Cardiovascular System Anatomy and

Physiology

Journey to the heart of our being with the cardiovascular system study guide.
Aspiring nurses, chart the pulsating rivers of life as you discover the anatomy and
dynamics of the body’s powerful pump and intricate vessel networks.

Functions of the Heart

The functions of the heart are as follows:

1. Managing blood supply. Variations in the rate and force of heart

contraction match blood flow to the changing metabolic needs of the
tissues during rest, exercise, and changes in body position.
2. Producing blood pressure. Contractions of the heart produce blood
pressure, which is needed for blood flow through the blood vessels.
3. Securing one-way blood flow. The valves of the heart secure a one-way
blood flow through the heart and blood vessels.
4. Transmitting blood. The heart separates the pulmonary and systemic
circulations, which ensures the flow of oxygenated blood to tissues.
Anatomy of the Heart
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.

Heart Structure and Functions

The modest size and weight of the heart give few hints of its incredible strength.

 Weight. Approximately the size of a person’s fist, the hollow, cone-

shaped heart weighs less than a pound.
 Mediastinum. Snugly enclosed within the inferior mediastinum, the medial
cavity of the thorax, the heart is flanked on each side by the lungs.
  Apex. Its more pointed apex is directed toward the left hip and rests on
the diaphragm, approximately at the level of the fifth intercostal space.
 Base. 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.
 Pericardium. The heart is enclosed in a double-walled sac called the
pericardium which is the outermost layer of the heart.
 Fibrous pericardium. The loosely fitting superficial part of this sac is
referred to as the fibrous pericardium, which helps protect the heart and
anchors it to surrounding structures such as the diaphragm and sternum.
 Serous pericardium. Deep to the fibrous pericardium is the slippery, two-
layer serous pericardium, where its parietal layer lines the interior of the
fibrous pericardium.

Layers of the Heart

The heart muscle has three layers and they are as follows:

 Epicardium. The epicardium or the visceral and outermost layer is

actually a part of the heart wall.
 Myocardium. The myocardium consists of thick bundles of cardiac muscle
twisted and whirled into ringlike arrangements and it is the layer that
actually contracts.
 Endocardium. The endocardium is the innermost layer of the heart and is
a thin, glistening sheet of endothelium hat lines the heart chambers.

Chambers of the Heart

The heart has four hollow chambers, or cavities: two atria and two ventricles.

 Receiving chambers. The two superior atria are primarily the receiving
chambers, they play a lighter role in the pumping activity of the heart.
 Discharging chambers. The two inferior, thick-walled ventricles are the
discharging chambers, or actual pumps of the heart wherein when they
contract, blood is propelled out of the heart and into circulation.
  Septum. The septum that divides the heart longitudinally is referred to as
either the interventricular septum or the interatrial septum, depending
on which chamber it separates.
Associated Great Vessels

The great blood vessels provide a pathway for the entire cardiac circulation to
proceed.

 Superior and inferior vena cava. The heart receives relatively oxygen-
poor blood from the veins of the body through the large superior and
inferior vena cava and pumps it through the pulmonary trunk.
 Pulmonary arteries. 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.
 Pulmonary veins. Oxygen-rich blood drains from the lungs and is
returned to the left side of the heart through the four pulmonary veins.
 Aorta. 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.
The figure provide a functional representation of the blood circulatory system. The
percentages indicate the approximate relative percentages of the cardiac output that is
delivered, at a given moment in time, to the major organ systems within the body.

Heart Valves

The heart is equipped with four valves, which allow blood to flow in only one
direction through the heart chambers.

 Atrioventricular valves. Atrioventricular or AV valves are located between

the atrial and ventricular chambers on each side, and they prevent
backflow into the atria when the ventricles contract.
 Bicuspid valves. The left AV valve- the bicuspid or mitral valve, consists of
two flaps, or cusps, of the endocardium.
 Tricuspid valve. The right AV valve, the tricuspid valve, has three flaps.
 Semilunar valve. The second set of valves, the semilunar valves, guards
the bases of the two large arteries leaving the ventricular chambers, thus
they are known as the pulmonary and aortic semilunar valves.

Cardiac Circulation Vessels

Although the heart chambers are bathed with blood almost continuously, the
blood contained in the heart does not nourish the myocardium.
  Coronary arteries. The coronary arteries 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, and these arteries are compressed
when the ventricles are contract and fill when the heart is relaxed.

 Cardiac veins. The myocardium is drained by several cardiac veins, which

empty into an enlarged vessel on the posterior of the heart called
the coronary sinus.

Route of blood flow Through the Heart

The path of blood flow through the heart takes the following route: blood flows
from the vena cava to the right atrium, then through the tricuspid valve to the
right ventricle, then through the pulmonary valve to the pulmonary artery, then
onward to the lungs, the pulmonary veins, the left atrium, the mitral valve, the
left ventricle, the aortic valve, the aorta, and finally to the tissues of the body.

The following chart shows the functions of some of the major body parts in the
circulatory system:

Part of Circulatory
Function
System
Vena Cava Delivers deoxygenated blood to the right atrium

Right Atrium Delivers deoxygenated blood to the right ventricle

Right Ventricle Delivers deoxygenated blood to the lungs

Receives deoxygenated blood from the lungs and

Left Atrium
delivers it to the left ventricle

Left Ventricle Gives the oxygenated blood to the aorta

Delivers the oxygenated blood to the other areas of the

Aorta
body

Regulation of Heart Function

The regulation of heart rate involves both intrinsic and extrinsic regulation.
Intrinsic regulation is the ability of the heart to regulate its own rate through
specialized cardiac muscle cells, while extrinsic regulation involves the
influence of neural and hormonal factors on heart rate.

Heart rate is controlled by the two branches of the autonomic

(involuntary) nervous system. The sympathetic nervous system (SNS)
and the parasympathetic nervous system (PNS). The sympathetic
nervous system (SNS) releases the hormones (catecholamines -
epinephrine and norepinephrine) to accelerate the heart rate.
What is intrinsic regulation of cardiac function?
There are two primary modes by which the blood volume pumped by the heart, at any
given moment, is regulated: 1) intrinsic cardiac regulation, in response to changes in the
volume of blood flowing into the heart; and 2) control of heart rate and cardiac
contractility by the autonomic nervous system.

The intrinsic ability of the heart to adapt to changing volumes of inflowing blood is
known as the Frank-Starling mechanism (law) of the heart. In general, this response
can simply be described as: the more the heart is stretched (increased blood volume),
the greater will be the subsequent force of ventricular contraction and, thus, the amount
of blood ejected through the aortic valve. In other words, within its physiological limits,
the heart will pump out all the blood that enters it without allowing excessive damming
of blood in veins.
The pumping effectiveness of the heart is also effectively controlled by the autonomic
nervous system by both the sympathetic and parasympathetic components of this
system. There is extensive innervation of the myocardium by such. To get a feel for how
effective the modulation of the heart by this innervation is, it has been reported that the
cardiac output often can be increased by more than 100% by sympathetic stimulation
and, by contrast, output can be nearly terminated by parasympathetic (vagal)
stimulation.
Cardiovascular function is also modulated through reflex mechanisms that involve
baroreceptors, the chemical composition of the blood, and via the release of various
hormones. More specifically, baroreceptors, which are located in the walls of some
arteries and veins, exist to monitor the relative blood pressure. Those specifically
located in the carotid sinus help to reflexively maintain normal blood pressure in the
brain, whereas those located in the area of the ascending arch of the aorta help to
govern general systemic blood pressure (for more details, see the chapter on the
Autonomic Nervous System). Chemoreceptors that monitor the chemical
composition of blood are located close to the baroreceptors of the carotid sinus
and arch of the aorta, in small structures known as the carotid and aortic bodies.
The chemoreceptors within these bodies detect changes in blood levels of O2,
CO2, and H+. Hypoxia (a low availability of O2), acidosis (increased blood
concentrations of H+), and/or hypercapnia (high concentrations of CO2) stimulate
the chemoreceptors to increase their action potential firing frequencies to the
brain cardiovascular control centers. In response to this increased signaling, the
central nervous system control centers, the hypothalamus, in turn, cause an increased
sympathetic stimulation to arterioles and veins, producing vasoconstriction and a
subsequent increase in blood pressure. In addition, the chemoreceptors simultaneously
send neural input to the respiratory control centers in the brain, so to induce the
appropriate control of respiratory function (e.g., increase O2 supply and reduce CO2
levels

What is the extrinsic regulation of the heart?

Extrinsic controls of the cardiovascular system include neuronal, humoral, reflex, and
chemical regulatory mechanisms. These extrinsic controls regulate heart rate,
myocardial contractility, and vascular smooth muscle to maintain cardiac output, blood
flow distribution, and arterial blood pressure.
Heart Sounds

What are the sounds of our heart?

In a healthy adult, the heart makes two sounds, commonly described as 'lub' and
'dub. ' The third and fourth sounds may be heard in some healthy people, but can
indicate impairment of the heart function. S1 and S2 are high-pitched and S3 and S4
are low-pitched sounds.

The vibrations of heart chambers from the blood flow create audible sounds: the more turbulent
the blood flow, the stronger the sound due to more vibrations being created. These sounds are
known as lub-dub.

Types Of Heart Sounds

Heartbeat is constituted by two phases which make up a cardiac cycle. These two
phases are –

 Contraction of ventricles to pump out blood – systole

 Relaxation of ventricles filling with blood – diastole

There are 4 types of heart sounds –

 S1 – “lub” caused by the closing of the AV valves

 S2 – “dub” caused by the closing of semilunar valves
  S3 – linked with flow of blood into the ventricles
 S4 – linked with atrial contraction

Generally, the heart makes two sounds – “lub” and “dub”. The third and fourth sounds
are audible in individuals, however, they could show abnormalities in the functioning of
the heart. While the S1 and S2 are high-pitched, S3 and S4 are low-pitched sounds.

Heart Murmurs
Heart murmurs are ectopic or abnormal heart sounds. These occur when there are
some valvular or other abnormalities that cause turbulence in the flow of blood, either
because of the high velocity of ejection or their regurgitation.

Types of Murmurs
Murmurs are of the following types –

 Aortic stenosis
 Mitral stenosis
 Aortic regurgitation
 Mitral regurgitation

Stenosis – It is the abnormal narrowing in the blood vessels that is due to the
narrowed blood vessels. It is linked with abnormal heart sounds. The main reason is
atherosclerosis because of which there is a drop in the stroke volume, resulting in a
decrease in the cardiac output. This causes blood to be ejected at high velocities as a
result of a decrease in the blood vessel’s diameter.

Regurgitation – Regurgitation is the flow of the blood in the opposite direction to the
normal due to the backward blood flow between chambers or into the heart. It takes
place as a result of abnormalities in the valves of the heart.

Blood Vessels

Blood circulates inside the blood vessels, which form a closed transport system,
the so-called vascular system.

 Arteries. As the heart beats, blood is propelled into large arteries leaving
the heart.
  Arterioles. It then moves into successively smaller and smaller arteries and
then into arterioles, which feed the capillary beds in the tissues.
 Veins. Capillary beds are drained by venules, which in turn empty into
veins that finally empty into the great veins entering the heart.

Tunics

Except for the microscopic capillaries, the walls of the blood vessels have three
coats or tunics.
  Tunica intima. The tunica intima, which lines the lumen, or interior, of the
vessels, is a thin layer of endothelium resting on a basement membrane
and decreases friction as blood flows through the vessel lumen.
 Tunica media. The tunica media is the bulky middle coat which mostly
consists of smooth muscle and elastic fibers that constrict or dilate, making
the blood pressure increase or decrease.
 Tunica externa. The tunica externa is the outermost tunic composed
largely of fibrous connective tissue, and its function is basically to support
and protect the vessels.
Major Arteries of the Systemic Circulation

The major branches of the aorta and the organs they serve are listed next in the
sequence from the heart.
Arterial Branches of the Ascending Aorta

The aorta springs upward from the left ventricle of the heart as the ascending
aorta.
  Coronary arteries. The only branches of the ascending aorta are the right
and left coronary arteries, which serve the heart.

Arterial Branches of the Aortic Arch

The aorta arches to the left as the aortic arch.

 Brachiocephalic trunk. The brachiocephalic trunk, the first branch off the
aortic arch, splits into the right common carotid artery and right
subclavian artery.
 Left common carotid artery. The left common carotid artery is the second
branch of the aortic arch and it divides, forming the left internal carotid,
which serves the brain, and the left external carotid, which serves the skin
and muscles of the head and neck.
 Left subclavian artery. The third branch of the aortic arch, the left
subclavian artery, gives off an important branch- the vertebral artery,
which serves as part of the brain.
 Axillary artery. In the axilla, the subclavian artery becomes the axillary
artery.
 Brachial artery. the subclavian artery continues into the arm as the
brachial artery, which supplies the arm.
 Radial and ulnar arteries. At the elbow, the brachial artery splits to form
the radial and ulnar arteries, which serve the forearm.

Arterial Branches of the Thoracic Aorta

The aorta plunges downward through the thorax, following the spine as the
thoracic aorta.

 Intercostal arteries. Ten pairs of intercostal arteries supply the muscles of

the thorax wall.

Arterial Branches of the Abdominal Aorta

Finally, the aorta passes through the diaphragm into the abdominopelvic cavity,
where it becomes the abdominal aorta.

 Celiac trunk. The celiac trunk is the first branch of the abdominal aorta
and has three branches: the left gastric artery supplies the stomach;
the splenic artery supplies the spleen, and the common hepatic
artery supplies the liver.
 Superior mesenteric artery. The unpaired superior mesenteric artery
supplies most of the small intestine and the first half of the large intestine
or colon.
 Renal arteries. The renal arteries serve the kidneys.
 Gonadal arteries. The gonadal arteries supply the gonads, and they are
called ovarian arteries in females while in males they are testicular
arteries.
 Lumbar arteries. The lumbar arteries are several pairs of arteries serving
the heavy muscles of the abdomen and trunk walls.
 Inferior mesenteric artery. The inferior mesenteric artery is a small,
unpaired artery supplying the second half of the large intestine.
 Common iliac arteries. The common iliac arteries are the final branches of
the abdominal aorta.

Major Veins of the Systemic Circulation

Major veins converge on the venae cavae, which enter the right atrium of the
heart.
Veins Draining into the Superior Vena Cava

Veins draining into the superior vena cava are named in a distal-to-proximal
direction; that is, in the same direction the blood flows into the superior vena
cava.

 Radial and ulnar veins. The radial and ulnar veins are deep veins draining
the forearm; they unite to form the deep brachial vein, which drains the
arm and empties into the axillary vein in the axillary region.
 Cephalic vein. The cephalic vein provides for the superficial drainage of
the lateral aspect of the arm and empties into the axillary vein.
 Basilic vein. The basilic vein is a superficial vein that drains the medial
aspect of the arm and empties into the brachial vein proximally.
 Median cubital vein. The basilic and cephalic veins are joined at the
anterior aspect of the elbow by the median cubital vein, often chosen as
the site for blood removal for the purpose of blood testing.
 Subclavian vein. The subclavian vein receives venous blood from the arm
through the axillary vein and from the skin and muscles of the head
through the external jugular vein.
 Vertebral vein. The vertebral vein drains the posterior part of the head.
 Internal jugular vein. The internal jugular vein drains the dural sinuses of
the brain.
 Brachiocephalic veins. The right and left brachiocephalic veins are large
veins that receive venous drainage from the subclavian, vertebral, and
internal jugular veins on their respective sides.
 Azygos vein. The azygos vein is a single vein that drains the thorax and
enters the superior vena cava just before it joins the heart.

Veins Draining into the Inferior Vena Cava

The inferior vena cava, which is much longer than the superior vena cava, returns
blood to the heart from all body regions below the diaphragm.

 Tibial veins. The anterior and posterior tibial veins and the fibular
vein drain the leg; the posterior tibial veins become the popliteal vein at
 the knee and then the femoral vein in the thigh; the femoral vein becomes
the external iliac vein as it enters the pelvis.
 Great saphenous veins. The great saphenous veins are the longest veins
in the body; they begin at the dorsal venous arch in the foot and travel up
the medial aspect of the leg to empty into the femoral vein in the thigh.
 Common iliac vein. Each common iliac vein is formed by the union of the
external iliac vein and the internal iliac vein which drains the pelvis.
 Gonadal vein. The right gonadal vein drains the right ovary in females and
the right testicles in males; the left gonadal vein empties into the left renal
veins superiorly.
 Renal veins. The right and left renal veins drain the kidneys.
 Hepatic portal vein. The hepatic portal vein is a single vein that drains the
digestive tract organs and carries this blood through the liver before it
enters the systemic circulation.
 Hepatic veins. The hepatic veins drain the liver.

Physiology of the Heart

As the heart beats or contracts, the blood makes continuous round trips- into
and out of the heart, through the rest of the body, and then back to the heart-
only to be sent out again.

Intrinsic Conduction System of the Heart

The spontaneous contractions of the cardiac muscle cells occurs in a regular and
continuous way, giving rhythm to the heart.

 Cardiac muscle cells. Cardiac muscle cells can and do contract

spontaneously and independently, even if all nervous connections are
severed.
 Rhythms. Although cardiac muscles can beat independently, the muscle
cells in the different areas of the heart have different rhythms.
 Intrinsic conduction system. The intrinsic conduction system, or
the nodal system, that is built into the heart tissue sets the basic rhythm.
 Composition. The intrinsic conduction system is composed of a special
tissue found nowhere else in the body; it is much like a cross between a
muscle and nervous tissue.

 Function. This system causes heart muscle depolarization in only one

direction- from the atria to the ventricles; it enforces a contraction rate of
approximately 75 beats per minute on the heart, thus the heart beats as a
coordinated unit.
 Sinoatrial (SA) node. The SA node has the highest rate of
depolarization in the whole system, so it can start the beat and set the
pace for the whole heart; thus the term “pacemaker“.
 Atrial contraction. From the SA node, the impulse spread through the
atria to the AV node, and then the atria contract.
  Ventricular contraction. It then passes through the AV bundle, the
bundle branches, and the Purkinje fibers, resulting in
a “wringing” contraction of the ventricles that begins at the heart apex
and moves toward the atria.
 Ejection. This contraction effectively ejects blood superiorly into the large
arteries leaving the heart.

The Pathway of the Conduction System

The conduction system occurs systematically through:

 SA node. The depolarization wave is initiated by the sinoatrial node.

 Atrial myocardium. The wave then successively passes through the atrial
myocardium.
 Atrioventricular node. The depolarization wave then spreads to the AV
node, and then the atria contract.
 AV bundle. It then passes rapidly through the AV bundle.
 Bundle branches and Purkinje fibers. The wave then continues on
through the right and left bundle branches, and then to the Purkinje fibers
in the ventricular walls, resulting in a contraction that ejects blood, leaving
the heart.
ormal
In the normal ECG pattern, there is a regular pattern of The P wave, QRS complex, and
T wave. They occur in a sequence.

Angina

When the heart muscle doesn’t get enough blood with oxygen, it causes discomfort, that
feels like putting pressure on the chest. This condition is termed as Angina pain. It can
sometimes be misunderstood as indigestion. As you can see in the figure above (see
arrow), the ST-segment dips, which normally is flat.

Serious heart attack

The elevated ST segment of the ECG is an indication of a serious heart attack. In the
medical terminology, it is referred to as “STEMI”, which needs immediate attention.
Generally, the ST segment remains flat.

Atrial fibrillation

Atrial fibrillation is the state when the atria and the ventricles show a lack of coordination
of movement. It results in rapid heartbeat, weakness and shortness of breath. On ECG,
it is represented by jumpy baseline and the P wave disappears.

Cardiac Cycle and Heart Sounds

In a healthy heart, the atria contract simultaneously, then, as they start to relax,
contraction of the ventricles begins.

 Systole. Systole means heart contraction.

 Diastole. Diastole means heart relaxation.
 Cardiac cycle. The term cardiac cycle refers to the events of one complete
heartbeat, during which both atria and ventricles contract and then relax.

 Length. The average heart beats approximately 75 times per minute, so

the length of the cardiac cycle is normally about 0.8 seconds.
 Mid-to-late diastole. The cycle starts with the heart in
complete relaxation; the pressure in the heart is low, and blood is flowing
passively into and through the atria into the ventricles from the pulmonary
and systemic circulations; the semilunar valves are closed, and the AV
valves are open; then the atria contract and force the blood remaining in
their chambers into the ventricles.
 Ventricular systole. Shortly after, the ventricular contraction begins, and
the pressure within the ventricles increases rapidly, closing the AV valves;
when the intraventricular pressure is higher than the pressure in the large
arteries leaving the heart, the semilunar valves are forced open, and blood
rushes through them out of the ventricles; the atria are relaxed, and their
chambers are again filling with blood.
 Early diastole. At the end of systole, the ventricles relax, the semilunar
valves snap shut, and for a moment the ventricles are completely closed
chambers; the intraventricular pressure drops and the AV valves are forced
 open; the ventricles again begin refilling rapidly with blood, completing
the cycle.
 First heart sound. The first heart sound, “lub”, is caused by the closing of
the AV valves.
 Second heart sound. The second heart sound, “dub”, occurs when the
semilunar valves close at the end of systole.

Cardiac Output

Cardiac output is the amount of blood pumped out by each side of the heart in
one minute. It is the product of the heart rate and the stroke volume.

 Stroke volume. Stroke volume is the volume of blood pumped out by a

ventricle with each heartbeat.
 Regulation of stroke volume. 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; the more they are stretched,
the stronger the contraction will be; and anything that increases the
volume or speed of venous return also increases stroke volume and force
of contraction.
 Factors modifying basic heart rate. The most important external
influence on heart rate is the activity of the autonomic nervous system,
as well as physical factors (age, gender, exercise, and body temperature).

Physiology of Circulation

A fairly good indication of the efficiency of a person’s circulatory system can be

obtained by taking arterial blood and blood pressure measurements.
Cardiovascular Vital Signs

Arterial pulse pressure and blood pressure measurements, along with those of
respiratory rate and body temperature, are referred to collectively as vital signs in
clinical settings.

 Arterial pulse. The alternating expansion and recoil of an artery that

occurs with each beat of the left ventricle create a pressure wave-a pulse-
that travels through the entire arterial system.
 Normal pulse rate. Normally, the pulse rate (pressure surges per minute)
equals the heart rate, so the pulse averages 70 to 76 beats per minute in
a normal resting person.
 Pressure points. There are several clinically important arterial pulse points,
and these are the same points that are compressed to stop blood flow
into distal tissues during hemorrhage, referred to as pressure points.
 Blood pressure. Blood pressure is the pressure the blood exerts against
the inner walls of the blood vessels, and it is the force that keeps blood
circulating continuously even between heartbeats.
 Blood pressure gradient. The pressure is highest in the large arteries and
continues to drop throughout the systemic and pulmonary pathways,
reaching either zero or negative pressure at the venae cavae.
 Measuring blood pressure. Because the heart alternately contracts and
relaxes, the off-and-on flow of the blood into the arteries causes the blood
pressure to rise and fall during each beat, thus, two arterial blood pressure
measurements are usually made: systolic pressure (the pressure in the
arteries at the peak of ventricular contraction) and diastolic pressure (the
pressure when the ventricles are relaxing).
 Peripheral resistance. Peripheral resistance is the amount of friction the
blood encounters as it flows through the blood vessels.
 Neural factors. The parasympathetic division of the autonomic nervous
system has little or no effect on blood pressure, but the sympathetic
division has the major action of causing vasoconstriction or narrowing of
the blood vessels, which increases blood pressure.
 Renal factors. The kidneys play a major role in regulating arterial blood
pressure by altering blood volume, so when blood pressure increases
beyond normal, the kidneys allow more water to leave the body in
 the urine, then blood volume decreases which in turn decreases blood
pressure.
 Temperature. In general, cold has a vasoconstricting effect, while heat has
a vasodilating effect.
 Chemicals. Epinephrine increases both heart rate and blood
pressure; nicotine increases blood pressure by causing
vasoconstriction; alcohol and histamine cause vasodilation and decreased
blood pressure.
 Diet. Although medical opinions tend to change and are at odds from time
to time, it is generally believed that a diet low in salt, saturated fats,
and cholesterol help to prevent hypertension, or high blood pressure.
Blood Circulation Through the Heart

The right and left sides of the heart work together in achieving a smooth-
flowing blood circulation.
 Entrance to the heart. Blood enters the heart through two large veins, the
inferior and superior vena cava, emptying oxygen-poor blood from the
body into the right atrium of the heart.
  Atrial contraction. As the atrium contracts, blood flows from the right
atrium to the right ventricle through the open tricuspid valve.
 Closure of the tricuspid valve. When the ventricle is full, the tricuspid
valve shuts to prevent blood from flowing backward into the atria while the
ventricle contracts.
 Ventricle contraction. As the ventricle contracts, blood leaves the heart
through the pulmonic valve, into the pulmonary artery, and to the lungs
where it is oxygenated.
 Oxygen-rich blood circulates. The pulmonary vein empties oxygen-rich
blood from the lungs into the left atrium of the heart.
 Opening of the mitral valve. As the atrium contracts, blood flows from
your left atrium into your left ventricle through the open mitral valve.
 Prevention of backflow. When the ventricle is full, the mitral valve shuts.
This prevents blood from flowing backward into the atrium while the
ventricle contracts.
 Blood flow to the systemic circulation. As the ventricle contracts, blood
leaves the heart through the aortic valve, into the aorta, and to the body.
Capillary Exchange of Gases and Nutrients

Substances tend to move to and from the body cells according to their
concentration gradients.

 Capillary network. Capillaries form an intricate network among the body’s

cells such that no substance has to diffuse very far to enter or leave a cell.
 Routes. Basically, substances leaving or entering the blood may take one
of four routes across the plasma membranes of the single layer of
endothelial cells forming the capillary wall.
 Lipid-soluble substances. As with all cells, substances can
diffuse directly through their plasma membranes if the substances are
lipid-soluble.
 Lipid-insoluble substances. Certain lipid-insoluble substances may enter
or leave the blood and/or pass through the plasma membranes within
vesicles, that is, by endocytosis or exocytosis.
 Intercellular clefts. Limited passage of fluid and small solutes is allowed
by intercellular clefts (gaps or areas of plasma membrane not joined by
tight junctions), so most of our capillaries have intercellular clefts.
  Fenestrated capillaries. Very free passage of small solutes and fluid is
allowed by fenestrated capillaries, and these unique capillaries are found
where absorption is a priority or where filtration occurs.

Age-Related Physiological Changes in the Cardiovascular

System
The capacity of the heart for work decreases with age. Older peoples’ rate is
slower to respond to stress and slower to return to normal after periods
of physical activity. Changes in arteries occur frequently which can negatively
affect blood supply.

Health promotion teaching can include risk detection and reduction for
cardiovascular diseases, blood pressure and cholesterol level monitoring, ideal
weight maintenance, and a low-sodium diet.