Module 1: Unit 2 - Cardiovascular 1

00:06
The heart is, of course, one of the most important organs
in the body; you only live a few minutes if it completely
stops working. Its job is to pump blood around the body.
Blood brings nutrients and essential oxygen to the body
tissues, so they can maintain their energy levels to carry
out their assigned functions. It also carries away the end-
products of metabolism, including carbon dioxide or
CO2, which is exhaled by the lungs. In this picture, the
person is standing in what is called the anatomical
position. Left and right refer to the person’s left and right
sides. And that’s also true for the individual organs.

00:48
The cardiovascular system means the heart and the blood
vessels. Vessels leaving the heart are called arteries;
vessels returning blood to the heart are called veins.
As you see, there are two circuits: The left one, from the
heart to the body and back again, and the right one, from
the heart to the lungs and back again.

The huge main artery from the left heart to the body is
the aorta, and arteries branch and branch, getting smaller
and smaller. The littlest (the arterioles) lead to the
capillaries, which are tiny and thin-walled. That’s where
almost all of the exchange of gasses and nutrients take
place. It’s estimated that we each have about 100,000
kilometers of capillaries! Blood from the capillaries, with
its oxygen depleted, collects in the venules. Then it
travels on by the veins back to the right side of the heart.

From there, it is pumped via the pulmonary artery to the

lungs to be freshly oxygenated. It returns in pulmonary
veins to the left side of the heart for another trip around
the body.
   

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02:03
The heart has 4 chambers. In this diagram they’ve been
opened up a bit to make it clearer that the heart is really
two pumps in series, one after the other. Oxygen-poor
blood returns from the body in the great veins, which
empty into the right atrium. From there it’s pumped into
the right ventricle. That stronger chamber contracts and
pushes the blood through the pulmonary arteries into the
lungs. In the lungs the capillaries are very close to the air
sacs, and oxygen is taken up while CO2 is released. The
blood flows back into the left atrium of the heart, which
pumps it into the left ventricle. When the strong, thick-
walled left ventricle contracts, blood is sent at high
pressure to circulate all around the body. It eventually
returns to the right atrium and starts the cycle over again.
02:57
Cardiac output is the term for the amount of blood the
heart circulates in one minute. At rest, an average
cardiac output is 5 Liters, or about 1.3 US gallons. Since
the average heart rate is about 70 beats per minute, that
means the heart ejects about 70 milliliters per beat, or 2
and a half ounces. In exercise, cardiac output of a top
athlete can go from 5 Liters to an amazing 25 liters a
minute. That’s done by increasing heart rate and the
volume ejected per beat.

   

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03:33
Blood flow should always be forwards, and the heart has
4 valves that prevent backwards flow. Your heart
sounds—traditionally called LUB and DUP—are the
sounds of those valves closing. Doctors listen to them to
hear if the valves are working properly. The large
ventricles contract together, and when they do, the
increased pressure makes the valves snap shut to prevent
backflow to the atria. That creates the first heart sound, or
LUB. When the ventricles finish contracting and begin to
relax, their exit valves to the lungs and aorta close,
creating the second sound, DUP.

The valves, in order, are called the tricuspid, pulmonic,

mitral, and aortic valves.

Here’s what a normal heart sounds like.

Sometimes the valves are damaged by disease, and

become leaky. For example, if the valve between a
ventricle and an atrium is leaky, there will be turbulent
flow heard right after the valve tries to close; instead of
LUB DUP the sound may be LUBshhh DUP; that’s
called a heart murmur. Doctors get very good at
interpreting heart sounds, and there are many more
sophisticated—and expensive—tests to follow up.
04:58
The muscles of the heart are so thick that they can’t get
nutrients and oxygen from the blood in the chambers;
they require their own arteries, called the coronary
arteries, which come directly off the aorta. These vessels
get a lot of squeezing by the contracting heart muscles,
and in fact most or all of the flow in them has to happen
during the relaxation phase. Some cardiologists suspect
that all the buffeting makes them susceptible to
atherosclerosis or plaque, which is the accumulation of
lipids like cholesterol, and inflammatory white blood
cells.
   

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05:35
Here is a cross section of a normal coronary artery; it has
a smooth lining and a muscular wall. As plaque builds up
beneath the arterial lining, the passage for blood—the
lumen—begins to narrow. At 70 or 80% blockage,
activity becomes limited and there is often pain, called
angina, on exertion. Because the flow over the plaque is
turbulent, clotting or thrombosis is made possible. If
there is a coronary thrombosis, the narrowed lumen can
suddenly be blocked; that’s a heart attack. The muscle
downstream of the blockage becomes ischemic (a word
that means, not enough blood reaching it) and can die if
the blockage is not rapidly reversed; the sudden onset of
new heart pain is a true medical emergency where
minutes count. Ischemic heart disease of this type is the
number one cause of death in the world; it’s related to
obesity, smoking, and lack of exercise.

06:38
If you observe someone collapse, you can help by
performing compression-only resuscitation; you do not
need training or certification to do it. Lock your hands
tightly together and press firmly down on the person’s
breastbone, at the rate of 100 beats per minute.
 

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Heart images: Human Anatomy, Dover Publications Inc. 2011. Used with permission.
Heart diagram: Patrick J. Lynch, medical illustrator [CC BY 2.5] via Wikimedia
Commons
Coronary arteries: from CDC.gov
Stayin’ Alive: Bee Gees, 1997 At ~100 beats/minute, the perfect timer for CPR

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