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The Cardiovascular System
Anatomy and Physiology
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Is about 4.8 inches tall and 3.35 inches wide Weighs about .68 lb. in men and .56 lb. in women Beats about 100,000 times per day Beats 2.5 billion time in an average 70 yr. lifetime Pumps about 2000 gallons of blood each day Circulates blood completely 1000 times each day Pumps blood through 62,000 miles of vessels Suffers 7.2 mil. CAD deaths worldwide each year
The Heart
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The heart resides in the pericardiumo A loose membranous sac.
Epicardium ◦ Continuous with the pericardium
Myocardium ◦ Composed of bands of involuntary striated
muscle fibers Endocardium
◦ Thin layer of tissue lining the inside of the heart
Three Layers of The Heart
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Atria
◦ Thin-walled upper chambers
◦ Separated by atrial septum
◦ Right side of septum has oval depression, fossa ovalis cordis, remnant of the foramen ovale
◦ Act as receiving chamber for blood returning from the body and lungs
Four Chambers of The Heart
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Left atriumFossa ovalis cordis
Right atriumAtrial septum
EpicardiumMyocardiumEndocardium
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Ventricles
◦ Lower chambers which make up the bulk of the muscle mass of the heart
◦ Left ventricle 2/3 larger than right ventricle
◦ Right ventricle is a thin-walled and oblong, like pocket attached to left ventricle
Four Chambers of The Heart
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Ventricles
◦ Contraction of left ventricle pulls in right ventricle, aiding its contraction (termed left ventricular aid)
◦ Separated by intraventricular septum
Four Chambers of The Heart
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Right ventricle
Left ventricle
Intraventricular septum
Superior vena cava
Inferior vena cava
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Four Valves of the Heart
Tricuspid valve
◦ Separates right atrium from right ventricle
Pulmonic semilunar valve
◦ Separates right ventricle from pulmonary artery
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Four Valves of the Heart
Bicuspid (mitral) valve
◦ Separates left atrium from left ventricle
Aortic semilunar valve
◦ Separates left ventricle from aorta
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Blood flow from right ventricle to lungs Blood flow from left ventricle to aorta
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Four Valves of the Heart
Chordae tendineae cordis
◦ Anchor free ends of A-V valves to papillary muscles
◦ Prevent A-V valves from pushing upward into atria during ventricular contraction
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Aortic semilunar valvePulmonic semilunar valve
Bicuspid (mitral) valveTricuspid valveChordae tendineae cordis
Papillary muscles
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Cardiac Circulation
Pulmonary artery to left lungPulmonary Artery to right lung
Pulmonary veins from left lung
Pulmonary veins from right lung
Superior vena cava
Aorta
Brachiocephalic artery
Left common carotid artery
Left subclavian artery
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Coronary Circulation Arises from root of the aorta
Left Coronary Artery Right Coronary Artery
Anterior Descending Artery
Circumflex Artery
Posterior Descending Artery
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Circulation of the Blood
1) Blood enters the heart through the inferior and superior vena cava, flowing into the right atrium.
2) The blood passes through the tricuspid valve into the right ventricle.
3) It then passes through the pulmonic semilunar valve, entering the pulmonary artery of the pulmonary circulation.
4) It flows through the pulmonary bed of the right and left lungs to the pulmonary vein, reentering the heart at the left atrium.
5) It then flows through the bicuspid valve into the left ventricle.
6) Passing through the aortic semilunar valve, the blood enters the aorta and systemic vascular system.
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Anterior descending artery
◦ Supplies anterior sulcus and apex
◦ “Widow maker” heart attack
Circumflex artery
◦ Supplies posterior side of left ventricle
Left Coronary Artery
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Together supply most of left ventricle, left atrium, 2/3 of intra ventricular septum, half of intra atrial septum, and part of right atrium
Left Coronary Artery
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Anterior View
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Posterior View
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Posterior descending artery
◦ Supplies posterior intraventricular sulcus
Has numerous smaller branches
Right Coronary Artery
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Supplies anterior and posterior portions of right ventricular myocardium, right atrium, sinus node, posterior 1/3 of intraventricular septum, and portion of base of right ventricle
Right Coronary Artery
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Closely parallel the arterial system
Some coronary venous blood enters the heart through the Thebesian veins
◦ Thebesian veins empty directly into all chambers thus creating some venous admixture lowering Pa02
Coronary Veins
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Blood Vessels
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Large, highly elastic, low resistance to blood flow
Small muscular arterioles of varying resistance
The Vascular System-Arterial
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Transport blood away from the heart
Generally contain oxygenated blood Exception: pulmonary artery
Composed of three layers◦Tunica adventitia (external layer)◦Tunica media (thickest layer)◦Tunica intima (thinnest layer)
The Vascular System-Arterial
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Tunica adventitia◦Consists of connective tissue surrounding
collagenous and elastic fibers◦Supports and protects the vessel◦Contains lymphatic vessels and nerve
fibers◦Has fine vessels that provide its blood
supply
The Vascular System-Arterial
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Tunica media◦Thickest layer◦Composed of concentrically arranged
smooth muscle and elastic fibers◦Nerve fibers of tunica adventitia
terminate in tunica media
The Vascular System-Arterial
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Tunica intima◦Thinnest layer of the artery◦Consists of the epithelium – flat layer of
simple squamous cells◦Common to all blood vessels including
the endocardium
The Vascular System-Arterial
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Large arteries are termed conductance or elastic arteries because the tunica media has less smooth muscle and more elastic fibers
Medium sized arteries are termed the nutrient arteries because they control the flow of blood to the various regions of the body
Arterioles have a thin tunica intima and adventitia, but a thick tunica media composed almost entirely of smooth muscle and control blood flow to the capillary bed◦ Called resistance vessels because they control the
rate that the blood leaves the arterial tree , control arterial blood volume and thereby blood pressure
The Vascular System-Arterial
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AortaBrachial
Radial
Ulnar
Femoral
Anterior tibial
Peroneal artery
Posterior tibial
Aortic knob
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Circle of Willis
Internal carotidsExternal carotids
Common carotidsVertebral arteries
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Microcirculation Maintains constant environment for the cells and
tissues Exchange of nutrients, gases, and wastes
The Vascular System-Capillary
The blood does not directly come in contact with the parenchymal cells and tissues in the body, but constituents of the blood first exit the micro vascular exchange blood vessels to become interstitial fluid, which comes into contact with the parenchymal cells of the body. Lymph is the fluid that is formed when interstitial fluid enters the initial lymphatic vessels of the lymphatic system
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Pre-capillary sphincter valves◦ Smooth muscle rings at the proximal end of the
capillary◦ Contraction decreases blood flow◦ Relaxation increases blood flow◦ Responsive to local changes in PaO2, PaCO2, pH,
and temperature◦ Called exchange vessels because they are the
site of gas, fluid, nutrient, and waste exchange
The Vascular System-Capillary
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The Vascular System-Capillary
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Transport deoxygenated blood back to the heart – exception: pulmonary vein
Composed of the same layers as arteries, but are thinner Called capacitance or reservoir vessels because 70% to
75% of the blood volume is contained in the venous system Peripheral veins contain one-way valves.
◦ Valves are formed by duplication of endothelial lining◦ Found in veins >2mm in diameter◦ Are in areas subjected to muscular pressure, arms/legs◦ Prevent retrograde flow of blood
The Vascular System-Venous
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Mechanisms aiding venous return to the heart:◦ Sympathetic venous tone◦ Skeletal muscle pumping or “milking” combined
with the one-way valves◦ Cardiac suction◦ Thoracic pressure differences created by
respiratory efforts (thoracic pump)
The Vascular System-Venous
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The Vascular System
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Histological Structure of Blood Vessels
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Blood
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Consists of formed elements (cells) suspended & carried in plasma (fluid part)
Total blood volume: 60-80 mL/kg of body weight
Plasma is straw-colored liquid consisting of 90% H20 & dissolved solutes◦ Includes ions, metabolites, hormones, antibodies,
proteins
Composition of Blood
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Constitute 7-9% of plasma Three types of plasma proteins: albumins,
globulins, & fibrinogen◦ Albumin accounts for 60-80%
Creates colloid osmotic pressure that draws H20 from interstitial fluid into capillaries to maintain blood volume & pressure
Globulins carry lipids◦ Gamma globulins are antibodies
Fibrinogen serves as clotting factor◦ Converted to fibrin when clotting blood ◦ Serum is fluid left when blood clots
Plasma Proteins
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Composed of erythrocytes (RBCs) & leukocytes (WBCs)
RBCs are flattened biconcave discs◦ Generated in the red bone marrow by
the process of erythropoiesis from the hemocytoblast, a common stem cell
◦ Shape provides increased surface area for diffusion
◦ Lack nuclei & mitochondria◦ Has semi-permeable membrane◦ Contains hemoglobin molecule that
transports oxygen◦ Approx. 30 trillion in the body
Formed Elements
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Is the formation of blood cells from stem cells in marrow (myeloid tissue) & lymphoid tissue◦ RBC’s increase in number above normal with
chronic hypoxia Erythropoiesis is formation of RBCs
◦ Stimulated by erythropoietin (EPO) from kidney Leukopoiesis is formation of WBCs
◦ Stimulated by variety of cytokines
Hematopoiesis
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2.5 million RBCs created daily
Lifespan of 120 days Old RBCs removed
from blood by phagocytic cells in liver, spleen, & bone marrow◦ Iron recycled back
into hemoglobin production
Erythropoiesis
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Have nucleus, mitochondria, & amoeboid ability
Formed in the myeloid tissue Can squeeze through capillary walls
(diapedesis)◦ Granular leukocytes help detoxify foreign
substances & release heparin Include eosinophils, basophils, & neutrophils
Leukocytes
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Agranular leukocytes are phagocytic & produce antibodies
Include lymphocytes & monocytes
Leukocytes
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Specialized type of blood cell Fragments into small irregular pieces of
protoplasm called thrombocytes and platelets
Have no nucleus Have a granular cytoplasm Function in clot formation
Megakaryocyte
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Are smallest of formed elements, lack nucleus
Constitute most of mass of blood clots
Release serotonin to vasoconstrict & reduce blood flow to clot area
Secrete growth factors to maintain integrity of blood vessel wall
Survive 5-9 days
Platelets (thrombocytes)
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RBC’s – Males: 4.6 - 6.2 x 10 /mm Females: 4.2 – 5.4 x 10 /mm• Hb – Males: 13.5 – 16.5 g/dl
Females: 12 – 15 g/dl• Hematocrit – Males: 42 – 54% Females: 38 – 47% • Leukocytes – 4500 – 11,500/mm
Normal Values
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Neutrophils: 40 – 75% Eosinophils: 0 – 6% Monocytes: 2 – 10% Basophils: 0 – 1% Megakaryocyte: 150,000 – 400,000/mm
Normal Values
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Systolic pressure
◦ Pressure during contraction phase of heart
◦ Normal value: 90 – 140 mmHg
Diastolic pressure
◦ Pressure during relaxation phase of heart
◦ Normal value: 60 – 90 mmHg
The Vascular System-Blood Pressure
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Mean arterial pressure (MAP)
◦ Average pressure in the arterial system over a given time
◦ Normal value: 80 – 100 mmHg
The Vascular System-Blood Pressure
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Mean arterial pressureMAP = (2 x diastolic pressure) + (systolic pressure)
3A MAP of approximately 60 mmHg is necessary to
perfuse coronary arteries, brain, kidneys.
The Vascular System-Blood Pressure
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Reflects right atrial pressure Influenced by changes in right ventricular
function Measured with catheter placed in superior
vena cava just above right atrium
Central Venous Pressure (CVP)
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Purpose◦ Assess blood volume status◦ Administration of fluids◦ Sampling of blood◦ Measurement of SvO2◦ Assessment of right ventricular pre-load
Normal valueoCVP: < 6 mmHgoRight atrial pressure (RAP): 2-6 mmHg
Central Venous Pressure (CVP)
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Used to assess filling pressure of the left side of heart
Measured by flow-directed, balloon-tipped catheter
Measures◦ Pulmonary artery pressures – systolic, diastolic,
mean◦ Right ventricular preload (via right atrial pressure)◦ Right ventricular afterload (via PA systolic
pressure)
Pulmonary Artery Pressure
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Normal values
◦ Pulmonary artery pressure, systolic: 20-30 mmHg◦ Pulmonary artery pressure, diastolic: 6-15 mmHg◦ Pulmonary artery pressure, mean: 10-20 mmHg◦ Pulmonary artery wedge pressure, mean:
4-12 mmHg
Pulmonary Artery Pressure
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Total amount of blood pumped by the heart per minute
Cardiac Output = Heart Rate x Stroke
Volume
Normal value – 5L/min
Cardiac Output
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Cardiac Index
◦ Volume of blood pumped by the heart per minute divided by body surface area
CI = CO BSANormal range: 2.5 - 4.0 L/min per square meter
Low values can indicate cardiogenic shock
Cardiac Output
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Amount of blood ejected from the ventricle with each ventricular systole
End-systolic volume (ESV)
◦ Volume remaining after systole
Stroke Volume
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End-diastolic volume (EDV)
◦ Volume to which the ventricles fill during diastole
SV = EDV – ESV
Normal value: 60 – 130 ml/beat
Stroke Volume
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Ejection fraction (EF)
◦ Proportion of EDV ejected on each stroke
EF = SV EDV
◦ Normal value – 64%
Stroke Volume
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Preload
◦ Initial stretch of the ventricle
◦ The greater the preload, the greater the tension on contraction
Factors Affecting Stroke Volume
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Afterload
◦ Force against which the heart must pump.
◦ In clinical practice, left ventricular afterload equals systemic vascular resistance.
Factors Affecting Stroke Volume
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Contractility
◦ Amount of systolic force exerted by heart muscle at any given preload.
◦ Increases in contractility leads to higher EF, lower end systolic volume, and higher stroke volume
◦ Decreases in contractility lead to lower ejection fraction, higher end systolic volume, and decreased stroke volume.
Factors Affecting Stroke Volume
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Contractility Inotropism: any factor which affects the
contractility of the heart◦ Positive inotropism
Higher stroke volumes for a given preload: indicating an increase in contractility
◦ Negative inotropism Decreased stroke volumes for a given preload;
indicates a decrease in contractility
Factors Affecting Stroke Volume
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Heart rate
Autonomic nervous system
oSympathetic: fight or flight: HR, RR, BP, pupil dilation and bronchodilation
o Parasympathetic: rest and digest
Factors Affecting Stroke Volume
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Heart Rate◦ Cardiac output directly proportional to heart
rate Relationship exists up to 160 to 180
beats/min Filling time for ventricles insufficient at
higher rates
Factors Affecting Stroke Volume
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Sum of all frictional forces opposing blood flow through the vascular circulation.
SVR = Mean Aortic Pressure-Right Atrial Pressure Cardiac Output
◦ Mean Aortic Pressure - use systolic pressure (normal mean = 90mmhg)
◦ Right Atrial Pressure - use central venous pressure (normal mean = 4mmhg)
◦ Cardiac Output normal mean = 5L/min.
Normal value: 15 – 20 mmHg/L/min
The Vascular System-Systemic Vascular Resistance (SVR)
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Cardiac anatomy◦ Layers of the heart◦ Chambers of the heart◦ Valves◦ Coronary arteries
Blood flow through the heart Arterial system
◦ Structure of artery◦ Purpose◦ Major arteries
Key Points
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Venous system◦ Structure of system◦ Purpose◦ Aids to venous flow
Capillary system◦ Structure of system◦ Purpose
Key Points
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Composition of blood Plasma proteins Types of cells, functions, normal values,
abnormalities◦ Erythrocytes◦ Leukocytes◦ Megakaryocytes◦ Platelets◦ Hemoglobin◦ Hematocrit
Key Points
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Definition, normal values, and formula (if applicable)◦ Systemic vascular resistance◦ Systolic pressure◦ Diastolic pressure◦ Mean arterial pressure◦ Cardiac output and index◦ Stroke volume, esv, edv, efFactors affecting stroke volume
Key Points