillary sphincter- monitors the blood flow into the capillary.

Capillaries
the smallest of blood vessels

Three different types of capillaries Continuous capillaries Fenestrated capillaries Sinusoids

Venules drain the capillary blood and begin the return flow of blood back toward the heart

Postcapillary Venules venules that initially receive blood from capillaries.

Muscular Venules have thicker walls across which exchanges with the interstitial fluid can no longer occur.

Veins the blood vessels that convey blood from the tissues back to the heart.

Blood Distribution

The largest portion of your blood volume at restabout 64%is in systemic veins and venules. Systemic arteries and arterioles hold about 13% of the blood volume, systemic capillaries hold about 7%, pulmonary blood vessels hold about 9%, and the heart holds about 7%.

CAPILLARY EXCHANGE The mission of the entire cardiovascular system is to keep blood flowing through capillaries to allow capillary exchange, the movement of substances between blood and interstitial fluid. The 7% of the blood in systemic capillaries at any given time is continually exchanging materials with interstitial fluid

Substances enter and leave capillaries by three basic mechanisms

Diffusion The most important method of capillary exchange Transcytosis A small quantity of material crosses capillary walls Bulk Flow a passive process in which large numbers of ions, molecules, or particles in a fluid move together in the same direction.

Two pressures promote filtration: blood hydrostatic pressure(BHP) interstitial fluid osmotic pressure(IFOP) The main pressure promoting reabsorption blood colloid osmotic pressure (BCOP)

Net Filtration Pressure determines whether the volumes of blood and interstitial fluid remain steady or change Starling law of the capillaries balance of hydrostatic and osmotic pressures.

Hemodynamics

-- (or haemodynamics in British English), meaning literally "blood movement" is the study of blood flow or the circulation. Blood flow is the volume of blood that flows through any tissue in a given time period (in mL/min). Total blood flow is cardiac output (CO), the volume of blood that circulates through systemic (or pulmonary) blood vessels each minute. Two factors: (1) the pressure difference that drives the blood flow through a tissue and, (2) the resistance to blood flow in specific blood vessels flow. But the higher the resistance, the smaller the blood flow.

The greater the pressure difference, the greater the blood

Factors Affecting Blood Flow

A. Blood Pressure is a measure of the force blood exerts against the blood vessel walls. BP is highest in the aorta and large systemic arteries; in a resting, young adult, BP rises to about 110 mmHg during systole (ventricular contraction) and drops to about 70 mmHg during diastole (ventricular relaxation). Systolic blood pressure -- is the highest pressure attained in arteries during systole, it measures blood pressure when the heart contracts to empty its blood into the circulatory system. Diastolic blood pressure -- is the lowest arterial pressure during diastole, measures blood pressure when the heart relaxes and fills with blood.

The standard unit for measuring blood pressure is millimeters mercury (mm Hg).

Mean arterial pressure (MAP), the average blood pressure in arteries, is roughly one-third of the way between the diastolic and systolic pressures. It can be estimated as follows: MAP = diastolic BP + 1/3 (systolic BP - diastolic BP) Thus, in a person whose BP is 110/70 mmHg, MAP is about 83 mmHg (70 + 1/3(110 - 70)).

Blood pressure also depends on the total volume of blood in the cardiovascular system. The normal volume of blood in an adult is about 5 liters (5.3 qt).

B. Vascular Resistance

-- is the opposition to blood flow due to friction between blood and the walls of blood vessels. Vascular resistance depends on: (1) size of the blood vessel lumen, Resistance is inversely proportional to the fourth power of the diameter (d) of the blood vessels lumen (R1/d4) (2) blood viscosity, and (3) total blood vessel length Resistance to blood flow through a vessel is directly proportional to the length of the blood vessel.

Systemic vascular resistance (SVR), also known as total peripheral resistance (TPR), refers to all the vascular resistances offered by systemic blood vessels. -- controlled by arterioles Arterioles need to vasodilate or vasoconstrict only slightly to have a large effect on SVR.

C. Venous return

-- is the volume of blood flowing back to the heart through the systemic veins, occurs due to the pressure generated by contractions of the hearts left ventricle. The pressure difference from venules (averaging about 16 mmHg) to the right ventricle (0 mmHg), although small, normally is sufficient to cause venous return to the heart.

D. Velocity of Blood Flow The speed or velocity of blood flow (in cm/sec) is inversely related to the cross-sectional area. Each time an artery branches, the total cross-sectional area of all its branches is greater than the cross-sectional area of the original vessel, so blood flow becomes slower and slower as blood moves further away from the heart, and is slowest in the capillaries. Thus, the velocity of blood flow decreases as blood flows from the aorta to arteries to arterioles to capillaries, and increases as it leaves capillaries and returns to the heart.

Circulation time is the time required for a drop of blood to pass from the right atrium, through the pulmonary circulation, back to the left atrium, through the systemic circulation down to the foot, and back again to the right atrium. In a resting person, circulation time normally is about 1 minute.

CONTROL OF BLOOD PRESSURE AND BLOOD FLOW

Role of the Cardiovascular Center

helps regulate heart rate and stroke volume. controls neural, hormonal, and local negative feedback systems that regulate blood pressure and blood flow to specific tissues. the cardiovascular center receives input both from higher brain regions and from sensory receptors. sends impulses to smooth muscle in blood vessel walls via vasomotor nerves.

The three main types of sensory receptors that provide input to the cardiovascular center are: (1)Proprioceptors -- monitor movements of joints and muscles and provide input to the cardiovascular center during physical activity. (2)Baroreceptors -- monitor changes in pressure and stretch in the walls of blood vessels (3)Chemoreceptors -- monitor the concentration of various chemicals in the blood

Output from the cardiovascular center flows along sympathetic and parasympathetic neurons of the ANS. Sympathetic impulses reach the heart via the cardiac accelerator nerves. Parasympathetic stimulation, conveyed along the vagus (X) nerves, decreases heart rate.

Neural Regulation of Blood Pressure Two types of reflexes: (1)Baroreceptor reflexes They send impulses to the cardiovascular center to help regulate blood pressure

carotid sinus reflex, which helps regulate blood pressure in the brain aortic reflex, which regulates systemic blood pressure. Impulses to the cardiovascular center pass from baroreceptors in the carotid sinuses via the glossopharyngeal (IX) nerves and from baroreceptors in the arch of the aorta via the vagus (X) nerves. (2)Chemoreceptor reflexes sensory receptors that monitor the chemical composition of blood provide input to the respiratory center in the brain stem to adjust the rate of breathing.

CHECKING CIRCULATION

Pulse -- is the alternate expansion and recoil of elastic arteries after each systole of the left ventricle creates a traveling pressure wave. The pulse is strongest in the arteries closest to the heart, becomes weaker in the arterioles, and disappears altogether in the capillaries. The pulse rate normally is the same as the heart rate, about 70 to 80 beats per minute at rest. v Tachycardia is a rapid resting heart or pulse rate over 100 beats/min. v Bradycardia is a slow resting heart or pulse rate under 50 beats/min.

Measuring Blood Pressure

Blood pressure is usually measured in the brachial artery in the left arm. The device used to measure blood pressure is a sphygmomanometer : sphygmo- pulse; manometer instrument used to measure pressure.

Normal BP is below - 120/80 Pre hypertension is 120/80 up to 139/89 Stage 1 hypertension is - 140/90 up to 159/99 Stage 2 hypertension is - 160/ 100 above

The various sounds that are heard while taking blood pressure are called Korotkoff sounds (ko-ROT-kof).

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