THE CARDIOVASCULAR SYSTEM

SUBMITTED TO:

MR. ARCHIE FIDELES ANADON

SUBMITTED BY:

GROUP 5

GONZALES, KEYZIELY.

INATO, RUSELLE JOY L.

JACOB, KATHRINE AUDREY R.

MIOLE, DIANE T.

MAPAYO, VINCE NICO G.

PALUMBI, JANNA S.

TIODIANCO, CHRISTIAN PAUL M.

BMLS 1-10-1B

OCTOBER 15, 2019

HEART ANATOMY

 The size of the heart is approximately the same size of your fist
 Location:
 Enclosed within the inferior mediastinum → medial section of the
thoracic cavity
 Left of the midline
 Apex – pointed part of the heart directed goes to the left hip and rests on the
diaphragm
 Base – broad posterior and superior aspect that points toward the right shoulder
and lies beneath the second rib.
→ Where’s the great vessels emerges.

Coverings and Walls of the Heart

 Pericardium – a three-layered sac around the heart composed of:

1. An outer layer fibrous pericardium → helps protect the heart and
anchors it to surrounding structures, such as diaphragm and sternum
2. An inner two-layer serous pericardium
a. The parietal layer is the internal surface lining of the pericardium
b. The visceral layer or epicardium lines the outermost surface of
the heart wall and innermost layer of the pericardium.
c. They are separated by the fluid-filled pericardial cavity.
 PERICARDITIS → inflammation of the pericardium; often results in a decrease in
the amount of serous fluid.

3 Layers of the Heart Wall

 Epicardium – visceral layer of the serous pericardium

 Myocardium – cardiac muscle layer forming the bulk of the heart.
→ It is the layer that contracts.

→ Reinforced internally by a network of dense fibrous connective tissue called

the “skeleton of the heart”

 Endocardium – lines the heart chambers. It is continuous with the

linings of the blood vessels leaving and entering the heart.
CHAMBERS AND ASSOCIATED GREAT VESSELS

Chambers of the Heart

 Atria (2) – receiving chambers of the heart.

→ assists with filling the ventricles.

→ Interatrial septum – septum that divides the atria

 Ventricles (2) – discharging chambers or actual pumps of the heart.

→ when they contract, blood is propelled out of the heart and into
circulation.

 Right ventricle pumps blood into the pulmonary trunk; forms

most of the heart’s anterior surface.
 Left ventricle pumps blood into the aorta; forms the apex.
→ Interventricular septum – septum that divides the ventricles

Major Vessels of the Heart

 Veins – carries blood towards the heart

1. Superior and inferior venae cava → receives oxygen-poor blood from
the veins of the body
2. Right and left pulmonary veins (4) → left side of the heart wherein
oxygen-rich blood enters and returns to the heart.
 Arteries – carries blood away from the heart
1. Pulmonary trunk
→ splits into right and left pulmonary arteries which carries blood to the
lungs wherein Oxygen is picked up and CO 2 is unloaded.
2. Aorta → wherein oxygen-rich blood is pumped out and flows through the
systemic arteries to supply essentially all body tissues.
 PULMONARY CIRCULATION – carries blood to the lungs for gas exchange and
then returns it to the heart.

 SYSTEMIC CIRCULATION – supplies oxygen- and nutrient-rich blood to all body

organs.
HEART VALVES

 Atrioventricular Valves (AV) – valves that lie between the atria and the
ventricles.
→ prevents backflow into the atria when the ventricles contract.
 → open during heart relaxation and closed when the ventricles are
contracting.

1. Bicuspid Valves – left AV valve; mitral valve

→ consists of two flaps/cusps of endocardium.

2. Tricuspid Valves – right AV valve

→ cusps are anchored to the walls of the ventricles by the chordae

tendineae.
 Semilunar Valves (SV) – guards the bases of the 2 large arteries leaving the
ventricular chambers.
→ prevents arterial blood from reentering the heart.

→ closed during heart relaxation and are forced open when the ventricles
contract.

1. Aortic semilunar valve

2. Pulmonary semilunar valve

 VALVULAR STENOSIS – the valve cusps become stiff due to endocarditis →

bacterial infection of the endocardium.
Cardiac Circulation

 Coronary Arteries – branches off from the base of the aorta and encircle the
heart in the coronary sulcus

 Coronary Sinus – enlarged vessel on the posterior of the heart that

empties blood into the right atrium.

 MYOCARDIAL INFARCTION (HEART ATTACK) – results when an angina

pectoris (crushing chest pain due to oxygen deprivation in the myocardium) is
prolonged that causes the oxygen-deprived heart cells to die.

PHYSIOLOGY OF THE HEART

 The heart supplies the body an approximate of 6 quarts (6 L) of blood through

the blood vessels over 1,000 times meaning, it actually pumps 6,000 quarts
(1500 gal) of blood per day.
Intrinsic Conduction System of the Heart

→ also called as nodal system

→ it is built into the heart tissue and sets its basic rhythm

→ it causes the heart muscle depolarization in only one direction – from the atria to
the ventricles.

 Sinoatrial (SA) node – generates impulses about 75 times per minute.

 → a crescent-shaped node of tissue located in the right atrium.

→ tiny cell mass with a mammoth job.

→ often called the pacemaker – starts each heartbeat and sets the pace for the
whole heart.

 Atrioventricular (AV) node – delays the impulse approximately 0.1 second.

→ located at the junction of the atria and ventricles.

 Atrioventricular bundle (bundle of His) – splits into two pathways in the

interventricular septum (bundle branches)

1. Bundle branches – (left and right) carry the impulse toward the apex
of the heart
2. Purkinje fibers – carry the impulse to the heart apex and ventricular
walls
Heart Excitation related to ECG (see next page for picture)

 HEART BLOCK – damage to the AV node that can partially or totally block the
ventricles from the control of the SA node.
 ISCHEMIA – lack of adequate blood supply to the heart.
 FIBRILLATION – a rapid, uncoordinated quivering of the ventricles. It makes the
heart unable to pump any blood that can cause death.
 TACHYCARDIA – rapid heart rate (over 100 beats/minute)
 BRADYCARDIA – heart rate is slower than normal (less than 60 beats/minute)

Cardiac Cycle and Heart Sounds

Cardiac cycle - refers to all events of one complete heartbeat. It consists of 5 periods.

 First sound occurs as AV valves close and signifies beginning of systole

(contraction)
 Second sound occurs when SL valves close at the beginning of ventricular
diastole (relaxation)
 1. Atrial diastole – ventricular filling; Heart blood pressure is low as blood enters
atria (passively) and flows into ventricles. AV valves are open, then atrial systole
occurs.

2. Atrial systole – Atria contracts – forcing blood into the ventricles to complete
ventricular filling.

3. Isovolumetric contraction - Atria relax;

Rising ventricular pressure results in closing of AV valves.

4. Ventricular systole - Ventricular ejection; the semilunar valves are open causing
blood to be ejected from the ventricles.

5. Isovolumetric relaxation – the ventricles relax; semilunar valves close to

prevent backflow into the ventricles. Atrial filling occurs then the cycle repeats.

 HEART MURMURS – abnormal or unusual heart sounds.

Cardiac Output

Cardiac Output – is the amount of blood pumped by each ventricle in one minute.

→ CO is the product of heart rate (HR) and stroke volume (SV)

 HR is the number of heart beats per minute. Normal resting heart rate = 75
beats/minute.

 SV is the volume of blood pumped out by a ventricle with each heartbeat. Normal
resting stroke volume = 75 mL/beat.

 Normal CO = 75 beats/min x 70 mL/beat = 5250 mL/min = 5.25 L/min

Regulation of Stroke Volume

 A normal heart pumps out about 60% of the blood present in its
ventricles.

Starling’s law of the heart

→ the critical factor controlling stroke volume is how much the cardiac muscle cells are
stretched by the filling of the chambers just before they contract.

 Venous return – important factor stretching the heart muscles; the amount of
blood entering the heart and distending its ventricles.
 Muscular pump – plays a major role in increasing the venous return.

 Slow heartbeat and exercise increase venous return to the heart,

increasing SV
  Blood loss and extremely rapid heartbeat decrease SV

Factors Modifying Basic Heart Rate

1. Neural (ANS) controls.

→ During stress, the sympathetic division of the ANS strongly stimulate the SA
and AV nodes and the cardiac muscle itself causing the heart to beat more
rapidly. The parasympathetic nerves slow and steady the heart giving it time to
rest.

2. Hormones and ions.

→ The hormones epinephrine and thyroxine increase heart rate. Electrolyte
imbalances poses a real threat to the heart. Intra- and extracellular ion
concentrations must be maintained for normal heart function.
3. Physical Factors.
→ includes age, gender, exercise and body temperature.

 CONGESTIVE HEART FAILURE – a progressive condition that reflects

weakening of the heart by coronary atherosclerosis (clogging of the coronary
vessels with fatty buildup), hypertensive heart disease or multiple myocardial
infarctions.

 Left side heart failure

 less effective pump so more blood remains in ventricle
 blood backs up into lungs causing pulmonary edema
 If untreated, the person drowns in these fluids.
 Right side failure
 Blood backs up in the systemic circulation causing peripheral
congestion/edema.

BLOOD VESSELS

 Vascular systems – a closed transport system that is formed by circulating

blood inside the blood vessels
 Arteries – carries blood away from the heart; RED in color.
 Arterioles – transport blood from the small arteries to the capillaries;
SMALLEST ARTERIES
 Venules – a little bit larger than the capillaries; transports blood from the
capillaries to the small veins; SMALLEST VEINS
 Veins – drains the tissues and returns blood to the heart; BLUE in color.
 Capillaries – branches to form networks and connect the smallest
arteries to the smallest veins.
→ ‘side streets/alleys’ of the body; exchange of blood and
tissue cells occur here.
Capillary beds consist of two types of vessels:

1. Vascular shunt – directly connects an arteriole to a venule at opposite

ends of the bed.
2. True capillaries – exchange vessels; 10-100 per capillary bed
MICROSCOPIC ANATOMY OF BLOOD VESSELS

 Tunics – layers of blood vessel walls

Three layers of tunics:

 Tunica intima: innermost layer; single thin layer of endothelium.

 Tunica media: middle layer; consists of smooth muscle cells
 Tunica externa: Is the outermost tunic and composed of fibrous
connective tissue; supports and protect the vessels
Microcirculation - the flow of blood from an anteriole to venule through a capillary bed.

Precapillary sphinter – a cuff of smooth muscle fibers; acts as a valve to regulate the
flow of blood into the capillary.

 THROMBOPHLEBITIS – Inflammation of vein that result when a clot forms in

vessels with poor circulation.
 PULMONARY EMBOLISM – a clot detachment from the vessels; life threatening
condition in which the embolism lodges in a vessels in the lungs.
 VARICOSE VEINS – pooling of the blood in the feet and legs and inefficient
venous return resulting from inactivity or pressure in the veins.

GROSS ANATOMY OF BLOOD VESSELS

MAJOR ARTERIES OF THE SYSTEMIC CICULATION

AORTA – largest artery of the body.

 ASCENDING AORTA – passes posteriorly from the left ventricle

 Arterial branches of the ascending aorta:
1. RIGHT CORONARY ARTERY
2. LEFT CORNARY ARTERY
AORTIC ARCH – the portion of the main artery that bends between the ascending
aortas.

ARTERIAL BRANCHES OF THE ASCENDING AORTA

 BRACHIOCEPHALIC TRUNK – the first branch off the aortic arch; vessel to the
arm and head
 RIGHT/LEFT COMMON CAROTID ARTERY – transports blood to the right/left
side of the head and neck.
 1. RIGHT/LEFT INTERNAL CAROTID serves the brain,
2. RIGHT/LEFT EXTERNAL CAROTID which serves the skin and muscles of
the head and neck
 RIGHT/LEFT SUBCLAVIAN ARTERY – transports blood to the right/left upper
limb
1. VERTEBRAL ARTERY – to the brain.
2. AXILLARY ARTERY – to the axilla/armpit
3. BRACHIAL ARTERY – to the arm.
4. ULNAR ARTERY – to the forearm.

ARTERIAL BRANCHES OF THORACIC AORTA

 INTERCOSTAL ARTERIES – 10 pairs; supplies muscle of the of the thorax wall

ARTERIAL BRANCHES OF THE THORACIC AORTA

 CELIAC TRUNK – branch of the abdominal aorta.

 SUPERIOR MESENTERIC ARTERY – supplies most of the small intestine and
first half of large intestine or colon.
 RENAL ARTERIES – serves the kidneys.
 GONADAL ARTERIES – Supply the gonads also called ovarian arteries.
 INFERIOR MESENTERIC ARTERY – small unpaired artery supplying the
second half of the large intestine.
 COMMAN ILIAC ARTERIES – final branches of the abdominal aorta.
MAJOR ARTERIES OF THE SYSTEMATIC CIRCULATION, ANTERIOR VIEW.
SUPERIOR VENA CAVA – veins draining the head and arms empty

INFERIOR VENA CAVA – veins draining the lower body empty

Veins Draining into the Superior Vena Cava (listed in a distal-to-proximal direction)

 Radial vein and Ulnar vein – deep veins draining the forearm
 Brachial vein – drains the arm
 Axillary vein – empties in the axillary region
 Cephalic vein – provides for the superficial drainage of the lateral aspect of the
arm and empties into the axillary vein
 Basilic vein – drains the medial aspect of the arm and empties into the brachial
vein
 Median cubital vein - site for withdrawing blood for the purpose of blood testing
 Subclavian vein – receives venous blood from the arm through the axillary vein
 Vertebral vein – drains the posterior part of the head
 Internal jugular vein – drains the dural sinuses of the brain
 Brachiocephalic (R. and L.) vein – large veins that receive venous drainage
from the subclavian, vertebral, and internal jugular veins on their respective sides
 Azygos vein – single vein that drains the thorax and enters the superior vena
cava just before it joins the heart
Veins Draining into the Inferior Vena Cava (listed in a distal-to-proximal direction)

 Anterior tibial vein, Posterior vein & Fibular vein – drain the leg
 Popliteal vein – posterior tibial vein at the knee
 Femoral vein – posterior tibial vein in the thigh
 External iliac vein – the femoral vein as it enters the pelvis
 Great saphenous vein – longest veins in the body
 Dorsal venous arch – where the superficial drainage of the leg begins
 Common iliac (R. and L.) vein – formed by the union of the external iliac vein
and internal iliac vein
 External and Internal iliac vein – drains the pelvis
 R. gonadal vein – drains the right ovary in females and the right testicle in males
 L. gonadal vein – empties into the left renal vein superiorly
 Renal (R. and L.) vein – drain the kidneys
 Hepatic portal vein – a single vein that drains the digestive tract organs
 Hepatic (R. and L.) vein – drain the liver

ARTERIAL SUPPLY OF THE BRAIN AND THE CIRCLE OF WILLIS

→ formed by branches of paired vertebral and internal carotid arteries

 Internal Carotid Arteries – supplies blood in the cerebrum and internal region of
the brain
Have 2 division which supply cerebrum:

a.) anterior cerebral artery

b.) middle cerebral artery

  Vertebral Arteries – a pair of arteries that pass upward from subclavian arteries
at the base of the neck
 Basilar Artery – serves the brain stem and cerebellum as it travels upward
Circle of Willis (Cerebra Arterial Circle) – a complete circle of connecting blood
vessels; surrounds the base of the brain

Hepatic Portal Circulation – formed by veins draining the digestive organs, which
empty into the hepatic portal vein.

 Hepatic Portal Vein – carries nutrient-rich blood to the liver, where it is

processed before blood is allowed to enter the systemic circulation.

Physiology of Circulation

 Vital Signs – the measurement of arterial pulse and blood pressure alongside
with respiratory rate and body temperature as indication of the efficiency of a
person's circulatory system.

1. Arterial Pulse – the alternating expansion and recoil of an artery that occurs
with each beat of the left ventricle
9 PULSE/PRESSURE POINTS OF THE BODY

1.) Superficial temporal artery

2.) Facial artery

3.) Common carotid artery

4.) Brachial artery

5.) Radial artery

6.) Femoral artery

7.) Popliteal artery

8.) Posterior tibia artery

9.) Dorsalis pedis artery

2. Blood pressure- is the pressure the blood exerts againts the inner walls of the
blood vessels

 Auscultatory method – procedure used to measure blood pressure in the

brachial artery of the arm.

Effects of various factors on blood pressure

Peripheral resistance – is the amount of friction the blood encounters as it flows

through the blood vessels.
  Neural factors
 Vasoconstriction- the major action of the sympathetic nerves on the
vascular system
→ narrowing of the blood vessels which increases the blood pressure

 Renal Factors:
 The kidneys – regulates arterial blood pressure by altering blood volume
 Temperature
 Chemical – epinephrine → increases both heart rate and blood pressure
 Diet

HYPOTENSION- low blood pressure

ORTHOSTATIC HYPOTENSION- temporary hypotension in elderly

CIRCULATORY SHOCK – inadequate blood flow throughout the body that causes
tissue damage due to lack of Oxygen.

HYPERTENSION- high blood pressure; mostly hereditary.

Capillary Exchange of Gases and Nutrients

1. Direct diffusion through membranes.

2. Diffusion through intercellular clefts → gaps between cells in the capillary
wall
3. Diffusion through pores.
 Fenestrated Capillaries→ found where absorption is a priority or where
filtration occurs.
4. Transport via vesicles → either by endocytosis or exocytosis.

Developmental Aspects of the Cardiovascular System

4th week of pregnancy – hearts begins to form as a simple tube and 1st organ to
function.

Umbilical artery (2) – carries CO 2 and waste products from the fetus to the placenta

Umbilical Vein – carries blood rich in oxygen and nutrients to the fetus

Ductus Venosus – immature liver of the fetus

Ductus Arteriosus – short vessel that connects the aorta and pulmonary trunk;
converted

to ligamentum arteriosum at birth.

References

Marieb, E. & Keller, S. Essentials of Human Anatomy and Physiology, 12th Edition

Vanputte et. Al Seeley’s Essentials of Human Anatomy & Physiology, 9th

Edition