This presentation covers the anatomy and physiology of the cardio-vascular and lymphatic systems; and the commonly associated disorders.

1. The
Circulatory
System
Prepared by Mickelder Kercy, MD - Instructor

2. Anatomy of the Heart
 Pericardium : The outer Layer
 Myocardium : The middle layer/heart muscle
 Endocardium : The innermost layer

3.  Right Atrium : Right upper chamber
 Left Atrium : Left upper chamber
 Right Ventricle : Right lower chamber
 Left Ventricle : Left lower chamber

4.  Tricuspid Valve : Between the RA and the RV
 Mitral Valve : Bicuspid valve located between the LA
and the LV
 Pulmonary Semilunar Valve : Between the RV and the
Lungs
 Aortic Semilunar Valve : Between the LV and the Aorta

5. Physiology of blood flow through
the Heart
 SVC : Drains blood from the head, upper extremities
and chest to the RA
 IVC : Drains blood from the lower extremities and
pelvis and abdomen to the RA

6.  PA : Brings blood from the RV to the Lungs
 PV : Brings blood from the Lungs to the LA
 Aorta : Largest artery bringing the blood from the LV
to the rest of the body
 Coronary Arteries : Supply blood to the heart tissue
 Coronary veins : Drain blood from the heart into the
coronary sinus which
drains into the right
atrium

8. Anatomy & Physiology of the
Conduction System of the Heart
 SA : Pacemaker in the upper wall of RA initiating the
heartbeat
 AV node : Under the endocardium of the RA sending
impulses from the SA node to the Bundle of His
 Bundle of His : AV bundle sending impulses from the
AV node to the Purkinje fibers through the RBB and
the LBB
 RBB + LBB : In the septum
 Purkinje Fibers : Within the walls of the ventricles
causing the ventricles to contract

10. Cardiac cycle
 During relaxation/diastole the chambers fill up with
blood
 During contraction/systole the chambers forcefully
move the blood out
 During diastole the RA receives blood from the SVC
+ the LA receives blood from the PV. At the same
time the Ventricles are in systole. The RV ejects the
blood into the PA and the LV ejects the blood into the
Aorta

11. Heart sounds
 Closure of the A-V valves produces the 1st heart sound
 Closure of the Semilunar valves produces the 2nd heart
sound

12. Anatomy of the Arteries
 Elastic tubes that expand with pressure (during
contraction of the heart). Composed of the tunica
externa/adventitia, tunica media and the tunica intima

15. Arterioles - Capillaries - Venules
 Arterioles : Tunica adventitia, media and intima
 Capillaries : Endothelium
 Venules : Tunica adventitia, media and intima

17. Veins
 Thin-walled vessels with low pressure. Contain valves
preventing backflow of blood. Composed of tunica
externa/adventitia, tunica media and tunica intima
 Venipuncture/phlebotomy : Incision of a vein to draw
blood for examination

19. Physiology of the blood vessels
circulation
 Arteries : Carry the blood away from the aorta
 Arterioles : Smaller vessels carrying the blood away from
the arteries to the capillaries
 Capillaries : Smallest vessels where the nutrients and
oxygen leave the blood and go into the cells. The waste
products and carbon dioxide from the cells pass through
the capillaries into the bloodstream
 Venules : Larger than the capillaries but as small as the
arterioles carrying the blood filled with waste products
away. Also carry the blood filled with nutrients from the
small intestine to the hepatic vein. Carry the blood filtered
though the kidneys to the hepatic vein
 Veins : Larger than the venules carrying the blood from
the upper part of the body to the SVC and from the lower
part of the body to the IVC

20. Obtaining a pulse
 Radial Artery : Lateral wrist + proximal to the thumb
 Apex of the heart : 5th intercostal space
 Brachial Artery : Antecubital space of the elbow or
between the biceps and triceps muscle
 Carotid artery : Lateral neck
 Temporal Artery : Temple
 Femoral Artery : Inguinal
 Popliteal Artery : Posteromedial (knee)
 Dorsalis Pedis Artery : Upper surface of the foot
 Anterior Tibial Artery : Medial side of the ankle

22. Blood Pressure
 Determined by the force exerted by the blood on the
walls of the arteries, the amount of blood pumped, the
size and the flexibility of the arteries
 Measured in the arm (brachial artery) using the
sphygmomanometer
 1st korotkoff sounds and last korotkoff sounds heard
through the stethoscope
 N° BP : 120/80 mmHg

23. Pulmonary Circulation
Heart
Pulmonary
Artery
Pulmonary
arterioles
Pulmonary
capillaries
Pulmonary
venules
Pulmonary
vein

25. Systemic Circulation
Heart
Aorta
Arteries
Arterioles
Capillaries
Venules
veins
SVC + IVC

27. Blood
 Composed of cells : -Erythrocytes/RBC
(45%) Male (4.3-5.9 million/mm³)
Female (3.5-5.5 million/mm³)
-Leukocytes/WBC
(4500-11,000/mm³)
-Thrombocytes/Platelets/clotting
cells (150,000-400,000/mm³)
and of plasma : -Fluid Portion
(55%)

28. Blood Cells Formation

29.  Erythrocyte : Biconcave. No nuclei. Made up of
Hemoglobin (protein & iron). Hb Carries oxygen
from the lungs to the cells and carbon dioxide from
the cells to the lungs. Produced in the bone marrow

30.  Leucocyte : Larger. Contains a nucleus. Has to be
stained to be seen. Fight infection. Categorized as
granulocyte or agranulocyte.
 Granulocytes : Basophils, Eosinophils and
Neutrophils have granules in their cytoplasm
Basophils Eosinophils Neutrophils

31.  Agranulocytes : Monocytes and Lymphocytes T and
B do not have granules in their cytoplasm
Monocytes Lymphocytes

32.  Thrombocytes : Smaller than the RBC and WBC.
Control the loss of blood by congregating to form a
clot (coagulation) at the site of injury

34. Functions of the blood
 Transportation : -Oxygen from the lungs to the cells
-Carbon dioxide from the cells to the lungs
-Nutrients from the digestive tract to the
cells
-Hormones from the endocrine glands
to the cells of each organ
-Waste materials from the cells to the liver
to be excreted in the feces through the bile and to the
kidney to be eliminated in the urine

35.  Regulation : -Body Temperature
(vasodilation vs vasoconstriction)
-Water and salt balance
-pH balance
-Blood loss with coagulation

37.  Defense : -Neutrophils and Monocytes phagocyte
(destroy the germ)
-Lymphocytes B secrete antibodies that
attach to the germ before it is phagocytized
-Lymphocytes T attack directly the germ

38. Blood Types
 Type A : Type A antigen on the RBC and anti-B
antibody in the plasma
 Type B : Type B antigen on the RBC and anti-A
antibody in the plasma
 Type AB : Both A and B antigens on the RBC and no
anti-A or anti-B antibodies in the plasma
 Type O : No A or B antigens on the RBC but anti-A
and anti-B antibody in the plasma

40.  The Rhesus Factor/Rh+ : Antigen on the RBC.
Pregnant woman without the antigen(Rh-) whose
fetus’ RBC has the antigen(Rh+) will develop
antibodies against the antigen. During the next
pregnancy the antibodies will attack the RBC of the
fetus and the fetus will become anemic and may die
 In general, Rh negative blood is given to Rh-negative
patients, and Rh positive blood or Rh negative blood
may be given to Rh positive patients.
 The universal red cell donor has Type O negative
blood type
 The universal plasma donor has Type AB positive
blood type.

41. The lymphatic System
 Lymphatic vessels : Transport excess fluids away
from the interstitial space (in-between the cells) into
the bloodstream. Contain valves that prevent
backflow which leads to edema
 Lymphatic nodes : Filter out and trap bacteria,
viruses, cancer cells, destroyed pathogens and
unwanted substances

42. Common disorders associated with the
circulatory System
 Iron-deficiency Anemia : Low iron level leading to
low hemoglobin production

43.  Pernicious Anemia (Vit-deficiency Anemia) : Lack of
secretion of intrinsic factor from the stomach causing
vitamin B12 not to be absorbed. Leads to macrocytic
anemia and glossitis (swollen red tongue), neuropathy
etc..

44.  Hemolytic Anemia : Premature destruction of RBCs
by antibodies produced by the immune system
 Sickle cell Anemia : Hemoglobin S disease with a
sickle-shaped RBC in people of African origins

45.  Aplastic Anemia : Failure of the bone marrow to
produce the blood cells. The bone marrow is replaced
with fat cells

46.  Aneurysm : Abnormal widening of a portion of an
artery because of weakness in the vessel wall

47.  Tachycardia : Fast heartbeat >100bpm
 Bradycardia : Slow heartbeat <60bpm

48.  Arteriosclerosis : Hardening of the arteries. Caused
by HTA, Atherosclerosis, Calcium deposits etc…

49.  Atherosclerosis : Buildup of plaque(fatty acids) in the
wall of the artery. May lead to the narrowing of the
lumen and hardening (arteriosclerosis) of the vessel.
Leading cause of coronary artery disease(CAD)

50.  Coronary artery disease : Narrowing of the coronary
arteries that supply blood to the heart.

51.  Cerebrovascular accident : Stroke resulting from a
complete interruption of blood flow to the brain by a clot
(Thrombotic/Embolic Stroke) or a ruptured blood vessel
(Hemorrhagic Stroke)

52.  Cardiac Tamponade : Congestion of the heart muscle
and restriction of heart movement caused by blood or
fluid trapped in the pericardial sac

53.  Cardiogenic Shock : Collapse of the cardiovascular
system resulting from vasodilation and fluid shifting
away from the heart

54.  Cardiomyopathy : Disease of the myocardium

56.  Pericarditis : Inflammation of the pericardium
 Myocarditis : Inflammation of the myocardium
 Endocarditis : Inflammation of the endocardium

57.  Congestive Heart Failure : Heart is unable to pump
sufficient blood to the rest of the body

58.  Cor Pulmonale : Lung disease blocking the flow of
blood from the right ventricle to the lungs. Results in
an enlargement of the RV

59.  Myocardial Infarction : Infarction/death of heart
tissue because of severe reduction or absence of
supply of blood to an area of the myocardium

60.  Hemophilia : Hereditary deficiency of clotting factors
most frequently in male
 Pre-Hypertension : BP from 120/80 – 139/89
 Hypertension : BP>140/90
 Hypotension : BP <90/60

61.  Leukemia : Abnormal growth/Cancer of the
leukocytes

62.  Thrombophlebitis : Blood clot causing inflammation
in the vein

63.  Petechiae : Small red/purple eruptions on the body
caused by broken capillaries

64.  Transfusion Reaction : When the blood type
transfused to a patient is incompatible with the
patient’s blood type causing an agglutination of the
patient’s RBC

65.  Mitral Stenosis : Mitral valve disease/calcification
causing the valve to narrow not able to open up
sufficiently when blood enters the RV

66.  Mitral Valve Prolapse : Mitral valve is above its
normal location between the atrium and the ventricle
causing the leaflets to go all the way into the atrium
rather than get close to each other horizontally at the
end of the ventricular contraction

67.  Varicose veins : Enlarged and tortuous veins caused
by malfunctioning valves

68. The End