Chapter 11: THE Cardiovascular System

Chapter 11:
The Cardiovascular
System
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
McConnell and Hull: Human Form and Human Function
Chapter Objectives
The Organization of the Cardiovascular System
Describe the pathway a blood cell takes from the lungs to the
tissues and back.
Structure and Function of the Heart
Accurately describe the anatomical location of the heart, and
describe the layers of the heart wall and the pericardium.
Compare skeletal and cardiac muscle in terms of their
microscopic appearance, the role of calcium in muscle
contraction, and the method of generating stronger and
weaker contractions.
Explain the importance of the longer duration of the action
potential in cardiac muscle than in skeletal muscle.
Chapter Objectives (cont'd)

Structure and Function of the Heart (cont'd)
Explain the importance of pressure gradients and valves in
governing blood flow through the heart and great vessels.
Label the coronary arteries and the coronary sinus on
anterior and posterior views of the heart.
The Heartbeat
For each stage of the cardiac cycle, know which valves are
open, which chambers are contracting, and the direction of
blood flow (if any).
List the structures that make up the cardiac conducting
system, and explain why the sinoatrial (SA) node is usually
the pacemaker.

The Heartbeat (cont'd)
Link the events of an electrocardiogram (ECG) to the cardiac
cycle.
Cardiac Output
Discuss the effects of the autonomic nervous system on
heart rate, stroke volume, and cardiac output.
Explain the relationship between preload, cardiac muscle
fiber length, and stroke volume. Discuss the relevance of this
relationship to cardiovascular function.
Structure and Function of Blood Vessels
Describe the different tunics present in the five type of
vessels.

Structure and Function of Blood Vessels (cont'd)
Compare the function of elastic arteries, muscular arteries,
arterioles, and precapillary sphincters.
List four methods of capillary exchange.
Predict the effects of changes in hydrostatic and osmotic
pressure on bulk flow and fluid balance.
List three mechanisms that assist venous return to the heart.
Blood Flow and Pressure
Compare diastolic pressure, systolic pressure, mean arterial
pressure, and pulse pressure.
Explain how arterial blood volume and vessel compliance are
the major determinants of blood pressure.

Blood Flow and Pressure (cont'd)
Explain how overall blood volume, cardiac output, and
peripheral resistance all modify blood pressure by altering
arterial blood volume.
Describe how the sympathetic nervous system acts to
increase blood pressure.
Myocardial Infarction: The Case of Bob W.
Use the case study to illustrate the relevance of heart rate
and the strength of myocardial contraction to maintaining
adequate blood pressure.
The Major Blood Vessels
Discuss the advantages of portal circulations and
anastomoses, giving and example of each.

The Major Blood Vessels (contd)
Label diagrams of the major veins and arteries of the head,
upper limb, torso, and lower limb.
Trace the pathway that a blood cell would take in leaving
from and returning to different body regions, such as the big
toe, large intestine, and left cerebral hemisphere.
The Organization of the Cardiovascular System

Pulmonary circulation
transfers blood between heart and lungs
Systemic circulation
transfers blood between heart and other tissues of the body
Artery
carries blood from the heart
Vein
delivers blood back to the heart
Back to chapter objectives
The Cardiovascular System
Structure and Function of the Heart

The heart is two pumps.
Right heart pumps oxygen-poor blood to the lungs
Left heart pumps oxygen-rich blood to the rest of the body
The Heart and Its Coverings

Position of the heart:
apex points towards the
left hip
base points towards the
posterior left shoulder
The Heart and Its Coverings (contd)

The heart is
attached to the
diaphragm and
major blood vessels
by the pericardium.
The heart wall
contains three
layers.
Epicardium
Myocardium
Endocardium
The Heart and Its Coverings (Review)

Which layer of the pericardium is part of the heart wall?
The Heart and Its Coverings (Review)

Answer: The visceral layer of the serous pericardium
Cardiac Muscle
Cardiac myocytes are cardiac muscle cells.
Cardiac muscle cells are joined end-to-end with intercalated
discs.
Cardiac Muscle versus Skeletal Muscle

Both skeletal muscle and cardiac muscle are striated.
Myofilaments are organized into sarcomeres.
Each myofilament contains an orderly arrangement of thick and thin filaments.
Cardiac muscle regulation is also similar to skeletal muscle.
Calcium binds to troponin.
Troponin frees myosin binding sites on the actin molecules of the thin filaments.
Skeletal muscle fibers are electrically insulated from one another.
Cardiac muscle fibers are interconnected so the heart muscle beats as a single unit
like a single-unit of smooth muscle.
Cardiac Muscle (Review)

What is the purpose of gap junctions--to physically hold cells
together or to electrically couple cells together?
Cardiac Muscle (Review)

Answer: Electrically couple cells together
Cardiac Muscle Action Potentials

A. The action potential in
skeletal muscle cells is
of short duration.
B. The action potential in

cardiac muscle cells has
an extended plateau
period.
Cardiac Muscle Action Potential

Strength of a cardiac contraction depends on amount of calcium
available
Myocardial action potentials last longer than those in skeletal
muscles
Calcium (not membrane depolarization) opens Ca++
channels in the endoplasmic reticulum
Longer cardiac action potential means the heart fills with blood
before another beat can occur
Prevents tetanus (a prolonged state of contraction)
Cardiac Muscle Action Potentials (Review)

Which ion participates in the action potential in cardiac muscle
but not skeletal muscle?
Cardiac Muscle Action Potentials (Review)

Answer: Calcium
Blood Flow Through the Heart

1. from one of three
veins
2. to right atrium
3. to right ventricle
4. to pulmonary trunk
5. to right and left
pulmonary arteries
6. to four pulmonary
veins
7. to left atrium
Blood Flow Through the Heart (cont'd)

8. to left ventricle
9. to aorta (ascending
portion)
10. to systemic
capillaries of entire
body
Blood Flow Through the Heart (contd)
Valves and the Fibrous Skeleton

Valves of the heart
Atrioventricular valve (AV)
Pulmonary valve
Divides into tricuspid valve (right AV valve) and mitral

valve (left AV valve)
Composed of three cup-like leaflets with open end of cup

facing into lumen of main pulmonary artery
Aortic Valve
Three leaflet valve between left ventricle and the aorta
Valves and the Fibrous Skeleton (contd)

A. The fibrous skeleton separates the atria from the ventricles
and supports the heart valves.
Valves and the Fibrous Skeleton (contd)

B. In response to
increased pressure in
the atrium, the left
atrioventricular (AV)
valve opens, enabling
blood to flow from the
atrium to the ventricle.
C. The left AV valve
closes, preventing
blood flow from the
ventricle to the atrium.
Valves and the Fibrous Skeleton (Review)

Answer: The left atrioventricular valve
Valves and the Fibrous Skeleton (Review)

Which valve has only two flaps?
External Features / Circulation

The coronary
circulation supplies
most of the heart
muscle.
Only the major vessels
are illustrated here;
there are many more.
External Features / Circulation (contd)

Interruption of blood supply to any tissue causes tissue
dysfunction or death.
Partial blockage causes angina pectoris, which is pain beneath
the sternum
Pain has a crushing, choking, and aching character
Localized area of dead tissue is an infarct, or heart attack
Pain is similar to angina but longer-lasting
Causes muscle cells to stop contracting and can be fatal
External Features / Circulation (Review)

Name the artery that descends the posterior surface of the left
ventricle.
External Features / Circulation (Review)

Answer: The circumflex artery
The Heartbeat: The Cardiac Cycle

The cardiac cycle is the sequence of events between the
beginning of one heartbeat and the beginning of the next.
Three stages are
Atrial systole
Ventricular systole
Complete diastole
Flow is not audible except in diseased hearts, where flow is
turbulent and noisy, called a murmur.
The Cardiac Cycle
Three stages of the

cardiac cycle
1.Atrial systole
2.Ventricular systole
3.Complete diastole
Cardiac Cycle (Review)

During which stage is blood NOT flowing into the atria?
Cardiac Cycle (Review)

Answer: Atrial systole
Cardiac Conduction System (contd)
Steps involved in a single heartbeat:

1. Sinoastrial (SA) node cells fire an action potential
2. Wave of action potential passes from SA node through contractile cells of the atria
3. Some action potential cells take shortcut to arrive at atrioventricular (AV) node
4. Atrioventricular bundle (also bundle of His) pierces the fibrous skeleton that
insulates atria from ventricles, carrying the signal into the interventricular septum
5. AV bundle splits into bundle branches, which extend down the interventricular
septum to the apex of the heart
6. At apex of ventricle, bundle branches into Purkinje fibers, which carry signal to
ventricular contractile cells

A. Pacemaker potentials in autorhythmic cells.

B. The anatomical components of the cardiac conduction system,
and the steps involved in one heartbeat. The black arrows
indicate the spread of electrical impulses through the
conducting system.

Normal resting heart rate is less than 100 beats per minute
In healthy people, SA node sets pace of heartbeat
Every time SA node fires an action potential, all downstream
conducting cells must also fire an action potential
If people are diseased or injured, the AV node sets the pace if the
SA node is inactivated
Intrinsic rate becomes slower
Heart block is the delay or bloc of signal generation or
transmission through the AV node
Cardiac Conduction System (Review)

Which structure sends electrical impulses directly to ventricular
cells the bundle branches or the Purkinje fibers?
Cardiac Conduction System (Review)

Answer: Purkinje fibers
Electrocardiogram
An electrocardiogram is an electric record of a heartbeat.
The image shows the electrical changes in the heart over two
heartbeats.
Electrocardiogram (contd)
Four major voltage changes with each heartbeat:
Atrial depolarization
Atrial repolarization
Ventricular depolarization
Ventricular repolarization
Three corresponding waves detectable in normal ECG:
P wave: small and represents atrial depolarization
QRS complex: rapid series of three waves that represent

ventricular depolarization (atrial repolarization is hidden in
QRS complex)
T wave: midsize wave that represents ventricular

repolarization
Electrocardiogram (contd)
Two periods (intervals or segments) separating the three waves:
P-Q segment: represents duration of the atrial action

potential
Q-T segment: indicates duration of the ventricular action

potential
Atrial systole begins at peak of P wave and ends at

about Q wave
Ventricular systole begins at R wave and ends at

midpoint of T wave
Time between beginnings of successive P waves is a cardiac

cycle
Used to calculate heart rate

Electrocardiogram (Review)
Which wave indicates the beginning of ventricular diastole?
Electrocardiogram (Review)
Answer: T-wave
Cardiac Output
Cardiac output (CO): volume of blood ejected per minute by the left
ventricle into the aorta; measures the total amount of blood flow in the body
CO = HR SV
CO is the product of the heart rate (HR, beats/min) and the volume ejected
per beat (ml/beat), called the stroke volume (SV).
In a healthy person, CO is about 5 L per minute.
The entire blood volume circulates through the body about once per
minute.
Output changes to meet changing demands.
Autonomic Innervation of the Heart

The vasomotor center
controls the heart rate and
force of cardiac muscle
contraction.
Sympathetic fibers
are shown in green.
Parasympathetic
fibers are shown in
red.
Autonomic Innervation of the Heart (contd)

Parasympathetic system determines vagal tone
Suppresses SA firing to about 75 discharges per minute
in healthy adults
Strength of contraction depends on preload (end diastolic
volume)
Greater fiber length results in stronger contraction
In a healthy heart, each beat of the ventricle pumps out
the same volume of blood it receives
Autonomic Innervation of the Heart (Review)

Which branch of the ANS does not pass through the spinal
cord?
Autonomic Innervation of the Heart (Review)

Answer: Parasympathetic
Structure and Function of Blood Vessels

The arterial wall can be divided into three layers, or tunics:
tunica interna (or intima)
composed of the endothelium and supporting basement
membranes
tunica media (or media)
composed of smooth muscle mixed with elastic fibers
tunica externa (or adventitia)
consists of collagen and elastic fibers
Microanatomy of Blood Vessels
Microanatomy of Blood Vessels (Review)

Which tunic is found in all types of vessels?
Microanatomy of Blood Vessels (Review)

Answer: Tunica interna
Vasoconstriction and Vasodilation

Vasoconstriction and vasodilation alter resistance of blood
vessel
Blood follows path of least resistance
Inhibition or interruption of sympathetic tone causes smooth
muscle relaxation and vasodilation
Vasoconstriction and Vasodilation (contd)

The smooth muscle of the tunica
media contracts or relaxes to
alter lumen diameter and thereby
modulate blood flow.
Vasoconstriction increases
resistance, and blood follows the
path of least resistance.
Vasoconstriction and Vasodilation (Review)

Nitric oxide relaxes vascular smooth muscle. Would nitric
oxide increase or decrease blood flow?
Vasoconstriction and Vasodilation (Review)

Answer: Increase
Arteries and Blood Pressure

Elastic arteries: the largest arteries (such as the aorta);
squeeze blood forward to maintain blood pressure as they
relax
Muscular arteries: medium-sized vessels that direct blood
flow to body regions
Arterioles: small arteries that distribute blood to individual
capillary beds; major site of resistance in the vascular system
Precapillary sphincters: formed of smooth muscle; relax
when more blood flow is needed
Capillary Beds
The precapillary sphincters
A. open to permit flow through the
capillary bed
or
B. close to restrict flow to the

metarteriole.
Capillary Beds (Review)

Which figure shows vasoconstriction of the arteriole part A or
part B?
Capillary Beds (Review)

Answer: Part A
Methods of Capillary Exchange

Four methods of capillary exchange are:
directly through endothelial cells by simple diffusion or by
use of transporter proteins
directly through endothelial cells by vesicular transport
between endothelial cells, by simple diffusion
bulk flow
Exchange Across Capillary Walls

A. Substances can move between the blood and the tissues by
four different mechanisms.
Exchange Across Capillary Walls (contd)

A. Bulk flow is determined by the balance between outwarddirected hydrostatic pressure and inward-directed osmotic
pressure.
Exchange Across Capillary Walls (Review)
If someone has high blood pressure, will they have greater

filtration or greater reabsorption?
Exchange Across Capillary Walls (Review)
Answer: Greater filtration
Venous Return
Three mechanisms assist venous return to the heart
Vein constriction
Skeletal muscle pump
Respiratory pump
The Skeletal Muscle Pump
Muscle contraction
forces blood to flow
through veins
Valves ensure that blood

flows only toward the
heart
The Skeletal Muscle Pump (Review)
In the right-hand diagram,

what would happen if the
lower valve did not close?
The Skeletal Muscle Pump (Review)
Answer: Blood would be

pushed back into the foot.
Blood Flow and Blood Pressure: Blood Pressures
Systolic pressure: peak pressure developed in the aorta and

large arteries; normally about 120mg
Diastolic pressure: lowest pressure, normally around 80mg
Pulse pressure: difference between systolic and diastolic

blood pressure
MAP: average (mean) blood pressure in the arteries
Blood Pressures (contd)
Pressure can be increased by adding volume or by squeezing

the fluid.
Systolic arterial pressure represents added volume during

ventricular ejection.
Diastolic arterial pressure represents the squeezing effect

of arterial elastic recoil.
In both cases, the pressure enables blood to flow.
Pressures in the Systemic Circulations
Pressure decreases as the blood passes through the systemic

circulation.
Pressures in the Systemic Circulations (Review)
Is it possible to detect pulse pressure in the veins?
Pressures in the Systemic Circulations (Review)
Answer: No
Determinants of Blood Pressure

A. Arterial blood pressure is determined
by two primary determinants:
1. arterial blood volume and
2. vessel compliance.
B. Increasing cardiac output and/or

arteriolar resistance increases blood
pressure by augmenting arterial
blood volume.
Determinants of Blood Pressure (Review)
If arteriolar radius increases, will blood pressure rise or fall?
Determinants of Blood Pressure (Review)
Answer: Fall
The Baroreceptor Reflex
Changes in blood pressure are detected by baroreceptors,

which activate the vasomotor center.
The vasomotor center attempts to reverse the change by

modulating arteriole diameter and cardiac output.
The Baroreceptor Reflex (Review)
If the baroreceptor firing rate increases, will the vasomotor

center induce vasoconstriction or vasodilation?
The Baroreceptor Reflex (Review)
Answer: Vasodilation
Hypertension
Hypertension: sustained high blood pressure
Optimum blood pressure: <120/80
Prehypertension: persistent readings between 120/80 and

140/90
Hypertension causes no symptoms of its own, but promotes

heart attack, stroke, and other serious conditions.
A growing body of experts recommends treatment of

prehypertension.
Blood Pressure Management

A. Blood pressure can be measured by a sphygmomanometer.
B. As the clinician lowers cuff pressure, Korotkoff sounds begin at
the systolic pressure and disappear at the diastolic pressure.
Blood Pressure Management (Review)
What is the systolic pressure in part B?
Blood Pressure Management (Review)
Answer: 120 mm Hg.
Myocardial Infarction: The Case of Bob W.
The events resulting in Bobs death.
The Case of Bob W. (Review)
Why was Bobs heart rate low?
The Case of Bob W. (Review)
Answer: Because cells in the cardiac conduction system died

and could not convey signals from the atrium to the ventricles.
As a consequence the slower pacemaker potential of CCS
cells below the AV node took over pacing.
The Major Blood Vessels: The Portal Circulation
Portal Circulation: any circulatory pathway that includes two

capillary beds - one drains into another, such as venous return
from the intestines.
An example is hepatic portal circulation.
Anastomosis: union of two or more blood vessels by a vessel

larger than a capillary; for example, the left coronary artery
gives rise to the posterior descending coronary artery. These
provide an alternative route for blood delivery if one small
branch is occluded.
Major Systemic Arteries
The circles indicate pulse points, where the heart rate can be
measured.
Major Systemic Arteries (Review)
Which artery passes behind the knee--the popliteal artery or

the axillary artery?
Major Systemic Arteries (Review)
Answer: Popliteal artery
Major Systemic Veins
Deep veins are light blue; superficial veins dark purple.
Major Systemic Veins (Review)
Which vein is superficial the brachial vein or the basilic vein?
Major Systemic Veins (Review)
Answer: Basilic vein
Arteries and Veins of the Upper Limb
Branches of axillary arteries supply upper limbs
Veins of upper limb are more complex than arteries
Consist of deep set and superficial set
Many veins are paired (shown in subsequent images as

one vein for clarity)
Arteries of the Right Upper Limb
Veins of the Right Upper Limb
Arteries and Veins of Lower Limbs
Organization similar to upper limbs
Images in next slides show veins in right leg and arteries in left
leg
Saphenous vein is longest vein in the body
Sometimes used to replace damaged veins in the body
Plantar arches, like palmar arches, are anastomoses
Arteries and Veins of the Lower Limb
Arterial and Venous Flow of the Lower Limbs
Arteries and Veins of the Head and Neck
Dual supply routes on each side of head and neck
If one is blocked, the other is used
Arteries connect in the circle of Willis, on the floor of the

brain
Circle of Willis consists of short segments of arteries
Each internal carotid artery enters the skull and branches to

form middle and anterior cerebral arteries
Vertebral arteries arise from subclavian arteries and travel a

posterior route upward through foramina
Pass through foramen magnum and join to form basilar

artery
Arteries of the Head and Neck
Cerebral Arteries
Cerebral Arterial Flow
Veins of the Head and Neck
Schematic View of Veins and Dural Sinuses of the

Head

Chapter 11: THE Cardiovascular System

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Chapter 11:

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

McConnell and Hull: Human Form and Human Function

McConnell and Hull: Human Form and Human Function

Chapter Objectives (cont'd)

McConnell and Hull: Human Form and Human Function

Chapter Objectives (cont'd)

McConnell and Hull: Human Form and Human Function

Chapter Objectives (cont'd)

McConnell and Hull: Human Form and Human Function

Chapter Objectives (cont'd)

McConnell and Hull: Human Form and Human Function

Chapter Objectives (cont'd)

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

McConnell and Hull: Human Form and Human Function

The Organization of the Cardiovascular System

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Back to chapter objectives

McConnell and Hull: Human Form and Human Function

The Cardiovascular System

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Back to chapter objectives

McConnell and Hull: Human Form and Human Function

Structure and Function of the Heart

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Back to chapter objectives

McConnell and Hull: Human Form and Human Function

The Heart and Its Coverings

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McConnell and Hull: Human Form and Human Function

The Heart and Its Coverings (contd)

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Back to chapter objectives

McConnell and Hull: Human Form and Human Function

The Heart and Its Coverings (Review)

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McConnell and Hull: Human Form and Human Function

The Heart and Its Coverings (Review)

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Back to chapter objectives

McConnell and Hull: Human Form and Human Function

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Back to chapter objectives

McConnell and Hull: Human Form and Human Function

Cardiac Muscle versus Skeletal Muscle

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McConnell and Hull: Human Form and Human Function

Cardiac Muscle (Review)

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McConnell and Hull: Human Form and Human Function

Cardiac Muscle (Review)

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McConnell and Hull: Human Form and Human Function

Cardiac Muscle Action Potentials

B. The action potential in

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McConnell and Hull: Human Form and Human Function

Cardiac Muscle Action Potential