ANATOMY & PHYSIOLOGY

The heart is the muscular pump that is located between your lungs,
slightly to the left of your breastbone. It is slightly larger than a human fist, with a
weight of between 200 to 425 grams. Everyone's heart has to beat approximately
100,000 times each and every day.

Your heart comprises of four chambers, the upper chambers are referred
to as the left and right atria, collectively called the atrium, whilst the lower
chambers are called the right and left ventricle. A wall of muscle known as the
septum separates the four chambers.

The largest of the chambers is the left ventricle, as they have to force the
blood through the aortic valve into the body. The right side of the heart is small
because it only has to transmit blood a short distance to the lungs.

The heart itself is merely a pump which contracts and relaxes, in the
cardiac cycle. The coronary arteries feed the oxygen, and the nutrients to the
heart muscles, which need it to function effectively. The two coronary arteries,
exit the heart through the aorta. The left main coronary artery is less than an inch
long and very thin; it later branches into two smaller arteries, which themselves
branch into arteries of decreasing size. The smaller vessels are capable of
penetrating the heart muscle. The capillaries are so tiny that the red blood cells
can only travel in single file. The functions of these tiny blood vessels is to
transfer oxygen and nutrient filled blood to the cardiac muscles, and then take
the waste products such as carbon dioxide away for effective disposal by lungs,
kidney's and the liver.

The superior and inferior vena cava are the two main veins which bring
the deoxygenated blood to the heart, and they empty into the right atrium. The
veins from the upper torso and head empty in the superior, and the veins from
the legs and lower torso feed into the inferior vena cava.

The aorta is the largest of the body's blood vessels, being about the
diameter of the thumb, and carries the reoxygenated blood from the largest heart
chamber the left ventricle to the body.

The deoxygenated blood is taken from the right ventricle to the lungs, by
the pulmonary artery. Arteries carry blood away from the heart, but it not always
reoxygenated. Conversely veins carry blood towards the heart, and it is the
pulmonary vein, which carries the oxygen rich blood from the lungs to the left
atrium. At this time the left atrium is contracting and forcing the oxygenated blood
through the mitral valve into the left ventricle. When the ventricle is full of blood it
contracts and forces the aortic valve open and the mitral valve closes. This action
causes the blood to be pumped into the left atrium. The mitral valve closes to
prevent a back flow of the blood and the blood exits the heart through the aorta.
The tricuspid valve separates the right atrium from the right ventricle, and assists
the blood to flow through.

As the right ventricle receives the blood the right atrium contracts, which
makes the ventricle fill, when this process is complete the right ventricle contracts
forcing the tricuspid valve to close.

Central Nervous System

Medulla Oblongata relays motor and sensory impulses between other parts of
the brain and the spinal cord. Reticular formation (also in pons, midbrain, and
diencephalon) functions in consciousness and arousal. Vital centers regulate
heartbeat, breathing (together with pons) and blood vessel diameter.

Hypothalamus controls and intergrates activities of the autonomic nervous

system and pituitary gland. Regulates emotional and behavioral patterns and
circadian rhythms. Controls body temperature and regulates eating and drinking
behavior. Helps maintain the waking state and establishes patterns of sleep.
Produces the hormones oxytocin and antidiuretic hormone.

Cardiovascular System

Baroreceptor pressure-sensitive sensory receptors, are located in the aorta,

internal carotid arteries, and other large arteries in the neck and chest. They
send impulses to the cardiovascular center in the medulla oblongata to help
regulate blood pressure. The two most important baroreceptor reflexes are the
carotid sinus reflex and the aortic reflex.

Chemoreceptor, sensory receptors that monitor the chemical composition of

blood, are located close to the baroreceptors of the carotid sinus and the arch of
the aorta in small structures called carotid bodies and aortic bodies, respectively.
These chemoreceptors detect changes in blood level of O2, CO2, and H+.

Renal System

Renin-Angiotensin-Aldosterone system. When blood volume falls or blood

flow to the kidneys decreases, juxtaglomerular cells in the kidneys secrete renin
into the bloodstream. In sequence, renin and angiotensin converting enzyme
(ACE) act on their substrates to produce the active hormone angiotensin II, which
raises blood pressure in two ways. First, angiotensin II is a potent
vasoconstrictor; it raises blood pressure by increasing systemic vascular
resistance. Second, it stimulates secretion of aldosterone, which increases
reabsorption of sodium ions and water by the kidneys. The water reabsorption
increases total blood volume, which increases blood pressure.

Antidiuretic hormone. ADH is produced by the hypothalamus and released

from the posterior pituitary in response to dehydration or decreased blood
volume. Among other actions, ADH causes vasoconstriction, which increases
blood pressure.

Atrial Natriuretic Peptide. Released by cells in the atria of the heart, ANP
lowers blood pressure by causing vasodilation and by promoting the loss of salt
and water in the urine, which reduces blood volume.
PATHOPHYSIOLOGY
 Hypertension (high blood pressure) is a disease of vascular regulation
resulting from malfunction of arterial pressure control mechanisms (central nervous
system, rennin-angiotensinaldosterone system, extracellular fluid volume.) the cause is
unknown, and there is no cure. The basic explanation is that blood pressure is elevated
when there is increased cardiac output plus increased peripheral vascular resistance.

The two major types of hypertension are primary (essential) hypertension, in

which diastrolic pressure is 90 mm Hg or higher and systolic pressure is 140 mm Hg or
higher in absence of other causes of hypertension (approximately 95 % of patients); and
Secondary hypertension, which results primarily from renal disease, endocrine
disorders, and coarctation of the aorta. Either of these conditions may give rise to
accelerated hypertension – a medical emergency – in which blood pressure elevates
very rapidly to threaten one or more of the target organs: the brain, kidney, or the heart.

Hypertension is one of the most prevalent chronic diseases for which

treatment is available; however, most patients with hypertension are unaware,
untreated, or inadequately treated. Risk factors for hypertension are age between 30
and 70; black; overweight; sleep apnea; family history; cigarette smoking; sedentary
lifestyle; and diabetes mellitus. Because hypertension presents no over symptoms, it is
termed the “silent killer.” The untreated disease may progress to retinopathy, renal
failure, coronary artery disease, heart failure, and stroke.

Hypertension in children is defined as the average systolic or diastolic blood

pressure greater than or equal to the 95th percentile for age and sex with measurement
on at lease three occasions. The incidence of hypertension in children is low, but it is
increasingly being recognized in adolescents; and it may occur in neonates, infants, and
young children with secondary causes.