Written Report

Anatomy and Physiology

(Lecture)
Cardiovascular System

Submitted by:

Cernal, Rafael Reggie

Gorospe, Alice May

Pagasian, Shee Ann Mae

Santiago, John Axcel

Tenorio, Adrianne Erica

Submitted to:

Mr. Kahlil Arbo

September 2018
 BLOOD

Is defined as a type of connective tissue consisting of a liquid matrix containing cells and cell
fragments.
Liquid matrix- Plasma and cells (forms 55% of total blood volume)

Cell fragments-Formed elements (45%)

Total Blood Volume:

Females: 4-5 L

Males: 5-6 L
FUNCTIONS

1. Transport of gases, nutrients, and waste products

• Oxygen enters the blood in the lungs and is carried to the cells.
• Carbon dioxide, produced by the cells, is carried in the blood to the lungs, from
which it is expelled.
• The blood transports ingested nutrients, ions, and water from the digestive tract to
the cells.
• And it also transports waste products to the kidneys for elimination.
2. Transport of processed molecules
Many substances are produced in one part of the body and transported by the blood to
another part, where they are modified.
Example: Precursor to Vitamin D is produced in the skin and transported by blood to the
lover and then to the kidneys for processing into active vitamin D, blood transports it to
the small intestine to promote the uptake of calcium.
3. Transport of regulatory molecules
Blood carries the hormones and many of the enzymes that regulate the body processes
from one part of the body to another.
4. Regulation of pH and osmosis
Buffers which help keep the blood’s pH within its normal range of 7.35 -7.45 are in the
blood. The osmotic composition of blood is also critical for maintaining normal fluid and
ion balance.
5. Maintenance of body temperature
Movement of warm blood from the interior of the body, to its surface where heat is
released, is one of the several mechanisms that help regulate body temperature.
6. Protection against foreign substances
Certain cells and chemicals in the blood make up an important part of the immune
system, protecting against foreign substances, such as microorganisms and toxins.
7. Clot formation
When blood vessels are damaged, blood clotting protects against excessive blood loss.
When tissues are damaged, the blood clot that forms is also the first step in tissue repair
and restoration of normal function.
 PLASMA

It is the liquid part of the blood, a pale yellow fluid that consists of 91% water and 9% other
substances, such as proteins, ions, nutrients, gases, waste products and regulatory substances.
Since plasma is a colloid, it contains suspended substances that do not settle out of the solution.

Most of these substances are plasma proteins, namely:

Albumin (58%) -maintains blood colloid osmotic pressure

Globulin (38%)-part of immunity, plays a role for protection against microorganisms
Fibrinogen (4%)-Responsible for the formation of blood clots

FORMED ELEMENTS
95% are Red blood cells (Erythrocytes), 5% are White Blood Cells (Leukocytes) and cell
fragments called Platelets (Megakaryoblast)

Hematopoiesis/Hemopoiesis-The process of red blood cell production.

Embryo &Fetus- Occurs in tissues such yolk sac, liver, thymus, spleen, lymph nodes,
red bone marrow
After Birth-Occurs primarily to red bone marrow with some lymphatic tissue helping
produce lymphocytes
Children-Nearly all marrow is red bone marrow
Adults-Red marrow is confined to ribs, sternum, vertebrae, pelvis, proximal femur, and
proximal humerus, yellow marrow replaces red marrow in other parts of the body.
 R

RED BLOOD CELLS

1. They are about 700 times more numerous than white blood cells and 17 million times
more numerous than platelets in the blood.
2. Structure: They are biconcave discs with about 7.5 μm diameter. This means that their
edges are thicker than the center of the cell. The biconcave shape increased the surface
area of the cell’s surface area compared to flat discs of the same size. The greater surface
area allows gases to move in and out of the red blood cell more rapidly. In addition, the
red blood cell can bend or fold arounds its thin center, thereby decreasing it size and
enabling it to pass more easily through smaller blood vessels.
3. They are derived from specialized cells that lose their nuclei and nearly all their cellular
organelles during maturation.
4. MAIN COMPONENT: HEMOGLOBIN
FUNCTIONS
1. Transport oxygen from the lungs to the various body tissues
Approximately 98.5 % of the oxygen in blood is transported in combination with
the hemoglobin in red blood cell, and the remaining 1.5% is dissolved in the water
part of plasma.
2. Transport carbon dioxide from tissues to the lungs for expulsion.
Carbon dioxide is transported in the blood in three major ways: 7% is dissolved in
the plasma; approximately 23% is combined with hemoglobin; and 70% is in the
form of bicarbonate ions. The bicarbonate ions are produced when carbon dioxide
and water combine to form carbonic acid, which dissociates to form hydrogen and
bicarbonate ions. The combination of carbon dioxide and water is catalyzed by an
enzyme, carbonic anhydrase which is located primarily within red blood cells.
Hemoglobin- Occupies about one-third of the total cell volume and accounts for its red color. It
consists of four polypeptide chains, called a globin, is bound to one heme. Each heme is a red-
pigmented molecule containing one iron atom.
Three forms:

• Embryonic-First type of hemoglobin produced during development.

• Fetal-Replaces embryonic hemoglobin at the third month of development
• Adult-Constitutes 60-90% after birth.
They have different affinities for, or abilities to bind with oxygen. Embryonic and fetal
hemoglobin have a higher affinity for oxygen than adult hemoglobin does. In the embryo and
fetus, hemoglobin picks up oxygen from the mother’s blood at the placenta. Even though
placental blood contains less oxygen than air, adequate amounts of oxygen are picked up
because of the higher affinity of embryonic and fetal hemoglobin for oxygen. After birth,
hemoglobin picks up oxygen from the air in the baby’s lungs.

Iron is necessary for the normal function of hemoglobin because each oxygen molecule that
is transported is associated with an iron atom. The adult human body normally contains about
4g of iron. Two-thirds of which is associates with hemoglobin. Small amounts of iron are
regularly lost from the body in waste products, such as urine and feces. Females lose
additional iron as a result of menstrual bleeding, and therefore require more dietary iron than
males do.

Oxyhemoglobin- An oxygenated form of hemoglobin, bright red

Deoxyhemoglobin- Contains no oxygen, dark red

Carbaminohemoglobin-Transports carbon dioxide which does not combine with iron atoms
but is attached to the globin molecule.

Carboxyhemoglobin- A hemoglobin with Carbon monoxide (CO) attached to it. It cannot

transport oxygen because CO binds strongly to it. Nausea, headache, unconsciousness, and
death are possible consequences of prolonged exposure to carbon monoxide.
LIFE HISTORY OF RED BLOOD CELLS

About 2.5 million red blood cells are destroyed every second. This lost might seem
staggering, but it represents only 0.00001% of the total 25 trillion red blood cells contained
in in the normal adult circulation. Homeostasis is maintained by replacing the 2.5 million
cells lost every second. Thus, approximately 1% of the total number of red blood cells is
replaced each day.

Erythropoiesis- The process by which new red blood cells are produced. The time
required to produce a single red blood cell is about 4 days.

Early erythroblasts give rise to intermediate (polychromatic) erythroblasts, which stain

different colors with basic and acidic dyes. As hemoglobin is synthesized and accumulates in
the cytoplasm, it’s stained a reddish color by an acidic dye. Intermediate erythroblasts
continue to produce hemoglobin, and then most of their ribosomes and other organelles
 degenerate. The resulting late erythroblasts have a reddish color because about one-third of
the cytoplasm is now hemoglobin. The late erythroblasts lose their nuclei by a process of
extrusion to become immature red blood cells, which are called reticulocytes because a
reticulum, or network, can be observed in the cytoplasm when a special staining technique is
used. The reticulum is artificially produced by the reaction of the dye with the few remaining
ribosomes in the reticulocyte. Reticulocytes are released from the bone marrow into the
circulating blood, which normally consists of mature red blood cells and 1%–3%
reticulocytes. Within 1 to 2 days, reticulocytes become mature red blood cells when the
ribosomes degenerate.

RED BLOOD CELL PRODUCTION

Red blood cell production is stimulated by low blood oxygen levels, typical causes of which are
decreased numbers of red blood cells, decreased or defective hemoglobin, diseases of the lungs,
high altitude, inability of the cardiovascular system to deliver blood to tissues, and increased
tissue demands for oxygen, for example, during endurance exercises. Low blood oxygen levels
stimulate red blood cell production by increasing the formation of the glycoprotein
erythropoietin, which is a hormone produced by the kidneys. Erythropoietin stimulates red bone
marrow to produce more red blood cells by increasing the number of proerythroblasts formed
and by decreasing the time required for red blood cells to mature.
Red blood cells normally stay in the circulation for about 120 days in males and 110 days in

females. These cells have no nuclei and, therefore, cannot produce new proteins.
 HEMOGLOBIN BREAKDOWN

WHITE BLOOD CELLS

White blood cells, or leukocytes, are clear or whitish-colored cells that lack hemoglobin but
have a nucleus. In stained preparations, white blood cells attract stain, whereas red blood cells
remain relatively unstained

Functions:
• White blood cells protect the body against invading microorganisms and remove dead
cells and debris from the body.

Most white blood cells are motile, exhibiting amoeboid movement, which is the ability to move
like an ameba by putting out irregular cytoplasmic projections. White blood cells leave the
circulation and enter tissues by diapedesis, a process in which they become thin and elongated
and slip between or, in some cases, through the cells of blood vessel walls. The white blood cells
can then be attracted to foreign materials or dead cells within the tissue by chemotaxis. At the
site of an infection, white blood cells accumulate and phagocytize bacteria, dirt, and dead cells;
then they die. The accumulation of dead white blood cells and bacteria, along with fluid and cell
debris, is called pus.

TYPES OF WHITE BLOOD CELLS

Neutrophils
• the most common type of white blood cells in the blood
• Have small cytoplasmic granules that stain with both acidic and basic dyes.
• Their nuclei are commonly lobed with the number of lobes varying from two to five.
• Often called polymorphonuclear neutrophils
• Neutrophils usually remain in the circulation for about 10–12 hours and then move into
other tissues where they become motile and seek out and phagocytize bacteria, antigen–
antibody complexes (antigens and antibodies bound together), and other foreign matter.
• Also secrete a class of enzymes called lysozymes, which are capable of destroying
certain bacteria.
• Usually survive for1–2 days after leaving the circulation.
Eosinophils
• Contain cytoplasmic granules that stain bright red with eosin, an acidic stain.
• They are motile cells that leave the circulation to enter the tissues during an inflammatory
reaction.
• They are most common in tissues undergoing an allergic response, and their numbers are
elevated in the blood of people with allergies. Eosinophils apparently reduce the
inflammatory response by producing enzymes that destroy inflammatory chemicals like
histamine.
• Eosinophils also release toxic chemicals that attack certain worm parasites, such as
tapeworms, flukes, pinworms, and hookworms.
Basophils
• the least common of all white blood cells
• Contain large cytoplasmic granules that stain blue or purple with basic dyes.
• Basophils, like eosinophils and neutrophils, leave the circulation and migrate through the
tissues, where they play a role in both allergic and inflammatory reactions.
• Basophils contain large amounts of histamine, which they release within tissues to
increase inflammation.
• They also release heparin, which inhibits blood clotting.
Lymphocytes
• Smallest white blood cells a
• The lymphocytic cytoplasm consists of only a thin, sometimes imperceptible ring around
the nucleus.
• Although lymphocytes originate in red bone marrow, they migrate through the blood to
lymphatic tissues, where they can proliferate and produce more lymphocytes.
• The majority of the body’s total lymphocyte population is in the lymphatic tissues: the
lymph nodes, spleen, tonsils, lymphatic nodules, and thymus.
• Although they cannot be identified by standard microscopic examination, a number of
different kinds of lymphocytes play important roles in immunity.
 • For example, B cells can be stimulated by bacteria or toxins to divide and form cells that
produce proteins called antibodies. Antibodies can attach to bacteria and activate
mechanisms that result in destruction of the bacteria. T cells protect against viruses and
other intracellular microorganisms by attacking and destroying the cells in which they
are found. In addition, T cells are involved in the destruction of tumor cells and tissue
graft rejections.
Monocytes
• Are typically the largest of the white blood cells.
• They normally remain in the circulation for about 3 days, leave the circulation, become
transformed into macrophages, and migrate through various tissues.
• They phagocytize bacteria, dead cells, cell fragments, and other debris within the
tissues.
• An increase in the number of monocytes is often associated with chronic infections.
• In addition, macrophages can break down phagocytized foreign substances and present
the processed substances to lymphocytes, which results in activation of the lymphocytes

BLOOD CLOTTING, GROUPS, CHEMISTRY

Vascular Spasm
Vascular spasm is the immediate but temporary constriction of a blood vessel. Vascular spasm
occurs when smooth muscle within the wall of the vessel contracts. This constriction can close
small vessels completely and stop the flow of blood through them. Damage to blood vessels can
activate nervous system reflexes that cause vascular spasms. Chemicals released by cells of the
damaged vessel as well as platelets also stimulate vascular spasms. For example, during the
formation of a platelet plug, platelets release thromboxanes (throm′bok-zānz), which are derived
from certain prostaglandins, and endothelial cells release the peptide endothelin (en-dō′thē-lin),
both of which lead to constriction of the vessel.

Platelet Plug Formation

Coagulation
Vascular spasms and platelet plugs alone are not sufficient to close large tears or cuts. When a
blood vessel is severely damaged, coagulation (kō-ag-ū-lā′shŭn), or blood clotting, results in the
formation of a clot. A blood clot is a network of threadlike protein fibers, called fibrin, that traps
blood cells, platelets, and flun inactive state and do not cause clotting. After injury, the clotting
factors are activated. The activation of clotting factors is a complex process involving many
chemical reactions, some of which require calcium ions (Ca2+ ) and molecules on the surface of
activated platelets, such as phospholipids and factor V. Clotting factors are activated in two
ways: the extrinsic pathway and the intrinsic pathway. These two pathways converge to form the
common pathway, which results in the formation of a fibrin clot. (Extrinsic pathway is so named
because it begins with chemicals that are outside of, or extrinsic to, the blood, on the other hand,
intrinsic pathway begins with chemicals inside the blood) After that is the common pathway
which consists of the cascade of activation events leading from the formation of activated factor
X to the formation of active thrombin, the cleavage of fibrinogen by thrombin, and the fid (Blood
clot formation depends on a number of clotting factors, or coagulation factors, which are proteins
found within plasma. Normally, the clotting factors are in formation of cleaved fibrin into a
stable multimeric, cross-linked complex.
Control of Clot Formation

Without control, clot formation would spread from the point of initiation through the entire
circulatory system. Furthermore, blood vessels in a healthy person contain rough areas that can
stimulate clot formation, and small amounts of prothrombin are constantly being converted into
thrombin. To prevent unwanted clotting, the blood contains several anticoagulants (an′tē-kō-
ag′ū-lantz). These anticoagulants prevent clotting factors from initiating clot formation under
normal concentrations in the blood.

Clot Retraction and Dissolution

The fibrin meshwork constituting a clot adheres to the walls of the blood vessel. Once a clot has
formed, clot retraction occurs, a process whereby the blood clot condenses into a denser,
compact structure. Platelets contain the contractile proteins actin and myosin, which operate in a
similar fashion to actin and myosin in smooth muscle Platelets form extensions, which attach to
fibrinogen through fibrinogen receptors Contraction of the extensions pulls on the fibrinogen and
leads to clot retraction. As the clot retracts, a fluid called serum (sēr′ŭm) is squeezed out of the
clot. Serum is plasma from which fibrinogen and some of the clotting factors have been
removed. The blood clot is usually dissolved within a few days after clot formation. The process
that dissolves the blood clot is called fibrinolysis (fī-bri-nol′i-sis).
ABO Blood Group The ABO blood group system is used to categorize human blood based on
the presence or absence of A and B antigens on the surface of red blood cells. Note that there are
only two possible antigens associated with the ABO blood group: antigen A and antigen B. Type
A blood has type A antigens, type B blood has type B antigens, type AB blood has both A and B
antigens, and type O blood has neither A nor B antigens on the surface of red blood cells. The
ABO blood group is an example of codominance in that the A and B antigens can be expressed
at the same time

In the event of a blood transfusion, it is very important to match the blood types of both the
donor and the recipient to avoid transfusion reactions. When a blood transfusion is performed,
the donor is the person who gives blood, and the recipient is the person who receives it. Usually,
a recipient can successfully receive blood from a donor as long as they both have the same blood
type

Agglutination Reaction
Rh Blood Group

A second clinically important blood group is the Rh blood group. The Rh blood group is so
named because it was first studied in rhesus monkeys. The antigen involved in this blood group
is the D antigen. People are Rh-positive if they have the D antigen on the surface of their red
blood cells, and people are Rh-negative if they do not have the D antigen.

Rh incompatibility can pose a major problem in a pregnancy when the mother is Rh-negative and
the fetus is Rh-positive. If fetal blood leaks through the placenta and mixes with the mother’s
blood, the mother becomes sensitized to the Rh antigen and produces anti-Rh antibodies. These
antibodies can cross the placenta and enter the fetal blood. In the fetal blood, the Rh antibodies
will act against the D antigens on the red blood cells and cause agglutination and hemolysis of
fetal red blood cells. This disorder is called hemolytic (hē-mō-lit′ik) disease of the newborn
(HDN), or erythroblastosis fetalis (ĕ-rith′rō-blas-tō′sis fē-ta′lis;

Prevention of HDN is often possible if the Rh-negative mother is injected with a specific type of
antibody preparation, called Rho(D) immune globulin (RhoGAM), which contains antibodies
against Rh antigens.

Erythroblastosis Fetalis
Type and Crossmatch To prevent transfusion reactions, blood is typed. Blood typing
determines the ABO and Rh blood groups of the blood sample. Typically, the cells are separated
from the serum and then tested with known antibodies to determine the type of antigen on the
cell surface. In a crossmatch, the donor’s blood cells are mixed with the recipient’s serum, and
the donor’s serum is mixed with the recipient’s cells. The donor’s blood is considered safe for
transfusion only if no agglutination occurs in either match.

Complete Blood Count is an analysis of blood that provides much useful information. A CBC
consists of a red blood count, hemoglobin and hematocrit measurements, a white blood count,
and a differential white blood count.

Red Blood Count Blood cell counts are usually performed with an electronic instrument, but
they can also be done manually with a microscope. A red blood count (RBC) is the number
(expressed in millions) of red blood cells per microliter of blood. (Male 4.6-6.2
million/microliter, Female 4.2-5.4 million/microliter)

Hemoglobin determines the amount of hemoglobin in a given volume of blood, usually

expressed as grams of hemoglobin per 100 mL of blood(Male 14-18 g/100mL, Female 12-16
g/100mL)
Hematocrit Measurement The hematocrit (hē′mă-tō-krit, hem′ă-tō-krit) is the percentage of the
total blood volume that is composed of red blood cells. One way to determine hematocrit is to
place blood in a tube and spin it in a centrifuge The red blood cells account for 40–54% of the
total blood volume in males and 38–47% in females.

White Blood Count measures the total number of white blood cells in the blood. Normally,
5000–10,000 white blood cells are present in each microliter of blood.

Clotting

The blood’s ability to clot can be assessed by the platelet count and the prothrombin time
measurement.

Platelet Count

A normal platelet count is 250,000–400,000 platelets per microliter of blood. In the condition
called thrombocytopenia (throm′bō-sī-tō-pē′nē-ă), the platelet count is greatly reduced, resulting
in chronic bleeding through small vessels and capillaries. It can be caused by decreased platelet
production as a result of hereditary disorders, lack of vitamin B12, drug therapy, or radiation
therapy.

Prothrombin Time Measurement

Expresses how long it takes for the blood to start clotting, which is normally 9–12 seconds.
Prothrombin time is determined by adding thromboplastin to whole plasma. Thromboplastin is a
chemical released from injured tissues that starts the process of clotting Prothrombin time is
officially reported as the International Normalized Ratio (INR), which standardizes the time
blood takes to clot based on the slightly different thromboplastins used by different labs. Because
many clotting factors must be activated to form fibrin, a deficiency of any one of them can cause
the prothrombin time to be abnormal. Vitamin K deficiency, certain liver diseases, and drug
therapy can increase prothrombin time.

Blood Chemistry

The composition of materials dissolved or suspended in the plasma can be used to assess the
functioning of many of the body’s systems. For example, high blood glucose levels can indicate
that the pancreas is not producing enough insulin; high blood urea nitrogen (BUN) can be a sign
of reduced kidney function; increased bilirubin can indicate liver dysfunction or hemolysis; and
high cholesterol levels can signify an increased risk for cardiovascular disease. A number of
blood chemistry tests are routinely done when a blood sample is taken, and additional tests are
available.

Functions of the Heart

The heart is actually two pumps in one.
 • Pulmonary Circulation carries blood from the body to the lungs, where carbon dioxide
diffuses from the blood into the lungs and oxygen diffuses from the lungs into the blood,
and returns it to the left side of the heart
• Systemic Circulation carries blood from the left side of the heart, which delivers oxygen
and nutrients to the remaining tissues of the body, where carbon dioxide and waste
products are carried back to the right side of the heart.

The following are the functions of the heart:

1. Generates blood pressure
2. Responsible for routing blood
3. Ensures one way flow of blood
4. Regulates blood supply

Heart Wall
The heart wall consists of three layers of tissue:
1. The epicardium or visceral pericardium is a thin serous membrane that constitutes the smooth,
outer surface of the heart. It is called epicardium when it is considered as part of the heart and
visceral pericardium when considered part of the pericardium.
2. The myocardium is responsible for the ability of heart to contract and is composed of cardiac
muscle cells.
3. The endocardium consists of simple squamous epithelium over a layer of connective tissue.
This smooth, inner surface allows blood to move easily through the heart. It also covers the
surfaces of the heart valves.
Coronary Circulation
There are four chambers of the heart.
• Two (2) thin-walled atria form the superior and posterior parts of the heart.
• Two (2) thick-walled ventricles form the inferior and anterior parts of the heart.

Veins carry blood to the heart.

1. Superior Vena Cava carries blood from the body to the right atrium.
2. Inferior Vena Cava carries blood from the body to the right atrium.
3. Four (4) pulmonary veins carry blood from the lungs to the right atrium.
In addition, the smaller coronary sinus carries blood from the walls of the heart to the right
atrium.
Major draining veins of the heart are:
1. Great cardiac vein drains the tissue on the left side of the heart.
2. Small cardiac vein drains the tissue on the right margin of the heart.
These two veins converge toward the posterior part of the coronary sulcus and empty into the
coronary sinus. Coronary sinus is a large venous cavity that empties into the right atrium.

Arteries carry blood away from the heart.

1. Aorta carries blood from the left ventricle to the body.
• Right coronary artery is usually smaller in diameter as it does not carry as much blood as
the left one. It lies within the coronary sulcus and extends from the aorta around to the
posterior part of the heart.
§ Right marginal artery, a larger branch of right coronary artery supplies blood to the
lateral wall of the right ventricle
§ Posterior interventricular artery supplies blood to the posterior and inferior part of the
heart.
• Left coronary artery
§ Anterior interventricular artery or left anterior descending artery supplies blood to
most of the anterior part of the heart.
§ Left marginal artery supplies blood to the lateral wall of the left ventricle.
§ Posterior interventricular artery supplies blood to the posterior and inferior part of the
heart.
2. Pulmonary trunk carries blood from the right ventricle to the lungs.

Coronary sulcus runs obliquely around the heart and separates the atria from the ventricles. In a
healthy heart, the sulci are covered by adipose tissue and can only be seen after the tissue is
removed.
2. Anterior Interventricular Sulcus (Groove) is on the anterior surface of the heart.
2. Posterior Interventricular Sulcus (Groove) is on the posterior surface of the heart.

Heart Chambers and Valves

Right and Left Atria
The right atrium has three major openings.
• The opening from superior vena cava receives blood from the body.
• The opening from inferior vena cava receives blood from the body.
• The opening of coronary sinus receives blood from the heart itself.
The left atrium has four relatively uniform openings
 • The openings from four pulmonary veins receive blood from the lungs.
The two atria are separated by the interatrial septum. Fossa ovalis, a slight depression on the
right side of the septum marks the former location of foramen ovale, an opening in between the
right and left atria in fetus and embryo. This allows blood to flow from the right to left atrium
without bypassing the pulmonary circulation.
Right and Left Ventricles
• The right ventricle opens into the pulmonary trunk.
• The left ventricle opens into the aorta.
The two ventricles are separated by each other by interventricular septum, which has a thick and
muscular part toward the apex and a thin membranous part toward the atria. This is for the reason
that the thicker wall of the ventricle allows for stronger contractions to pump blood though
systemic circulation.

Atrioventricular Valve
Atrioventricular valve is composed of cusps or flaps. It allows blood to flow from the atria to the
ventricle and prevents blood from flowing blood back into the atria.
• Tricuspid valve is the atrioventricular valve between the right atrium and right ventricle
and has three cusps.
• Bicuspid valve or mitral valve is the atrioventricular valve between the left atrium and
left ventricle and has two cusps.
Each ventricle contains papillary muscles, a cone-shaped muscular pillar. These muscles are
attached by thin, strong connective tissue strings called chordae tendineae to the cusps of the
atrioventricular valves. The papillary muscles contract when the ventricles contract and prevent
valves from opening into the atria by pulling on the chordae tendineae attached to the valve
cusps. Blood flowing from the atrium into the ventricle pushes the valve open into the ventricle
however, when the ventricle contracts, blood pushes the blood back toward the atrium. The
atrioventricular canal is closed as the valve cusps meet.

Semilunar Valve
Within the aorta and pulmonary trunk are the:
• Aortic semilunar valve
• Pulmonary semilunar valve
Each valve consists of three pocketlike semilunar cusps. The free inner borders of the cusps meet
in the center of the artery to vblock blood flow. Blood flowing out of the ventricles pushes
against each valve, forcing it open. However, when blood flows back from the aorta or
pulmonary trunk toward the ventricles, it enters the pockets of the cusps, causing them to meet in
the center of aorta or pulmonary trunk, thus causing them to close and keeping the blood from
flowing back into the ventricles.

Route of Blood Flow through the Heart

Cardiac Muscle
Cardiac muscle cells are elongated, branching cells with one or two centrally located nuclei.
They contain actin and myosin filaments organized to form sarcomeres to form myofibrils. The
actin and myosin are responsible for muscle contraction and their organization gives cardiac
muscle a striated or banded appearance.
Cardiac muscle has:
1. Smooth sarcoplasmic reticulum without dilated cisternae and is not as regularly arranged as in
skeletal muscle.
2. Transverse (T) tubules larger in diameter and has extensions parallel with the sarcoplasmic
reticulum.
The loose association between the sarcoplasmic reticulum and the T tubules is partly responsible
for the slow onset of contraction phase in cardiac muscle. Also, cardiac muscle cells are rich in
mitochondria, which perform oxidative metabolism at a rapid rate. The extensive capillary
network provides an adequate oxygen supply to the cardiac muscle cells.
Cardiac muscle cells are organized in spiral bundles or sheets.
• Intercalated disks are specialized cell-to-cell contacts which bound cardiac muscle cells
end-to-end and laterally to adjacent cells.
• Desmosomes are specialized plasma membrane structures that hold the cells together.
• Gap junctions allow cytoplasm to flow freely between cells that results to low electrical
resistance between cells. This enables action potentials to pass easily from one cell to
next.
Blood Vessels
Functions:
1. Carries blood throughout the body
2. Transport nutrients and waste products
3. Regulates blood pressure of the body
4. Directs blood flow to the tissue

Blood Vessels of the Pulmonary Circulation

- System of blood vessels that carries blood from the right ventricle of the heart to the
lungs and back to the left atrium of the heart.

Blood Vessels of the Systemic Circulation

- System of blood vessels that carries blood from the aorta of the heart to the rest of
the body and back to the right atrium of the heart.
 http://realtyconnect.me/diagram-of-systemic-circulation/diagram-of-systemic-circulation-pulmonary-with/

Blood flow of Arteries and Veins

Blood Pressure
- Measure of the force blood exerts against the blood vessels.
- Normal blood pressure: 120/80
- mm/Hg
Types:
1. Systolic Pressure – Blood pressure reaches the maximum value (Contraction)
2. Diastolic Pressure – Blood pressure reaches the minimum value (Relaxation)
Auscultatory Method – Method used to determine blood pressure.
- Instruments used are the sphygmomanometer and stethoscope
Steps:
 1. A blood pressure cuff connected to a sphygmomanometer is wrapped around
the patient’s arm and a stethoscope is placed over the brachial artery.
2. The cuff is then inflated and until the brachial artery is completely blocked (No
sounds can be heard through the stethoscope).
3. The pressure in the cuff is gradually lowered. The first Korotkoff sound
(sound that is produce by the vibration of the vessels and the surrounding tissue)
is the systolic pressure.
4. When the pressure drop until the brachial artery is no longer constricted, the
sounds disappear. The pressure at which the Korotkoff sound disappear is the
diastolic pressure.
Blood Flow Through a Blood Vessel
• Blood flow through the blood vessel is the volume of blood that passes through the
vessel per unit in time.

𝑃' − 𝑃'
𝐹𝑙𝑜𝑤 =
𝑅
Where P1 and P2 are the pressures at the vessel at points one and two, respectively
and R is the resistance to flow.

Blood always flow from an area of higher pressure to an area of lower pressure. The
greater the pressure difference, the greater the rate of flow. As the resistance increase,
blood flow decrease.
• Resistance
128𝑣𝑙
𝐹𝑙𝑜𝑤 =
𝜋𝑑 1
v – viscosity l – length d – diameter
• Poiseuille’s Law
“A small change in the diameter of a blood vessel dramatically changes the resistance to
flow, and therefore the amount of blood that flows through the vessel.”
Vasoconstriction decreases the diameter of a vessel, increases the resistance to flow,
and decrease the blood flow through the vessel.
Vasodilation increases the diameter of a vessel, decreases the resistance to flow,
and increase the blood flow through the vessel.
• Viscosity
Measure of the resistance of a liquid to flow
Blood viscosity is 3.0 – 4.5
As the viscosity increases, the pressure required to force the blood to flow increase.
The viscosity of blood is greatly influenced by Hematocrit (percentage of the total blood
volume composed of red blood cell.
 Viscosity above its normal range of values increases the workload on the heart; if this
workload is great enough, it would result to heart failure.
Blood Flow Through the Body
𝑀𝐴𝑃 = 𝐶𝑂 𝑥 𝑃𝑅
MAP (Mean Arterial Pressure) – Slight less than the average systolic and diastolic
pressure
CO (Cardiac Output) – volume of blood pumped per minute by the left ventricle
PR (Peripheral Resistance) – sum of all the resistance to blood flow in all of the blood
vessel.
Vasomotor tone – state of partial constriction.

Changing the amount of sympathetic stimulation changes vasomotor tone and peripheral
resistance. Increased sympathetic stimulation of blood vessel smooth muscle cause
vasoconstriction by decreasing blood vessel diameter. Increased vasoconstriction,
increases vasomotor tone and the resistance to blood flow, which increases peripheral
resistance. Conversely, decreased sympathetic stimulation of blood vessels smooth
muscle result in vasodilation, decreased vasomotor tone and decreased peripheral
resistance.
Blood Pressure and the Effect of Gravity
Hydrostatic pressure is the pressure, or weight, produced by a column of fluid due to
the effects of gravity. When a person is standing, the blood pressure in a blood vessel in the
foot results from the pressure generated by contraction of the heart plus the hydrostatic
pressure produced by the “column” of blood above the foot. When a person changes position
from lying down to standing, the blood pressure in the vein of the lower limb increases. The
compliance of veins is approximately 24 times greater than the compliance of artery. The
increased blood pressure causes the distensible (compliant) veins to expand, but has little effect
on the arteries. Venous return decreases because less blood is returning to the heart as the
veins are filling with blood. As venous return decreases, cardiac output and blood pressure
decreases. If negative feedback mechanism does not compensate and cause blood pressure to
increase, there is inadequate delivery of blood to the brain. Homeostasis of the brain is
disrupted and dizziness or fainting can occur.

Pulse Pressure
- Difference between systolic pressure and diastolic pressure.
Ex. 120 mm Hg (Systolic) – 80mm Hg (Diastolic) = 40 mm Hg (Pulse Pressure)

Factors:
1. Stroke Volume
- Increased stroke volume results to increased systolic pressure, thus
increased pulse pressure.
 2. Vascular Compliance
- elasticity of the blood vessel wall
- the increase in pressure is determined by the compliance of the aorta
at
that particular range of volumes. The more compliant the aorta, the
smaller the pressure change during ventricular ejection.
Vascular Compliance
- The ability of a blood vessel wall to expand and contract passively with changes in
pressure

Δ𝑉
𝐶=
Δ𝑃
C – Vessel Compliance V – Volume P – Pressure
- Compliance decreases at higher pressures and volumes
- At lower pressures, the compliance of a vein is about 10 to 20 times greater than an
artery. Therefore, the veins can accommodate a large changes in blood volume with
only a small change in pressure
Capillary Exchange and Regulation of Interstitial Fluid
There are approximately 10 billion capillaries in the body. The heart and blood
vessels all maintain blood flow through those capillaries and support capillary
exchange, movement of substances between capillaries and the interstitial fluids of
tissues.
Lipid-soluble molecules cross capillary walls by diffusing through the plasma
membranes of the endothelial cells of capillaries.
The permeability of capillaries to water-soluble substances varies tremendously.
In a typical capillary the space between the endothelial cells allows the passage of most
substances, except for proteins.
Diffusion and Filtration are the primary means by which most substances cross
capillary walls.
Edema or swelling of tissues is caused by increased interstitial fluid caused by
inwardly and outwardly directed pressures across the capillary walls.

Control of Blood Flow

Mechanisms that control the blood flow to and through tissues are classified as
(1) local control and (2) nervous and hormones
Local Control
 Blood flow at the tissues is regulated by arterioles by controlling the amount of
blood reaching the capillary beds, and by precapillary sphincters through controlling the
flow of the blood through capillaries. They are both regulated by local control.
Nervous and Hormonal Control
Blood flow through arterioles, arteries, and veins is reulated by nervous and
hormonal mechanisms. The vasomotor center, an area of the lower pons and upper
medulla oblongata continually transmits a low frequency of action potentials through
sympathetic fibers to the smooth muscles of blood vessels that promote
vasoconstriction and vasodilation
On the other hand, the neurotransmitters norepinephrine and epinephrine for the
sympathetic fibers binds to alpha-adregenic receptors on blood vessels smooth muscles
to cause vasoconstriction. In skeletal and cardiac muscles, epinephrine causes
vasodilation because of the large numbers of beta-adregenic receptors in both muscles.
Arteries
Muscular arteries and arterioles control blood delivery by vasoconstricting and
vasodilating. Muscular arteries control the flow of blood to large areas of the body.
Veins
The compliance of veins is approximately 24 times greater than the compliance
of arteries because of the structure of their walls.
According to Starling’s Law, as venous return increases, the heart contracts
more forcefully, causing stroke volume and cardiac output to increase.
Venous return is affected by the following:
(1) Vasoconstriction and vasodilation of veins
(2) Blood volume
(3) Valves and the Skeletal Muscle Pump

Regulation of Mean Arterial Pressure

Blood flow to all areas of the body depends on the maintenance of an adequate
pressure in the arteries. As long as arterial blood pressure is adequate, local control of
blood flow through tissues is appropriately matched to their metabolic needs.
Blood flow through the circulatory system is determined by the cardiac output
(CO), which is equal to the heart rate (HR) times the stroke volume (SV), and peripheral
resistance (PR), which is the resistance to blood flow in all the blood vessels.
MAP= CO X PR or MAP= HR X SV X PR

Short-Term Regulation of Blood Pressure

 The regulatory mechanisms that control pressure on a short-term basis respond
quickly but begin to lose their capacity to regulate blood pressure a few hours to a few
days after the blood pressure is maintained at higher or lower levels.
Under these are:
(a) Baroreceptor Reflexes
Help regulate blood pressure by modifying heart rate and stroke volume.
In addition, they regulate blood pressure by changing peripheral resistance.
Baroreceptors are sensory receptors that respond to stretch in large
arteries of neck and thorax caused by increased blood pressure.
A sudden increase in blood pressure detected by baroreceptors will send
signals or action potentials to medulla oblongata causing the arteries to
vasodilate to lower the blood pressure. Other response can also include the
activity of the parasympathetic system.
Meanwhile, a sudden decrease of blood pressure detected by
baroreceptors stimulates centers in the medulla oblongata produces responses
that raise blood pressure.
The baroreceptor reflexes regulate blood pressure on a moment-to-
moment basis.

(b) Adrenal Medulla Mechanism

The adrenal medulla is responsible for the release of the hormones
epinephrine and norepinephrine into the blood. Their main effect is to increase
heart rate and stroke volume.
Epinephrine causes vasodilation in skeletal and cardiac muscles and
vasoconstriction in the skin and kidneys. Norepinephrine increases
vasoconstriction everywhere.
The adrenal medulla mechanism usually responds within seconds to
minutes and is usually active from minutes to hours.

(c) Chemoreceptor reflexes

Help maintain homeostatis when oxygen tension in the blood decreases or
when carbon dioxide and hydrogen ion concentration increase.
Chemoreceptors are sensory receptors responding to chemicals, such as
oxygen, Carbon dioxide, and PH.
The peripheral chemoreceptors are most sensitive to oxygen. On the
other hand, Central chemoreceptors are most sensitive to changes in carbon
dioxide and PH.
Long-Term Regulation of Blood Pressure
The long-term regulation of blood pressure is controlled primarily by
mechanisms that influence kidney function, and those mechanisms do not adapt
rapidly to alter blood pressures.
(a) Renin-Angiotensin-Aldosterone Mechanism
Helps regulate blood pressure by changing peripheral resistance and
blood volume. When blood flow reduces, kidney releases renin in the blood
stream. Renin acts on blood as protein angiotensinogen to produce angiotensin I.
Another enzyme called angiotensin-converting enzyme found in the lungs, acts
on angiotensin I to convert it to its most active form, angiotensin II, a potent
vasoconstrictor substance. This process causes blood pressure to increase
toward its normal value.
Angiotensin II also acts on the adrenal cortex to increase the secretion of
aldosterone. It acts on kidneys, causing them to conserve sodium (Na+) and
water. As a result, the volume of water lost from the blood into the urine is
reduced, which maintains blood volume.
(b) Vasopressin (ADH) Mechanism
Decreased values in blood pressure detected by the baroreceptors result
in the release of vasopressin or antidiuretic hormone (ADH) from the posterior
pituitary.
ADH acts directly on blood pressure to cause vasoconstriction. It also
decreases the rate of urine production by the kidneys, which helps to maintain
blood volume and pressure.
(c) Atrial Natriuretic Mechanism
A polypeptide called atrial natriuretic hormone is releases from the cells in
the atria of the heart. It is a major stimulus for increased venous return. Atrial
natriuretic hormone acts on the kidneys to increase the rate of urine production. It
also dilates arteries and veins. Vasodilation results in decreased peripheral
resistance, thus decreasing blood pressure.
(d) Fluid shift mechanism
The fluid shift mechanism causes fluid shift, which is a movement of fluid
from the interstitial spaces into the capillaries in response to a decrease in blood
pressure to maintain blood volume.
Examples of Cardiovascular Regulation Exercise
Local control mechanisms increase blood flow through exercising muscles, which
lowers peripheral resistance.
Cardiac output increases because of increased venous return, stroke volume,
and heart rate.
Vasoconstriction in the skin, the kidneys, the gastrointestinal tract, and skeletal
muscle increases peripheral resistance, which helps prevent a drop in blood pressure.
 Blood pressure increases despite an overall decrease in peripheral resistance
because of increased cardiac output.
Circulatory Shock
Circulatory shock is inadequate blood flow throughout the body. As
consequence, tissues suffer damage resulting from the lack of oxygen.
(a) Hypovolemic shock- the result of reduced blood volume. Hemorrhagic shock
is caused by internal or external bleeding. Plasma loss shock results from a
loss of plasma. Interstitial fluid loss shock is reduced blood volume resulting
from loss of interstitial fluid, as diarrhea, vomiting, and dehydration
(b) Neurogenic Shock- is caused by vasodilation in response to emotional upset or
anesthesia.
(c) Anaphylactic shock- is caused by an allergic response, resulting in the release
of inflammatory substances that cause vasodilation and increase in capillary
permeability.
(d) Septic shock (blood poisoning)- caused by infections that result in the release
of toxic substances into the circulatory system, which depress the activity of the
heart and lead to vasodilation and increased capillary permeability.
(e) Cardiogenic shock- result from a decrease in cardiac output caused by events
that decrease the heart’s ability to function.