Lecture Exam 2: Heart & Blood Vessels

THE HEART
I. INTRODUCTION
A.The heart is the center of the cardiovascular system..
B. The study of the normal heart and diseases associated with it is known as cardiology.
II. LOCATION AND SIZE OF THE HEART
A. The heart is situated between the lungs in the mediastinum
B. About two-thirds of its mass is to the left of the midline.
C. The heart is about 12 cm long, 9 cm wide, and 6 cm thick.
III. PERICARDIUM
A.The heart is enclosed and held in place by the pericardium.
1. The pericardium consists of an outer fibrous pericardium and an inner
serous pericardium
2. The serous pericardium is composed of a parietal layer and a visceral
layer.
3. Between the parietal and visceral layers of the serous pericardium is the
pericardial cavity,
a potential space filled with pericardial fluid that reduces friction
between the two membranes.
B. An inflammation of the pericardium is known as pericarditis. Associated bleeding into
the pericardial cavity compresses the heart (cardiac tamponade) and is potentially
lethal.
IV. HEART WALL
A. The wall of the heart has three layers: epicardium, myocardium, and endocardium
B. The epicardium consists of mesothelium and connective tissue, the myocardium is
composed of cardiac muscle tissue, and the endocardium consists of endothelium and
connective tissue
V. CHAMBERS OF THE HEART
A. The chambers of the heart include two upper atria and two lower ventricles
B. An interatrial septum separates the atria; an interventricular septum separates the
ventricles.
VI. BLOOD FLOW THROUGH THE HEART
A. Blood flows through the heart from the superior and inferior venae cavae and the
coronary sinus to the right atrium, through the tricuspid valve to the right
ventricle,through the pulmonary trunk and pulmonary arteries to the lungs, through
the pulmonary veins into the left atrium, through the bicuspid valve to the left
ventricle, and out through the aorta).
B. Divisions of the aorta are the ascending aorta, arch of the aorta, thoracic aorta,
and abdominal aorta.
VII. VALVES OF THE HEART
A.Valves, composed of dense connective tissue covered by endothelium, prevent
backflow of blood in the heart.
1. Atrioventricular (AV) valves, between the atria and their ventricles, are the
tricuspid valve on the right side of the heart and the bicuspid (mitral) valve on the
left
2. The chordae tendineae and their papillary muscles keep the flaps of the valves
pointing in the direction of the blood flow and stop blood from backing into the
atria
3. Semilunar valves prevent blood from flowing back into the heart as it leaves
the heart for the lungs (pulmonary semilunar valve) or for the rest of the body
(aortic semilunar valve)
B. Rheumatic fever is precipitated by infection with group A, 13-hemolytic strains of
Streptococcus pyogenes bacteria. The ultimate result is damage to valves of the
 heart, most commonly the bicuspid and aortic semilunar valves.
VIII. HEART BLOOD SUPPLY
A.The flow of blood through the many vessels that pierce the myocardium of the heart
is called the coronary (cardiac) circulation; it delivers oxygenated blood and nutrients
to the myocardium and removes carbon dioxide and wastes from it.
B. The principal arteries, branching from the ascending aorta and carrying
oxygenated blood, are the right and left coronary arteries; deoxygenated blood
returns to the right atrium primarily via the principal vein, the coronary sinus
C. Most heart problems result from faulty coronary circulation due to blood clots, fatty
atherosclerotic plaques, or spasms of the smooth muscle in coronary artery walls.
Complications of this system include angina pectoris (severe pain that accompanies
reduced blood flow, or ischemia, to the myocardium) and myocardial infarction (MI,
or heart attack, in which there is death of an area of the myocardium due to an
interruption of the blood supply; it may result from a thrombus or embolus).
IX. CONDUCTION SYSTEM AND PACEMAKER
A.The conduction system consists of tissue specialized for generation and conduction of
spontaneous action potentials that stimulate the cardiac muscle fibers (cells) to
contract.
B. Components of this system are the sinoatrial (SA) node (pacemaker),
atrioventricular (AV) node, atrioventricular (AV) bundle (bundle of His), right and left
bundle branches, and the conduction myofibers (Purkinje fibers)
C. Signals from the autonomic nervous system and hormones, such as epinephrine, do
modify the heartbeat (in terms of rate and strength of contraction), but they do not
establish the fundamental rhythm.
D.An artificial pacemaker may be used to restore cardiac rhythm due to disruption of
some component of the conduction system.
X. ELECTROCARDIOGRAM
A.Impulse conduction through the heart generates electrical currents that can be
detected at the surface of the body. A recording of the electrical changes that
accompany each cardiac cycle (heartbeat) is called an electrocardiogram (ECG or
EKG).
B. A normal ECG consists of a P wave (atrial depolarization -- spread of impulse
from SA node over atria), QRS complex (ventricular depolarization -- spread of
impulse through ventricles), and T wave (ventricular repolarization).
C. The P-Q (PR) interval represents the conduction time from the beginning of atrial
excitation to the beginning of ventricular excitation.
D.The S-T segment represents the time when ventricular contractile fibers are fully
depolarized, during the plateau phase of the impulse.
E. The ECG is invaluable in diagnosing abnormal cardiac rhythms and conduction patterns
and following the course of recovery from a heart attack.
XI. CARDIAC CYCLE
A. A cardiac cycle consists of the systole (contraction) and diastole (relaxation) of both
atria, rapidly followed by the systole and diastole of both ventricles
B. With an average heart rate of 75 beats/mm, a complete cardiac cycle requires 0.8
sec
C. The act of listening to sounds within the body is called auscultation, and it is usually
done with a stethoscope. The sound of a heartbeat comes primarily from the
turbulence in blood flow caused by the closure of the valves, not from the
contraction of the heart muscle
1.The first heart sound (S1 -- lubb) is created by blood turbulence associated with
the closing of the atrioventricular valves soon after ventricular systole begins.
2.The second heart sound (S2 -- dupp) represents the closing of the semilunar valves
close to the end of ventricular systole.
3.A heart murmur is an abnormal sound that consists of a flow noise that is heard
before, between, or after the Iubb-dupp or that may mask the normal sounds
entirely. Some murmurs are caused by turbulent blood flow around valves due to
abnormal anatomy or increased volume of flow.
a. Not all murmurs are abnormal or symptomatic, but most indicate a valve
disorder.
b. Among the valvular disorders that may contribute to murmurs are mitral
 stenosis, mitral insufficiency, aortic stenosis, aortic insufficiency, and mitral
valve prolapse (MVP).
XII. CARDIAC OUTPUT
A.Since the body’s need for oxygen varies with the level of activity, the heart’s ability
to discharge oxygen-carrying blood must also be variable.
B. Cardiac output (CO) is the amount of blood ejected by the left ventricle (or right
ventricle) into the aorta (or pulmonary trunk) per minute. It is calculated as follows:
CO = stroke volume x beats per minute.
1.Stroke volume (SV) is the amount of blood ejected by the ventricles during each
systole. Stroke volume depends on three factors:
a. Preload or (End Diastolic Volume) this is the “stretch” that is put on the
ventricles as they fill with blood. The more blood that enters the ventricles the
more they are stretched and this causes them to contract with more force. The
more stretch the greater the force of contraction will be.
b. Contractility is the strength or force of contraction
c. Afterload is the amount of pressure that is needed to push open the semilunar
valves of
the heart (aortic and pulmonary). An increase in afterload pressure will cause
stroke volume
to decrease ex. arthrosclerosis
According to the Frank-Starling law of the heart, a greater preload (stretch) on
cardiac muscle fibers just before they contract increases their force of
contraction during systole.
C. Cardiac reserve is the ratio between the maximum cardiac output a person can
achieve and the
cardiac output at rest.
D. Congestive heart failure (CHF) results when the heart cannot supply the oxygen
demands of the
body; it is characterized by diminished blood flow to the various tissues of the
body and
by accumulation of excess blood in the various organs because the heart is
unable to pump out
the blood returned to it by the great veins. Causes include chronic hypertension
and
myocardial infarction (heart attack).
2. Cardiac output depends on heart rate as well as stroke volume. Changing heart rate is
the body’s principal mechanism of short-term control over cardiac output and blood
pressure.
a. Nervous system control of the cardiovascular system stems from the
cardiovascular center in the medulla
1. Sympathetic impulses increase heart rate and force of contraction;
parasympathetic impulses decrease heart rate.
2. Baroreceptors (pressure receptors) are nerve cells that respond to changes in
blood pressure and relay the information to the cardiovascular center;
important baroreceptors are located in the arch of the aorta and carotid
arteries
b. Heart rate is also affected by hormones (epinephrine, norepinephrine, thyroid
hormones), ions (Na+, K+, Ca2+), age, gender, physical fitness, and temperature.
Blood Vessels
I. ANATOMY OF BLOOD VESSELS
A. Arteries
1. Arteries carry blood away from the heart to the tissues.
a. The wall of an artery consists of a tunica intema, tunica media (which maintains
elasticity
and contractility), and tunica externa
b. Large arteries are referred to as elastic (conducting) arteries, and medium-
sized arteries
 are called muscular (distributing) arteries, small arteries – arterioles( Organ
arteries) control
routes of blood flow and metarterioles – connect arterioles to capillaries
2. Many arteries anastomose -- the distal ends of two or more vessels unite
a. Anastomoses between arteries provide alternate routes for blood to reach a
tissue or organ.
b. Thus, if a vessel is blocked by disease, injury, or surgery, circulation to a part
of the body is
not necessarily stopped.
1.An alternate blood route from an anastomosis is called collateral circulation.
2.Arteries that do not anastomose are called end arteries. Occlusion of an end
artery interrupts the blood supply to a whole segment of an organ, producing
necrosis (death) of that segment.
B.Arterioles
1. Arterioles are very small, almost microscopic, arteries that deliver blood to
capillaries
2. Through vasoconstriction (decrease in the size of the lumen of a blood vessel) and
vasodilation (increase in the size of the lumen of a blood vessel), arterioles assume
a key role in regulating blood flow from arteries into capillaries and in altering
arterial blood pressure.
C.Capillaries
1. Capillaries are microscopic blood vessels through which materials are exchanged
between blood and tissue cells.
a. They usually connect arterioles and venules.
b. Capillary walls are composed of only a single layer of cells (endothelium) and a
basement
membrane
2. Capillaries branch to form an extensive capillary network throughout the tissue.
This network
increases the surface area, allowing a rapid exchange of large quantities of
materials.
a. The flow of blood through capillaries is regulated by vessels with smooth muscle
in their
walls
b. Rings of smooth muscle fibers (cells) called precapillary sphincters regulate blood
flow
through true capillaries.
c. Some capillaries are continuous, whereas others are fenestrated
d. Microscopic blood vessels in organs such as the liver, spleen, and bone marrow
are called sinusoids they are wider than capillaries, more tortuous, and
specialized for the functions of the specific organs.
D. Venules
1. Venules are small vessels that are formed from the union of several capillaries;
venules merge to form veins.
2. They drain blood from capillaries into veins.
E. Veins
1. Veins consist of the same three tunics as arteries but have a thinner tunics
interna and media
and a thicker tunica externa; they have less elastic tissue and smooth muscle and
are therefore
thinner-walled than arteries.
a. They contain valves to prevent backflow of blood.
b. Weak valves can lead to varicose veins.
2. Vascular (venous) sinuses are veins with very thin walls with no smooth muscle to
alter their
diameters. Examples are the brain’s superior sagittal sinus and the coronary sinus
of the heart.
G. Blood Distribution
1. The volume of blood in various parts of the cardiovascular system varies
considerably.
2. At rest, the largest portion of the blood volume is in systemic veins and venules,
collectively called blood reservoirs.
a. They store blood and, through venous vasoconstriction, can move blood to other
parts of the body if the need arises.
b. In cases of hemorrhage, when blood pressure and volume decrease,
vasoconstriction of veins in venous reservoirs helps to compensate for the blood
loss.
3. The principal reservoirs are the veins of the abdominal organs (liver and spleen)
and skin.
II. HEMODYNAMICS: PHYSIOLOGY OF CIRCULATION
A. Velocity of Blood Flow
1.The volume of blood that flows through any tissue in a given period of time is blood
flow.
2. The velocity of blood flow is inversely related to the cross-sectional area of blood
vessels; blood flows most slowly where cross-sectional area is greatest.
3. Blood flow decreases from the aorta to arteries to capillaries and increases as it
returns to the heart.
B. Volume of Blood Flow
1.Blood flow is determined by blood pressure, Cardiac output and resistance.
a. Blood pressure
b. Cardiac output
c. resistance
2. Blood pressure (BP) is the pressure exerted on the walls of a blood vessel; in
clinical use, BP refers to pressure in arteries. (As blood leaves the aorta and flows
through systemic circulation, its pressure progressively falls to 0 mm Hg by the
time it reaches the right atrium)
Factors that affect blood pressure include:
a. Cardiac Output
b. Blood volume = BP
c. Viscosity
d. Resistance
e. Elasticity reduces BP – the more elastic our blood vessels are the lower the BP
of that individual. Persons with rigid blood vessels will have higher BP readings.
3. Vascular resistance refers to the opposition to blood flow as a result of friction
between blood
and the walls of the blood vessels. Resistance depends on:
a. blood viscosity
b. blood vessel length
c. blood vessel size
Laminar flow is the normal way that blood flows through our blood vessels.  It is
characterized by concentric layers of blood moving in parallel down the length of a
blood vessel. The highest velocity is found in the center of the vessel. The lowest
velocity is found along the vessel wall.
Systemic vascular resistance (SVR) (also known as total peripheral resistance)
refers to all of the vascular resistances offered by systemic blood vessels; most
resistance is in arterioles, capillaries, and venules due to their small diameters. *
The major function of arterioles is to control SVR, BP and Blood flow.
C. Capillary Exchange
1. Substances enter and leave capillaries by diffusion, vesicular transport
(endocytosis and exocytosis), and bulk flow (filtration and absorption)
2.The movement of water and dissolved substances (except proteins) through
capillaries is dependent upon hydrostatic and osmotic pressures.
a. The near equilibrium at the arterial and venous ends of a capillary by which
 fluids exit and enter is called Starling’s law of the capillaries .
b. Occasionally, the balance of filtration and reabsorption between interstitial fluid
and plasma is disrupted, allowing an abnormal increase in interstitial fluid called
edema. Edema may be caused by several factors:
1. Increased blood hydrostatic pressure in capillaries due to an increase in
venous pressure.
2. Decreased concentration of plasma proteins that lower blood colloid osmotic
pressure.
3. Increased permeability of capillaries, allowing greater amounts of plasma
proteins to leave the blood and enter tissue fluid.
4. Increased extracellular fluid volume as a result of fluid retention.
5. Blockage of lymphatic vessels postoperatively or due to filarial worm infection.
D. Venous Return
1.A number of factors aid venous return, the volume of blood flowing back to the
heart from the systemic veins, by increasing the magnitude of the pressure
gradient between the venules and the right atrium.
2. Blood return to the heart is maintained by several factors, including skeletal
muscular contractions, valves in veins (especially in the extremities), and pressure
changes associated with breathing.
III. CONTROL OF BLOOD PRESSURE AND BLOOD FLOW
A. Cardiovascular Center
1.The cardiovascular (CV) center is a group of neurons in the medulla that regulates
heart rate, contractility, and blood vessel diameter.
2. The CV center receives input from higher brain regions and sensory receptors
(baroreceptors and chemoreceptors)
3. Output from the CV center flows along sympathetic and parasympathetic
fibers.
a.Sympathetic impulses along cardioaccelerator nerves increase heart rate and
contractility.
b.Parasympathetic impulses along vagus (X) nerves decrease heart rate.
B. Neural Regulation
1.Baroreceptors (pressoreceptors) are important pressure-sensitive sensory neurons
that monitor stretching of the walls of blood vessels and the atria.
a. The cardiac sinus reflex is concerned with maintaining normal blood pressure in
the brain and is initiated by baroreceptors in the wall of the carotid sinus.
b. The aortic reflex is concerned with general systemic blood pressure and is
initiated by
baroreceptors in the wall of the arch of the aorta or attached to the arch.
c. If blood pressure falls, the baroreceptor reflexes accelerate heart rate,
increase force of
contraction, and promote vasoconstriction.
d. The right heart (atrial) reflex responds to increases in venous blood pressure
and is initiated
by baroreceptors in the right atrium and venae cavae.
2.Receptors sensitive to chemicals are called chemoreceptors.
a. They monitor blood levels of oxygen, carbon dioxide, and hydrogen ion
concentration.
3.Several hormones affect blood pressure and flow by acting on the heart, altering
blood vessel diameter, or adjusting the total blood volume.
a. Among the hormones that help regulate blood pressure are epinephrine,
norepinephrine (NE), antidiuretic hormone (ADH), angiotensin II, atrial
natriuretic peptide (ANP), histamine, and kinins.
C. Autoregulation
1.Autoregulation refers to local, automatic adjustments of blood flow in a given
region to match the particular needs of the tissue.
2.In most body tissues, oxygen is the principal, though not direct, stimulus for
autoregulation.
D. Syncope, or faint, refers to a sudden, temporary loss of consciousness followed by
spontaneous recovery. It is most commonly due to cerebral ischemia (lack of
 sufficient blood flow).
IV. SHOCK AND HOMEOSTASIS
A. Shock is an inadequate cardiac output that results in failure of the cardiovascular
system to deliver adequate amounts of oxygen and nutrients to meet the metabolic
needs of body cells. As a result, cellular membranes dysfunction, cellular metabolism
is abnormal, and cellular death may eventually occur without proper treatment.
B. Signs and symptoms of shock include clammy, cool, pale skin; tachycardia; weak,
rapid pulse; sweating; hypotension (systemic pressure < 90 mm Hg); altered mental
status; decreased urinary output; thirst; and acidosis.
C.Stages of shock are all characterized by inadequate perfusion of tissues.
1.The stages of shock are described in the textbook as they apply to hypovolemic
shock, since it has been studied so extensively. Hypovolemic shock refers to
decreased blood volume resulting from loss of blood or plasma due to acute
hemorrhage or excessive fluid loss (as in excess vomiting, diarrhea, sweating,
dehydration, urine production, and burns).
2.The development of shock occurs in three principal stages, which merge with one
another.
a. Stage I is compensated (nonprogressive) shock, in which negative feedback
systems restore homeostasis.
1. If the initiating cause does not get any worse, a full recovery follows.
2. Compensatory adjustments include activation of the sympathetic division of
the ANS, the renin-angiotensin pathway, release of antidiuretic hormone
(ADH), and release of vasodilator factors in response to hypoxia
b. Stage II is decompensated (progressive) shock, in which positive feedback cycles
intensify the shock and immediate medical intervention is required.
1. It occurs when there has been a reduction in blood volume of 15-25%.
2. Among the positive feedback cycles that contribute to decreased cardiac
output and blood pressure are depression of cardiac activity, depression of
vasoconstriction, increased permeability of capillaries, intravascular clotting,
cellular destruction, and acidosis.
c. Stage III is irreversible shock, in which there is rapid deterioration of the
cardiovascular system than cannot be helped by compensatory mechanisms or
medical intervention.
V. CHECKING CIRCULATION
A. Pulse
1. Pulse is the alternate expansion and elastic recoil of an artery wall with each
heartbeat. It may
be felt in any artery that lies near the surface or over a hard tissue, and is
strongest in the
arteries closest to the heart; the radial artery is most commonly used to feel the
pulse
2. A normal resting pulse (heart) rate is between 70 and 80 beats per minute.
a. Tachycardia means a rapid resting heart or pulse rate (> 100 beats/mm).
b. Bradycardia indicates a slow resting heart or pulse rate (<60 beats/mm).
B. Measurement of Blood Pressure (BP)
1.Blood pressure is the pressure exerted by blood on the wall of an artery when the
left ventricle undergoes systole and then diastole. It is measured by the use of a
sphygmomanometer, usually in one of the brachial arteries.
a. Systolic blood pressure (SBP) is the force of blood recorded during ventricular
contraction
b. Diastolic blood pressure (DBP) is the force of blood recorded during ventricular
relaxation.
c. The various sounds that are heard while taking blood pressure are called
Korotkoff sounds.
d. The normal blood pressure of a young adult male is 120180 mm Hg (8-10 mm Hg
less in a young adult female). The range of average values varies with many
factors.
2.Pulse pressure (PP) is the difference between systolic and diastolic pressure. It
normally is about 40 mm Hg and provides information about the condition of the
arteries.