Introduction: The circulatory system consists of the heart, blood vessels & blood.

The cardiovascular system refers to heart and

vessels. The fundamental purpose of the circulatory system is to transport substances from place to place in the body. The
cardiovascular system has two major divisions i.e. Pulmonary circulation and Systemic circulation. Pulmonary circulation carries
blood to the lungs for gas exchange and returns it to the heart and a systemic circulation supplies blood to every organ of the body,
including other parts of the lungs and the wall of the heart itself. Right heart pumps into pulmonary circulation where blood collects
O 2 from air sacs and excess CO 2 diffuses into air sacs for exhalation. Left heart pumps into systemic circulation where blood supplies
O 2 and nutrients to the cells and waste products are removed.
Heart: It is roughly cone-shaped hollow muscular organ. It is about the size of owner’s fist. Its weighs is heavier in men. Its weight is
310 gm in man and 225 gm in women.

Location of Heart: The heart is located in the thoracic cavity in the mediastinum, between the lungs and deep to the sternum. It lies
obliquely and is tilted toward the left so two-thirds of the heart lies to the left of the median plane. The broad superior portion of the
heart, called the base, is about 9 cm to left of midline at level of 5th ICS, a little below nipple (apex beat). The inferior end tapers to a
blunt point, extends to level of 2nd rib.

Organs associated with Heart

Inferiorly: Diaphragm
Superiorly: Great blood vessels
Posteriorly: Esophagus, Trachea, Descending aorta, IVC, Thoracic vertebrae
Laterally: Lungs
Anteriorly: Sternum, Ribs, Intercostal muscles
Structure of Heart: It is composed of 3 layers of tissue i.e. Pericardium, Myocardium,
Endocardium.
Pericardium: The heart is enclosed in a double-walled sac called as pericardium. The
outer wall, called as pericardial sac (parietal pericardium), has a tough and superficial
fibrous layer of dense irregular connective tissue. Similarly inner serous membrane
forms the epicardium (visceral pericardium) covering of the heart surface. Pericardial
fluid (5-30 ml) is present in between double layered serous membranes and helps for
smooth movement of heart during the heartbeat.

Myocardium: It consists of cardiac muscle which is involuntary and consists of Intercalated

discs. Each fiber has a nucleus and one or more branches. The intercalated discs can be seen as
lines which are thicker and darker than the ordinary cross-stripes. The end-to-end continuity of
cardiac muscle cells has significance in relation to the way the heart contracts as a single unit.
A wave of contraction spreads from cell to cell across intercalated discs so cells do not need to
be stimulated individually and excitation occurs very rapidly.
Endocardium: It forms the lining of the myocardium and the heart valves. It is thin, smooth and glistening membrane. The layer is
continuous with the endothelium lining the blood vessels. The heart also has a framework of collagenous and elastic fibers that make
up the fibrous skeleton. This tissue is especially concentrated in the walls between the heart chambers, in fibrous rings around the
valves and in sheets of tissue that interconnect these rings.

The fibrous skeleton has multiple functions:

(1) It provides structural support for the heart, especially around valves and the openings of great vessels.
(2) It anchors the cardiocytes and gives them something to pull against.
(3) It serves as electrical insulation between the atria and the ventricles so the atria cannot stimulate the ventricles directly. This
insulation is important to the timing and coordination of electrical and contractile activity.

External Features: The boundaries of the four chambers are marked by three sulci (grooves), which are largely filled by fat and the
coronary blood vessels. The coronary (atrioventricular) sulcus encircles the heart near the base and separates the atria above from the
ventricles below. The other two sulci extend obliquely down the heart from the coronary sulcus toward the apex - one on the front of
the heart called the anterior interventricular sulcus and one on the back called the posterior interventricular sulcus. These sulci overlie
an internal wall, the interventricular septum, that divides the right ventricle from the left. The coronary sulcus and two interventricular
sulci harbor the largest of the coronary blood vessels.
Internal Features
Chambers of heart: Left and right side of heart is divided by an atrioventricular valve into an atrium and ventricle. Heart is made up
of four chambers. The upper two chambers are known as atrium and lower two chambers are known as ventricles.

a. Atrium: The right and left atrium together forms the upper thin walled chambers. They are separated by inter-atrial septum. Right
atrium receives the opening of superior venacava, inferior venacava and coronary sinus and left atrium receives the opening of four
pulmonary veins (Two right and Two left pulmonary veins). Ear-like right auricle is a conical muscular pouch that projects from right
chamber like an add-on room which increases the capacity of atrium. The smooth and rough parts of the atrial wall are separated
externally by a shallow vertical groove i.e. the sulcus terminalis and composed of pectinate muscles.

b. Ventricles: They forms largest part of anterior surface of the heart, a small part of the diaphragmatic surface and almost entire
inferior border of heart. They are internally separated by inter ventricular septum (Left and Right). Left and right ventricles have
muscular projection or ridges on their inner lining which are called as papillary muscle. The left ventricle is thicker than right ventricle
because it has to pump blood to all over the body. They has irregular muscular elevations i.e. trabeculae carneae. Supraventricular
crest separates inflow (rough) and outflow (smooth) parts of ventricles. Right AV orifice guarded by chordae tendinae arise from
papillary muscles

Valves of the Heart

i. Atrioventricular valves: The atrioventricular (AV) valves regulate the openings between the atria and ventricles.
► Right Atrioventricular valve: It lies between right atrium and right ventricle. It is also known as tricuspid valve as it has three flaps.
► Left Atrioventricular valve: It lies between left atrium and left ventricle. It is also known as bicuspid valve and mitral valve as it
has two flaps.
AV valves open and close passively based on changes of pressure in chambers. Valves open if pressure in atria is more than in
ventricles and close if pressure in ventricle is more. The cardiac valves are composed of fibrous tissue and allow blood to flow in one
direction Valves are prevented from opening upwards by tendinous cords as called chordae tendinae. These cords extend from inferior
surface of valves to projections of myocardium in ventricles through papillary muscles.
ii. Semilunar valves
► Pulmonary valve: It controls the opening from the right ventricle into the pulmonary trunk.
► Aortic valve: It controls the opening from the left ventricles into the aorta.

Flow of Blood Through Heart

1st Phase: The right atrium receives deoxygenated blood from body except the lungs through two main vessels.
i. Superior venacava: It collects blood from head and upper part of body.
ii. Inferior venacava: It collects of blood from lower part of the body.
2nd Phase: The blood is then pumped into the right ventricle due to the contraction of right atrium.
3rd Phase: Contraction of right ventricle allows deoxygenated blood to pass to lungs through pulmonary artery.
4th Phase: - After oxygenation in lungs, oxygenated blood is return to left atrium through pulmonary vein.
5th Phase: - The blood is then passed into the left ventricle due to contraction of left atrium.
6ST Phase: - Then oxygenated blood is passed to aorta and distributed to all parts of body due to contraction of left ventricle.
Blood Supply to the Heart

i. Arterial supply: The heart is supply with arterial blood

by the right and left coronary arteries which branch from
the aorta. Right coronary arteries supply blood to right
auricle, right ventricle, posterior part of interventricular
septum, SA & AV node. Similarly left coronary arteries
supply blood to the left auricle, left ventricle and anterior
part of interventricular septum. The left coronary artery
(LCA) travels through the coronary sulcus under the left
auricle and divides into two branches.

ii. Venous supply: Most of the venous blood is collected

into several small veins that join form the coronary sinus.
Coronary sinus is the largest vein of heart which lies on
posterior coronary sulcus and opens to right auricle.
Venae cordis minimi is a smallest cardiac veins which
present in all chambers and open directly to same
chambers.
Conducting System: Heart can contract without nerve
supply. Heart has intrinsic system for automatic
rhythmic contraction. Intrinsic system can be stimulated
or depressed by nerve impulses Small groups of
specialized neuromuscular cells in myocardium initiate
and conduct impulses causing coordinated and
synchronized contraction of heart muscle.
i. Sinoatrial node (SA node): SA node is a collection
of neuromuscular tissues on a posterior wall of right
atrium near the opening of superior venacava. It cans
initiates and spread the action potential or impulse in
the form of electric wave. Thus it is called pacemaker of
the heart. The normal heartbeat triggered by the SA
node is called sinus rhythm. At rest, the adult heart
typically beats about 70 to 80 times per minute although
heart rates from 60 to 100 bpm are not unusual.
Stimuli such as the hypoxia, electrolyte imbalances, caffeine and nicotine can cause other parts of the conduction system to fire before
the SA node does by setting off an extra heartbeat which is called as premature ventricular contraction (PVC) or Extrasystole. Any
region of spontaneous firing other than SA node is called an ectopic focus. Most common ectopic focus is the AV node which
produces a slower heartbeat of 40 to 50 bpm which is called as nodal rhythm.

ii. Atrioventicular node (AV node): It is situated in the interatrial septum towards the right atrium near the Atrioventicular valves (AV
valve). It is stimulated by impulses that come from SA node. It can initiate the wave of contraction but at a very slower rate than SA
node. Its main function is to pick up the wave of contraction from myocardium of right atrium.

iii. Atrioventicular bundle (Bundle of His or AV bundle): AV bundles are the mass of specialized fibres that originate from AV
node. AV node gives a bundle of cardiac muscle fiber in the interatrial septum. It divides into right and left branches which run along
the inteventriecular septum.

iv. Purkinje fibres: These are very fine fibers which arise from Bundle of His. The cardiac impulse is passed to apex of heart and then
through the ventricles by the helps of Purkinje fibers.

Nervous regulation of Heart: Although the nervous system does not initiate the heartbeat, it modulate its rate, rhythm and
contracting force.
Sympathetic Pathway to Heart: Sympathetic pathway to heart originates in lower cervical to upper thoracic segments of spinal cord.
Preganglionic nerve fibers extend to adjacent sympathetic chain gangli. Postganglionic fibers pass through a cardiac plexus in
mediastinum and continue by way of cardiac nerves to heart. These fibers terminate in the SA and AV nodes and in the atrial and
ventricular myocardium as well as in the aorta, pulmonary trunk and coronary arteries. Sympathetic stimulation increases the heart
rate and contraction strength and dilates the coronary arteries to increase myocardial blood flow.
The sympathetic postganglionic fibers are adrenergic. They release norepinephrine, which binds to adrenergic fibers in the heart. This
activates the cyclic adenosine monophosphate (cAMP) second-messenger system in the cardiocytes and nodal cells. Cyclic AMP
activates an enzyme that phosphorylates and opens a calcium channel in the plasma membrane. The inflow of calcium accelerates
depolarization of the SA node and contraction of the cardiocytes so it speeds up the heart. In addition cAMP accelerates the uptake of
calcium by the sarcoplasmic reticulum and thereby enables cardiocytes to relax more quickly. By accelerating both contraction and
relaxation, norepinephrine and cAMP increase the heart rate.
Parasympathetic Pathway to Heart: The parasympathetic pathway begins with nuclei of the vagus nerves in the medulla oblongata.
Preganglionic fibers extend through the vagus nerves to the cardiac plexus, where they mingle with the sympathetic fibers and
continue to the heart by way of the cardiac nerves. They synapse with postganglionic neurons in the epicardial surface and within the
heart wall. Postganglionic fibers from the right vagus nerve lead mainly to the SA node and those from the left vagus lead mainly to
the AV node but each has some fibers that cross over to the other target cells. There is little or no vagal parasympathetic innervation of
the myocardium. The parasympathetic vagus nerves have cholinergic inhibitory effects on the SA and AV nodes. Acetylcholine (ACh)
binds to muscarinic receptors and opens potassium gates in the nodal cells. As potassium exits the cells, they become hyperpolarized
and fire less frequently so the heart slows down. The vagus nerves have a faster-acting effect on the heart than the sympathetic nerves
because ACh acts directly on ion channels in the plasma membrane.

Blood Vessels

Arteries: The arteries are the blood vessel which carry blood away from the heart to different organs. It diameter is 4 mm. The
smallest parts of arteries are called arterioles.

Veins: The veins are blood vessels. Which carry blood towards the heart from different parts of the body. It diameter is 5 mm. The
smallest parts of veins are called venues.

Capillaries: Capillaries are network of microscopic endothelial tubes. Capillaries wall consists of single endothelial cells sitting on a
very thin basement membrane. The average diameter of capillaries is 6-8 micron.

Sinusoids: Sinusoids, replace capillaries in certain organ, like liver, spleen, bone marrow, suprarenal glands, parathyroid glands,
carotid body etc.

Structures of Blood Vessels

i. Tunica adventitia: It is outer layer of blood vessels composed of fibrous tissue.

ii. Tunica media: It is middle layer of blood vessels composed of smooth muscle and elastic tissue.
iii. Tunica intima: It is an inner layer of blood vessels composed of squamous epithelium called endothelium.

Blood supply to blood vessels: The blood supply of blood vessels are nutrient vessels called vasa-vasorum.

Controls of blood vessels: The controls of blood vessels are the autonomic nervous system. These nerves arise from the vasomotor
centre in the medulla oblongata. And they change the diameter of the lumen of the blood vessels, controlling the volume of blood.

ARTERIES VEINS
 Arteries carry oxygenated blood, away from the heart Veins carry deoxygenated blood, towards the heart except pulmonary
except pulmonary artery. veins
These are mostly deeply situated in the body. These are superficial and deep in location.
These are thick walled. These are thin wall.
These passes narrow lumen. These passes wide lumen.
These are reddish in colour. These are bluish in colour.
Arteries blood pressure is high. Veins blood pressure is low.
Highly elasticity. Low elasticity.
Internal valve are absent. Internal valve are present.

Pulse: Rhythmic distension of peripheral artery felt against a rigid structure (bone).

Pulmonary Circulation: The flow of blood between the heart and lungs for purification or oxygenation called pulmonary
circulation. It another way pulmonary circulation means the flow of blood from right ventricle to left atrium. Right ventricle contract
and the impure blood is forced into pulmonary artery which divides into left and right branches in the lungs capillaries
(Alveoli)blood receives oxygen and loses carbon dioxide. Now the pure blood is carried to left atrium through the pulmonary vein (2
rights & 2 left).

Systemic Circulation: The flow of blood between the heart and different parts of the body except the lungs. The pure blood from
left atrium passes into the left ventricle from where it is forced into the aorta. Aorta gives off different branches through which the
blood is transported to different parts of the body. In the cellular level or tissue level, the blood loses oxygen and receives carbon
dioxide and becomes deoxygenated. The deoxygenated blood from the upper part of the body is carried by superior venacava, from
the lower parts by inferior venacava and ultimately to right atrium.

Systemic Circulation on Heart Pulmonary Circulation on Heart

Passage of blood from left ventricle to tissue and Passage of blood from right ventricle to lungs and from lung to left
from tissue to right atrium. atrium.
Exchange of various substances between blood and Exchange of gases occurs between blood and alveoli of lungs at
tissues occurs at the capillaries. pulmonary capillaries.
Here artery carries oxygenated blood and veins Here pulmonary artery carries deoxygenated blood and pulmonary
carries deoxygenated blood. veins carries oxygenated blood.
It supplies nutrition to body tissue. It carries blood to lungs for oxygenation.
Here BP is high. Here BP is low.
Human Aortic system: It conveys arterial blood from the left ventricle to all parts of body. It distributes blood through three main
branches:

1. Branchiocephalic artery: It divides into two artery.

i. Right common carotid artery: It passes upwards on the side of neck at the level of upper border of thyroid cartilage and divides
into external carotid and internal carotid. They supply blood to the right side of head and face.
ii. Right subclavian artery: It arises from innominate artery and divides into following arteries
► Right cervical artery: Supplies blood to the muscle of neck.
► Right axillary artery: Supplies blood to scapular region.
► Right brachial artery: Supplies blood to arm.
► Right internal mammary: Supplied blood to the brest and other structure of thoracic cavity.

2. Left common carotid artery: It arises directly from aortic arch & runs upward on side of neck. It divides into external carotid
artery and internal carotid artery. It supplies blood to left side of head and face.

3. Left subclavian artery : It arises from the aortic arch.blood supplies to left side of arm

4. Thoracic Artery: The aortic arch curve down as thoracic aorta gives following artery.
► Intercostal artery: Supplies blood to ribs and intercostal muscles.
► Hepatic artery: Supplies blood to the liver.
► Lieno-gastric artery: Supplies blood to the stomach and spleen.
► Anterior mesenteric artery: Supplies blood to duodenum, jejunum, ileum and colon.
► Renal artery: Paired renal artery supplies to kidney
► Gonadal arteries: Supplies blood to either testis or in ovaries.
► Lumbar arteries: Supplies blood to the body wall of abdominal cavity.
► Common iliac arteries: Supplies blood to leg.

Human Venous system

Main veins on human body:
1. Superior venacava: They are in paired on number. They collect deoxygenated blood from anterior part of the body. They pass
blood into right atrium. Each superior venacava is formed by the union of following veins.
► External jugular: Collects blood from lower jaw.
► Internal jugular: Collects Blood from brain
► Subclavian vein: Collects blood from fore limb.
► Internal mammary vein: Collects blood from inner surface of the ventral thoracic wall.
► Anterior intercostal: Collect blood from intercostal space.
► Phrenic vein: Collects blood from diaphragm.
► Azygos vein: Collects blood from region of vertebral column.
2. Inferior venacava: The major veins to collects the blood for inferior venacava are as:
► Femoral vein: Collects blood from the outer side of the leg.
► Sciatic vein: Collects blood from inner side of the leg.
► Posterior mesenteric vein: Collects blood from various parts of the large intestine.
► Ilio-lumbar vein: Collects blood from lumbar region.
► Gonadeal vein: Collects blood from gonads.
► Renal vein: Collects blood from kidney.
► Hepatic vein: Collects blood from liver.

Hepatic portal system: A hepatic portal system is a network of veins which carries blood from the alimentary canal into liver and
from the liver blood is further carried to heart by hepatic vein. Blood collected from alimentary canal, spleen and pancreas enter into
liver by hepatic portal vein. Hepatic portal vein after entering liver further divides into network of capillaries then these capillaries
again unite to form hepatic vein.
Components of hepatic portal veins:
● Gastric vein: It collects blood from stomach and distal end of esophagus.
● Cystic vein: It collects blood from gall bladder.
● Splenic vein: It collects blood from spleen.
● Inferior mesenteric vein: It collects blood from rectum, pelvic and descending colon of large intestine.
● Superior mesenteric vein: It collects blood from small intestine and proximal parts of large intestine.

Circulus arteriosus (Circle of Willi): The greater part of brain is supplied

with arterial blood by an arrangement of arteries called circle of Willis.
Four large arteries contribute to its formation as the two internal carotid
arteries and the two vertebral arteries. The vertebral arteries arise from
subclavian arteries pass upwards through foramina in transverse processes
of the cervical vertebrae to form the basilar artery. The arrangement of
different arteries on circulus arteriosus help brain to receive an adequate
blood supply when a contributing artery is damaged or during extreme
movements of head and neck.
Anteriorly the two anterior cerebral arteries arise from internal carotid
arteries and are joined by anterior communicating artery. Posteriorly two
vertebral arteries join to form basilar artery. After travelling for a short
distance, basilar artery divides to form two posterior cerebral arteries
which are joined to the corresponding internal carotid artery by a helps of
posterior communicating artery for completion of circle.
Components of Circulus Arteriosus:
● 2 anterior cerebral arteries ● 2 posterior cerebral arteries
● 2 posterior communicating arteries ● 1 anterior communicating artery
● 2 internal carotid arteries ● 1 basilar artery
Cardiac output (Stroke Volume × Heart rate): Cardiac output is an amount of blood that pumped out by each ventricles of heart in
one minute. It is further determined by Stroke Volume and Heart rate. Its normal value is about 5 liter per minute.
i. Stroke Volume: It is an amount of blood ejected by each ventricle in each heart beats. It is affected by Preload, Afterload and
Myocardial contractility. Its normal value is about 70ml.
► Preload: Preload is the stretching of the cardiac muscle fibers at the end of diastole just before contraction. It is due to increase in
ventricular pressure caused by filling of blood during diastole. Force of contraction of heart and cardiac output are directly
proportional to preload.
► Afterload: Afterload is the force against which ventricles must contract and eject the blood in a form of aortic and pulmonic
pressure. The afterload for left ventricle is determined by aortic pressure and afterload for right ventricle is determined by pressure in
pulmonary artery. Force of contraction of heart and cardiac output are inversely proportional to afterload.
ii. Heart rate: It is the number of heart per minute. Its normal value is 72 per minute on adult. Heart rate is generally increases on
presence of sympathetic nerve while its rate is generally decreases on presence of parasympathetic nerve. Heart rate will be more on
upright position then on lying position. The heart rate is faster in women than men.
Blood Pressure: Blood pressure is a force or pressure which blood exerts on walls of the blood vessels. Blood pressure is a result of
discharge of blood from left ventricle into the already full aorta. There are two types of blood pressures. Systolic pressure is the peak
arterial BP attained during ventricular contraction while diastolic pressure is the minimum arterial BP occurring during the ventricular
relaxation between heartbeats. BP can be measured within a blood vessel or the heart by inserting a catheter or needle connected to an
external manometer (sphygmomanometer). When LV contracts and pushes blood into aorta then pressure produced within arterial
system is called as systolic blood pressure (SBP). SBP is normally is about 120 mm Hg in adults. Similarly when heart is resting
following ejection of blood then the pressure within arteries is called as diastolic blood pressure (DBP). DBP is normally is about 80
mm Hg in adults. The difference between SBP and DBP is called as pulse pressure. BP is based on cardiac output and peripheral
resistance.
Peripheral resistance: It is refers as resistance provided by peripheral circulation to the passage of blood through small vessels
especially arteries. It is further depends on Vessel diameter, viscosity of blood and vessel length.

Vessel diameter: Vasoconstriction leads to increase peripheral resistance while vasodilation leads to decrease peripheral resistance.

Viscosity of blood: Viscosity of blood increases on polycythemia and spherocytosis leads to increase peripheral resistance while
blood viscosity decreases on anemia leads to decreases peripheral resistance.
Vessel length: Peripheral resistance will increase with increase on vessel length while decrease with decrease on vessel length.
Regulation of Blood Pressure
1. Short term regulation
Baroreceptor Reflex: A baroreflex is an autonomic negative feedback response to changes in blood pressure. The changes are
detected by carotid sinuses. Glossopharyngeal nerve fibers from these sinuses transmit signals continually to the brainstem. When the
blood pressure rises, their signaling rate rises. This input inhibits the sympathetic cardiac and vasomotor neurons and reduces
sympathetic tone, and it excites the vagal fibers to the heart. Thus, it reduces the heart rate and cardiac output, dilates the arteries and
veins and reduces the blood pressure. When blood pressure drops below normal, on the other hand, the opposite reactions occur and
BP rises back to normal.
Chemoreceptor Mechanism: Chemoreceptors are receptors giving response to change in chemical constituents of blood. Peripheral
chemoreceptors influence vasomotor center. Peripheral chemoreceptors are sensitive to lack of O 2, excess of CO2 and hydrogen ion
concentration in blood. Whenever blood pressure decreases then blood flow to chemoreceptors decreases resulting on decrease on O 2
content and excess of CO2 and hydrogen ion. These factors excite chemoreceptors which send impulses to stimulate vasoconstrictor
center. Chemoreceptors play important role on respiration rather than on blood pressure regulation.
2. Long term regulation
Renin-Angiotensin Mechanism: When blood pressure and ECF volume decrease, renin secretion from kidney is increased by
Juxtaglomerular cell. It converts angiotensinogen into angiotensinogen I which further converted into angiotensin II by angiotensin
converting enzymes.
Angiotensin II acts on two ways to restore blood pressure as:
i. It causes constriction of arterioles in body which leads to increases on peripheral resistance and rises on BP. Angiotensin II
alternately causes constriction of afferent arterioles in kidneys which leads to reduction of glomerular filtration and increase on
retention of water and salts. This result on increases of ECF volume on normal level and BP is maintains.
ii. Simultaneously angiotensin II stimulates adrenal cortex to secrete aldosterone. This hormone increases reabsorption of sodium from
renal tubules. Sodium reabsorption is follow by water reabsorption resulting on increased ECF volume and blood volume. It increases
BP on normal level.
Cardiac Cycle: The phenomenon of contraction and relaxation of heart on rhythmical manner is called cardiac cycle. Normal number
of cardiac cycles per minute is about 60 to 100. Each cycle is about 0.8 second.
Stages of cardiac cycle:
a. Atrial systole:
► Simultaneous contractions of both atria.
► Opens AV valves [Tricuspid & Bicuspid valves]
► Blood flows within the ventricles of respective sides.
► No heart sound is produced.
► It completes within 0.1 sec.

b. Ventricular systole:
► Simultaneous contraction of both ventricles
► Bicuspid valve and tricuspid valves gets closed so that first heart sound [LUBB] is produced.
► Blood is forced into pulmonary artery and aorta.
► It completes within 0.3sec.

c. Complete cardiac diastole

► Relaxation of both atria and ventricles together.
► Takes about 0.4 sec.
► Both atria get filled with blood
► Pulmonary and aortic valves get closed to prevent back flow of blood due to which heart second sound [DUB] is produced

Major Events occur during Cardiac Cycle:

[In Atria]
1. Atrial systole: 0.1 sec
2. Atrial diastole: 0.7 sec

[In Ventricle]
1. Ventricular Systole: 0.3 sec
Isovolumic contraction phase:
► QRS complex of ECG signal beginning of this phase.
► Papillary muscle contract along chordae tendinae to prevents valve leaflets from bulging back into atria.
►Ventricular wall tension produces rapid increase on intra-ventricular pressure on this phase.
► The mitral valve close earlier than tricuspid valve and causes split on first heart sound.
► Ventricular contraction occurs without change on volume.
Rapid ejection phase:
► The aortic and pulmonary valves open and blood is pumped out of ventricles.
► Total energy of blood within ventricles excesses than that of blood within aorta.
► This energy gradient helps to enter blood into aorta and pulmonary artery.

Reduced ejection phase:

► T wave represents ventricular repolarization and causes ventricular tension to decrease.
► The rate of ventricular emptying declines and intra-ventricular pressure falls slightly below pressure on aorta and pulmonary artery.

2. Ventricular Diastole: 0.5 sec

Protodiastole:
► It is the first stage of ventricular diastole.
► The pressure in aorta and pulmonary artery increases and pressure in ventricles drops.
► Intra-ventricular pressure become less than the pressure in aorta and pulmonary artery then semilunar valves close which help to
produce second sound of heart.
► Protodiastole indicates only the end of systole and beginning of diastole.

Isovolumic relaxation phase:

►Ventricles continue to relax, intra-ventricular pressure falls and total energy of blood within ventricles is less than in aorta and
pulmonary artery than second heart sound is hear.
► Volume of blood remaining in ventricles i.e. end systolic volume remains constant without changes on volume.

Rapid Filling Phases:

►Ventricular pressure falls below atrial pressure AV valves open and blood in atria flow into ventricles.
►Ventricular relaxation proceeds and intra-ventricular pressure continues to fall by few mm of Hg which cause rapid flow of blood
from auricle to ventricles.
► Third sound of heart is heard during this phase.

Reduced Filling Phase:

► Ventricles continue to be filled with blood and intra-ventricular pressure rises.
► The pressure gradients across AV valves decreases and rate of filling falls.
► Aortic pressure and pulmonary pressure continue to fall during this phase.
► The reduced filling phase is term as diastasis.
Electrocardiogram [ECG]: It is a graphic record of electrical variations produced by beating of heart which is based on Einthoven's
principle. Its amplification can be displayed on cathode ray tube or on graph paper. Analysis of such electrocardiogram helps to
analyses different heart diseases. The ECG originates from the SA node is known as sinus rhythm. The rate of sinus rhythm is 60 to
100 beats per minute. A faster heart rate is called tachycardia and a slower heart rate is called bradycardia. The T wave represents the
relaxation of ventricular muscle [ventricular repolarization]. We can know information about the state of the myocardium and the
cardiac conduction system by examining the pattern of waves and the time interval between cycles.

WAVE OF NORMAL ECG: The waves of ECG recorded by limb Lead II are considered as the typical waves. Normal ECG has the
following waves namely P, Q, R, S and T
 P wave is the atrial complex.
 QRST complex is the ventricular complex.
 QRS complex is the initial ventricular complex.
 T wave is the final ventricular complex.

ECG is useful for determine and diagnosis of:

► Heart rate ►Heart attack
► Heart rhythm ► Coronary artery disease
►Abnormal electrical conduction ► Hypertrophy of heart
► Poor blood flow to heart muscle
Heart beat: One complete sequence of contraction and relaxation of the heart is called heartbeat. Normal heart rate is 72/minute. Its
average is between 60 -70 /minute.
Factor affecting Hearty Beat:
1. Sex: Women have a slightly faster pulse rate than man.
2. Age: Heart beat gradually decreases from birth to adulthood then increases with advancing old age.
3. Body temperature: Heart beat generally increases 7- 10 beats for each degree of temperature elevation.
4. Digestion: The increased metabolic rate during digestion will increase the pulse rate slightly.

5. Pain: Pain increased pulse rate.

6. Emotion: Fear, anger, anxiety and excitement increase the pulse rate.
7. Exercise: The heart must be faster during exercise to meet the increased demand for oxygen.

8. Blood pressure: Heart rate and blood pressure have an inverse relationship. When the blood pressure is low, there is an increase in
pulse rate as the heart attempts to increase the output of blood from the heart.

Pulse: The pulse is a wave of distension and elongation felt in an artery wall due to the contraction of left ventricle. Each contraction
of the left ventricle forces about 60 to 80 milliliters of blood through the already full aorta and into the arterial system. The aortic
pressure wave is transmitted through the arterial system and can be felt at any point where a superficial artery can be pressed gently
against a bone. The number of pulse beats per minute normally represents the heart rate. An average of 60 to 80 is common at rest.

Information that may be obtained from the pulse includes:

►The rate at which the heart is beating
► The regularity of the heartbeat
►The volume or strength of the beat

Heart sound: The vibratory motion of the heart produced during the different events of the cardiac cycle conducts through the
structure surrounding the heart and produces special audible sound called the heart sound.

i. First heart sound [LUBB]: Produced during ventricular systole due to closure of bicuspid valve & tricuspid valve. It has low
pitched.
ii. Second heart sound [DUBB]: Produced during complete cardiac diastole due to closure pulmonary and aortic valve. It is high
pitch. iii. Third
heart sound: It is produced due to the first rapid filling of ventricular diastole. It occurs by the sudden rush of atrial blood into
ventricles when atrioventricular valves open. It has low frequency and is not audible by stethoscope and is recorded only by
phonocardiograph.
iv. Fourth heart sound: It occurs during atrial contraction due to inrush of blood form atria to ventricle. It occurs just before first
heart sound and indicates the end of ventricular filling. It is also not audible by stethoscope and is recorded only by phonocardiograph.