CARDIOVASCULAR

SYSTEM
BY: CYBILL D. DIAZ, RN, MAN
 Hollow muscular organ providing the force for flow of blood
Heart
thoroughout human body
Pathways of blood flow in human body, hollow tubes, of 3 types
Carry blood away from heart to other body parts, very
Arteries
muscular and elastic
Blood Microscopic blood vessels where exchange of
Capillaries
Vessels nutrients with tissues take place
Components Carry blood towards the heart from other body parts,
Veins their walls are thinner as compared to corresponding
arteries.
Special type of body tissue that is in fluid form, consists of the
following components;
Blood Blood cells
Plasma
White Blood Cells Red Blood Cells Platelets

Provide nutrients to body parts, Remove excretory Products from body parts,
Functions
Protects body against infection, Distribution of heat.
Cardiovascular System
• Cardiovascular system means the system of heart
and blood vessels of human body.
• The term “cardiovascular” is a combination of two
word; “Cardio” and “vascular”.
• The term “cardio” is derived from “cardiac”
meaning Heart and the term “vascular” means
blood vessels.
• Cardiovascular system is also known as “Circulatory
System”.
Components Of Cardiovascular
System:
•Cardiovascular system is made
up of three major components:
• Heart
• Blood vessels
• Blood
Components Of Cardiovascular
System:
• HEART:
• a hollow muscular organ made of
strong cardiac muscles. Heart can push
the blood through the circulatory
system with great force. In fact push of
the heart is the major force that
causes circulation of blood throughout
human body. Heart is made up of
three layers; Pericardium, Myocardium
and Endocardium.
Components Of Cardiovascular
System:
• BLOOD VESSELS:
• are pathways of blood flow in
human body.
• There are three main types of blood
vessels: Arteries, Capillaries and
Veins.
Components Of Cardiovascular
System:
• BLOOD:
• a specialized tissue of body that exists in
fluid form. Blood consists of two major
portions: Blood cells and Plasma.
• Plasma is the watery portion of blood that
makes it a fluid. 90% of blood plasma is
water and remaining 10% are proteins,
inclusions and waste products etc.
• Blood cells are of three main types: Red
Blood Cells (RBCs), White Blood Cells
(WBCs) and Platelets.
Importance of Cardiovascular
System:
• The flow of blood is necessary for existence
of life. If the flow of blood is stopped, life will
stop.
• Heart is the main organ of cardiovascular
system and it is responsible for distributing
blood all over human body.
Anatomy of Heart
Heart is a hollow muscular organ, which is
somewhat pyramidal in shape. It lies within
the pericardium in the mediastinum. It lies
free within the pericardium except at its base
where it is connected to great blood vessels.
Surfaces of heart:
• Because of its shape, the heart has
three surfaces: anterior, inferior and
posterior.
• The apex of the heart is directed
downward, forward and to the left.
• Often the surfaces are referred to as:
• sternocostal (anterior)
• diaphragmatic (inferior)
• base (posterior).
 Anterior Inferior
The base of the heart
(Sternocostal) (Diaphragmatic)
(posterior surface):
surface: surface:
• Formed mainly by • Formed mainly by • Formed mainly by
the right atrium and the right and left the left atrium, into
right ventricle. They ventricles separated which the four
are separated from by the posterior pulmonary veins
each other by the interventricular drain. It lies
vertical groove. The inferior opposite to the
atrioventricular surface of the right apex. The posterior
groove. The right atrium into which surface is called the
border of the the inferior vena base because it lies
anterior surface is cava opens, also opposite to the
formed by the right forms part of this apex of the
atrium while the left surface. pyramidal shaped
border is formed by heart.
left atrium and part
of left auricle.
Apex of the heart:
• It is formed by the left
ventricle and is
directed downward,
forward and the left. It
lies at the level of the
fifth intercostals space,
about 3.5 inches from
the midline. The apex
beat can be palpated in
the region of apex of
the heart.
Borders of the heart:
Because of pyramidal nature of its shape, the
heart has three borders: right, left and lower.
• Right border is formed by the right atrium.
• The left border is formed by the left auricle
and left ventricle.
• The lower border is formed by right
ventricle, however, some part of it is also
formed by the right atrium.
 Wall of the heart:
• It has strong wall that are composed of three
main layers.
• The bulk of the wall of the heart is formed by
cardiac muscles called the myocardium.
• On the outer side, the endocardium is covered
with visceral layer of serous pericardium,
known as epicardium.
• On the inner side, the myocardium is lined with
a layer of endothelium known as epicardium.
Chambers of the heart:
• It has been divided by vertical septa into
four chambers:
• two atria (right and left)
• two ventricles (right and left)
• The atria lie superior to the ventricles
Right atrium:
• It consists of two regions: the main concavity
and a small outpouching called auricle.
• At the region of junction between these two
parts, on the outer side, there is a vertical
groove called sulcus terminalis, which on the
inner side forms a ridge known as crista
terminalis.
Right atrium:
• The main part of the atrium lies
posterior to crista terminalis and is
derived embryologically from sinus
venosus.
• The part of the atrium, which lies in
front of crista terminalis, is roughened
by bundles of muscle fibers, the musculi
pectinati. This anterior part is derived
embryologically from primitive atrium.
Openings in the right atrium:
• Opening for superior vena cava: It lies in the upper
part and has no valves
• Opening for inferior vena cave: It lies in the lower
part and is guarder by a rudimentary, and
nonfunctioning valve.
• Opening for the coronary sinus: It lies between the
opening for inferior vena cave and the
atrioventricular orifice. It is also guarded by a
rudimentary, nonfunctioning valve.
• Right atrioventricular orifice: It lies anterior to the
opening for inferior vena cava and is guarded by
the tricuspid valve.
Right ventricle:
• The walls of right ventricle are much
thicker as compared to those of right
atrium.
• They show several internal projecting
ridges, which are formed of muscle
bundles.
• These ridges are known as trabeculae
carneae and they give the walls a
spongy appearance
TRABECULAE CARNEAE
• They are of three types:
• Type 1: First type of trabeculae consists of papillary
muscles, which project inward. They are attached by
their bases to the ventricular wall and their apices are
attached by fibrous chords, known as chordae
tendinae, to the cusps of the tricuspid valve.
• Type 2: Second type consists of muscle fibers attached
to the ventricular walls in the same way as the first type
but they are free in the middle. One of them, known as
the moderator band, crosses the entire ventricular
cavity from septal to anterior wall.
• Type 3: It is simply composed of prominent ridges.
Openings in the right ventricle:
There are two openings in the right
ventricle:
• the right atrioventricular orifice
(guarded by tricuspid valve)
• the opening for the pulmonary trunk
(guarded by the pulmonary valve)
Left atrium:
• Similar to right atrium, it consists of a
main cavity and the left auricle.
• In anatomic position of the heart, it is
situated behind the right atrium and
forms greater part of the base of heart.
• The interior of the left atrium is smooth
but the auricle possesses muscular
ridges as was the case with right atrium.
Openings in the left atrium:
• There are a total of five openings in the
left atrium, four of which are for the
pulmonary veins and one is the left
atrioventricular orifice.
• The openings of the pulmonary veins
are not guarded by any valve, however,
the left atrioventricular orifice is
guarded by bicuspid valve.
Left ventricle:
• It is the strongest chamber of the heart.
• Its walls are three times thicker than
those of the right ventricle. The reason
for extra thick walls is that the left
ventricle has to deal with high
pressures.
• The pressure inside the left ventricle is
about six times higher than that inside
the right ventricle.
Left ventricle:
• In cross section, the right ventricle is
circular and consequently the right
ventricle is crescentic.
• It is because of the bulging of the
interventricular septum into the right
ventricle.
Openings in the left ventricle:
There are two openings in the left
ventricle:
• the left atrioventricular orifice (guarded
by mitral valve, also known as bicuspid
valve)
• the aortic opening (guarded by aortic
valve).
Valves of the Heart
• Tricuspid Valve
• Pulmonary Valve
• Bicuspid/Mitral Valve
• Aortic Valve

Essentials for properly working valves

• The valve is properly formed and flexible.
• The valve should open all the way so that the right
amount of blood can pass through
• The valve closes tightly so that no blood leaks back
into the chamber.
TRICUSPID VALVE
• Closes off the upper right chamber (or
atrium) that holds blood coming in from the
body.
• Opens to allow blood to flow from the top
right chamber to the lower right chamber (or
from right atrium to right ventricle).
• Prevents the back flow of blood from the
ventricle to the atrium when blood is
pumped out of the ventricle.
Tricuspid valve:
• It consists of three cusps each of which is
formed by a fold of endocardium with a little
amount of connective tissue enclosed.
• The bases of all three cusps are attached to
the fibrous ring of the skeleton of heart and
their free edges are attached to chordae
tendinae.
• Chordae tendinae connect them to the
papillary muscles, which prevent the cusps
from being forced into the atrium of turning
inside out during ventricular contraction.
PULMONARY VALVE
• Closes off the lower right chamber (or right
ventricle).
• Opens to allow blood to be pumped from
the heart to the lungs (through the
pulmonary artery) where it will receive
oxygen.
Pulmonary valve:
• It also consists of three cusps with similar
formation, however, in this case the cusps
are semilunar in shape.
• The curved lower margins and sides of each
cusp are attached to the arterial wall and
their open mouths are directed into the
pulmonary trunk. No chordae tendinae or
papillary muscles are associated with this
valve.
• External to each cusp, the wall of pulmonary
trunk bulges out to form a sinus.
MITRAL VALVE
• Closes off the upper left chamber (or
left atrium) collecting the oxygen-rich
blood coming in from the lungs.
• Opens to allow blood to pass from the
upper left side to the lower left side (or
from the left atrium to the left
ventricle).
Mitral valve:
• It consists of two cusps, which have the
structure similar to the cusps of
tricuspid valve.
• The anterior of the two cusps is larger
and intervenes between atrioventricular
and aortic orifices.
• The attachment of chordae tendinae
and papillary muscles is also similar to
that of tricuspid valve.
AORTIC VALVE
• Closes off the lower left chamber that
holds the oxygen-rich blood before it is
pumped out to the body.
• Opens to allow blood to leave the heart
(from the left ventricle to the aorta and
on to the body).
• It is precisely similar to the pulmonary
valve. Behind each cusp the aortic wall
bulges to form an aortic sinus.
Relative structure of chambers of
the heart:
• The atrial portion of heart is
relatively thin walled and is divided
into right and left atria by the
interatrial septum.
• This septum runs from the anterior
wall of heart backward and to the
right.
Relative structure of chambers of
the heart:
• . The ventricular portion of the heart has
thick wall. It is divided into right and left
ventricles by the interventricular spetum.
• This septum is placed obliquely and its
position is indicated by anterior and
posterior interventricular grooves. The lower
part of the septum is thick and formed of
muscular tissue while the upper part is thin
and membranous.
Skeleton of heart:
• The skeleton of the heart is not an actual bony
skeleton.
• It just consists of fibrous rings that surround right
and left atrioventricular, aortic and pulmonary
orifices.
• It is continuous with the membranous part of the
interventricular septum. It separates the muscular
wall of the atria from that of the ventricles and
forms the basis of electrical discontinuity between
them.
• The skeleton also supports the bases of the valve
cusps and prevents them from stretching and
becoming incompetent.
Conducting system of the heart:
• It consists of specialized cardiac muscle
present in the sinuatrial node,
atrioventricular node and
atrioventricular bundle along with its
right and left terminal branches and
Purkinje fibers (specialized cardiac
muscle fibers that form the conducting
system of the heart).
Sinuatrial node:
• It is located in the wall of the right atrium in
the upper part of the sulcus terminalis just to
the right of the opening of superior vena
cava.
• The sinuatrial node gives origin
spontaneously to rhythmical impulses that
spread in all direction through the cardiac
muscle of the atria.
• As a result, the atrial muscle contracts.
Atrioventricular node:
• It is strategically placed in the lower part of
the right atrium just above the attachment
of the septal cusp of the tricuspid valve.
• Through this node, the cardiac impulse is
conducted from atria to the ventricles.
• The speed of conduction of impulse through
the atrioventricular node is very slow, which
allows sufficient time for the atria to empty
their blood into the ventricles completely.
Atrioventricular bundle:
• It is also known as “the bundle of His”.
• It is the only pathway that connects the
myocardium of the atria to the
myocardium of the ventricles
electrically.
• Thus it is the only route for transmission
of impulse from atria into the ventricles.
Atrioventricular bundle:
• The bundle descends through the fibrous
skeleton of the heart to reach the inferior
border of the membranous part of the
ventricular septum.
• When it reaches the muscular part of the
septum, it divides into two branches, one for
each ventricle. The right bundle branch
passes to the right ventricle and the left
bundle branch passes to the left.
• After this point, they become continuous
with the fibers of Purkinje plexus.
Function of conducting system of
heart:
• The conducting system of heart is responsible not only
for generating rhythmical cardiac impulses but also for
conducting these impulses rapidly throughout the
myocardium of the heart. Thus it aids in coordinated
and efficient contraction of different chambers of the
heart.
• The activities of the conducting system of heart can be
influenced by the autonomic nerve supply of heart.
The parasympathetic nerves slow the rhythm and
diminish the speed of conduction, while the
sympathetic nerves have the opposite effect.
Coronary Circulation
• The heart has its own set of blood vessels
that provide the myocardium with the
oxygen and nutrients necessary to pump
blood throughout the body.
• The left and right coronary arteries branch
off from the aorta and provide blood to the
left and right sides of the heart.
• The coronary sinus is a vein on the posterior
side of the heart that returns deoxygenated
blood from the myocardium to the vena
cava.
Arterial supply of the heart:
• Arterial supply of the heart consists of
right and left coronary arteries.
• These arteries arise from the ascending
aorta immediately above the aortic
valve. The coronary arteries along with
their major branches are distributed
over the surface of the heart.
Right coronary artery:
• It arises from the anterior aortic sinus of the
ascending aorta and runs forward between
the pulmonary trunk and right auricle.
• After reaching the surface of the heart, it
descends almost vertically into the right
atrioventricular groove.
• After reaching the inferior border, it
continues posteriorly and anastomose with
the left coronary artery.
Branches of right coronary artery:
• Right conus artery: It supplies the anterior
surface of pulmonary conus and upper part
of the right ventricle on anterior side.
• Anterior ventricular branches: They are two
or three in number and all of them supply
the anterior surface of the right ventricle.
• Posterior ventricular branches: They are
usually two in number and both of them
supply the diaphragmatic surface of the right
ventricle.
Branches of right coronary artery:
• Posterior interventricular artery:It is also known as
posterior descending artery. It runs towards the
apex of the heart in the posterior interventricular
groove and gives of branches to the right and left
ventricles.It also supplies the posterior part of the
ventricular septum (not the apical part, which
receives blood from the anterior interventricular
branch of left coronary artery) and the
atrioventricular node.
• The atrial branches: They supply the anterior and
lateral surfaces of the right atrium. They also supply
the sinuatrial node. In 35% individuals, the atrial
branches arise from the left coronary artery.
Left coronary artery:

• It is usually larger than the right coronary

artery and supplies the major part of heart.
• It arises from the left posterior aortic sinus of
the ascending aorta and passes forward
between pulmonary trunk and left auricle.
• Then it enters the atrioventricular groove
and divides into anterior interventricular
branch and circumflex branch.
Branches of left coronary artery:
• Anterior interventricular branch:
It is also known as the anterior descending branch. It
runs downward in the anterior interventricular
groove to the apex of the heart.
After reaching the apex, it passes around to enter the
posterior interventricular groove and anastomoses
with the terminal branches of the right coronary
artery. In 33% individuals, it ends in the apex of the
heart.
Anterior interventricular branch supplies the right
and left ventricles along with the anterior part of the
ventricular septum.
Branches of left coronary artery:
• Circumflex artery:
It is the same size as the anterior
interventricular artery. It winds around the left
margin of the heart in the atrioventricular
groove. It is further divided into a number of
branches that supply various parts of heart as
described below.
• Left marginal artery: It supplies the left margin
of the left ventricle till the apex.
• Anterior ventricular and posterior ventricular
branches: They supply the left ventricle
• Atrial branches: They supply the left atrium.
 Right coronary artery: It
Left coronary artery: It supplies
supplies
• The entire right ventricle • Most of the left ventricle
except for the small to the • Small area of the right
right ventricle that is not supplied
• Variable part of the by right coronary artery
diaphragmatic surface of right • Anterior two thirds of the
ventricle ventricular septum
• Posteroinferior third of the • Most of the left atrium
ventricular septum • Right bundle branch
• Right atrium • Left bundle branch
• Part of the left atrium
• Sinuatrial node
• Atrioventricular node
• Atrioventricular bundle
• A part of the Left bundle
branch of atrioventricular
bundle
Venous drainage of the heart:
• Most blood from the heart wall drains into the right
atrium through the coronary sinus.
• This sinus lies in the posterior part of the anterior
interventricular groove and is a continuation of the
great cardiac vein.
• It opens into the right atrium to the left of the inferior
vena cava. The small and middle cardiac veins are
tributaries of the coronary sinus.
• The remainder of the blood is returned to right atrium
through anterior cardiac vein and by other small veins
that open directly into the heart chambers.
PERICARDIUM
Pericardium
• Pericardium is a fibroserous sac, which
encloses the heart and roots of great
vessels.
• It has two primary functions.:
• Firstly, it restricts excessive movements of
the heart so that injury to this vital organ of
human body is avoided.
• Secondly, it serves as a lubricated container
in which different parts of the heart can
contract.
Pericardium
• The pericardium lies within the middle
mediastinum, posterior to body of
sternum and anterior to fifth to eighth
thoracic vertebrae.

• The pericardium consists of two parts:

• fibrous pericardium
• serous pericardium
Fibrous pericardium:
• It is the strong fibrous part of pericardium,
which is attached firmly to the central tendon
of diaphragm below.
• It fuses with the outer coats of great blood
vessels that pass through it.
• These blood vessels are: Aorta, Superior vena
cave, Inferior vena cave, Pulmonary trunk,
Pulmonary veins.
• Fibrous pericardium is attached in front to the
sternum by means of sternopericardial
ligaments.
Serous pericardium:
• This part of pericardium coats the heart and lines the
fibrous pericardium on the inside. It is composed of
two layers: Parietal and Visceral.

Parietal layer of serous pericardium:

It lines the fibrous pericardium and is reflected
around the roots of great blood vessels. At the
region of reflection, it becomes continuous with
the visceral layer of serous pericardium, which
covers the heart closely.
Serous pericardium:

Visceral layer of serous pericardium:

This layer is closely applied to the heart and is
often called the epicardium. There exists a slit
like space between the parietal and visceral
layers of serous pericardium. This space is
known as pericardial cavity and it contains a
small amount of tissue fluid called pericardial
fluid. Pericardial fluid acts as a lubricant to
facilitate the movements of heart.
Pericardial sinuses:
• On the posterior surface of the heart, the reflection
of the serous pericardium around the large veins
form a recess called oblique sinus.
• There is another sinus on the posterior surface of
the heart, which is called transverse sinus.
Transverse sinus is in the form of a short passage
that lies between the reflection of serous
pericardium around the aorta and reflection
around large veins.
• The pericardial sinuses form as a consequence of
the way the heart bends during development. They
don’t have any clinical significance.
MEDIASTINUM
 Mediastinum
Mediastinum is a movable It contains the following
partition of the thorax that structures:
extends superiorly to the • Thymus
thoracic outlet in the root of
the neck and inferiorly to the • Heart and large blood
diaphragm. vessels
Anteriorly it extends to the • Trachea
sternum and posteriorly to • Esophagus
the vertebral column.
• Thoracic duct
• Lymph nodes
• Vagus and phrenic nerves
• Sympathetic trunk
 Divisions of mediastinum:

Anterior Posterior Middle

mediastinum: mediastinum: mediastinum:
• It is the • It lies • It contains
space between the pericardium
between the pericardium and heart
pericardium and the
and the vertebral
sternum. column