CVS I

The cardiovascular system is sometimes called the blood-vascular, or simply the

circulatory, system. It consists of the heart, which is a muscular pumping device, and

a closed system of vessels called arteries, veins, and capillaries. As the name implies,

blood contained in the circulatory system is pumped by the heart around a closed

circle or circuit of vessels as it passes again and again through the various

"circulations" of the body.

The heart

The heart is located under the rib cage 2/3 of it is to the left of your breastbone

(sternum) and between your lungs and above the diaphragm. The heart is about the

size of a closed fist, weighs about 10.5 ounces, and is somewhat cone-shaped. It is

covered by a sack termed the pericardium or pericardial sack.

The normal heart anatomy consists of a four-chambered, hollow organ. It is divided

into the left and right sides by a muscular wall called the septum. The right and left

sides of the heart are further divided into two top chambers called the atria (also

termed the right and left atrium), which receive blood and then pump it into the two

bottom chambers called ventricles, which pump blood to the lungs and to the body.

The coronary arteries are on the heart surface (left main, right coronary). The

coronary arteries and veins comprise the heart’s own mini-circulatory system.

Two major coronary arteries branch off from the aorta near the point where the

aorta and the left ventricle meet:

The right coronary artery supplies the right atrium and right ventricle with blood. It

branches into the posterior descending artery, which supplies the bottom portion of

the left ventricle and back of the septum with blood.

The left main coronary artery which divides into the left anterior descending

coronary artery and the circumflex artery supplies most of the left heart wall.

The heart is a muscular pump that provides the force necessary to circulate the

blood to all the tissues in the body. Its function is vital because, to survive, the

tissues need a continuous supply of oxygen and nutrients, and metabolic waste

products have to be removed. Deprived of these necessities, cells soon undergo

irreversible changes that lead to death. While blood is the transport medium, the

heart is the organ that keeps the blood moving through the vessels. The normal

adult heart pumps about 5 liters of blood every minute throughout life. If it loses its

pumping effectiveness for even a few minutes, the individual's life is jeopardized.

Structures of the heart

The human heart is a four-chambered muscular organ, shaped and sized roughly like

a man's closed fist with two-thirds of the mass to the left of midline.

The heart is enclosed in a pericardial sac that is lined with the parietal layers of a

serous membrane. The visceral layer of the serous membrane forms the epicardium.
Layers of the heart

Three layers of tissue form the heart wall.

The outer layer of the heart wall is the epicardium which is a thin serous layer, the

middle layer is the myocardium and it's a thick muscular layer, and the smooth inner

layer is the endocardium which comes in contact with blood.

Chambers of the heart.

The internal cavity of the heart is divided into four chambers:

1. Right atrium: a low pressure chamber which receives systemic venous blood

through the superior vena cava, inferior vena cava and coronary sinus.The

right atrium, or right superior portion of the heart, is a thin-walled chamber

receiving blood from all tissues except the lungs. Three veins empty into the

right atrium, the superior and inferior venae cavae, bringing blood from the

upper and lower portions of the body, respectively, and the coronary sinus,

draining blood from the heart itself.

2. Right ventricle: another low pressure chamber which receives blood from the

right atrium through the tricuspid valve during ventricular diastole. It then

ejects deoxygenated blood through the pulmonic valve into the pulmonary

artery and into pulmonary circulation during ventricular systole.

3. Left atrium: low pressure chamber which receives oxygenated blood

returning to the heart from the lung through the pulmonary veins.The left

atrium, the left superior portion of the heart, is slightly smaller than the right

atrium and has a thicker wall. The left atrium receives the four pulmonary

veins, which bring oxygenated blood from the lungs.

4. Left ventricle: a high pressure chamber which receives blood from the left

atrium through the mitral valve during ventricular diastole. It then ejects

oxygenated blood through the aortic valve into the aorta and into systemic

circulation during ventricular systole.

Heart valves
Pumps need a set of valves to keep the fluid flowing in one direction and the heart is

no exception. The heart has two types of valves that keep the blood flowing in the

correct direction. The valves between the atria and ventricles are called

atrioventricular valves (also called cuspid valves), while those at the bases of the

large vessels leaving the ventricles or between each ventricle and it's corresponding

artery are called semilunar valves.

 The right atrioventricular valve is the tricuspid valve: it contains three cusps

or leaflets and it's located between the right atrium and ventricle.

 The left atrioventricular valve is the bicuspid, or mitral valve: it's located

between the left atrium and ventricle.

 The valve between the right ventricle and pulmonary trunk is the pulmonary

semilunar valve.

 The valve between the left ventricle and the aorta is the aortic semilunar

valve.

When the ventricles contract, atrioventricular valves close to prevent blood from

flowing back into the atria. When the ventricles relax, semilunar valves close to

prevent blood from flowing back into the ventricles.

Papillary muscles: muscle bundles on the ventricular walls and chordae tendineae

(strong fibrous connective tissue between the valve leaflets and papillary muscles)

keep the valves closed during systole. This maintains unidirectional blood flow

through the AV valves and prevents backflow of blood.

Functions of the heart

1. Cardiac conduction system (conductive system of the heart)the cardiac

conduction system consists of specialized cardiac cells that initiate or

propagate electric impulses throughout the myocardium as a precursor to

cardiac muscle contraction.

a. Electrical conducting system of the heart:

The sinoatrial (SA) node, located at the junction of the right atrium and

the superior vena cava, functions as the pacemaker for the myocardium,

initiating ethic electrical impulses at an intrinsic rate of 60 to 100 impulses

per minute.

The atrioventricular (AV) node, located at the septal wall of the right

atrium receives impulses from the SA node and relays them to the

ventricles.

The bundle of His, a bundle of specialized muscle fibers in the myocardial,

septum, conducts impulses from the AV node. The bundles of His divides

into the right and left branches. The right bundles branches (RBB)

conducts impulses down the right side of the septum while the left

bundle branches (LBB) conducts impulses into the right and left fascicles

that fan out I to the left ventricular muscle.

The RBB and LBB terminates in the purkinje fibers which propagates

electrical impulses into the endocardium and onto the myocardium.

 b. Electrical impulse activity: electrical impulses travelling through the

cardiac conduction system can be measured and recorded by

electrocardiography. Phases of ECG are labeled P,Q,R,S, and T.

The P wave represents atria depolarization, the PR interval represents the

time from the beginning of atrial depolarization to the beginning of

ventricular depolarization. The QRS complex represents ventricular

depolarization and the T wave represents ventricular repolarization.

 Heart rate is 60-100bpm

 P waves precede each QRS complex

 PR interval is 0.12

to 0.2 secs

 QRS complex s

0.04 to 0.1secs

 Rhythm is regular

with no abnormal

delay.
  Wave: A positive/negative deflection from baseline that indicates a specific

electrical event i.e P,Q,S,R,T,U.

 Interval: Time between two specific ECG events e g PR interval.

 Segment: length between two specific points on an ECG that are supposed to

be at the baseline amplitude e.g PR segment.

 Complex: Combination of multiple waves grouped together. The only

complex on an ECG is QRS complex.

The heart also has electro physiologic, mechanical and neurologic properties that

coordinate to produce effective myocardial contraction and pumping of blood.

1. Cardiac output is defined as the volume of blood ejected by each ventricle in

1 minute. The cardiac output in a resting adult is about 5 L per minute but

varies greatly depending on the metabolic needs of the body. CO= SV (stroke

volume) × HR ( heart rate). SV is the amount of blood ejected by the left

ventricle with each heartbeat. While, heart rate is the number of heartbeats

per minute.

2. Cardiac cycle: Each complete heartbeat or cardiac cycle consists of two

phases in response to electrical stimulation.

a. Systole is the contraction phase. It is triggered by depolarization of

cardiac muscle cells, which involves a transient change in sodium and

potassium ion concentration inside and outside of the cell.

 b. Diastole: the relaxation ( filling) phase. Immediately after depolarization is

completed, the process reverses itself, resulting in repolarization and a

return to the resting state.

3. Heart sounds: results from the vibrations caused by valve closure and

ventricular filling.

a. The first heart sound (S1) is associated with trucuspid and mital valve

closure and it is also called LUP.

b. The second heart sound (S2) is associated with aortic and pulmonic valve

closure and it is called DUP.

c. The third heart sound (S3) known as ventricular gallop is often normalin

persona younger than the age of 30 but pathologic in older person's and

occurs during the rapid ventricular filling stage of diastole.

d. The fourth heart sound (S4) or atrial gallop is linked to resistance to

ventricular filling, as in hypertrophy or injury of the ventricular wall.