CARDIOVASCULAR

SYSTEM
LEARNING OUTCOMES
• Distinguish between the pulmonary and the systemic circulation
• List the contents of the middle mediastinum
• Describe the surface anatomy of the heart
• Describe the pericardium
• List the layers of the heart from superficial to deep
• Identify and describe the structure of all the 4 chambers
• Identify the major blood vessels associated with the heart
LEARNING OUTCOMES
• Describe the flow of blood in the body
• Describe the arteries that supply the heart and to describe which
regions are being supplied by coronary arteries
• Describe and identify the venous drainage of the heart
• Describe the foetal circulation
• Identify the 3 short-circuits or shunts found the foetal circulation
• Describe the changes that occur after birth in a baby
• Mention the structures that are found between T4/T5
 CARDIOVASCULAR SYSTEM
• Consists of:
heart, blood vessels and the blood
• Carry the blood to and from the body’s organs
• 2 Divisions:
• Pulmonary circuit: carries blood to the lungs for gas exchange
and returns it to the heart
• Systemic circuit: Supply blood to every organ of the body
including other parts of the lungs and the wall of the heart itself
PULMONARY CIRCULATION
• The right side of the heart serves the pulmonary circuit
• It receives deoxygenated blood
• Pumps deoxygenated blood to the a pulmonary trunk
• Eventually to the pulmonary arteries
• These transports blood to the lungs to be oxygenated
• Then oxygenated blood flows back to the left atrium through the
pulmonary veins
 SYSTEMIC CIRCULATION
• The left side serves the systemic circuit
• The oxygenated blood leaves the heart through the aorta
• To the rest of the body
• After circulating to through the whole body, the now-deoxygenated
systemic blood returns to the right side of the heart
• Mainly by the SVC (draining the head, neck, upper limbs and the
thoracic organs) and IVC (draining the organs below the diaphragm)
 SYSTEMIC VS. PULMONARY
Systemic circulation Pulmonary circulation

• O2 blood leaves left ventricle • CO2 blood leaves right ventricle

• Circulates through body via • Travels to lungs via pulmonary
systemic arteries arteries
• CO2 blood returns to right atrium • O2 blood returns to left atrium via
via systemic veins pulmonary veins
POSITION, SIZE AND SHAPE OF THE
HEART
• Located in thoracic cavity in the mediastinum between the lungs and
deep to the sternum
• Tilted to the left (apex at the 5th intercostal space)
• Lies anterior to the vertebral column and posterior to the sternum
MEDIASTINUM
Mediastinum is
further divided into
superior and inferior
mediastinum

By a transverse
plane from the
sternal angle to the
IV disc between T4
& T5

Inferior
mediastinum is
further divided into :
Anterior, middle &
posterior
mediastinum by the
pericardial sac
MIDDLE MEDIASTINUM
• Contains the heart and the pericardium
• Heart is enclosed in a double-walled sac called the pericardium
• 2 layers: Fibrous pericardium & serous pericardium
• Which consists of the parietal and visceral serous layers
• Visceral layer of the pericardium is equivalent to the epicardium
• Between 2 serous layers –there is a pericardial cavity, contains
pericardial fluid
• Function: lubricates the membranes, allows heart to beat with minimal
friction
SURFACE ANATOMY OF THE HEART
SURFACE ANATOMY OF THE HEART
• The right margin of the heart extends from the right 3rd costal cartilage
to the near right 6th costal cartilage
• The left margin of the heart descends laterally from the 2nd intercostal
space to the apex located near the midclavicular line in the 5th
intercostal space
• The lower margin of the heart extends from the sternal end of the right
6th costal cartilage to the apex in the 5th intercostal space near the
midclavicular line
SURFACE ANATOMY OF THE HEART
HEART WALL

• Consist of 3 layers: Epicardium, myocardium and the endocardium

• Epicardium, outer layer, the coronary vessels travel on this layer
• Myocardium , is composed of the cardiac tissue, thickest layer and
performs the work of the heart
• Myocardium of the left ventricle is thicker than that of the right ventricle
• Endocardium, lines the interior of the heart chambers, covers the
surface of the heart and is continuous with endothelium of the blood
vessels
HEART
CHAMBERS

• 4 chambers
• Sup: Left & Right Atrium – Thin walled receiving blood
• Each atria has a earlike flap called the auricle
• The atria are separated from each other by the interatrial septum
• Right atrium +auricle = pectinate muscles
CHAMBERS

• Inf Left & Right ventricles – Are the pumps that eject into arteries
• Between LV and RV – interventricular septum (thick muscular wall)
• LV is thicker than the RV because it bears the greatest work load than
all the other chambers, pumping blood through the entire body
• Internal Ridges – Trabeculae carneae
• Keep the ventricular walls from clinging on each other
• Allows the chambers to expand more easily when they fill
SULCI
• Surface – sulci or grooves
• 3 and are filled by fat and the coronary vessels
• Coronary (atrioventricular) sulcus – separates the atria from the
ventricles
• Anterior interventricular sulcus – anterior surface and extends obliquely
to downwards to the apex
• Posterior interventricular sulcus – posterior surface
VALVES
• Function: ensure a one way flow
• Structure: 2 or 3 cusps
• Tricuspid (3 cusps) valve = Right atrium and the right ventricle
• Bicuspid (2 cusps) or mitral valve = Left atrium and the left ventricle
• Chordae tendineae – connect the cusps to the papillary muscles (floor of
the ventricle)
VALVES
• Pulmonary and aortic valves – Known as the semilunar valves
• Regulate the flow of blood from ventricles into the great arteries
• Pulmonary valve – between the right ventricle and the pulmonary trunk
• Aortic valve - between the left ventricle and the aorta
• Each has 3 cusps
MAJOR BLOOD VESSELS OF THE
HEART
Descending
aorta
BLOOD FLOW THROUGH THE
HEART CHAMBERS
ARTERIAL BLOOD SUPPLY OF THE
HEART
• Coronary circulation
• Aorta gives of the Right and Left Coronary arteries
• Left coronary artery travels in through the coronary sulcus
• Under the left auricle and gives off 2 branhes:
• Anterior interventricular (LAD) branch:
Anterior interventricular sulcus to the apex & joins the
post interventricular branch
Supplies both ventricles + ant 2/3 of the interventricular
septum
ARTERIAL BLOOD SUPPLY OF THE
HEART

• Circumflex branch: Continues around the left side of the heart

Gives of a Left marginal branch
Supplies the left atrium & posterior wall of the left
ventricle
ARTERIAL BLOOD SUPPLY OF THE HEART
• Right coronary artery:
Supplies the RA and sinoatrial node (pacemaker)
Continues around the coronary sulcus & under the right auricle
Gives of 2 major branches
Right marginal branch - Supplies the lateral aspect of the right atrium and
ventricle
Continues around the right margin to the posterior side
and gives off a branch to the AV (atrioventricular) node
Then gives off the large posterior interventricular branch
Supplies the post walls of both ventricles and the post portion
of the interventricular septum
Anastomosing with anterior interventricular branch
 BLOOD SUPPLY OF THE HEART
Ant. Post.
VENOUS DRAINAGE
• Great cardiac vein – collects blood from the anterior aspect of the heart
Travels along the anterior interventricular artery
• Posterior interventricular vein (middle cardiac vein) – Found of the
posterior interventricular sulcus
Collects blood from the posterior aspect of the heart
Also from the apex of the heart
Travels along with the posterior interventricular artery
VENOUS DRAINAGE
• Left marginal vein – Travels along the left marginal artery
• Small cardiac vein – Travels along the right coronary artery
• Coronary sinus – A large transverse vein
Found on the posterior side of the heart
Receives venous blood from the above mentioned
veins
Empties at the right atrium
INNERVATION

Nerve supply to the heart

• Pacemaker
• Receives parasympathetic (vagus n) and sympathetic
(cervical ganglia) nerves
• R vagus N innervates SA node; L vagus N innervates AV
node
CONDUCTION SYSTEM
• Order of electrical signal through the cardiac conduction
system
• SA Node: located in the RA. Pacemaker. Spreads
throughout atria
• AV node: located near R AV valve; electrical gateway to
ventricles
• AV Bundle: pathway by which signals leave the AV node;
bundle forks into R and L bundle branches which enters
the interventricular septum
• Purkinje fibers: distribute the electrical excitation to the
myocytes of the ventricles
 FOETAL CIRCULATION
• The foetal heart function as an effective pump from the age of 8 weeks
• To obtain nutrients and oxygen , the foetal blood must flow
• Through 2 umbilical arteries (carbon dioxide – rich/oxygen-poor blood) to the placenta
• From the placenta:
• Foetal blood returns to the foetus via the umbilical veins (oxygen + nutrients)
• Because no digestion takes place at this stage,
• Blood flow to the liver is not necessary
• Thus a short-circuit between the umbilical vein, vena porta/hepatic portal vein and
IVC is formed
• Called the ductus venosus
 FOETAL CIRCULATION
• Obliterated at birth, it forms the ligamentum venosum
• The lungs are also not yet functional
• Therefore blood circulation through them is not necessary
• The blood then follows a short – cut through the heart
• Through an opening between the right and left atria (the foramen ovale
in the interatrial septum)
• Through which most of the blood flows from the right atrium to the left
atrium
 FOETAL CIRCULATION
• Then flows to the left ventricle pumping oxygenated blood to the aorta
• Which is then distributed to the rest of the body
• After birth the foramen ovale closes and its remnant is known as the
fossa ovalis
• Not all the blood flow through the foramen ovale
• The rest flows through the right ventricle
• To the pulmonary trunk
• Because the lungs are excluded, another short-cut is formed
 FOETAL CIRCULATION

• Namely the ductus arteriosus (which runs between the pulmonary trunk
and the aorta)
• Also called the ductus Botalli
• After birth its closes and forms a remnant called the ligamentum
arteriosus
 FOETAL CIRCULATION

• 3 short – circuits : Ductus venosus

: Foramen ovale
: Ductus arteriosus
FIGURE 29.10
 CHANGES AT BIRTH
• Umbilical arteries contract – so that the blood does not flow
• The umbilical vein can still pass blood to the new born for about 5 min
after birth
• IF the umbilical cord is not cut off
• In this way approximately an extra 100 ml of blood can reach the new-
born baby
• Foramen ovale closes
• ALL the blood then flows from the right atrium to the right ventricle
 CHANGES AT BIRTH
• Closure of foramen ovale and the ductus arteriosus occurs in the 1st week after birth
• Normal heart rate of the fetus : 120 – 150 bpm
• 1st 24 hrs after birth : 123 – 140 bpm (but can be up to 180 bpm if the baby is busy)
• The pulse can be taken at the following places:
• Radial artery (by the hand)
• Femoral artery (by the thigh)
• Temporal artery (by the head)
• Listening with the stethoscope at the heart (considered the best method)
STRUCTURES AT T4/T5 VERTEBRAL
LEVEL
• Costal cartilage of rib 2 articulates with the sternum
• Superior mediastinum is separated from the inferior mediastinum
• Ascending aorta ends and the arch of the aorta begins
• Arch of the aorta ends and the thoracic aorta begins
• Trachea bifurcates