CARDIO VASCULAR SYSTEM

INTRODUCTION

The cardiovascular system is sometimes called the blood-vascular, or simply the

circulatory, system. It consists of the heart, which is a muscular pumping device,
and a closed system of vessels called arteries, veins, and capillaries. As the name
implies, blood contained in the circulatory system is pumped by the heart around a
closed circle or circuit of vessels as it passes again and again through the various
"circulations" of the body.

As in the adult, survival of the developing embryo depends on the circulation of

blood to maintain homeostasis and a favorable cellular environment. In response to
this need, the cardiovascular system makes its appearance early in development
and reaches a functional state long before any other major organ system. Incredible
as it seems, the primitive heart begins to beat regularly early in the fourth week
following fertilization.

The vital role of the cardiovascular system in maintaining homeostasis depends on

the continuous and controlled movement of blood through the thousands of miles
of capillaries that permeate every tissue and reach every cell in the body. It is in
the microscopic capillaries that blood performs its ultimate transport function.
Nutrients and other essential materials pass from capillary blood into fluids
surrounding the cells as waste products are removed.

.PARTS & FUNCTIONS OF CARIOVASCULAR SYSTEM

The cardiovascular system consists of the heart, blood vessels, and blood. This
system has three main functions:

 Transport of nutrients, oxygen, and hormones to cells throughout the body

and removal of metabolic wastes (carbon dioxide, nitrogenous wastes).
 Protection of the body by white blood cells, antibodies, and complement
proteins that circulate in the blood and defend the body against foreign
microbes and toxins. Clotting mechanisms are also present that protect the
body from blood loss after injuries.
 Regulation of body temperature, fluid pH, and water content of cells.
Structure of the heart

The heart consists of four distinct chambers: two upper chambers called “atria” and
two lower chambers called “ventricles.” A wall or “septum” separates the atria and
ventricles. Valves control the flow of blood within the different chambers.

Pathway of Blood through the Heart

Blood follows the following path through the heart:

1. Blood lacking oxygen returns from the body and enters the right atrium
(upper right chamber) via the inferior vena cava and superior vena cava
veins.
 2. Blood flows through the tricuspid valve and enters the right ventricle (lower
right chamber).
3. The right ventricle pumps blood through the pulmonary valve and out of the
heart via the main pulmonary artery.
4. The blood then flows through the left and right pulmonary arteries into the
lungs. Here, the process of breathing draws oxygen into the blood and
removes carbon dioxide. As a result, the blood is now rich in oxygen.
5. The blood returns to the heart and flows into the left atrium (upper left
chamber) via four pulmonary veins.
6. Blood flows through the mitral valve and enters the left ventricle (lower left
chamber).
7. The left ventricle pumps the blood through the aortic valve into a large
artery called the “aorta.” This artery delivers blood to the rest of the body.
.
Layers of the Heart Wall
Three layers of tissue form the heart wall. The outer layer of the heart wall is the
epicardium, the middle layer is the myocardium, and the inner layer is
the endocardium.

Chambers of the Heart

The internal cavity of the heart is divided into four chambers:

 Right atrium
 Right ventricle
 Left atrium
 Left ventricle
The two atria are thin-walled chambers that receive blood from the veins. The two
ventricles are thick-walled chambers that forcefully pump blood out of the heart.
Differences in thickness of the heart chamber walls are due to variations in the
amount of myocardium present, which reflects the amount of force each chamber
is required to generate.

The right atrium receives deoxygenated blood from systemic veins; the left atrium
receives oxygenated blood from the pulmonary veins.

Valves of the Heart

Pumps need a set of valves to keep the fluid flowing in one direction and the heart
is no exception. The heart has two types of valves that keep the blood flowing in
the correct direction. The valves between the atria and ventricles are called
atrioventricular valves (also called cuspid valves), while those at the bases of the
large vessels leaving the ventricles are called semilunar valves.

The right atrioventricular valve is the tricuspid valve. The left atrioventricular

valve is the bicuspid, or mitral, valve. The valve between the
right ventricle and pulmonary trunk is the pulmonary semilunar valve. The valve
between the left ventricle and the aorta is the aortic semilunar valve.

When the ventricles contract, atrioventricular valves close to prevent blood from
flowing back into the atria. When the ventricles relax, semilunar valves close to
prevent blood from flowing back into the ventricles.
Blood Supply to the Myocardium
The myocardium of the heart wall is a working muscle that needs a continuous
supply of oxygen and nutrients to function efficiently. For this reason, cardiac
muscle has an extensive network of blood vessels to bring oxygen to the
contracting cells and to remove waste products.

The right and left coronary arteries, branches of the ascending aorta, supply blood
to the walls of the myocardium. After blood passes through the capillaries in the
myocardium, it enters a system of cardiac (coronary) veins. Most of the cardiac
veins drain into the coronary sinus, which opens into the right atrium

Common diseases of the cardiovascular system

Cardiovascular diseases can be severe and potentially life threatening.Some

CardioVascular Diseases are

Heart attack

A heart attack happens when a part of the heart muscle does not receive enough
blood. This can occur due to a blockage, a tear in an artery around the heart, or if
the heart requires more oxygen than is available.

Symptoms of a heart attack include

 chest pain or discomfort

 feeling lightheaded
 pain or discomfort in the jaw, neck, or back
 pain or discomfort in one or both arms or shoulders
 shortness of breath

Three of the main risk factors of a heart attack are:

  high blood cholesterol
 high blood pressure
 smoking

People who have had a heart attack can lower their chances of future
cardiovascular problems by engaging in the following:

 regular physical activity

 reaching or maintaining a moderate weight
 following a heart-healthy diet
 quitting smoking
 undergoing cardiac rehabilitation

Stroke

A stroke is a medical condition in which the blood supply to a part of the brain
becomes cut off. This lack of blood supply triggers the death of brain cells.

There are two types of stroke. Ischemic stroke occurs as a result of a blood

clot blocking blood flow to the brain. Hemorrhagic stroke occurs as a result of a
bleed in or around the brain.

Some significant risk factors of a stroke include:

 high blood pressure

 diabetes
 heart disease
  smoking
 personal or family history of stroke
 older age
 being of African American heritage

Symptoms of a stroke begin suddenly and may include:

 one-sided weakness or numbness of the leg, arm, or face

 vision problems in one or both eyes
 difficulty speaking or understanding speech
 confusion
 dizziness, loss of balance, or difficulty walking
 severe headache

The treatment for stroke will depend on the type. A person who experiences
ischemic stroke may receive medications to help break up the blood clot and
restore blood flow to their brain.

Conduction system of the Heart

The electrical conduction system of the heart transmits signals generated usually by

the sinoatrial node to cause contraction of the heart muscle. The pacemaking signal generated in
the sinoatrial node travels through the right atrium to the atrioventricular node, along the Bundle
of His and through bundle branches to cause contraction of the heart muscle. This signal
stimulates contraction first of the right and left atrium, and then the right and left ventricles. This
process allows blood to be pumped throughout the body.
The conduction system consists of specialised heart muscle cells, and is situated within
the myocardium. There is a skeleton of fibrous tissue that surrounds the conduction system
which can be seen on an ECG. Dysfunction of the conduction system can cause irregular, fast, or
slow heart rhythms.
BLOOD:

COMPONENTS OF BLOOD.

Blood, by definition, is a fluid that moves through the vessels of a circulatory

system. In humans, it includes plasma (the liquid portion), blood cells (which
come in both red and white varieties), and cell fragments called platelets.

BLOOD CIRCULATION:

 Blood leaves the heart via arteries that branch repeatedly until they become
capillaries
 Oxygen (O2) and nutrients diffuse across capillary walls and enter tissues
 Carbon dioxide (CO2) and wastes move from tissues into the blood
 Oxygen-deficient blood leaves the capillaries and flows in veins to the heart
 This blood flows to the lungs where it releases CO2 and picks up O2
 The oxygen-rich blood returns to the heart.

Composition of Blood

 Blood is the body’s only fluid tissue

 It is composed of liquid plasma and formed elements
 Formed elements include:
 Erythrocytes, or red blood cells (RBCs)
 Leukocytes, or white blood cells (WBCs)
 Platelets
 Hematocrit – the percentage of RBCs out of the total blood volume .
CENTRIFUGATION

Centrifugation is a technique used for the separation of particles from a solution

according to their size, shape, density, viscosity of the medium and rotor speed.
The particles are suspended in a liquid medium and placed in a centrifuge
tube. The tube is then placed in a rotor and spun at a define speed.
Separation through sedimentation could be done naturally with the earth gravity,
nevertheless, it would take ages.
Centrifugation is making that natural process much faster.
Rotation of the rotor about a central axis generates a centrifugal force upon the
particles in the suspension.

PHYSICAL CHARACTERISTICS & VOLUME

 Blood is a sticky, opaque fluid with a metallic taste

 The pH of blood is 7.35–7.45

 Temperature is 38C, slightly higher than “normal” body temperature

 Blood accounts for approximately 8% of body weight

  Average volume of blood is 5–6 L for males, and 4–5 L for females

Blood Plasma

Plasma, the liquid component of blood, can be isolated by spinning a tube of whole
blood at high speeds in a centrifuge. The denser cells and platelets move to the
bottom of the tube, forming red and white layers, while the plasma remains at the
top, forming a yellow layer.

The plasma is about 90%,water, with the remaining 10%, percent made up of ions,

proteins, nutrients, wastes, and dissolved gases. The ions, proteins, and other
molecules found in plasma are important for maintaining blood pH and osmotic
balance, with albumin (the main protein in human plasma) playing a particularly
important role.

Some of the molecules found in the plasma have more specialized functions. For
example, hormones act as long-distance signals, antibodies recognize and
neutralize pathogens, and clotting factors promote blood clot formation at the site
of wounds.

Formed Elements
  Erythrocytes, leukocytes, and platelets make up the formed elements

 Only WBCs are complete cells

 RBCs have no nuclei or organelles, and platelets are just cell

fragments

 Most formed elements survive in the bloodstream for only a few days

Most blood cells do not divide but are renewed by cells in bone marrow

 Biconcave discs, anucleate, essentially no organelles

 97 % hemoglobin (Hb), a protein that functions in gas transport

 Contain the plasma membrane protein spectrin and other proteins that:

 Give erythrocytes their flexibility

 Allow them to change shape as necessary

Red blood cells

Red blood cells, or erythrocytes, are specialized cells that circulate through the
body and deliver oxygen to tissues. In humans, red blood cells are small and
biconcave. These characteristics allow red blood cells to effectively perform their
task of oxygen transport. Small size and biconcave shape increase the surface area-
to-volume ratio,improving gas exchange, while lack of a nucleus makes additional
space for hemoglobin, a key protein used in oxygen transport. Lack of
mitochondria keeps red blood cells from using any of the oxygen they’re carrying,
maximizing the amount delivered to tissues of the body.

In the lungs, red blood cells take up oxygen, and as they circulate through the rest
the body, they release the oxygen to the surrounding tissues. Red blood cells also
play an important role in transport of carbon dioxide, a waste product, from the
tissues back to the lungs. Some of the carbon dioxide binds directly to hemoglobin,
and red blood cells also carry an enzyme that converts carbon dioxide into
bicarbonate. The bicarbonate dissolves in plasma and is transported to the lungs,
where it's converted back into carbon dioxide and released.

Red blood cells have an average life span of 120days. Old or damaged red blood
cells are broken down in the liver and spleen, and new ones are produced in the
bone marrow. Red blood cell production is controlled by the
hormone erythropoietin, which is released by the kidneys in response to low
oxygen levels. This negative feedback loop ensures that the number of red blood
cells in the body remains relatively constant over time.

Platelets and clotting

Platelets, also called thrombocytes, are cell fragments involved in blood clotting.
They are produced when large cells called megakaryocytes break into pieces, each
one making 2000 - 3000 platelets as it comes apart. Platelets are roughly disc-
shaped and small, about 2 - 4 μm in diameter.

When the lining of a blood vessel is damaged , platelets are attracted to the wound
site, where they form a sticky plug. The platelets release signals, which not only
attract other platelets and make them become sticky, but also activate a signaling
cascade that ultimately converts fibrinogen, a water-soluble protein present in
blood plasma, into fibrin (a non-water soluble protein). The fibrin forms threads
that reinforce the platelet plug, making a clot that prevents further loss of blood.

White blood cells

White blood cells, also called leukocytes, are much less common than red blood
cells and make up less than 1%, percent of the cells in blood. Their role is also very
different from that of red blood cells: they are primarily involved in immune
responses, recognizing and neutralizing invaders such as bacteria and viruses.

White blood cells are larger than red blood cells, and unlike red blood cells, they
have a normal nucleus and mitochondria. White blood cells come in five major
 types, and these are divided into two different groups, named for their appearance
under a microscope.

 One group, the granulocytes, includes neutrophils, eosinophils, and basophils, all

of which have granules in their cytoplasm when stained and viewed on a
microscope.

 The other group, the agranulocytes, includes monocytes and lymphocytes, which

do not have granules in the cytoplasm.

Each type of white blood cell plays a specific role in defense. For example, some
white blood cells are involved in engulfing and breaking down pathogens, while
others recognize specific microorganisms and launch immune responses against
them. Different types of white blood cells have different lifetimes, ranging from
hours to years, and new cells are produced primarily in the bone marrow.

Stem cells and blood cell production

Red blood cells, white blood cells, and platelet-producing cells are all descended
from a common precursor: a hematopoietic stem cell.
A hallmark of stem cells is that they divide asymmetrically. That is, one daughter
cell remains a stem cell of the same type, while the other daughter cell acquires a
new identity. For hematopoietic stem cells, which are found in the bone marrow,
one daughter cell remains a hematopoietic stem cell, while the other goes on to
become a different type of stem cell: either a myeloid stem cell or a lymphoid stem
cell.

The myeloid stem cells and lymphoid stem cells also divide asymmetrically, with
their non-stem cell daughters generating the mature cell types of the
blood. Myeloid stem cells give rise to red blood cells, platelets, and some types of
white blood cells, while lymphoid stem cells give rise to the types of white blood
cells classified as lymphocytes.
BLOOD GROUP AND ITS IMPORTANCE

ANTIGEN & ANTIBODY

Antigens are molecules capable of stimulating an immune response. Each antigen has distinct

surface features, or epitopes, resulting in specific responses. Antibodies(immuniglobins) are Y-

shaped proteins produced by B cells of the immune system in response to exposure to antigens.

Each antibody contains a paratope which recognizes a specific epitope on an antigen, acting like a

lock and key binding mechanism.  This binding helps to eliminate antigens from the body, either by

direct neutralization or by ‘tagging’ for other arms of the immune system.

 Antigen Antibody

Overview Substance that can induce an Proteins that recognize and

immune response bind to antigens
Molecule type Usually proteins, may also be Proteins
polysaccharides, lipids or
nucleic acids
Origin Within the body or externally Within the body
Specific binding site Epitope Paratope
Image

The ABO blood group system is used to determine the different types of antigens in the red
blood cells and antibodies in the plasma.

This system and RhD antigen status determine which blood type or types will match for a safe
red blood cell transfusion.

There are four ABO groups:

Group A: The surface of the red blood cells contains A antigen, and the plasma has anti-B
antibody that would attack any foreign B antigen containing red blood cells.

Group B: The surface of the red blood cells contains B antigen, and the plasma has anti-A
antibody that would attack any foreign A antigen containing red blood cells.

Group AB: The red blood cells have both A and B antigens, but the plasma does not contain
anti-A/anti-B antibodies. Individuals with type AB can receive any ABO blood type.
 Group O: The plasma contains both types of anti-A/anti-B antibodies, but the surface of the red
blood cells does not contain any A/B antigens. Having none of these A/B antigens means that
they can be donated to a person with any ABO blood type.

Some red blood cells have the Rh factor, which is also called RhD antigen.

Rhesus grouping adds another dimension.

If the red blood cells contain the RhD antigen, they are RhD positive. If they do not, they are
RhD negative.

This means that there are eight main blood types in the ABO/RhD blood group system. Some of
these are more common than others

 A-positive (A+) occurs in 30 percent of people in the U.S.

 A-negative (A-) occurs in 6 percent of people

 B-positive (B+) occurs in 9 percent of people

 B-negative (B-) occurs in 2 percent of people

 AB-positive (AB+) occurs in 4 percent of people

 AB-negative (AB-) occurs in 1 percent of people

 O-positive (O+) occurs in 39 percent of people

 O-negative (O-) occurs in 9 percent of people

Around 82 percent of the population in the U.S. has RhD-positive blood. The rarest blood type is
AB negative.
.

1. Sinoatrial node
2. Atrioventricular node
3. Bundle of His
4. Left bundle branch
5. Left posterior fascicle
 6. Left-anterior fascicle
7. Left ventricle
8. Ventricular septum
9. Right ventricle
10.Right bundle branch
Electrical signals arising in the SA node (located in the right atrium) stimulate the atria to
contract. Then the signals travel to the atrioventricular node (AV node), which is located in
the interatrial septum. After a delay, the electrical signal diverges and is conducted through the
left and right bundle of His to the respective Purkinje fibers for each side of the heart, as well as
to the endocardium at the apex of the heart, then finally to the ventricular epicardium; causing its
contraction.[1] These signals are generated rhythmically, which in turn results in the coordinated
rhythmic contraction and relaxation of the heart.

Action potential generation

Cardiac muscle has some similarities to neurons and skeletal muscle, as well as important unique
properties. Like a neuron, a given myocardial cell has a negative membrane potential when at
rest. Stimulation above a threshold value induces the opening of voltage-gated ion channels and
a flood of cations into the cell. The positively charged ions entering the cell cause
the depolarization characteristic of an action potential

Requirements for effective pumping[edit]

In order to maximize efficiency of contractions and cardiac output, the conduction system of the
heart has:

 Substantial atrial to ventricular delay. This will allow the atria to completely empty their

contents into the ventricles; simultaneous contraction would cause inefficient filling and
backflow. The atria are electrically isolated from the ventricles, connected only via the AV
node which briefly delays the signal.
 Coordinated contraction of ventricular cells. The ventricles must maximize systolic pressure
to force blood through the circulation, so all the ventricular cells must work together.
 Absence of tetany. After contracting, the heart must relax to fill up again. Sustained
contraction of the heart without relaxation would be fatal, and this is prevented by a
temporaryinactivation of certain ion channels.

Properties of cardiac muscle

1. Rhythmicity:
One of the main characteristic features of the cardiac muscle is that it can initiate its own impulse
rhythmically. This inherent rhythmical property is present throughout the cardiac muscle as
evident from the electro-physiological studies of the single fibre from the S.A. node, A.V. node,
atrial muscle, Purkinje fibre and also from the ventricular muscle fibre.
2. Trans-Membrane Potential:
Trans-membrane potential recorded from the single cell of S.A. node shows certain characteristic
features which are absent in the same of the atrial muscle, Purkinje fibres and ventricular muscle
fibres. In the trans-membrane potential of S.A. node, there are slow de-polarisation phase, re-
polarisation phase and also slope of slow diastolic de-polarisation phase 

3. Conductivity:
The impulse originated at the S.A node spreads over the atria and reaches the A. V. node through
the internodalfibres.

The A.V. node transmits the impulse through the bundle of His and its branches to the ventricles.
From the apex of the heart through the Purkinje fibres the impulse is conducted to the base. 
4. Excitability and Contractility:
Like other muscles, the cardiac muscle is excitable by adequate stimuli and responds by
contraction. The fundamental contractile unit of the cardiac muscle is myofibril which contains
the protein units, actin and myosin. During contraction these two units are associated in presence
of ATP and thus the fibre is shortened, but during rest these are dissociated again with the re-
synthesis of ATP.

5. All-or-None Response:
If a quiescent heart muscle is stimulated at widely spaced electrical shocks of increasing strength
then muscle contracts as a whole only when the threshold strength is reached. But there was no
such increasing amplitude of contraction with increasing intensities of stimulation. 

Cardiac cycle:

The cardiac cycle is the performance of the human heart from the ending of one heartbeat to the
beginning of the next. It consists of two periods: one during which the heart muscle relaxes and
refills with blood, called diastole followed by a period of robust contraction and pumping of
blood, dubbed systole

he cardiac cycle involves four major stages of activity:

1) "Isovolumic relaxation",
2) Inflow,
3) "Isovolumic contraction",
4) "Ejection".
Moving from the left along the Wiggers diagram shows the activities within four stages during a
single cardiac cycle.
Wiggers diagram
 Stages 1 and 2 together—"Isovolumic relaxation" plus Inflow comprise the ventricular
"Diastole" period, including atrial systole, during which blood returning to the heart flows
through the atria into the relaxed ventricles.
 Stages 3 and 4 together—"Isovolumic contraction" plus "Ejection"—are the ventricular
"Systole" period, which is the simultaneous pumping of separate blood supplies from the two
ventricles, one to the pulmonary artery and one to the aorta.
 Notably, near the end of the "Diastole", the atria begin contracting, then pumping blood into
the ventricles; this pressurized delivery during ventricular relaxation (ventricular diastole) is
called the atrial systole.
 The time-wise increases and decreases of the heart's blood volume (see Wiggers diagram),
are also instructive to follow. The red-line tracing of "Ventricular volume" provides an
excellent track of the two periods and four stages of one cardiac cycle.
 Starting with the Diastole period: the low-volume plateau of "Isovolumic relaxation" stage,
followed by a rapid rise and two slower rises, all components of the "Inflow stage"—
increasing to the high-volume plateau of the "Isovolumic contraction" stage.
 Then, the Systole, including the high "Isovolumic contraction" stage to the rapid decrease in
blood volume (i.e., the vertical drop of the red-line tracing) which signifies the emptying of the
ventricles during the "Ejection" stage of the completed cycle—all equal to one heartbeat.