CARDIOVASCULAR SYSTEM

DR. DIPTI VASANI

 Overview

• heart
• blood vessels
• blood
• transport of oxygen, nutrients, hormones, and
cellular waste products throughout the body.
• body’s hardest-working organ — the heart.
• Even at rest, the average heart easily pumps over
5 liters of blood throughout the body every
minute.
THE HEART
 INTRODUCTION

• Cone shaped muscle

• Four chambers
– Two atria, two ventricles
• Double pump – the ventricles
• Two circulations
– Systemic circuit: blood vessels that transport
blood to and from all the body tissues
– Pulmonary circuit: blood vessels that carry blood
to and from the lungs
Heart’s position in thorax

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 Heart’s position in thorax
• In mediastinum – behind sternum and pointing left,
lying on the diaphragm
• It weighs 250-350 gm (about 1 pound)
Feel your heart beat at apex

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(this is of a person lying down)
 CXR
(chest x ray)

Normal male
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 Chambers of the heart
divided by septae:

• Two atria-divided by
interatrial septum
– Right atrium
– Left atrium
• Two ventricles-
divided by
interventricular septum
– Right ventricle
– Left ventricle

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 Valves
three tricuspid
(cusp means flap)
one bicuspid

• “Tricuspid” valve
– RA to RV
• Pulmonary or pulmonic valve
– RV to pulmonary trunk (branches R and L)
• Mitral valve (the bicuspid one)
– LA to LV
• Aortic valve
– LV to aorta
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 Pattern of flow
(simple to more detailed)

• Body Body to right heart to lungs to

left heart to body
• RA
Body, then via vena cavas and coronary
• RV sinus to RA, to RV, then to lungs via
pulmonary arteries, then to LA via
• Lungs pulmonary veins, to LV, then to body via
aorta
• LA
From body via SVC, IVC & coronary sinus to
• LV RA; then to RV through tricuspid valve; to
• Boby lungs through pulmonic valve and via
pulmonary arteries; to LA via pulmonary
veins; to LV through mitral valve; to body via
aortic valve then aorta

LEARN THIS
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Simplified flow: print and fill in details

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another flow chart

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 Heartbeat
Definition: a single sequence of atrial contraction followed by ventricular contraction

• Systole: contraction
• Diastole: filling
• Normal rate: 60-100
• Slow: bradycardia
• Fast: tachycardia
***Note: blood goes to RA, then RV, then lungs, then LA, then LV, then body; but the
fact that a given drop of blood passes through the heart chambers sequentially does
not mean that the four chambers contract in that order; the 2 atria always contract
together, followed by the simultaneous contraction of the 2 ventricles
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 Heart sounds
• Called S1 and S2
• S1 is the closing of AV (Tricuspid) valves at the start of
ventricular systole
• S2 is the closing of the semilunar (Aortic and Pulmonic)
valves at the end of ventricular systole
– Separation easy to hear on inspiration therefore S2 referred to
as A2 and P2
• Murmurs: the sound of flow
– Can be normal
– Can be abnormal

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Places to auscultate

• Routine places are at

right and left sternal
border and at apex

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 Electrical conduction system:
specialized cardiac muscle cells that carry
impulses throughout the heart musculature,
signaling the chambers to contract in the
proper sequence

(Explanation in next slides)

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 Conduction system

• SA node ( sinoatrial )
– In wall of RA
– Sets basic rate: 70-80
– Is the normal pacemaker
(setting a rhythm for heart)
• Impulse from SA to atria
• Impulse also to AV node via internodal
pathway
• AV node
– In interatrial septum
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 Conduction continued

• AV node through AV bundle (bundle of His)

– Into interventricular septum
– Divides
R and L bundle branches
become subendocardial
branches (“Purkinje
fibers”)
• Contraction begins
at apex

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 ECG(electrocardiogram)
• Electrical depolarization
is recorded on the body
surface by up to 12 leads
• Pattern analyzed in each
lead

P wave=atrial depolarization
QRS=ventricular depolarization
T wave=ventricular repolarization
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BLOOD VESSELS
 INTRODUCTION
• body’s highways that allow blood to flow quickly
and efficiently from the heart to every region of
the body and back again.
• The size of blood vessels corresponds with the
amount of blood that passes through the vessel.
• All blood vessels contain a hollow area called the
lumen through which blood is able to flow.
Around the lumen is the wall of the vessel, which
may be thin in the case of capillaries or very thick
in the case of arteries.
 3 Major types of blood
vessels
• Body
1. Arteries
• RA 2. Capillaries

• RV 3. Veins

• Lungs
• LA
• LV Arteries carry blood away from the heart
• Boby -”branch,” “diverge” or “fork”
Veins carry blood toward the heart
-”join”, “merge,” “converge”

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 Vascular System
(Blood vessels of the body)

• Two circulations
– Systemic
– Pulmonary

• Arteries and veins usually run together

• Often nerves run with them
• Sometimes the systems do not have bilateral
symmetry
– In head and limbs, most are bilaterally symmetrical

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 Pulmonary Circulation

• After gas exchange blood enters venules

• Larger and larger into Superior and Inferior Pulmonary
veins
• Four Pulmonary Veins empty into left atrium
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 Systemic Circulation
• Oxygenated blood to body
• Leaves LV through Ascending Aorta

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Angiogram

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 COMMON DISEASES OF HEART AND
BLOOD VESSELS
HEART BLOCK

ARRYTHMIAS

FLUTTER

FIBRILLITIONS

CARDIAC ARREST

PALPITATIONS
 Artificial
Pacemaker

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Congenital
Anomalies

Congenital (means born with)

abnormalities account for nearly half of
all deaths from birth defects
One of every 150 newborns has some
congenital heart defect

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more…

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 Other diseases
• Congenital heart failure
• Coronary artery disease
• Endocarditis
• Hypertensive heart disease
• Mitral valve prolapse
• Murmur
• Pericarditis
• Rheumatic heart disease
 Diseases of Blood vessels
• Atherosclerotic cardiovascular disease
– Cerebrovascular disease – affects brain, strokes
– Coronary artery disease (CAD) – arteries of heart
– Peripheral vascular disease (PVD) – arterial
• Affecting veins
– Chronic venous insufficiency – venous = veins
– Deep venous thrombosis (DVT)
• Aneurysms
• Portal hypertension
• Hypertension

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Hematology

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 FUNCTION

TRANSPORTATION

PROTECTION REGULATION
 Basic scheme
• Blood leaves the heart in
arteries
• Branching of arteries until
they become tiny capillaries
– Oxygen and nutrients diffuse out
– CO2 and wastes diffuse in
• Capillaries form veins going to the heart
• The blood leaves the right side of the heart for the
lungs to pick up O2 and release CO2
• Blood goes back to the left side of the heart to start
all over
Note: vessels going to the heart are veins; those leaving the heart are arteries
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 characteristics
• Specialized connective tissue
• Blood cells (formed elements) suspended in plasma

• Blood volume: 5-6 liters (approx 1.5 gal) in males and

4-5 liters in females
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 Blood
• Sticky fluid
• Temp-38 degree
• pH -7.35 to 7.45
• Centrifuged (spun) to separate
• Clinically important hematocrit
– % of blood volume consisting of erythrocytes (red
blood cells)
– Male average 47; female average 42

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 CBC is probably commonest test done
(“complete blood count”-how much of each type of cell)
• Hemoglobin (gm/dl) usually
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• Hematocrit (%)
• RBC count
• WBC in thousands/cumm
– Differential if ordered:
broken down to amount of
each type WBC
• Platelet count in
thousands/cumm

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 BLOOD CELLS
Erythrocytes
• Also called RBCs or red blood cells
• Biconcave discs and flexible
• Plasma membrane but no nuclei
or organelles
• Packed with hemoglobin
molecules
– Oxygen carrying protein
– 4 chains of amino acids, each with
iron which is binding site for oxygen;
heme
CO2 carried also
• Young ones still containing iron atom

ribosomes are called reticulocytes

• Live 100-120 days
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 __RBC

Leukocytes

neutrophil eosinophil AKA WBCs: white

blood cells
Are complete cells
Function outside the
blood
basophil
Note the size difference
compared to erythrocytes

small lymphocyte monocyte

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 Leukocyte types
• Artificial division into granulocytes and
agranulocytes
• Granulocytes: neutrophils, eosinophils, basophils
(according to how stain)
– Granules
– Lobed nuclei
– All are phagocytic
• Agranulocytes: lymphocytes, monocytes
• All except for lymphocytes arise from myeloid
stem cells
All originate in the bone marrow

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 Platelets

• Not cells
• Small fragments broken off from megakaryocytes
• Important in forming clots in damaged vessels
• AKA thrombocytes

*
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 Clots
Platelet__________________

Undesirable clots:
– Thrombus
Platelet and several RBCs trapped
– Embolus in a fibrin mesh

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 Significant
young cells
• Reticulocytes* (young erythrocytes): 1-2%of all RBCs
– “retic count” helps determine if producing RBCs at accelerated rate
(anemia, move to a high climate, etc.)
• Bands* (young neutrophils): 1-2% of all WBCs
– Increases with acute bacterial infections

*
*
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 Disorders of Erythrocytes
• Polycythemia: too many cells
• Anemia: not enough cells
• Sickle cell disease: genetic disease AR
– 1/400 African Americans
– Defect in hemoglobin
• Plus many others

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 Disorders of Leukocytes
• Leukemia: too many, abnormal, crowd out
normal marrow
• Classified into
– Lymphoblastic or myeloblastic
– Acute or chronic

Disorders of Platelets
• Thrombocytopenia
– Causes internal bleeding
– Many causes
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 Laboratory
CBC: complete blood count (to review…)

• Hemoglobin (gm/dl)
• Hematocrit (%)
• RBC count
• WBC in thousands/cumm
– Differential if ordered: broken down to amount of each
type WBC
• Platelet count in thousands/cumm

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 Laboratory continued
Clotting: “coags”
– for preop evaluation (before surgery)
– to evaluate effectiveness of anticoagulant drugs, e.g.
aspirin, heparin, coumadin
• Bleeding time
• PT - Protime
• PTT - Partial thromboplastin time
• INR

ESR – erythrocyte sedimentation rate

– Indicator of infection or inflammation
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 Blood Typing
ABO blood groups: A, B, AB, and O

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If a blood transfusion is given to a person who
has antibodies to that type of blood, then the
transfused blood will be attacked and
destroyed (transfusion reaction)
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 Rh factor
• The “Rh factor” is another major antigen on the RBC, called D
– is autosomal recessive
– DD and Dd: Rh+
– dd: Rh-
• If mom is Rh- and baby is Rh+, then small amount of blood
leaks into mom’s blood through placenta, and she makes
antibodies to D antigen; first Rh- pregnancy usually ok, but
not later Rh- ones (can be lethal to baby)
• If mom is Rh- then give “Rhogam” during pregnancy [(is anti-
Rh(D): Rh(D) Ig (immunoglobin)], an antibody which will
destroy any of the baby’s RBCs which leak into mom’s blood
during the pregnancy so she will not mount an immune
response to the D antigen
• If father is Rh+:
– If DD then all pregnancies will be Rh+
– If Dd then half of the pregnancies with this mom will be Rh- (no Rh
incompatibility problems)
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THANK YOU