CARDIOVASCULAR SYSTEM
Blood Vessels:
3 types of blood vessels
1. Arteries – carry oxygenated blood from heart to body parts except pulmonary artery
which carries deoxygenated blood from heart to lungs.
2. Veins – carry deoxygenated blood from body parts to heart except pulmonary vein
which carries oxygenated blood from lungs to heart.
3. Capillaries – smallest blood vessels
Veins have thinner walls compared with arteries.
Arteries and Veins –
3 layers or walls –
I. Tunica Externa/Adventitia,
II. Tunica Media, and
III. Tunica Interna
Largest artery – Aorta
Largest vein - Superior and Inferior Vena Cava
• Blood in an average adult – 4.7 liters (5quarts)
• Innermost lining of blood vessels – endothelium.
Anatomy of Heart:
• Location of heart:
▪ Mediastinum in the thoracic cavity behind the sternum (breastbone).
• Mediastinum -space between lungs
• Chambers – 4
▪ Right Atrium,
▪ Right Ventricle,
▪ Left Atrium, and
▪ Left Ventricle
Page 1 of 9
Valves – 4
▪ Aortic, Pulmonary – Semilunar Valves
▪ Tricuspid, Bicuspid (Mitral Valve) – Atrioventricular Valves.
Function of valve –
• Opening and closing to prevent backward direction of blood.
Septum –
1. Atrial Septum – divides left atrium and right atrium.
2. Ventricular septum – divides left ventricle and right ventricle.
Entire heart structure lies in sac called as Pericardial Sac.
Space between 2 pericardium called as Pericardial Cavity which is filled with Pericardial Fluid.
Heart muscles –
• 3 layers
a. Endocardium
b. Myocardium – thickest layer
c. Pericardium
Heartbeat And Heart Sounds:
• BP – sphygmomanometer
• Normal BP -120/80
• Normal heart rate 72 beats/min
• Normal pulse - 72
Systolic – contraction phase – pulmonary and aortic valves opens whereas tricuspid and
bicuspid/mitral valve closes, which produces 1st heart sound - S1 (lub)
Diastolic – relaxation phase – tricuspid and bicuspid/mitral valve open whereas pulmonary
and aortic valve closes, which produces 2nd heart sound -S2 (dub)
Murmur - abnormal swishing sound
Page 2 of 9
Circulation of Blood
• Systemic circulation – circulation between the heart and body parts
• Pulmonary circulation – circulation between heart and lungs.
Deoxygenated blood:
• Blood enters heart through – superior and inferior vena cava – RA - tricuspid valve –
RV – pulmonary valve - pulmonary artery – lung capillaries
Oxygenated blood:
• Blood flows from heart to body parts – pulmonary vein – LA – mitral/bicuspid valve –
LV – aorta – all body parts.
Conduction System of Heart:
• The current of electricity generated by the pacemaker causes the walls of the atria to
contract and force blood into the ventricles.
• Electric pulse generated to SA node (natural pacemaker) – AV node – bundle of His –
Right and left bundle of His branches – Purkinje fibers
Stroke volume – amount of blood expelled through each ventricle per 1 beat
Ejection fraction – percentage of blood
Heart Rhythm originating in SA node and travelling through the heart is called as normal sinus
rhythm.
SA Node (Natural pacemaker): Specialized nervous tissue in the right atrium that begins the
heartbeat.
AV Node: Specialized muscle fibers connecting the atria with the ventricles and transmitting
electrical impulses between them.
Electrocardiogram: Record of the electricity flowing through the heart. The electricity is
represented by waves or deflections called P, QRS, or T.
Pathology of Heart and Blood Vessels:
Heart
Arrythmias: Abnormal heart rhythm
Examples of arrythmia:
Page 3 of 9
1. Bradycardia and heart block (AV block):
▪ Failure of proper conduction of impulses from SA node through the AV node to
the bundle of His.
▪ If the failure occurs only occasionally, the heart misses a beat in a rhythm at
regular intervals – partial heart block.
▪ If no impulses reach the AV node from the SA node, the ventricles contract
slower than the atria and are not coordinated. This is the complete heart block.
2. Flutter:
▪ Rapid but regular contractions, usually of the atria.
▪ Heart rhythm may reach up to 300 beats per minute.
3. Fibrillation:
▪ Very rapid, random, inefficient, and irregular contractions of heart (350 beats
or more per minute).
Atrial fibrillation (Afib) – most common type of cardiac arrythmia.
Electrical impulses move randomly throughout the atria, causing the atria
to quiver instead of contracting in a coordinated rhythm.
Ventricular fibrillation (Vfib) – electrical impulses move randomly
throughout the ventricles.
ICD – Implantable cardioverter-defibrillator:
o small electrical device that is implanted inside the chest to sense
arrhythmias and terminate them with an electric shock.
Catheter ablation:
o minimally invasive treatment to treat cardiac arrhythmias.
o This technique uses radiofrequency energy delivered from the tip of
catheter inserted through a blood vessel and into the heart, destroys
tissue that causes arrhythmias.
Congenital Heart Disease – abnormalities in the heart at birth.
1. Coarctation of aorta – narrowing of the aorta.
2. Patent Ductus Arteriosus (PDA): passageway between aorta and pulmonary artery
remains open (patent) after birth.
3. Septal Defects: small holes in the wall between the atria (atrial septal defects) or
the ventricles (ventricular septal defects).
4. Tetralogy of Fallot: congenital malformation involving four distinct heart defects.
1) Pulmonary Artery Stenosis: pulmonary artery is narrowed or
obstructed.
2) Ventricular Septal Defect: large hole between 2 ventricles lets venous
blood pass from the right to the left ventricle and out to the aorta
without oxygenation.
Page 4 of 9
3) Shift of the Aorta to the Right: aorta overrides the interventricular
septum. Oxygen-poor blood passes from the right ventricle to the
aorta.
4) Hypertrophy of the Right Ventricle: Myocardium works harder to
pump blood through a narrowed pulmonary artery.
Congestive Heart Failure (CHF)
• Heart is unable to pump its required amount of blood.
• 2 types: systolic CHF and diastolic CHF
• Ejection fraction – the amount of blood that leaves the left ventricle
• Most common cause of diastolic CHF is hypertension.
Coronary Artery Disease (CAD):
Disease of the arteries surrounding the heart.
CAD usually is a result of atherosclerosis (hardening of arteries)
• Thrombotic occlusion – blocking of coronary artery by a clot.
• Infarct – the area of dead myocardial tissue.
• Acute coronary syndromes are conditions caused by myocardial ischemia. The
conditions are unstable angina and myocardial infarction.
• Unstable Angina – chest pain at rest or chest pain of increasing frequency.
For acute attacks of angina, nitroglycerin is given sublingually.
Drugs include:
Aspirin – prevent clumping of platelets
Beta-blockers – reduce the force and speed of the heartbeat and lower blood pressure
ACE inhibitors – reduce high blood pressure and risk of future heart attack even if the
patient is not hypertensive
Calcium channel blockers – relax muscles in blood vessels
Statins – lower cholesterol levels.
• Endocarditis – Inflammation of the inner lining of the heart.
• Hypertensive heart disease: High blood pressure affecting the heart.
• Mitral Valve Prolapse: Improper closure of mitral valve.
Murmur: extra heart sound heart between the normal beats.
Bruit – abnormal sound
Thrill – vibration felt on palpation of the chest.
Page 5 of 9
Palpation – an act of touching or feeling.
Palpitation – type of abnormal heart rhythm.
• Pericarditis – Inflammation of the membrane (pericardium) surrounding the heart.
• Cardiac tamponade – Compression of heart caused by collection of fluid in the
pericardial cavity
• Rheumatic heart disease: Heart disease caused by rheumatic fever.
Pathology of Blood Vessels:
• Aneurysm: local dilation (widening) of arterial wall.
o Berry aneurysm – aneurysms of small vessels in the brain.
o Aneurysms are common in aorta.
• DVT (deep vein thrombosis): blood clot forms in a large vein, usually in a lower limb.
• Hypertension: high blood pressure
• Hypotension: low blood pressure
• PAD (Peripheral Arterial Disease): blockage of arteries carrying blood to legs, arms,
kidneys, and other organs.
• Raynaud Disease: recurrent episodes of pallor and cyanosis primarily in fingers and
toes.
• Varicose Veins: abnormally swollen and twisted veins usually occurring in legs.
Abbreviations:
CAD – coronary artery disease
BBB- Bundle Branch Block
AAA- Abdominal Aortic Aneurysm
AICD – Automatic Implantable Cardioverter-Defibrillator.
CABG: Coronary Artery Bypass Grafting.
CoA: Coarctation of Aorta.
DVT: Deep Vein Thrombosis.
EF: Ejection Fraction.
VSD – Ventricular Septal Defect.
Page 6 of 9
Terminology:
Angio – vessel Lysis – breakdown
Cardio – heart Valvulo/valvo – valve
Athero – yellowish plaque, fatty substance Vaso or vasculo – vessel
Brachio – arm Phlebo or veno or veni – vein
Corono – heart Ventriculo – ventricle
Megaly - enlargement Stetho – chest
Cyano – blue Rhythmo – rhythm
Myxo – mucus Pericardio – pericardium
Oxo – oxygen Cholesterolo - Cholesterol
Sphygmo – pulse Aorto – aorta
Thrombo – clot
Laboratory Tests and Clinical Procedures
Laboratory tests:
1. BNP test:
• Measurement of BNP (Brain Natriuretic Peptide) in blood.
2. Cardiac biomarkers:
• Chemicals are measured in the blood as evidence of a heart attack.
• Substances are tested for troponin-I and troponin-T.
• Troponin is a heart muscle protein released into circulation after myocardial
injury.
3. Lipid Tests (Lipid Profile):
• Measurement of cholesterol and triglycerides (fats) in a blood sample.
4. Lipoprotein Electrophoresis:
• Lipoproteins (combination of fat and protein) are physically separated and
measured in a blood sample.
• Ex: LDL (low-density lipoprotein) and HDL (high-density lipoprotein).
Clinical Procedures:
1. Angiography: X-ray imaging of blood vessels after injection of contrast material.
2. Arteriography - X-ray imaging of arteries after injection of contrast material.
3. CTA (computed tomography angiography):
Page 7 of 9
• Three-dimensional x-ray images of the heart and coronary arteries using
computed tomography (64-slice CT scanner).
4. DSA (Digital Subtraction Angiography): Video equipment and a computer produce x-
ray images of blood vessels.
5. EBCT Or EBT (Electron Beam Computed Tomography): electron beams and CT
identify calcium deposits in and around coronary arteries to diagnose early CAD.
6. Ultrasound examinations:
7. Doppler Ultrasound Studies: Sound waves measure blood flow within blood vessels.
8. Echocardiography (ECHO): Echoes generated by high-frequency sound waves
produce images of heart.
Nuclear Cardiology:
1. PET (positron emission tomography) scan: images show blood flow and myocardial
function following uptake of radioactive glucose.
2. Technetium Tc 99m Sestamibi Scan: Technetium Tc 99m sestamibi injected
intravenously is taken up in cardiac tissue where it is detected by scanning.
3. Thallium 201 Scan: Concentration of radioactive thallium is measured to give
information about blood supply to the heart muscle.
MRI (magnetic resonance imaging)
1. Cardiac MRI : Images of heart are produced using radiowave energy in a magnetic
field.
2. MRA: Magnetic Resonance Angiography – gives highly detailed images of blood
vessels.
Gadolinium is the most common contrast agent used for MRI procedures.
Diagnostic Procedures
1. Cardiac Catheterization: Thin, flexible tube is guided into the heart via a vein or an
artery.
2. ECG (electrocardiography): Recording of electricity flowing through the heart.
3. Holter Monitoring: An ECG is worn during a 24-hour period to detect cardiac
arrhythmias.
4. Stress test: Exercise tolerance test (ETT) determines the heart’s response to physical
exertion (stress).
Page 8 of 9
CLINICAL PROCEDURES: TREATMENT
1. Catheter Ablation: brief delivery of radiofrequency energy to destroy areas of heart
tissue that may be causing arrhythmias.
2. CABG (Coronary Artery Bypass Grafting): Arteries and veins are anastomosed to
coronary arteries to detour around blockages.
3. Defibrillation: Brief discharges of electricity are applied across the chest to stop
dysrhythmias.
4. Endarterectomy: Surgical removal of plaque from the inner layer of an artery.
5. Extracorporeal circulation: Heart-lung machine diverts blood from the heart and
lungs while the heart is repaired.
6. Heart Transplantation: A donor heart is transferred to a recipient.
7. PCI (Percutaneous Coronary Intervention): Balloon-tipped catheter is inserted into
coronary artery to open the artery; stents are put in place.
8. Thrombolytic Therapy: Drugs to dissolve clots are injected into the bloodstream of
patients with coronary thrombosis.
9. TAVR (Transcatheter Aortic Valve Replacement): Placement of a balloon-expandable
aortic heart valve into the body via a catheter.
…………………………………………………….xxx……………………………………………………………………….
Page 9 of 9
