1. Anatomy and Physiology of the Circulatory System
Basic Cardiac Anatomy

2. The Heart and Circulation
The circulatory system is composed of four main parts:
Heart—the pump
Blood vessels—transport system
Blood—the circulating fluid
Lymphatic system—an immunological axillary fluid system

3. Heart
Acting as a double pump, its structure is divided into the right and left heart by the septum.
The heart has four chambered, Rt & Lt Atria, Rt & Lt Ventricles.
Although it is not much bigger than a human fist and weighs less than a pound, the heart is a very powerful organ. Each day the heart pumps approximately 2,000 gallons of blood through 70,000 miles of blood vessels by beating approximately 100,000 times a day.

4. Linings of the Heart Endocardium - inner lining of the heart
Myocardium-muscular, middle layer
Pericardium-outer membranous sac

5. Upper Chambers of the Heart - Atria
Right atrium receives deoxygenated blood from all body parts (except the lungs) through the superior and inferior vena cava as the SA node contracts. Left atrium receives blood rich in oxygen returning from the lungs via the left and right pulmonary veins and sends it to the left ventricle and out to the aorta to the rest of the body also as the SA node contracts.

6. Lower Chambers of the Heart - Ventricles
Right ventricle- receives deoxygenated blood from the right atrium through the tricuspid valve or AV valve and pumps it though a semilunar valve to the lungs to drop off waste product and get oxygenated. Left ventricle- receives oxygenated blood from the left atrium through the bicuspid valve or mitral valve where it is pumped through the semilunar valve to the large artery known as the aorta and from there to all parts of the body except the lungs.

7. Review-gross anatomy of the heart
Aorta
Separated L and R by Septum
4 chambers L &R atrium, L&R ventricles
Three layers of tissue-pericardium, myocardium and endocardium
Septum

8. Blood Vessels and Circulation
Fuel line and transportation network.
There are approximately 70,000 miles of blood vessels.
(almost 1/3 of the distance from the Earth to the Moon)
Arteries are the vessels that lead away from the heart; all have a pulse reflecting the rhythmical beating of the heart used to check rate, rhythm and condition of the arterial walls and downsize to arterials (heart to body).
Veins are thinner walled vessels compared to arteries. They move deoxygenated blood toward the heart from the tissues; they have valves that prevent the backflow of blood (back to heart).
Capillaries are the smallest vessels. They have singled cell walls that connect arterioles with venules and form the point of exchange for oxygen and nutrients into body cells and waste products coming from body cells.

9. Capillaries

10. Coronary Arteries and Veins

11. Coronary Arteries and Veins (cont’d)

12. Major Valves of the Heart
Tricuspid valve: also known as the AV valve (cusps are flaps of the valves): between right atrium and right ventricle.
We know blood flows into and out of chambers through valves. Valves get their names either by how they look, or where they lead to
Tricuspid-three edges

13. Major Valves of the Heart
Pulmonary semilunar valve: between right ventricle and pulmonary artery; allows blood to flow to the lungs.
Pulmonary semilunar-goes to the lungs and are half moon shaped

14. Major Valves of the Heart
Bicuspid or mitral valve: between left atrium and the left ventricle; allows blood to flow to the left ventricle
Bicuspid-two edges

15. Major Valves of the Heart
Aortic semilunar valve: between left atrium and aorta where blood exits out to the body; blood leaving the left ventricle passes through the aortic semilunar valve and into the systemic circuit by way of the ascending aorta.
Aortic semilunar-goes to the Aorta and are half moon shaped

16. Pathway of blood through the heart
Lets follow a drop of blood as it moves through the circulatory system

17. Pathway of blood through the heart
Superior Vena Cava
Pulmonary Semilunar Valve
Aorta
Pulmonary Arteries
Pulmonary Veins
Left Atrium
Right Atrium
Bicuspid Valve
Tricuspid Valve
Right Ventricle
Inferior Vena Cava
Right Ventricle
Aortic Semilunar Valve

18. Heart Sounds
Closure of valves associated with sounds “lub, dub, lub, dub”.
Lub: closure of the tricuspid and mitral valves at the beginning of systole.
Dub: closure of the aortic and pulmonary valves at the end of systole.
Murmur: abnormal heart sound caused by improper valve closure.

19. Cardiac Cycle
Cardiac cycle is controlled by the autonomic nervous system.
There are two phases of the heartbeat representing blood pressure:
Systole: contraction phase
Diastole: relaxation phase
The systole-diastole- cardiac cycle occurs between times per minute (over 100,000 times per day).
The heart pumps 3 ounces of blood with each contraction. This means that about 5 quarts are pumped per minute (75 gallons an hour and about 2000 gallons a day).
Autonomic-not consciously controlled by the person

20. Cardiac Cycle
ECG or EKG (electrocardiogram): the record used to detect electrical changes in heart muscle as the heart beats.
The P wave -indicates that the atria are contracting to pump out blood.  
the QRS complex-indicates that the ventricles are contracting to pump out blood.  Systole
The T wave- indicates the resting Diastole
Rarely you will find a U wave; also indicates resting

21. Blood Pressure systolic pressure/diastolic pressure.
Blood pressure: the force that blood exerts on arterial walls.
Measured using sphygmomanometer and stethoscope.
Usually expressed as a fraction:
systolic pressure/diastolic pressure.
Example: 120/80 mm Hg
Pulse pressure is difference between systolic and diastolic readings and tone of arterial walls (BP=120/80, then the Pulse Pressure =40)

22. Conduction System of the Heart
Nodal Cells
Sinoatrial node (SA node): pacemaker of the heart located in the upper wall of the right atrium.
Atrioventricular node (AV node): this sends the excitation wave to a bundle of specialized fibers called atrioventricular bundle or Bundle of His.
Conducting Cells
Bundle of His (pronounced “hiss”): helps form conduction myofibers that extend to ventricle walls and stimulate them to contract, beginning systole. A short rest period follows.
Bundle Branches-Separate the impulses to Left and Right ventricles
Purkinje fibers: Distribute SA impulses to contractile cells in the ventricle walls

23. Conducting System of the Heart
Bundle of His
Bundle Branches
Purkinje fibers

24. Conducting System of the Heart

25. Aging and the Cardiovascular System
Blood
Age related changes include:
Decreased hematocrit.
Constriction or blockage of peripheral veins by formation of
thrombus.
Pooling of blood in veins of lower legs due to ineffective valves.
Heart
Major related heart changes are:
Reduction in maximum cardiac output.
Changes in the activities of nodal and conducting cells.
Replacement of damaged cardiac cells by scar tissue.
Progressive changes in blood vessels that restrict coronary circulation.
The Blood Vessels
Age related changes in blood vessels:
Changes are often related to arteriosclerosis or atherosclerosis.
May lead to coronary artery disease.

26. Common Diseases and Disorders
Hypertension—high blood pressure; higher than 140/90.
Hypotension—low blood pressure; less than 90/60.
Myocarditis—inflammation of the heart muscle.
Mitral Stenosis—a condition of narrowing of the mitral valve.
Phlebolith—a calcification within a vein.
Thrombosis—a condition in which there is a blood clot within the system.
Tachycardia—fast heartbeat (>100 BPM).
Bradycardia—slow heartbeat (<60 BPM).

27. Common Diseases and Disorders
Ischemia—a condition in which there is a lack of blood supply to a part, caused by constriction or obstruction of a blood vessel.

28. Common Diseases and Disorders (cont’d)
Congestive Heart Failure (CHF): the heart is unable to pump the required amount of blood.
In U.S., this is primarily the result of high blood pressure and coronary artery disease.
Results in pulmonary edema.
Fatal if untreated.
Coronary Artery Disease (CAD): disease of the arteries surrounding the heart.
Atherosclerosis
thrombotic occlusion
ischemia
necrosis
infarction

29. Common Diseases and Disorders (cont’d)
Varicose
Veins

30. Laboratory Tests Lipid tests such as cholesterol and triglycerides.
Lipoprotein electrophoresis
Serum enzyme tests
Cardiac enzymes
Performed to determine cardiac damage in an acute myocardial infarction
The only TRUE way of telling of a previous MI (EKG won’t always show an inversion of a T wave or elevated ST segment.)

31. Common Diagnostic Tests
Angiogram: test used to determine size and shape of arteries, veins and organs.
Doppler ultrasound: Measurement of sound-wave echoes as they bounce off tissues and organs. Can assist in determining heart and blood vessel damage. Also called Echocardiogram (ECHO).

32. Common Diagnostic Tests (cont’d)
Cardiac catheterization: test used in diagnosis of heart disorders using a catheter inserted into an artery in the groin area and fed to the heart.

33. Common Diagnostic Tests (cont’d)
Electrocardiography (ECG, EKG) – graphic recording of the heart.
Holter monitoring: method of recording a patient’s portable EKG for 24 hours worn during all activities.
Stress tests: method of evaluating cardiovascular fitness utilizing a treadmill or ergo meter.

34. Treatment Procedures Treatment procedures
Cardioversion (defibrillation): Converting a cardiac arrhythmia (irregular heart action) to a normal sinus rhythm using a cardioverter (defibrillator) to give countershocks to the heart
Endarterectomy: The surgical removal of material that is wholly or partially obstructing blood flow in an artery
Extracorporeal circulation: Circulation of blood outside the body
Heart transplantation: Transfer a heart from one body to another
Thrombolytic therapy: The use of drugs that degrade blood clots in the treatment of acute myocardial infarction, pulmonary embolism, or stroke

35. Treatment Procedures
Coronary artery bypass graft (CABG): Open-heart surgery in which a shunt is created to permit blood to travel around the constriction of a coronary blood vessel

36. Treatment Procedures
Pacemaker

37. Questions What are the layers of the heart wall?
Name the valves of the heart.
What are the coronary vessels and what is their purpose?
Describe the pathway through the heart.
What is Myocarditis?
What is arrhythmia?