CVS physiology Dr.

Abdulraheem Jaber +962781531792 (for Qs and private lessons)

‫ وﻻ حاجة لغيره‬%100 ‫هذا الملف شامل‬ oxygenated  then returning oxygenated blood to
heart through pulmonary veins to be pumped into
 Introduction: the systemic circulation.
 CVS = cardio (heart) vascular (blood vessels) system.
 Arteries are vessels that go away from heart and
veins are BVs that carry blood toward heart.
 The largest artery that leaves heart is the aorta
and it divides into left subclavian ( left upper
limb), left common carotid ( head), and
brachiocephalic (that divides into right common
carotid and right subclavian).

 Heart is composed of two sides that are separated

by a septum:
1) Right side that receives blood poor in oxygen
and rich in CO2 from the body and pumps it to
the lungs through the pulmonary circulation to
be oxygenated.
2) Left side that receives the oxygenated blood
from the lungs and pumps it to the body
organs through the systemic circulation.

 Arterioles are small branches that originate from

arteries, and they give capillaries (BVs inside
tissues where exchange of gases and other
molecules occurs)
 Capillaries form venules are that form larger veins.
 Microcirculation: arterioles  capillaries 
venules. Capillaries are BVs where exchange of
nutrients and waste products between blood and
tissues occurs.

 Systemic circulation (from the LV to the RA):

providing the functional blood supply to all body
tissues except the lung.
 Pulmonary circulation (from the RV to the LA):
transporting deoxygenated blood from heart to
lungs through pulmonary arteries to be
CVS physiology Dr. Abdulraheem Jaber +962781531792 (for Qs and private lessons)
 Each side of the heart contains two chambers becomes deoxygenated after exchange  blood
(upper atrium and lower ventricle)  total 4 collects into venules then veins then superior and
chambers (2 atria separated by interatrial septum inferior vena cavae (the largest veins that enter the
and 2 ventricles separated by interventricular RA)  RA  RV  pulmonary arteriy 
septum). pulmonary capillaries (where oxygenation
 There are 4 valves: 2 semilunar valves (between happens)  pulmonary veins  LA  LV. And so
the ventricle of each side and the vessel originating on.
from it  pulmonary on the right and aortic on the  Heart wall consists of three layers: Endocardium (a
left) and 2 atrioventricular valves (tricuspid on the layer of endothelial cells that lines the interior of
right and mitral on the left between atrium and the heart)  Myocardium (muscular layer that is
ventricle on each side). thicker in ventricles than in atria)  Pericardium
 These are one-way valves that prevent blood from (consists of two layers and a pericardial space,
flowing backward. which contains pericardial fluid to reduce friction
 The edges of the atrioventricular valves are within the pericardium = shock absorber).
connected to the wall of ventricles by papillary  The pericardium consists of 2 layers  visceral
muscles, through chordae tendinea. layer close to the myocardium and parietal layer.
 Clinical note: if there is an excessive amount of the
pericardial fluid (e.g., because of infection) it will
press on the heart and prevent it from filling with
blood  this will prevent pumping it to the body.
This case is called cardiac tamponade.

 Blood journey: oxygenated blood leaves LV into

body tissues  blood reaches capillaries where it

 Cardiac vs skeletal muscle:

1) Skeletal cells are spindly shaped + their sizes
arrange from millimeters to meters, on the other
hand the cardiac muscles are rectangular shaped,
and smaller in size
2) Cardiac cells are connected to each other by
desmosomes (physical connection) and gap
junctions (electrical couplers that ensure
syncytium).
 Syncytium = the organized movement of the heart
where the two atria contract as one unit (atrial
syncytium) and the two ventricles contract as one
unit (ventricular syncytium)  when syncytium is
lost, we have ventricular fibrillation which is fatal.
CVS physiology Dr. Abdulraheem Jaber +962781531792 (for Qs and private lessons)
two main phases: depolarization and
repolarization. Also, the resting membrane
potential of skeletal muscle is -70 mV.
In the cardiac muscles, action potential is much
longer, and there are 5 phases. also resting
membrane potential is -90 mV.
 Myocardial action potential consists of 5 phases as
the following:
a) Phase 4: resting membrane potential.
b) Phase 0: a change in the membrane potential
(coming from the pacemaker as we will explain
3) In the cardiac muscles, T-tubules are shorter and later)  opening of voltage-gated Na+ channels
wider, they occur at the Z-lines, while in skeletal  Na+ flows in  depolarization.
muscles they occur at the I-band. So, there is one T- c) Phase 1: opening of K+  K+ flows out 
tubule per sarcomere in the cardiac muscle while repolarization starts.
in skeletal muscle there are 2 T-tubules per
sarcomere.

d) Phase 2: opening of the slow, voltage-gated Ca+2

channels  Ca+2 flows in  depolarization (now
depolarization and repolarization opposes each
other  plateau = prolonged period of
depolarization).
e) Phase 3: Ca+2 channels closes and K+ channels
dominate  repolarization  returning to resting
potential.

4) The SR in the skeletal muscle is well developed (it

has enough calcium stored) and it is much less  The presence of plateau causes ventricular
developed in the cardiac muscles (has far less contraction to last 15 times as long as skeletal
calcium). The cardiac muscles have slow voltage muscle contraction.
gated Ca+2 channels and they pump the Ca +2 ions  Excitation-Contraction coupling: Cardiac muscle
that are essential for the contraction from the begins to contract a few milliseconds after the
extracellular matrix (this decreases cardiac muscle’ action potential begins and continues to contract
need for Ca+2 from SR). until a few milliseconds after the action potential
5) There are more mitochondria and less nuclei in the ends  the duration of contraction of cardiac
cardiac muscles. muscle is mainly a function of the duration of the
6) Action potential in skeletal muscles is very short, 1 action potential (including the plateau)  longer
millisecond to 10 milliseconds, and it consists of plateau = more Ca+2 in = longer contraction.
CVS physiology Dr. Abdulraheem Jaber +962781531792 (for Qs and private lessons)
 Refractory period is the time during action
potential (AP) during which another AP can’t be
achieved.
 In the plateau (phase 2) of cardiac AP Ca+2 ions are
entering the cell and another AP can’t be
generated as we are very far from the resting
membrane potential  plateau is the component
of cardiac AP that prolongs the refractory period.
 Voltage-gated Na+ channels contain 2 gates:
activation gate (opens immediately when
membrane potential is less negative
(depolarization)) and inactivation gate (closes
slowly when membrane potential is less negative).

7) In skeletal muscle, each electrical response (action

potential) is immediately followed by a mechanical
response (contraction), and due to the short  Excitation-contraction coupling
duration of the action potential, the absolute  The rapid communication between electrical
refractory period is also short, this allows the events occurring in the plasma membrane of
possibility of multiple action potentials occurring muscle cells and Ca2+ release from the SR, which
during muscle contraction, leading to sustained leads to contraction.
contraction, which is known as tetanus.
Conversely, cardiac muscle cannot undergo tetanus
because its absolute refractory period is
considerably longer when compared to skeletal
muscle, during this extended refractory period, the
cardiac muscle contracts and relaxes sequentially
to ensure proper functioning of the heart.
 Tetanus is impossible in cardiac muscles.

 Ca+2 is responsible for contraction (contraction

results from an interaction between the actin and
myosin filaments in the presence of Ca+2).
 Ca+2 enters the cell during phase 2 and its entry
induces release of stored Ca+2 in the sarcoplasmic
reticulum (Ca+2-induced Ca+2 release).
 Contraction ends when Ca+2 levels decrease (by
8) Refractory period is longer in cardiac muscle. storage of Ca+2 in the SR (= calcium pump =
primary active) and transporting it outside the cell
CVS physiology Dr. Abdulraheem Jaber +962781531792 (for Qs and private lessons)
through Ca+2-Na+ exchanger (transports 3 Na+ in
for each Ca+2 out  secondary active transport).

 In heart failure, sometimes we try to increase the

power of contraction of cardiac muscle by using
drugs  one of these is digoxin: digoxin blocks
Na+-K+ pump  less Na+ outside  less Na+ to be
exchanged with Ca+2 by Na+-Ca+2 exchanger 
more Ca+2 inside  increased contractility).
 Ca+2 channel blockers are drugs that block C+2
channels  no Ca+2 entry  less contraction 
less work. We want sometimes to decrease ATP
consumption in cardiac muscle.

9) Both cardiac and skeletal muscles contract using

the “walk-along” theory  as we said, tetanus
occurs in skeletal muscle only.
10) Cardiac muscle depends on fatty acids while
skeletal muscle depends on glycogen for energy
(both uses oxidative phosphorylation finally).