Cardiovascular system

The cardiovascular system

(Cardio - heart; vascular - blood or
blood vessels)
Consists of three interrelated
components:
• Heart
• Blood
• Blood vessels
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 HEART
• For blood to reach body cells and exchange
materials with them, it must be pumped
continuously by the heart through the
body’s blood vessels.

• The heart beats about 100,000 times every

day, which adds up to about 35 million beats
in a year, and approximately 2.5 billion
times in an average lifetime.

• Cardiology is the scientific study of the

normal heart and diseases associated with it.
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 HEART
• A four chambered, hollow muscular
organ approximately the size of a
closed fist.

• Heart pumps more than about 14,000

liters (3600 gal) of blood in a day, or 5
million liters (1.3 million gal) in a year.

• Its mass averages 250g in adult

females and 300g in adult males.
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Position of the heart in mediastinum

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 HEART
• The heart lies in the mediastinum, an
anatomical region that extends from the
sternum to the vertebral column, from the
first rib to the diaphragm, and between the
lungs.

• About two-thirds of the mass of the heart lies

to the left of the body’s midline.

• It rests on the diaphragm, near the midline of

the thoracic cavity.
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HEART

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 The apex of the heart
 Apex is formed by:
• The inferolateral part of
the left ventricle
• It projects forward &
downward.
• Lies posterior to the left 5th
intercostal space, usually ˜9
cm from the median plane.
• the apex underlies the site
where the heartbeat may
be auscultated on the
thoracic wall.
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 The base of the heart
• Posterior aspect of the
heart (opposite of the
apex).
• formed mainly by the
left atrium, with a
lesser contribution by
the right atrium.
• It is posterior toward
vertebrae of T6-T9.

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Base of the heart

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 Surface anatomy of the Heart

• Knowledge of the surface

anatomy of the thorax is
particularly important

• B/c it is one of the areas

most frequently subjected
to physical examination,
like auscultation and pe
rcussion

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Surface landmarks of the heart

1. The upper limit of the heart:

– reaches as high as the 3rd costal
cartilage on the right side of the
sternum and the 2nd intercostal space
on the left side of the sternum.
2. The lower margin of the heart:
– extends from the sternal end of the
right 6th costal cartilage to the apex in
the 5th intercostal space near the MCL.

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Surface landmarks of the heart
3. The right margin of the heart:
– extends from the right 3rd costal
cartilage to near the right 6th costal
cartilage
4. The left margin of the heart:
– descends laterally from the 2nd
intercostal space to the apex located
near the midclavicular line in the 5th
intercostal space.

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 Listening sites for heart sounds
• The tricuspid valve is heard
just to the left of the lower part
of the sternum near the 5th
intercostal space.

• The mitral valve is heard

over the apex of the heart in
the left 5th intercostal space at
the MCL line.
• The pulmonary valve is
heard over the medial end of
the left 2nd intercostal space.
• The aortic valve is heard over
the medial end of the right 2nd 14
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Coverings of the Heart
(Pericardium)

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 Pericardium
• Is a fibro-serous membrane that covers
the heart and the beginning of its great
vessels.
• It confines the heart to its position and
allowing sufficient freedom of movement
for vigorous and rapid contraction.
• The pericardium is a closed sac
composed of two layers;
- the external layer, fibrous
pericardium and
- the internal layer, Serous
pericardium 17
 Pericardium
• The deeper serous pericardium is a
thinner, more delicate membrane that
forms a double layer around the heart ;
1. The outer parietal layer of the serous
pericardium
• Is fused to the fibrous pericardium.
2. The inner visceral layer of the serous
pericardium also called the epicardium
• Adheres tightly to the surface of the
heart.
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 Pericardium
 Pericardial cavity
• Is the potential space
b/n the parietal and
visceral layers of serous
pericardium.
• It normally contains a
thin film of fluid that
enables the heart to
move and beat in a
frictionless environment.

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 The wall of each heart
chamber
 The heart wall consists of
three layers;
1. Endocardium
• a thin internal layer lining
membrane of the heart that
also covers its valves.
2. Myocardium
• a thick, helical middle layer
composed of cardiac
muscle.
3. Epicardium
• a thin external layer
(mesothelium) formed by
 The walls
the visceral layer of
of the heart serousmostly of
consist
pericardium.
myocardium, especially in the ventricles.
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Heart wall

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 The Heart
 The right side (right heart):
– receives poorly oxygenated (venous) blood from
the body through the SVC and IVC and pumps it
through the pulmonary trunk to the lungs for
oxygenation.

 The left side (left heart):

– receives well-oxygenated (arterial) blood from
the lungs through the pulmonary veins and
pumps it into the aorta for distribution to the
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The heart

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 Chambers of the heart
The heart has four chambers;
– Right and left atria & ventricles

- the atria are receiving chambers

- the ventricles are discharging chambers
Valves at the bottom of each atrium empty into the two
ventricles.

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Cardiac cycle

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• There are two phases in the cardiac cycle Systole and
diastole.
• The former is when the ventricles contract and pump
blood out, and the latter is when the ventricles relax
and fill with blood.
• These two phases make up the heartbeat.

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Vasculature of the Heart
The heart is supplied by:
– Coronary arteries which arise
from:
• The aortic sinuses of
ascending aorta
– And drained is by cardiac
veins

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Coronary arteries

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 Coronary arteries
 There are two major branches of
coronary artery:
1.Left coronary artery (LCA):
I. Anterior interventricular
artery(AIVA):
II. Coronary circumflex artery

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Coronary circulation

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 Coronary arteries

2. Right coronary artery

(RCA):
I. A right marginal branch
II. Posterior interventricular
artery

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Vasculature of the Heart

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 Venous Drainage of the
Heart
• The heart is drained mainly
by cardiac veins that
empty into the coronary
sinus and partly by small
veins that empty into the
right atrium directly.
• Coronary sinus:
– a wide venous channel that
runs from left to right in the
posterior part of the coronary
groove.

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 Venous Drainage of the
Heart
1. Great Cardiac Vein;
– Is the main tributary of the coronary sinus
– It drains the areas of the heart supplied by the LCA.
2. Middle cardiac vein
– accompanies the posterior interventricular
artery (usually arising from the RCA).
3. Small cardiac vein
– accompanies the right marginal branch of the
RCA.
4. Smallest veins of heart/ Cordis
minimae
– Are the smallest cardiac veins which open directly
into the chambers of the heart, chiefly the Rt atria.
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Cardiac veins

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Innervation of the Heart
• The heart has an internal nervous
system (Conducting System of the
Heart)
• Made up of the SA (sinuatrial) & the
AV (atrioventricular) nodes
• The AV bundle (His) leaves the AV
node near the lower part of
interatrial septum & splits over upper
part of interventricular septum into
a left bundle branch (LBB) & a right
bundle branch (RBB).
• Cardiac muscle is then supplied by
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Conduction system of
the Heart

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 Innervation of the Heart
Conducting System of the Heart: (Summary
Review)
• Conducting System activities are influenced by the
Autonomic Nerve supply of the heart:
– Parasympathetic Nerves: slow the rhythm & decrease
the rate of conduction of impulse
– Sympathetic Nerves have the opposite effect
• Autonomic nerves system consists:
1. Parasympathetic from vagus nerve
2. Sympathetic from:
A. Cervical sympathetic trunk
B. Upper thoracic sympathetic trunk

• Blood supply of conducting system – may be

from right or left coronary arteries. 38
 Blood Vessels
• The blood vessels contributes to
homeostasis of other body systems by
transporting and distributing blood
throughout the body to deliver:
– Oxygen
– Nutrients
– Hormones
– And carry away wastes
• It is a closed system: blood never
leaves the network of arteries, veins and
capillaries.
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 Blood Vessels
Blood Vascular System are:
• Heart, arteries, veins and capillaries
• Functions
1. Transports O2 and nutrients to the
tissues
2. Circulates hormones to target cells
3. Carries away CO2 and waste
products from the tissues

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 Blood Vessels
• Blood vessels are made of 3
concentric layers:
1. Tunica intima (inner layer)
2. Tunica media(middle layer muscular)
3. Tunica adventitia (outer)
• These three layers are analogous to
the 3 layers of the heart:
1. Endocardium
2. Myocardium
3. Epicardium
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 Structural Plan of Blood
Vessels
consist of concentric
different tissue types
layers or "tunics" of

Tunica interna (muscle)

Tunica externa (CT)

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Blood vessels

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 Capillaries
• Capillaries are the smallest of blood
vessels
• Have a diameters of 5–10 um
• It connect the arterial outflow to the
venous return.
• The primary function of capillary is
exchange of substances between the
blood and interstitial fluid.
• Because of this, these thin-walled vessels
are referred to as exchange vessels.
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Capillaries

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 Venules
• Venules (little veins)
• Venules drain the capillary blood and
begin the return flow of blood back
toward the heart.
• Venules that initially receive blood
from capillaries are called
postcapillary venules

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 Veins
• Veins return blood to the heart by the
actions of the smooth muscles and the
specialized valves ➯ prevent
retrograde flow of blood.
• Veins have thinner walls and larger,
more regular lumen than the
corresponding arteries.
• These valves:
– Are especially abundant in the veins of
the lower limbs.
– Direct venous blood towards the heart
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 Circulatory Routes
• Arteries, arterioles, capillaries,
venules, and veins are organized into
circulatory routes that deliver
blood throughout the body.
1. The Systemic Circulation:
– Carries oxygen and nutrients to body
tissues and removes carbon dioxide and
other wastes and heat from the tissues.
– All systemic arteries branch from the
aorta.
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 Systemic Circulation
– Deoxygenated blood returns to the
heart through the systemic veins
– All the veins of the systemic
circulation drain into:
• Superior venacava (SVC)
• Inferior venacava (IVC)
• Coronary sinus
– Which in turn empty into the right
atrium.
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 Pulmonary circulation
• Pulmonary circulation:
– Moves blood between the heart and the
lungs via pulmonary veins and
pulmonary arteries
– It transports deoxygenated blood to
the lungs to absorb oxygen and
release carbon dioxide.
– The oxygenated blood then flows back
to the heart

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 Hepatic Portal
Circulation
• The hepatic portal circulation carries venous
blood from the gastrointestinal (GI) organs
and spleen to the liver.
• The hepatic portal vein receives blood from
capillaries of GI organs and the spleen and
delivers it to the sinusoids of the liver.
• After a meal, hepatic portal blood is rich in
nutrients absorbed from the GI tract.
• The liver stores some of them and modifies
others before they pass into the general
circulation.
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 Hepatic Portal
Circulation
• For example:
1. The liver converts glucose into glycogen for
storage.
2. The liver also detoxifies harmful substances,
such as alcohol, that have been absorbed
from the GI tract and destroys bacteria by
phagocytosis.

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DIVISION AND BRANCHES REGIONS SUPPLIED

ASCENDING AORTA
• Right and left coronary arteries • Heart
ARCH OF AORTA
1. Right Brachiocephalic trunk
a. Right common carotid artery • Right side of head and neck
b. Right subclavian artery • Right upper limb and CNS
2. Left common carotid artery • Left side of head and neck
3. Left subclavian artery • Left upper limb and CNS

THORACIC AORTA
1. Pericardial arteries • Pericardium
2. Bronchial arteries • Bronchi of lungs
3. Esophageal arteries • Esophagus
4. Mediastinal arteries • Structures in mediastinum
5. Posterior intercostal arteries • Intercostal and chest muscles
6. Subcostal arteries • Same as posterior intercostal
7. Superior phrenic arteries • Superior and posterior surfaces of diaphragm

ABDOMINAL AORTA
1. Inferior phrenic arteries • Inferior surface of diaphragm
2. Celiac trunk
1. Common hepatic artery • Liver, stomach, duodenum, and pancreas.
2. Left gastric artery • Stomach and esophagus
3. Splenic artery • Spleen, pancreas, and stomach
3. Superior mesenteric artery • Small intestine, cecum, ascending & transverse colons, and
4. Suprarenal arteries pancreas
5. Renal arteries • Adrenal (suprarenal) glands
6. Gonadal arteries (Ovarian/testicular arteries) • Kidneys
7. Inferior mesenteric artery • Ovaries/Testes
 Common iliac arteries • Transverse, descending, and sigmoid colons; rectum
• External iliac arteries • Lower limbs
• Internal iliac arteries • Uterus (female), prostate (male), muscles of buttocks, and
urinary bladder
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Ascending aorta

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Thoracic Aorta

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Abdominal Aorta

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Celiac trunk

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Common iliac

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Arteries of the pelvis and right free lower limb

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Venous Drainage

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 BLOOD
• Blood is a specialized connective tissue in which cells are
suspended in fluid extracellular material called plasma .
• By rhythmic contractions of the heart, about 5 L of blood
in an average adult moves unidirectionally within the
closed circulatory system.
• The formed elements circulating in the plasma are
erythrocytes (red blood cells), leukocytes (white blood
cells), and platelets .

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• Erythrocytes make up the sedimented material and their
volume, normally about 45% of the total blood volume in
healthy adults, is called the hematocrit .

• The straw-colored, translucent, slightly viscous

supernatant comprising 55% at the top half of the
centrifugation tube is the plasma.

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• Blood is a distributing vehicle, transporting O2 , CO2 ,
metabolites, hormones, and other substances to cells
throughout the body.

• O2 is bound mainly to hemoglobin in erythrocytes and is

much more abundant in arterial than venous blood, while
CO2 is carried in solution as CO2 or HCO3 , in addition
to being hemoglobin-bound.

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• Nutrients are distributed from their sites of synthesis or
absorption in the gut, while metabolic residues are collected
from cells all over the body and removed from the blood by
the excretory organs
• Hormone distribution in blood permits the exchange of
chemical messages between distant organs regulating
normal organ function.
• Blood also participates in heat distribution, the regulation of
body temperature, and the maintenance of acid-base and
osmotic balance. 66
• Leukocytes have diversified functions and are one of the
body’s chief defenses against infection.

• These cells are generally spherical and inactive while

suspended in circulating blood, but, when called to sites
of infection or inflammation, they cross the wall of
venules, become motile and migrate into the tissues, and
display their defensive capabilities.

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• Mature blood cells have a relatively short life spine.

• Blood cells are synthesized mainly in the red bone

marrow.
• Some lymphocytes, additionally are produced in
lymphoid tissue.
• Erythrocytes (red blood cells or RBCs) are
terminally differentiated structures lacking nuclei and
completely filled with the O2-carrying protein
hemoglobin. 69
• Erythrocytes are produced in red bone marrow (in the
ends of long bones and in flat and irregular bones).
• They pass through several stages of development
before entering the blood.
• Their life span in circulation is about 120 days.
• The process of RBC development from stem cells
takes about 7 days and is called erythropoiesis.

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 Leukocytes

• Leucocytes are the largest blood cells.

• They account for only about 1% of the blood volume.
• All leukocytes are key players in the defense against
invading microorganisms, and in the repair of injured
tissues, specifically leaving the microvasculature in injured
or infected tissues.

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 Thrombocytes ( Platelets)
• Blood platelets are non-nucleated disc like cell fragments
2-4 µm in diameter.
• Platelets are not true cells.
• Platelets promote blood clotting and help repair gaps in the
walls of blood vessels, preventing loss of blood.
• Normal platelets counts range from 200,000- 400000 per
microliter of blood.
• Platelets have a life span of about 10 days 74
THE END

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