Physiology of

the
Cardiovascular System-CVS

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 FUNCTIONS OF THE CVS
1. Convective (mass movement of fluid caused by pressure
gradient) transport of O2, nutrients, water, hormones,
electrolytes, and drugs
2. Rapid washout of metabolic wastes
3. Control function relating to distribution of hormones to
tissues and secretion of some hormones like atrial
natriuretic peptide(ANP)
4. Contribution to regulation of temperature and blood flow
5. Vital role in reproduction - hydraulic mechanism for penile
erection
6. Contribution to defense mechanisms by delivering
antibodies, platelets and leucocytes to affected areas of the
body.
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 Components of the CVS

CVS composed of
Heart: Pumping centre
Blood vessels
Arteries: Distributing system
Capillaries: Exchange system
Veins: Collecting system

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 ARTERIES (LOW COMPLIANCE)
HEART

DIASTOLE
High
VEINS Compliance

80 mmHg 120 mmHg

CAPACITY
VESSELS Low
Pressure

SYSTOLE

CAPILLARIES
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 Division of the Circulation
In the CVS, blood passes through two (double) circulations:
Systemic circulation
Pulmonary circulation
Systemic circulation:
Starts in the LV Aorta Systemic arteries Systemic
capillaries Veins SVC & IVC ends in RA
Pulmonary circulation:
Starts in the RVPulmonary trunk Pulmonary arteries
Pulmonary capillaries Pulmonary veins ends in the LA.
LA=left atrium
LV=left ventricle, SVC=superior vena cava
IVC=inferior vena cava

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Pathway of Blood Through the Heart and Lungs

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PULMONARY
CIRCULATION
1. LOW RESISTANCE
2. LOW PRESSURE
(25/10 mmHg)

SYSTEMIC
CIRCULATION
1. HIGH RESISTANCE
2. HIGH PRESSURE
(120/80 mmHg)
PARALLEL
SUBCIRCUITS

UNIDIRECTIONAL
FLOW 7
 The Heart
Heart is the hollow, muscular
organ that plays a central
pumping role
Vertically divided into left &
right sides by a structure
called septum
Composed of 4-chambers: 2
atria and 2 ventricles
Has 4 valves: 2 AV valves
(TCV &BCV) and 2 SLV
(PV &AV)
Size: Approximately
equivalent to clenched fist
Weight: 280 to 320 grams in
average adults
Located in the midiastenum 8
Pathway of Blood Through the Heart and Lungs
Right atrium tricuspid valve right ventricle
pulmonary semilunar valve pulmonary arteries lungs
pulmonary veins left atrium bicuspid valve left
ventricle aortic semilunar valve aorta systemic
circulation

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 Histology of the heart
Heart is made up of 3 distinct
layers:
1 - Endocardium - innermost
layer; epithelial tissue that
lines the entire circulatory
system
2 - Myocardium - thickest layer;
consists of cardiac muscle
cells
3 - Epicardium - thin, external
membrane around the heart

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 Cardiac muscle (myocardium)
The is composed of 3 types of cardiac muscles
1. The atrial muscle
2. The ventricular muscle
3. The specialized excitatory and conductive muscle fibres
(Autorhythmic Cells)
Atrial and ventricular muscles are contractile components
(Contain too many actin & myosin)
The atrial and the ventricular muscles are separated by the
fibrous skeleton of the heart
Function: -form cardiac valves
-serve as a means of attachment and
insertion of cardiac muscles
Specialized excitatory muscle are weakly contractile but
qualified for autorhythmicity.

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 Cardiac muscle
Cardiac muscle cells are
striated, mono-nucleated and
branched, connecting to each
other through intercalated
disks that include gap
junctions, for chemical and
electrical communication.
Cardiac muscle has many
mitochondria and utilizes
most of the O2

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Striated (consists of sarcomeres
just like skeletal muscle) Cardiac muscle
Cells contain numerous
mitochondria (up to 40% of
cell volume)
Adjacent cells join end-to-end by
structures called intercalated
discs
Intercalated discs contain two
types of specialized junctions:
(a) Desmosomes (which act
like rivets & hold the cells
tightly together) and
(b) Gap junctions (which
permit action potentials to
easily spread from one
cardiac muscle cell to
adjacent cells)
Cardiac muscle tissue forms 2
functional syncytia or units:
(a) The atria syncytium & 13
(b) The ventricles syncytium
 Cardiac muscle
T-tubules, larger than
in skeletal muscle,
are aligned with Z-
disks (one per
sarcomere).
SR is juxtaposed
with T-tubules at
very small terminal
bulbs, rather than
large cisternae.

SR is thin with much

smaller volume than muscle
skeletal SR
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 Properties of cardiac muscles
Cardiac muscles have 4 physiological properties, which are
essential for the function of the heart as the central pumping
organ.
These are
Autorythmicity
Excitability
Conductivity
Contractility

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 Autorhythmicity

Autorhythmicity is the ability of the heart to generate

cardiac impulse and to beat regularly independent of any
external stimulus.
The heart is provided with specialized excitatory and
conductive muscle systems having two functions:
1. They generate rhythmic cardiac impulse
2. They conduct cardiac impulse

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Specialized excitatory and conductive system of the heart
1. Sino-atrial node (SA-node): in which the normal
rhythmical self-excitatory impulse is generated
2. Internodal pathways: conduct impulse from the SA-node
to the Atrioventricular node (AV-node)
3. AV-node: in which impulse from the atria delayed to be
conducted to the ventricle. Site of nodal delay.
4. Atrioventricular bundle (bundle of His): which conducts
impulse from the atria to the ventricle.
5. Purkinje fibers: conduct cardiac impulse to the ventricles.

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 Specialized excitatory and conductive system of the heart

Various automatic cells

have different
'rhythms':
SA node: 80 - 120 per
minute (usually 70 - 80
per minute)
AV node, AV bundle:
40 - 60 per minute
Bundle branches &
Purkinje fibers: 20 -
40 per minute.

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19
 Innervation of the Heart
Heart has dual autonomic
innervation from both SNS and
PNS with afferent and efferent
components.
The sympathetic nerve supply
to the heart is controlled by the
medullary vasoconstrictor/
cardio accelerator center
Preganglionic sympathetic
fibers arise from the lateral
horn of the upper 5-thoracic
spinal segments
Postganglionic sympathetic
fibers arise from the cervical
and thoracic ganglia and
proceed to supply atria,
ventricles and nodal areas
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 Innervation of the heart.... contd
The parasympathetic nerve supply to the heart is controlled
by the vasodilator/ cardio inhibitor center.
Preganglionic parasympathetic fibers arise from cardio
inhibitory center in the medulla and proceed as vagal fibers
to relay in terminal ganglia in the wall of the atria
Short postganglionic fibers arise from terminal ganglia and
supply the atria, SA-node and the AV-node
The right vagus has a strong influence on SA node, while
the left vagus has dominant effect on AV node
Ventricles are not supplied by vagus nerve
Afferent cardiac nerves
Pain receptors Visceral afferent fibers
Stretch receptors
Chemo receptors Sympathetic/vagus 21
 Electrophysiology of the heart
Phases and ionic basis of
myocardial action potential PCl
It has the following phases
Phase-0: Rapid depolarization
Caused by rapid Na-influx
Phase-1: Early brief repolarization
Caused by Cl- influx
Phase-2: The plateau (prolonged
depolarization) RMP = -90 mv
Caused by Ca2+influx via L-
channels
Phase-3: Repolarization
Caused by K+ efflux Action potential of the ventricular muscle
Phase-4: complete repolarization Refractory period of AP of
RMP re-established ventricular muscle
Caused by Na+-K+-ATPase 22
Excitation-contraction coupling in cardiac muscle

It is a mechanism by which an action potential causes

contraction of myocardium.
It has the following sequences
Auto-rhythmicity Membrane depolarization T-
tubule depolarization Release of Ca2+ from SR +
from T-tubule (ECF) Ca2+ activates contractile
molecules Sliding of filaments Contraction
The action potential of cardiac muscle has a prolonged
refractory period.
Advantage: prevents tetanic contraction of the heart
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Ca2+ signaling in cardiac muscle
Affected by epinephrine () and ACh ()
Inhibited by digitalis &
1 Ca2+ out
Entry of Ca2+ during for 3 Na+ in
ouabain; indirectly
action potential Na+/Ca2+ inside

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Velocity of conduction of AP in cardiac muscles
Structures Conduction velocity
(m/s)
SA-node 0.05
Internodal fibers 1.0

Atrial muscle 0.3

AV-node 0.05
AV-bundle 1.0
Purkinje fibres 4.0
Ventricular 1.0
muscles
*AV nodal delay allows the atria to pump blood to
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ventricles before ventricular depolarization
 Important terms
Ventricular volumes: The volume of blood in the ventricles
Ventricular end diastolic volume (VEDV): The volume of blood
in the ventricle at the end of ventricular diastole (relaxation
phase)
EDV = 120-140 ml
Ventricular end systolic volume (VESV): The volume of blood
that remains in the ventricle at the end of ventricular systole
(contraction phase).
VESV = 50-60 ml
Stroke volume (SV): the volume of blood ejected from the
ventricle during ventricular systole.
(stroke volume) SV = VEDV VESV, 70 80 ml
Cardiac output: the volume of blood ejected from the heart per
minute. CO = SV x HR =5-6 L/min
Ejection fraction: the blood proportion that enters the ventricles
during diastole to the amount ejected.
EF = SV/VEDV, 60% - 70% 26
 Cardiac Output (CO) and Reserve
CO is the amount of blood pumped by each ventricle in one
minute
CO is the product of heart rate (HR) and stroke volume (SV)
HR is the number of heart beats per minute
SV is the amount of blood pumped out by ventricle with each
beat
Cardiac reserve is the difference between maximal exercise
and resting CO
CO = 5-6 liters per minute at rest
CO = 20-40 liters per minute at maximum exercise

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 Cardiac output
CO is determined by SV & HR in turn SV is determined by 3
factors
1. Preload/VR/EDV VR=venous return
2. Myocardial contractility
3. After load
VR is affected by the following factors
1. Central venous pressure
2. Systemic vascular resistance
3. Other factors
Sympathetic stimulation
Blood volume
Respiratory movements
Skeletal muscle contraction 28
 Cardiac output...contd
Action of the skeletal muscle pump
in returning blood to the heart
At rest, both proximal and distal
venous valves are open and
blood flows toward the heart
Contraction of leg muscles
pushes blood through the
proximal valve while closing the
distal valve
As the leg muscles relax, the
proximal valve closes and the
distal valve opens. When the
vein fills with blood from the
foot, the proximal valve reopen
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 Cardiac output...contd

Respiratory pump
During inhalation, the diaphragm moves downward, which
causes a decrease in pressure in the thoracic cavity and an
increase in pressure in the abdominal cavity
As a result, abdominal veins are compressed, and a greater
volume of blood moves from the compressed abdominal
veins into the decompressed thoracic veins and then into
the right atrium
When the pressures reverse during exhalation, the valves in
the veins prevent backflow of blood from the thoracic veins
to the abdominal veins

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 Cardiac output...contd

Gravity
When a person changes from supine to a standing posture,
gravity acts on the vascular volume, causing blood to
accumulate in the lower extremities
This reduces right ventricular filling pressure (preload) and
stroke volume by the Frank-Starling mechanism.
Left ventricular stroke volume subsequently falls because of
reduced pulmonary venous return to the left ventricle; the
reduced stroke volume causes cardiac output and arterial blood
pressure to decrease.
If systemic arterial pressure falls by more than 20 mm Hg
upon standing, this is termed orthostatic or postural
hypotension.
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 Factors affecting stroke volume
Preload amount of ventricles are stretched by contained
blood (EDV)
Contractility (inotropy) cardiac cell contractile force due
to factors other than EDV
After load pressure exerted by blood in the large arteries
leaving the heart (MAP)

MAP=Mean Arterial Pressure

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Preload and After load

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 Cardiac output-CO

CO (ml/min) = HR (72 beats/min) x SV (75ml/beat)

Autoregulation
(Frank-Starling Law of the Heart

CARDIAC OUTPUT = STROKE VOLUME x HEART RATE

Contractility

Sympathetic
Nervous System
Parasympathetic
Nervous System
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Heart Rate
HR is the number of cardiac cycles per minute
Normal HR: 60 to 100 beats/minute
< 60 beats/minute, bradycardia but normal in athletes
> 100 beats/minute, tachycardia
HR varies with the following factors
1. Age: higher in newborn infants (120 b/min)
2. Sex: higher in females (85 b/min)
3. Time of the day: morning, evening
4. Resting and sleep: decreased
5. Physical training: low in athletes (45-60 b/min)
6. Body position: standing, supine positions
How to count HR
Counting arterial pulsation, heart sound and ECG cycles
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 Regulation of HR
The HR is determined by the rate of discharge of impulse from
the SA-node
The following factors affect the SA node directly or indirectly
1. Factors that directly stimulate SA-node
Body temperature = HR
R-atrial distension, by blood volume = HR
R-atrial distension Stretch receptors medullary CV-
center sympathetic stimulation HR
Catecholamine: AD, NAD = HR (+ve chronotropic effect)
2. Factors influencing SA-nodal discharge by stimulating
medullary CV-centre
Stimulation higher centre (cerebral cortex, HT, LS);
LS=limbic system
Chemical content of blood (PO2, PCO2, H+)
CV-reflexes (baroreceptor, chemoreceptor)
Stress (pain, fear, excitement)
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Factors Involved in Regulation of Cardiac Output

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38
 Regulation of pumping activity of the heart
Two groups of regulatory mechanisms
1. The intrinsic autoregulatory mechanisms (The Frank-Starling
mechanism)
Within physiologic limits, the heart pumps all the blood that returns to it
by the veins. When an extra amount of blood flows into the
ventricles, the cardiac muscle itself is stretched to greater length.
This in turn causes the muscle to contract with increased force
because the actin and myosin filaments are brought to a more nearly
optimal degree of overlap for force generation. Therefore, the
ventricle, because of its increased pumping, automatically pumps
the extra blood into the arteries.
2. The extrinsic regulatory mechanisms
Sympathetic, parasympathetic stimulation
Catecholamine
Electrolytes (Ca+, K+)
Hormones: Adrenalin, Glucagon, T3/T4

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 Frank-Starling Law of the Heart

Frank-Starling mechanism means the greater the heart muscle is

stretched during filling force of contraction blood
pumped to the aorta.
Preload, or degree of stretch, of cardiac muscle cells before they
contract is the critical factor controlling stroke volume depends
on EDV
exercise increases venous return to the heart, increasing
EDV SV
Blood loss and extremely rapid heartbeat (decreases ventricular
filling time and decreasing EDV) SV

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Starlings Law of the Heart

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CONTRACTILITY:THE VENTRICULAR
FUNCTION CURVE
+ve inotropic
agents
-Sympathetic
stimulation
-Hypercalcemia
-Glucagon, T3/T4
-Digitalis, Xanthenes
ve
-Cathecolamines
inotropic agents
-Parasympathetic
stimulation
CHANGES IN -Hyperkalemia
CONTRACTILITY -Hypocalcemia
-Acidosis
-Toxins
-Heart diseases 42
 Cardiac valves
Cardiac valves are made
up of fibrous connective
tissues
There are 4 valves
1. Tricuspid valve (RAV-
valve, T-valve)
2. Bicuspid valve (LAV-valve,
M-valve)
3. Pulmonary semi lunar
valve (P-valve)
4. Aortic semi lunar valve
(A-valve)
Function: prevent back flow
of blood
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 Cardiac valves...contd
All valves consist of connective tissue (not cardiac muscle
tissue) and, therefore, open & close passively.
Valves open & close in response to changes in pressure:
AV valves - open when pressure in the atria is greater than
pressure in the ventricles (i.e., during ventricular diastole) &
closed when pressure in the ventricles is greater than pressure in
the atria (i.e., during ventricular systole)
Semi lunar valves - open when pressure in the ventricles is
greater than pressure in the arteries (i.e., during ventricular
systole) and closed when pressure in the pulmonary trunk &
aorta is greater than pressure in the ventricles (i.e., during
ventricular diastole)

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 Heart Sounds
Heart sounds (lubb-dubb) are associated with closing of heart
valves
4-separate audible heart sounds (S1, S2, S3 and S4)
Means of identification
1. Auscultation: direct/immediate auscultation
Stethoscope mediated auscultation
2. Phonocardiographic based recording

S3
S4 S1 S2
S1: is always audible, has a LUBB-sound
S2: is always audible, has DUBB-sound
Continuous heart sound: Lubb-Dubb, Lubb-Dubb
Duration of Lubb is longer than that of Dubb
S3: is audible in children and in adults during exercise 45
S4: is audible very rarely
 Heart Soundscontd
S1: First heart sound
Caused by
sudden closure of AV-valves.
Timing: occurs at the beginning of ventricular systole
S2: Second heart sound
Cause: Sudden closure of semilunar valves
Timing: occurs at the beginning of ventricular diastole

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 Heart Soundscontd
S3: Third heart sound
Cause: rapid filling of the ventricles with blood during
ventricular diastole
It is audible in children and in adults during exercise
S4: Fourth heart sound
Cause: rapid ventricular filling during atrial systole
Timing: during atrial systole

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Abnormal Heart sounds
Heart murmurs
Systolic murmurs:-AV-valve insufficiency
-Semi lunar valve stenosis
-High CO (physiological)
Diastolic murmurs: Semi lunar valve insufficiency
-Av-valve stenosis
Valvular insufficiency causes regurgitation

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 Cardiac cycle
Activities in the heart in a single beat
Contraction and relaxation of cardiac chambers
A single cardiac cycle comprised of
- Atrial systole and atrial diastole
-Ventricular diastole + ventricular systole
75 cycles completed per minute
Duration of each cycle = 0.8 second
-Ventricular diastole = 0.5 second
-Ventricular systole = 0.3 second
Means of exploring activities accomplished in a cardiac cycle
1. Auscultation of heart sounds, phonograph
2. ECG tracing
3. Measuring aortic pressure
4. Measuring atrial pressure
5. Measuring ventricular pressure and volumes 49
 Phases of the Cardiac Cycle
Cardiac cycle has 3 major phases
I. Atrial systole
II. Ventricular systole
III. Diastole of the whole heart
I. Atrial systole
Duration: 0.15 second
Valvular events: SL-valves closed, AV-valves opened
Phonocardiogram: S4
ECG: P-wave, PR-segment and Q-wave are recorded
Ventricular volume : increased
Ventricular pressure: increased

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 Phases of the Cardiac Cycle contd
II. Ventricular systolic phase (contraction)
Duration: 0.3 sec., has 3 phasses
A. Isovolumic phase
Ventricles contract with no change in volume (EDV=130 ml)
Ventricular pressure rises from 4-80 mm Hg
All valves are closed
S1 is produced, QRS- complex is recorded
B. Rapid ejection phase
Maximum contraction of the ventricle
Ventricular pressure rises from 80-120 mm Hg
SL-valves opened
Blood will be ejected (70% of SV), Ventricular Volume
Aortic pressure increases
Atrial pressure decreases
C. Slow ejection phase
The remaining 30% of the SV is ejected
Ventricles start to be relaxed
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Phases of the cardiac cyclecontd

III. Ventricular diastole: duration 0.5 sec, 4-phase

A. Isovolumic relaxation phase
Ventricular pressure drops from 80 to 4 mm Hg
4-valves are closed, no change in volume and S2 is
produced
Ventricular pressure drops rapidly
Aortic pressure declines
T-wave completes, ventricles relax
B. Rapid ventricular filling phase
Atrial pressure is higher than ventricular pressure
AV-valves opened
Ventricular pressure falls near 0 mm Hg
Ventricular volume rises sharply
80% of the filling blood run to the relaxed ventricle
C. Slow filling phase 20% of EDV fills the ventricle,
pumped by atrial contraction & ventricular volume still 52
increasing, S4 produced
53
Ventricular Pressure-Volume Diagram

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Cardiac cycle, summary

Aortic pressure
Aortic pressure

Ventricular pressure
Ventricular pressue

Atrial pressure

EDV
EDV

ESV
ESV
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THANK YOU !!

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