- Very significant system of the body. It delivers oxygen and nutrients to the body tissues and it carries away wastes such as carbon dioxide via the blood.
* Major functions of the cardiovascular system is transportation as it carries it various cargos back and forth, which is very vital for homeostasis
I. THE HEART ▪ Size of a person's fist, hollow, cone-shaped, and weighs less than a pound. ▪ Enclosed within inferior mediastinum. ▪ Pointed apex, toward left hip, rests on diaphragm, at 5th ICS. ▪ Broad at the base, where great vessels emerge toward right shoulder, beneath 2nd rib.
COVERINGS AND WALL
▪ A heart is actually eclosed with a sac which we call the pericardium.
▪ Pericardium has three layers: 1st is outer fibrous layer (fibrous pericardium), 2nd and 3rd layer is the inner serous membrane pair (two layers of the serous pericardium). ▪ Fibrous pericardium: it helps protect the heart and anchors it to the surrounding structures such as the diaphragm and the sternum. ▪ Serous pericardium: the visceral and parietal layer. ▪ The parietal line the interior of the fibrous pericardium. The superior aspect of the heart it attaches to the large arteries leaving, and then it will return continuously on the inferior in the heart's surface. ▪ Visceral layer: also known as epicardium, it's a part of the heart wall. The innermost layer of pericardium and the outermost layer of the heart wall. ▪ 3 layers of the Heart Wall: the epicardium, the myocardium, and the endocardium ▪ Epicardium: visceral pericardium ▪ Myocardium: it consists of thick bundles of cardiac muscle. It is reinforced internally by a network of dense fibrous connective tissue which we call the skeleton of the heart . ▪ Endocardium: is a thin glistening sheath of endothelium and it lines the heart chambers. It is continuous with the linings of the blood vessels, leaving and entering the heart.
CHAMBERS
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CHAMBERS
▪ Pulmonary circulation: involves movement of blood to and from the lungs.
▪ Systemic circulation: it involves all organ system of the body as each cells receive oxygenated blood from the aorta. (oxygenated to unoxygenated) ▪ The superior atria are primarily receiving chambers which assist with filling the ventricles. ▫ Right Atrium: collects unoxygenated blood from systemic circulation ▫ Left Atrium: collects oxygenated blood from pulmonic circulation. ▪ The inferior, thick-walled ventricles are the discharging chambers or pumps which contract so blood is propelled out of the heart. ▫ Right Ventricle: pumps unoxygenated blood from pulmonic circulation ▫ Left Ventricle: pump oxygenated blood to systemic circulation
GREAT VESSELS
ARTERIES: (movement of blood is away from the heart)
▪ Systemic Circulation: blood flow from aorta to vena cava, oxygenated to unoxygenated blood. ▪ Pulmonic Circulation: blood flow from pulmonary artery to pulmonary vein, unoxygenated to oxygenated blood.
VALVES
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Atrioventricular Valves ▪ Prevent backflow into the atria when the ventricles contract. ▫ Tricuspid Valve ▫ Mitral Valve * Open during heart relaxation and close when ventricles are contracting Semilunar Valves ▪ Guards the bases of the two large arteries leaving the ventricular chambers. ▫ Pulmonary valve ▫ Mitral valve * Closed during heart relaxation and are forced open when the ventricles contract. Incompetent Valves 1. Valvular Stenosis: narrowing of valves 2. Valvular Atresia: closed valves Heart Infections: 1. Carditis: 2. Pericarditis: 3. Myocarditis 4. Endocarditis * If the heart is no longer opening and closing it needs replacement with a synthetic valve prosthetic heart valve
* 2nd is cryopreserved human heart from a donor.
* Another is chemically treated valve taken from an animal usually a pig's heart.
BLOOD FLOW IN AND OUT OF THE HEART
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▪ One way direction ▪ An oxygenated blood that was used by our cells in our body coming from synthetic circulation will enter the heart via the SUPERIOR and INFERIOR VENA CAVA ▪ The RIGHT ATRIUM, ATRIA collects from the vena cava. ▪ Now the TRICUSPID VALVE will open from the atria (that collects unoxygenated blood). The PULMONARY VALVE is closed. ▪ The RIGHT VENTRICLE now if its filled it will pump. If it pumps unoxygenated blood the tricuspid valve will be closed, and pulmonary valve will open. ▪ That’s why the pump unoxygenated blood it will pass the PULMONARY ARTERY. ▪ PULMONARY ARTERY is a way from the heart, it carries unoxygenated blood. ▪ It will enter the PULMONARY CIRCULATION, and the unoxygenated blood, when it reaches the lungs, it will be oxygenated. ▪ Lungs has made the blood oxygenated because gas exchange occurred, the oxygenated blood will now enter the PULMONARY VEIN. ▪ Pulmonary Vein, the movement of it is towards the heart. ▪ And then it is connected to LEFT ATRIUM ▪ Left Atrium, is a collecting chamber. It collects oxygenated blood. ▪ As it collects oxygenated blood the MITRAL VALVE is open and AORTIC VALVE is close. As it fills the LEFT VENTRICLE. ▪ The LEFT VENTRICLE, once it's ready to pump, the aortic valve opens and mitral valve closes. ▪ The AORTA now carries oxygenated blood going to the SYSTEMIC CIRCULATION, to use all the body cells of the oxygenated blood.
❖ VIEW OF CORONARY ARTERIES AND CARDIAC VEINS
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❖ ARTERIA BLOOD FLOW PROBLEMS
▪ Angina Pectoris: insufficient oxygen supply to the heart resulting in crushing chest pain.
▪ Myocardial Infarction: oxygen deprivation to the heart cells causing cell death. (example given is heart attack)
INTRINSIC CONDUCTION
What makes the heartbeat?
▪ Two systems act to actually regulate the heart activity: ▫ Autonomic Nervous System: they act like brakes and gas pedals to either decrease or increase the heart rate depending on which division is activated. ▫ Intrinsic Conduction System (Nodal System): built into the heart tissues and it sets basic rhythm which causes heart muscle depolarization or contraction in only one direction which is from the atria to the ventricles. ▪ The conduction occurs in sequence (1-4): ▫ SA Node (Sinoatrial Node): • Pacemaker of the heart located at junction of the superior vena cava and right atrium. • Generates electrical impulses approximately 60 to 100 times per minute but can adjust its rate. • Sympathetic and Parasympathetic nervous systems controls the SA node. ▫ AV Node (Atrial Ventricular Node): • Located in the lower aspect of the atrial septum. • Receives electrical impulses from the SA node. ▫ AV Bundle (bundle of His): • Fuses with AV node to form another pacemaker site. • If SA node fails, the Bundle of his can initiate and sustain a heart rate of 40 to 60 beats per minute. ▫ Purkinje's fibers:
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▫ Purkinje's fibers: • Diffuse network of conducting strand beneath the ventricular endocardium. • They rapidly spread the wave of depolarization through the ventricles. • Activation of the ventricles begins in the septum and moves from apex upward. • Within the ventricular walls, depolarization proceeds from endocardium to epicardium. • Repolarization occurs in reverse, so that last cells to depolarize are the first one to repolarize.
CARDIAC CYCLE AND SOUND
◊ SYSTOLE AND DIASTOLE ▪Systole: contraction ▪Diastole: relaxation Cardiac Cycle ▪One complete heartbeat, where atria and ventricles contract and then relax. ▪Beats 75 times per minute (60 to 100 range), about 0.8 seconds per cycle. ▫ Bradycardia: slow heartbeat, less than 100 ▫ Tachycardia: fast heartbeat, more than 100 * Electrocardiography (ECG): it's a test which measures the electrical activity of the heart. Specifically how well the atria and ventricles contract and relax.
◊ HEART SOUNDS First Heart Sound (S1, Lub): closing of atrioventricular valves. (tricuspid and mitral valves) Second Heart Sound (S2, Dup): closing of semilunar valves. (pulmonic and aortic valves) * S1 is longer than S2 * S1 is louder than S2 * S2 sound is short and sharp. While S1 is long and loud.
* STETHOSCOPE: ▫ Diaphragm: best for higher pitch sounds. Like breath and normal heart sounds. ▫ Bell: best for detecting lower pitch sounds. Like some heart murmurs.
CARDIAC OUTPUT
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CARDIAC OUTPUT Regulation of Stroke Volume ▪ Is the amount of blood pumped by each ventricle for every heartbeat. It is normally 70 ml/beat (50 to 100 range). ▪ Starling's law of the heart: says that the critical factor controlling stroke volume is how much the cardiac muscle cells are stretched just before they contract. ▪ Venous return: is an important factor to stretch the heart muscle. ▪ Muscular pump: or the enhanced squeezing action of active skeletal muscles on the veins returning to the heart, plays a major role in increasing venous return. CARDIAC OUTPUT IS THE AMOUNT OF BLOOD BEING PUMPED BY EACH VENTRICLE EVERY 1 MINUTE. ▪ Cardiac Output = Heart Rate x Stroke Volume ▪ CO = HR x SV ▪ 5250 ml/minute = 75 beats per minute x 70 ml per beat ▪ CO = 5.25 liter/minute (range of 4 to 6 liters)
II. BLOOD VESSELS
TUNICS
▪ Blood circulates inside the blood vessels which form a closed transport system which we call the Vascular System. ▪ There are three walls of the blood vessels: ▫ Tunica Intima: innermost layer ▫ Tunica Media: middle layer, where muscle cells are found. ▫ Tunica Adventitia ◊ THREE SIGNIFICANT BOOD VESSELS: Arteries: ▪ has high pressure, and walls are thicker and heavier than veins. Veins: ▪ Has low pressure, and walls are thinner and lighter than arteries. Capillaries: ▪ Has transparent walls, and only once cell layer thick, the tunica intima. ▪ Exchanges are easily made between blood and tissue cells. ▪ Tiny capillaries form interweaving networks called capillary beds.
Arterial supply of the brain and circle of Willis ▪ Internal Carotid Artery ▫ Anterior, middle, and cerebral artery- cerebrum ▪ Vertebral Artery ▫ Basilar artery: brainstem and cerebellum ▫ Posterior cerebral artery: posterior part of the cerebrum ▪ Small, communicating arterial branches which unite anterior and posterior blood supplies of the brain. ▪ Surrounds base of brain. ▪ Provides more than one route for blood to reach brain tissue is case of clot or impaired blood flow.
Fetal Circulation
▪ Placenta ▪ Umbilical Cord ▫ One umbilical vein ▫ Two umbilical arteries ▪ Ductus Venosus ▪ Foramen Ovale ▫ Opening between the right and left atrium ▪ Ductus Arteriosus ▫ Communication between pulmonary artery and aorta.
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Hepatic Portal Circulation
▪ Veins of hepatic portal circulation drain the digestive organs, spleen, and pancreas; and delver this blood to the liver through hepatic portal vein. ▪ When you have just eaten, hepatic portal blood contains large amounts of nutrients, this system now takes a detour to ensure that the liver processes these substances before they enter systemic circulation. • Inferior mesenteric vein: drains terminal part of large intestine • Splenic vein: drains spleen, pancreas, and left side of stomach • Superior mesenteric vein: drains small intestine and first part of colon. • Left gastric vein: drains right side of stomach.
❖ PULSE:
• A pressure wave that travels the entire arterial system created from alternating expansion and recoil of an artery that occurs with each beat of the left ventricle. Normal Findings Upon Palpation: ▫ Rate at 60 to 100 beats/minute
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▫ Rate at 60 to 100 beats/minute ▫ Strong, not weak and bounding ▫ Rhythm is regular ▫ Symmetric, equal right and left ▫ Warm to touch
❖ BLOOD PRESSURE • Pressure that the blood exerts against the inner walls of the arteries, and it is the force that keeps blood circulating continuously even between heartbeats. • NORMAL: 120/80 mm Hg (Systolic/Diastolic)
❖ KOROTKOFF SOUNDS: • The pressure read as the first soft tapping sounds are heard (the first point at which a small amount of blood is spurting through the constricted artery) is recorded as the systolic pressure. • As the pressure is reduced still further, the sounds become louder and more distinct. When the artery is no longer constricted and blood flows freely, the sounds can no longer be heard. The pressure at which the sounds disappear is recorded as the diastolic pressure.
