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Cardiovascular System

The heart is a muscular organ whose function is to generate the force that
propels blood through the blood vessels. The heart contains 4 chambers,
two upper chambers called atria (atrium singular) which receive the blood
that comes back to the heart and 2 lower chambers called ventricles
which receive blood from the atria and generate the force that pushes the
blood away from the heart and through the blood vessels. The heart is
separated into left and right halves: the atrium and ventricle on the left
side of the heart constitute the left heart, whereas the atrium and
ventricle on the right side constitute the right heart. The atria and
ventricles on either side of the heart are separated by a wall called the
septum that prevents blood in the left feart from mixing with blood in the
right heart.
As blood flows away from the heart, the blood vessels branch repeatedly,
becoming more numerous and smaller in diameter, just as the limbs of a
tree become smaller and more numerous as you move from the trunk to
outer branches. When blood leaves the heart, its transported to the
bodys organs and tissues in relatively large vessels called arteries. from
the capillaries, blood moves to larger vessels called venules, which lead to
still larger vessels called veins, which in turn carry blood back to the
heart. The cardiovascular system is a closed system.
The most numerous cells are erythrocytes, also known as red blood cells,
these cells contain haemoglobin, a protein that carries oxygen. The
remainder of the cells are leucocytes, or white blood cells, also present
are platelets. The liquid portion of the blood is called plasma, is made of
water and dissolved proteins and other solutes.

The path of blood flow through the heart and

The right heart supplies blood to the pulmonary circuit, whereas the
left heart supplies blood to the systemic circuit.

The left ventricle pumps oxygenated blood through the aortic valve into
the aorta, a major artery whose branches carry blood to capillary beds of
all organs and tissues in the systemic circuit.
Blood becomes deoxygenated in systemic capillaries and then travels
back to the heart in the venae cavae (singular vena cava) two large veins

that carry blood into the right atrium. The superior vena cava carries
blood from parts of the body above diaphragm, whereas the inferior vena
cava carries blood from parts below the diaphragm.
From the right atrium, blood passes through the tricuspid valve into the
right ventricle
The right ventricle pumps blood through the pulmonary semilunar valve
into the pulmonary trunk, which almost immediately branches into the
pulmonary arteries, which carry deoxygenated blood to the lungs.
Blood becomes oxygenated in the lungs and then travels to the left atrium
in the pulmonary veins. These are the only veins in the body carrying
oxygenated blood.
From the left atrium, blood passes through the bicuspid valve into the left
ventricle, which is where it started. The whole cycle then repeats.
The heart works in parallel with the other organs in the systemic circuit.
Even though the heart pumps a large volume of blood, the blood within
the hearts chambers does not supply the heart muscle with significant
quantities of oxygen or nutrients. Instead, the heart muscle obtains most
of it nourishment from blood via the coronary arteries, which branch off
the aorta near its base and run through the heart muscle.
The parallel arrangement of organs in the systemic circuit confers 2
distinct advantages. First, because each organ is fed by a separate artery,
each receives fully oxygenated blood thats, blood that has not been
depleted of oxygen as a result of having already lowed through another
organ. Second, because blood reaches the organs via parallel paths, blood
flow to the organs can be independently regulated. Thus blood flow can be
adjusted to match the constantly changing metabolic needs of organs.

Myocardium and heart wall

The heart consists of 3 layers: An outer layer of connective tissue
called epicardium, a middle layer of cardiac muscle called the
myocardium, and an inner layer of epithelial cells called
endothelium. The ventricular muscle is substantially thicker than
atrial muscle. This difference reflects the fact that the ventricles
pump blood over relatively long distances through the vasculature
(and not just into the next chamber, as the atria do), so they must
work harder to pump a given volume of blood. The ventricular
muscle is much thicker on the left side than it is on the right side.
The thicker muscle enables the left ventricle to develop greater
pressure than the right ventricle, which is necessary because the

left ventricle pumps blood to all the organs in the body except the
lungs, whereas the right ventricle pumps blood only to the lungs.

Valves and unidirectional blood flow

The heart has four valves that keep blood flowing in the proper
direction within the heart itself and between the heart and the
arteries. the atrium and ventricle on each side are separated by
atrioventricular valves (AV valves), which permit blood to flow from
the atrium to the ventricle but not in the opposite direction.
When atrial pressure is higher than ventricular pressure, the valves
open: when ventricular pressure becomes higher than atrial
pressure, the valves close. The AV valve on the left consists of 2
flaps or cusps of connective tissue, therefore is called the bicuspid
valve: its also known as the mitral valve, because it looks like a
bishops hat. The right AV valve has three cusps and is called the
tricuspid valve. In addition to the AV valves, other valves called
semilunar valves are found between the ventricles and arteries. The
aortic valve is located between the left ventricle and the aorta, and
the pulmonary valve is located between the right ventricle and the
pulmonary trunk.

Electrical activity of the heart

For the heart to adequately pump blood through the circulatory
system, the cardiac muscle must contract in a highly synchronized
manner. The ability of the heart to generate signals that trigger its
contractions on a periodic basis that is, to generate its own rhythm
is called autorhythmicity. 2 types of autorhythmic exist: Pacemaker
cells, which initiate action potentials and establish the heart rhythm,
and conduction fibers, which transmit action potentials through the
heart in a highly coordinated manner. Together, these cells make up
the conduction system of the heart. The cells that generate
contractile force are called contractile cells. Pacemaker cells are
concentrated in 2 specific regions of the myocardium: the sinoatrial
node (SA node) , located in the wall of the upper right atrium near
where it joins with the superior vena cava, and the atrioventricular
node (AV node), localized near the tricuspid valve in the interatrial

Conduction fibers of the myocardium

Conduction fibers are specialized to quickly conduct the action
potentials generated by the pacemaker cells from place to place

through the myocardium, thereby triggering heart muscle

contractions. In the heart gap junctions are concentrated in
structures called intercalated disks. Intercalated disks also contain
large numbers of desmosomes, forming a physical bond between
the disks that resists mechanical stress. This property is important
because it enables the myocardium to resist stretching, which
occurs every time the heart fills with blood, and because it enables
the myocardium to withstand the tension that is generated every
time the muscle cells contract.

1. An action potential is initiated in the SA node. From the SA

node, impulses travel to the AV mode by way of internodal
2. The impulse is conducted to cells of the AV node, which
transmit action potentials less rapidly than other cells of the
conduction system. As a result, the impulse is momentarily
delayed by about 0.1 sec (called the AV nodal delay) before
moving onward.
3. From the AV node, the impulse travels through the
atrioventricular bundle also known as the bundle of His.
4. The signal travels only a short distance through the
atrioventricular bundle before it splits into left and right
bundle branches, which conduct impulses to the left and right
ventricles respectively.
5. From the bundle branches, impulses travel through an
extensive network of branches referred to as Purkinje fibers,
which spread through the ventricular myocardium from the
apex upward toward the valves. From these fibers, impulses
travel through the rest of the myocardial cells.

Control of the heartbeat by pacemakers

The AV node rarely initiates contractions for 2 reasons. First, action
potentials originating in the SA node travel through the AV node on
their way to the ventricles. When this happens, cells in the AV node
go into a refractory period , during which they cannot generate their
own action potentials. Second, the SA node has a higher frequency
of action potentials than the AV node about 70 impulses per
minute for the SA node, as opposed to 50 impulses per minute for

the AV node. However if the SA fails to fire an action potential, the

AV node will initiate action potentials. The AV node can also take
over the control of the heartbeat if conduction between the nodes
becomes blocked or slows down for some reason. If for some reason
the AV node is unable to drive ventricular contraction, the heart has
yet another backup system: certain cells in the Purkinke fibers can
take over.

Electrical activity in pacemaker cells

The slow depolarization or ramps that leads up to each action
potential are referred to as pacemaker potentials. As a membranes
permeability to a particular ion increases relative to that of others
ions, the membrane potential moves toward the equilibrium
potential of that ion. The ions involved are Na+ K+ and Ca2+. The
slow depolarization that occurs in the early stages of the pacemaker
potential is duet to closing of potassium channels and opening of so
called funny channels. Funny channels open after the cell
repolarizes and allow sodium and potassium ions to cross the
plasma membrane. The closing of potassium channels and the
opening of funny channels during the early stages of the pacemaker
potential have a net effect of decreasing potassium movement out
of the cell and increasing sodium movement into the cell, causing
the initial depolarization. However, the initial depolarization triggers
the opening voltage-gated calcium channels called T-typed
channels. The resulting depolarization to threshold triggers the
opening of a second population of voltage-gated calcium channels
called L-type channels. As these calcium channels open, they also
allow some sodium to flow into the cell, which increases PNa and
adds to the depolarization effect.

Electrical activity in cardiac contractile cells

0 Phase 0 depolarization of the membrane triggers the opening
of voltage-gated sodium channels, which raises PNa and increases
the flow of sodium ions into the cell.
1. Phase 1 - the sodium channels that were opened in phase 0
start to become inactivated, which reduces PNa. the closing of
voltage-gated potassium channels which reduces PK and
decreases the flow of potassium out of the cell: and the
opening of L-type calcium channels, which raises PCa and
increases the flow of calcium into the cell. Both of these
changes act to depolarize the membrane , thereby
counteracting the effect of sodium channel inactivation.

2. Phase 2 during phase 2, which is also referred to as the

plateau phase. The PK remains lower than its resting value,
most of the calcium channels that opened in phase 1 remain
open, and PCa remains elevated
3. Phase 3 During this phase PK increases partly, as PK rises, the
flow of potassium out of the cell increases, which pulls the
membrane potential down toward more negative values. PCa is
reduced and flow into the cell decreases as well.
4. Phase 4 during this phase, which corresponds to the resting
potential, PK , PNa , and PCa are at their resting values. Because
PK is much greater than PNa or PCa under these conditions, the
membrane potential is roughly -90 mV, which is close to the
equilibrium potential of potassium

The ECG is a record of the overall spread of electrical current
through the heart as a function of time during the cardiac
cycle. The P wave is an upward deflection that is due to atrial
depolarization. The QRS complex is a series of sharp upward
and downward deflections due to ventricular depolarization; it
is correlated with phase 0of the ventricular contractile cell
action potential. The T wave is an upward deflection caused
by ventricular repolarization; it is correlated with phase 3 of
the ventricular contractile cell action potential.
The P-Q or P-R interval occurs between the onset of the P
wave and the onset of the QRS complex and is an estimate of
the time of conduction through the AV node. The Q-T interval
is the time from the onset of the QRS complex to the end of
the T wave and is an estimate of the time the ventricles are
contracting, called ventricular systole. The R-R interval is the
time between the peaks of two successive QRS complexes; it
represents the time between heartbeats.
Abnormal electrical activity of the heart is called cardiac
arrhythmias. Abnormal SA nodal firing can cause sinus
arrhythmias, including tachycardia, which is abnormally fast
resting heart rate and bradycardia, abnormally slow resting

heart rate. During first degree heart block, conduction through

the AV node is slowed, causing a longer delay in AV nodal
conduction (an increased P-Q interval). During second degree
heart block, conduction through the AV node does not occur,
the ventricles do not depolarize (resulting in the absence of a
QRS complex and T wave) and, therefore do not contract.
During third degree heart block, conduction through the AV
node does not exist at all, causing complete dissociation of
atrial and ventricular contractions.
If the depolarization occurs in the atrium, then premature
atrial contraction (PAC) occurs, and conduction follows through
the AV node, causing contraction of the ventricle. If the
depolarization occurs in ventricle, the premature ventricle
contraction (PVC) occurs, and no atrial contraction precedes it.
PACs and PVCs are generally of little clinical significance
unless they occur at high frequencies.