Chapter 6

The Cardiovascular System

Module Description
This learning material emphasizes the heart as a vital organ of the body. This chapter
highlights parts and structures of the heart and their functions. The types, structures,
and functions of the blood vessels are also discussed in this section.

Learning Outcomes
At the end of the module, you are expected to:
1. Distinguish and discover the anatomic structures and physiologic mechanisms/processes/
systems involved in the concept of human body.
2. Relate basic anatomical facts and physiological concepts and principles in the nursing care
of individuals.
3. Describe the functions of the cardiovascular system.

Pre-test
Direction: Each question in this section is a multiple-choice question. Read each
question and answer choice carefully and encircle the ONE best answer.
1. The cardiac conduction system includes all of the following except:
a. the SA node.
b. the AV node.
c. the bundle branches.
d. the chordae tendineae.
2. To get from the right atrium to the right ventricle, blood flows through
a. the pulmonary valve.
b. the tricuspid valve.
c. the bicuspid valve.
d. the aortic valve.
3. The blood supply to the myocardium is the coronary circulation; everything else is called
the systemic circuit.
a. True
b. False
4. No blood can enter the ventricles until the atria contract.
a. True
b. False
5. An electrocardiogram is a tracing of the action potential of a cardiac myocyte.
a. True
b. False
 Module Content
The cardiovascular system consists of two components: (1) the heart, which pumps
blood so that it flows to tissue capillaries and lung capillaries, and (2) the blood vessels
through which the blood flows.

Main Function
The main function of the cardiovascular system is
transportation. With the use of the blood as the
transport vehicle, and the blood vessels as the
pathways, the system carries oxygen, nutrients, cell
wastes, hormones and other substances vital for body
homeostasis to and from the cells.
FUNCTIONS OF THE CARDIOVASCULAR SYSTEM
1. Respiration - delivers oxygen to the cells and removing carbon dioxide from them
2. Nutrition - carries digested food substances to the cells of the body
3. Waste Removal -  disposes of waste products and poisons that would harm the body
if they accumulated
4. Immunity - helps protect the body from disease
5. Cellular Communication - the circulatory system provides a mode of transport for
hormones
6. Thermoregulation - the circulatory system transports heat (can both warm and cool
body)

THE HEART
- Cone shaped organ that weighs less than a pound.
- Size and shape
▪ Infant: 1/130 of the total body weight and appears
transverse and large
▪ Adult: 1/300
▪ Between puberty and 25 years, the heart attains its
adult shape and weigh:
a) male – 310g
b) female – 225g
But it only weighs about 250 to 350
grams
- Dimensions:
▪ Length: 12 cm (4.5 in)
▪ Width: 9 cm (3.5 in)
▪ Depth: 6 cm (2.5 in)
- Located in between the lungs in thoracic cavity
- ORIENTATION: apex (bottom) towards the heart
- The apex of the heart lies on the diaphragm pointing to the left, approximately located
between the fifth and sixth intercostal space, left midclavicular line.
- The base of the heart lies on the second rib.
- It is separated from the other organs by a
double-layered membrane = PERICARDIUM
- The Pericardium is composed of a
Fibrous Pericardium & a Serous
Pericardium.
- The serous pericardium has 2 parts:
1. Parietal layer - attached to the
back of the fibrous pericardium
2. Visceral layer (epicardium) -
attached to the heart muscle
● These two are separated
by a fluid filled space =
pericardial cavity.
 ● This fluid allows the heart to beat easily in a relatively frictionless
environment.
THE HEART WALL
The wall of the heart has three layers which include: a) epicardium, b) myocardium, and c)
the endocardium.

✔ Epicardium
The epicardium refers to both the outer
layer of the heart and the inner layer of the
serous visceral pericardium, which is
attached to the outer wall of the heart. The
epicardium is a thin layer of elastic
connective tissue and fat that serves as an
additional layer of protection from trauma
or friction for the heart under the
pericardium. This layer contains the
coronary blood vessels, which oxygenate
the tissues of the heart with a blood supply
from the coronary arteries.

✔ Myocardium
The middle layer of the heart wall is the myocardium—the muscle tissue of the heart and
the thickest layer of the heart wall. It is composed of cardiac muscle cells, or cardiomyocytes.
Cardiomyocytes are specialized muscle cells that contract like other muscle cells but differ in
shape. Compared to skeletal muscle cells, cardiac muscle cells are shorter and have fewer
nuclei. Cardiac muscle tissue is also striated (forming protein bands) and contains tubules and
gap junctions, unlike skeletal muscle tissue. Due to their continuous rhythmic contraction,
cardiomyocytes require a dedicated blood supply to deliver oxygen and nutrients and remove
waste products such as carbon dioxide from the cardiac muscle tissue. This blood supply is
provided by the coronary arteries.

✔ Endocardium
The inner layer of the heart wall is the endocardium, composed of endothelial cells that
provide a smooth, elastic, non-adherent surface for blood collection and pumping. The
endocardium may regulate metabolic waste removal from heart tissues and act as a barrier
between the blood and the heart muscle, thus controlling the composition of the extracellular
fluid in which the cardiomyocytes bathe. This in turn can affect the contractility of the heart.
This tissue also covers the valves of the heart and is histologically continuous with the
vascular endothelium of the major blood vessels entering and leaving the heart. The Purkinje
fibers are located just beneath the endocardium and send nervous impulses from the SA and AV
nodes outside of the heart into the myocardial tissues.
The endocardium can become infected, a serious inflammatory condition called infective
endocarditis. This and other potential problems with the endocardium may damage the valves
and impair the normal flow of blood through the heart.
THE HEART CHAMBERS
The heart has four chambers. The two atria receive blood into the heart and the two
ventricles pump blood into circulation.

✔ The Atria

The atria are chambers in which

blood enters the heart. They are
located on the anterior end of the
heart, with one atrium on each side.
The right atrium receives
deoxygenated blood from systemic
circulation through the superior
vena cava and inferior venae cavae.
The left atrium receives oxygenated
blood from pulmonary circulation
through the left and right
pulmonary veins.

Blood passively flows into the atria without passing through valves. The atria relax and
dilate (expand) while they fill with blood in a process called atrial diastole. The atria and
ventricles are separated by the mitral and tricuspid valves. The atria undergo atrial systole,
a brief contraction of the atria that ejects blood from the atria through the valves and into
the ventricles. The chordae tendinae are elastic tendons that attach to the valve from the
ventricles and relax during atrial systole and ventricular diastole, but contract and close off
the valve during ventricular systole.

One of the defining characteristics of the atria is that they do not impede venous flow
into the heart. Atria have four essential characteristics that cause them to promote
continuous venous flow:

There are no atrial inlet valves to interrupt blood flow during atrial systole. The venous
blood entering the heart has a very low pressure compared to arterial blood, and valves
would require venous blood pressure to build up over a long period of time to enter the
atria.

The atrial systole contractions are incomplete and do not block flow from the veins
through the atria into the ventricles. During atrial systole, blood not only empties from the
atria to the ventricles but continues to flow uninterrupted from the veins right through the
atria into the ventricles.
 The atrial contractions are slight, preventing significant back pressure that would
impede venous flow.

The relaxation of the atria is coordinated to begin before the start of ventricular
contraction, which also helps prevent the heart from beating too slowly.

✔ The Ventricles

The ventricles are located on the posterior end of the heart beneath their
corresponding atrium. The right ventricle receives deoxygenated blood from the right atria
and pumps it through the pulmonary vein and into pulmonary circulation, which goes into
the lungs for gas exchange. The left ventricle receives oxygenated blood from the left atria
and pumps it through the aorta into systemic circulation to supply the tissues of the body
with oxygen.

The walls of the ventricles are thicker and stronger than those of the atria. The
physiologic load on the ventricles, which pump blood throughout the body and lungs, is
much greater than the pressure generated by the atria to fill the ventricles. Further, the left
ventricle has thicker walls than the right because it pumps blood throughout the body,
while the right ventricle pumps only to the lungs, which is a much smaller volume of blood.

During ventricular diastole, the ventricles relax and fill with blood. During ventricular
systole, the ventricles contract, pumping blood through the semi-lunar valves into systemic
circulation.
 Right atrium
larger than the left atrium but walls are thin; 3 veins empty into it
superior vena cava – from upper portions of the body
inferior vena cava – from the lower parts of the body
coronary sinus – drains most of cardiac veins

Left atrium
has thicker walls; receives blood from the lungs by way of 4 pulmonary veins
interatrial septum – separates the R and L atria
fossa ovalis – depression in the septum that represents the foramen ovale, an opening b/n
atria during fetal life

Right ventricle
right inferior portion of the apex of the heart; receives blood from right atria and brings blood
to the lungs through pulmonary artery

Left ventricle
constitutes the left inferior portion of the apex of the heart; this has thicker walls because it
pumps blood from the left atrium to the whole body through the aorta
interventricular septum – separates the right and left ventricles

THE FOUR HEART VALVES

❖ ATRIOVENTRICULAR or AV VALVES
❑ located between the atrial and ventricular chambers on each side.
❑ prevent backflow into the atria when ventricles contract.
❑ AV valves open during heart relaxation and closed during contraction.

o Bicuspid or Mitral valve - left AV valve, consist of two flaps or cusps of endocardium.
- let oxygen-rich blood from the lungs pass from the left atrium
into the left ventricle
o Tricuspid valve - right AV valve, has three flaps.
- regulates blood flow between the right atrium and right ventricle

⚫ CHORDAE
TENDINEAE- tiny
white cords that
anchor the flaps to
the walls of the
ventricles.

❖ SEMILUNAR VALVES
 ❑ guards the bases of the two large arteries leaving the ventricular chambers.
❑ each valve has three leaflets that fit tightly together when the valves are closed.
❑ semilunar valves are closed during heart relaxation and are forced open when the
ventricles contract.

o Pulmonary valve - between right ventricle and pulmonary artery.

❑ controls blood flow from the right ventricle into the pulmonary
arteries, which carry blood to the lungs to pick up oxygen
o Aortic semilunar valve - between left ventricle and aorta.
- opens the way for oxygen-rich blood to pass from the left ventricle
into the aorta, the body's largest artery, where it is delivered to the
rest of the body

BLOOD PATHWAY THROUGH THE HEART

The heart functions as a double pump: the right side for pulmonary circuit pump and
the left for the systemic circuit pump.

While it is convenient to describe the flow of blood through the right side of the heart and
then through the left side, it is important to realize that both atria contract at the same time and
both ventricles contract at the same time. The heart works as two pumps, one on the right and one
on the left, working simultaneously. Blood flows from the right atrium to the right ventricle, and
then is pumped to the lungs to receive oxygen. From the lungs, the blood flows to the left atrium,
then to the left ventricle. From there it is pumped to the systemic circulation.
✔ Pulmonary Circuit Pump (right side)
Pulmonary circulation transports
oxygen-poor blood from the right ventricle
to the lungs where blood picks up a new
blood supply. Then it returns the oxygen-
rich blood to the left atrium.
✔ Systemic Circuit Pump (left side)
 The systemic circulation provides
the functional blood supply to all body
tissue. It carries oxygen and nutrients
to the cells and picks up carbon
dioxide and waste products. Systemic
circulation carries oxygenated blood
from the left ventricle, through the
arteries, to the capillaries in the
tissues of the body. From the tissue
capillaries, the deoxygenated blood
returns through a system of veins to
the right atrium of the heart.
The coronary arteries are the only
vessels that branch from the
ascending aorta. The brachiocephalic, left common carotid, and left subclavian arteries
branch from the aortic arch. Blood supply for the brain is provided by the internal carotid
and vertebral arteries. The subclavian arteries provide the blood supply for the upper
extremity. The celiac, superior mesenteric, suprarenal, renal, gonadal, and inferior
mesenteric arteries branch from the abdominal aorta to supply the abdominal viscera.
Lumbar arteries provide blood for the muscles and spinal cord. Branches of the external
iliac artery provide the blood supply for the lower extremity. The internal iliac artery
supplies the pelvic viscera.

CORONARY CIRCULATION

In order for the heart to sustain its function, the

heart muscles (myocardium) needs to be delivered with
necessary nutrients. The coronary circulation is
responsible for delivering blood to the heart tissue itself.
Blood from the aorta reaches the heart muscles through
the following blood vessels:

❖ Blood from the aorta reaches the heart muscles through the following blood vessels:
❑ Right and left CORONARY ARTERIES
▪ provides blood supply that oxygenates and nourishes the heart.
▪ branch from the base of the aorta and encircle the heart the coronary
sulcus at the junction of atria and ventricles
▪ major branches:
❑ Anterior interventricular and circumflex arteries at left
side
 ❑ Posterior interventricular and marginal arteries at right
side
❑ Major branches compressed when the ventricles are
contracting and fill when heart are relaxed
▪ Coronary arteries are so vital to the function of heart; whenever
disease states are associated with flow restriction through the
coronary arteries, and subsequently the remainder of the coronary
circulations (capillaries and veins), the effects on cardiac performance
are quite dramatic and often fatal.

❖ The blood returns from the heart muscle via 2 major veins:
❑ Great Cardiac vein
▪ brings deoxygenated blood back from the anterior heart wall 
❑ Middle Cardiac vein
▪ brings deoxygenated blood back from the posterior heart wall.
❑ Both vessels empty into the Coronary Sinus (a large vein on back of heart). It
empties into the right atrium.

PHYSIOLOGY OF THE HEART

The physiology of the heart pertains to its pumping action— that is, the heartbeat. It
is estimated that the heart beats two-and- a-half billion times in a lifetime, continuously
recycling some 5 liters (L) of blood to keep us alive. In this section, we will consider what
causes the heartbeat, what it consists of, and its consequences.
CONDUCTION SYSTEM OF THE HEART
The conduction system of the heart is a route of specialized cardiac muscle fibers
that initiate and stimulate contraction of the atria and ventricles. The conduction system is
said to be
intrinsic, meaning that the heart
beats automatically without the
need for external nervous
stimulation. The conduction system
coordinates the contraction of the
atria and ventricles
so that the heart is an effective
pump. Without this conduction
system, the atria and ventricles
would contract at different rates.

This system causes heart muscle

depolarization in only one direction
(from the atria to the ventricles). It
enforces a contraction rate
approximately 75 bpm on the heart.

❑ Sinoatrial (SA) Node

- also known as the natural “pacemaker”
- crescent- shaped node located in the posterior wall of right atrium near the
superior vena cavae.
- it starts each heartbeat and sets the pace for the whole heart.

**From the S-A node impulses are conducted along the interatrial muscle throughout the
atrial myocardium with the help of the intercalated disks that connect all cardiac muscle
fibers.
❑ Atrioventricular (AV) Node
- located in the inferior interatrial septum
- conducts impulses between the atria and ventricles
- impulse is delayed briefly to give the atria time to finish contracting.
- neurons fire at 40-50 beats per minute
- typically, the SA node overrides it, but if SA node is not functioning it will
ultimately cause ventricles to contract at a slower rate

❑ AV Bundle (Bundle of His)

- located in the interventricular septum
- divide into left and right bundle branches
 - conducts impulses between ventricles
- give rise to Purkinje fibers that carry impulses throughout the ventricular
myocardium

CARDIAC CYCLE AND HEART

REMEMBER!
SOUNDS
A cardiac cycle includes all the SYSTOLE refers to heart contraction
events that occur during one heartbeat. DIASTOLE refers to heart relaxation
On average, the heart beats about 70
times a minute, although a normal adult heart rate can vary from 60 to 100 beats per
minute. The length is 0.8 second.
After tracing the path of blood through the heart, it might seem that the right and left
sides of the heart beat independently of one another, but actually, they contract together.
First the two atria contract simultaneously; then the two ventricles contract together. The
term systole refers to contraction of heart muscle, and the term diastole refers to
relaxation of heart muscle. During the cardiac cycle, atrial systole is followed by ventricular
systole.

PHASES OF CARDIAC CYCLE

✔ Phase 1: Atrial Systole.

o Time = 0.15 sec.
o During this phase, both atria are in systole (contracted), while the ventricles are
in diastole (relaxed). Rising blood pressure in the atria forces the blood to enter
the two ventricles through the AV valves. At this time, both atrioventricular
valves are open, and the semilunar valves are closed.
✔ Phase 2: Ventricular Systole.
o Time = 0.30 sec.
o During this phase, both ventricles
are in systole (contracted), while
the atria are in diastole (relaxed).
Rising blood pressure in the
ventricles forces the blood to enter
the pulmonary trunk leading to the
pulmonary arteries and aorta
through the semilunar valves. At
this time, both semilunar valves are
open, and the atrioventricular
valves are closed.
⚫ Phase 3: Atrial and Ventricular Diastole.
 o Time = 0.40 sec.
o During this period, both atria and both ventricles are in diastole (relaxed). At
this point, pressure in all the heart chambers is low. Blood returning to the heart
from the superior and inferior venae cavae and the pulmonary veins fills the
right and left atria and flows passively into the ventricles. At this time, both
atrioventricular valves are open, and the semilunar valves are closed.

REMEMBER!
Atrial systole: atria contract and push blood into the ventricles; atrioventricular
valves are open, and the semilunar valves are closed.
Ventricular systole: ventricles contract as AV valves close and semilunar valves
open
Atrial & Ventricular diastole: both atria and both ventricles are relaxed; both
atrioventricular valves are open, and the semilunar valves are closed.

Note that the R and L atria contract together followed by the R and L ventricles
contracting together. This results in the typical lub-dup sound in a stethoscope.
Note that it takes two such sounds, lub-dup lub-dup, for one complete passage of
one volume of blood through the R and L sides of the heart.

HEART SOUNDS
● “Lub” and “dup”

Heart sounds are heard through a stethoscope at 2nd/3rd ribs and 5th/6th ribs and can indicate
the condition of the heart valves: First lub-dup goes with transport to lungs; second lub-dup goes
with transport to the body.

Follow one volume through the heart:

⚫ Lubb: aortic valve open, R and L AV-valves close = emptying of the ventricles to the body
and filling of the atria.
Dupp: aortic valve close, R and L AV-valves open = filling of the R ventricles; emptying of the
atria
● Lubb: pulmonary valve open, AV-valves closed = emptying of the ventricles to the lungs and
filling of the atria.
● Dupp: pulmonary valve close, AV-valves open = filling of the ventricles; emptying of the atria

NOTE!
The first heart sound is caused by closing of the AV valves, longer and
louder
The 2nd heart sound is caused by the closing of the semilunar valves, short
and sharp
Vibrations: due to blood flow and opening and closing of the heart valves
Murmurs- abnormal or unusual heart sound

ELECTROCARDIOGRAM (ECG OR EKG)

- It is a recording of the myocardial
electrical changes during the
cardiac cycle.
- Electrical changes precede
cardiac muscle contraction
❑ P wave: corresponds to
depolarization of the muscle
membrane in the atria prior to
contraction
❑ QRS complex: corresponds to
ventricular depolarization of the
muscle membrane prior to
contraction
❑ T wave: corresponds to
ventricular repolarization

CARDIAC OUTPUT
- The amount of blood pumped out by each side of the heart in 1 minute.
- Heart rate X Stroke volume
 - CO adjust to meet the metabolic needs of the body. When metabolic demands
increase, such as during exercise, the CO will INCREASE

● Stroke volume
o the volume of blood pumped out by a ventricle with each contraction
measured in mL/beat
o healthy heart pumps 60% or approximately 70 ml of blood with each
heartbeat.

REGULATION OF STROKE VOLUME

● “Starling’s Law of the heart”
o the more the cardiac muscle cells are stretched, the stronger the contraction.
o increase in venous return increases stroke volume and force of contraction.

a. EXERCISE
b. Muscular pump- plays a major role in increasing stroke volume

STROKE VOLUME
● Determined by three factors: pre-load, contractility, and afterload.
 ● PRELOAD
o amount of tension in the ventricular myocardium immediately before it
begins to contract.

**Venous Return - an important factor stretching the heart muscle.

- the amount of blood entering the heart and distending its ventricles.
- As venous return increases the myocardium is stretched.
- As the myocardium is moderately stretched, the cardiac muscles are
able to generate more tension and thus increase stroke volume.

● CONTRACTILITY
o refers to the strength of contraction for a given pre-load. The ion that is
essential to the excitation-contraction coupling of muscle is Calcium.
o By increasing the amount of available CALCIUM; contraction strength will
INCREASE, thus stroke volume will INCREASE.

● AFTERLOAD
o is the blood pressure in the arteries on the other side of the semilunar valves.
This pressure opposes the opening of the semilunar valves.
o thus, if the afterload INCREASES, then the stroke volume will DECREASE.

NOTE!
Positive and Negative Chronotropic agents – agents that increase or decrease
heart rate
Positive and Negative Inotropic agents – agents that increase or decrease stroke
volume

FACTORS MODIFYING BASIC HEART RATE

✔ Heart rate is under control by the S-A node. Hence, any dysfunction that alters the
conduction system of the heart, can cause changes in the heart rate.
✔ Neural (ANS) Controls
o The nerves of the sympathetic division (accelerator nerves) of the autonomic nervous
system more strongly stimulate the SA and AV nodes and the cardiac muscle itself
increasing the HR.
❑ Vagus
nerve: cholinergic parasympathetic fibers that decrease heart rate;
to keep the heart slowed.
❑ Accelerator nerves: adrenergic sympathetic nerves increase heart rate
and strength of contraction.
✔ Hormones and ions can have dramatic effect also on the heart activity.
o EPINEPHRINE - mimics the effect of sympathetic nerves
 o THYROXINE- increases heart rate
✔ Electrolytes such as CALCIUM, POTASSIUM and SODIUM IONS
o decrease levels of calcium depresses the heart
o excessive levels of calcium cause prolonged contractions which may stop the
heart entirely
o decrease potassium in the blood causes abnormal heart rhythm

✔ Medulla oblongata of the brain

o is the cardiac control center/ cardio regulatory center:
▪ cardioinhibitory reflex center
▪ cardioacceleratory reflex center
✔ Baroreceptors
o in carotid and aortic bodies respond to blood pressure changes
✔ Stretch receptors in the vena cava
o control heart rate and force of contraction of the heart

Heart rate and stroke volume and thus cardiac output can be altered by a
baroreceptor reflex. Baroreceptors located in the aortic arch and the carotid arteries
detect changes in blood pressure. If blood pressure decreases, the baroreceptors inform
the cardioregulatory center in the medulla oblongata. The medulla oblongata increases
sympathetic stimulation to the SA node thus increasing stimulation to the myocardium,
which increases calcium availability and thus increases heart rate (the rate at which the
heart contracts) and stroke volume

✔ Physical Factors
o such as age, gender, exercise and body temperature influence the heart rate.
o female heart rate is faster (72- 80 bpm) and male heart rate (64-72 bpm)
o heat increases heart rate by boosting the metabolic rate of the cells.
BLOOD VESSELS (BLOOD FLOW)
- it is where our blood circulates, forms a transport system –”vascular system”
- Blood flows from the heart through progressively narrowing vessels
(artery ->arteriole -> capillary) and returns through progressively enlarging vessels
(venules -> vein-> heart)

Artery carries blood away from the heart.

Veins drain the tissues and bring the blood back to the heart.

STRUCTURE: ARTERIES AND VEINS HAVE 3 TUNICS

1. Tunica Intima
● innermost,
● made up of endothelium
▪ squamous epithelial cells, lines the
lumen or interior of the vessels.
▪ decreases friction as blood flows
past.
● in arteries, the endothelium forms a
smooth lining.
● in veins, it forms semilunar valves
2. Tunica media
● Middle
● thickest layer in the arteries
● made up of smooth muscle sandwiched
with a layer of elastic connective tissue.
▪ the smooth muscles permit
changes in diameter
▪ the smooth muscles are innervated
by autonomic nerves and supplied
by tiny vasa vasorum.
3. Tunica Externa
● outermost tunic
● composed of fibrous connective tissue
▪ its function is to support and
protect vessels.
▪ helps hold vessels open and
prevents tearing of the vessel
walls during body movements
✔ ARTERIES
o Carries blood away from the heart, blood passes through elastic arteries,
muscular arteries and arterioles.
o Elastic arteries
▪ large, extremely resilient vessels with diameters of up to 2.5 cm.
▪ contain tunica media dominated by elastic fibers rather than smooth
muscle cells
▪ able to absorb the pressure changes that occur during the cardiac
cycle.
▪ ex. Pulmonary trunk and aorta 7 their major arterial branches
o Muscular arteries
▪ aka medium-sized arteries/ distribution arteries
▪ distribute blood to skeletal muscles and internal organs.
▪ 0.4 cm (0.15 in.) in diameter
▪ its tunica media contains more smooth muscle and fewer elastic fiber
▪ ex. External carotid arteries

✔ ARTERIOLES
o smallest artery
o its tunica media very thin
(<10 layers) its tunica
media consist of one to
two layers of smooth
muscle cells.
o Maintains blood pressure
and circulation
o The individual smooth
muscle in the walls of the
arterioles serve as
precapillary sphincters
which function as
regulatory valves
o Has lamina on each face of its tunica media

✔ VEINS
o Carry blood towards the heart
o veins have low pressure, they are modified to ensure that venous return is
equal to cardiac output.
o has large lumens and has valves
 ✔ CAPILLARIES
o Functional units" of circulatory system
o Primary exchange vessels of the cardiovascular system
o Keeps the cells supplied with vital materials and rid of injurious wastes
o very thin-walled
o allows for exchange of gases, nutrients, & waste products between the blood
and tissue cells.
o composed of the Tunica Intima only

MICROCIRCULATION
▪ flow of blood from an arteriole to venule through capillary bed.
▪ Capillary bed consists of two types
o Vascular shunt
▪ vessel that directly connects the arteriole and venule at opposite ends
of the bed
o True capillaries
▪ the actual exchange vessels, spring from the terminal arteriole and
empty through postcapillary venule

▪ Pre-capillary sphincter
o smooth muscle fibers, surrounds the root of each true capillary and acts as valve to
regulate the flow of blood into the capillary.
o if the pre- capillary sphincters are relaxed, blood flows through the true capillaries
o if the sphincters are contracted, blood flows through the shunts and bypasses the
tissue cells.
 ANATOMY OF BLOOD VESSELS

MAJOR ARTERIES OF THE SYSTEMIC CIRCULATION

✔ Aorta
o largest artery, connected from the left
ventricle of the heart
▪ ascending aorta- springs
upward from the left ventricle.
▪ aortic arch- arches to the left
▪ thoracic aorta- downward
▪ abdominal aorta

✔ Arterial branches of the Ascending aorta

o Right and Left coronary arteries

✔ Arterial branches of the Aortic

arch
o Brachiocephalic trunk
- “innominate artery”
- a short artery originating as the first large branch of the aortic arch,
passing upwards to the right, and ending at the lower neck near the
right sternoclavicular joint.
- divides into the Right common carotid and Right subclavian
artery.

▪ Left common carotid artery

o second branch off the aortic arch.
o forms the Left internal carotid (serves the brain, forehead,
nose, eyes and middle ear) and Left external carotid (face,
scalp and neck)
▪ Left subclavian artery
o third branch of the aortic arch
o VERTEBRAL ARTERY – serves
part of the brain.
o AXILLARY ARTERY,
o BRACHIAL ARTERY - supplies the
arms,
▪ divides into:
● Radial artery (pass superficially down the
forearm to the styloid process of the radius at
the wrist, winds around the wrist and enters the
palm of the hands, sending out branches to the
fingers)
● Ulnar artery (arise at the elbow and running
deep within the muscles of the medial side of the
forearm, passes into the palm and unites with
the arch of the radial artery
✔ Arterial branches of the thoracic aorta
● Intercostal arteries- supply the muscles of the thorax wall
● Bronchial arteries- supply the lungs
● Esophageal arteries- esophagus
● Phrenic arteries- diaphragm

✔ Arterial branches of the abdominal aorta

o delivers blood to all the abdominopelvic organs and structures
o CELIAC TRUNK
- first branch
- has three branches:
 ● L. gastric artery
● Splenic artery
● Common hepatic artery- supplies the liver
o SUPERIOR MESENTERIC ARTERY
- supply the small intestines and first half of the large intestines.
o R and L RENAL ARTERIES
- supply the kidneys.
o GONADAL ARTERIES
- supply the gonads
a. ovarian arteries
b. testicular arteries
o LUMBAR ARTERIES
- several pairs of arteries serving the heavy muscles of the abdomen and
trunk walls.
o INFERIOR MESENTERIC ARTERY
- supply the second half of the large intestines.
o R and L COMMON ILIAC ARTERIES- final branches of the abdominal aorta.
- divides into:
▪ Internal iliac artery - supplies the pelvic organs
▪ External iliac artery - enters the thigh
● Femoral artery & deep femoral artery (serve the thigh)
● popliteal artery (splits into anterior and posterior tibial
artery) supplies the leg and foot.
● dorsalis pedis (supplies the dorsum of the foot.

MAJOR VEINS OF THE SYSTEMIC CIRCULATION

✔ VEINS DRAINING into the SUPERIOR VENA CAVA
o The Radial and Ulnar veins
 ▪ drain the forearms. They form brachial vein which drains the arm and
empties into the axillary vein.
o Cephalic vein
▪ superficial drainage of the lateral aspect of the arm and empties into
axillary vein.
o Basilic vein
▪ superficial vein that drains the medial aspect of the arm and empties
into brachial artery.
▪ **median cubital vein- joins the cephalic and basilic vein
▪ site for blood removal
o Subclavian vein
▪ receives venous blood from the arm through the axillary vein and
from the head through the external jugular vein.
o Vertebral vein
▪ drains the posterior part of the brain
o Internal Jugular vein
▪ drains the dural sinuses of the brain.
o R and L Brachiocephalic veins
▪ large veins that receive venous drainage from the subclavian,
vertebral and internal jugular veins to form the superior vena cava.
o Azygos vein
▪ single vein that drains the thorax and enters the SVC just before it
joins the heart
✔ VEINS DRAINING into the INFERIOR VENA CAVA
o Anteritor and Posterior Tibial veins and Fibular veins
▪drain the leg (calf, foot)
▪the posterior tibial vein becomes the Popliteal vein at the knee, and
Femoral vein in the thigh.
▪ the femoral vein becomes External iliac vein in the pelvic region.
o Great Saphenous vein
▪ longest vein the body, receive superficial drainage of the leg
▪ originates at the Dorsal venous arch in the foot up to medial aspect of
the leg then empties into the femoral vein.
o R. and L. Common Iliac vein
▪ formed by the union of E. and I. iliac vein.
▪ form the inferior vena cavae.
o R. and L. Gonadal vein
▪ the R. vein drains the R. ovary in female and R. testicle in male.
▪ L. gonadal vein empties into the left renal vein.
o R. and L. Renal vein
▪ drains the kidney
o Hepatic Portal vein
▪ drains the digestive tract, carries blood through the liver before it
enters the systemic circulation.
o R. and L. Hepatic veins
▪ drain the liver
SPECIAL CIRCULATIONS
❖ Arterial Supply of the Brain and the Circle of Willis
o The brain is supplied with blood by the internal carotid (anterior blood supply) and
vertebral arteries (posterior blood supply)
o The anterior and posterior blood vessels are united by small communicating arterial
branches resulting in a circle called cerebral arterial circle or Circle of Willis.

o Internal Carotid Artery

▪ branches of the common carotid arteries, runs through the neck and enters
the skull through temporal bone.
▪ divides into Anterior and Middle cerebral arteries.
▪ supplies most of the cerebrum, forehead, nose, eye and middle ear.
o Vertebral Arteries
▪ forms the Basilar Artery (serves the brain stem and cerebellum as it travels
upward).
▪ Basilar artery divides at the base of the cerebrum to form the Posterior
Tibial arteries (supply the posterior part of the cerebrum).

o CIRCLE OF WILLIS
▪ a circle on the undersurface of the brain formed by linked branches of the
arteries (communicating arterial branches) that supply the brain.
▪ protects the brain by providing more than one route for blood to
reach the brain tissue in case of a clot or impaired blood flow in the
system.
❖ Hepatic Portal Circulation
● Hepatic Portal vein- drains the digestive organs, spleen, and the pancreas and
delivers the blood to the liver.

Inferior Mesenteric vein- drains the terminal part of the large intestine.

Spleenic vein- drains the Superior Mesenteric vein

spleen, pancreas, and the - drains the small intestines

left side of the stomach. & the 1st part of the colon.

↓Hepatic portal circulation

o L. Gastric vein- drains the R. side of the stomach and drains directly into the
hepatric portal vein.
❖ Fetal Circulation
✔ Placenta
▪ an organ within the uterus by means of which the embryo is attached to the
wall of the uterus.
▪ its function is to provide the fetus with nourishment, eliminate its waste, and
exchange of respiratory gases.
✔ Umbilical cord has 3 blood vessels:
▪ 1 umbilical vein- carries blood rich in nutrients and oxygen to the fetus.
▪ 2 umbilical arteries- carry CO2 and debris-laden blood from the fetus to
the placenta.
placenta

Umbilical vein

blood bypass liver

via Ductus Venousus

Inferior Vena Cavae

Right Atrium Right ventricles

Foramen Ovale
 Left Atrium Pulmonary Trunk

Left Ventricle Ductus Arteriosus

Aorta

Systemic circulation

Umbilical arteries

placenta

PHYSIOLOGY OF CIRCULATION
❖ VITAL SIGNS
✔ Arterial Pulse
▪ PULSE - a series of pressure waves within an artery caused by
contractions of the left ventricle and travels through the arterial
system
▪ average adult pulse rate is 60 to 80 bpm, influenced by activity,
postural changes and emotion.
▪ arterial pulse points or
pressure points:
● Radial artery
● Facial
● Carotid
● Brachial
● Radial
● Femoral
 ● Popliteal
● Posterior Tibial
● Dorsalis Pedis

BP is measured in
millimeters of mercury
(mmHg) by means of
sphygmomanometer at
the brachial artery
(where the pressure is
most similar to that of
blood leaving the
heart)
✔ Blood Pressure
▪ is the pressure the blood exerts against the inner
walls of the blood vessel.
▪ Blood pressure gradient- high to low pressure
▪ MEASURING BLOOD PRESSURE
● Systolic pressure- the pressure in the arteries at the peak of
ventricular contraction
● Diastolic pressure- the pressure when ventricles are relaxing

▪ EFFECTS OF VARIOUS FACTORS ON BLOOD

PRESSURE
● Cardiac output
Any increase in cardiac
● Peripheral resistance
output or peripheral
o is the amount of friction encountered by the blood as it flows
resistance causes an
through the blood vessels.
almost immediate
o can be increased by:
reflex rise on blood
pressure
▪ constriction or narrowing of blood vessels
▪ increased blood volume or blood viscosity

● Neural Factors: the autonomic nervous system

● Renal Factors
BP / blood volume
o sympathetic nervous system- causes vasoconstriction on
the vascular system
o example:
▪ Sudden change of position
▪ sudden decrease of blood volume due to hemorrhage
▪ exercise or trying to escape causes generalized
vasoconstriction except skeletal muscles.
o kidneys- play a major role in regulating arterial BP by
altering the blood volume.
water excretion blood volume/ BP

BP water retention release of the enzyme Renin

formation of angiotensin

release of aldosterone (enhances Na reabsorption)

 blood volume & BP

● Temperature
o cold temperature causes vasoconstriction
o heat causes vasodilation
● Chemicals
o Nicotine (increases BP and causes vasoconstriction)
o alcohol and histamine ( vasodilation and decrease BP)
● Diet
o low salt, saturated fats, and cholesterol helps prevent
high blood pressure.

CONTROL OF BLOOD VESSELS

❖ Vasomotor Control Mechanism
✔ Control changes in the diameter of vessels/ arterioles
✔ Vasomotor center/ vasoconstrictor center
✔ Found in medulla
✔ Initiate an impulse outflow via sympathetic fibers to the blood vessels’
smooth muscles
❖ Vasomotor Pressoreflexes
✔ Increase in arterial BP stimulates aortic and carotid baroreceptors
(decreasing HR), inhibiting the vasoconstrictor center
✔ Decrease in BP causes the aortic and carotid baroreceptors to send more
impulse to the medulla’s vasoconstrictor center
❖ Vasomotor Chemoreflexes
✔ Located in the aortic and carotid bodies
✔ Sensitive to excess CO2, hypoxia and decreased pH.
✔ Transmits impulses to the medulla’s vasoconstrictor center
✔ Emergency mechanism when hypoxia or hypercapnia endangers the stability
of the internal environment
❖ Medullary Ischemic Reflex
✔ Acts on emergency situation when there is decreased blood flow to the
medulla; causes marked arteriole and venous constriction
❖ Vasomotor control by higher brain centers
✔ Impulses from the cerebral cortex and hypothalamus are transmitted to
vasomotor centers in the medulla to help control vasoconstriction or dilation.
❖ Local Control of Arterioles
✔ Several local mechanisms produce vasodilation in localized areas –
hyperemia

POST TEST
Direction: Each question in this section is a multiple-choice question with four answer choices. Read
each question and answer choice carefully and encircle the ONE best answer.

1. The layer of the heart wall synonymous with the visceral layer of the serous
pericardium is:
a. myocardium
b. endocardium
c. epicardium
d. parietal layer of the serous pericardium
2. Pulmonary circulation involves blood flow to and from the heart and the:
a. body
b. digestive organs
c. skin
d. lungs
3. The right AV valve is known as the:
a. aortic semilunar valve
b. tricuspid valve
c. mitral valve
d. pulmonary semilunar valve
4. Pulmonary veins:
a. transport oxygenated blood to the lungs
b. transport blood rich in carbon dioxide to the lungs
c. transport oxygenated blood to the heart
d. split off the pulmonary trunk
5. What structure divides the left from the right ventricle:
a. interventricular septum
b. interatrial septum
c. bicuspid valve
d. tricuspid valve
6. When the ventricles contract, the bicuspid (mitral) valve prevents blood from
flowing from the:
a. right ventricle to the right atrium
b. left ventricle to the left atrium
c. left atrium to the right atrium
d. right atrium to the left atrium
7. Which one of the following blood vessels carries oxygenated blood:
a. superior vena cava
b. inferior vena cava
c. pulmonary artery
d. pulmonary vein
8. The sinoatrial node is located in the:
a. aorta
b. right atrium
 c. left atrium
d. right ventricle
9. Which one of the following are direct branches of the left coronary artery:
a. circumflex and marginal arteries
b. anterior and posterior interventricular arteries
c. anterior interventricular and marginal arteries
d. anterior interventricular and circumflex arteries
10.Which one of the following represents the correct path for the transmission of an
impulse in the intrinsic conduction system of the heart:
a. atrioventricular (AV) node, sinoatrial (SA) node, atrioventricular (AV)
bundle, right and left bundle branches, Purkinje fibers
b. atrioventricular (AV) node, atrioventricular (AV) bundle, sinoatrial (SA)
node, Purkinje fibers, right and left bundle branches
c. sinoatrial (SA) node, atrioventricular (AV) bundle, atrioventricular (AV)
node, right and left bundle branches, Purkinje fibers
d. sinoatrial (SA) node, atrioventricular (AV) node, atrioventricular (AV)
bundle, right and left bundle branches, Purkinje fibers
 ACTIVITY

TRUE OR FALSE: Read each statement and determine whether it is correct or not. Write TRUE if
the statement is correct and FALSE if it is not.
1. The fibrous pericardium is superficial to the serous pericardium surrounding the
heart.
a. TRUE
b.FALSE
2. The interatrial septum divides the two atria transversely
a. TRUE
b.FALSE
3. The chordae tendineae anchor the semilunar valves to the walls of the ventricles.
a. TRUE
b.FALSE
4. Arteries always carry blood away from the heart.
a. TRUE
b.FALSE
5. The coronary sinus on the backside of the heart drains deoxygenated blood from the
wall of the heart into the left atrium.
a. TRUE
b.FALSE
MATCHING TYPE: Match column A with column B

COLUMN A COLUMN B
The coronary sinus empties A) right ventricle
blood from cardiac circulation into
this chamber. (E) B) left atrium

Inferior discharging chamber C) right atrium

on the left side of the heart (D)
D) left ventricle
Heart chamber that pumps
blood to the pulmonary trunk (A)

Heart chamber that

contains the sinoatrial node (C)
The four pulmonary veins
return oxygenated blood to this
chamber (B)
 REFLECTION
Can a broken heart can really hurt? Is there such a thing as "broken heart
syndrome"?

If we talk about anatomy and physiology, there is no such thing called broken heart syndrome but if
we encounter people or base on researches

REFERENCES

Libretexts. (2020a). 17.1C: Layers of the Heart Walls. Retrieved from

https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book:_Anatomy_and_Physio
logy_(Boundless)/17:_Cardiovascular_System:_The_Heart/17.1:_The_Heart/
17.1C:_Layers_of_the_Heart_Walls#:~:text=The Heart Wall: The wall,heart wall is the
epicardium.
Libretexts. (2020b). 17.1D: Chambers of the Heart. Retrieved from
https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book:_Anatomy_and_Physio
logy_(Boundless)/17:_Cardiovascular_System:_The_Heart/17.1:_The_Heart/
17.1D:_Chambers_of_the_Heart
Mader, S. S. (2005). Chapter 12: The Cardiovascular System. In Understanding human anatomy &
physiology. (5th ed., pp. 224-252). McGraw-Hill Publishing Company.
Marieb, E. and Keller, S., 2018. Essentials of Human Anatomy & Physiology. 12th ed. Pearson
Education Limited, pp.74-76 and 111-113.