Cardiovasc Block 10

Block 10 The Cardiovascular System
Dr Mutiara Budi Azhar, SU., MMedSc

Faculty of Medicine Sriwijaya University
Introduction
The
cardiovascular system is a transport system bringing nutrients to and returning waste products from the tissues. This system is divided into two main parts:
The circulatory system, consisting of the heart, which acts as a pump, and the blood vessels through which the blood circulates. The lymphatic system, consisting of lymph nodes and lymph vessels, through which colourless lymph flows.
Dr MBA Cardiovascular System 2
Introduction (Cont. 2)
The heart pumps oxygen-rich blood via the arteries, arterioles and capillaries to the tissues. Venules and veins bring oxygen-poor blood back to the heart, which shunts it to the lungs to be oxygenated via the pulmonary circulation. Picture
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Cardiovascular System
Carbon dioxide (CO2) is eliminated by the lungs, and other waste products are eliminated by the kidneys. Lymph return some substances that have leaked from the capillaries into the tissues back into the venous system. The exchange of nutrients and waste products in tissues involves the capillaries.
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The circulatory system

The pulmonary circulation The systemic circulation
The right side of the heart pumps blood to the lungs (the pulmonary system) where gas exchange occurs (CO2 leaves the blood and enters the lungs, and O2 leaves the lungs and enters the blood) The left side of the heart pumps blood into the systemic circulation, which supply the rest of the body; here, tissue wastes are passed into the blood for excretion, and the body cells extract nutrients and O2.
Blood Vessels
Arteries (arteriae = aa; arteria = a) Arterioles (arteriolae; arteriola) Capillaries Venules (venulae; venula) Veins (venae = vv; vena = v)
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The relationship between the heart and the different types of blood vessel.
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Arteries and Arterioles

(Arteriae et Arteriolae)
The blood vessels that transport blood away from the heart. Vary considerably in size. Their walls consists of three layers:
Tunica adventitia or outer layer of fibrous tissue. Tunica media or middle layer of smooth muscle and elastic tissue Tunica intima or inner lining of squamous epithelium called endothelium.
Structures of artery and vein
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Find out the variation of the amount of muscular and elastic tissue amongst blood vessels.
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Anastomoses and end arteries
Anastomoses are arteries that form a link between main arteries supplying an area (e.g. the arterial supply to the palms of the hands). What is collateral circulation? End arteries are the arteries with no anastomosis.
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Veins and Venules

(Venae et Venulae)
The blood vessels that return blood at low pressure to the heart. Its wall are thinner than those of arteries (what make them different and why?).beban kerja lebih ringan Some veins posses valves (where the valves abundant and where they absent, and why?) The smallest veins are called venules (venulae, plural; venula, singular)
Interior of a vein
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Capillaries and Sinusoids
The smallest arterioles break up into a number of minute vessels called capillaries. Describe the structure of a capillary wall! What is capillary bed? Sinusoids are wider than capillaries and have extremely thin walls separating blood from the neighbouring cells. The blood pressure is sinusoids is lower than in capillaries and there is a slower rate of blood flow (Why?)
The CAPILLARY
A collection of capillaries is known as a capillary bed.
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Blood Supply
The outer layer of tissues of thick-walled blood vessels receive their blood supply via a network of blood vessels called vasa vasorum. Vessels with thin walls and the endothelium of the others receive oxygen and nutrients by diffusion from the blood passing through them.
The Heart
The heart is a roughly cone-shaped hollow muscular organ. It is about 10 cm long and is about the size of the owners fist. It weights about 225 g in women and is heavier in men (about 310 g)
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The Position of the Heart
Lies in the thoracic cavity in the mediastinum between the lungs. Lies obliquely, a little more to the left than the right, and presents a base (basis) above, and apex below. The apex is about 9 cm to the left of the midline and the level of the 5th intercostal space (spatium intercostale), a little below the nipple and slightly nearer the midline. The base extends to the level of the 2nd rib.
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The position of the heart in the thorax
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Organs associated with the heart
Inferiorly (identify) Superiorly (identify) Posteriorly (identify) Laterally (identify) Anteriorly (identify)
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Organs associated with the heart
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Structure of the heart
The heart is composed of three layers of tissue: Pericardium Myocardium Endocardium
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The pericardium
is
made up of two sacs; the outer sac consist of fibrous tissue and the inner of a continues double layer of serous membrane (See
Snell, RS. Clinical Anatomy)
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Myocardium
Composed of specialized cardiac muscle found only in the heart. Not under voluntary control but, like skeletal muscle, cross-stripes are seen on microscopic examination. Thickest at the apex and thins out towards the base (Why?) Each fibre (muscle cell) has a nucleus and one or more branches.
Cardiac muscle with fibres separated
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Myocardium
The atria and the ventricles are separated by a ring of fibrous tissue that does not conduct electrical impulses (Why this is important?)
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Endocardium
This forms the lining of the myocardium and the heart valves. It is a thin, smooth, glistening(berkilauan) membrane which permits smooths flow of blood inside the heart. It consist of flattened epithelial cells, continous with the endothelium that lines the blood vessels.
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Interior of the Heart
The heart is divided into right and left side by the septum (septum interatriale and septum interventriculare), a partition consisting of myocardium covered by endocardium. After birth blood cannot cross the septum from one side to the other. Each side is divided by an atrioventricular valve into an upper chamber, the atrium, and a lower chamber, the ventricle.
Atrioseptal valve: normal and defective closure after birth
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Interior of the heart
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Sceleton Cordis
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The valves
Valve (valvula = valva) Valvula atrioventriculare dextra (valvula tricuspidalis) Valvula atrioventriculare sinistra (valvula bicuspidalis). The valves open and close passively according to changes in pressure in the chambers.
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Flow of blood through the heart
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The left atrioventricular valve
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Direction of blood flow through the heart
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Blood supply to the heart
Arterial supply Left and right coronary arteries Venous drainage Coronary sinuses Little venous channels (whats the name) (See Sobotta)
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The coronary arteries
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Conducting System of the Heart

Small
groups of specialized neuromuscular cells in the myocardium which initiated and conduct impulses causing coordinated and synchronized contraction of the heart muscle.
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Conducting System of the Heart (Cont. 2)
SA-Node AV-Node AV bundle or bundle of Hiss Purkinje fibres Normally, SANode is the Pacemaker
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Conducting System of the Heart (Cont. 3)
The heart is an intrinsic system whereby the cardiac muscle is automatically stimulated to contract without the need for a nerve supply from the brain. However, the system can be stimulated of depressed by nerve impulses initiated in the brain (autonomic nervous system) and circulating chemicals including hormones.
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Factors affecting heart rate
Autonomic nervous system (How this system influencing the heart rate) Circulating chemicals (the homones adrenaline and noradrenaline Whats their effects). Position (upright, lying down)
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Exercise (autonomic nervous system!!!) Emotional states. Gender Age Temperature Baroreceptor reflex.
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Pulse
The main pulse points (pulse taking arteries)
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Systemic or General Circulation

Aorta:
Aorta ascendence Arcus aorta Aorta descendence:

Aorta thoracalis Aorta abdominalis
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The aorta and its main branches
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Arcus aorta and its branches
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Main arteries of the left side of the head and the neck
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The aorta and the main arteries of the limbs
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The venae cavae and the main veins of the limbs
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Arteries forming circulus arteriosus Willisi
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The right vertebral artery
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Veins of the left side of the head and the neck
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Venous sinuses of the brain viewed from the right
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Venous sinuses of the brain from above
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The main arteries of the right arm
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The main veins of the right arm
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The aorta and its main branches in the thorax
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The superior vena cava and the main veins of the thorax
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The abdominal aorta and its branches
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Truncus coeliacus and its branches and a. phrenica inferior
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a. Mesenterica superior and a. mesenterica inferior and their branches
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Venous drainage from the abdominal organs and the formation of the portal system
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The portal vein formation and termination
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The femoral artery and its main branches
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The right popliteal artery and its main branches
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Ductus arteriosus
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Superficial veins of the legs
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Thank you very much for your kind attention
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Block 10 The Cardiovascular System

Dr Mutiara Budi Azhar, SU., MMedSc

The circulatory system

Arteries and Arterioles

Structures of artery and vein

Anastomoses and end arteries

Veins and Venules

Capillaries and Sinusoids

The Position of the Heart

The position of the heart in the thorax

Organs associated with the heart

Organs associated with the heart

Structure of the heart

The heart is composed of three layers of tissue: Pericardium Myocardium Endocardium

Cardiac muscle with fibres separated

Interior of the Heart

Atrioseptal valve: normal and defective closure after birth

Interior of the heart

Flow of blood through the heart

The left atrioventricular valve

Direction of blood flow through the heart

Blood supply to the heart

The coronary arteries

Conducting System of the Heart

Conducting System of the Heart (Cont. 2)

Conducting System of the Heart (Cont. 3)

Factors affecting heart rate

The main pulse points (pulse taking arteries)

Systemic or General Circulation

Aorta ascendence Arcus aorta Aorta descendence:

The aorta and its main branches

Arcus aorta and its branches

The aorta and the main arteries of the limbs

The venae cavae and the main veins of the limbs

Arteries forming circulus arteriosus Willisi

The right vertebral artery

Veins of the left side of the head and the neck

Venous sinuses of the brain viewed from the right

Venous sinuses of the brain from above

The main arteries of the right arm

The main veins of the right arm

The aorta and its main branches in the thorax

The abdominal aorta and its branches

Truncus coeliacus and its branches and a. phrenica inferior

a. Mesenterica superior and a. mesenterica inferior and their branches

The portal vein formation and termination

The femoral artery and its main branches

The right popliteal artery and its main branches

Superficial veins of the legs

Thank you very much for your kind attention

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