BLG111:

Anatomy &
Physiology
Dr. Frances Wong

LOGO
Week 1: Blood & Heart, pt1
 Chapter 18
Valves

Cardiac Muscle

Chapter 19
Blood Vessels

Grey’s Anatomy
Circulation
Heart Valves
• Ensure unidirectional blood flow through heart
• Open and close in response to pressure changes

• Two major types of valves

• Atrioventricular valves located between atria and ventricles
• Tricuspid valve
• Mitral (bicuspid) valve
• Semilunar valves located between ventricles and
major arteries
• No valves are found between major veins and atria

• Incompetent valve – blood backflows

• Valvular stenosis – stiff flaps constrict open
Atrioventricular Valves
Semilunar Valves
Coronary
Circulation
• Functional blood supply to heart muscle itself
• Shortest circulation in body
• Delivered when heart is relaxed

• Both left and right coronary arteries arise from base of

aorta and supply arterial blood to heart
• Arteries contain many anastomoses

• Cardiac veins collect blood from capillary beds

• Coronary sinus empties into right atrium
Improper blood flow?
• Angina pectoris
• Thoracic pain caused by fleeting deficiency in
blood delivery to myocardium
• Cells are weakened

• Myocardial infarction (heart attack)

• Prolonged coronary blockage
• Areas of cell death are repaired with
noncontractile scar tissue
 Two forms:
Cardiac Muscle • Covering and lining epithelia
• External and internal

Fibers
surfaces

• Glandular epithelia
• Secretory tissue
Microscopic Anatomy
• Cardiac muscle cells: striated, short, branched, fat,
interconnected
• One central nucleus (at most, 2 nuclei)
• Contain numerous large mitochondria (25–35% of cell
volume) that afford resistance to fatigue
• Rest of volume composed of sarcomeres
• T tubules are wider, but less numerous
• Enter cell only once at Z disc

• Intercalated disks – junctions connecting cardiac cells

• Intercellular space has endomysium

Microscopic Anatomy
Skeletal vs Cardiac Muscle
Similarities Differences
• Muscle contraction is • Some cardiac muscle cells are self-excitable
preceded by depolarizing • Contractile cells: responsible for contraction
action potential • Pacemaker cells: noncontractile cells, spontaneously depolarize
• Depolarization wave
travels down T tubules • Heart contracts as a unit
• Excitation-contraction
coupling • Influx of Ca2+ from extracellular fluid triggers Ca2+ release from
SR

• Tetanic contractions cannot occur in cardiac muscles

• Longer absolute refractory period
Cardiac muscle cells have several similarities with skeletal
muscle cells. Which of the following is not a similarity?

a) The cells are each innervated by a nerve ending.

b) The cells store calcium ions in the sarcoplasmic reticulum.
c) The cells contain sarcomeres.
d) The cells become depolarized when sodium ions enter the
cytoplasm.

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Intrinsic Conduction System
• Heart depolarizes and contracts without
nervous system stimulation

• Coordinated heartbeat is a function of:

• Presence of gap junctions
• Intrinsic cardiac conduction system

• Action potential initiation by pacemakers

1. Pacemaker potential
• K+ closed, slow Na+ channels
2. Depolarization
• Ca2+ open
3. Repolarization
• K+ open
Intrinsic Conduction System Superior
vena cava Right atrium • Arrythmias
• Fibrillation
1 The sinoatrial
(SA) node (pacemaker)
• Ectopic focus
generates impulses.
Internodal pathway

2 Left atrium
atrioventricular
(AV) node.

3 Subendocardial
atrioventricular conducting
(AV) bundle network
. (Purkinje fibers)

4 bundle branches
Inter-
ventricular
septum

5 subendocardial
conducting network
Extrinsic Innervation
• Heartbeat modified by ANS via cardiac centers in
medulla oblongata

• Cardioacceleratory center: sends signals

through sympathetic trunk to increase both rate
and force

• Cardioinhibitory center: parasympathetic

signals via vagus nerve to decrease rate
Cardiac Action Potentials
• Contractile muscle fibers
• Cardiac muscle AP have plateau

1. Depolarization
• Na+ influx, positive feedback
• Na+ channels will inactivate
2. Plateau
• Ca2+ influx
3. Repolarization
• Ca2+ channels will inactive
• K+ efflux

• AP much longer in cardiac (200ms) vs skeletal

muscle (1-2ms)
Electrocardiograph
• Electrocardiograph can
detect electrical currents
generated by heart
• Electrocardiogram (ECG or
EKG) is a graphic recording
of electrical activity
• Composite of all action
potentials at given time
• Electrodes are placed at
various points on body to
measure voltage
differences
• 12 lead ECG is most typical
Electrocardiograph

• Indications of pathology?
• Enlarged R waves – enlarged ventricles
• Elevated or depressed S-T segment – cardiac ischemia
• Prolonged Q-T interval – ventricular arrhythmias
Predict the nature of an ECG recording when the
atrioventricular node becomes the pacemaker.

a) There would continue to be a normal sinus rhythm.

b) The P wave would be much larger than normal.
c) The rhythm would be slower.
d) The T wave would be much smaller than normal.

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Self-Study
• Indications of pathology?
• Enlarged R waves – enlarged ventricles
• Elevated or depressed S-T segment – cardiac ischemia
• Prolonged Q-T interval – ventricular arrhythmias

• How do pathologies translate to ECG tracings?

 AV valves SL valves

Mechanical
close open

Events SL valves
open
• Systole
• period of heart contraction AV valves
• Diastole open
• period of heart relaxation

• Cardiac cycle: blood flow through

heart during one complete
heartbeat
• Series of pressure and blood
volume changes
• Mechanical events follow
electrical events seen on ECG
 P wave QRS complex T wave

Mechanical ECG

Events
120

Pressure 80
(mmHg)
• Systole 40
• period of heart contraction
• Diastole 120
• period of heart relaxation Volume
(ml)
• Cardiac cycle: blood flow through 50
heart during one complete
heartbeat Blood
• Series of pressure and blood Flow
volume changes
• Mechanical events follow Isovolumetric Ventricular Isovolumetric
Ventricular filling
contraction ejection relaxation
electrical events seen on ECG
Cardiac Output
• Cardiac output - Amount of blood pumped out by each ventricle in 1 minute

• Stroke volume - volume of blood pumped out by one ventricle with each beat

𝑚𝑙 75 𝑏𝑒𝑎𝑡𝑠 70 𝑚𝑙
• At rest: 𝐶𝑂 = 𝐻𝑅 ∗ 𝑆𝑉
𝑚𝑖𝑛 𝑚𝑖𝑛 𝑏𝑒𝑎𝑡
• Cardiac reserve – difference between resting and maximal CO
Cardiac Output
Exercise (by Ventricular Bloodborne CNS output in
sympathetic activity, filling time (due epinephrine, response to exercise,
skeletal muscle and to heart rate) thyroxine, fright, anxiety, or
respiratory pumps; excess Ca2+ blood pressure
see Chapter 19)

Venous Sympathetic Parasympathetic

return Contractility activity activity

EDV
(preload) ESV

Stroke volume (SV) Heart rate (HR)

Initial stimulus
Physiological response
Cardiac output (CO = SV  HR)
Result
Stroke Volume
• volume of blood pumped out by one ventricle with each beat

𝑆𝑉 = 𝐸𝐷𝑉 − 𝐸𝑆𝑉

• Three main factors that affect SV:  Venous Return →  EDV → SV → CO

• Preload Frank-Starling Law
• Degree to which cardiac muscle are stretched just before they contract, affect EDV
• Increased venous return distends ventricles and increases contraction force
• Contractility
• Contractile strength at given muscle length, lowers ESV
• Afterload
• Back pressure exerted by arterial blood
• Increased by hypertension, consequently increasing ESV and reduced SV
Heart rate
• If SV decreases as a result of decreased blood volume or weakened heart, CO can be
maintained by increasing HR and contractility
• Chronotropic factors affect heart rate, positive vs negative

• Heart rate can be regulated by:

• Autonomic nervous system; Vagal tone at rest
• Sympathetic - Norepinephrine is released and binds to β1-adrenergic receptors on
heart, Atrial (Bainbridge) reflex
• Parasympathetic - Acetylcholine hyperpolarizes pacemaker cells by opening K+
channels
• Chemicals
• Hormones and Ions
• Other factors
• Age, Gender, Exercise, Body temperature
Contractility
• Increased contractility lowers ESV
• Sympathetic epinephrine
• Positive inotrophic agents

• Decreased by negative inotrophic

agents
Self-Study
• Homeostatic Imbalances of Cardiac Output
• Congestive heart failure

• Development Aspects of the heart

• Early development
• Fetal structures

• Congenital Heart Defects

Concept Map
• Chapter 18
• Covered in lectures week 1-2

• Max 2 pages

• Due Tuesday March 5 at 6PM

• Rubric will be posted this week.

Predict what happens to end diastolic volume when an
increase in heart rate is not accompanied by an increase in
contractility.

a) End diastolic volume is increased.

b) End diastolic volume is decreased.
c) End diastolic volume is unchanged.
d) End diastolic volume is not affected by heart rate.

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 CHAPTER 19
Blood Vessel
Structure and
Function

Physiology of
Circulation

Circulatory Pathways
Blood &
Lymph
systems
 Two forms:

Blood Vessel Structure • Covering and lining epithelia

• External and internal
surfaces

and Function • Glandular epithelia

• Secretory tissue
 Blood Vessels
Tunica externa Tunica media Tunica intima

• “intimate”
• Endothelium
• Subendothelial

• Smooth muscle
• Elastin

• Collagen fibers
• Infiltrated with
nerve fibers and
lymphatic vessels
• Vasa vasorum
Arteries
• Arteries divided into three groups, based on size and function

• Elastic arteries (conducting)

• Thick-walled with large, low-resistance lumen
• Elastin found in all three tunics, pressure reservoirs

• Muscular arteries (distributing)

• Thickest tunica media, more smooth muscle + less elastin
• Active in vasoconstriction

• Arterioles (resistance)
• Larger contain all three tunics, smaller mostly smooth muscle
+ endothelial cell
• Change diameters to resist changes in blood flow
Capillaries
• Microscopic vessels
• Diameters so small only single RBC can pass through at a
time
• Walls just thin tunica intima
• In smallest vessels, one cell forms entire circumference

• Pericytes: spider-shaped stem cells help stabilize capillary

walls, control permeability, and play a role in vessel repair

• Functions: exchange of gases, nutrients, wastes, hormones,

etc., between blood and interstitial fluid
• Supply almost every cell, except for cartilage, epithelia, cornea,
and lens of eye
Capillaries
Continuous Fenestrated
• Abundant in skin, muscles, • Areas involved in active
lungs, and CNS filtration (kidneys),
• Unique blood-brain barrier absorption (intestines), or
endocrine hormone
secretion
Sinusoidal
• Fewer tight junctions;
incomplete basement
membranes
• Found only in the liver,
bone marrow, spleen, and
adrenal medulla
Capillary Beds
• Interwoven network of capillaries between arterioles and venules
• Microcirculation: flow of blood through bed from arteriole to
venule
• Terminal arteriole: branch off arteriole that further branches into
10 to 20 capillaries (exchange vessels) that form capillary bed
• Capillaries then drain into postcapillary venule

• Capillaries in serious membranes of intestinal mesenteries have

two additional features
• Vascular shunt
• Precapillary sphincter
Veins
• Varicose veins –
• Carry blood towards the heart dilated and painful
veins
• Capillary beds
• Postcapillary venules
• Endothelium and a few pericytes, larger have smooth muscle
• Ver porous
• Increasingly larger veins
• All tunics
• Thinner than arteries

• Capacitance vessels
• 65% of blood supply
• Adaptations to low pressure
Anastomose
• Blood vessel connections

• Vascular anastomoses
• Arterial anastomoses
• Common in joints, abdominal organs, brain, and heart
• None in retina, kidneys, spleen

• Arteriovenous anastomoses: shunts in capillaries

• metarteriole–thoroughfare channel
• Venous anastomoses: so abundant that occluded veins rarely
block blood flow
Some of the least permeable capillaries are found in the __________, while some of
the most permeable capillaries are found in the __________.

a) kidney; brain
b) intestine; muscles
c) bone marrow; brain
d) brain; bone marrow

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 Two forms:

Physiology of • Covering and lining epithelia

• External and internal

Circulation
surfaces

• Glandular epithelia
• Secretory tissue
Terminology
Blood flow ml/min volume of blood flowing through vessel, organ, or entire
circulation in given period
Blood mmHg force per unit area exerted on wall of blood vessel by
Pressure blood
Resistance Opposition to flow
• Blood viscosity
• Total blood vessel length
• Blood vessel diameter

F = P / R
Systemic Blood Pressure
Blood pressure (mm Hg) 120
Systolic pressure
100
Mean pressure
80

60
Diastolic
40
pressure
20

0
Arterial Blood Pressure
• Determined by two factors:
• Elasticity (compliance or distensibility) of arteries close to heart
• Volume of blood forced into them at any time

• Blood pressure near heart is pulsatile

• Pulse pressure: difference between systolic and diastolic pressure
• Pulse: throbbing of arteries due to difference in pulse pressures, which can be felt under skin

• Mean arterial pressure (MAP): pressure that propels blood to tissues

• calculated by adding diastolic pressure + 1/3 pulse pressure
Clinical Monitoring ( A r t e r i a l )
• Clinical monitoring of circulatory efficiency
• Vital signs: pulse and blood pressure, along with respiratory rate
and body temperature

• Taking a pulse
• Radial pulse (taken at the wrist): most routinely used, but there
are other clinically important pulse points
• Pressure points: areas where arteries are close to body surface
• Can be compressed to stop blood flow in event of
hemorrhaging

• Measuring blood pressure

• Systemic arterial BP is measured indirectly by
sphygmomanometer
Capillary Blood Pressure
• Ranges from 35 mm Hg at beginning of capillary bed to ∼17 mm Hg at the end of the bed

• Low capillary pressure is desirable

Venous Blood Pressure
• Relatively stable, within 15 mmHg

• Low pressure is due to cumulative effects of peripheral

resistance

• Low pressure of venous side requires adaptations to

help with venous return
• Muscular pump
• Respiratory pump
• Sympathetic venoconstriction
Blood Pressure Regulation
• Homeostasis regulated by the brain

• Three main factors regulating blood pressure

• Cardiac output (CO)
• Peripheral resistance (PR)
• Blood volume

• Factors can be affected by:

• Short-term regulation
• Long-term regulation
Blood Pressure Regulation
Stroke Heart Diameter of Blood Blood
volume rate blood vessels viscosity Vessel
length

Cardiac output Total Peripheral resistance

Mean arterial pressure (MAP)

Short-term Reg: Neural
• Two main neural mechanisms control peripheral resistance
• MAP is maintained by altering blood vessel diameter
• Can alter blood distribution to organs in response to specific demands

• Neural controls operate via reflex arcs that involve:

• Cardiovascular center of medulla
• Cardiac center, Vasomotor center
• Baroreceptors
• Carotid sinuses, aortic arch, and walls of large arteries of neck and thorax
• Carotid sinus reflex, Aortic reflex
• Chemoreceptors
• Aortic arch and large arteries of neck
• Higher brain centers
• Hypothalamus, cerebral cortex modify via relays to medulla
Short-term Reg: Hormonal
• Hormones regulate BP in short term via changes in peripheral resistance or long term via
changes in blood volume
• Adrenal medulla hormones
• Epinephrine and norepinephrine from adrenal gland increase CO and vasoconstriction
• Angiotensin II stimulates vasoconstriction
• ADH: high levels can cause vasoconstriction
• Atrial natriuretic peptide decreases BP by antagonizing aldosterone, causing decreased
blood volume
Long-term Reg: Renal
Direct renal mechanism Indirect renal mechanism (renin-angiotensin-aldosterone)

Initial stimulus
Arterial pressure Arterial pressure
Physiological response

Direct Result
Indirect
Inhibits baroreceptors

Sympathetic nervous
system activity
Filtration by kidneys Angiotensinogen
Renin release
from kidneys
Angiotensin I
Angiotensin converting
enzyme (ACE)
Angiotensin II
Urine formation

Adrenal cortex ADH release by Thirst via Vasoconstriction; total

posterior pituitary hypothalamus peripheral resistance

Secretes
Aldosterone

Blood volume
Sodium reabsorption Water reabsorption Water intake
by kidneys by kidneys

Blood volume

Mean arterial pressure Mean arterial pressure

Predict what might happen to peripheral resistance in arterioles supplying skeletal
muscle when pH levels drop.

a) Vasoconstriction in vessels supplying skeletal muscle

b) Vasodilation in vessels supplying digestive viscera
c) Vasodilation in vessels supplying skeletal muscle
d) No change in the skeletal muscle vessels

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Self-Study
• Homeostatic Imbalances in Blood Pressure
• Hypertension
• Hypotension
• Chronic
• Acute
• Orthostatic

• Circulatory shock
Control of Blood Flow
• Tissue perfusion: blood flow through body tissues
Autoregulation
• Local (intrinsic) conditions that regulate blood flow to that area
• Reactive hyperemia: increased blood flow to an area due to intrinsic factors

• Two types of intrinsic mechanisms both determine final autoregulatory response

• Metabolic controls
• Limited blood flow cannot meet a tissue’s metabolic needs
• Low oxygen, High H+, K+, adenosine, and prostaglandins
• Release nitric oxide (NO) and endothelins

• Myogenic controls
• Local vascular smooth muscle responds to changes in MAP to keep perfusion constant
to avoid damage to tissue
• Passive stretch: increased MAP stretches vessel wall more than normal
• Reduced stretch: decreased MAP causes less stretch than normal
Skeletal Muscle
• Blood flow varies with fiber type and activity

• At rest, myogenic and neural mechanisms

predominate
• Maintain flow at ~1L /min

• Active or exercise hyperemia

• Blood flow increases in direct proportion
to metabolic activity
Brain
• Blood flow to brain must be constant
because neurons are intolerant of ischemia

• Metabolic controls
• Decreased pH or increased carbon dioxide
cause marked vasodilation

• Myogenic controls respond to MAP

• Low MAP at risk of syncope
Skin
• Supplies nutrients to cells
• Helps regulate body temperature
• Provides a blood reservoir

• Flow controlled by sympathetic nervous

system reflexes
Lungs
• Pulmonary circuit is unusual; pathway is
short
• Arteries/arterioles are more like
veins/venules (thin walled, large lumens)

• Autoregulatory mechanisms are opposite

Heart
• Blood flow through heart is influenced by
aortic pressures and ventricular pumping

• During ventricular systole, coronary vessels

are compressed
• During diastole, high aortic pressure forces
blood through coronary circulation

• During strenuous exercise, coronary

vessels dilate in response to local
accumulation of vasodilators
• Blood flow may increase three to four times
Velocity of Blood Flow
Capillary Exchange
Fluid Movement
• Bulk fluid flow across capillary walls causes
continuous mixing of fluid between plasma and
interstitial fluid; maintains interstitial environment.

• Direction and amount of fluid flow depend on two

opposing forces, in capillary and interstitial fluid
• Hydrostatic pressures
• Force exerted by fluid pressing against wall
• Colloid osmotic pressures
• “Sucking” pressure created by plasma
proteins pulling water back into capillary

• NFP = (HPc + OPif) − (HPif + OPc)

Capillary colloid osmotic pressure created by __________ tends to
__________.

a) blood volume; push fluids out of the capillary

b) nondiffusable plasma proteins; draw fluids into the capillary
c) interstitial fluid; draw fluids out of the capillary
d) proteins in the interstitial fluid; push fluids into the interstitial
fluid

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 Two forms:

Circulatory • Pulmonary circulation

Pathways
• Systemic circulation
Pulmonary Circulation
Systemic Circulation
• Arteries and veins
tend to run side by
side, and, in many
places, they also run
with nerves

• Systemic vessels do
not always match on
right and left sides
of body
Major
Arteries
Aortic Arch

1
Thoracic aorta
Abdominal aorta
Abdominal aorta