CARDIOVASCULAR SYSTEM

 The cardiovascular (cardio – heart, vascular – blood vessels) system is divided for
descriptive purposes into two main parts:
o The heart, whose pumping action ensures constant circulation of the blood
o The blood vessels, which form a lengthy network through which the blood flows.
 The heart pumps blood into two anatomically
separate systems of blood vessels:
o The pulmonary circulation
o The systemic circulation.

 The pulmonary circulation: the right side of the

heart pumps blood to the lungs where gas exchange
occurs, i.e., the blood collects oxygen from the air
sacs and excess carbon dioxide diffuses into the air
sacs for exhalation.

 The systemic circulation: The left side of the heart

pumps blood into the systemic circulation, which supplies the rest of the body.
 The cardiovascular system ensures a continuous flow of blood to all body cells, and its
function is subject to continual physiological adjustments to maintain an adequate blood
supply.

HEART
 The heart is a roughly cone-shaped hollow muscular organ.
 It is about 10 cm long and is about the size of the owner’s fist.
 It weighs about 225 g in women and is heavier in men (about 310 g).
 The heart lies in the thoracic cavity.
 It lies obliquely, a little more to the left than the right, and presents a base above, and an
apex below.
Structure: The heart wall is composed of three layers of tissue:
o Pericardium
o Myocardium
o Endocardium
 Pericardium: The pericardium is the outermost layer and is made up of two sacs. The
outer sac (the fibrous pericardium) consists of fibrous tissue and the inner (the serous
pericardium) of a continuous double layer of serous membrane.
 Myocardium: The myocardium is
composed of specialised cardiac
muscle found only in the heart.
 It is striated, like skeletal muscle, but
is not under voluntary control.

 Endocardium: This lines the

chambers and valves of the heart. It
is a thin, smooth membrane to ensure
smooth flow of blood through the
heart.
 The heart is divided into a right and
left side by the septum, a partition
consisting of myocardium covered
by endocardium.
 Each side is divided by an atrioventricular valve into the upper atrium and the ventricle
below.
 The atrioventricular valves are formed by double folds of endocardium strengthened by a
little fibrous tissue.
 The right atrioventricular valve (tricuspid valve) has three flaps or cusps and the left
atrioventricular valve (mitral valve) has two cusps.
 Flow of blood in the heart is one way; blood enters the heart via the atria and passes into
the ventricles below.
 The valves between the atria and ventricles open and close passively according to changes
in pressure in the chambers. They open when the pressure in the atria is greater than that
in the ventricles.
 During ventricular systole (contraction) the pressure in the ventricles rises above that in
the atria and the valves snap shut, preventing backward flow of blood.

Blood Circulation
 The two largest veins of the body, the superior and inferior vena cava, empty their contents
into the right atrium.
 This blood passes via the tricuspid valve into the right ventricle, and from there is pumped
into the pulmonary artery.
 The opening of the pulmonary artery is guarded by the pulmonary valve, this valve
prevents the backflow of blood into the right ventricle when the ventricular muscle relaxes.
 After leaving the heart the pulmonary artery
divides into left and right pulmonary arteries,
which carry the venous blood to the lungs
where exchange of gases takes place: carbon
dioxide is excreted and oxygen is absorbed.
 Two pulmonary veins from each lung carry
oxygenated blood back to the left atrium.
 Blood then passes through the mitral valve
into the left ventricle, and from there it is
pumped into the aorta, the first artery of the
general circulation.
 The opening of the aorta is guarded by the aortic valve.
 It should be noted that both atria contract at the same time and this is followed by the
simultaneous contraction of both ventricles.

Blood supply to the heart:

 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.
 This large blood supply, of which a large proportion goes to the left ventricle.
 Venous blood is collected into a number of cardiac veins that join to form the coronary
sinus, which opens into the right atrium.

Conducting System of The Heart

 The heart possesses the property of autorhythmicity, which means it generates its own
electrical impulses and beats independently.
 However, it is supplied with both sympathetic and parasympathetic nerve fibres, which
increase and decrease respectively the intrinsic heart rate.
 Small groups of specialised neuromuscular cells in the myocardium initiate and conduct
impulses, causing coordinated and synchronized contraction of the heart muscle.

 Sinoatrial node (SA node): This small mass of specialized cells lies in the wall of
the right atrium near the opening of the superior vena cava.
 The sinoatrial cells generate these regular impulses leads them to discharge (depolarise)
regularly, usually between 60 and 80 times a minute, followed by recovery
(repolarisation).
 SA node is called the pacemaker of the heart.
 Firing of the SA node triggers atrial contraction.
 Atrioventricular node (AV node): This small mass of neuromuscular tissue is
situated in the wall of the atrial septum near the atrioventricular valves.
 Normally, the AV node transmits the electrical signals from the atria into the ventricles.
 There is a delay here; the electrical signal takes 0.1 of a second to pass through into the
ventricles. This allows the atria to finish contracting before the ventricles start.
 The AV node also has a secondary pacemaker function and takes over this role if there is
a problem with the SA node itself.
 Its intrinsic firing rate is slower than that of SA node (40–60 beats per minute).

Atrioventricular bundle (AV bundle or bundle of His): This mass of

specialised fibres originates from the AV node.
 It divides into right and left bundle branches. Within the ventricular myocardium the
branches break up into fine fibres, called the Purkinje fibres. The AV bundle, bundle
branches and Purkinje fibres transmit electrical impulses from the AV node to the apex of
the myocardium where the wave of ventricular contraction begins, then sweeps upwards
and outwards, pumping blood into the pulmonary artery and the aorta.

Nerve supply to the heart: The heart is influenced by autonomic (sympathetic and
parasympathetic) nerves originating in the cardiovascular centre in the medulla oblongata.
 The vagus nerve (parasympathetic) supplies mainly the SA and AV nodes and atrial
muscle. Vagal stimulation reduces the rate at which impulses are produced, decreasing the
rate and force of the heartbeat.
 Sympathetic nerves supply the SA and AV nodes and the myocardium of atria and
ventricles, and stimulation increases the rate and force of the heartbeat.

The Cardiac Cycle

 At rest, the healthy adult heart is likely to beat at a rate of 60–80 beats per minute (b.p.m.).
During each heartbeat, or cardiac cycle the heart contracts (systole) and then relaxes
(diastole).
Stages of the cardiac cycle: Taking 74 b.p.m. as an example, each cycle lasts about
0.8 of a second and consists of:
1. Atrial systole – contraction of the atria
2. Ventricular systole – contraction of the ventricles
3. Complete cardiac diastole – relaxation of the atria and
ventricles.
Atrial Systole: The superior vena cava and the inferior vena cava transport
deoxygenated blood into the right atrium at the same time as the four pulmonary veins
bring oxygenated blood into the left atrium.
 The bicuspid and mitral valves (input valves) are open and blood flows passively through
to the ventricles.
 The SA node triggers a wave of contraction that spreads over the myocardium of both
atria, emptying the atria and completing ventricular filling (atrial systole 0.1 sec).

Ventricular Systole: When the electrical impulse reaches the AV node it is slowed
down, delaying atrioventricular transmission.
 This delay allows the atria to finish emptying into the ventricles before the ventricles begin
to contract.
 After this brief delay, the AV node triggers its own electrical impulse, which quickly
spreads to the ventricular muscle via the AV bundle, the bundle branches and Purkinje
fibres.
 This results in a wave of contraction which sweeps upwards from the apex of the heart
and across the walls of both ventricles pumping the blood into the pulmonary artery and
the aorta (ventricular systole 0.3 sec).
 The high pressure generated during ventricular contraction forces the bicuspid and mitral
valves to close, preventing backflow of blood into the atria.

Complete Cardiac Diastole: After contraction of the ventricles there is complete

cardiac diastole, a period of 0.4 seconds, when atria and ventricles are relaxed.
 During this time the myocardium recovers ready for the next heartbeat, and the atria refill
ready for the next cycle.
 Heart Sounds
 The first sound, ‘lub’, is fairly loud and is due to the closure of the Tricuspid and Mitral
valves. This corresponds with the start of ventricular systole.
 The second sound, ‘dup’, is softer and is due to the closure of the aortic and pulmonary
valves. This corresponds with ventricular diastole.
 Electrocardiogram (ECG)
 The electrical activity in the heart can
be recorded on the skin surface using
electrodes positioned on the limbs
and/or the chest. This recording, called
an electrocardiogram (ECG) shows the
spread of the electrical signal
generated by the SA node as it travels
through the atria, the AV node and the
ventricles.
 The normal ECG tracing shows five
waves which, named P, Q, R, S and T.
 The P wave arises when the impulse
from the SA node sweeps over the atria
(atrial depolarisation).
 The QRS complex represents the very rapid spread of the impulse from the AV node
through the AV bundle and the Purkinje fibres and the electrical activity of the ventricular
muscle (ventricular depolarisation).
 Note the delay between the completion of the P wave and the onset of the QRS complex.
This represents the conduction of the impulse through the AV node.
 The T wave represents the relaxation of the ventricular muscle (ventricular
repolarisation).
 By examining the pattern of waves and the time interval between cycles and parts of
cycles, information about the state of the myocardium and the cardiac conduction system
is obtained.

Cardiac Output
 The cardiac output is the amount of blood ejected from each ventricle every minute.
 Cardiac output is expressed in litres per minute (L/min) and is calculated by multiplying
the stroke volume by the heart rate (measured in beats per minute):
Cardiac output = Stroke volume × Heart rate
 The amount expelled by each contraction of each ventricle is the stroke volume.
 In a healthy adult at rest, the stroke volume is approximately 70 mL and if the heart rate
is 72 per minute, the cardiac output is 5 L/minute.
 This can be greatly increased to meet the demands of exercise to around 25 L/minute, and
in athletes up to 35 L/minute.
 Blood Vessels
 Blood vessels vary in structure, size and function, and there are several types:
o Arteries
o Arterioles
o Capillaries
o Venules
o Veins
Arteries and arterioles: These blood vessels
transport blood away from the heart.
 They vary considerably in size and their walls consist of
three layers of tissue:
o Tunica adventitia or outer
layer of fibrous tissue
o Tunica media or middle layer of smooth muscle and elastic
tissue
o Tunica intima or inner lining of squamous epithelium called
endothelium.
 In the large arteries, including the aorta, sometimes called elastic arteries, the tunica media
contains more elastic tissue and less smooth muscle.
 In the arterioles (the smallest arteries) the tunica media consists almost entirely of smooth
muscle.
 Arteries have thicker walls than veins to withstand the high pressure of arterial blood.

Capillaries and Sinusoids: The smallest arterioles break up into a number of minute
vessels called capillaries.
 Capillary walls consist of a single layer of endothelial cells sitting on a very thin basement
membrane, through which water and other small molecules can pass.
 Blood cells and large molecules such as plasma proteins do not normally pass-through
capillary walls. The capillaries form a vast network of tiny vessels that link the smallest
arterioles to the smallest venules.
 The capillary bed is the site of exchange of substances between the blood and the tissue
fluid.
 These capillaries are called sinusoids and because their walls are incomplete and their
lumen is much larger than usual, blood flows through them more slowly under less
pressure and can come directly into contact with the cells outside the sinusoid wall.

Veins and Venules: Veins return blood at low pressure to the heart.
 The walls of the veins are thinner than arteries but have the same three layers of tissue.
 They are thinner because there is less muscle and elastic tissue in the tunica media, as
veins carry blood at a lower pressure than arteries.
 When cut, the veins collapse while the thicker-walled arteries remain open.
 Some veins possess valves, which prevent backflow of blood, ensuring that it flows
towards the heart.
 The smallest veins are called venules.

Capillary Exchange
 Internal respiration is the process by which gases are exchanged between capillary blood
and local body cells.
 Exchange in the tissues takes place between blood at the arterial end of the capillaries and
the tissue fluid and then between the tissue fluid and the cells.
 Oxygen diffuses down its concentration gradient, from the oxygen-rich arterial blood, into
the tissues, where oxygen levels are lower because of constant tissue consumption.
 The two main forces determining overall fluid movement across the capillary wall are the
hydrostatic pressure (blood pressure), which tends to push fluid out of the bloodstream,
and the osmotic pressure of the blood, which tends to pull it back in, and is due mainly to
the presence of plasma proteins, especially albumin.
 At the arterial end, the hydrostatic pressure is about 35 mmHg, and the opposing osmotic
pressure of the blood is only 25 mmHg due to this arterial end of the capillary therefore
drives fluid out of the capillary and into the tissue spaces.
 At the venous end of the capillary, the situation is reversed. Blood flow is slower than at
the arterial end because the hydrostatic pressure drops along the capillary to only 15
mmHg. The osmotic pressure remains unchanged at 25 mmHg and, because this now fluid
moves back into the capillary.

Blood Pressure
 Blood pressure is the force or pressure that the blood exerts on the walls of blood vessels.
 Systemic arterial blood pressure maintains the essential flow of blood into and out of the
organs of the body.
 Keeping blood pressure within normal limits is very important.
 If it becomes too high, blood vessels can be damaged, causing clots or bleeding from sites
of blood vessel rupture.
 If it falls too low, then blood flow through tissue beds may be inadequate.

Systolic and diastolic pressures: When the left ventricle contracts and pushes blood
into the aorta, the pressure produced within the arterial system is called the systolic blood
pressure. In adults it is about 120 mmHg.
 In complete cardiac diastole when the heart is resting the pressure within the arteries is
much lower and is called diastolic blood pressure. In an adult this is about 80 mmHg.
 Arterial blood pressure (BP) is measured with a sphygmomanometer and is usually
expressed with the systolic pressure written above the diastolic pressure:
BP = 120/80 mmHg

Control of blood pressure (BP):

 The cardiovascular centre (CVC) is a collection of interconnected neurons in the medulla
and pons of the brain stem.
 The CVC receives, integrates and coordinates inputs from:
 Baroreceptors (pressure receptors)
 Chemoreceptors (sensitive to changes in the levels of CO2, O2)
 Higher centres in the brain (influenced by emotional states such as fear,
anxiety, pain and anger)

Figure: Summary of the main mechanisms in blood pressure control

Figure: The Baroreceptor Reflux
 Disorders/Disease of the Heart
1. Thrombosis: Thrombosis is the formation of a blood clot (thrombus) inside a blood
vessel, interrupting blood supply to the tissues.
2. Embolism: Embolism is the blocking of a blood vessel by any mass of material (an
embolus) travelling in the blood.
3. Infarction and ischaemia: Infarction is the term given to tissue death because of
interrupted blood supply. Ischaemia means tissue damage because of reduced blood
supply.
4. Arteriosclerosis: This is a progressive degeneration of arterial walls, associated with
ageing and accompanied by hypertension.
5. Oedema: In oedema, excess tissue fluid accumulates, causing swelling. It may
occur either in superficial tissues or deeper organs.
6. Heart (cardiac) failure: The heart is described as failing when the cardiac output is
unable to circulate sufficient blood to meet the needs of the body.
7. Angina pectoris: This is sometimes called angina of effort because the increased
cardiac output required during extra physical effort causes severe chest pain, which may
also radiate to the arms, neck and jaw. A narrowed coronary artery may supply sufficient
blood to the myocardium to meet its needs during rest or moderate exercise but not when
greatly increased cardiac output is needed.
8. Myocardial infarction: when a branch of a coronary artery is blocked. Due to the
thrombosis. The damage is permanent because cardiac muscle cannot regenerate, and the
dead muscle is replaced with nonfunctional fibrous tissue. Myocardial infarction is usually
accompanied by very severe crushing chest pain behind the sternum which, unlike angina
pectoris, continues even when the individual is at rest. It is a significant cause of death in
the developed world.
9. Cardiac arrhythmias: A cardiac arrhythmia is any disorder of heart rate or rhythm,
and is the result of abnormal generation or conduction of impulses.