System

Structure of the 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 lef t of midline.
• The heart is enclosed in a pericardial sac that is lined with the parietal
layers of a serous membrane. The visceral layer of the serous
membrane forms the epicardium.
Layers of the Heart Wall
• Three layers of tissue form the heart wall. The outer layer of the heart wall is the epicardium, the
middle layer is the myocardium, and the inner layer is the endocardium.
• Chambers of the Heart
• The internal cavity of the heart is divided into four chambers:
• Right atrium
• Right ventricle
• Left atrium
• Left ventricle
• The two atria are thin-walled chambers that receive blood from the veins. The two ventricles are
thick-walled chambers that forcefully pump blood out of the heart. Differences in thickness of the
heart chamber walls are due to variations in the amount of myocardium present, which reflects the
amount of force each chamber is required to generate.
• The right atrium receives deoxygenated blood from systemic veins; the left atrium receives
oxygenated blood from the pulmonary veins.
Valves of the Heart

• Pumps need a set of valves to keep the fluid flowing in one direction and the heart
is no exception. The heart has two types of valves that keep the blood flowing in
the correct direction. The valves between the atria and ventricles are called
atrioventricular valves (also called cuspid valves), while those at the bases of the
large vessels leaving the ventricles are called semilunar valves.
• The right atrioventricular valve is the tricuspid valve. The left atrioventricular
valve is the bicuspid, or mitral, valve. The valve between the right ventricle and
pulmonary trunk is the pulmonary semilunar valve. The valve between the left
ventricle and the aorta is the aortic semilunar valve.
• When the ventricles contract, atrioventricular valves close to prevent blood from
flowing back into the atria. When the ventricles relax, semilunar valves close to
prevent blood from flowing back into the ventricles.
Pathway of Blood through the Heart
• While it is convenient to describe the flow of blood through the right side of the
heart and then through the left side, it is important to realize that both atria and
ventricles contract at the same time. The heart works as two pumps, one on the
right and one on the left, working simultaneously. Blood flows from the right
atrium to the right ventricle, and then is pumped to the lungs to receive oxygen.
From the lungs, the blood flows to the left atrium, then to the left ventricle. From
there it is pumped to the systemic circulation.
Blood Supply to the Myocardium

• 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.
• The right and left coronary arteries, branches of the ascending aorta, supply blood
to the walls of the myocardium. After blood passes through the capillaries in the
myocardium, it enters a system of cardiac (coronary) veins. Most of the cardiac
veins drain into the coronary sinus, which opens into the right atrium.
Physiology of the Heart

• The conduction system includes several components. The first part of the conduction
system is the sinoatrial node . Without any neural stimulation, the sinoatrial node
rhythmically initiates impulses 70 to 80 times per minute. Because it establishes the
basic rhythm of the heartbeat, it is called the pacemaker of the heart. Other parts of
the conduction system include the atrioventricular node, atrioventricular bundle,
bundle branches, and conduction myofibers. All of these components coordinate the
contraction and relaxation of the heart chambers.
• Cardiac Cycle
• The cardiac cycle refers to the alternating contraction and relaxation of the
myocardium in the walls of the heart chambers, coordinated by the conduction
system, during one heartbeat. Systole is the contraction phase of the cardiac cycle,
and diastole is the relaxation phase. At a normal heart rate, one cardiac cycle lasts for
0.8 second.Heart Sounds
• The sounds associated with the heartbeat are due to vibrations in the tissues and
blood caused by closure of the valves. Abnormal heart sounds are called murmurs.
Heart Rate

• The sinoatrial node, acting alone, produces a constant rhythmic heart

rate. Regulating factors are reliant on the atrioventricular node to
increase or decrease the heart rate to adjust cardiac output to meet
the changing needs of the body. Most changes in the heart rate are
mediated through the cardiac center in the medulla oblongata of the
brain. The center has both sympathetic and parasympathetic
components that adjust the heart rate to meet the changing needs of
the body.
• Peripheral factors such as emotions, ion concentrations, and body
temperature may affect heart rate. These are usually mediated
through the cardiac center.
Heart Rate

• The sinoatrial node, acting alone, produces a constant rhythmic heart

rate. Regulating factors are reliant on the atrioventricular node to
increase or decrease the heart rate to adjust cardiac output to meet
the changing needs of the body. Most changes in the heart rate are
mediated through the cardiac center in the medulla oblongata of the
brain. The center has both sympathetic and parasympathetic
components that adjust the heart rate to meet the changing needs of
the body.
• Peripheral factors such as emotions, ion concentrations, and body
temperature may affect heart rate. These are usually mediated
through the cardiac center.
Blood

• Blood is the fluid of life, transporting oxygen from the lungs to body
tissue and carbon dioxide from body tissue to the lungs. Blood is the
fluid of growth, transporting nourishment from digestion and
hormones from glands throughout the body. Blood is the fluid of
health, transporting disease-fighting substances to the tissue and
waste to the kidneys. Because it contains living cells, blood is alive.
Red blood cells and white blood cells are responsible for nourishing
and cleansing the body.
• Without blood, the human body would stop working.
Arteries

• Arteries
• Arteries carry blood away from the heart. Pulmonary arteries
transport blood that has a low oxygen content from the right ventricle
to the lungs. Systemic arteries transport oxygenated blood from the
left ventricle to the body tissues. Blood is pumped from the ventricles
into large elastic arteries that branch repeatedly into smaller and
smaller arteries until the branching results in microscopic arteries
called arterioles. The arterioles play a key role in regulating blood flow
into the tissue capillaries. About 10 percent of the total blood volume
is in the systemic arterial system at any given time.
Arteries

• The wall of an artery consists of three layers. The innermost layer, the
tunica intima (also called tunica interna), is simple squamous epithelium
surrounded by a connective tissue basement membrane with elastic
fibers. The middle layer, the tunica media, is primarily smooth muscle
and is usually the thickest layer. It not only provides support for the
vessel but also changes vessel diameter to regulate blood flow and
blood pressure. The outermost layer, which attaches the vessel to the
surrounding tissue, is the tunica externa or tunica adventitia. This layer is
connective tissue with varying amounts of elastic and collagenous fibers.
The connective tissue in this layer is quite dense where it is adjacent to
the tunic media, but it changes to loose connective tissue near the
periphery of the vessel.
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 between the blood and
tissue cells.
• 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
percent of the total blood volume is in the systemic capillaries at any given
time. Another 10 percent is in the lungs.
• Smooth muscle cells in the arterioles where they branch to form capillaries
regulate blood flow from the arterioles into the capillaries.
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.
Veins
• 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.
Physiology of Circulation

• Roles 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.
Blood Flow
• Blood flow refers to the movement of blood through the vessels from arteries to the
capillaries and then into the veins. Pressure is a measure of the force that the blood
exerts against the vessel walls as it moves the blood through the vessels. Like all fluids,
blood flows from a high pressure area to a region with lower pressure. Blood flows in the
same direction as the decreasing pressure gradient: arteries to capillaries to veins.
• The rate, or velocity, of blood flow varies inversely with the total cross-sectional area of
the blood vessels. As the total cross-sectional area of the vessels increases, the velocity
of flow decreases. Blood flow is slowest in the capillaries, which allows time for
exchange of gases and nutrients.
• Resistance is a force that opposes the flow of a fluid. In blood vessels, most of the
resistance is due to vessel diameter. As vessel diameter decreases, the resistance
increases and blood flow decreases.
• Very little pressure remains by the time blood leaves the capillaries and enters the
venules. Blood flow through the veins is not the direct result of ventricular contraction.
Instead, venous return depends on skeletal muscle action, respiratory movements, and
constriction of smooth muscle in venous walls.
Pulse and Blood Pressure
• Pulse refers to the rhythmic expansion of an artery that is caused by ejection of
blood from the ventricle. It can be felt where an artery is close to the surface
and rests on something firm.
• In common usage, the term blood pressure refers to arterial blood pressure, the
pressure in the aorta and its branches. Systolic pressure is due to ventricular
contraction. Diastolic pressure occurs during cardiac relaxation. Pulse pressure
is the difference between systolic pressure and diastolic pressure. Blood
pressure is measured with a sphygmomanometer and is recorded as the systolic
pressure over the diastolic pressure. Four major factors interact to affect blood
pressure: cardiac output, blood volume, peripheral resistance, and viscosity.
When these factors increase, blood pressure also increases.
• Arterial blood pressure is maintained within normal ranges by changes in
cardiac output and peripheral resistance. Pressure receptors (barareceptors),
located in the walls of the large arteries in the thorax and neck, are important
for short-term blood pressure regulation.
Circulatory Pathways

• The blood vessels of the body are functionally divided into two
distinctive circuits: pulmonary circuit and systemic circuit. The pump
for the pulmonary circuit, which circulates blood through the lungs, is
the right ventricle. The left ventricle is the pump for the systemic
circuit, which provides the blood supply for the tissue cells of the
body. Pulmonary Circuit
• Pulmonary circulation transports oxygen-poor blood from the right
ventricle to the lungs, where blood picks up a new blood supply. Then
it returns the oxygen-rich blood to the left atrium.
Systemic Circuit
• The systemic circulation provides the functional blood supply to all body
tissue. It carries oxygen and nutrients to the cells and picks up
carbon dioxide and waste products. Systemic circulation carries oxygenated
blood from the left ventricle, through the arteries, to the capillaries in the
tissues of the body. From the tissue capillaries, the deoxygenated blood
returns through a system of veins to the right atrium of the heart.
• The coronary arteries are the only vessels that branch from the
ascending aorta. The brachiocephalic, left common carotid, and left
subclavian arteries branch from the aortic arch. Blood supply for the brain is
provided by the internal carotid and vertebral arteries. The subclavian
arteries provide the blood supply for the upper extremity. The celiac,
superior mesenteric, suprarenal, renal, gonadal, and inferior mesenteric
arteries branch from the abdominal aorta to supply the abdominal viscera.
Lumbar arteries provide blood for the muscles and spinal cord. Branches of
the external iliac artery provide the blood supply for the lower extremity.
Major Systemic Arteries

• All systemic arteries are branches, either directly or indirectly, from

the aorta. The aorta ascends from the left ventricle, curves posteriorly
and to the left, then descends through the thorax and abdomen. This
geography divides the aorta into three portions: ascending aorta,
arotic arch, and descending aorta. The descending aorta is further
subdivided into the thoracic arota and abdominal aorta.
Major Systemic Veins
• After blood delivers oxygen to the tissues and picks up carbon dioxide,
it returns to the heart through a system of veins. The capillaries,
where the gaseous exchange occurs, merge into venules and these
converge to form larger and larger veins until the blood reaches either
the superior vena cava or inferior vena cava, which drain into the right
atrium.
Fetal Circulation
• Most circulatory pathways in a fetus are like those in the adult but
there are some notable differences because the lungs, the
gastrointestinal tract, and the kidneys are not functioning before
birth. The fetus obtains its oxygen and nutrients from the mother and
also depends on maternal circulation to carry away the carbon dioxide
and waste products.
• The umbilical cord contains two umbilical arteries to carry fetal blood
to the placenta and one umbilical vein to carry oxygen-and-nutrient-
rich blood from the placenta to the fetus. The ductus venosus allows
blood to bypass the immature liver in fetal circulation. The foramen
ovale and ductus arteriosus are modifications that permit blood to
bypass the lungs in fetal circulation.
Factors Regulating Blood Pressure

• The arterial blood pressure is mainly controlled by the renal system.

The nervous system and hormones also play a vital role in controlling
blood pressure. Here, let us discuss the various factors that regulate
arterial blood pressure.
Factors Regulating Blood
Pressure
• Even under normal physiological conditions, arterial blood pressure varies. However, due to the
body’s well-organised regulating processes, it is promptly returned to normal levels. The body
has four of these regulating systems to keep the blood pressure within acceptable ranges:
• The nervous system or the short-term regulatory system
• A long-term regulatory mechanism or the renal system
• The hormonal system
• Regional system
• The Nervous System or the Short-Term Regulatory System
• The regulation of blood pressure by the nervous system is the fastest of all the systems.
• Within a few minutes of a pressure change, the nervous system returns the pressure to normal.
Although the neurological system reacts quickly, it only works for a brief time before adapting to
the new pressure. As a result, it is known as short-term regulation. The vasomotor system is
used by the neurological system to control arterial blood pressure.
• Renal System or Long-Term Regulatory System
• The long-term regulation of blood pressure is largely controlled by the kidneys. When blood
pressure fluctuates gradually over a period of days, weeks, or even years, the nervous system
adjusts to the new pressure and loses sensitivity to fluctuations. It is no longer able to control
the pressure. The renal system effectively controls blood pressure under these circumstances. As
a result, it is known as long-term regulation. There are two ways that kidneys control arterial
blood pressure:
• 1. By controlling ECF (extracellular fluid) volume.
• 2. Through the renin-angiotensin system.
• Regulation of ECF (Extracellular Fluid) Volume
• As blood pressure rises, pressure diuresis and pressure natriuresis occur in the kidneys, which
cause significant excretion of water and salt, particularly sodium. Because of natriuresis and
diuresis, there is a reduction in blood and ECF volume that returns arterial blood pressure to
normal levels.
• Renin-Angiotensin System
• The renin-angiotensin system is a complicated multi-organ endocrine
system that controls vascular resistance and tone in addition to fluid
and electrolyte balance to regulate blood pressure. It also controls
water and sodium absorption in the kidney and directly affects the
overall blood pressure.
• See more: Renal Failure
• The Hormonal System
• Blood pressure is regulated by a variety of hormones.
• Here, thyroxine and adrenaline increases systolic pressure but
decreases diastolic blood pressure.
• Regional System
• Blood pressure is regulated by local chemicals in addition to
neurological, renal, and hormonal systems.
• Local chemicals control blood pressure by either vasodilation or
vasoconstriction. Medication for vasoconstriction and vasodilation
function differently. Vasodilating drugs enlarge or dilate your blood
vessels to promote blood flow whereas vasoconstricting medications
tighten them to elevate blood pressure.
• Blood Pressure
• Blood pressure is a serious health problem which affects nearly 40 to 50
per cent of the total population.
• Blood is a fluid connective tissue which is carried to all parts of our body
with the help of arteries. It plays a key factor in providing blood (thus
oxygen and energy) to organs.
• Blood pressure is the force of blood against the arteries. An individual
should maintain a normal blood pressure from 90 – 120 / 60 – 80 mm
Hg. Blood pressure is given by two numbers, with one above or before
the other – 120/80.120 – This is called systolic pressure and 80 – This is
called diastolic pressure.
• Types of Blood Pressure
• Systolic Blood Pressure.
• The normal range of systolic blood pressure should be 90 – 120 mm
Hg.
• Diastolic Blood Pressure.
• The normal range of diastolic blood pressure should be 60 – 80 mm
Hg.
• Both Diastolic and Systolic are derived from the Greek word. Diastolic
meaning drawing apart and Systolic meaning a drawing together.
Cardiovascular disease

• Cardiovascular disease (CVD) is a general term for conditions

affecting the heart or blood vessels.
• It's usually associated with a build-up of fatty deposits inside the
arteries (atherosclerosis) and an increased risk of blood clots.
• It can also be associated with damage to arteries in organs such as the
brain, heart, kidneys and eyes.
• CVD is one of the main causes of death and disability in the UK, but it
can often largely be prevented by leading a healthy lifestyle.
• Types of CVD
• There are many different types of CVD. 4 of the main types are described on this
page.
• Coronary heart disease
• Coronary heart disease occurs when the flow of oxygen-rich blood to the heart
muscle is blocked or reduced.
• This puts an increased strain on the heart, and can lead to:
• angina – chest pain caused by restricted blood flow to the heart muscle
• heart attacks – where the blood flow to the heart muscle is suddenly blocked
• heart failure – where the heart is unable to pump blood around the body properly
Strokes and TIAs
• Strokes and TIAs
• A stroke is where the blood supply to part of the brain is cut off, which can cause brain damage
and possibly death.
• A transient ischaemic attack (also called a TIA or "mini-stroke") is similar, but the blood flow to
the brain is only temporarily disrupted.
• The main symptoms of a stroke or TIA can be remembered with the word FAST, which stands for:
• Face – the face may have drooped on one side, the person may be unable to smile, or their
mouth or eye may have dropped.
• Arms – the person may not be able to lift both arms and keep them there because of arm
weakness or numbness in one arm.
• Speech – their speech may be slurred or garbled, they may not be able to talk at all or they may
not be able to understand what you are saying to them.
• Time – it's time to dial 999 immediately if you see any of these signs or symptoms.
Peripheral arterial disease

• Peripheral arterial disease occurs when there's a blockage in the

arteries to the limbs, usually the legs.
• This can cause:
• dull or cramping leg pain, which is worse when walking and gets
better with rest
• hair loss on the legs and feet
• numbness or weakness in the legs
• persistent ulcers (open sores) on the feet and legs
Aortic disease

• Aortic diseases are a group of conditions affecting the aorta. This is

the largest blood vessel in the body, which carries blood from the
heart to the rest of the body.
• One of most common aortic diseases is an aortic aneurysm, where
the aorta becomes weakened and bulges outwards.
• This doesn't usually have any symptoms, but there's a chance it could
burst and cause life-threatening bleeding.
• Causes of CVD
• The exact cause of CVD isn't clear, but there are lots of things that can increase
your risk of getting it. These are called "risk factors".
• The more risk factors you have, the greater your chances of developing CVD.
• If you're over 40, you'll be invited by your GP for an NHS Health Check every 5
years.
• Part of this check involves assessing your individual CVD risk and advising you
how to reduce it if necessary.
• High blood pressure
• High blood pressure (hypertension) is one of the most important risk factors for
CVD. If your blood pressure is too high, it can damage your blood vessels.
• High blood pressure
• High blood pressure (hypertension) is one of the most important risk
factors for CVD. If your blood pressure is too high, it can damage your
blood vessels.
• Read more about high blood pressure.
• Smoking
• Smoking and other tobacco use is also a significant risk factor for CVD.
The harmful substances in tobacco can damage and narrow your
blood vessels.
• If you don't exercise regularly, it's more likely that you'll have high
blood pressure, high cholesterol levels and be overweight. All of these
are risk factors for CVD.
• Exercising regularly will help keep your heart healthy. When combined
with a healthy diet, exercise can also help you maintain a healthy
weight.
• Being overweight or obese
• Being overweight or obese increases your risk of developing diabetes
and high blood pressure, both of which are risk factors for CVD.
• You're at an increased risk of CVD if: