PHG 216 / 231

Introductory Cardiovascular and Respiratory

Systems
CARDIOVASCULAR PART
By
Dr. A. A. ADEJARE
Department of Physiology
Faculty of Basic Medical Sciences
College of Medicine of the University of Lagos
Email: aadejare@unilag.edu.ng
 Course outline
• Why CVS
• Organization of the cardiovascular system
• Physiological properties of the heart
• Control of heart rate
• Regulation of cardiac output
• Peripheral resistance
• Regulation of arterial blood pressure
• Regional circulation: cerebral, coronary and pulmonary
 Why CVS
• Cardiovascular diseases are responsible for most of the morbidities and
mortalities worldwide.
• Hypertension, myocardial infarction, coronary artery diseases are among
the fallouts of our present lifestyles
• There is therefore a need to have good understanding of the physiology of
the heart and blood vessels
 Organization of the cardiovascular system
• The three principal components that make up the circulatory system are the heart,
blood vessels, and the blood itself.
• As reported by the British physiologist William Harvey in 1628, the cardiovascular
system forms a closed loop, so that blood pumped out of the heart through one set
of vessels returns to the heart by a different set.
 Systemic and pulmonary circulations
• There are actually two circuits both originating and terminating in the
heart
• The pulmonary circulation includes blood pumped from the right
ventricle through the lungs and then to the left atrium.
• The systemic circulation includes blood pumped from the left
ventricle through all the organs and tissues of the body except the
lungs, and then to the right atrium.
• In both circuits, the vessels carrying blood away from the heart are
called arteries, and those carrying blood from body organs and
tissues back toward the heart are called veins.
• Systemic circuit:
• LV
• aorta
• arteries
• microcirculation (arterioles capillaries venules)
• veins
• IVC and SVC
• RA
• Pulmonary circuit
• RV
• 2 Pulmonary arteries (right and left)
• Lung (right and left)
• Capillaries
• Venules
• 4 Pulmonary veins
• Left atrium
• It must be emphasized that the lungs receive all the blood pumped by the
right side of the heart, whereas each of the peripheral organs and tissues
receives only a fraction of the blood pumped by the left ventricle
 Portal system
• Exceptions to the usual anatomical pattern
• Observed in the liver, kidneys, and pituitary,
• blood passes through two capillary beds, arranged in series, before
returning to the heart.
 Functional anatomy of the heart
• Enclosed in a fibrous sac of pericardium
• Enclosed by another fibrous membrane of epicardium
• Space between pericardium and epicardium is filled by a lubricant fluid.
• Walls of the heart composed of myocardium
• Inner surface lined by endothelial cells or endothelium
• 4 chambers: 2 atria, 2 ventricles: seperated by atrioventricular valves: right valve
(tricuspid) and left valve (bicuspid/mitral)
• Atrioventricular flow is unidirectional
• Chordae tendinae fastens the valves to papillary muscles to prevent backflow
(prolapse)
• RV opens to pulmonary valve, LV opens to aortic valve (both called semilunar
valves): also for unidirectional flow
• All valves act passively: guided by pressure difference, offers no resistance to
flow
 Cardiac muscle
• Cardiac muscle combines properties of both
skeletal and smooth muscle.
• Cardiac myocytes are short branched striated
muscle cells
• Involuntary
• Connected by gap junctions (low resistance
passages) like those in smooth muscles. The
gap junctions make the cells to be electrically
coupled.
• Cardiac myocytes act as a single functional
unit called syncytium (mass of cytoplasm with
numerous nuclei)
• Cardiac muscle cells are considerably
shorter than skeletal muscle fibers.
• They have several branching
processes.
• Adjacent cells are joined end to end
at structures called intercalated
disks (present along the Z-lines of
the sarcomeres), within which are
desmosomes that hold the cells
together and to which the myofibrils
are attached.
• The myocardial fibers are thus
tethered end-to-end for strong
cohesion
Physiological properties of the heart muscle
• Rhythmicity
• Excitability
• Conductivity
• Contractility
 Rhythmicity
• Rhythmicity means the ability of the heart to
beat regularly without external stimulation
• It is myogenic in origin, not neurogenic
• The cells of SAN (posterior wall of RA) is the
primary pacemaker of the heart
• The nodal fibres and conducting system are
self-excitable
• SAN 110 bts/min.
• AVN 90
• Bundle of His (A-V bundle) 45
• Purkinje fibres 35
• Ventricular fibres 25
 Excitability
• The heart muscle responds to stimuli which may be mechanical, electrical
or chemical
• Refractory Period
• The refractory period of the myocardial fibers is of much longer
duration than that of skeletal muscle fibers and lasts approximately as
long as the cardiac contraction--------- so no continous contraction without
relaxation (tetanus) can occur in heart.
 Conductivity
• The ability to conduct impulse from
one cell to another---facilitated by
the presence of gap junctions that
transmit electrical currents
• From SAN→ atrial muscle &
atrioventricular node (AVN)
• From AVN (slowest) →
atrioventricular (AV) bundle (bundle
of His) →left & right bundles
→purkinje fibres (fastest)
 Rules controlling contractility
• 1. All or none law
• The cardiac muscle contracts
either maximally or not at all
(under constant conditions)
• The Atria contract as one unit
& the ventricles contract as one
unit
• This is significant for efficient
pumping of the blood
• 2- Staircase or Treppe Phenomenon
• Rapidly Repeated stimulation of the cardiac
muscle produce gradual increase in the strength of
contraction
• The earlier contractions produce better
conditions (heat, less viscosity between muscle
fiber, more Ca) for the following contraction
• 3. Starling Law
• Within limits, the greater the initial length of cardiac muscle fibre
(stretch), the greater the force of contraction
• The initial length is determined by the volume of blood filling
ventricles at end of diastole (end-diastolic volume; EDV)
 Fiber types in the cardiac muscle
• Nodal fibers
• Conducting fibers
• Contractile fibers
Cardiac muscle fibers
• Conducting system of the heart (1%) :
do not function in contraction, in
contact with the cardiac muscle cells via
gap junctions
• The conducting system initiates heart
beat
• Causes sequential rhythmic excitation of
the heart
• Helps spread the impulse rapidly
throughout the heart
• Atria cells secrete ANP
Sequence of cardiac excitation
 Conducting system of the heart
• Composed of modified cardiac muscle, devoid of
contractile filaments
• SAN (Node of Keith & Flack): located in the
superior posterolateral wall of the right atrium
immediately below and slightly lateral to the
opening of the superior vena cava. contains P cells
that exhibit “pacemaker potential”. have the
capability of self-excitation. Innervated by the
right vagus
• Internodal pathways: SAN is connected to AVN by
1. anterior bundle of Bachmann, the middle bundle
of Wenckebach and the posterior bundle of Thorel
• AVN (Node of Tawara): contains the P cells,
 Conducting system of the heart
Bundle of His: the bundle divides into 2. the minor left bundle (Left Bundle
Branch) and the major right bundle (Right Bundle Branch). The LBB
divides into the anterior fascicle and the posterior fascicle.
Purkinje fibers: they originate from the bundle branches. They move nerve
impulses from the Apex to the Base of the heart
 Heartbeat Coordination
• The heart is a dual pump in that the left and right
sides of the heart pump blood separately, but
simultaneously, into the systemic and pulmonary
circuits.
• Atria contract first
• Ventricles contract last
• Contraction is triggered by depolarization of CM
that arises from the SAN:
• Gap junctions for easy spread of excitation
• The action potential spreads from the SA node
throughout the atria and then into and throughout
the ventricles.
 Sequence of excitation

• SAN remains the pacemaker: determines HR

• Atrial depolarization: SAN to RA to LA: spread indpt of the
conducting system: rapid
• AVN links atrial depolarization with ventricular depolarization
• RA to AVN (the propagation of action potentials through the AV node
is relatively slow (requiring approximately 0.1 s))
• This results in a delay that allows atrial contraction to be completed
before ventricular excitation occurs.
• AVN to AVB (Bundle of His in the
interventricular septum) (the only electrical link
between the atria and the ventricles)
• AVB to Right and Left Bundle branches
• Right and Left Bundle branches to Purkinje
fibers
• Purkinje fibers to Ventricular cells
• Though depolarization and contraction begin
slightly earlier in the bottom (apex) of the
ventricles and spread upward, the result is a
more efficient contraction, like squeezing a tube
of toothpaste from the bottom up.
 Nerve supply of the heart
• A) Sympathetic supply: fibers from stellate
ganglion to SAN to AVN to Atria to Ventricles.
Noradrenergic fibers are mainly epicardial
• 1.↑es all cardiac properties
• 2. ↑es the coronary blood flow.
• B) Parasympathetic supply: Right vagus to SAN;
Left vagus to AVN. Vagus innervation is only to
the atria, not to ventricle. Vagal fibers are mainly
endocardial
• 1.↓es all cardiac properties except the ventricles (not
supplied by vagus nerve)
• 2.↓es the coronary blood flow