Cardiovascular

System
Anatomy and
Physiology
Functions of the Heart
• The functions of the heart are as follows:

• Managing blood supply. Variations in the rate and force of heart

contraction match blood flow to the changing metabolic needs of the
tissues during rest, exercise, and changes in body position.
• Producing blood pressure. Contractions of the heart produce blood
pressure, which is needed for blood flow through the blood vessels.
• Securing one-way blood flow. The valves of the heart secure a one-way
blood flow through the heart and blood vessels.
• Transmitting blood. The heart separates the pulmonary and systemic
circulations, which ensures the flow of oxygenated blood to tissues.
Anatomy of the Heart
• The cardiovascular system can be compared to a muscular pump
equipped with one-way valves and a system of large and small
plumbing tubes within which the blood travels.
Heart Structure
and Functions
• The modest size and weight
of the heart give few hints of
its incredible strength.
Heart Structure and Functions
• Weight. Approximately the size of a person’s fist, the hollow, cone-shaped heart weighs less than
a pound.
• Mediastinum. Snugly enclosed within the inferior mediastinum, the medial cavity of the thorax,
the heart is flanked on each side by the lungs.
• Apex. It’s more pointed apex is directed toward the left hip and rests on the diaphragm,
approximately at the level of the fifth intercostal space.
• Base. Its broad posterosuperior aspect, or base, from which the great vessels of the body emerge,
points toward the right shoulder and lies beneath the second rib.
• Pericardium. The heart is enclosed in a double-walled sac called the pericardium and is the
outermost layer of the heart.
• Fibrous pericardium. The loosely fitting superficial part of this sac is referred to as the fibrous
pericardium, which helps protect the heart and anchors it to surrounding structures such as the
diaphragm and sternum.
• Serous pericardium. Deep to the fibrous pericardium is the slippery, two-layer serous
pericardium, where its parietal layer lines the interior of the fibrous pericardium.
Layers of the Heart
• The heart muscle has three layers and they are as follows:

• Epicardium. The epicardium or the visceral and outermost layer is

actually a part of the heart wall.
• Myocardium. The myocardium consists of thick bundles of cardiac
muscle twisted and whirled into ringlike arrangements and it is the
layer that actually contracts.
• Endocardium. The endocardium is the innermost layer of the heart
and is a thin, glistening sheet of endothelium hat lines the heart
chambers.
Chambers of the Heart
• The heart has four hollow chambers, or cavities: two atria and two
ventricles.

• Receiving chambers. The two superior atria are primarily the receiving
chambers, they play a lighter role in the pumping activity of the heart.
• Discharging chambers. The two inferior, thick-walled ventricles are the
discharging chambers, or actual pumps of the heart wherein when they
contract, blood is propelled out of the heart and into the circulation.
• Septum. The septum that divides the heart longitudinally is referred to as
either the interventricular septum or the interatrial septum, depending on
which chamber it separates.
Associated Great Vessels
• The great blood vessels provide a pathway for the entire cardiac circulation to
proceed.

• Superior and inferior vena cava. The heart receives relatively oxygen-poor blood
from the veins of the body through the large superior and inferior vena cava and
pumps it through the pulmonary trunk.
• Pulmonary arteries. The pulmonary trunk splits into the right and left pulmonary
arteries, which carry blood to the lungs, where oxygen is picked up and carbon
dioxide is unloaded.
• Pulmonary veins. Oxygen-rich blood drains from the lungs and is returned to the
left side of the heart through the four pulmonary veins.
• Aorta. Blood returned to the left side of the heart is pumped out of the heart into
the aorta from which the systemic arteries branch to supply essentially all body
tissues.
Heart Valves
• The heart is equipped with
four valves, which allow
blood to flow in only one
direction through the heart
chambers.
Heart Valves
• Atrioventricular valves. Atrioventricular or AV valves are located
between the atrial and ventricular chambers on each side, and they
prevent backflow into the atria when the ventricles contract.
• Bicuspid valves. The left AV valve- the bicuspid or mitral valve,
consists of two flaps, or cusps, of endocardium.
• Tricuspid valve. The right AV valve, the tricuspid valve, has three flaps.
• Semilunar valve. The second set of valves, the semilunar valves,
guards the bases of the two large arteries leaving the ventricular
chambers, thus they are known as the pulmonary and aortic
semilunar valves.
Cardiac Circulation Vessels

• Although the heart chambers are bathed with blood almost continuously,
the blood contained in the heart does not nourish the myocardium.

• Coronary arteries. The coronary arteries branch from the base of the aorta
and encircle the heart in the coronary sulcus (atrioventricular groove) at
the junction of the atria and ventricles, and these arteries are compressed
when the ventricles are contracting and fill when the heart is relaxed.
• Cardiac veins. The myocardium is drained by several cardiac veins, which
empty into an enlarged vessel on the posterior of the heart called the
coronary sinus.
Blood Vessels
• Blood circulates inside the blood vessels, which form a closed
transport system, the so-called vascular system.

• Arteries. As the heart beats, blood is propelled into large arteries

leaving the heart.
• Arterioles. It then moves into successively smaller and smaller
arteries and then into arterioles, which feed the capillary beds in the
tissues.
• Veins. Capillary beds are drained by venules, which in turn empty into
veins that finally empty into the great veins entering the heart.
Tunics
• Except for the microscopic
capillaries, the walls of the
blood vessels have three
coats or tunics.
Tunics
• Tunica intima. The tunica intima, which lines the lumen, or interior, of
the vessels, is a thin layer of endothelium resting on a basement
membrane and decreases friction as blood flows through the vessel
lumen.
• Tunica media. The tunica media is the bulky middle coat which mostly
consists of smooth muscle and elastic fibers that constrict or dilate,
making the blood pressure increase or decrease.
• Tunica externa. The tunica externa is the outermost tunic composed
largely of fibrous connective tissue, and its function is basically to
support and protect the vessels.
Major Arteries of
the Systemic
Circulation
• The major branches of the
aorta and the organs they
serve are listed next in
sequence from the heart.
Major Arteries of the Systemic Circulation
• Arterial Branches of the Ascending Aorta

• The aorta springs upward from the left ventricle of heart as the
ascending aorta.

• Coronary arteries. The only branches of the ascending aorta are the
right and left coronary arteries, which serve the heart.
Major Arteries of the Systemic Circulation
• Arterial Branches of the Aortic Arch

• The aorta arches to the left as the aortic arch.

• Brachiocephalic trunk. The brachiocephalic trunk, the first branch off the aortic arch, splits into the right
common carotid artery and right subclavian artery.
• Left common carotid artery. The left common carotid artery is the second branch off the aortic arch and it
divides, forming the left internal carotid, which serves the brain, and the left external carotid, which serves
the skin and muscles of the head and neck.
• Left subclavian artery. The third branch of the aortic arch, the left subclavian artery, gives off an important
branch- the vertebral artery, which serves part of the brain.
• Axillary artery. In the axilla, the subclavian artery becomes the axillary artery.
• Brachial artery. the subclavian artery continues into the arm as the brachial artery, which supplies the arm.
• Radial and ulnar arteries. At the elbow, the brachial artery splits to form the radial and ulnar arteries, which
serve the forearm.
• Arterial Branches of the Thoracic Aorta

• The aorta plunges downward through the thorax, following the spine
as the thoracic aorta.
• Intercostal arteries. Ten pairs of intercostal arteries supply the
muscles of the thorax wall.
• Arterial Branches of the Abdominal Aorta

• Finally, the aorta passes through the diaphragm into the abdominopelvic
cavity, where it becomes the abdominal aorta.

• Celiac trunk. The celiac trunk is the first branch of the abdominal aorta and
has three branches: the left gastric artery supplies the stomach; the splenic
artery supplies the spleen, and the common hepatic artery supplies the
liver.
• Superior mesenteric artery. The unpaired superior mesenteric artery
supplies most of the small intestine and the first half of the large intestine
or colon.
• Renal arteries. The renal arteries serve the kidneys.
• Gonadal arteries. The gonadal arteries supply the gonads, and they
are called ovarian arteries in females while in males they are
testicular arteries.
• Lumbar arteries. The lumbar arteries are several pairs of arteries
serving the heavy muscles of the abdomen and trunk walls.
• Inferior mesenteric artery. The inferior mesenteric artery is a small,
unpaired artery supplying the second half of the large intestine.
• Common iliac arteries. The common iliac arteries are the final
branches of the abdominal aorta.
Major Veins of
the Systemic
Circulation
• Major veins converge on the
venae cavae, which enter the
right atrium of the heart.
Major Veins of the Systemic Circulation
• VEINS DRAINING INTO THE SUPERIOR VENA CAVA

• Veins draining into the superior vena cava are named in a distal-to-
proximal direction; that is, in the same direction the blood flows into the
superior vena cava.

• Radial and ulnar veins. The radial and ulnar veins are deep veins draining
the forearm; they unite to form the deep brachial vein, which drains the
arm and empties into the axillary vein in the axillary region.
• Cephalic vein. The cephalic vein provides for the superficial drainage of the
lateral aspect of the arm and empties into the axillary vein.
Major Veins of the Systemic Circulation
• Basilic vein. The basilic vein is a superficial vein that drains the medial aspect of the arm
and empties into the brachial vein proximally.
• Median cubital vein. The basilic and cephalic veins are joined at the anterior aspect of
the elbow by the median cubital vein, often chosen as the site for blood removal for the
purpose of blood testing.
• Subclavian vein. The subclavian vein receives venous blood from the arm through the
axillary vein and from the skin and muscles of the head through the external jugular vein.
• Vertebral vein. The vertebral vein drains the posterior part of the head.
• Internal jugular vein. The internal jugular vein drains the dural sinuses of the brain.
• Brachiocephalic veins. The right and left brachiocephalic veins are large veins that receive
venous drainage from the subclavian, vertebral, and internal jugular veins on their
respective sides.
• Azygos vein. The azygos vein is a 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

• The inferior vena cava, which is much longer than the superior vena cava,
returns blood to the heart from all body regions below the diaphragm.

• Tibial veins. The anterior and posterior tibial veins and the fibular vein
drain the leg; the posterior tibial veins becomes the popliteal vein at the
knee and then the femoral vein in the thigh; the femoral vein becomes the
external iliac vein as it enters the pelvis.
• Great saphenous veins. The great saphenous veins are the longest veins in
the body; they begin at the dorsal venous arch in the foot and travel up the
medial aspect of the leg to empty into the femoral vein in the thigh.
• Common iliac vein. Each common iliac vein is formed by the union of the
external iliac vein and the internal iliac vein which drains the pelvis.
• Gonadal vein. The right gonadal vein drains the right ovary in females and
the right testicles in males; the left gonadal veins empties into the left renal
veins superiorly.
• Renal veins. The right and left renal veins drain the kidneys.
• Hepatic portal vein. The hepatic portal vein is a single vein that drains the
digestive tract organs and carries this blood through the liver before it
enters the systemic circulation.
• Hepatic veins. The hepatic veins drain the liver.
Physiology of the Heart
• As the heart beats or contracts, the blood makes continuous round
trips- into and out of the heart, through the rest of the body, and
then back to the heart- only to be sent out again.
Physiology of
the Heart
• Intrinsic Conduction System
of the Heart
• The spontaneous
contractions of the cardiac
muscle cells occurs in a
regular and continuous way,
giving rhythm to the heart.
Physiology of the Heart
• Cardiac muscle cells. Cardiac muscle cells can and do contract
spontaneously and independently, even if all nervous connections are
severed.
• Rhythms. Although cardiac muscles can beat independently, the
muscle cells in the different areas of the heart have different rhythms.
• Intrinsic conduction system. The intrinsic conduction system, or the
nodal system, that is built into the heart tissue sets the basic rhythm.
• Composition. The intrinsic conduction system is composed of a
special tissue found nowhere else in the body; it is much like a cross
between a muscle and nervous tissue.
Physiology of the Heart
• Function. This system causes heart muscle depolarization in only one direction-
from the atria to the ventricles; it enforces a contraction rate of approximately 75
beats per minute on the heart, thus the heart beats as a coordinated unit.
• Sinoatrial (SA) node. The SA node has the highest rate of depolarization in the
whole system, so it can start the beat and set the pace for the whole heart; thus
the term “pacemaker“.
• Atrial contraction. From the SA node, the impulse spread through the atria to the
AV node, and then the atria contract.
• Ventricular contraction. It then passes through the AV bundle, the bundle
branches, and the Purkinje fibers, resulting in a “wringing” contraction of the
ventricles that begins at the heart apex and moves toward the atria.
• Ejection. This contraction effectively ejects blood superiorly into the large arteries
leaving the heart.
The Pathway of the Conduction System
• The conduction system occurs systematically through:

• SA node. The depolarization wave is initiated by the sinoatrial node.

• Atrial myocardium. The wave then successively passes through the atrial
myocardium.
• Atrioventricular node. The depolarization wave then spreads to the AV
node, and then the atria contract.
• AV bundle. It then passes rapidly through the AV bundle.
• Bundle branches and Purkinje fibers. The wave then continues on through
the right and left bundle branches, and then to the Purkinje fibers in the
ventricular walls, resulting in a contraction that ejects blood, leaving the
heart.
Cardiac Cycle and Heart Sounds
• In a healthy heart, the atria contract simultaneously, then, as they
start to relax, contraction of the ventricles begin.

• Systole. Systole means heart contraction.

• Diastole. Diastole means heart relaxation.
• Cardiac cycle. The term cardiac cycle refers to the events of one
complete heart beat, during which both atria and ventricles contract
and then relax.
• Length. The average heart beats approximately 75 times per minute,
so the length of the cardiac cycle is normally about 0.8 second.
Cardiac Cycle and Heart Sounds
• Mid-to-late diastole. The cycle starts with the heart in complete relaxation;
the pressure in the heart is low, and blood is flowing passively into and
through the atria into the ventricles from the pulmonary and systemic
circulations; the semilunar valves are closed, and the AV valves are open;
then the atria contract and force the blood remaining in their chambers
into the ventricles.
• Ventricular systole. Shortly after, the ventricular contraction begins, and
the pressure within the ventricles increases rapidly, closing the AV valves;
when the intraventricular pressure is higher than the pressure in the large
arteries leaving the heart, the semilunar valves are forced open, and blood
rushes through them out of the ventricles; the atria are relaxed, and their
chambers are again filling with blood.
Cardiac Cycle and Heart Sounds
• Early diastole. At the end of systole, the ventricles relax, the
semilunar valves snap shut, and for a moment the ventricles are
completely closed chambers; the intraventricular pressure drops and
the AV valves are forced open; the ventricles again begin refilling
rapidly with blood, completing the cycle.
• First heart sound. The first heart sound, “lub”, is caused by the closing
of the AV valves.
• Second heart sound. The second heart sound, “dub”, occurs when
the semilunar valves close at the end of systole.
Cardiac Output
• Cardiac output is the amount of blood pumped out by each side of the heart in
one minute. It is the product of the heart rate and the stroke volume.

• Stroke volume. Stroke volume is the volume of blood pumped out by a ventricle
with each heartbeat.
• Regulation of stroke volume. According to Starling’s law of the heart, the critical
factor controlling stroke volume is how much the cardiac muscle cells are
stretched just before they contract; the more they are stretched, the stronger the
contraction will be; and anything that increases the volume or speed of venous
return also increases stroke volume and force of contraction.
• Factors modifying basic heart rate.The most important external influence on
heart rate is the activity of the autonomic nervous system, as well as physical
factors (age, gender, exercise, and body temperature).
Physiology of Circulation
• A fairly good indication of the efficiency of a person’s circulatory
system can be obtained by taking arterial blood and blood pressure
measurements.
Cardiovascular Vital Signs
• Arterial pulse pressure and blood pressure measurements, along with
those of respiratory rate and body temperature, are referred to collectively
as vital signs in clinical settings.

• Arterial pulse. The alternating expansion and recoil of an artery that occurs
with each beat of the left ventricle creates a pressure wave-a pulse- that
travels through the entire arterial system.
• Normal pulse rate. Normally, the pulse rate (pressure surges per minute)
equals the heart rate, so the pulse averages 70 to 76 beats per minute in a
normal resting person.
• Pressure points. There are several clinically important arterial pulse points,
and these are the same points that are compressed to stop blood flow into
distal tissues during hemorrhage, referred to as pressure points.
Cardiovascular Vital Signs
• Blood pressure. Blood pressure is the pressure the blood exerts against the
inner walls of the blood vessels, and it is the force that keeps blood
circulating continuously even between heartbeats.
• Blood pressure gradient. The pressure is highest in the large arteries and
continues to drop throughout the systemic and pulmonary pathways,
reaching either zero or negative pressure at the venae cavae.
• Measuring blood pressure. Because the heart alternately contracts and
relaxes, the off-and-on flow of the blood into the arteries causes the blood
pressure to rise and fall during each beat, thus, two arterial blood pressure
measurements are usually made: systolic pressure (the pressure in the
arteries at the peak of ventricular contraction) and diastolic pressure (the
pressure when the ventricles are relaxing).
Cardiovascular Vital Signs
• Peripheral resistance. Peripheral resistance is the amount of friction the blood encounters as it
flows through the blood vessels.
• Neural factors. The parasympathetic division of the autonomic nervous system has little or no
effect on blood pressure, but the sympathetic division has the major action of causing
vasoconstriction or narrowing of the blood vessels, which increases blood pressure.
• Renal factors. The kidneys play a major role in regulating arterial blood pressure by altering blood
volume, so when blood pressure increases beyond normal, the kidneys allow more water to leave
the body in the urine, then blood volume decreases which in turn decreases blood pressure.
• Temperature. In general, cold has a vasoconstricting effect, while heat has a vasodilating effect.
• Chemicals. Epinephrine increases both heart rate and blood pressure; nicotine increases blood
pressure by causing vasoconstriction; alcohol and histamine cause vasodilation and decreased
blood pressure.
• Diet. Although medical opinions tend to change and are at odds from time to time, it is generally
believed that a diet low in salt, saturated fats, and cholesterol help to prevent hypertension, or
high blood pressure.
Blood Circulation
Through the
Heart
• The right and left sides of the
heart work together in
achieving a smooth flowing
blood circulation.
Blood Circulation Through the Heart
• Entrance to the heart. Blood enters the heart through two large veins,
the inferior and superior vena cava, emptying oxygen-poor blood
from the body into the right atrium of the heart.
• Atrial contraction. As the atrium contracts, blood flows from the right
atrium to the right ventricle through the open tricuspid valve.
• Closure of the tricuspid valve. When the ventricle is full, the tricuspid
valve shuts to prevent blood from flowing backward into the atria
while the ventricle contracts.
• Ventricle contraction. As the ventricle contracts, blood leaves the
heart through the pulmonic valve, into the pulmonary artery and to
the lungs where it is oxygenated.
Blood Circulation Through the Heart
• Oxygen-rich blood circulates. The pulmonary vein empties oxygen-
rich blood from the lungs into the left atrium of the heart.
• Opening of the mitral valve. As the atrium contracts, blood flows from
your left atrium into your left ventricle through the open mitral valve.
• Prevention of backflow. When the ventricle is full, the mitral valve
shuts. This prevents blood from flowing backward into the atrium
while the ventricle contracts.
• Blood flow to systemic circulation. As the ventricle contracts, blood
leaves the heart through the aortic valve, into the aorta and to the
body.
Capillary Exchange of Gases and Nutrients
• Substances tend to move to and from the body cells according to their
concentration gradients.

• Capillary network. Capillaries form an intricate network among the body’s

cells such that no substance has to diffuse very far to enter or leave a cell.
• Routes. Basically, substances leaving or entering the blood may take one of
four routes across the plasma membranes of the single layer of endothelial
cells forming the capillary wall.
• Lipid-soluble substances. As with all cells, substances can diffuse directly
through their plasma membranes if the substances are lipid-soluble.
Capillary Exchange of Gases and Nutrients
• Lipid-insoluble substances. Certain lipid-insoluble substances may
enter or leave the blood and/or pass through the plasma membranes
within vesicles, that is, by endocytosis or exocytosis.
• Intercellular clefts. Limited passage of fluid and small solutes is
allowed by intercellular clefts (gaps or areas of plasma membrane not
joined by tight junctions), so most of our capillaries have intercellular
clefts.
• Fenestrated capillaries. Very free passage of small solutes and fluid is
allowed by fenestrated capillaries, and these unique capillaries are
found where absorption is a priority or where filtration occurs.
"Success seems to
be connected with
action. Successful
people keep
moving. They make
mistakes, but they
don't quit."