Cardiovascular Physiology

Dr. Abdulhalim Serafi, MB ChB,MSc,PhD,FESC

Assistant Professor & Consultant Cardiologist
Faculty of Medicine
Umm Al-Qura University
Drserafi.com
Serafi@UQU.EDU.SA

CARDIOVASCULAR PHYSIOLOGY
LECTURE I: Introduction
Outline:

Components of the cardiovascular system (CVS)

The systemic and pulmonary circulation
.Basic functions of the various parts of the CVS
.General function of the CVS
.Physiological anatomy of the heart
The cardiac muscle as a functional sancytum
.Specialized tissues of the heart
Mechanism of heart beating

:Further Reading
Guyton: Textbook of Medical Physiology
Ganong: Review of Medical Physiology

Introduction
The cardiovascular system (CVS) is a closed system in
which the blood circulates throughout the body. It consist of
the heart (pump) and the blood vessels.
Components of the CVS:
1. Heart: It is a pump composed of 4 chambers (2 atria & 2
ventricles.
2. Blood Vessels: The blood vessels are systems of tubes
including:
a) Arteries and arteriols which carry the blood from the
heart to all parts of the body.
b) Venules and veins which carry the blood back from the
tissues to the heart.
c) Blood capillaries which form a network of fine vessels
connecting the arteriols with the venules. The blood
capillaries are the sites of exchange of gases (O 2 & CO2),
nutrients and waste products between blood and tissues.

Major Components of the CVS

Circulatory System
The cardiovascular system (CVS) consists of
the heart and blood vessels.
It is a closed system in which blood
circulates, hence the synonym circulatory
system.

Basic Function of the various

parts of the CVS
a) HEART:
1) The left side of the heart (high pressure side) acts a
pressure pump that pumps blood into the systemic
arteries at a sufficient pressure that drives blood to
the tissues.
2) The right side of the heart (low pressure side) pumps
blood into the pulmonary arteries at a relatively
lower pressure that drives blood into the lungs.
b) BLOOD VESSELS:
1) The arteries: the aorta and the pulmonary artery are
elastic arteries i.e. they are the properties of stretch
(=distension or compliance) and recoil.
During ventricular contraction (systole), they distend by
the blood ejected into them; and energy is at load in
their walls.

During ventricular relaxation (diastole), this energy is

released causing elastic recoil of their walls, which acts
as an additional pump to blood during diastole.
Thus on efficient pressure is maintained during systole
and diastole, resulting in a continuous blood flow
through the tissues. In other words, the arteries act as
damping (wind vessel) vessels which convert
intermittent pressure into steady pressure that rapidly
deliver blood to the tissues.
2) The arteriols are resistance vessels that act as variable
resistors because their diameters continuously undergo
changes in order to regulate the amount of blood flow
into the capillaries. Therefore, the arterioles are
considered the taps regulating blood flow to the
tissues.

3) The capillaries act as exchange vessels between blood

and tissues; as through the blood capillaries O2 as
nutrients are supplied to the tissues and CO2 as waste
products are drained from them.
4) The veins act as capacitance vessels (volume reservoir)
that hold most of the blood volume. Veins have a high
distending capacity (=high compliance) and they can
store or mobilize blood depending upon the underlying
condition.

GENERAL FUNCTION OF THE CVS:

The normal function of the CVS is to maintain
homeostasis (i.e. a constant optimum internal
environment). Thus, in spite of continuous metabolic
activity of the tissue cells, homeostasis is maintained by
continuous adequate blood flow to the tissues.

Components:
1.

The heart provides the driving force for

the cardiovascular system.

2.

The arteries serve as distribution

channels to the organs.

3.

The microcirculation, which includes

the capillaries, serve as the exchange
region.

4.

The veins serve as blood reservoirs and

collect the blood to return it to the
heart.

THE HEART

The heart
The heart is the central pump of the cardiovascular
.system that drives blood through the blood vessels
It is a muscular structure, which is made up of four
.chambers
Systole Diastole
A heart beat consists of a systole plus a diastole of cardiac
.chambers
The heart of a normal adult male beats automatically and
regularly at a rate of 75 beats/minute during rest. The
.normal range of heart rate is between 60 100
.Tachycardia
.Bradycardia

PHYSIOLOGICAL ANATOMY
of the HEART
The HEART is the great central pump of the CVS. It
lies in the left side of the thoracic cavity partly behind the
sternum and between the right and left lungs. It is covered
by a fibrous sac called the pericardium.

GENERAL STRUCTURE OF THE HEART

The heart is a hollow muscular organ. Its walls are
composed of a muscle called the cardiac muscle or the
myocardium which is lined by a endothelial layer
called the endocardium (in contact with the blood
inside the heart cavity) and covered by a thin layer
called the epicardium (=visceral layer of the pericardial
sac).

Cardiac Chambers & their functions

The human HEART is consist of four chambers:
Two atria (right and left) which are separated from
each other by the interatrial septum.
Two ventricles (right and left) which are separated
from each other by the interventricular septum. The
wall of the left ventricle is about 3 times thicker than
the wall of the right ventricle.
The ventricular myocardium (wall) is much thicker and
stronger than the atrial myocardium (wall). The atrial
muscle (of both atria) is completely separated from the
ventricular muscle (of both ventricles) by a fibrous ring
called AV ring (atrioventricular ring).

The atria have 2 main functions:

1) They act as blood reservoir for the blood returning
back to the heart.
2) They act as pumps (primer pumps). Atrial
contraction pushes about 25% of the blood filling
the ventricles during ventricular diastole and about
75% of the blood that ventricles during their
diastole pass passively i.e. by its own weight.
The ventricles, on the other hand,a re the powerful
cardiac pumps filling the arteries with blood. The right
ventricle (pulmonary pumps) pushes blood into the
pulmonary arteries and the left ventricle (systemic
pump) pushes blood into the aorta during ventricular
systole.

Cardiac Valves and their functions

The human heart contains four valves
Two atrioventricular valves (AV valves) between the
atria and the ventricles:
Tricuspid valve between the right atrium and the right
ventricle.
Mitral or tricuspid valve between the left atrium and
there left ventricle.
Two semilunar valves:
Aortic valve between the left ventricle and the aorta.
Pulmonary valve between the right ventricle and the

Functions of the cardiac valves

The cardiac valves allow for the blood to pass only in
one direction i.e.
- The AV valves allow for the blood to pass from the
atria into the ventricles during ventricular diastole.
During ventricular systole, the AV valves close to
prevent back flow of blood from the ventricles into
the atria.
- The semilunar valves allow for the blood to pass
from the ventricles into the arteries during
ventricular systole. During ventricular diastole,
these valves prevent back flow of blood from the
arteries into the ventricles (as these valves become
closed during ventricular diastole).

It should be noted that:

a) The valves open or close depending upon the
pressure gradient of the blood on both sides of the
valves e.g.
The AV valves:
- Open when the atrial pressure becomes higher than
the ventricular pressure or
- Close when the ventricular pressure becomes higher
that the atrial pressure.
The semilunar valves:
- Open when the ventricular pressure becomes higher
than the arterial pressure and
- Close when the arterial pressure becomes higher
than the ventricular pressure.

Cardiac muscle as a
functional sancytum
The cardiac muscle is formed of a network of branching
muscle fibers. Each muscle fiber has a separate cell
membrane. The sites of contact (end to end contact)
between the different fibers are called intercalated discs.
Also, the membranes of the adjacent fibers fuse for
considerable distances producing gap functions.
These functions provide low electrical resistance for rapid
spread of the excitation wave (=cardiac action potential)
from one fiber to the other ones. Thus, the cardiac muscle
acts as functional sanctum and it contracts as one unit.

The human heart contains 2 separate syncytia, atrial

sancytum (= wall of the two atria) and ventricular
sancytum (= wall of the two ventricles). The two
syncytia are completely separated by a fibrous ring
called the AV ring which prevents passage of the
excitation waves from one sancytum to the other one.
Therefore, there is a special conducting system for
transmission of the excitation waves from the atrial
sancytum to the ventricular sancytum.

:The heart as a pump

The heart is two pumps in series
(i.e., the right and left sides) that
are connected by the pulmonary
.and systemic circulations

Systemic and pulmonary

circulations

Systemic Circulation & Pulmonary

Circulation
In the human body, the blood circulates within the CVS in 2
circulations:
The 1st one to the lungs and it is called the pulmonary or
lesser circulation
1)Systemic or greater circulation:
It starts from the left ventricle and it ends in the right
atrium of the heart as follows:
The blood is pumped from the left ventricle of the heart to
the aorta, then nutrients are given to the tissue cells and
CO2 and waste products of metabolism are taken from
them).
The blood is collected from the capillaries by the venules to
the veins to the superior and inferior vena cava which carry
the blood to the right atrium of the heart.

2)Pulmonary or lesser circulation:

It starts from the right ventricle and it ends in the left
atrium of the heart as follows:
The blood is pumped from the right ventricle to the
pulmonary arteries & to the pulmonary capillaries (where
exchange of O2 and CO2 occurs between the blood and the
air in the alveoli of the lungs.
The blood is then collected by the pulmonary veins which
carry the blood to the left atrium of the heart. The blood
then passes from the LA to LV where systemic circ. begin.

In the cardiovascular system, blood passes through two

circulations in series. One full circulation consists of these
two circulations together. Both circulations start and end
:in the heart. These two circulations are
:The systemic (or greater or high-pressure) circulation
It starts in the left ventricle the aorta systemic arteries
systemic capillaries systemic veins superior and
.inferior vena cavae ends in the right atrium
:The pulmonary (or lesser or low-pressure) circulation
It starts in the right ventricle the pulmonary trunk
pulmonary arteries pulmonary capillaries
.pulmonary veins ends in the left atrium

The two circulations are in series. So, blood finishes*

. one circulation to start the other
This allows the whole blood volume to carry out its*
respiratory function more efficiently as blood goes
once through the systemic capillaries and once
. through the pulmonary capillaries
Thus, both ventricles must pump the same volume of*
blood during any significant time interval because of
the series arrangement of the systemic and
pulmonary circulations. In other words, pulmonary
blood flow (right-sided output) must equal systemic
blood flow (left-sided output). The balanced output
is achieved by an intrinsic property of cardiac
.muscle known as the Frank-Starling mechanism

Parallel distribution to the

organs
Although the right and left sides of the heart are*
connected in series, the various systemic organs
receive blood flow through parallel distribution
.channels
This parallel arrangement supplies systemic*
organs with blood that has the same arterial
composition (e.g., the same O2 and CO2
tensions, pH, glucose levels, and so on) and
.essentially the same arterial pressure

Organization in the Circulatory System

SERIES AND
PARALLEL CIRCUITS

The right ventricle

The right ventricle pumps relatively large volumes of*
blood at a low pressure through the pulmonary
circulation (the right ventricle is essentially flow
.generator)
The normal cross-section of the right ventricle is*
.crescent-shaped
If the right ventricle must eject blood against a high*
pressure for prolonged periods (as seen in certain
pulmonary diseases), it assumes a much more
cylindrical appearance and there is a thickening of
the right ventricular free wall (right ventricular
.hypertrophy)

The left ventricle

The left ventricle pumps blood through the
.systemic circulation
It is cylindrical in shape and normally has a thicker
.wall than does the right ventricle
The left ventricle works much harder than the right
ventricle because of the higher pressure in the
systemic circulation (the left ventricle is essentially
.pressure generator)
Consequently, the left ventricle is more commonly
affected by disease processes than is the right
.ventricle

Blood flow from the heart

During ventricular systole, blood is pumped into
.the circulation
During diastole, the pumping of blood stops and
.the ventricles get filled with blood
In this way, the flow of blood from the ventricles
into the systemic and pulmonary circulations is
.an intermittent pulsatile flow

Cardiac output
Cardiac output is the blood flow generated by*
.each ventricle per minute
The cardiac output is equal; to the volume of*
blood pumped by one ventricle per beat times the
:number of beats per minute
Q = SV . HR
Where Q = cardiac output, SV = stroke volume,
.and HR = heart rate

The stroke volume for each ventricle averages 70 ml

of blood, and a normal heart rate is approximately
70-75 beats/minute; therefore, the cardiac output
.at rest is approximately 5 L/min
The heart rate is under neural control. Cardiac
sympathetic efferent activity increases the heart
rate, whereas parasympathetic (vagal) efferent
.impulses decreases heart rate
The stroke volume varies with the volume of blood in
the ventricle at the onset of contraction, changes in
the force of ventricular contraction, and the
.arterial pressure

Blood vessels

Blood vessels

Blood vessels
.Elastic vessels. 1
.Low-resistance vessels. 2
.High-resistance vessels. 3
.Exchange vessels. 4
.Capacitance vessels. 5

Blood pressure
What drives blood along the blood vessels
? after it has left the heart

The peripheral resistance

As the blood flows from the arterial to the venous side of
the circulation, it meets resistance because of the smaller
caliber of the vessels and the viscous nature of the blood.
This is called the peripheral resistance. It is an important
factor in generating and maintaining the arterial blood
pressure. Vasoconstriction of the small vessels increases
the peripheral resistance, which in turn elevates the
arterial blood pressure. Whilst vasodilatation decreases
.the resistance and lowers the pressure

.The main factor is a gradient of blood pressure

RESISTANCES IN SERIES
RT = RA + RC + RV

RESISTANCES IN PARALLEL
R1
1 = 1 + 1 + 1
RT R1 R2
R3
RT =

1
1 + 1 + 1
R1 R2 R3

PV

PA
R2
R3

Pressure Drop in the Vascular System

ELASTIC TISSUE
MUSCLE

MEAN PRESSURE

LARGE ARTERIES

LARGE

SMALL ARTERIES

ARTERIOLES

CAPILLARIES
VENULES &VEINS
SMALL

INSIDE DIAMETER

LARGE

Pressure Drop in the Vascular System

THE SYSTEMIC CIRCULATION

NORMAL

NORMAL

The wall of the left ventricle is much thicker (15 *

mm) than the wall of the right ventricle (5 mm),
yet the capacities and outputs of both ventricles
. are equal
The thickness of the ventricular wall reflects the *
pressure load on the ventricle. The pressure
load on the left ventricle (the aortic pressure) is
much higher than the pressure load on the right
.ventricle (the pulmonary arterial pressure)

Ventricles occupy the bulk of the heart.

?Why
Left ventricle wall is thicker than that of
?the right. Why
?Blood flows unidirectionally. How

The continuous adequate blood flow to various tissues

depends directly on the ability of the heart to pump
blood into the arteries and to maintain sufficient
pressure within the circulatory system.