Cardiovascular System

Heart
1. General information
A) Located within mediastinum (medial cavity of the thorax), within the pericardial cavity; flanked on each
side by the lungs.
B) Hollow, cone-shaped, relatively small, about the size of a fist, weighs less than a pound.
C) Apex: (point of heart) facing left hip rests on the diaphragm, approximately at the level of the fifth
intercostal space.
D) Base: (broad posterosuperior aspect) from which the great vessels of the body emerge, points toward the
right shoulder and lies beneath the second rib.
E) Main function is to pump blood, but also manages blood supply & blood pressure
2. Coverings of the heart
A) Surrounded by the pericardium: double-walled sac, outermost layer, encloses the heart
1) Fibrous pericardium: loosely fitting superficial part of sac
a) dense irregular CT
b) Protects heart & Prevents overfilling
c) Anchors heart to diaphragm & surrounding structures, fused to vessels going to & from heart
2) Serous pericardium: slippery, two-layer, deep to the fibrous pericardium
a) 2 layers: both layers are simple squamous epithelium and areolar CT
1) Parietal layer: outer layer
a) Attached & lines inside of fibrous pericardium
2) Visceral layer (epicardium): closet to the heart
a) Integral part of the heart wall
b) Pericardial cavity
1) lies between, separates parietal and visceral
layers
2) Filled with pericardial fluid (serous fluid);
creates friction-free work area
3. Layers of the heart wall
A) Epicardium: same as visceral layer
1) thin outermost layer of the heart, composed of CT
2) part of the heart wall
B) Myocardium: middle layer
1) the thickest layer, composed of cardiac muscle tissue
2) dense CT fibers that reinforce myocardium and support
valves
3) this layer contracts.
4) limits spread of electrical activity
C) Endocardium: innermost layer
1) very thin smooth layer of cells composed of simple
squamous epithelium & areolar CT
2) Is continuous with blood vessels entering & leaving heart
3) lines the interior of the heart (chambers), covers valves.
4. Chambers of the heart: four hollow chambers, or cavities: two atria and two ventricles
A) Atria: receiving chambers (receive blood from entire body)
1) Auricle: exterior extruding surface
2) R & L are separated by the interatrial septum, divides the atrium longitudinally
a) Fossa ovalis: shallow depression found in right atrium; remnant of foramen ovale
3) Thin walled, not much contracting
4) Receive blood from veins (vessel that brings blood to heart)
a) Right atrium receives deoxygenated blood by way of
 1) Superior vena cava: receives deoxygenated blood from structures above diaphragm
2) Inferior vena cava: receives deoxygenated blood from structures below diaphragm
3) Coronary sinus (hole in atrium): receives deoxygenated blood from heart itself
b) Left atrium receives oxygenated blood from
1) 4 pulmonary veins (vessel that brings blood to the heart): from the lungs
a) Blood returned to the left side of the heart is pumped out of the heart into the aorta
1) systemic arteries branch from aorta to supply essentially all body tissues.
B) Ventricles: discharging chambers (sends blood to entire body)
1) two inferior, thick-walled pumps of the heart
2) Separated from atria by the
atrioventricular septum
3) R & L separated by
interventricular septum, divides
ventricles longitudinally
4) Within the ventricles, 2 distinct
muscle formations exist
a) Trabeculae carneae
1) Internal ridges
b) Papillary muscles
1) Finger-like projections
2) anchor AV valves
C) Heart valves: four valves keep
blood flowing in one direction; one set
open at a time, either AV or Semilunar
1) Atrioventricular (AV) valves
a) Found between atria & ventricles on each side
b) prevent backflow into the atria when the ventricles contract.
c) Name refers to the number of cusps
1) Tricuspid valve (3 flaps & papillary muscles): right AV valve between R atrium & ventricle
2) Bicuspid valve (2 flaps & papillary muscles): left AV valve between L atrium & ventricle
c) Attached to papillary muscles via chordae tendineae (collagen cords/strings)
1) The papillary muscles contract and pull on the chordae tendineae to keep the AV valves
closed during ventricular contraction
d) Remain open when ventricles are relaxed
e) CT covered with endothelium
2) Semilunar valves: guards the bases of the two
large arteries leaving the ventricular chambers
a) Named according to the corresponding artery
1) Pulmonary valve: between R ventricle
& pulmonary trunk (carry blood to the
lungs)
2) Aortic valve: between L ventricle &
aorta
b) Remain closed when ventricles are relaxed
c) CT covered with endothelium
5. Pulmonary circulation: heart to lungs and back; done
by right side of heart; short distance, low pressure circulation
A) De-oxygenated blood moves from the right atrium
to right ventricle thru tricuspid valve
B) Right ventricle into pulmonary trunk thru the
pulmonary valve
C) To lungs for gas exchange
 1) Occurs in the alveoli – O2 in and CO2 out
D) Oxygenated blood moves back to left atrium via pulmonary veins
6. Systemic circulation: heart to body tissues and back; done by left side
of heart; long distance, high resistance pathway
A) Oxygenated blood moves from the left atrium to left ventricle
thru bicuspid/mitral valve
B) Left ventricle into aorta thru aortic valve
C) To body for gas exchange
1) Occurs in the capillaries within the tissues – O2 out and CO2
in
D) De-oxygenated blood moves back to right atrium via inferior &
superior vena cava
7. Coronary circulation: branch of systemic loop, heart receives its blood
supply from right and left coronary arteries, most blood delivered to
heart when ventricles are relaxed
A) Aorta receives blood from L ventricle
B) R & L coronary arteries receive blood from the aorta
1) coronary arteries branch from the base of the aorta and encircle
the heart in the coronary sulcus (atrioventricular groove) at the
2) Right coronary artery (vessel that takes blood away from
heart)
a) Supplies right atrium
b) 2 main branches
1) Marginal artery
a) Supplies anterior & lateral portions of right
ventricle
2) Posterior interventricular artery
a) Supplies posterior side of both ventricles
3) Left coronary artery (vessel that takes blood away from heart)
a) 2 main branches
1) Anterior interventricular artery (Widow maker)
a) Supplies anterior side of both ventricles
2) Circumflex artery
a) Supplies left atrium and all portions of the left ventricle
C) Myocardial capillaries: site of gas exchange
D) Cardiac veins
1) Great cardiac vein: Drains the anterior aspect of heart
2) Posterior, middle, & small cardiac veins: Drain the
posterior & lateral aspects of
the heart
E) Coronary sinus: Empties
into right atrium
 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.
1) Cardiac muscle cells: involuntary
A) Striated, short, branching & mononucleated (one central nucleus)
B) some cells are autorhythmic, self-excitable, contract spontaneously and independently
C) Intercalated discs: cellular junctions that allow ion movement between cells
1) Allow the heart to act as a single, coordinated, functional unit
2) Longer refractory period than skeletal muscle tissue; cannot undergo tetanus
D) Rhythms
1) Although cardiac muscles can beat independently, the muscle cells in the different areas of the heart
have different rhythms.
2) Cardiac Muscle Contraction
A) Involves autorhythmic cells and cardiac muscle cells
B) Autorhythmic cells: Pacemaker cells (generate their own electrical activity without action potential)
1) Make up the conduction system
2) Responsible for AP (action potential) generation & conduction
a) Cells have an unstable resting potential
b) Hyperpolarization at the end of an AP causes a closing of K+ channels and an opening of slow
Na+ channels = causes movement towards threshold
c) At threshold, voltage-gated Ca++ channels open = depolarization
d) At peak voltage, voltage-gated Ca++ channels close and voltage-gated K+ channels open =
repolarization
C) AP generation
1) Depolarization (from a negative # to positive) caused by an opening of voltage-gated Na+ channels
2) Repolarization (from a positive # negative) caused by an opening of voltage-gated K+ channels
3) Plateau caused by an opening of voltage-gated Ca++ channels, leakage of K+
D) Intrinsic Conduction System: sets basic rhythm of heart beats
E) Extrinsic Conduction System: modifies basic rhythm
as needed
1) ANS
a) sympathetic division increases rate and force
b) parasympathetic slows rate
3) Conduction Pathway
1) SA (sinoatrial) node: top of right atrium
a) Considered the heart’s normal pacemaker
b) Under control of nervous and endocrine systems
1) Without control it would generate 90-100
AP’s/min = 90-100 bpm.
2) With control, it will generate about 75
AP’s/min = 75 bpm.
c) Impulse travel to AV node via internodal
pathway
d) Impulses also travels to atrial myocardium
via gap junctions (intercalated discs)
 1) Causes atrial contraction
2) AV (atrioventricular) node: bottom of right atrium
a) AV nodal delay: 0.1 sec
2) Allows for complete atrial contraction (ventricular filling)
b) Under nervous & endocrine control as well
3) Bundle of His (AV bundle)
a) Electrically connects atria & ventricles
4) Left & right bundle branches
a) Carry impulses to the left and right ventricles
5) Purkinje fibers
a) Start near the apex & moves up thru ventricles
b) Site of synapse between conduction system & ventricular myocardium
4) Process of Contraction
1) contraction triggered by electrical signals
2) AP generated in SA node travels to atrial myocardium
and AV node
a) causes atrial contraction
3) AP travels from AV node to bundle of His then along
bundle branches to the Purkinje fibers
a) Purkinje fibers synapse with the ventricular
myocardium
4) AP travels down the sarcolemma and causes voltage-
gated Ca++ channels in
sarcolemma to open and
5) Ca++ moves into the cell from the ECF and binds to
receptors on the SR
6) This causes an opening of Ca++ release channels in the
SR, causing larger amounts of Ca++ to be released from
the SR = calcium-induced calcium release
7) Ca++ binds to troponin initiating contraction (sliding
filament mechanism)
5) Cardiac Cycle
A) All the events of one complete during one heartbeat during which both atria and ventricles contract and
then relax; 4 events occur in 3 phases
1) average heart beats approximately 75 times per minute
2) the length of the cardiac cycle is normally about 0.8 second.
3) Atrial & ventricular systole
a) Systole is contraction phase
4) Atrial & ventricular diastole
b) Diastole is relaxation phase
B) 3 phases
1) Ventricular relaxation
a) Occurs just after blood is ejected from the ventricles
b) Semilunar valves are open & AV valves are closed
c) Characterized by:
1) Ventricular diastole
a) Causes decreased ventricular pressure
2) Closing of semilunar valves
3) Opening of AV valves
2) Ventricular filling
a) Begins when AV valves open
b) Characterized by:
 1) Rapid ventricular filling (80%)
2) Atrial systole (20%)
c) End diastolic volume (EDV)
1) Volume of blood in the ventricle just prior to contraction
3) Ventricular ejection
a) Characterized by:
1) Ventricular systole
a) Causes increased ventricular pressure
2) Closing of AV valves
3) Opening of semilunar valves
4) Ventricular ejection
a) Stroke volume (~70ml)
5) Atrial filling also occurs during this phase
6) Heart sounds
1) Described as lub-dup
2) Caused by blood turbulence when valves close
a) "lub" - closing of AV valves
b) "dup" - closing of semilunar valves
7) Cardiac Output – total amount of blood pumped by each ventricle per minute
A) CO = SV x HR (5.25L/min)
B) Regulation of Cardiac Output: 2 mechanisms
1) Regulation of Stroke Volume: 3 factors
a) Preload: stretch on the cardiac muscle just before contraction
1) Associated with EDV: end diastolic volume
2) Frank-Starling Law of the Heart
b) Contractility: strength of contraction
1) Positive inotropic agents
a) Promote Ca++ movement into cells
2) Negative inotropic agents
a) Inhibit Ca++ movement into cells
c) Afterload: pressure the ventricles must overcome to eject blood
2) Regulation of HR
a) ANS Control
1) Cardiovascular center
a) Composed of 3 centers
1) Cardioacceleratory center
2) Cardioinhibitory center
3) Vasomotor center
b) Receives input from:
1) Chemoreceptors in aortic arch & bifurcation of common carotid
artery
2) Baroreceptors in aortic arch and carotid sinus
3) Proprioceptors in skeletal muscles & joints
c) Sends output signals via:
1) Sympathetic NS (responds to hypoxia, hypercapnia, acidosis, or low
BP)
a) Stimulates cardiac accelerator nerves (NE)
1) Innervate the SA & AV nodes
2) Also innervate the ventricular myocardium
2) Parasympathetic NS (responds to alkalosis or high BP)
a) Stimulates the Vagus nerves (ACh)
1) Innervate the SA & AV nodes but not the myocardium
 b) Hormonal Control (low BP)
1) Epinephrine & norepinephrine
c) Other Factors
1) Hypernatremia: blocks Ca++ movement into SA node
2) Hyperkalemia: inhibits AP generation
3) Hypercalcemia: increases conc. gradient
4) Hypocalcemia: decreases conc. gradient
8) Electrocardiogram (ECG or EKG)
A) P-wave
1) Atrial depolarization
B) QRS-complex
1) Ventricular depolarization
2) Atrial repolarization is occurring but is masked
C) T-wave
1) Ventricular repolarization
9) Heart Disorders
A) Valve disorders
1) Heart murmur: abnormal heart sounds
a) Stenosis: valve flaps become stiff and
narrowed thereby restricting normal blood flow
b) Incompetent valve: valves fail to close
properly resulting in a backflow of blood
c) Mitral valve prolapse (MVP): chordae
tendineae are abnormal and/or the papillary
muscle malfunction resulting in the flaps
becoming inverted
B) Arrhythmias: abnormal heart rate
1) Tachycardia: more than 100 beats per minute; fast heartbeat
a) May be caused by elevated temp, certain drugs, stress, or heart disease
2) Bradycardia: less than 60 beats per minute; slow heartbeat
a) May be caused by low temp, certain drugs, or parasympathetic activation
3) Fibrillation: uncoordinated or quivering heartbeat
a) Caused by damage/defect of conduction system
4) Heart block: inability of impulse to reach ventricles
a) Blockage in the AV node, bundle of His or one of the bundle branches
C) Others
1) Myocardial Infarction (MI): “heart attack”
a) Infarction: tissue death due to loss of blood supply
b) Often presents with an elevated S-T segment on an EKG
2) Ischemia: decreased blood flow; results in hypoxia
3) Angina pectoralis: chest pain related to coronary problems
4) Endocarditis: inflammation of the endocardium usually of the heart valves
a) Often results from a bacterial infection