Overview of the Cardiovascular

System, 2
• Cardiovascular system – includes the heart
and blood vessels
• Circulatory system – includes the heart, blood
vessels and blood
• Heart – a muscular pump that keeps blood
flowing through the vessels
• Cardiology – study of the heart; clinical
evaluation and treatment of disorders
1
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 The Pulmonary and Systemic
Circuits, 1
•The
  cardiovascular system has two major
divisions: pulmonary and systemic circuits
Pulmonary circuit
• The right side of the heart receives oxygen-poor
blood from the body and pumps it into a large
artery called the pulmonary trunk
• Oxygen-poor blood is distributed to the lungs,
where it unloads and picks up
• Returns oxygen-rich blood to the left side of the
heart by way of the pulmonary veins 2
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The Pulmonary and Systemic Circuits, 2

Systemic circuit
• The left side of the heart pumps blood into a large
artery called the aorta
• Gives off branches to the body
• Oxygen-rich blood is distributed to the body
• Also picks up carbon dioxide from the tissues
• Returns oxygen-poor blood to the right side of the
heart
• Superior vena cava drains the upper body
• Inferior vena cava drains below the diaphragm
3
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General Schematic of the
Cardiovascular System
(Figure 13.1)

4
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Position, Size, and Shape of the Heart

Heart
• In the thoracic cavity in the mediastinum,
between the lungs and deep to the sternum
• Tilted slightly to the left
• Broad superior portion is called the base
• Point of attachment for the great vessels (pulmonary
trunk, veins, and aorta)
• Inferior end tapers to a point called the apex
• Roughly the size of a person’s fist
5
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Anterior View of Heart (Figure 13.2b)

6
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 The Pericardium, 1
Pericardium
• Double-walled sac enfolding the heart
• Reduces friction
• Isolates the heart from other thoracic organs
• Anchors the heart within the thoracic cavity
• Pericarditis – inflammation of the pericardium
• Most often caused by viral infection

7
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 The Pericardium and Heart Wall
(Figure 13.2c)

8
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 Pericardial Cavity, 1
Pericardial cavity
• Space between parietal and visceral pericardium
• Contains only a small amount of pericardial fluid
• Secreted by the serous layer of the pericardium
• Lubricates membranes; allows the heart to beat with
minimal friction

9
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 Pericardial Cavity, 2
Pericardial cavity, continued
• Pericarditis – inflammation of the pericardium
• Usually caused by a viral infection
• Membranes can become rough and produce a friction
rub with each contraction

10
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 The Chambers, 1
Left and right atria (sing., atrium)
• Two smaller superior chambers of heart
• Thin-walled due to light workload
• Only need to pump blood to the ventricles below
• Receive blood returning to the heart via the great
veins
• Most of their mass is on the posterior side of the
heart
• Interatrial septum is between the atria
11
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 External Anatomy of the Heart:
Anterior View (Figure 13.3a)

a) Anterior view 12
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 External Anatomy of the Heart:
Posterior View (Figure 13.3b)

b) Posterior view
13
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 The Chambers, 2
Left and right ventricles
• Two larger inferior chambers of heart
• Thick walls
• Eject blood into arteries, keeping it flowing around
the body
• Right ventricle makes up most of the anterior
heart

14
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 The Chambers, 3
Left and right ventricles, continued
• Left ventricle
• Forms the apex and inferoposterior part of the heart
• Thicker than the right ventricle because it pumps to the
entire body
• Interventricular septum
• Thick wall between the two ventricles

15
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 Internal Anatomy of the Heart
(Figure 13.4a)

16
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 The Valves
Heart valves
• Ensure one-way flow of blood
• Four valves:
• Two between each atrium and ventricle
• Two between each ventricle and its great artery
• Consist of two or three flaps of thin tissue called
cusps (leaflets)

17
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 The Atrioventricular Valves, 1
Atrioventricular (AV) valves
• Control the opening between each atrium and the
ventricle below it
• Ensure blood cannot regurgitate back into the
atria when the ventricles contract
• Right AV valve (tricuspid valve) has three cusps
• Left AV valve (mitral valve)
• Formerly thought to have two cusps so was known as the
bicuspid valve

18
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 The Atrioventricular Valves, 2
Atrioventricular (AV) valves, continued
• Cusps anchored to papillary muscles on ventricle
by tendinous cords (chordae tendineae)
• When the ventricles contract, the papillary muscles
tense the tendinous cords
• Prevents AV valves from bulging or flipping inside out
• Excessive bulging due to slack tendinous cords is called
valvular prolapse

19
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 Semilunar Valves
Semilunar valves
• Lie between the ventricles and great arteries
• Have three cusps
• Do not require tendinous cords
• Pulmonary valve
• Controls the opening from the right ventricle into the
pulmonary trunk
• Aortic valve
• Controls the opening from the left ventricle into the
aorta
20
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Blood Flow Through the Chambers, 1
Blood in the left and right chambers is kept
totally separate in adults
• Deoxygenated blood doesn’t mix with oxygenated

Blood from the systemic circuit returns via the

superior and inferior venae cavae
• Venae cavae empty into the right atrium
• Blood then flows through the right AV valve to the
right ventricle
• Blood is then ejected through the pulmonary valve
to the pulmonary trunk 21
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Blood Flow Through the Chambers, 2
Blood returning from the lungs returns via
four pulmonary veins
• They empty into the left atrium
• Blood then flows through the left AV valve to the
left ventricle
• Blood is then ejected through the aortic valve to
the ascending aorta

22
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 Coronary Circulation
Coronary circulation – the heart’s blood
supply
Coronary arteries
• Blockage can lead to heart attacks
• Right and left coronary arteries are the first
branches off the aorta
• Openings are behind the cusps of the aortic valve, so
blood flow into the right and left coronary arteries
peaks during ventricular relaxation
23
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The Major Coronary Blood Vessels:
Anterior View
(Figure 13.5a)

a) Anterior view 24
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 Perspectives on Health:
Atherosclerosis and Hardening of the
Arteries, 1
Arteriosclerosis – stiffness of the arteries
• Common in the elderly
• Results from continuous damage by free radicals

Atherosclerosis – lipid deposits in arterial

walls
• Contributes to arteriosclerosis
• Begins when arterial walls are damaged by
hypertension, diabetes, etc. 25
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 Perspectives on Health:
Atherosclerosis and Hardening of the
Arteries, 2
Atherosclerosis, continued
• Macrophages then invade the lesion and deposit
fat
• The lesion grows into a fatty plaque (atheroma)
• Platelets adhere to the plaques and secrete growth
factors, causing the plaque to grow and block blood
flow
• Blood clots can develop, further blocking blood flow
• Blood clots can break free and become emboli
• Leads to kidney failure, heart attacks, strokes
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26
 Atherosclerosis (Figure 13.5d)

d: © Ed Reschke
27
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 Perspectives on Health: Coronary
Artery Disease, 1
Coronary Artery Disease (CAD)
• Degenerative disease of the coronary arteries,
associated with atherosclerosis
• Most common cause of heart failure and is a
leading cause of death in the U.S.
• Angina pectoris
• Early symptom of CAD
• Transient pain in the chest when coronary arteries are
blocked; inadequate oxygen delivery to the
myocardium
28
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 Perspectives on Health: Coronary
Artery Disease, 2

Coronary Artery Disease (CAD), continued

• Balloon angioplasty
• Treatment for atherosclerosis
• A catheter is inserted into a diseased coronary artery
• A tiny balloon at the tip of the catheter is inflated,
which crushes the atheroma and opens the vessel
• Restores blood flow but is a temporary solution –
often has to be repeated

29
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 Perspectives on Health: Coronary
Artery Disease, 3
Coronary Artery Disease (CAD), continued
• Coronary bypass surgery
• Chest is opened, patient is put on a heart-lung bypass
machine
• A healthy blood vessel is attached above and below the
damaged portion of the artery
• Provides a detour for blood to flow around the
blockage

30
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Perspectives on Health: Prevention
of Coronary Artery Disease

Prevention of coronary artery disease

• Regular exercise, healthy body weight, good diet
help prevent CAD
• Genetics play a strong role, however
• Age is a factor as well
• Drugs that control hypertension and cholesterol
are used to prevent CAD

31
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 Cardiac Muscle, 3
Heart’s energy demand
• Uses 5 kg of ATP/day
• Energy for this mostly comes from fatty acids and
glucose
• Makes ATP almost exclusively from aerobic
respiration
• Makes cells very resistant to fatigue
• Cardiomyocytes have exceptionally large
mitochondria

32
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 The Cardiac Conduction System, 1
The heart is autorhythmic
• Beats without stimuli from the nervous system
• There are modified cardiomyocytes that do not
contract but regularly depolarize
• They are concentrated in the sinoatrial (SA) and
atrioventricular (AV) nodes
• Other modified cardiomyocytes act like nerves
• Together these myocytes form the cardiac conduction
system
• Electrical signals travel through this, ultimately
generating the heartbeat
33
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 The Cardiac Conduction System, 2
Sinoatrial (SA) node
• Heart’s pacemaker
• In the right atrium near the superior vena cava
• Starts each heartbeat and determines heart rate
• Normal HR = 70 beats per minute

34
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 The Cardiac Conduction System, 3
Internodal conduction
• The spread of signals from the SA node through
both atria
• Causes contraction of the atria before the
ventricles

35
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 More Cardiac Conduction System, 1
Atrioventricular (AV) node
• Similar to the SA node
• In the interatrial septum above the tricuspid valve
• A gateway for electrical signals headed to the
ventricles
• Delays the signal somewhat; allows the ventricles
time to fill with blood

36
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 More Cardiac Conduction System, 2
Atrioventricular (AV) bundle
• Cord of cells that leave the AV node and travel to
the interventricular septum
• In the septum, it forks into the right and left
bundle branches, which descend toward the apex

37
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 The Cardiac Conduction System
(Figure 13.7)

38
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Electrical Activity and Contraction, 1
•Cells
  of the SA node do not rely on external
stimulation
• Do not have a stable resting potential
• Their cell membranes are leaky, continually
allowing into the cell
• Eventually, this raises the membrane potential to
threshold voltage and sets off an action potential
• The pacemaker then fires, initiating a heartbeat

39
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 The Electrocardiogram, 1
Electrocardiogram (ECG or EKG)
• Noninvasive clinical method for evaluating heart
function
• A recording of the depolarization and
repolarization of the myocardium
• They generate electrical currents that are detectable by
electrodes

40
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 The Electrocardiogram, 2
Events of the ECG:
• P wave
• Reflects the depolarization of the atria
• QRS complex
• Represents depolarization of ventricles
• The largest wave of ECG
• The atria also repolarize here but that is masked by
depolarization of the ventricles
• T wave
• Represents ventricular repolarization
41
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 The Electrocardiogram (Figure 13.8)

42
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 Clinical Application 13.1: Cardiac
Arrhythmia, 1

Cardiac arrhythmia – any change in the

normal heart rhythm
• Can occur in any of the chambers
• Atrial flutter – most common form occurring in the
atria
• The atria weakly contract at 250-350 bpm
• Not life-threatening but can cause dizziness and
sometimes dangerous blood clots

43
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 Clinical Application 13.1: Cardiac
Arrhythmia, 2
Cardiac arrhythmia, continued
• Ventricular fibrillation (VF or V-fib)
• The most serious of the arrhythmias
• Uncoordinated, squirming contraction of the ventricles
• Often caused by myocardial infarction (tissue death)
• No effective pumping of blood; death is imminent
• Can be stopped by a machine called a defibrillator
• Doesn’t fix the cause of the VF; just resets the heart

44
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 The Cardiac Cycle, 1
The cardiac cycle
• One complete contraction and relaxation of all
four chambers
• Systole – when the chambers contract
• Results from excitation of a chamber (and therefore
depolarization)
• Expels blood from the chamber
• Diastole – when chambers are relaxed
• Results from repolarization
• Allows the chamber to refill
45
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 More Cardiac Cycle, 1
Steps of the cardiac cycle, continued
• Ventricular pressure exceeds pressure in the
arteries, semilunar valves open and blood spurts
into the aorta and pulmonary trunk
• Stroke volume – the amount of blood the ventricles
expel with each contraction
• Usually about 70 mL
• Increases with exercise

46
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 More Cardiac Cycle, 2
Steps of the cardiac cycle, continued
• The myocardium repolarizes
• •  Ventricles relax and expand (T wave)
• Blood in the aorta and pulmonary trunk briefly surges
backward, closing the cusps of the semilunar valves
• Surge of blood against these valves creates the
second heart sound ()
• AV valves reopen

47
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 Heart Sounds
•Listening
  to heart sounds
• An example of auscultation (listening to body
sounds)
• First heart sound, , is louder and longer (lubb)
• Second heart sound, , is softer and shorter (dupp)
• Heart murmur
• Whooshing or swishing sounds
• Some are harmless; others indicate problems
• E.g., valvular problems

48
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 Cardiac Output, 1
•Cardiac
  output (CO)
• The volume of blood ejected by each ventricle per
minute

• Typical values:

• Therefore, only two ways to increase CO: increase HR or

increase SV
• Increases dramatically during exercise
49
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 Cardiac Output, 2
Agents that increase cardiac output
• Increased heart rate:
• Sympathetic nervous system (norepinephrine)
• Epinephrine, thyroid hormone, nicotine, and caffeine
• Increased contraction strength:
• Epinephrine, norepinephrine, calcium, glucagon and
the drug digitalis

50
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 Cardiac Output, 3
Agents that decrease cardiac output
• Decreased heart rate:
• Parasympathetic stimulation with acetylcholine
• Excess calcium or potassium
• Decreased contraction strength:
• Excess potassium or calcium, oxygen deficiency
• Abnormally low blood pH (acidosis)

51
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 Arteries, Capillaries, and Veins
Arteries
• Carry blood away from the heart
• Withstand surges of pressure
• More muscular than veins; retain shape even
when empty
• Divided into three categories based on size:
conducting arteries, distributing arteries,
resistance arteries

52
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 Capillaries, 1
Capillaries
• Where materials pass between blood and tissues
• Also called exchange vessels
• Made only of endothelium and a basement
membrane
• There are about a billion of them; each tissue cell
is only a few cells away from one
• There are two types: continuous and fenestrated

53
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 Blood Capillaries (Figure 13.11a)

54
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 Blood Capillaries (Figure 13.11b-c)

55
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 Veins
Veins
• Thin-walled and flaccid
• Expand easily to accommodate more blood than
arteries
• Much lower blood pressure than in arteries
• Blood flow is steady, not pulsatile like in arteries
• So do not require muscular or elastic walls
• Start small near the capillaries and get larger as
move toward the heart
56
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 Types of Veins, 1
Venules
• The smallest veins
• Receive blood from capillaries
• Smallest are quite porous
• This is where white blood cells leave the bloodstream

57
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 Variations in the Systemic Circuit
(Figure 13.12)

58
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 Blood Pressure, 1
Blood pressure (BP)
• The force exerted by blood on a vessel wall
• Decreases as blood flows away from the ventricle
• Blood always flows down a gradient (from a point
of high pressure to low pressure)
• The greater the pressure difference, the greater the
flow
• Determined by three main variables:
• Cardiac output, blood volume, and resistance

59
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 Blood Pressure, 2
Blood pressure, continued
• Expressed as a ratio of systolic pressure to
diastolic pressure, in mm of Hg
• About 120/80 for a healthy adult
• Measured with a sphygmomanometer
• Inflatable cuff is placed around the arm and inflated
• Cuff collapses the brachial artery, cutting off blood flow
• Stethoscope is placed at the elbow while the cuff
deflates; as soon as systolic BP exceeds cuff pressure,
blood passing through the artery causes sounds, which
stop again once diastolic pressure has been reached
60
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 Blood Pressure, 3
Blood pressure, continued
• Hypertension – resting BP above 140/90
• High blood pressure
• Causes cardiovascular disease
• Weight loss, exercise and healthy diets can lower BP
• Hypotension – low BP
• E.g., can be caused by blood loss or dehydration

61
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 Hormonal Control, 1
Hormones that control BP by constricting or
dilating vessels
• Epinephrine and norepinephrine
• Dilate arteries of the skeletal muscles
• Constrict other vessels, like those in the digestive tract
• Angiotensin II
• Vasoconstrictor that raises BP
• Angiotensin-converting enzyme is required for
synthesis, so hypertension is treated with drugs called
ACE inhibitors
62
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 Hormonal Control, 3
Hormones affecting BP, continued
• Aldosterone
• Secreted by the adrenal glands
• Promotes sodium and water retention
• Decreases urine volume, so increases blood volume
and pressure
• Antidiuretic hormone
• Secreted by the pituitary gland
• Promotes water retention
• Decreases urine volume, so increases blood volume
and pressure
63
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Clinical Application 13.2: Congestive
Heart Failure, 1
Heart failure – the heart fails to pump with
sufficient force to adequately supply tissues
with oxygen
• High blood pressure causes the heart to work
harder; the heart enlarges and its walls become
thin and weak
• The kidneys respond by retaining salt and water,
which increases blood volume and pressure
64
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 Clinical Application 13.2:
Congestive Heart Failure, 2
Heart failure, continued
• Increased BP increases the amount of fluid filtered
into the tissues, causing edema in the ankles, feet
and lungs
• Congestive heart failure – body is congested with fluid
• Heart failure can’t be reversed but symptoms can
be relieved by drugs called diuretics
• Increase urine volume, which decreases blood volume
and pressure

65
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 Circulatory Shock
Circulatory shock
• Caused by failure of heart to pump enough blood
• One cause is loss of blood volume by hemorrhaging
• Other causes: tumors that compress veins and block
the flow of blood
• Venous pooling – blood accumulates in the lower part
of the body instead of returning to the heart
• Can occur from allergic reactions that lead to
widespread vasodilation
• Standing for too long prevents the skeletal muscle
pump from working; can lead to syncope (fainting)
66
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 The Pulmonary Circuit, 1
•Pulmonary
  circuit
• Functions only to exchange for
• The lungs have a separate systemic blood supply
via the bronchial arteries to nourish the lung
tissues
• Pulmonary trunk arises from the right ventricle
and branches into the right and left pulmonary
arteries

67
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The Pulmonary Circuit (Figure 13.16)

68
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 The Pulmonary Circuit, 2
Pulmonary circuit, continued
• The pulmonary arteries give off further branches
before entering the lung
• Lead to a web of capillaries around the alveoli (air sacs)
• Blood then flows into pulmonary venules and
veins, which lead to two pulmonary veins from
each lung
• Pulmonary veins empty into the left atrium

69
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 The Systemic Circuit
Systemic circuit
• Supplies oxygen and nutrients to all organs, and
removes their metabolic wastes
• Coronary circulation is part of it
• Large arteries have branches (smaller arteries
coming off of them)
• Larger veins have tributaries (smaller veins that
feed into them)
• Trunks – arteries and veins that are short and
branch right away
70
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 Aging of the Circulatory System, 1
Cardiovascular disease (CVD) – a leading
cause of death in old age
Cardiac muscle atrophies with age, becoming
thinner and weaker
• Results in decreased cardiac output

Degenerative changes in the nodes and

conducting system lead to arrhythmias

71
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 Aging of the Circulatory System, 2
Coronary atherosclerosis is universal in aging
hearts
• Can lead to myocardial infarction

Blood pressure steadily increases with age

Atherosclerosis reduces blood flow to many
organs, weakening them
Reduced blood flow to skeletal muscles
decreases stamina
72
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 Aging of the Circulatory System, 3
Atherosclerotic plaques become the site of
thrombi
• 25% of people over 50 have venous blockage from
blood clots

Venous valves become weaker

• Varicose veins and hemorrhoids become more
common

Exercise slows degeneration of the

cardiovascular system 73
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