Cardiac Cycle and Heart Sounds Systole- heart contraction Diastole- heart relaxation CARDIAC CYCLE- refers to the

the events of of complete heartbeat, during which both atria and ventricles contract and then relax. - length is 0.8 second 1. Mid-to-late diastole- begins during heart relaxation - the pressure in the heart is low - blood is flowing passively into and through the atria into ventricles from the pulmonary and systemic circulations. - the semilunar valves are closed and AV valves are open. 2. Ventricular systole - ventricular contraction - pressure within the ventricles increases rapidly, closing the AV valves -the intraventricular pressure is higher than the pressure in the large arteries leaving the heart, this causes the Semilunar valve to open. - during this period the atria is relaxed and their chambers are again filling with blood. 3. Early diastole - at the end of systole, the ventricles relax, the semilunar valves shut to prevent backflow - for a moment the ventricles are completely closed chambers - the intraventricular pressure drops, the AV valves are forced open and the ventricles again begin to refill rapidly with blood HEART SOUNDS Lub and dup The first heart sound is caused by closing of the AV valves, -longer and louder The 2 heart sound is caused by the closing of the semilunar valves - short and sharp **Murmurs- abnormal or unusual heart sounds Cardiac Output The amount of blood pumped out by each side of the heart in 1 minute. Heart rate X Stroke volume CO adjust to meet the metabolic needs of the body. When metabolic demands increase, such as during exercise, the CO will Stroke volume- the volume of blood pumped out by a ventricle with each contraction. -healthy heart pumps 60% or approximately 70 ml of blood with each heartbeat. Regulation of Stroke Volume
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REGULATION OF STROKE VOLUME Starlings Law of the heart the more the cardiac muscle cells are stretched, the stronger the contraction.

**Venous Return- an important factor stretching the heart muscle. - the amount of blood entering the heart and distending its ventricles. - increase in venous return increases stroke volume and force of contraction. a. EXERCISE b. Muscular pump- plays a major role in increasing stroke volume

Stroke Volume Determined by three factors: pre-load, contractility, and afterload.

PRELOAD- amount of tension in the ventricular myocardium immediately before it begins to contract. **Venous Return- an important factor stretching the heart muscle. - the amount of blood entering the heart and distending its ventricles. - As venous return increases the myocardium is stretched. - As the myocardium is moderately stretched, the cardiac muscles are able to generate more tension and thus increase stroke volume. CONTRACTILITY- refers to the strength of contraction for a given pre-load. The ion that is essential to the excitation-contraction coupling of muscle is Calcium. - By increasing the amount of available CALCIUM; contraction strength will INCREASE, thus stroke volume will INCREASE. AFTERLOAD- is the blood pressure in the arteries on the other side of the semilunar valves. This pressure opposes the opening of the semilunar valves. -thus, if the afterload INCREASES, then the stroke volume will DECREASE. Factors modifying basic heart rate Heart rate is under control by the S-A node Neural (ANS) Controls-Vagus nerve: cholinergic parasympathetic fibers that decrease heart rate; to keep the heart slowed. - Accelerator nerves: adrenergic sympathetic nerves increase heart rate and strength of contraction.

** hormones and ions can have dramatic effect also on the heart activity. EPINEPHRINE- mimics the effect of sympathetic nerves THYROXINE- increases heart rate Electrolytes such as CALCIUM, POTASSIUM and SODIUM IONS. decrease levels of calcium depresses the heart, excessive levels of calcium causes prolonged contractions which may stop the heart entirely. decrease potassium in the blood causes abnormal heart rhythm.

Physical Factors - such as age, gender, exercise and body temperature influence the heart rate. **female heart rate is faster ( 72- 80 bpm) and male heart rate (64-72 bpm) ** heat increases heart rate by boosting the metabolic rate of the cells.

Blood Vessels: blood flow - it is where our blood circulates, forms a transport system vascular system Blood flows from the heart through progressively narrowing vessels; artery ->arteriole -> capillary

And returns through progressively enlarging vessels; venules -> vein-> heart 1. Structure: arteries and veins have 3 tunics Tunica Intima- innermost, a. Endothelium- squamous epithelial cells - lines the lumen or interior of the vessels. - decreases friction as blood flows past. 2. Tunica media- middle, thickest layer in the arteries - smooth muscle and elastic tissue. 3. Tunica Externa- outermost tunic -composed of fibrous connective tissue, its function is to support and protect vessels. Arteries the heart Muscular- tunica media is predominantly smooth muscle Elastic - large amount of Carries blood away from

elastin expandable Veins Carry blood towards the heart Veins have low pressure, they are modified to ensure that venous return is equal to cardiac output. Has large lumens and has valves

Capillaries Functional units" of circulatory system, very thin-walled, allows for exchange of gases, nutrients, & waste products between the blood and tissue cells.

Composed of the Tunica Intima only MICROCIRCULATION- flow of blood from an arteriole to venule through capillary bed. Capillary bed consist of two types a. Vascular shunt- vessel that directly connects the arteriole and venule at opposite ends of the bed b. True capillaries- the actual exchange vessels, spring from the terminal arteriole and empty through postcapillary

venule. - Pre-capillary sphincter- smooth muscle fibers - surrounds the root of each true capillary and acts as valve to regulate the flow of blood into the capillary. ** if the pre- capillary sphincters are relaxed, blood flows through the true capillaries and takes part in exchanges with tissue cells. **if the sphincters are contracted, blood flows through the shunts and bypasses the tissue cells. MAJOR ARTERIES of the SYSTEMIC CIRCULATION a. Aorta- largest artery, connected from the left ventricle of the heart a. ascending aorta- springs upward from the left ventricle. b. aortic arch- arches to the left c. thoracic aorta- downward d. abdominal aorta Right and Left coronary arteries Arterial branches of the Aortic arch Brachiocephalic trunk- innominate artery

- a short artery originating as the first large branch of the aortic arch, passing upwards to the right, and ending at the lower neck near the right sternoclavicular joint. - divides into the R.common carotid and R. subclavian artery. Left common carotid artery- second branch off the aortic arch.

- forms the L. internal carotid (serves the brain, forehead, nose, eyes and middle ear) and L. external carotid (face, scalp and neck) Left subclavian artery- third branch of the aortic arch - VERTEBRAL ARTERY serves part of the brain. - AXILLARY ARTERY, -BRACHIAL ARTERY- supplies the arms,, divides into **Radial artery (pass superficially down the forearm to the styloid process of the radius at the wrist, winds around the wrist and enters the palm of the hands, sending out branches to the fingers) and ** Ulnae artery (arise at the elbow and running deep within the muscles of the medial side of the forearm, passes into the palm and unites with the arch of the radial artery

Arterial branches of the thoracic aorta Intercostal arteries- supply the muscles of the thorax wall Bronchial arteries- supply the lungs Esophageal arteries- esophagus Phrenic arteries- diaphragm

Arterial branches of the abdominal aorta CELIAC TRUNK- first branch - has three branches: a. b. c. L. gastric artery Splenic artery Common hepatic artery- supplies the liver SUPERIOR MESENTERIC ARTERY- supply the small intestines and first half of the large intestines. R and L RENAL ARTERIES- supply the kidneys. GONADAL ARTERIES- supply the gonads a. ovarian arteries b. testicular arteries LUMBAR ARTERIES- several pairs of arteries serving the heavy muscles of the abdomen and trunk walls. INFERIOR MESENTERIC ARTERY- supply the second half of the large intestines. R and L COMMON ILIAC ARTERIES- final branches of the abdominal aorta. -divides into: a. b. Internal iliac artery- supplies the pelvic organs External iliac artery- enters the thigh--- Femoral artery & deep femoral artery (serve the thigh)

---popliteal artery ( splits into anterior and posterior tibial artery )supplies the leg and foot. --- dorsalis pedis (supplies the dorsum of the foot. Major Veins of the Systemic Circulation VEINS DRAINING into the SUPERIOR VENA CAVA The Radial and Ulnar veins- drain the forearms. They form brachial vein which drains the arm and empties into the axillary vein. Cephalic vein- superficial drainage of the lateral aspect of the arm and empties into axillary vein. Basilic vein- superficial vein that drains the medial aspect of the arm and emties into brachial artery. **median cubital vein- joins the cephalic and basilic vein - site for blood removal Subclavian vein- receives venous blood from the arm through the axillary vein and from the head through the external jugular vein. Vertebral vein- drains the posterior part of the brain

Internal Jugular vein- drains the dural sinuses of the brain. R and L Brachiocephalic veins- large veins that receive venous drainage from the subclavian, vertebral and internal jugular veins to form the superior vena cava. Azygos vein- single vein that drains the thorax and enters the SVC just before it joins the heart

VEINS DRAINING into the INFERIOR VENA CAVAE Anteritor and Posterior Tibial veins and Fibular veins - drain the leg (calf, foot) - the posterior tibial vein becomes the Popliteal vein at the knee, and Femoral vein in the thigh. - the femoral vein becomes External iliac vein in the pelvic region. Great Saphenous vein- longest vein the body - receive superficial drainage of the leg -originates at the Dorsal venous arch in the foot up to medial aspect of the leg then empties into the femoral vein. R. and L. Common Iliac vein- formed by the union of E. and I. iliac vein. - form the inferior vena cavae. R. and L. Gonadal vein- the R. vein drains the R. ovary in female and R. testicle in male. - L. gonadal vein empties into the left renal vein. R. and L. Renal vein- drains the kidney Hepatic Portal vein- drains the digestive tract, carries blood through the liver before it enters the systemic circulation. R. and L. Hepatic veins- drain the liver

Special Circulations I. Arterial Supply of the Brain and the Circle of Willis Internal Carotid Artery- branches of the common carotid arteries, runs through the neck and enters the skull through temporal bone. - divides into Anterior and Middle cerebral arteries. - supplies most of the cerebrum, forehead, nose, eye and middle ear. Vertebral Arteries- forms the Basilar Artery (serves the brain stem and cerebellum as it travels upward).

- Basilar artery divides at the base of the cerebrum to form the Posterior Tibial arteries (supply the posterior part of the cerebrum).

CIRCLE OF WILLIS- a circle on the undersurface of the brain formed by linked branches of the arteries (communicating arterial branches) that supply the brain. - protects the brain by providing more than one route for blood to reach the brain tissue in case of a clot or impaired blood flow in the system.

II. Hepatic Portal Circulation Hepatic Portal vein- drains the digestive organs, spleen, and the pancreas and delivers the blood to the liver. Inferior Mesenteric vein- drains the terminal part of the large intestine.

Spleenic vein- drains the spleen, pancreas, and the left side of the stomach.

Superior Mesenteric vein - drains the small intestines & the 1 part of the colon. Hepatic portal circulation
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L. Gastric vein- drains the R. side of the stomach and drains directly into the hepatric portal vein. III. Fetal Circulation Placenta- an organ within the uterus by means of which the embryo is attached to the wall of the uterus. - its function is to provide the fetus with nourishment, eliminate its waste, and exchange of respiratory gases. Umbilical cord has 3 blood vessels: 1 umbilical vein- carries blood rich in nutrients and oxygen to the fetus. 2 umbilical arteries- carry CO2 and debris-laden blood from the fetus to the placenta.

PhysiologyCirculation of VITAL SIGNS Arterial Pulse PULSE- a series of pressure waves within an artery caused by contractions of the left ventricle and travels through the arterial system - average adult pulse rate is 60 to 80 bpm. - influenced by activity, postural changes and emotion. - arterial pulse points or pressure points: (Radial artery, Facial, Carotid, Brachial, Radial, Femoral, Popliteal, Posterior Tibial, Dorsalis Pedis). Blood Pressure - is the pressure the blood exerts against the inner walls of the blood vessel. Blood pressure gradient- high to low pressure Measuring Blood pressure Systolic pressure- the pressure in the arteries at the peak of ventricular contraction Diastolic pressure- the pressure when ventricles are relaxing Measure in millimeters of mercury (mmHg) by means of sphygmomanometer at the brachial artery ( where the pressure is most similar to that of blood leaving the heart. Effects of Various Factors on Blood Pressure Cardiac output Peripheral resistance- is the amount of friction encountered by the blood as it flows through the blood vessels. -can be increased by: a. constriction or narrowing of blood vessels b. increased blood volume or blood viscosity

1. Neural Factors: the autonomic nervous system - sympathetic nervous system- causes vasoconstriction on the vascular system example. a. Sudden change of position b. sudden decrease of blood volume- hemorrhage c. exercise or trying to escape generalized vasoconstriction except skeletal muscles. 2. Renal Factors: kidneys- play a major role in regulating arterial BP by altering the blood volume. BP / blood volume water excretion blood volume/ BP release of the enzyme Renin formation of angiotensin release of aldosterone (enhances Na reabsorption) blood volume & BP 3. Temperature- cold temp. causes vasoconstriction heat- causes vasodilation BP water retention

4. Chemicals- Nicotine (increases BP and causes vasoconstriction) - alcohol and histamine ( vasodilation and decrease BP) 5. Diet- low salt, saturated fats, and cholesterol helps prevent high blood pressure.