- its pointed apex is directed toward the left

hip and rests on the diaphragm,

approximately at the level of the fifth
intercostal space
- its broad posterosuperior aspect, or base,
from which the great vessels of the body
emerge, points toward the right shoulder
and lies beneath the second rib.
CARDIOVASCULAR SYSTEM

- delivers oxygen and nutrients to the body

COVERINGS AND WALLS OF THE HEART
tissues and carries away wastes such as
carbon dioxide via blood
PERICARDIUM
- heart pumps blood throughout the body
- a sac which encloses the heart
in blood vessels. Blood flow requires both
- made up of three layers:
the pumping action of the heart and
 outer fibrous layer
changes in blood pressure
 inner serous membrane pair
- major function: transportation
- using blood as the transport vehicle, the
FIBROUS PERICARDIUM
system carries oxygen, nutrients, cell wastes,
- loosely fitting superficial part of this sac
hormones, and many other substances vital
- a fibrous layer that helps protect the heart
for body homeostasis to and from the cells
and anchors it to surrounding structures,
- the force to move the blood around the
such as the diaphragm and sternum
body is provided by the beating heart and by
blood pressure
SEROUS PERICARDIUM
- includes a muscularpump equipped with
- a slippery, two-layered which is deep to the
one-way valves and a system of large and
fibrous pericardium
small “plumbing” tubes within which the
- parietal layer of the serous pericardium, or
blood travels
parietal pericardium, lines the interior of the
fibrous pericardium.
HEART
VISCERAL LAYER OF THE SEROUS PERICARDIUM
ANATOMY OF THE HEART
- or visceral pericardium
- also called the epicardium
SIZE, LOCATION, AND ORIENTATION
- part of the heart wall
- the innermost layer of the pericardium and
- approximately the size of a person’s fist, the
the outermost layer of the heart wall
hollow, cone-shaped heart weighs less than
- at the superior aspect of the heart, this
a pound
attaches to the large arteries leaving the
- snugly enclosed within the inferior
heart and then makes a U-turn and
mediastinum, the medial section of the
continues inferiorly over the heart surface
thoracic cavity, the heart is flanked on each
side by the lungs
LUBRICATING SEROUS FLUID ATRIA
- produced by the serous pericardial - superior atria are primarily receiving
membranes and collects in the pericardial chambers
cavity between these serous layers - they are not important in the pumping
- allows the heart to beat easily in a relatively activity of the heart
frictionless environment as the serous - they assist with filling the ventricles. Blood
pericardial layers slide smoothly across each flows into the atria under low pressure from
other the veins of the body and then continues on
to fill the ventricles
- heart walls are composed of three layers:
VENTRICLES
1. OUTER EPICARDIUM - the inferior, thick-walled ventricles are the
- the visceral pericardium just described discharging chambers, or actual pumps of
the heart
2. MYOCARDIUM - when they contract, blood is propelled out
- consists of thick bundles of cardiac muscle of the heart and into circulation
twisted and whorled into ringlike - right ventricle forms most of the heart’s
arrangements anterior surface
- the layer that actually contracts - left ventricle forms its apex
- Myocardial cells are linked together by
intercalated discs, which contain both INTERATRIAL SEPTUM
desmosomes and gap junctions - the septum that divides the heart
- is reinforced internally by a network of longitudinally
dense fibrous connective tissue called the - divides the atria
“skeleton of the heart.”
INTERVENTRICULAR SEPTUM
- where it divides the ventricles

3. INNERMOST ENDOCARDIUM HOW HEART FUNCTIONS:

- a thin, glistening sheet of endothelium that - heart functions as a double pump
lines the heart chambers  arteries carrying blood away from the
- is continuous with the linings of the blood heart
vessels leaving and entering the heart  veins carrying blood toward the heart

- Right side = Pulmonary circuit pump

CHAMBERS AND ASSOCIATED GREAT VESSELS  receives oxygen-poor blood from the
- the heart has four hollow cavities, or veins of the body through the large
chambers: superior vena cava and inferior vena
 two atria (singular atrium) cava
 two ventricles  pumps it out through the pulmonary
- each of these chambers is lined with trunk
endocardium, which helps blood flow  pulmonary trunk splits into the right
smoothly through the heart and left pulmonary arteries, which
carry blood to the lungs, where oxygen
 is picked up and carbon dioxide is atrium flows into the left ventricle and is
unloaded pumped out into the aorta, from which
 Oxygen-rich blood drains from the lungs the systemic arteries branch to supply
and is returned to the left side of the essentially all body tissues
heart through the four pulmonary veins  After oxygen is delivered to tissues,
 Pulmonary circulation - circuit from the oxygen -poor blood circulates from the
right ventricle (the pump) to the lungs tissues back to the right atrium via the
and back to the left atrium (receiving systemic veins, which empties their
chamber) cargo into either the superior or inferior
 Function: carry blood to the lungs for vena cava
gas exchange and return it to the heart  Systemic circulation - circuit from the
left ventricle through the body tissues
 Oxygen-rich blood returned to the left and back to the right atrium
 Function: supplies oxygen- and
nutrient-rich blood to all body organs
HEART VALVES into the atria when the ventricles are
- heart is equipped with four valves, which contracting
allow blood to flow in only one direction
through the heart chambers—from the atria
through the ventricles and out the great SEMILUNAR VALVES
arteries leaving the heart - second set of valves
- guards the bases of the two large arteries
ATRIOVENTRICULAR (AV) VALVES leaving the ventricular chambers:
- are located between the atria and ventricles  pulmonary semilunar valve
on each side  aortic semilunar valve
- these valves prevent backflow into the atria - each semilunar valve has three cusps that fit
when the ventricles contract tightly together when the valves are closed
- when the ventricles are contracting and
BICUSPID/ MITRAL VALVE forcing blood out of the heart, the cusps are
- left AV valve forced open and flattened against the walls
- consists of two flaps, or cusps, of of the arteries by the force of rushing blood
endocardium - when the ventricles relax, the blood begins
to flow backward toward the heart, and the
TRICUSPID VALVE cusps fill with blood, closing the valves
- right AV valve - this prevents arterial blood from reentering
- has three cusps the heart

CHORDAE TENDINEAE - AV valves

- Tiny white cords  open during heart relaxation
- tendinous cords (“heart strings”)  closed when the ventricles are
- anchor the cusps to the walls of the contracting
ventricles - semilunar valves
 closed during heart relaxation
- when the heart is relaxed and blood is  forced open when the ventricles
passively filling its chambers, the AV valve contract
cusps hang limply into the ventricles
- as the ventricles contract, they press on the
blood in their chambers, and the pressure CARDIAC CIRCULATION
inside the ventricles (intraventricular - the blood contained in the heart does not
pressure) begins to rise nourish the Myocardium
- this forces the AV valve cusps upward, - the functional blood supply that oxygenates
closing the valves. At this point the chordae and nourishes the myocardium is provided
tendineae tighten and anchor the cusps in a by the right and left coronary arteries
closed position
- if the cusps were unanchored, they would CORONARY ARTERIES
blow upward into the atria like an umbrella - branch from the base of the aorta and
being turned inside out by a gusty wind. In encircle the heart in the coronary sulcus
this manner, the AV valves prevent backflow (atrioventricular groove) at the junction of
the atria and ventricles
- Coronary arteries and their major branches - causes heart muscle depolarization
are compressed when the ventricles are in only one direction— from the
contracting and fill when the heart is relaxed atria to the ventricles
- major branches: - enforces a contraction rate of
approximately 75 beats per minute
 Anterior interventricular artery and on the heart
circumflex artery on the left - Components include:
 Sinoatrial (SA) node - one of the
 Posterior interventricular artery and most important part; a crescent
marginal artery on the right -shaped node of tissue located in
the right atrium
CORONARY SINUS  Atrioventricular (AV) node at the
- an enlarged vessel on the posterior of the junction of the atria and ventricles
heart which empties Myocardium when  Atrioventricular (AV) bundle
drained by several cardiac veins (bundle of His)
- empties into the right atrium  Right and left bundle branches
located in the interventricular
septum
PHYSIOLOGY OF THE HEART  Purkinje fibers - spread within the
- as the heart beats, or contracts, the blood myocardium of the ventricle walls
makes continuous round-trips—into and out
of the heart, through the rest of the body, TACHYCARDIA
and then back to the heart - a rapid heart rate (over 100 beats per
minute)

INTRINSIC CONDUCTION SYSTEM OF THE HEART: BRADYCARDIA

SETTING THE BASIC RHYTHM - a heart rate that is substantially slower than
normal (less than 60 beats per minute)
- Atrial cells beat about 60 times per minute
- Ventricular cells contract 20–40 times per - neither condition is pathological, but
minute prolonged tachycardia may progress to
- two systems act to regulate heart activity: fibrillation

 Nerves of the autonomic nervous

system - act like brakes and gas pedals CARDIAC CYCLE AND HEART SOUNDS
to decrease or increase the heart rate,
depending on which division is activated SYSTOLE AND DIASTOLE
- heart contraction and relaxation respectively
 Intrinsic conduction system - or nodal - these terms refer to the contraction and
system, that is built into the heart tissue relaxation of the ventricles unless otherwise
and sets its basic rhythm stated
- is composed of a special tissue found
nowhere else in the body
CARDIAC CYCLE
- events of one complete heartbeat, during BLOOD VESSELS
both atria and ventricles contract and relax
- average heart beats approximately 75 times VASCULAR SYSTEM
per minute; length of the cardiac cycle is - a close transport system formed when blood
normally about 0.8 second circulates inside the blood vessels
- when using a stethoscope, you can hear two - has its freeways, secondary roads, and alleys
distinct sounds during each cardiac cycle - as the heart beats, it propels blood into the
- often described by the two syllables “lub” large arteries leaving the heart
and “dup,” and the sequence is lubdup, - as the large arteries branch, blood moves
pause, lub-dup, pause, and so on into successively smaller arteries and then
into the arterioles, which feed thecapillary
LUB beds in the tissues
- is caused by the closing of the AV valves. - Capillary beds - drained by venules, which in
turn empty into veins that merge and empty
DUP into the great veins entering the heart
- occurs when the semilunar valves close at - Arteries and veins are simply conducting
the end of ventricular systole vessels
- Capillaries - side streets/ alleys that
- the first heart sound is longer and louder intertwine among the body cells and provide
than the second heart sound, which tends to access to individual “homes”
be short and sharp

MICROSCOPIC ANATOMY OF BLOOD VESSELS

CARDIAC OUTPUT
TUNICS
- the amount of blood pumped out by each - the walls of blood vessels have three layers,
side of the heart (each ventricle) in 1 minute or tunics
- the product of the heart rate (HR) and the
stroke volume (SV) 1. TUNICA INTIMA
- Stroke volume - volume of blood pumped - lines the lumen, or interior, of the vessels, is
out by a ventricle with each heartbeat a thin layer of endothelium (squamous
- increases as the force of ventricular epithelial cells) resting on a basement
contraction increases membrane
- Normal adult blood volume - about 6,000 - its cells fit closely together and form a slick
ml surface that decreases friction as blood
- Cardiac output varies with the demands of flows through the vessel lumen.
the body:
 Rises when the stroke volume is 2. TUNICA MEDIA
increased or the heart beats faster or - is the bulky middle layer, made up mostly of
both smooth muscle and elastic fibers
 Drops when either or both of these - the smooth muscle, which is controlled by
factors decrease the sympathetic nervous system, is active in
changing the diameter of the vessels
 the heart, and because blood returning to
3. TUNICA EXTERNA the heart often flows against gravity
- is the outermost tunic - veins are modified to ensure that the
- composed largely of fibrous connective amount of blood returning to the heart
tissue, and its function is to support and (venous return) equals the amount being
protect the vessels pumped out of the heart (cardiac output) at
any time
- the lumens of veins tend to be much larger
than those of corresponding arteries, and
they tend to have a thinner tunica media but
a thicker tunica externa
- the larger veins have valves that prevent
backflow of blood like those in the heart

SKELETAL MUSCLE ACTIVITY

- known as the muscular pump
- enhances venous return
- as the muscles surrounding the veins
contract and relax, the blood is squeezed
through the veins toward the heart
- respiratory pump also helps return blood to
the heart

STRUCTURAL DIFFERENCES IN ARTERIES, VEINS,

AND CAPILLARIES GROSS ANATOMY OF BLOOD VESSELS
- walls of arteries are usually much thicker
than those of veins MAJOR ARTERIES OF THE SYSTEMIC
CIRCULATION
ARTERIES
- carry blood away from the heart AORTA
- able to expand as blood is forced into them - largest artery of the body
and then recoil passively as the blood flows - springs upward from the left ventricle of the
off into the circulation during diastole heart as the ascending aorta, arches to the
- their walls must be strong and stretchy left as the aortic arch, and then plunges
enough to take these continuous changes in downward through the thorax, following the
pressure without stretching out spine (thoracic aorta) finally to pass through
permanently the diaphragm into the abdominopelvic
cavity, where it becomes the abdominal
VEINS aorta
- carry blood back toward the heart, and the
pressure in them tends to be low all the time ARTERIAL BRANCHES OF THE ASCENDING
- have thinner walls AORTA
- because the blood pressure in veins is
usually too low to force the blood back to 1. RIGHT (R.) CORONARY ARTERY
2. LEFT (L.) CORONARY ARTERY ARTERIAL BRANCHES OF THE THORACIC AORTA
- both serves the heart
1. INTERCOSTAL ARTERIES
ARTERIAL BRANCHES OF THE AORTIC ARCH - 10 pairs
- supply the muscles of the thorax wall
1. BRACHIOCEPHALIC TRUNK - other branches of the thoracic aorta
- the first branch of the aortic arch supplies the:
- splits into  Lungs (bronchial arteries)
 Esophagus (esophageal arteries)
 R. common carotid artery - further  Diaphragm (phrenic arteries)
branches into the:
 R. Internal
 R. external carotid arteries ARTERIAL BRANCHES OF THE ABDOMINAL
AORTA
 R. subclavian artery
1. CELIAC TRUNK
2. L. COMMON CAROTID ARTERY - first branch of the abdominal aort
- second branch of the aortic arch - a single vessel that has three branches:
- divides and forming:
 L. internal carotid - serves the brain  L. gastric artery - supplies the stomach

 L. external carotid - serves the skin and  Splenic artery - supplies the spleen
muscles of the head and neck
 Common hepatic artery - supplies the
3. L. SUBCLAVIAN ARTERY liver
- third branch of the aortic arch
- gives of an important branch: 2. UNPAIRED SUPERIOR MESENTERIC ARTERY
- supplies most of the small intestine and the
 Vertebral artery - serves part of the first half of the large intestine, or colon
brain
3. RENAL (R. AND L.) ARTERIES
 Axillary artery -known as the subclavian - serve the kidneys
artery in the axilla
4. GONADAL (R. AND L.) ARTERIES
 Brachial artery - known as the - supply the gonads
subclavian artery that continues into the - area called the ovarian arteries in females
arm which supplies the arm (serving the ovaries) and the testicular
- splits at the elbow to form: arteries in males (serving the testes)
 Radial artery
 Ulnar artery 5. LUMBAR ARTERIES
- both serves the forearm - several pairs of arteries serving the heavy
muscles of the abdomen and trunk walls
6. INFERIOR MESENTERIC ARTERY - unite to form the deep brachial vein, which
- a small, unpaired artery supplying the drains the arm and empties into the axillary
second half of the large intestine vein in the axillary region

7. COMMON ILIAC (R. AND L.) ARTERIES 2. CEPHALIC VEIN

- the final branches of the abdominal aorta - provides for the superficial drainage of the
- divides into: lateral aspect of the arm and empties into
 Internal iliac artery - supplies the pelvic the axillary vein
organs (bladder, rectum, and so on)
3. BASILIC VEIN
 External iliac artery - enters the thigh, - a superficial vein that drains the medial
where it becomes the femoral artery aspect of the arm and empties into the
brachial vein proximally
- Femoral artery and its branch: - basilic and cephalic veins are joined at the
 Deep artery of the thigh - serve the anterior aspect of the elbow by the median
thigh cubital vein
 Popliteal artery - known as the femoral - median cubital vein is often chosen as the
artery in the knee, which then splits site for withdrawing blood for the purpose
into: of blood testing
 Anterior tibial artery - supplies the
leg and foot; terminates in the 4. SUBCLAVIAN VEIN
dorsalis pedis artery - receives venous blood from the arm through
 Posterior tibial artery - supply the the axillary vein and from the skin and
leg and foot muscles of the head through the external
jugular vein
MAJOR VEINS OF THE SYSTEMIC CIRCULATION
5. VERTEBRAL VEIN
- major systemic arteries branch of the aorta, - drains the posterior part of the head
whereas the veins converge on the venae
cavae, which enter the right atrium of the 6. INTERNAL JUGULAR VEIN
heart - drains the dural sinuses of the brain
- veins draining the head and arms empty into
the superior vena cava, and those draining 7. BRACHIOCEPHALIC (R. AND L.) VEINS
the lower body empty into the inferior vena - are large veins that receive venous drainage
cava from the subclavian, vertebral, and internal
jugular veins on their respective sides
VEINS DRAINING INTO THE SUPERIOR VENA - join to form the superior vena cava, which
CAVA enters the heart
- listed in a distal-to-proximal direction; that is,
in the same direction the blood flows into 8. AZYGOS VEIN
the superior vena cava - is a single vein that drains the thorax and
enters the superior vena cava just before it
1. RADIAL VEIN AND ULNAR VEIN joins the heart
- are deep veins draining the forearm
VEINS DRAINING INTO THE INFERIOR VENA 6. HEPATIC PORTAL VEIN
CAVA - a single vein that drains the digestive tract
organs and carries this blood through the
INFERIOR VENA CAVA liver before it enters the systemic circulation
- much longer than the superior vena cava
- returns blood to the heart from all body 7. HEPATIC (R. AND L.) VEINS
regions inferior to the diaphragm - drain the liver

1. ANTERIOR TIBIAL VEIN AND POSTERIOR

TIBIAL SPECIAL CIRCULATIONS
- vein and the fibular vein
- drain the leg (calf and foot) ARTERIAL SUPPLY OF THE BRAIN AND THE
- posterior tibial vein becomes the popliteal CIRCLE OF WILLIS
vein at the knee and then the femoral vein
in the thigh - brain is supplied by two pairs of arteries:
- femoral vein becomes the external iliac vein
as it enters the pelvis 1. INTERNAL CAROTID ARTERIES
- branches of the common carotid arteries
2. GREAT SAPHENOUS VEINS - run through the neck and enter the skull
- the longest veins in the body through the temporal bone
- receive the superficial drainage of the leg - once inside the cranium, each divides into:
- begin at the dorsal venous arch in the foot  Anterior cerebral artery
and travel up the medial aspect of the leg to  Middle cerebral artery
empty into the femoral vein in the thigh - both supply most of the cerebrum

3. COMMON ILIAC (R. AND L.) VEIN 2. PAIRED VERTEBRAL ARTERIES

- formed by the union of the external iliac - pass upward from the subclavian arteries at
vein and the internal iliac vein on its own the base of the neck
side - within the skull, the vertebral arteries join
- join to form the inferior vena cava, which to form the single basilar artery
then ascends superiorly in the abdominal
cavity BASILAR ARTERY
- serves the brain stem and cerebellum as it
4. GONADAL VEIN travels upward
- Right: drains the right ovary in females and - at the base of the cerebrum it divides to
the right testicle in males form:
- Left: empties into the left renal vein  Posterior cerebral arteries
superiorly - supply the posterior part of the
Cerebrum
5. RENAL (R. AND L.) VEINS - anterior and posterior blood supplies of the
- drain the kidneys brain are united by small communicating
arterial branches
CEREBRAL ARTERIAL CIRCLE/CIRCLE OF WILLIS
- a complete circle of connecting blood
vessels
- surrounds the base of the brain
- protects the brain by providing more than
one route for blood to reach brain tissue in
case of a clot or impaired blood flow
anywhere in the system

HEPATIC PORTAL CIRCULATION

- veins of h.p.c. drain the digestive organs,
spleen, and pancreas and deliver this blood
to the liver through the h.p. vein
- major vessels composing the hepatic portal
circulation include:

 Inferior mesenteric veins - draining the

terminal part of the large intestine, drains
into the splenic vein, which itself drains the
spleen, pancreas, and the left side of the
stomach

 Superior mesenteric veins - drains the small

intestine and the first part of the colon

 Splenic vein - joins with superior mesenteric

veins to form the hepatic portal vein

 Left gastric vein - drains the right side of the

stomach, drains directly into the hepatic
portal vein
PHYSIOLOGY OF CIRCULATION SYSTEMIC ARTERIAL BLOOD PRESSURE
- is measured indirectly by the auscultatory
VITAL SIGNS method. This procedure is used to measure
- referred in clinical settings blood pressure in the brachial artery of the
- arterial pulse and blood pressure arm
measurements, along with those of
respiratory rate and body temperature
EFFECTS OF VARIOUS FACTORS ON BLOOD
PRESSURE
ARTERIAL PULSE
- the alternating expansion and recoil of an ARTERIAL BLOOD PRESSURE (BP)
artery that occurs with each beat of the left - is directly related to cardiac output (CO) and
ventricle creates a pressure wave (pulse) peripheral resistance (PR)
that travels through the arterial system - this relationship is expressed by the
- Pulse rate (pressure surges per minute) equation BP = CO × PR
=
heart rate (beats per minute) CARDIAC OUTPUT
- pulse averages 70 to 76 beats per minute in - the amount of blood pumped out of the left
a healthy resting person ventricle per minute)

MEASURING BLOOD PRESSURE VARIATIONS IN BLOOD PRESSURE

- the off-and-on flow of blood into the - In normal adults at rest,
arteries as the heart alternately contracts  systolic blood pressure varies between
and relaxes causes the blood pressure to rise 110 and 140 mm Hg
and fall during each beat  diastolic pressure between 70 and 80
- two arterial blood pressures are usually mm Hg
measured: - blood pressure varies considerably from one
person to another and cycles over a 24-hour
1. SYSTOLIC PRESSURE period, peaking in the morning
- the pressure in the arteries at the peak of - blood pressure varies with age, weight, race,
ventricular contraction mood, physical activity, and posture.

2. DIASTOLIC PRESSURE HYPOTENSION

- the pressure when the ventricles are - or low blood pressure
relaxing - considered to be a systolic blood pressure
below 100 mm Hg
BLOOD PRESSURES - low blood pressure is an expected result of
- are reported in millimeters of mercury (mm physical conditioning and is often associated
Hg), with the higher systolic pressure written with long life and an old age free of illness
first—120/80 (read “120 over 80”) translates
to a systolic pressure of 120 mm Hg and a CHRONIC HYPOTENSION
diastolic pressure of 80 mm Hg - not explained by physical conditioning
- may hint at poor nutrition and inadequate
levels of blood proteins
- because blood viscosity is low, blood
pressure is also lower than normal

ACUTE HYPOTENSION
- is one of the most important warnings of
circulatory shock
- a condition in which the blood vessels are
inadequately filled and blood cannot
circulate normally
- most common cause is blood loss

- a brief elevation in blood pressure is a

normal response to fever, physical exertion,
and emotional upset, such as anger or fear

PERSISTENT HYPERTENSION
- high blood pressure
- is pathological and is defined as a condition
of sustained elevated arterial pressure of
140/90 or higher

REFERENCE:

Essentials of Human Anatomy & Physiology 12th

Edition. Marieb, E.N & Keller, 2016. S.M. Boston :
Pearson. (PDF)