CARDIOVASCULAR

SYSTEM
Sindhu Wisesa
Heart’s position in thorax

3
 Heart’s position in thorax
• In mediastinum – behind sternum and pointing left, lying on
the diaphragm
• It weighs 250-350 gm (about 1 pound)
Feel your heart beat at apex

4
(this is of a person lying down)
FIGURE 20-2(a) An anterior view of the open chest cavity, showing the
position of the heart and major vessels relative to the lungs.
6
mediastinum
Posisi jantung di thorax :
 Chest x rays

Lateral (male)

Normal female 9
Source Undetermined
 Human Heart

Without most of pericardial layers 11

 General Anatomy of the Heart
• Great veins and arteries at the base
• Pointed tip is apex
• Surrounded by pericardial sac

Figure 20–2c
Figure 12-3(b)
Layers of pericardium and heart wall

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Heart Wall

16
Cardiac
Muscle Cells

Figure 20–5
 Relative thickness of muscular walls
LV thicker than RV because it forces blood out against more resistance; the systemic
circulation is much longer than the pulmonary circulation

Atria are thin because ventricular filling is done by gravity, requiring little atrial effort

18
 FIGURE 20-4 Layers of the Myocardium.
Cardiac muscle tissue forms concentric layers that wrap around the atria
and spiral within the walls of the ventricles.
(c) Diagrammatic views of the ventricles just before a contraction
(dilated) and just after a contraction (contracted).
25
 Cardiac Cycle

HODS - November 2006 26

Figure 12-5
• The Valves of the Heart

Figure 12-6(a)
Figure 12-6(b)
Function of AV valves

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Function of semilunar valves
(Aortic and pulmonic valves)

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(c) The aortic semilunar valve in the open (left) and closed (right)
positions. The individual cusps brace one another in the closed
position.
Figure 20–16
Cardiac Cycle
Phases
Location of Heart Valves
Places to auscultate

36
 Enlarged
Right Atrium

Source Undetermined

Source Undetermined
 Enlarged
Right Ventricle

Source Undetermined

Source Undetermined
 Enlarged
Right Ventricle
(lateral CXR)

Source Undetermined

Source Undetermined
Kelainan jantung (congenital)
Kelainan jantung (congenital)
Valve Stenosis and Prolapse
Figure 12-7(a)
Figure 12-7(b)
Coronary heart disease
The Conducting System

Figure 20–12
Impulse Conduction
through the Heart

Figure 20–13
 Heart Excitation Related to ECG
SA node generates impulse; Impulse delayed Impulse passes to Ventricular excitation
atrial excitation begins at AV node heart apex; ventricular complete
excitation begins

SA node AV node Bundle Purkinje

branches fibers

Figure 18.17
 Autonomic
innervation

• Sympathetic
– Increases rate and force of
contractions
• Parasympathetic
(branches of Vagus n.)
– Slows the heart rate

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Atrial Depolarization
 CORRELATION BETWEEN LOCATION OF ISCHAEMIC,
ECG AND CORONARY ARTERY ANATOMY

LOCATION OF INFARCT/ ECG CORONARY ARTERY INVOLVED

ISCHAEMIC

ANTERIOR EKSTENSIVE I, Avl, V1-V6 LAD, LCX

ANTEROSEPTAL V1- V3 LAD

ANTEROLATERAL I, aVL, V4- V6 LCX

INFERIOR II, III, aVF RCA, PDA

POSTERIOR V7- V9 PL (POSTEROLATERAL)

RV V3R – V5R RCA/ RV BRANCH

Ventricle
Depolarization

0.12 second
VASCULAR SYSTEM
Circulatory
Routes -
overview
Macam2 type arteri & vena
 Arteries & Veins

Both are comprised of 3 layers of tissue surrounding

“lumen” through which blood will flow: tunica interna,
tunica media & tunica externa

Structural difference between arteries & veins

primarily due to differences in pressure of blood
flowing within
Anatomy of the Heart and Vessels

Arteries and Veins and

Arterioles Venules

Tunica Intima
Endothelial cells
Valve

Tunica Media

Tunica
Externa
or Adventia

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• In most capillaries there is more filtration than absorption
• 90% the volume of fluid filtered out at the arterial end is
absorbed back into the capillary at the venous end
– the other 10% enters lymphatic vessels where it is returned
back into circulation as the lymph vessels empty lymph fluid
into blood at the right atrium
Pembuluh darah arteri
Capillaries  Microscopic, very thin-walled
vessels comprised of endothelium
with basement membrane; allows
for filtration and reabsorption
 Found in all tissues of the body
except for those that are
“avascular”
 Usually form branching networks
(“capillary beds”) within tissues for
increased surface area
 blood flow into capillaries may be
regulated by “pre- capillary
sphincters”
 may have a central or
“thoroughfare” channel that
provides direct connection
between “metarteriole” (terminal
end of arteriole) & venule
Circulasi Pulmonal
Vascular Anastomoses
• Arterial
Anastomoses
- provide collateral supply
to some organs and tissues,
e.g., skeletal muscles
• Arteriovenous
Anastomoses
- thoroughfare channels
• Venous Anastomoses
- most common, e.g., deep
and superficial veins in
limbs and head
 Circulatory Routes – Systemic circuit
 Arterial blood from left ventricle into
ascending aorta
 Venous return to right atrium through
SVC, IVC & coronary sinus
Left common carotid artery
Brachiocephalic Left subclavian artery
trunk

Ascending aorta
(gives off Aortic arch
coronary
arteries)
Thoracic (descending) aorta

Abdominal aorta

Common iliac
arteries
Circulasi Sistemik
Head and Neck Arteries
Head and Thorax Arteries
7

posterior communicating
middle cerebral artery

4
6 3

5 2

1
Cerebral Circulation
Upper Limb Arteries
Abdominal and Pelvic Arteries
Lower Limb Arteries
Arteri Anggota Gerak Bawah
 Measuring
Heart Rate

Feeling the radial pulse

Sport Books Publisher 87

Sistem Vena
Head and Neck Veins
Thoracal Vein
Head and Thorax Vein
Upper Extrimity Vein
Hepatic Portal System
Abdominal and pelvic veins
Lower Extremity Veins
Lower Extremity Veins
 Venous Return/Valves
• Assistance for venous return
– skeletal muscles act as pumps
• contracting muscles squeeze veins
• force blood back to the heart
• valves prevent back flow

– respiratory pump
• inhaling causes a lowered pressure
in the thoracic cavity
• primarily to pull air into the lungs
• helps to draw blood into thorax via
pulmonary circulation
Anatomy of the Heart and Vessels

Venous Return
Position (gravity)

Muscular contraction

Breathing
Negative pressure in thorax
Positive abdominal pressure

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Varicose Veins
Natural history of Atherosclerosis
 Fetal Circulation
Placenta – O2/CO2 &
nutrient/waste between
mom & baby
Umbilical cord – (2)
umbilical arteries (baby 
mom) & (1) umbilical vein
(mom  baby)

Umbilical vein
(O2/nutrient rich
blood)  hepatic
portal vein & ductus
venosus  IVC  Rt.
atrium
Rt. Atrium  some blood to rt.
Ventricle, most shunts across
foramen ovale in interatrial septum 
lt. atrium  lt. ventricle
 Fetal Circulation
Blood from Rt. Ventricle
 pulmonary trunk 
across ductus arteriosus
to aorta

Aorta  systemic arteries

internal iliac arteries 
umbilical arteries 
placenta
 Fetal Circulation- Changes at Birth
 Umbilical vein  ligamentum
teres (round ligament)
 Umbilical arteries  lateral
umbilical ligaments
 Ductus venosus 
ligamentum venosum
 Foramen ovale  fossa ovalis
 Ductus arteriosus 
ligamentum arteriosum
 Placenta delivered
(“afterbirth”)
 Fetal
Circulation
• ductus venosus
bypasses liver
• 3 Right  Left
shunts
• because
oxygenated blood
is derived from the
placenta
• ductus arterious 
ligametum arteriosum
• foramen ovale  fossa
ovalis
• interventricular shunt
 no remnant
In the fetus, the RA
received oxygenated
blood from mom through
umbilical cord, so blood R
to L through the foramen
ovale: fossa ovalis is left
after it closes

The pulmonary trunk had

high resistance (because
lungs not functioning yet)
& ductus arteriosus
shunted blood to aorta;
becomes ligamentum
arteriosum after birth

108
Flow Chart of Fetal Circulation
Terimakasih