Chapt15 cardiovascular

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Chapt15 cardiovascular

  1. 1. BIOL 2074: Anatomy & Physiology II Chapter 15 Cardiovascular System Brenda Holmes MSN/ED, RN Associate Professor Biology South Arkansas Community College Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display
  2. 2. 15.1: Introduction <ul><li>The heart pumps 7,000 liters of blood through the body each day </li></ul><ul><li>The heart contracts 2.5 billion times in an average lifetime </li></ul><ul><li>The heart and all blood vessels make up the cardiovascular system </li></ul><ul><li>The blood vessels make up two circuits: </li></ul><ul><ul><li>Pulmonary circuit </li></ul></ul><ul><ul><li>Systemic circuit </li></ul></ul>
  3. 3. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Alveolus Oxygenated blood Deoxygenated blood CO 2 CO 2 CO 2 CO 2 CO 2 CO 2 O 2 O 2 O 2 O 2 O 2 O 2 O 2 O 2 CO 2 CO 2 Right atrium Right ventricle Left atrium Left ventricle Systemic circuit delivers oxygen to all body cells and carries away wastes. Oxygenated blood pumped to all body tissues via aorta Deoxygenated blood pumped to lungs via pulmonary arteries Pulmonary circuit eliminates carbon dioxide via the lungs and oxygenates the blood. Oxygenated blood returns to heart via pulmonary veins Deoxygenated blood returns to heart via venae cavae
  4. 4. 15.2: Structure of the Heart <ul><li>The heart is a hollow, cone-shaped, muscular pump </li></ul><ul><li>There are four chambers: </li></ul><ul><ul><li>Two atria (for blood storage) </li></ul></ul><ul><ul><li>Two ventricles (one low pressure pump and one high pressure pump) </li></ul></ul>
  5. 5. Size and Location of the Heart Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 0 1 2 3 4 5 cm © McGraw-Hill Companies, Inc./Photo and dissection by Christine Eckel <ul><li>The heart size varies with body size </li></ul><ul><li>The heart lies in the thoracic cavity </li></ul><ul><li>The average size of the heart is: </li></ul><ul><ul><li>14 cm long </li></ul></ul><ul><ul><li>9 cm wide </li></ul></ul><ul><li>The heart is: </li></ul><ul><ul><li>Posterior to the sternum </li></ul></ul><ul><ul><li>Medial to the lungs </li></ul></ul><ul><ul><li>Anterior to the vertebral column </li></ul></ul><ul><ul><li>The base lies beneath the 2 nd rib </li></ul></ul><ul><ul><li>The apex at the 5 th intercostal space </li></ul></ul><ul><ul><li>It lays just above the diaphragm </li></ul></ul>
  6. 6. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Diaphragm Base of heart Apex of heart Heart Sternum
  7. 7. Coverings of the Heart <ul><li>The coverings of the heart include the pericardium: </li></ul><ul><ul><li>Fibrous pericardium </li></ul></ul><ul><ul><li>Visceral pericardium </li></ul></ul><ul><ul><li>Parietal pericardium </li></ul></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Auricle of right atrium Right ventricle Pericardial cavity Left ventricle Pulmonary trunk Auricle of left atrium Fibrous pericardium Aorta Right lung Left lung Diaphragm Superior vena cava Anterior interventricular sulcus Heart (covered by visceral pericardium) Cut edge of parietal pericardium
  8. 8. Wall of the Heart Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Endocardium Myocardium Epicardium (visceral pericardium) Pericardial cavity Parietal pericardium Fibrous pericardium Coronary blood vessel <ul><li>The heart wall has three distinct layers: </li></ul><ul><ul><li>Epicardium (outer layer) </li></ul></ul><ul><ul><li>Myocardium (middle layer) </li></ul></ul><ul><ul><li>Endocardium (inner layer) </li></ul></ul>
  9. 9.
  10. 10. Heart Chambers and Valves <ul><li>The heart is divided into four chambers: </li></ul><ul><ul><li>Right atrium: </li></ul></ul><ul><ul><ul><li>Receives blood from the: </li></ul></ul></ul><ul><ul><ul><ul><li>Inferior vena cava </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Superior vena cava </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Coronary sinus </li></ul></ul></ul></ul><ul><ul><li>Right ventricle </li></ul></ul><ul><ul><ul><li>Receives blood from the right atrium </li></ul></ul></ul><ul><ul><li>Left atrium </li></ul></ul><ul><ul><ul><li>Receives blood from the pulmonary veins </li></ul></ul></ul><ul><ul><li>Left ventricle </li></ul></ul><ul><ul><ul><li>Receives blood from the left atrium </li></ul></ul></ul>
  11. 11.
  12. 12. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Superior vena cava Aortic valve Right atrium Inferior vena cava (b) (c) Right ventricle Tricuspid valve Left ventricle Papillary muscle Chordae tendineae Left atrium Pulmonary trunk Aorta Superior vena cava Pulmonary valve Right atrium Inferior vena cava (a) Right ventricle Tricuspid valve Left ventricle Papillary muscle Chordae tendineae Mitral (bicuspid) valve Left atrium Pulmonary trunk Aorta Right pulmonary artery Right pulmonary veins Left pulmonary artery Left pulmonary veins Interventricular septum Right pulmonary artery Right pulmonary veins Opening of coronary sinus Left pulmonary artery Left pulmonary veins Mitral (bicuspid) valve Interventricular septum c: © The McGraw-Hill Companies, Inc.
  13. 13. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Right atrium Cusps of tricuspid valve Chordae tendineae Interventricular septum Papillary muscles Muscular ridges © McGraw-Hill Higher Education, Inc./University of Michigan Biomedical Communications Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. © McGraw-Hill Higher Education, Inc./University of Michigan Biomedical Communications
  14. 14. Skeleton of the Heart <ul><li>The fibrous rings, together with other masses of dense connective tissue in the portion of the septum between the ventricles (interventricular septum), constitute the skeleton of the heart </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Fibrous skeleton Mitral valve Posterior Opening of left coronary artery Aortic valve Tricuspid valve Pulmonary valve
  15. 15. Path of Blood Through the Heart Tissue cells Tissue cells Alveolus Alveolus Left atrium Mitral valve Aortic valve Left ventricle Right atrium Tricuspid valve Pulmonary valve Inferior vena cava Right ventricle Aorta O 2 CO 2 O 2 O 2 CO 2 CO 2 O 2 CO 2 Systemic capillaries Superior vena cava Alveolar capillaries Systemic capillaries Pulmonary veins Alveolar capillaries Pulmonary artery Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  16. 16. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Tricuspid valve Right atrium Right ventricle Pulmonary trunk Pulmonary arteries Alveolar capillaries (lungs) Pulmonary veins Left atrium Left ventricle Aorta Blood to systemic circuit Pulmonary valve Mitral valve Aortic valve Venae cavae and coronary sinus Blood from systemic circuit
  17. 17. Blood Supply to the Heart <ul><li>The left and right coronary arteries supply blood to the tissues of the heart </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Aorta Cardiac veins Coronary sinus Right atrium Right coronary artery Left coronary artery Posterior interventricular artery Marginal artery Circumflex artery Anterior interventricular artery Myocardial capillaries in ventricular walls Myocardial capillaries in ventricular walls Myocardial capillaries in walls of right atrium and right ventricle Myocardial capillaries in walls of left atrium and left ventricle
  18. 18. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Aorta Part of aorta removed Aortic valve cusps Right coronary artery Opening of left coronary artery
  19. 19. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Aorta Pulmonary trunk Left pulmonary artery Left pulmonary veins Left auricle Left coronary artery Great cardiac vein Left ventricle Apex of the heart Superior vena cava Right auricle Inferior vena cava Small cardiac vein Anterior cardiac vein Right ventricle (a) Left pulmonary artery Aorta Left auricle Circumflex artery Cardiac vein Left ventricle Apex of the heart Superior vena cava Left atrium Right atrium Inferior vena cava Coronary sinus Middle cardiac vein Right ventricle (b) Right pulmonary artery Right pulmonary veins Right coronary artery Anterior interventricular artery (left anterior descending artery) Left pulmonary veins Right pulmonary artery Right pulmonary veins Posterior interventricular artery
  20. 20. 15.3: Heart Actions <ul><li>The heart chambers function in coordinated fashion </li></ul><ul><li>Heart actions are regulated so that atria contract (atrial systole) while ventricles relax (ventricular diastole); followed by ventricles contract (ventricular systole) while atria relax (atrial diastole) </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. (a) (b) Atrial systole LA LV RV RA Atrial diastole Aortic valve open Ventricular systole Tricuspid and mitral valves closed Ventricular diastole Pulmonary valve open Aortic valve closed Pulmonary valve closed Tricuspid and mitral valves open
  21. 21. Cardiac Cycle <ul><li>During a cardiac cycle, the pressure in the heart chambers rise and falls </li></ul><ul><li>In atrial systole and ventricular diastole: </li></ul><ul><ul><li>Blood flows passively into the ventricles </li></ul></ul><ul><ul><li>The remaining 30% of blood is pushed into the ventricles </li></ul></ul><ul><ul><li>The A-V valves open and the semilunar valves close </li></ul></ul><ul><ul><li>The ventricles relax </li></ul></ul><ul><ul><li>This causes an increase in ventricular pressure </li></ul></ul><ul><li>In ventricular systole and atrial diastole: </li></ul><ul><ul><li>The A-V valves close </li></ul></ul><ul><ul><li>The chordae tendinae prevent the cusps of the valves from bulging too far into the atria </li></ul></ul><ul><ul><li>The atria relax </li></ul></ul><ul><ul><li>The blood flows into atria </li></ul></ul><ul><ul><li>The ventricular pressure increases and opens the semilunar valves </li></ul></ul><ul><ul><li>The blood flows into pulmonary trunk and aorta </li></ul></ul>
  22. 22. Heart Sounds <ul><li>A heart beat through a stethoscope sounds like “lubb-dupp” </li></ul><ul><li>The “lubb” </li></ul><ul><ul><li>The first heart sound </li></ul></ul><ul><ul><li>It occurs during ventricular systole </li></ul></ul><ul><ul><li>The A-V valves are closing </li></ul></ul><ul><li>The “dupp” </li></ul><ul><ul><li>The second heart sound </li></ul></ul><ul><ul><li>It occurs during ventricular diastole </li></ul></ul><ul><ul><li>The pulmonary and aortic semilunar valves are closing </li></ul></ul><ul><ul><li>A murmur – abnormal heart sound from the cusps not completely closing </li></ul></ul>
  23. 23. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Aortic area Pulmonary area Mitral area Tricuspid area
  24. 24. Cardiac Muscle Fibers <ul><li>Cardiac muscle fibers form a functional syncytium </li></ul><ul><li>This is a mass of cells that function as a unit </li></ul><ul><li>Two such areas exist in the heart: </li></ul><ul><ul><li>In the atrial walls called the atrial syncytium </li></ul></ul><ul><ul><li>In the ventricular walls called the ventricular syncytium </li></ul></ul>
  25. 25. Cardiac Conduction System <ul><li>Clumps or strands of specialized cardiac muscle tissue which initiate and distribute impulses throughout the myocardium </li></ul><ul><li>The cardiac conduction system coordinates the events of the cardiac cycle </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Atrial syncytium Junctional fibers Bundle branches Purkinje fibers SA node AV node AV bundle Ventricular syncytium
  26. 26. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Purkinje fibers Interatrial septum Left bundle branch Interventricular septum Right bundle branch Junctional fibers AV node SA node AV bundle Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. (b) Myocardial muscle fibers (a)
  27. 27. 15.1 From Science to Technology Replacing the Heart – From Transplants to Stem Cell Implants
  28. 28. Electrocardiogram <ul><li>An electrocardiogram or ECG is a recording of electrical changes that occur in the myocardium during the cardiac cycle </li></ul><ul><li>It is used to assess the hearts ability to conduct impulses </li></ul><ul><li>The deflections in the normal ECG, or waves, include: </li></ul><ul><ul><li>P wave – atrial depolarization </li></ul></ul><ul><ul><li>QRS complex (three waves) – ventricular depolarization </li></ul></ul><ul><ul><li>T wave – ventricular repolarization </li></ul></ul>
  29. 29. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. (b) (c) (d) (e) (f) Millivolts 0 – .5 .5 1.0 Milliseconds 0 200 400 600 Millivolts 0 – .5 .5 1.0 Milliseconds 0 200 400 600 Millivolts 0 – .5 .5 1.0 Milliseconds 0 200 400 600 P Millivolts 0 – .5 .5 1.0 Milliseconds 0 200 400 600 S Q R QRS complex (h) (g) Millivolts 0 – .5 .5 1.0 Milliseconds 0 200 400 600 Millivolts 0 – .5 .5 1.0 Milliseconds 0 200 400 600 T Millivolts 0 – .5 .5 1.0 Milliseconds 0 200 400 600 (a) Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. S Q R
  30. 30. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 0 +1 – 1 0 120 100 80 60 40 20 0 160 120 80 P Q S T R P Q S T R 0.3 0.6 0.9 seconds Heart sounds Electrocardiogram (ECG) Pressure changes Aortic pressure Atrial pressure Volume (mL) Millivolts Pressure (mm Hg) One cardiac cycle Atrial systole Ventricular diastole Ventricular systole Aortic semilunar valve opens AV valve closes AV valve opens Ventricular pressure Aortic semilunar valve closes Atrial diastole Ventricular diastole Ventricular systole Atrial systole Ventricular diastole Atrial diastole Ventricular volume Lubb: AV valves close Dupp: Semilunar valves close Ventricular volume
  31. 31. Regulation of the Cardiac Cycle <ul><li>The SA node controls the heart rate </li></ul><ul><li>There are also sympathetic and parasympathetic fibers that control the heart rate as well </li></ul><ul><li>There are also regulatory reflex centers that influence heart rate </li></ul><ul><li>Additional factors that may influence heart rate include: </li></ul><ul><ul><li>Physical exercise </li></ul></ul><ul><ul><li>Body temperature </li></ul></ul><ul><ul><li>Concentration of various ions including: </li></ul></ul><ul><ul><ul><li>Potassium </li></ul></ul></ul><ul><ul><ul><li>Calcium </li></ul></ul></ul><ul><ul><li>Parasympathetic impulses decrease heart action </li></ul></ul><ul><ul><li>Sympathetic impulses increase heart action </li></ul></ul><ul><ul><li>Cardiac center regulates autonomic impulses to the heart </li></ul></ul>
  32. 32. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. (b) Hypothalamus Sympathetic trunk Aorta (a) Receptor Sensory or afferent neuron Central Nervous System Motor or efferent neuron Effector (muscle or gland) Carotid sinus Sensory fibers Parasympathetic vagus nerve SA node Sympathetic nerve AV node Aortic baroreceptors Common carotid artery Carotid baroreceptors Cerebrum (frontal section) Medulla (transverse section) Cardiac center Spinal cord (transverse sections)
  33. 33. 15.1 Clinical Application Arrhythmias
  34. 34. 15.4: Blood Vessels <ul><li>The blood vessels are organs of the cardiovascular system </li></ul><ul><li>The blood vessels form a closed circuit to and from the heart </li></ul><ul><li>The blood vessels include: </li></ul><ul><ul><li>Arteries - carry blood away from the ventricles of the heart </li></ul></ul><ul><ul><li>Arterioles - receive blood from the arteries and carry blood to the capillaries </li></ul></ul><ul><ul><li>Capillaries - sites of exchange of substances between the blood and the body cells </li></ul></ul><ul><ul><li>Venules - receive blood from the capillaries </li></ul></ul><ul><ul><li>Veins - carry blood toward the atria of the heart </li></ul></ul>
  35. 35. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Artery Lumen (a) (b) (c) Lumen Vein Valve Endothelium of tunica interna Connective tissue (elastic and collagenous fibers) Tunica media Tunica externa Endothelium of tunica interna Middle layer (tunica media) Outer layer (tunica externa) c: © The McGraw-Hill Companies, Inc./Al Telser, photographer
  36. 36. 15.2 From Science to Technology Altering Angiogenesis
  37. 37. Arteries and Arterioles <ul><li>Arteries: </li></ul><ul><ul><li>Thick strong wall (three layers or tunics) </li></ul></ul><ul><ul><li>Endothelial lining </li></ul></ul><ul><ul><li>Middle layer of smooth muscle and elastic tissue </li></ul></ul><ul><ul><li>Outer layer of connective tissue </li></ul></ul><ul><ul><li>Carries blood under relatively high pressure </li></ul></ul><ul><li>Arterioles: </li></ul><ul><ul><li>Thinner wall than an artery (three layers or tunics) </li></ul></ul><ul><ul><li>Endothelial lining </li></ul></ul><ul><ul><li>Middle and outer layers are thinned </li></ul></ul><ul><ul><li>Some smooth muscle tissue </li></ul></ul><ul><ul><li>Small amount of connective tissue </li></ul></ul><ul><ul><li>Helps control blood flow into a capillary </li></ul></ul>
  38. 38. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Arteriole Capillary Endothelium Smooth muscle cell Precapillary sphincter
  39. 39. Capillaries <ul><li>Capillaries are the smallest diameter blood vessels </li></ul><ul><li>They connect the smallest arteriole and the smallest venule </li></ul><ul><li>They are extensions of the inner lining of arterioles </li></ul><ul><li>The walls are endothelium only </li></ul><ul><li>They are semi-permeable </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Arteriole Artery Blood flow Blood flow Capillaries Metarteriole (forming arteriovenous shunt) Venule Vein Precapillary sphincter
  40. 40. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. (c) Cell junction (b) Slit Capillary (a) Endothelial cell Nucleus of endothelial cell Endothelial cell cytoplasm Lumen of capillary Tissue fluid Tissue fluid b,c, : © Don. W. Fawcett/Visuals Unlimited
  41. 41. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Arteriole Capillary Venule © Don. W. Fawcett/Visuals Unlimited
  42. 42. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Net force at arteriolar end Outward force, including hydrostatic pressure = 35 mm Hg Inward force of osmotic pressure = 24 mm Hg Net outward pressure = 11 mm Hg Net force at venular end Outward force, including hydrostatic pressure = 16 mm Hg Inward force of osmotic pressure = 24 mm Hg Net inward pressure = 8 mm Hg Capillary Blood flow from arteriole Outward force, including hydrostatic pressure 35 mm Hg Inward force of osmotic pressure 24 mm Hg Net outward pressure 11 mm Hg Lymphatic capillary Tissue cells Outward force, including hydrostatic pressure 16 mm Hg Inward force of osmotic pressure 24 mm Hg Net inward pressure 8 mm Hg Blood flow to venule
  43. 43. Venules and Veins <ul><li>Venule: </li></ul><ul><ul><li>Microscopic vessels that continue from the capillaries and merge to form veins </li></ul></ul><ul><ul><li>Thinner walls than arterioles </li></ul></ul><ul><ul><li>Less smooth muscle and elastic tissue than arteriole </li></ul></ul><ul><li>Veins: </li></ul><ul><ul><li>Thinner walls than arteries (three layers or tunics) </li></ul></ul><ul><ul><li>Middle wall poorly developed </li></ul></ul><ul><ul><li>Many have flap-like valves </li></ul></ul><ul><ul><li>Carry blood under relatively low pressure </li></ul></ul><ul><ul><li>Function as blood reservoirs </li></ul></ul>
  44. 44. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. (a) (b) Toward heart Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 100 90 80 70 60 50 40 30 20 10 0 Percent distribution Large veins Small veins and venules Systemic veins 60–70% Lungs 10–12% Heart 8–11% Systemic arteries 10–12% Capillaries 4–5%
  45. 45.
  46. 46. 15.5: Blood Pressure <ul><li>Blood pressure is the force the blood exerts against the inner walls of the blood vessels </li></ul>
  47. 47. Arterial Blood Pressure <ul><li>Arterial blood pressure: </li></ul><ul><ul><li>Rises when the ventricles contract </li></ul></ul><ul><ul><li>Falls when the ventricles relax </li></ul></ul><ul><ul><li>Systolic pressure is the maximum pressure during ventricular contraction </li></ul></ul><ul><ul><li>Diastolic pressure is the minimum pressure when the ventricles relax </li></ul></ul>
  48. 48. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Temporal a. Carotid a. Brachial a. Radial a. Dorsalis pedis a. Posterior tibial a. Popliteal a. Femoral a. Facial a.
  49. 49. 15.2 Clinical Application Blood Vessel Disorders
  50. 50. Factors That Influence Arterial Blood Pressure Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Blood pressure increases Blood volume increases Heart rate increases Stroke volume increases Blood viscosity increases Peripheral resistance increases
  51. 51. 15.3 Clinical Application Measurement of Arterial Blood Pressure
  52. 52. 15.4 Clinical Application Space Medicine
  53. 53. Control of Blood Pressure <ul><li>Blood pressure (BP) is determined by cardiac output (CO) and peripheral resistance (PR) according to this relationship: BP = CO x PR </li></ul><ul><li>Maintenance of blood pressure requires regulation of these two factors </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Decreased cardiac output Increased cardiac output Increased blood pressure Decreased blood pressure Blood pressure maintained Decreased heart rate Decreased stroke volume Increased heart rate Increased stroke volume Decreased peripheral resistance Increased peripheral resistance
  54. 54. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Cardiac output increases Blood pressure rises Sensory impulses to cardiac center Parasympathetic impulses to heart Heart rate decreases Baroreceptors in aortic arch and carotid sinuses are stimulated Blood pressure returns toward normal SA node inhibited Rising blood pressure Sensory impulses to vasomotor center Decreased peripheral resistance Blood pressure returns toward normal Stimulation of baroreceptors in aortic arch and carotid sinuses Less frequent sympathetic impulses to arteriole walls Vasomotor center inhibited Vasodilation of arterioles
  55. 55. Venous Blood Flow <ul><li>Blood pressure decreases as the blood moves through the arterial system and into the capillary network, so little pressure remains at the venular ends of the capillaries </li></ul><ul><li>Only partly a direct result of heart action </li></ul><ul><li>Dependent on: </li></ul><ul><ul><li>Skeletal muscle contraction </li></ul></ul><ul><ul><li>Breathing </li></ul></ul><ul><ul><li>Venoconstriction </li></ul></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Valve open Contracted skeletal muscle Vein Valve closed Relaxed skeletal muscle Vein To heart To heart
  56. 56. 15.5 Clinical Application Hypertension
  57. 57. Central Venous Pressure <ul><li>All veins, except those returning to the heart from the lungs, drain into the right atrium </li></ul><ul><li>This is therefore pressure in the right atrium </li></ul><ul><li>Factors that influence it alter flow of blood into the right atrium </li></ul><ul><li>It effects pressure within the peripheral veins </li></ul><ul><li>A weakly beating heart increases central venous pressure </li></ul><ul><li>An increase in central venous pressure causes blood to back up into the peripheral veins </li></ul><ul><li>This can lead to peripheral edema </li></ul>
  58. 58. 15.6 Clinical Application Exercise and the Cardiovascular System
  59. 59. 15.6: Paths of Circulation <ul><li>Blood vessels can be divided into two major pathways: </li></ul><ul><ul><li>The pulmonary circuit </li></ul></ul><ul><ul><li>The systemic circuit (includes coronary circulation) </li></ul></ul>
  60. 60. Pulmonary Circuit Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Left pulmonary artery Pulmonary capillaries Left pulmonary veins Left lung Aorta Right pulmonary artery Pulmonary capillaries Pulmonary trunk Right pulmonary veins Right lung Inferior vena cava Superior vena cava
  61. 61. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1 3 4 2 Interstitial space Blood flow Blood flow Alveolar capillary Alveolar air Alveolar wall Capillary wall Fluid from the interstitial space enters lymphatic capillary or alveolar (blood) capillary Any excess water in alveolus is drawn out by the higher osmotic pressure of the interstitial fluid Solutes fail to enter alveoli but contribute to the osmotic pressure of the interstitial fluid Slight net outflow of fluid from capillary Lymphatic capillary Lymph flow
  62. 62. Systemic Circuit <ul><li>Composed of vessels that lead from the heart to all body parts (except the lungs) and back to the heart </li></ul><ul><li>Includes the aorta and its branches </li></ul><ul><li>Includes the system of veins that return blood to the right atrium </li></ul>
  63. 63. 15.7: Arterial System Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Superficial temporal a. External carotid a. Internal carotid a. Common carotid a. Brachiocephalic a. Axillary a. Intercostal a. Suprarenal a. Brachial a. Renal a. Radial a. Common iliac a. Internal iliac a. External iliac a. Ulnar a. Deep femoral a. Popliteal a. Anterior tibial a. Fibular a. Dorsalis pedis a. Subclavian a. Aorta Coronary a. Celiac a. Superior mesenteric a. Lumbar a. Inferior mesenteric a. Gonadal a. Femoral a. Posterior tibial a. Vertebral a.
  64. 64. Principal Branches of the Aorta
  65. 65. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Right common carotid a. Right internal jugular v. Right subclavian a. Brachiocephalic a. Superior vena cava Right pulmonary a. Right auricle Pulmonary trunk Left common carotid a. Left subclavian a. Aortic arch Ligamentum arteriosum Left pulmonary a. Left pulmonary vv. Left auricle Brachiocephalic vv. Right pulmonary vv. Left internal jugular v.
  66. 66. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Hepatic a. Renal aa. Splenic a. Celiac a. (b) (a) Right gastric a. Hepatic a. Celiac a. Phrenic aa. Suprarenal a. Renal a. Middle sacral a. Gonadal a. Lumbar aa. Abdominal aorta Splenic a. Left gastric a. Common iliac aa. Superior mesenteric a. Inferior mesenteric a. Intestinal branches from superior mesenteric a. Branches from inferior mesenteric a. Common iliac aa. Abdominal aorta b: © Dr. Kent M. Van De Graaff
  67. 67. Arteries to the Brain, Head, and Neck Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Basilar a. Basilar a. Vertebral a. Spinal cord Spinal a. Anterior cerebral a. Middle cerebral a. Posterior communicating a. Posterior cerebral a. Anterior communicating a. Internal carotid a. Pituitary gland Anterior cerebral a. Middle cerebral a.
  68. 68. Arteries to the Brain, Head, and Neck Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Basilar a. Occipital a. Carotid sinus Subclavian a. Lingual a. Common carotid a. Brachiocephalic a. Anterior choroid a. Maxillary a. Facial a. Superior thyroid a. Superficial temporal a. Posterior auricular a. Internal carotid a. External carotid a. Thyrocervical axis Vertebral a.
  69. 69. Arteries to the Shoulder and Upper Limb Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Right common carotid a. Right subclavian a. Anterior circumflex a. Posterior circumflex a. Axillary a. Brachial a. Radial recurrent a. Radial a. Ulnar a. Deep volar arch a. Superficial volar arch a. Digital a. Ulnar recurrent a. Deep brachial a. Principal artery of thumb
  70. 70. Arteries to the Thoracic and Abdominal Walls Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Internal intercostal m. External intercostal m. Costal cartilage Internal thoracic a. Posterior intercostal a. Anterior intercostal aa. Sternum Thoracic aorta Vertebral body
  71. 71. Arteries to the Pelvis Inferior mesenteric a. Inferior epigastric a. Right common iliac a. Internal iliac a. External iliac a. Femoral a. Obturator a. Superior vesical a. Aorta Left common iliac a. Middle sacral a. Iliolumbar a. Superior gluteal a. Lateral sacral a. Inferior gluteal a. Internal pudendal a. Inferior vesical a. Perineal a. Inferior rectal a. Deep circumflex iliac a. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  72. 72. Arteries to the Lower Limb Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. External iliac a. Deep femoral a. Lateral femoral a. Femoral a. Deep genicular a. Anterior tibial a. Posterior tibial a. Dorsalis pedis a. Medial plantar a. Anterior view Posterior view Lateral plantar a. Fibular a. Popliteal a. Right common iliac a. Deep circumflex iliac a. Superficial circumflex iliac a. Superficial pudendal a. Internal iliac a. Abdominal aorta
  73. 73. 15.8: Venous System Superior vena cava Inferior vena cava Anterior tibial vv. Small saphenous v. Posterior tibial vv. Popliteal v. Femoral v. External iliac v. Common iliac v. Ulnar vv. Radial vv. Renal v. Median cubital v. Great saphenous v. Internal iliac v. Gonadal v. Ascending lumbar v. Hepatic v. Azygos v. Subclavian v. External jugular v. Superficial temporal v. Anterior facial v. Internal jugular v. Right brachiocephalic v. Axillary v. Cephalic v. Brachial vv. Basilic v. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  74. 74. Characteristics of Venous Pathways <ul><li>Vessels of the venous system originate with the merging of capillaries into venules, venules into small veins, and small veins into larger ones </li></ul><ul><li>Unlike arterial pathways, those of the venous system are difficult to follow due to irregular networks and unnamed tributaries </li></ul>
  75. 75. Veins from the Brain, Head, and Neck Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Venous sinuses Vertebral v. Right external jugular v. Right Subclavian v. Right axillary v. Right brachiocephalic v. Superior ophthalmic v. Anterior facial v. Right internal jugular v.
  76. 76. Veins from the Upper Limb and Shoulder Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Superior vena cava Left brachiocephalic v. Right internal jugular v. Right external jugular v. Right subclavian v. Right brachiocephalic v. Axillary v. Brachial vv. Cephalic v. Basilic v. Median cubital v. Radial vv. Ulnar vv. Dorsal arch v.
  77. 77. Veins from the Abdominal and Thoracic Walls Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Brachial v. Basilic v. Azygos v. Cephalic v. External jugular v. Subclavian v. Superior vena cava Axillary v. Inferior hemiazygos v. Posterior intercostal v. Superior hemiazygos v. Brachiocephalic vv. Internal jugular v.
  78. 78. Veins from the Abdominal Viscera Liver Gallbladder Pancreas Ascending colon Stomach Spleen Descending colon Rectum Hepatic portal v. Superior mesenteric v. Portion of small intestine Inferior mesenteric v. Splenic v. Right gastric v. Left gastric v. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
  79. 79. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Lungs Aorta Liver Renal capillaries Lower limb capillaries Hepatic vein Splenic artery Hepatic artery Oxygenated blood Deoxygenated blood Head and upper limb capillaries Superior vena cava Inferior vena cava Common iliac vein Trunk capillaries Renal efferent arterioles Hepatic portal vein Common iliac artery Renal afferent arterioles Mesenteric artery (to intestine)
  80. 80. Veins from the Lower Limb and Pelvis Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Anterior view Posterior view Right common iliac v. External iliac v. Inferior vena cava Internal iliac v Femoral v. Great saphenous v. Popliteal v. Anterior tibial vv. Fibular vv. Posterior tibial vv Lateral plantar vv. Small saphenous v. Dorsalis pedis v. Medial plantar vv.
  81. 81. 15.9: Lifespan Changes <ul><li>Cholesterol deposition in the blood vessels </li></ul><ul><li>Heart enlargement </li></ul><ul><li>Death of cardiac muscle cells </li></ul><ul><li>Increase in fibrous connective tissue of the heart </li></ul><ul><li>Increase in adipose tissue of the heart </li></ul><ul><li>Increase in blood pressure </li></ul><ul><li>Decrease in resting heart rate </li></ul>
  82. 82. 15.7 Clinical Application Molecular Causes of Cardiovascular Disease
  83. 83. 15.8 Clinical Application Coronary Artery Disease
  84. 84. Important Points in Chapter 15: Outcomes to be Assessed <ul><li>15.1: Introduction </li></ul><ul><li>Discuss the functions of the organs of the cardiovascular system. </li></ul><ul><li>15.2: Structure of the Heart </li></ul><ul><li>Distinguish between the various coverings of the heart and the layers that compose the wall of the heart. </li></ul><ul><li>Identify and locate the major parts of the heart and discuss the function of each part. </li></ul><ul><li>Trace the pathway of the blood through the heart and the vessels of coronary circulation. </li></ul><ul><li>15.3: Heart Actions </li></ul><ul><li>Describe the cardiac cycle and explain how heart sounds are produced. </li></ul>
  85. 85. Important Points in Chapter 15: Outcomes to be Assessed <ul><li>Identify the parts of a normal ECG pattern and discuss the significance of this pattern. </li></ul><ul><li>Explain control of the cardiac cycle. </li></ul><ul><li>15.4: Blood Vessels </li></ul><ul><li>Compare the structures and functions of the major types of blood vessels. </li></ul><ul><li>Describe how substances are exchanged between blood in capillaries and the tissue fluid surrounding body cells. </li></ul><ul><li>15.5: Blood Pressure </li></ul><ul><li>Explain how blood pressure is produced and controlled. </li></ul><ul><li>Describe the mechanisms that aid in returning venous blood to the heart. </li></ul>
  86. 86. Important Points in Chapter 15: Outcomes to be Assessed <ul><li>15.6: Paths of Circulation </li></ul><ul><li>Compare the pulmonary and systemic circuits of the cardiovascular system. </li></ul><ul><li>15.7-15.8: Arterial System – Venous System </li></ul><ul><li>Identify and locate the major arteries and veins. </li></ul><ul><li>15.9: Lifespan Changes </li></ul><ul><li>Describe the lifespan changes in the cardiovascular system. </li></ul>

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