Cardiovascular system

BY
F. PHIRI
 Introduction

• Cardiovascular system, also known as

the circulatory system
• ensures a continuous flow of blood
to all body cells and consists of the
heart and blood vessels (arteries,
veins, capillaries) and the blood
 The Heart

Learning objectives
• Define terms used in cardiovascular system
• Outline size, location, and relations of the heart
• Outline the structure of the heart
• State the function of the heart
• Describe the cardiac cycle
• Discus the conduction system of the heart
 Terminology

• Angio; vessel
• Pericardium
• Systole
• Diastole
• Pulse
• Blood pressure
• Pace maker
 Terminologies

• Aneurysm - sac-like protrusion from a blood vessel

or the heart, resulting from a weakening of the vessel
wall or heart muscle.
Arrhythmia (or dysrhythmia); abnormal heartbeat.
• Blood pressure; pressure exerted by the heart in
pumping blood; the pressure of blood in the
arteries.
• Bradycardia - Abnormally slow heartbeat
 Terminologies

• Cardiomegaly.
 Cardiovascular system

• The heart is a hollow muscular

contractile organ, the centre of
the circulatory system (Davies,
1989).
 The Heart

• is roughly cone shaped,

• about 10 -12cm long, 9cm
wide at its broadest point
• weighs about 250g in women
and about 300g in men.
 The heart

• Heart Pumps Blood into 2 Circuits in

Sequence
• Pulmonary circuit
• To and from the lungs
• Systemic circuit
• To and from the rest of the body
 The heart

• Located in the mediastinum (inferior-middle)

• Behind sternum
• Between 2nd and 6th ribs
• Between Thorax vert. T5-T8
• Surrounded by pericardium
• Apex – Located at the 5th intercostal space
• Base of the heart located posteriorly
 Thoracic Cavity

Thoracic Cavity

Right Pleural Left Pleural

Mediastium
Cavity Cavity

Right Lung Left Lung

• Mediastinum; median
The Heart
region between the two
pleural sacs
 The heart

• Is pyramidal in shape,
• a pyramid that has fallen over and is
resting on one of its sides, the apex
pyramid projects forward, downward,
and to the left,
• the base is opposite the apex and
faces in a posterior direction
 The heart

• sides of the pyramid consist of:

• a diaphragmatic (inferior) surface on
which the pyramid rests;
• an anterior (sternocostal) surface
oriented anteriorly;
• a right pulmonary surface; Rt laterally
• and a left pulmonary surface. Lt Laterally
 The heart

• base of the heart is quadrilateral and

directed posteriorly.
• consists of: the left atrium; a small portion
of the right atrium; and proximal parts of
the great veins (superior and inferior
venae cavae and the pulmonary veins)
 The Heart
• enclosed in the pericardium.
• placed obliquely behind the body of the sternum and
the adjoining costal cartilages and ribs
• Approximately 1/3 of the mass lies to the right of
the midline
• About 2/3 of the mass of the heart lies to the left of
the body’s midline
• a little more to the left than the right,
 The heart

• Apex of the heart is formed by

the inferolateral part of the left
ventricle
• Positioned deep to the left 5th
intercostal space, 8-9 cm from the
midsternal line.
 Surfaces of the heart

• Anterior surface; formed mostly of the right

ventricle and a part of the right atrium on the
right and some of the left ventricle on the left
• Inferior surface; heart (anatomical position)
rests on the diaphragmatic surface, which
consists of the left ventricle and a part of the
right ventricle, and extends from the base to
the apex of the heart.
 Surfaces of the heart

• left pulmonary surface; lies on left

lung, it is broad and convex, and
consists of the left ventricle and a
portion of the left atrium
• right pulmonary surface faces the
right lung, is broad and convex, and
consists of the right atrium
 Relations

• Superiorly; great blood vessels i.e. aorta, superior

vena cava, pulmonary artery, pulmonary vein
• Anteriorly; sternum, ribs, and intercostal muscles.
• Posteriorly; oesophagus, trachea, left and right
bronchus, descending aorta, inferior venacava, and
thoracic duct.
• Laterally; the lungs
• Inferiorly; diaphragm
 The structure of the heart

• heart is composed of three

layers of tissue; pericardium,
myocardium and endocardium
The structure of the heart
 Pericardium

• is a fibroserous sac surrounding

the heart and the roots of the
great vessels.
• consists of 2 components,
• the fibrous pericardium
• the serous pericardium
 Pericardium

• Fibrous pericardium; tough connective tissue

outer layer that defines the boundaries of the middle
mediastinum.
• Serous pericardium; thin and consists of 2 parts:
• parietal layer lines the inner surface of the fibrous;
• visceral layer (epicardium) of serous pericardium
adheres to the heart and forms its outer covering.
 Pericardium

• Parietal and visceral layers of serous pericardium are

continuous at the roots of the great vessels,
• Potential space created between the 2 layers of
serous and parietal pericardium, containing a small
amount of fluid(about 15-50mls), is the pericardial
cavity.
• Potential space allows for the relatively uninhibited
movement of the heart.
 Pericardium
• fibrous pericardium is a cone-shaped bag; continuous
with the adventitia of the great vessels
• base is attached to the central tendon of the diaphragm
and a part of the muscular area of the diaphragm on the
left side.
• Anteriorly; attached to the posterior surface of the
sternum by sternopericardial ligaments.
• these attachments help to retain the heart in its position in
the thoracic cavity.
• sac also limits cardiac distention.
 Pericardium
Nerve supply:
• Fibrous and parietal layer of serous: phrenic Nerve C3,4,5
• Visceral layer of serous innervated by autonomic nervous
system
Blood supply; derived from the internal thoracic artery and
musculophrenic arteries and the descending thoracic aorta;
veins are tributaries of the azygos system.
Applied Anatomy:
• Pericardial effusion
• pericardiocentensis
 The heart

• The 3 layers of the heart

1. Epicardium; (visceral layer of pericardium) simple
squamous mesothelium supported by a loose
connective tissue that contains blood vessels
 The heart

• Myocardium
• Muscle tissue of the heart,
• Thickest layer and is responsible for pumping
blood.
• Composed of specialised cardiac muscle cells
aranged spirally around each heart chamber
• Muscle fibre is striated like skeletal muscle but not
under voluntary control.
 Myocardium

• Myocardial cells have specialised

partitions between the cells called
intercalated discs (modified cell
membranes) which allow rapid transfer
of electrical impulses between cells
• Allow cardiac muscle cells to function
as a single unit ; syncytium
 Myocardium

• cardiac muscle fibres are shorter

in length and less circular in
transverse section
• exhibit branching, which gives
individual cardiac muscle fibres a
“stair-step” appearance.
• The discs contain desmosomes, which hold the
fibres together, and gap junctions, which allow
muscle action potentials to conduct from one muscle
fibre to its neighbours.
• Mitochondria are larger and more numerous in
cardiac muscle fibres than in skeletal muscle fibres.
• Cardiac muscle tissue has branching muscle fibres
which are interwoven so that stimulation causes
contraction of the whole group of fibres.
Copyright © McGraw-Hill Companies
 Endocardium

• thin smooth layer of flattened

epithelial cells.
• Lines the interior of the heart and
the heart valves.
• It is continuous with the endothelium
that lines the blood vessels it permits
smooth flow of blood in the heart.
 Interior of the heart

• heart is divided into right and left

side by the septum which consists
largely of the myocardium covered
by endocardium
• septum ensures that blood never
mixes from either side (except in the
foetus).
 The heart

• is divided into 4 chambers, the divisions produces

boundaries that are visible externally as grooves
(sulci).
• Septum divides the heart into right and left parts,
each part is further divided into 2making 4 chambers.
• The upper chambers are known as atria (atrium),
lower chambers are known as ventricles.
• interatrial groove is hallow separating the 2 atria.
 The heart

• atrioventricular (coronary) groove (or

sulcus) separates the atria from the
ventricles, groove, contains the main
trunks of the coronary arteries, is
oblique.
• descends to the right on the
sternocostal surface
• Internally; ventricles are separated by the septum.
• Functionally the heart consists of 2 pumps separated by a
septum.
• Each pump consists of an atrium and a ventricle
separated by a valve
• The right pump receives deoxygenated blood from the
body and sends it to the lungs.
• The left pump receives oxygenated blood from the lungs
and sends it to the body.
• .
 Right atrium of the heart

• In anatomical position, the right border of the heart

is formed by the right atrium.
• Blood returning to the right atrium enters through:
the superior and inferior venae cavae, from the
body; and the coronary sinus, which returns blood
from the walls of the heart itself.
• Blood passes into right ventricle through the right
atrioventricular orifice, guarded by the tricuspid
valve.
 Crista
terminalis

Fossa
ovalis

Coronary sinus
 The heart

• Right atrium is divided into 2 continuous spaces.

• Externally, separation is indicated by a shallow,
vertical groove the sulcus terminalis cordis,
• Internally, indicated by the crista terminalis, a
smooth, muscular ridge
 The heart

• Posterior to the crista is the sinus of venae cavae

has smooth, thin walls, and both venae cavae empty
into this space.
• anterior to the crista, right auricle, walls are covered
by ridges called the musculi pectinati (pectinate
muscles), which fan out from the crista like the "teeth
of a comb
• Coronary sinus, opens medially to the opening of
inferior vena cava
 The heart

• Interaterial septum has a depression; the fossa ovalis

(oval fossa), marks the location of the embryonic
foramen ovale an important part of foetal
circulation.
• Foramina of the venae cordis minimae; small veins
that drain the myocardium directly into the right
atrium.
 Right ventricle

• forms most of the anterior surface of the heart and a

portion of the diaphragmatic surface. The outflow
tract of the right ventricle, which leads to the
pulmonary trunk, is the conus arteriosus
(infundibulum). This area has smooth walls.
• Inflow portion contains numerous muscular,
irregular structures called trabeculae carneae
• trabeculae carneae (papillary muscles) some ends
serves as point of attachment for chordae tendineae,
which connect to the cusps of the tricuspid valve.
• 3 papillary muscles in the right ventricle namely;
anterior, posterior, and septal papillary muscles:
 Tricuspid valve

• right atrioventricular orifice is closed during

ventricular contraction by the tricuspid valve (3
cusps) namely; anterior, septal, and posterior
cusps,
• base of each cusp is secured to the fibrous ring that
surrounds the atrioventricular orifice, fibrous ring
helps to maintain the shape of the opening.
• cusps are continuous with each other near their bases
at sites termed commissures.
• free margins of the cusps are attached to the
chordae tendineae, arise from the tips of the
papillary muscles.
• contraction of the papillary muscles attached to the
cusps by chordae tendineae prevent the cusps from
being everted into the right atrium
 Pulmonary valve

• Right ventricle Opens into pulmonary trunk,

orifice is closed by the pulmonary valve;
• consists of 3 semilunar cusps with free edges
projecting upward into the lumen of the
pulmonary trunk.
• free superior edge of each cusp has a middle,
thickened portion, the nodule of the semilunar
cusp, and a thin lateral portion, the lunula of the
semilunar cusp
• cusps are named the left, right, and anterior
semilunar cusps,
• Each cusp forms a pocket-like sinus a dilation in the
wall of the initial portion of the pulmonary trunk.
• After ventricular contraction, the recoil of blood fills
these pulmonary sinuses forcing the cusps to close,
preventing back flow.
 The left atrium

• The left atrium forms most of the base/posterior

surface of the heart. posterior half, (inflow portion),
receives the 4 pulmonary veins
• anterior 1/2 is continuous with the left auricle.
• It contains musculi pectinati no distinct structure
separates the two components of the left atrium.
 Left ventricle

• lies anterior to the left atrium,

contributes to the anterior, diaphragmatic,
and left pulmonary surfaces of the heart,
and forms the apex.
• Blood enters the ventricle through the
left atrioventricular orifice and flows in a
forward direction to the apex.
• trabeculae carneae in the left ventricle are fine and
delicate
• 2 papillary muscles, the anterior and posterior
papillary muscles
 Mitral valve

• left atrioventricular orifice opens into the left

ventricle.
• closed during ventricular contraction by the mitral
valve (left atrioventricular valve), (bicuspid valve)
anterior and posterior cusps
• bases of the cusps are secured to a fibrous ring
surrounding the opening, and the cusps are
continuous with each other at the commissures.
 Aortic valve

• opening from the left ventricle into the aorta is

closed by the aortic valve, is similar in structure to
the pulmonary valve.
• Between the semilunar cusps and the wall of the
ascending aorta are pocket-like sinuses-the right, left,
and posterior aortic sinuses.
• right and left coronary arteries originate from the
right and left aortic sinuses.
Aortic valves
 Cardiac skeleton

• is a collection of dense, fibrous connective tissue in

form of 4 rings with interconnecting areas in a plane
between the atria and the ventricles
• 4 rings of the cardiac skeleton surround 2 atrio-
ventricular orifices, the aortic orifice and opening of
the pulmonary trunks known as the anulus fibrosus.
• interconnecting areas include:
• right fibrous trigone, thickened area of connective tissue
between the aortic ring and right atrioventricular ring
• left fibrous trigone,thickened area of connective tissue
between the aortic ring and the left atrioventricular ring
 Cardiac skeleton

• helps maintain the integrity of the openings it surrounds

and provides points of attachment for the cusps
• separates the atrial musculature from the ventricular
musculature.
• serves as a dense connective tissue partition that
electrically isolates the atria from the ventricles.
• atrioventricular bundle, passes through the anulus, is the
single connection between these two groups of
myocardium
 Cardiac conduction system

• musculature of the atria and

ventricles is capable of
contracting spontaneously.
• cardiac conduction system initiates
and coordinates contraction;
autorhymicity.
 Cardiac conduction system

• consists of nodes and networks of specialized

cardiac muscle cells organized into 4 basic
components:
• sinu-atrial node;
• atrioventricular node;
• atrioventricular bundle; right and left bundle
branches;
• subendocardial plexus of ventricular conduction
cells/ Purkinje fibres
 Cardiac conduction system

Sino-atrial node
• cardiac pacemaker
• located at the superior end of the crista terminalis at
the junction of the superior vena cava and the right
atrium
• excitation signals generated by the sinu-atrial node
spread across the atria, causing the muscle to contract.
• SA node is a 6 to 7mm3 mass of cardiac muscle cells
small in size, fewer myofibrils
 Cardiac conduction system

Atrioventricular node
• located near the opening of the coronary sinus, close
to the attachment of the septal cusp of the tricuspid
valve, and within the atrioventricular septum
• the wave of excitation in the atria stimulates the
atrioventricular node,
 Cardiac conduction system

Atrioventricular bundle
• is a direct continuation of the atrioventricular node .
• follows along the lower border of the
interventricular septum before splitting into right and
left bundles.
 Cardiac conduction system

• right bundle branch; continues on the right side of

the interventricular septum toward the apex of the
right ventricle,
• Enters septomarginal trabecula to reach the base of
the anterior papillary muscle.
 Cardiac conduction system

• subendocardial plexus of ventricular conduction

cells or Purkinje fibres.
 Cardiac conduction system

• left bundle branch; left side of the muscular

interventricular septum ascends to the apex gives off
branches the subendocardial plexus of conduction
cells (Purkinje fibers).
•
 Cardiac cycle

• Heart muscle function in a

coordinated fashion.
• atria walls contract while
ventricular walls relax.
76
 Cardiac cycle

• series of events constitutes a

cardiac cycle or heat beat.
• Electrical activity coordinates
the rhythmic contraction and
relaxation of the hearts
chambers. 77
 Cardiac cycle

• consists of 2 phases called

diastole and systole.

78
79
 Cardiac cycle

• Diastole; heart’s ventricles are

relaxed is a longer a phase
• Systole; blood is ejected from
ventricles

80
 Cardiac cycle

• During diastole the sinus node

generates an impulse that forces
the two atria to contract
• in this phase the tricuspid and
mitral valve are open and blood is
propelled from the atria into the
relaxed ventricles.
81
 Cardiac cycle

• By the end of the diastole

the electric impulse reaches
the ventricles causing them
to contract.
82
 Cardiac cycle
• During systole, the contracting ventricles
close the tricuspid and mitral valves, shortly
afterwards the pressure of the blood inside
the ventricles rises sufficiently to force the
pulmonary and aortic valve to open and
blood is ejected into the pulmonary artery
and aorta,
83
 Cardiac cycle

• as the ventricles relax again blood backs up

from the pulmonary artery and aorta closing
down the pulmonary and aortic valve.
• pressure in the relaxed ventricles is now
lower than in the atria, causing the tricuspid
and mitral valves open again and the cardiac
cycle starts again.
84
 Cardiac cycle

• This sequence of events in fact

takes approximately a second. The
familiar double throb (lub dub) of
the beating of the heart
corresponds to the two sets of
synchronised contractions that
occur during the cardiac cycle.
85
• intercalated discs; are modified cell
membranes that separate individual cardiac
muscle cells
• intercalated disc form permeable gap
junctions that allow almost totally free
diffusion of ions; so that action potentials
travel easily from one cardiac muscle cell to
the next
• cardiac muscle is a syncytium of many heart
muscle cells; excitation of 1 cell causes action
potential to spread to all of them.
• The heart is composed of 2 syncytiums:
• atrial syncytium; walls of the 2 atria,
• ventricular syncytium; walls of the 2 ventricles.
• atria are separated from the ventricles by fibrous
tissue that surrounds the atrioventricular (A-V)
valvular openings between the atria and ventricles.
• division of the cardiac muscle into 2 functional
syncytiums allows the atria to contract a short time
ahead of ventricular contraction, which is important
for effectiveness of heart pumping.
• Cardiac cycle; cardiac events that occur from the
beginning of one heartbeat to the beginning of the
next.
• Each cycle is initiated by spontaneous generation of
an action potential in the sinus node, as
• action potential travels from here SA node rapidly
through both atria and then through the A-V bundle
into the ventricles
• A delayof more than 0.1 second occurs during
passage of the cardiac impulse from the atria into the
ventricles allowing the atria to contract ahead of
ventricules; pumping blood into the ventricles
before the strong ventricular contraction begins.
• atria act as primer pumps for the ventricles, and
the ventricles in turn provide the major source of
power for moving blood through the body’s vascular
system.
Diastole and Systole
• cardiac cycle consists of a period of relaxation
called diastole, during which the heart fills with
blood, followed by a period of contraction called
systole
• normal heart sounds are described as
“lub,dub,lub,dub.
• Lub is associated with closure of atrio- ventricular
(A-V) valves at the beginning of systole,
• Dub is associated with closure of the semilunar
(aortic and pulmonary) valves at the end of
systole.
• “lub” sound is called the first heart sound, and the
“dub” is called the second heart sound,
 Clinical application

Discuss the following

• Pulse
• Blood pressure
• Asculation for heart sounds
 References

• Mescher AL Junqeira’s Basic histology 13th Edition

• Gray’s anatomy for students
• Guyton medical physiology