Circulation Medsparkles Notes Physiology

CIRCULATION
PHYSIOLOGY CRASH COURSE BY MEDSPARKLES
S.no Topics Page number
1 Blood and components 1-7
2 Cardiovascular system 8-10

• Heart structure
• Heart beat co-
ordination
• Cardiac cycle
3 Lymphatic system 11
4 Hemorrhage 12
5 Hypotension 13
6 Coronary artery disease 13-15

• Angina
• Myocardial Infarction
7 Hypertension 15-16
8 Heart Failure 16-18

1
PHYSIOLOGY NOTES TOPIC (CIRCULATION) BY DR RUQAIYA FAROOQ MEDSPARKLES
Blood by definition, is a fluid that moves through the vessels of a circulatory

system. In humans, it includes plasma (the liquid portion), blood cells (which come
in both red and white varieties), and cell fragments called platelets.
• Plasma is the main component of blood and consists mostly of water, with
proteins, ions, nutrients, and wastes mixed in.
• Red blood cells are responsible for carrying oxygen and carbon dioxide.
• Platelets are responsible for blood clotting.
• White blood cells are part of the immune system and function in immune
response.
Red blood cell, cellular component of blood, millions of which in the circulation of
vertebrates give the blood its characteristic colour and carry oxygen from the lungs to
the tissues. The mature human red blood cell is small, round, and biconcave; it appears
dumbbell-shaped in profile. The cell is flexible and assumes a bell shape as it passes
through extremely small blood vessels. It is covered with a membrane composed of
lipids and proteins, lacks a nucleus, and contains hemoglobin—a red iron-rich protein
that binds oxygen.
Structure:
Non-Nucleated
Mitochondria, Golgi apparatus and DNA is absent
RBCs has a special type of cytoskeleton which is made up of actin and spectrin
Properties:
Rouleaux formation (like pile of coins)
Suspension stability (remain suspended in blood)
Fate of RBCS:
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2
When the lifespan of RBCs (120 days) is completed, they become fragile and the
diameter of capillary is either less or become equal to that RBC, so that because of
fragile nature they couldn’t pass through the splenic capillaries and while trying to
squeeze through it they destroyed there hence spleen is called graveyard of RBCs.
Destroyed RBCs are fragmented and hemoglobin is released from the fragmented
parts. Hemoglobin is immediately phagocytized by macrophages of the body,
particularly the macrophages present in liver (Kupffer cells), spleen and bone
marrow.
Hemoglobin is degraded into iron, globin and porphyrin. Iron combines with the
protein called apoferritin to form ferritin, which is stored in the body and reused
later. Globin enters the protein depot for later use. Porphyrin is degraded into
bilirubin, which is excreted by liver through bile. Daily 10% RBCs, which are senile,

3
are destroyed in normal young healthy adults. It causes release of about0.6 g/dL of
hemoglobin into the plasma. From this 0.9 to1.5 mg/dL bilirubin is formed.
Variations in RBCs count:
Increase in RBCs is polycythemia which can be physiological and pathological.

Polycythemia due to physiological reason is called physiological polycythemia. It
occurs in following conditions;
• High altitude
• Muscular exercise
• Emotional condition
Decrease in RBCs count is due to;
• High barometric pressures

• During sleep
• Pregnancy
In pathological conditions, the variations in size of RBCs are:

• 1. Microcytes (smaller cells)
• 2. Macrocytes (larger cells)
• 3. Anisocytes (cells with different sizes).
Hemoglobin (Hb)
It is the iron containing coloring matter of red blood cell (RBC). Hemoglobin is a
conjugated protein. It consists of a protein combined with an iron containing
pigment. The protein part is globin and the iron containing pigment is heme.
Abnormalities of Hb:
Hemoglobinopathies are genetic disorders caused by abnormal polypeptide chains
of hemoglobin.
Hb S It is found in sickle cell anemia. In this, the α-chains are normal and β-chains
are abnormal.
Hb C The β-chains are abnormal. It is found in people with hemoglobin C disease,
which is characterized by mild hemolytic anemia and splenomegaly.

4
Hb E Here also the β-chains are abnormal. It is present in people with hemoglobin
E disease which is also characterized by mild hemolytic anemia and splenomegaly.
Hb M It is the abnormal hemoglobin present in the form of methemoglobin. It
occurs due to mutation of genes of both in α and β chains, resulting in abnormal
replacement of amino acids. It is present in babies affected by hemoglobin M
disease or blue baby syndrome. It is an inherited disease, characterized by
methemoglobinemia.
Hemoglobin in thalassemia
In α-thalassemia, the α-chains are decreased, absent or abnormal and in β-
thalassemia, the β-chains are decreased, absent or abnormal.
Abnormal Hb derivatives
• Carboxyhemoglobin or carbon monoxyhemoglobin is the abnormal
hemoglobin derivative formed by the combination of carbon monoxide with
hemoglobin.
• Sulfhemoglobin is the abnormal hemoglobin derivative, formed by the
combination of hemoglobin with hydrogen sulfide. It is caused by drugs
such as phenacetin or sulfonamides.
WHITE BLOOD CELLS:

White blood cells (WBCs) or leukocytes are the colorless and nucleated formed
elements of blood (leuko is derived from Greek word leukos = white). Alternate
spelling for leukocytes is leucocytes. Compared to RBCs, the WBCs are larger in
size and lesser in number. Yet functionally, these cells are important like RBCs
because of their role in defense mechanism of body and protect the body from
invading organisms by acting like soldiers.

5
CLASSIFICATION:
Some of the WBCs have granules in the cytoplasm. Based on the presence or
absence of granules in the cytoplasm, the leukocytes are classified into two groups:
1. Granulocytes which have granules (Neutrophils, Eosinophils, Basophils)
2. Agranulocytes which do not have granules (Monocytes, Lymphocytes)
Platelets are the smallest blood component produced from the very large bone
marrow cells called megakaryocytes and they play a fundamental role in
thrombosis and hemostasis. Platelets contribute their hemostatic capacity via

6
adhesion, activation and aggregation, which are triggered upon tissue injury, and
these actions stimulate the coagulation factors and other mediators to achieve
hemostasis.
Plasma
Plasma is a straw-colored clear liquid part of blood. It contains 91% to 92% of
water and 8% to 9% of solids. The solids are the organic and the inorganic
substances.

7
Plasma proteins are:

1. Serum albumin
2. Serum globulin
3. Fibrinogen.
Origin of Plasma Proteins
In Embryo
In embryonic stage, the plasma proteins are synthesized by the mesenchyme cells.
The albumin is synthesized first and other proteins are synthesized later.
In Adults
In adults, the plasma proteins are synthesized mainly from reticuloendothelial
cells of liver. The plasma proteins are synthesized also from spleen, bone marrow,
disintegrating blood cells and general tissue cells. Gamma globulin is synthesized
from B lymphocytes.
Role of Plasma proteins:

• Coagulation
• Defense mechanism
• Transport mechanism
• Suspension stability
• Erythrocyte sedimentation rate
• As reserve proteins
Plasmapheresis:
It is a therapeutic intervention that involves extracorporeal removal, return, or
exchange of blood plasma or components.
This procedure enables effective removal of substances with large molecular mass
(i.e. antibodies, complement components, antibodies and coagulation cascade
factors) from the plasma. Thus, if a specific blood component is recognized as
harmful, it can be selectively removed and subsequently replaced with the same
component from healthy donors.

8
CARDIOVASCULAR SYSTEM
Cardiovascular system includes heart and blood vessels. Heart pumps blood into
the blood vessels. Blood vessels circulate the blood throughout the body. Blood
transports nutrients and oxygen to the tissues and removes carbon dioxide and
waste products from the tissues.
Heart
Heart is a muscular organ that pumps blood throughout the circulatory system. It is
situated in between two lungs in the mediastinum. It is made up of four chambers,
two atria and two ventricles. The musculature of ventricles is thicker than that of
atria. Force of contraction of heart depends upon the muscles.
Right side of the heart has two chambers, right atrium and right ventricle. Right
atrium is a thin walled and low pressure chamber. It has got the pacemaker known
as sinoatrial node that produces cardiac impulses and atrioventricular node that
conducts the impulses to the ventricles. Right atrium communicates with right
ventricle through tricuspid valve. Wall of right ventricle is thick.
Venous blood from the right atrium enters the right ventricle through this valve.
From the right ventricle, pulmonary artery arises. It carries the venous blood from
right ventricle to lungs. In the lungs, the deoxygenated blood is oxygenated.
Left side of the heart has two chambers, left atrium and left ventricle. Left atrium
is a thin walled and low pressure chamber. It receives oxygenated blood from the
lungs through pulmonary veins. This is the only exception in the body, where an
artery carries venous blood and vein carries the arterial blood.
Blood from left atrium enters the left ventricle through mitral valve (bicuspid
valve). Wall of the left ventricle is very thick. Left ventricle pumps the arterial
blood to different parts of the body through systemic aorta.
Arterial system comprises the aorta, arteries and arterioles. From the capillaries,
venous system starts and it includes venules, veins and venae cavae. Capillaries
end in venules and venules are continued as veins
Heart beat Co-ordination:
Heart has a special electrical system called the cardiac conduction system. This
system controls the rate and rhythm of the heartbeat.

9
With each heartbeat, an electrical signal travels from the top of the heart to the
bottom. As the signal travels, it causes the heart to contract and pump blood.
The signal begins in a group of cells, called pacemaker cells, located in the
sinoatrial (SA) node in the right atrium. The electrical signal travels through the
atria, causing them to pump blood into the ventricles.
The electrical signal then moves down to a group of pacemaker cells called the
atrioventricular (AV) node, located between the atria and the ventricles. Here the
signal slows down slightly, allowing the ventricles time to finish filling with blood.
The AV node fires another signal that travels along the walls of your ventricles,
causing them to contract and pump blood out of your heart.
The ventricles relax, and the heartbeat process starts all over again in the SA node
Cardiac cycle
It is defined as the succession of (sequence of) coordinated events taking place in
the heart during each beat. Each heartbeat consists of two major periods called
systole and diastole. During systole, heart contracts and pumps the blood through
arteries. During diastole, heart relaxes and blood is filled in the heart. All these
changes are repeated during every heartbeat, in a cyclic manner.

10
Events of Cardiac cycle:

• Atrial contracts and a small amount of blood enter into ventricles
• Isometric contraction is when all the valves are closed, ventricles undergoes
isometric contraction and pressure in the ventricles increased.
• Ejection period is when semilunar valves are opened. Ventricles contract and
blood is ejected out.
• Rapid and slow filling occurs and all atrioventricular valves are opened,
Ventricles relax and filling occurs.
• Isometric relaxation when all the valves are closed and pressure in ventricles
decreased.
• Protodiastole-this is first stage of diastole , the semilunar valves are closed at
the end of this period
Cardiac output is the amount of blood pumped from each ventricle. Usually, it
refers to left ventricular output through aorta. Cardiac output is the most important
factor in cardiovascular system, because rate of blood flow through different parts
of the body depends upon cardiac output.
Usually, cardiac output is expressed in three ways:
1. Stroke volume
2. Minute volume
3. Cardiac index.
Cardiac output is maintained (determined) by four factors:

1. Venous return
2. Force of contraction
3. Heart rate
4. Peripheral resistance

11
Lymphatic system
It is composed of lymphatic fluid, lymphatic vessels, and lymphatic cells.

Lymphatic cells include macrophages, dendritic cells, lymphocytes, as well as
lymphatic organs such as the spleen and thymus.
The lymphatic system is commonly divided into the primary lymphoid organs,
which are the sites of B and T cell maturation, and the secondary lymphoid organs
Mature B and T lymphocytes exit the primary lymphoid organs and are transported
via the bloodstream to the secondary
lymphoid organs, where they become
activated by contact with foreign
materials, such as particulate matter and
infectious agents
Primary lymphoid organs are thymus and

bone marrow. Secondary lymphoid
organs include;
Lymph node
Spleen
Tonsils
Peyer’s patches, (lymphoid tissues) of the small intestine
Distribution of Lymph Nodes

Lymph nodes are present along the course of lymphatic vessels in elbow, axilla,
knee and groin. Lymph nodes are also present in certain points in abdomen, thorax
Functions of Lymph Nodes
Lymph nodes serve as filters which filter bacteria and toxic substances from the
lymph.
1. When lymph passes through the lymph nodes, it is filtered, i.e. the water and
electrolytes are removed but, the proteins and lipids are retained in the lymph.

12
2. Bacteria and other toxic substances are destroyed by macrophages of lymph

nodes. Because of this, lymph nodes are called defense barriers
Hemorrhage
Hemorrhage is defined as the excess loss of blood due to rupture of blood vessels.
Hemorrhage occurs due to various reasons. Based on the cause, hemorrhage is

classified into five categories:
1. Accidental Hemorrhage
Accidental hemorrhage occurs in road accidents and industrial accidents
2. Capillary Hemorrhage
Capillary hemorrhage is the bleeding due to the rupture of blood vessels,
particularly capillaries. It is very common in brain (cerebral hemorrhage) and
heart during cardiovascular diseases.
3. Internal Hemorrhage
Internal hemorrhage is the bleeding in viscera. It is caused by rupture of blood
vessels in the viscera. The blood accumulates in viscera.
4. Postpartum Hemorrhage
Excess bleeding that occurs immediately after labor (delivery of the baby) is called
postpartum hemorrhage. In some cases, it is very severe and leads to major
complications.
5. Hemorrhage Due to Premature Detachment of Placenta
In some cases, the placenta is detached from the uterus of mother before the due
date of delivery causing severe hemorrhage.
Complications of hemorrhage includes seizures, coma, hypoxia and cell death.

13
Hypotenssion:
Hypotension is a decrease in systemic blood pressure below accepted low values.
Hypotension, or low blood pressure, means that the pressure of blood circulating
around the body is lower than normal or lower than expected.
While there is not an accepted standard hypotensive value, pressures less than
90/60 are recognized as hypotensive.
Causes:
Emotional stress, fear.

Dehydration, which reduces blood volume.
The body’s reaction to heat, which is to shunt blood into the vessels of the skin,
leading to dehydration.
Internal bleeding, such as a perforated stomach ulcer.
Pregnancy
Coronary artery diseases

Coronary arteries supply blood to the heart muscle. Like all other tissues in the
body, the heart muscle needs oxygen-rich blood to function, and oxygen-depleted
blood must be carried away.
Left main coronary artery (LMCA)

left anterior descending artery
circumflex artery
Right coronary artery (RCA)

Right posterior descending artery
acute marginal artery
Since coronary arteries deliver blood to the heart muscle, any coronary artery
disorder or disease can reduce the flow of oxygen and nutrients to the heart, which
may lead to a heart attack and possibly death.

14
Coronary heart disease, or coronary artery disease (CAD), is characterized by

inflammation and the buildup of and fatty deposits along the innermost layer of the
coronary arteries
Angina Pectoris:
Angina is chest pain or discomfort caused when your heart muscle doesn't get
enough oxygen-rich blood.
There are four main types of angina

Stable angina.
Unstable angina.
Microvascular angina.
Prinzmetal (variant) angina.
Stable angina
Pain lasts a few minutes and occurs in a pattern, such as during exercise or stress.
Unstable angina
Pain can be stronger or last longer than stable angina and does not follow a pattern.
Unstable angina is a medical emergency
Microvascular angina
Was previously called cardiac syndrome X.
Spasms within the walls of these very small arterial blood vessels reduce blood
flow to the heart muscle, leading to a type of chest pain referred to as
microvascular angina
Vasospastic angina, also known as Prinzmetal angina or variant angina, is not

very common. It occurs when a spasm — a sudden tightening of the muscles
within the arteries of your heart — causes the arteries to narrow temporarily.
What’s different about Prinzmetal angina is that it usually happens when you’re
relaxing or resting. It also usually affects younger, healthier people

15
Myocardial Infarction:
colloquially known as "heart attack," is caused by decreased or complete cessation
of blood flow to a portion of the myocardium. Myocardial infarction may be
"silent," and go undetected
Prolonged deprivation of oxygen supply to the myocardium can lead to myocardial

cell death and necrosis.
Hypertension
Systemic arterial hypertension (hereafter referred to as hypertension) is

characterized by persistently high blood pressure (BP) in the systemic arteries.
BP is commonly expressed as the ratio of the systolic BP (that is, the pressure that
the blood exerts on the arterial walls when the heart contracts) and the diastolic BP
(the pressure when the heart relaxes)
Based on recommendations of the Seventh Report of the Joint National Committee

on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC
7), the classification of BP for adults aged 18 years or older has been as follows;
Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg

Prehypertension: Systolic 120-139 mm Hg, diastolic 80-89 mm Hg
Stage 1: Systolic 140-159 mm Hg, diastolic 90-99 mm Hg
Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater

16
Primary hypertension is the elevated blood pressure in the absence of any

underlying disease. It is also
called essential hypertension
Secondary hypertension is the high blood pressure due to some underlying
disorders like hypertension due to cardiovascular, renal or endocrine disorder
Management:
DASH stands for Dietary Approaches to Stop Hypertension (high blood pressure).
The diet is simple:

Eat more fruits, vegetables, and low-fat dairy foods
Cut back on foods that are high in saturated fat, cholesterol, and trans fats
Eat more whole-grain foods, fish, poultry, and nuts
Limit sodium, sweets, sugary drinks, and red meats
In research studies, people who were on the DASH diet lowered their blood
pressure within 2 weeks.
Pharmacological Management
Beta blockers
Alpha blockers
Calcium channel blockers
Vasodilators
Diuretics
ACE inhibitors
ARBs Blockers
Heart Failure
Heart failure or cardiac failure is the condition in which the heart looses the
ability to pump sufficient amount of blood to all parts of the body. Heart failure
may involve left ventricle or right ventricle or both.
CO = H.R ×stroke volume
Determinants of stroke volume:

1-Intrinsic health of myocardium
2-Pre-load (Preload is the force that stretches the cardiac muscle prior to

17
contraction, when the end-diastolic volume becomes excessive, cardiac function

can decrease
3-After load
Abnormality in any one of the factor decreases the cardiac output and results in
heart failure.
Types of Heart failure:
Right sided heart failure occurs due to loss of pumping action of the right side of
the heart. Because of loss of pumping action of right ventricle, blood accumulates
in right atrium and blood vessels. It causes edema in the feet, ankles, legs and
abdomen.
Left sided heart failure is due to the loss of pumping action of the left side of the
heart. It causes congestion of lungs.

18
Management
• Medicines that remove extra sodium and fluid from your body, including
diuretics and aldosterone antagonists (such as spironolactone) lower the
amount of blood that the heart must pump.
• ACE inhibitors and angiotensin receptor blockers (ARBs).
• Beta blockers
• Digoxin makes your heart beat stronger and pump more blood. This
medicine is mostly used to treat serious heart failure

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CIRCULATION

PHYSIOLOGY CRASH COURSE BY MEDSPARKLES

S.no Topics Page number

1 Blood and components 1-7

2 Cardiovascular system 8-10

6 Coronary artery disease 13-15

8 Heart Failure 16-18

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

+923489085185 medsparkles@gmail.com www.medsparkles.com

+923489085185 medsparkles@gmail.com www.medsparkles.com

Variations in RBCs count:

Increase in RBCs is polycythemia which can be physiological and pathological.

Decrease in RBCs count is due to;

• High barometric pressures

In pathological conditions, the variations in size of RBCs are:

+923489085185 medsparkles@gmail.com www.medsparkles.com

WHITE BLOOD CELLS:

+923489085185 medsparkles@gmail.com www.medsparkles.com

+923489085185 medsparkles@gmail.com www.medsparkles.com

+923489085185 medsparkles@gmail.com www.medsparkles.com

Plasma proteins are:

Role of Plasma proteins:

+923489085185 medsparkles@gmail.com www.medsparkles.com

+923489085185 medsparkles@gmail.com www.medsparkles.com

+923489085185 medsparkles@gmail.com www.medsparkles.com

Events of Cardiac cycle:

Cardiac output is maintained (determined) by four factors:

+923489085185 medsparkles@gmail.com www.medsparkles.com

It is composed of lymphatic fluid, lymphatic vessels, and lymphatic cells.

Primary lymphoid organs are thymus and

Distribution of Lymph Nodes

+923489085185 medsparkles@gmail.com www.medsparkles.com

2. Bacteria and other toxic substances are destroyed by macrophages of lymph

Hemorrhage occurs due to various reasons. Based on the cause, hemorrhage is

Complications of hemorrhage includes seizures, coma, hypoxia and cell death.

+923489085185 medsparkles@gmail.com www.medsparkles.com

Hypotension is a decrease in systemic blood pressure below accepted low values.

Emotional stress, fear.

Coronary artery diseases

Left main coronary artery (LMCA)

Right coronary artery (RCA)

+923489085185 medsparkles@gmail.com www.medsparkles.com

Coronary heart disease, or coronary artery disease (CAD), is characterized by

There are four main types of angina

Vasospastic angina, also known as Prinzmetal angina or variant angina, is not

+923489085185 medsparkles@gmail.com www.medsparkles.com

Prolonged deprivation of oxygen supply to the myocardium can lead to myocardial

Systemic arterial hypertension (hereafter referred to as hypertension) is

Based on recommendations of the Seventh Report of the Joint National Committee

Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg

+923489085185 medsparkles@gmail.com www.medsparkles.com

Primary hypertension is the elevated blood pressure in the absence of any

The diet is simple:

Determinants of stroke volume:

+923489085185 medsparkles@gmail.com www.medsparkles.com

contraction, when the end-diastolic volume becomes excessive, cardiac function

Types of Heart failure:

+923489085185 medsparkles@gmail.com www.medsparkles.com