Lecture 7 Cardiovascular system

Dr. HANADI A. HAFTH

(B.D.S., M.Sc.)
∙The function of the cardiovascular system is to deliver oxygen and
nutrients and to remove carbon dioxide and other waste products 3
 Heart anatomy
❖ Approximately the size of your fist
❖ Heart is a muscular organ that pumps blood
throughout the circulatory system

□ Superior surface of diaphragm

□ Left of the midline
□Anterior to the vertebral column, posterior
to the sternum

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 Pericardium
Pericardium is the outer covering of the heart. It
is made up of two layers:

□Outer parietal pericardium which forms a strong

protective sac around the heart

□Inner visceral pericardium or epicardium that

covers myocardium. These two layers are
separated by a space called pericardial cavity
which contains a thin film of fluid.

□ The pericardium
□ Protects and anchors the heart
□ Prevents overfilling of the heart with blood
□ Allows the heart to work in a relatively friction-free environment 6
Myocardium

Myocardium is the middle layer of the wall of the

heart and it is formed by cardiac muscle fibers. It
forms the bulk of the heart and it is responsible for
the pumping action of the heart.

Myocardium is formed by three types of

cardiac muscle fibers:

❖ 1.Muscle fibers which form the contractile unit

of the heart

❖ 2.Muscle fibers which form pacemaker

❖ 3. Muscle fibers which form the conductive

system.
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 1. Muscle fibers which form the contractile unit
of the heart
Cardiac muscle is striated, branched, and interconnected.

❑ The important difference between skeletal muscle and cardiac

muscle is that the cardiac muscle fiber is branched and the
skeletal muscle is not branched.

Intercalated disk
Intercalated disk is a tough double membranous structure
situated at the junction between the branches of
neighboring cardiac muscle fibers. The intercalated disks
form adheres junctions which play an important role in
contraction of the muscle as a single unit.

**Intercalated
discs anchor cardiac cells together
and allow free passage of ions
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Some of the muscle fibers of the heart are modified into a specialized structure
known as pacemaker. The muscle fibers forming the pacemaker have less
striation.
Pacemaker is structure in the heart that generates the impulses for heart beat. It is
formed by the pacemaker cells called P cells. Sinoatrial (SA) node forms the
pacemaker in human
Heart.
❑ S.A. node: node is composed of a group of specialized cardiac muscle cells (have
almost no contractile muscle filaments Instead they are the cells that gained a property
to generate spontaneous action potentials.
❑ Located at the junction of the superior vena cava with the right atrium & attached to 3
bundles which connect S.A. node to A.V. node (internodal atrial fibers).
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3-muscle fibers which form the conductive system
The conductive system of the heart is formed by the modified cardiac muscle fibers. The
impulses from SA node are transmitted to the atria directly.
However, the impulses are transmitted to the ventricles, through various components of
conducting system ex, AV node, atrioventricular bundle (bundle of His), Purkinje fibers
spread the action potential.

Bundle of His:
Gives of a left bundle branch at the top of the
septum & continue as the right bundle branch.

Purkinje fibers :
spread to all parts of the ventricle
 Right side of the heart

Right side of the heart has two chambers, the upper

right atrium and lower right ventricle. Right atrium is a
thin walled and low pressure chamber. It has got the
pacemaker known as sinoatrial node that produces
cardiac impulses and atrioventricular node that
conducts the impulses to the ventricles. It receives
venous (deoxygenated) blood via two large veins:

1.Superior vena cava that returns the venous blood from

the head, neck and upper limbs
2.Inferior vena cava that returns the venous blood from lower
parts of the body.

Right atrium communicates with the right ventricle through

the tricuspid valve. Venous blood from the right atrium
enters the right ventricle through this valve.
From the right ventricle, pulmonary artery arises. It carries
the venous blood from right ventricle to the lungs. In the
Left side of the heart

Left side of the heart has two chambers, the upper left
atrium and lower left ventricle.
Left atrium is a thin walled and low pressure chamber.
It receives oxygenated blood from the lungs through
pulmonary veins. This is the only exception in the
body where an artery carries venous blood and vein
carries the arterial blood.
Blood from left atrium enters the left ventricle
through the mitral valve (bicuspid valve). Wall of
the left ventricle is very thick. Left ventricle pumps
the arterial blood to different parts of the body
Septa
throughofsystemic
the heartaorta.

Right and left atria of the heart are separated from one
another by interatrial septum.
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The ventricles are separated from one another by
interventricular septum.
 ❑ Heart valves ensure unidirectional blood flow through the
heart.

❖ Atrioventricular (AV) valves lie between the atria

and the ventricles (2 AV: Left AV and Right AV)
Left atrioventricular valve is otherwise known as mitral
valve or bicuspid valve.
Right atrioventricular valve is known as tricuspid valve.

❑ AV valves prevent backflow into the atria when

ventricles contract.

❖ Aortic semilunar valve lies between the left

ventricle and the aorta.

❖ Pulmonary semilunar valve lies between the

right ventricle and pulmonary trunk.
❑ Semilunar valves prevent backflow of blood
into the ventricles.
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 Maj o r vessels of the heart
❖ Vessels returning blood to the heart include:
❖ Superior and inferior venae cavae
❖ Right and left pulmonary veins
❖ □ Vessels conveying blood away from the heart include:
❖ □ Pulmonary trunk, which splits into right and left
pulmonary arteries
❖ □ Ascending aorta (three branches) – brachiocephalic,
left common carotid, and subclavian arteries
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
 Blood flows through two divisions of circulating system:
1. Systemic circulation
2.Pulmonary circulation.

Systemic circulation:-
It is otherwise known as greater circulation The blood pumped from left ventricle passes through a series
of blood vessels of arterial system and reaches the tissues. Exchange of various substances between blood
and the tissues takes place in the capillaries. After the exchange of substances in the capillaries, the blood
enters the venous system and returns to right atrium and then the right ventricles.
Pulmonary circulation;-
It is otherwise called lesser circulation. Blood is pumped from right ventricle to lungs through
pulmonary artery. The exchange of gases occurs between blood and alveoli of the lungs through
pulmonary capillary membrane. The oxygenated blood returns to left atrium through the pulmonary
veins. Thus, the left side of the heart contains oxygenated or arterial blood and the right side of the
heart contains the venous blood.

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1- Rhythmicity
Rhythmicity is the ability of a tissue to produce its own impulses regularly. It is more
appropriately named as auto rhythmicity. It is also called self-excitation. Heart has a
specialized excitatory structure from which the discharge of impulses is rapid. This
specialized structure is called pacemaker. From this, the impulses spread to other parts
through the specialized conductive system.

❖ Automaticity & rhythmicity

S.A node ,A.V node& other parts of the conductive system have capability of
spontaneous genesis of A.P. & in a rhythmic manner
2- Conductivity
Human heart has a specialized conductive system through which the impulses
from SA node are transmitted to all other parts of the heart.
The conductive system: (a. A.V node b. Bundle of His c. Purkinje fiber)
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 3- Excitability
Excitability is defined as the ability of a living tissue to give response to a stimulus. In all the tissues, the initial
response to a stimulus is the electrical activity in the form of action potential. It is followed by mechanical
activity in the form of contraction, secretion, etc.
The action potential is transmitted from atria to ventricles Sequence of Excitation
through the fibers of specialized conductive system.

□Sinoatrial (SA) node generates impulses about 75

times/minute

□Atrioventricular (AV) node delays the impulse

approximately 0.1 second
 The Cardiac Cycle

► Cardiac cycle is defined as the events that occur in the heart

cyclically, from the beginning of one heart beat to the beginning of
the next beat.
► When the heart beats at a normal rate of 72-75 beats/minute, duration
of each cardiac cycle is about 0.8 second.
► Cycle consists of two phases:
► 1-Systole which is a period of contraction of heart.
► 2-Diastole which is a period of relaxation of heart.
► In clinical practice, the term ‘systole’ refers to ventricular systole and ‘diastole’
refers to ventricular diastole.
The different phases of the cardiac cycle:-
❑ 1-Atrial systole
❑ 2-Ventricular systole
► i. Isometric (isovolumetric) contraction phase
► ii. Ejection period
3-Ventricular diastole
► i. Protodiastole
► ii. Isometric (isovolumetric) relaxation phase
► iii. Rapid filling phase
► iv. Slow filling phase
* v. Last rapid filling phase (Atrial diastole)
1.Atrial Systole: : During atrial systole, 70% of blood from atria already
flown into ventricles.

2.Ventricular Systole. This phase is divided into:

i. isometric(isovolumetric) contraction phase:
► When the ventricle contracting, the intraventricular pressure
increases and when it become greater than atrial pressure AV valves
will close.
* Frist heart sound:- closure of AVV at beginning of this phase
The Semilunar valves are already in the closed chambers and they
contract as closed state. So, the ventricles become closed chamber and
they contract as closed chambers. The contraction in this phase is
referred to as isometric or isovolumetric since there is no change of
muscle fibers and there is no movement of blood during this period.
This causes a sharp rise in the intraventricular pressure.
► ii. Ejection period
► When the ventricular pressure exceeds aortic and pulmonary arterial pressure, the SL valves
open.
► the SLV are open and blood rushes into the great vessels at a very high speed. Since the
ventricles are contracting powerfully, the ventricular pressure goes in rising even through blood
is being emptied from the ventricles. Simultaneously, pressure in the aorta and pulmonary
artery, also rises due to ejection of blood into these vessels.
► Ventricular diastole:-
► i. protodiastole:-
► It is the first stage of ventricular diastole, in this period the pressure
drops due to the ejection of blood and less than in the aorta and
pulmonary artery. This causes closure of SLV and AVV valves already
closed. (it is the end of systole and beginning of diastole).
► Second heart sound:- Closure of SLV during this phase produces this
sound.
► ii. Isometric (isovolumetric) relaxation
phase:-
The ventricles relax as decrease in tension without
any change in length of muscle fibers. During this
period again all the valves are closed. The
intra-ventricular pressure falls very much. The
atrial pressure is now greater than ventricular
pressures, the AVV open lead to ventricular
filling.

► iii. Rapid filling phase When the AVV are opened

there is sudden rush of blood from the atria into the
ventricles, 70% of the filling occurs during this phase.
► Third heart sound:- rushing of blood into ventricles
during this phase causes this sound
❑ iv. Slow filling:- After the sudden rush of
blood, the ventricular filling becomes slow,
about 20% of filling occurs in this phase.

❑ v. Last rapid filling:- This occurs because of

atrial systole, after slow filling period, the atria
contract and push a small amount of blood into
the ventricles, about 10% of ventricles filling
takes place during this phase.
Blood pressure

► Blood pressure:- The lateral pressure exerted by the column of blood on the wall of
arteries.
ABP is expressed in four different terms:
1. Systolic blood pressure= 120 mmHg
2. Diastolic blood pressure= 80 mmHg
3. Pulse pressure:- is the difference between the systolic p. and diastolic p= 40
mmHg.
4. Mean arterial blood Pressure:- the average pressure on the arterial wall during the
cardiac cycle= 93.2 mmHg
Physiological Variations:-

► 1. Age : are increases as age advances.

► 2. Sex :
► 3. Body Built
► 4. Diurnal Variation
► 5. After Meals
► 6. During Sleep
► 7. Emotional Conditions
► 8. After Exercise
Regulation of arterial blood pressure:-

► Body has four regulatory mechanisms to maintain the blood

pressure within normal limits:
► l. Nervous mechanism or short-term regulatory mechanism
► 2. Renal mechanism or long-term regulatory mechanism
► 3. Hormonal mechanism
► 4. Local mechanism
 Renal mechanism for regulation of blood pressure - long-term
regulation:-

► The Kidneys regulate arterial blood pressure by two ways:

► 1. By regulation of ECF volume.
► 2. Through renin-angiotensin mechanism.
► By regulation of extracellular fluid volume:
► When the BP increases, kidneys excrete large amounts of water &
salt, particularly (sodium), lead to the decrease in the ECF volume &
blood volume, which in turn brings the ABP back to normal level.
When BP decreases, the reabsorption of water from renal tubules is
increased. This in turn, increases ECF volume, blood volume &
cardiac output resulting in restoration of BP.
 2. Renin-angiotensin mechanism
► Actions of Angiotensin II When BP & ECF
volume decrease, renin secretion from kidneys is
increased. It converts angiotensinogen into
angiotensin I. This is converted into angiotensin
II by ACE (angiotensin converting enzyme).
► Angiotensin II acts in 2 ways to restore
the BP:
► i. It causes constriction of arterioles in the body ,
& BP rises.
► angiotensin II causes constriction of afferent
arterioles in kidneys so that, glomerular filtration
reduces. This results in retention of water & salts.
This increases ECF volume and the BP to normal
level.
► ii. Simultaneously, angiotensin II stimulates the
adrenal cortex to secrete aldosterone. This
hormone increases reabsorption of sodium from
renal tubules, is followed by water reabsorption
resulting in increased ECF volume and blood
volume. It increases the BP to normal level.
Hormonal mechanism for regulation of blood pressure

► Hormones which Increase the Blood Pressure

► 1. Adrenaline
► 2. Noradrenaline
► 3. Thyroxine 2.
► 4. Aldosterone
► 5. Vasopressin
► 6. Angiotensin
► 7. Serotonin
 Hormones which Decrease the Blood Pressure

❑ 1. Vasoactive intestinal polypeptide (VIP)

❑ 2.Bradykinin
❑ 3. Prostaglandin
❑ 4. Histamine
❑ 5. Acetylcholine
❑ 6. Atrial natriuretic peptide
❑ 7 . Brain natriuretic peptide.
 The pathological variations of arterial blood pressure
► l.
Hypertension
► 2.Hypotension

► Hypertension:
► persistent high blood pressure. Clinically, when the systolic pressure
remains elevated above 150 mm Hg & diastolic pressure remains
elevated above 90 mm Hg, it is considered as hypertension. If there is
increase only in systolic pressure called (systolic hypertension).
 Types of Hypertension

► 1. Primary hypertension (essential hypertension) :

elevated blood pressure in absence of any underlying
disease, called essential hypertension. The arterial blood
pressure is increased because of increased peripheral
resistance, which occurs due to some unknown cause.
► 2. Secondary hypertension: high BP due to some
underlying disorders. The different forms of secondary
hypertension are:
► i. Cardiovascular hypertension; produced due to the CVS
disorders- atherosclerosis.
► ii. Endocrine hypertension: due to hyperactivity of some
endocrine glands such as Cushing's syndrome.
► iii. Renal hypertension: is caused by renal diseases like
glomerulonephritis & stenosis of renal arteries.
► iv. Neurogenic hypertension: which is developed by
nervous disorders such as increased intracranial
pressure.
► v. Hypertension during pregnancy
► Hypotension:
► low BP. When the systolic pressure is less than 90 mm Hg.
► Types of hypotension:
► Primary hypotension: low blood pressure that develops in the
absence of any underlying disease & due to some unknown
cause called essential hypotension. Frequent fatigue &weakness
are the common symptoms of this condition.
► 2. Secondary hypotension - occurs due to some underlying diseases
are:
► i. Myocardial infarction
► ii. Hypoactivity of pituitary gland
► iii. Hypoactivity of adrenal glands
► iv. Tuberculosis
► v. Nervous disorders