[TRANS] MODULE 3: THE CIRCULATORY SYSTEM

OUTLINE
I The Circulatory System
II Heart
III Vascular System
IV Blood Vessels
V Blood Cells
VI Lymphatic System

THE CIRCULATORY SYSTEM

 Responsible for transporting throughout the body
oxygenated blood from the heart and lungs via the
arteries. Then the oxygen-depleted blood is returned
to its origin through the veins.
 Delivers the oxygen and nutrients to all cells in the
human body.
 It transports carbon dioxide and other wastes to the
other organs of the body and away from the cells.
 It helps in the coagulation process, regulates body
temperature, and assists the body in fighting diseases.
 Two main components:
o Cardiovascular system
LAYERS OF THE HEART
 Composed of the heart, blood vessels, and
 Epicardium
blood which helps in the circulation
o thin, watery membrane on the outer layer of the
o Lymphatic system
 Made up of the lymph, lymph nodes, and heart
o Function: covers the heart and is attached to the
vessels.
pericardium
 The circulatory (cardiovascular) system consists of the
 Myocardium
heart, blood vessels, and the blood. Blood is circulated
o thick layer of cardiac muscles in the middle layer
through the blood vessels by the heart to deliver oxygen
and nutrients to the cells and transport waste products of the heart
o Function: pumps blood into the arteries by
to the organs that remove them from the body
contracting
 Endocardium
HEART
o thin layer of epithelial cells in the inner layer of the
 The heart is a hollow muscular organ that has four
heart
chambers (left atrium, right atrium, left ventricle, and right
o Function: lines the valves and interior chambers
ventricle) and is surrounded by a thin, fluid-filled sac
called pericardium.
CHAMBERS OF THE HEART
 A human heart is about the same size as that of a
 Right Atrium
person's clenched fist.
o upper right chamber
 It is located in the thoracic cavity between the lungs and
o Function: receives deoxygenated blood from the
slightly to the left of the body midline that consists of two
body
pumps to circulate blood throughout the circulatory
 Right Ventricle
system.
o lower right chamber
o Function: receives the blood from the right
atrium and pumps it into the pulmonary artery
 Left Atrium
o upper left chamber
o Function: receives oxygenated blood from the
lungs and pumps it into the left ventricle
 Left Ventricle
o lower left chamber
o Function: receives blood from the left atrium and
pumps it into the aorta

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Table 1. Functions of the Human Heart

VALVES OF THE HEART Function Description
 Right AV valve Systole (contraction) and diastole
o tricuspid valve located between the right atrium and Cardiac Cycle (relaxation) which lasts about 0.8
the right ventricle seconds
o Function: closes as the right ventricle contracts Sends electric impulses throughout
Electrical
preventing blood from flowing back to the right the myocardium which is initiated
Conduction
atrium by the sinoatrial (SA) node
System
o Prevents backflow into the right atrium (pacemaker)
 Left AV valve Electrocardiogram Provides the graphical
o bicuspid or mitral valve located between the left (ECG) representation of the cardiac
atrium and the left ventricle cycle's activity
o Function: closes as the left ventricle contracts "Lubb" which is the first sound as
preventing blood from flowing back to the left atrium the ventricles contract or the AV
Origin of Heart
o Prevents backflow into the left atrium valves close and "dupp" or the
Sounds
 Right semilunar valve second sound which is heard when
o pulmonary or pulmonic valve located at the the semilunar valves close and the
entrance of the pulmonary artery ventricles relax
o Function: closes when the right ventricle relaxes The average heart rate is 72 beats
preventing blood from flowing back to the right Heart Rate and per minute (bpm) and the cardiac
ventricle Cardiac Output output refers to the volume of blood
o Allows blood flow into the pulmonary artery pumped per minute
 Left semilunar valve A rhythmic throbbing resulting from
o aortic valve located at the entrance of the aorta Pulse the alternating expansion and
o Function: closes when the left ventricle relaxes contraction of the artery
preventing blood from flowing back to the left The force exerted by the blood on
ventricle the walls of the vessel measured
o Allows blood flow into the aorta by the sphygmomanometer; the
Blood Pressure difference between the systolic
pressure during contraction) and
diastolic (pressure during
relaxation)

SEPTA
 Interatrial septum
o partition that separates the right from the left atria
 Interventicular septum
o separates the right and the left ventricles
CORONARY CIRCULATION
 The heart receives blood supply through the left and
right coronary arteries, and the coronary veins return
the oxygen-depleted blood from the heart muscle back
to the heart.
HEART FUNCTION
 The coronary circulation supplies the blood as well as
provides drainage to the tissues.
 It is composed of the left and right coronary arteries
and coronary veins.
 Poor circulation could lead to ischemia which is
caused by inadequate supply of oxygen and myocardial
infarction or heart attack which may be due to complete
obstruction of the coronary artery.
DISORDERS AND DIAGNOSTICS TESTS
 The human heart may have disorders that can be
detected and addressed using the proper diagnostic
tests.
o Angina pectoris
 chest pain resulting from reduced blood flow
to the heart, usually because of an obstruction
in the coronary arteries.
o Aortic stenosis
 a murmuring sound produced when the aortic
leaflets fail to fully open during systole
o Bacterial endocarditis
 an infection that happens when a bacteria
enters and resides in the heart lining or blood
vessel which causes inflammation.
o Congestive heart failure
 a chronic progressive condition that affects
the pumping power of the heart muscles,
causing fluid accumulation in the lungs and
other tissues.

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o Myocardial infarction
 known as heart attack, it is caused by a
decrease or full stoppage of blood flow that
damages the heart muscle
 Death (necrosis) of the heart muscle caused by
a lack of oxygen to the myocardium because
of an occluded coronary artery
o Pericarditis
 inflammation of the pericardial sac that may
be due to viral infection

LIST OF DIAGNOSTIC TESTS FOR HEART

DISORDERS:
 Arterial blood gases (ABG)
 Aspartate aminotransferase (AST) or serum glutamic-
oxaloacetic transaminase (SGOT)
 Cholesterol
 Creatine kinase (CK)
 Creatine kinase (CK)-MB
 Digoxin
 Electrocardiogram (ECG or EKG)
 Lactate dehydrogenase (LDH) isoenzymes
 Microbial cultures
 Myoglobin
 Potassium (K)
 Triglycerides
 Troponin T (TnT)

TWO MAIN DIVISIONS AND FUNCTIONS OF THE

VASCULAR SYSTEM
 The vascular system is the loop consisting of a network
of blood vessels through which blood is circulated to the
rest of the body.
 Two divisions:
o Pulmonary circulation
 moves the blood between the right ventricle of
the heart to the lungs.
 During the process, oxygen is absorbed and
carbon dioxide is released, after which, the
oxygenated blood flows back to the left atrium of
the heart.
o Systematic circulation
 moves the oxygenated blood and nutrients
from the left ventricle of the heart to the rest of
the body.
 The deoxygenated blood with carbon dioxide
and wastes flows back to the right atrium.
STRUCTURE OF THE VASCULAR SYSTEM
 Arteries
o thick-walled blood vessels that carry oxygen-rich
blood from the heart to the tissues of the body (from
the heart to the capillaries).
 Arterioles
o small-diameter blood vessels that branch out
from the arteries and lead (connect) to the
capillaries
 Veins
o tubes with thin walls that carry deoxygenated
blood from tissues to the heart
o thinner walls than arteries and carry oxygen-poor
blood, carbon dioxide, and other waste products
back to the heart
 Venules
o very small veins that collect blood from the
capillaries
o these connect capillaries to larger veins.
 Capillaries
o smallest blood vessels.
o fine hair-like blood vessels that connect arterioles
and veins
o consist of a single layer of epithelial cells to allow
exchanges of oxygen, carbon dioxide, nutrients, and
waste products between the blood and tissue cells.
The blood in capillaries is a mixture of arterial and
venous blood.

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TYPES, STRUCTURES, AND FUNCTIONS OF

BLOOD VESSELS

BLOOD VESSEL STRUCTURE

 Layers
o the blood vessels have three layers:
 tunica adventitia/externa (outer connective
tissue);
 tunica media (middle, muscle and elastic
fiber);
 tunica intima (inner, endothelial cell).
 Lumen
o space inside the blood vessel where the blood
THE FLOW OF BLOOD
flows.
 The pathway for the blood flow of the human body
 Valves
consists of arteries, veins, and capillaries that allow the
o found in the veins, these are thin membranous
transport of oxygen and nutrients to the cells of the
leaflets that prevent the backflow of blood.
body and also make it possible to remove carbon
dioxide and other waste materials of metabolism.
 The order of vascular flow is as follows:
o Oxygen-poor blood is returned to the heart through
the superior and inferior venae cavae. It enters the
right atrium of the heart.
o The right atrium contracts, pushing blood through
the tricuspid valve, and into the right ventricle.
o The contraction on the right ventricle forces the blood
through the pulmonary semilunar valve into the
pulmonary artery.
o It flows through the pulmonary artery to the
capillaries of the lungs.
o Oxygen-rich blood flows back to the heart through
the pulmonary veins and enters the left atrium.
o The left atrium contracts forcing the blood through
the bicuspid valve into the left ventricle.
o The contraction of the left ventricle forces the blood
through the aortic semilunar valve into the aorta.
o The blood travels through the body by way of the
arteries. These arteries branch into smaller ones,
the smallest of which are the arterioles.
o The arterioles connect with the capillaries. Oxygen,
water, and nutrients from the blood are diffused
through the capillary walls to the cells and carbon
dioxide and other end products enter the
bloodstream.
o The capillaries connect with the venules.

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o The venules merge into larger veins until the blood
returns to the heart by the superior or inferior vena
cava.
DISORDERS OF THE VASCULAR SYSTEM
 Aneurysm
o enlargement of the artery due to the weakening of
the artery wall
o bulge formed by a weakness in the wall of a blood
vessel, usually an artery, that can burst and cause
severe hemorrhaging.
 Arteriosclerosis
o hardening of the artery wall due to aging
contributing to aneurysm or stroke.
 Atherosclerosis
o formation of plaques in the inner walls
o A form of arteriosclerosis characterized by the
accumulation of lipids and other materials in the
walls of arteries causing the lumen of the vessel to
narrow and stimulate clot formation.
 Embolism
o clot or bubble that causes obstruction of an artery
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 Embolus
o obstruction that is carried and lodged in a vessel
 Hemorrhoids
o swollen veins in the area of the anus
 Phlebitis
o inflammation of the veins particularly the wall
 Thrombophlebitis
o swelling of the veins of the legs that usually occurs
during pregnancy
 Thrombus
o blood clot that impedes blood flow
 Varicose veins
o usually found in the legs, these are veins that have
been twisted and enlarged
o Swollen peripheral veins caused by damaged
valves, allowing backflow of blood that causes
swelling (edema) in the tissues.
DIAGNOSTIC TESTS
 D-dimer
 Fibrin degradation products (FDP)
 Lipoproteins
 Prothrombin time (PT)
 Partial thromboplastin time (PTT/APTT)
 Triglycerides
MAJOR CONSTITUENTS AND FUNCTIONS OF
BLOOD CELLS
 The blood is the red fluid that is transported
throughout the body via the circulatory system.
 Blood is the body’s main fluid for transporting nutrients,
waste products, gases, and hormones through the
circulatory system.
 Two types
o arterial blood
 oxygen and nutrients are carried to the
tissues
o venous blood
 carbon dioxide and metabolic by-products are
carried to the lungs and kidneys for removal
from the body.
 The human blood is composed of plasma and other
formed elements.
 Plasma is a clear, straw-colored liquid portion of the
blood which is 90% water. It contains gases (O2, CO2,
N), minerals (Na, K, Ca, Mg), carbs and lipids, proteins,
etc. The formed elements are cells, cell remnants, and
cell fragments found in the human blood.
 In the human blood, there are three types of cells:
o Erythrocytes (red blood cells)
 Carry O2 and CO2 and are produced in the
bone marrow.
o Leukocytes (white blood cells)
 formed in the marrow and the lymphatic
tissue. They neutralize pathogens.
 The two types are granulocytes and
agranulocytes.
o Thrombocytes (platelets)
 Pieces of very large cells in the bone marrow
that help form blood clots.
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BLOOD TYPE
 The human blood type is inherited and determined by
the antigens on the surface of the red blood cells. The
blood contains or can develop antibodies directed at the
opposite blood type.
 Blood type match is important especially during blood
transfusion because the wrong type could agglutinate
the red blood cells.
 When a doctor mentions blood type, he/she is referring to
a person's ABO blood group system or Rhesus (Rh)
factor.
ABO BLOOD GROUP SYSTEM
 This is a system of classifying human blood by the
presence of antigens A and B and based on the
antigenic components found on the surface of the red
blood cells. A person's blood could be classified as A, B,
0 (universal donor), or AB (universal recipient).
 This system of classification is of primary importance in
obstetrics because of the hemolytic disease of the
newborn (HDN). This is based on the "D" antigen or the
Rh factor. Rh positive (Rh+) has red blood cells that
have the D antigen while the Rh negative (Rh-) does not
have the D antigen.
 Cross-matching is necessary to determine the
compatibility of the donor's blood with the recipient's
blood because an individual who does not produce the D
antigen will produce anti-D which could be fatal if it
encounters the D antigen.
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RH BLOOD-GROUP SYSTEM
WHOLE BLOOD, SERUM, AND PLASMA
 There are three blood specimens that are collected for
testing purposes: serum, plasma, and whole blood.
 Serum
o the fluid part of the blood that is left after clotting
because it does not have fibrinogen. This can be
separated by centrifugation.
 Plasma
o the fluid portion that is separated by centrifugation
from the red blood cells, white blood cells, and
platelets. It has fibrinogen and could be collected
using an anticoagulant tube. It is also collected in
cases where serum could not be used.
 Whole blood
o The same as blood in the bloodstream and it
should neither clot nor separate.
o Just like plasma, it could be collected using the
anticoagulant tube and must be mixed for a
minimum of 2 minutes prior to testing.
BLOOD DISORDERS
 Anemia
o caused by not having enough healthy red blood
cells or hemoglobin
 Leukemia
o cancer of the blood; the formation of abnormal
tissues or cells in the bone marrow or the lymphatic
system
o a marked increase in the number of WBCs in the
bone marrow and circulating blood
 Urinary tract infection
o shown by high number of leukocytes
 Leukocytosis
o increased number of white blood cells in the blood
due to illness or infection
 Leukopenia
o reduced number of white cells in the blood, often
caused by exposure to radiation or chemotherapy.
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 Polycythemia through the lymph nodes, which produce

o the marrow produces too many red blood cells lymphocytes, before it reaches the duct.
resulting in the thickening of blood
 Thrombocytosis FUNCTIONS OF THE LYMPHATIC SYSTEM
o the body produces too many platelet  Aside from transporting white blood cells to and from
(thrombocytes) which affect the blood clotting the lymph nodes, the lymphatic system has other
 Thrombocytopenia functions:
o characterized by low platelet count o It transports the tissue fluids back into the
bloodstream.
DIAGNOSTIC TESTS o It removes impurities.
 ABO and RH type o It processes lymphocytes.
 Bone marrow examination o It transports the fats absorbed from the small
 Complete blood count (CBC) intestine into the bloodstream.
 Cross-matching  The lymph is an excess tissue fluid that filters through
 Differential (diff) count the lymphatic capillaries. The capillaries are joined and
form the larger vessels that empty into the right
 Eosinophil (Eos) count
lymphatic duct and thoracic duct, which, in turn, empty
 Erythrocyte sedimentation rate (ESR)
into the larger veins of the upper body. The lymph is
 Ferritin
moved as a result of skeletal muscle contraction.
 Hematocrit (Hct) Impurities are removed when the lymph passes
 Hemoglobin (Hb or Hgb) through the lymph nodes.
 Hemogram
 Indices (MCH, MCV, MCHC) DISORDERS OF THE LYMPHATIC SYSTEM
 Iron (Fe)  Lymphangitis
 Reticulocyte (retic) count o inflammation of lymphatic channels resulting from
 Total iron-binding capacity (TIBC) an infection at a site distal to the channel
 Lymphadenitis
STRUCTURE AND FUNCTIONS OF THE o refers to the inflammation of the lymph nodes
LYMPHATIC SYSTEM  Lymphadenopathy
 The lymphatic system is a network of tissues and o also called adenopathy, a disease in which there is
organs responsible for the removal of toxins and waste abnormality in the size or number of lymph nodes
in the human body.  Splenomegaly
 Its primary function is to transport the white blood cells o enlargement of the spleen
to and from the lymph nodes throughout the body.  Hodgkin's disease
o cancer that affects the immune system and is
characterized by enlarged lymph nodes
 Lymphosarcoma
o a type of cancer that develops from lymphocytes
 Lymphoma
o cancer of the lymphatic system that begins in the
lymphocytes

DIAGNOSTIC TESTS
 Bone marrow biopsy
 Complete blood count
 Culture and sensitivity
 Lymph node biopsy
 Mononucleosis test

HEMOSTASIS, BASIC COAGULATION, AND

FIBRINOLYSIS PROCESSES
 Hemostasis is the stoppage of bleeding as a response
to an injury whether it be normal vasoconstriction where
the vessel walls close temporarily, abnormal obstruction
like plaque, or coagulation such as litigation.
 Hemostasis is the process of forming a blood clot to
stop the leakage of blood when injury to a blood vessel
occurs and lysing the clot when the injury has been
repaired.
 This process happens daily just like the repair of a
vessel. It requires coordination between the endothelial
cells lining the blood vessels, platelets, and other blood
STRUCTURE OF THE LYMPHATIC SYSTEM
cells, and the plasma proteins.
 The lymphatic system is composed of fluids or lymph
 There are four interrelated responses:
which is similar to plasma but is composed of 95%
o Vasoconstriction
water.
 the vessel walls are constricted after an injury,
 The lymph is transported throughout the system which results in reduced flow of blood in the
through the lymphatic vessels, ducts, and masses of site of injury
lymph tissue called nodes. o Formation of the primary platelet plug
 The body's excess tissue fluid filters into lymphatic  platelets stick together on the site of the injury
capillaries which join larger lymphatic vessels until forming a plug
they empty into either the right lymphatic duct or the o Progression to the stable blood clot
thoracic duct. The lymph moves through the vessels with o Fibrinolysis or dissolving of clot
the help of skeletal muscle contraction. It passes

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COAGULATION FACTORS AND PATHWAYS DIAGNOSTIC TESTS

 Coagulation or clotting is the process in which the
blood changes from a liquid state into a gel that forms
the blood clot.
 The coagulation factors refer to the proteins that are
needed in the coagulation.
 There are three types:
o enzyme precursors that turn into enzymes when
activated,
o cofactors that accelerate enzymatic reactions, and
o substrates which are the substances that are acted
on and changed by the enzymes.
 The clotting cascade has two separate but interacting
pathways:
o the extrinsic pathway which is activated by external
trauma (initiates coagulation)
o the intrinsic pathway which is activated by trauma
inside the bloodstream (produces thrombin). It has
three cell-based coagulation phases, namely
initiation, amplification, and propagation.
 Bleeding time
 D-dimer Factor assays
 Platelet function assay (PFA)
 Prothrombin time (PT)
 Partial thromboplastin time (PTT or APTT)
 Fibrin degradation products (FDP)
MAJOR ARM AND LEG VEINS IN VENIPUNCTURE
 Antecubital fossa
o also called the elbow pit, is the triangular area on
the anterior of the elbow, which is a site of major
veins.
o This is the first choice for routine venipuncture
because there are several major arm veins called
antecubital veins which are dose to the surface
which makes them easy to locate and penetrate.

ROLE OF THE THROMBIN

 Thrombin is an enzyme that plays an important role in
coagulation.
 It is produced at the site of injury from the
prothrombin.
 It amplifies coagulation and converts fibrinogen into
soluble fibrin. This supports the platelet plug
formation by activating factor XIII to cross-link fibrin and
also to control the formation and coagulation process
by activating protein C.

 H-shaped antecubital veins

o refer to a vein arrangement that occurs in about
70% of the population.

FIBRINOLYSIS
 Fibrinolysis is the process in which the fibrin is
dissolved.
 It has two main activities:
o reopens intact vessels by dissolving clots
o removes hemostatic clots from the tissue as part
of the healing process

THE ROLE OF THE LIVER IN HEMOSTASIS

 The liver's role in hemostasis is to synthesize
coagulation factors such as V, VIII, prothrombin, and
fibrinogen.
 This organ produces heparin and bile salts needed for
synthesis.
 It is also responsible for the production of bile salts
needed for vitamin K absorption.

HEMOSTATIC DISORDERS
 Deep venous thrombosis (DVT)
o happens when blood clot forms in one or more
deep veins, usually in the legs.
 Disseminated intravascular coagulation o Median cubital vein
o occurs when the formation of small clots blocks  preferred venipuncture site.
the small blood vessels.  It is the easiest to access and least painful for
 Hemophilia the patient.
o a disorder involving the lack of sufficient blood  Large and does not tend to move when the
clotting proteins. needle is inserted.
o hereditary disorder characterized by excessive  It is often closer to the surface of the skin,
bleeding because of the lack of a coagulation more isolated from underlying structures, and
cascade factor. the least painful to puncture as there are fewer
 Thrombocytopenia nerve endings in this area.
o a condition characterized by abnormally low levels o Cephalic vein
of platelets in the blood.  second choice for venipuncture.

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 It is harder to palpate but is usually better

when drawing blood from an obese patient.
o Basilic vein
 last choice-vein for venipuncture as it is not
well anchored and punctures on this vein are
more painful.
 the least firmly anchored; therefore, it has a
tendency to “roll” and hematoma formation is
more likely.
 M-shaped antecubital veins
o intermediate antebrachial veins which include the
median, median cephalic, and median basilic veins
o Median vein
 intermediate antebrachial vein; first choice vein.
safest and less painful
o Median cephalic vein
 intermediate cephalic vein;
 second choice for venipuncture: less likely to roll
o Median basilic vein
 intermediate basilic vein;
 last choice vein because it is more painful

 Other arm and hand veins are used only if the antecubital
veins are not accessible. The veins at the back of the
hand that can be used are smaller, so using them may be
very painful. Take note that the underside of the wrist is
never used as a venipuncture site.
 Leg, ankle, and foot veins must not be used in
venipuncture without the permission of a physician due to
complications such as thrombosis.

 Arteries are not used for routine blood collection and are
limited to the collection of arterial blood gas. Special
training is needed and the procedure is risky for the
patient.

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