LESSON 6

CARDIOVASCULAR SYSTEM

TOPICS
1. Cardiovascular System

LEARNING OUTCOMES
At the end of the lesson, you should be able to:
1.trace the pathway of blood through and from the heart;
2.name and explain the effects of various factors involved in
regulation of strike volume and heart rate;
3. explain the role of the autonomic nervous system in regulating
cardiac output;
4. describe the structure and function of blood vessels;
5. explain the relationship among blood flow, blood pressure and
resistance; and
6. explain the causes of cardiovascular diseases.

TOPIC 1: CARDIOVASCULAR SYSTEM

Hematology. The branch of science
The cardiovascular system (cardio-
concerned with the study of blood, blood-
heart; -vascular blood or blood vessels) forming tissues, and the disorders
consists of three interrelated components: associated with them.
blood, the heart, and blood vessels.

Blood
It is a liquid connective tissue that consists of cells surrounded by
extracellular matrix.
 General Functions of the Blood
Transportation Regulation Protection
Blood transports oxygen Blood helps regulate the Blood clots in response to
and carbon dioxide;it also pH of body fluids injury; white blood cells
carries nutrients, heat produces antibodies
and waste products, and
hormones

Components of a Whole Blood

Formation of Blood

Hemopoiesis also called hematopoiesis is the process by which the formed

elements of blood develop. In the human embryo, the first site of blood formation
is the yolk sac. Later in embryonic life, the liver becomes the most important red
blood cell-forming organ, but it is soon succeeded by the bone marrow, which in
adult life is the only source of both red blood cells and the granulocytes. Both the
red and white blood cells arise through a series of complex, gradual, and
successive transformations from primitive stem cells, which have the ability to form
any of the precursors of a blood cell. Precursor cells are stem cells that have
developed to the stage where they are committed to forming a particular kind of
new blood cell. In a normal adult the red cells of about half a litre (almost one pint)
of blood are produced by the bone marrow every week. Almost 1 percent of the
body’s red cells are generated each day, and the balance between red cell
production and the removal of aging red cells from the circulation is precisely
maintained. The rate of blood cell formation varies depending on the individual, but
a typical production might average 200 billion red cells per day, 10 billion white
cells per day, and 400 billion platelets per day.

Red Blood Cells (RBC)

RBC are also called erythrocytes, the blood cells that carry oxygen. Red
cells contain hemoglobin and it is the hemoglobin which permits them to transport
oxygen (and carbon dioxide). Hemoglobin, aside from being a transport molecule,
is a pigment. It gives the cells their red color (and their name). RBC are made in
the bone marrow. They typically live for about 120 days, and then they die. The
process of formation just RBCs (not the whole blood in general) is called
erythropoiesis.

White Blood Cells (WBC)

WBC are also known as leukocytes, they do not contain hemoglobin. The
WBC is composed of the following:

• Monocytes. They have a longer lifespan than many white blood cells and
help to break down bacteria.
• Lymphocytes. They create antibodies to fight against bacteria, viruses, and
other potentially harmful invaders.
• Neutrophils. They kill and digest bacteria and fungi. They are the most
numerous types of white blood cell and your first line of defense when
infection strikes.
• Basophils. These small cells seem to sound an alarm when infectious
agents invade your blood. They secrete chemicals such as histamine, a
marker of allergic disease, that help control the body’s immune response.
• Eosinophils. They attack and kill parasites and cancer cells, and help with
allergic responses.

Platelets

Platelets are tiny blood cells that help your body form clots to stop bleeding.
If one of your blood vessels gets damaged, it sends out signals to the platelets.
The platelets then rush to the site of damage. they form a plug (clot) to fix the
damage.
Hemostasis

It is a sequence of responses that stops bleeding when blood vessels are

injured. The three mechanisms that can reduce blood loss in the blood vessels are
vascular spasms, platelet plug formation, and blood clotting.

Vascular • The contraction of the

smooth muscle in the wall
of the blood vessels that
Spasm are damaged.

• An aggregation of platelets
Platelet Plug formed during the earlier
stage of hemostasis in
Formation response to blood vessel
injury.
• A gel-like clumps of blood.
Blood They form in response to
injusry, plugging the injured
clotting blood vessel to stop
bleeding.

Heart
Cardiology. It is the scientific study
The heart is situated between the two of the normal heart and the
lungs in the thoracic cavity. It is about the size diseases associated with it.
of your fist. The
heart has four
chambers. These are the right atrium, the right
ventricle, the left atrium, and the left ventricle.

• Right Atrium. It receives blood from the veins and

pumps it to the right ventricle.
• Right ventricle. It receives blood from the right
atrium and pumps it to the lungs, where it is loaded
with oxygen.
• Left atrium. It receives oxygenated blood from the
lungs and pumps it to the left ventricle.
• Left ventricle. It is the strongest chamber which pumps oxygen-rich blood to
the rest of the body. The left ventricle’s vigorous contractions create our blood
pressure.

Arteries are blood vessels that carry blood

away from the heart. The coronary arteries run along
the surface of the heart and provide oxygen-rich blood
to the heart muscle. A web of nerve tissue also runs
through the heart, conducting the complex signals that
govern contraction and relaxation. Surrounding the
heart is a sac called the pericardium, the membrane
that protects the heart and holds it in place.
The aorta is the largest artery in the body. It is
divided into four sections: the ascending aorta, aortic
arch, descending thoracic aorta, and the abdominal
aorta.

• Ascending aorta. It rises up from the heart and is about 2 inches long. The
coronary arteries branch off the ascending aorta to supply the heart with
blood.
• Aortic arch curves over the heart, giving rise to branches that bring blood to
the head, neck, and arms.
• Descending thoracic aorta. This travels down through the chest. Its small
branches supply blood to the ribs and some chest structures.
• Abdominal aorta. It begins at the diaphragm, splitting to become the paired
iliac arteries in the lower abdomen. Most of the major organs receive blood
from branches of the abdominal aorta.

Figure 6.1 The Circulation of Blood Through the Heart

The heart is a large muscular organ which constantly pushes oxygen-rich

blood to the brain and extremities and transports oxygen-poor blood from the brain
and extremities to the lungs to gain oxygen. Blood comes into the right atrium from
the body, moves into the right ventricle and is pushed into the pulmonary arteries
in the lungs. After picking up oxygen, the blood travels back to the heart through
the pulmonary veins into the left atrium, to the left ventricle and out to the body's
tissues through the aorta.

Blood flow
It refers to the movement of blood through a vessel, tissue, or organ, and is
usually expressed in terms of volume of blood per unit of time. It is initiated by the
contraction of the ventricles of the heart.
Blood pumped by the heart flows through a series of vessels known as
arteries, arterioles, capillaries, venules, and veins before returning to the heart.
• Arteries are the blood vessels that deliver oxygen-rich blood from the heart
and branch into smaller vessels.
• Arterioles are small branches of artery leading to capillaries. They distribute
blood to capillary beds.
• Capillaries.They are the smallest and the most numerous blood vessels.
They serve as the exchange of materials between blood and tissue cells.
• Venules. These are the smallest veins where the blood enters after passing
through the capillaries.
• Veins. They are blood vessels that support circulation by conveying blood
toward the heart.

Components of Arterial Pressure

Diastole. It is the phase when the
When systemic arterial blood pressure is
measured and recorded as a ratio of two heart muscle relaxes and allows
numbers wherein 120/80 is the normal adult the chambers to fill with blood.
blood pressure. Systole. It is the part of the cardiac
cycle during which some chambers
• Systolic is the higher value and reflects of the heart muscle contract after
the arterial pressure resulting from the refilling with blood.
ejection of blood during ventricular
contraction, or systole.

• Diastolic Pressure is the lower value and represents the arterial pressure of
blood during ventricular relaxation, or diastole.

• Pulse pressure is the difference between the systolic pressure and diastolic
pressure.

Variables Affecting Blood Flow and Blood Pressure

There are factors that impede or slow blood flow, a phenomenon known as
resistance. Five variables influence blood flow and blood pressure:
 • Cardiac output is the measurement of blood flow from the heart through the
ventricles, and is usually measured in liters per minute. Any factor that
causes cardiac output to increase, by elevating heart rate or stroke volume
or both, will elevate blood pressure and promote blood flow.
• Compliance is the ability of any compartment to expand to accommodate
increased content. The greater the compliance of an artery, the more
effectively it is able to expand to accommodate surges in blood flow without
increased resistance or blood pressure. Higher pressure within the vessel,
and reduced blood flow. This increases the work of the heart.
• Volume of the blood. As blood volume decreases, pressure and flow
decrease. As blood volume increases, pressure and flow increase.
• Viscosity of the blood. Viscosity is the thickness of fluids that affects their
ability to flow. The viscosity of blood is directly proportional to resistance
and inversely proportional to flow; therefore, any condition that causes
viscosity to increase will also increase resistance and decrease flow.
• Blood vessel length and diameter. The length of a vessel is directly
proportional to its resistance: the longer the vessel, the greater the
resistance and the lower the flow. As with blood volume, this makes intuitive
sense, since the increased surface area of the vessel will impede the flow
of blood. Likewise, if the vessel is shortened, the resistance will decrease
and flow will increase.

Cardiac Output
The amount of blood the heart pumps through the circulatory system in a
minute is known as the cardiac output (CO). It is determined by the stroke volume
(SV), the amount of blood ejected by the left ventricle during each beat
(contraction), and heart rate (HR), the number of heart beats per minute.

Regulation of Stroke Volume

Three factors regulate stroke volume and ensure that the left and right
ventricles pump equal volumes of blood:
The degree of stretch in the heart before it contracts. Within limits, the more the heart
is stretched as it fills during the diastole, the greater the force of contraction during
systole, a relationship known as the Frank-Starling law of the heart.

The forcefulness of contraction of individual ventricular muscle fibers. Even at a

constant degree of stretch, the heart can contract more or less forcefully when certain
substances are present.

The pressure required to eject blood from the ventricles. When the required pressure is
higher than normal, the valves open later than normal, stroke volume decreases, and
more blood remains in the ventricles at the end of the systole.
Regulation of Heart Rate
The cardiovascular system circulates blood throughout the body in order to
supply oxygen and other nutrients and to remove waste products. Each time the
heart beats; blood is pumped out of the heart and into the body to supply oxygen
to working muscles or to the lungs for re-oxygenation. Heart rate refers to the
number of times the heart beats per minute, and is directly related to the workload
being placed on the heart. When the body is in a resting state (i.e. lying down in a
quiet area for at least five minutes), resting heart rate is measured. A normal
resting heart rate ranges from 60-100 beats per minute (bpm). Resting rates higher
than 100 bpm suggest that the heart is working too hard to circulate blood, and
thus may indicate a serious problem that should be monitored by a physician.
Resting rates lower than 60 bpm occur more often with endurance-trained athletes
whose bodies are more efficient at utilizing oxygen from the blood.

Autonomic regulation of heart rate

Heart rate is controlled by the two branches of the autonomic (involuntary)
nervous system. The sympathetic nervous system (SNS) and the parasympathetic
nervous system (PNS). The sympathetic nervous system (SNS) releases the
hormones (catecholamines - epinephrine and norepinephrine) to accelerate the
heart rate. The parasympathetic nervous system (PNS) releases the hormone
acetylcholine to slow the heart rate.
Sinoatrial Nodes (SAN). Tissues in The parasympathetic input into the heart
the heart that are specialized in is via the vagus nerve. The vagus nerve
pacemaking (the pacemakers of the forms synapses with postganglionic cells in
heart). sinoatrial node (SAN) and atrioventricular
node (AVN). When stimulated, acetylcholine
Atrioventricular Nodes (AVN). which binds on to M₂ receptors, which acts
They are specialized for slow to decrease the slope of the pacemaker
conduction of the action potential potential, leading to a decrease in heart rate.
(to introduce a delay between atrial The sympathetic input into the heart is via
and ventricular activation during the postganglionic fibres from the
the cardiac cycle). sympathetic trunk which innervate the SAN
and AVN. The post ganglionic fibres release
Muscarinic receptors (M2) are noradrenaline, which acts on B₁
located in the heart, where they act adrenoreceptors to increase the slope of the
to slow the heart rate down to pace maker potential, thereby increasing the
normal sinus rhythm after positive heart rate.
stimulatory actions of the Baroreceptors are mechanoreceptors
sympathetic nervous system, by located in both the carotid sinus and the
slowing the speed of aortic arch. They are sensitive to stretch.
depolarization. Their function is to detect changes in arterial
pressure and communicate this to the
Beta 1 (B1) receptor in the heart medulla oblongata in the brainstem.
increases SAN, AVN, and • If an increased arterial pressure is
ventricular muscular firing, thus detected, the parasympathetic pathway is
increasing heart rate and activated to reduce heart rate. This, along
contractility. with increasing vasodilation of vessels, acts
to reduce the arterial pressure.
• If a decrease in arterial pressure is
detected, the sympathetic pathway is activated to increase the heart rate and the
force of contraction of the heart. This, along with increasing vasoconstriction of
vessels, acts to increase the arterial pressure.

Chemical regulation of heart rate

Certain chemicals influence both the basic physiology of cardiac
muscle and its rate of contraction. Chemicals with major effects
on the heart fall into one of two categories:
• Hormones. Epinephrine and norepinephrine (from the adrenal medullae)
enhance the heart’s pumping effectiveness by increasing both heart rate
and contraction force. Exercise, stress, and excitement cause the adrenal
medullae to release more hormones. Thyroid hormones also increase heart
rate.
• Ions. Elevated blood levels of K+ or Na+ decrease heart rate and contraction
force. A moderate increase in extracellular and intracellular Ca2+ level
increases heart rate and contraction force.

Other Factors in Heart Rate Regulation

• Age
• Gender
• Physical fitness
• Body temperature

Cardiovascular Diseases

Cardiovascular diseases (CVDs) are a group of disorders of the heart and

blood vessels and they include:

Heart attack is the death of a segment of heart muscle caused by a loss of

blood supply. The blood is usually cut off when an artery supplying the heart
muscle is blocked by a blood clot.

Stroke is a sudden interruption in the blood supply of the brain. Most strokes
are caused by an abrupt blockage of arteries leading to the brain (ischemic stroke).
Other strokes are caused by bleeding into brain tissue when a blood vessel bursts
(hemorrhagic stroke).

Coronary heart disease (CHD) also known as coronary artery disease,

develops when the coronary arteries become too narrow. CHD tends to develop
when cholesterol builds up on the artery walls, creating plaques. These plaques
cause the arteries to narrow, reducing blood flow to the heart. A clot can sometimes
obstruct the blood flow, causing serious health problems. It sometimes lead to
heart attack. Coronary arteries form the network of blood vessels on the surface
of the heart that feed it oxygen. If these arteries narrow, the heart may not receive
enough oxygen rich blood, especially during physical activity.
 Cerebrovascular Disease. It refers to a group of conditions, diseases, and
disorders that affect the blood vessels and blood supply to the brain.
Cerebrovascular disease can develop from a variety of causes, including
atherosclerosis, where the arteries become narrow; thrombosis, or embolic arterial
blood clot, which is a blood clot in an artery of the brain; or cerebral venous
thrombosis, which is a blood clot in a vein of the brain. Cerebrovascular diseases
include stroke, transient ischemic attack (TIA), aneurysm, and vascular
malformation.
Rheumatic Heart Disease. Rheumatic heart disease is caused by rheumatic
fever, an inflammatory disease that can affect many connective tissues, especially
in the heart, joints, skin, or brain. The heart valves can be inflamed and become
scarred over time. This can result in narrowing or leaking of the heart valve making
it harder for the heart to function normally. This may take years to develop and can
result in heart failure.

Peripheral artery disease (PAD) also called peripheral arterial disease, is a

common circulatory problem in which narrowed arteries reduce blood flow to your
limbs. When you develop peripheral artery disease (PAD), your extremities —
usually your legs — don't receive enough blood flow to keep up with demand. This
causes symptoms, most notably leg pain when walking (claudication).

Congenital heart defect is a problem with the structure of the heart. It is

present at birth. Congenital heart defects are the most common type of birth defect.
The defects can involve the walls of the heart, the valves of the heart, and the
arteries and veins near the heart. They can disrupt the normal flow of blood through
the heart. The blood flow can slow down, go in the wrong direction or to the wrong
place, or be blocked completely.

Pulmonary Embolism usually happens when a blood clot called a deep vein
thrombosis, often in your leg, travels to your lungs and blocks a blood vessel. That
leads to low oxygen levels in your blood. It can damage the lung and other organs
and cause heart failure, too.