CARDIOVASCULAR SYSTEM

The cardiovascular system is one of the major body systems. It transports oxygen, carbon
dioxide, waste products, nutrients and hormones to and from various parts of the body.

The cardiovascular system is made up of the heart, the blood vessels (arteries and veins
and capillaries) and blood. The heart has major vessels that supply it with deoxygenated
blood (travels back to the heart from the body), and major vessels that carry oxygenated
blood away from the heart to all the parts of the body.

The major vessels that carry blood to and from the heart
are:
inferior vena cava conveys deoxygenated blood (blood low in oxygen) from the lower
extremities of the body to the heart
 superior vena cava coveys deoxygenated blood from the upper
extremities of the body to the heart
 aorta conveys oxygenated blood (blood high in oxygen) away from the
heart
Heart
The heart is a hollow organ about the size of a fist and is composed of special muscle tissue
(cardiac muscle). It lies under the breast bone in the centre of the cardiothoracic cavity. In the
average lifetime the heart beats 250 million times and pumps 340 million litres of blood. The
heart is a sophisticated pump that is controlled by an electrical current that is initiated in the
brain.
The heart is divided into a left and right side by a muscular wall called the septum and has
four chambers.

Heart chambers and valves

The chambers of the heart include the:
 right atrium which receives deoxygenated blood (low in oxygen) from all over the
body
 right ventricle receives blood from the right atrium and sends it to the lungs via the
pulmonary artery to become oxygenated and get rid of carbon dioxide
 left atrium receives oxygenated blood from the lungs and sends it to the left ventricle
 left ventricle receives blood from the left atrium and sends it out to the body via the
aorta.
The heart wall consists of three layers - the endocardium is the inner lining, the myocardium
is the muscle layer and the pericardium is the outer covering.
The chambers of the heart are separated by valves:
  tricuspid valve is located between the right atrium and right ventricle
 bicuspid (mitral) valve is located between the left atrium and left ventricle
 pulmonary valve is between the right ventricle and the pulmonary artery
 aortic valve is between the left ventricle and the aorta
The major vessels that carry blood to and from the heart are:
 inferior vena cava conveys deoxygenated blood (blood low in oxygen) from the lower
extremities of the body to the heart
 superior vena cava coveys deoxygenated blood from the upper extremities of the
body to the heart
 aorta conveys oxygenated blood (blood high in oxygen) away from the heart

Blood vessels
The cardiovascular system consists of arteries and veins and capillaries. Arteries carry
oxygenated blood to the cells of the body, veins carry deoxygenated blood away from the
cells.

Arteries
Arteries are tubes that carry oxygenated blood (high in oxygen) away from the heart.
Arteries have thick, muscular, elastic walls. They branch off forming arterioles with thinner
walls that then become capillaries. Arteries carry blood rich in oxygen and nutrients.
Blood that comes from a wound to an artery is bright red and spurts. The aorta is the largest
artery and as it leaves the heart it branches into smaller arteries, eventually they become
capillaries.
Veins
Veins are tubes that carry deoxygenated blood (low in oxygen) from the cells back to the
heart where it is pumped to the lungs so that the blood can pick up more oxygen. The veins
have one-way valves that help move the blood toward the heart.
Veins have thinner muscular walls. They carry blood back to the heart that is low in oxygen
and high in carbon dioxide, a waste product.

Capillaries
Capillaries are very small vessels that surround the cells of the body and facilitate the
movement of oxygen and nutrients into the cells and carbon dioxide and waste products away
from the cells.
The flow of blood through the heart
The correct term for contraction of the heart is systole. This is followed by relaxation of the
heart called diastole. One systole and diastole form the cardiac cycle. A cardiac cycle takes
only 0.8 seconds and during this time the following events occur.
First, the upper chambers, or atria, of the heart relax and fill with blood as the lower
ventricles contract, forcing out blood through the aorta and pulmonary arteries. Next the
ventricles relax, allowing blood to flow into them from the contracting upper chambers. Then
the cycle is repeated; this happens approximately 70 to 80 times per minute.
The rate and rhythm of the heart is regulated by the conduction system that is made up of
specialised neuromuscular tissue that sends out impulses. The impulses begin at the Sino-
Atrial (SA) node in the right atrium and spread across the two atria. The atria then contract
and the impulses from the S-A node reach the Atrio-Ventricular (AV) node in the right
atrium. Messages from the A-V node then travel down the Bundle of His in the septum and
continue through the Purkinje fibres to the walls of the ventricles.
An electrocardiogram, or ECG, is a diagnostic test that records the electrical impulses of the
heart.
The blood flows around the body continuously due to the regular beat of the heart. Beginning
at cells, the passage of blood is as follows:
 Circ
ulatory system

Scheme of the organs of the circulatory system

Vessels carrying blood to the heart are referred to as veins.
Vessels carrying blood away from the heart are referred to as arteries.
Arteries in the pulmonary circulation transfer poorly oxygenated blood, whereas in systemic
circulation, they transfer oxygen-rich blood.

Systemic & Pulmonary circulation

Systemic Circulation is a part of the cardiovascular system which is responsible for carrying
oxygenated blood away from the heart to the body, and return deoxygenated blood back to
the heart. The aorta is divided into arterioles which are further divided into capillaries. The
blood is then transported to major arteries in the upper body before passing through the
diaphragm, where it branches further into arteries which supply the lower parts of the body
through the capillaries.

The oxygenated blood replaces the waste and carbon dioxide from cells with oxygen through
diffusion and carries the waste to the capillaries. The heart itself receives oxygen and
nutrients through a small "loop" of the systemic circulation.

During systemic circulation, the blood also passes through the kidneys, which filter as much
waste from the blood as it can. This is known as renal circulation. The blood also passes
through the small intestine during circulation. This is known as portal circulation. The blood
from the small intestine is collected in the portal vein and is carried through the liver, which
filters sugars and stores them for later use.
Pulmonary Circulation is a part of the cardiovascular system which is responsible for
carrying de-oxygenated from the heart to the lungs and then back to the heart for it to transfer
the oxygenated blood to the rest of the body. The deoxygenated blood from the cells enters
the heart from the right atrium. The blood then flows from the atrium by the contracting
muscle through the tricuspid valve, a valve which opens only one way, to the right ventricle.

Blood is then passed on to the lungs via the pulmonary artery, where it the carbon dioxide
from the blood is replaced with oxygen through diffusion. The oxygenated blood is passed on
to first to the left atrium of the heart by the pulmonary veins and then to the left ventricle for
the systemic circulation to take place. The heartbeats that one hears is the opening and
closing of the one-way valves that allow blood to flow from one ventricles to the other. This
is an important process of pulmonary circulation.

Pulmonary circulation and systemic circulation go hand in hand and are jointly responsible
for sending blood throughout the body. Pulmonary Circulation takes deoxygenated blood and
converts it back to oxygenated blood, while systemic circulation takes the oxygenated blood
to the cells and brings back the deoxygenated blood that is released by the cells in the body.
Pulmonary Circulation deals solely with the lungs, while systemic circulation deals with the
rest of the body.

Systemic Circulation Pulmonary Circulation

Definition Systemic circulation is part of Pulmonary Circulation is the
the cardiovascular system half portion of the
which helps carries cardiovascular system which
oxygenated blood away from helps carry oxygen-depleted
 blood away from the heart, to
the heart to the body, and
the lungs, and returns
returns deoxygenated blood
oxygenated blood back to the
back to the heart.
heart.
Help carry oxygen-depleted
To carry oxygenated blood to
Function blood to the lungs and return
the body.
oxygenated blood to the heart.
In pulmonary circulation, de-
In systemic circulation, blood
oxygenated blood leaves the
leaves through the left
heart, goes to the lungs and
ventricle to the aorta, which is
then re-enters the heart; de-
then sent to smaller arteries,
oxygenated blood leaves
arterioles, and finally
through the right ventricle
capillaries. Waste and carbon
through the pulmonary artery
in a cell is replaced by oxygen
to the capillaries where carbon
Course and the waste and carried
dioxide diffuses out of the
away by the blood to venious
blood cell into the alveoli, and
capillaries, and then the venae
oxygen diffuses out of the
cavae: the lower inferior vena
alveoli into the blood. Blood
cava and the upper superior
leaves the capillaries to the
vena cava, through which the
pulmonary vein to the heart,
blood re-enters the heart at the
where it re-enters at the left
right atrium.
atrium.
Deals with which side of the
Left side of the heart. Right side of the heart.
heart

The cardiac conduction system

The excitations needed for the contractions of the myocardium originate in the heart itself.
Pulse frequency and contraction strength are influenced by the sympathetic and the
parasympathic parts of the autonomic nervous system.
The heart rate is usually between 60 and 100 per minute. A failure of this system can have
fatal consequences and lead to cardiac arrest. Therefore, nature has built in several
precautionary measures. Should the sinus node fail, other mechanisms of impulse
propagation will come into action.

The structures of the cardiac conduction system

Several structures within the heart are part of the cardiac conduction system:

 The sinus node

The sinus node lies in the right atrium at the opening of the superior vena cava. Here, the
electrical impulses are generated and then conducted. At rest, the sinus node independently
produces 60 - 80 impulses/minute and conducts them to the AV node.
 The AV node (atrio-ventricular node)
The AV node is in the right atrial wall at the border between atrium and ventricle. It transfers
the impulses produced by the sinus node to the His bundle. If the sinus node fails, the AV
node can still produce a rhythm of 40-60 impulses/minute.
 The His bundle
The His bundle is a bundle of fibres running in the ventricular septum dividing into the right
and left bundle branches. The impulses are conducted from here to the Purkinje fibres. If
sinus and AV nodes fail, here a rhythm of 20 impulses/minute can still be produced.
 The Purkinje fibres Anaesthetic
The Purkinje fibres are terminal branches of the His bundle and conduct the impulses to the
ventricular muscles.

CARDIAC CYCLE – SYSTOLE AND DIASTOLE

The mechanical events occurring during one systole and diastole.

One cardiac cycle = 1 systole + 1 diastole

Phases of Cardiac Cycle

Atrial contraction (First Phase) This is the phase of atrial contraction. 80% of ventricular
filling has been done passively even before the onset of atrial contraction and the remaining
20% of ventricular filling is due to atrial contraction. This active filling of ventricles becomes
valuable during physical activity.

When pressure in the atrium increases, blood rush into the ventricles through the opened
mitral valve. During left atrium contraction, pressure and volume are transferred into left
ventricle through opened mitral valve. Remember aortic valve is closed because pressure in
aorta is greater than the pressure in left ventricle at this moment.

Isovolumetric Contraction (Second Phase)

This is the early phase of ventricular systole. When ventricles contract, there is a progressive
increase in intraventricular pressure. When intraventricular pressure increase than atrial
pressure, This wil leads to closure of mitral valve. That closure of mitral valve produces first
heart sound (S1)

Intraventricular pressure progressively increases upto 80mmHg yet it is not competent

enough to open the aortic valve. At this moment ventricle is contracting with closed mitral
and aortic valves. Meanwhile, intra atrium pressure is gradually increasing due to
accumulation of blood returning from lungs into the left atrium. During the same phase, aorta
pumps whatever blood it contains into more peripheral part of arterial tree due to its elastic
nature.

Rapid Ventricular Ejection (Third Phase)

When pressure reaches to 81mmHg, aortic valve opens. Third phase of cardiac cycle has
started. Ventricles keep on contracting and there is a progressive increase in intraventricular
pressure upto 120mmHg. During this phase, aortic valve opens and blood is ejected rapidly
into aorta. Now left ventricle and aorta behave as a single chamber. The pressure changes
occurred in the ventricles results in faithfully transmission of pressure to aorta. Meanwhile
left atrium is still receiving blood from the lungs

Slow Ventricular Ejection (Fourth Phase)

Mitral valve is closed. Ventricles are still contracting but due to ejection of blood
intraventricular pressure starts falling. Hence, pressure in aorta also starts falling, but
intraventricular pressure is still more than aortic pressure. Aortic valve remains open leading
to slow ejection of blood into aorta. Elastic aorta keeps on squeezing the blood and pumps it
into peripheral arterial tree.

Isovolumetric Relaxation (Fifth Phase)

In this phase ventricles start relaxing. Intraventricualr pressure falls rapidly. In the beginning,
as soon as the ventricular pressure becomes less than pressure in aorta, aortic valve closes.
Even though pressure in ventricle is falling, it is still high enough compared to pressure in
atrium. So ventricle is relaxing with closed valves and it is known as isovolumetric
relaxation. During this phase atrium is still behaving as reservoir of blood.

Rapid Passive Ventricular Filling (Sixth Phase)

When left ventricle start relaxing, pressure in left ventricle start dropping rapidly until it
reaches the point where pressure in the ventricle becomes less than the pressure in atrium,
leads to opening of mitral valve. Blood which was previously accumulated in atrium will rush
into ventricle. This rapid filling is done without atrial contraction.

Slow Passive Ventricular Filling (Seventh Phase)

As atrioventricular valve open, blood coming to atrium directly rushes into the ventricle.
Here atrium is not acting as reservoir.

Definition of Heart sounds (S1, S2, S3, S4)

S1 Heart Sound
In the beginning of ventricular systole, mitral and tricuspid valves closure produce a sound.
This is called first heart sound.
S2 Heart Sound
Closure of aortic and pulmonary valve at the end of ventricular systole, produce a sound. This
is called second heart sound.
S3 Heart Sound
In some young person; in the last moments of rapid passive ventricular filling phase, heart
may produce a sound. This is called third heart sound.
S4 Heart Sound
In some young person; in the last moments of rapid passive ventricular filling phase, heart
may produce a sound. This is called third heart sound.
The first phase starts with atrial contraction, atrial pressure rise and mitral valve become
open. So the pressure transfers to the ventricle. There is equal rise in ventricular pressure
graph. Aortic pressure graph still shows 80 mm Hg.

Heart Sounds

One of the simplest, yet effective, diagnostic techniques applied to assess the state of a
patient’s heart is auscultation using a stethoscope.

In a normal, healthy heart, there are only two audible heart sounds: S1 and S2. S1 is the sound
created by the closing of the atrioventricular valves during ventricular contraction and is
normally described as a “lub,” or first heart sound. The second heart sound, S 2, is the sound
of the closing of the semilunar valves during ventricular diastole and is described as a “dub”.
In both cases, as the valves close, the openings within the atrioventricular septum guarded by
the valves will become reduced, and blood flow through the opening will become more
turbulent until the valves are fully closed. There is a third heart sound, S 3, but it is rarely
heard in healthy individuals. S3 may be heard in youth, some athletes, and pregnant women.
If the sound is heard later in life, it may indicate congestive heart failure. The fourth heart
sound, S4, results from the contraction of the atria pushing blood into a stiff or hypertrophic
ventricle, indicating failure of the left ventricle. A few individuals may have both S 3 and S4,
and this combined sound is referred to as S7.

Figure 3. In this illustration, the x-axis reflects time with a recording of the heart sounds. The
y-axis represents pressure.

Important Definition

cardiac cycle period of time between the onset of atrial contraction (atrial systole) and
ventricular relaxation (ventricular diastole)
diastole:: period of time when the heart muscle is relaxed and the chambers fill with blood
end diastolic volume (EDV): (also, preload) the amount of blood in the ventricles at the end
of atrial systole just prior to ventricular contraction
end systolic volume (ESV): amount of blood remaining in each ventricle following systole
 heart sounds: sounds heard via auscultation with a stethoscope of the closing of the
atrioventricular valves (“lub”) and semilunar valves (“dub”)
isovolumic contraction: also, isovolumetric contraction) initial phase of ventricular
contraction in which tension and pressure in the ventricle increase, but no blood is pumped or
ejected from the heart
isovolumic ventricular relaxation phase: initial phase of the ventricular diastole when
pressure in the ventricles drops below pressure in the two major arteries, the pulmonary
trunk, and the aorta, and blood attempts to flow back into the ventricles, producing the
dicrotic notch of the ECG and closing the two semilunar valves
murmur: unusual heart sound detected by auscultation; typically related to septal or valve
defects
preload: (also, end diastolic volume) amount of blood in the ventricles at the end of atrial
systole just prior to ventricular contraction
systole: period of time when the heart muscle is contracting
ventricular ejection phase: second phase of ventricular systole during which blood is
pumped from the ventricle

BLOOD PRESSURE

Blood pressure is the force of blood pushing against the walls of the arteries as the heart
pumps blood. High blood pressure, sometimes called hypertension, happens when this force
is too high. Health care workers check blood pressure readings the same way for children,
teens, and adults. They use a gauge, stethoscope or electronic sensor, and a blood pressure
cuff. With this equipment, they measure:

 Systolic Pressure: blood pressure when the heart beats while pumping blood
 Diastolic Pressure: blood pressure when the heart is at rest between beats

Health care workers write blood pressure numbers with the systolic number above the
diastolic number. For example:

Normal Blood Pressure

Normal blood pressure for adults is defined as a systolic pressure below 120 mmHg and a
diastolic pressure below 80 mmHg. It is normal for blood pressures to change when you
sleep, wake up, or are excited or nervous. When you are active, it is normal for your blood
pressure to increase. However, once the activity stops, your blood pressure returns to your
normal baseline range.

Blood pressure normally rises with age and body size. Newborn babies often have very low
blood pressure numbers that are considered normal for babies, while older teens have
numbers similar to adults.

Abnormal Blood Pressure

Abnormal increases in blood pressure are defined as having blood pressures higher than
120/80 mmHg. The following table outlines and defines high blood pressure severity levels.

Stages of High Blood Pressure in Adults

Systolic Diastolic
Stages
(top number) (bottom number)

Prehypertension 120–139 OR 80–89

High blood pressure Stage

140–159 OR 90–99
1

High blood pressure Stage

160 or higher OR 100 or higher
2

The ranges in the table are blood pressure guides for adults who do not have any short-term
serious illnesses. People with diabetes or chronic kidney disease should keep their blood
pressure below 130/80 mmHg.

Although blood pressure increases seen in prehypertension are less than those used to
diagnose high blood pressure, prehypertension can progress to high blood pressure and
should be taken seriously. Over time, consistently high blood pressure weakens and damages
your blood vessels, which can lead to complications.

Types of High Blood Pressure

There are two main types of high blood pressure: primary and secondary high blood pressure.

Primary High Blood Pressure

Primary, or essential, high blood pressure is the most common type of high blood pressure.
This type of high blood pressure tends to develop over years as a person ages.

Secondary High Blood Pressure

Secondary high blood pressure is caused by another medical condition or use of certain
medicines. This type usually resolves after the cause is treated or removed.