Chapter 15

The Cardiovascular System: The Heart & Blood Vessels

The Cardiovascular System
The cardiovascular system consists of:
1. blood - The fluid which transports nutrients, respiratory gases, wastes etc.
to body tissues.
2. heart - The pump which moves the blood through the blood vessels.

I. Heart Anatomy
A. size, location & orientation
1. mediastinum = medial cavity of thorax
2. PMI = point of maximal intensity = between 5th & 6th ribs, just
below left nipple
B. coverings
1. double-layered pericardium
a. fibrous pericardium = outer, tough, dense
connective tissue that protects heart, anchors
heart to diaphragm and great vessels, and prevents
overfilling of heart with blood
b. serous pericardium = thin, two-layered serous
membrane
(1) parietal pericardium lines internal surface
of the heart, the fibrous
pericardium attaches to large arteries at
base, then turns inferiorly to become
the visceral pericardium
(2) visceral pericardium /epicardium = part of
heart wall
(3) pericardial cavity = between serous layers,
contains serous fluid for lubrication
pericarditis = inflammation of pericardium
-->friction
cardiac tamponade = heart compressed by
fluid (blood or excess serous fluid;
relieved by draining with needle)
C. heart wall – consist of three, highly vascular layers
1. epicardium
2. myocardium = mostly cardiac muscle, arranged in circular/spiral
bundles; connected to each other by a dense network of
connective tissue fibers called the fibrous skeleton which
reinforces/anchors, and electrically insulates.
3. endocardium = squamous epithelium plus connective tissue; lines
chambers, covers valves

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 D. chambers & associated great vessels
1. two atria = small, thin-walled, superior chambers, each with a
small, wrinkled protruding appendage called an auricle
a. right atrium receives 3 veins (deoxygenated blood):
superior vena cava from upper body, inferior vena cava
from lower body, coronary sinus from
myocardium itself
b. left atrium makes up most of the heart’s base and receives
four pulmonary veins from lungs (oxygenated)
c. interatrial septum
d. atrioventricular groove/coronary sulcus at A-V junction
e. pectinate muscles (pectin = comb) = muscle bundles on
anterior internal walls of atria
f. fossa ovalis = depression in interatrial septum; was
foramen ovale in fetus
g. functions - receives blood returning to heart; “pump” into
ventricles
2. two ventricles = large, thick-walled, inferior chambers:
right ventricle forms most of anterior surface of heart;
left ventricle dominates inferoposterior aspect, forms apex, and
has much thicker walls
a. pulmonary trunk carries deoxygenated blood from right
ventricle to lungs
b. aorta carries oxygenated blood from left ventricle to body
c. interventricular septum
d. anterior interventricular sulcus/anterior
interventricular artery overlies anterior
interventricular septum
e. posterior interventricular sulcus overlies posterior
interventricular septum
f. trabeculae carneae = ridges of muscles on internal walls
g. papillary muscles = conelike muscle bundles which
anchor some of the valves (later)
h. functions - discharge: Right ventricle --> pulmonary trunk
to lungs (deox)
Left ventricle --> aorta to body (oxygenated)
i. ventricles make up most of the mass of the heart
E. pathway of blood through heart
1. pulmonary circuit = short, low-pressure
2. systemic circuit = long, much more resistance --> thicker walls
F. heart valves
1. atrioventricular valves
a right atrioventricular (Rt. AV)/tricuspid
b. left atrioventricular (L. AV)/bicuspid/mitral
c. chordae tendineae = tiny collagen cords that anchor cusps
of AV valves to papillary muscles

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 2. semilunar valves
a. aortic semilunar valve
b. pulmonary semilunar valve
c. no valves on vessels atria; little backflow because atria
compress/collapse these vessels when they contract
II. Coronary Circulation: myocardium = too thick to be served by diffusion from
within
A. right & left coronary arteries arise from base of aorta and encircle heart
in atrioventricular groove
B. cardiac veins & coronary sinus
C. anastomosis = merging of nerves, blood vessels, or lymph vessels;
existence of many anastomoses among coronary arterial branches
provides collateral routes for blood delivery
D. main coronary arteries lie in epicardium and send branches into
myocardium; deliver when heart is relaxed (vessels are compressed
during contraction & partly blocked by open aortic semilunar valve)
E. disorders
1. angina pectoris = thoracic pain due to temporary deficiency in
blood to myocardium (due to stress-induced vessel spasms
or increased physical demands)
2. myocardial infarction/heart attack/coronary = tissue death due
to prolonged coronary blockage (replaced by noncontractile
scar tissue)
Ill. Properties of Cardiac Muscle
A. microscopic anatomy
striated, cells = short, fat, & branched, with abundant mitochondria;
intercalated discs hold cells together during contraction &
electrically couple cells --> myocardium acts as single coordinated unit
(functional syncytium) contracts by sliding filament
B. energy requirements
all aerobic respiration, using any nutrient supply available; therefore
damage from myocardial infarction is due to anoxia, not lack of
fuel
C. mechanism & events of contraction
1. differences between cardiac & skeletal muscle
cardiac muscle = 1 % autorhythmic (with ability to pace the heart)
remainder = contractile muscle fibers
a. all or none law
(1) in skeletal muscle = applies to each fiber
(2) in cardiac muscle = whole organ
b. means of stimulation
skeletal = 1 nerve ending/muscle fiber
cardiac = some cells = self-excitable (autorhythmicity)
c. absolute refractory period = much longer in cardiac -->
prevents tetanic contractions which would stop
pumping action by preventing filling

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IV. Heart Physiology
A. electrical events
two types of controlling systems regulate heart activity:
• nerves of autonomic nervous system increase or decrease heart rate
• the intrinsic conduction system, built into heart tissue, sends
depolarization one direction, from atria to ventricles
1. intrinsic conduction system
a. cardiac muscle fibers can contract spontaneously, even if
nerve connections are severed
b. different regions of heart have different rhythms (atria are
faster), so need unifying control system for effective
pumping
c. intrinsic conduction system sets basic rate of heart beat
2. action potential generated by autorhythmic cells
a. autorhythmic cells produce pacemaker potentials =
unstable resting potentials which continuously
depolarize
b. autorhythmic cells = localized in several areas; sequence
of excitation:
1. sinoatrial (SA) node in right atrial wall -->
depolarizes 75x/min--> pacemaker -->
produces sinus rhythm; depolarization spreads
through atria
--> atrial contraction
2. atrioventricular (AV) node = just above AV
junction small diameter fibers here delay
impulse so atria complete contraction before ventricles
contract
3. AV bundle of His in inferior part of interatrial
septum = only electrical connection between
atria & ventricles (rest = insulated by fibrous
skeleton
4. right & left bundle branches carry impulse along
interventricular septum toward apex
5. Purkinje fibers continue through interventricular
septum into apex, then turn superiorly into
the ventricular walls; more extensive on thicker,
larger left side of heart; Purkinje fibers supply
papillary muscles before lateral walls of
ventricles to assure tension on AV valve cusps
before full force of ventricular contraction
6. “wringing contraction” of ventricles begins at
apex and moves toward atria, ejecting blood
superiorly into large arteries leaving
ventricles

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 c. defects/problems
1. arrhythmias = irregular rhythms
2. fibrillation = rapid, irregular shuddering (no
pumping)
3. ectopic focus may take over after SA node damage
or may develop without damage-->
extrasystole (premature contraction)
4. heart block damage to AV node--> no impulses to
ventricles, intrinsic rate is too slow -->
implant pacemaker
5. ischemia (is-) = inadequate blood to heart muscle
6. tachycardia = heart rate over 1 00 beats/mm
7. bradycardia = heart rate less than 60 beats/mm
3. extrinsic innervation of heart
autonomic fibers (in medulla) modify activity of intrinsic system:
a. sympathetic --> cardioacceleratory center --> increases
rate & force of heartbeat
b. parasympathetic --> cardioinhibitory center --> slows
heart (via vagus nerves)
4. electrocardiography – discussed in lecture
B. the cardiac cycle
1. terms
a. systole = period of contraction
b. diastole = relaxation period
(since ventricles do most of pumping, these terms refer to
ventricles unless otherwise indicated)
c. cardiac cycle = 1 complete heartbeat (atrial systole/diastole
& ventricular systole/diastole) = usually sec’s (at 75
beats/mm)
(1) mid-to-late diastole heart relaxed, pressure in heart
= low; semilunar valves = closed; AV valves
= open
blood flows passively into & thru atria into
ventricles --> 70% of ventricular filling:
then atria contract, forcing remaining blood in
atria--> ventricles
(2) ventricular systole ventricular contraction begins,
pressure in ventricles rises sharply, closing
AV valves & then opening semilunar valves
(meanwhile atria relax & again begin filling with blood)
(3) early diastole at end of systole, ventricles relax and
semilunar valves close (prevent backflow);
then intraventricular pressure drops --> AV
valves open, ventricles begin to refill (completes
cycle)
C. heart sounds

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 1. normal = lub-dup, pause lub-dup, pause
lub = closing of AV valves; dup = closing of semilunar valves
1. Second sound = longer/louder
2. abnormal or unusual murmurs = due to turbulent blood
flow; may indicate valve problem

D. cardiac output (CO)

1. cardiac output = amount blood pumped out by each ventricle/rnkj
stroke volume = volume blood pumped out of each ventricle/
therefore:
CO = heart rate(HR) X stroke volume(SV)
average adult CO = (75 beats/mm) X (70m) = 5250 ml/mm
normal adult blood volume 5L (5000ml) so entire blood supply
passes thru each side of heart once each minute
CO varies with body’s demands; increases with increased SV or
HR
cardiac reserve = difference between resting & maximal CO;
increases with training
2. regulation of stroke volume
healthy heart pumps out -60% of blood which enters it, 70ml/beat
major factor affecting SV = preload = degree of stretch of cardiac
muscle cells just before contraction
Frank-Starling Law of the Heart = the greater the stretch --> the
stronger the contraction
increased stretch = due to increased venous return = due to slow
heartbeat (more filling), exercise (increased HR & force),
muscular pump of active skeletal muscles
decreased venous return = due to severe blood loss, very rapid HR
3. regulation of heart rate
a. autonomic nervous system regulation
1. sympathetic NS increases HR during
emotional/physical stress
2. parasympathetic NS (mostly vagus) resumes slow &
steady;
normal resting conditions --> both divisions send impulses to SA
node; dominant
influence = inhibitory, slows inherent rate of SA node stronger
stimulation of either division by sensory inputs (mostly
from baroreceptors/pressoreceptors) --> temporarily inhibits the
alternate division
eg: Atrial (Bainbridqe) reflex
increase in venous return --> blood congestion in atria -->
stretching of atrial walls --> increase in HR and force by
directly stimulating the SA node AND by stimulating
baroreceptors in atria that trigger reflexive increase in sympathetic
stimulation of heart

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 b. chemical regulation
1. hormones
epinephrine mimics sympathetic stimulation to
increase HR
thyroxine --> increases HR

c. other factors - age, gender. exercise, body temp

resting fetal HR = 140-160 --> decreases throughout life female
HR = faster (72-80 vs 64-72 in male)
heat increases HR (increases metabolic rate of heart cells/cold
decreases it)
exercise acts through sympathetic division to increase HR
4. homeostatic imbalance of cardiac output
a. congestive heart failure pumping efficiency depressed -->
inadequate circulation to meet tissue needs (due to
coronary atherosclerosis, high BP or Ml’s)
b. left side failure --> pulmonary congestion-- increased BP
in lung vessels --> leak --> pulmonary edema
c. right side failure --> peripheral congestion --> distal
edema (eg feet)

Blood Vessels
I. Structure & Function
Blood vessels = closed circuit of tubes: arteries (away from heart), arterioles,
capillary beds (exchange), venules, veins (toward heart)
A. structure of walls
1. all blood vessels except capillaries = 3 layers; an inner endothelial
lining, a middle layer of smooth muscle & elastic tissue,
and an outer layer of fibrous connective tissue; capillaries = 1
layer
lumen = blood-containing space
B. arteries
1. much thicker-walled with more smooth muscle & elastic tissue
than veins --> allows them to expand & recoil with blood
surges from heart, to maintain continuous pressure & continuous
flow
2. arterioles = small arteries; regulate blood flow into capillary beds
C. capillaries = microscopic vessels with thin walls; diameter < 1 RBC 3
types:
1. continuous capillaries have continuous walls with intercellular
clefts between cells; passage of fluids and small solutes =
through clefts and through endothelial cells by vesicular
transport; = most common; abundant in skin and muscles;
in brain = no clefts --> structural basis for blood-brain barrier

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 2. fenestrated = with pores = in areas of active absorption or
filtration
3. sinusoids = leaky capillaries with larger clefts to allow passage of
larger molecules or blood cells
4. capillary beds = true capillaries (exchange vessels) plus
metarteriole-thoroughfare channels (vascular shunts)
which directly connect arteriole and venule at opposite ends of
bed;
precapillary sphincters regulate blood flow into capillaries
5. veins
1. venules
smallest venules = very porous
2. veins have larger lumens & thinner walls than arteries plus
a system of venous valves (in limbs) to prevent
backflow
3. skeletal muscle contractions aid venous return of blood to
heart
4. most veins are usually only partially filled (blood reservoir)
5. varicose veins = dilated due to incompetent valves
E. vascular anastomoses = merging of vessels
1. arterial anastomoses provide collateral (alternate) channels to same
tissue/organ
2. venous anastomoses = much more abundant
II. Physiology of Circulation
A. terms:
1. blood flow = amount of blood through vessel/organ per unit time
(ml/mm)
2. blood pressure (BP) = force/unit area of blood on vessel wall
3. peripheral resistance (PR) = opposition to blood flow (friction)
sources = blood viscosity, vessel length, vessel diameter
4. relationship between blood flow, BP, and PR:
blood flow = directly proportional to BP & inversely proportional
to PR
B. systemic BP is highest in aorta; lowest in venae cavae
1. arterial BP depends on compliance (distensibility) of arteries &
amount of blood forced into them, a BP peaks during
systole (pressure BP is lowest during diastole) pressure =
due to recoil of elastic arteries
pulse pressure = systolic minus diastolic
2. mean arterial pressure (MAP = diastolic plus 1/3 pulse pressure);
keeps blood moving throughout cardiac cycle
3. capillary BP = low to prevent rupture while still allowing
adequate exchange (capillaries are very permeable)
4. venous BP steady (low) (due to resistance)
a. factors aiding venous return
1. large lumens & venous valves

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 2. respiratory & muscular pumps
5. maintaining BP involves three major factors
a. cardiac output = volume/mm from left ventricle
b. peripheral resistance = mainly due to vessel diameter
c. blood volume
6. short-term neural controls of BP
a. vasomotor center = sympathetic center (medulla) which
regulates blood vessel diameter
b. baroreceptors = in carotids, aortic arch, & large arteries of
neck & thorax; prevent acute BP changes (eg from standing
up), increase in BP --> baroreceptors inhibit vasomotor
center --> vasodilation, decreasing BP -->
baroreceptors activate cardioinhibitory center --> reduce
HR & force
decrease in BP --> baroreceptors stimulate vasomotor
center --> vasoconstriction, increasing BP
--> baroreceptors activate cardioacceleratory center -->
increase HR & force
c. chemoreceptors = in large arteries of neck
increase blood CO or decrease blood pH or O levels -->
chemoreceptors stimulate vasomotor center -->
vasoconstriction which increases BP,
speeding blood to lungs
d. higher brain centers (cerebrum & hypothalamus) may
modify neural controls of BP by influencing the
medullary control centers. eg fight-or-flight response
mediated by hypothalamus
7. short-term chemical controls of BP
a. increase BP by promoting vasoconstriction
(1) adrenal medulla hormones (epinephrine & NE) -
also increase HR & contractility
(2) antidiuretic hormone (from hypothalamus) - also
stimulates kidneys to conserve water
(3) angiotensin II (generated in response to renin
release by kidneys) - also stimulates release
of aldosterone
(4) endothelium-derived factors = affect vascular
smooth muscle
b. reduce BP by promoting vasodilation
(1) atrial natriurectic factor produced by atria- also
causes decline in blood volume by causing
kidneys to excrete more sodium & water
(2) nitric oxide (NO) released by vascular endothelium
(3) inflammatory chemicals: ie. histamine
(4) alcohol inhibits ADH release & depresses
vasomotor center --> vasodilation

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 8. long-term controls of BP renal regulation
kidneys regulate blood volume both directly and indirectly:
a. direct mechanism
increased BP --> increases filtrate formation & fluid loss
in urine
decreased BP --> kidneys retain more H increasing BP
b. indirect decreased BP --> kidneys release renin, triggering
formation of angiotensin II (vasoconstrictor) & release of
aldosterone (causes retention of salt & H)
9. monitoring circulatory efficiency
a. alternating expansion & recoil of arterial walls with each
heartbeat; pulse points = pressure points
b. BP: normal adult = 1 20/80 (systolic/diastolic)
BP cuff = sphygmomanometer
10. variations in blood pressure
a. hypotension = systolic below 100 = usually due to
conditioning
b. hypertension = 140/90 or higher; increases PR --> strains
heart and may cause vascular complications,
especially in eyes and kidneys
C. blood flow = tissue perfusion
1. velocity of blood flow
fastest in aorta (smaller cross-sectional area);
slowest in capillaries (large combined cross-sectional area), to
allow nutrient waste exchanges
2. autoregulation - local adjustment of blood flow to individual
organs based on immediate requirements
a. metabolic controls = chemical factors (especially low 02)
that cause vasodilation of arterioles serving the area
and open the precapillary sphincters
b. myogenic controls changes in BP directly stimulate
vascular smooth muscle
c. long-term autoregulation increase in number and size of
blood vessels in region in response to occluded
coronary vessel or high altitude
3. blood flow in special areas in most instances, autoregulation is
controlled by oxygen deficits and accumulation of local
metabolites. However, autoregulation in brain,
heart, and kidneys = extra efficient
4. capillary dynamics
a. exchanges of respiratory gases & nutrients (small) =
diffusion -solubles --> through clefts or
fenestrations
fat-solubles --> through lipid portion of endothelial cell
membrane
b. fluid movements

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 (1) hydrostatic pressures
(2) osmotic pressures
(3) hydrostatic-osmotic pressure interactions:
hydrostatic pressures dominate arterial end of
capillary bed, forcing fluids out;
osmotic pressures dominate venous end, forcing
fluids in
(4) small net loss of fluid & protein into interstitial
space--> lymph vessels to cardiovascular
system
5. circulatory shock = inadequate blood perfusion of tissues
a. hypovolemic shock = low blood volume
b. vascular shock = abnormal vasodilation
c. cardiogenic shock = pump failure
d. orthostatic intolerance in returning astronauts
weightlessness --> decrease in blood volume --> inadequate
perfusion of brain on reentry

Cardiovascular System: Heart & Blood Vessels

Review Sheet

Heart
1. Describe the size and shape of the heart, and indicate its location and orientation
in the thorax.
2. Describe the structure, location, and function of the fibrous pericardium, parietal
pericardium, and visceral pericardium.
3. Describe the structure and function of each of the three layers of the heart wall.
4. Describe the structure and functions of the four heart chambers. Include
associated structures as well as the names and general routes of the great vessel(s)
associated with each chamber.
5. Describe the structure, function and location of the skeleton of the heart.
6. How do the right and left sides of the heart differ in structure and function?
7. Trace the path of blood through the heart. Locate and describe the function of
each of the major vessels that enter and leave the heart. Which carry
oxygenated blood?
8. Distinguish between the pulmonary and systemic circuits.
9. Name the heart valves and describe their location and function.
10. Describe how and when blood is delivered to the heart itself.
11. Define the following: ischemia, angina pectoris, myocardial infarction.
12. Describe the microscopic structure of cardiac muscle cells. What are intercalated
discs?
13. Compare the contraction of cardiac muscle to that of skeletal muscle. Include the
all-or- none law and the absolute refractory period in your comparison. Define
autorhythmic.
14. Name the elements of the intrinsic conduction system of the heart in order,
beginning with the pacemaker. Trace the conduction pathway.

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15. Define the following: arrhythmia, fibrillation, heart block, tachycardia,
bradycardia.
16. Distinguish between systole and diastole.
17. Describe the timing and events of the cardiac cycle.
18. Describe the normal heart sounds. What causes them?
19. Define cardiac output. How does it relate to heart rate and stroke volume? What is
cardiac reserve?
20. Name and explain the effects of the various factors involved in regulation of
stroke volume and heart rate.
21. Explain the role of the autonomic nervous system in regulating cardiac output.
What is vagal tone?
22. List several chemical factors which influence heart rate.
23. Describe the effect of the following on heart rate: stimulation by the vagus nerve,
exercise, epinephrine, advanced age, and gender.
24. Define congestive heart failure.
25. Compare the effects of a failing right ventricle to those of a failing left ventricle.
26. Describe several age-related changes in the heart.

Blood Vessels
1. Describe the three layers that typically form the wall of a blood vessel, and state
the function of each.
2. Define vasoconstriction and vasodilation.
3. Compare the structure and function of arteries, arterioles, veins, venules, and
capillaries.
4. Describe the structure and function of a capillary bed.
5. How is blood flow into capillaries controlled?
6. Define blood flow, blood pressure, and resistance, and explain the relationship
between these factors.
7. List and explain the factors that influence blood pressure, and describe how blood
pressure is regulated.
8. Define hypertension. Note both its symptoms and consequences.
9. Explain how blood flow is regulated in the body in general. Describe the unique
features of arterial circulation of the brain and hepatic portal circulation.
10. Define circulatory shock. Note several possible causes.
11. Describe the forces responsible for the exchange of substances between blood and
the tissue fluid. Why do water and dissolved substances leave the arteriole end of
a capillary and enter the venule end? How is excess interstitial fluid returned to
venous circulation?
12. Define: atherosclerosis, ateriosclerosis, aneurysm , phlebitis , and varicose veins.
13. List the major factors that promote the flow of venous blood.
14. What changes occur in blood vessels as a person ages.

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