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Power point the cardiovascular system - anatomy and physiology

The document discusses the anatomy and physiology of the heart and cardiovascular system. It describes the size and structure of the heart, including the four chambers and valves. It explains how blood flows through the heart and is pumped into the arteries and circulated throughout the body before returning to the heart through the veins. It also discusses the composition of blood and its transport of oxygen, nutrients and waste products.

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Anatomy and Physiology
 Is about 4.8 inches tall and 3.35 inches wide  Weighs about .68 lb. in men and .56 lb. in women  Beats about 100,000 times per day  Beats 2.5 billion time in an average 70 yr. lifetime  Pumps about 2000 gallons of blood each day  Circulates blood completely 1000 times each day  Pumps blood through 62,000 miles of vessels  Suffers 7.2 mil. CAD deaths worldwide each year
 The heart resides in the pericardium o A loose membranous sac.  Epicardium ◦ Continuous with the pericardium  Myocardium ◦ Composed of bands of involuntary striated muscle fibers  Endocardium ◦ Thin layer of tissue lining the inside of the heart
 Atria ◦ Thin-walled upper chambers ◦ Separated by atrial septum ◦ Right side of septum has oval depression, fossa ovalis cordis, remnant of the foramen ovale ◦ Act as receiving chamber for blood returning from the body and lungs
Left atrium Fossa ovalis cordis Right atrium Atrial septum Epicardium Myocardium Endocardium
 Ventricles ◦ Lower chambers which make up the bulk of the muscle mass of the heart ◦ Left ventricle 2/3 larger than right ventricle ◦ Right ventricle is a thin-walled and oblong, like pocket attached to left ventricle
 Ventricles ◦ Contraction of left ventricle pulls in right ventricle, aiding its contraction (termed left ventricular aid) ◦ Separated by intraventricular septum
Superior vena cava Inferior vena cava Right ventricle Left ventricle Intraventricular septum
 Tricuspid valve ◦ Separates right atrium from right ventricle  Pulmonic semilunar valve ◦ Separates right ventricle from pulmonary artery
 Bicuspid (mitral) valve ◦ Separates left atrium from left ventricle  Aortic semilunar valve ◦ Separates left ventricle from aorta
Blood flow from right ventricle to lungs Blood flow from left ventricle to aorta
 Chordae tendineae cordis ◦ Anchor free ends of A-V valves to papillary muscles ◦ Prevent A-V valves from pushing upward into atria during ventricular contraction
Pulmonic semilunar valve Aortic semilunar valve Bicuspid (mitral) valve Tricuspid valve Chordae tendineae cordis Papillary muscles
Left subclavian artery Pulmonary artery to left lung Superior vena cava Pulmonary Artery to right lung Pulmonary veins from left lung Pulmonary veins from right lung Aorta Brachiocephalic artery Left common carotid artery
 Arises from root of the aorta Left Coronary Artery Right Coronary Artery Anterior Descending Artery Circumflex Artery Posterior Descending Artery
1) Blood enters the heart through the inferior and superior vena cava, flowing into the right atrium. 2) The blood passes through the tricuspid valve into the right ventricle. 3) It then passes through the pulmonic semilunar valve, entering the pulmonary artery of the pulmonary circulation. 4) It flows through the pulmonary bed of the right and left lungs to the pulmonary vein, reentering the heart at the left atrium. 5) It then flows through the bicuspid valve into the left ventricle. 6) Passing through the aortic semilunar valve, the blood enters the aorta and systemic vascular system.
 Anterior descending artery ◦ Supplies anterior sulcus and apex ◦ “Widow maker” heart attack  Circumflex artery ◦ Supplies posterior side of left ventricle
 Together supply most of left ventricle, left atrium, 2/3 of intra ventricular septum, half of intra atrial septum, and part of right atrium
 Posterior descending artery ◦ Supplies posterior intraventricular sulcus  Has numerous smaller branches
Supplies anterior and posterior portions of right ventricular myocardium, right atrium, sinus node, posterior 1/3 of intraventricular septum, and portion of base of right ventricle
 Closely parallel the arterial system  Some coronary venous blood enters the heart through the Thebesian veins ◦ Thebesian veins empty directly into all chambers thus creating some venous admixture lowering Pa02
 Large, highly elastic, low resistance to blood flow  Small muscular arterioles of varying resistance
 Transport blood away from the heart  Generally contain oxygenated blood Exception: pulmonary artery  Composed of three layers ◦ Tunica adventitia (external layer) ◦ Tunica media (thickest layer) ◦ Tunica intima (thinnest layer)
 Tunica adventitia ◦ Consists of connective tissue surrounding collagenous and elastic fibers ◦ Supports and protects the vessel ◦ Contains lymphatic vessels and nerve fibers ◦ Has fine vessels that provide its blood supply
 Tunica media ◦ Thickest layer ◦ Composed of concentrically arranged smooth muscle and elastic fibers ◦ Nerve fibers of tunica adventitia terminate in tunica media
 Tunica intima ◦ Thinnest layer of the artery ◦ Consists of the epithelium – flat layer of simple squamous cells ◦ Common to all blood vessels including the endocardium
 Large arteries are termed conductance or elastic arteries because the tunica media has less smooth muscle and more elastic fibers  Medium sized arteries are termed the nutrient arteries because they control the flow of blood to the various regions of the body  Arterioles have a thin tunica intima and adventitia, but a thick tunica media composed almost entirely of smooth muscle and control blood flow to the capillary bed ◦ Called resistance vessels because they control the rate that the blood leaves the arterial tree , control arterial blood volume and thereby blood pressure
Aortic knob Brachial Aorta Radial Ulnar Femoral Anterior tibial Peroneal artery Posterior tibial
Circle of Willis Internal carotids External carotids Common carotids Vertebral arteries
 Microcirculation  Maintains constant environment for the cells and tissues  Exchange of nutrients, gases, and wastes The blood does not directly come in contact with the parenchymal cells and tissues in the body, but constituents of the blood first exit the micro vascular exchange blood vessels to become interstitial fluid, which comes into contact with the parenchymal cells of the body. Lymph is the fluid that is formed when interstitial fluid enters the initial lymphatic vessels of the lymphatic system
 Pre-capillary sphincter valves ◦ Smooth muscle rings at the proximal end of the capillary ◦ Contraction decreases blood flow ◦ Relaxation increases blood flow ◦ Responsive to local changes in PaO2, PaCO2, pH, and temperature ◦ Called exchange vessels because they are the site of gas, fluid, nutrient, and waste exchange
 Transport deoxygenated blood back to the heart – exception: pulmonary vein  Composed of the same layers as arteries, but are thinner  Called capacitance or reservoir vessels because 70% to 75% of the blood volume is contained in the venous system  Peripheral veins contain one-way valves. ◦ Valves are formed by duplication of endothelial lining ◦ Found in veins >2mm in diameter ◦ Are in areas subjected to muscular pressure, arms/legs ◦ Prevent retrograde flow of blood
 Mechanisms aiding venous return to the heart: ◦ Sympathetic venous tone ◦ Skeletal muscle pumping or “milking” combined with the one-way valves ◦ Cardiac suction ◦ Thoracic pressure differences created by respiratory efforts (thoracic pump)
 Consists of formed elements (cells) suspended & carried in plasma (fluid part)  Total blood volume: 60-80 mL/kg of body weight  Plasma is straw-colored liquid consisting of 90% H20 & dissolved solutes ◦ Includes ions, metabolites, hormones, antibodies, proteins
 Constitute 7-9% of plasma  Three types of plasma proteins: albumins, globulins, & fibrinogen ◦ Albumin accounts for 60-80%  Creates colloid osmotic pressure that draws H20 from interstitial fluid into capillaries to maintain blood volume & pressure  Globulins carry lipids ◦ Gamma globulins are antibodies  Fibrinogen serves as clotting factor ◦ Converted to fibrin when clotting blood ◦ Serum is fluid left when blood clots
 Composed of erythrocytes (RBCs) & leukocytes (WBCs)  RBCs are flattened biconcave discs ◦ Generated in the red bone marrow by the process of erythropoiesis from the hemocytoblast, a common stem cell ◦ Shape provides increased surface area for diffusion ◦ Lack nuclei & mitochondria ◦ Has semi-permeable membrane ◦ Contains hemoglobin molecule that transports oxygen ◦ Approx. 30 trillion in the body
 Is the formation of blood cells from stem cells in marrow (myeloid tissue) & lymphoid tissue ◦ RBC’s increase in number above normal with chronic hypoxia  Erythropoiesis is formation of RBCs ◦ Stimulated by erythropoietin (EPO) from kidney  Leukopoiesis is formation of WBCs ◦ Stimulated by variety of cytokines
 2.5 million RBCs created daily  Lifespan of 120 days  Old RBCs removed from blood by phagocytic cells in liver, spleen, & bone marrow ◦ Iron recycled back into hemoglobin production
 Have nucleus, mitochondria, & amoeboid ability  Formed in the myeloid tissue  Can squeeze through capillary walls (diapedesis) ◦ Granular leukocytes help detoxify foreign substances & release heparin  Include eosinophils, basophils, & neutrophils
 Agranular leukocytes are phagocytic & produce antibodies  Include lymphocytes & monocytes
 Specialized type of blood cell  Fragments into small irregular pieces of protoplasm called thrombocytes and platelets  Have no nucleus  Have a granular cytoplasm  Function in clot formation
 Are smallest of formed elements, lack nucleus  Constitute most of mass of blood clots  Release serotonin to vasoconstrict & reduce blood flow to clot area  Secrete growth factors to maintain integrity of blood vessel wall  Survive 5-9 days
 RBC’s – Males: 4.6 - 6.2 x 10 /mm Females: 4.2 – 5.4 x 10 /mm • Hb – Males: 13.5 – 16.5 g/dl Females: 12 – 15 g/dl • Hematocrit – Males: 42 – 54% Females: 38 – 47% • Leukocytes – 4500 – 11,500/mm
 Neutrophils: 40 – 75%  Eosinophils: 0 – 6%  Monocytes: 2 – 10%  Basophils: 0 – 1%  Megakaryocyte: 150,000 – 400,000/mm
 Systolic pressure ◦ Pressure during contraction phase of heart ◦ Normal value: 90 – 140 mmHg  Diastolic pressure ◦ Pressure during relaxation phase of heart ◦ Normal value: 60 – 90 mmHg
 Mean arterial pressure (MAP) ◦ Average pressure in the arterial system over a given time ◦ Normal value: 80 – 100 mmHg
 Mean arterial pressure MAP = (2 x diastolic pressure) + (systolic pressure) 3 A MAP of approximately 60 mmHg is necessary to perfuse coronary arteries, brain, kidneys.
 Reflects right atrial pressure  Influenced by changes in right ventricular function  Measured with catheter placed in superior vena cava just above right atrium
 Purpose ◦ Assess blood volume status ◦ Administration of fluids ◦ Sampling of blood ◦ Measurement of SvO2 ◦ Assessment of right ventricular pre-load  Normal value o CVP: < 6 mmHg o Right atrial pressure (RAP): 2-6 mmHg
 Used to assess filling pressure of the left side of heart  Measured by flow-directed, balloon-tipped catheter  Measures ◦ Pulmonary artery pressures – systolic, diastolic, mean ◦ Right ventricular preload (via right atrial pressure) ◦ Right ventricular afterload (via PA systolic pressure)
 Normal values ◦ Pulmonary artery pressure, systolic: 20-30 mmHg ◦ Pulmonary artery pressure, diastolic: 6-15 mmHg ◦ Pulmonary artery pressure, mean: 10-20 mmHg ◦ Pulmonary artery wedge pressure, mean: 4-12 mmHg
 Total amount of blood pumped by the heart per minute  Cardiac Output = Heart Rate x Stroke Volume  Normal value – 5L/min
 Cardiac Index ◦ Volume of blood pumped by the heart per minute divided by body surface area CI = CO BSA Normal range: 2.5 - 4.0 L/min per square meter Low values can indicate cardiogenic shock
 Amount of blood ejected from the ventricle with each ventricular systole  End-systolic volume (ESV) ◦ Volume remaining after systole
 End-diastolic volume (EDV) ◦ Volume to which the ventricles fill during diastole  SV = EDV – ESV  Normal value: 60 – 130 ml/beat
 Ejection fraction (EF) ◦ Proportion of EDV ejected on each stroke EF = SV EDV ◦ Normal value – 64%
 Preload ◦ Initial stretch of the ventricle ◦ The greater the preload, the greater the tension on contraction
 Afterload ◦ Force against which the heart must pump. ◦ In clinical practice, left ventricular afterload equals systemic vascular resistance.
 Contractility ◦ Amount of systolic force exerted by heart muscle at any given preload. ◦ Increases in contractility leads to higher EF, lower end systolic volume, and higher stroke volume ◦ Decreases in contractility lead to lower ejection fraction, higher end systolic volume, and decreased stroke volume.
 Contractility Inotropism: any factor which affects the contractility of the heart ◦ Positive inotropism  Higher stroke volumes for a given preload: indicating an increase in contractility ◦ Negative inotropism  Decreased stroke volumes for a given preload; indicates a decrease in contractility
 Heart rate  Autonomic nervous system o Sympathetic: fight or flight: HR, RR, BP, pupil dilation and bronchodilation o Parasympathetic: rest and digest
 Heart Rate ◦ Cardiac output directly proportional to heart rate  Relationship exists up to 160 to 180 beats/min  Filling time for ventricles insufficient at higher rates
 Sum of all frictional forces opposing blood flow through the vascular circulation.  SVR = Mean Aortic Pressure-Right Atrial Pressure Cardiac Output ◦ Mean Aortic Pressure - use systolic pressure (normal mean = 90mmhg) ◦ Right Atrial Pressure - use central venous pressure (normal mean = 4mmhg) ◦ Cardiac Output normal mean = 5L/min.  Normal value: 15 – 20 mmHg/L/min
 Cardiac anatomy ◦ Layers of the heart ◦ Chambers of the heart ◦ Valves ◦ Coronary arteries  Blood flow through the heart  Arterial system ◦ Structure of artery ◦ Purpose ◦ Major arteries
 Venous system ◦ Structure of system ◦ Purpose ◦ Aids to venous flow  Capillary system ◦ Structure of system ◦ Purpose
 Composition of blood  Plasma proteins  Types of cells, functions, normal values, abnormalities ◦ Erythrocytes ◦ Leukocytes ◦ Megakaryocytes ◦ Platelets ◦ Hemoglobin ◦ Hematocrit
 Definition, normal values, and formula (if applicable) ◦ Systemic vascular resistance ◦ Systolic pressure ◦ Diastolic pressure ◦ Mean arterial pressure ◦ Cardiac output and index ◦ Stroke volume, esv, edv, ef  Factors affecting stroke volume