Unit : 5 ( The Cardiovascular System)

• Blood is a specialized, fluid connective tissue that circulates throughout the body
to transport essential substances and maintain homeostasis.Blood consists of
plasma, blood cells and platelets.
• Blood Group System
• The blood grouping system is pivotal in blood transfusion. Our immune
system recognizes another blood type as foreign and attacks it if introduced in
the body causing a transfusion reaction. Any inappropriate match with the Rh
and ABO blood types, causes the most serious and life-threatening
transfusion reactions. Therefore, before blood transfusion, it is suggested to
have a blood group checked.
• What are ABO and Rh blood groups?
• During the blood transfusion, the two most important group systems
examined are the ABO-system and the Rhesus system.
• The ABO blood group system consists of 4 types of blood group – A, B, AB,
and O and is mainly based on the antigens and antibodies on red blood cells
and in the plasma.
• Both antigens and antibodies are protein molecules in which antigens are
present on the surface of Red Blood Cells and antibodies are present in the
plasma which is involved in defending mechanisms.
• 1. ABO blood Group system
• The basis of ABO grouping is of two antigens- Antigen A and Antigen B. The ABO
grouping system is classified into four types based on the presence or absence of
antigens on the red blood cells surface and plasma antibodies.
• Group A – contains antigen A and antibody B.
• Group B –contains antigen B and antibody A.
• Group AB –contains both A and B antigen and no antibodies (neither A nor B).
• Group O – contains neither A nor B antigen and both antibodies A and B.
• The ABO group system is important during blood donation or blood transfusion
as mismatching of blood group can lead to clumping of red blood cells with
various disorders. It is important for the blood cells to match while transfusing
i.e. donor-recipient compatibility is necessary. For example, a person of blood
group A can receive blood either from group A or O as there are no antibodies
for A and O in blood group A.

As shown in the above table, individuals

of blood group O are called as universal
donors, whereas individuals of blood
group AB are universal recipients.
• 2. Rh Blood Group System
• In addition to the ABO blood grouping system, the other prominent one is the
Rh blood group system. About two-thirds of the population contains the third
antigen on the surface of their red blood cells known as Rh factor or Rh antigen;
this decides whether the blood group is positive or negative. If the Rh factor is
present, an individual is rhesus positive (Rh+ve); if an Rh factor is absent
individual is rhesus negative (Rh-ve) as they produce Rh antibodies. Therefore,
compatibility between donor and individual is crucial in this case as well.
• Structure and function of arteries, capillaries and veins
• Blood is pumped from the heart in the arteries. It is returned to the heart in the
veins. The capillaries connect the two types of blood vessel and molecules are
exchanged between the blood and the cells across their walls.
• Arteries
• Always carry blood away from the heart
• Carry oxygenated blood, except for the pulmonary artery
• Carry blood under high pressure
• Have thick muscular and elastic walls to pump and accommodate blood
• A type of supporting tissue called connective tissue provides strength
• The channel in the blood vessel that carries blood - the lumen - is narrow
• Veins
• Always carry blood to the heart
• Always carry deoxygenated blood, except for the pulmonary vein
• Carry blood under low or negative pressure
• Have thin walls - have less muscular tissue than arteries
• Have less connective tissue than arteries
• Have a wide lumen
• Veins contain valves which prevent the backflow of blood.
• Controlling blood flow
• In order to control blood flow through the vessels, the smooth muscle
surrounding the arteries can constrict which causes vasoconstriction or they can
relax which causes vasodilation.
• Capillaries
• Capillaries connect the smallest branches of arteries and veins

The walls of capillaries are just one cell

thick. Capillaries therefore allow the
exchange of molecules between the blood
and the body's cells - molecules can
diffuse
across their walls. This exchange of
molecules is not possible across the walls
of other types of blood vessel.
• Exchange of molecules
• Oxygen diffuses through the capillary wall, into the tissue fluid and the cells.
• Carbon dioxide diffuses from the cells into the tissue fluid, then across the
capillary walls into the blood plasma.
• Glucose diffuses from the blood plasma, across the capillary walls to the tissue
fluid, and then to the cells.
• The waste product urea diffuses from the cells of the liver to the tissue fluid, and
then across the capillary walls into the blood plasma.
• Capillaries allow exchange of substances with body tissues through their thin
walls.
• As blood travels at high pressure in the arteries towards the capillaries, pressure
filtration occurs which results in plasma passing through the capillary wall into
the tissue fluid which surrounds the cell.
• Tissue fluid provides cells with useful substances such as glucose and oxygen and
waste products are passed out of the cells into the tissue fluid to be removed.
• Most of the tissue fluid is returned to the blood. Any excess tissue fluid is
absorbed by lymphatic vessels which return it to the circulatory system as lymph.
• Plasma and tissue fluid are composed of similar substances except for plasma
proteins which are only found in plasma. They are too large to be filtered through
the capillary walls.
• Functions of the Heart
• The functions of the heart are as follows:
1.Managing blood supply. Variations in the rate and force of heart contraction
match blood flow to the changing metabolic needs of the tissues during rest,
exercise, and changes in body position.
2.Producing blood pressure. Contractions of the heart produce blood pressure,
which is needed for blood flow through the blood vessels.
3.Securing one-way blood flow. The valves of the heart secure a one-way blood
flow through the heart and blood vessels.
4.Transmitting blood. The heart separates the pulmonary and systemic circulations,
which ensures the flow of oxygenated blood to tissues.
•
• 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.
• 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, depending on which
chamber it separates.
• 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 body tissues.
• Heart Valves
• The heart is equipped with four valves, which allow blood to flow in only one
direction through the heart chambers.
• Atrioventricular valves. Atrioventricular 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 valves.
• 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 the coronary sinus.
• 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
• Tunics
• the walls of the blood vessels have three coats or tunics.
• Tunica intima. The tunica intima, which lines the lumen, or interior, of the vessels, is a thin
layer of endothelium resting on a basement membrane and decreases friction as blood flows
through the vessel lumen.
• Tunica media. The tunica media is the bulky middle coat which mostly consists of smooth
muscle and elastic fibers that constrict or dilate, making the blood pressure increase or
decrease.
• Tunica externa. The tunica externa is the outermost tunic composed largely of fibrous
connective tissue, and its function is basically to support and protect the vessels.
• Major Arteries of the Systemic Circulation
• 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.
• 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.
• 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.
• 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.
• Common iliac arteries. The common iliac arteries are the final branches of the
abdominal aorta.
• 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. The 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. The cephalic vein provides for the superficial drainage of the lateral
aspect of the arm and empties into the axillary vein.
• Basilic vein. The 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
• Subclavian vein. The 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. The vertebral vein drains the posterior part of the head.
• Internal jugular vein. The 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. The 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 the thigh.
• 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.
• Hepatic veins. The hepatic veins drain the liver.
• Physiology of the Heart
• As the heart beats or contracts, the blood makes continuous round trips- into and
out of the heart, through the rest of the body, and then back to the heart- only to
be sent out again.
• Intrinsic Conduction System of the Heart
• The spontaneous contractions of the cardiac muscle cells occurs in a regular and
continuous way, giving rhythm to 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
• 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.
• 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. Systole means heart contraction.
• Diastole. 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 Circulation
• A fairly good indication of the efficiency of a person’s circulatory system can be
obtained by taking arterial blood and blood pressure measurements.
• Cardiovascular Vital Signs
• Arterial pulse pressure and blood pressure measurements, along with those of
respiratory rate and body temperature, are referred to collectively 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
• 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.
• Blood Circulation Through the Heart
• The right and left sides of the heart work together in achieving a smooth-flowing
blood circulation.
• 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.
• An ECG (electrocardiogram) is a simple, non-invasive test that measures the
electrical activity of the heart. It records the heart's electrical signals using
electrodes placed on the skin, creating a graph of voltage versus time. ECGs can help
diagnose and monitor various heart conditions, including abnormal rhythms and
heart attacks.
• What it is:
• Non-invasive:
• The test doesn't involve any needles or entry into the body.
• Records electrical activity:
• ECGs measure the electrical signals that travel through the heart during each
heartbeat.
• Graphical representation:
• The electrical signals are displayed as a graph, showing the heart's rhythm and rate.
• Commonly used:
• ECGs are routinely used in hospitals and clinics to assess a wide range of heart
• What it can help diagnose:
• Abnormal heart rhythms (arrhythmias):
• ECGs can detect irregular heartbeats, such as tachycardia (fast heart rate) or
bradycardia (slow heart rate).
• Heart attacks (myocardial infarction):
• ECGs can show signs of damage to the heart muscle, which can be an indicator of
a heart attack.
• Other heart conditions:
• ECGs can also be used to assess conditions like heart failure, valve problems, and
electrolyte imbalances.
• Monitor treatment effectiveness:
• ECGs can help track how well heart medications or devices like pacemakers are
working.