Kheio and Shen

CIRCULATORY
MIDTERM: PT I
WHAT
• The cardiovascular system delivers
Maximum intensity/ maximal impulse- Location of which the
oxygen and nutrients to the body cardiac impulse can be best palpated on the chest wall
tissues and carries away wastes *Where can you find Apex? Or point of maximal impulse = It is
such as carbon dioxide via blood in the 4th - 5th intercostal space , left midclavicular line
(below the nipple line)

HOW
• The heart pumps blood through the
body in blood vessels.
• Blood flow requires both the
pumping action of the heart and
changes in blood pressure

WHY
• If the cardiovascular system
cannot perform its functions, waste
builds up in tissues.
• Body organs fail to function
properly, and then, once oxygen
becomes depleted, they will die.

SIZE, LOCATION, ORIENTATION

• A muscular organ
• Size:
a. Fist
b. Hollow
c. Cone-shaped
d. Weight less than a pound
• Location:
a. Slightly left of the
breastbone.
b. In the thoracic cavity,
c. Flanked on each side by the
lungs
d. In the inferior mediastinum.
e. Apex:
➢ Is directed toward the
left hip and rests on
the diaphragm
➢ Fifth intercostal
space: exactly where
one would place a
stethoscope top
count the heart rate
for apical pulse
f. Base- Points towards right
shoulder; lies beneath the
second rib. Superior part of
heart
Major difference between the
cardiovascular system and the
circulatory system
➢ Circulatory System=Lymphatic
➢ Cardiovascular System:
• “Cardio”= Heart
• “Vascular”=Blood vessels
• Closed system- of heart and blood
vessels
• Function is Related to blood
• Transport system of the body
(includes heart-pumping system
CARDIOVASCULAR SYSTEM
and blood vessels-piping system)
• Transport of oxygen and CO2
(Carried by RBC)
• RBC travel through blood vessels
• Transport nutrients to the cell (The
glucose is an important food of the
cell, so that it can provoke cellular
metabolism)
• Movement of immune system
(WBC)
 COVERINGS AND WALLS

INTERCALATED DISKS

CARDIOMYOCYTES

COVERINGS; DOUBLE WALLS PERICARDIUM

OUTER INNER FIBROUS
Outer layer FIBROUS SEROUS PERCARDIUM
• Double wall LAYER MEMBRANE -Loosely fitting
• Fibrous pericardium superficial
• Serous Pericardium
SEROUS PARIETAL
Inside of Serous Pericardium PERICARDIUM PERICARDIUM
• Parietal(outer)
• Visceral (internal or hollow organ) VISCERAL Lubricating serous fluid is
PRICARDIUM produced by a serous
Epicardium or pericardial membrane and
• Viscera/ visceral EPICARDIUM collects in the pericardial cavity
between the serous layer
Between the parietal and visceral
• Pericardium =CARDIAL CAVITY
• has a serous fluid for lubrication Note: Fluid allows the heart to beat easily
• Prevent damage of the heart in a relatively frictionless environment, as
• An enclosed sac of heart the serous pericardial layers slide smoothly
across each other.

3 WALLS OF THE HEART 4 CHAMBERS OF THE HEART

1. Atria (right and left)
1. Epicardium
• Receiving chambers
• Visceral (made up of connective
• Assist with filling the ventricles
tissue for protection of the heart)
• Blood enters under low pressure
2. Myocardium
(elastic) inner chamber
• Cardiac muscle
• Auricle- protective covering over
• Middle Layer
the atria (pouch like structure)
• Dense fibrous connective tissue
• Skeleton of the heart
2. Ventricles (right and left)
3. Endocardium
• Discharging chambers
• Endothelium- Inner layer of the wall
• Thick-walled pumps of the heart
• Visceral Pericardium- Outside layer
• Discharge blood outside
Cardiomyocytes- Cell found In the HEART • Pumping blood to the aorta and
goes throughout the body
Intercalated disks- Gap Junctions, allows
ions to flow from cell to cell
3. Interatrial septum
• Separates the two atria
HEART VALVES
longitudinally • Allow blood to flow in only one
4. Interventricular Septum direction, to prevent backflow
• Separates the two ventricles • One direction/ unidirectional
longitudinally • Opens when the blood comes
through
Coronary sulcus- The one that lines your
• Close- response to pressure
atria and ventricle externally outside your
heart changes
• *opens and closes due to the
pressure changes of the heart
THE GREAT VESSELS
• Aorta.
• Main pulmonary artery
(also called your pulmonary trunk).
• Pulmonary veins.
• Superior vena cava.
• Inferior vena cava.

THE SEPARATING STRUCTURE

• Interatrial septum
• Septum divides
-(left and right atrium, leftt and
1. Atrioventricular (AV) valves
right ventricle)
• Between atria and ventricles
• Septum divides
-(upper atria and lower ventricle) a. Left AV valve: bicuspid (mitral) valve
• Interventricular septum b. Right AV valve: tricuspid valve
-(between both ventricles)
• Anchored the cusps in place by
SYSTEMIC CIRCULATION chordae tendinae (CT) to the walls
of the ventricles
• Oxygen-rich blood returned to the • Open during heart relaxation,
left side of the heart is pumped out when blood passively fills the
into the aorta chambers
• Blood circulates to systemic arteries • Closed during ventricular
and to all body tissues contraction
• Left ventricle has thicker walls
because it pumps blood to the
body through the systemic circuit
• Oxygen-poor blood returns to the
right atrium via systemic veins,
which empty blood into the
superior or inferior vena cava

Chordae tendinae (CT)/ Heart String

holding your valves open and close
together with papillary muscle and
prevents back flow.
2. Semilunar valves
• between ventricle and artery
CARDIAC CIRCULATION
SUPERIOR VENA CAVA RIGHT
a. Pulmonary semilunar valve INFERIOR VENA CAVA ATRIUM
- goes to the lungs, pulmonary artery
b. Aortic semilunar valve TRICUSPID
-Aorta VALVE

• Closed during heart relaxation PULMONARY PULMONARY RIGHT

• Open during ventricular ARTERY VALVE VENTRICLE
contraction
• Valves open and close in response
to pressure changes in the heart LEFT
LUNGS ATRIUM
BLOOD VESSELS MITRAL
VALVE

REST OF
THE AORTA AORTIC LEFT
VALVE VENTRICLE
BODY

➢ Blood in the heart chambers does

not nourish the myocardium.
➢ Coronary/ Cardiac Circulation-
“Corona Heart” around the heart
➢ It has its own blood vessel system
➢ Heart has its own nourishing
circulatory system consisting of:

Blood Vessels are tubular structures
carrying blood to the tissues and organs.
There are are:
3 MAJOR TYPES OF BLOOD
VESSELS
Arteries
• Transport blood and other
substances away from the heart.
Veins
• Return blood back toward the
heart.
Capillaries
• Surround body cells and tissues to
deliver and absorb oxygen,
nutrients and other substances.
CLOSE SYSTEM
1. Coronary arteries
• branch from the ascending aorta
• to supply the heart muscle with
oxygenated blood.
• Coronary artery gets blood in the
aorta
• When there is a blockage in one of
the arteries= HEART ATTACK
/Myocardial infarction
2.Cardiac veins
• Drain the myocardium of blood
through Coronary Sinus and into
the right atrium
3. Coronary sinus
• A large vein on the posterior of the
heart; receives blood from
4. Cardiac veins.
• Blood empties into the right atrium
via the coronary sinus.
• (3 openings/holes) superior, inferior
vena cava, coronary sinus
• They all contain deoxygenated
blood
 PULMONARY SYSTEMIC
CIRCULATION CIRCULATION
Right -Side of the Left-Side of the
Heart Heart
Low Pressure High Pressure
System System
RA→ RV→ PV→ LA→LV→
PA→Lungs Aorta→ Body

ADD ON NOTE: NOT VV IMPORTANT

Open circulatory system: It is primarily

found in invertebrates. Here, the blood
flows freely through cavities since there
are no vessels to conduct the blood.

Closed circulatory system: It is found in

vertebrates and a few invertebrates, like
earthworms. This system has vessels that
conduct blood throughout the body.
 CIRCULATORY COMPONENTS INCLUDE

MIDTERM:PT II
1. Heart functions as a double pump.
2. Arteries carry blood away from the
heart.
3. Veins carry blood toward the heart.

DOUBLE PUMP

PULMONARY SYSTEMIC
CIRCULATION CIRCULATION
Right -Side of the Left-Side of the 1. Sinoatrial (SA) node
Heart Heart • Located in the right atrium
Low Pressure High Pressure • Serves as the heart’s pacemaker
System System
RA→ RV→ PV→ LA→LV→ 2. Atrioventricular (AV) node
PA→Lungs Aorta→ Body • Is at the junction of the atria and
• Cardiac muscle contracts ventricle.
spontaneously and independently ➢ Atrioventricular (AV) bundle
(bundle of His) and bundle
of nerve impulses.
branches are in the interventricular
• Spontaneous contractions occur in
septum.
a regular and continuous way. ➢ Purkinje fibers spread within the
Atrial cells beat 60 times per ventricle wall muscles
• minute.
• Ventricular cells beat 20−40 times • The sinoatrial node (SA node)
• per minute. starts each heartbeat.
• It needs a unifying control system— • Impulse spreads through the
the intrinsic conduction system atria to the AV node.
(nodal system) • Atria contract. At the AV node,
the impulse is delayed briefly.
• Impulse travels through the AV
TWO SYSTEM REGULATE
bundle, bundle branches, and
HEART ACTIVITY Purkinje fibers.
• Ventricles contract; blood is
1. Autonomic nervous system
ejected from the heart
2. Intrinsic conduction system/ the nodal
system
• Sets the heart rhythm PHYSIOLOGY
• Composed of special nervous
Tachycardia
tissue
• rapid heart rate
• Ensures heart muscle
• over >100 beats per minute
depolarization in one direction only
(atria to ventricles)
Normocardia
• Enforces a heart rate of 75 beats
• Normal/Neutral
per minute
• 60-100 BPM Ave. 75

Bradycardia
• slow heart rate
• less than <60 beats per minutes
 75 beats per minute
CARDIAC CYCLE • Average heart rate
The cardiac cycle refers to one complete
heartbeat, in which both atria and 0.8 second
ventricles contract and then relax • Normal cardiac cycle length

Systole = Contraction (SC)

Diastole = Relaxation (DR)

Atrial diastole (ventricular filling)

CYCLE

Atrial diastole (Ventricular Filling) Isovolumetric Contraction

• Heart is relaxed and pressure in
heart is low.
• At this point, Atrioventricular valves
are open and blood flows passively
into the atria and into ventricles.
• Semilunar valves are closed
• Atrial systole ends; ventricular
systole begins.
• Intraventricular pressure rises.
• AV valves close.
• For a moment, the ventricles are
completely closed chambers

Ventricular Systole (ejection phase)
• Ventricles continue to contract.
• Intraventricular pressure now
surpasses the pressure in the major
arteries leaving the heart.
• Semilunar valves open.
• Blood is ejected from the ventricles.
• Atria are relaxed and filling with
blood.
Isovolumetric Relaxation
• Ventricular diastole begins. Pressure
falls below that in the major
arteries.
• Semilunar valves close.
• For another moment, the ventricles
are completely closed chambers.
• When atrial pressure increases
above intraventricular pressure, the
AV valves open.
HEART SOUNDS
1. Lub
• Longer, louder heart sound caused
by the closing of the AV valves
2. Dub
• Short, sharp heart sound caused by
the closing of the semilunar valves
at the end of ventricular systole
FIRST HEART SOUND SECOND SOUND
S1 (Lub) S2 (Dub/Dupp)
Caused by closing Occurs when
of AV Valves Semilunar Valves
close at the end of
systole
Longer and Louder Short and Sharp
3. Murmurs
• Abnormal heart sounds caused by
turbulent flow of blood such as with
presence of obstruction.
• Usually indicates valve problems
CARDIO CONCEPTS
PERIPHERAL VASCULAR RESISTANCE
• The resistance in the circulatory
system that is used to create blood
pressure
• The flow of blood and is also a
component of cardiac function
Cardiac output (CO)
• Amount of blood pumped by each side
(ventricle) of the heart in 1 minute.
Stroke volume (SV)
• Volume of blood pumped by each
ventricle in one contraction (each
heartbeat).
• About 70 ml of blood is pumped out of
the left ventricle with each heartbeat.
Heart rate (HR)
• Typically 75 beats per minute.
• Cardiac output is the product of the heart
rate (HR) and the stroke volume (SV)
➢ CO = HR × SV
➢ CO = HR (75 beats/min) × SV (70 ml/beat)
➢ CO = 5250 ml/min = 5.25 L/min
Regulation of Stroke Volume
• 60 percent of blood in ventricles (about
70 ml) is pumped with each heartbeat.
Starling’s law of the heart
• The critical factor controlling SV is how
much cardiac muscle is stretched.
• The more the cardiac muscle is stretched,
the stronger the contraction.
• Venous return is the important factor
influencing the stretch of heart muscle
FACTORS MODIFYING BASIC
HEART ATTACK
1. Neural (ANS) controls
• Sympathetic nervous system
speeds heart rate
• Parasympathetic nervous
system, primarily vagus
nerve fibers, slow and
steady the heart rate
2. Hormones and ions
• Epinephrine and thyroxine
speed heart rate
• Excess or lack of calcium,
sodium, and potassium ions
also modify heart activity
3. Physical factors
• Age, gender, exercise, body
temperature influence heart
rate.
BLOOD VESSELS
Blood vessels form a closed vascular
system
WALLS OF THE VESSELS
MICROSCOPIC ANATOMY OF BLOOD VESSELS
• Acts as vessels for blood to be
carried AWAY and TOWARD the
heart
• Play a role in gas exchange
between tissues and blood

VESSELS THAT CARRY BLOOD

AWAY FROM THE HEART
Arteries and arterioles.
• Vessels that play a role in
exchanges between tissues and
blood.
• Most arterial blood is pumped by
the heart
Capillaries
• Walls of Capillaries are only one
cell layer thick to allow for
exchange between blood and
tissue through DIFFUSION
Capillary beds
• Form a network called Capillary
beds that consist of a vascular
shunt and true capillaries where
Microcirculation occurs
• Vessels that return blood toward
the heart
Venules and veins
• Use the milking action of muscles to
help move blood
1. Tunica intima
• Forms a friction-reducing lining.
• Endothelium
2. Tunica Media
• Smooth muscle and elastic tissue
• Controlled by sympathetic nervous
system.
• Vasodilation/Vasoconstriction
3. Tunica externa
• Strengthen/ Anchors
• Forms protective outermost
covering
• Mostly fibrous connective tissue
• Supports and protects the vessel.
STRUCTURAL DIFFERENCES IN
ARTERIES, VEINS,
AND CAPILLARIES

ARTERIES VS VEINS
ARTERIES VEINS
DIRECTION Blood Blood
OF FLOW AWAY from TOWRD the
the Heart Heart
PRESSURE Higher Lower
WALLS THICKER: THINNER:
Tunica Tunica
• Arteries have a heavier, stronger,
media externa
stretcher tunica media than veins
thicker than thicker that
tunica tunica to withstand changes in pressure.
externa media • Veins have a thinner tunica media
LUMEN Small Large than arteries and operate under
VALVES No Valves Valves low pressure.
• Veins also have valves to prevent
backflow of blood.
• Lumen of veins is larger than that of
arteries.
 • Skeletal muscle “milks” blood in
veins toward the heart.
• Capillaries have only one cell layer
thick (tunica intima).
• Allow for exchanges between
blood and tissue.
• Blood flow through a capillary bed
is known as microcirculation.
• Form networks called capillary
beds that consist of:
a. A vascular shunt
b. True capillaries
• True capillaries is a branch off a
terminal arteriole.
• Empty directly into a postcapillary
venule.
• Its Entrances to capillary beds are
guarded by precapillary sphincters.
GROSS ANATOMY OF BLOOD
VESSELS
Ovarian arteries in females serve the ovaries
Testicular arteries in males serve the testes
Lumbar arteries serve muscles of the
abdomen and trunk
Major arteries of systemic circulation
Aorta
• largest artery in the body. Leaves
from the left ventricle of the heart
Regions
a. Ascending aorta
• leaves the left ventricle
b. Aortic arch
• arches to the left
c. Thoracic aorta
• travels downward through the
thorax
d. Abdominal aorta
• passes through the diaphragm into
the abdominopelvic cavity.
• Arterial branches of the abdominal
aorta.
• Celiac trunk is the first branch of
the abdominal aorta.
THREE BRANCHES ARE
1. Left gastric artery (stomach)
2. Splenic artery (spleen)
3. Common hepatic artery (liver)
Superior mesenteric artery
supplies most of the:
• small intestine and first half of the
large intestine.
• Left and right renal arteries
(kidney).
• Left and right gonadal arteries
e. Arterial branches of the ascending
aorta
• Right and left coronary arteries
serve the heart.
• Intercostal arteries supply the
muscles of the thorax wall.
• Other branches of the thoracic
aorta (not illustrated) supply the:
➢ Lungs (bronchial arteries)
➢ Esophagus (esophageal
arteries)
➢ Diaphragm (phrenic arteries)
f. Arterial branches of the aortic arch
Brachiocephalic trunk splits into the:
• Right common carotid artery
• Right subclavian artery
Left common carotid artery splits into the:
• Left internal and external carotid
arteries
Left subclavian artery branches into the:
• Vertebral artery
• In the axilla, the subclavian artery
becomes the axillary artery →
brachial artery → radial and ulnar
arteries
• serves the second half of the large
intestine.
Left and right common iliac arteries
• the final branches of the aorta.
Internal iliac arteries
• serve the pelvic organs.
External iliac arteries
• enter the thigh → femoral artery
→ popliteal artery → anterior and
posterior tibial arteries

MAJOR VEINS OF SYSTEMATIC CIRCULATION

______________________________________
Inferior mesenteric artery
Superior vena cava and inferior vena
cava enter the right atrium of the heart.
• Superior vena cava-drains the
head and arms.
• Inferior vena cava- drains the lower
body
Veins draining into the superior vena
cava.
• Radial and ulnar veins → brachial
vein → axillary vein.
Cephalic vein
• Drains the lateral aspect of the arm
and empties into the axillary vein.
Basilic vein
• Drains the medial aspect of the
arm and empties into the brachial
vein.
Basilic and cephalic veins
• Are joined at the median cubital
vein (elbow area)
Subclavian vein receives:
• Venous blood from the arm via the
axillary vein
• Venous blood from skin and
muscles via external jugular vein.
Vertebral vein
• drains the posterior part of the
head.
Internal jugular vein
• drains the dural sinuses of the brain.
Left and right brachiocephalic veins
receive venous blood from the:
• Subclavian veins
• Vertebral veins
• Internal jugular veins
Brachiocephalic veins join to form
The superior vena cava → right atrium of
heart Azygos vein drains the thorax
Veins draining into the inferior vena cava
Anterior and posterior tibial veins and
fibial veins
• drain the legs.
Posterior tibial vein → popliteal vein →
femoral vein → external iliac vein.
Great saphenous veins (longest veins of
the body) receive superficial drainage of
the legs.
Each common iliac vein (left and right) is
formed by the union of the internal and
external iliac vein on its own side.
Right gonadal vein
• drains the right ovary in females
and right testicle in males.
Left gonadal vein
• empties into the left renal vein.
Left and right renal veins
• drain the kidneys.
Hepatic portal vein
• drains the digestive organs and
travels through the liver before it
enters systemic circulation.
Left and right hepatic veins
• drain the liver.
ARTERIAL SUPPLY OF THE BRAIN
AND THE CIRCLE OF WILLIS
Internal carotid arteries
1. Anterior cerebral arteries
2. Middle cerebral arteries
These arteries supply most of the
cerebrum.
_____________________________________
Basilar artery
• Vertebral arteries join once within
the skull to form the basilar artery.
• Serves the brain stem and
cerebellum.
• Posterior cerebral arteries form from
the division of the basilar artery.
o These arteries supply the
posterior cerebrum
Circle of Willis HEATIC PORTAL SYSTEM
• Anterior and posterior blood STOMACH & INTESTINES
supplies are united by small
communicating arterial branches.
• Result—complete circle of SUP. & INF MESENTERIC VEINS
connecting blood vessels called
cerebral arterial circle, or circle of
Willis. HEPATIC PORTAL VEIN

HEPATIC PORTAL SYSTEM

LIVER SIUSOIDS
is an arrangement of blood vessels, such
that blood passes from capillary bed into
larger blood vessels and then into another HEPATIC VEIN
capillary bed

INFERIOR VENA CAVA

PHYSIOLOGY OF CIRCULATION
A. Vital signs
• Measurements of arterial pulse
• respiratory rat
• body temperature
• blood pressure

Hepatic portal circulation

• formed by veins draining the
digestive organs, which empty into
the hepatic portal vein:

1. Digestive organs
2. Spleen
3. Pancreas

Hepatic portal vein

• carries this blood to the liver, where
it is processed before returning to
systemic circulation
• Receives venous blood from the
stomach, the small intestines, the
large intestines, as well as venous
blood from the gallbladder, spleen,
and pancreas
• called a portal vein because it
leads into thee hepatic portal
system
B. Arterial pulse
• Alternate expansion and recoil of a
blood vessel wall (the pressure
wave) that occurs as the heart
beats.
• Monitored at pressure points in
superficial arteries, where pulse is
easily palpated.
• Pulse averages 70 to 76 beats per
minute at rest, in a healthy person.
C. Blood Pressure
• The pressure the blood exerts
against the inner walls of the blood
vessels.
• The force that causes blood to
continue to flow in the blood
vessels.
o The pressure of the blood
exerts against the inner walls
of the blood vessels
o Pressure in blood vessels
DECREASES as the distancce
away from the heart
INCREASES
When the ventricles contract:
• Blood is forced into elastic arteries
close to the heart and blood flows
along a descending pressure
gradient.
• Pressure decreases in blood vessels
as distance from the heart
increases.
• Pressure is high in the arteries, lower
in the capillaries, and lowest in the
veins
PHYSIOLOGY OF CIRCULATION
Systolic
• pressure in the arteries at the peak
of ventricular contraction
• ranges from 110 to 140 mm Hg
Diastolic
• pressure when ventricles relax
• ranges from 70 to 80 mm Hg
Expressed as systolic pressure over
diastolic pressure in millimeters of mercury
(mm Hg) For example, 120/80 mm Hg.
AUSCULTATORY METHOD
is an indirect method of measuring
systemic arterial blood pressure, most
often in the brachial artery
Effects of Various Factors on
Blood Pressure
Arterial blood pressure (BP)
• is directly related to cardiac output
and peripheral resistance.
Cardiac output
• (CO; the amount of blood pumped
out of the left ventricle per minute).
Peripheral resistance
• (PR; the amount of friction blood
encounters as it flows through
vessels):
• BP = CO × PR
Hypotension
• (low blood pressure).
• Low systolic (below 100 mm Hg).
• Often associated with illness.
• Acute hypotension is a warning sign for
circulatory shock
Hypertension
• (high blood pressure).
• Sustained elevated arterial pressure of
140/90 mm Hg.
• Warns of increased peripheral resistance.
Normotensive
• <120/80 mmHg
 Arteriosclerosis
DEVELOPMENTAL ASPECTD OF • Hardening and thickening of
CARDIOVASCULAR SYSTEM arterial wall

• In an embryo Artherosclerosis
• The heart develops as a simple • Chronic inflammatory disorder
tube and pumps blood by week 4 • Medium and Large arteries
of pregnancy. • Build-up of cholesterol plaques
• The heart becomes a four-
chambered organ capable of Most Common Arteries Affected
acting as a double pump over the 1. Abdominal Aorta
next 3 weeks 2. Coronary
3. Popliteal
ADULT FETUS 4. Carotid
Fossa ovale Foramen ovale
Ligamentum arteriosum Ductus arteriosus

Medial umbilical Umbilical aa.

ligaments (wiithin fetus)
Round ligament Umbilical v.
(ligamentumteres) of (within fetus)
liver
Ligamentum venosum Ductus venosus
Medial umbilical Umbilical cord (
ligament leaving fetus)

AGE-RELATED CHANGES OF THE

CARDIOVASCULAR SYSTEM

1. Weakening of venous valves

2. Varicose veins
3. Progressive arteriosclerosis
4. Hypertension resulting from loss of
elasticity of vessels
5. Coronary artery disease resulting
from fatty, calcified deposits in the
vessels