Cardiovascular System: Heart & Circulation

I. Anatomy of the Heart A. Coverings

1. Pericardium fibrous pericardium

serous pericardium parietal pericardium visceral pericardium B. Heart wall layers 1. Epicardium (visceral pericardium) protects heart 2. Myocardium cardiac muscle 3. Endocardium epithelial/ connective/ fibers

C. Chambers, Vessels, and Valves 1. Four chambers upper chambers rt and left atria Collects blood lower chambers rt and left ventricle pumps blood from heart 2. Arteries carry blood away from heart

3. Veins
blood toward heart

4. Valves AV valves

Tricuspid rt atrium Bicuspid or mitral - lt atrium

Semilunar valves

Pulmonary semilunar (pulmonary trunk) Aortic semilunar (aortic arch)

II. Pulmonary and Systemic Circulation

A. Pulmonary pathway
oxygenated blood rt ventricle from rt atrium myocardium (rt ventricle) contracts

low oxygen blood through pulmonary semilunar pulmonary trunk -> arteries -> lungs

oxygenated blood -> rt & lt pulmonary veins ->

left atrium B. Systemic pathway Oxygenated blood -> Lt atrium to Lt ventricle Left ventricle contracts ->aortic semilunar Aortic arch -> arteries to tissues oxygen depleted blood from tissues -> veins to heart -> rt atrium (vena cava)

Passage of Blood Through the Heart

Blood follows this sequence through the heart: superior and inferior vena cava right atrium tricuspid valve right ventricle pulmonary semilunar valve pulmonary trunk and arteries to the lungs pulmonary veins leaving the lungs left atrium bicuspid valve left ventricle aortic semilunar valve aorta to the body.

Direction of blood flow through the heart

The relationship between the systemic and pulmonary circulations

Blood supply to the heart or coronary circulation

The coronary arteries

Blood supply to the heart

Arterial supply

The heart is supplied with arterial blood by the right and left coronary arteries, which branch from the aorta immediately distal to the aortic valve The coronary arteries receive about 5% of the blood pumped from the heart, although the heart comprises a small proportion of body weight This large blood supply, especially to the left ventricle, highlights the importance of the heart to body function The coronary arteries traverse the heart, eventually forming a vast network of capillaries

Blood supply to the heart

Venous drainage

Most of venous blood is collected into several small veins that join to form coronary sinus, which opens into right atrium The remainder passes directly into the heart chambers through little venous channels

THE CARDIAC CYCLE

What is the cardiac cycle

The cardiac cycle is the sequence of events that occur when the heart beats There are two phases of this cycle: Diastole - Ventricles are relaxed Systole - Ventricles contract

The cardiac cycle

Exercise increases blood flow through the heart so that the cardiac cycle accelerates to accommodate the increased demand for oxygen The normal cycle is around 0.8 seconds. This accelerates with faster and more powerful atrial and ventricular contraction, which is stimulated by the cardiac centre in the brain Heart rate:- is defined as the number of heart contractions in each minute # There are two distinct periods in the cardiac cycle- one of the heart muscle relaxation (cardiac diastole), the other of contraction (cardiac systole)

Cardiac diastole
During cardiac diastole The bicuspid and tricuspid valves are closed and the atrium is full Once full with blood, the atria forces the bicuspid and tricuspid valves to open and fill the ventricles This lasts for around 0.4 seconds at rest

Cardiac systole
Cardiac systole The atria contract and send blood via the bicuspid and tricuspid valves into the ventricles When full, these contract causing blood to be expelled from the heart via the semilunar valves (the bicuspid and tricuspid valves are closed at this time) This lasts around 0.4 seconds at rest

The Cardiac Cycle

Heart at rest
Blood flows from large veins into atria Passive flow from atria into ventricles

Atria (R & L) contract simultaneously

Blood forced into ventricles

Ventricles (R & L) contract simultaneously

Atrioventricular valves close lubb sound Blood forced into large arteries

Ventricles relax
Semilunar valves close dub sound

Heart at rest

Heart valves
Valves are flap-like structures that allow blood to flow in one direction The heart has two kinds of valves, atrioventricular and semilunar valves Heart sounds The audible sounds that can be heard from the heart are made by the closing of the heart valves These sounds are referred to as the lub-dupp sounds The lub sound is made by the contraction of the ventricles and the closing of the atria-ventricular valves The dupp sound is made by the semi-lunar valves closing

Conducting system of Heart

Stimulation of the heart originates in the cardiac centre, in the medulla oblongata. The sympathetic and parasympathetic nervous systems work antagonistically and provide the stimulation for acceleration and deceleration of the heart rate Cardiac systole (contraction) is initiated by the electrical cardiac impulse from the sinuatrial node (the pace-maker found in the right atria wall) This distributes electrical stimulus through the myocardial (heart muscle) wall between the heart chambers where the atrio-ventricular node (between the right atrium and right ventricle) continues distribution of the electrical signal across the ventricles

The SA node In the upper part of the right atrium of the heart is a specialized bundle of neurons known as the sino-atrial node (SA node) Acting as the heart's natural pacemaker, the SA node "fires" at regular intervals to cause the heart of beat with a rhythm of about 60 to 70 beats per minute for a healthy, resting heart The electrical impulse from the SA node triggers a sequence of electrical events in the heart to control the orderly sequence of muscle contractions that pump the blood out of the heart The AV node The AV node (AV stands for atrioventricular) is an electrical relay station between the atria (the upper) and the ventricles (the lower chambers of the heart) Electrical signals from the atria must pass through the AV node to reach the ventricles

AV node (bundle of his)

The bundle of His is located in the proximal interventicular septum It emerges from the AV node to begin the conduction of the impulse from the AV node to the ventricles

Purkinje fibers
Purkinje fibers are heart muscle tissues that are specialized to conduct electrical impulses to ventricular cells, which induce the lower chambers of the heart to contract Impulses from the upper chambers of the heart are relayed by this node to large bundles of Purkinje fibers referred to as the Bundle of His These bundles branch into smaller elements and eventually form terminal ends that burrow into left and right ventricular chamber muscles As the impulse is passed to the ventricles, the muscles contract and pump blood The contraction caused by the specialized fibers begins from the bottom of the ventricles and move upwards so that the blood leaves the lower chambers through the pulmonary arteries and the aorta

Signal Conduction Pathway SA action potentials -> contraction in atrium

AV action potentials (slower) -> bundle of HIS->

through septum -> Purkinje fibers -> contraction C. Electrocardiography

electrical events corresponding to mechanical

P wave: atrial fibers depolarize QRS complex: ventricles depolarize

T wave: ventricles repolarize

Electrocardiography

Cardiac Output (CO)

CO 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 Output: Example

CO (ml/min) = HR (75 beats/min) x SV (70 ml/beat) CO = 5250 ml/min (5.25 L/min)

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

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

Preload and Afterload

Regulation of Heart Rate

Positive chronotropic factors increase heart rate Negative chronotropic factors decrease heart rate Autonomic nervous system Hormones

Blood Pressure & its regulation

Blood pressure is the force or pressure that the blood exerts on the walls of the blood vessels BP = CO x TPR CO= SV x HR BP = Blood Pressure CO = Cardiac Output TPR = Total Peripheral Resistance SV = Stroke Volume HR = Heart rate

Control of Arterial Blood Pressure

Control of Blood Pressure

Short term control :

Baroreceptors Chemoreceptors Higher centres in the brain

Long term control: RAAS system

Summary of the main mechanisms in blood pressure control

Baroreceptors

Located in walls of aortic arch and left and right carotid sinus Mechanical stretch receptors Neuronal circuits in brainstem compare actual value of BP provided by the baroreceptors with the set point or optimal value

The baroreceptor reflex

Chemoreceptor
Nerve ending situated in the carotid and aortic bodies

control of respiration
Sensitive to changes in the levels of Co2 , O2 and acidity of the blood

The relationship between stimulation of chemoreceptors and arterial blood pressure

Higher centres in the brain

Fear
Anxiety Pain

Anger

Long term Blood pressure regulation

Renin-angiotensin-aldosterone system (RAAS) Anti-diuretic harmone (ADH) Atrial natriuretic peptide (ANP) harmone released by heart sodium and water loss from the kidney reduces blood pressure

RAAS System

Disorder of CVS
Hypertension

Hypotension
Congestive heart failure Cardiac Arrhythmia

Angina Pectoris
Arteriosclerosis Myocardial Infarction

Hypertension
Essential hypertension

Benign (chronic ) hypertension

Malignant ( accelerated) hypertension

Secondary hypertension
Kidney disease Endocrinal disorders

Heart failure Acute heart failure Chronic heart failure

Right-sided (congestive) heart failure

Left-sided (left ventricular) heart failure

Cardiac arrhythmia
Sinus bradycardia Sinus tachycardia Asystole Fibrillation Atrial fibrillation Ventricular fibrillation Heart block

Blood Vessels
Functions: Distribution of blood Exchange of materials with tissues Return of blood to the heart
Structure: Most have the same basic structure: 3 layers surrounding a hollow lumen

General Structure of Blood Vessels

Arteries and veins are composed of three tunics:

tunica interna tunica media tunica externa

Capillaries are composed of endothelium

General Structure

The Vessels
1. Tunica Intima innermost smooth layer simple squamous epithelium continuous with the endocardium present in all vessels

The Vessels
2. Tunica Media layer of smooth muscle - circular arrangement contains elastin

supplied by sympathetic division of the ANS

depending on bodys needs lumen is narrowed (vasoconstriction) or widened (vasodilation)

The Vessels
3. Tunica Externa (Adventitia) thin layer of CT elastic & collagen fibres

The Vessels
Types of Vessels:

Arteries carry blood away from the heart Veins carry blood towards the heart Capillaries the most important part of the vascular system; site of exchange of materials

Types of Blood vessels: Arteries

Elastic Arteries: Thick-walled arteries near the heart; the aorta and its major branches

Large lumen allows low-resistance conduction of blood

Contain lots of elastin in all three tunics walls stretch and recoil to propel blood Withstand and fluctuations regulate large blood pressure

Types of Blood vessels: Arteries

Muscular (distributing) arteries medium sized vessels tunica media more smooth muscle; less elastin major area of vaso-constriction & dilation to regulate blood flow

The Vessels
Arterioles (diameter of 0.3 mm or less) - smallest arteries; lead to capillary beds - close to capillaries - single layer of muscle spiralling around the endothelial lining - regulates blood flow to capillary

The Vessels
Capillaries Smallest vessels diameter just large enough for a red blood cell walls consist of tunica intima only (i.e. layer of endothelium) thinness facilitates exchange of materials