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The Cardiovascular System

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
Anatomy of the Heart

o In the thoracic cavity within the

o Heart functions:
• Keeps O2-poor blood separate from
O2-rich blood
• Keeps the blood flowing in one
• Creates blood pressure
• Regulates the blood supply
Anatomy of the Heart

o The Wall and Coverings of the Heart

• Pericardium

Two-layered serous membrane that encloses the heart

Visceral pericardium (epicardium) forms the outer surface of
the heart
• Myocardium

Thickest part of heart wall

Made of cardiac muscle
• Endocardium

Inner layer of heart

Composed of simple squamous epithelium
• Pericardial fluid

Secreted by epicardium and parietal pericardium

Reduces friction as the heart beats
• The coverings of the heart:

Protect the heart

Confine it to its location

Prevent it from overfilling
Fig 12.2
Anatomy of the Heart

o Chambers of the Heart

• Right atrium
 Receives O2-poor blood

Vessels that empty into right atrium:
 Superior vena cava
 Inferior vena cava
 Coronary sinus

Venous blood leaves right atrium through the an
atrioventricular (AV) valve (tricuspid)
 Directs the flow of blood
 Prevents backflow
 Has three cusps
• Right ventricle

Chordae tendineae
 Fibrous cords connected to the tricuspid valve
 Connected to the papillary muscle in ventricle

Blood passes through the pulmonary semilunar
valve into the pulmonary trunk
Anatomy of the Heart

• Left atrium
 Receives O2-rich blood

Blood enters atrium through 4 pulmonary

Blood leaves left atrium through an AV
valve (bicuspid or mitral)
• Left ventricle

Forms the apex of the heart

Blood leaves the left ventricle through the
aortic semilunar valve and enters the
Fig 12.3
Anatomy of the Heart

o Operation of the Heart Valves

• AV valves

Normally open

When ventricle contracts
 AV valves shut
 Papillary muscles contract, preventing valve
from reverting into an atrium
• Semilunar valves

Normally closed

Contraction of ventricles forces valves
Anatomy of the Heart

o Heart Sounds
• First sound, "lub"

Heard when ventricles begin to contract

AV valves close

Lasts longer and has a lower pitch
• Second sound, "dup"

When ventricles relax

Semilunar valves close
• Heart murmurs

Due to ineffective, leaky valves

Valves do not close properly

Allows blood to backflow into atria or ventricles
after valves have closed
Anatomy of the Heart

o Coronary Circulation
• Heart cells are not nourished by the blood in
the chambers
• The left and right coronary arteries branch
from the aorta

Coronary arteries branch numerous times

Heart is encircled by small blood vessels
• After blood passes through cardiac
capillaries it enters the cardiac veins
• Cardiac veins enter the coronary sinus
• Coronary sinus enters the right atrium
Fig 12.4
Physiology of the Heart

o Conduction System of the Heart

• Initiates and stimulates contraction of
the atria and ventricles
• Is intrinsic – does not require nervous
• Coordinates contraction of atria and
Physiology of the Heart

• Nodal Tissue

Has muscular and nervous characteristics

SA (sinoatrial) node – upper posterior
wall of the right atrium
 Initiates the heartbeat
 Sends out an excitation impulse every 0.85
 Pacemaker of the heart

AV (atrioventricular) node – base of the
right atrium
 Impulse is delayed
 Signals the ventricles to contract

Atrioventricular bundle (AV bundle)

Purkinje fibers
Fig 12.5
Physiology of the Heart

Artificial pacemaker may be implanted if the SA
node fails to work properly

Heart block – slow beating of the heart due to a
damaged AV node

Ectopic pacemaker
 An area other than the SA node that can become the
 May cause an extra beat
 Caffeine and nicotine can stimulate an ectopic


 Electrolyte changes within the myocardium can be

detected by electrical recording devices
 Helps a physician detect and diagnose the cause of
an irregular heartbeat (arrhythmias)
Physiology of the Heart
• Cardiac Cycle

All events that occur during one heartbeat

Systole – contraction of heart muscle

Diastole – relaxation of heart muscle

Three phases of the cardiac cycle:
 Phase 1: Atrial Systole
- Both atria are in systole
- Ventricles are in diastole
- Both AV valves are open
- The semilunar valves are closed
 Phase 2: Ventricular Systole
- Both ventricles are in systole
- The atria are in diastole
- Semilunar valves are forced open
- Both AV valves are closed
 Phase 3: Atrial and Ventricular Diastole
- Both atria and both ventricles are in diastole
- Both AV valves are open
- The semilunar valves are closed
Fig 12.6
Physiology of the Heart

• Cardiac Output (CO)

Volume of blood pumped out of a ventricle in one

Average CO is 5,250 ml/minute

Dependent on two factors:
 Heart rate
- Beats per minute
- Can be altered by the autonomic nervous system
- Temperature affects the heart rate
- Proper electrolytes are needed to keep the heart
rate regular
 Stroke volume
- Amount of blood pumped by a ventricle each
time it contracts
- Depends on the strength of contraction
- Influenced by blood electrolyte concentration and
the activity of the autonomic nervous system
- Venous return and difference in blood pressure
also affect the strength of contraction
Fig 12.7
Anatomy of Blood Vessels

o Vessels function to:

• Transport blood and its contents
• Carry out gas exchange
• Regulate blood pressure
• Direct blood flow
o Arteries and Arterioles
Anatomy of Blood Vessels

o Arteries and Arterioles

• Transport blood away from the heart
• Thick, strong walls composed of:

Tunica interna - endothelium

Tunica media – smooth muscle and elastic fibers

Tunica externa – outer connective tissue layer
• Elasticity allows an artery to expand and
• Arterioles are small arteries

Constriction and dilation affect blood distribution
and blood pressure

Autonomic nervous system regulates the number
of arterioles that are contracted
Anatomy of Blood Vessels

o Capillaries
• Microscopic blood vessels
• One layer of endothelial cells
• Site of nutrient and gas exchange
• Not all capillary beds are in use at the
same time

Most have a shunt

Precapillary sphincters control the
entrance of blood into capillaries
Fig 12.9
Anatomy of Blood Vessels

o Veins and Venules

• Return blood to the heart
• Venules

Drain blood from the capillaries

Join together to form veins
• Vein walls are thinner than arterial walls
• Valves in veins prevent backward flow of blood
• Varicose veins and phlebitis

Varicose veins
 Abnormal and irregular dilations in superficial veins
 Hemorrhoids are varicose veins in the rectum
 Develop when the valves of the veins become weak

 Inflammation of a vein
 Thromboembolism can occur
Fig 12.8
Physiology of Circulation

o Velocity of Blood Flow

• Slowest in capillaries

Cross-sectional area is at its maximum

Allows time for gas and nutrient exchange
• Blood flow increases as venules
combine to form veins
• Velocity of blood returning to the heart
is low compared to that of blood
leaving the heart
Fig 12.10
Physiology of Circulation

o Blood Pressure
• The force of blood against blood vessel walls
• Highest in the aorta
• Decreases with distance from left ventricle and is lowest
in the venae cavae
• Fluctuates between systolic blood pressure and diastolic
blood pressure
• Mean arterial blood pressure
 Pressure in the arterial system averaged over time
 Equals cardiac output x peripheral resistance
 Increasing CO increases MABP
 Peripheral resistance is the resistance to flow between blood and the
walls of a blood vessel
- The smaller the blood vessel or the longer the blood vessel the
greater the resistance
- The greater the resistance the higher the blood pressure
Fig 12.11
Physiology of Circulation

• Blood pressure and cardiac output

The faster the heart rate the greater the
cardiac output

As cardiac output increases, blood
pressure increases

The larger the stroke volume, the greater
the blood pressure

Stroke volume and heart rate increase
blood pressure only if the venous return is
Physiology of Circulation

Venous return depends on:
 A blood pressure difference
 The skeletal muscle pump and the respiratory
- Contraction of skeletal muscles compress
the walls of veins causing blood to move
past a valve
- During inhalation, thoracic pressure falls
and abdominal pressure rises and blood will
flow from an area of higher pressure to an
area of lower pressure
 Total blood volume
- If blood volume decreases, blood pressure
- If blood volume increases, blood pressure
Fig 12.12
Physiology of Circulation

• Blood pressure and peripheral resistance

Neural regulation of peripheral resistance
 Vasomotor center regulates vasoconstriction
 Also causes blood to be shunted from one area of the
body to another

Hormonal regulation of peripheral resistance
 Epinephrine and norepinephrine increase heart rate and
constrict arterioles
 Renin-angiotensin-aldosterone system
- Angiotensin II constricts the arterioles
- Aldosterone causes the reabsorption of sodium and
water in the kidneys
 Antidiuretic hormone causes the reabsorption of water
and vasoconstriction
 Atrial natriuretic hormone inhibits renin and aldosterone
Fig 12.13
Physiology of Circulation

• Evaluating circulation

 Alternating expansion
and recoil of arterial Fig 12.14
 Can be felt in
superficial arteries
(pulse points)
- Radial artery
- Common carotid
 Pulse rate normally
indicates the rate of
the heartbeat
Physiology of Circulation

Blood pressure
 Usually measured in
brachial artery
 Sphygmomanometer is an
instrument that records
pressure changes Fig 12.15
 The blood pressure cuff is
inflated until no blood flows
through the artery
 Korotkoff sounds
- produced when the
pressure in the cuff is
released and blood
begins to hit the arterial
- Systolic pressure
- When sounds end
diastolic pressure is
Physiology of Circulation

 Normal blood pressure is 120/80

- Higher number is systolic pressure –
pressure recorded when the left ventricle
- Lower number is diastolic pressure –
pressure recorded when the left ventricle
 Hypertension is high blood pressure
- When the systolic pressure is 140 or greater
- When the diastolic pressure is 90 or greater
Circulatory Routes

o Pulmonary circuit
• Blood from the body collects in the
right atrium
• Blood moves into the right ventricle
• Right ventricle pumps blood into the
pulmonary trunk
• Blood flows into the pulmonary
capillaries in the lungs
• Blood flows from the lungs through the
pulmonary veins and into the left
Circulatory Routes

o Congestive Heart Failure

• Damaged left side of the heart fails to pump
adequate blood
• Blood backs up in the pulmonary circuit

Pulmonary blood vessels have become congested

Causes pulmonary edema
• Indicated by shortness of breath, fatigue, and a
constant cough
• Treatment

Diuretics – increase urinary output

Digoxin – increases the heart's contractile force

Dilators – relax blood vessels
Circulatory Routes

o Systemic circuit
• Includes all other arteries and veins of the body
• Aorta and venae cavae are the major pathways
for blood in the systemic circuit

Aorta is the largest artery

Superior and inferior venae cavae are the largest veins
• Begins in the left ventricle
• The left ventricle pumps blood into the aorta
• Branches from the aorta go to the major body
regions and organs
Circulatory Routes

Table 12.1
Fig 12.16
Circulatory Routes

Table 12.2
Fig 12.17
Circulatory Routes

o Special Systemic Circulations

• Hepatic Portal System

Carries venous blood from the stomach, intestines, and
other organs to the liver

Capillaries of the digestive tract empty into the superior
mesenteric and the splenic veins

Superior mesenteric and splenic vein join to form the
hepatic portal vein

Gastric veins empty into the hepatic portal vein

Nutrients and wastes diffuse into liver cells

The hepatic veins drain the liver and enter the inferior
vena cava
Fig 12.18
Circulatory Routes

• Hypothalamus-Hypophyseal Portal
• Blood Supply to the Brain

Anterior and posterior cerebral arteries and
the carotid arteries supply the brain with
arterial blood

Cerebral arterial circle (circle of Willis)
 The blood vessels form a circle
 Provides alternate routes for supplying arterial
blood to the brain
 Equalizes blood pressure in the brain's blood
Fig 12.19
Circulatory Routes

• Fetal Circulation

Four circulatory features do not present in
adult circulation
 Foramen ovale
 Ductus arteriosus
 2 Umbilical arteries, 1 umbilical vein
 Ductus venosus
Fetal Circulation


Site of exchange of oxygen, carbon dioxide
and nutrients, waste material occur in
placenta between fetus and the mother is
placenta ( 2 umbilical arteries, 1 umbilical
vein) by diffusion and active transport

Fetal blood does not mix with maternal

the fetus does not use its lungs (deflated)
and no gaseous exchange occurs
Path of blood in the fetus
 Blood in the umbilical arteries is oxygen poor
 Blood in the umbilical veins is oxygen rich

-Mostly enters the ductus venosus and

some blood to fetal liver
 The ductus venosus then joins with the inferior vena cava
 From the right atrium
- Most blood enters the left atrium via the foramen ovale
- Blood that has entered the right ventricle and then the
pulmonary trunk is shunted to the aorta through the ductus
Fig 12.20
Effects of Aging

o Heart http://file.zhangxiu.com/source/7/5/7/9/7579c443l1GE.mp3

• Grows larger with age

• In many middle-aged people, heart is
covered by a layer of fat
• Number of collagenous fibers in the
endocardium increases
• Valves become thicker and more rigid
• The myocardium loses contractile power
and ability to relax
• Resting heart rate decrease
Effects of Aging

o Arteries
• Atherosclerosis and arteriosclerosis are
• Chances of coronary thrombosis and
heart attack increase
• Occurrence of varicose veins increases


Pulmonary embolism

o Maintaining blood composition, pH, and

• Growth factors regulate the manufacture of formed
elements in the red bone marrow
• The digestive system absorbs nutrients into the blood
• The lungs and kidneys remove metabolic wastes from
the blood
• The kidneys help maintain the pH of blood
• The blood distributes heat
• Blood vessels in the skin dilate or constrict in response
to changing temperatures

o Maintaining blood pressure

• Sensory receptors within the aortic arch
detect a decrease in blood pressure
• The lymphatic system collects excess
tissue fluid, which helps regulate blood
volume and pressure
• The endocrine and nervous systems work
together to regulate blood pressure
• Venous return is aided by the muscular
and respiratory systems
The Lymphatic System
and Body Defenses

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
Lymphatic System
o Three main functions
• Fluid balance
• Fat absorption
• Defense
o Lymphatic vessels
• Form a one-way system
• Begins with lymphatic capillaries

Tiny, closed-ended vessels

Take up excess tissue fluid (lymph)
• Vessels merge and then enter one of two ducts:

Thoracic duct

Right lymphatic duct
• Vessels have valves and movement of lymph depends on
skeletal muscle contraction
• Edema is localized swelling caused by the accumulation of
Fig 13.1
Organs, Tissues, and Cells of the
Immune System
o Primary Lymphatic Organs
• Lymphocytes originate and/or mature in
these organs
• Red Bone Marrow

Site of stem cells that produce blood cells

In an adult, red bone marrow is found in:
 Sternum
 Vertebrae
 Ribs
 Skull
 Part of the pelvic girdle
 Proximal heads of the humerus and femur

Lymphocytes differentiate into B and T
 B lymphocytes mature in the red bone marrow
 T lymphocytes mature in the thymus
Organs, Tissues, and Cells of the
Immune System
• Thymus Gland

In the thoracic cavity

Largest in children and shrinks as a
person ages

Lobules are filled with lymphocytes

Produces thymic hormones
 Aids in maturation of T lymphocytes
 May have other functions in immunity

Critical to immunity
Fig 13.2
Fig 13.3
Organs, Tissues, and Cells of the
Immune System
o Secondary Lymphatic Organs
• Places where lymphocytes encounter and
bind with antigens
• Spleen

Largest lymphatic organ

Consists of two types of tissue:
 White pulp – has a concentration of lymphocytes
 Red pulp – surrounds venous sinuses and is involved
in filtering blood

Blood entering the spleen is filtered through
venous sinuses
 Lymphocytes and macrophages react to pathogens
 Macrophages engulf debris and remove old red blood
Organs, Tissues, and Cells of the
Immune System
• Lymph nodes

Small structures occurring along lymphatic vessels

Connective tissue
 Forms a capsule
 Divides node into compartments
- Contains nodules packed with B lymphocytes
- Sinus that contains T lymphocytes

Lymph passing through the sinus is filtered by

T lymphocytes fight infection and attack cancer
• Lymphatic nodules

Concentrations of lymphatic tissue not surrounded
by a capsule


Peyer patches

Nonspecific and Specific Defenses

o Nonspecific Defenses
• Barriers to entry

 Intact skin
 Mucous membranes

 Sebaceous gland secretions
 Lysozyme in perspiration, saliva, and tears
 Urine
 pH of the stomach
 Normal flora
Nonspecific and Specific Defenses

• Inflammatory reaction

Four signs:
 Redness
 Heat
 Swelling
 Pain

Chemical mediators cause capillaries to dilate and
become more permeable
 Excess blood causes redness and increased
 Fluids and proteins escape the capillaries and cause
swelling and clot formation

Migration of phagocytes

Chronic inflammation is treated with anti-
inflammatory agents
Fig 13.4
Nonspecific and Specific Defenses

• Natural killer cells

Kill virus-infected cells and tumor cells

Large, granular lymphocytes

No specificity and no memory
• Protective proteins

 Composed of blood plasma proteins
 Activated when pathogens enter the body
 Amplify the inflammatory response
 Bind to the surface of pathogens, ensuring that they
will be phagocytized
 Form a membrane attack complex that punches
holes in the walls and membranes of bacteria

 Produced by virus-infected cells
 Produce substances that interfere with viral
Nonspecific and Specific Defenses

o Specific Defenses
• Respond to antigens
• Lymphocytes have antigen receptors

B lymphocytes
 Mature in the bone marrow
 Give rise to plasma cells that produce

T lymphocytes
 Mature in the thymus gland
 Directly attack cells that have nonself proteins
or regulate the immune response
Nonspecific and Specific Defenses

o B cells and Antibody-mediated

immunity (humoral immunity)
• When B cells encounter an antigen they are
activated to divide many times

Plasma cells – mature B cell that produces

 Most mature to form plasma cells
 Some become memory cells
- Make long-term immunity possible
- A second exposure to the same antigen produces
a stronger, faster immune response
• Plasma cells undergo apoptosis when an
infection has passed
Fig 13.5
Nonspecific and Specific Defenses

o Structure of Antibodies
• Basic unit is a Y-shaped protein molecule with two

"heavy" polypeptide chain

"light" polypeptide chain
• Chains have constant regions at the trunk of the Y
• The class of antibody is determined by the structure
of the constant region
• Monomers – single Y-shaped molecules
• Dimers – paired Y-shaped molecules
• Pentamers – clusters of 5 Y-shaped molecules linked
o Function of Antibodies
• Neutralization
• Forming immune complexes
Fig 13.6
Nonspecific and Specific Defenses

Table 13.1
Nonspecific and Specific Defenses

o T Cells and Cell-Mediated Immunity

• Antigen must be presented to T cells by an
antigen-presenting cell
• Major histocompatability (MHC) proteins

Called HLA (human leukocyte antigens)

Are self proteins
• T cell compares the antigen and the self

Activated T cell and all daughter cells can
recognize "foreign" from "self"

Will destroy cells carrying foreign antigens
• Activated T cells produce cytokines that
stimulate various immune cells to perform
their functions
Fig 13.7
Nonspecific and Specific Defenses

o Types of T Cells
• Cytotoxic T cells

Destruction of virus-infected or cancer

Have storage vacuoles containing Perforin

Responsible for cell-mediated immunity
• Helper T cells regulate immunity by
secreting cytokines
Fig 13.8
Nonspecific and Specific Defenses

o Cytokines in Cancer Chemotherapy

• Used as immunotherapeutic drugs
• Interferon and interleukins are also
used as immunotherapeutic drugs
Induced Immunity

o Active Immunity
• Often develops naturally
• Immunization

Involves the use of vaccines

After the first exposure, a primary
response occurs

A second exposure ("booster") produces a
secondary response
• Depends on the presence of memory
• Usually long-lasting
Induced Immunity

o Passive Immunity
• Occurs when an individual is given
prepared antibodies
• Is temporary
• Can be used in the event of an
unexpected exposure to an infectious
Induced Immunity

o Monoclonal Antibodies
• Every plasma cell derived from the
same B cell
• Secretes antibodies against one
• Can be produced in vitro
• Are being used for quick and certain
diagnosis of various conditions
• Used to carry radioactive isotopes or
toxic drugs to tumors
Fig 13.11
Induced Immunity

o Hypersensitivity Reactions
• Allergies

Response to substances that are harmless
to the body (allergens)

Type I, II, III, IV
Allergic Reactions
Immune attacks against nonharmful substances
that can damage tissues
IgE-Mediated Allergic Response (Type I)
 Immediate allergic response (within seconds of contact
with an allergen)
 Caused by IgE antibodies
 IgE antibodies are attached to the plasma membrane of
mast cells in the tissues and basophils in the blood
 When an allergen attaches to the IgE antibodies,
histamine is released
 E.g. hay fever, asthma
 Anaphylactic shock occurs when the allergen has entered
the blood stream. This causes drop in blood pressure due
to increased blood vessel dilation and permeability of
the capillaries. E.g. bee stings, penicillin shots
T-Cell Mediated Allergic Response
(Type IV)
 Initiated by memory T-cells at the site of
allergen contact
 Delayed allergic responses, developed more
slowly than Ig-E regulated responses
 Regulated by cytokines secreted by T cells and
 E.g. skin test of tuberculosis, contact dermatitis
such as cosmetics, jewelry, poison ivy.
Induced Immunity

• Tissue Rejection

Transplanted tissue is recognized as not

Cytotoxic T cells cause disintegration of
the transplanted tissue

Can be controlled by:
 Selecting organs that have the same type of
HLA antigens as those of the recipient
 Administering immunosuppressive drugs
Induced Immunity

• Autoimmune Diseases

Cytotoxic T cells or antibodies attack the
body's own cells

Cause is unknown

 Myasthenia gravis
 Multiple sclerosis
 Systemic lupus erythematosus
 Rheumatoid arthritis

No cures, but can be managed with
Induced Immunity

• Immune Deficiency

The immune system is unable to protect
the body from disease

Can be acquired or genetic

Without treatment, common infections
can be fatal
Effects of Aging

o Aging people become more

susceptible to infections and
o Thymus gland degenerates and
number of T cells decreases
o B cells sometimes do not form
o Incidence of autoimmune diseases
o Response to vaccines is decreased

o The lymphatic system helps the following:

• The digestive system by absorbing fat
• The cardiovascular system by absorbing lymph
• The immune system in protection against infectious
o Nonspecific immune responses are dependent
• The skin
• Mucous membranes of the respiratory tract, the
digestive tract, the reproductive and urinary systems
o Specific defenses are dependent on blood cells
o There is a strong connection between the
immune, nervous, and endocrine systems
CC2418 Human Biology

Week 5 Open book

Individual Assessment
Open book Individual
o Date: 25 Feb 2010 (Week 5 Thurs)
o Time: 6:45 to 7:45pm
o Venue: To be confirmed in Moodle in
week 5 with seating plans
o 30% of continuous assessment
o No make-up test will be given to
absentees without prior notification
with justifiable reasons.
Preparation for the test

o Students SHOULD download and

pre- read the suggested reading
materials to ensure you have
enough time to do the test paper
although it is an open-book
Suggested reading materials

o Lecture notes and textbook (cardiovascular system)

o Journals:
• Prystowsky, "Should atrial fibrillation ablation be considered
first-line therapy for some patients?" Circulation
2005;112:1214-1231, p. 1228.
o Websites:
• Please read about:

How the heart work

Atrial fibrillation
• National Heart Lung and Blood Institute

• Medline Plus


o An arrhythmia is a problem with the

rate or the rhythm of the heartbeat
o The heart can beat too fast, too slow,
or with an irregular rhythm
o Different types of the arrhythmias:
• Atria
• Superventricular (atria or AV node)
• Ventricles

o Atrial fibrillation is the most

common type of arrhythmia
o Please read the suggested
materials for the information