CARDIOVASCULAR SYSTEM

ANATOMY LEVEL 100 PHYSICIAN ASSISTANTSHIP

Prepared by Bernard Owusu Mensah BSc Physician Assistantship
Supervisor: Dr. Frank Amankona Abebrese FGCS
 OBJECTIVES
• At the end of the presentation, students should be able to;
Define the cardiovascular system
Identify and state the components of the cardiovascular system
Describe the heart
Describe the location of the heart
Describe the chambers of the heart
Describe the valves of the heart
Describe the path that blood takes in moving in the heart
Describe the pulmonary and systemic circulation
 OBJECTIVES CONT’D.
Identify the major blood vessels connected to the heart
Explain why the muscle wall of the left ventricle is thicker than the
wall of the right ventricle
List define and describe the different types of blood vessels in the
body
Describe the histological structure of the blood vessels of the heart
Describe in simple terms, the conduction system of the heart
 CARDIOVASCULAR SYSTEM
• “Cardio” means the heart and “vascular” refers to the blood vessels.
Hence, the cardiovascular system consists of the heart and the blood
vessels.
• The heart is made up of cardiac muscle tissues adapted to contract
and relax to pump blood to the whole body.
• Blood is delivered through vessels to all parts of the body and back to
the heart. These vessels include arteries, veins, and capillaries.
• The heart, arteries, veins and capillaries make up two major
components: systemic and pulmonary circulation
• (see figure 1).
 CARDIOVASCULAR SYSTEM CONT’D.
• Pulmonary circulation moves blood between the heart and the lungs.
• It transports deoxygenated blood to the lungs to absorb oxygen and
release carbon dioxide.
• The oxygenated blood flows back to the heart.
• Systemic circulation moves blood between the heart and the rest of
the body. This includes organs such as the brain, kidneys, abdominal
organs, skeletal muscle and skin.
 CARDIOVASCULAR SYSTEM

(Figure 1: Pulmonary and Systemic circulation)

 THE HEART
• It is located just to the left of the midline of the thoracic cavity resting
on the diaphragm.
• It lies within the mediastinum in between the lungs.
• The heart is cone-shaped which presents a base above and an apex
below. The apex normally lies at the level of the left 5th intercostal
space, midclavicular line.
• (see figure 2)
(Figure 2: Heart position in the thorax)
 THE HEART CONT’D.
• Organs associated with the heart
Anteriorly- the sternum, ribs and intercostal muscles
Posteriorly- the oesophagus, trachea, left and right bronchus,
descending aorta, inferior vena cava, thoracic vertebrae
Superiorly- great blood vessels, i.e. the aorta, vena cava (superior
and inferior) and the pulmonary arteries and veins.
Inferiorly- the apex rests on the diaphragm
Laterally- the lungs
• (see figure 3)
(Figure 3: Organs associated with the heart)
 THE HEART CONT’D.
• The structure of the heart is composed of three layers of tissue. Namely
the pericardium, myocardium and endocardium.
• Pericardium
“peri” means around and “kardia” means heart. Hence pericardium refers
to the membranous sac around the heart
It consists of an outer fibrous layer and a double layered serous
membrane consisting of an outer layer called the parietal pericardium and
an inner layer called the visceral pericardium.
The parietal layer is over lined with a fibrous tissue which prevents
overdistension of the heart. This is also necessary to prevent the heart
from overfilling with blood.
In between the parietal and visceral pericardium is the pericardial fluid
which provides lubrication between the two layers. (see figure 4)
 THE HEART CONT’D.
• Myocardium
 “myo” means muscle and “cardia” means the heart. The
myocardium is the middle muscular layer of the heart.
The cells of the myocardium are specialized to allow transmission of
electrical impulses in a coordinated and efficient manner.
It is thicker at the apex and thinner at the base
• Endocardium
Forms the inner lining of the myocardium and heart valves
It is thin and smooth to permit smooth flow of blood inside the heart.
(Figure 4: Layers of the heart wall)
 THE HEART CONT’D.
• The heart consists of four chambers: two upper chambers called the
“atria” and two lower chambers called the “ventricles”. The atria
receives blood returning to the heart. The ventricles receive blood
from the atria which is then pumped into arteries.
• A wall or septum separates the atria and ventricles. The upper
chamber is divided by the interatrial septum and the lower chamber
is divided by the interventricular septum. The septum keeps blood
from one side of the heart from mixing with blood the other side.
 THE RIGHT ATRIUM
• Receives deoxygenated blood the superior
and inferior vena cavae and the carotid
sinus.
• Pumps blood through the tricuspid valve to
the right ventricle
• In anatomical position the right atrium
forms the right border of the heart.
• Extending antero-medially is the right
auricle to increase the capacity of the
atrium.
• Crista terminalis is a C- shaped ridge
extending from just to the left of the orifice
of the superior vena cava towards the
inferior vena cava.
 THE RIGHT ATRIUM CONT’D.
• Carotid sinus is channel that receives
blood from the coronary veins.
• Fossa ovalis is a small shaped oval
depression in the interatrial septum. It is
the remaining of foramen ovale in the
fetal heart which allowed blood to move
directly from right atrium to the left
atrium sto bypass the lung (fetal lungs
are not matured for effective
oxygenation). The foetus gets oxygen rich
blood from the placenta of the mother.
The opening is supposed to close after
birth but sometimes it does not.
 RIGHT VENTRICLE
• Receives deoxygenated blood
from the right atrium and pumps
it through the pulmonary valve
into the pulmonary artery.
• Triangular and forms a major
part of the anterior border of
the heart.
• It is divided into by the
supraventricular crest into two
portions namely the inflow and
outflow portion.
 RIGHT VENTRICLE CONT’D.
• The inflow part is covered by irregular
trabeculations which gives the ventricle a
sponge-like appearance.
• Moderator band is attached to the
ventricles at both ends but lies free in the
middle. It contains the right bundle
branches which functions in the electrical
conductivity of the heart.
• The superior and inferior papillary muscles
are anchored to the base of the ventricles.
They attach their apices to chordae
tendineae which are also attached to the
three tricuspid valve cusps. This prevents
prolapse of the tricuspid valve during
ventricular contraction.
 LEFT ATRIUM
• Receives oxygenated blood from
the four pulmonary veins and
pumps it to the left ventricle
through the mitral valve.
• Forms the posterior border
(base) of the heart
• Left auricle extends from the
superior aspect of the chamber.
 LEFT VENTRICLE
• Receives oxygenated blood from the left atrium
and pumps it through the aortic valve into the
aorta
• Forms the apex of the heart.
• Inflow portion is lined by trabiculations. Two
papillary muscles(anterior and posterior papillary
muscles) attach to the cusp of the mitral valve.
• Outflow part is the aortic cavity or vestibule
• The wall of the left ventricle is thicker than the right
ventricle because it is adapted to pump blood and
generate pressure to drive blood all the around
systemic circulation, this needs greater pressure as
against the left ventricle, pumping blood to only the
pulmonary circulation, which is not extensive and
needs lower pressure to move the blood in the lungs.
 VALVES OF THE HEART
• Heart valves ensure one
directional flow of blood.
• They are composed of
connective tissue and
endocardium
• There are four valves which are
divided into two categories.
Namely the atrioventricular
valve(tricuspid and mitral valve)
and semilunar valves
(pulmonary and aortic valve).
 VALVES OF THE HEART CONT’D.
• ATRIOVENTRICULAR VALVE
 Located between the atria and ventricles
 They close during the start of ventricular contraction
producing the first heart sound.
 The Tricuspid valve is located between the right atrium and
right ventricle. It consists of three cusps with each of the
three cusp held to a fibrous ring at the opening.
 The Mitral valve is located in between the left atrium and
the left ventricle. It is also known as bicuspid valve because
it has two cusps. Like the tricuspid valve it is also secured
to a fibrous ring that surrounds the surface.
 The tricuspid and mitral valve are supported by fibrous
chordae tendinae which are in turn attached to the
papillary muscles anchored to the base of the ventricles.
There are 3 papillary muscles in the right ventricle and 2 in
the left ventricle.
 VALVES OF THE HEART CONT’D.
• SEMILUNAR VALVE
 Located between the ventricles and the
outflow vessels.
 They close at the beginning of ventricular
relaxation to produce to second heart sound.
 The pulmonary valve is located between the
right ventricle and the pulmonary trunk.
 The aortic valve is located between the left
ventricle and the ascending aorta.
 The left and right aortic sinuses mark the
origin of the left and right coronary arteries.
As blood recoils during the ventricular
diastole, it fills the sinus and enters the
coronary arteries to supply the myocardium.
 THE HEART CONT’D.

Direction of flow of blood in the heart

 BLOOD SUPPLY TO THE HEART
• ARTERIAL SUPPLY TO THE HEART
 The heart is supplied with arterial blood by the right and left
coronary arteries which branch from the aorta immediately distal to
the aortic valve.
 The coronary arteries receive about 5% of blood pump from the
heart.
There is larger blood supply to the left ventricle highlighting its
importance to the heart’s function. The left ventricle is supplied by
the Left main coronary artery.
 BLOOD SUPPLY TO THE HEART CONT’D.
• VENOUS DRAINAGE OF THE HEART
Most of the venous blood is collected into several small veins that
join to form the coronary sinus which opens into the right atrium.
The remainder passes directly into the heart’s chambers through
little venous channels.
The coronary arteries
 MAJOR BLOOD VESSELS CONNECTED TO THE
HEART
• The major or great vessels of the heart function to carry blood to and
from the heart as pumps, located largely within the middle
mediastinum.
• The major vessels include the aorta, pulmonary arteries and veins and
the superior and inferior vena cavae.
 MAJOR BLOOD VESSELS CONNECTED TO THE
HEART CONT’D.
• AORTA
 It is the largest artery in the body.
 It carries oxygenated blood(pumped by the left side of the heart)
to the rest of the body.
 The aorta arises from the aortic opening at the base of the left
ventricle.
 The first segment is known as the ascending aorta. From it branch
the coronary arteries.
 The second segment is the arch of aorta, from which branch the
major arteries of the head, neck and upper limbs. These are:
i. Brachiocephalic trunk
ii. Left common carotid artery
iii. Left subclavian artery
 After the arch of the aorta, the aorta becomes descending aorta
which continues down through the diaphragm into the abdomen.
 MAJOR BLOOD VESSELS CONNECTED TO THE
HEART CONT’D.
• PULMONARY ARTERIES
The pulmonary arteries receives deoxygenated blood from the right
ventricles and deliver it to the lungs for gaseous exchange to take place.
The arteries begin at the pulmonary trunk, a thick and short vessel, which
is separated from the right ventricle by the pulmonary valve.
The trunk is located anteriorly and medially to the right atrium.
At around the level of T5-T6, the pulmonary trunk splits into right and left
pulmonary arteries. The left pulmonary artery supplies the left lung and
branches into two to supply each lobe of the lung. The right pulmonary
artery is thicker and longer supplying the right lung. It also further divides
into two branches.
 MAJOR BLOOD VESSELS CONNECTED TO THE
HEART CONT’D.
• PULMONARY VEINS
The pulmonary veins receive oxygenated blood from the lungs,
delivering it to the left side of the heart.
There are four pulmonary veins, with one superior and one inferior
for each of the lungs. They drain into the pericardium at the superior
part of the left atrium.
The superior pulmonary veins return blood from the upper lodes of
the lung, with the inferior veins returning blood from the lower lobes.
 MAJOR BLOOD VESSELS CONNECTED TO THE
HEART CONT’D.
• SUPERIOR VENA CAVA
Receives deoxygenated blood from the upper body(superior to the diaphragm,
excluding the lungs and heart), delivering it to the right atrium.
It is formed by merging of the brachiocephalic veins, travelling inferiorly through
the thoracic region until draining into the superior portion of the right atrium at
the level of the third rib.
• INFERIOR VENA CAVA
Receives deoxygenated blood from the lower body(all structures inferior to the
diaphragm) delivering back to the heart.
 It is initially formed in the pelvis by the common iliac veins joining together. It
travels through the abdomen, collecting blood from the hepatic, lumbar, gonadal,
renal and phrenic veins. The inferior vena cava then passes through the
diaphragm, entering the pericardium at the level of T8. It drains into the inferior
portion of the right atrium.
Superior vena cava
Inferior vena cava
 CONDUCTION SYSTEM OF THE HEART
• The heart has an intrinsic system, whereby the heart is stimulated to
contract without the need for nerve supply from the brain. However, the
intrinsic system can be depressed or stimulated by nerve impulses and
hormones. The following are phases of the electrical conduction of the
heart;
The sinoartrial node located near the opening of the right atrium
spontaneously initiate the electrical impulses
From the sinoartrial node the heart beats rapidly through throughout both
atria, extending to the left atrium to contract simultaneously.
An internodal conduction pathway conduction pathway transmits the
impulse directly to the atrioventricular node (AV node).
From the AV node, the electrical impulse spreads through the AV bundle or
bundle of His.
CONDUCTION SYSTEM OF THE HEART CONT’D.
• The bundle of His further branches to form Right and left bundle
branches.
• The bundle branches travels towards the apex of the heart and then
travels back towards the atria along the ventricles.
• The bundle branches further terminate into the purkinje fibers which
spread throughout the whole myocardium.
 BLOOD VESSELS
• The heart pumps blood through a network of tubes to all parts of the
body called blood vessels.
• There are three types of blood vessels:
Arteries, which transport blood away from the heart
Veins, which transport blood towards the heart
Capillaries, which connect the arteries and veins, are the smallest of
the blood vessels and are where oxygen, nutrients, and wastes are
exchanged within the tissues.
 BLOOD VESSELS CONT’D.
• The walls of the blood vessels of
the cardiovascular usually consist
of three layers
Tunica externa (adventitia)- outer
connective tissue layer
Tunica media- the middle smooth
muscle layer(may contain varying
amounts of elastic fibers in
medium and large arteries)
Tunica intima- the inner
endothelial lining of the blood
vessels
 BLOOD VESSELS CONT’D.
• ARTERIES
Made up fibrous connective tissue that strengthens them and enables
them to withstand high pressures generated by the heart.
Arteries are also made up of elastic connective tissue to enable distend to
accommodate the pressure changes of the heart. With each heartbeat,
blood is ejected can be felt as rhythmic beat called a pulse.
As arteries travel towards the peripheries, they further become smaller,
less elastic and more muscular. These are called arterioles.
Arterioles can alter their luminal diameter upon degree of
vasoconstriction, hence are also called resistant vessels.
 BLOOD VESSELS CONT’D.
• CAPILLARIES
 Smallest vessels of the circulatory system
They are the site of exchange between the blood and the interstitium.
Has a large surface area and is thin walled to allow for the exchange of substances.
• VEINS
After the exchange of substances, the blood begins its route back to the heart.
Blood flows from the capillaries to smaller veins called venules.
From the venules, that blood travels towards veins that become larger as they
travel towards the heart.
Veins have much thinner walls and wider diameters than the arteries. Hence are
distensible and hold large volume of blood at a low pressure
During exercise, the skeletal muscles act as pumps to generate pressure to force
blood towards the heart.
Veins have valves(most abundant in the lower limbs where effects of gravity is
prevalent) to ensure one-way flow of blood.
ANY QUESTIONS
 REFERENCES
• PhD, R. D. L., PhD, W. V. A., & Frcr, F. B. M. A. M. W. M. (2014). Gray’s
Anatomy for Students: With Student Consult Online Access (4th ed.).
Elsevier.
• Teach me series. (n.d.). The heart. Retrieved February 14, 2023, from
[Link]
• Waugh, A., Grant, A., & Chambers, G. (2014). Ross and Wilson
Anatomy and Physiology Colouring and Workbook. Elsevier
Gezondheidszorg.
REVIEW QUESTIONS 1
Which of the following is not important in preventing
backflow of blood?
a. chordae tendineae
b. papillary muscles
c. AV valves
d. endocardium
REVIEW QUESTIONS 2
Which valve separates the left atrium from the left
ventricle?
a. mitral
b. tricuspid
c. pulmonary
d. aortic
REVIEW QUESTIONS 3
Which of the following lists the valves in the order
through which the blood flows from the vena cava through
the heart?
a. tricuspid, pulmonary semilunar, bicuspid, aortic
semilunar
b. mitral, pulmonary semilunar, bicuspid, aortic
semilunar
c. aortic semilunar, pulmonary semilunar, tricuspid,
bicuspid
d. bicuspid, aortic semilunar, tricuspid, pulmonary
semilunar
REVIEW QUESTIONS 4
Which chamber initially receives blood from the
systemic circuit?
a. left atrium
b. left ventricle
c. right atrium
d. right ventricle
REVIEW QUESTIONS 5
The myocardium would be the thickest in the ________.
a. left atrium
b. left ventricle
c. right atrium
d. right ventricle
REVIEW QUESTIONS 6
In which septum is it normal to find openings in the
adult?
a. interatrial septum
b. interventricular septum
c. atrioventricular septum
d. all of the above
REVIEW QUESTIONS 7
Which of the following is unique to cardiac muscle
cells?
a. Only cardiac muscle contains a sarcoplasmic
reticulum.
b. Only cardiac muscle has gap junctions.
c. Only cardiac muscle is capable of
autorhythmicity
d. Only cardiac muscle has a high concentration of
mitochondria.
REVIEW QUESTIONS 8
The earliest organ to form and begin function within
the developing human is the ________.
a. brain
b. stomach
c. lungs
d. heart
REVIEW QUESTIONS 9
The endothelium is found in the ________.
a. tunica intima
b. tunica media
c. tunica externa
d. lumen
REVIEW QUESTIONS 10
Nervi vasorum control ________.
a. vasoconstriction
b. vasodilation
c. capillary permeability
d. both vasoconstriction and vasodilation
REVIEW QUESTIONS 11
Closer to the heart, arteries would be expected to have a
higher percentage of ________.
a. endothelium
b. smooth muscle fibers
c. elastic fibers
d. collagenous fibers
REVIEW QUESTIONS 12
Which of the following best describes veins?
a. thick walled, small lumens, low pressure, lack
valves
b. thin walled, large lumens, low pressure, have
valves
c. thin walled, small lumens, high pressure, have
valves
d. thick walled, large lumens, high pressure, lack
valves
REVIEW QUESTIONS 13
The hepatic portal system delivers blood from the
digestive organs to the ________.
a. liver
b. hypothalamus
c. spleen
d. left atrium