BMICCT 102, MODULE II: CARDIOVASCULAR SYSTEM Sujoy Tontubay

Unit 1: Physiology of heart Assistant Professor,Ilead

In humans, the heart is situated between the two lungs and slightly to the left of center, behind the
breastbone. It rests on the diaphragm, the muscular partition between the chest and the abdominal
cavity.

The heart is a fist-sized organ that pumps blood throughout your body. It's the primary organ of your
circulatory system.

Your heart contains four main sections (chambers) made of muscle and powered by electrical
impulses. Your brain and nervous system direct your heart’s function.

Heart Structure and Function:

Function:

How blood circulates in the heart

The heart consists of four chambers, four one-way valves, and a set of arteries and veins that
regulate the normal flow of blood within the body.

The smooth functioning of the circulatory system is maintained by a complex network of blood
vessels that circulate blood throughout the body and back to the heart. Whereas veins bring
deoxygenated blood back into the heart, those that carry oxygenated blood away from the heart to
other tissues in the body are known as arteries. The two exceptions to these are the pulmonary
arteries and pulmonary veins, as well as the umbilical artery and vein.

The heart's two upper chambers are called the atria, with the atrial septum dividing the right and left
atria. The superior and inferior vena cava are major veins that supply the right atrium with
deoxygenated blood from the rest of the body.

The superior vena cava brings deoxygenated blood into the right atrium from the upper limbs and
head, whereas deoxygenated blood from the lower abdomen and limbs is brought into the heart
through the inferior vena cava.

The pulmonary veins supply oxygenated blood from the lungs into the left atrium and are the only
veins in the body to carry oxygenated blood. However, during pregnancy, the umbilical vein carries
oxygenated and nutrient-rich blood from the placenta to the fetus.

Both atria contract and release blood into the ventricles when full, a process controlled by the
atrioventricular valves. The flow of deoxygenated blood from the right atrium into the right ventricle
is regulated by the tricuspid valve, while the mitral valve controls the flow of oxygenated blood from
the left atrium to the left ventricle.
The two lower chambers of the heart are called the ventricles. The right ventricle receives
deoxygenated blood that collects in the right atrium. This process occurs by systematically opening
and closing the atrioventricular and semilunar valves.

The semilunar valve connecting the right ventricle to the lungs is the pulmonary valve. This valve
remains closed while the tricuspid valve opens and releases blood into the right ventricle from the
right atrium.

Similarly, the left ventricle receives oxygenated blood from the left atrium through the mitral valve.
During this process, the other semilunar valve, known as the aortic valve, remains closed to allow
the left ventricle to fill with blood. The ventricles contract when full, subsequently causing the
tricuspid and mitral valves to close and the pulmonary and aortic valves to open on the right and left
sides, respectively.

When the right ventricle contracts, deoxygenated blood flows through the pulmonary valve into the
lungs through the pulmonary trunk. The pulmonary trunk splits into the left and right pulmonary
arteries, the only arteries in the body to carry deoxygenated blood. However, during pregnancy, the
umbilical artery will also carry deoxygenated blood from the fetus to the placenta to re-oxygenate
the fatal blood supply.

Oxygenated blood is pumped through the aortic valve into the aorta when the left ventricle
contracts. The aortic valve splits into smaller arteries, known as common iliac arteries, which carry
blood to the rest of the body through a complex network of arteries.

Structure of the heart

The heart wall is composed of three layers, including the outer epicardium (thin layer), middle
myocardium (thick layer), and innermost endocardium (thin layer). The myocardium is made up of
cardiac muscle fibers and is responsible for the contraction and relaxation that results in the
pumping of the heart.

The two atria have a thinner myocardium layer than the ventricles, as the force required for atrial
contractions is much less than that needed for ventricular contractions. The walls of the right
ventricle are also thinner, as this ventricle only pumps blood a short distance to the lungs.
Comparatively, the left ventricle, which has much thicker walls, must generate enough force to
pump oxygenated blood throughout the rest of the body.

The myocardium requires a constant supply of oxygen and nutrients to maintain the contractions
and relaxations that keep the heart pumping. This blood supply is maintained through a set of
coronary arteries and veins in the myocardium.

The right and left coronary arteries, which branch off the first section of the aorta known as the
ascending aorta between the left ventricle and aortic arch, supply blood to a network of capillaries in
the myocardium. Deoxygenated blood from the myocardium is carried through a set of cardiac veins
to the right atrium that is subsequently drained through the coronary sinus.
What is a heartbeat?
On average, the heart beats 100,000 times a day and circulates about 5.6 liters of blood throughout
the body three times a minute. The cardiac cycle, also known as the heartbeat, begins with
deoxygenated blood collecting in the right atrium.

Simultaneously, the left atrium gets filled with oxygenated blood from the lungs. The sinoatrial node
(SA node), located in the right atrium's superior wall, rhythmically initiates electrical impulses 70-80
times per minute to both atria. The SA node can be influenced by nerve impulses from the
autoimmune nervous system and specific hormones, such as the thyroid hormone and epinephrine.

The SA node is often referred to as the heart's pacemaker, as it sets the rhythm of the heartbeat.
Additional components of the heart's electrical conduction system include the atrioventricular node,
bundle branches, atrioventricular bundle, and conduction myofibers known as Purkinje's fibers.

When full, the right and left atria contract together, thereby opening the atrioventricular valves and
draining blood into the right and left ventricles, respectively. The electrical impulse from the SA node
then proceeds through the His-Purkinje conduction system that stimulates the contraction of the
ventricles.

Ventricular contraction pumps oxygenated blood from the left ventricle into the aorta and the rest
of the body, whereas deoxygenated blood from the right ventricle into the lungs.
The contraction phase of the atria and ventricles is known as systole. Conversely, the relaxation
phase is known as diastole. Systole and diastole constitute one cardiac cycle, which takes about 0.8
seconds at a normal heart rate.

The heart rate is the number of times the heart beats in one minute. A healthy adult's resting heart
rate varies between 60 and 100 beats a minute. Children usually have higher heart rates. The heart
rate is also affected by emotions, body temperature, and activity levels.

Cardiac cycle:

The cardiac cycle attributes to a comprehensive heartbeat from its production to the
commencement of the next beat. It comprises diastole, the systole, and the intervening pause. The
occurrence of a cardiac cycle is illustrated by a heart rate, which is naturally indicated as beats per
minute. A healthy human heart beats 72 times per minute which states that there are 72 cardiac
cycles per minute. The cardiac cycle involves a complete contraction and relaxation of both the atria
and ventricles and the cycle last approximately 0.8 seconds.

Cardiac Cycle Diagram

The diagram below represents the different
phases of the cardiac cycle. The atrial systole,
ventricular diastole, ventricular systole and
ventricular diastole are clearly mentioned in the
cardiac cycle diagram given below.

Cardiac Cycle Physiology

The human heart consists of four chambers,
comprising left and right halves. Two upper
chambers include left and right atria; lower two
chambers include right and left ventricles. The
key function of the right ventricle is to pump deoxygenated blood through the pulmonary arteries
and pulmonary trunk to the lungs. While the left ventricle is responsible for pumping newly
oxygenated blood to the body through the aorta.

Cardiac Cycle Phases:

Following are the different phases that occur in a cardiac cycle:
Atrial Diastole: In this stage, chambers of the heart are calmed. That is when the aortic valve and
pulmonary artery closes and atrioventricular valves open, thus causing chambers of the heart to
relax.
Atrial Systole: At this phase, blood cells flow from atrium to ventricle and at this period, atrium
contracts.
Isovolumic Contraction: At this stage, ventricles begin to contract. The atrioventricular valves, valve,
and pulmonary artery valves close, but there won’t be any transformation in volume.
Ventricular Ejection: Here ventricles contract and emptying. Pulmonary artery and aortic valve close.
Isovolumic Relaxation: In this phase, no blood enters the ventricles and consequently, pressure
decreases, ventricles stop contracting and begin to relax. Now due to the pressure in the aorta –
pulmonary artery and aortic valve close.
Ventricular Filling Stage: In this stage, blood flows from atria into the ventricles. It is altogether
known as one stage (first and second stage). After that, they are three phases that involve the flow
of blood to the pulmonary artery from ventricles.

Heart Sounds:

The flow of blood generates vibrations in the valves and chambers of the heart, producing audible
sounds which are audible through a stethoscope. A low-resistance, smooth blood flow is referred to
as a laminar flow. When there is a rough flow offering a high-resistance, referred to as turbulent
flow. The vibrations increase through the blood flow turbulence depending on the blood vessel’s
diameter and the blood’s –

 Density
 Viscosity
 Velocity
A few functions of the heart which generate heart sounds are –

 Blood flow through the valve opening

 Rubbing of cardiac surfaces
 Closing and opening of the valves of the heart
 Blood flow into the ventricles of the heart

Types Of Heart Sounds

Heartbeat is constituted by two phases which make up a cardiac cycle. These two phases are –

 Contraction of ventricles to pump out blood – systole

 Relaxation of ventricles filling with blood – diastole
There are 4 types of heart sounds –

 S1 – “lub” caused by the closing of the AV valves

 S2 – “dub” caused by the closing of semilunar valves
 S3 – linked with flow of blood into the ventricles
 S4 – linked with atrial contraction
Generally, the heart makes two sounds – “lub” and “dub”. The third and fourth sounds are audible in
individuals, however, they could show abnormalities in the functioning of the heart. While the S1
and S2 are high-pitched, S3 and S4 are low-pitched sounds.

Heart Rate:

Heart rate (or pulse rate) is the speed of the heartbeat measured by the number of contractions
(beats) of the heart per minute (bpm). The heart rate can vary according to the
body's physical needs, including the need to absorb oxygen and excrete carbon dioxide, but is also
modulated by numerous factors, including, but not limited to, genetics, physical fitness, stress or
psychological status, diet, drugs, hormonal status, environment, and disease/illness as well as the
interaction between and among these factors. It is usually equal or close to the pulse measured at
any peripheral point.
The American Heart Association states the normal resting adult human heart rate is 60–100
bpm. Tachycardia is a high heart rate, defined as above 100 bpm at rest. Bradycardia is a low heart
rate, defined as below 60 bpm at rest. When a human sleeps, a heartbeat with rates around 40–50
bpm is common and is considered normal. When the heart is not beating in a regular pattern, this is
referred to as an arrhythmia. Abnormalities of heart rate sometimes indicate disease.

Blood Pressure:
Blood pressure is the pressure of blood pushing against the walls of our arteries. Arteries carry
blood from our heart to other parts of our body.

our blood pressure normally rises and falls throughout the day.

Blood pressure is measured using two numbers:

The first number, called systolic blood pressure, measures the pressure in our arteries when our
heart beats.

The second number, called diastolic blood pressure, measures the pressure in our arteries when our
heart rests between beats.

If the measurement reads 120 systolic and 80 diastolic, we would say, “120 over 80,” or write,
“120/80 mmHg.”

Mechanism of circulation:

Mechanism of centralisation of blood circulation

From the pulmonary veins, the oxygenated blood flows to the left atrium. The mitral valve(bicuspid)
then pumps the blood to the LV (left ventricle). The blood reaches the body’s largest artery, the
aorta, through the aortic valve from the left ventricle. Before passing the blood through the
diaphragm, the aorta arches into the arteries of the upper body. From the diaphragm, it branches
into the lower parts of the body( suprarenal and renal).
The arteries separate into smaller arteries like arterioles, final capillaries and smaller arteries. Within
capillaries that flow through the organs and tissues, the exchange of nutrients and gases happens.
Now diffusing out of carbon dioxide and metabolic wastes occur. Meanwhile, the glucose and
oxygen present in the blood will enter the cells and tissues. Systemic circulation plays a vital role in
the metabolism of all organs and tissues in the body, except the lungs (parenchyma). Here another
circulation happens, which is pulmonary circulation.
The formed deoxygenated blood flows through the capillaries and merges into the venules and
veins, finally, the vena cava. After reaching the vena cava, the blood clears out into the right atrium.
Before returning to the systemic circulation, the blood will flow to the pulmonary circulation to get
oxygenated. The highest blood pressure in the body is experienced in the arterial region of the
systemic circulation. Comparing the arterial component blood pressure the, the venous component
of the systemic circulation has less blood pressure. But when we compare the pressure regulation of
systemic circulation with pulmonary circulation, Systemic circulation has more pressure because
systemic circulation has to apply greater force to move a bigger amount of blood throughout the
body.
Types of circulation
Before explaining the mechanism of circulation in our body, we have to look at the types of
circulation present in our body. Two types of circulations are present in our body, and they are.
 Pulmonary circulation
 Systemic circulation
Systemic circulation
Systemic circulation comprises the largest circulatory system in our body. This system maintains the
continuous supply of oxygenated blood to all tissues in the body. The deoxygenated blood from the
tissue is brought back by Systemic circulation. Carrying and supplying nutrients to all cells is another
function of the systemic circulation. Through the arteries, from the LV (left ventricle), they carry
oxygenated blood states to the capillaries and supply the body tissues. Now, after supplying blood to
the capillaries, the deoxygenated blood is returned to the right atrium through the system of veins.
Pulmonary circulation
In this circulation oxygenation, the blood moves from the heart to the lungs and then again flows
back to reach the heart to continue the process of the systemic circulation.
Mechanism of circulation
When the blood enters the right atrium through the vena cava(inferior and superior), the blood with
less amount of blood leaves systemic circulation. Then the blood is pumped to the RV(right ventricle)
through the right atrioventricular valve(tricuspid valve). The blood will be pumped to the pulmonary
valve from the RV(right ventricle) to the pulmonary artery. The pulmonary artery does the splitting
of blood into both pulmonary arteries (left and right). The blood flows to each lung after splitting.
After the blood reaches the lungs, the blood will start to flow through the capillary beds. These
capillary beds are seen in alveoli. Due to a partial pressure gradient, gas exchange occurs across
alveoli. Now through pulmonary veins, the oxygenated blood leaves and returns to the left atrium.
This completes a pulmonary circuit. When the pulmonary circuit finishes, the systemic circuit begins.
Functions of circulation
 They are the transport system of our body
 Get rid of wastes in the tissues
 Oxygen and nutrients carrying ability
 Fighting invading pathogen
 Regulating homeostasis of the body

Definition of hypertension

Blood pressure is determined by two things: the amount of blood the heart pumps and how hard it
is for the blood to move through the arteries. The more blood the heart pumps and the narrower
the arteries, the higher the blood pressure, called hypertension.

There are two main types of high blood pressure.

Primary hypertension, also called essential hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high blood
pressure is called primary hypertension or essential hypertension. It tends to develop gradually over
many years. Plaque buildup in the arteries, called atherosclerosis, increases the risk of high blood
pressure.
Secondary hypertension

This type of high blood pressure is caused by an underlying condition. It tends to appear suddenly
and cause higher blood pressure than does primary hypertension. Conditions and medicines that can
lead to secondary hypertension include:

 Adrenal gland tumors

 Blood vessel problems present at birth, also called congenital heart defects

 Cough and cold medicines, some pain relievers, birth control pills, and other
prescription drugs

 Illegal drugs, such as cocaine and amphetamines

 Kidney disease

 Obstructive sleep apnea

 Thyroid problems

What is mean arterial pressure?

Automatic blood pressure monitors give you a systolic and diastolic blood pressure reading.
Many of them also include a small number in parentheses underneath or beside your
standard blood pressure reading. This number in parentheses is the mean arterial pressure
(MAP).

MAP is a calculation that doctors use to check whether there’s enough blood flow to supply
blood to all your major organs. Too much resistance and pressure may impede that flow.

“Resistance” refers to the way the width of a blood vessel impacts blood flow. For example,
it’s harder for blood to flow through a narrow artery. As resistance in your arteries increases,
blood pressure also increases while the flow of blood decreases.

You can also think of MAP as the average pressure in your arteries throughout one cardiac
cycle, which includes the series of events that happen every time your heart beats.

Keep reading to learn more about the normal, high, and low ranges of MAP and what they
mean.

What is a normal MAP?

In general, most people need a MAP of at least 60 mm Hg (millimeters of mercury) or

greater to ensure enough blood flow to vital organs, such as the heart, brain, and kidneys.
Doctors usually consider anything between 70 and 100 mm hg to be normal.

A MAP in this range indicates that there’s enough consistent pressure in your arteries to
deliver blood throughout your body.
arrhythmia

An arrhythmia is an irregular heartbeat. If you have an arrhythmia, your heart may beat faster or
slower than others without arrhythmia. There are several different conditions might cause your
heart to beat abnormally, and treatment depends on the cause. Talk to your healthcare provider if
you feel like your heart is racing, if you feel dizzy or lightheaded, or you have chest pain.

An arrhythmia (also called dysrhythmia) is an irregular or abnormal heartbeat.

What are the types of arrhythmias?

 Supraventricular arrhythmias: Arrhythmias that begin in the atria (the heart’s upper
chambers). "Supra” means above. “Ventricular” refers to the lower chambers of the heart
or ventricles.
 Ventricular arrhythmias: Arrhythmias that begin in the ventricles (the heart’s lower
chambers).
 Bradyarrhythmias: Slow heart rhythms that may be caused by disease in the heart’s
conduction system, such as the sinoatrial (SA) node, atrioventricular (AV) node or HIS-
Purkinje network.

Electrocardiogram: Principles of ECG, Normal ECG

 Electrocardiogram refers to the recording of electrical changes that occurs
in heart during a cardiac cycle. It may be abbreviated as ECG or EKG.
 It is an instrument that picks up the electric currents produced by the heart
muscle during a cardiac cycle of contraction and relaxation.

Working principle of electrocardiograph:

 It works on the principle that a contracting muscle generates a small electric

current that can be detected and measured through electrodes suitably placed
on the body.
 For a resting electrocardiogram, a person is made to lie in the resting position
and electrodes are placed on arms, legs and at six places on the chest over the
area of the heart. The electrodes are attached to the person’s skin with the
help of a special jelly.
 The electrode picks up the current and transmit them to an amplifier inside
the electrocardiograph. Then electrocardiograph amplifies the current and
records them on a paper as a wavy line.
 In an electrocardiograph, a sensitive lever traces the changes in current on a
moving sheet of paper.
 A modern electrocardiograph may also be connected to an oscilloscope, an
instrument that display the current on a screen.
Normal ECG wave:

 A normal ECG makes a specific pattern of three recognizable waves in a

cardiac cycle. These wave are- P wave, QRS wave and T-wave, P-R interval,
S-T segment

 P-wave:
 It is a small upward wave that appears first
 It indicates atrial depolarization (systole), during which
excitation spreads from SA node to all over atrium
 About 0.1 second after P-wave begins, atria contracts. Hence
P-wave represents atrial systole
 QRS wave:
 It is the second wave that begins as a little downward wave
but continues as a large upright triangular wave and ends as
downward wave
 It represents the ventricular depolarization (systole)
 Just after QRS wave begins, ventricles starts to contracts.
Hence QRS wave represents ventricular systole
 T- wave:
 It is third small wave in the form of a dome-shaped upward
deflection.
 It indicates ventricular repolarization (diastole)
 It also represents the beginning of ventricular diastole
 ** ATRIAL DIASTOLE MERGES WITH QRS-WAVE
 P-R interval:
 It represents the time required for an impulse to travel
through the atria, AV node and bundle of his to reach
ventricles.
 S-T segment:
 It is measured from the end of S to the beginning of T- wave
 It represents the time when ventricular fibres are fully
depolarized.