Cardiovascular system L1

Faisal I. Mohammed, MD, PhD

Yanal A. Shafagoj, MD, PhD
Ebaa M. Alzayadneh, DDS, PhD

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The Stages of Heart Failure –
NYHA Classification
Class Patient Symptoms
Class I (Mild) No limitation of physical activity. Ordinary physical
activity does not cause undue fatigue, palpitation, or
dyspnea (shortness of breath).
Class II (Mild) Slight limitation of physical activity. Comfortable at
rest, but ordinary physical activity results in fatigue,
palpitation, or dyspnea.
Class III Marked limitation of physical activity. Comfortable at
(Moderate) rest, but less than ordinary activity causes fatigue,
palpitation, or dyspnea.
Class IV Unable to carry out any physical activity without
(Severe) discomfort. Symptoms of cardiac insufficiency at rest.
If any physical activity is undertaken, discomfort is
increased.

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Cardiovascular
System Anatomy
Anatomy of the heart

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Anatomy of the heart

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Cardiac valves
Cardiac Valves
Open and Close
Passively
 Importance of
Chordae Tendineae
 Importance of
Chordae Tendineae
Layers of the Heart Wall

1. Epicardium (external layer)…prevent the heart from

overstretching as we will see later when we discuss
Frank-Starling law of the heart.
 Visceral layer of serous pericardium
 Smooth, slippery texture to outermost surface
2. Myocardium
 95% of heart is cardiac muscle
3. Endocardium (inner layer)
 Smooth lining for chambers of heart, valves and
continuous with lining of large blood vessels

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Internal anatomy of the heart and
Cardiac valves

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Heart Valves and Circulation of
Blood
 Atrioventricular valves…all valves open and close passively
 Tricuspid and bicuspid valves (mitral valve)

 When Atria are contracting the ventricles are relaxing. The opposite is

true
 AV valve opens, cusps project into ventricle

 In ventricle, papillary muscles are relaxed and chordae tendinae slack

 Atria relaxed/ ventricle contracts…there is a time where both atria and

ventricles are relaxing…but there is no way both are contracting

simultaneously…the importance of the AV delay as we will discuss later.
 Pressure drives cusps upward until edges meet and close the opening

 Papillary muscles contract tightening chordae tendinae

Regurgitation from ventricle to atrium is prevented

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Movement of blood in the heart

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Systemic and pulmonary circulation - 2 circuits
in series
 Systemic circuit…high resistance circulation
 From left side of heart (LV)to right atrium
 Receives blood from lungs → to left atrium
 Ejects blood from LV to aorta
 Systemic arteries → arterioles → capillaries → venules → veins →
back to right atrium
 Gas and nutrient exchange in systemic capillaries
 Pulmonary circuit…low resistance circulation: one seventh
 Right side of heart RA and RV
 Receives blood from systemic circulation
 Ejects blood into pulmonary trunk then pulmonary arteries
 Gas exchange in pulmonary capillaries
 Pulmonary veins takes blood to left atrium

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Cardiac Muscle Tissue and the Cardiac
Conduction System
 Histology
 Shorter and less circular than skeletal muscle fibers
 Branching gives “stair-step” appearance
 Usually, one centrally located nucleus
 Ends of fibers connected by intercalated discs
 Discs contain desmosomes (hold fibers together) and gap
junctions (allow action potential conduction from one fiber to the
next) → syncytium
 Mitochondria are larger and more numerous than skeletal muscle
 Same arrangement of actin and myosin

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 Cardiac Myocyte
• 50-100 µm long
• 10-20 µm in diameter
• single central nucleus
• the cell is branched, attached to adjacent
cells in an end-to-end fashion (intercalated
disc)
– desmosomes (connexons)
– gap junction

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Cardiac Muscle Tissue
 Cardiac muscle, like skeletal muscle, is striated. Unlike
skeletal muscle, its fibers are shorter, they branch, and
they have only one (usually centrally located) nucleus.
 Cardiac muscle cells connect to and communicate
with neighboring cells through
gap
junctions in
intercalated
discs.
 Cardiac and Skeletal Muscles
Differences

Skeletal muscle Cardiac Muscle

• Neurogenic • Myogenic
(motor neuron-end (action potential
plate-acetylcholine) originates within the
• Insulated from each muscle)
other • Gap-junctions
• Short action potential • Action potential is
longer

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Action Potentials and Contraction

 Action potential initiated by SA node spreads out

to excite “working” fibers called contractile fibers
1. Depolarization
2. Plateau…in ventricles this phase prevent the
occurrence of tetanization
3. Repolarization

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Action Potentials and Contraction

1. Depolarization – contractile fibers (ventricular) have

stable resting membrane potential..they cannot reach
threshold by themselves
 Voltage-gated fast Na+ channels open →Na+ flows in

 Then deactivate and Na+ inflow decreases

2. Plateau – period of maintained depolarization

 Due in part to opening of voltage-gated slow Ca2+

channels – Ca2+ moves from interstitial fluid into cytosol

 Ultimately triggers contraction

 Depolarization sustained due to voltage-gated K+

channels balancing Ca2+ inflow with K+ outflow

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Action Potentials and Contraction

3. Repolarization – recovery of resting membrane potential

 Resembles that in other excitable cells

 Additional voltage-gated K + channels open

 Outflow K+ of restores negative resting membrane potential

 Calcium channels closing

 Refractory period – time interval during which second

contraction cannot be triggered
 Lasts longer than contraction itself
 Tetanus (maintained contraction) cannot occur
 Blood flow would cease

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 Action Potential in a ventricular contractile fiber
22 Plateau (maintained depolarization) due to Ca inflow
2+

when voltage-gated slow Ca channels open and

2+

+ 20 K+ outflow when some K+ channels open

–20 33 Repolarization due to closure

of Ca2+ channels and K+ outflow
Membrane –40 11 Rapid depolarization due to when additional voltage-gated
potential (mV)
Na+ inflow when voltage-gated K+ channels open
– 60 fast Na+ channels open

– 80

–100
0.3 sec

Depolarization Repolarization

Refractory period

Contraction

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