CARDIO NOTES- MGSOTELO

The Circulatory System

 The Circulatory System is responsible for transporting materials throughout the entire body.
 It transports nutrients, water, and oxygen to your billions of body cells and carries away wastes such as
carbon dioxide that body cells produce.
 It is an amazing highway that travels through your entire body connecting all your body cells.

Circulatory System Components

Heart
Blood
Vessels – Arteries, Veins, Capillaries

Circulatory System
The circulatory system carries two types of blood
Arrangement of the circulatory system means that these two types of blood do not mix.
The inside of the heart is divided into two sections so that the two types of blood (oxygen-rich and oxygen-
poor) are kept apart
The heart is the organ at the center of the circulatory system. It pumps blood around the body.

MYOCARDIAL THICKNESS AND FUNCTION

ATRIA : thin walled
VENTRICLES :thick walled
LEFT VENTRICLE IS THICKER THAN THE RIGHT VENTRICLE.
The Heart: Structures
Heart coverings
Pericardium -Covers the heart and large blood vessels attached to the heart
Visceral pericardium - Innermost layer, directly on the heart
Parietal pericardium - Layer on top of the visceral pericardium
Epicardium - Outermost layer, fat to cushion heart
Myocardium - Middle layer, primarily cardiac muscle
Endocardium - Innermost layer, thin and smooth, stretches as the heart pumps
Myocardium- The muscle of the heart, strong and thick
Composed of spontaneously contracting cardiac muscle fibers
Can conduct electricity like nerves.
It’s blood supply comes from the coronary arteries.
 The right and left sides of the heart are separated by a septum, or wall.
 The septum prevents the mixing of oxygen rich and oxygen poor blood.
 On each side of the septum are two chambers.
 The upper chamber (receives blood) is the atrium.
 The lower chamber (pumps blood out of heart) is the ventricle.

Four chambers
Two Atria
• Upper chambers
• Left and right
• Separated by interatrial septum

Two Ventricles
• Lower chambers
 • Left and right
• Separated by interventricular septum
 The chambers of the heart have different functions:
 he valves between the atria and ventricles are connected to the inner walls of the heart by tough tendons.
 The tendons allow the valves to close and hold the valve flaps in place. They prevent the valves from flipping
up and turning inside out
 A valve acts like a door that only opens in one direction.
 If the door is held by someone at a fixed point, only the arm moves as the door opens and closes.
 When the door is closed the arm is fully extended, so the door can only be opened in one direction.
 A valve acts like a door that only opens in one direction.
 In the heart, the tendons holding the valve are like the arm holding the door.
 One end of each tendon is fixed to the wall of the heart and so the valve can only open in one direction.

How does the heart pump blood?

The heart can pump blood because it is made of muscle. Muscle tissue works by contracting (squeezing) and
relaxing.
All the parts of the heart on either side, work together in a repeated sequence.
The two atria contract and relax; then the two ventricles contract and relax.
This is how blood moves through the heart and is pumped to the lungs and the body.
One complete sequence of contraction and relaxation is called a heartbeat.

HEART VALVES AND CIRCULATION OF BLOOD

ATRIOVENTRICULAR & SEMILUNAR VALVES
SYSTEMIC AND PULMONARY CIRCULATION
LEFT SIDE IS A PUMP TO THE SYSTEMIC CIRCULATION.
RIGHT SIDE IS A PUMP TO THE PULMONARY CIRCULATION.

Pathway of Blood Through the Heart and Lungs

Right atrium  tricuspid valve  right ventricle
Right ventricle  pulmonary semilunar valve  pulmonary arteries  lungs
Lungs  pulmonary veins  left atrium
Left atrium  bicuspid valve  left ventricle
Left ventricle  aortic semilunar valve  aorta
Aorta  systemic circulation

Coronary Circulation
Coronary circulation is the functional blood supply to the heart muscle itself
Collateral routes ensure blood delivery to heart even if major vessels are occluded
Coronary Circulation: Arterial Supply
Coronary Circulation: Venous Supply

The conduction system

Inherent and rhythmical beat is due to autorhythmic fibers of the cardiac muscle.
These fibers have 2 important function:
- act as pace maker
- form the conduction system

SA Node Would Initiates Action Potential About Every 0.6 sec or 100 Times/min
The Autonomic Nervous System Alters the Strength and Timing of Heart Beats.

PHYSIOLOGIC CHARACTERISTICS OF THE CONDUCTION CELLS

 Automaticity
  Excitability
 Conductivity
 Rhythmicity
 Contractility
 Tonicity

CARDIAC CYCLE
ATRIAL SYSTOLE
Lasts for 0.1 sec
Atrial Depolarization Causes Atrial Systole
It Contributes a final 25mL of Blood to each VENTRICLE
End of Atrial Systole is also end of Ventricular DIASTOLE
End-Diastolic Volume is 130 mL

VENTRICULAR SYSTOLE
Lasts for 0.3 seconds
It is caused by VENTRICULAR DEPOLARIZATION
Isovolumetric Contraction lasts for 0.05 seconds when both the SEMILUNAR and ATRIOVENTRICULAR VALVES
are closed.
The semilunar valves (sl) open when:
-the left ventricular pressures surpasses aortic pressure(80 mm of mercury)
-the right ventricular pressure rises above pulmonary pressure (20 mmhg)
- sl valves open for 0.25 sec

The left ventricle ejects about 70 ml into the aorta

The right ventricle ejects the same volume into the pulmonary trunk.
End systolic volume is 60ml in each ventricle .

RELAXATION PERIOD
Both atria and ventricles are relaxed. It lasts for 0.4 sec.
When heart beats faster, the relaxation time shortens.
Ventricular repolarization causes ventricular diastole.

HEART SOUNDS
Produced from blood turbulence caused by closing of heart valves
S1 – atrioventricular valve closure
S2 – semilunar valve closure
S3 – rapid ventricular filling
S4 – atrial systole

CARDIAC OUTPUT (CO) = SV X HR

FOR A RESTING ADULT

CO = 70mL/beat x75beats/min
= 5250 mL/min
= 5.25 L/min
Stroke volume = End Diastolic Vol- End Systolic Volume
- volume of blood pumped from the left ventricle per beat

REGULATION OF STROKE VOLUME

Three factors regulate stroke volume
-preload
-contractility
 -afterload
PRELOAD
Stretch of cardiac muscle prior to contraction.
Frank-starling law
Preload is proportional to end diastolic volume
If HR is more than 160 beats/min stroke volume declines due to short filling time.

Frank-Starling Law of the Heart

Preload, or degree of stretch, of cardiac muscle cells before they contract is the critical factor controlling stroke
volume.
Slow heartbeat and exercise increase venous return to the heart, increasing SV.
Blood loss and extremely rapid heartbeat decrease SV
CONTRACTILITY
It is the strength of contraction at any given preload.
Positive and negative ionotropic.
Stimulation of sympathetic division of and leads to positive ionotropic effect
Inhibition of sympathetic division of and leads to negative ionotropic effect
AFTERLOAD
The pressure that must be overcome before a semilunar valve can open is termed the afterload.
Increase in afterload cause decrease in stroke volume
Hypertension and atherosclerosis increases the afterload.

REGULATION OF HEART RATE

Sa node initiates 100 beats/min if left to itself.
Tissue require different volume of blood flow under different conditions(ex: exercise)
Ans and hormones of adrenal medulla are important in regulating the heart rate.

AUTONOMIC REGULATION OF HEART RATE

 Input to cardiovascular center
 sympathetic neurons extend from medulla oblongata
 the spinal cord (thoracic region)
 nor-epinephrine - has 2 effects
-in SA node, speeds the rate of spontaneous depolarization
-in AV node, increases contractility
-increases stroke volume
PARASYMPATHETIC EFFECT
 parasympathetic nerve reaches the heart via left vagus (x) nerves
 they release acetyl choline, which decreases the heart rate
 at rest parasympathetic stimulation predominates

CHEMICAL REGULATION OF HEART RATE

Hormones: epinephrine and norepinephrine, thyroid hormone also increases heart rate
Cations: elevated k+ and na+ decreases heart rate, moderate increase in interstitial ca+ levels speeds heart rate.

OTHER FACTORS IN HEART RATE REGULATION

Age
Gender physical fitness
Body temperature
Age-related changes affecting the heart
Sclerosis and thickening of valve flaps
Decline in cardiac reserve
Fibrosis of cardiac muscle
Atherosclerosis
STRUCTURE AND FUNCTIONS OF BLOOD VESSELS

Blood
How much blood do we contain?
 On average 4-6 liters
 We contain about a pint of blood for every 15 pounds of body weight
Composition of Blood:
Composed of plasma (55%) and blood cells (45%)
Types of Cells are: Red Blood Cells, White Blood Cells, Platelets
Plasma proteins
3 Types: Albumins, globulins and fibrinogen.
Albumins and Globulins- transport substances such as fatty acids, hormones and vitamins.
Fibrinogen- Responsible for blood’s ability to clot

Red Blood Cells

o Most numerous type
o Transport oxygen
o Get color from hemoglobin
o Disk shaped
o Made in red bone marrow
o Circulate for 120 days

White Blood Cells

 Guard against infection, fight parasites, and attack bacteria
 Number of WBC’s increases when body is fighting
 Lymphocytes produce antibodies which fight pathogens and remember them
Platelets
 Aid the body in clotting
 Small fragments
 Stick to edges of broken blood cell and secrete clotting factor to help form clot.

Blood Vessels
As blood moves through the circulatory system it moves through 3 types of blood vessels:
Arteries: Carry blood away from the heart.
Capillaries: Link arterioles to veins.
Veins: Carry blood towards the heart

Arteries
Large vessels
Carry blood from heart to tissues of body.
Carry oxygen rich blood, with the exception of pulmonary arteries.
Thick walls-need to withstand pressure produced when heart pushes blood into them.
Veins
Once blood has passed through the capillary systems it must be returned to the heart. Done by veins
Walls contains connective tissue and smooth muscle.
Largest veins contain one-way valves that keep blood flowing toward heart.
Many found near skeletal muscles. When muscles contract, blood is forced through veins.
Blood has 3 main Functions
 Transport
 Protection
 Temperature Regulation
BODY CONTAINS THREE KINDS OF CAPILLARIES

Continuous- lung, smooth muscle, connective tissues

Fenestrated- kidney, small intestine, brain
Sinusoids- liver, red bone marrow, spleen and endocrine glands

BLOOD DISTRIBUTION IN THE CARDIOVASCULAR SYSTEM

Pulmonary vessels - 9%
Heart – 7%
Systemic arteries and arterioles
Systemic capillaries – 7%
Systemic veins and venules – 64%

CONTROL OF BLOOD PRESSURE AND BLOOD FLOW

Blood Pressure
The heart produces pressure

The force of blood on the wall of the arteries is known as blood pressure.

Blood pressure decreases as the heart relaxes, but the rest of the circulatory system is still under pressure.

When blood pressure is taken, the cuff is wrapped around the upper portion of the arm and pumped with air
until blood flow in the artery is blocked.

As the pressure in the cuff is relaxed, 2 numbers are recorded.

– Systolic pressure- the first number taken, is the force felt in the arteries when the ventricles contract.

– Diastolic pressure- the second number taken, is the force of the blood on the arteries when the
ventricles relax.
During systemic circulation, blood pressure falls as the distance from the left ventricle increases
In arterioles and arteries – 35 mm hg
In venous end of capillaries– 16mm hg
When blood flow in rt. ventricle – 0 mmhg

HEMODYNAMIC AFFECTING BLOOD FLOW

BLOOD PRESSURE
RESISTANCE
VENOUS RETURN
What is MAP (Mean Arterial Pressure)? Short Rule: 123 = ( 1 diastolic pressure+ 2 diastolic pressure / 3)

VASCULAR RESISTANCE
It is the oppostion to blood flow due to friction between blood and the walls of blood vessels.

VASCULAR RESISTANCE DEPENDS ON

 size of the lumen- resistance is inversely propotional to 1/diameter
 blood viscosity
 total blood vessel length

VENOUS RETURN
Depends on:
Heart contraction
Pressure in the right atrium
 besides this: it is affected by: skeletal muscle pump, respiratory pump

VELOCITY OF BLOOD FLOW

 Velocity is inversely proportional to cross sectional area.
 Velocity decreases as it proceeds from arteries, arterioles, capillaries
 Velocity increases as it proceeds from venules, veins.
 This allows exchange of materials in the capillaries.

ROLE OF CARDIOVASCULAR CENTER

PROPRIORECEPTORS - a sensory receptor that receives stimuli from within the body, especially one that
responds to position and movement.
Baroreceptors
Chemoreceptors

NEURAL REGULATION 0F BLOOD PRESSURE

Baroreceptors
Chemoreceptors

BARORECEPTORS
Pressure sensitive located in the aorta, internal carotid and other large arteries.
2 important baroreceptor reflex are
- carotid sinus reflex
- aortic reflex

CHEMORECEPTOR REFLEX
Present close to the:
baroreceptors of carotid sinus and arch of aorta
they are called carotid bodies and aortic bodies.

HORMONAL REGULATION OF BLOOD PRESSURE

Renin angiotensin-aldosterone mechanism
Epinephrine and nor epinephrine
Antidiuretic hormone
Atrial natriuretic peptide

AUTOREGULATION OF BLOOD PRESSURE

Ability of tissue to automatically adjust its blood flow to match its metabolic demand is called autoregulation.
Mainly during exercise.

TWO TYPE OF STIMULI CAUSES AUTOREGULATORY CHANGES PHYSICALLY

- physical change
- vasodilating and vasoconstricting
- chemicals

PHYSICAL CHANGES
Warming and cooling causes vasodilation and vasoconstriction.
Smooth muscle in arteriole exhibit myogenic response
VASODILATING AND VASOCONSTRICTING CHEMICALS

Several cells release a wide variety of chemicals that alter the blood vessel diameter
Vasodilators - k+, h+, lactic acid and adenosine
Vasoconstrictors – thrombaxane a2 , serotonin and endothelins