1. Structure and Function of the Cardiovascular and Lymphatic Systems Chapter 29 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

2. 2 Circulatory System  Heart  Right heart Pumps blood through the lungs (pulmonary circulation) Pumps blood through the lungs (pulmonary circulation)  Left heart Pumps blood through the systemic circulation Pumps blood through the systemic circulation

3. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Circulatory System

4. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Circulatory System  Heart  Mediastinum  Heart wall Pericardium Pericardium  Parietal and visceral  Pericardial cavity and fluid Myocardium Myocardium Endocardium Endocardium  Endothelium Multifunctional organ Multifunctional organ Essential to normal vascular physiology Essential to normal vascular physiology Dysfunction contributes to vascular disease Dysfunction contributes to vascular disease

5. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 5 The Heart Wall

6. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 6 The Chambers of the Heart  Right atrium  Left atrium  Right ventricle  Left ventricle  Thickness of each chamber depends on the pressure or resistance it must overcome to eject blood

7. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 7 The Chambers of the Heart

8. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 8 The Valves of the Heart  Atrioventricular valves  Tricuspid valve  Bicuspid valve  Semilunar valves  Pulmonic semilunar valve  Aortic semilunar valve

9. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 9 The Valves of the Heart

10. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 10 The Great Vessels  Superior and inferior venae cavae  Pulmonary artery (trunk)  Right and left pulmonary arteries  Pulmonary veins

11. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Blood Flow  Cardiac cycle  Diastole  Systole  Phases of the cardiac cycle  Atrial systole  Ventricular systole  Ventricular ejection (semilunar valves open)  Ventricular relaxation (closure of aortic valve)  Ventricular filling (opening of mitral valve)

12. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Blood Flow

13. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Normal Intracardiac Pressures  A wave  V wave  X descent  Y descent  C wave

14. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Normal Intracardiac Pressures

15. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Normal Intracardiac Pressures

16. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 16 The Coronary Vessels  Right coronary artery  Conus  Right marginal branch  Posterior descending branch  Left coronary artery  Left anterior descending artery  Circumflex artery

17. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 17 The Coronary Vessels  Collateral arteries  Diabetes impedes collateral formation  Increased production of antiangiogenic factors (endostatin and angiostatin)  Presence of an effective collateral system is protective

18. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 18 The Coronary Vessels  Coronary capillaries  Coronary veins  Coronary sinus  Great cardiac vein  Posterior vein of the left ventricle  Coronary lymphatic vessels

19. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 19 The Coronary Vessels

20. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Structures That Control Heart Action  Cardiac action potentials  Conduction system  Sinoatrial node (SA) Intranodal pathways Intranodal pathways  Atrioventricular node (AV)  Bundle of His (AV bundle)  Right and left bundle branches  Purkinje fibers

21. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Conduction System of the Heart

22. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Structures That Control Heart Action  Cardiac excitation  Propagation of cardiac action potentials  Depolarization  Repolarization  Electocardiogram  Automaticity  Rhythmicity

23. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Electrocardiogram  Sum of all cardiac action potentials  P wave: atrial depolarization  PR interval: time from the onset of atrial activation to the onset of ventricular activation Time necessary to travel from the sinus node through the atrium, AV node, and His-Purkinje system to activate ventricular myocardial cells Time necessary to travel from the sinus node through the atrium, AV node, and His-Purkinje system to activate ventricular myocardial cells  QRS complex: sum of all ventricular depolarizations  ST interval: ventricular myocardium depolarized  QT interval: “electrical systole” of the ventricles Varies inversely with the heart rate Varies inversely with the heart rate

24. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Structures That Control Heart Action  Cardiac innervation  Sympathetic nerves  Parasympathetic nerves  Adrenergic receptor function  α- or β-adrenergic receptors  Norepinephrine or epinephrine

25. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Adrenergic Receptors  β 1 + epinephrine = impact rate and strength  β 2 + epinephrine = dilation of arterioles  α 1 + norepinephrine = vasoconstriction  α 2 + norepinephrine inhibits norepinephrine, allowing vasodilation

26. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Myocardial Cells  Nearly identical to skeletal muscle cells  Intercalated disks  Actin, myosin, and the troponin-tropomyosin complex  Troponin T, I, and C  Myocardial metabolism  Myocardial oxygen consumption

27. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Myocardial Contraction and Relaxation

28. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Cardiac Performance  Preload  Afterload  Frank-Starling law of the heart  End-diastolic volume  Laplace’s law

29. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Afterload  EDV-ESV = stroke volume, blood moved with each beat  SV/EDV = EFx (ejection fraction)

30. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Frank-Starling Law of the Heart  Myocardial stretch determines force of myocardial contraction  More stretch = increased force of contraction  Major way right and left ventricles maintain equal minute outputs despite stroke (beat) output variation

31. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Laplace’s Law  Contractile force within a chamber depends on the radius of the chamber and the thickness of its wall  Smaller chambers and thicker chamber walls = increased contraction force  In ventricular dilation the force needed to maintain ventricular pressure lessens available contractile force

32. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 32 Cardiac Performance  Heart rate  Cardiovascular control center Cardioexcitatory and cardioinhibitory centers Cardioexcitatory and cardioinhibitory centers  Neural reflexes Bainbridge and baroreceptor reflexes Bainbridge and baroreceptor reflexes  Atrial receptors  Hormones and biochemicals

33. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Cardiac Performance  Myocardial contractility  Stroke volume  Inotropic agents  Oxygen and carbon dioxide levels  Cardiac output  Volume of blood flowing through either the systemic or pulmonary circuit in liters per minute

34. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Cardiac Output

35. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 35 Systemic Circulation  Arteries  Arterioles  Capillaries  Venules  Veins

36. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Structure of Blood Vessels  Lumen  Tunica intima  Tunica media  Tunica externa (adventitia)

37. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 37 Endothelium

38. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 38 Structure of Blood Vessels

39. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 39 Factors Affecting Blood Flow  Poiseuille’s law  Pressure  Force exerted on a liquid per unit area  Resistance  Opposition to force  Diameter and length of the blood vessels contribute to resistance

40. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 40 Factors Affecting Blood Flow  Neural control of total peripheral resistance  Change in diameter of the vessels  Baroreceptors  Arterial chemoreceptors  Hormones  Epinephrine, norepinephrine, antidiuretic hormone, renin-angiotensin-aldosterone system, natriuretic peptides, adrenomedullin, insulin, and others

41. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Baroreceptor and Chemoreceptors

42. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 42 Factors Affecting Blood Flow  Velocity  Laminar vs. turbulent flow  Vascular compliance

43. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 43 Laminar vs. Turbulent Flow

44. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 44 Regulation of Blood Pressure  Arterial pressure  Mean arterial pressure (MAP)  Effects of cardiac output  Effects of total peripheral resistance  Effects of hyperemia  Effects of hormones Epinephrine and norepinephrine Epinephrine and norepinephrine Antidiuretic hormone, renin-angiotensin-aldosterone system, and natriuretic peptides Antidiuretic hormone, renin-angiotensin-aldosterone system, and natriuretic peptides

45. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 45 Regulation of Blood Pressure  Adrenomedullin  Insulin  Venous pressure

46. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 46 Regulation of Coronary Circulation  Coronary perfusion pressure  Autoregulation  Autonomic regulation

47. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 47 Lymphatic System  Special vascular system that picks up excess fluid and returns it to the bloodstream  Lymphatic fluid  Lymphatic veins and venules  Right lymphatic duct  Thoracic duct  Afferent and efferent lymphatic vessels

48. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 48 Lymphatic System

49. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 49 Tests of Cardiovascular Function  Noninvasive assessments  Sensorium of the individual  Mucous membrane color  Manually palpated pulse  Auscultation of heart sounds  Cardiography

50. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 50 Tests of Cardiovascular Function  Noninvasive assessments  Pulse tracing  Magnetic resonance imaging  Doppler studies  Stress testing  Chest x-ray examinations

51. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 51 Tests of Cardiovascular Function  Invasive assessments  X-ray films with barium  Nuclear imaging with radiolabeled pharmaceuticals Hot spot imaging Hot spot imaging Cold spot imaging Cold spot imaging  Tomographic studies

52. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 52 Tests of Cardiovascular Function  Invasive assessments  Atrioventricular bundle electrocardiography  Cardiac catheterization  Coronary angiography

53. Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 53 Aging and the Cardiovascular System  Arteriosclerosis  Cross-linking of collagen  Increased collagen  Changes in elastin  Atherosclerosis