Cardiovascular System (CVS)
Heart

The central blood pumping organ that
receives & pumps out blood to the whole
body.
Position: In middle mediastinum ...
Position of the Heart
Nervous Regulation of Heart
Superficial Anatomy of the Heart
Inside heart there are
Four chambers
Four openings, guarded by
Four valves
Right & Left A...
Openings of Heart
1.

1.
2.
3.
4.

Right atrio-ventricular
opening

Right atrio-ventricular opening
Left atrio-ventricular...
Valves of Heart
There are four valves:
1. Right atrioventricular
valve
(tricuspid valve)
2. Left atrioventricular valve
(m...
Heart valves ensure unidirectional blood flow through the
heart.
Atrio-ventricular (AV) valves lie between the atria and t...
Valves of Heart
Functions of Valves
• Maintain unidirectional flow of blood
• Prevent backflow
• Produce heart sound
Circulatory Pathway
Right Atrium
Tricuspid
valve

Right Ventricle

Tissue

ary
on
ulm ins
P ve

Lungs
a ry
on
ulm alve
P v...
Heart Muscle:
Syncytium
• Cardiac muscle fibers are striated –
sarcomere is the functional unit
• Fibers are branched; con...
Major Types of Cardiac Muscle
• Atrial Muscle
• Ventricular Muscle
• Specialized excitatory and conductive muscle
fibers
S...
Heart Muscle: Cardiac Conduction System
• Specialized muscle cells “pace” the
rest of the heart; cells contain less
actin ...
Properties of Heart Muscle
Autorhythmicity
Conductivity
 Excitability & Contractility
 All or none law
 Frank Starlin...
Blood Vessel
Hollow tubes, which carry blood along with
oxygen, nutrients & metabolic waste
products within the body.
Type...
Blood Vessel
Difference between artery and vein
Artery

Vein

Carries oxygenated blood Carries deoxygenated
blood
Carries nutrients to ...
Circulation
Circulation:
The flow of blood & lymph throughout the body
within a close system of vessels.
Types:
• Systemic...
Circulatory Pathway
Blood flow through Heart
Pathway of Blood Through the Heart
and Lungs
• Right atrium  tricuspid valve  right ventricle
• Right ventricle  pulmon...
Pathway of Blood Through
the Heart & Lungs
Coronary Circulation
• Coronary circulation is the functional blood
supply to the heart muscle itself
• Collateral routes ...
Coronary Circulation: Arterial Supply
Arteries include:
1. the right and left
coronary arteries
2. marginal arteries
3. an...
Coronary Circulation: Venous Supply
Veins include:
• the great cardiac
vein
• anterior and
posterior cardiac
veins
• the m...
Coronary Circulation
Importance of Circulation
• Supply oxygen, nutrients to tissue
• Carry away CO2 & waste products
• Prevent intravascular c...
Important Terms
• Cardiac output: The amount of blood that is
ejected by heart per minute.
• Stroke Volume: The amount of ...
Abnormalities of Heart Rate
Tachycardia: Increased heart rate above the
upper normal physiological limit
Bradycardia: Decr...
Pulse
The rhythmic dilatation & elongation of arterial
wall by intermittent ejection of blood from heart
transmitted as a ...
Some Diseases
• Myocardial Infarction: Acute ischaemic necrosis
of an area of heart muscle.
• Heart Block: Transmission of...
BLOOD PRESSURE
AND
HYPERTENSION
Blood Pressure
It is the lateral pressure exerted by
blood on the vessel wall while
flowing through it.
BP is expressed as...
Blood pressure
Blood pressure =
Cardiarc output × Peripheral resistance
• Peripheral resistance is the resistance of the
v...
Factors affecting
Blood Pressure:
•
•
•
•
•
•
•

Age
Sex
Build & Posture
Exercise
Sleep, meal
Emotion
Respiration etc.
Hypertension
Persistent rise of blood pressure above normal
range in respect of age & sex.
Types:
• Essential Hypertension...
Receptors & Neurotransmitters
•

Receptors are substances, lipoprotein in nature,
present in the cell membrane or inside t...
Adrenergic receptors
The receptors of the sympathetic nervous systems
are called adrenergic receptors. Sympathetic
neurotr...
Complications of Hypertension
Affected organs:
• Brain
• Eye
• Heart
• Kidney
• Artery
Brain:
• Cerebral hemorrhage
• Cerebral infarction
• Stroke
• Paralysis and
• even death
Eye:
Retina is damaged leading to...
Heart:
• Coronary artery disease
• Left ventricular hypertrophy
• Left ventricular failure
• Artial fibrillation
Kidney:
•...
Antihypertensive Drugs
Drugs that are used to control hypertension are called
antihypertensive drugs.
Antihypertensives ar...
Diuretics
Diuretics promote the excretion of water
and electrolytes by the kidneys.These are
used either alone or in combi...
Diuretics
1. Loop diuretics:
· Frusemide
· Ethacrynic acid
2. Thiazides:
· Hydrochlorothiazide
· Bendrofluazide
3. K+ spar...
Alpha Blocking drugs
Alpha (α) blockers block the α1 & α2 adrenoceptors.
Blockade of α1 receptor results in vasodilatation...
Beta Blockers
Beta blockers block beta adrenergic receptor
and are used in the management of
cardiovascular disorder like ...
Beta Blockers
Drugs

Receptors blocked

Atenolol
Metoprolol

β1

Butaxamine

β2

Propanolol
Timolol
Labetolol
Carvedilol

...
Calcium Channel Blockers
Calcium Channel Blockers inhibit the influx
of calcium in vascular smooth muscle and
myocardial c...
Drugs used as calcium channel blockers are
• Amlodipine
• Nifedipine
• Diltiazem
• Verapamil
• Lacidipine
• Lercanidipine ...
ACE Inhibitors
Angiotensin II is a very potent vasoconstrictor.
ACE Inhibitors inhibit angiotensin converting
enzyme (ACE)...
Drugs used as ACE Inhibitors are:
•
•
•
•

Captopril
Enalapril
Lisinopril
Ramipril
Angiotensin II Receptor
Antagonists
These act mainly by selective blockade of
Angiotensin II receptors resulting in vasodi...
Vasodilators
Vasodialators dilate arterioles and decrease
peripheral resistance; thus lower blood
pressure.
• Oral vasodil...
Centrally Acting
Antihypertensives
These stimulate α2 adrenoceptor in the CNS
results in a reduction in sympathetic tone
a...
Guideline for the use of
Antihypertensives
Grading of Hypertension
Hypertension can be graded on the basis of
diastolic blood pressure.
Mild :
90 to 105 mm Hg
Modera...
Treatment of Mild & Moderate
Hypertension
First line treatment (any one drug)
1. Diuretics
–
–

Particularly in the elderl...
Sencond line treatment (addition of a 2nd drug)
• If first line therapy fails
• To minimize side effects
Logical combinati...
Treatment of Severe Hypertension
In case of severe hypertension or despite second
line therapy hypertension is not control...
Treatment of Malignant
Hypertension
Emergency management is lowering diastolic
BP upto 100 mm Hg with Intravenous
vasodila...
If hypertension is associated with other disease:
Associated with

Choice of drugs

Diabetes
Hyperlipidemia

ACE inhibitor...
Cvs
Cvs
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  • Mediastinum: pl. Mediastina 1. A septum or cavity between two principal portions of an organ. 2. The mass of organs and tissues separating the lungs. It contains the heart and its large vessels, trachea, esophagus, thymus, lymph nodes, and connective tissue.
  • Right atrium  tricuspid valve  right ventricle
    Right ventricle  pulmonary semilunar valve  pulmonary arteries  lungs
    Lungs  pulmonary veins  left atrium
    Left atrium  bicuspid valve  left ventricle
    Left ventricle  aortic semilunar valve  aorta
    Aorta  systemic circulation
  • Cvs

    1. 1. Cardiovascular System (CVS)
    2. 2. Heart The central blood pumping organ that receives & pumps out blood to the whole body. Position: In middle mediastinum in between the two lungs, behind body of sternum, about 1/3rd of it is on the right side &2/3rd are on the left side of the body
    3. 3. Position of the Heart
    4. 4. Nervous Regulation of Heart
    5. 5. Superficial Anatomy of the Heart Inside heart there are Four chambers Four openings, guarded by Four valves Right & Left Atrium are receiving chambers Right & Left Ventricle are distributing chambers
    6. 6. Openings of Heart 1. 1. 2. 3. 4. Right atrio-ventricular opening Right atrio-ventricular opening Left atrio-ventricularLeft atrio-ventricular 2. opening opening Aortic opening Pulmonary opening 3. Aortic opening 4. Pulmonary opening
    7. 7. Valves of Heart There are four valves: 1. Right atrioventricular valve (tricuspid valve) 2. Left atrioventricular valve (mitral valve) 3. Pulmonary valve 4. Aoritc valve
    8. 8. Heart valves ensure unidirectional blood flow through the heart. Atrio-ventricular (AV) valves lie between the atria and the ventricles. AV valves prevent backflow into the atria when ventricles contract. Aortic semilunar valve lies between the left ventricle and the aorta . Pulmonary semilunar valve lies between the right ventricle and pulmonary trunk. Semilunar valves prevent backflow of blood into the ventricles
    9. 9. Valves of Heart
    10. 10. Functions of Valves • Maintain unidirectional flow of blood • Prevent backflow • Produce heart sound
    11. 11. Circulatory Pathway Right Atrium Tricuspid valve Right Ventricle Tissue ary on ulm ins P ve Lungs a ry on ulm alve P v Left Atrium Bicuspid valve Left Ventricle Aortic valve Aorta Systemic Circulation
    12. 12. Heart Muscle: Syncytium • Cardiac muscle fibers are striated – sarcomere is the functional unit • Fibers are branched; connect to one another at intercalated discs. The discs contain several gap junctions • Nuclei are centrally located • Abundant mitochondria • SR is less abundant than in skeletal muscle, but greater in density than smooth muscle • Sarcolemma has specialized ion channels that skeletal muscle does not – voltage-gated Ca2+ channels • Fibers are not anchored at ends; allows for greater sarcomere shortening and lengthening
    13. 13. Major Types of Cardiac Muscle • Atrial Muscle • Ventricular Muscle • Specialized excitatory and conductive muscle fibers SA Node Inter-nodal pathway  AV Node  The AV Bundle  The left & right bundles of purkinje fibers 
    14. 14. Heart Muscle: Cardiac Conduction System • Specialized muscle cells “pace” the rest of the heart; cells contain less actin and myosin, are thin and pale microscopically • Sinoatrial (SA) node; pace of about 65 bpm • Internodal pathways connect SA node to atrioventricular (AV) node • AV node could act as a secondary pacemaker; autorhythmic at about 55 bpm • Bundle of His • Left and right bundle branches • Purkinje fibers; also autorhythmic at about 45 bpm
    15. 15. Properties of Heart Muscle Autorhythmicity Conductivity  Excitability & Contractility  All or none law  Frank Starling Law  Refractory Period Absolute  Relative  Tonicity
    16. 16. Blood Vessel Hollow tubes, which carry blood along with oxygen, nutrients & metabolic waste products within the body. Types: • Artery • Vein • Capillary
    17. 17. Blood Vessel
    18. 18. Difference between artery and vein Artery Vein Carries oxygenated blood Carries deoxygenated blood Carries nutrients to cell Carries waste products away from cell Thick walled Thin walled Blood flow is projectile Blood flow is sluggish
    19. 19. Circulation Circulation: The flow of blood & lymph throughout the body within a close system of vessels. Types: • Systemic • Pulmonary • Portal
    20. 20. Circulatory Pathway
    21. 21. Blood flow through Heart
    22. 22. Pathway of Blood Through the Heart and Lungs • Right atrium  tricuspid valve  right ventricle • Right ventricle  pulmonary semi lunar valve  pulmonary arteries  lungs • Lungs  pulmonary veins  left atrium • Left atrium  bicuspid valve  left ventricle • Left ventricle  aortic semi lunar valve  aorta • Aorta  systemic circulation
    23. 23. Pathway of Blood Through the Heart & Lungs
    24. 24. Coronary Circulation • Coronary circulation is the functional blood supply to the heart muscle itself • Collateral routes ensure blood delivery to heart even if major vessels are occluded
    25. 25. Coronary Circulation: Arterial Supply Arteries include: 1. the right and left coronary arteries 2. marginal arteries 3. anterior and posterior interventricular arteries and 4. the circumflex artery
    26. 26. Coronary Circulation: Venous Supply Veins include: • the great cardiac vein • anterior and posterior cardiac veins • the middle cardiac vein and • the small cardiac vein
    27. 27. Coronary Circulation
    28. 28. Importance of Circulation • Supply oxygen, nutrients to tissue • Carry away CO2 & waste products • Prevent intravascular coagulation • Thermal balance
    29. 29. Important Terms • Cardiac output: The amount of blood that is ejected by heart per minute. • Stroke Volume: The amount of blood pumped out by ventricles in each beat/contraction. It is about 70-80 ml. • Heart rate: The number of contractions of heart per minute. • Cardiac Output = Stroke Volume  Heart rate
    30. 30. Abnormalities of Heart Rate Tachycardia: Increased heart rate above the upper normal physiological limit Bradycardia: Decreased heart rate below normal physiological limit
    31. 31. Pulse The rhythmic dilatation & elongation of arterial wall by intermittent ejection of blood from heart transmitted as a wave to the periphery. Importance: • Heart rate is counted • Few clinical condition can be recognized: Hypertrophy, arrhythmia, Fibrillation etc.
    32. 32. Some Diseases • Myocardial Infarction: Acute ischaemic necrosis of an area of heart muscle. • Heart Block: Transmission of impulse through the heart is blocked. • Shock: Widespread hypo perfusion of tissue due to reduction of blood volume or cardiac output is called shock. • Angina Pectoris: Cardiac pain due to impaired coronary blood flow.
    33. 33. BLOOD PRESSURE AND HYPERTENSION
    34. 34. Blood Pressure It is the lateral pressure exerted by blood on the vessel wall while flowing through it. BP is expressed as systolic (during systole) and diastolic (during diastole) blood pressure. Normal BP in healthy adult: Systolic: 120 ± 15 mm Hg Dialstolic: 80 ±10 mm Hg
    35. 35. Blood pressure Blood pressure = Cardiarc output × Peripheral resistance • Peripheral resistance is the resistance of the vessels to blood while passing within it.
    36. 36. Factors affecting Blood Pressure: • • • • • • • Age Sex Build & Posture Exercise Sleep, meal Emotion Respiration etc.
    37. 37. Hypertension Persistent rise of blood pressure above normal range in respect of age & sex. Types: • Essential Hypertension: 85 to 90% Unknown cause. • Secondary Hypertension: 10 to 15% Causes are: – – – – Kidney diseases Endocrine diseases Stricture of Aorta Drugs like oral contraceptives, steroids etc.
    38. 38. Receptors & Neurotransmitters • Receptors are substances, lipoprotein in nature, present in the cell membrane or inside the cell, with which neurotransmitters and drugs combine in order to produce various effects. • Neurotransmitters are chemical substances released from nerve terminals and acts on various receptors to produce physiological effects.
    39. 39. Adrenergic receptors The receptors of the sympathetic nervous systems are called adrenergic receptors. Sympathetic neurotransmitters like adrenaline and noradrenaline stimulates these receptors. There are mainly two types of adrenergic receptors: α (alpha) and β (beta) receptors. They are further subdivided into α1, α2, β1 and β2 receptors. These receptors are found in heart, blood vessels, kidney, pancreas, uterus and some other organs.
    40. 40. Complications of Hypertension Affected organs: • Brain • Eye • Heart • Kidney • Artery
    41. 41. Brain: • Cerebral hemorrhage • Cerebral infarction • Stroke • Paralysis and • even death Eye: Retina is damaged leading to blindness
    42. 42. Heart: • Coronary artery disease • Left ventricular hypertrophy • Left ventricular failure • Artial fibrillation Kidney: • Proteinuria • Progressive renal failure Artery: • Atherosclerosis • Aneurism
    43. 43. Antihypertensive Drugs Drugs that are used to control hypertension are called antihypertensive drugs. Antihypertensives are mainly of following groups: • Diuretic • Alpha Blocker • Beta Blocker • Calcium Channel Blocker • ACE inhibitor • Angiotensin II antagonist
    44. 44. Diuretics Diuretics promote the excretion of water and electrolytes by the kidneys.These are used either alone or in combination to reduce blood pressure. Classification of Diuretics: 1. Loop diuretics (high efficacy) 2. Thiazides (moderate efficacy) 3. K+ sparing diuretics (low efficacy)
    45. 45. Diuretics 1. Loop diuretics: · Frusemide · Ethacrynic acid 2. Thiazides: · Hydrochlorothiazide · Bendrofluazide 3. K+ sparing diuretics: · Spironolactone · Amiloride
    46. 46. Alpha Blocking drugs Alpha (α) blockers block the α1 & α2 adrenoceptors. Blockade of α1 receptor results in vasodilatation leading to fall of blood pressure due to decrease in peripheral resistance. Drugs are: • Prazosin • Doxazosin • Terazosin
    47. 47. Beta Blockers Beta blockers block beta adrenergic receptor and are used in the management of cardiovascular disorder like hypertension, angina pectoris , cardiac arrhythmia and myocardial infarction.
    48. 48. Beta Blockers Drugs Receptors blocked Atenolol Metoprolol β1 Butaxamine β2 Propanolol Timolol Labetolol Carvedilol both β1 and β2 β1, β2 and α1
    49. 49. Calcium Channel Blockers Calcium Channel Blockers inhibit the influx of calcium in vascular smooth muscle and myocardial cells. This results in dilatation of coronary and peripheral arteries & arterioles. CCB have no effect in venous tone.
    50. 50. Drugs used as calcium channel blockers are • Amlodipine • Nifedipine • Diltiazem • Verapamil • Lacidipine • Lercanidipine etc.
    51. 51. ACE Inhibitors Angiotensin II is a very potent vasoconstrictor. ACE Inhibitors inhibit angiotensin converting enzyme (ACE) thus preventing conversion of Angiotensin I to Angiotensin II . This results in vasodilation and fall of blood pressure.
    52. 52. Drugs used as ACE Inhibitors are: • • • • Captopril Enalapril Lisinopril Ramipril
    53. 53. Angiotensin II Receptor Antagonists These act mainly by selective blockade of Angiotensin II receptors resulting in vasodilation and fall of BP Drugs are: » Losartan » Irbesartan » Valsartan
    54. 54. Vasodilators Vasodialators dilate arterioles and decrease peripheral resistance; thus lower blood pressure. • Oral vasodilators: Hydralazine Minoxidil • Intravenous: Sodium nitroprusside Diazoxide
    55. 55. Centrally Acting Antihypertensives These stimulate α2 adrenoceptor in the CNS results in a reduction in sympathetic tone and a fall in blood pressure. Drugs are: » Clonidine » Methyldopa etc.
    56. 56. Guideline for the use of Antihypertensives
    57. 57. Grading of Hypertension Hypertension can be graded on the basis of diastolic blood pressure. Mild : 90 to 105 mm Hg Moderate: 105-120 mm Hg Severe: >120 mm Hg Malignant: rising rapidly over 140 mm Hg
    58. 58. Treatment of Mild & Moderate Hypertension First line treatment (any one drug) 1. Diuretics – – Particularly in the elderly Thiazides are the drug of choice 2. Beta blockers 3. ACE inhibitors or Angiotensin II antagonists can be used as alternative first line therapy, if the above drugs are not tolerated
    59. 59. Sencond line treatment (addition of a 2nd drug) • If first line therapy fails • To minimize side effects Logical combination of drugs: First line drug + Additional drug ACE inhibitor + CCB Diuretics Beta blocker + Diuretics Diuretics + ACE inhibitor Beta blocker
    60. 60. Treatment of Severe Hypertension In case of severe hypertension or despite second line therapy hypertension is not controlled, a third drug, especially, Vasodilators is added with second line therapy.
    61. 61. Treatment of Malignant Hypertension Emergency management is lowering diastolic BP upto 100 mm Hg with Intravenous vasodilators. Next management is as for severe hypertension.
    62. 62. If hypertension is associated with other disease: Associated with Choice of drugs Diabetes Hyperlipidemia ACE inhibitor CCB Asthma Diuretics CCB Angina pectoris Beta blocker CCB Heart failure Diuretics ACE inhibitor Previous MI Beta blocker ACE inhibitor Drugs avoided Beta blocker Verapamil

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