LECTURE NOTES ON

THE CARDIOVASCULAR
SYSTEM
INTRODUCTION

• Circulation/Transportation
• two major transport systems in body:
• A. The Circulatory System
• B. The Lymphatic System
• circulatory system works in conjunction with the lymphatic system and are directly connected to each
other
• A. Circulatory (cardiovascular) System
• circulatory system consists of the heart, the vessels and blood
• B. Lymphatic System
• an open system that returns excess materials in the tissue spaces back to the blood fluid = lymph
• no dedicated pump; muscle contractions move lymph along
• lymphatic vessels move lymph in one direction; lymph does not circulate
The Circulatory System(Cardiovascular System)

• major connection between external and internal environment:

• everything going in or out of body must go through the circulatory system to get to
where its going
General Functions of Circulatory System:
• A. Transport
• B. Homeostasis
• C. Protection
• A. Transport functions:
1. Pick up food and oxygen from digestive and respiratory systems and deliver them to cells
2. pick up wastes and carbon dioxide from cells and deliver to kidneys and lungs
3. Transport hormones & other chemicals, enzymes etc throughout the body
• B. Homeostasis functions:
• 4.maintain fluid and electrolyte balances in tissues and cells
• 5. maintain acid/base balances in tissues and cells
• 6. help regulate temperature homeostasis- transfers excess heat from
core to skin for removal
• C. Protective Functions:
• 7. Clotting and Inflammation prevent excessive fluid loss and limit the
spread of infection
• 8. Circulating cells and chemicals actively seek out and remove
pathogens from the body “immune system”
The Heart – Anatomy

• We are more aware of our heart than most other internal organs
• The heart is one of first organ systems to appear in developing embryo and is beating by 4th week,
crucial to supply nutrients for growth
• No machine works as long or as hard as your heart beats: about 3 billion times in average lifespan
• Heart is about size and shape of closed fist, lies behind sternum ,between the two lungs in the
mediastinum
• The heart’s position between bony structures anteriorly and posteriorly makes it possible to
manually drive blood out of the heart when it is not pumping effectively.
• Rhythmically depressing the sternum compresses the heart between the sternum and the
vertebrae so that blood is squeezed out into the blood vessels, maintaining blood flow to the
tissues.
• This external cardiac compression, which is part of cardiopulmonary resuscitation (CPR), may be
lifesaving until appropriate therapy can restore the heart to normal function
• broad superior border of heart = base, lower border of heart (=apex)
lies on diaphragm
• heart is enclosed in its own sac, = pericardium (=pericardial sac)
(parietal pericardium)
• composed of tough fibrous outer layer and inner serous membrane
• outer surface of heart is covered with serous membrane (= visceral
pericardium) (=epicardium) continuous with the pericardium
• between the 2 membranes is pericardial fluid → lubrication
• pericarditis = inflammation of pericardium, membranes become dry,
each heartbeat becomes painful
walls of heart:
• epicardium = visceral pericardium thin & transparent serous tissue
that covers the heart
• myocardium = cardiac muscle cell, bulk of heart, branching,
interlacing contractile tissue acts as single unit (gap junctions)
• endocardium = delicate innermost layer of heart wall ,thin,
smooth ,glistening ,formed by a single layer of endothelial cells,
continuous with inner lining of blood vessels
• SEPTA OF THE HEART
• Atria of the heart are separated from one another by a fibrous septum called
interatrial septum
• And ventricles by interventricular septum – upper part – membranous; lower
part- muscular
• Heart Chambers
• interior of heart is subdivided into 4 chambers:
• atria = two upper chambers with auricles smaller, thinner, weaker
• ventricles = two lower chambers larger, thicker, stronger
• left ventricle much larger and thicker than right ventricle ,left ventricle is at apex
of heart
• Heart Vessels
• There are 4 major vessels attached to heart:
• 2 arteries (take blood away from heart):
• Aorta - from left ventricle
• pulmonary trunk - from right ventricle
• 2 veins (bring blood back to heart):
• vena cava (superior & inferior) - to right atrium
• pulmonary veins (4 in humans) – left atrium
• Heart Valves
• There are also 4 one-way valves that direct flow of blood through the
heart in one direction:
• A. 2 Atrioventricular (AV) valves
• bicuspid (Mitral) valve - separates left atrium and ventricle,- consists of two flaps of
tissues
• tricuspid valve - separates right atrium and ventricle,- consists of three flaps of
tissues
• both held in place by chordae tendinae ,attached to papillary muscles.
prevent backflow (eversion)
• keeps valves pointed in direction of flow
• B. 2 Semilunar valves
• at beginning of arteries leaving the ventricles
• aortic SL valve at beginning of aorta
• pulmonary SL valve at beginning of pulmonary trunk
Blood Vessels
• blood flows in closed system of vessels , over 60,000 miles of vessels (mainly
capillaries)
• arteries & arterioles -take blood away from heart to capillaries
• Capillaries- actual site of exchange
• venules & veins– bring blood from capillaries back to heart
Types of Blood Vessels

• 1. Arteries & Arterioles

• built to withstand the greatest pressure of the system→ strong resilient walls, have
thick layers of connective tissues
• more muscular than veins
• arteries and arterioles typically contain ~25% of all blood in circulation-15% in
arteries; 10% in arterioles
• pressure is variable
• Arterial branches become narrower and walls become thinner as they reach the
periphery
• Resistance to blood flow is offered in the arterioles and thus called resistance vessels
• most organs receive blood from >1 arterial branch, provides alternate pathways
• 2. Veins & Venules
• Generally, have a greater diameter than arteries , but thinner walls, flaccid,
more compliant
• three layer are all thinner than in arteries
• tunica adventitia is thickest of three, but not as elastic as arteries ; little smooth
muscle
• ~70% of all blood is in veins & venules : ~60% in veins, ~10% in venules
• called capacitance vessels
• low pressure:12 – 8 mmHg in venules , 6 – 1 mmHg in veins, larger veins near 0
• many of the medium veins, especially in limbs have 1 way valves
• 3. Capillaries:
• actual site of exchange of materials,
• consist of only a single layer of squamous epithelium= endothelial
layer (=tunica intima) arranged into capillary beds
• These are the functional units of circulatory system
• capillaries are extremely abundant in almost every tissue of the body
• → most of the 62,000 miles of blood vessels is capillaries
• only 5% of blood at any one time is in capillaries
• Histology of Vessels
• walls of arteries and veins consist of three layers:
• a. Tunica Externa
• b. Tunica Media
• c. Tunica Interna
A. Tunica Externa (= T. adventitia)
• outer loose connective tissue
• anchors the vessel and provides passage for small nerves, lymphatic
vessels and smaller blood vessels
• b. Tunica Media
• middle, made mainly of smooth muscle with some elastic tissue and collagen
fibers
• strengthens vessel walls and prevent high pressure from rupturing them
• allows vasodilation and vasoconstriction
• usually the thickest layer, especially in arteries
• c. Tunica Interna (=T. Intima)
• inner endothelium, exposed to blood
• when damaged or inflamed induce platelets or WBC’s to adhere
• → may lead to plaque buildup and atherosclerosis
MYOCARDIUM

• The middle layer of the wall of the heart, forms the bulk and is responsible for the
pumping action of the heart
• 3 types of muscle fibers are present : those that form
Contractile unit of heart
Pacemaker
Conductive system
• A. Muscle fibers which form the contractile unit:
• Striated, central nucleus, muscle protein- actin, myosin, troponin, tropomyosin,
branched fibers
• Intercalated disc- formed by fusion of membrane of the cardiac muscle branch , form
adherens junction which pulls the muscle fibers with one another during contraction
• The individual cardiac muscle cells are interconnected to form branching
fibers, with adjacent cells joined end to end at specialized structures
called intercalated discs
• Two types of membrane junctions are present within an intercalated
disc: desmosomes and gap junctions
• A desmosome, a type of adhering junction that mechanically holds cells
together, is abundant in the heart .
• At intervals along the intercalated disc, the opposing membranes
approach each other closely to form gap junctions, which are areas of
low electrical resistance that allow action potentials to spread from one
cardiac cell to adjacent cells
• Thus the cardiac muscle fibers act like a single unit
• The heart muscle only acts like a physiological syncytium ( tissue in
which there is cytoplasmic continuity) as the muscle fibers are
separated from each other by cell membrane
• The syncytium is divided into that of the atria and that of the ventricle
connected by a thick non conducting fibrous ring called
atrioventricular ring.
• Thus the atria of the heart contract separately from the ventricles
• Circuits of Blood flow (divisions of circulation)
• arteries, capillaries and veins are arranged into two circuits:
• Pulmonary circulation(lesser circulation): heart → lungs → Heart
• Rt ventricle→ pulmonary arteries (trunk) → lungs → pulmonary Veins → left
atrium
• Systemic circulation (greater circulation) : heart → rest of body → heart
• left ventricle → aorta → body(arteries, arterioles → vena cava → rt atrium
• oxygenated blood is supplied from the heart to the tissues and venous blood
returns to the heart from the tissue.
• oxygen deficient blood in pulmonary artery and vena cava
Special Circulation Patterns

• 1. Coronary Circulation (or Cardiac Circulation)

• heart needs an abundant supply of oxygen and nutrients.
• myocardium has its own supply of vessels
• ~5% of blood goes to heart muscle tissue: ~10-x’s its “fair share” based on weight alone
• any interruption of blood flow can cause necrosis within minutes= myocardial infarction
(heart attack)
• R & L Coronary Artery branch from aorta just beyond aortic SL valve
• blood enters when Left Ventricle relaxes(most vessels receive blood when ventricles
contract)
• most blood returns to heart through veins that drain into coronary sinus which empties
into Right Atrium beneath entrance of Inferior Vena Cava
• 2. Circle of Willis
• 7 separate arteries branch from the internal carotids and vertebral arteries
• arterial anastomosis interconnects them to form a circle of connecting arteries at
base of brain
• more than one route for blood to get to brain
• 3. Hepatic Portal System
• veins from spleen, stomach, pancreas,
• Gall bladder, and intestines superior and inferior mesenteric merge to form hepatic
portal vein
• do not take blood directly to vena cava instead take it to liver for “inspection”
• -phagocytic cells remove toxins , vitamins and minerals are stored
INNERVATION OF THE HEART

• Parasympathetic : supplies only the atria

• The right vagus supplies the SA node, the left supplies the AV node
• Sympathetic: supply motor and sensory fibers to the ventricles and atria
• Stimulation increases the rate and force of cardiac contraction and dilates the coronary artery
• Metabolism of the myocardium
• cardiac muscle cells cannot stop contracting to build up glycogen stores for anaerobic
metabolism
• need constant supply of oxygen & nutrients to remain aerobic
• greater dependence on oxygen than skeletal muscles
• have exceptionally large mitochondria comprise 25% of cell volume (vs skeletal mm →2%)
• cells are more adaptable in nutrient use; can use: fatty acids (60 % of energy),Lactate and
glucose -35%,Ketones and amino acids 5%
• The force of contraction refers to inotropic state and changes in the heart rate refer to the
chronotropic characteristics.
• Both characteristics are sensitive to many drugs, which can alter the effects of nerves activity.
• Parasympathetic stimulation
• Acetylcholine has a marked negative inotropic effect on myocardium decreasing contractility.
• ACh also reduces heart rate and makes heart more refractory, and slows conduction through
the heart
• Sympathetic Stimulation
• Norepinephrine and epinephrine increase myocardial contractility, accelerates heart rate,
decrease the refractory period, and shortens the conduction time through the heart.
• Improves synchronous contraction and relaxation of each heart chamber so that maximum
ejection is achieved
PROPERTIES OF CARDIAC MUSCLES
• EXCITABILITY: ability of a living tissue to respond to stimulus
• The response to a stimulus is the development of an action potential.
• MYOCARDIAL ACTION POTENTIAL
• The total duration of the AP in the ventricles is about 250ms against that of 2 -4 ms in nerve or
skeletal tissue
• The resting membrane potential in a single cardiac muscle fiber is -85 to -90 mV
• The ventricular action potential occurs in 4 phases:
• Initial rapid depolarization:
• The resting membrane potential ( RMP) rapidly rises from -90 mV to 0 mV then to +20mV
• This is due to the opening of the voltage gated Na ⁺ channels with a rapid influx of Na ⁺ and some Ca ²⁺
• Initial repolarization:
• Initial rapid depolarization for a short period of 2 msec , represented by a notch
• Due to the transient opening of K ⁺ channel and efflux of a small quantity of K ⁺ from the muscle fiber
• Also, the fast Na ⁺ gates close suddenly and slow Na ⁺ channels open→ slow influx of Na ⁺
Plateau – final depolarization :
Slow Ca ²⁺ channels open for a longer period resulting in influx of large
Ca ²⁺ ions
(slow Na ⁺ channel still open)
Positivity is maintained inside the muscle fiber producing prolonged
depolarization - plateau
Final repolarization:
Efflux of k ⁺ increases and exceeds influx of Ca ²⁺ leading to negativity
within
Restoration of RMP:
At the end of final repolarization, all the Na ⁺ move out of the cell by
the Na ⁺ -K ⁺ pump , also excess Ca ²⁺ is removed by the Na ⁺ –Ca ²⁺
pump
• Refractory period : Period in which the muscle does not show any response to a stimulus
• Absolute refractory period: the muscle does not show any response at all, no matter the
strength of the stimulus.
• It is because depolarization occurs and so another depolarization cannot occur
• Relative refractory period : the muscle shows response if the strength of the stimulus is
increased to a maximum; The muscle is in a repolarizing state
• The cardiac muscle has a long refractory period (0.53 s) ( 0.01s in skeletal muscle)
absolute being 0.27 s ; occurs during cardiac contraction and refractory being 0.26 s
occurs during first half of relaxation period
• Advantages in the long refractory period are: the heart cannot be fatigued or tetanized
unlike skeletal muscle
• A tetanized heart cannot pump blood !
AUTORHYTHMICITY

• Is the ability of a tissue to produce its own impulses regularly

• The heart has a specialized excitatory structure called the pace maker
• The pacemaker is the part of the heart from which impulses are produced normally
• The normal pacemaker is the sinoatrial node( SA node)
• A small strip of modified cardiac tissue located in the superior part of the lateral wall of
right atrium , just below the opening of the SVC
• intrinsic rhythm
• 70-80 beats/min
• initiates stimulus that causes atria to contract (but not ventricles directly due to
separation)
• Other regions can spontaneously generate action potentials : the AV node and the
Purkinje fibers but are suppressed by AP originating in the SA node
Pacemaker potential (PP)

• The action potential ( AP) in the SA node is peculiar and different from that in
other parts of the heart:
• The RMP is lower at -60mV,and unstable as the membrane spontaneously
depolarizes and triggers AP known as pacemaker potentials
• The RMP is not stable , Na⁺ leak in and cause slow depolarization which forms the
initial part of the PP
• Also ,a slow influx of Ca ²⁺ causes further depolarization – later part of the PP
• When the negativity is reduced to – 40 mV,(threshold), the AP starts with rapid
depolarization due to influx of more Ca ²⁺ (not Na ⁺)
• This is followed by repolarization due to the efflux of K⁺
• The slow depolarization starts again leading to development of PP
• Exptl evidences to prove
the SA node is the pacemaker
The Stannius ligature,READ UP
Conducting System
• Conductivity :cardiac muscle cells are not individually innervated as
are skeletal muscle cells
• they are self stimulating
• the rhythmic beating of the heart is coordinated and maintained by
the heart conducting system
• conducting system consists of:
• AV node
• Bundle of His
• Right and Left bundle branches
• Purkinje fibers
• AV Node
• Situated in right posterior portion of the intra atrial septum,
• picks up stimulus from SA Node via some specialized fibers called internodal
fibers
• 3 types:
• anterior internodal fiber of Bachman
• Middle internodal fiber of Wenckebach
• Posterior internodal fiber of Thorel
• if SA Node is not functioning, it can act as a pacemaker = ectopic pacemaker
(usually slower intrinsic rhythm) of 40 – 60beats/min
• Atrioventricular Bundle (Bundle of His)
• Connected to AV node
• Begins at the top of the interventricular septum and descends down
• Divides into the left and right bundle branches, runs under the
endocardium
• takes stimulus from AV Node to ventricles
• Continuous with the Purkinje fibers
• Purkinje Fibers
• takes impulse from AV Bundle out to cardiac muscle fibers of ventricles
causing ventricles to contract simultaneously
 Tissue Conduction r

SA node 0.05

Atrial pathways 1

AV node 0.05
Velocity of Signal Conduction in Cardiac Muscle.
Bundle of His 1
the velocity is maximum in the Purkinje
Purkinje system 4
fibers and least in the SA,AV node(nodal delay)
Ventricular muscle 1
Importance :
• AV delay allows for the atria to contract and empty their contents before the
ventricles contract
• The rapid conduction of the Purkinje fibers enables impulses to reach all parts
of the large ventricular mass immediately
• SA delay prevents re-entry of impulses from the atria to the pacemaker