The

Cardiovascular
System
Ms. Louradel Ulbata-Alfonso,MAN, RN
Heart
A hollow muscular organ
Located in thorax between 2
lungs
4 chambers
2 atria (atrium) & 2 ventricles
4 valves
2 separate pumps (R & L
sides)
Right side receives blood from
the body and sends it to the
lungs (pulmonary)
Left side receives blood from
lungs and sends it to the body
(systemic)
PMI midclavicular line @ 5
th

IC space
Position of Heart
3 LAYERS:
1. ENDOCARDIUM
2. MYOCARDIUM
3. EPICARDIUM
Layers of the Heart
Pericardium
Myocardium
Fibrous pericardium
Serous pericardium (parietal layer)
Pericardial space
Serous pericardium (visceral layer - Epicardium)
Endocardium
The heart lies between
the lungs in a region
called the
mediastinum.
heart is wrapped by
some membranes that
also hold the heart in
its position relative to
the diaphragm and
lungs.
The Pericardium
The pericardium is the set of membranes around the
heart. It is actually composed of three layers of
membranes.
visceral pericardium - the innermost
parietal pericardium - the middle,
fibrous pericardium - the outer one is the extra one,
and is tough.

Pericardial Cavity- tiny space between the
visceral pericardium and the parietal
pericardium
15-50 ml
Pericardial Effusion VS Cardiac
Tamponade
Layers of the Heart
Pericardium
Myocardium
Fibrous pericardium
Serous pericardium (parietal layer)
Pericardial space
Serous pericardium (visceral layer - Epicardium)
Endocardium
CORONARY ARTERIES
L & R coronary arteries supply arterial
blood to the heart
Originate from the aorta above the aortic
valve leaflets
Perfused during diastole
HR Blood flow myocardial
ischemia
Heart has high metabolic requirements
(extract 70-80% of the oxygen delivered)


LEFT CORONARY ARTERIES
3 BRANCHES

1. Left main coronary artery
2. Left anterior descending artery
anterior wall of the heart
3. Circumflex artery circles around to the
lateral left wall of the heart
CORONARY ARTERIES
RIGHT CORONARY ARTERY
Right coronary artery
- inferior wall of the heart

Posterior descending artery
- posterior wall of the heart


- Drains into the coronary sinus
CORONARY ARTERIES
Coronary Arteries
Atherosclerosis is an accumulation
of fat on the inner walls of arteries.

When coronary arteries become
partially blocked.angina

When coronary arteries become
significantly blocked.myocardial
infarction
Chambers of the Heart
Valves of the Heart
4 valves
One way flow
Leaky valve = heart murmur
2 atrioventricular valves
Left AV valve- bicuspid or mitral
Right AV valve- tricuspid
2 semilunar valves
Pulmonic semilunar valve
Aortic semilunar valve
Valves of the Heart
Tricuspid Valve
Mitral Valve
Pulmonic
Valve
Aortic Valve
Atrioventricular Valves
1. Right AV valve
Between right atrium and right ventricle
Also called the tricuspid valve because it has three cusps.
Cusps close when right ventricle contracts.preventing blood
from going back up into the right atrium
2. Left AV valve
Between the left atrium and the left ventricle
Also called the bicuspid valve because it only has two cusps
Also called the mitral valve
Cusps close when left ventricle contracts.preventing blood
from back up into the left atrium

Semilunar Valves
1. Pulmonary semilunar valve
When right ventricle contracts, blood is forced
through this valve to enter pulmonary trunk
2. Aortic semilunar valve
When left ventricle contracts, blood is forced
through this valve to enter the aorta

Papillary muscles located on the sides of the
ventricular walls and and connected to the valve
leaflets by thin fibrous bands called CHORDAE
TENDINAE
CHORDAE TENDINAE
2 Pumps
Blood flow in the Heart
CARDIAC
ELECTROPHYSIOLOGY
Cardiac Conduction System
The cardiac conduction system generates
and transmits impulses that stimulate
contraction of the myocardium.
Under normal circumstances, the conduction
system first stimulate the contraction of the
atria and then the ventricles.
CONDUCTION SYSTEM
SA NODE- main regulator of HR
- transmit impulse to the surrounding atrial
muscle.
AV NODE- transmit impulses to the
surrounding ventricular muscle.
BUNDLE OF HIS- continuation of AV Node
and has a left and right bundles and fuse
with purkinje fibers.
PURKINJE FIBERS- terminal branches of the
conduction system and are responsible for
carrying the wave of depolarization to both
ventricular walls.

10/17/2014
10/17/2014
2 TYPES OF SPECIALIZED ELECTRICAL
CELLS IN THE HEART
1. NODAL CELLS
2. PURKINJE CELLS

These provide synchronization
ELECTRICAL CELLS
Nodal Cells SA and AV nodes
Purkinje Cells Purkinje Fibers
3 Physiologic Properties of the Electrical Cells

Excitability. The ability of the heart to depolarize in response to a
stimulus. Once stimulated, the whole heart muscle contracts. It is
influenced by hormones, electrolytes, nutrition, oxygen supply,
medications, infection, and nerve characteristics.
- The ability to RESPOND
Automaticity/Rhythmicity. The ability of cardiac cells to initiate an
impulse spontaneously and repetitively, without external
neurohormonal control.

Conductivity. The ability of the heart muscle fibers to
propagate/ transmit electrical impulses along and across
cell membranes.


CONDUCTION SYSTEM OF
THE HEART
SA NODE (Primary pacemaker)

AV NODE

Bundle of his

R bundle L bundle
branch branch


PURKINJE FIBERS

VENTRICULAR CONTRACTIONS
Conduction System of the Heart
CARDIAC
ELECTROPHYSIOLOGY
CARDIAC
ELECTROPHYSIOLOGY
CARDIAC ACTION POTENTIAL
IONS
1. Sodium
2. Potassium
3. Calcium

3 PHASES
1. Resting membrane state
2. Depolarization
3. Repolarization
REFRACTORY PERIODS
Myocardial cells must COMPLETELY
repolarize (rest) before they can
depolarize/ stimulated again

2 PHASES:
1. Effective/ Absolute refractory period
2. Relative refractory period
ABSOLUTE REFRACTORY
Cell is COMPLETELY UNRESPONSIVE
to any electrical impulse
It is INCAPABLE of initiating early
depolarization


RELATIVE REFRACTORY
If an electrical stimulus is stronger than
normal, the cell may depolarize early or
prematurely

Early depolarization of atrium or ventricle
premature contractions
DYSRHYTHMIAS
CARDIAC HEMODYNAMICS
Principle that fluids flow from a region of
higher pressure to a region of lower
pressure
Cardiac Cycle- refers to the events
of one complete heart beat. The length of the
cardiac cycle is usually about 0.8 sec.
Systole (contraction of the muscle)- there
is ventricular pumping, the chambers of
the heart become smaller as the blood is
ejected. Occurs secondary to
depolarization of cells

Diastole (relaxation of the muscle)- there
is ventricular filling, the heart chambers fill
with blood in preparation for subsequent
ejection.
Cardiac Output
Volume of blood ejected per minute
Each ventricle ejects approximately 70mL of
blood/ beat
Averages between 4-8L/min
CO = Stroke volume X heart rate
=70 ml X 60 beats/min
=4,200 ml/min

Changes in SV and HR affects cardiac output
Controls of the heart
1. AUTONOMIC NS
- sympathetic and parasym

2. CNS and baroreceptors and
chemoreceptors
Baroreceptors
- aortic arch and R & L internal carotid
arteries
- sensitive to changes in BP
Chemoreceptors
- sensitive to CO2 level
Subdivisions of ANS
Parasympathetic acetylcholine produces
inhibitory response
Sympathetic catecholamines stimulate
Increase heart rate Beta 1 receptors
Dilate smooth muscles Beta 2 receptors
Vasoconstrict vessels Alpha receptors


Stroke Volume Is Determined
By Three Factors
Preload
Afterload
Contractility
Preload
Degree of stretch of myocardial fibers
Determined by the volume of blood in left
ventricle (LV) at end of diastole
Increased blood volume increased
preload- increased cardiac output (CO)
Decreased blood volume decreased
preload decreased cardiac output (CO)
Frank- Starling Law-the critical factor controlling
stroke volume is how much the cardiac muscle cells
are stretched just before the contract. The more they
are stretched, the stronger the contraction will be. The
important factor stretching the heart muscles is the
venous return.
Factors Which Increase
Preload
IV fluids
Blood
Vasoconstriction

Factors Which Decrease
Preload
Diuretics
Dehydration
Hemorrhage
Vasodilation
Resistance or pressure the ventricles must
overcome to pump blood out
Left ventricle (LV) affected by systemic
vascular resistance (SVR)
Right ventricle (RV) affected by pulmonary
vascular resistance (PVR)
Related to arterial pressure or diameter of
arteries
As pressure increases, resistance
increases, afterload increases
As pressure decreases, resistance
decreases, afterload decreases


Contractility
Force generated by the myocardium when it
contracts inotropic property
END