Chapter 2

Cardiovascular system
Cardiovascular system

 Transport system in which oxygen, carbon dioxide and nutrients are

carried by the blood to and from different parts of the body.

 It consists of two separate parts: the systemic circulation and the

pulmonary circulation. The two circulations are connected by the
heart.
 Cardiovascular system
o From the left ventricle blood is pumped, through the aortic valve into the
systemic circulation to the aorta (which is the largest artery in the body).
o The systemic arteries transport oxygen and nutrients to the various muscles
and organs.
o In the capillaries oxygen and nutrients diffuse from the vessels into the target
tissues.
o In the muscles and organs oxygen is exchanged with carbon dioxide and the
blood becomes deoxygenated.
o From the capillaries blood flows into venules and then into veins.
o Through a network of joining channels the blood reaches the superior vena
cava and inferior vena cava and from there it enters the right atrium of the
heart.
 Cardiovascular system
o From the right atrium, through the tricuspid valve, blood enters the
right ventricle.
o Heart contraction ejects blood from the right ventricle through the
pulmonary valve into the pulmonary arteries.
o The deoxygenated blood is carried to the lungs, where carbon dioxide
is exchanged for oxygen in the alveoli.
o Re oxygenated blood is carried back to the left atrium through the
pulmonary veins.
o From there the blood re-enters the left ventricle through the mitral
valve.
o Coronary circulation is the functional blood supply to the heart
muscle itself
Pressure distribution in the cardiovascular system
 The pressure (cleared from the hydrostatic pressure) in each portion
of the circulation changes significantly. It is highest in the ventricles
during ejection and the progressively decreases towards the atria.
 The maximum pressure in the left ventricle is significantly higher
than that in the right ventricle.
 Maximum and minimum pressures in the aorta are approximately 120
mmHg and 80 mmHg (≈ 16000 − 10665 Pa).
 Blood volume distribution
 Approximately 74% of blood volume is contained in the systemic
circulation (systemic arteries ≈ 20%, Systemic veins ≈ 54% ), 14% is in
the pulmonary circulation and 12% is in the heart.
 Cardiac output in man may increase from a resting level of about 5 l
min−1 to 25 l min−1 in strenuous exertion. In all cases the output of the
two pumps (left and right ventricles) is the same, being the two systems
in series.
 The response of the heart involves an increase in rate of contraction
and output per beat (stroke volume). This implies that cardiac muscle
fibers are capable of varying both the duration and amplitude of their
contraction.
 Anatomy of the heart
 The heart is the pump of the circulatory system, i.e. it is the source
of energy that makes the blood flow. Approximately the size of your
fist
 The heart may be thought of as a couple of pumps in series. Each
of the cardiac pumps consists of a low-pressure chamber (atrium),
which is filled by the venous system, and a high-pressure chamber
(ventricle).
 The two chambers are separated by a non-return valve. From the
ventricle the blood exits to an artery through another non-return
valve.
External Heart View

Figure 18.4b
 Atria

o Atria are the receiving chambers of the heart

o Each atrium has a protruding auricle
o Pectinate muscles mark atrial walls
o Blood enters right atria from superior and inferior venae cavae and
coronary sinus
o Blood enters left atria from pulmonary veins
o The two atrioventricular valves have different structure
- the one on the right side (tricuspid valve) has three cusps;
- the one on the left side (mitral valve) has two cusps.
 Ventricles of the Heart

o Ventricles are the discharging chambers of the heart

o Papillary muscles and trabeculae carneae muscles mark
ventricular walls
o Right ventricle pumps blood into the pulmonary trunk
o Left ventricle pumps blood into the aorta
o Ventricle walls are much thicker and stronger
- right ventricle supplies blood to the lungs (little
flow resistance)
- left ventricle wall is the thickest to supply systemic
circulation
 Pulmonary and aortic valves
The valve cusps consist of flaps attached along one edge to a
fibrous ring in the heart wall and with free edges projecting into
the ventricles. They are very thin (≈ 0.1 mm).
The free edges are attached (’tethered’) to the ventricle walls
through fibrous bands (chordae tendinae) which prevent the valve
turning inside out when the pressure in the ventricle rises.
Heart valves open more than 30 million times a year!
The valves are made up of a meshwork of collagen and elastic
fiberes, covered by endothelium (the cell layer which also covers
the walls of the heart chambers and blood-vessels).
 Pulmonary and aortic valves
The exit valves from the
ventricles, the pulmonary and
aortic valves, are very similar to
each other and consist of three
cusps with free margins. These
cusps are not tethered but can
nonetheless support considerable
pressure differences between the
arteries and the ventricles (in the
aortic valve ≈ 100 mmHg). The
four valve orifices are
approximately aligned in a plane.
 The cardiac muscle structure
Pericardium – a double-walled sac around the heart composed of:
1. A superficial fibrous pericardium
2. A deep two-layer serous pericardium
The parietal layer lines the internal surface of the fibrous
pericardium
The visceral layer or epicardium lines the surface of the heart
They are separated by the fluid-filled pericardial cavity

The Function of the Pericardium:

• Protects and anchors the heart
• Prevents overfilling of the heart with blood
• Allows for the heart to work in a relatively friction-free
environment
 Heart Wall
Epicardium – visceral layer of the serous
pericardium
Myocardium – cardiac muscle layer forming the
bulk of the heart
Fibrous skeleton of the heart – crisscrossing,
interlacing layer of connective tissue
Endocardium – endothelial layer of the inner
myocardial surface
 What is septum
o Is a solid wall like structure that separate left atrial
and ventricle from the right atrial and ventricle.
o This keeps blood from one side of the heart from
mixing with the other side of the heart.
 Cardiac cycle
o The contraction cycle of the heart is governed by electrical impulses.
It is initiated in a localized area of the nervous tissue in the wall of the
right atrium, known as pacemaker or Sino-atrial node. Auto rhythmic
cells:
o The cycles of depolarization and repolarization in the cardiac muscle
can be recorded as the electrocardiogram (ECG)
o When depolarization occurs in the pacemaker it spreads quickly into
the muscle of the right and left atrial walls and causes atrial
contraction. This produces a small deflection in the ECG known as ’P’
wave.
 Cardiac cycle
o The ’P’ wave is followed, after about 0.2 s, by a larger deflection of
the ECG, known as the ’QRS’ complex. This corresponds to
depolarization of the ventricles and the consequent ventricle
contraction.
o Finally, there is the ’T’ wave, which is generated during repolarization
of the ventricles.
 Cardiac cycle
o We consider the mechanical events taking place during the cardiac
cycle in the left heart.
o In correspondence of the QRS complex in the ECG, ventricles
contract. As the transmission of the electrical signal in the ventricular
wall muscles is very fast (≈ 5 m/s) the contraction of the two ventricles
is almost synchronous.
o As contraction starts in the ventricle, the blood pressure there grows
rapidly. At this stage the aortic valve is still closed because the
pressure in the aorta exceeds that in the ventricle.
 Cardiac cycle
o As the pressure in the ventricle grows larger than that in the atrium
and, after a very short period of backward flow into the atrium, the
mitral valve closes.
o The valve closure is accompanied by a sound which is audible at the
chest. It is known clinically as the first heart sound. This sound marks
the start of the systole, which is the period of ventricular contraction.
o The pressure in the ventricle keeps rising until it exceeds that in the
aorta. During this phase there is no change of ventricular volume as
there is no flux through the valves and the blood is effectively
incompressible. This phase is known as isovolumetric period.
 Cardiac cycle
o When the pressure in the ventricle exceeds that in the aorta the aortic
valve opens. At this moment the blood ejection into the systemic
circulation starts.
o As the tension in the ventricle wall falls, the ventricular pressure starts
to decrease. The pressure gradient between the ventricle and the aorta
is reversed and flow starts to decelerate.
o After a short period of backflow into the ventricle the aortic valve
closes again. This generates the second heart sound, which marks the
onset of the diastole.
 Cardiac cycle
o At this stage all valves are closed again and a second isovolumetric
period occurs during which the ventricular muscle relaxes and the
pressure in the ventricle decrease.
o At the same time the pressure in the atrium rises again as the left
atrium is filled from the pulmonary venous system.
o When the pressure in the atrium exceeds that of the ventricle the
mitral valve reopens. At this stage flow occurs that refills the ventricle.
This process is initially passive, driven by a pressure difference
between the atrium and the ventricle. Then, after the P wave in the
ECG, it becomes active as the atrium contracts (atrial systole).
o Shortly after that the ventricle contracts again (QRS wave) and the
cycle starts again.
 Sequence of Excitation

o Sinoatrial (SA) node generates impulses about 75 times/minute

o Atrioventricular (AV) node delays the impulse approximately 0.1
second
Sequence of Excitation
o Impulse passes from atria to ventricles via the atrioventricular bundle
(bundle of His)
o AV bundle splits into two pathways in the interventricular septum
(bundle branches)
1. Bundle branches carry the impulse toward the apex of the heart
2. Purkinje fibers carry the impulse to the heart apex and ventricular walls
 Extrinsic Innervation of the Heart
• Heart is
stimulated by the
sympathetic
cardio
acceleratory
center
• Heart is inhibited
by the
parasympathetic
cardio inhibitory
center

Figure 18.15
Conduction system
Figure 18.14a
Heart Excitation Related to ECG

Figure 18.17
 Electrocardiography
Electrical activity is recorded by
electrocardiogram (ECG)
o P wave corresponds to
depolarization of SA node
o QRS complex corresponds to
ventricular depolarization
o T wave corresponds to
ventricular repolarization
o Atrial repolarization record is
masked by the larger QRS
complex
 Cardiac Cycle
Cardiac cycle refers to all events associated with blood flow through the
heart
• Systole – contraction of heart muscle
• Diastole – relaxation of heart muscle

Heart sounds (lub-dup) are associated with closing of heart valves

• First sound occurs as AV valves close and signifies beginning of
systole (contraction)
• Second sound occurs when SL valves close at the beginning of
ventricular diastole (relaxation)
 Phases of the Cardiac Cycle
• Ventricular filling – mid-to-late diastole
• Heart blood pressure is low as blood enters atria (passively) and flows into ventricles
• AV valves are open, then atrial systole occurs
• Ventricular systole (contraction)
• Atria relax
• Rising ventricular pressure results in closing of AV valves
• Isovolumetric contraction phase
• Ventricular ejection phase opens semilunar valves
• Isovolumetric relaxation – early diastole
• Ventricles relax
• Backflow of blood in aorta and pulmonary trunk closes semilunar valves
• Dicrotic notch – brief rise in aortic pressure caused by backflow of blood
rebounding off semilunar valves
 Cardiac Output (CO) and Reserve
Cardiac Output is the amount of blood pumped by each ventricle in one
minute
o CO is the product of heart rate (HR) and stroke volume (SV)
• HR is the number of heart beats per minute
• SV is the amount of blood pumped out by a ventricle with each
beat
o Cardiac reserve is the difference between resting and maximal CO
 Regulation of Stroke Volume
o SV = end diastolic volume (EDV) minus end systolic volume (ESV)
• EDV = amount of blood collected in a ventricle during diastole
• ESV = amount of blood remaining in a ventricle after contraction

Factors Affecting Stroke Volume

o Preload – amount ventricles are stretched by contained blood
o Contractility – cardiac cell contractile force due to factors other than EDV
o Afterload – back pressure exerted by blood in the large arteries leaving the
heart
o Preload, or degree of
stretch, of cardiac
muscle cells before they
contract is the critical
factor controlling stroke
volume
o Slow heartbeat and
exercise increase
venous return to the
heart, increasing SV
o Blood loss and
extremely rapid
heartbeat decrease SV
Thank you