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  1. 1. The Heart and Circulation Cardiovascular System = Heart, Blood and Vessels Lymphatic System = Lymph nodes, Organs and Vessels
  2. 2. Functions of Heart and Cardiovascular System <ul><li>Cardiovascular System </li></ul><ul><ul><li>Bulk flow of blood </li></ul></ul><ul><ul><li>Exchange with tissue </li></ul></ul><ul><li>Heart </li></ul><ul><ul><li>Right side receives oxygen-poor blood from body tissues and pumps the blood to the lungs </li></ul></ul><ul><ul><li>Left side receives the oxygenated blood from the lungs and pumps the blood throughout the body </li></ul></ul>
  3. 3. Location of Heart in Chest <ul><li>Oblique Position </li></ul><ul><li>Apex = Left of Midline (5th ICS), Anterior to rest of heart </li></ul><ul><li>Base (posterior surface) sits on vertebral column </li></ul><ul><li>Superior Right = 3rd Costal Cartilage, 1” right midsternum </li></ul><ul><li>Superior Left = 2nd Costal Cartilage, 1” left midsternum </li></ul><ul><li>Inferior Right = 6th Costal Cartilage, 1” right midsternum </li></ul><ul><li>Inferior Left = 5th Intercostal Space at Midclavicular line </li></ul>Pg 155
  4. 4. Cardiac Conduction <ul><li>Intrinsic system initiating and coordinating contraction of heart muscle </li></ul><ul><ul><li>Sinoatrial node (where SVC enters RA) </li></ul></ul><ul><ul><li>Atrioventricular node (in atrioventricular septum) </li></ul></ul><ul><ul><li>AV Bundle (in IV septum then splits) </li></ul></ul><ul><ul><li>Purkinje fibers (throughout LV) </li></ul></ul><ul><li>Cardiac Plexus (external innervation) </li></ul><ul><ul><li>Vagus (parasympathetic) </li></ul></ul><ul><ul><li>Sympathetic trunk </li></ul></ul>pg 178
  5. 5. Pericardium <ul><li>Pericardium (3 layers) </li></ul><ul><ul><ul><li>1) Outer-fibrous pericardium </li></ul></ul></ul><ul><ul><li>Serous pericardium </li></ul></ul><ul><ul><ul><li>2) parietal </li></ul></ul></ul><ul><ul><ul><li>3) visceral (epicardium) </li></ul></ul></ul><ul><li>Pericardial Cavity </li></ul><ul><ul><li>between layers of serous pericardium </li></ul></ul><ul><ul><li>serous fluid </li></ul></ul><ul><ul><li>lubricate heart while beating </li></ul></ul>pg 178
  6. 6. External Features of Heart <ul><li>Interventricular sulcus </li></ul><ul><li>Coronal/Coronary sulcus </li></ul><ul><li>Auricles of atria </li></ul><ul><li>Apex </li></ul><ul><li>Base </li></ul><ul><li>Coronary vessels </li></ul><ul><li>Ligamentum Arteriosum </li></ul>Pg 158
  7. 7. The Great Vessels and major branches <ul><li>Aorta (from Left Ventricle) </li></ul><ul><li>Ascending </li></ul><ul><ul><li>Coronary arteries </li></ul></ul><ul><li>Aortic Arch </li></ul><ul><ul><li>Brachiocephalic trunk </li></ul></ul><ul><ul><li>Left Common Carotid </li></ul></ul><ul><ul><li>Left Subclavian </li></ul></ul><ul><li>Descending (Thoracic/Abdominal) </li></ul><ul><ul><li>Many small branches to organs </li></ul></ul><ul><li>Pulmonary Trunk (from Rt Ventricle) </li></ul><ul><ul><li>-2 Pulmonary Arteries into lungs </li></ul></ul><ul><li>Inferior/Superior Vena Cava </li></ul><ul><li>- Coronary sinus </li></ul>Pg 180
  8. 8. Layers of Heart <ul><li>Epicardium (most superficial) </li></ul><ul><li>– Visceral serosa </li></ul><ul><li>Myocardium (middle layer) </li></ul><ul><ul><li>Cardiac muscle </li></ul></ul><ul><ul><li>Contracts </li></ul></ul><ul><li>Endocardium (inner) </li></ul><ul><ul><li>Endothelium on CT </li></ul></ul><ul><ul><li>Lines the heart </li></ul></ul><ul><ul><li>Creates the valves </li></ul></ul>
  9. 9. Fibrous Skeleton of Heart <ul><li>Insertion for cardiac muscle </li></ul><ul><li>Anchors valve cusps </li></ul><ul><li>Prevents valves from opening too much </li></ul><ul><li>Block electrical impulses from atria to ventricles </li></ul><ul><li>Contains AV node </li></ul>Pg 170
  10. 10. Heart Chambers <ul><li>2 receiving chambers: </li></ul><ul><ul><li>Right atria </li></ul></ul><ul><ul><li>Left atria </li></ul></ul><ul><li>2 pumping chambers: </li></ul><ul><ul><li>Right ventricle </li></ul></ul><ul><ul><li>Left ventricle </li></ul></ul>
  11. 11. Right Heart Chambers: Pulmonary Pump <ul><li>Right Atrium (forms most of base of heart) </li></ul><ul><ul><li>Receives O 2 -poor blood from body via IVC, SVC, Coronary sinus </li></ul></ul><ul><ul><li>Ventral wall ( w/Pectinate muscles) and dorsal wall (no pectinate muscles) separated by crista terminalis </li></ul></ul><ul><ul><li>Fossa Ovalis - on interatrial septum, remnant of Foramen Ovale </li></ul></ul><ul><li>Right Ventricle </li></ul><ul><ul><li>Receives O 2 -poor blood from right atrium through tricuspid valve </li></ul></ul><ul><ul><li>Pumps blood to lungs via Pulmonary Semilunar Valve in pulmonary trunk </li></ul></ul><ul><ul><li>Trabeculae Carnae- muscle ridges along ventral surface </li></ul></ul><ul><ul><li>Chordae Tendinae- fibrous cords running between AV valve cusps and papilary muscles </li></ul></ul><ul><ul><li>Papillary Muscles (3) -cone-shaped muscles within ventricles to which chordae tendinae are anchored </li></ul></ul><ul><ul><li>Moderator Band (septomarginal trabeucla)-muscular band connecting anterior papillary muscle to interventricular septum </li></ul></ul>pg 163, 165
  12. 12. Left Heart Chambers: Systemic Pump <ul><li>Left Atrium </li></ul><ul><ul><li>Receives O 2 -rich blood from 4 Pulmonary Veins </li></ul></ul><ul><ul><li>Pectinate Muscles line only auricle </li></ul></ul><ul><li>Left Ventricle (forms apex of heart) </li></ul><ul><ul><li>Receives blood from Left Atrium via bicuspid valve </li></ul></ul><ul><ul><li>Pumps blood into aorta via Aortic Semilunar Valve to body </li></ul></ul><ul><ul><li>Same structures as Rt Ventricle: Trabeculae carnae , Papillary muscles (2) , Chordae tendinae </li></ul></ul><ul><ul><li>No Moderator band </li></ul></ul>
  13. 13. Heart Valves: Lub*- Dub** <ul><li>*Tricuspid Valve : Right AV valve </li></ul><ul><ul><li>3 Cusps (flaps) made of endocardium and CT </li></ul></ul><ul><ul><li>Cusps anchored in Rt. Ventricle by Chordae Tendinae </li></ul></ul><ul><ul><li>Chordae Tendinae prevent inversion of cusps into atrium </li></ul></ul><ul><ul><li>Flow of blood pushes cusps open </li></ul></ul><ul><ul><li>When ventricle is in diastole (relaxed), cusps hang limp in ventricle </li></ul></ul><ul><ul><li>Ventricular contraction increases pressure and forces cusps closed </li></ul></ul><ul><li>* Bicuspid (Mitral) Valve : Left AV valve </li></ul><ul><ul><li>2 cusps anchored in Left Ventricle by chordae tendinae </li></ul></ul><ul><ul><li>Functions same as Rt. AV valve </li></ul></ul><ul><li>They close together </li></ul>pg 165
  14. 14. Semilunar Valves (the dub) <ul><li>Semilunar valves : prevents backflow in large arteries </li></ul><ul><li>Pulmonary Semilunar Valve </li></ul><ul><ul><li>Right Ventricle and Pulmonary Trunk </li></ul></ul><ul><li>Aortic Semilunar Valve </li></ul><ul><ul><li>Left Ventricle and Aorta </li></ul></ul><ul><li>Made of 3 Cusps </li></ul><ul><ul><li>As blood rushes past the cusps are flattened </li></ul></ul><ul><ul><li>As it settles they’re pushed down (valve closed) </li></ul></ul>pg 165
  15. 15. Flow of Blood <ul><li>O 2 -poor blood (S+I VC, Coronary Sinus) enters Rt Atrium </li></ul><ul><li>Travels through Tricuspid Valve into Rt Ventricle </li></ul><ul><li>Pumped out through Pulmonary Semilunar Valve into Pulmonary trunk (branches into Pulmonary Arteries) and to lungs </li></ul><ul><li>After circulating through lungs, O 2 -rich blood returns to the heart through 4 Pulmonary veins </li></ul><ul><li>The O 2 -rich blood enters the Left Atrium </li></ul><ul><li>Travels through Bicuspid/Mitral Valve into Left Ventricle </li></ul><ul><li>Pumped out through Aortic Semilunar Valve into Aorta to be distributed to rest of body by descending aorta and branches of aortic arch </li></ul>
  16. 16. Cardiovascular Flow of Blood <ul><li>Heart  Arteries  (conducting-distributing)  Arterioles  Capillaries of tissues </li></ul><ul><li>At Capillaries O 2 is delivered and CO 2 picked up </li></ul><ul><li>Capillaries  Venules  Veins  Heart </li></ul>
  17. 17. Circuits <ul><li>Pulmonary Circuit </li></ul><ul><ul><li>Vessels carrying blood to and from lungs </li></ul></ul><ul><ul><li>Pulmonary arteries and veins </li></ul></ul><ul><li>Systemic Circuit </li></ul><ul><ul><li>Vessels carrying blood to and from the rest of the body </li></ul></ul><ul><ul><li>All other vessels </li></ul></ul>
  18. 18. Blood Flow to Supply the Heart Muscle <ul><li>Heart wall too thick for diffusion of nutrients </li></ul><ul><li>Rt and Lft Coronary Arteries </li></ul><ul><ul><li>Branch from Ascending Aorta </li></ul></ul><ul><ul><li>Have multiple branches along heart </li></ul></ul><ul><ul><li>Sit in Coronary Sulcus </li></ul></ul><ul><ul><li>Coronary Heart Disease </li></ul></ul><ul><li>Cardiac Veins </li></ul><ul><ul><li>Coronary Sinus (largest) </li></ul></ul><ul><ul><li>Many branches feed into sinus </li></ul></ul><ul><ul><li>Sits in Coronary Sulcus </li></ul></ul>pg 171
  19. 19. Blood Vessels <ul><li>Powered by the heart! </li></ul><ul><li>Carry blood to and from the heart </li></ul><ul><li>3 main types: </li></ul><ul><ul><li>Arteries </li></ul></ul><ul><ul><ul><li>Carry blood away from heart </li></ul></ul></ul><ul><ul><ul><li>arterioles </li></ul></ul></ul><ul><ul><li>Capillaries </li></ul></ul><ul><ul><li>Veins </li></ul></ul><ul><ul><ul><li>Carry blood toward heart </li></ul></ul></ul><ul><ul><ul><li>Venules </li></ul></ul></ul>
  20. 20. Anatomy of Arteries and Veins <ul><li>Tunica externa </li></ul><ul><ul><li>Outermost layer </li></ul></ul><ul><ul><li>CT w/elastin and collagen </li></ul></ul><ul><ul><li>Protects, Strengthens, Anchors </li></ul></ul><ul><li>Tunica media </li></ul><ul><ul><li>Middle layer </li></ul></ul><ul><ul><li>Circular Smooth Muscle </li></ul></ul><ul><ul><li>Collagen & Elastic Fibers </li></ul></ul><ul><ul><li>Vaso-constriction/dilation </li></ul></ul><ul><li>Tunica intima </li></ul><ul><ul><li>Innermost layer </li></ul></ul><ul><ul><li>Endothelium </li></ul></ul><ul><ul><li>Minimize friction </li></ul></ul><ul><li>Lumen </li></ul>
  21. 21. Vessels of Cardiovascular System: Arteries <ul><li>Carry blood AWAY from heart </li></ul><ul><li>Systemic Circuit: carry O 2 blood </li></ul><ul><li>Pulmonary Circuit: carry de-O 2 blood </li></ul><ul><li>Walls thicker than Veins </li></ul><ul><ul><li>Tunica media > Tunica externa </li></ul></ul><ul><li>3 Types </li></ul><ul><ul><li>Conducting (elastic) </li></ul></ul><ul><ul><ul><li>large, elastin, high pressure </li></ul></ul></ul><ul><ul><li>Distributing (muscular) </li></ul></ul><ul><ul><ul><li>medium size, to organs </li></ul></ul></ul><ul><ul><li>Arterioles </li></ul></ul><ul><ul><ul><li>smallest </li></ul></ul></ul>
  22. 22. Capillaries <ul><li>Smallest BV </li></ul><ul><li>Usually 1 RBC thick </li></ul><ul><li>1 layer endothelial cell thick surrounded by basal lamina </li></ul><ul><li>Deliver O 2 and nutrients to cells and remove waste </li></ul><ul><li>Capillary Beds: networks of capillaries </li></ul><ul><ul><li>Regulating amount of blood going to cells throughout tissues </li></ul></ul><ul><ul><li>Supply tissues and organs that otherwise have poor capillary circulation </li></ul></ul><ul><li>Epithelium, cartilage has no capillaries </li></ul>
  23. 23. Vessels of Cardiovascular System: Veins <ul><li>Carry blood from capillaries INTO the heart </li></ul><ul><li>Systemic Circuit: O 2 poor blood </li></ul><ul><li>Pulmonary Circuit: O 2 –rich blood </li></ul><ul><li>Pressure in Veins less than that in arteries </li></ul><ul><ul><li>Thinner walls than arteries (tunica externa > tunica media, less elastin) </li></ul></ul><ul><ul><li>Larger lumen than arteries </li></ul></ul><ul><ul><li>Contain valves (made of T. intima) </li></ul></ul><ul><ul><li>Normal movement, Muscular contraction push blood through </li></ul></ul><ul><li>Venules- smallest veins </li></ul>
  24. 24. Cardiovascular Blood Flow <ul><li>Portal System : Special vascular circulation where blood goes through 2 capillary beds before returning to the heart to achieve 2 nd function </li></ul><ul><ul><li>(eg) Hepatic Portal System: aids digestion by picking up digestive nutrients from stomach + intestines and delivers to liver for processing/storage </li></ul></ul><ul><ul><li>Pick-up occurs at capillaries of stomach and intestine </li></ul></ul><ul><ul><li>Via Hepatic Portal Vein goes to capillaries of liver </li></ul></ul><ul><ul><li>Via Hepatic Vein blood goes back to heart </li></ul></ul>
  25. 25. Vascular Anastomoses <ul><li>Vessels unite and connect </li></ul><ul><li>Arteriole Anastomoses </li></ul><ul><ul><li>Communication between arteries </li></ul></ul><ul><ul><li>Joints, Abdominal Organs, Brain, Heart </li></ul></ul><ul><li>Venous Anastomoses </li></ul><ul><ul><li>Communication between veins </li></ul></ul><ul><ul><li>More common </li></ul></ul><ul><ul><li>(eg) back of hand </li></ul></ul><ul><li>Vaso Vasorum </li></ul><ul><ul><li>Tiny arteries, veins, capillaries in tunica externa of vessels to nourish them (outer half) </li></ul></ul>pg 726
  26. 26. Fetal Circulation <ul><li>All major vessels in place by third month </li></ul><ul><li>2 main differences: </li></ul><ul><ul><li>1. Fetus must supply blood to placenta </li></ul></ul><ul><ul><li>2. Lungs do not need much blood because respiratory organ is the placenta </li></ul></ul>
  27. 27. 1. Blood to Placenta <ul><li>Umbilical vessels </li></ul><ul><ul><li>Run in umbilical cord </li></ul></ul><ul><ul><li>2 umbilical arteries </li></ul></ul><ul><ul><ul><li>Carry blood (little oxygen and waste) to placenta </li></ul></ul></ul><ul><ul><li>1 umbilical vein </li></ul></ul><ul><ul><ul><li>Returns this blood (with oxygen and nutrients) to fetus and to portal vein (to liver) </li></ul></ul></ul><ul><li>Ductus venosus </li></ul><ul><ul><li>Shunt that puts blood to hepatic veins, IVC, and RA from placenta </li></ul></ul><ul><ul><li>Too much blood for liver to handle </li></ul></ul><ul><ul><li>Results in highly O 2 blood going to heart </li></ul></ul>
  28. 28. 2. Bypassing the Lungs: Foramen Ovale <ul><li>Becomes Fossa Ovalis </li></ul><ul><li>Hole in the inter-atrial septum </li></ul><ul><li>Allows blood to flow from RA to LA </li></ul><ul><li>Bypasses the RV </li></ul><ul><ul><li>Would usually bring blood to lungs </li></ul></ul>pg 163
  29. 29. 2. Bypassing the Lungs: Ductus Arteriosus <ul><li>Becomes Ligamentum arteriosum </li></ul><ul><li>Carries blood from pulmonary trunk to aortic arch </li></ul><ul><ul><li>Empties distal to coronary arteries </li></ul></ul><ul><ul><ul><li>This enables the heart and brain to receive the most highly oxygenated blood </li></ul></ul></ul><ul><li>Bypasses the lungs </li></ul>pg 186
  30. 30. First Breath!! <ul><li>Lungs inflate </li></ul><ul><ul><li>Ductus arteriosus constricts and closes </li></ul></ul><ul><li>Oxygenated blood begins pouring into LA for first time </li></ul><ul><ul><li>Raises the pressure within the LA </li></ul></ul><ul><ul><li>This pushes the 2 flaps of foramen ovale together and closes it </li></ul></ul>