Chapter 15 Handout- Cardiovascular System

I. Heart
A. Coverings Fig. 15.4
1. Fibrous pericardium
a. Outer fibrous bag
b. Composed of dense connective tissue
c. Attached to the diaphragm, sternum, vertebral column and blood vessels
2. Visceral pericardium- membrane surrounding heart
3. Parietal pericardium- visceral pericardium folds back upon itself and forms this outer membrane
4. Pericardial cavity
a. Space between visceral and parietal pericardium membranes
b. Filled with serous fluid
c. Lubricates and allows the heart to move within the membranes
B. Wall of the heart Fig. 15.5
1. Epicardium= visceral pericardium- outer layer
a. Includes blood capillaries, lymph capillaries and nerve fibers
b. Contains fat especially near the paths of coronary arteries and cardiac veins
2. Myocardium- middle layer
a. Cardiac muscle tissue
b. Arranged in planes
c. Planes are separated by connective tissue containing blood capillaries, lymph capillaries and
nerve fibers
3. Endocardium- inner layer
a. Consists of epithelium and connective tissue containing many elastic and collagenous fibers
b. Also contains blood vessels and purkinjie fibers (specialized cardiac muscle fibers)
c. Lines all of the interior structure of the heart including the valves
d. Continuous with the endothelium of blood vessels coming from the heart
C. Chambers and valves Figs. 15.4, 15.6, 15.9 and Table 15.2
1. Atria- thin walls, receive blood returning to the heart
a. Right- receives deoxygenated blood from tissues returning to the heart via the superior vena cava,
inferior vena cava and coronary sinus
b. Left- receives oxygenated blood from the lungs via four pulmonary veins
2. Auricles- projections extending anteriorly from the atria
3. Ventricles- lower chambers force blood out of the heart and into arteries
a. Right- pumps blood to the lungs via pulmonary arteries
b. Left- pumps blood to the rest of the body via the aorta
4. Septae
a. Interatrial septum- separates atria
b. Intraventricular septum- separates ventricles
5. Valves Fig. 15.8 and Table 15.2
1. Atrioventricular (AV) valves- between atria and ventricles
a. Contain fibrous strings attached on ventricle side (chordae tendineae)
b. Chordae tendineae are attached to papillary muscles in the wall of the ventricle
c. The papillary muscles contract when the ventricle contracts & pull on the chordae tendineae,
this keeps the atrioventricular valves from swinging back into the atrium
d. Open when blood pressure is greater in the atria
e. Close when blood pressure is greater in the ventricle
f. Two valves
i. Tricuspid valve- between right atrium and ventricle
ii. Bicuspid valve (mitral valve)- between left atrium and ventricle
2. Pulmonary valve- between right ventricle and pulmonary trunk (branches into left and right
pulmonary arteries)
a. Opens when right ventricle contracts
b. Closes when right ventricle relaxes and blood backs up in the pulmonary trunk preventing
backflow into the right ventricle
c. Tricuspid valve
d. No chordae tendineae or papillary muscle attached to this valve
3. Aortic valve- between the left ventricle and the aorta
a. Opens when left ventricle contracts
b. Closes when left ventricle relaxes preventing backflow into the left ventricle
6. Grooves
a. Atrioventricular sulcus- circles the heart between atria and ventricles
b. Interventricular sulci- mark the septum between the right and left ventricles
i. Anterior
ii. Posterior
7. Skeleton of heart
a. Rings of dense connective tissue surrounding the proximal ends of the pulmonary trunk and aorta
Fig. 15.9
b. Provide firm attachment for the valves and muscle fibers
c. Prevent the outlets of atria and ventricles from dilating during contractions
d. Dense connective tissue in the septum also make up the skeleton of the heart
D. Flow of blood through the heart Figs. 15.10 and 15.11
1. Deoxygenated blood flows into right atrium from venae cavae and coronary sinus
2. Right atrial wall contracts forcing blood through the right AV valve (tricuspid valve) and into the
right ventricle
3. Right ventricle contracts closing the tricuspid valve and forcing blood into the pulmonary arteries
4. Right ventricle relaxes and closes the pulmonary valve
5. Carbon dioxide/ oxygen exchange occurs in the capillaries of the lungs
6. Oxygenated blood returns to the left atrium via the pulmonary veins
7. Left atrium contracts and forces blood through the left AV valve (bicuspid) and into the left
ventricle
8. Left ventricle contracts closing the bicuspid valve and forcing blood into the aorta
9. Left ventricle relaxes and closes the aortic valve
10. Oxygenated blood is distributed to tissues
E. Blood supply to the heart Figs. 15.12-15.15
1. Coronary arteries
a. First branch of aorta just after aortic valve
b. Supply heart tissue with oxygenated blood
c. Right- branches into posterior interventricular artery (ventricular walls) and marginal artery
(walls of right atrium and ventricle)
d. Left- branches into anterior interventricular artery (ventricular walls) and circumflex artery (walls
of left atrium and ventricle)
e. Branch into capillaries with anastomoses (alternate branches between vessels- collateral
circulation)
f. Unlike other parts of the body coronary perfusion is at its highest when the ventricle is relaxing
i. During contraction aortic valve partially blocks opening of coronary artery
ii. Contraction of ventricle pinches closed small coronary vessels in myocardium
2. Cardiac veins- returns deoxygenated blood to heart
a. Joined into cardiac sinus
b. Cardiac sinus empties into right atrium
F. Cardiac cycle Figs. 15.16 and 15.22
1. Atrial systole- atria contract and ventricles relax (ventricular diastole)
a. Pressure is relatively low in ventricle before contraction (diastole)
b. Causes AV valves to open and 70% of returning blood flows into ventricles
c. Atria contract and remaining 30% of returning blood flows into ventricle
d. Pressure builds in ventricle
2. Ventricular systole- ventricles contract and atria relax (atrial diastole)
a. I ncreased pressure closes AV valve and contraction of papillary muscle prevents AV valves
from swinging back into atria
b. As pressure increases in ventricles it opens the pulmonary and aortic valves
c. During ventricular contraction pressure in atria is low and blood from venae cavae flows into
atria
3. Followed by a brief relaxation of both atria and ventricles
a. As the ventricle relaxes the pulmonary valve and aortic valve close
b. Pressure in atria exceeds pressure in ventricles and AV valves open starting the cycle again
G. Heart sounds Fig. 15.17
1. First sound (lubb)- ventricular contraction when AV valves are closing
2. Second sound (dubb)- ventricular relaxation when pulmonary and aortic valves are closing
3. Murmur- abnormal sound when valves don't close completely and blood leaks back through them
4. Each valve can be heard from a different region of the thoracic cavity with a stethoscope Fig.
15.22
H. Cardiac conduction system Figs. 15.18-15.22
1. Functional synctium- mass of specialized cardiac cells whose fibers contain only a few myofibrils,
instead of contracting muscle tissue they initiate and distribute impulses throughout the myocardium and
act as a unit
a. Atrial synctium
b. Ventricular synctium
2. Sinoatrial node (S-A node)
a. Small elongated mass of specialized cardiac cells just beneath the epicardium
b. Located in the right atrium near the opening of the superior vena cava
c. Fibers are continuous with the atrial synctium
d. Can reach threshold potential on their own
e. The membranes of these cells contact one another
f. Without stimulation from nerve fibers, the S-A node cells initiate impulses that spread through
the myocardium and cause cardiac muscle to contract
g. S-A node activity is rhythmic (pacemaker), causing 70-80 beats per minute in an average adult
h. Impulse travels from cell to cell by gap junctions
i. Both atria contract almost simultaneously
j. The signal does not flow into the ventricular synctium directly because its blocked in most areas
by the fibrous skeleton of the heart
k. Signal passes along fibers that are continuous with the atrial muscle fibers to the
atrioventricular node
3. Atrioventricular node (A-V node)- also specialized cardiac muscle tissue
a. Located in the inferior portion of the interarterial septum just beneath the endocardium
b. Provides the only normal conduction between atrial & ventricular synctia
c. J unctional fibers- small fibers (slow conduction) that carry the cardiac impulse into the A-V
node
d. A-V node conduction also slows the impulse allowing complete contraction and emptying of
the atria before ventricular contraction
e. The impulse travels from the A-V node into the A-V bundle and rapidly continues through the
interventricular septum
f. The signal then divides into right and left branches that lie just beneath the endocardium
g. Half way down the septum the branches give rise to enlarged Purkinjie fibers
h. Purkinjie fibers carry the impulse to distant regions of the ventricular myocardium much
faster then cell to cell conduction could
i. The signal branches into papillary muscle projecting inward from the ventricular walls
j. The signal progresses to the apex of the heart and upward to the lateral walls of the chambers
k. Purkinjie fibers give off small branches which become continuous with cardiac muscle fibers
l. Muscle fibers in the walls of the ventricles form irregular whorls that contract with a twisting
motion Fig. 15.20
m. The contraction is initiated at the apex to insure blood is pumped upward and out of the
ventricles
4. Electrocardiogram (ECG) Fig. 15.21
a. P wave- depolarization of atrial fibers
b. QRS complex- Q wave, R wave and S wave- corresponds to depolarization of the ventricles
c. T wave- repolarization of ventricular fibers
d. QRS wave obscures the repolarization of atrial fibers
5. Regulation of cardiac cycle Fig. 15.24
a. Parasympathetic fibers of the vagus nerve originating in the medulla oblongata innervate the S-A
and A-V node
i. Vagus nerve fibers secrete acetylcholine which decreases S-A and A-V node activity
ii. Increase in vagus nerve activity decreases heart rate
iii. Decrease in vagus nerve activity can increase heart rate
b. Sympathetic fibers of the accelerator nerves also originating in the medulla oblongata innervate
the S-A and A-V node as well as other regions of the atrial and ventricular myocardium
i. These nerves secrete norepinephrine
ii. Increases the rate and force of contraction
c. Cardiac control center in medulla oblongata- two masses of neurons controlling the heart receive
sensory impulses from throughout the circulatory system and relay motor impulses to the heart
i. Cardioinhibitor
ii. Cardioaccelerator
d. Baroreceptors- located in the aortic arch and carotid artery are sensitive to stretch
i. Detect changes in blood pressure- increased blood pressure causes stretching of the vessel and
baroreceptors
ii. These sensory receptors signal the cardioinhibitory center to send parasympathetic impulses
(vagus nerve) to the heart and decrease the heart rate (lowers arterial blood pressure)
e. Stretch receptors in the venae cavae
i. Stimulation of these receptors by increase in blood pressure
ii. These sensory receptors signal the cardioaccelerator center to send sympathetic impulses to the
heart & increase rate and force of contraction (lowers venous blood pressure)
f. Impulses from the cerebrum and hypothalamus also influence the cardiac control center of the
medulla- increase or decrease heart rate from change in emotions
g. Temperature effects heart rate- increase in body temperature increases heart rate while a decrease
in body temperature decreases heart rate
h. Ions influence heart rate
i. Potassium- effects electrical potential of membrane
ii Calcium- required for contraction of cardiac muscle (more dependent on extracellular calcium
then skeletal muscle)
II. Blood vessels
A. Arteries and arterioles
1. Layers Fig. 15.25
a. Tunica interna (intima)- simple squamous epithelium (endothelium)
b. Tunica media- thick, smooth muscle fibers and elastic connective tissue that encircle the vessel,
allows vessel to withstand arterial pressure
c. Tunica externa (adventitia)- thin, connective tissue with irregular elastic and collagenous fibers,
attaches vessel to other tissue
2. Innervated by sympathetic nervous system
a. Vasomotor fibers- stimulate smooth muscle cells to contract (vasoconstriction)
b. If vasomotor impulses are inhibited smooth muscle cells relax (vasodilation)
3. Arterioles Fig. 15.26, 15.25 and Table 15.3
a. Smaller diameter
b. Tunica media and externa are thinner
c. Very small arterioles only have endothelial lining, layer of smooth muscle and a layer of
connective tissue
4. Metarterioles- microscopic arterioles that give rise to capillaries, sometimes they connect directly to
venules (arteriovenous shunt) Fig. 15.28
5. Capillaries Fig. 15.29 and 15.30
a. Single layer of simple squamous epithelium
b. Semipermeable layer for exchange of substances between blood and tissues
c. Gaps between endothelial cells dictate the permeability of substances in different tissues
i. Small openings in skeletal muscle, smooth muscle and cardiac muscle
ii. Larger openings in endocrine glands, kidneys and small intestine
iii. Largest openings (sinusoids) in liver, spleen and red bone marrow- discontinuous epithelial
cell layer will allow large proteins and cells to pass through
d. The higher a tissue's metabolism the denser its capillary network ex. muscle and nerve tissue are
richly supplied (high metabolism) whereas epidermis, cartilaginous tissue and the cornea lack capillaries
(metabolism is slow)
e. Precapillary sphincters- regulate the flow of blood to capillaries in response to the needs of cells
in the tissue
f. Exchange of substances Fig. 15.31
i. Diffusion- oxygen, carbon dioxide and fatty acids are lipid soluble and pass through cell
membranes readily whereas ions and water pass through pores
ii. Filtration- hydrostatic pressure (blood pressure) forces substances through the cell membrane
iii. Osmosis- greater concentration of solutes (plasma proteins) in blood causes some of the fluid
to return to the capillaries
B. Veins and venules Fig. 15.25C and Table 15.3
1. Layers- similar to arteries but middle layer is less developed with less smooth muscle and elastic
tissue
2. Their lumens are bigger then arteries
3. Contain valves (semilunar) which aid in the flow of blood back to the heart (close if blood flows
away from heart) Fig. 15.32
4. Function as blood reservoirs ex. venous constriction during hemorrhaging maintains blood pressure
Fig. 15-33
III. Arterial blood pressure
A. Systolic- maximum pressure after ventricular contraction
B. Diastolic- minimum pressure before ventricular contraction
C. Pulse- alternating expanding and recoiling of an artery Fig. 15.34
D. Factors that influence arterial blood pressure Fig. 15.35
1. Heart action
a. Stroke volume- volume of blood discharged with each ventricular contraction (average
resting=70ml)
b. Cardiac output- volume discharged from the ventricle each minute calculated by multiplying the
stroke volume times the heart rate in beats per minute ex. 70ml x 72 beats/min = 5,040 ml/min
c. If stroke volume or heart rate increases then blood pressure will rise and vice versa
2. Blood volume (8% of body weight in kilograms)- blood pressure is directly proportional to blood
volume ie. volume decreases blood pressure decreases
3. Peripheral resistance
a. Friction between blood and the walls of blood vessels creates a force that hinders blood flow
b. Elasticity of arteries and arterioles allows the vessel to swell during systole and recoil during
diastole while moving the blood along its path
c. Vasoconstriction raises blood pressure and vasodilation lowers it Fig. 15.36
4. Viscosity (determined by the constituents in blood ex. RBC and plasma proteins)- blood pressure
increases with increased viscosity and decreases with decreased viscosity
E. Control of arterial blood pressure BP= cardiac output x peripheral resistance Figs. 15.37, 15.38 and
15.39
1. Blood entering the ventricle controls stroke volume
a. Myocardial fibers in ventricle wall are mechanically stretched as blood enters ventricle
b. The greater the length of these fibers, the greater the force with which they contract (Starling's
law of the heart)
c. Ensures that the volume of blood that enters the heart is the volume that is pumped and that both
ventricles pump the same volume
2. Vasomotor center of medulla oblongata continually sends sympathetic signals to smooth muscle in
arteriole walls
a. Increased sympathetic outflow- vasoconstriction (after hemorrhage epinephrine and
norepinephrine are released)
b. Decreased sympathetic outflow- vasodilation (after stimulation of baroreceptors in aortic arch
and carotid artery)
3. Arteriole's of abdominal viscera (splanchic region)
a. If fully dilated could hold the entire blood volume and BP would drop to zero
b. Important in the regulation of peripheral vascular resistance
4. Chemicals that influence peripheral resistance
a. Carbon dioxide- increasing levels relax precapillary sphincters and arteriole smooth muscle
b. Oxygen- decreasing levels relax precapillary sphincters and arteriole smooth muscle
c. Hydrogen ions- decreasing Ph of blood relaxes precapillary sphincters and arteriole smooth
muscle
d. Nitric oxide- produced by endothelial cells- vasodilator
e. Bradykinin- formed in the blood- vasodilator
f. Angiotensin- released by kidneys- vasoconstrictor
g. Endothelin- released by endothelium- vasoconstrictor
IV. Venous blood pressure
A. BP drops as blood moves through arterioles and capillaries so little pressure remains at the venules
B. Blood flow is only partly controlled by heart action
C. Other factors
a. Skeletal muscle contraction Fig. 15.40
b. Breathing movements- blood is squeezed out of abdominal veins and into thoracic veins during
inspiration from a change in pressure
c. Vasoconstriction of veins
D. Central venous pressure (equal to pressure in right atrium)
a. If heart beats weakly, central venous pressure builds up and pressure in venous network increases
b. If heart is beating forcefully, central venous pressure and pressure in venous network decreases
c. Increase in blood volume can raise central venous pressure
d. Venoconstriction can increase central venous pressure
e. Any increase in central venous pressure can lead to edema (favors movement of fluid into tissues)
V. Paths of circulation
A. Pulmonary circuit Figs. 15.41 and 15.42
1. Lower pressure in pulmonary arteries (right ventricle contracts less forcefully then left ventricle)
2. Alveolar capillary pressure is low and therefore the capillary filtration pressure is low
3. Low pressure allows a small, net movement of fluid into the interstitial space to keep alveoli
lubricated
4. Excess fluid is taken back by osmosis or drainage into lymphatic vessels
5. Epithelial cells in alveolar capillaries are tightly packed and do not allow ions, glucose or urea to
enter interstitial space (maintains osmotic gradient)
B. Systemic circuit
1. Arterial Fig. 15.52
2. Venous Fig. 15.59
VI. Diseases or conditions affecting the heart
A. Pericarditis- inflammation of the pericardium
1. Caused by viral or bacterial infections
2. Interrupts movements of the heart
B. Mitral valve prolapse
1. One or both flaps of valve stretches and bulges into left atrium
2. Causes backflow of blood (heard as a murmur)
3. Symptoms- fatigue, chest pains, palpitations and anxiety
4. Valve can be damaged by streptococcal bacterial infections- endocarditis
C. Angina pectoris
1. Thrombus or embolus blocks coronary blood supply- chest pain
2. Worse during exercise or emotional stress due to increased oxygen demand
3. Symptoms- heavy pressure, tightness or squeezing sensation in chest may radiate to neck, jaw,
throat, shoulder, upper limb, back or abdomen, also profuse perspiration (diaphoresis), difficulty breathing
(dyspnea), nausea or vomiting
D. Myocardial infarction- block of coronary blood vessel by a blood clot causing death of part of the
heart
E. Arrhythmias- part of the myocardium contracting in an uncoordinated fashion
1. Atrial fibrillation- not a serious because ventricles continue to pump blood
2. Ventricular fibrillation- ventricles no longer pump blood- life threatening
F. Tachycardia- abnormally fast heart rate
1. Increase in body temperature
2. Nodal stimulation by sympathetic fibers
3. Certain drugs or hormones
4. Heart disease
5. Exercise
6. Anemia
7. Shock
G. Bradycardia- abnormally slow heart rate
H. Ion imbalance
1. Hyperkalemia (excess potassium)
a. Decreases rate and force of contraction
b. High concentration can cause block of conduction of cardiac impulses (cardiac arrest)
2. Hypokalemia (too little potassium)- arrhythmias
3. Hypercalcemia (excess calcium)- increases heart action (danger of prolonged contraction)
4. Hypocalcemia (too little calcium)- depresses heart action
I. Edema
1. Fluid build up in tissue
2. Due to inability of right ventricle to pump blood out as rapidly as it enters
3. Blood backs up into veins, venules and capillaries causing an increase in pressure
4. Blood pressure overwhelms osmotic pressure less return of interstitial fluid to the capillaries
J. Atherosclerosis
1. Build up of plaque (fat and cholesterol) within the intima & inner lining of arterial walls
2. Plaque can initiate blood clot formation leading to blood tissue deficiency (ischemia) or tissue death
(necrosis)
3. Risk factors
a. Fatty diet
b. Hypertension
c. Smoking
d. Obesity
e. Lack of exercise
f. Genetic and emotional factors
K. Aneurysm- weakening of arterial wall causes a bulge that may rupture
L. Phlebitis
1. Inflammation of a vein
2. Can cause clotting of blood
3. Risk of the clot dislodging and traveling to the lung causing an obstruction (pulmonary embolism)
M. Varicose veins
1. Abnormal & irregular dilations of veins due to gravity
2. Risk factors
a. Genetics
b. Pregnancy
c. Obesity
d. Prolonged standing
N. Cardiac tamponade
1. Build up of fluid in the pericardial cavity
2. Increased pressure limits heart movement
O. Hypertension- increased blood pressure leading to stroke or enlargement of the heart (hypertrophy)
1. Drugs used to treat
a. Angiotensin converting enzyme (ACE) inhibitors- blocks formation of angiotensin and prevents
vasoconstriction
b. Beta blockers- lowers heart rate
c. Calcium channel blockers- dilate blood vessels by preventing influx of calcium necessary for
smooth muscle contraction
d. Diuretics- increase sodium excretion, increase urine output and lower blood volume
P. Stroke or cerebral vascular accident- cerebral thrombosis, embolism or hemorrhage
1. Risk factors
a. Alcohol
b. Diabetes
c. High cholesterol
d. Genetics
e. Hypertension
f. Smoking
g. Transient ischemic attacks
Q. Pulmonary edema- failing left ventricle or damaged bicuspid valve causes pressure buildup in
alveolar capillaries and fluid retention in lungs