Cardiovascular System Lecture Recent
Cardiovascular System Lecture Recent
• The heart weighs between 200 and 425g, a little larger than the
fist.
• The two semilunar (SL)valves namely the aortic valve and the
pulmonary valve, which are in the arteries leaving the heart.
These control blood flow out of the ventricles.
Vessels of the Cardiovascular system
• Aorta
• Arteries
• Arterioles
• Capillaries
• Venules
• Veins
• Venae Cavae
S/N CHARACTERISTICS ARTERIES VEINS
1 Arteries carry blood Veins carry blood
away from the heart from the tissues of
Blood Circulation
to the tissues of the the body back to the
body. heart.
2 Arteries carry Veins carry
oxygenated blood deoxygenated blood
Blood Type
expect pulmonary except pulmonary
artery. vein.
3 Arteries have thick Veins have thin non
Thickness elastic muscular elastic less muscular
walls. walls.
4 Veins are usually
Arteries are usually
positioned closer
Position positioned deeper
beneath the surface
within the body.
of the skin.
5 Valves Valves are absent. Valves are present.
6 These possess These possess wide
Lumen
narrow lumen. lumen
7 Blood flows under Blood flows under
Pressure
high pressure. low pressure.
8 These are reddish in These are bluish in
Color
color. color.
9 Superficial veins,
Pulmonary and deep veins,
Types
systemic arteries. pulmonary veins and
systemic veins.
10 Internal Diameter Narrower (4mm) Wider (5mm)
11 Volume Low (15%) High (65%)
12 These show spurty
These show sluggish
Movement movement of blood
movement of blood.
giving pulse.
•The cardiovascular system is composed of two
circulatory paths: pulmonary circulation, the circuit
through the lungs where blood is oxygenated; and
systemic circulation, the circuit through the rest of
the body to provide oxygenated blood. The two
circuits are linked to each other through the heart,
creating a continuous cycle of blood through the
body.
PULMONARY CIRCULATION
• Pulmonary circulation is the movement of blood from the heart to
the lungs for oxygenation, then back to the heart again. Oxygen-
depleted blood from the body leaves the systemic circulation when it
enters the right atrium through the superior and inferior venae cavae.
The blood is then pumped through the tricuspid valve into the right
ventricle. From the right ventricle, blood is pumped through the
pulmonary valve and into the pulmonary artery. The pulmonary
artery splits into the right and left pulmonary arteries and travel to
each lung.
• At the lungs, the blood travels through capillary beds on the alveoli
where gas exchange occurs, removing carbon dioxide and adding
oxygen to the blood. The oxygenated blood then leaves the lungs
through pulmonary veins, which returns it to the left atrium,
completing the pulmonary circuit. As the pulmonary circuit ends, the
systemic circuit begins.
SYSTEMIC CIRCULATION
• Systemic circulation is the movement of blood from the
heart through the body to provide oxygen and nutrients
to the tissues of the body while bringing deoxygenated
blood back to the heart. Oxygenated blood enters the
left atrium from the pulmonary veins. The blood is then
pumped through the mitral valve into the left ventricle.
From the left ventricle, blood is pumped through the
aortic valve and into the aorta, the body’s largest artery
to other parts of the body.
• The arteries branch into smaller arteries, arterioles, and finally
capillaries. Gas and nutrient exchange with the tissues occurs within
the capillaries that run through the tissues. Metabolic waste and
carbon dioxide diffuse out of the cell into the blood, while oxygen and
glucose in the blood diffuses out of the blood and into the cell.
Systemic circulation keeps the metabolism of every organ and every
tissue in the body alive, with the exception of the parenchyma of the
lungs, which are supplied by pulmonary circulation.
1. Atrial contraction
2. Isovolumetric ventricular contractions
3. Rapid ventricular ejection
4. Reduced ventricular ejection
5. Isovolumetric ventricular relaxation
6. Rapid ventricular filling(ventricular gallop and S3
7. Reduced ventricular filling (atrial gallop and S4
Atrial contraction (A-V Valves Open; Semilunar Valves
Closed) Phase 1
• Atrial depolarization initiates contraction of the atrial musculature. As
the atria contract, the pressure within the atrial chambers increases,
which forces more blood flow across the open atrioventricular (AV)
valves, leading to a rapid flow of blood into the ventricles.
• Atrial contraction (atrial kick) normally accounts for about 10- 20% of
left ventricular filling. It lasts for about 0.11s.
• No heart sounds are ordinarily noted during ejection because the opening of
healthy valves is silent. The presence of sounds during ejection (i.e., systolic
murmurs) indicate valve disease or intracardiac shunts.
• Left atrial pressure initially decreases as the atrial base is pulled downward,
expanding the atrial chamber. Blood continues to flow into the atria from their
respective venous inflow tracts and the atrial pressures begin to rise. This rise in
pressure continues until the AV valves open at the end of phase 5.
Isovolumetric Relaxation (Phase 5)-All Valves Closed
• When the intraventricular pressures fall sufficiently at the end of phase 4, the
aortic and pulmonic valves abruptly close (aortic precedes pulmonic) causing the
second heart sound (S2) and the beginning of isovolumetric relaxation. Valve
closure is associated with a small backflow of blood into the ventricles and a
characteristic notch (incisura or dicrotic notch) in the aortic and pulmonary artery
pressure tracings.
• After valve closure, the aortic and pulmonary artery pressures rise slightly
(dicrotic wave) following by a slow decline in pressure.
• Although ventricular pressures decrease during this phase, volumes do not
change because all valves are closed. The volume of blood that remains in a
ventricle is called the end-systolic volume and is ~50 ml in the left ventricle. The
difference between the end-diastolic volume and the end-systolic volume is ~70
ml and represents the stroke volume.
• Left atrial pressure (LAP) continues to rise because of venous return from the
lungs. The peak LAP at the end of this phase is termed the v-wave.
Rapid Filling (Phase 6)- A-V Valves Open
• As the ventricles continue to relax at the end of phase 5, the
intraventricular pressures will at some point fall below their respective
atrial pressures. When this occurs, the AV valves rapidly open and
passive ventricular filling begins.
• The opening of the mitral valve causes a rapid fall in LAP. The peak of
the LAP just before the valve opens is the "v-wave." This is followed by
the y-descent of the LAP. A similar wave and descent are found in the
right atrium and in the jugular vein.
• Ventricular filling is normally silent. When a third heart sound (S3) is
audible during rapid ventricular filling, it may represent tensing of
chordae tendineae and AV ring during ventricular relaxation and filling.
This heart sound is normal in children; but is often pathological in
adults and caused by ventricular dilation.
Reduced Filling (Phase 7)-A-V Valves Open
• As the ventricles continue to fill with blood and expand, they become
less compliant and the intraventricular pressures rise. The increase in
intraventricular pressure reduces the pressure gradient across the AV
valves so that the rate of filling falls late in diastole.
• In normal, resting hearts, the ventricle is about 90% filled by the end of
this phase. In other words, about 90% of ventricular filling occurs
before atrial contraction (phase 1) and therefore is passive.
1. Chronotropic action
2. Inotropic action
3. Dromotropic action
4. Bathmotropic action
CHRONOTROPIC ACTION
• Is the frequency of heart beat or heart rate. There are 2 types
Tachycardia- increase in HR
Bradycardia- decrease in HR
INOTROPIC ACTION
• Is the force of contraction of the heart. There are 2 types
Positive inotropic- Increase in the force of contraction
Negative inotropic- Decrease in the force of contraction
DROMOTROPIC ACTION
• Is the conduction of impulse through the heart. There are 2 types
Positive dromotropic action : Increase in velocity of conduction
Negative dromotropic action: Decrease in Velocity of conduction
BATHMOTROPIC ACTION
• Is the excitability of cardiac muscle. There are 2 types
Positive bathmotropic action: Increase in the excitability of cardiac
muscle
Negative bathmotropic action: Decrease in the excitability of cardiac
muscle
• Preload can be defined as the initial stretching of the cardiac
myocytes prior to contraction. Preload, therefore, is related to
muscule sarcomere length. Because sarcomere length cannot
be determined in the intact heart, other indices of preload are
used such as ventricular end-diastolic volume or pressure.
Relation with ECG Coincides with peak Precedes or appears Between ‘T’ wave and Between ‘T’ wave and
of ‘R’ 0.09s after peak of ‘T’ ‘P’ wave ‘Q’ wave
wave
No. of vibrations in 9-13 4-6 1-4 1-2
phonocardiogram
• Also called augmented limb leads. One electrode is active while the
other is an indifferent electrode.
• There are three unipolar limb leads
1. aVR lead
2. aVL lead
3. aVF lead
aVR lead Active electrode from R arm, Indifferent connected to R arm and L leg
aVL lead Active electrode from L arm, Indifferent connected to R arm and L leg
aVF lead Active electrode from L leg, Indifferent connected to R arm and L arm
Unipolar Chest Leads
• Chest leads are also called Precardial leads. The indifferent electrode
is obtained by connecting the three limbs- L leg, Larm and R arm
through a resistance of 5000 ohms. The active electrode is placed on
six points over the chest called V1, V2, V3, V4, V5 and V6. V indicates
vector
Unipolar Chest leads
Lead Position
V1 Over the 4th Intercostal Space (4ICS) near right sternal margin
V3 Between V2 and V4
MINUTE VOLUME
• Minute volume is the amount of blood pumped out by each ventricle in one
minute. It is the product of stroke volume and heart rate:
Minute volume = Stroke volume × Heart rate
Normal value: 5 L/ventricle/minute
CARDIAC INDEX
• Cardiac index is the minute volume expressed in relation to square
meter of body surface area. It is defined as the amount of blood
pumped out per ventricle/minute/ square meter of the body surface
area. Normal value: 2.8 ± 0.3 L/square meter of body surface
area/minute (in an adult with average body surface area of 1.734
square meter and normal minute volume of 5 L/minute).
EJECTION FRACTION
• Ejection fraction is the fraction of end diastolic volume that is ejected
out by each ventricle. Normal ejection fraction is 60% to 65%.
CARDIAC RESERVE
• Cardiac reserve is the maximum amount of blood that can be pumped out by
heart above the normal value. Cardiac reserve plays an important role in
increasing the cardiac output during the conditions like exercise. It is essential to
withstand the stress of exercise. Cardiac reserve is usually expressed in
percentage. In a normal young healthy adult, the cardiac reserve is 300% to
400%. In old age, it is about 200% to 250%. It increases to 500% to 600% in
athletes. In cardiac diseases, the cardiac reserve is minimum or nil.
VARIATIONS IN CARDIAC OUTPUT
PHYSIOLOGICAL VARIATIONS
1. Age: In children, cardiac output is less because of less blood volume.
Cardiac index is more than that in adults because of less body surface
area.
2. Sex: In females, cardiac output is less than in males because of less
blood volume. Cardiac index is more than in males, because of less body
surface area.
3. Body build: Greater the body build, more is the cardiac output.
4. Diurnal variation: Cardiac output is low in early morning and increases
in day time. It depends upon the basal conditions of the individuals.
5. Environmental temperature: Moderate change in temperature does not affect cardiac
output. Increase in temperature above 30°C raises cardiac output.
6. Emotional conditions: Anxiety, apprehension and excitement increases cardiac output
about 50% to 100% through the release of catecholamines, which increase the heart rate
and force of contraction.
7. After meals: During the first one hour after taking meals, cardiac output increases.
8. Exercise: Cardiac output increases during exercise because of increase in heart rate and
force of contraction.
9. High altitude: In high altitude, the cardiac output increases because of increase in
secretion of adrenaline. Adrenaline secretion is stimulated by hypoxia (lack of oxygen).
10. Posture: While changing from recumbent to upright position, the cardiac output
decreases.
11. Pregnancy: During the later months of pregnancy, cardiac output increases by 40%.
12. Sleep: Cardiac output is slightly decreased or it is unaltered during sleep
PATHOLOGICAL VARIATIONS
Kidney 1,300 26
Brain 800 16
1. Venous return
2. Force of contraction
3. Heart rate
4. Peripheral resistance
VENOUS RETURN
• Venous return is the amount of blood which is returned to heart from different
parts of the body. When it increases, the ventricular filling and cardiac output are
increased. Thus, cardiac output is directly proportional to venous return,
provided the other factors (force of contraction, heart rate and peripheral
resistance) remain constant.
• Venous return depends upon five factors:
i. Respiratory pump
ii. Muscle pump
iii. Gravity
iv. Venous pressure
v. Sympathetic tone.
Respiratory Pump
• Respiratory pump is the respiratory activity that helps the return of
blood, to heart during inspiration. It is also called abdominothoracic
pump.
Muscle Pump
• Muscle pump is the muscular activity that helps in return of the blood to heart.
During muscular activities, the veins are compressed or squeezed. Due to the
presence of valves in veins, during compression the blood is moved towards the
heart. When muscular activity increases, the venous return is more. When the
skeletal muscles contract, the vein located in between the muscles is
compressed.
Gravity
• Gravitational force reduces the venous return. When a person stands for a long
period, gravity causes pooling of blood in the legs, which is called venous pooling.
Because of venous pooling, the amount of blood returning to heart decreases.
Venous Pressure
• Venous pressure also affects the venous return. Pressure in the venules is 12 to
18 mm Hg. In the smaller and larger veins, the pressure gradually decreases. In
the great veins, i.e. inferior vena cava and superior vena cava, the pressure falls
to about 5.5 mm Hg. At the junction of venae cavae and right atrium, it is about
4.6mm Hg. Pressure in the right atrium is still low and it alters during cardiac
action. It falls to zero during atrial diastole. This pressure gradient at every part
of venous tree helps as a driving force for venous return
Sympathetic Tone
• Venous return is aided by sympathetic or vasomotor tone which causes
constriction of venules. Venoconstriction pushes the blood towards heart.
2. FORCE OF CONTRACTION
Cardiac output is directly proportional to the force ofcontraction,
provided the other three factors remain constant. According to Frank-
Starling law, force of contraction of heart is directly proportional to the
initial length of muscle fibers, before the onset of contraction. Force of
contraction depends upon preload and afterload.
Preload
• Preload is the stretching of the cardiac muscle fibers at the end of
diastole, just before contraction. It is due to increase in ventricular
pressure caused by filling of blood during diastole. Stretching of
muscle fibers increases their length, which increases the force of
contraction and cardiac output. force of contraction of heart and
cardiacoutput are directly proportional to preload
Afterload
• Afterload is the force against which ventricles must contract and eject
the blood. Force is determined by the arterial pressure. At the end of
isometric contraction period, semilunar valves are opened and blood
is ejected into the aorta and pulmonary artery. So, the pressure
increases in these two vessels. Now, the ventricles have to work
against this pressure for further ejection. Thus, the afterload for left
ventricle is determined by aortic pressure and afterload for right
ventricular pressure is determined by pressure in pulmonary artery.
• Force of contraction of heart and cardiac output are inversely
proportional to afterload.
3. HEART RATE
• Cardiac output is directly proportional to heart rate provided, the other
three factors remain constant. Moderate change in heart rate does not
alter the cardiac output. If there is a marked increase in heart rate,
cardiac output is increased. If there is marked decrease in heart rate,
cardiac output is decreased.
4. PERIPHERAL RESISTANCE
• Peripheral resistance is the resistance offered to blood flow at the
peripheral blood vessels. Peripheral resistance is the resistance or load
against which the heart has to pump the blood. So, the cardiac output
is inversely proportional to peripheral resistance
MEASUREMENT OF CARDIAC OUTPUT
Cardiac Outout can be measured through
Direct methods used to measure cardiac output in animals:
1. By using cardiometer
2. By using flowmeter.
Indirect methods used to measure cardiac output (Used for
animals and humans):
1. By using Fick principle
2. Indicator (dye) dilution technique
3. Thermodilution technique
4. Ultrasonic Doppler transducer technique
5. Doppler echocardiography
6. Ballistocardiography.
• Adolph Fick described Fick principle in 1870. According to this
principle, the amount of a substance taken up by an organ (or by the
whole body) or given out in a unit of time is the product of amount of
blood flowing through the organ and the arteriovenous difference of
the substance across the organ.
Amount of substance taken or given= Amount of blood flow /minute x
Arteriovenous difference
Eg. Amount of blood flowing through lungs is 5,000 mL/minute
O2 content in arterial blood = 20 mL/100 mL of blood
O2 content in venous blood = 15 mL/100 mL of blood
Amount of O2 moved from lungs to blood= Amount of blood flow /minute x
Arteriovenous difference of O2
5,000 x 20-15/ 100 = 250 mL/minute
• Amount of oxygen moved from lungs to blood= 250 mL/minute
Modification of Fick principle to
measure cardiac output
• Fick principle is modified to measure the cardiac output or a
part of cardiac output (amount of blood to an organ).Thus,
cardiac output or the amount of blood flowing through an
organ in a given unit of time is determined by the formula: