CARDIOVASCULAR SYSTEM

Body cells require constant supply of food and oxygen to produce energy Cardiovascular system, consisting of the heart (a powerful muscular pump) and blood vessels (fuel line and transportation network), delivers the required food and oxygen to all the cells in the body.

BLOOD VESSELS: There are 3 types of blood vessels in the body: 1. arteries 2. veins 3. capillaries

ARTERIES Large blood vessels that carry blood away from the heart Walls are lined with connective tissue, muscle tissue, and elastic fibers, with an innermost layer of epithelial cells called endothelium Endothelial cells found in all blood vessels - secrete factors that affect the size of the blood vessels - reduce blood clotting - promote the growth of blood vessels Elastic walls expand as the heart beat forces blood into the arterial system throughout the body

Arterioles smaller branches of arteries - thinner than arteries - carry the blood to the tiniest of blood vessels, the capillaries

CAPILLARIES Tiniest blood vessels Lined only with endothelium Carry nutrient rich oxygenated blood from the arteries and arterioles to the body cells Thin walls allow the nutrients and oxygen pass from the blood to the body cells Waste products (CO2, H2O, etc) pass out of the cells into the thin walled capillaries Waste filled then flows back to the venules which combine to form larger vessels called veins.

VEINS Veins have thinner walls than arteries Carries blood from the tissues to the heart Has comparatively less elastic, connective tissue than arteries Pressure is very low than arteries Has valves to prevent back flow of blood Muscular action also helps blood flow in the veins

BLOOD FLOW CHART

Carry blood back to heart

HEART

Carry blood away from the heart

VEINS
Thin walls with valves

ARTERIES

Strong, thick, elastic walls BP is high

BP is low Carry O2 rich blood to tissues Carry O2 poor blood from tissues

VENULES

ARTERIOLES

TISSUE CAPILLARIES

CIRCULATION Arteries, arterioles, veins, venules, and capillaries together with the heart, form a circulatory system for the flow of blood.

PULMONARY CIRCULATION: Oxygen-poor blood from the tissue capillaries enters the right side of the heart through the venae cavae. Travels to the (RT & LT) lung through the two branches (RT& LT) of pulmonary artery (ONLY ARTERY THAT CARRIES DEOXYGENATED BLOOD) The oxygen is absorbed in to the pulmonary artery at the lung (pulmonary) capillaries level. The newly oxygenated blood enters the pulmonary veins (ONLY VEIN THAT CARRIES OXYGENATED BLOOD) which in turn opens into the left side of the heart. The circulation of blood through the vessels from the heart to the lungs and then back to the heart again is the pulmonary circulation.

SYSTEMIC CIRCULATION Oxygen-rich blood enters the left side of the heart from the pulmonary veins. Then it is pumped out to the largest artery, aorta. The aorta branches out and supply blood to all parts of the body. E.g., brachial, axillary, splenic, renal, gastric, and carotid for the head and neck, etc. The arteries branches and the oxygen transport to the body cells take place at the tissue capillaries level. Then the oxygen-poor blood (rich in CO2) enters the venules and finally drain into the vena cavae. Vena cavae opens into the right side of the heart. The path way of blood from the heart to the tissue capillaries and back to the heart is the systemic circulation.

ANATOMY OF THE HEART:

Human heart weighs less than a pound and is roughly the size of an adult fist. Lies in the thoracic cavity, in the mediastinum between the two lungs. The heart is a muscular pump, consisting of four chambers, two upper chambers called atria and the two lower chambers called ventricles. The venae cavae opens into the thin walled right chamber of the heart. The right atrium contracts the blood to the right ventricle through the tricuspid valves

The right ventricle pumps the oxygen poor blood to the pulmonary artery through the pulmonary valve. Pulmonary artery branches into each lung with the oxygen poor blood. Oxygen and CO2 transport takes place at the pulmonary capillaries. The oxygenated blood is brought back to the left atrium via the pulmonary veins. Then it moves to the left ventricle through the mitral valve. The left ventricle has the thickest walls than the right ventricle because it has to pump the blood to all parts of the body. The left ventricle pumps the blood to the aorta through the aortic valve.

SEPTUM: The four chamber of the heart are separated by walls called septum. Interatrial septum separates the two upper atria. Interventricular septum separates the two lower ventricles.

LAYERS OF THE HEART: Endocardium, a smooth layer of endothelial cells, lies the interior of the heart and heart valves. Myocardium, the thickest, middle muscular layer. Pericardium, fibrous and membranous sac and composed of two layers, -visceral pericardium, adhering to the heart - parietal pericardium, lining the outer fibrous coat Pericardial cavity contains 10 to 15 ml of pericardial fluid, which lubricates the membranes as the heart beats.

PATHWAY OF BLOOD THROUGH THE HEART:

HEART BEAT: There are 2 phases of the heart beat, diastole (relaxation) systole (contraction) DIASTOLE: - occurs when the ventricle walls relax and the blood flows into the heart through the venae cavae and pulmonary veins. - tricuspid and mitral valves are open (blood passes from both the atria to the ventricles) - pulmonary and aortic valves are closed SYSTOLE: - occurs next, as the walls of the ventricles contract to pump blood into the pulmonary artery and the aorta - tricuspid and mitral valves are closed during the systole, to prevent the back flow of blood into the atria - the pulmonary and aortic valves are open to allow the blood flow The diastole systole cardiac cycle occurs between 70 to 80 beats per minute. The heart pumps, 3 ounces of blood per contraction 5 quarts per minute 75 gallons per hour 2000 gallons per day

HEART SOUNDS: Closure of the heart valves are associated with the audible sounds, lubb-dubb Lubb - S1, the first heart sound -associated with the closure of tricuspid and mitral valves at the beginning of systole

Dubb- S2, the second heart sound - associated with the closure of the aortic and pulmonary valves at the end of systole Murmur the flow of blood through the valves can produce an abnormal swishing sound known as murmur

CONDUCTION SYSTEM OF THE HEART Heart beat is initiated in the muscle tissue called SINOATRIAL NODE (pace maker), located in the posterior portion of the right atrium. The electricity passed from the SA node to the ATRIOVENTRICULAR NODE in the interatrial septum. The AV node sends the excitation wave to the special muscle fibers called ATRIOVENTRICULAR BUNDLE or BUNDLE OF HIS. Within the interventricular septum the bundle of His divides into left bundle branch and the right bundle branch in the ventricles. The record used to record the electrical changes in the heart muscle as the heart beats is an ELECTROCARDIOGRAM (ECG or EKG) The normal ECG shows the five waves or deflections P, Q, R, S and T. Heart rhythm originating in the SA node and traveling through the heart is called normal sinus rhythm (NSR). Sympathetic nerves speed up the heart rate during crisis Parasympathetic nerves slow the heart rate when there is no need for extra pumping.

BLOOD PRESSURE BLOOD PRESSURE is the force that the blood exerts on the arterial walls. This pressure is measured with sphygmomanometer. Blood pressure is expressed as a fraction 120/80 mm Hg, in which the upper (120) is the systolic pressure and the lower (80) is the diastolic pressure. DESCRIPTION Abnormal heart rhythms Faliure of proper conduction of impulses from the SA node through the AV node to the atrioventricular bundle (bundle of His) Rapid but regular contractions usually of the atria Very rapid, random, inefficient, and irregular contractions of the heart DESCRIPTION Narrowing of the aorta Passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth Small holes in the wall between the atria (atrial septal defects) or the ventricles (ventricular septal defect) Congenital malformation involving four distinct heart defects, 1. pulmonary artery stenosis 2. ventricular septal defect 3. shift of the aorta to the right 4. hypertrophy of the right ventricle DESCRIPTION Heart is unable to pump its required amount of blood Disease of the arteries surrounding the heart Inflammation of the inner lining of the heart High blood pressure affecting the heart Improper closure of the mitral valve Extra heart sound, between normal beats Inflammation of the membrane (pericardium) surrounding the heart Heart disease caused by rheumatic fever DESCRIPTION Local widening of an arterial wall Blood clot forms in a large vein, usually in a lower limb High blood pressure Blockage of arteries carrying blood to the legs, arms, kidneys, and other organs Recurrent episodes of pallor and cyanosis primarily in fingers and toes Abnormally swollen and twisted veins, usually occurring in the legs

ARRHYTHMIA Arrythmia Bradycardia and heart block (atrioventricular block) Flutter Fibrillation CONGENITAL HEART DISEASE Coarctation of the aorta (CoA) Patent Ductus Arteriosus (PDA) Septal defects Tetrology of Fallot

HEART DISEASE Congestive heart failure Coronary artery disease (CAD) Endocarditis Hypertensive heart disease Mitral valve prolapse (MVP) Murmur Pericarditis Rheumatic heart disease BLOOD VESSEL CONDITION Aneurysm Deep vein thrombosis (DVT) Hypertension (HT) Peripheral arterial disease (PAD) Raynaud disease Varicose veins

LABORATORY TESTS BNP test Cardiac biomarkers Lipid tests (lipid profile) Lipoprotein electrophoresis X-RAY & ELECTRON BEAM TESTS Angiography Computed tomography angiography (CTA) Digital subtraction angiography (DSA) Electron beam computed tomography (EBCT or EBT) ULTRASOUND EXAMINATION Doppler ultrasound studies Echocardiography (ECHO) NUCLEAR CARDIOLOGY Positron emission tomography (PET) Technetium Tc 99m sestamibi scan Thallium 201 scan MAGNETIC RESONANCE IMAGING Cardiac MRI OTHER PROCEDURES Cardiac catheterization Electrocardiography (ECG) Holter monitoring Stress test TREATMENT Catheter ablation Coronary artery bypass grafting (CABG) Defibrillation Endarterectomy

DESCRIPTION Measurement of BNP (brain natriuretic peptide) in blood Chemicals are measured in the blood as evidence of a heart attack Measurement of cholesterol and triglycerides (fats) in a blood sample Lipoproteins (combination of fat and proteins) are physically separated and measured in a blood sample DESCRIPTION X-ray imaging of a blood vessels after injection of contrast material Three dimensional X-ray images of the heart and coronary arteries using computed tomography Video equipment and computer produces X-ray images of blood vessels Electron beams and CT identify deposits in and around coronary arteries to diagnose early CAD DESCRIPTION Sound waves measure blood flow within blood vessels Echoes generated by high frequency sound waves produce images of the heart DESCRIPTION Images show blood flow and myocardial function following uptake of radioactive glucose Technetium Tc 99m setamibi injected intravenously is taken up to cardiac tissue, where it is detected by scanning Concentration of radioactive thallium is measured to give information about blood supply to the heart muscle DESCRIPTION Images of the heart are produced using radiowave energy in a magnetic field DESCRIPTION Thin, flexible tube is guided into the heart via a vein or an artery Recording of electricity flowing through the heart An ECG device is worn during a 24-hour period to detect cardiac arrhythmias Exercise tolerance test (ETT) determines the hearts response to physical exertion (stress) DESCRIPTION Brief delivery of radiofrequency or cryosurgery to destroy areas of heart tissue that may be causing arrhythmias Arteries and veins are anastomosed to coronary arteries to detour around blockage Brief discharges of electricity are applied across the chest to stop dysrhythmias (ventricular fibrillation) Surgical removal of plaque from the inner layer of an artery

Extracorporeal circulation Heart transplantation Percutaneous coronary intervention (PCI) Thrombolytic therapy

Heart-lung machine diverts blood from the heart and lungs while the heart is repaired A donor heart is transferred to a recipient Balloon-tipped catheter is inserted into a coronary artery to open the artery, stents are put in place. Drugs to dissolve clots are injected into the blood stream of patients with coronary thrombosis

EXERCISES I COMPLETE THE FOLLOWING 1. Valve that lies between the right atrium and right ventricle --------2. Smallest blood vessel ----------3. Carries oxygenated blood from the lungs to the heart ----------4. Largest artery in the body ----------5. Brings oxygen-poor blood into the heart from the upper parts of the body ----------6. Upper chamber of the heart ----------7. Carries oxygen-poor blood to the lungs from the heart ---------------8. Small artery ------------9. Valve that lies between the left atrium and left ventricle ------------10. Brings blood from the lower half of the body to the heart -----11. A small vein --12. Lower chamber of the heart ----------II COMPLETE THE FOLLOWING 1. The pacemaker of the heart is the ---------2. The sac-like membrane surrounding the heart is the ------------3. The wall of the heart between the right and left atria is the --------------4. The relaxation phase of the heart beat is called ----------5. Specialized connective tissue in the wall between the ventricles is the -----------6. The inner lining of the heart is the --------------

7. The contractive phase of the heartbeat is called ------------8. A gas released as a metabolic product of catabolism is ---9. Specialized connective tissue at the base of the wall between the two upper heart chambers is the ---------------10. The inner lining of the pericardium, adhering to the outside of the heart, is the -----------11. An abnormal heart sound due to improper closure of heart valves is a ---12. The beat of the heart as felt through the walls of arteries is called the ------III COMPLETE TE FOLLOWING TERMS 1. Hardening of arteries: arterio-------2. Disease condition of heart muscle: cardio----3. Enlargement of the heart: cardio------4. Inflammation of a vein: phleb------5. Condition of rapid heartbeat: ----cardia 6. Condition of slow heart beat: ---------cardia 7. High levels of cholesterol if the blood: hyper 8. Surgical repair of a valve: valvulo-----9. Condition of deficient oxygen: hyp---10. Pertaining to an upper heart chamber: -----al 11. Narrowing of the mitral valve: mitral--------12. Breakdown of a clot: thrombo----------------------------------------------------------------------------------------------------------------------------------------------