Cardiovascular system

Physiological Anatomy of heart

• Cardiac chambers
• Four chambers – two atria and two ventricles
• Atria are thin walled and ventricles are thick walled
• The atria are separated by interatrial septum and the ventricles
are separated by interventricular septum
• The cavities of the cardiac chamber are lined by endothelial
lining called – ENDOCARDIUM
• The muscles of the heart is called MYOCARDIUM
• The heart is covered by a double layered structure called
PERICARDIUM
Physiological Anatomy of heart
 Atria

• They serve as primer pumps

• Right atrium receives blood from the systemic circulation
via superior and inferior vena cava
• Left atrium receives blood from the lungs via pulmonary
veins
Ventricles
• Ventricle serves as the major pump
• The right ventricle pumps blood to the lung circuit via
pulmonary artery. The pulmonary circulation offers less
resistance.
• The left ventricle pumps to the systemic circuit via the aorta.
The systemic arteries offer great resistance hence the left
ventricle has to do more work in comparison to the right.
• Hence the left ventricular musculature becomes more
thicker than right ventricle
Valves in the heart

• Atrioventricular valves (AV valve)

– Between rt. Atrium and rt. Ventricle – tricuspid valve
– Between lt. atrium and lt. ventricle – mitral valve
• Semilunar valves
– Between rt ventricle and pulmonary artery – pulmonary valve
– Between left ventricle and aorta – aortic valve
Heart sounds
• Closure of valves causes vibration
• Closure of AV valves – first heart sound – S1
• Closure of semilunar valves – second heart sound – S2
Conduction system of the heart
• SA node (sino-atrial node) – located on the posterior wall of
right atrium, can generate and discharge impulses more rapidly
than any other cardiac tissue and its rate of discharge determines
the heart rate. Also known as the cardiac pacemaker
• AV node (Atrio-ventricular node) – located on the right side of
interatrial septum. Internodal fibers carry impulse from SAN to
AVN
• Atrio-ventricular bundle or bundle of his – divides into right
and left bundle branches.
• Purkinje fibres – conducts the impulse fast which helps in
conduction of the entire ventricular system.
Conduction system of the heart
 Properties of the cardiac muscle

• Morphological properties
– Show striations
– At the point of contact of 2 muscle fibers – forms
tight junctions called intercalated discs
– Along the sides of the muscle membrane the have gap
junction – helps in permitting the heart as a single
unit called syncytium
– Involuntary muscle
Electrical properties of the heart

• Excitability – cardiac muscle is excitable in response to a

stimulus
• Auto rhythmicity – ability to beat on its own
• Conductivity – ability to conduct the depolarization
Mechanical properties
• 1) Contractility – excitation contraction coupling similar to
skeletal muscle
• Factors affecting force of contraction – preload and
afterload
• Preload – preload is the load which acts on the muscle
before it contracts. It is given by frank starling law – the
force of contraction is directly proportional to the initial
length of the muscle fibre within physiological limits.
• Afterload – after load is the load which acts on the muscle
after it starts to contract. For heart contraction afterload is
the resistance offered by the blood vessels.
• 2) obeys all or none law
• When a stimulus is given the cardia muscle responds to its
maximum ability (when stimulus is threshold or above) or
does not respond at all (when stimulus is below threshold)
• 3) Refractory period
• Cardiac muscle is refractory during maximum period of
action potential. Hence it cannot be tetanized.
Metabolic properties
• Myocardium has abundant blood supply
• Cardiac muscle fiber has numerous mitochondria
• Has high myoglobin content – O2 storing muscle protein
• Heart works under complete aerobic condition with
essentially accumulation of no lactic acid
Cardiac cycle
Events in cardiac cycle
• The events occurring between beginning of one heart beat
to the next beat is called cardiac cycle.
• 2 major events happen – systole – contraction of the heart
and diastole – relaxation of the heart
• Atrial – systole – 0.1 seconds and diastole – 0.7 seconds
• Ventricular – systole – 0.3 seconds and diastole – 0.5
seconds
Atrial systole
• Atria acts as a primer pump
• Happen following atrial depolarization
• Atrial muscles contract and add the blood into the
ventricles
Ventricular systole
• When ventricle starts to contract, the pressure raises above
the atrium leading to closure of AV valve (heart sound S1).
• When the pressure exceeds the aortic pressure then
ventricular ejection happens.
• The amount of blood ejected by each ventricle at rest is 70-
80ml. This is called stroke volume.
• 65% of end diastolic volume is pumped out. This is called
ejection fraction
• Remaining blood is called end systolic volume which is 50
ml
Ventricular systole
Atrial diastole
• During this phase the atrial muscle relax and receives the
venous return from the rest of the body
Ventricular diastole
• During the ventricular relaxation, the pressure inside the
ventricles falls below the arterial pressure leading to closure
of semilunar valves – S2 is heard
• The interventricular pressure continues to drop thill it falls
below the atrial pressure and results in opening of AV valve.
Ventricular diastole
ECG - Electrocardiogram
Electrocardiogram
• Human body is a volume conductor. Body fluids are good
conductor of electricity.
• Electrical changes from the heart can be recorded from the
surface. These recordings are called electrocardiogram.
Sequence of depolarisation
Normal ECG
• The waves associated with electrical activity are represented by letters
P,Q,R,S,T
• P wave – first wave of ECG – represents atrial depolarization. Indicates
the spread of impulse from SA node to atrial muscle
• PR segment – brief isoelectric period following P wave.
• QRS complex- ventricular depolarization
• Q wave – negative deflection – interventricular septal depolarization
• R wave – prominent and positive wave. It represents the
depolarization of major ventricles
• S wave – negative deflection which follows R wave –depolarization of
basal parts of ventricle
• ST segments – isoelectric period following QRS complex
• T wave – represents ventricular repolarization.
Circulation
Functions of circulation

• To supply the tissues of various organs with nutrient

substance. For example; O2, carbohydrates, amino acids,
fats, hormones and immunological agents.
• To remove waste products of tissue metabolism
• Control heat loss by controlling blood supply to the skin
• Helps in body defense mechanisms by delivering antibodies,
platelets and leucocytes
Pressure changes in vascular system
• Pressure changes in systemic and pulmonary circulation
• Based on pressure changes – high pressure system and low
pressure system
Pressure changes in vascular system
 Blood vessels

Layers of blood vessel

Tunica intima – innermost layer with single
continuous layer of endothelial cells. It is
separated from tunica media by internal elastic
lamina
Tunica media – middle coat which is made up of
smooth muscle cells and elastic fibres. Provide
mechanical strength to blood vessel
Tunica adventitia – outermost coat made up of
collagen and fibroblasts
Arteries vs veins
Arteries Veins
Transport blood away from the Transport blood towards the heart
heart
Thicker walls because of the Relatively thin walls
presence of more smooth muscle
cells and elastic fibers
Thick tunica media and thin tunica Thin tunica media and thick tunica
adventitia adventitia
They can withstand high pressure The venous system can withstand
and blood flows at much higher only lower pressures
pressures
Retain their shape even under low Has the tendency to collapse
pressure
Arteries of the body
• Two major arteries leave from the heart
• From right ventricle – pulmonary artery – which divides into
two branches and supply the right and left lung
• From left ventricle – aorta
– Aorta – divides into 1) ascending aorta 2) aortic arch 3) descending
aorta
– Coronary arteries arise from the ascending aorta
Branches of aortic arch
Branches of descending aorta
Veins
• The venous system runs complimentary to the arteries and
in many places they have the common names
Organisation and functions of vascular system
• Types of blood vessels
– Windkessel (distensible) vessels
– Resistance vessels
– Exchange vessels
– Capacitance vessels
– Shunt vessels
 Windkessel vessels

• Windkessel vessel are the vessels which are highly elastic

• Eg aorta, pulmonary artery
• Heart beats in pulsatile nature and blood flow must be
maintained during the diastole also this is achieved by
– 1) elastic recoil of the arterial system – windkessel effect
– 2) Resistance to outflow offered by peripheral vessels
Resistance vessels
• Resistance vessels offer maximum resistance to blood flow
towards the capillaries
• Eg arterioles
• Resistance is inversely proportional to the radium of the
arterioles
Exchange vessels
• Exchange vessels are involved in easy exchange of gases.
• Eg capillaries
• They consists of only thin layer of endothelial cells
• The total cross sectional area of capillary bed is 2800 times
of the aorta
Capacitance vessels
• These vessels can accommodate large volume of blood
without much increase in pressure
• Eg. Veins
• At rest 54% of circulating blood is present in the veins
Shunt vessels
• These vessels bypass the capillaries. They connect
metaarterioles to veins
• Eg vessels located in certain sites like skin, toes, palms
• They can help in handling thermal stress
• When patent they connect blood of arteries and send them
to veins for heat exchange.
• During cold they prevent the heat loss
Lymphatic system – lymphatic
vessels, lymph, lymphatic organs
Lymphatic vessels

• System of network that carry lymph from the peripheral

tissues to the venous system
• Lymphatics begin as narrow passageways called lymphatic
capillaries in areas of loose connective tissue
• Lymphatics vessels ultimately empty into thoracic duct and
right lymphatic vessels
Lymph
• The tissue fluid absorbed in the lymphatic vessels is called
lymph
• It resembles plasma but contains less proteins
• Lymphatic organs – lymph nodes, thymus , spleen
Lymph nodes
• The lymph nodes are located in various sites of the body.
Collection of lymphatic tissue. Round shaped organs of different
sizes.
• Important sites ; neck, armpits, groin, mediastinum, mesentry
and pelvis
• Structure – outer capsule of fibrous tissue throws dips known as
trabeculae.
- medulla contains many lymphocytes and
macrophages

- Four to five afferent lymph vessels enter and one

large efferent vessel carries the lymph away from the
node
• Functions
– Filter the debris or pathogens and engulf with the help of
macrophages
– Defense – can form large number of lymphocytes
• Clinical importance
– Enlargement of lymph node indicates the presence of disease
– Evaluation of lymph nodes in cancer patients helps to assess the
prognosis and helps in planning the treatment
Thymus
• Location – behind the sternum in the mediastinum.
• Reaches maximum size during childhood and starts to
involute and disappears in adults
• structure – has two lobes and consists of outer cortex and
medulla
• Maturation of T – lymphocytes happens in the thymus
Spleen
• Location – left upper part of the abdominal cavity.
• Structure – has outer capsule , trabeculae to partion and
inner medulla
• Functions – reservoir of blood cells, phagocytosis of
abnormal blood components, initiate immune response by
B and T lymphocytes
• Clinical importance – enlargement of spleen is called as
splenomegaly correlates the presence of various diseases
Splenectomy is being advocated in few diseases
Regulation of cardiovascular
system
Regulation of cardiovascular system
• Classification – Local regulation and systemic regulation
• Local autoregulatory mechanism
– The capacity of tissue to regulate their own blood flow is called
autoregulation
– Cause – the smooth muscle of blood vessels possess basal
myogenic tone which regulates the flow..
– This is under the control of local vasoconstrictors and vasodilators
– Vasodilators – decreases arterial pO2, decreased blood pH,
increased arterial pCO2, increased body temperature, lactic acid
– Vasoconstrictors – serotonin and decreased body temperature
Systemic regulatory mechanism

• Classification – chemical regulation and neural regulation

• Chemical regulatory mechanism –
– Circulating vasodilators – helps in dilation of blood vessels Eg.
Bradykinins
– Circulating vasoconstrictors – helps in generalized
vasoconstriction - epinephrine, nor epinephrine, angiotensin II,
vasopressin
 Neural regulatory mechanism

• Neural is under the control of autonomic and

medullary regulation
• Autonomic control is from autonomic nervous
system
• The divisions are sympathetic and para-
sympathetic
• They innervate both cardiac and blood vessels
Action of ANS on heart
• Sympathetic supply : innervation from T1 to T5 spinal
segment
• Sympathetic stimulation produces the following effects on
heart
– Increases the heart rate
– Increases the force of contraction
– Increases the conductivity in the conducting tissue
– Increases the excitability of the heart
Action of ANS on heart
• Para-Sympathetic supply : innervation from vagi of both
side. Innervation to ventricles is absent
• Para -Sympathetic stimulation produces the following
effects on heart
– Decreases the heart rate
– Decreases the force of contraction of atria
– Decreases the conductivity in the conducting tissue
– Decreases the excitability of the heart
Peripheral vascular innervation
• The effects produced by these nerves are vasoconstriction
and vasodilation
• Vasoconstriction – done by sympathetic nerves emerging
from T1 to L2 spinal segments
• Vasodilation achieved by two mechanisms
– Reduction of sympathetic vasoconstrictor tone
– Vasodilator nerve activation – sympathetic cholinergic system and
parasympathetic vasodilator nerve(eg. Penile erection)
 Medullary regulation
• Medullary regulation done by two different
centres – vasomotor centre and cardio-vagal
centre
• Vasomotor centre
– Pressor area – shows inherent tonic activity.
Stimulation causes – increase in heart rate,
cardiac output and blood pressure
– Depressor area - Stimulation causes – decrease
in heart rate, cardiac output and blood pressure
• Cardiac vagal centre
– Decreases the sympathetic activity
– Decreases the heart rate
Cardiac output
• The amount of blood pumped out by ventricle into the
circulation per minute is called cardiac output
• Normal range – 5-6L
• Cardiac output = stroke volume X heart rate
Control of heart rate
• Factors affecting heart rate??
• Sympathetic – increases the heart rate
• Parasympathetic – decreases the heart rate
Control of stroke volume
• Venous return – determines the preload- frank starling law
• Sympathetic – increases the stroke volume
• Parasympathetic – decreases the stroke volume
Blood pressure
• Blood pressure is the pressure exerted by the column of
blood on the blood vessels
• Systolic pressure – it is the maximum pressure exerted
during systole – range 100 - 140 mmHg
• Diastolic pressure – it is the minimum pressure exerted
during diastole – range 60 – 90 mmHg
• Pulse pressure – difference between systolic blood pressure
and diastolic blood pressure = SBP –DBP
• Mean blood pressure – average pressure throughout the
cardiac cycle
Factors affecting BP

• Activity
Regulation of arterial blood pressure
• Classification
• Rapidly acting mechanisms
• Intermediate acting mechanisms
• Long term mechanisms
Rapidly acting mechanism
• Baroreceptor reflexes
– Sensitive to stretch
– Sensors – carotid and aortic sinus
– When there is a rise in Bp baroreceptor helps to bring it back to
normal range
Baroreceptor mechanism
Chemoreceptor reflex
• Effective when BP falls below 60mmHg
• Sensors – aortic bodies and carotid bodies
• Mechanism of operation: decrease in BP  decreased blood
flow  decreased pO2 and increased CO2 
chemoreceptor activation  influence medullary centres
final effect – increase in BP, Heart rate
CNS ischemic response
• Activated when BP falls to very low levels
• Last ditch stand – final try by the body to correct BP to
prevent death
• It can increase the BP to 250mmHg by direct stimulation of
vasomotor centres
Intermediate mechanism
• Capillary fluid shift
– Rise in BP  increases the hydrostatic pressure and the fluid shifts
to the capillaries
Long term regulation by kidneys
Hypertension

• Activity
Shock
• Shock is a clinical syndrome characterized by impairment of
adequate tissue perfusion primarily due to low cardiac
output
• Classification :
– Hypovolemic shock
– Distributive shock
– Cardiogenic shock
– Obstructive shock
Classification of shock
Type of shock Mechanism Causes

Hypovolemic shock Decrease in blood volume Hemorrhage,

Dehydration

Distributive or vasogenic Size of capacitance vessel Neurogenic shock,

shock increased by vasodilation anaphylaxis, sepsis
– CO decreased in spite of
normal blood
Cardiogenic shock Inadequate pumping Myocardial infarction,
action of the heart congestive heart failure

Obstructive shock Obstruction to blood flow Pulmonary embolism,

cardiac tumor