ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY LABORATORY BSMLS

CARDIOVASCULAR SYSTEM

DID YOU KNOW? o formed mostly by Left Atrium (upper

 The heart beats about 100,000 times every day; chamber of the heart)
3.5 million beats/year o directed posteriorly and to the right
 Your heart is about the size of your fist.
 Your heart weighs less than a pound. SURFACES OF THE HEART
 The left side of the heart pumps blood through
an estimated 100,000km of blood vessels
(equivalent around the earth’s equator about 3x)
 The right side of the heart pumps blood through
the lungs, enabling blood to pick up oxygen and
unload carbon dioxide

ANATOMY and PHYSIOLOGY of the

HEART
SURFACE PROJECTION OF THE HEART
THE HEART
 Relatively small, cone-shaped, roughly a sized
of a closed fist
 Measures 12cm long, 9cm wide and 6cm thick
 Average mass in weight:
o Adult Female - 250 grams
o Adult Male – 300 grams
 The heart continues to increase in weight and
size up to an advanced period of life. This
increase is more marked in men than in women. PERICARDIUM
 The membrane that surrounds and protects the
heart
 It confines the heart in mediastinal cavity while
allowing sufficient freedom of movement of
contraction.
 2 Principal layers:
1. Superficial Fibrous pericardium
 composed of dense irregular
connective tissue
 Prevents overstretching of the heart,
protection and anchors the heart in the
mediastinum
2. Deep Serous pericardium
 Outer Parietal Layer – fused to the
fibrous pericardium
 Inner Visceral Layer – adheres
POSITION OF THE HEART IN THE tightly to the surface of the heart
MEDIASTINUM o aka EPICARDIUM
 The heart is enclosed in the mediastinal cavity of
the thorax between the lungs
 It extends downwards between the 2nd and 5th
intercostal space midclavicular line
 2/3 mass of the heart lies on the left of the body’s
midline
 APEX – pointed end of the heart, rests on
diaphragm
o formed by the tip of the Left Ventricle
(lower chamber of the heart)
o directed anteriorly, inferiorly, and to the
left
o Apex beat or Point of Maximal impulse
(PMI), the most forceful part of the heart,
can be felt at the Left 5th intercostal
space, midclavicular line
 BASE – opposite the Apex of the heart,
ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY LABORATORY BSMLS
CARDIOVASCULAR SYSTEM

 Superficial FIBROUS PERICARDIUM –

functions to protect, anchor the heart to
surrounding structures and prevent overfilling. FIBROUS SKELETON OF THE HEART
 2 layers separated by fluid - filled pericardial  Dense connective tissue that surrounds and
cavity (decreases friction) supports the valves of the heart
 Parietal layer of the SEROUS  Point of insertion for cardiac muscle bundles
PERICARDIUM has 2 layers:  Prevents the direct spread of action potential
1. PARIETAL LAYER – lines the internal from the atria to the ventricles
surface of the fibrous pericardium
2. VISCERAL LAYER (EPICARDIUM) –
lines the external surface of the heart
 MYOCARDIUM - Circular or spiral bundles of
contractile cardiac muscle cells

LAYERS OF THE HEART WALL

 EPICARDIUM – external layer
o Visceral layer of the serous pericardium CARDIAC CHAMBERS
o Contains blood vessels, lymphatics, and
nerves that supply the myocardium
 MYOCARDIUM – middle layer
o Responsible for the pumping action of
the heart
o Composed of involuntary cardiac
muscle tissue
o Approximately 95% of the heart wall
 ENDOCARDIUM – innermost layer RIGHT ATRIUM
o Thin layer of endothelium overlying  Forms the right border of the heart
connective tissue  About 2-3mm in thickness
o It provides smooth lining for the
 Pectinate muscles – parallel ridges on the atrial
chambers of the heart and covers the wall which signify the original embryonic atrial
valves of the heart wall chambers
o Continuous with the endothelial lining
 Interatrial Septum – a thin partition between the
of the large blood vessels attached to the right and left atria.
heart
 Receives deoxygenated blood from the 3 veins:
1. Superior vena cava
2. Inferior vena cava
3. Coronary sinus
 Blood passes from the right atrium into the right
ventricle through TRICUSPID VALVE

RIGHT VENTRICLE
CARDIAC MUSCLE FIBERS  Forms most of the anterior surface of the heart
 Involuntary muscles in the myocardium  About 4 -5mm in thickness
 Single centrally located nucleus  Trabeculae carneae – ridges formed by raised
 Large mitochondria, smaller sarcoplasmic cardiac bundle fibers and are part of the
reticulum and wider transverse tubules located at conduction system of the heart
Z discs  Chordae tendineae – are tendon-like cords
 Connected via end-to-end intercalated discs connected to cusps of the tricuspid valve
 Desmosomes in the discs provide strength  Interventricular Septum – a partition between
 Gap junctions allow muscle action potentials to the RV and the LV
conduct from one muscle fiber to its neighbors  Receives deoxygenated blood from the RA
through TRICUSPID VALVE and passes blood
to the PULMONARY VALVE into pulmonary
trunk (divides into RPA and LPA) to carry blood
to the lungs.

LEFT ATRIUM
 Forms most of the base of the heart
 Receives oxygenated blood from the LUNGS
through 4 pulmonary veins.
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CARDIOVASCULAR SYSTEM

 Anterior wall is smooth since the ridged 2. Mitral valve (Left atrioventricular valve) –
pectinate muscles are confined to the auricle of LA to LV
the LA  2 Semilunar valves
 Blood passes from the LA into the LV through 1. Pulmonary valve – RV to Pulmonary trunk
the bicuspid (MITRAL) valve aka as Left (Lungs)
Atrioventricular valve 2. Aortic valve – LV to the Aorta (Body)

LEFT VENTRICLE
 Forms the apex of the heart
 Thickest part of the heart measuring 10 - 15mm
 Trabeculae carneae and chordae tendineae that
anchors the cusps of the bicuspid valve to
papillary muscles
 Blood passes from the LV through the AORTIC
VALVE into the Ascending Aorta and to its
coronary arteries and carry blood to the heart
wall
 Arch of the Aorta and Descending Aorta carry
blood throughout the body.
 DUCTUS ARTERIOSUS – a temporary blood
vessel during fetal life shunts blood from the
pulmonary trunk into the aorta so small amount
of blood will enter the fetal lungs. (closes at
birth)
 Ligamentum arteriosum – remnant of DA BLOOD SUPPLY OF THE HEART
connects the arch of aorta and pulmonary trunk
GREAT VESSELS
 MAIN PULMONARY ARTERY, also known
as the pulmonary trunk, emerges from the right
ventricle and delivers unoxygenated blood to the
pulmonary circulation.
 AORTA emerges from the left ventricle and
delivers oxygenated blood to the rest of the
body.
 SUPERIOR VENA CAVA and INFERIOR
Atrium are THIN-WALLED – delivery of blood into VENA CAVA are the main veins that deliver
adjacent ventricles are under less pressure. venous blood from the rest of the body back to
Ventricles are THICK-WALLED – pumping of blood the heart, specifically the right atrium.
under high pressure over great distances  PULMONARY VEINS are the main veins that
RV and LV are two separate pumps but simultaneously deliver blood from the pulmonary circulation
eject equal volumes of blood but LV > RV in workload back to the heart, specifically the left atrium.
Functional difference: LV is thicker than RV

CARDIAC VALVES

CORONARY ARTERIES
 LEFT CORONARY ARTERY – passes
inferior to the left auricle and divides into
anterior interventricular and circumflex branches
 Cardiac valves ensure a one-way system of o Anterior interventricular branch (left
blood flow. Valves open and close in response to anterior descending artery or LAD) –
pressure changes as the heart contracts and supplies oxygenated blood to the walls
relaxes. of the ventricle
 2 Atrioventricular valves o Circumflex branch – supplies
1. Tricuspid valve (Right atrioventricular oxygenated blood to the walls of the LV
valve)- RA to RV and LA
ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY LABORATORY BSMLS
CARDIOVASCULAR SYSTEM

 RIGHT CORONARY ARTERY – supplies

atrial branches to the RA. Passes inferior to the
right auricle and divides into posterior
interventricular and marginal branches
o Posterior interventricular branch
(posterior descending artery) – supplies
the walls of the 2 ventricles with
oxygenated blood
o Marginal branch – transports blood to
the wall of RV

CORONARY VEINS
 Coronary Sinus – a vascular sinus where most
deoxygenated blood from the myocardium
drains. Empties in RA.
 Tributaries of Coronary Sinus:
1. Great Cardiac Vein – drains the heart
supplied by the left coronary artery (RV, LV
and LA)
2. Middle Cardiac Vein – drains the heart CARDIAC CYCLE
supplied by posterior interventional branch
of the right coronary artery (RV and LV) 2 Phases of the Cardiac cycle:
3. Small Cardiac vein – drains the RA and 1. Systole – contraction phase
RV 2. Diastole – relaxation phase
4. Anterior Cardiac vein – drains the RV and
open directly to RA 1 Cardiac Cycle = 1 heartbeat
1. Relaxation Period
 All chambers are in diastole
 Semilunar valves close; AV valves open
 Period of Ventricular filling (75%)
2. Atrial Systole (contraction)
 Marks the end of relaxation period
 AV valves still open; Semilunar valves still
close
 Period of Ventricular Filling (25%)
3. Ventricular Systole (contraction)
THE CONDUCTION SYSTEM AND HEART  Ventricular contraction pushes blood up
RHYTHM against the AV valves, forcing them to shut
 An electrical conduction system stimulates and  When LV pressure > arteries, semilunar
coordinates the contraction of cardiac muscle valves open
 SINOATRIAL (SA) NODE  Beginning of blood ejection from the heart
o Situated in the right atrium near the  Ventricle relaxation, the semilunar valves
junction of the vena cava close.
o Act as natural pacemaker and
automatically discharges an impulse
about 90-100 times per minute
o Sets the heart rhythm (sinus rhythm)
which initiates impulses on myocardium
= contraction
 Electrical impulse (Sinus node)  Atria (AV
node) delay of 0.1sec of impulse Bundle of
His Ventricles Right and Left Bundle
branches (Interventricular septum) Purkinje
Fibers (inferior aspect of the heart then loop
upwards to lateral RV and LV
ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY LABORATORY BSMLS
CARDIOVASCULAR SYSTEM

 A sound of blood flowing passing through an

abnormal heart valves
 Heart murmurs in children are common often
subsides with growth
HEART SOUNDS  Valve disorders of the Heart:
 Heart sounds are generated from the blood o Systolic murmur. This happens during
turbulence due to closure of the valve leaflets a heart muscle contraction. Systolic
and pressure gradients at the time of atrial and murmurs are divided into ejection
ventricular systole. murmurs (due to blood flow through a
 AUSCULTATION is the act of listening to narrowed vessel or irregular valve) and
sounds within the body with the use of regurgitant murmurs (backward blood
Stethoscope. flow into one of the chambers of the
heart).
o Diastolic murmur. This happens during
heart muscle relaxation between beats.
Diastolic murmurs are due to a
narrowing (stenosis) of the mitral or
tricuspid valves, or regurgitation of the
aortic or pulmonary valves.
 Diaphragm o Continuous murmur. This happens
o used for detection of relatively high throughout the cardiac cycle.
pitch sounds; filter out low pitched
sounds
o used for analyzing the first (S1) and
second (S2) heart sound, Aortic
Regurgitation (AR), Mitral regurgitation
(MR), Pericardial Friction Rub
 Bell
o Use to detect low pitch sounds at the
Left sternal border/Apex
o Used for listening to mid diastolic
murmur of Mitral stenosis, third (S3)
and fourth (S4) heart sound

ANATOMICAL LOCATION FOR

AUSCULTATION OF THE HEART
 AORTIC VALVE
o Right 2nd ICS (radiation of sound to
Apex)
 PULMONIC VALVE
o Left 2nd and 3rd ICS close to sternum
 TRICUSPID VALVE
o At or near lower left sternal border
 MITRAL VALVE
o At or near the Apex (Left 5th ICS
Midclavicular line)

AUSCULTATION OF THE HEART

MURMURS
ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY LABORATORY BSMLS
CARDIOVASCULAR SYSTEM

BRACHIAL PULSE
 BRACHIAL ARTERY
 Assess the Brachial Pulse if patient has carotid
obstruction
 Extend the elbow, palm up
 Flex the elbow to varying degree to get optimal
muscular relaxation
 Feel for the pulse just medial to the biceps
PULSES tendon using your index and middle fingers.

JUGULAR VEIN PULSE

 Internal Jugular Vein
 Closely parallels pressure in the Right atrium
 Best assessed from pulsations in the right
internal jugular vein which is directly in line
with superior vena cava and right atrium

RADIAL PULSE
 RADIAL ARTERY
 Palpate the Radial Pulse with the pads of your
index and middle fingers on the flexor surface of
the lateral wrist
 Partially flexing the patient’s wrist may help you
feel the pulse.
CAROTID PULSE
 CAROTID ARTERY
 Palpate the carotid artery with the pads of your
index and middle fingers or thumb just inside
the medial border of sternocleidomastoid muscle
 Never palpate carotid arteries at the same time.
This may decrease blood flow to the brain and
induce syncope

HOW TO TAKE THE PROPER BLOOD

PRESSURE
 BEFORE TAKING THE BP:
 If the patient just walked, rest for 5
minutes. If the patient just smoked
ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY LABORATORY BSMLS
CARDIOVASCULAR SYSTEM

cigarette or drink coffee, rest for 30

minutes.
 Make sure the room is quiet and
comfortably warm.
 Make sure the patient is sitting quietly
and both feet must be relaxed on the
floor
 Check the arms of the patient if free
from any clothing, AV fistula or lesions
 Put the patient’s arm at the level of the
heart. FACTORS AFFECTING THE BLOOD PRESSURE

 PALPATORY METHOD:
 Make sure the BP cuff is snuggly fit on
the upper arm and the lower end of the
cuff must be about 2.5cm or 1 inch from
antecubital fossa.
 Clip the BP gauge on the patient’s
sleeve or the superior end of the BP cuff
 Place 2-3 fingers at the level of the
RADIAL ARTERY in the distal end of
the radius
 Inflates the cuff until you feel the pulse
disappear. Take note on the reading.
(example: 100mmHg). Deflate the cuff.
 To get the Maximum Inflation of the
cuff, add 30mmHg to your previous
reading. (example: 100mmHg +
30mmHg = 130mmHg). You will use EXERCISE AND THE HEAR T
the Maximum Inflation reading in  “Exercise is good for the heart”
getting the blood pressure.  Aerobics – brisk walking, running, bicycling,
and swimming
 GETTING THE BLOOD PRESSURE: o minimum of 20minutes; 3-5
 Loosen the BP cuff or make the arm rest sessions/week
for about 30 seconds to 1 minute after o elevates cardiac output (CO) and
the palpatory method. increases metabolic rate
 Make sure the BP cuff is snuggly fit on  Sustained exercise/ long term training –
the upper arm and the lower end of the o Increases oxygen demand of muscles
cuff must be about 2.5cm or 1 inch from o Elevates cardiac output, increases
antecubital fossa with the gauge clip on delivery of oxygen to tissue
the superior end of cuff.  Strenuous exercise
 Place the BELL of the stethoscope to the
o A well-trained athlete can achieve a
Brachial artery (above the medial level
cardiac output 2x that of sedentary
of the antecubital fossa)
person
 Inflate the cuff the level of maximum
o Hypertrophy of the heart = physiological
impulse determined from palpatory
method (example: 130mmHg) cardiomegaly (vs Pathological
 Deflate the cuff slowly about 2- cardiomegaly)
3mmHg/second o Resting CO is same as healthy untrained
 Note at which you hear the Korotkoff person with increased Stroke volume
sound at least 2 consecutive beats (SV), decreased Heart rate (HR)
(SYSTOLIC BLOOD PRESSURE)  Regular Exercise = reduce blood pressure,
 Continue to deflate the cuff until sound anxiety, and depression, control weight and
is muffled and disappear (DIASTOLIC increase the ability of the body to dissolve clots
BLOOD PRESSURE)
 Deflate the cuff fully to zero. DEVELOPMENT OF THE HEART
 Tell and explain the correct BP reading
to your patient.
ANATOMY AND PHYSIOLOGY WITH PATHOPHYSIOLOGY LABORATORY BSMLS
CARDIOVASCULAR SYSTEM

 Heart is the first functional organ in an embryo

 Blood vessels in the chorionic villi connect to
embryonic heart through umbilical arteries and
umbilical vein (Umbilical cord = AVA: 2
arteries, 1 vein)
 Following Fertilization:
o Day 18-19 – Start of development of
heart from Mesodermal cells
(Cardiogenic Area) cardiogenic cords
endocardial tubes (Day 20)
o Day 21 – endocardial tubes fused into a
single tube Primitive heart tube
o Day 22 – begins to pump blood through
development of sinus venosus, primitive
atrium, primitive ventricle, bulbus
cordis, and truncus arteriosus
o Day 23-25 – Elongation of Primitive
tubes. It begins to loop and assumes U
shape and later Sshaped
o Day 28 – Atria and Ventricle assume
final adult positions. Inner linings of
Mesoderm thickened in the heart wall
(endocardial cushions) fuse and divide
the Atrioventricular canal into Right and
Left AV canals and the Interatrial
septum develop into the endocardial
cushions
 Interatrial septum and endocardial cushions
unite to form FORAMEN OVALE
 The interatrial septum divides into R atrium and
L atrium
 FORAMEN OVALE
o Before birth: allows blood from R
atrium to pass to L atrium bypassing the
ventricles.
o After birth: the opening normally closes.
Interatrial septum is a complete
partition.
o Fossa Ovalis - remnant of foramen
ovale
 Interventricular septum Right ventricle and Left
ventricle
 5th week – completion of partitioning of AV
canal, atrial and ventricular region
 5th - 8th weeks – Atrioventricular valves
 5th – 9th weeks – Semilunar valves