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CARDIOVASCULAR SYSTEM pericardium)

- This is the visceral and parietal layer
- Very significant system of the body > Parietal Layer- Lines the interior of the fibrous
- It delivers oxygen and nutrients to the body tissue pericardium. It attaches to the large arteries leaving the
- Carries away waste such as carbon dioxide via the heart and the turns U-turn continuously in the inferior
blood in the heart’s surface
- Major Functions of the cardiovascular system is > Visceral Layer – Also called the pericardium. It is a
transportation, as it carries its various cargo back and part of heart wall; epicardium is the innermost layering
forth which is vey vital for homeostasis of pericardium and the outermost layer of heart wall
- There is a lubricating fluid between these serous layers
STRUCTURES OF THE CARDIOVASCULAR SYSTEM
that allows the heartbeat easily in a relatively
1. Heart – Pumps Blood
frictionless environment as the serous pericardial layers
2. Blood Vessels- Carry Blood
slide smoothly across each other especially when the
heart beats
1. Heart
Heart Walls
- Size of a person’s fist, hollow, cone-shaped, and
Epicardium – The visceral pericardium (discussed
weighs less than a pound
above)
- Enclosed within inferior mediastinum
Myocardium – It consist of thick bundles of cardiac
> Mediastinum is the medial section of the thoracic
muscle. Myocardium is the layer that contract, it is
cavity, it is a flank on each side by the lungs
reinforced internally by a network of dense fibrous
- Pointed apex, toward left hip, rest on diaphragm, at 5 th
connective tissue which we call the skeleton of the
ICS.
heart.
> 5th ICS Is left clavicular line, this is where one would
Endocardium – It is a thin glistening sheath of
place a stethoscope to count the heart rate for an apical
endothelium and it actually lines the heart chambers. It
pulse
is continuous with the lining of the blood vessels leaving
> PMI or the point of maximum impulse
and entering the heart.
- Broad at the base, where great vessels emerge, toward
right shoulder, beneath 2nd rib CHAMBERS
COVERINGS AND WALL

- The heart is enclosed by a sac called pericardium

Pericardium has three (3) layers - Heart has 4 chambers or 4 hollow cavities, 2 atria and
1. The outer fibrous layer is the fibrous pericardium 2 ventricles
2 and 3. The inner serous membrane pair. These are - The superior atria are primarily receiving chambers
two (2) layers of the serous pericardium which assist with filling the ventricles
Fibrous Pericardium > Atria – The receiving or the collecting chambers
- Helps protect the heart and anchors it to the > Right Atrium – collects unoxygenated blood from
surrounding structures such as the diaphragm and systemic circulation (galing sa body cells)
sternum > Left Atrium – collects oxygenated blood from
Serous Pericardium (parietal layer of serous pulmonic circulation (galing sa lungs)
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- The inferior, thick-walled ventricles are the discharging - There are 4 great vessels in our heart, this is the
chambers or pumps which contract so blood is biggest blood vessel in our body
propelled out of the heart Arteries: The movement of the blood is away from the
> Ventricle – They are the discharging or the pumping heart
chambers > Aorta – carries oxygenated blood, from the left
>Right Ventricles – pumps unoxygenated blood to ventricle to the systemic circulation this means that all
pulmonic circulation (papunta sa lungs) the blood that the aorta carries is released towards
> Left Ventricle – pumps oxygenated blood to systemic body cells
circulation (papunta sa body cells) > Pulmonary Artery – carries unoxygenated blood,
connecting the right ventricle to the pulmonic
circulation which means that the blood that pulmonary
artery carries is carried towards lungs
- Both arteries are connected to ventricles
Veins: The movement of the blood is towards the heart
> Vena Cava – carries unoxygenated blood, it connects
the blood coming from the systemic circulation to the
right atrium. The blood is from the body cells
> Pulmonary Vein – carries oxygenated blood,
connecting the pulmonary circulation to the left atrium.
The blood is from lungs
- Both veins are connected to atrium
- Both pulmonic and systemic circulation is linked by our Systemic Circulation – Blood flow from aorta to vena
heart cava, oxygenated to unoxygenated blood
Pulmonary Circulation > Function: Supply oxygen and nutrient rich to all body
- Involves the action of the lungs as it receives an organs
oxygenated blood from the pulmonary artery and sends Pulmonic Circulation – Blood flow from pulmonary
blood to the pulmonary vein artery to pulmonary vein, unoxygenated to oxygenated
- the transition of this circulation is oxygenated to blood. This is where the exchange of gases happens
oxygenated blood particularly oxygen and carbon dioxide
Systemic Circulation > Function: carry blood to the lungs for gas exchange
- Involves all the organ system of the body, as each cells and return it to the heart
receive oxygenated blood from the aorta, it is used by
all cells to function after the cell used it the oxygenated
blood with the waste products will now be sent back
through the vena cava
- The transition of this circulation is oxygenated to
unoxygenated blood

GREAT VESSELS

- The left side of the heart is the systemic pump

- The right side of the heart is pulmonic pump
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VALVES backflow
1. Valvular stenosis – Narrowing of valves
2. Valvular atresia – closed valves
- These valve problems may be caused by either
congenital and acquired causes because of bacterial or
viral infection
HEART INFECTION:
1. Carditis
2. Pericarditis
3. Myocarditis
4. Endocarditis
- I f the heart’s workload increases and ultimately the
heart weakens it may eventually fail, under such
- The heart is equipped with 4 valves which allow blood conditions if the valves does not open and close and the
to flow in only 1 direction valves cannot maintain the one-way direction of blood
ATRIOVENTICULAR VALVES flow in the heart, the faulty valves need to be replaced
- Prevent backflow into the atria when the ventricles 1. Prosthetic heart valve:
contract
- Located between the atria and ventricles on each side
- The purpose of AV valves is it open and close when the
heart is relaxed and the blood is passively filling its
chambers
- AV Valve cusps they just hang limply into the ventricles
but when the ventricles contract the AV valve is closed
because it prevents back flow of the blood from the
ventricles back to the atria
- When the right and left atrium starts to pump mitral
and tricuspid valve is closed 2. Cryopreservation human valve from a donor
- AV Valves are open during heart relaxation and close 3. Chemically treated valve taken from an animal
when ventricles are contracting usually in a pig’s heart
> Tricuspid Valve – between the right atrium and right
ventricle
> Mitral Valve – between the left atrium and left BLOOD FLOW IN AND OUT OF THE HEART
ventricle
SEMILUNAR VALVE
- Guards the bases of the two large arteries leaving the
ventricular chambers.
- Semilunar valves are close during heart relaxation and
closed and are forced open when the ventricles contract

> Pulmonary Valve – between the pulmonary artery

and right ventricle
> Aortic Valve – between the aorta and the left
ventricle

INCOMPETENT VALVES
- This force the heart to pump and repump blood
- The oxygenated blood that the cell body used coming
because the blood does not close properly it causes
from the systemic circulation, will enter the heart via
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the vena cava (superior and inferior vena cava) VIEW OF CORONARY ARTERIES AND CARDIAC VEINS
- Atria collects the unoxygenated blood coming from
the vena cava.
- The movement of vena cava is entering the heart
- As the right atrium collects the unoxygenated blood
the tricuspid blood opens and the pulmonary valve is
closed
- The unoxygenated blood goes down to the right
ventricle
- Right ventricle will pump if its filled, when the right
ventricle pumps unoxygenated blood the tricuspid valve
will be closed and the pulmonary valve will open and
the pumped blood will pass through pulmonary artery - The heart being one of the organs of the systemic
-Pulmonary artery the movement of blood is away from circulation also need oxygenated blood so it can
heart it carries unoxygenated blood as it enters perform its function which is to pump blood
pulmonary circulation and when it goes to the lungs the - The oxygenated blood from the aorta also goes to the
blood will become oxygenated heart through the cardiac arteries
-The lungs has made the blood oxygenated because gas - The heart uses oxygenated blood carried by cardiac
exchange occurred arteries in the systemic circulation, for the heart to
- The oxygenated blood will now enter the pulmonary function
vein - When the heart use it, it will become unoxygenated
- Pulmonary vein the movement of the blood is towards blood and it travels back now to the vena cava through
the heart and then it’s connected down to the left the cardiac veins following the same blood flow
atrium
- The left atrium is a collecting chamber and collects its - Arterial blood flow problems to the heart may lead to
oxygenated blood, while its collecting oxygenated blood serious conditions:
the mitral valve is opened and the aortic valve is closed ANGINA PECTORIS
as it fills the left ventricle > Insufficient oxygen supply to the heart resulting in
- The left ventricle once it’s ready to pump the mitral crushing chest pain
will open and aortic will close > It could be a mild heart attack
- When the left ventricle pumps blood which is
oxygenated blood, the aortic valve will open and the
mitral valve will close to deliver oxygenated blood to
aorta
- The aorta now carries oxygenated blood going to the
system as it enters systemic circulation for the body MYOCARDIAL INFRACTION
cells to use the oxygenated blood > Oxygen deprivation to the heart cells causing cell
death
> This is what we call heart attack
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INTRINSIC CONDUCTION from endocardium to epicardium.

- Repolarization occurs in reverse, so that last cells to
depolarize are the first one to repolarize.
DEPOLARIZE – Contract, systole, similar to S1, lub
REPOLARIZE – Relaxed, diastole, similar to S2 , dup
sound

CARDIAC CYCLE AND SOUND

SYSTOLE AND DIASTOLE

CARDIAC CYCLE
-One complete heartbeat, where atria and ventricles
contract and then relax.
- Two systems act to regulate the heart activity:
- Beats 75 times per minute (60 to 100 range), about 0.8
1. The nerves of the autonomic nervous system – They
seconds per cycle.
act like breaks and gas pedals to either decrease or
increase the heart rate depending on which division is 1. BRADYCARDIA – Slow heartbeat less than 100
activated 2. TACHYCARDIA – Fast heartbeat more than 100
2. Intrinsic conduction system or the nodal system – ELECTROCARDIGRAPHY (ECG) – It is a test which
This is built into the heart tissues, and it sets a basic measures the electrical activity of the heart specifically
rhythm which causes heart muscle depolarization or how well the atria and ventricles contract and relax
contraction in only one direction which is from the atria
to the ventricles HEART SOUNDS
- The conduction occurs in sequence from 1-4 initiated
FIRST HEART SOUND (S1, Lub)
by:
1. SA node/sinoatrial node Closing of atrioventricular valves.
- Pace maker of the heart located at the junction of the
superior vena cava and right atrium. SECOND HEART SOUND (S2, Dup)
-Generates electrical impulses approximately 60 to 100 Closing of semilunar valves.
times per minute but can adjust its rate
- Sympathetic and parasympathetic nervous system S1 > S2 – S1 is longer than S2, S1 is louder than S2
controls SA node - S2 is a sound that is short and sharp
2. AV node/atrial ventricular node - S1 is a sound that is long and loud
- Located in the lower aspect of the atrial septum - In stethoscope the diaphragm for higher pitch sound
- Receives electrical impulse from SA node ex. Breath sound and normal heart sound
3. AV bundle/bundle of His - The bell is best for detecting lower pitch sounds ex.
-Fuses with the AV node to form another pacemaker Heart murmurs and some vowel sounds
site
- If SA node fails, the bundle of his can initiate and
sustain a heart rate of 40 to 60 beats per minute
4. Purkinje’s Fibers
- Diffuse network of conducting strands beneath the
ventricular endocardium.
- They rapidly spread the wave of depolarization
through the ventricles.
- Activation of the ventricles begins in the septum and
moves from apex upward.
- Within the ventricular walls, depolarization proceeds
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VALVE LANDMARK TO AUSCULATE HEART SOUNDS muscle cells are stretched just before they contract.
- Venous return is an important factor to stretch the
heart muscle.
- Muscular pump or the enhanced squeezing action of
active skeletal muscles on the veins returning blood to
the heart, plays a major role in increasing venous
return.

CARDIAC OUTPUT IS THE AMOUNT OF BLOOD BEING

PUMPED BY EACH VENTRICLE EVERY 1 MINUTE.

CARDIAC OUTPUT = HEART RATE x STROKE VOLUME

CO = HR x SV
- The pulmonary valve is located specifically to hear the 5250 ml/minute = 75 beats per minute x 70 ml per beat
best on the second ICS just to the left of the sternum CO = 5.25 liter/minute (range of 4 to 6 liters)
- The aortic valve is also on the second ICS just to the
right of the sternum
- To hear the tricuspid valve, we put the stethoscope on
the 5th ICS, just to the left of the sternum
- The mitral valve location to hear it best, that’s the
point of maximum impulse the apical pulse on the 5 th
ICS, left mid clavicular line
NORMAL FINDINGS

Inspection – Flat precordium

Palpation – No heaves and thrills
> Heaves – these are palpable large beating of the heart

> Heaves – these are the palpable vibration usually from

a heart murmur, it is an abnormal heart sound When the pumping efficiency of the heart is reduced do
that circulation is inadequate to meet the tissue need
Auscultation CONGESTIVE HEART FAILURE (CHF) occurs;
1. Rate at 60 to 100 beats/minute - Inability of the heart to pump blood effectively
2. Regular rhythm - Tachycardia is the early sign of chf
3. PMI at 5th ICS left midclavicular line
4. S1 > S2 2. BLOOD VESSELS
5. No murmurs
TUNICS

CARDIAC OUTPUT

REGULATION OF STROKE VOLUME

- A healthy heart pumps out about 60 of the blood
present in its ventricles
- Stroke volume is the amount of blood pumped by each
ventricle for every heartbeat. It is normally 70 ml/beat
(50 to 100 range).

- Starling’s law of the heart says that the critical factor - Blood circulates inside the blood vessels which form a
controlling stroke volume is how much the cardiac closed transport system which we call the vascular
system
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There are 3 walls of the blood vessels: MAJOR ARTERIES

1. Tunica intima – inner most layer
2. Tunica media – middle layer where muscle cells are
found, tunica media is also the one who is responsible
for the contraction of the blood vessel
- Blood vessel also contract to allow movement of blood
inside
3. Tunica adventitia

ARTERIES – movement is away from the heart

- Has high pressure, and walls are thicker and heavier
than veins.
VEINS
- Has low pressure, and walls are thinner and lighter - The one in the middle is the biggest artery which is the
than arteries. aorta, from the ascending to the aortic arch to the
CAPILLARIES thoracic aorta into the abdominal depicted with color
- Has transparent walls, and only one cell layer thick, red, which means it delivers oxygenated blood to all the
the tunica intima. system of the body
- Exchanges are easily made between blood and tissue
cells.
MAJOR VEINS
- Tiny capillaries form interweaving networks called
capillary beds.

- We have the biggest one in the middle of the body,

superior and inferior vena cava and depicted with color
- Smaller arteries are arteriole blue which means it carries unoxygenated blood which
- Smaller veins are venule gets blood and delivers it back to the heart

SPECIAL CIRCULATION

1. Arterial supply of the brain and circle of Willis

- The brain has a special circulation because lack of
blood for even for few minutes causes the delicate brain
cells to die, a continuous blood supply to the brain is
very crucial
The brain is supplied by two pairs of arteries. These are
small communicating arterial branches which untie
anterior and posterior blood supplies of the brain. It
surround the base of the brain and is very important
because it provides more than one route for blood to
reach brain tissue especially in cases of a clot or
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impaired blood flow

> INTERNAL CAROTID ARTERY
- Anterior, middle, and cerebral artery – cerebrum
> VERTEBRAL ARTERY
- Basilar artery – brainstem and cerebellum
- Posterior cerebral artery – posterior part of cerebrum
* Small communicating arterial branches which untie
anterior and posterior blood supplies of the brain
* Surrounds base of brain
* Provides more than one route for blood to reach brain
tissue in case of a clot or impaired blood flow

3. Hepatic portal circulation

- Veins of hepatic portal circulation drain the digestive
organs, spleen, and pancreas; and deliver this blood to
the liver through hepatic portal vein.
- When you have just eaten, hepatic portal blood
contains large amounts of nutrients, this system now
takes a detour to ensure that the liver processes these
substances before they enter systemic circulation.
A. Inferior mesenteric vein - Drains terminal part of
large intestine.
B. Splenic vein - Drains spleen, pancreas, and left side of
stomach.
2. Fetal circulation C. Superior mesenteric vein - Drains small intestine and
- When we say fetal circulation or fetus this is the baby first part of colon.
inside the uterus of the mommy D. Left gastric vein- Drains right side of stomach.
- Fetal circulation is very important because fetal lungs
does not function. The fetus does not inhale and exhale
inside the uterus. The oxygen supply of the fetus is from
the placenta, it gives oxygenated blood, and it also
receives unoxygenated blood and waste products
- PLACENTA
- UMBILICAL CORD
> One umbilical vein.
> Two umbilical arteries
- DUCTUS VENOSUS – connects the umbilical vein to the
inferior vena cava of the heart of the baby
- FORAMEN OVALE
> Opening between the right and left atrium
- DUCTUS ARTERIOSUS
> Communication between pulmonary artery and aorta
PULSE

PULSE
A pressure wave that travels the entire arterial system
created from alternating expansion and recoil of an
artery that occurs with each beat of the left ventricle.
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- Why left ventricle? Because left ventricle is the one

pumping oxygenated blood to the system
NORMAL FINDINGS UPON
PALPATION:
1. Rate at 60 to 100 beats/minute
2. Strong, not weak and bounding
3. Rhythm is regular
4. Symmetric, equal right and left
5. Warm to touch

BLOOD PRESSURE
Pressure that the blood exerts against the inner walls of
the arteries, and it is the force that keeps blood
circulating continuously even between heartbeats.
NORMAL: 120/80 mm Hg
(Systolic/Diastolic)
Korotkoff Sounds:
The pressure read as the first soft tapping sounds are
heard (the first point at which a small amount of blood
is spurting through the constricted artery) is recorded as
the systolic pressure.
- As the pressure is reduced still further, the sounds
become louder and more distinct. When the artery is no
longer constricted and blood flows freely, the sounds
can no longer be heard. The pressure at which the
sounds disappear is recorded as the diastolic pressure.

Needed to measure bp:

1. Stethoscope
2. Sphygmomanometer