VI.

The Cardiovascular System

Introduction

Known as the vital system of the body as it pertains to mainly on the existence of human
life. The continous pumping of the heart, day and night throughout your entire lifetime is such an
obvious key to the presence of life that it is no surprise that this organ has been the subject of
wonderment and poetry. When your heart stops pumping, your life ceases.

Objectives

At the end of this lesson, you should be able to:

1. Describe the heart as to location, position, structure, function and blood supply
2. Discuss the different types of circulation:
a. Pulmonary Circulation
b. Systemic Circulation
c. Portal Circulation
d. Fetal Circulation
3. Differentiate arteries, veins, and capillaries in terms of structure and functions.
4. Discuss the control of blood pressure and pulse rate.

Try This!

Activity 1. Answer the given questions based on your own understanding.

Place your index and middle finger on your wrist. Locate your pulse by applying gentle
palpation. Count your pulse in one full minute. Do this in two separate occasions of activity. For
example, while sitting and right after walking.

Describe the characteristic (regularity and strength) of your pulse? __________________

______________________________________________________________________________
What is your pulse rate per minute? _________________________________________________
Compare the characteristics and rate of your pulse taken from two different activities. _________
______________________________________________________________________________

You did great in answering Activity 1. Congratulations!

Think Ahead!

Activity 1 shows how your blood circulates throughout the body. The arterial pulse on your
wrist is the radial pulse.

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 VI. The Cardiovascular System

Arteries expand and recoil in every ventricular contraction, this pressure is called pulse. In
normal adult, average pulse rate is about 70 to 76 beats per minute. Pulse rate can be obtained
manually by placing two or three fingers (do not use thumb) on arterial pulse points (Fig. 58).

Figure 58. Arterial pulse points

To learn more, do the next activity.

Try This!

Activity 2. Tracing the pathway of the blood.

A. Go With the Flow

You need colored pens/pencils or crayons for this activity. Using lines and arrows, trace the
pathway of blood through the heart. Color RED the lines and arrows for the oxygen-rich blood
and BLUE for the oxygen-poor blood. Then, label the parts of the heart (You may use references,
textbook or internet, to help you with this activity).

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 VI. The Cardiovascular System

B. As you go tracing the flow of the blood, make a list of all the structures that the blood passes
through. Using one sentence per structure, briefly describe each structure’s functions.
___________________ _____________________ ____________________
___________________ _____________________ ____________________
___________________ _____________________ ____________________
___________________ _____________________ ____________________
___________________ _____________________ ____________________

Great! You are done with Activity 2.

Think Ahead!

Activity 2 helps you understand the concept of blood circulation. Furthermore, you have
identified the structures of the heart. Compare your answers on the Read and Ponder section. Did
you get it correct? To learn more, move to the next activity.

Try This!

Activity 3. Differentiate the two (2) major blood vessels. Fill-out your answers for each
question on the table below.

Questions Arteries Veins

1. Describe the structures
of each type of blood
vessel.
2. What are the major
functions?

Congratulations for completing Activity 3!

Think Ahead!

Activity 3 helps you to understand about the two major blood vessels that make up the
cardiovascular system. Blood flows through pathways called blood vessels. The circulation of
blood within these vessels is called the vascular system. Oxygen-rich blood is distributed to tissues
through arteries. Veins carry the oxygen-poor blood or carbon-dioxide rich blood from tissues
going to the heart.

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 VI. The Cardiovascular System

Read and Ponder

In every pumping of the heart, it supplies oxygen and nutrients throughout the body as
delivered through blood vessels. To maintain the normal functions of all systems and organs, the
cardiovascular system also works on the transport of waste and carbon dioxide as blood vessels
carry it away from tissues.

The Heart

The heart is situated in the thorax, specifically on the medial section of the thoracic cavity.
Its apex is at the level of the fifth intercostal space, directed toward the left side of the body. The
base or the broad aspect is directed toward the right shoulder under the second rib. (Fig. 59)

Figure 59. Location of the heart.

The heart walls are composed of three muscular layers – Epicardium, Endocardium and
Myocardium. (Fig. 60)
▪ Epicardium – the innermost layer of the Pericardium. Pericardium is the outermost
membrane that surrounds the heart. A serous lubricating fluid produced by pericardial
membranes in which it reduces friction within the pericardial cavity when the heart
contracts.
▪ Myocardium – made of thick bundles of cardiac muscle. This layer contracts and pumps
blood through the heart and other major arteries.
▪ Endocardium – the innermost layer of the heart walls that lined the heart chambers.

Figure 60. Membranes of the heart

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 VI. The Cardiovascular System

The four chambers of the heart are the atria and ventricles. The upper chambers or the
superior atria are known as the receiving chambers. The ventricles are the discharging
chambers, inferior chambers, its thick wall defines the pumping action of the heart.

The heart valves are responsible in keeping the blood flow in one direction. The four
different heart valves are the following:
▪ Atrioventricular valves (AV valves) – located between atria and ventricles.
Bicuspid or mitral valve is a left AV valve and made of two flaps. The right AV
valve is the tricuspid valve and has three flaps. These valves prevent backflow into
the atria during ventricular contraction.
▪ Semilunar valves – these valves prevent backflow into the ventricles during
ventricular relaxation. It opens when ventricles contract and blood is pumped out.
These valves are known as pulmonary semilunar valve and aortic semilunar valve.

Figure 61. Structures of the Heart

Blood is pumped out from the heart and further circulated throughout the body.
Simultaneously, the heart receives blood or oxygen-poor blood from body systems. This action is
achieved when the ventricles contract and atria relax or ventricles relax while atria contract.

In order for the heart to pump, there are two known systems that influence the heart
contractions. The involvement of the autonomic nervous system influences the regulation of the
heart rate. For example, sympathetic division response is to increase the heart rate; whereas,
parasympathetic response is when the heart rate is slow or at rest.

The heart muscles contract independently. A built-in system in a heart tissue known as
the intrinsic conduction system or the nodal system, stimulates the heart muscles to depolarize
(Fig. 62). The depolarization runs in one direction, starting from the atria to the ventricles. The
impulse is triggered by sinoatrial node (SA node) or known as the pacemaker. Impulse is further
spread through the atria passing through the AV node. When atria relax, impulse is rapidly
travelled through the bundle of His or AV bundle to bundle branches, reaching the Purkinje
fibers resulting ventricular contraction. This heart activity resulted a single heart rate. This is to
conclude, in each ventricular contraction equals to a heartbeat resulting to pump out about 6 Liters
of blood throughout the body in one minute in normal adult. The process of the intrinsic conduction

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 VI. The Cardiovascular System

system is best translated when electrical activity of the heart is measured using the
electrocardiogram or ECG.

Figure 62. The intrinsic conduction system

There are other factors that influence the heart rate activity. Hormones like epinephrine
and thyroid hormone influence the heart muscles resulting in increased heart rate. Ions play a role
in heart activity; imbalance of electrolytes affects the heart muscles. For example, sodium,
potassium and calcium ions which are essential in muscle contraction. In addition, heart activity is
influenced by physical factors such as, age, gender and physical activities.

Each complete heartbeat is termed as cardiac cycle. As discusses previously, when

ventricles and atria contract and relax simultaneously resulting a single heartbeat. In normal adult,
about 75 heart beats per minute; normal cardiac cycle is about 0.8 second. Ventricular contraction
is known as systole, and diastole refers to ventricular relaxation. When taking the heart rate using
a stethoscope, distinct sounds are heard in each heartbeat or cardiac cycle. The first heart sound
heard is “lub”, longer and louder sound, this is due to the closing of AV valves. Followed by a
short and sharp sound “dup”, due to the closing of semilunar valves.

When blood is pumped out by each ventricle in one minute, the amount of blood is known
as the cardiac output. Whereas, the amount of blood pumped out by ventricles in each heartbeat
is known as the stroke volume. When analyzing the cardiac output of an individual, cardiac output
is the product of the heart rate and the stroke volume. For example, a person with a heart rate of
80 beats per minute and a stroke volume of 70mL per minute (the normal resting value of an adult),
cardiac output is 5,600 mL which supplies the body in each minute.

You may view videos about blood circulation at

https://www.visiblebody.com/learn/circulatory/circulatory-pulmonary-systemic-circulation.

Pulmonary Circulation

The right and left chambers of the heart have distinct functions in terms of blood
circulation. Pulmonary circulation refers to blood flow pumped out from right ventricle going
through pulmonary trunk and further passes through pulmonary arteries reaching the lungs (Fig.
63).
Oxygen-poor blood from different systems of the body enters the right atrium or into the

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receiving chamber through the superior and inferior

vena cava. As the right atrium contracts, right
ventricle is filled. Right ventricle contracts which
pushes blood out going to the lungs. Gas exchange
takes place on the lungs; where carbon dioxide is
excreted and oxygen is picked up. Oxygen-rich blood
will now flow back to heart through pulmonary veins,
entering the left atrium.

Systemic Circulation

Oxygen-rich blood from the left atrium flows

going to the left ventricle. Left ventricle contracts and
pumps out blood exiting the aorta and oxygen-rich
blood is delivered throughout the body. Systemic
circulation is completed when oxygen-poor blood
from tissues is transported to the right atrium (Fig.
63).
Figure 63. Pulmonary and systemic circulation

Portal Circulation

The hepatic portal circulation is the flow of blood draining from digestive organs –
intestines and stomach, and spleen and pancreas to the liver. When digestion takes place, nutrient-
rich blood is absorbed and drained through mesenteric veins, splenic vein and gastric veins (Fig.
64); and to be further delivered to the liver for detoxification entering through the hepatic portal
vein. The liver removes toxins and other harmful substances from the blood. From the liver, blood
will now enter the systemic circulation exiting through the hepatic vein going to the inferior vena
cava entering the heart (Fig.65).

Figure 64. Hepatic Portal System Figure 65. Hepatic Portal Circulation

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 VI. The Cardiovascular System

Fetal Circulation

The fetus is nourished by the mother’s blood through the placenta. Gas exchanges, waste
excretion and absorption of nutrients occurs through the placenta. The umbilical cord is composed
of two arteries and one vein. Oxygen and nutrients from maternal blood flows through the
umbilical vein going to the fetus. Umbilical
arteries carry carbon dioxide and metabolic
waste from the fetus to the placenta.

Since the liver of the fetus is still

immature, blood flow bypasses the liver
entering through the ductus venosus and
further flows to the inferior vena cava
reaching the right atrium of the fetal heart.
Fetal lungs are non-functional, blood from
right atrium enters through foramen ovale
going to the left atrium, left ventricle then
exiting through the aorta. Simultaneously,
blood from the right atrium going to the
right ventricle, pulmonary trunk then
passing through ductus arteriosus
bypassing the lungs respectively. From the
aorta, blood flows through the umbilical
arteries, transporting oxygen-poor blood
and metabolic waste to the placenta (Fig.
66). Figure 66. Fetal circulation

Blood Vessels

As discussed earlier, oxygen-rich blood is distributed to tissues through arteries. Veins carry
the oxygen-poor blood or carbon-dioxide rich blood from tissues going to the heart. The unloading
of carbon dioxide and loading of oxygen take place within the capillaries.

Recall the concept of the pulmonary

circulation, pulmonary veins carry oxygen-rich
blood from the lungs to the heart. This is to
exempt that only pulmonary veins transport
oxygen-rich blood.

Blood vessels are composed of layers or

tunics. The innermost layer is called tunica
intima, made of thin layer of endothelium which
helps blood to flow smoothly within the vessel.
Tunica media is the middle layer, it is made of
elastic fibers. The outermost layer is the tunica
externa, made of fibrous connective tissue which protects Figure 67. Structure of blood vessels

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 VI. The Cardiovascular System

and supports the blood vessels (Fig. 67).

Arteries

Basically, arteries carry blood away from the heart. Considering blood carried by arteries is
to be distributed throughout the body, strong pressure is required. The arterial wall is thicker and
heavier. It can adapt the changes in pressure as it is capable to stretch and recoil.

The largest artery is the aorta. From the aorta, branched out to major arteries that serve
different organs of the body. Take a closer look on the illustration below (Fig. 68, 69 and 70).
Arteries are named based on the organs, regions, locations or shape it served.

Figure 69. Major arteries of the brain

Figure 68. Major arteries

Figure 70. Major Blood Vessels of the Heart

Veins

These vessels carry blood back to the heart. Compared to arteries, veins have low pressure
and walls are thinner. Due to low pressure within the vessel, the tunica externa of the veins is
thicker than arteries. To be able to compensate the blood flowing back to the heart, large veins
have valves. The valves prevent backflow of blood and to promote good circulation or venous
return.

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 VI. The Cardiovascular System

Most of the veins are named identically with arteries. Like arteries, veins are named from
organs, regions, location or shape it drained (Fig. 71).

Figure 71. Major veins Figure 72. Capillary bed

Capillaries

These fine blood vessels have only one layer, its tunica intima is thick. Due to its thinness,
movements and exchanges of substances between tissue cells and blood are easily permitted. When
blood flows from the arteries to the target tissue cells, exchanges take place on the capillary bed
(Fig. 72), in return blood is drained through veins; this process is called microcirculation.

The movement of fluid and substances at the capillary bed is due to the pressure within the
blood vessels. On the arterial end, blood pressure is higher than the osmotic pressure, forcing fluid
to move out of the capillary and into the interstitial fluid. While on the venule end of the capillary,
blood pressure is less than osmotic pressure; thus, fluid moves from the interstitial fluid into the
capillary.

Blood Pressure

Blood circulation is mainly influenced by pressure within the inner wall of the blood
vessels. This pressure is called blood pressure. In the systemic arterial circulation, blood coming
out from the heart has higher pressure and as it continuously flows through branches of arteries, to
capillaries, to veins and back to the right side of the heart, blood pressure gradient differs. The
pressure in the arteries is stronger than the veins. When arterial wall constricts, blood pressure is
relatively high. Blood pressure drops when arteries dilate.

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 VI. The Cardiovascular System

Systolic pressure refers to an arterial pressure when ventricular contraction is at peak. When
ventricles relax, arterial pressure is call diastolic pressure. Using a sphygmomanometer, blood
pressure is taken and measured in millimeters of Mercury (mmHg).

Blood pressure is affected by different factors. Peripheral resistance is increased due to

many factors, to include age, weight, activity or exercise, emotional state, temperature and drugs.
Peripheral resistance is the amount of friction of blood flowing through blood vessels.
Vasoconstriction or narrowing of blood vessels is also influenced by the autonomic nervous
system. When blood pressure drops, neural factor will compensate by activating the baroreceptors
to increase blood pressure or to homeostasis. Kidneys play a role in regulating blood pressure.
Kidneys release an enzyme called renin when blood pressure falls. Renin triggers the formation
of Angiotensin II, which stimulates arteries to constrict; simultaneously it will trigger the release
of aldosterone from the adrenal cortex. Aldosterone reabsorbs sodium; thus, water is retained.
Sodium and water retention will eventually increase blood volume and arterial blood pressure.

Composition of Blood

As mentioned on the previous discussion about blood circulation that is constantly

distributed throughout the body. Blood is made of essential components. When it reaches the target
organs and tissues, it transports oxygen, nutrients and passing other route in transporting metabolic
waste, carbon dioxide and other substances for excretion. Blood is considered as a connective
tissue; it is composed of two parts – plasma and formed elements.

About 55% is plasma and 45% are formed elements. Formed elements are heavier in nature
than plasma. Thus, when allowing a blood bag hanging, the plasma components will appear on top
of the red blood cells or the formed elements.

Figure 73. Composition of blood

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 VI. The Cardiovascular System

▪ Plasma – it contains about 90% of water which is essential for saturation of nutrients,
electrolytes, respiratory gases, plasma proteins, hormones and other products of cell
metabolism. The major component of plasma protein is the albumin. Albumin is a by-
product of protein produced by the liver. It is essential in maintaining the osmotic pressure
of the blood to maintain appropriate amount of water.

▪ Formed Elements – this component includes the red blood cells or erythrocytes, white
blood cells or leukocytes and platelets. Table below shows the summary of functions of
formed elements.

Figure . Lobes of the brain

Figure 74. Types and functions of formed elements of blood

Blood Grouping, Typing and RH Factor

Blood grouping or the ABO blood groups are basically inherited genetically. Blood type
A, B, AB and O is determined based on the antigen component of the blood plasma. Blood type A
contains antigen A, type B has antigen B, type AB contains both antigen A and B, and type O has
no antigen neither A or B.

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 VI. The Cardiovascular System

In normal conditions, antigens are considered foreign proteins and antibodies are produced
when the body is exposed to antigen. In ABO blood group, Blood type A contains anti-B
antibodies, and blood type B has anti-A antibodies in blood plasma. Blood type AB which has
antigen A and B, does not perform antibodies both anti-A and anti-B. Blood type O, which contains
no antigens A or B, both anti-A and anti-B antibodies are present in blood plasma.

Thus, when performing blood typing, blood type with antigen A will agglutinate with blood
type containing antigen B when added together. For example, Blood type A will agglutinate with
blood type B; this is due to, type A contains anti-B antibodies while type B has anti-A antibodies,
making it incompatible. Agglutination is when RBCs clumped together which will create
obstruction on blood vessels. Eventually, RBCs will hemolyse (rupture) where hemoglobin will be
detached and released into the bloodstream. In this case, severe reaction will cause and it may lead
to death.

There is a known second erythrocyte antigen called Rh. It is also known agglutinogen D
or Rh D Antigen. Any blood type with erythrocytes presence of Rh D antigen is called Rh positive
or Rh +, and erythrocytes lacks or absence of Rh D antigen is termed Rh negative or Rh -. Thus,
any ABO blood type may have either Rh+ or Rh-. For example, an individual with blood type A
and Rh D antigen is present; the blood type is documented as A +.

Like the ABO blood group, Rh blood group occurs incompatibility problem. This happens
a case of a Rh- pregnant woman carries Rh+ baby. During or immediate after delivery of the baby,
maternal blood will be exposed to the Rh+ fetal blood. Initially, no reactions will occur. However,
maternal blood will start to develop anti-Rh antibodies. On the second pregnancy of the mother,
maternal blood with anti-Rh antibodies will cross the placenta and attack the fetal blood, causing
destruction of fetal RBCs leading to fatal condition and even death. This condition is known as
hemolytic disease of the newborn.

For additional information about concepts of Cardiovascular System, you may read any
textbook or references on Human Anatomy and Physiology. You may also go to
https://www.visiblebody.com/learn/circulatory.

See if you can do this!

You have learned the concepts of structures and functions of Cardiovascular System. Take
a review by answering the following exercises.

1. What blood vessels that serve and drain the kidneys? __________________________________
___________________________________________________________________________

2. Nurse Mario is going to take the vital signs of his patient. Nurse Mario is aware that pulse rate
can be palpated on the wrist. What artery is palpated on this site? _______________________

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 VI. The Cardiovascular System

3. What component of plasma that plays a major function on osmotic balance?_______________

____________________________________________________________________________

4. What structures that can be located between the atria and ventricles on each side of the heart?
____________________________________________________________________________

5. The nurse assesses the heart sounds of a 16-year old client who is complaining of chest pain.
How will the nurse document the findings of a normal heart sounds? ____________________
___________________________________________________________________________

6. What component of leukocytes that release histamine at the site of inflammation?___________

____________________________________________________________________________

7. Maria needs a blood transfusion. Her blood type is B+. If Maria will be transfused with blood
type A+, what will likely happen? Discussed briefly your answer. _______________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

8. Immediately after a baby is born, fetal lungs will become functional. What changes will occur
on ductus arteriosus and foramen ovale? Explain the process involved. ___________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

9. A 55-year old male with a heart rate of 78 beats/min and a stroke volume of 70 mL/beat. What
is the cardiac output? __________________________________________________________
___________________________________________________________________________

10. A client who had an injury on the right arm asked the nurse about the purpose of applying a
cold compress to a bruised area. What will be the best answer of the nurse? ______________
___________________________________________________________________________
___________________________________________________________________________

Congratulations for a job well done!!

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