Cardiovascular System

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  • Syncytium: a multinucleate mass of protoplasm (as in the plasmodium of a slime mold) resulting from fusion of cells
  • In liver and bone marrow
  • Hormones and enzymes
  • Cardiovascular System

    1. 1. Cardiovascular System - The Heart - Give a detailed description of the superficial and internal anatomy of the heart, including the pericardium, the myocardium, and the cardiac muscle. Explain the functioning of the valves of the heart and how they relate to the heart sounds. Discuss the conductive pathway of the heart, and relate that to clinical uses of the ECG. Goals www.freelivedoctor.com
    2. 2. Pulmonary & Systemic Circuits artery vein capillaries www.freelivedoctor.com
    3. 3. Location of Heart within Thoracic Cavity <ul><li>Inside thoracic cavity </li></ul><ul><li>In center of chest deep to sternum, apex tipped toward the left; base superior </li></ul><ul><li>Inside mediastinum </li></ul><ul><li>In pericardial space </li></ul>www.freelivedoctor.com
    4. 4. Pericardium - Covering <ul><li>1. Fibrous pericardium - tough, collagenous </li></ul><ul><li>2. Serous parietal pericardium (lines fibrous pericardium) </li></ul><ul><li>3. Pericardial space with 10-20 ml of pericardial fluid </li></ul><ul><li>4. Serous visceral pericardium adheres to the heart surface </li></ul><ul><li>(also known as epicardium) </li></ul>
    5. 5. Structure of Heart Wall <ul><li>Epicardium = visceral Pericardium (serosa) </li></ul><ul><li>Myocardium : muscle tissue + c.t. + blood vessels + ? </li></ul><ul><li>Endocardium : simple squamous epithelium continuous with endothelia of blood vessels </li></ul>
    6. 6. Cardiac Muscle <ul><li>Striated, aerobic, interwoven, autorhythmic </li></ul><ul><li>Intercalated discs - gap junctions, strong desmosomes </li></ul><ul><li>Functional syncytium </li></ul>
    7. 7. Fibrous Skeleton <ul><li>Internal c.t. network with lots of collagen and elastic fibers </li></ul><ul><li>Encircles bases of great vessels </li></ul><ul><li>Encircles bases of valves </li></ul><ul><li>functions: </li></ul><ul><li>Isolate atria from ventricles elctrically </li></ul><ul><li>Reinforce myocardium itself </li></ul>
    8. 8. Surface Anatomy of Heart <ul><li>Auricle of atria (expandable) </li></ul><ul><li>Coronary sulcus (between atria & ventricles) </li></ul><ul><li>Ant. & post. interventricular sulcus </li></ul><ul><li>Base (3 rd costal cartilage) vs. apex (5 th intercostal space) </li></ul><ul><li>Vessels entering & leaving the heart </li></ul>www.freelivedoctor.com
    9. 9. Sectional (Internal) Heart Anatomy <ul><li>Atria & ventricles </li></ul><ul><li>Interatrial & interventricular septae </li></ul><ul><li>Valves (fibrous tissue) </li></ul><ul><li>Pectinate muscles (auricles & ant. atria) </li></ul><ul><li>Trabeculae carneae (ventricles) </li></ul><ul><li>Chordae tendinae & papillary muscles </li></ul>www.freelivedoctor.com
    10. 10. Left vs. Right Ventricle <ul><li>Left: high pressure pump - Right: low pressure pump  right chamber is thinner walled than left </li></ul><ul><li>Ventricles separated by interventricular septum </li></ul>
    11. 11. Structure and Function of Valves = Mitral valve 4 sets of valves Prevent backflow of blood Close passively under blood pressure Heart sounds produced by valve closure www.freelivedoctor.com
    12. 12. picture taken from R ventricle, looking toward R atrium Support for AV valves: valves are restrained by chordae tendinae which are in turn attached to papillary muscles (prevention of backflow!) www.freelivedoctor.com
    13. 13. Blood flow pattern through the heart <ul><li>Blood enters right atrium </li></ul><ul><li>Passes tricuspid valve into right ventricle </li></ul><ul><li>Leaves by passing pulmonary semilunar valves into pulmonary trunk and to the lungs to be oxygenated </li></ul><ul><li>Returns from the lung by way of pulmonary veins into the left atrium </li></ul><ul><li>From left atrium past bicuspid valve into left ventricle </li></ul><ul><li>Leaves left ventricle past aortic semilunar valves into aorta </li></ul><ul><li>Distributed to rest of the body </li></ul>www.freelivedoctor.com
    14. 14. <ul><li>Actual physical contraction pattern of the myocardium as determined by the conduction. </li></ul><ul><li>Contraction is systole </li></ul><ul><li>Relaxation is diastole </li></ul><ul><li>The two atria are in systole and diastole together as are the two ventricles. </li></ul>Cardiac Cycle
    15. 15. Auscultation of Heart Sounds: 1st HS: at beginning of ventricular contraction, due to? 2nd HS: at beginning of ventricular diastole, due to?
    16. 16. Coronary Circulation Coronary arteries: first branches off the ascending aorta.
    17. 17. coronary veins coronary sinus right atrium (inferior to opening of inferior vena cava) posterior view www.freelivedoctor.com
    18. 18. Conducting System of the Heart <ul><li>Specialized muscle cells (autorhythmic cells) conduct APs to time and synchronize the action of the chambers </li></ul><ul><li>SA node -pacemaker, spontaneously depolarizes most rapidly and initiate heart beat, positioned on back wall of right atrium , transmits action potential to </li></ul><ul><li>AV node - (where the four chambers meet). </li></ul><ul><li>AV bundle (bundle of His) transmits down top of interventricular septum where it divides into two </li></ul><ul><li>Bundle branches , one of which supplies each ventricle where they branch into </li></ul><ul><li>Purkinje fibers reflect up external walls of ventricles and stimulate contraction of cardiac muscle cells as a unit. </li></ul><ul><li>Purkinje fibers extend into papillary muscles as well </li></ul>www.freelivedoctor.com
    19. 19. The Circuits www.freelivedoctor.com Pulmonary Circuit:` From the “Right Heart” to the Lungs Systemic Circuit: From the “Left Heart” to Everywhere Else 65 -70% in veins (= blood reservoir); lumen is larger than in corresponding arteries 30-35% in heart, arteries and capillaries N.B. The chambers pump the same VOLUME
    20. 20. <ul><li>elastic arteries </li></ul><ul><li>muscular arteries </li></ul><ul><li>arterioles </li></ul>www.freelivedoctor.com capillaries large vein medium-sized vein venules Arteries – ALWAYS carry blood away from heart Veins – ALWAYS return blood to heart, contain about 2/3 body's blood at any given time
    21. 21. Capillaries <ul><li>The smallest </li></ul><ul><li>Only vessels that allow exchange </li></ul><ul><ul><li>Diffusion or active transport </li></ul></ul><ul><li>Precapillary Sphincters regulate flow and blood pressure </li></ul>
    22. 22. Normal Blood Flow: From artery to capillary bed to vein and back to heart <ul><li>3 exceptions: from artery to capillary to artery (or venule) to capillary to vein </li></ul><ul><li>Hypophysis </li></ul><ul><li>Liver </li></ul><ul><li>In kidney nephrons </li></ul>www.freelivedoctor.com Portal Systems
    23. 23. Gross Anatomy of Circulatory System Pulmonary & Systemic Circulations
    24. 24. Pulmonary Circuit Right ventricle into pulmonary trunk to pulmonary arteries to lungs Return by way of 4 pulmonary veins to left atrium www.freelivedoctor.com
    25. 25. Arteries to the Head <ul><li>Common carotid (2) </li></ul><ul><li>Vertebral Artery (2) </li></ul><ul><ul><li>Through the transverse foramina </li></ul></ul><ul><li>Basilar Artery (1) </li></ul><ul><ul><li>Through foramen magnum </li></ul></ul><ul><li>Circle of Willis </li></ul>
    26. 26. Circle of Willis = Cerebral Arterial Circle <ul><li>= Ring of vessels surrounding pituitary gland - supplies cerebrum and cerebellum </li></ul><ul><li>Brain can receive blood from carotid or vertebral or basilar aa. </li></ul><ul><ul><li>Collateral circulation </li></ul></ul><ul><ul><ul><li>(significance?) </li></ul></ul></ul>
    27. 27. Circle of Willis www.freelivedoctor.com
    28. 28. Arteries of the Arm <ul><li>Difference Between Right and Left?? </li></ul><ul><li>Subclavian </li></ul><ul><li>Axillary </li></ul><ul><li>Brachial </li></ul><ul><ul><li>Radial </li></ul></ul><ul><ul><li>Ulnar </li></ul></ul>
    29. 29. Descending Aorta - Thoracic Area <ul><li>Bronchial arteries - supply bronchi and lungs </li></ul><ul><li>Pericardial arteries - supply pericardium </li></ul><ul><li>Mediastinal arteries - supply mediastinal structures </li></ul><ul><li>Esophageal arteries - supply esophagus </li></ul><ul><li>Paired intercostal arteries- thoracic wall </li></ul><ul><li>Superior phrenic arteries - supply diaphragm </li></ul>
    30. 30. Descending Aorta: Abdominal Area <ul><li>Celiac trunk - 3 branches – to liver, gallbladder, esophagus, stomach, duodenum, pancreas, and spleen </li></ul><ul><li>Superior mesenteric– to pancreas and duodenum, small intestine and colon </li></ul><ul><li>Paired suprarenal - to adrenal glands </li></ul><ul><li>Paired renal – to kidneys </li></ul><ul><li>Paired gonadal – to testes or ovaries </li></ul><ul><li>Inferior mesenteric – to terminal colon and rectum </li></ul><ul><li>Paired lumbar – to body wall </li></ul>
    31. 31. Circulation of the Leg <ul><li>Common Iliac A. and V. </li></ul><ul><li>External Iliac A. & V. </li></ul><ul><li>Femoral A. & V. </li></ul><ul><li>Popliteal A. & V. </li></ul><ul><ul><li>Anterior Tibial </li></ul></ul><ul><ul><li>Posterior Tibial </li></ul></ul><ul><li>Dorsal Pedal A. </li></ul><ul><ul><li>Pulse checking </li></ul></ul><ul><li>Great Saphenous V. </li></ul><ul><ul><li>Used for coronary bypasses </li></ul></ul><ul><ul><li>Longest vessel </li></ul></ul>
    32. 32. Venous Circulation <ul><li>Mostly parallels arterial circulation </li></ul><ul><li>Veins are more superficial in limbs </li></ul><ul><li>Major exception in the abdomen </li></ul><ul><ul><li>Portal Circulation </li></ul></ul>
    33. 33. Venous Circulation <ul><li>Mostly parallels arterial circulation </li></ul><ul><li>Veins are more superficial in limbs </li></ul><ul><li>Major exception in the abdomen </li></ul><ul><ul><li>Portal Circulation </li></ul></ul>
    34. 34. Portal vein www.freelivedoctor.com
    35. 35. VEINS www.freelivedoctor.com Postcapillary venule Venule Vein Thin wall Large lumen Low pressure Low velocity Valves
    36. 36. Fetal circulation www.freelivedoctor.com During fetal life, all oxygen and nutrition comes not from the intestine and lungs, but from the placenta. The fetus has different circulatory pathways to accommodate these different needs. These pathways must change AT the time of birth.
    37. 37. Circulation Changes AT Birth <ul><li>No blood coming from placenta </li></ul><ul><li>Ductus venosus becomes ligamentum venosus (=ligamentum teres) </li></ul><ul><li>Foramen ovale closes & becomes fossa ovale </li></ul><ul><li>Ductus arteriosus closes and becomes ligamentum arteriosum </li></ul><ul><li>Umbilical vein and arteries degenerate </li></ul>
    38. 38. Patent foramen ovale www.freelivedoctor.com
    39. 39. Distinguishing Arteries from Veins: <ul><li>Artery walls thicker (more muscle and elastic fibers) </li></ul><ul><li>Additional: internal & external elastic membranes </li></ul><ul><li>Artefacts when fixing slides: </li></ul><ul><li>Arterial walls contract; endothelium cannot contract: pleated appearance </li></ul><ul><li>Veins collapse </li></ul>Fig 22.1 www.freelivedoctor.com
    40. 40. <ul><li>elastic arteries </li></ul><ul><li>muscular arteries </li></ul><ul><li>arterioles </li></ul>capillaries large vein medium-sized vein venules Arteries – ALWAYS carry blood away from heart Veins – ALWAYS return blood to heart, contain about 2/3 body's blood at any given time www.freelivedoctor.com
    41. 41. Pulmonary trunk & aorta and their major branches Superior & inferior vena cava and their tributaries Largest, conducting arteries – lead directly from heart, subject to high pressures www.freelivedoctor.com
    42. 42. External and internal carotids, brachial & femoral arteries External and internal jugular, brachial & femoral veins  2 - 9 mm  ~ 4 mm www.freelivedoctor.com
    43. 43.  ~ 10-50 µm  ~ 30 µm www.freelivedoctor.com
    44. 44. Capillaries Intestinal mucosa Choroid plexus, endocrine glands, kidneys Most body regions Only endothelium Variably permeable somewhat permeable Characterized by circular fenestrae or pores that penetrate the endothelium -permit exchange of larger molecules.  ~ 8 µm www.freelivedoctor.com
    45. 45. Sinusoids <ul><li>Resemble fenestrated capillaries, yet </li></ul><ul><ul><li>irregular shapes </li></ul></ul><ul><ul><li>have longer pores </li></ul></ul><ul><ul><li>thinner (or no) basement membranes </li></ul></ul><ul><li>Blood movement very slow </li></ul><ul><li>Found in the liver, heart, etc. sometimes called sinusoidal capillary. </li></ul>www.freelivedoctor.com
    46. 46. Capillary Bed <ul><li>= Capillary region supplying a body area </li></ul><ul><li>Metarteriole – shunt - preferred channel through a capillary bed </li></ul><ul><li>Precapillary sphincter - closes bed temporarily to redistribute blood flow </li></ul><ul><li>Arteriovenous anastomosis: interconnections , alternative routes of supply </li></ul>Fig 22.4 www.freelivedoctor.com
    47. 47. Normal: From capillary bed into veins and back to heart <ul><li>3 exceptions </li></ul><ul><li>Hypophysis _________________ </li></ul><ul><li>Liver _________________ </li></ul><ul><li>In kidney nephrons </li></ul>Fig 19.6 Fig 22.26 www.freelivedoctor.com
    48. 48. The Blood Discuss the composition of blood including the functions of the various components Explain the anatomy and functions of the red blood cells, including a description of blood typing Discuss the types of white blood cells found in the blood and give the functions of each Give a brief accounting of the platelets Review hemopoiesis, including RBC and leukocyte formation www.freelivedoctor.com
    49. 49. Functions of Blood <ul><li>Distribution - nutrients, wastes, hormones, gases, etc. </li></ul><ul><li>Self-sealing – hemostasis </li></ul><ul><li>Disease/ infection fighting </li></ul>www.freelivedoctor.com
    50. 50. <ul><li>Blood = connective tissue </li></ul>extracellular matrix: Plasma specialized cells: (= Formed elements) RBCs WBCs Platelets color ? volume ?
    51. 51. Plasma Composition <ul><li>Water 92% </li></ul><ul><li>Plasma proteins 7% </li></ul><ul><li>Other solutes 1% </li></ul>Transports organic and inorganic molecules, formed elements, and heat
    52. 52. Plasma Proteins <ul><li>Albumin (60%) Major contributor to osmotic concentration of plasma. Transport of lipids and steroid hormones </li></ul><ul><li>Globulins (35%) Transport ions, hormones, lipids; immune function </li></ul><ul><li>Fibrinogen (4%) Essential component of clotting system (conversion to insoluble fibrin) </li></ul><ul><li>Regulatory proteins (< 1%) ???? </li></ul>
    53. 53. Other Solutes <ul><li>Electrolytes : Normal extracellular fluid ion composition (????) </li></ul><ul><li>Organic nutrients: glucose, FA, AA </li></ul><ul><li>Organic wastes: urea, bilirubin </li></ul>
    54. 54. Difference between Plasma and Interstitial Fluid : <ul><li>Plasma has more: </li></ul><ul><li>Dissolved O 2 O 2 diffuses out into tissue </li></ul><ul><li>Dissolved proteins (too big to cross caps.) </li></ul><ul><ul><li>Albumins </li></ul></ul><ul><ul><li>Globulins </li></ul></ul><ul><ul><ul><li> globulins </li></ul></ul></ul><ul><ul><ul><li> and  globulins </li></ul></ul></ul><ul><ul><li>Fibrinogen </li></ul></ul><ul><li>Similar concentration: Salts & small molecules </li></ul>www.freelivedoctor.com
    55. 55. <ul><li>serum = plasma - </li></ul>Difference between plasma and serum? www.freelivedoctor.com
    56. 56. . . . . 2 more things: <ul><li>Most plasma proteins are made in liver. Exception: ? </li></ul><ul><li>Lipoproteins = particles containing lipids (cholesterol & triglycerids) and proteins (albumins & globulins) </li></ul>www.freelivedoctor.com
    57. 57. Formed Elements <ul><li>Red and White Blood Cells </li></ul><ul><li>Platelets </li></ul><ul><li>Platelets </li></ul><ul><li>WBCs </li></ul><ul><li>RBCs </li></ul>.1% 99.9% www.freelivedoctor.com
    58. 58. Formed Elements cont. Why white blood cells??? www.freelivedoctor.com
    59. 59. RBCs = Erythrocytes <ul><li>Measured by hematocrit or PCV </li></ul><ul><li>Most abundant blood cell: 1000 RBCs/1 WBC </li></ul><ul><li>Contain hemoglobin, carry O2 </li></ul><ul><li>Very regular shape - biconcave discs </li></ul><ul><li>Anucleate : Lifespan ~ 120 days replacement rate ~ 3 mio RBCs / sec </li></ul>
    60. 60. Structure of Hemoglobin (Hb) <ul><li>Fe ion in heme group reversibly binds O 2 </li></ul><ul><li>How many oxygen </li></ul><ul><li>molecules can 1 </li></ul><ul><li>Hb molecule </li></ul><ul><li>carry? </li></ul> 
    61. 61. ABO & Rh Blood Types <ul><li>Blood groups (types) based on specific RBC surface antigens (= proteins) </li></ul><ul><li>> 30 common varieties of antigens known. Most important ABO & Rh </li></ul>blood type ? www.freelivedoctor.com
    62. 62. ABO Blood typing: 4 combinations possible <ul><li>A surface antigen = blood type A </li></ul><ul><li>B surface antigen = blood type B </li></ul><ul><li>both surface antigens = type AB </li></ul><ul><li>neither surface antigen = type O </li></ul><ul><li>Rh surface antigen = + blood type </li></ul><ul><li>no Rh antigen = negative blood type </li></ul>www.freelivedoctor.com
    63. 63. . . . 2 - 8 months after birth: <ul><li>Anti-A and anti-B antibodies can be formed in plasma ! </li></ul>normally NO anti Rh present www.freelivedoctor.com
    64. 64. Transfusion Reaction <ul><li>Transfusion of incompatible blood can be fatal! </li></ul>Universal Donor vs. Universal Recipient Only for emergencies - must be given slowly !
    65. 65. Clinical Brief <ul><li>Anemia: </li></ul><ul><ul><li>Reduced oxygen carrying ability of blood. Causes?? </li></ul></ul><ul><li>Polycythemia: </li></ul><ul><ul><li>Erythrocytosis: excessive increase in RBCs </li></ul></ul><ul><ul><li>Polycythemia vera: </li></ul></ul><ul><li>Blood Doping: </li></ul><ul><ul><li>Via direct transfusion, or </li></ul></ul><ul><ul><li>EPO use </li></ul></ul>www.freelivedoctor.com
    66. 66. WBCs = Leukocytes <ul><li>Quantity and type determined by differential WBC count </li></ul><ul><li>Circulating WBCs are only a small fraction of total WBCs. Most are located in ? </li></ul><ul><li>Diapedesis </li></ul><ul><li>Chemotaxis </li></ul>Granulocytes and Agranulocytes
    67. 67. Neutrophil (= PMN) <ul><li>Up to ~ 70% (~ 2/3) of circulating WBCs </li></ul><ul><li>Cytoplasm packed with pale granules containing lysosomal enzymes </li></ul>phagocytic
    68. 68. Eosinophil <ul><li>~ 2% - 4% of circulating WBCs </li></ul><ul><li>Granules stain with eosin </li></ul><ul><li>Increased in allergies and parasitic infections </li></ul>
    69. 69. Basophil <ul><li>< 1% of circulating WBCs </li></ul><ul><li>Granules stain with basic dyes and contain histamine </li></ul><ul><li>Discharge of histamine promotes inflammation at site of injury (Similar to mast cells) </li></ul>
    70. 70. Monocyte <ul><li>~ 2% - 8% of circulating WBCs </li></ul><ul><li>Large kidney shaped nucleus </li></ul><ul><li>In tissue called Macrophage </li></ul>
    71. 71. Lymphocytes <ul><li>~ 20% - 30% of circulating WBCs </li></ul><ul><li>Relatively small (slightly larger than RBCs) </li></ul><ul><li>Large round nucleus </li></ul><ul><li>B, T, NK </li></ul>
    72. 72. Platelets = Thrombocytes <ul><li>Cell fragments of Megakaryocytes </li></ul><ul><li>(~ 4,000 thrombocytes per Megakaryocyte) </li></ul><ul><li> ~ 160  m </li></ul><ul><li>Lifespan ~ 12 days </li></ul><ul><li>involved in blood clotting </li></ul>
    73. 73. Abnormal Blood Cell Counts <ul><li>Leukopenia < 2,500/  L (normal 6000 – 9000) </li></ul><ul><li>Leukocytosis > 30,000/  L </li></ul><ul><li>Thrombocytopenia: < 80,000/  L (normal ~ 350,000) </li></ul><ul><li>Thrombocytosis: > 1,000,000/  L </li></ul><ul><li>Also </li></ul><ul><li>Lymphopenia vs. _____________ </li></ul><ul><li>_________vs. Neutrophilia </li></ul>www.freelivedoctor.com
    74. 74. Hemopoiesis = Blood Cell Formation Hemocytoblasts: One type of stem cell for all blood cells In red bone marrow <ul><li>. . . then differentiation into 4 types of progenitor stem cells: </li></ul><ul><ul><li>Erythroblast </li></ul></ul><ul><ul><li>Myeloblast </li></ul></ul><ul><ul><li>Monoblast </li></ul></ul><ul><ul><li>Lymphoblast </li></ul></ul>Fig 20.8 The End

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