B Curr 2002

CARDIOVASCULAR SYSTEM
Dr EM Peters-Futre

The functions of the cardiovascular system include:

 transporting nutrients and oxygen to the tissues

 transporting waste products (including CO2 ) away from tissues
 conveying hormones from the endocrine glands to target tissue
 maintaining an appropriate environment in all tissue fluids for optimal
survival and function of cells (homeostasis)
 transporting blood coagulation and immune substances to areas of need
 assisting in regulating body temperature
 maintaining blood pressure and adequate perfusion of organs and tissues

The pulmonary circulation

 transports oxygen-poor and carbon-dioxide rich blood to the lungs for
oxygenation and carbon dioxide unloading
 transports oxygen-rich blood to heart
Systemic circulation
 transports oxygen-rich blood to the tissue and carbon dioxide ladened
blood back to heart.

Structure of the heart (please work through this section in Marieb carefully)
- 4 chambers
- you need to understand blood flow through the heart
- valves: you need to understand how these open and close passively; you must be able
to describe these processes
- Atrio-ventricular valves:
- tricuspid valve between right atrium and right ventricle
- bicuspid valve between left atrium and left ventricle
Semi-lunar valves
- aortic semilunar valve between left ventricle and aorta
pulmonary semilunar valve between right ventricle and pulmonary trunk
Valve defects/deformities include :
incompetent valves, rupture of chordae tendinae, paralysed papillary muscles;
stenotic valves

Cardiac muscle
 Different from skeletal muscle in that the fibers branch and reunite
 Cells (muscle fibres) separated by intercalated discs
 Discs permit action potentials to travel easily from one cell to another
 Thus, there is communication between individual cells – allows heart muscle to
operate as a functional syncytium or network

Electrical events
 Human heart composed of 2 separate syncytia (atria and ventricles)
 Syncytia are connected by way of AV bundle
 AV (atrioventricular bundle) = small band of cardiac muscle fibres specially
modified to transmit impulses from atria to ventricles.
 Thus when, action potential reaches AV bundle, whole heart contracts.

Pacemaker and conduction system

 Heart has ability to contract rhythmically even if all the nervous connections are cut
off
 Is brought about by specially conductive tissue called sino-atrial (SA) node.
 SA node – lies in the wall of the right atrium
 By initiating the impulse for each heartbeat, the SA node sends an impulse through
myocardia of both atria  atrial contraction
 AV node receives impulse from walls atrium - relays it through the left and right
branches of AV bundle
 Branches of `AV bundle subdivide into Purkinje fibers
 Latter sends impulses to myocardial cells in ventricles -> ventricular contraction
 SA node, atria and ventricles each have their own basic intrinsic rates of contraction
 Thus, SA node has highest rate of contraction, followed by atria, then ventricles
 Each is capable to be driven to higher rates of contractions under various
physiological situations.
 Since SA node has the fastest rate of intrinsic contraction, and the others are capable
of going ate faster rates, the SA node is the pacemaker of the heart.
 Intrinsic rhythms of the heart is modified by the autonomics (ANS)
 In general, parasympathetic stimulation of atria decreases heart rate and strength of
contraction; sympathetic stimulation of atria and ventricles increases heart rate and
strength of contraction.

Cardiac cycle
 This is a repeating series of events that take place each time the heart beats; it is the
period from the end of one contraction to end of the next
 4 phases of the cardiac cycle include:
 Ventricular Filling: during mid to late ventricular diastole (period of relaxation) of
the heart chambers
 Isovolumic Contraction: at beginning of systole
 Ventricular Ejection: during ventricular systole
 Isovolumic relaxation: at end of systole & beginning of diastole
ECG (electrocardiogram)
 Is a useful tool that provides information about heart rate, orientation of the heart in
the body, and any physical and functional abnormalities of the heart.
 ECG measures the change in electrical activity of the heart generated by the action
potentials across the heart before, during and after the contraction
 P-wave = atrial depolarization - produces the atrial systole
 QRS complex = ventricular depolarization – produces the ventricular systole. At this
time the atria are experiencing diastole, but is not recorded
 T-wave = repolarization of ventricles -> produces the ventricular diastole.
 P-R interval = interval between activation of SA node and beginning of ventricular
depolarization
 Q-T interval = beginning of ventricular depolarization to end of ventricular
repolarization

Phases of cardiac cycle

The 2 sides of the heart do not contract independently, but in unison
1. Ventricular filling (mid-to-late diastole)
Large amounts of blood accumulate in atria – moderately increased pressures in atria
push the A-V valves open and allow blood to flow rapidly into ventricles
Atria also contract towards the end to give an additional thrust of blood flow to
ventricles. About 120 ml of blood accumulates in the ventricles. Semi-lunar valves
are closed.
2. Ventricular systole (atria in diastole)
a. Isovolumic contraction phase
Ventricular pressure rises to 80 mm Hg– contraction is occurring in ventricles, but
both sets of valves are closed
b. Ventricular ejection phase
Ventricular pressures push the semilunar valves open, blood pours out of
ventricles into aorta and pulmonary arteries.
3. Isovolumic relaxation: Both sets of valves are closed; intraventricular pressures fall
rapidly.
A-V valves open to start a new cycle.

Heart Sounds:
You need to understand
 that the 1st and 2nd heart sounds are caused by the closing of the a-v and
semi-lunar valves
 the locations at which these heart sounds can be heard
 the difference between the two heart sounds
 factors which may result in murmurs

PRESSURE, FLOW AND RESISTANCE

Flow through a blood vessel – determined by only 2 factors:

1) pressure difference between 2 ends of vessel (a.k.a force)
2) impediment to blood flow through vessel (remember water always flow outwards),
i.e. the resistance

Thus, Ohm’s law describes flow through a vessel as:

Q = P , where
R , P = P1 –P2 (pressure difference between 2 ends of vessel), R is resistance
Also,
P = Q X R

R = P
Q
Formula states that blood flow is directly proportional to the pressure difference,
inversely proportional to resistance.
E.g. If pressure difference is high, flow is high
If resistance is high, flow is low

Cardiac Output

 Quantity of blood that passes a given point in the circulation in a given period of time
(in ml or litres per minute)
 In adult, it is ~ 5000 ml per minute at rest; called the cardiac output (CO).
 CO = HR X SV; volume of blood pumped out by each ventricle in 1 minute
 SV = vol pumped out by each ventricle per heart beat.
 HR = number of heart beats per min
Factors which control cardiac output include:

Those that control Heart-rate (chronotropic action)

Those that control Stroke volume (inotropic action):

Sympathetic/parasympathetic nervous stimulation

Blood hormone concentrations
Certain drugs

Blood pressure
 Force exerted by blood against any unit area of vessel wall (mm Hg); this is
determined by the resistance to blood flow x cardiac output

Resistance to blood flow

 Tells how difficult it is for blood to flow between two points at any given pressure
difference
 Direct measurement not possible; can only be calculated from other measurements
(see above)
 But what determines resistance?
 Determinants of resistance
1. viscosity, which is s function of friction between adjacent layers in a flowing fluid
(e.g water has low viscosity; condensed milk high viscosity)
2. length of vessel
3. radius of vessel

Poiseuille’s law states,

R = (L/r4)(8/), where  = viscosity of fluid

L = length of vessel
r = inside radius of vessel
8/ = a constant

 Blood viscosity increases as haematocrit increases

 Normally, however, blood viscosity is relatively constant
 Similarly, lengths of vessels is constant in out bodies - thus not a factor.
 What does change, is radii of blood vessels – this (L/ r4) is the most important
determinant of changes in the resistance along blood vessels
 Example: Decreasing radius of a tube 2-fold increases resistance 16-fold. Also if the
pressure difference is held constant in this example, flow through the tube decreases
16-fold since F = P/R

In terms of the circulation, the size of the arterioles is a major determinant of peripheral
resistance; resistance of aorta and other large arteries is almost nothing.
Thus, flow of blood in each tissue is controlled almost entirely by changes in the
diameters of the arterioles.

Thus, Blood pressure (BP) = CO X TPR

TPR = total peripheral resistance.
Lastly, you are required to think about how blood pressure is regulated in a person.
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