PHYSIOLOGY OF CARDIOVASCULAR SYSTEM

Dr. Dini Sri Damayanti,MKes

Atria

Relatively thin myocardium, ridges called pectinate muscles L and R atria separated by interatrial septum Atrial myocardium forms a single functional unit called the atrial syncytium (depolarization spreads throughout all myocardial cells)

Ventricles

Trabeculae carneae: muscular ridges found on inner surface of ventricles (helps ensure mixing of blood?) Left ventricle: inverted cone shape Right ventricle: shaped like a pouch Ventricular syncytium, interventricular septum

Heart Valves

4 valves, located in fibrous skeleton between atria and ventricles 2 atrioventricular valves (AV valves)
Right

AV valve = tricuspid valve Left AV valve = bicuspid v. = mitral v.

2 semilunar valves
Pulmonary

semilunar valve Aortic semilunar valve

AV Valves

Atrioventricular valves, prevent blood flowing back into atria during ventricular contraction Tricuspid valve = right AV valve Bicuspid valve = mitral valve = left AV valve

AV Valves

Attached to edges of AV valves are chordae tendineae (dense regular CT) Papillary muscles pull on chordae tendineae during ventricular contraction to hold valve closed against the high pressure in the ventricles

Semilunar Valves

Between ventricles and the large blood vessels that leave the ventricles (pulmonary trunk, aorta) 3 flaps each, no chordae tendineae or papillary muscles needed

Direction of Blood Flow

Blood enters the right atrium from

Superior

and inferior vena cavae Coronary sinus

To right ventricle through tricuspid valve Through pulmonary semilunar valve into pulmonary trunk and on to the lungs

Direction of Blood Flow

From lungs, blood enters left atrium through pulmonary veins Through bicuspid valve to left ventricle Though aortic semilunar valve into aorta Aorta branches into arteries supplying systemic circuit

Circulation system

Blood Supply to the Heart

Left and right coronary arteries originate at base of aorta, behind 2 of the 3 flaps of the aortic semilunar valve Blood returns through great cardiac vein, which empties through coronary sinus into right atrium

Cardiac Muscle Function

Adjacent cardiac muscle cells connected by intercalated discs Forms atrial and ventricular syncytia, action potential spreads throughout myocardium so atria contract as a single unit, ventricles contract as a single unit (a fraction of a second later)

Cardiac Muscle Function

Myogenic: cardiac muscle cells can contract without direct stimulation from CNS Neurogenic: autonomic nervous system can change heart rate

Cardiac Muscle Function

Action potential
depolarization (fast Na+ channels) Plateau phase (slow Ca+2 channels)* Repolarization (slow K+ channels)
Rapid

*plateau phase makes action potential in cardiac muscle much longer (~300 msec) than action potential in skeletal muscle (~100 msec)

Conducting System

Composed of specialized cardiac muscle cells that carry electrical impulses but do not contract
Sinoatrial node (SA node) Internodal pathways Atrioventricular node (AV node) Atrioventricular bundle (AV bundle, bundle of His) Bundle branches, Purkinje fibers

Conducting System

Slow sodium leak (prepotential or pacemaker potential) causes cells to gradually depolarize until reaching threshold First cell to reach threshold is usually in the SA node (posterior wall of R atrium) Delay at AV node ensures atria finish contraction before ventricles begin contraction

Conducting System

SA node sodium leak determines heart rate (HR)

Normal

rate would be around 90 to 100 beats/minute (bpm), except Parasympathetic stimulation (vagus nerve) slows normal resting HR to ~70 bpm

AV node can support HR around 40 to 60 bpm if SA node not functioning

Cardiac Cycle

From the end of one heart contraction to the end of the next contraction Systole = contraction Diastole = relaxation

Heart Sounds

Lubb dup sound represents heart valves closing 1st heart sound (lubb) = AV valves closing during ventricular contraction 2nd heart sound (dup) = semilunar valves closing

Heart Murmurs

Turbulent blood flow through damaged valves leads to a blowing or vibrating sound Valvular insufficiency: valves not closing completely Valvular prolapse: flaps go past closed Valvular stenosis: valves too narrow

Cardiac Output

The most important single factor in cardiovascular physiology is the question, How much blood does the heart pump?

SV = EDV - ESV CO = HR x SV

Regulation of CO

Heart rate
Cardioacceleratory (CA) center and cardioinhibitory (CI) center (both in medulla oblongata) Atrial reflex (Bainbridge reflex): right atrium stretching signals CA center to increase heart rate Aortic reflex: stretching of aorta signals CI center to decrease heart rate Carotid sinus reflex: similar to aortic reflex Drugs, hormones, temperature, age, etc.

Regulation of CO

End diastolic volume

Filling

time: how long the ventricle is able to fill with blood before next contraction Venous return: how much blood per minute is returning through the right atrium

Regulation of CO

End systolic volume

Preload:

how stretched are the cardiac muscle fibers in the ventricle at the end of diastole Contractility: how much force can be produced during contraction Afterload: how hard is it to open the semilunar valve

PHYSIOLOGY OF CIRCULATION SYSTEM

Dr. Dini Sri Damayanti,MKes

The Blood Vessels

The cardiovascular system has three types of blood vessels: Arteries (and arterioles) carry blood away from the heart Capillaries where nutrient and gas exchange occur Veins (and venules) carry blood toward the heart.

Blood vessels

The Arteries

Arteries and arterioles take blood away from the heart. The largest artery is the aorta. The middle layer of an artery wall consists of smooth muscle that can constrict to regulate blood flow and blood pressure. Arterioles can constrict or dilate, changing blood pressure.

The Capillaries

Capillaries have walls only one cell thick to allow exchange of gases and nutrients with tissue fluid. Capillary beds are present in all regions of the body but not all capillary beds are open at the same time. Contraction of a sphincter muscle closes off a bed and blood can flow through an arteriovenous shunt that bypasses the capillary bed.

Anatomy of a capillary bed

The Veins
Venules drain blood from capillaries, then join to form veins that take blood to the heart. Veins have much less smooth muscle and connective tissue than arteries. Veins often have valves that prevent the backward flow of blood when closed. Veins carry about 70% of the bodys blood and act as a reservoir during hemorrhage.

The Vascular Pathways

1)

2)

3)

The cardiovascular system includes two circuits: Pulmonary circuit which circulates blood through the lungs, and Systemic circuit which circulates blood to the rest of the body. Both circuits are vital to homeostasis.

Cardiovascular system diagram

The Pulmonary Circuit

The pulmonary circuit begins with the pulmonary trunk from the right ventricle which branches into two pulmonary arteries that take oxygen-poor blood to the lungs. In the lungs, oxygen diffuses into the blood, and carbon dioxide daiffuses out of the blood to be expelled by the lungs. Four pulmonary veins return oxygenrich blood to the left atrium.

The Systemic Circuit

The systemic circuit starts with the aorta carrying O2-rich blood from the left ventricle. The aorta branches with an artery going to each specific organ. Generally, an artery divides into arterioles and capillaries which then lead to venules.

The vein that takes blood to the vena cava often has the same name as the artery that delivered blood to the organ. In the adult systemic circuit, arteries carry blood that is relatively high in oxygen and relatively low in carbon dioxide, and veins carry blood that is relatively low in oxygen and relatively high in carbon dioxide. This is the reverse of the pulmonary circuit.

Blood Flow
The beating of the heart is necessary to homeostasis because it creates pressure that propels blood in arteries and the arterioles. Arterioles lead to the capillaries where nutrient and gas exchange with tissue fluid takes place.

Blood Flow in Arteries

Blood pressure due to the pumping of the heart accounts for the flow of blood in the arteries. Systolic pressure is high when the heart expels the blood. Diastolic pressure occurs when the heart ventricles are relaxing. Both pressures decrease with distance from the left ventricle because blood enters more and more arterioles and arteries.

Cross-sectional area as it relates to blood pressure and velocity

Blood Flow in Capillaries

Blood moves slowly in capillaries because there are more capillaries than arterioles. This allows time for substances to be exchanged between the blood and tissues.

Blood Flow in Veins

1)
2) 3)

Venous blood flow is dependent upon: skeletal muscle contraction, presence of valves in veins, and respiratory movements. Compression of veins causes blood to move forward past a valve that then prevents it from returning backward.

Changes in thoracic and abdominal pressure that occur with breathing also assist in the return of blood. Varicose veins develop when the valves of veins become weak. Hemorrhoids (piles) are due to varicose veins in the rectum. Phlebitis is inflammation of a vein and can lead to a blood clot and possible death if the clot is dislodged and is carried to a pulmonary vessel.

Blood pressure (BP)

A constant flow of blood is necessary to transport oxygen to the cells of the body The arteries maintain an average blood pressure of around 90 mmHg This helps push the blood from the arteries into the capillaries In the capillaries, oxygen transfers from the blood to the cells

Systole and Diastole

The arteries fluctuate between a state of systole and diastole In systole, the pressure in the arteries increases as the heart pumps blood into the arterial system As the pressure increases, the elastic walls of the arteries stretch This can be felt as a pulse in certain arteries

Systole and Diastole

In diastole, the recoil of the elastic arteries forces blood out of the arterial system into the capillaries The pressure in the arteries falls as blood leaves the system Minimum diastolic pressure is typically 70-80 mmHg

Maximum systolic pressure is typically 110-120 mmHg

Factors affecting ABP:

Sex M > F due to hormones/ equal at menopause. Age Elderly > children due to atherosclerosis.

Emotions due to secretion of adrenaline & noradrenaline.

Exercise due to venous return.

Hormones (e.g. Adrenaline, noradrenaline, thyroid H).

Gravity Lower limbs > upper limbs.

Race Orientals > Westerns ? dietry factors, or

weather.

Factors determining ABP:

Blood Pressure = Cardiac Output X Peripheral Resistance
(BP) (CO) Flow (PR) Diameter of arterioles

BP depends on:

1. Cardiac output CO = SV X HR. 2. Peripheral resistance. 3. Blood volume.

More cells

constriction of blood vessel walls

Regulation of ABP:
Maintaining B.P. is important to ensure a steady

blood

flow (perfusion) to tissues.

B.P. is regulated neurally through centers in

medulla

oblongata:

1. Vasomotor Center (V.M.C.), or (pressor area): Sympathetic fibers. 2. Cardiac Inhibitory Center (C.I.C.), or (depressor area): Parasympathetic fibers (vagus).

Regulation of ABP (continued)

cardiac control centers in medulla oblongata
1. Cardiacaccelerator center (V.M.C)
Sympathetic n. fibers

2. Cardiacinhibitory center (C.I.C)

Parasympathetic n. fibers

Regulatory mechanisms depend on:

a. Fast acting reflexes: b. Long-term mechanism:

Concerned by controlling CO (SV, HR), & PR. Concerned mainly by regulating the blood volume.

Regulation of CO:
A fast acting mechanism. CO regulation depends on the regulation of:
a. Stroke volume, & b. Heart rate

Regulation Of COP

COP = SV X HR HR : Sympatic /parasympatic SV : Venous return, Contractility

A fast acting mechanism. Controlled by 3 mechanisms:

neural, local, and hormonal

Neural : sympatic or parasympatic activity Local factors : consentrasion of CO2, O2, and p H Hormonal : norepinefrin, estrogen, angiotensin II, vasopresin

Baroreceptors

How does the body know that there has been a fall in blood pressure? Baroreceptors on the aorta and carotid artery respond to falls in BP

They send signals to the cardiovascular centre in the brain stem medulla The medulla sends signals along the sympathetic nerves to the arterioles and heart, increasing SVR and cardiac output

1. Baroreceptors reflex:
Baroreceptors are receptors found in carotid sinus & aortic arch. Are stimulated by changes in BP.
BP + Baroreceptors

= V.M.C
= Sympathetic Vasodilatation & TPR

++ C.I.C
+ Parasympathetic Slowing of SA node ( HR) & CO

2. Chemoreceptors reflex:
Chemoreceptors are receptors found in carotid &

aortic bodies. Are stimulated by chemical changes in blood mainly hypoxia ( O2), hypercapnia ( CO2), & pH changes. Haemorrhage
BP
Hypoxia

++ V.M.C
+ Adrenal medulla + Sympathetic Vasoconstriction & TPR

+ Chemoreceptors

= C.I.C
= Parasympathetic
HR

3. Other Vasomotor Reflexes:

1. Atrial stretch receptor reflex:
Venous Return ++ atrial stretch receptors reflex vasodilatation & BP.

2. Thermoreceptors: (in skin/or hypothalamus)

to heat vasodilatation. Exposure to cold vasoconstriction.
Exposure

3. Pulmonary receptors:
Lung inflation vasoconstriction.

4. Hormonal Agents:
NA vasoconstriction. A vasoconstriction (except in sk. ms.). Angiotensin II vasoconstriction. Vasopressin vasoconstriction.

B. Regulation of Blood Volume

REGULATION OF ARTERIAL BLOOD PRESSURE

Regulation of Blood Volume:

A long-term regulatory mechanism. Mainly renal:
1. Renin-Angiotensin System. 2. Anti-diuretic hormone (ADH), or vasopressin. 3. Low-pressure volume receptors.

1. Renin-Angiotensin System:
Most important mechanism for Na+ retention in order to maintain the blood volume. Any drop of renal blood flow &/or Na+, will stimulate volume receptors found in juxtaglomerular apparatus of the kidneys to secrete Renin which will act on the Angiotensin System leading to production

 Renin-Angiotensin System:
renal blood flow &/or Na+ ++ Juxtaglomerular apparatus of kidneys (considered volume receptors) Renin Angiotensinogen Angiotensin I
(Lungs) Converting enzymes

Angiotensin III
(powerful vasoconstrictor)

(powerful vasoconstrictor) Adrenal cortex

Angiotensin II

Aldosterone N.B. Aldosterone is the main regulator of Na+ retention.

Corticosterone

2. Anti-diuretic hormone (ADH), or vasopressin:

Hypovolemia & dehydration will stimulate the osmoreceptors in the hypothalamus, which will lead to release of ADH from posterior pituitary gland.

ADH will cause water reabsorption at kidney tubules.

3. Low-pressure volume receptors:

Atrial natriuritic peptide (ANP) hormone, is secreted from the wall of right atrium to regulate Na+ excretion in order to maintain blood volume.