CARDIOVASCULAR SYSTEM

MARIE VONNE OLIVAR VENUS

CARDIOVASCULAR SYSTEM person’s fist, the hollow, cone-shaped

● The cardiovascular system consists of
the heart, blood vessels, and blood. Its
primary function is to transport nutrients
and oxygen-rich blood to all parts of the
body and to carry deoxygenated blood
back to the lungs.
HEART
● When most people hear the term
cardiovascular system, they immediately
think of the heart. We have felt our own
heart “pound” from time to time, and we
tend to get a bit nervous when this
happens.
● The crucial importance of the heart has
been recognized for a long time, and both
serious and comical songs referring to it
have been written. However, the
cardiovascular system is more than just
the heart.
ANATOMY OF THE HEART
● The anatomy of the heart can be divided
into the following:
1. Location & Size
2. Coverings & Walls
3. Chambers & Associated Great
Vessels
4. Valves
5. Cardiac Circulation
heart weighs less than a pound.
● The heart is located within the bony
thorax and is flanked on each side by the
lungs.
● Its more pointed apex is directed
toward the left hip and rests on the
diaphragm, approximately at the level of
the fifth intercostal space (this is where
exactly one would place a stethoscope to
count the heart rate for an apical pulse. Its
border posterior aspect, or base, from
which the great vessels of the body
emerge, points toward the right shoulder
and lies beneath the second rib.
SIZE: approximately similar to a person's
fist, hollow, cone-shaped, and weighs
less than 1lb
LOCATION: mediastinum (Between the
lungs)
APEX - towards the hips, rests on the
diaphragm at the level of 5th
Intercostal space.
BASE - towards the right shoulder and
lies beneath the 2nd rib.

LOCATION & SIZE

● The relative size and weight of the heart
give few hints of its incredible strength.
The heart is approximately the size of a
 COVERINGS & WALLS 3. ENDOCARDIUM
- The endocardium is a thin,
● The heart is enclosed by a double sac of
glistening sheet of endothelium
serous membrane called pericardium. The
that lines the heart chambers. It is
double sac of pericardium consists of
continuous with the linings of the
inner & outer parietal reinforced by a
blood vessels leaving and entering
fibrous pericardium.
the heart.
● This fibrous layer helps protect the heart
- Endocardium also forms the heart
and anchors it to surrounding structures,
valves.
such as the diaphragm and sternum. A
slippery lubricating fluid (serous fluid) is
produced by the serous pericardial
membranes. This fluid allows the heart to
beat easily in a relatively frictionless
environment as the pericardial layers slide
smoothly across each other.

▶ WALLS OF THE HEART

- Composed of three layers
a) Epicardium (outermost)
b) Myocardium (middle)
c) Endocardium (innermost) Inflammation of the pericardium is
called “pericarditis”, often resulting in a
decrease in the amount of serous fluid.
1. EPICARDIUM
This causes the pericardial layers to bind
- Also called “visceral pericardium”. and stick to each other, forming painful
- The epicardium tightly hugs the adhesions that interfere with heart
external surface of the heart and is movements.
actually part of the heart wall.

CHAMBERS & ASSOCIATED

2. MYOCARDIUM
- Myocardium consists of thick
bundles of cardiac muscle twisted
and whorled into ringlike
arrangements. It is the layer that
actually contracts.
- The myocardium is reinforced
internally by a dense, fibrous
connective tissue network called
the "skeleton of the heart."
GREAT VESSELS
● The heart has four hollow chambers or
cavities — two atria & two ventricles.
Each of these chambers is lined with
endocardium, which helps blood flow
smoothly through the heart.
● The superior atria are primarily
“receiving chambers”. As a rule, they are
not important in the pumping activity of
the heart. Blood flows into the atria under
low pressure from the veins of the body
and then continues on to fill the
ventricles.
● The inferior ventricles, thick-walled
ventricles are the “discharging chambers”,
or actual pumps of the heart. When they
contract, blood is propelled out of the
heart and into the circulation. The heart is
somewhat twisted; the right ventricle
forms most of its anterior surface; the left
ventricle forms its apex.
● The septum that divides the heart
longitudinally is referred to as the
“interventricular septum” or “interatrial
septum”, depending on which chamber it
divides and separates.
1. Interventricular Septum - divides
the two ventricles.
2. Interatrial Septum - divides the
two atria.
● Although the heart is a single organ, it
functions as a double pump. The right
side of the heart works as the “pulmonary
circuit pump”. It receives relatively
oxygen-poor blood from the veins of the
body through the large superior and
inferior vena cava and pumps it out
through the pulmonary trunk. The
pulmonary trunk splits into the right and
left pulmonary arteries, which carry blood
to the lungs, where oxygen is picked up
and carbon dioxide is unloaded.
Oxygen-rich blood drains from the lungs
and is returned to the left side of the
heart through the four pulmonary veins.
The circulation just described, from the
right side of the heart to the lungs and
back to the left side of the heart, is called
the “pulmonary circulation”.
● Blood returned to the left side of the
heart is pumped out of the heart into the
aorta, from which the systemic arteries
branch to supply essentially all body
tissues. Oxygen-poor blood circulates from
the tissues back to the right atrium via the
systemic veins, which finally empty their
cargo into either the superior or inferior
vena cava. This second circuit, from the
left side of the heart through the body
tissues and back to the right side of the
heart, is called the “systemic circulation".
It supplies oxygen- and nutrient-rich blood
to all body organs. Because the left
ventricle is the systemic pump that pumps
blood over a much longer pathway
through the body, its walls are
substantially thicker than those of the
right ventricle, and it is a much more
powerful pump.
2 ATRIA
- Receiving chambers
- Thin walled, low pressure
- ROLE: receive blood entering the
heart
- Divided by the INTERATRIAL
SEPTUM
2 VENTRICLES
- Pumping chambers
- Thick walled, high pressure
- ROLE: pumps blood out the
heart into the circulation
- Divided by the
INTERVENTRICULAR SEPTUM
● RIGHT ATRIUM (RA) - Receives blood
from the rest of the body
● RIGHT VENTRICLE (RV) - Forms most
of the anterior surface
● LEFT ATRIUM (LA) - Receives blood
from the lungs
● LEFT VENTRICLE (LV) - Forms the apex
RIGHT SIDE
- Pulmonary circuit pump
- Receives oxygen poor blood
from the veins (superior and
inferior vena cava)
- Pumps blood to the pulmonary
trunk to pick up oxygen
(pulmonary arteries to the
lungs)

PULMONARY CIRCULATION (right side)

- From the right side of the heart,
to the lungs , through the left
side of the heart
- FUNCTION: carry blood to the
lungs for gas exchange

LEFT SIDE
- Systemic circuit pump
- Receives oxygen rich blood from
the lungs (pulmonary veins)
- Pumps blood to the aorta to be
distributed to the body

SYSTEMIC CIRCULATION (left side)

- From the left side of the heart,
to the body, through the right
side of the heart.
- FUNCTION: circulate blood to all
body organs
 VALVES ▶ SEMILUNAR VALVES
- The second set of valves, the
● The heart is equipped with four valves,
semilunar valves, guards the bases
which allow blood to flow in only one
of the two large arteries leaving
direction through the heart chambers —
the ventricular chambers.
from the atria through the ventricles and
- Thus, they are known as the
out the great arteries leaving the heart.
a) Pulmonary valve
● The valves of the heart are classified
b) Aortic valves
into two sets:
- Each semilunar valve has three
1. Atrioventricular Valves
cusps that fit tightly together when
2. Semilunar Valves
the valves are closed. When the
ventricles are contracting and
▶ ATRIOVENTRICULAR VALVES
forcing blood out of the heart, the
- The atrioventricular, or AV, valves
cusps are forced open and
are located between the atrial and
flattened against the walls of the
ventricular chambers on each side.
arteries by the tremendous force
The AV valves prevent backflow
of rushing blood. Then, when the
into the atria when the ventricles
ventricles relax, the blood begins
contract.
to flow backward toward the
a) The left AV valve — the
heart, and the cusps fill with
bicuspid, or mitral valve —
blood, closing the valves. This
consists of two cusps, or
prevents arterial blood from
flaps, of endocardium.
reentering the heart.
b) The right AV valve, the
tricuspid valve, has three
Each set of valves operates at a
cusps.
different time. The AV valves are open
- Tiny white cords, the chordae
during heart relaxation and closed when
tendineae — literally, "heart
the ventricles are contracting. The
strings" — anchor the cusps to the
semilunar valves are closed during heart
walls of the ventricles. When the
relaxation and are forced open when the
heart is relaxed and blood is
ventricles contract. As they open and
passively filling its chambers, the
close in response to pressure changes in
AV-valve flaps hang limply into the
the heart, the valves force blood to
ventricles bella being turned inside
continually move forward in its journey
out by a gusty wind. In this
through the heart.
manner, the AV valves prevent
backflow into the atria when the
ventricles are contracting.
 HEART VALVES (4)
- FUNCTION: allow one way flow
of blood through the heart
- Chordae tendineae: tendinous
chords that support heart valves
1. ATRIOVENTRICULAR VALVES (AV
VALVES)
- Between the atria and ventricles
a) Bicuspid/Mitral Valve -
between left atrium and
left ventricle
b) Tricuspid Valve -
between right atrium
and right ventricle
2. SEMILUNAR VALVES
- Guard the bases of the 2 large
arteries leaving the heart.
a) Pulmonary Valve -
between right ventricle
and pulmonary trunk
b) Aortic Valve - between
left ventricle and aorta
CARDIAC CIRCULATION
● Although the heart chambers are
bathed with blood almost continuously,
the blood contained in the heart does not
nourish the myocardium. The blood
supply that oxygenates and nourishes the
heart is provided by the right and left
coronary arteries.
● The coronary arteries branch from the
base of the aorta and encircle the heart in
the atrioventricular groove at the junction
of the atria and ventricles. The coronary
arteries and their major branches (the
anterior interventricular and circumflex
arteries on the left, and the posterior
interventricular and marginal arteries on
the right) are compressed when the
ventricles are contracting and fill when the
heart is relaxed.
● The myocardium is drained by several
cardiac veins, which empty into an
enlarged vessel on the backside of the
heart called the “coronary sinus”. The
coronary sinus, in turn, empties into the
right atrium.
When the heart beats at a very rapid
rate, the myocardium may receive an
inadequate blood supply because the
relaxation periods (when the blood is
able to flow to the heart tissue) are
shortened. Situations in which the
myocardium is deprived of oxygen often
result in crushing chest pain called
angina pectoris. This pain is a warning
that should never be ignored because, if
angina is prolonged, the ischemic heart
cells may die, forming an infarct. The
resulting myocardial infarction is
commonly called a "heart attack" or
"coronary."
PHYSIOLOGY OF THE HEART
● As the heart beats or contracts, the
blood makes continuous round trips — in
and out of the heart, through the rest of
the body, and then back to the heart —
only to be set out again. The amount of
work that a heart does is almost too
incredible to believe. In one day it pushes
the body’s supply of 6 quarts or so of
blood through the blood vessels over 1000
times, meaning that it actually pumps
about 6000 quarts of blood in a single day.
CONDUCTION SYSTEM OF THE HEART
● Unlike skeletal muscle cells that must be
stimulated by nerve impulses before they
will contract, cardiac muscle cells can and
do contract spontaneously and
independently, even if all nervous
connections are severed. Moreover, these
spontaneous contractions occur in a
regular and continuous way. Although
cardiac muscle can beat independently,
the muscle cells in different areas of the
heart have different rhythms. The atrial
cells beat about 60 times per minute, but
the ventricular cells contract much more
slowly (20-40/min). Therefore, without
some type of unifying control system, the
heart would be an uncoordinated and
inefficient pump.
● Two types of controlling systems act to
regulate heart activity.
1. Autonomic Nervous System
2. Intrinsic Conduction System
(Nodal System)
▶ AUTONOMIC NERVOUS SYSTEM
- One of these involves the nerves of
the autonomic nervous system
that act like "brakes" and
"accelerators" to decrease or
increase the heart rate depending
on which division is activated.
▶ INTRINSIC CONDUCTION SYSTEM
- Also called “Nodal System”
- The second system is the intrinsic
conduction system, or nodal
system, that is built into the heart
tissue. The intrinsic conduction
system is composed of a special
tissue found nowhere else in the
body; it is much like a cross
between muscle and nervous
tissue. This system causes heart
muscle depolarization in only one
direction — from the atria to the
ventricles. In addition, it enforces a
contraction rate of approximately
75 beats per minute on the heart;
thus, the heart beats as a
coordinated unit.
- One of the most important parts of
the intrinsic conduction system is a
crescent-shaped node of tissue
called the sinoatrial (SA) node,
located in the right atrium. Other
components include the
atrioventricular (AV) node at the
junction of the atria and ventricles,
the atrioventricular (AV) bundle
(bundle of His) and the right and
left bundle branches located in the
interventricular septum, and finally
the Purkinje fibers, which spread
within the muscle of the ventricle
walls.
- The SA node is a tiny cell mass
with a mammoth job. Because it
has the highest rate of
depolarization in the whole
system, it starts each heartbeat
and sets the pace for the whole
heart. Consequently, the SA node
is often called the “pacemaker”.
From the SA node, the impulse
spreads through the atria to the AV
node, and then the atria contract.
At the AV node, the impulse is
delayed briefly to give the atria
time to finish contracting. It then
passes rapidly through the AV
bundle, the bundle branches, and
the Purkinje fibers, resulting in a
"wringing" contraction of the
ventricles that begins at the heart
apex and moves toward the atria.
 This contraction effectively ejects
blood superiorly into the large
arteries leaving the heart.
Electrocardiography is the clinical
procedure for mapping the
electrical activity of the heart.
CONDUCTION SYSTEM
- Heart can contract
spontaneously and
independently.
- Regular and continuous
contractions
- 2 systems regulate heart activity
a) Autonomic Nervous
System
b) Intrinsic Conduction
System/Nodal System
1. INTRINSIC CONDUCTION
SYSTEM/NODAL SYSTEM
- Built into the heart tissue
- Sets the basic rhythm of the
heart
- Special tissues in the
myocardium
- Causes depolarization (action
potential) in one direction
- Sets basic heart rate
(approximately 75 beats per
minute)
● SINOATRIAL NODE (SA NODE)
- “pacemaker” of the heart
- Highest rate of depolarization
that sets the pace for heart
beats
- LOCATION: wall of right atrium
● ATRIOVENTRICULAR NODE (AV NODE)
- Delays impulse briefly to allow
atria to finish contraction
- LOCATION: right side
atrioventricular septum
● ATRIOVENTRICULAR BUNDLE
(BUNDLE OF HIS)
- LOCATION: interventricular
septum
Bundle branches → Purkinje
fibers (heart muscle)
CONDUCTION SYSTEM PROBLEMS
1. HEART BLOCK
- ANATOMY: atria and ventricles
separated by fibrous skeleton
Impulse spreads from atrium →
ventricle only through AV Node
- CAUSE: damage to AV node
- EFFECT: ventricles beat at their
own rate (slower)
2. DAMAGE TO SA NODE
- Slower heart rate (bradycardia)
- TREATMENT: pacemaker
3. FIBRILLATION
- CAUSE: ischemia (lack of adequate
blood supply to the heart)
- EFFECT: rapid uncoordinated
shuddering of the heart
 ELECTROCARDIOGRAPHY ventricles, these terms always refer to the
contraction and relaxation of the
● Electrocardiograph is the machine
ventricles unless otherwise stated.
machine
● The term cardiac cycle refers to the
● Electrocardiogram reading produced by
events of one complete heartbeat, during
the ECG
which both atria and ventricles contract
● FUNCTION: trace the flow of current
and then relax. Since the average heart
through the heart
beats approximately 75 times per minute,
● BASIS: as impulses pass through the
the length of the cardiac cycle is normally
heart, electrical currents are generated on
about 0.8 second. We will consider the
the surface of the body
cardiac cycle in terms of events occurring
● Normal ECG has 3 waves
during three periods.
❖ P wave atrial depolarization
1. Mid-to-late diastole
❖ QRS complex ventricular
2. Ventricular systole
depolarization
3. Early diastole
❖ T wave ventricular repolarization
● Abnormal ECG
▶ MID-TO-LATE DIASTOLE
❖ Different shape of the waves
- Mid-to-late diastole begins with
❖ Different timing of the waves
the heart in complete relaxation.
❖ Could indicate:
At this point, the pressure in the
a) Myocardial infarct (dead
heart is low, and blood is flowing
cardiac tissue)
passively into and through the
b) Fibrillation
atria into the ventricles from the
pulmonary and systemic
circulations. The semilunar valves
are closed, and the AV valves are
open. Then the atria contract and
force the blood remaining in their
chambers into the ventricles.

▶ VENTRICULAR SYSTOLE
- Ventricular systole. Shortly after,
ventricular contraction (systole)
begins and the pressure within the
CARDIAC CYCLE & HEART SOUNDS ventricles increases rapidly, closing
● In a healthy heart, the atria contract the AV valves. When the
simultaneously. Then, as they start to intraventricular pressure (pressure
relax, contraction of the ventricles begins. in the ventricles) is higher than the
Systole & diastole mean heart contraction pressure in the large arteries
and relaxation, respectively. Since most of leaving the heart, the semilunar
the pumping work is done by the valves are forced open, and blood
 rushes through them out of the
ventricles. During ventricular
systole, the atria are relaxed, and
their chambers are again filled
with blood.
▶ EARLY DIASTOLE
- Early diastole. At the end of the
systole, the ventricles relax, the
semilunar valves snap shut
(preventing backflow), and for a
moment, the ventricles are
completely closed chambers.
During early diastole, the
intraventricular pressure drops.
When it drops below the pressure
in the atria (which has been
increasing as blood has been filling
their chambers), the AV valves are
forced open, and the ventricles
again begin to refill rapidly with
blood, completing the cycle.
When using a stethoscope, you can
hear two distinct sounds during each
cardiac cycle. These heart sounds are
often described by the two syllables "lub"
and "dub", and the sequence is lub-dub,
pause, lub-dub, pause, and so on. The first
heart sound (lub) is caused by the closing
of the AV valves. The second heart sound
(dub) occurs when the semilunar valves
close at the end of systole. The first heart
sound is longer and louder than the
second heart sound, which tends to be
short and sharp.
CARDIAC CYCLE
- Event that occur in one
complete heartbeat
- Involve 2 stages:
a) Systole (contraction) -
pumping of blood by the
ventricles
b) Diastole (relaxation) -
filling of heart chambers
with blood
- NORMAL: 75 bpm at 0.8 seconds
per cycle
1. MID-TO-LATE DIASTOLE
- Complete relaxation and low
pressure in the heart
- Blood flows passively INTO the
heart
- AV valves open, semilunar valves
closed
- Atria contract to actively pump
blood to the ventricles
2. VENTRICULAR SYSTOLE
- Increasing pressure as ventricles
contract
- Semilunar valves open,
semilunar valves closed
- Atria are relaxed and filling with
blood
3. EARLY DIASTOLE
- Ventricles relax and semilunar
valves closed
- Intraventricular pressure drops
and AV valves open
 HEART SOUNDS
- Heard with a stethoscope
- Described as “lub dub” pause
“lub dub” pause, and so on
1 st heart sound (“lub”)
- Caused by closing of AV valves
- Longer and louder
2 nd heart sound (“dub”)
- Caused by closing semilunar
valves (end of systole)
- Shorter and sharper
Abnormal or unusual heart sounds
are called “murmurs”. Blood flows silently
as long as the flow is smooth and
uninterrupted. If it strikes obstructions, its
flow becomes turbulent and generates
sounds, such as heart murmurs, that can
be heard with a stethoscope. Heart
murmurs are fairly common in young
children (and some elderly people) with
perfectly healthy hearts, probably because
their heart walls are relatively thin and
vibrate with rushing blood. However, most
often, murmurs indicate valve problems.
For example, if a valve does not close
tightly (is incompetent), a swishing sound
will be heard after that valve has
(supposedly) closed, as the blood flows
back through the partially open valve.
Distinct sounds also can be heard when
blood flows turbulently through stenosed
(narrowed) valves.
CARDIAC OUTPUT
● Cardiac output (CO) is the amount of
blood pumped out by each side of the
heart (actually each ventricle) in 1 minute.
● It is the product of the heart rate (HR)
and the stroke volume (SV). Stroke
volume is the volume of blood pumped
out by a ventricle with each heartbeat. In
general, stroke volume increases as the
force of ventricular contraction increases.
If we use the normal resting values for
heart rate (75 beats per minute) and
stroke volume (70 ml per beat), the
average adult cardiac output can be easily
figured:
CO = HR (75 beats/min) x SV (70 ml/beat)
CO = 5250 ml/min
● Since the normal adult blood volume is
about 5000ml, the entire blood supply
passes through the body once each
minute. Cardiac output varies with the
demands of the body. It rises when the
stroke volume is increased or the heart
beats faster or both; it drops when either
or both of these factors decrease.
CARDIAC OUTPUT (CO)
- Amount of blood pumped by
each side of the heart in 1
minute
- CO = heart rate (HR) X stroke
volume (SV)
- Stroke volume = volume of
blood pumped by each ventricle
- Normal average CO:
Given normal SV= 70 ml/ min
Given normal HR= 75 bpm
- Varies depending on demands of
the body
▶ REGULATION OF STROKE VOLUME
- A healthy heart pumps out about
60 percent of the blood that enters
it. As noted above, this is
approximately 70ml (about 2
ounces) with each heartbeat.
- According to Starling's law of the
heart, the critical factor controlling
stroke volume is how much the
cardiac muscle cells are stretched
just before they contract. The
more they are stretched, the
stronger the contraction will be.
- The important factor stretching the
heart muscle is venous return, the
amount of blood entering the
heart and distending its ventricles.
If one side of the heart suddenly
begins to pump more blood than
the other, the increased venous
return to the opposite ventricle
will force it to pump out an equal
amount, thus preventing backup of
blood in the circulation.
- Anything that increases the
volume or speed of venous return
also increases stroke volume and
force of contraction. For example,
a slow heartbeat allows more time
for the ventricles to fill. Exercise
speeds venous return because it
results in increased heart rate and
force. The enhanced squeezing
action of active skeletal muscles on
the veins returning blood to the
heart, the so-called “muscular
pump”, also plays a major role in
increasing the venous return. On
the other hand, low venous return,
such as might result from severe
blood loss or an extremely rapid
heart rate, decreases stroke
volume, causing the heart to beat
less forcefully.
STROKE VOLUME
● Starling’s law of the heart
- The most important factor
affecting SV is how much the
heart muscles are stretched just
before they contract
● Venous return
- An important factor for
stretching the heart
- Amount of blood entering the
heart and distending the
ventricles
- INCREASED: slow heartbeat,
exercise
- DECREASED: blood loss, rapid HR
▶ REGULATION OF HEART RATE
- In healthy people, stroke volume
tends to be relatively constant.
However, when blood volume
drops suddenly or when the heart
has been seriously weakened,
stroke volume declines, and
cardiac output is maintained by a
faster heartbeat. Although heart
contraction does not depend on
the nervous system, its rate can be
changed temporarily by the
“autonomic nerves”. Indeed, the
most important external influence
on heart rate is the activity of the
autonomic nervous system. Heart
rate is also modified by various
chemicals, hormones, and ions.
a) Epinephrine
b) Thyroxine
c) Low blood calcium or
potassium
 - During times of physical or
emotional stress, the nerves of the
sympathetic division of the
autonomic nervous system
stimulate the SA and AV nodes and
the cardiac muscle itself. As a
result, the heart beats more
rapidly. This is a familiar
phenomenon to anyone who has
ever been frightened or has had to
run to catch a bus. As fast as the
heart pumps under ordinary
conditions, it really speeds up
when special demands are placed
on it. Since a faster blood flow
increases the rate at which fresh
blood reaches body cells, more
oxygen and glucose are made
available to them during periods of
stress. When demand declines, the
heart adjusts. Parasympathetic
nerves, primarily the vagus nerves,
slow and steady the heart, giving it
more time to rest during non-crisis
times. In patients with congestive
heart failure, a condition in which
the heart is nearly "worn out" due
to age or hypertensive heart
disease, the heart pumps weakly.
Oh in For those patients the drug
digitalis is routinely prescribed. It
acts in much the same way as the
vagus nerves; that is, it slows and
steadies the heart, resulting in a
stronger heartbeat.
HEART RATE
- Maintains CO if SV decreases
- Controlled by the autonomic
nervous system
a) Sympathetic - stimulates
SA and AV nodes
b) Parasympathetic (vagus
nerve) - slows down the
heart
- Drugs, hormones and ions
a) Epinephrine - mimics
effect of sympathetic NS
b) Thyroxine - from the
thyroid gland increases
HR
c) Low blood calcium or
potassium - depress the
heart
- Affected by physical factors
a) Age fetus 140 160 bpm
and decreases with age
b) Faster in females
c) Heat increases heart
rate (increased
metabolic rate)
d) Exercise increases heart
rate
➢ action of skeletal
muscles
➢ Sympathetic
nervous system
COMMON DISORDERS OF THE HEART
1. Aneurysm - a localized abnormal
dilation of a blood vessel, usually
an artery.
2. Angina Pectoris - discomfort
around the heart, caused by
insufficient blood supply to the
heart.
3. Arrhythmia - any abnormality in
the rate of rhythm of the
heartbeat. Also called
“dysrhythmia”.
4. Atherosclerosis - the development
of fatty, fibrous patches in the
lining of the arteries causing
narrowing of the lumen and
hardening of the vessel wall.
5. Cyanosis - bluish discoloration of
the skin due to lack of oxygen.
6. Dyspnea - difficulty in breathing.
7. Embolism - obstruction of a blood
vessel by a blood clot or other
matter carried in the circulation.
8. Fibrillation - spontaneous,
quivering and ineffectual
contraction of the muscle fibers.
9. Infarction - localized necrosis of
the tissue resulting from a
blockage or narrowing of the
artery that supplies the area.
10. Ischemia - local deficiency of blood
supply due to obstruction in the
circulation.
11. Murmur - an abnormal heart
sound.
12. Phlebitis - an inflammation of a
vein.
13. Stenosis - constriction or
narrowing of an opening.
14. Stroke - sudden damage to the
brain resulting from the reduction
of blood flow. Causes include
atherosclerosis, thrombosis, or
bleeding from ruptured aneurysm
15. Syncope - a temporary loss of
consciousness due to inadequate
blood supply to the brain.
16. Thrombosis - development of a
blood clot within a vessel.
17. Thrombus - a blood clot that forms
in a vessel.
TREATMENT AND SURGICAL
PROCEDURES
1. Atherectomy - removal of
atheromatous plaque from the
lining of a vessel.
2. Commissurotomy - surgical
incision of a scarred mitral valve to
increase the size of the valve.
3. CABG (Coronary Artery Bypass
Grafting) - surgical creation of
shunt to bypass a blocked coronary
artery.
4. PTCA (Percutaneous Transluminal
Coronary Angioplasty) - dilatation
a blood vessel by means of a
balloon catheter inserted into the
vessel and then inflated to flatten
plaque against the artery.
VASCULAR SYSTEM
● The vascular system, also called the
“circulatory system”, is made up of the
vessels that carry blood and lymph
through the body. The arteries and veins
carry blood throughout the body,
delivering oxygen and nutrients to the
body tissues and taking away tissue waste
matter.
BLOOD VESSELS
● Blood circulates inside the blood
vessels, which form a closed transport
system, the so-called “vascular system”.
● Like a system of roads, the vascular
system has its freeways, secondary roads,
and alleys. As the heart beats, blood is
propelled into the large arteries leaving
the heart. It then moves into successively
smaller and smaller arteries and then into
the arterioles, which feed the capillary
beds in the tissues. Capillary beds are
drained by venules, which in turn empty
into veins that finally empty into the great
veins entering the heart.
● Thus arteries, which carry blood away
from the heart, and veins, which drain the
tissues and return the blood to the heart,
are simply conducting vessels — the
freeways and secondary roads.
● Only the tiny hairlike capillaries, which
extend and branch through the tissues
and connect the smallest arteries
(arterioles) to the smallest veins (venules),
directly serve the needs of the body cells.
The capillaries are the alleys that are
intimately intertwined among the body
cells. It is only through their walls that
exchanges between the tissue cells and
the blood can occur.
BLOOD VESSELS
- Forms a closed system: vascular
system
- FUNCTION: transports blood
- 3 types:
a) Arteries - receives blood
from the heart. It carries
oxygen-rich blood.
b) Capillaries - supplies
blood to every organ. It
carries a mix of
oxygenated and
deoxygenated blood.
c) Veins - brings blood back
to the heart. It carries
oxygen-poor blood.
MICROSCOPIC ANATOMY
OF BLOOD VESSELS
● Except for the microscopic capillaries,
the walls of blood vessels have three
coats, or tunics.
1. Tunica Intima
2. Tunica Media
3. Tunica Externa
▶ TUNICA INTIMA
- The tunica intima, which lines the
lumen or interior of the vessels, is
a thin layer of endothelium
(squamous epithelial cells) resting
on a scanty layer of loose
connective tissue. Its cells fit
closely together and form a slick
surface that decreases friction as
blood flows through the vessel
lumen.
▶ TUNICA MEDIA
- The tunica media is the bulky
middle coat. It is mostly smooth
muscle and elastic tissue. The
smooth muscle, which is controlled
by the sympathetic nervous
system, is active in changing the
diameter of the vessels. As the
vessels constrict or dilate, blood
pressure increases or decreases,
respectively.
▶ TUNICA EXTERNA
- The tunica externa is the
outermost tunic; it is composed
largely of fibrous connective tissue.
Its function is basically to support
and protect the vessels.
● The walls of arteries are usually much
thicker than the walls of veins. Their
tunica media, in particular, tends to be
much heavier. This structural difference is
related to a difference in function of these
two types of vessels. Arteries, which are
closer to the pumping action of the heart,
must be able to expand as blood is forced
into them and then recoil passively as the
blood flows off into the circulation during
diastole. Their walls must be strong and
stretchy enough to take these continuous
changes in pressure.
● On the other hand, veins are far from sympathetic nervous system
the heart in the circulatory pathway, and - Smooth muscle and elastic fibers
the pressure in them tends to be low all
the time. Thus veins have thinner walls. 3. TUNICA EXTERNA
However, since the blood pressure in veins - Outer layer
is usually too low to force the blood back - Fibrous connective tissue: rich in
collagen
to the heart and blood returning to the
heart often flows against gravity, veins are
modified to ensure that the amount of STRUCTURAL DIFFERENCES
blood returning to the heart (venous 1. ARTERIES
return) equals the amount being pumped - thicker walls, heavier tunica
out of the heart (cardiac output) at any media
time. The lumens of veins tend to be
2. VEINS
much larger than those of corresponding
- Thinner walls, larger lumen
arteries, and the larger veins have valves - With valves that prevent
that prevent backflow of blood. Skeletal backflow of blood
muscle activity also enhances venous
return. As the muscles surrounding the 3. CAPILLARIES
veins contract and relax, the blood is - 1 layer only: tunica intima
- Microcirculation capillary beds
"milked" through the veins toward the
- Vascular shunts v.s. true
heart. Finally, when we inhale, the drop in capillaries
pressure that occurs in the thorax causes - Terminal arteriole →
the large veins near the heart to expand precapillary sphincter →
and fill. Thus, the "respiratory pump" also postcapillary venule
helps return blood to the heart.
● The transparent walls of the capillaries
PATHWAY OF BLOOD
are only one cell layer thick — just the
tunica intima. Because of this exceptional Heart → Arteries → Capillaries →
thinness, exchanges are easily made Venules → Vein → Heart
between the blood and the tissue cells.
WHAT HELPS THE VEINS RETURN
BLOOD TO THE HEART?
MICROSCOPIC ANATOMY - Valves
- 3 tunic layers in arteries and - Skeletal muscles
veins, single layer in capillaries - Pressure changes in the thorax

1. TUNICA INTIMA
- Inner lining
- Endothelium with basement
membrane

2. TUNICA MEDIA
- Middle layer that responds to

GROSS ANATOMY OF BLOOD VESSELS
● Can be divided into two parts:
1. Major Arteries of the systemic
circulation
2. Major Veins of the Systemic
Circulation
MAJOR ARTERIES OF THE
SYSTEMIC CIRCULATION
● The aorta is the largest artery of the
body, and it is a truly splendid vessel. In
adults, the aorta is about the size of a
garden hose (with an internal diameter
the size of your thumb) where it issues
from the left ventricle of the heart. It
decreases only slightly in size as it runs to
its terminus. Different parts of the aorta
are named for their location or shape.
● The aorta curves upward from the left
ventricle of the heart as the ascending
aorta, arches to the left as the aortic arch,
and then plunges downward through the
thorax following the spine (thoracic aorta)
to finally pass through the diaphragm into
the abdominopelvic cavity, where it
becomes the abdominal aorta.
● The major branches of the aorta and the
organs they serve are listed next in
sequence from the heart. In many cases
the name of the artery tells you the body
region or organs served (renal artery,
brachial artery, and coronary artery) or
the bone followed (femoral artery and
ulnar artery).
MAJOR ARTERIES
1. AORTA
- Largest artery in the body
- Emerges from the left ventricle
- Different names depending on
location
a) Ascending aorta
b) Arch of aorta
c) Thoracic aorta
d) Abdominal aorta
ARTERIAL BRANCHES OF THE
ASCENDING AORTA
● The only branches of the ascending
aorta are the right and left coronary
arteries, which serve the heart.
ARTERIAL BRANCHES OF
THE AORTIC ARCH
● The brachiocephalic artery (the first
branch off the aortic arch) splits into the
right common carotid artery and right
subclavian artery (see the same named
vessels on the left side of the body for
organs served).
● The left common carotid artery is the
second branch off the aortic arch. It
divides, forming the left internal carotid,
which serves the brain, and the left
external carotid, which serves the skin
and muscles of the head and neck.
● The third branch of the aortic arch, the
left subclavian artery, gives off an
important branch — the vertebral artery,
which serves part of the brain. In the
axilla, the subclavian artery becomes the
axillary artery and then continues into the
arm as the brachial artery, which supplies
the arm. At the elbow, the brachial artery
splits to form the radial & ulnar arteries,
which serve the forearm.

ARTERIAL BRANCHES OF THE
THORACIC AORTA
● The intercostal arteries (ten pairs)
supply the muscles of the thorax wall.
Other branches of the thoracic aorta
supply the lungs (bronchial arteries), the
esophagus (esophageal arteries), and the
diaphragm (phrenic arteries).
ARTERIAL BRANCHES OF THE
ABDOMINAL AORTA
● The celiac trunk is the first branch of the
abdominal aorta. It is a single vessel that
has three branches: (1) the left gastric
artery supplies the stomach, (2) the
splenic artery supplies the spleen, and (3)
the common hepatic artery supplies the
liver.
● The unpaired superior mesenteric
artery supplies most of the small intestine
and the first half of the large intestine, or
colon.
● The renal (right & left) arteries serve
the kidneys.
● The gonadal (right & left) arteries
supply the gonads. They are called the
ovarian arteries in females (serving the
ovaries) and the testicular arteries in
males (serving the testes).
● The lumbar arteries are several pairs of
arteries serving the heavy muscles of the
abdomen and trunk walls.
● The inferior mesenteric artery is a
small, unpaired artery supplying the
second half of the large intestine.
● The common iliac (right & left) arteries
are the final branches of the abdominal
aorta. Each divides into an internal iliac
artery, which supplies the pelvic organs
(bladder, rectum, and so on), and an
external iliac artery, which enters the
thigh, where it becomes the femoral
artery. The femoral artery and its branch,
the deep femoral artery, serve the thigh.
At the knee, the femoral artery becomes
the popliteal artery, which then splits into
the anterior & posterior tibial arteries,
which supply the leg and foot. The
anterior tibial artery terminates in the
dorsalis pedis artery, which supplies the
dorsum of the foot (the dorsalis pedis is
often palpated in patients with circulatory
problems of the legs to determine if the
distal part of the leg has adequate
circulation).
ASCENDING AORTA
- Left and right coronary
ARCH OF AORTA
- Brachiocephalic → right common
carotid & right subclavian
- Left common carotid → left
internal carotid & left external
carotid
- Left subclavian → vertebral →
axillary → brachial → radial & ulnar
THORACIC AORTA
- Intercostal, bronchial, esophageal,
phrenic arteries
ABDOMINAL AORTA
- Celiac trunk → left gastric, splenic,
common hepatic
- Superior mesenteric (unpaired)
- Renal
- Gonadal
- Lumbar
- Inferior mesenteric (unpaired)
- Left & right common iliac →
external and internal iliac
➢ External iliac → femoral →
popliteal → anterior and
posterior tibial arteries
➢ Anterior tibial → dorsalis
pedis

MAJOR VEINS OF THE
SYSTEMIC CIRCULATION
● Although arteries are generally located
in deep, well-protected body areas, many
veins are more superficial and some are
easily seen and palpated on the body
surface. Most deep veins follow the
course of the major arteries, and with a
few exceptions, the naming of these veins
is identical to that of their companion
arteries. Major systemic arteries branch
off the aorta, whereas the veins converge
on the vena cava, which enter the right
atrium of the heart. Veins draining the
head and arms empty into the superior
vena cava and those draining the lower
body empty into the inferior vena cava.
MAJOR VEINS
- Drain every organ in the body
and returns it to the heart
- Veins are more superficial and
easily seen and palpated
- Most follow the course of the
arteries
- Naming is similar to the arteries
they accompany
- 2 largest veins
a) Superior Vena Cava
(SVC) - drains the head
and arms
b) Inferior Vena Cava (IVC)
- drains the lower body
VEINS DRAINING INTO THE
SUPERIOR VENA CAVA
Veins draining into the superior vena
cava are named in a distal to proximal
direction; that is, in the same direction the
blood flows into the superior vena cava.
● The radial & ulnar veins are deep veins
draining the forearm. They unite to form
the deep brachial vein, which drains the
arm and empties into the axillary vein in
the axillary region.
● The cephalic vein provides for the
superficial drainage of the lateral aspect of
the arm and empties into the axillary vein.
● The basilic vein is a superficial vein that
drains the medial aspect of the arm and
empties into the brachial vein proximally.
The basilic and cephalic veins are joined at
the anterior aspect of the elbow by the
median cubital vein (the median cubital
vein is often chosen as the site for blood
removal for the purpose of blood testing).
● The subclavian vein receives venous
blood from the arm through the axillary
vein and from the skin and muscles of the
head through the external jugular vein.
● The vertebral vein drains the posterior
part of the head.
● The internal jugular vein drains the
dural sinuses of the brain.
● The brachiocephalic (right & left) veins
are large veins that receive venous
drainage from the subclavian, vertebral,
and internal jugular veins on their
respective sides. The brachiocephalic
veins join to form the superior vena cava,
which enters the heart.
● The azygos vein is a single vein that
drains the thorax and enters the superior
vena cava just before it joins the heart.
VEINS DRAINING INTO THE
INFERIOR VENA CAVA
The inferior vena cava, which is much
longer than the superior vena cava,
returns blood to the heart from all body
regions below the diaphragm. As before,
we will trace the venous drainage in a
distal to proximal direction.
● The anterior & posterior tibial veins
and the peroneal vein drain the leg (calf
and foot). The posterior tibial vein
becomes the popliteal vein at the knee
and then the femoral vein in the thigh.
The femoral vein becomes the external
iliac vein as it enters the pelvis.
● The great saphenous veins are the
longest veins in the body. They receive the
superficial drainage of the leg. They begin
at the dorsal venous arch in the foot and
travel up the medial aspect of the leg to
empty into the femoral vein in the thigh.
● Each common iliac (right & left) vein is
formed by the union of the external iliac
vein and the internal iliac vein (which
drains the pelvis) on its own side. The
common iliac veins join to form the
inferior vena cava, which then ascends
superiorly in the abdominal cavity.
● The right gonadal vein drains the right
ovary in females and the right testicle in
males (the left gonadal vein empties into
the left renal vein superiorly).
● The renal (right & left) veins drain the
kidneys.
● The hepatic portal vein is a single vein
that drains the digestive tract organs and
carries this blood through the liver before
it enters the systemic circulation (the
hepatic portal system is discussed in the
next section).
● The hepatic (right & left) veins drain the
liver.
VEINS THAT DRAIN INTO THE SUPERIOR
VENA CAVA
- Radial & ulnar → brachial →
axillary → subclavian
- Cephalic → axillary
- Basilic → brachial
- Cephalic & basilic → median
cubital (blood removal)
- Axillary & external jugular →
subclavian
- Vertebral & internal jugular
- Right & left brachiocephalic →
superior vena cava
- Azygos → superior vena cava
VEINS THAT DRAIN INTO THE INFERIOR
VENA CAVA
- Anterior and posterior tibial,
fibular → popliteal → femoral →
external iliac
- Dorsal venous arch → great
saphenous femoral
- External & internal iliac → right
& left common iliac → inferior
vena cava
- Cephalic & basilic → median
cubital (blood removal)
- Right gonadal → inferior vena
cava
- Left gonadal → left renal →
inferior vena cava
- Right renal → inferior vena cava
- Hepatic portal → inferior vena
cava
- Hepatic → inferior vena cava
 CIRCULATORY SYSTEM ▶ VERTEBRAL ARTERIES
- The paired vertebral arteries pass
● The blood circulatory system is a system
upward from the subclavian
of organs that includes the heart, blood
arteries at the base of the neck.
vessels, and blood which is circulated
Within the skull, the vertebral
throughout the entire body of a human or
arteries join to form the single
other vertebrate. It includes the
basilar artery, which serves the
cardiovascular system, or vascular system,
brain stem and cerebellum as it
that consists of the heart and blood
travels upward. At the base of the
vessels.
cerebrum, the basilar artery
divides to form the posterior
SPECIAL CIRCULATION cerebral arteries, which supply the
● Special circulation can be divided into 3, posterior part of the cerebrum.
namely:
1. Arterial supply of the Brain and ● The anterior and posterior blood
the Circle of Willis supplies of the brain are united by small
2. Hepatic Portal Circulation communicating arterial branches. The
3. Fetal circulation result is a complete circle of connecting
blood vessels called the Circle of Willis,
which surrounds the base of the brain.
ARTERIAL SUPPLY OF THE BRAIN & THE
The circle of Willis protects the brain,
CIRCLE OF WILLIS
because it provides more than one route
● A continuous blood supply to the brain
for blood to reach brain tissue in case of a
is crucial, since a lack of blood for even a
clot or impaired blood flow anywhere in
few minutes causes the delicate brain cells
the system.
to die. The brain is supplied by two pairs
of arteries, the internal carotid arteries
and the vertebral arteries.

▶ INTERNAL CAROTID ARTERIES

- The internal carotid arteries,
branches of the common carotid
arteries, run through the neck and
enter the skull through the
temporal bone. Once inside the
cranium, each divides into the
anterior & middle cerebral
arteries, which supply most of the
cerebrum.
 HEPATIC PORTAL CIRCULATION
● The veins of the hepatic portal
circulation drain the digestive organs,
spleen, and pancreas and deliver this
blood to the liver through the hepatic
portal vein. After you have just eaten, the
hepatic portal blood contains large
amounts of nutrients. Since the liver is a
key body organ involved in maintaining
the proper glucose, fat, and protein
concentrations in the blood, this system
"takes a detour" to ensure that the liver
processes these substances before they
enter the systemic circulation. As blood
flows slowly through the liver, some of the
nutrients are removed to be stored or FETAL CIRCULATION
processed in various ways for later release ● Since the lungs and digestive system are
to the blood. not yet functioning in a fetus, all nutrient,
● The liver is drained by the hepatic veins excretory, and gas exchanges occur
that enter the inferior vena cava. Like the through the placenta. Nutrients and
portal circulation that links the oxygen move from the mother's blood
hypothalamus of the brain and the into the fetal blood, and fetal wastes move
anterior pituitary gland, the hepatic portal in the opposite direction. The umbilical
circulation is a unique and unusual cord contains three blood vessels:
circulation. Normally, arteries feed 1. One large umbilical vein
capillary beds, which in turn drain into 2. Two smaller umbilical arteries
veins. Here we see veins feeding the liver
circulation. ▶ UMBILICAL VEIN
● The inferior mesenteric vein, draining - The umbilical vein carries blood
the terminal part of the large intestine, rich in nutrients and oxygen to the
drains into the splenic vein, which itself fetus.
drains the spleen, pancreas, and the left
side of the stomach. The splenic vein and ▶ UMBILICAL ARTERIES
superior mesenteric vein (which drains - The umbilical arteries carry carbon
the small intestine and the first part of the dioxide and debris-laden blood
colon) join to form the hepatic portal vein. from the fetus to the placenta.
The left gastric vein, which drains the
right side of the stomach, drains directly ● As blood flows superiorly toward the
into the hepatic portal vein. heart of the fetus, most of it bypasses the
immature liver through the ductus
venosus and enters the inferior vena cava,
which carries the blood to the right atrium
of the heart.
● Since fetal lungs are nonfunctional and
collapsed, two shunts see to it that they
are almost entirely bypassed. Some of the
blood entering the right atrium is shunted
directly into the left atrium through the
foramen ovale, a flaplike opening in the
interatrial septum. Blood that does
manage to enter the right ventricle is
pumped out the pulmonary trunk, where
it meets a second shunt, the ductus
arteriosus, a short vessel that connects
the aorta and the pulmonary trunk.
Because the collapsed lungs are a
high-pressure area, blood tends to enter
the systemic circulation through the
ductus arteriosus. The aorta carries blood
to the tissues of the fetal body and
ultimately back to the placenta through
the umbilical arteries.
● At birth, or shortly after, the foramen
ovale closes, and the ductus arteriosus
collapses and is converted to fibrous
ligamentum arteriosum. As blood stops
flowing through the umbilical vessels, they
become obliterated, and the circulatory
pattern becomes that of an adult.
PHYSIOLOGY OF CIRCULATION
● A fairly good indication of the efficiency
of a person's circulatory system can be
obtained by taking arterial pulse and
blood pressure measurements. These
measurements, along with those of
respiratory rate and body temperature,
are referred to collectively as vital signs in
clinical settings.
ARTERIAL PULSE
● The alternating expansion and recoil of
an artery that occurs with each beat of the
left ventricle creates a pressure wave — a
pulse — that travels through the entire
arterial system. Normally the pulse rate
(pressure surges per minute) equals the
heart rate (beats per minute). The pulse
averages 70-76 beats per minute in a
normal resting person. It is influenced by
activity, postural changes, and emotions.
● You can feel a pulse in any artery lying
close to the body surface by compressing
the artery against firm tissue; this
provides an easy way of counting heart
rate. Because it is so accessible, the point
where the radial artery surfaces at, the
wrist (the radial pulse) is routinely used to
take a pulse measurement, but there are
several other clinically important arterial
pulse points. Because these same points
are compressed to stop blood flow into
distal tissues during hemorrhage, they are
also called pressure points. For example, if
you seriously cut your hand, you can stop
the bleeding somewhat by compressing
the radial artery or the brachial artery.
 BLOOD PRESSURE
● Any system equipped with a pump that
forces fluid through a network of closed
tubes operates under pressure. The closer
you get to the pump, the higher the
pressure. Blood pressure is the pressure
the blood exerts against the inner walls of
the blood vessels, and it is the force that
keeps blood circulating continuously even
between heartbeats. Unless stated
otherwise, the “term blood” pressure is
understood to mean the pressure within
the large systemic arteries near the heart.
BLOOD PRESSURE GRADIENT
● When the ventricles contract, they force
blood into large, thick-walled elastic
arteries that expand as the blood is
pushed into them. The high pressure in
these arteries forces the blood to
continually move into areas where the
pressure is lower. The pressure is highest
in the large arteries and continues to drop
throughout the pathway, reaching zero or
negative pressure at the vena cava. Thus,
the blood flows into the smaller arteries,
then arterioles, capillaries, venules, veins,
and finally back to the large vena cava
entering the right heart. Blood thus flows
continually along a pressure gradient
(from high to low pressure) as it makes its
circuits day in and day out. Notice that if
venous return depended entirely on a
high blood pressure throughout the
system, blood would probably never be
able to complete its circuit back to the
heart. This is why the valves in the larger
veins, the milking activity of the skeletal
muscles, and pressure changes in the
thorax are so important.
● The pressure differences between
arteries and veins become very clear
when these vessels are cut. If a vein is cut,
the blood flows evenly from the wound; a
lacerated artery produces rapid spurts of
blood.
● Continual blood flow absolutely
depends on the stretchiness of the larger
arteries and their ability to recoil and keep
the pressure on the blood as it flows off
into the circulation. To illustrate this, think
of a garden hose with relatively hard
walls. When the water is turned on, the
water spurts out under high pressure
because the hose walls don't expand.
However, when the water faucet is
suddenly turned off, the flow of water
stops just as abruptly. This is because the
walls of the hose cannot recoil to keep
pressure on the water; therefore, the
pressure drops and the flow of water
stops. The importance of the elasticity of
the arteries is best appreciated when it is
lost, as happens in arteriosclerosis.
Arteriosclerosis, also called "hardening of
the arteries".
MEASURING BLOOD PRESSURE
● Because the heart alternately contracts
and relaxes, the off-and-on flow of blood
into the arteries causes the blood
pressure to rise and fall during each beat.
Thus, two arterial blood pressure
measurements. are usually made: systolic
pressure, the pressure in the arteries at
the peak of ventricular contraction, and
diastolic pressure, the pressure when the
ventricles are relaxing. Blood pressures
are reported in millimeters of mercury
(mm Hg), with the systolic pressure
written first — 120/80 (120 over 80) responsive to many different
translates to a systolic pressure of 120mm factors. The major action of the
Hg and a diastolic pressure of 80mm Hg. sympathetic nerves on the
Most often, systemic arterial blood vascular system is to cause
pressure is measured indirectly by the vasoconstriction, or narrowing of
“auscultatory method”. This procedure, as the blood vessels, which increases
used to measure blood pressure in the the blood pressure. The
brachial artery of the arm. sympathetic center in the medulla
of the brain is activated to cause
EFFECTS OF VARIOUS FACTORS vasoconstriction in many different
ON BLOOD PRESSURE circumstances. For example, when
we stand up suddenly after lying
● Arterial blood pressure is directly
down, the effect of gravity causes
related to cardiac output (the amount of
blood to pool in the vessels of the
blood pumped out of the left ventricle per
legs and feet and the blood
minute and peripheral resistance.
pressure to drop. This activates
● Peripheral resistance is the amount of
pressoreceptors in the large
friction encountered by the blood as it
arteries of the neck and chest.
flows through the blood vessels. It is
They send off warning signals that
increased by many factors, but probably
result in reflexive vasoconstriction,
the most important is the constriction, or
which increases blood pressure
narrowing, of blood vessels, especially
back to homeostatic levels.
arterioles, as a result of sympathetic
- When blood volume suddenly
nervous system activity or atherosclerosis.
decreases, as in hemorrhage,
● Increased blood volume or blood
blood pressure drops, and the
viscosity (thickness) also raises peripheral
heart begins to beat more rapidly
resistance. Any factor that increases either
(as it tries to compensate).
the cardiac output or peripheral resistance
However, because venous return is
causes an almost immediate reflex rise in
reduced by blood loss, the heart
blood pressure. Many factors can alter
also beats weakly and inefficiently.
blood pressure — age, weight, time of
In such cases, the sympathetic
day, exercise, body position, emotional
nervous system causes
state, and various drugs, to name a few.
vasoconstriction to increase the
The influence of a few of these factors are:
blood pressure so that (hopefully)
venous return increases and
1. NEURAL FACTORS: AUTONOMIC
circulation can continue.
NERVOUS SYSTEM
- The final example concerns
- The parasympathetic division of
sympathetic nervous system
the autonomic nervous system has
activity when we exercise
little or no effect on blood
vigorously or are frightened and
pressure, but the sympathetic
have to make a hasty escape.
division is important and is
 Under these conditions, there is a
generalized vasoconstriction
except in the skeletal muscles. The
vessels of the skeletal muscles
dilate to increase the blood flow to
the working muscles (it should be
noted that the sympathetic nerves
never cause vasoconstriction of
blood vessels of the heart or
brain).
2. RENAL FACTORS: KIDNEY
- The kidneys play a major role in
regulating arterial blood pressure
by altering blood volume. As blood
pressure (and/or blood volume)
increases beyond normal, the
kidneys allow more water to leave
the body in the urine. Since the
source of this water is the
bloodstream, blood volume
decreases, which in turn decreases
blood pressure. However, when
arterial blood pressure falls, the
kidneys retain body water,
increasing blood volume, and
blood pressure rises.
- In addition, when arterial blood
pressure is low, certain kidney cells
release the enzyme renin into the
blood. Renin triggers a series of
chemical reactions that result in
the formation of angiotensin II, a
potent vasoconstrictor chemical.
Angiotensin also stimulates the
adrenal cortex to release
aldosterone, a hormone that
enhances sodium ion reabsorption
by the kidneys. As sodium moves
into the blood, water follows.
Thus, blood volume and blood
pressure both rise.
3. TEMPERATURE
- In general, cold has a
vasoconstricting effect. This is why
your exposed skin feels cold to the
touch on a winter day and why
cold compresses are
recommended to prevent swelling
of a bruised area. On the other
hand, heat has a vasodilating
effect, and warm compresses are
used to speed the circulation into
an inflamed area.
4. CHEMICALS
- The effects of chemical substances,
many of which are drugs, on blood
pressure are widespread and well
known in many cases.
a) Epinephrine - increases both heart
rate and blood pressure.
b) Nicotine - increases blood pressure
by causing vasoconstriction.
c) Alcohol & Histamine - cause
vasodilation and decrease the
blood pressure. The reason a
person who has "one too many"
becomes flushed is that the skin
vessels have been dilated by
alcohol.
5. DIET
- Although medical opinions tend to
change and are at odds from time
to time, it is generally believed that
a diet low in salt, saturated fats,
and cholesterol helps to prevent
hypertension, or high blood
pressure.
 VARIATIONS IN BLOOD PRESSURE
● In normal adults at rest, systolic blood
pressure varies between 110 and 140mm
Hg, and diastolic pressure between 75 and
80mm Hg — but blood pressure varies
considerably from one person to another.
What is normal for you may not be normal
for your grandfather or your neighbor.
Blood pressure varies with age, weight,
race, mood, physical activity, and posture.
Nearly all these variations can be
explained in terms of the factors affecting
blood pressure.
● Hypotension, or low blood pressure, is
generally considered to be a systolic blood
pressure below 100mm Hg. In many cases,
it simply reflects individual differences and
is no cause for concern. In fact, low blood
pressure is an expected result of physical
conditioning and is often associated with
long life and an old age free of illness.
Elderly people may experience
temporary low blood pressure and
dizziness when they rise suddenly from
a reclining or sitting position — a
condition called orthostatic
hypotension. Because an aging
sympathetic nervous system reacts
more slowly to postural changes, blood
pools briefly in the lower limbs,
reducing blood pressure and,
consequently, blood delivery to the
brain. Making postural changes more
slowly to give the nervous system time
to make the necessary adjustments
usually prevents this problem.
Chronic hypotension (not explained
by physical conditioning) may hint at
poor nutrition and inadequate levels of
blood proteins. Because blood viscosity
is low, blood pressure is also lower than
normal. Acute hypotension is one of
the most important warnings of
circulatory shock, a condition in which
the blood vessels are inadequately filled
and blood cannot circulate normally.
The most common cause is blood loss.
A brief elevation in blood pressure is
a normal response to fever, physical
exertion, and emotional upset, such as
anger and fear. Persistent hypertension,
or high blood pressure, is pathological,
and is defined as a condition of
sustained elevated arterial pressure of
140/90 or higher.
Chronic hypertension is a common
and dangerous disease that warns of
increased peripheral resistance.
Although it progresses without
symptoms for the first 10 to 20 years, it
slowly and surely strains the heart and
damages the arteries. For this reason,
hypertension is often called the "silent
killer." Because the heart is forced to
pump against increased resistance, it
must work harder, and in time, the
myocardium enlarges. When finally
strained beyond its capacity to respond,
the heart weakens and its walls become
flabby. Hypertension also ravages blood
vessels, causing small tears in the
endothelium that accelerate the
progress of atherosclerosis.
CAPILLARY EXCHANGE
● Capillaries form an intricate network
among the body's cells such that no
substance has to diffuse very far to enter
or leave a cell. The substances exchanged
first diffuse through an intervening space
filled with interstitial fluid (tissue fluid).
● Substances tend to move to and from priority (intestinal capillaries or
body cells according to their concentration those serving endocrine glands) or
gradients. Thus, oxygen and nutrients where filtration occurs (the
leave the blood and move into the tissue kidney). A fenestra is an oval pore
cells, and carbon dioxide and other wastes (“fenestra” — window) or opening
exit the tissue cells and enter the blood. and is usually covered by a delicate
Basically, substances entering or leaving membrane. Even so, a fenestra is
the bloodstream may take one of four much more permeable than other
routes across the plasma membranes of regions of the plasma membrane.
the single layer of endothelial cells
forming the capillary wall. DEVELOPMENTAL ASPECT
● The heart begins as a simple tube in the
1. As with all cells, substances can
embryo. It is beating and busily pumping
diffuse directly through (cross)
blood by the fourth week of pregnancy.
their plasma membranes if they
During the next three weeks, the heart
are lipid-soluble (like the
continues to change and mature, finally
respiratory gasses).
becoming a four-chambered structure
2. Certain lipid-insoluble substances
capable of acting as a double pump — all
may enter or leave the blood
without missing a beat! During fetal life,
and/or endothelial cells within
the collapsed lungs and nonfunctional
vesicles, that is, by endocytosis or
liver are mostly bypassed by the blood,
exocytosis.
through special vascular shunts. After the
Diffusion of substances via the other two
seventh week of development, few
routes depends on the specific structural
changes other than growth occur in the
(and permeabil-ity) characteristics of the
fetal circulation until birth. Shortly after
capillary.
birth, the bypass structures become
3. Limited passage of fluid and small
blocked, and the special umbilical vessels
solutes is allowed by intercellular
stop functioning.
clefts (gaps or areas of plasma
membrane not joined by tight
junctions). It is safe to say that,
with the exception of brain
capillaries, which are entirely
secured together by tight junctions
(the basis of the blood-brain
barrier), most of our capillaries
have intercellular clefts.
4. Very free passage of small solutes
and fluids is allowed by fenestrated
capillaries. These unique capillaries
are found where absorption is a