Chapter 11.

Cardiovascular System
- The major function of the cardiovascular system is transportation
- Blood acts as the transport vehicle carrying oxygen, nutrients, cell wastes, hormones, and many other
substances vital for body homeostasis to and from the cell
- The cardiovascular system can be compared to a muscular pump equipped with one-way valves and a system
of large and small plumbing tubes within which the blood travels

The Heart
Anatomy of the Heart

Size, Location, and Orientation

- Approximately the size of a person’s fist
- Hollow, cone-shaped, weighs less than a pound
- Snugly enclosed within the inferior mediastinum, the medial section of the thoracic activity
- Flanked on each side by the lungs
 - The pointed apex is directed toward the left hip and rests on the diaphragm, approximately at the level of the
fifth intercostal space
- The 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

Coverings and Walls of the Heart

Enclosed by a double-walled sac called the pericardium
- Fibrous pericardium
o Loosely-fitting superficial part of the sac
o Helps protect the heart and anchors it to surrounding structures, such as the diaphragm and sternum
- Serous pericardium
o Slippery, two-layer
o Deep to the fibrous pericardium
- Parietal layer
o Lines the interior of the fibrous pericardium
o Attaches to the large arteries leaving the heart and then makes a U-turn and continues inferiorly over
the heart surface as the visceral layer or epicardium
- Serous fluid
o A slippery lubricating fluid
o Produced by the serous pericardial membranes
o Allows the heart to beat easily in a relatively frictionless environment as the serous pericardial layers
slide smoothly across each other
Homeostatic imbalance:
- Pericarditis
o Inflammation of the pericardium
o Often results in a decrease in the already small amount of serous fluid
o Caused the pericardial layers to bind and stick to each other
o Forms painful adhesions that interfere with heart movements
Three layers of the heart walls:
 1. Epicardium
o Outer layer
o The visceral layer of the pericardium
2. Myocardium
o Contracting layer
o Consists of thick bundles of cardiac muscle twisted and whorled into ringlike arrangements
o Reinforced internally by a dense, fibrous connective tissue network called the “skeleton of the heart”
o Its cells exhibit both desmosomes, which help bind mobile cardiac cells together, and gap junctions,
which allow ions to flow from cell to cell carrying a wave of excitement across the heart
3. Endocardium
o Inner layer
o Thin, glistening sheet of endothelium that lines the heart chambers
o Continuous with the linings of the blood vessels leaving and entering the heart

Chambers and Associated Great Vessels

Four hollow chambers or cavities of the heart:
- Two atria
o Receiving chambers
o Not important in the pumping activity of the heart
o Blood flows into the atria under low pressure from the veins of the body and then continues on to fill
the ventricles
- Two ventricles
o Thick-walled discharging chambers
o Actual pumps of the heart
o When they contract, blood is propelled out of the heart and into the circulation
o Right ventricle: forms most of the heart’s anterior surface
o Left ventricle: forms the apex
- Each of these chambers is lined with endocardium, which helps blood flow smoothly through the heart
Septum
- Divides the heart longitudinally
o Interventricular septum
o Interatrial septum
Pulmonary circulation
- The circulation from the right side of the heart to the lungs and back to the left side of the heart
- Carries blood to the lungs for gas exchange and then returns it to the heart
1) The right side of the heart works as the pulmonary circuit pump and receives oxygen-poor blood from
the veins of the body through the large superior and inferior vena cavae and pumped out through the
pulmonary trunk
 2) The pulmonary trunk splits into the right and left pulmonary arteries which carry blood to the lungs
where oxygen is picked up and carbon dioxide is unloaded
3) The oxygen-rich blood drains from the lungs and is returned to the left side of the heart through the
four pulmonary veins
Systemic circulation
- Second circuit, from the left side of the heart through the body tissues and back to the right side of the heart
- Supplies oxygen and nutrient-rich blood to all body organs
o Blood returned to the left side of the heart is pumped out of the heart into the aorta from which the
systemic arteries branch to supply essentially all body tissues
o Oxygen-poor blood circulates from the tissues back to the right atrium via the systemic veins, which
finally empty their cargo into either the superior or inferior vena cava

Heart Valves
Four valves which allow the blood to flow in only one direction through the heart chambers:
1. Atrioventricular (AV) valves
o Open during heart relaxation, closed during ventricles contraction
o Located between the atrial and ventricular chambers on each side
o Prevent backflow into the atria when the ventricles contract
o When the heart is relaxed and blood is passively filling its chambers, the AV valve flaps hang limply
into the ventricles
o When the ventricles contract, they press on the blood in their chambers, and the intraventricular
pressure begins to rise, the AV valve flaps upward, closing the valves
o Chordae tendineae (tendinous cords)
 Tiny white cords that anchor the flaps to the walls of the ventricles
2. Bicuspid or mitral valve
o Left AV valve
o Consists of two flaps or cusps of endocardium
3. Tricuspid valve
o Right AV valve
o Consist of three flaps or cusps of endocardium
4. Semilunar valves
o Closed during heart relaxation, open during ventricles contraction
o Has three leaflets that fit tightly together when the halves are closed
 o Guards the bases of the two large arteries leaving the ventricular chambers
o When the ventricles are contracting and forcing blood out of the heart, the leaflets are forced open and
flattened against the walls of the arteries by the tremendous force of rushing blood
o When the ventricles are relaxed and blood begins to flow backward toward the heart, the leaflets fill
with blood, closing the valves, and preventing arterial blood from reentering

Cardiac Circulation
- The blood contained in the heart does not nourish the myocardium
- The myocardium is drained by several cardiac veins, which empty into an enlarged vessel on the posterior of
the heart called the coronary sinus which then empties into the right atrium
Coronary arteries
- Provide the functional blood supply that oxygenates and nourishes the heart
- Branch from the base of the aorta and encircle the heart in the coronary sulcus (atrioventricular groove) at the
junction of the atria and ventricles
- Are compressed when the ventricles are contracting and fill when the heart is relaxed
- Major branches:
o Left: anterior interventricular and circumflex arteries
o Right: posterior interventricular and marginal arteries
Homeostatic imbalance:
- Angina pectoris
o Crushing chest pain when the myocardium is deprived of oxygen due to the heart beating at a very
rapid rate
o If prolonged, the oxygen-deprived heart cells may die, forming an area called infarct
- Myocardial infarction (MI)
o Commonly called “heart attack” or a “coronary”
Physiology of the Heart
- In one day, the heart pushes the body’s supply of 6 quarts or 6 liters or so of blood through the blood vessels
over 1,000 times, meaning that it pumps about 6,000 quarts of blood in a single day
Intrinsic Conduction System of the Heart: Setting the Basic Rhythm
- Cardiac muscle cells contract spontaneously and independently in a regular and continuous way even if all
nervous connections are severed
- Cardiac muscle cells in different areas of the heart have different rhythms so without some type of unifying
control system, the heart would be an uncoordinated and inefficient pump
o Atrial cells beat about 60 times per minute
o Ventricular cells beat 20-40 times per minute
Two systems that regulate heart activity:
1. Autonomic Nervous System
o Its nerves act like brakes and gas pedals to decrease or increase the heart rate depending on which
division is activated
2. Intrinsic Conduction System or Nodal System
o Built into the heart tissue and sets its basic rhythm
o Causes heart muscle depolarization in only one direction: from the atria to the ventricles
o Composed of a special tissue, much like a cross between muscle and nervous tissue, found nowhere
else in the body
o Enforces a contraction rate of approximately 75 beats per minute on the heart with the heart beating as
a coordinated unit
o Elements of the Intrinsic Conduction System:
 Sinoatrial (SA) node
 Located in the right atrium and often called the “pacemaker”
 Has the highest rate of depolarization and is one of the most important parts of this
system
 Crescent-shaped node of tissue that starts each heartbeat and sets the pace for the
whole heart
 Atrioventricular (AV) node
 Located at the junction of the atria and ventricles
 Atrioventricular (AV) bundle
 Bundle of His
 Bundle branches
 Located in the interventricular septum
 Purkinje fibers
 Spread within the muscle of the ventricle walls
o Flow of the impulse:
1) The impulse spreads from the SA node through the atria to the AV node, making the atria
contract.
2) At the AV node, the impulse is delayed briefly to give the atria time to finish contracting.
3) It then passes rapidly through the AV bundle, the bundle branches, and the Purkinje fibers.
4) This results in a “wringing” contraction of the ventricles that begins at the heart apex and
moves toward the atria
 5) The contraction effectively ejects blood superiorly into the large arteries leaving the heart.
Homeostatic imbalance:

- Heart block
o When the ventricles or the heart begins to beat at their own rate, which is much slower, some or all of
the time
o Happens when there is damage caused to the AV node which partially or totally release the ventricles
from the control of the SA node
- Ischemia
o Lack of an adequate blood supply to the heart muscle
o May lead to fibrillation
- Fibrillation
o A rapid, uncoordinated shuddering of the heart muscle
o Makes the heart totally useless as a pump and is a major cause of death from heart attacks in adults
- Tachycardia
o Rapid heart rate, over 100 beats per minute
o May progress to fibrillation if prolonged
- Bradycardia
o Heart rate that is substantially slower than normal, less than 60 beats per minute

Cardiac Cycle and Heart Sounds

Systole
- Heart contraction and atria relaxation
Diastole
- Heart relaxation and atria contraction
Cardiac cycle
- Events of one complete heartbeat during which both atria and ventricles contract and then relax
- Length is normally 0.8 seconds with an average heart beating 75 times per minute
Three Periods of the Cardiac Cycle:
1. Mid-to-late diastole
1) Heart is in complete relaxation and pressure is low
2) Blood is flowing passively into and through the atria into the ventricles from the pulmonary and systemic
circulations
3) Semilunar valves are closed, and AV valves are open
4) Atria contract and force the blood remaining in their chambers into the ventricles
2. Ventricular systole
1) Shortly after, ventricular contraction begins and pressure within the ventricles increases rapidly
2) AV valves close to prevent backflow into the atria
 3) Semilunar valves are forced open and blood rushes out of the ventricles when the intraventricular pressure
is higher than the pressure in the large arteries leaving the heart
4) Atria relax as their chambers fill again with blood
3. Early diastole
1) Occurs at the end of systole
2) Ventricles relax, semilunar valves snap shut, and ventricles are completely closed for a moment
3) Intraventricular pressure drops
4) AV valves are forced open when the intraventricular pressure drops below the increasing pressure in the
atria
5) Ventricles again begin to refill rapidly with blood, completing the cycle

Heart sounds
- Two distinct sounds heard using a stethoscope during each cardiac cycle
- Sequence: lub-dup, pause, lub-dup, pause
o Lub
 First heart sound
 Longer and louder
 Caused by the closing of the AV valves
o Dup
 Second heart sound
 Short and sharp
 Occurs when the semilunar valves close at the end of the systole
Homeostatic imbalance:
- Heart murmurs
o Abnormal or unusual heart sounds heard with a stethoscope
o Blood flow becomes turbulent and generates sounds due to obstructions
o Fairly common in young children, and some elderly people, with perfectly healthy hearts due to thin
heart walls that vibrate from rushing blood
o Other causes may be valve problems
 An incompetent valve not closing tightly will produce a swishing sound
 Turbulent blood flows through stenosed or narrowed valves produce distinct sounds
Cardiac Output
Cardiac output (CO)
- Amount of blood pumped out by each side of the heart, specifically ventricle, in 1 minute
- Product of the heart rate (RH) and stroke volume (SV)
o CO = HR x SV
 Ex: CO = 75 beats/min x 70 mL/beat = 5250 mL/min or 5.25 L/min
- Varies with the demands of the body
o Rises when stroke volume is increased and/or the heart beats faster
o Drops when stroke volume is decreased and/or the heart beats slower
Stroke volume (SV)
- Volume of blood pumped out by a ventricle with each heartbeat
- Directly proportional to the force of ventricular contraction
 - Normal adult blood volume is about 6000 mL
Regulation of Stroke Volume
- A healthy heart pumps out about 60% of the blood present in its ventricles, which is approximately 70 mL or
about 2 ounces with each heartbeat
- According to “Starling’s law of the heart,” the critical factor controlling stroke volume is how much the
cardiac muscle cells are stretched just before they contract
o The more they are stretched, the stronger the contraction will be
o The less they are stretched, the weaker the contraction will be
- If one side of the heart suddenly begins to pump more blood than the other, the increased venous return to the
opposite ventricle will force it to pump out an equal amount, thus preventing backup of blood in the
circulation
o Venous return
 The important factor stretching the heart muscle
 Amount of blood entering the heart and distending its ventricles
 Its volume and speed are directly proportional to the stroke volume and force of contraction
Factors Modifying Basic Heart Rate

1. Neural (ANS) controls

o Nerves of the sympathetic division of the ANS more strongly stimulate the SA and AV nodes and
cardiac muscles during times of physical or emotional stress, making the heart beat more rapidly
 Ex: when you are frightened or when you are trying to catch a bus
o Parasympathetic nerves, primarily the vagus nerves, slow and steady the heart, giving it more time to
rest during noncrisis times
o Heart pumps weakly for patients with congestive heart failure and they are prescribed with drug
digitalis to enhance the contractile force and stroke volume of the heart, resulting in greater cardiac
output
2. Hormones and ions
o Various hormones can affect heart activity
 Epinephrine
 Increases heart rate
 Mimics the effect of the sympathetic nerve stimulation
 Thyroxine
 Also increases heart rate
o Excess or lack of ions also modify heart activity and electrolyte imbalances pose threat
 Reduced levels of ionic calcium in the blood depress the heart
 Excessive blood calcium causes prolonged contractions that stop the heart entirely
  A deficit of potassium ions in the blood causes the heart to beat feebly and abnormal heart
rhythms appear
3. Physical factors
o Physical factors like age, gender, exercise, and body temperature, influence heart rate
 Resting heart rate is fastest in the fetus (140-160 bpm) and then gradually decreases
throughout life
 Females (72-80 bpm) have faster average heart rate than males (64-72 bpm)
 Heat increases heart rate by boosting the metabolic rate of heart cells
 Cold decreases heart rate to preserve your core temperature
 Exercise increases heart rate
Homeostatic imbalance:
- Congestive heart failure (CHF)
o When the pumping efficiency of the heart is depressed
o Circulation is inadequate to meet tissue needs
o A progressive condition that reflects the weakening of the heart by coronary atherosclerosis, persistent
high blood pressure, or multiple myocardial infarctions
 Coronary atherosclerosis: clogging of the coronary vessels with fatty buildup
- Pulmonary congestion
o Happens when the left side of the heart fails
o Right side of the heart continues to propel blood to the lungs but the left side is unable to eject the
returning blood into the systemic circulation
o Blood vessels become swollen with blood, the pressure within them increases, and fluid leaks from
the circulation into the lung tissue, causing pulmonary edema
 Pulmonary edema: too much fluid in the lungs
- Peripheral congestion
o Happens when the right side of the heart fails
o Blood backs up in the systemic circulation
o Edema, causing swelling and puffiness, is most noticeable in the distal parts of the body: feet, ankles,
and fingers