Cardiovascular System

Prepared by:
Roselle B. Anguay, R.
N
 The
Heart
 Cardiovascular
System

circulatory system

It's the muscle at the

center of your
circulation system,
pumping blood around
your body as your
heart beats.
 Functions of the
Heart
1. Managing blood supply
2. Producing blood pressure.
3. Securing one-way blood
flow.
4. Transmitting blood. Anatomy of the Heart

The cardiovascular system can

be compared to a muscular
pump equipped with one-way
valves and a system of large
and small plumbing tubes
within which the blood travels.
Heart Structure and Functions

The modest size

and weight of the
heart give few
hints of its
incredible
strength.
Weight. Approximately the size of a person’s fist, the hollow, cone-shaped heart
weighs less than a pound.
Mediastinum. Snugly enclosed within the inferior mediastinum, the medial cavity
of the thorax, the heart is flanked on each side by the lungs.
Apex. Its more pointed apex is directed toward the left hip and rests on the
diaphragm, approximately at the level of the fifth intercostal space.
Base. Its broad posterosuperior aspect, or base, from which the great vessels of
the body emerge, points toward the right shoulder and lies beneath the second rib.
Pericardium. The heart is enclosed in a double-walled sac, which is the
outermost layer of the heart.
Fibrous pericardium. The loosely fitting superficial part of this sac is referred
to as the fibrous pericardium, which helps protect the heart and anchors it to
surrounding structures such as the diaphragm and sternum.
Serous pericardium. Deep to the fibrous pericardium is the slippery, two-layer
serous pericardium, where its parietal layer lines the interior of the fibrous
pericardium
Layers of the Heart

The heart muscle has three layers and they are as follows:

1 Epicardium
The epicardium or the visceral and
Myocardium outermost layer is actually a part of
2 the heart wall.

The myocardium consists of thick

3 Endocardium.
bundles of cardiac muscle twisted and
whirled into ringlike arrangements and
it is the layer that actually contracts.

The endocardium is the innermost

layer of the heart and is a thin,
glistening sheet of endothelium hat
lines the heart chambers.
Structure of the Heart
Chambers of the Heart

The heart has four hollow chambers, or cavities: two atria and two
ventricles.

•Receiving chambers. The two superior atria are primarily the

receiving chambers, they play a lighter role in the pumping activity of
the heart.

•Discharging chambers. The two inferior, thick-

walled ventricles are the discharging chambers, or actual pumps of
the heart wherein when they contract, blood is propelled out of the
heart and into circulation.

•Septum. The septum that divides the heart longitudinally is referred

to as either the interventricular septum or the interatrial septum,
 Associated Great Vessels

The great blood vessels provide a pathway for the entire cardiac circulation to
proceed.

•Superior and inferior vena cava. The heart receives relatively oxygen-
poor blood from the veins of the body through the large superior and inferior
vena cava and pumps it through the pulmonary trunk.

•Pulmonary arteries. The pulmonary trunk splits into the right and left
pulmonary arteries, which carry blood to the lungs, where oxygen is picked up
and carbon dioxide is unloaded.

•Pulmonary veins. Oxygen-rich blood drains from the lungs and is returned
to the left side of the heart through the four pulmonary veins.

•Aorta. Blood returned to the left side of the heart is pumped out of the heart
into the aorta from which the systemic arteries branch to supply essentially all
 Heart Valves

The heart is equipped with four valves, which

allow blood to flow in only one direction through
the heart chambers.
• Atrioventricular valves or AV valves
are located between the atrial and
ventricular chambers on each side, and
they prevent backflow into the atria when
the ventricles contract.
• Bicuspid valves. The left AV valve- the
bicuspid or mitral valve, consists of two
flaps, or cusps, of the endocardium.
• Tricuspid valve. The right AV valve, the
tricuspid valve, has three flaps.
• Semilunar valve. The second set of
valves, the semilunar valves, guards the
bases of the two large arteries leaving the
ventricular chambers, thus they are known
as the pulmonary and aortic semilunar
 Cardiac Circulation Vessels

Although the heart chambers are bathed with blood almost

continuously, the blood contained in the heart does not nourish the
myocardium.

•Coronary arteries.
The coronary arteries branch from the base of the aorta and encircle
the heart in the coronary sulcus (atrioventricular groove) at the
junction of the atria and ventricles, and these arteries are
compressed when the ventricles are contract and fill when the heart
is relaxed.

•Cardiac veins.
The myocardium is drained by several cardiac veins, which empty
into an enlarged vessel on the posterior of the heart called
 Blood Vessels

Blood circulates inside the blood vessels, which form a closed transport
system, the so-called vascular system.

•Arteries. As the heart beats, blood is propelled into large arteries

leaving the heart.

•Arterioles. It then moves into successively smaller and smaller arteries

and then into arterioles, which feed the capillary beds in the tissues.

•Veins. Capillary beds are drained by venules, which in turn empty into
veins that finally empty into the great veins entering the heart.
Tunics

Except for the

microscopic capillaries,
the walls of the blood
vessels have three
coats or tunics.
• Tunica intima
• Tunica media
• Tunica externa
 Major Arteries of the Systemic
Circulation

The major branches of the aorta

and the organs

1. Arterial Branches of the

Ascending Aorta

2. Arterial Branches of the Aortic

Arch

3. Arterial Branches of the Thoracic

Aorta

4. Arterial Branches of the

Abdominal Aorta
1. Arterial Branches of the Ascending Aorta

The aorta springs upward from the left ventricle of the heart as the
ascending aorta.

• Coronary arteries. The only branches of the ascending aorta are

the right and left coronary arteries, which serve the heart.
 2. Arterial Branches of the Aortic Arch

The aorta arches to the left as the aortic arch.

• Brachiocephalic trunk.
The brachiocephalic trunk, the first branch off the aortic arch, splits
into the right common carotid artery and right subclavian
artery.

• Left common carotid artery.

The left common carotid artery is the second branch of the aortic arch
and it divides, forming the left internal carotid, which serves the
brain, and the left external carotid, which serves the skin and
muscles of the head and neck.
• Left subclavian artery.
The third branch of the aortic arch, the left subclavian artery, gives off an
important branch- the vertebral artery, which serves as part of the brain.

• Axillary artery.
In the axilla, the subclavian artery becomes the axillary artery.

• Brachial artery.
the subclavian artery continues into the arm as the brachial artery,
which supplies the arm.

• Radial and ulnar arteries.

At the elbow, the brachial artery splits to form the radial and ulnar
arteries, which serve the forearm.
 3. Arterial Branches of the Thoracic Aorta

The aorta plunges downward through the thorax, following the spine as the thoracic
aorta.
• Intercostal arteries. Ten pairs of intercostal arteries supply the muscles of the
thorax wall.

4. Arterial Branches of the Abdominal Aorta

Finally, the aorta passes through the diaphragm into the abdominopelvic cavity, where
it becomes the abdominal aorta.

• Celiac trunk. The celiac trunk is the first branch of the abdominal aorta and has
three branches: the left gastric artery supplies the stomach; the splenic
artery supplies the spleen, and the common hepatic artery supplies the liver.
• Superior mesenteric artery. The unpaired superior
mesenteric artery supplies most of the small intestine
and the first half of the large intestine or colon.
• Renal arteries. The renal arteries serve the kidneys.
• Gonadal arteries. The gonadal arteries supply the
gonads, and they are called ovarian arteries in
females while in males they are testicular arteries.
• Lumbar arteries. The lumbar arteries are several
pairs of arteries serving the heavy muscles of the
abdomen and trunk walls.
• Inferior mesenteric artery. The inferior mesenteric
artery is a small, unpaired artery supplying the second
half of the large intestine.
 Major Veins of
the Systemic
Circulation

Major veins converge on

the venae cavae, which
enter the right atrium of
the heart.
 Veins Draining into the Superior Vena Cava

Veins draining into the superior vena cava are named in a distal-to-
proximal direction; that is, in the same direction the blood flows into the
superior vena cava.

• Radial and ulnar veins - are deep veins draining the forearm; they
unite to form the deep brachial vein, which drains the arm and
empties into the axillary vein in the axillary region.
• Cephalic vein. - provides for the superficial drainage of the lateral
aspect of the arm and empties into the axillary vein.
• Basilic vein - is a superficial vein that drains the medial aspect of the
arm and empties into the brachial vein proximally.
• Median cubital vein. The basilic and cephalic veins are
joined at the anterior aspect of the elbow by the median
cubital vein, often chosen as the site for blood removal for
the purpose of blood testing.

• Subclavian vein - receives venous blood from the arm through the
axillary vein and from the skin and muscles of the head through
the external jugular vein.
• Vertebral vein - drains the posterior part of the head.
• Internal jugular vein - drains the dural sinuses of the brain.
• Brachiocephalic veins. The right and left brachiocephalic veins are
large veins that receive venous drainage from the subclavian, vertebral,
and internal jugular veins on their respective sides.
• Azygos vein - is a single vein that drains the thorax and enters the
superior vena cava just before it joins the heart.
 Veins Draining into the Inferior
Vena Cava

The inferior vena cava, which is much longer than the superior vena cava,
returns blood to the heart from all body regions below the diaphragm.

• Tibial veins. The anterior and posterior tibial veins and the fibular
vein drain the leg; the posterior tibial veins become the popliteal
vein at the knee and then the femoral vein in the thigh; the femoral
vein becomes the external iliac vein as it enters the pelvis.

• Great saphenous veins. The great saphenous veins are the longest
veins in the body; they begin at the dorsal venous arch in the foot and
travel up the medial aspect of the leg to empty into the femoral vein in
• Common iliac vein. Each common iliac vein is formed by
the union of the external iliac vein and the internal iliac vein
which drains the pelvis.

• Gonadal vein. The right gonadal vein drains the right ovary in females
and the right testicles in males; the left gonadal vein empties into the
left renal veins superiorly.

• Renal veins. The right and left renal veins drain the kidneys.

• Hepatic portal vein. The hepatic portal vein is a single vein that drains
the digestive tract organs and carries this blood through the liver before
it enters the systemic circulation.
Physiology Intrinsic
of the Conduction
Heart System of the
Heart
As the heart beats The spontaneous
or contracts, the contractions of
blood makes
continuous round the cardiac
trips- into and out muscle cells
of the heart, occurs in a
through the rest of regular and
the body, and then continuous way,
back to the heart-
only to be sent out giving rhythm to
again. the heart.
 • Cardiac muscle cells. Cardiac muscle cells can and do
contract spontaneously and independently, even if all
nervous connections are severed.

• Rhythms. Although cardiac muscles can beat independently, the muscle

cells in the different areas of the heart have different rhythms.
• Intrinsic conduction system. The intrinsic conduction system, or the
nodal system, that is built into the heart tissue sets the basic rhythm.
• Composition. The intrinsic conduction system is composed of a special
tissue found nowhere else in the body; it is much like a cross between a
muscle and nervous tissue.
• Function. This system causes heart muscle depolarization in only one
direction- from the atria to the ventricles; it enforces a contraction rate of
approximately 75 beats per minute on the heart, thus the heart beats as
a coordinated unit.
• Sinoatrial (SA) node. The SA node has the highest rate of
depolarization in the whole system, so it can start the beat and
set the pace for the whole heart; thus the term “pacemaker“.

• Atrial contraction. From the SA node, the impulse spread through the
atria to the AV node, and then the atria contract.
• Ventricular contraction. It then passes through the AV bundle, the
bundle branches, and the Purkinje fibers, resulting in
a “wringing” contraction of the ventricles that begins at the heart apex
and moves toward the atria.
• Ejection. This contraction effectively ejects blood superiorly into the
large arteries leaving the heart.
 The Pathway of the Conduction System

The conduction system occurs systematically through:

• SA node. The depolarization wave is initiated by the sinoatrial node.
• Atrial myocardium. The wave then successively passes through the
atrial myocardium.
• Atrioventricular node. The depolarization wave then spreads to the AV
node, and then the atria contract.
• AV bundle. It then passes rapidly through the AV bundle.
• Bundle branches and Purkinje fibers. The wave then continues on
through the right and left bundle branches, and then to the Purkinje
fibers in the ventricular walls, resulting in a contraction that ejects blood,
leaving the heart.
Electrical Conduction System of the Heart
Cardiac | SA Node, AV Node, Bundle of His

Please see attached video linked

• https://www.youtube.com/watch?v=-X9rYD8zSQg
 Cardiac Cycle and Heart Sounds

In a healthy heart, the atria contract simultaneously, then, as they start to

relax, contraction of the ventricles begins.

• Systole. means heart contraction.

• Diastole. means heart relaxation.
• Cardiac cycle. The term cardiac cycle refers to the events of one
complete heartbeat, during which both atria and ventricles contract and
then relax.
• Length. The average heart beats approximately 75 times per minute, so
the length of the cardiac cycle is normally about 0.8 seconds.
• Mid-to-late diastole. The cycle starts with the heart in
complete relaxation; the pressure in the heart is low, and blood is
flowing passively into and through the atria into the ventricles from the
pulmonary and systemic circulations; the semilunar valves are closed,
and the AV valves are open; then the atria contract and force the blood
remaining in their chambers into the ventricles.

• Ventricular systole. Shortly after, the ventricular contraction begins, and the
pressure within the ventricles increases rapidly, closing the AV valves; when
the intraventricular pressure is higher than the pressure in the large arteries leaving
the heart, the semilunar valves are forced open, and blood rushes through them out of
the ventricles; the atria are relaxed, and their chambers are again filling with blood.
• Early diastole. At the end of systole, the ventricles relax, the semilunar valves snap
shut, and for a moment the ventricles are completely closed chambers; the
intraventricular pressure drops and the AV valves are forced open; the ventricles again
begin refilling rapidly with blood, completing the cycle.
• First heart sound. The first heart sound, “lub”, is caused by the closing of the AV
valves.
• Second heart sound. The second heart sound, “dub”, occurs when the semilunar
valves close at the end of systole.
 Cardiac Output

Cardiac output is the amount of blood pumped out by each side of the heart
in one minute. It is the product of the heart rate and the stroke volume.

• Stroke volume. Stroke volume is the volume of blood pumped out by a

ventricle with each heartbeat.
• Regulation of stroke volume. According to Starling’s law of the heart,
the critical factor controlling stroke volume is how much the cardiac muscle
cells are stretched just before they contract; the more they are stretched,
the stronger the contraction will be; and anything that increases the
volume or speed of venous return also increases stroke volume and force of
contraction.
• Factors modifying basic heart rate. The most important external
influence on heart rate is the activity of the autonomic nervous system,
as well as physical factors (age, gender, exercise, and body temperature).
 Physiology of Cardiovascu
Circulation lar Vital
Signs

A fairly good
indication of the Arterial pulse pressure
efficiency of a
and blood pressure
person’s
circulatory system measurements, along
can be obtained by with those of respiratory
taking arterial rate and body
blood and blood temperature, are
pressure referred to collectively
measurements. as vital signs in clinical
settings.
• Arterial pulse. The alternating expansion and recoil of an artery
that occurs with each beat of the left ventricle create a pressure
wave-a pulse- that travels through the entire arterial system.

• Normal pulse rate. Normally, the pulse rate (pressure surges per minute) equals the heart rate, so
the pulse averages 70 to 76 beats per minute in a normal resting person.
• Pressure points. There are several clinically important arterial pulse points, and these are the same
points that are compressed to stop blood flow into distal tissues during hemorrhage, referred to as
pressure points.
• Blood pressure. Blood pressure is the pressure the blood exerts against the inner walls of the blood
vessels, and it is the force that keeps blood circulating continuously even between heartbeats.
• Blood pressure gradient. The pressure is highest in the large arteries and continues to drop
throughout the systemic and pulmonary pathways, reaching either zero or negative pressure at the
venae cavae.
• Measuring blood pressure. Because the heart alternately contracts and relaxes, the off-and-on flow
of the blood into the arteries causes the blood pressure to rise and fall during each beat, thus, two
arterial blood pressure measurements are usually made: systolic pressure (the pressure in the
arteries at the peak of ventricular contraction) and diastolic pressure (the pressure when the
ventricles are relaxing).
• Peripheral resistance. Peripheral resistance is the amount of friction
the blood encounters as it flows through the blood vessels.
• Neural factors. The parasympathetic division of the autonomic nervous system has
little or no effect on blood pressure, but the sympathetic division has the major action
of causing vasoconstriction or narrowing of the blood vessels, which increases blood
pressure.

• Renal factors. The kidneys play a major role in regulating arterial blood pressure by
altering blood volume, so when blood pressure increases beyond normal, the kidneys
allow more water to leave the body in the urine, then blood volume decreases which in
turn decreases blood pressure.
• Temperature. In general, cold has a vasoconstricting effect, while heat has a
vasodilating effect.
• Chemicals. Epinephrine increases both heart rate and blood
pressure; nicotine increases blood pressure by causing vasoconstriction; alcohol and
histamine cause vasodilation and decreased blood pressure.
• Diet. Although medical opinions tend to change and are at odds from time to time, it
is generally believed that a diet low in salt, saturated fats, and cholesterol help to
prevent hypertension, or high blood pressure.
 Normal Values:
BP – 110/70 mmHg
Heart Rate/Pulse Rate – 60 – 100 beats/minute
Respiration – 16 – 22 breath/min
 Healthy and unhealthy blood pressure ranges

BLOOD PRESSURE SYSTOLIC mm Hg DIASTOLIC mm Hg

CATEGORY (upper number) and/or (lower number)
NORMAL LESS THAN 120 and LESS THAN 80

ELEVATED 120 – 129 and LESS THAN 80

HIGH BLOOD PRESSURE 130 – 139 or 80 – 89

(HYPERTENSION) STAGE
1
HIGH BLOOD PRESSURE 140 OR HIGHER or 90 OR HIGHER
(HYPERTENSION) STAGE
2
HYPERTENSIVE CRISIS HIGHER THAN 180 and/or HIGHER THAN 120
(consult your doctor
immediately)
 Blood
Circulation
Through
the Heart

The right
and left
sides of the
heart work
together in
achieving a
smooth-
flowing
blood circul
ation
.
• Entrance to the heart. Blood enters the heart through two large veins, the
inferior and superior vena cava, emptying oxygen-poor blood from the body into
the right atrium of the heart.
• Atrial contraction. As the atrium contracts, blood flows from the right atrium to
the right ventricle through the open tricuspid valve.
• Closure of the tricuspid valve. When the ventricle is full, the tricuspid valve
shuts to prevent blood from flowing backward into the atria while the ventricle
contracts.
• Ventricle contraction. As the ventricle contracts, blood leaves the heart through
the pulmonic valve, into the pulmonary artery, and to the lungs where it is
oxygenated.
• Oxygen-rich blood circulates. The pulmonary vein empties oxygen-rich blood
from the lungs into the left atrium of the heart.
• Opening of the mitral valve. As the atrium contracts, blood flows from your left
atrium into your left ventricle through the open mitral valve.
• Prevention of backflow. When the ventricle is full, the mitral valve shuts. This
prevents blood from flowing backward into the atrium while the ventricle contracts.
• Blood flow to the systemic circulation. As the ventricle contracts, blood leaves
the heart through the aortic valve, into the aorta, and to the body.
Please see attached video linked:

• https://www.youtube.com/watch?v=jBt5jZSWhMI
• https://www.youtube.com/watch?v=2GMayj9O21o
 Capillary Exchange of
Gases and Nutrients

Substances tend to move to and from the body cells according to their
concentration gradients.

• Capillary network. Capillaries form an intricate network among the body’s

cells such that no substance has to diffuse very far to enter or leave a cell.
• Routes. Basically, substances leaving or entering the blood may take one of
four routes across the plasma membranes of the single layer of endothelial
cells forming the capillary wall.
• Lipid-soluble substances. As with all cells, substances can
diffuse directly through their plasma membranes if the substances are lipid-
soluble.
• Lipid-insoluble substances. Certain lipid-insoluble substances may
enter or leave the blood and/or pass through the plasma membranes
within vesicles, that is, by endocytosis or exocytosis.

• Intercellular clefts. Limited passage of fluid and small solutes is

allowed by intercellular clefts (gaps or areas of plasma membrane not
joined by tight junctions), so most of our capillaries have intercellular
clefts.

• Fenestrated capillaries. Very free passage of small solutes and fluid

is allowed by fenestrated capillaries, and these unique capillaries are
found where absorption is a priority or where filtration occurs.
Age-Related Physiological
Changes in the Cardiovascular
System

The capacity of the heart

for work decreases with
age. Older peoples’ rate is
slower to respond to
stress and slower to
return to normal after
periods of
physical activity. Changes
in arteries occur
frequently which can
negatively affect blood