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2/20/2016
1
Part 1
The Cardiovascular System
• Blood
• Heart
• Blood vessels
Cardiovascular System
• Functions
–Transport gases, wastes, food, hormones, blood cells
• Systems affected
–Respiratory
–Urinary
–Digestive
–Musculoskeletal
–Immune system
Cardiovascular System
• Four separate chambers in humans
– Also other mammals, birds
• Double pump � two closed circuits
• 5 L/minute
The Heart
Figure 18.5
Oxygen-rich,
CO2-poor blood
Oxygen-poor,
CO2-rich blood
Capillary beds
of lungs where
gas exchange
occurs
Capillary beds of all
body tissues where
gas exchange occurs
Pulmonary veinsPulmonary arteries
Pulmonary
Circuit
Systemic
Circuit
Aorta and branches
Left atrium
Heart
Left ventricleRight atrium
Right ventricle
Venae cavae
• Symmetrical in design, but not in position
– 2/3 of mass to the left of midline
– 1/3 to right
The Heart
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Figure 18.1a
Point of
maximal
intensity
(PMI)
Diaphragm
(a)
Sternum
2nd rib
Midsternal line
Located within mediastinum
Figure 18.1c
(c)
Superior
vena cava
Left lung
Aorta
Parietalpleura (cut)
Pericardium(cut)
Pulmonary
trunk
Diaphragm
Apex of
heart
–Membrane surrounding and protecting the heart
• Confines while still allowing free movement
Pericardium
–Double walled organ
• Fibrous pericardium
• Serous pericardium
Pericardium
–Double walled organ
• Fibrous pericardium
–Fibrous connective tissue
–Prevents overstretching, protection, anchorage
• Serous pericardium
Pericardium
–Double walled organ
• Fibrous pericardium
• Serous pericardium
–Serous epithelium
–Double layer
» Parietal layer
* Epithelial cells
* Secrete serous fluid (thin mucus)
* Fused to fibrous pericardium
» Visceral layer (epicardium)
* Thin connective tissue
* Forms surface of heart
Pericardium
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• Pericardial cavity
–Between visceral and parietal serous pericardium
–Scant amount of serous fluid – accumulation may cause…
• Pericarditis
– Inflammation of pericardium
–Sharp, stabbing chest pain
–May be caused by viral
infection, heart attack
–Begins suddenly but
resolves quickly
Pericardium
Figure 18.2
Fibrous pericardium
Parietal layer of
serous pericardium
Pericardial cavity
Epicardium
(visceral layer
of serous
pericardium)Myocardium
Endocardium
Pulmonary
trunk
Heart chamber
Heart
wall
Pericardium
Myocardium
• Three layers
–Epicardium
• Also called the…
–Myocardium
–Endocardium
Muscular Wall of the Heart
Figure 18.2
Fibrous pericardium
Parietal layer of
serous pericardium
Pericardial cavity
Epicardium
(visceral layer
of serous
pericardium)Myocardium
Endocardium
Pulmonary
trunk
Heart chamber
Heart
wall
Pericardium
Myocardium
• Epicardium
– Serous membrane
– Typicially infiltrated
with fat in the elderly
Muscular wall of the heart
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• Myocardium
–Primarily cardiac muscle
–Bulk of heart
–Variable thickness
• Ventricles thicker than atria
• Left ventricle thicker than right
– Inner surface raised into finger-
like projections
• Papillary muscles
Muscular wall of the heart
• Myocardium
–Branching cardiac muscle cells
–Connected to one another by crisscrossing connective tissue
fibers
• Non-excitable – limits the spread of action potentials to specific
pathways in the heart
–Arranged in spiral or circular bundles
–Bundles interlace and effectively link all parts of the heart
together
Muscular wall of the heart
Figure 18.3
Cardiac
muscle
bundles
Myocardium
• Endocardium
–Squamous epithelium
• Smooth, white
–Continuous with
endothelial linings
of large blood
vessels
entering/exiting
the heart
Muscular wall of the heart
• Endocardium
–Endocarditis – inflammation of the endocardium
–Common in IV drug users
–Leads to valve damage, emboli
Muscular wall of the heart
• Chambers
Anatomy of the Heart
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• Chambers
–Right and left atria
• Separated by interatrial septum
• Coronary sulcus (atrioventricular groove) encircles the junction of the
atria and ventricles
– Blood vessels that supply the myocardium rest inside
• Auricles
– Atrial appendages
– Increase atrial volume
Anatomy of the Heart
• Chambers
–Right and left ventricles
• Separated by interventricular septum
Anatomy of the Heart
Figure 18.6
Right
ventricle
Left
ventricle
Interventricular
septum
• Ventricular septal
defect (VSD)
Anatomy of the Heart
• Numerous blood vessels are associated with the
heart…
Major Vessels of the Heart
Figure 18.4b
(b) Anterior view
Brachiocephalic trunk
Superior vena cava
Right pulmonary
artery
Ascending aorta
Pulmonary trunk
Right pulmonary
veins
Right atrium
Right coronary artery
(in coronary sulcus)
Anterior cardiac vein
Right ventricle
Right marginal artery
Small cardiac vein
Inferior vena cava
Left common carotid
arteryLeft subclavian artery
Ligamentum arteriosum
Left pulmonary artery
Left pulmonary veins
Circumflex artery
Left coronary artery
(in coronary sulcus)
Left ventricle
Great cardiac vein
Anterior interventricular
artery (in anterior
interventricular sulcus)
Apex
Aortic arch
Auricle of
left atrium
Major Vessels of the Heart
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• Vessels entering right atrium
–Superior vena cava
– Inferior vena cava
–Coronary sinus
• Vessels entering left atrium
–Right and left pulmonary veins
AtriaThe Receiving Chambers
Figure 18.4b
(b) Anterior view
Brachiocephalic trunk
Superior vena cava
Right pulmonary
artery
Ascending aorta
Pulmonary trunk
Right pulmonary
veins
Right atrium
Right coronary artery
(in coronary sulcus)
Anterior cardiac vein
Right ventricle
Right marginal artery
Small cardiac vein
Inferior vena cava
Left common carotid
arteryLeft subclavian artery
Ligamentum arteriosum
Left pulmonary artery
Left pulmonary veins
Circumflex artery
Left coronary artery
(in coronary sulcus)
Left ventricle
Great cardiac vein
Anterior interventricular
artery (in anterior
interventricular sulcus)
Apex
Aortic arch
Auricle of
left atrium
Major Vessels of the Heart – Entering Right Atrium
Figure 18.4d
(d) Posterior surface view
Aorta
Left pulmonaryartery
Left pulmonaryveins
Auricle of leftatrium
Left atrium
Great cardiacvein
Posterior veinof left ventricle
Left ventricle
Apex
Superior vena cava
Right pulmonary artery
Right pulmonary veins
Right atrium
Inferior vena cava
Right coronary artery(in coronary sulcus)
Coronary sinus
Posteriorinterventricularartery (in posteriorinterventricular sulcus)
Middle cardiac vein
Right ventricle
Major Vessels of the Heart – Entering Right Atrium
Figure 18.4e
Aorta
Left pulmonary
arteryLeft atrium
Left pulmonary
veins
Mitral (bicuspid)
valve
Aortic valve
Pulmonary valveLeft ventricle
Papillary muscle
Interventricularseptum
EpicardiumMyocardium
Endocardium
(e) Frontal section
Superior vena cava
Right pulmonaryarteryPulmonary trunk
Right atrium
Right pulmonaryveinsFossa ovalis
Pectinate muscles
Tricuspid valve
Right ventricle
Chordae tendineae
Trabeculae carneae
Inferior vena cava
Major Vessels of the Heart – Entering Right Atrium
Figure 18.4b
(b) Anterior view
Brachiocephalic trunk
Superior vena cava
Right pulmonary
artery
Ascending aorta
Pulmonary trunk
Right pulmonary
veins
Right atrium
Right coronary artery
(in coronary sulcus)
Anterior cardiac vein
Right ventricle
Right marginal artery
Small cardiac vein
Inferior vena cava
Left common carotid
arteryLeft subclavian artery
Ligamentum arteriosum
Left pulmonary artery
Left pulmonary veins
Circumflex artery
Left coronary artery
(in coronary sulcus)
Left ventricle
Great cardiac vein
Anterior interventricular
artery (in anterior
interventricular sulcus)
Apex
Aortic arch
Auricle of
left atrium
Major Vessels of the Heart – Entering Left Atrium
Figure 18.4e
Aorta
Left pulmonary
arteryLeft atrium
Left pulmonary
veins
Mitral (bicuspid)
valve
Aortic valve
Pulmonary valveLeft ventricle
Papillary muscle
Interventricularseptum
EpicardiumMyocardium
Endocardium
(e) Frontal section
Superior vena cava
Right pulmonaryarteryPulmonary trunk
Right atrium
Right pulmonaryveinsFossa ovalis
Pectinate muscles
Tricuspid valve
Right ventricle
Chordae tendineae
Trabeculae carneae
Inferior vena cava
Major Vessels of the Heart – Entering Left Atrium
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• Vessel leaving the right ventricle
–Pulmonary trunk → right and le> pulmonary arteries
• Vessel leaving the left ventricle
–Aorta
Ventricles The Discharging Chambers
Figure 18.4b
(b) Anterior view
Brachiocephalic trunk
Superior vena cava
Right pulmonary
artery
Ascending aorta
Pulmonary trunk
Right pulmonary
veins
Right atrium
Right coronary artery
(in coronary sulcus)
Anterior cardiac vein
Right ventricle
Right marginal artery
Small cardiac vein
Inferior vena cava
Left common carotid
arteryLeft subclavian artery
Ligamentum arteriosum
Left pulmonary artery
Left pulmonary veins
Circumflex artery
Left coronary artery
(in coronary sulcus)
Left ventricle
Great cardiac vein
Anterior interventricular
artery (in anterior
interventricular sulcus)
Apex
Aortic arch
Auricle of
left atrium
Major Vessels of the Heart – Exiting Right Ventricle
Figure 18.4b
(b) Anterior view
Brachiocephalic trunk
Superior vena cava
Right pulmonary
artery
Ascending aorta
Pulmonary trunk
Right pulmonary
veins
Right atrium
Right coronary artery
(in coronary sulcus)
Anterior cardiac vein
Right ventricle
Right marginal artery
Small cardiac vein
Inferior vena cava
Left common carotid
arteryLeft subclavian artery
Ligamentum arteriosum
Left pulmonary artery
Left pulmonary veins
Circumflex artery
Left coronary artery
(in coronary sulcus)
Left ventricle
Great cardiac vein
Anterior interventricular
artery (in anterior
interventricular sulcus)
Apex
Aortic arch
Auricle of
left atrium
Major Vessels of the Heart – Exiting Right Ventricle
Figure 18.4e
Aorta
Left pulmonary
arteryLeft atrium
Left pulmonary
veins
Mitral (bicuspid)
valve
Aortic valve
Pulmonary valveLeft ventricle
Papillary muscle
Interventricularseptum
EpicardiumMyocardium
Endocardium
(e) Frontal section
Superior vena cava
Right pulmonaryarteryPulmonary trunk
Right atrium
Right pulmonaryveinsFossa ovalis
Pectinate muscles
Tricuspid valve
Right ventricle
Chordae tendineae
Trabeculae carneae
Inferior vena cava
Major Vessels of the Heart – Exiting Right Ventricle
Figure 18.4b
(b) Anterior view
Brachiocephalic trunk
Superior vena cava
Right pulmonary
artery
Ascending aorta
Pulmonary trunk
Right pulmonary
veins
Right atrium
Right coronary artery
(in coronary sulcus)
Anterior cardiac vein
Right ventricle
Right marginal artery
Small cardiac vein
Inferior vena cava
Left common carotid
arteryLeft subclavian artery
Ligamentum arteriosum
Left pulmonary artery
Left pulmonary veins
Circumflex artery
Left coronary artery
(in coronary sulcus)
Left ventricle
Great cardiac vein
Anterior interventricular
artery (in anterior
interventricular sulcus)
Apex
Aortic arch
Auricle of
left atrium
Major Vessels of the Heart – Exiting Left Ventricle
Figure 18.4e
Aorta
Left pulmonary
arteryLeft atrium
Left pulmonary
veins
Mitral (bicuspid)
valve
Aortic valve
Pulmonary valveLeft ventricle
Papillary muscle
Interventricularseptum
EpicardiumMyocardium
Endocardium
(e) Frontal section
Superior vena cava
Right pulmonaryarteryPulmonary trunk
Right atrium
Right pulmonaryveinsFossa ovalis
Pectinate muscles
Tricuspid valve
Right ventricle
Chordae tendineae
Trabeculae carneae
Inferior vena cava
Major Vessels of the Heart – Exiting Left Ventricle
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• Supply blood to the heart wall itself
Coronary Arteries
Figure 18.4b
(b) Anterior view
Brachiocephalic trunk
Superior vena cava
Right pulmonary
artery
Ascending aorta
Pulmonary trunk
Right pulmonary
veins
Right atrium
Right coronary artery
(in coronary sulcus)
Anterior cardiac vein
Right ventricle
Right marginal artery
Small cardiac vein
Inferior vena cava
Left common carotid
arteryLeft subclavian artery
Ligamentum arteriosum
Left pulmonary artery
Left pulmonary veins
Circumflex artery
Left coronary artery
(in coronary sulcus)
Left ventricle
Great cardiac vein
Anterior interventricular
artery (in anterior
interventricular sulcus)
Apex
Aortic arch
Auricle of
left atrium
Major Vessels of the Heart
• Atrioventricular (AV) valves
–Prevent backflow into the atria when ventricles contract
–Chordae tendineae (“heart strings”) anchor AV valve cusps to
papillary muscles
• Semilunar valves
–Prevent backflow into the ventricles when ventricles relax
Unidirectional blood flow through the heart
Heart Valves
Figure 18.8c
Pulmonary
valve
Aortic
valve
Area of
cutaway
Mitral
valve
Tricuspid
valve
Chordae tendineae
attached to tricuspid valve flap
Papillary
muscle(c)
• Atrioventricular
–Separate atria from ventricles
• Tricuspid
– Right side
• Mitral (bicuspid)
– Left side
• Semilunar
–Separate ventricles from great arteries
• Pulmonary semilunar
• Aortic semilunar
Heart Valves
Figure 18.4e
Aorta
Left pulmonary
arteryLeft atrium
Left pulmonary
veins
Mitral (bicuspid)
valve
Aortic valve
Pulmonary valveLeft ventricle
Papillary muscle
Interventricularseptum
EpicardiumMyocardium
Endocardium
(e) Frontal section
Superior vena cava
Right pulmonaryarteryPulmonary trunk
Right atrium
Right pulmonaryveinsFossa ovalis
Pectinate muscles
Tricuspid valve
Right ventricle
Chordae tendineae
Trabeculae carneae
Inferior vena cava
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Figure 18.8a
Pulmonary valveAortic valve
Area of cutaway
Mitral valveTricuspid valve
Myocardium
Tricuspid
(right atrioventricular)
valve
Mitral
(left atrioventricular)
valve
Aortic
valve
Pulmonary
valve
(b)
Pulmonary valveAortic valve
Area of cutaway
Mitral valve
Tricuspid valveMyocardium
Tricuspid
(right atrioventricular)
valve
(a)
Mitral
(left atrioventricular)
valveAortic valve
Pulmonary
valveFibrous
skeleton
Anterior
• The heart is two side-by-side pumps
–Right side = pulmonary circuit
• Vessels that carry blood to and from the lungs
–Left side = systemic circuit
• Vessels that carry the blood to and from all body tissues
Cardiac Circulation
Figure 18.5
Oxygen-rich,
CO2-poor blood
Oxygen-poor,
CO2-rich blood
Capillary beds
of lungs where
gas exchange
occurs
Capillary beds of all
body tissues where
gas exchange occurs
Pulmonary veinsPulmonary arteries
Pulmonary
Circuit
Systemic
Circuit
Aorta and branches
Left atrium
Heart
Left ventricleRight atrium
Right ventricle
Venae cavae
Right atrium (via vena cava)
Tricuspid valve
Right ventricle
Pulmonary semilunar valve
Pulmonary trunk
Pulmonary arteries
Lungs
Pathway of Blood Through the Heart
Lungs
Pulmonary veins
Left atrium
Bicuspid valve
Left ventricle
Aortic semilunar valve
Aorta
Systemic circulation
Figure 18.9
1 Blood returning to the
heart fills atria, puttingpressure against
atrioventricular valves;
atrioventricular valves areforced open.
1 Ventricles contract, forcing
blood against atrioventricularvalve cusps.
2 As ventricles fill,
atrioventricular valve flapshang limply into ventricles.
2 Atrioventricular valves
close.
3 Atria contract, forcing
additional blood into ventricles.
3 Papillary muscles
contract and chordaetendineae tighten,
preventing valve flaps
from everting into atria.
(a) AV valves open; atrial pressure greater than ventricular pressure
(b) AV valves closed; atrial pressure less than ventricular pressure
Direction of
blood flow
Atrium
Ventricle
Cusp of
atrioventricularvalve (open)
Chordae
tendineae
Papillary
muscle
Atrium
Blood in
ventricle
Cusps of
atrioventricularvalve (closed)
Figure 18.10
As ventriclescontract andintraventricularpressure rises,blood is pushed upagainst semilunarvalves, forcing themopen.
As ventricles relaxand intraventricularpressure falls, bloodflows back fromarteries, filling thecusps of semilunarvalves and forcingthem to close.
(a) Semilunar valves open
(b) Semilunar valves closed
Aorta
Pulmonarytrunk
2/20/2016
10
• “lub-dup”
Heart Sounds
• Blood from the chambers cannot serve as a functional blood
supply to the heart
• Heart muscle has its own blood supply
– Coronary circulation
Coronary (Cardiac) Circulation
• Arteries
– Right and left coronary arteries
– Branch off base of the aorta
– Extensive branching throughout epicardium
• Common for branches from right and left coronary arteries to unite
– Anastomoses
• Cardiac veins feed into coronary sinus directly into right atrium
Coronary (Cardiac) Circulation
2/20/2016
11
Figure 18.7a
Rightventricle
Rightcoronaryartery
Rightatrium
Rightmarginalartery
Posteriorinterventricularartery
Anteriorinterventricularartery
Circumflexartery
Leftcoronaryartery
Aorta
Anastomosis(junction ofvessels)
Leftventricle
Superiorvena cava
(a) The major coronary arteries
Left atrium
Pulmonarytrunk
Figure 18.4d
(d) Posterior surface view
Aorta
Left pulmonaryartery
Left pulmonaryveins
Auricle of leftatrium
Left atrium
Great cardiacvein
Posterior veinof left ventricle
Left ventricle
Apex
Superior vena cava
Right pulmonary artery
Right pulmonary veins
Right atrium
Inferior vena cava
Right coronary artery(in coronary sulcus)
Coronary sinus
Posteriorinterventricularartery (in posteriorinterventricular sulcus)
Middle cardiac vein
Right ventricle
Figure 18.7b
Superiorvena cava
Anteriorcardiacveins
Small cardiac vein
Middle cardiac vein
Greatcardiacvein
Coronarysinus
(b) The major cardiac veins
Coronary sinus drains into right atrium
• Benefits of anastomoses
• Provides additional route of blood flow
• Older heart attack patients are more likely to survive
than younger ones
– Sudden clot formation vs gradual
Collateral Circulation