CARDIOVASCULAR

SYSTEM
CARDIOVASCULAR SYSTEM

 Cardiovascular system includes heart and

blood vessels.
 Heart pumps blood into the blood vessels.
 Blood vessels circulate the blood throughout

the body.
 Blood transports nutrients and oxygen to the

tissues and removes carbon dioxide and

waste products from the tissues.
HEART
 Heart is a muscular organ that pumps blood
throughout.
 In humans, the heart is situated between the two
lungs and slightly to the left of center, behind the
breastbone. It rests on the diaphragm, the
muscular partition between the chest and the
abdominal cavity.
 It is situated in between two lungs in the
mediastinum. It is made up of four chambers, two
atria and two ventricles.
 The musculature of ventricles is thicker than that
of atria. Force of contraction of heart depends
upon the muscles
RIGHT SIDE OF THE HEART

 Right side of the heart has two chambers, right

atrium and 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. Right atrium
receives venous (deoxygenated) bloodvia two
large veins:
 Superior vena cava that returns venous blood
fromthe head, neck and upper limbs
 Inferior vena cava that returns venous blood
from lower parts of the body (Right atrium
and open into right atrium
 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 lungs. In the lungs, the
deoxygenated blood is oxygenated.
 The main difference between SA node and AV
node is that the SA node generates cardiac
impulses whereas the AV node relays and
intensifies cardiac impulses. Furthermore, SA
node is located in the right atrium, close to

the point of entry of the superior vena cava

while AV node is located in the right atrium,

close to the opening of the coronary sinus.
LEFT SIDE OF THE HEART
 Left side of the heart has two chambers: left atrium and 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 mitral valve

(bicuspid valve). Wall of the left ventricle is very thick. Left ventricle

pumps the arterial blood to different parts of the body through

systemic aorta.
LAYERS OF WALL OF THE HEART

Heart is made up of three layers of tissues:

 1. Outer pericardium
 2. Middle myocardium
 3. Inner endocardium.
VALVES OF THE HEART

 There are four valves in human heart.

 Two valves are in between atria and the

ventricles called atrioventricular valves.

 Other two are the semilunar valves, placed at

the opening of blood vessels arising from

ventricles, namely systemic aorta and
pulmonary artery.
 Valves of the heart permit the flow of blood

through heart in only one direction.

Atrioventricular Valves
 Left atrioventricular valve is otherwise known as
mitral valve or bicuspid valve. It is formed by two
valvular cusps or flaps
 Right atrioventricular valve is known as tricuspid
valve and it is formed by three cusps.
 Cusps of the valves are attached to papillary muscles
by means of chordae tendineae. Papillary muscles
arise from inner surface of the ventricles.
 Papillary muscles play an important role in closure of
the cusps and in preventing the back flow of blood
from ventricle to atria during ventricular contraction.
 Atrioventricular valves open only towards ventricles
and prevent the backflow of blood into atria.
Semilunar Valves

 Semilunar valves are present at the openings

of systemic aorta and pulmonary artery and
are known as aortic valve and pulmonary
valve respectively. Because of the half moon
shape, these two valves are called semilunar
valves.
 Semilunar valves are made up of three flaps.
 Semilular valves open only towards the aorta

and pulmonary artery and prevent the

backflow of blood into the ventricles.
ACTIONS OF THE HEART

Actions of the heart are classified into four

types:
 1. Chronotropic action
 2. Inotropic action
 3. Dromotropic action
 4. Bathmotropic action.
Chronotropic action
“Chronotropic action is the frequency of
heartbeat or heart rate.”

It is of two types:
 i. Tachycardia or increase in heart rate
 ii. Bradycardia or decrease in heart rate.
Ionotropic action
 “Force of contraction of heart is called inotropic
action.”

It is of two types:
 i. Positive inotropic action or increase in the force
of contraction
 ii. Negative inotropic action or decrease in the
force of contraction.
Dromotropic action
“Dromotropic action is the conduction of impulse
through heart”.

It is of two types:
 i. Positive dromotropic action or increase in the
velocity of conduction.
 ii. Negative dromotropic action or decrease in the
velocity of conduction.
Bathmotropic action
“Bathmotropic action is the excitability of cardiac
muscle.”

It is also of two types:

i. Positive bathmotropic action or increase in the
excitability of cardiac muscle
ii. Negative bathmotropic action or decrease in the
excitability of cardiac muscle.
Complications of blood vessels
 Arterial blood vessels are highly susceptible for
arteriosclerosis and atherosclerosis.
Arteriosclerosis is the disease of the arteries,
associated with hardening, thickening and loss
of elasticity in the wall of the vessels.
Atherosclerosis is the disease marked by the
narrowing of lumen of arterial vessel due to
deposition of cholesterol.
 Inflammation of the wall of veins leads to the
formation of intravascular clot called
thrombosis. The clot gets dislodged, as
thrombus. The thrombus travels through
blood and causes embolism. Embolism
obstructs the blood flow to vital organs such
as brain, heart and lungs, leading to many
complications
DIVISIONS OF CIRCULATION

Blood flows through two divisions of circulatory

system:
1. Systemic circulation
2. Pulmonary circulation.
Properties of Cardiac Muscle
 EXCITABILITY
 „RHYTHMICITY
 „CONDUCTIVITY
 CONTRACTILITY
 Excitability is defined as the ability of a living
tissue to give response to a stimulus. In all
the tissues, initial response to a stimulus is
electrical activity in the form of action
potential. It is followed by mechanical activity
in the form of contraction, secretion, etc.
 Rhythmicity is the ability of a tissue to
produce its own impulses regularly. It is also
called autorhythmicity or self-excitation.
Property of rhythmicity is present in all the
tissues of heart. However, heart has a
specialized excitatory structure, from which
the discharge of impulses is rapid. This
specialized structure is called pacemaker.
From here, the impulses spread to other parts
through the specialized conductive system.
 Pacemaker is the structure of heart from
which the impulses for heartbeat are
produced. It is formed by the pacemaker cells
called P cells. In mammalian heart, the
Pacemaker is sinoatrial node (SA node). It was
Lewis Sir Thomas, who named SA node as
pacemaker of heart,in 1918.
CONDUCTIVITY

 Human heart has a specialized conductive

system, through which impulses from SA
node are transmitted to all other parts of the
heart.
 Components of Conductive System in Human
Heart
 1. AV node
 2. Bundle of His
 3. Right and left bundle branches
 4. Purkinje fibers.
CONTRACTILITY

Contractility is ability of the tissue to shorten

in length (contraction) after receiving a
stimulus. Various factors affect the contractile
properties of the cardiac muscle.
Cardiac cycle
 Cardiac cycle is defined as the succession of (sequence of)
coordinated events taking place in the heart during each beat.
 Each heartbeat consists of two major periods called systole
and diastole.
 During systole, heart contracts and pumps the blood through
arteries.
 During diastole, heart relaxes and blood is filled in the heart.
All these changes are repeated during every heartbeat, in a
cyclic manner.
 „ ATRIAL EVENTS
 Atrial events are divided into two divisions:
 1. Atrial systole = 0.11 (0.1) sec
 2. Atrial diastole = 0.69 (0.7) sec.
 „ VENTRICULAR EVENTS
 Ventricular events are divided into two

divisions:
 1. Ventricular systole = 0.27 (0.3) sec
 2. Ventricular diastole = 0.53 (0.5) sec.
 Ejection fraction is a measurement of the
percentage of blood leaving the heart each time it
squeezes. When the heart squeezes, it's called a
contraction.
 Ejection fraction refers to the fraction (or portion)
of end diastolic volume that is ejected out by each
ventricle per beat. From 130 to 150 mL of end
diastolic volume, 70 mL is ejected out by each
ventricle (stroke volume).
 Normal ejection fraction is 60% to 65%.
Intrinsic and extrinsic function of
heart
 https://www.brainkart.com/article/
Regulation-of-Heart-Function_21884/
Heart Sounds
 Heart sounds are produced by:
 1. Flow of blood through cardiac chambers
 2. Contraction of cardiac muscle
 3. Closure of valves of the heart.
 Heart sounds are heard by placing the ear

over the chest or by using a stethoscope or

microphone. These sounds are also recorded
graphically.
Four heart sounds are produced during each
cardiac cycle:
1. First heart sound
2. Second heart sound
3. Third heart sound
4. Fourth heart sound.
First and second heart sounds are called classical
heart sounds and are heard by using the
stethoscope.
METHODS OF STUDY OF HEART SOUNDS

 Heart sounds are studied by three methods:

 1. By using stethoscope
 2. By using microphone
 3. By using phonocardiogram.
 These two sounds are more prominent and
resemble the spoken words ‘LUB, (or LUBB) and
‘DUBB’ (or DUP), respectively.
 Third heart sound is a mild sound and it is not
heard by using stethoscope in normal conditions.
But it can be heard by using a microphone. Fourth
heart sound is an inaudible sound. It becomes
audible in pathological conditions only. This sound
is studied only by graphic registration, i.e. the
phonocardiogram.
IMPORTANCE OF HEART SOUNDS

 Study of heart sounds has important

diagnostic value in clinical practice because
alteration in the heart sounds indicates
cardiac diseases involving valves of the heart.
Cardiac murmur
Cardiac murmur is the abnormal or unusual heart sound.

 It is also called abnormal heart sound or cardiac bruit.

 Cardiac murmur is heard by stethoscope, along with normal heart sounds.

 Cardiac murmur is heard by placing chest piece of stethoscope over the

auscultatory areas.

 Murmur due to disease of a particular valve is heard well over the

auscultatory area of that valve. Sometimes, the murmur is felt by palpation as

‘thrills’.

 In some patients, murmur is heard without any aid, even at a distance of few

feet away from the patient.

 Auscultation refers to the technique
performed by a variety of healthcare
professionals (e.g., medical doctors and
registered nurses) during a physical
examination in order to listen to the internal
sounds of the body, such as the heart sounds
, lung sounds, and bowel sounds.
6
CAUSES OF MURMUR

 Cardiac murmur is produced because of

change in the pattern of blood flow.
Normally, blood flows in streamline through
the heart and blood vessels.
 However, during abnormal conditions like

valvular diseases, the blood flow becomes

turbulent. It produces the cardiac murmur.
 Murmur is produced because of valvular

diseases, septal defects and vascular defects

Valvular Diseases

Valvular diseases are of two types:

 1. Stenosis
 2. Incompetence.
Stenosis
 Stenosis means narrowing of heart valve. Blood
flows rapidly with turbulence through the narrow
orifice of the valve, resulting in murmur.
Incompetence
 Incompetence refers to weakening of the heart valve.
 When the valve becomes weak, it cannot close
properly. It causes back flow of blood, resulting in
turbulence. This disease is also called regurgitation
or valvular insufficiency.
Electrocardiography

Electrocardiography is the technique by which electrical

activities of the heart are studied. The spread of excitation
through myocardium produces local electrical potential.
This low-intensity current flows through the body, which
acts as a volume conductor. This current can be picked up
from surface of the body by using suitable electrodes and
recorded in the form of electrocardiogram. This technique
was discovered by Dutch physiologist, Einthoven Willem,
who is considered the father of electrocardiogram (ECG).
Electrocardiograph
 Electrocardiograph is the instrument

(machine) by which electrical activities of the

heart are recorded
Electrocardiogram

 Electrocardiogram (ECG or EKG from

electrokardiogram in Dutch) is the record or
graphical registration of electrical activities of
the heart, which occur prior to the onset of
mechanical activities. It is the summed
electrical activity of all cardiac muscle fibers
recorded from surface of the body.
 USES OF ECG
 Electrocardiogram is useful in determining and
 diagnosing the following:
 1. Heart rate
 2. Heart rhythm
 3. Abnormal electrical conduction
 4. Poor blood flow to heart muscle (ischemia)
 5. Heart attack
 6. Coronary artery disease
 7. Hypertrophy of heart chambers.
ELECTROCARDIOGRAPHIC GRID

The paper that is used for recording ECG is called ECG

paper. ECG machine amplifies the electrical signals
produced from the heart and records these signals on a
moving ECG paper.

Electrocardiographic grid refers to the markings

(lines) on ECG paper. ECG paper has horizontal and

vertical lines at regular intervals of 1 mm. Every 5th line
(5 mm) is thickened.

„
 DURATION
 Time duration of different ECG waves is plotted
 horizontally on X-axis.
 On X-axis
 1 mm = 0.04 second
 5 mm = 0.20 second
 „ AMPLITUDE
 Amplitude of ECG waves is plotted vertically on Y-
axis.
 On Y-axis
 1 mm = 0.1 mV
 5 mm = 0.5 mV
WAVES OF NORMAL ECG

Normal ECG consists of waves, complexes, intervals

and segments. Waves of ECG recorded by limb

lead II are considered as the typical waves. Normal

electrocardiogram has the following waves, namely P,

Q, R, S and T). Einthoven had named the waves of ECG

starting from the middle of the English alphabets (P)
instead of starting from the beginning (A).
Major Complexes in ECG
1. ‘P’ wave, the atrial complex
2. ‘QRS’ complex, the initial ventricular
complex
3. ‘T’ wave, the final ventricular complex
4. ‘QRST’, the ventricular complex.
q
 Each of the 12 EKG leads represent a different
direction of cardiac activation in 3-D space.
The standard EKG leads are denoted as lead I,
II, III, aVF, aVR, aVL, V1, V2, V3, V4, V5, V6.
Leads I, II, III, aVR, aVL, aVF are denoted the
limb leads while the V1, V2, V3, V4, V5, and
V6 are precordial leads.