Module 3

CARDIOVASCULAR SYSTEM: Heart as a Pump

and Function of the Heart Valves – Arteries, Veins and
capillaries - Rhythmical Excitation of the Heart –
Cardiac cycle - The Normal Electrocardiogram.
Heart
• The human heart is a four-chambered muscular organ, shaped and sized roughly like
a man's closed fist with two-thirds of the mass to the left of midline.
• The heart is enclosed in a pericardial sac that is lined with the parietal layers of a
serous membrane.
• The endocardium is the inner layer of the heart lining the heart chambers. It is a
very smooth, thin layer that serves to reduce friction as the blood passes through the
heart chambers.
• The visceral layer of the serous membrane forms the epicardium.
• The myocardium of the heart wall is a working muscle that needs a continuous
supply of oxygen and nutrients to function efficiently.
• For this reason, cardiac muscle has an extensive network of blood vessels to bring
oxygen to the contracting cells and to remove waste products.
Physiology of Heart Muscles
• The heart is composed of three major types of cardiac muscle: atrial
muscle, ventricular muscle, and specialized excitatory and conductive
muscle fibres.
• The atrial and ventricular types of muscle contract in much the same way
as skeletal muscle, except that the duration of contraction is much longer.
• Conversely, the specialized excitatory and conductive fibres contract only
feebly because they contain few contractile fibrils; instead, they exhibit
either automatic rhythmical electrical discharge in the form of action
potentials or conduction of the action potentials through the heart,
providing an excitatory system that controls the rhythmical beating of the
heart.
Blood Flow
• Here is what happens as blood flows through the heart and lungs:
• The blood first enters the right atrium. The blood then flows through the tricuspid
valve into the right ventricle. When the heart beats, the ventricle pushes blood through
the pulmonic valve into the pulmonary artery.
• The pulmonary artery carries blood to the lungs where it “picks up” oxygen. It then
leaves the lungs to return to the heart through the pulmonary vein. The blood enters the
left atrium. It drops through the mitral valve into the left ventricle. The left ventricle
then pumps blood through the aortic valve and into the aorta. The aorta is the artery
that feeds the rest of the body through a system of blood vessels.
• Blood returns to the heart from the body via two large blood vessels called the
superior vena cava and the inferior vena cava. This blood carries little oxygen, as it is
returning from the body where oxygen was used. The vena cava pump blood into the
right atrium and the cycle begins all over again.
Heart As A Pump
• Heart is sort of like a pump, or two pumps in one. The right side of your heart
receives blood from the body and pumps it to the lungs.
• The left side of the heart does the exact opposite: It receives blood from the lungs
and pumps it out to the body.
• The human heart is very strong and is capable of pumping blood up to 30 feet
distance. An average heart beats maximum of 70-80 beats per minute and is
considered healthy. The efficiency of the heart can be maintained and improved
by performing physical activity.
• The heart is called a double pump because each side pumps blood to a different
circulation. Deoxygenated blood from the body drains to the right side of the
heart. This is the first pump that sends blood to the lungs, called the pulmonary
circulation, where it becomes oxygenated and releases carbon dioxide.
Function of the Heart Valves
• Heart is a muscle that pumps blood throughout your body. Heart valves are
parts of your heart that act like doors.
• They open and close to let blood flow from one area of your heart to another.
• They help ensure that blood moves at the right time and in the correct direction.
• As the valves open and close, they create two sounds, which are your heartbeat.
• The four valves of the heart are:
• Aortic valve.
• Mitral valve.
• Pulmonary valve (or pulmonic valve).
• Tricuspid valve.
How Do They Function?
• A healthy heart transports blood in a predictable route through four chambers. The four
chambers are the left and right atria on the top of your heart and the left and right ventricles
on the bottom.
• Between chambers, there are valves, which are made of thin but strong flaps of tissue.
They’re called leaflets or cusps. The valves open and close to help blood move along its path.
• Blood that needs oxygen flows from your body into the right atrium.
• It then flows through the tricuspid valve to the right ventricle.
• The right ventricle pumps the blood through the pulmonary valve and into your lungs, where
it picks up oxygen.
• The oxygen-rich blood then flows to the left atrium.
• The heart pumps blood through the mitral valve into the left ventricle.
• From the left ventricle, the blood flows through the aortic valve to the rest of your body.
Functions
• Each valve has a specific location, structure and job:
• Tricuspid valve: This valve has three leaflets. They allow blood to flow from the right atrium
to the right ventricle. They also prevent blood from flowing backward from the right ventricle
to the right atrium.
• Pulmonary valve: This valve also has three leaflets. They allow blood to pump from the right
ventricle to the pulmonary artery. This artery leads to the lungs, where blood picks up oxygen.
The pulmonary valve prevents blood from going backward from the pulmonary artery to the
right ventricle.
• Mitral valve: This valve has two leaflets. They allow blood to flow from the lungs into the left
atrium. And they prevent backward flow from the left ventricle to the left atrium.
• Aortic valve: This valve has three leaflets. They open to let blood flow from your heart’s left
ventricle to the aorta. The aorta is the largest blood vessel in your body. It brings oxygenated
blood from your heart to the rest of your body. The aortic valve prevents backward flow from
the aorta into the left ventricle.
Factors That Affect Your Heart Health

• If a heart valve doesn’t work correctly, your heart might have to work
harder to pump blood.
• The following factors are accountable for abnormal heart health.
• Changes to your body as you age.
• Congenital heart disease, birth defects in valve structure (for
example, missing leaflets or leaflets with the wrong size or shape).
• Infections.
• Underlying conditions, such as diabetes or another heart problem.
Heart Valve Problems
• There are three main types of heart valve problems. Each type of
problem can happen in any of the four valves:
• Regurgitation: Regurgitation is the backward flow of blood because a
valve doesn’t close properly. Another name for regurgitation is leaking
heart valve. One specific type of regurgitation is prolapse. Prolapse
involves a leaflet flopping or bulging backward. It tends to occur in
the mitral valve.
• Stenosis: Stenosis occurs when a valve’s leaflets get thick or stiff or
stick together.
• Atresia: Atresia means that a valve is missing.
Symptoms Of Heart Valve Problems

• The first sign of a heart valve problem is often a heart murmur (an
unusual sound when your heart beats).
• Chest pain.
• Dizziness.
• Fainting.
• Fatigue (feeling extremely tired).
• Feeling of fluttering or racing in your chest.
• Shortness of breath, especially when exercising or lying down.
• Swelling in the ankles, feet, legs or belly.
Heart Care
• Avoid smoking.
• Manage your blood pressure and cholesterol.
• Eat a heart-healthy diet that’s low in saturated and trans fats and loaded
with fruits and veggies.
• Exercise regularly.
• Have regular checkups with a primary care provider so they can listen to
your heart and catch any problems early.
• Take antibiotics before dental and other procedures.
• Tell all of your healthcare providers, including your dentist, that you have
a heart valve issue.
Arteries
• Arteries make up a major part of the circulatory system, with the veins and heart being the
other main components.
• Arteries make up tubelike structures responsible for transporting fluid (i.e., blood for the
circulatory system and lymph for the lymphatic system) to and from every organ in the body.
• Mainly, arteries manage the transportation of oxygen, nutrients, and hormones through our
bodies. Arteries can dispense fresh oxygen to the body after it gets loaded onto the Fe 2+ found
in the centre of hemoglobin.
• The oxygen binds to hemoglobin and is carried by the arteries to areas that lack oxygen.
• Through a shift in affinity for the oxygen, it is then unloaded to specific areas through high
surface areas knowns as capillaries.
• Far from being a changeless structure, arteries adapt through signals received from the central
nervous system, as they also react to an outer stimulus like pressure, temperature, and
substances.
• Vascular nerves are responsible for innervating the arteries allowing them to change to their
stimuli. As catecholamines get released into the blood, the nerves send signals to the arteries to
either constrict or dilate, leading to changes in pressure.
Continued..
• Arteries are composed of smooth muscle allowing constriction and dilation
through the parasympathetic nervous system.
• Arteries differ from veins in that they most often carry oxygenated blood away
from the heart and into the rest of the body system.
• However, this is not always the case, as the pulmonary artery moves
unoxygenated blood from the heart to the lungs to complete the gas exchange in
the alveoli.
• Additionally, arteries play an important role in maintaining proper blood flow to
the uterus during pregnancy, allowing proper fetal growth.
• Arteries play a crucial role in maintaining homeostasis in the body.
• They begin to clog with a thickening of plaque known as atherosclerosis
Artery Capillaries Veins
Veins
• Veins carry blood toward the heart. After blood passes through the capillaries, it
enters the smallest veins, called venules.
• From the venules, it flows into progressively larger and larger veins until it
reaches the heart.
• In the pulmonary circuit, the pulmonary veins transport blood from the lungs to
the left atrium of the heart.
• This blood has a high oxygen content because it has just been oxygenated in the
lungs.
• Systemic veins transport blood from the body tissue to the right atrium of the
heart.
• This blood has a reduced oxygen content because the oxygen has been used for
metabolic activities in the tissue cells.
Continued..
• The walls of veins have the same three layers as the arteries. Although all the
layers are present, there is less smooth muscle and connective tissue.
• This makes the walls of veins thinner than those of arteries, which is related to the
fact that blood in the veins has less pressure than in the arteries. Because the walls
of the veins are thinner and less rigid than arteries, veins can hold more blood.
• Almost 70 percent of the total blood volume is in the veins at any given time.
• Medium and large veins have venous valves, similar to the semilunar
valves associated with the heart, that help keep the blood flowing toward the heart.
• Venous valves are especially important in the arms and legs, where they prevent
the backflow of blood in response to the pull of gravity.
Capillaries
• Capillaries, the smallest and most numerous of the blood vessels, form the connection between
the vessels that carry blood away from the heart (arteries) and the vessels that return blood to
the heart (veins).
• The primary function of capillaries is the exchange of materials.
• Capillary distribution varies with the metabolic activity of body tissues.
• Tissues such as skeletal muscle, liver, and kidney have extensive capillary networks because
they are metabolically active and require an abundant supply of oxygen and nutrients.
• Other tissues, such as connective tissue, have a less abundant supply of capillaries.
• The epidermis of the skin and the lens and cornea of the eye completely lack a capillary
network.
• About 5 per cent of the total blood volume is in the systemic capillaries at any given time.
Another 10 per cent is in the lungs, the blood and tissue cells.
• Smooth muscle cells in the arterioles where they branch to form capillaries regulate blood flow
from the arterioles into the capillaries.
Role of Capillaries
• In addition to forming the connection between
the arteries and veins, capillaries have a vital role in the exchange of gases,
nutrients, and metabolic waste products between the blood and the tissue cells.
• Substances pass through the capillary wall by diffusion, filtration, and osmosis.
• Oxygen and carbon dioxide move across the capillary wall by diffusion.
• Fluid movement across a capillary wall is determined by a combination of
hydrostatic and osmotic pressure.
• The net result of the capillary microcirculation created by hydrostatic and
osmotic pressure is that substances leave the blood at one end of the capillary
and return at the other end.
Rhythmical Excitation of the Heart
• The rhythmical electrical impulses in a normal heart
allows:
• The atria to contract about one sixth of a second ahead
of ventricular contraction.
• Allows ventricular filling before they pump the blood
through the lungs and peripheral circulation.
• Allows all portions of the ventricles to contract almost
simultaneously.
• The entire process repeats with each heartbeat,
maintaining a coordinated and rhythmic cycle.
• Factors, such as hormones, nerve signals, and electrolyte
balance, can influence the rhythmical excitation of the
heart.
• Disruptions in this process can lead to cardiac
arrhythmia, which may have various causes and can
impact overall cardiovascular health.
Key Components Involved In This Process
1. Sinoatrial (SA) Node: The SA node, often referred to as the "natural pacemaker" of the
heart, is located in the right atrium. It generates electrical impulses at a regular rate, initiating
each heartbeat.
2. Atria Conduction: The electrical impulses generated by the SA node spread across the atria,
causing them to contract and push blood into the ventricles.
3. Atrioventricular (AV) Node: The electrical impulses then pass through the AV node, located
between the atria and ventricles. The AV node acts as a delay mechanism, allowing the
ventricles to fill with blood before contraction.
4. Bundle of His: After passing through the AV node, the electrical signals travel down the
Bundle of His, a bundle of specialized fibers that transmit the impulses from the atria to the
ventricles.
5. Purkinje Fibers: The Bundle of His branches into Purkinje fibers, which spread throughout
the ventricles, delivering the electrical impulses to the muscle cells. This causes the ventricles
to contract and pump blood to the lungs and the rest of the body.
Sinus (Sinoatrial Node)

• Strip of specialized cardiac muscle

• Sinus nodal fibers connect directly with
the atrial muscle fibers.
• Have the capability of self-excitation, a
process that can cause automatic
rhythmical discharge and contraction
Mechanism of Sinus Nodal Rhythmicity

• R.M.P (Resting Membrane Potential)of the

sinus nodal fiber has a negativity of about -55
to -60 millivolts, in comparison with -85 to -
90 millivolts for the ventricular muscle fiber.
• Cell membranes of the sinus fibers are
naturally leaky to sodium and calcium ions.
• At -55 mV, the fast sodium channels already
become “inactivated”.
• The atrial nodal action potential is slower to
develop than the action potential of the
ventricular muscle.
Resting Membrane Potential (RMP)
• The RMP for the SA Node which serves as the natural pacemaker of the heart, is typically around -55 to -60
millivolts (mV). The RMP is the electrical potential difference across the cell membrane when the cell is at
rest and not generating an action potential.
• In the SA node, the RMP is maintained by the movement of ions across the cell membrane. The primary ions
involved in establishing and maintaining the RMP are sodium (Na+), potassium (K+), and calcium (Ca2+).
1. Potassium (K+): The membrane of the SA node cells is more permeable to potassium ions. At rest,
potassium ions move out of the cell, leading to a net negative charge inside the cell and contributing to the
resting membrane potential.
2. Sodium (Na+): The sodium-potassium pump actively transports sodium ions out of the cell and potassium
ions into the cell, contributing to the negative charge inside the cell.
3. Calcium (Ca2+): While calcium does play a role in the SA node's action potential, it is not as prominent
during the resting phase. Calcium channels become more critical during the depolarization phase when the
SA node generates an action potential.
Continued..
• The movement of these ions helps maintain the electrical potential
across the SA node cell membrane during the resting state. When the
SA node initiates an action potential, there is a transient depolarization
followed by repolarization, leading to the restoration of the resting
membrane potential until the next cycle begins.
• Understanding the RMP of the SA node is crucial in the context of
cardiac physiology, as it influences the excitability and firing rate of
the SA node, which, in turn, determines the heart rate. The SA node's
ability to depolarize spontaneously and generate rhythmic electrical
impulses is a key factor in regulating the overall cardiac rhythm.
Transmission of the Cardiac Impulse
Through the Atria
• The A-V node is located in the posterior
wall of the right atrium immediately
behind the tricuspid valve.
• Action potentials originating in the sinus
node travel outward into the atrial muscle
fibers and to the A-V node.
• Impulse, after traveling through the
internodal pathways, reaches the A-V
node about 0.03 second after its origin in
the sinus node.
One-Way Conduction Through the A-V Bundle
Continued..
• The impulse is delayed more than 0.1 second in the A-V nodal
region before appearing in the ventricular septal A-V bundle.
• Once it has entered this bundle, it spreads very rapidly through
the Purkinje fibers to the entire endocardial surfaces of the
ventricles.
• Then the impulse once again spreads slightly less rapidly
through the ventricular muscle to the epicardial surfaces.
Why Sinus node controls heart rhythmicity?

• The discharge rate of the sinus node is considerably faster than the
natural self-excitatory discharge rate of either the A-V node or the
Purkinje fibers.
• Under abnormal conditions, few other parts of the heart can exhibit
intrinsic rhythmical excitation in the same way like the sinus nodal
fibers (A-V nodes and Purkinje fibres).
• The cardiac impulse arrives at almost all portions of the ventricles
within a narrow span of time, exciting the first ventricular muscle fiber
only 0.03 to 0.06 second ahead of excitation of the last ventricular
muscle fiber.
 Control of Heart Rhythmicity and Impulse Conduction The Sympathetic
and Parasympathetic Nerves

Parasympathetic Nerves Sympathetic Nerves

Releases acetylcholine Releases norepinephrine at
sympathetic endings.
Decreases heart rhythm and excitability.
Increases the rate of sinus
Excitatory signals are no longer nodal discharge.
transmitted into the ventricles.
Increases the overall heart
Ventricular Escape activity.

Increased permeability of the fiber Increases the permeability

membranes to potassium ions of Na+ and Ca2+ ions.
Cardiac cycle
• The cardiac events that occur from the beginning of one heartbeat to the beginning of
the next are called the cardiac cycle.
• Each cycle is initiated by spontaneous generation of an action potential in the sinus
node. This node is located in the superior lateral wall of the right atrium near the
opening of the superior vena cava, and the action potential travels from here rapidly
through both atria and then through the A-V bundle into the ventricles.
• Because of this special arrangement of the conducting system from the atria into the
ventricles, there is a delay of more than 0.1 second during passage of the cardiac
impulse from the atria into the ventricles.
• This allows the atria to contract ahead of ventricular contraction, thereby pumping
blood into the ventricles before the strong ventricular contraction begins.
• Thus, the atria act as primer pumps for the ventricles, and the ventricles in turn provide
the major source of power for moving blood through the body’s vascular system.
Diastole and Systole
• The cardiac cycle consists of a period of relaxation called diastole,
during which the heart fills with blood, followed by a period of
contraction called systole.
• Figure shows the different events during the cardiac cycle for the left
side of the heart.
• The top three curves show the pressure changes in the aorta, left
ventricle, and left atrium, respectively.
• The fourth curve depicts the changes in left ventricular volume, the fifth
is the electrocardiogram, and the sixth a phonocardiogram, which is a
recording of the sounds produced by the heart—mainly by the heart
valves—as it pumps.
Relationship between ECG and Cardiac cycle
• The electrical activity of the heart can be recorded as an electrocardiogram (ECG or EKG), which provides
valuable information about the heart's health and function.
• The electrocardiogram in the above Fig. shows the P, Q, R, S, and T waves.
• They are electrical voltages generated by the heart and recorded by the electrocardiograph from the surface
of the body.
• The P wave is caused by the spread of depolarization through the atria, and this is followed by atrial
contraction, which causes a slight rise in the atrial pressure curve immediately after the
electrocardiographic P wave.
• About 0.16 second after the onset of the P wave, the QRS waves appear as a result of electrical
depolarization of the ventricles, which initiates the contraction of the ventricles and causes the
ventricular pressure to begin rising, as also shown in the figure.
• Therefore, the QRS complex begins slightly before the onset of ventricular systole.
• Finally, one observes the ventricular T wave in the electrocardiogram. This represents the stage of
repolarization of the ventricles when the ventricular muscle fibers begin to relax.
• Therefore, the T wave occurs slightly before the end of ventricular contraction.
Electrical Signalling
• The sinus node generates an electrical stimulus regularly, 60 to 100
times per minute under normal conditions.
• The atria are then activated.
• The electrical stimulus travels down through the conduction pathways
and causes the heart's ventricles to contract and pump out blood.
ECG
• It is the procedure of recording the electrical activity of the heart. The electrode
combination records the difference of potential difference at two sites on the body. The
potential differences are produced due to the electrical activity of the heart.
• The characteristic shape and timing of the ECG waves are due to the spread of wave of
depolarization and repolarization associated with each heart beat.
• Electrocardiography (ECG) is a quick and easily accessible method for diagnosis and
screening of cardiovascular diseases including heart failure (HF). Artificial
intelligence (AI) can be used for semi-automated ECG analysis.
• Evaluation of symptoms suggestive of HF currently demands physicians to evaluate
various parameters including imaging and laboratory data and the electrocardiogram
(ECG).
• Besides a standard examination that includes an ECG, imaging information, such as
echocardiography or magnetic resonance imaging, is seen as gold standard in
diagnosis of HF.
What does ECG look like?
Flow of current in the chest around partially depolarized ventricles
ECG Monitoring
• ECG monitoring systems have been developed and widely used in the healthcare
sector for the past few decades and have significantly evolved over time due to the
emergence of smart enabling technologies.
• Nowadays, ECG monitoring systems are used in hospitals, homes, outpatient
ambulatory settings, and in remote contexts.
• They also employ a wide range of technologies such as IoT, edge computing, and
mobile computing.
• In addition, they implement various computational settings in terms of processing
frequencies, as well as monitoring schemes.
• They have also evolved to serve purposes and targets other than disease diagnosis
and control, including daily activities, sports, and even mode-related purposes.
THE END