L5Circulatory System

Cardiovascular System
1
CopyrightThe McGraw-Hill Companies, Inc. Permission required for reproduction or display.
 Introduction
A. The cardiovascular system consists of
the heart and vessels (arteries, capillaries and
veins.)
B. A functional cardiovascular system is
vital for supplying oxygen and nutrients to
tissues and removing wastes from them.
C. Deoxygenated blood is carried by the
pulmonary circuit to the lungs, while the
systemic circuit sends oxygenated blood to all
body cells.
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3
 Structure of the Heart

A. The heart is a hollow, cone-shaped,
muscular pump within the thoracic cavity.
B. Size and Location of the Heart
1. The average adult heart is 14 cm long and
9 cm wide (fist of an individual)
2. The heart lies in the mediastinum under the
sternum; its apex extends to the fifth intercostal
space.
4
C. Coverings of the Heart

1. The pericardium encloses the heart.
2. It is made of two layers: the outer, tough
connective tissue fibrous pericardium
surrounding a more delicate visceral
pericardium (epicardium) that surrounds
the heart.
5
3. At the base of the heart, the

visceral pericardium folds
back to become the parietal
pericardium that lines the
fibrous pericardium.
4. Between the parietal and visceral
pericardia is a potential
space (pericardial cavity)
filled with serous fluid.
6
7
Structures of the Heart (cont.)
• Heart coverings
– Pericardium
Click for Larger View
• Covers the heart and
large blood vessels • Heart walls:
attached to the heart – Epicardium
• Outermost layer
• Visceral pericardium • Fat to cushion heart
– Innermost layer
– Myocardium
– Directly on the heart • Middle layer
• Parietal pericardium • Primarily cardiac muscle
– Layer on top of the – Endocardium

visceral pericardium • Innermost layer
• Thin and smooth
• Stretches as the heart
23-8 pumps
D. Wall of the Heart

1. The wall of the heart is composed of
three distinct layers.
2. The outermost layer, the epicardium, is
made up of connective tissue and epithelium,
and houses blood and lymph capillaries along
with coronary arteries. It is the same as the
visceral pericardium.
9
3. The middle layer called myocardium

consists of cardiac muscle and is the thickest layer
of the heart wall.
4. The inner endocardium is smooth and is
made up of connective tissue and epithelium,
and is continuous with the endothelium of
major vessels joining the heart.
a. The endocardium contains the Purkinje
fibers.
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11
E. Heart Chambers and Valves

1. The heart has four internal chambers:
two atria on top and two ventricles below.
a. Atria receive blood returning to the
heart and have thin walls and ear-like
auricles projecting from their exterior.
b. The thick-muscled ventricles pump
blood to the body.
12
2. A septum divides the atrium and ventricle on

each side. Each also has an atrioventricular (A-V)
valve to ensure one way flow of blood.
a. The right A-V valve (tricuspid) and left A-V
valve (bicuspid or mitral valve) have cusps to
which chordae tendinae attach.
13
b. Chordae tendinae are, in turn,

attached to papillary muscles
in the inner heart wall that
contract during ventricular
contraction to prevent the
backflow of blood through the
A-V valves.
14
3. The superior and inferior vena cavae

bring blood from the body to the right atrium.
4. The right ventricle has a thinner wall
than does the left ventricle because it must
pump blood only as far as the lungs,
compared to the left ventricle pumping to the
entire body.
15
5. At the base of the pulmonary trunk

leading to the lungs is the
pulmonary valve, which prevents a
return flow of blood to the ventricle.
6. The left atrium receives blood from
four pulmonary veins.
7. The left ventricle pumps blood into
the entire body through the aorta,
guarded by the aortic valve that
prevents backflow of blood into the
ventricle.
16
Cardiac Cycle
 One heartbeat = one cardiac cycle
 Atria contract and relax
 Ventricles contract and relax
• Right atrium contracts • Left atrium contracts

– Tricuspid valve opens – Bicuspid valve opens
– Blood fills right ventricle – Blood fills left ventricle
• Right ventricle contracts • Left ventricle contracts

– Tricuspid valve closes
– Bicuspid valve closes
– Pulmonary semilunar valve
opens – Aortic semilunar valve
– Blood flows into pulmonary opens
artery – Blood pushed into aorta
23-17
Heart Sounds
• One cardiac cycle – two heart sounds
(lubb and dubb) when valves in the heart
snap shut
– Lubb – first sound
• When the ventricles contract, the tricuspid and
bicuspid valves snap shut
– Dubb – second sound
• When the atria contract and the pulmonary and
aortic valves snap shut
23-18
Cardiac Conduction System
• Group of structures that send electrical impulses through the
heart
• Sinoatrial node (SA node) • Bundle of His

– Wall of right atrium – Between ventricles
– Generates impulse – Two branches
– Natural pacemaker – Sends impulse to Purkinje
– fibers
Sends impulse to AV node
• Atrioventricular node (AV • Purkinje fibers

node) – Lateral walls of ventricles
– Between atria just above ventricles – Ventricles contract
– Atria contract
– Sends impulse to the bundle of His
23-19
23-20
F. Skeleton of the Heart

1. Rings of dense connective tissue
surround the pulmonary trunk and
aorta to provide attachments for
the heart valves and fibers.
2. These tough rings prevent dilating
of tissue in this area.
22
23
G. Path of Blood through the Heart

1. Blood low in oxygen returns to the
right atrium via the venae
cavae and coronary sinus.
2. The right atrium contracts, forcing
blood through the tricuspid
valve into the right ventricle.
24
3. The right ventricle contracts, closing

the tricuspid valve, and forcing blood
through the pulmonary valve into the
pulmonary trunk and arteries.
4. The pulmonary arteries carry blood
to the lungs where it can rid itself of
excess carbon dioxide and pick up a new
supply of oxygen.
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5. Freshly oxygenated blood is returned to

the left atrium of the heart through
the pulmonary veins.
6. The left atrium contracts, forcing blood
through the left bicuspid valve into
the left ventricle.
7. The left ventricle contracts, closing the
bicuspid valve and forcing open
the aortic valve as blood enters the
aorta for distribution to the body.
26
Blood Flow Through the Heart
(cont.)
Right Tricuspid Right Pulmonary

Atrium Valve Ventricle Valve
Body Lungs
Aortic Pulmonary
Left Bicuspid Left
Semilunar Semilunar
Ventricle Valve Atrium
Valve Valve
23-28
H. Blood Supply to the Heart

1. The first branches off of the aorta, which
carry freshly oxygenated blood, are the right
and left coronary arteries that feed the
heart muscle itself.
2. Branches of the coronary arteries feed
many capillaries of the myocardium.
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3. The heart muscle requires a continuous

supply of freshly oxygenated blood, so smaller
branches of arteries often have anastomoses
as alternate pathways for blood, should one
pathway become blocked.
4. Cardiac veins drain blood from the
heart muscle and carry it to the coronary
sinus, which empties into the right atrium.
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 Heart Actions
A. The cardiac cycle consists of the atria
beating in unison (atrial systole) followed by
the contraction of both ventricles, (ventricular
systole) then the entire heart relaxes for a brief
moment (diastole).
34
B. Cardiac Cycle
1. During the cardiac cycle, pressure within
the heart chambers rises and falls with
the contraction and relaxation of atria and
ventricles.
2. When the atria fill, pressure in the atria
is greater than that of the ventricles, which
forces the A-V valves open.
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3. Pressure inside atria rises further as

they contract, forcing the remaining blood
into the ventricles.
4. When ventricles contract, pressure
inside them increases sharply, causing A-V
valves to close and the aortic and
pulmonary valves to open.
a. As the ventricles contract, papillary
muscles contract, pulling on chordae
tendinae and preventing the backflow of
blood through the A-V valves.
36
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C. Heart Sounds
1. Heart sounds are due to
vibrations in heart tissues as blood
rapidly changes velocity
within the heart.
2. Heart sounds can be described as
a "lubb-dupp" sound.
38
3. The first sound (lubb) occurs as

ventricles contract and A-V
valves are closing.
4. The second sound (dupp) occurs
as ventricles relax and aortic and
pulmonary valves are
closing.
39
D. Cardiac Muscle Fibers

1. A mass of merging fibers that act
as a unit is called a functional
syncytium; one exists in the
atria (atrial syncytium) and one in
the ventricles (ventricular
syncytium).
40
E. Cardiac Conduction System

1. Specialized cardiac muscle tissue
conducts impulses throughout the myocardium
and comprises the cardiac conduction
system.
2. A self-exciting mass of specialized
cardiac muscle called the sinoatrial node
(S-A node or pacemaker), located on the
posterior right atrium, generates the impulses
for the heartbeat.
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3. Impulses spread next to the atrial

syncytium, it contracts, and impulses travel to
the junctional fibers leading to the
atrioventricular node (A-V node) located in the
septum.
a. Junctional fibers are small, allowing the
atria to contract before the impulse spreads
rapidly over the ventricles.
42
4. Branches of the A-V bundle give

rise to Purkinje fibers
leading to papillary muscles;
these fibers stimulate
contraction of the papillary muscles at
the same time the
ventricles contract.
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F. Electrocardiogram
1. An electrocardiogram is a recording of the
electrical changes that occur during a cardiac cycle.
2. P Wave
• Depolarization of the atrial fibers of the SA node produces
the P wave. The actual contraction of the atria follows the
P wave by a fraction of a second. The ventricles of the
heart are in diastole during the expression of the P wave.
A missing or abnormal P wave may indicate a dysfunction
of the SA node.
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P wave-S.A node
• The SA node, or pacemaker, is located in the
posterior
• wall of the right atrium where the superior vena cava
attaches to the heart. The SA node initiates the
cardiac cycle by producing an electrical impulse that
spreads over both atria, causing them to contract
simultaneously and force blood into the ventricles.
46
The basicdepolarization rate of the SA node
is 70 to 80 times per minute
P-R Interval
•On the ECG recording, the P-R interval is
the period of time from the start of the P
wave to the beginning of the QRS complex.
•This interval indicates the amount of time
required for the SA depolarization to reach
the ventricles.
•A prolonged P-R interval suggests a
conduction problem at or below the AV node.
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A.V node
• The impulse then passes to the AV node,
located in the inferior portion of the interatrial
septum.
• From here, the impulse continues through
the atrioventricular bundle, located at the top
of the interventricularseptum.
• The atrioventricular bundle divides into right
and left bundle branches, which are
continuous with the conduction
48
myofibers within the ventricular walls.
•Stimulation of these fibers causes the

ventricles to contract simultaneously.
3.QRS Complex
•The QRS complex begins as a short
downward deflection (Q),continues as a
sharp upward spike (R), and ends as a
downward deflection (S).
•The QRS complex indicates the
depolarization of the ventricles
49
• . During this interval, the ventricles are in
systole and blood is being ejected from the
heart.
• It is also during this interval that the atria
repolarize, but this event is obscured by the
greater depolarization occurring in the
ventricles.
• An abnormalQRS complex generally
indicates cardiac problems of the ventricles.
• An enlarged R spike, for example, generally
indicates enlarged ventricles.
50
S-T Segment
•The time duration known as the S-T
segment represents the period between the
completion of ventricular depolarization and
initiation of repolarization.
• The S-T segment is depressed when the
heart receives insufficient oxygen;
• in acute myocardial infarction,it is elevated.
51
T Wave
•The T wave is produced by ventricular
repolarization.
•An arteriosclerotic heart will produce altered T
waves, as will variousother heart diseases.
•The T waves ends the ECG pattern and
corresponds to ventricular repolarization.
52
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Significance of Heart Sounds
• Heart sounds are of clinical importance
because they provide information about the
condition of the heart valves and may
indicate heart problems.
• Abnormal sounds are referred to as heart
murmurs and are caused by valvular leakage
or restriction and the subsequent turbulence
of the blood as it passes through the heart.
54
In general, three basic conditions cause
murmurs:
(1) valvular insufficiency,
in which the cusps of the valves do not form
a tight seal;
(2) stenosis, in which the walls surrounding

a valve are roughened or
Constricted;
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• (3) a functional murmur, which is
frequent in children and is caused by
turbulence of the blood moving through
the heart during heavy exercise.
• Functional murmurs are not pathological

and are considered normal.
56
G. Regulation of the Cardiac Cycle

1. The amount of blood pumped at any
one time must adjust to the current needs
of the body (more is needed during strenuous
exercise).
2. The S-A node is innervated by
branches of the sympathetic and
parasympathetic divisions, so the CNS
controls heart rate.
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a. Sympathetic impulses increase

the speed of heart rate.
b. Heart rate is decreased by
parasympathetic impulses.
58
3. The cardiac control center of the

medulla oblongata
maintains a balance
between the sympathetic and
parasympathetic divisions of
the nervous system in response to
messages from baroreceptors
which detect changes in blood
pressure.
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4. Impulses from the cerebrum or

hypothalamus may also
influence heart rate, as do body
temperature and the
concentrations of certain ions.
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 Blood Vessels
A. The blood vessels (arteries, arterioles,
capillaries, venules, and veins) form a closed
tube that carries blood away from the heart, to
the cells, and back again.
B. Arteries and Arterioles
1. Arteries are strong, elastic vessels
adapted for carrying high-pressure blood.
2. Arteries become smaller as they divide
and give rise to arterioles.
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3. The wall of an artery consists of

an endothelium, tunica media
(smooth muscle), and tunica
externa (connective tissue).
4. Arteries are capable of
vasoconstriction as directed by the
sympathetic impulses; when
impulses are inhibited, vasodilation
results.
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C. Capillaries
1. Capillaries are the smallest vessels,
consisting only of a layer of endothelium
through which substances are exchanged
with tissue cells.
2. Capillary permeability varies from one
tissue to the next, generally with more
permeability in the liver, intestines, and
certain glands, and less in muscle and
considerably less in the brain (blood-brain
barrier).
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3. The pattern of capillary density also

varies from one body part to the
next.
a. Areas with a great deal of
metabolic activity (leg
muscles, for example) have
higher densities of capillaries.
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4. Precapillary sphincters can regulate

the amount of blood entering a
capillary bed and are controlled by
oxygen concentration in the area.
a. If blood is needed elsewhere
in the body, the capillary beds
in less important areas are shut
down.
68
D. Exchanges in the Capillaries

1. Blood entering capillaries contains
high concentrations of oxygen
and nutrients that diffuse out of the
capillary wall and into the
tissues.
a. Plasma proteins remain in
the blood due to their large size.
69
2. Hydrostatic pressure drives the

passage of fluids and very small
molecules out of the capillary at this
point.
3. At the venule end, osmosis, due to
the osmotic pressure of the blood,
causes much of the tissue fluid to
return to the bloodstream.
4. Lymphatic vessels collect excess
tissue fluid and return it to
circulation.
70
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E. Venules and Veins

1. Venules leading from capillaries
merge to form veins that
return blood to the heart.
2. Veins have the same three layers
as arteries have and have a
flap-like valve inside to prevent
backflow of blood.
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a. Veins are thinner and less

muscular than arteries; they
do not carry high-pressure
blood.
b. Veins also function as blood
reservoirs.
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 Blood Pressure
A. Blood pressure is the force of blood
against the inner walls of blood vessels
anywhere in the cardiovascular system,
although the term "blood pressure" usually
refers to arterial pressure.
76
B. Arterial Blood Pressure

1. Arterial blood pressure rises and falls
following a pattern established by the cardiac
cycle.
a. During ventricular contraction, arterial
pressure is at its highest (systolic pressure).
b. When ventricles are relaxing, arterial
pressure is at its lowest (diastolic pressure).
77
2. The surge of blood that occurs with

ventricular contraction can be felt at
certain points in the body as a
pulse.
78
C. Factors that Influence Arterial Blood Pressure

1. Arterial pressure depends on heart action,
blood volume, resistance to flow, and blood
viscosity.
2. Heart Action
a. Heart action is dependent upon stroke
volume and heart rate (together called cardiac
output); if cardiac output increases, so does
blood pressure.
79
3. Blood Volume
a. Blood pressure is normally
directly proportional to
the volume of blood within
the cardiovascular
system.
b. Blood volume varies with
age, body size, and gender.
80
4. Peripheral Resistance
a. Friction between blood and the walls of
blood vessels is a force called peripheral
resistance.
b. As peripheral resistance increases,
such as during sympathetic constriction of
blood vessels, blood pressure increases.
81
5. Blood Viscosity
a. The greater the viscosity
(ease of flow) of blood, the
greater its resistance to flowing,
and the greater the blood
pressure.
82
D. Control of Blood Pressure

1. Blood pressure is determined by
cardiac output and
peripheral resistance.
2. The body maintains normal blood
pressure by adjusting
cardiac output and peripheral
resistance.
83
3. Cardiac output depends on stroke

volume and heart rate, and
a number of factors can affect
these actions.
a. The volume of blood that
enters the right atrium
is normally equal to the
volume leaving the left
ventricle.
84
b. If arterial pressure increases, the

cardiac center of the medulla oblongata sends
parasympathetic impulses to slow heart
rate.
c. If arterial pressure drops, the medulla
oblongata sends sympathetic impulses to
increase heart rate to adjust blood pressure.
85
86
d. Other factors, such as

emotional upset,
exercise, and a rise in
temperature can result in
increased cardiac
output and increased blood
pressure.
87
4. The vasomotor center of the

medulla oblongata can
adjust the sympathetic impulses
to smooth muscles in arteriole
walls, adjusting blood pressure.
a. Certain chemicals, such as
carbon dioxide,
oxygen, and hydrogen
ions, can also affect peripheral
resistance.
88
E. Venous Blood Flow

1. Blood flow through the venous
system is only partially the
result of heart action and instead
also depends on skeletal muscle
contraction, breathing
movements, and vasoconstriction
of veins.
89
a. Contractions of skeletal
muscle squeeze blood
back up veins one valve at
a time.
b. Differences in thoracic and
abdominal pressures
draw blood back up the
veins.
90
 Paths of Circulation
A. The body’s blood vessels can be
divided into a pulmonary circuit, including
vessels carrying blood to the lungs and back,
and a systemic circuit made up of vessels
carrying blood from the heart to the rest of the
body and back.
91
B. Pulmonary Circuit
1. The pulmonary circuit is made up
of vessels that convey blood from
the right ventricle to the pulmonary
arteries to the lungs,
alveolar capillaries, and
pulmonary veins leading from the
lungs to the left atrium.
92
C. Systemic Circuit
1. The systemic circuit includes the
aorta and its branches
leading to all body tissues as well
as the system of veins returning
blood to the right atrium.
93
 Arterial System
A. The aorta is the body’s largest artery.
B. Principal Branches of the Aorta
1. The branches of the ascending aorta
are the right and left coronary arteries that
lead to heart muscle.
2. Principal branches of the aortic arch
include the brachiocephalic, left common
carotid, and left subclavian arteries.
94
3. The descending aorta (thoracic

aorta) gives rise to many
small arteries to the thoracic
wall and thoracic viscera.
4. The abdominal aorta gives off the
following branches: celiac,
superior mesenteric, suprarenal,
renal, gonadal, inferior
mesenteric, and common iliac
arteries.
95
96
97
98
C. Arteries to the Head, Neck, and Brain

1. Arteries to the head, neck, and
brain include branches of the
subclavian and common carotid
arteries.
2. The vertebral arteries supply the
vertebrae and their
associated ligaments and
muscles.
99
3. In the cranial cavity, the vertebral

arteries unite to form a basilar
artery which ends as two posterior
cerebral arteries.
4. The posterior cerebral arteries help
form the circle of Willis which provides
alternate pathways through which blood can
reach the brain.
100
101
5. The right and left common carotid

arteries diverge into the external carotid
and internal carotid arteries.
6. Near the base of the internal carotid
arteries are the carotid sinuses that
contain baroreceptors to monitor blood
pressure.
102
103
D. Arteries to the Shoulder and Upper Limb

1. The subclavian artery continues into the
arm where it becomes the axillary artery.
2. In the shoulder region, the axial artery
becomes the brachial artery that, in turn,
gives rise to the ulnar and radial arteries.
104
105
106
E. Arteries to the Thoracic and Abdominal

Walls
1. Branches of the thoracic aorta and
subclavian artery supply the
thoracic wall with blood.
2. Branches of the abdominal aorta, as
well as other arteries, supply the
abdominal wall with blood.
107
F. Arteries to the Pelvis and Lower Limb

1. At the pelvic brim, the abdominal
aorta divides to form the
common iliac arteries that
supply the pelvic organs, gluteal
area, and lower limbs.
108
2. The common iliac arteries divide into

internal and external iliac arteries.
a. Internal iliac arteries supply blood to
pelvic muscles and visceral structures.
b. External iliac arteries lead into the
legs, where they become femoral, popliteal,
anterior tibial, and posterior tibial
arteries.
109
110
 Venous System
A. Veins return blood to the heart after the
exchange of substances has occurred in the
tissues.
B. Characteristics of Venous Pathways
1. Larger veins parallel the courses of
arteries and are named accordingly;
smaller veins take irregular pathways and
are unnamed.
111
2. Veins from the head and upper

torso drain into the superior
vena cava.
3. Veins from the lower body drain
into the inferior vena cava.
4. The vena cavae merge to join the
right atrium.
112
C. Veins from the Head, Neck, and Brain

1. The jugular veins drain the
head and unite with the
subclavian veins to form the
brachiocephalic veins.
113
D. Veins from the Upper Limb and

Shoulder 1. The upper limb is drained by
superficial and deep veins.
2. The basilic and cephalic veins
are major superficial veins.
3. The major deep veins include
the radial, ulnar, brachial,
and axillary veins.
114
115
E. Veins from the Abdominal and Thoracic

Walls
1. Tributaries of the brachiocephalic and
azygos veins drain the abdominal
and thoracic walls.
116
F. Veins from the Abdominal Viscera

1. Blood draining from the intestines
enters the hepatic portal
system and flows to the liver first
rather than into general circulation.
2. The liver can process the
nutrients absorbed during digestion
as well as remove bacteria.
117
3. Hepatic veins drain the liver,

gastric veins drain the stomach,
superior mesenteric veins lead
from the small intestine and
colon, the splenic vein leaves the
spleen and pancreas, and the
inferior mesenteric vein
carries blood from the lower
intestinal area.
118
119
120
G. Veins from the Lower Limb and Pelvis

1. Deep and superficial veins drain the
leg and pelvis.
2. The deep veins include the anterior
and posterior tibial veins which unite into
the popliteal vein and femoral vein;
superficial veins include the small and great
saphenous veins.
3. These veins all merge to empty into
the common iliac veins.
121
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L5Circulatory System

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Cardiovascular System

 Structure of the Heart

C. Coverings of the Heart

3. At the base of the heart, the

– Layer on top of the – Endocardium

D. Wall of the Heart

3. The middle layer called myocardium

E. Heart Chambers and Valves

2. A septum divides the atrium and ventricle on

b. Chordae tendinae are, in turn,

3. The superior and inferior vena cavae

5. At the base of the pulmonary trunk

• Right atrium contracts • Left atrium contracts

• Right ventricle contracts • Left ventricle contracts

• Sinoatrial node (SA node) • Bundle of His

• Atrioventricular node (AV • Purkinje fibers

F. Skeleton of the Heart

G. Path of Blood through the Heart

3. The right ventricle contracts, closing

5. Freshly oxygenated blood is returned to

Right Tricuspid Right Pulmonary

H. Blood Supply to the Heart

3. The heart muscle requires a continuous

3. Pressure inside atria rises further as

3. The first sound (lubb) occurs as

D. Cardiac Muscle Fibers

E. Cardiac Conduction System

3. Impulses spread next to the atrial

4. Branches of the A-V bundle give

•Stimulation of these fibers causes the

(2) stenosis, in which the walls surrounding

• Functional murmurs are not pathological

G. Regulation of the Cardiac Cycle

a. Sympathetic impulses increase

3. The cardiac control center of the

4. Impulses from the cerebrum or

3. The wall of an artery consists of

3. The pattern of capillary density also

4. Precapillary sphincters can regulate

D. Exchanges in the Capillaries

2. Hydrostatic pressure drives the

E. Venules and Veins

a. Veins are thinner and less

B. Arterial Blood Pressure

2. The surge of blood that occurs with

C. Factors that Influence Arterial Blood Pressure

D. Control of Blood Pressure

3. Cardiac output depends on stroke

b. If arterial pressure increases, the

d. Other factors, such as

4. The vasomotor center of the

E. Venous Blood Flow

3. The descending aorta (thoracic

C. Arteries to the Head, Neck, and Brain

3. In the cranial cavity, the vertebral

5. The right and left common carotid

D. Arteries to the Shoulder and Upper Limb

E. Arteries to the Thoracic and Abdominal

F. Arteries to the Pelvis and Lower Limb

2. The common iliac arteries divide into

2. Veins from the head and upper

C. Veins from the Head, Neck, and Brain

D. Veins from the Upper Limb and

E. Veins from the Abdominal and Thoracic