THE

CARDIOVASCULAR
SYSTEM:
(CARDIO- HEART; VASCULAR-BLOOD OR BLOOD VESSELS)
THREE INTERRELATED COMPONENTS: BLOOD, THE HEART, AND BLOOD
VESSELS.
 THE CARDIOVASCULAR SYSTEM: BLOOD
• Functionally, the cardiovascular system transports substances to and from body
cells.
• To perform its functions, blood must circulate throughout the body. The heart
serves as the pump for circulation, and blood vessels carry blood from the heart to
body cells and from body cells back to the heart.
• Blood is a liquid connective tissue that consists of cells surrounded by
extracellular matrix.
• Study of blood, blood-forming tissues, and the disorders associated with them is
hematology (hemo- or hemato- blood; logy- study of)
 FUNCTIONS OF BLOOD
Three general functions of Blood:
1. Transportation. Blood transports oxygen from the lungs to cells
throughout the body and carbon dioxide from the cells to the lungs.
2. Regulation. Blood helps regulate the pH of body fluids.
3. Protection. Blood clots in response to an injury, which protects
against its excessive loss from the cardiovascular system.
-White blood cells protect against disease by carrying on
phagocytosis and producing proteins called antibodies. Blood
contains additional proteins, called interferons and complement.
COMPONENTS OF WHOLE BLOOD
• Blood is denser and more viscous than water.
• The temperature of blood is about 38C (100.4F).
• Its pH is slightly alkaline, ranging from 7.35 to 7.45.
• Blood constitutes about 8% of the total body weight.
• The blood volume is 5 to 6 liters (1.5 gal) in an average-sized adult
male
• The blood volume is 4 to 5 liters (1.2 gal) in an average-sized adult
female.
• The difference in volume is due to differences in body size.
WHOLE BLOOD IS COMPOSED OF TWO PORTIONS:

1. Blood plasma, a liquid

extracellular matrix that contains
dissolved substances
2. Formed elements, which are
cells and cell fragments.
The cells (which are more dense) sink to
the bottom of the tube.
The lighter-weight blood plasma (which
is less dense) forms a layer on top .
Blood is about 45% formed elements
and 55% plasma.
Pale, colorless white blood cells (WBCs) and
platelets occupy less than 1% of total blood
volume.
They form a very thin layer, called the buffy coat.
NOTE: Normally, more than 99% of the formed elements are red blood
cells (RBCs) since they are the most dense. The percentage of total
blood volume occupied by red blood cells is termed the hematocrit.
 BLOOD PLASMA
• Blood plasma- when the formed • Albumins help maintain proper blood osmotic
elements are removed from blood, a straw pressure, which is an important factor in the exchange
of fluids across capillary walls.
colored liquid remains called plasma.
• Globulins, which compose 38% of plasma proteins,
• Plasma is about 91.5% water, 7% proteins,
include antibodies, defensive proteins produced during
and 1.5% solutes other than proteins. certain immune responses.
• Proteins in the blood, the plasma proteins, • Fibrinogen makes up about 7% of plasma proteins
are synthesized mainly by the liver. and is a key protein in formation of blood clots.

• The most plentiful plasma proteins are the • Other solutes in plasma include electrolytes, nutrients,
gases, regulatory substances such as enzymes and
albumins, which account for about 54% of
hormones, vitamins, and waste products.
all plasma proteins.
FORMED ELEMENTS:

• I. Red blood cells

• II.A. White blood cells
Granular leukocytes
(contain conspicuous granules that are
visible under a light microscope after staining)
Neutrophils
Eosinophils
Basophils
B. Agranular leukocytes
(no granules are visible under a light
microscope after staining)

T and B lymphocytes and natural killer cells

Monocytes

• III. Platelets
 FORMATION OF BLOOD CELLS

• Hemopoiesis( poiesis = making) -The process by which the formed

elements of blood develop. It is also called hematopoiesis.
• Before birth, hemopoiesis first occurs in the yolk sac of an embryo
and later in the liver, spleen, thymus, and lymph nodes of a fetus.
• In the last three months before birth, red bone marrow becomes
the primary site of hemopoiesis and continues as the source of
blood cells after birth and throughout life.
 FORMATION OF BLOOD CELLS
• Red bone marrow is a highly vascularized
connective tissue located in the microscopic
spaces between trabeculae of spongy bone
tissue. It is present chiefly in bones of the axial
skeleton, pectoral and pelvic girdles, and the
proximal epiphyses of the humerus and femur.
• About 0.05–0.1% of red bone marrow cells are
cells called pluripotent stem cells
(pluri=several).
• Pluripotent stem cells are cells that have the
capacity to develop into many different types of
 Response to stimulation by specific
hormones
• Pluripotent stem cells generate two other types of stem cells which
have the capacity to develop into fewer types of cells: myeloid stem
cells and lymphoid stem cells.
• Myeloid stem cells begin their development in red bone marrow and
differentiate into several types of cells from which red blood cells,
platelets, eosinophils, basophils, neutro trophils, and monocytes
develop.
• Lymphoid stem cells begin their development in red bone marrow but
complete it in lymphatic tissues. They differentiate into cells from
which the T and B lymphocytes develop.
 FORMATION OF BLOOD CELLS: RBC
• Red blood cells (RBCs) or erythrocytes (erythro- red; cyte -cell)
contain the oxygen-carrying protein hemoglobin, which is a pigment
that gives whole blood its red color.
• Hemoglobin also transports about 23% of the carbon dioxide in the
blood.
• A healthy adult male has about 5.4 million red blood cells per microliter
of blood.
• A healthy adult female has about 4.8 million red blood cells per
microliter of blood.
 FORMATION OF BLOOD CELLS: RBC

• RBCs are biconcave (concave on both sides) discs averaging about

8micrometer* in diameter.
• Mature RBCs lack a nucleus and other organelles and can neither reproduce nor
carry on extensive metabolic activities.
• All of their internal space is available for oxygen and carbon dioxide transport.
• RBCs consist of a selectively permeable plasma membrane, cytosol, and
hemoglobin.
• Since a biconcave disc has a much greater surface area for its volume, this
shape provides a large surface area for the diffusion of gas molecules into and
out of a RBC.
RBC LIFE CYCLE
 RBC LIFE CYCLE EXPLANATION:

5 Erythropoiesis in red bone marrow results in the production

1.Macrophages in the spleen, liver, and red bone marrow
of red blood cells, which enter the circulation.
phagocytize ruptured and worn-out red blood cells,
splitting apart the heme and globin portions of 6 When iron is removed from heme, the non-iron portion of
heme is converted to biliverdin, a green pigment, and then
hemoglobin.
into bilirubin, a yellow-orange pigment. Bilirubin enters the
2. The protein globin is broken down into amino acids, blood and is transported to the liver. Within the liver, bilirubin
which can be reused by body cells to synthesize other is secreted by liver cells into bile, which passes into the small
proteins. intestine and then into the large intestine.
3. Iron removed from the heme portion associates with 7 In the large intestine, bacteria convert bilirubin into
the plasma protein transferrin ( trans- across; ferr- iron), urobilinogen Some urobilinogen is absorbed back into the
which acts as a transporter. blood, converted to a yellow pigment called urobilin and
excreted in urine. Most urobilinogen is eliminated in feces in
4. The iron-transferrin complex is then carried to red bone
the form of a brown pigment called stercobilin (ster-ko¯-BI¯ -
marrow, where RBC precursor cells use it in hemoglobin
lin), which gives feces its characteristic color. Because free
synthesis. Iron is needed for the heme portion of the iron ions bind to and damage molecules in cells or in the
hemoglobin molecule, and amino acids are needed for blood, transferrin acts as a protective “protein escort” during
the globin portion. Vitamin B12 is also needed for transport of iron ions. As a result, plasma contains virtually no
synthesis of hemoglobin. free iron.
 RBC PRODUCTION

• Hemopoiesis- The formation of blood cells in general.

• Erythropoiesis- Termed to the formation of just RBCs.
• Near the end of erythropoiesis, an RBC precursor ejects its nucleus and
becomes a reticulocyte. Loss of the nucleus causes the center of the cell to
indent, producing the RBC’s distinctive biconcave shape.
• Reticulocytes, which are about 34% hemoglobin and retain some mitochondria,
ribosomes, and endoplasmic reticulum, pass from red bone marrow into the
bloodstream.
• Reticulocytes usually develop into mature RBCs within 1 to 2 days after their
release from bone marrow.
 RBC PRODUCTION

• Normally, erythropoiesis and destruction

of RBCs proceed at the same pace. If the
oxygen-carrying capacity of the blood
falls because erythropoiesis is not
keeping up with RBC destruction, RBC
production increases.
• The controlled condition in this particular
negative feedback loop is the amount of
oxygen delivered to the kidneys (and
thus to body tissues in general).
 RBC PRODUCTION

• Hypoxia - a deficiency of oxygen, stimulates increased release

of erythropoietin or EPO,
• Erythropoeitin- a hormone made by the kidneys.
• EPO circulates through the blood to the red bone marrow,
where it stimulates erythropoiesis.
• The larger the number of RBCs in the blood, the higher the
oxygen delivery to the tissues .
 RBC PRODUCTION

• Cyanosis- A person with prolonged hypoxia may develop a life-

threatening condition. It characterized by a bluish-purple skin
coloration most easily seen in the nails and mucous membranes.
• Oxygen delivery may fall due to anemia (a lower-than-normal number
of RBCs or reduced quantity of hemoglobin) or circulatory problems
that reduce blood flow to tissues.
• A test that measures the rate of erythropoiesis is called a reticulocyte
count. This and several other tests related to red blood cells are
explained.
A TEST THAT MEASURES THE RATE OF ERYTHROPOIESIS IS CALLED A
RETICULOCYTE COUNT. THIS AND SEVERAL OTHER TESTS RELATED TO RED
BLOOD CELLS ARE EXPLAINED.

I. Obtaining Blood Samples

A.Venipuncture. This most frequently used procedure involves
withdrawal of blood from a vein using a sterile needle and
syringe..
B.Fingerstick. Using a sterile needle or lancet, a drop or two of
capillary blood is taken from a finger, earlobe, or heel.
C.Arterial stick. Sample is most often taken from radial artery in
the wrist or femoral artery in the thigh
A TEST THAT MEASURES THE RATE OF ERYTHROPOIESIS IS CALLED A RETICULOCYTE
COUNT. THIS AND SEVERAL OTHER TESTS RELATED TO RED BLOOD CELLS ARE EXPLAINED.

II. Testing Blood Samples

A.Reticulocyte count (indicates the rate of erythropoiesis)
Normal value: 0.5% to 1.5%.
Abnormal values: A high reticulocyte count might indicate
the presence of bleeding or hemolysis (rupture of
erythrocytes), or it may be the response of someone who is
iron deficient.
 A TEST THAT MEASURES THE RATE OF ERYTHROPOIESIS IS CALLED A RETICULOCYTE
COUNT. THIS AND SEVERAL OTHER TESTS RELATED TO RED BLOOD CELLS ARE
EXPLAINED.

B. Hematocrit (the percentage of red blood cells in blood).

A hematocrit of 40 means that 40% of the volume of blood is
composed of RBCs. Normal values: Females: 38 to 46 (average
42) Males: 40 to 54 (average 47) Abnormal values: The test is
used to diagnose anemia, polycythemia (an increased
percentage of red blood cells above 55), and abnormal states of
hydration. Anemia may vary from mild (hematocrit of 35) to
severe (hematocrit of less than 15).
 FORMATION OF BLOOD CELLS: WBC
WBC STRUCTURE AND TYPES

White blood cells (WBCs) or leukocytes (leuko- white) have nuclei and a full
complement of other organelles but they do not contain hemoglobin.
Classified as:
Granular leukocytes (contain conspicuous granules that are visible under a light microscope after
staining)
• Neutrophils
• Eosinophils
• Basophils

Agranular leukocytes (no granules are visible under a light microscope after
staining)
• T and B lymphocytes and natural killer cells
• Monocytes
 WBC FUNCTIONS

Wandering macrophages (macro- large; phages - eaters) - Monocytes that

migrate into infected tissues develop into cells , which can phagocytize
many more microbes than neutrophils. They also clean up cellular debris
following an infection.
• Leukocytosis - An increase in the number of WBCs, is a normal, protective
response to stresses such as invading microbes, strenuous exercise,
anesthesia, and surgery.
• Leukopenia - An abnormally low level of white blood cells (below 5000
cells/microL).
 FORMATION OF BLOOD CELLS: PLATELETS

• Pluripotent stem cells also differentiate into cells that produce platelet.
• Megakaryoblasts- Some myeloid stem cells develop into cells, which
transform into megakaryocytes, huge cells that splinter into 2000–3000
fragments in the red bone marrow and then enter the bloodstream.
• Between 150,000 and 400,000 platelets are present in each microL of
blood.
• When blood vessels are damaged, platelets help stop blood loss by
forming a platelet plug. Their vesicles also contain chemicals that
promote blood clotting (both processes are described shortly).
KEY TERMS
HEMOSTASIS
HEMORRHAGE- “burst forth”
-the loss of a large amount of blood from the vessels
VASOCONTRICTION - narrowing of a blood vessel
PLATELET PLUG - a mass of numerous platelets
- stops blood loss especially when the wound is small
SERUM - portion of plasma after coagulation of blood
FIBRIN - network of insoluble protein fibers
- where formed elements of blood are being trapped
 HEMOSTASIS

CLOT - gel-like collections of blood

CLOTTING or COAGULATION CASCADE
- process of clot formation
- a series of chemical reactions that culminates the formation
of fibrin threads.
-a complex process in which various chemicals known as
clotting factors activate each other
 HEMOSTASIS

THROMBOSIS - the result when blood clots too easily

- clotting in an unbroken blood vessel

HEMORRHAGE- the result when blood clotting is too long

PROTHROMBIN - a plasma protein formed by the liver with the

help of vitamin K

THROMBIN - a serine protease (enzyme)

HEMOSTASIS
• is a sequence of responses that stops bleeding when blood
vessels are injured
• involves platelets and clotting factors
• different from homeostasis
• successful hemostasis prevents hemorrhage
• can prevent hemorrhage from smaller blood vessels
• extensive hemorrhage from larger vessels usually requires
• medical intervention
 MECHANISMS USED TO REDUCE BLOOD LOSS

1. VASCULAR SPASM
• is a sudden and brief contraction of the smooth muscles of our
blood vessels
• secrete serotonin
• reduces blood loss for several minutes to several hours
• probably caused by damage to the smooth muscle and by
reflexes initiated by pain receptors
 MECHANISMS USED TO REDUCE BLOOD LOSS

2. PLATELET PLUG FORMATION

- the aggregation of platelets to stop bleeding
 PROCESS: PLATELET PLUG FORMATION

• Platelets come in contact and stick to parts of a damaged blood

vessel
( e.g collagen fibers).
• Activated platelets release chemicals that activate nearby
platelets and sustain the vascular spasm, which decreases blood
flow through the injured vessel.
• The release of platelet chemicals makes other platelets in the area
sticky, allowing them to stick to the originally activated platelets.
• Eventually, platelet plug will be formed
 MECHANISMS USED TO REDUCE BLOOD LOSS

3.)BLOOD CLOTTING OR COAGULATION

- liquid blood changes into a gel-like or semisolid state

- prevents excessive bleeding when blood vessels are injured
- involves clotting factors
 STAGES OF CLOTTING

A. PROTHROMBINASE IS FORMED

WAYS OF PROTHROMBINASE FORMATION

• Extrinsic pathway of Blood clotting

• Intrinsic Pathway of blood clotting
 EXTRINSIC PATHWAY OF BLOOD
CLOTTING

• occurs within seconds

• damaged tissue cells release a tissue protein called tissue
factor (TF) into the blood from outside (extrinsic to) blood
vessels
• TF is converted into Prothrombinase by undergoing
reactions that requires calcium ions and several clotting
factors
 INTRINSIC PATHWAY OF BLOOD
CLOTTING
• More complex than the extrinsic pathway
• It occurs more slowly, usually requiring several minutes
• Its activators are either in direct contact with blood or
contained within (intrinsic to) the blood
• Cells activate platelets and release phospholipids
• - Prothrombinase is formed after undergoing reactions that
requires clotting factors (e.g Calcium ions)
 STAGES OF CLOTTING

B.) PROTHROMBINASE CONVERTS PROTHROMBINE TO

THROMBIN

C.) THROMBIN CONVERTS SOLUBLE FIBRINOGEN

(another plasma protein formed by the liver) INTO
INSOLUBLE FIBRIN
 CLOT RETRACTION AND BLOOD VESSEL REPAIR

• CLOT RETRACTION - the consolidation or tightening of the

fibrin clot
- involved in normal coagulation
The formed clot plugs the ruptured area of the blood vessel
and stop the bleeding

The fibrin threads attached to the damaged surfaces of the

blood vessel gradually contract as platelets pull on them

As the clot retracts, it pulls the edges of the damaged

vessel closer together, decreasing the risk of further
damage
Permanent repair of the blood vessel can then take place

Then, fibroblasts form connective tissue in the ruptured area,

and new endothelial cells repair the vessel lining.
HEMOSTATIC CONTROL
MECHANISMS
KEY TERMS

• PLASMINOGEN - an inactive plasma enzyme

• PLASMIN - an active plasma enzyme
- dissolves clots at sites of damage once the
damage is repaired.
• thrombin and tissue plasminogen activator (tPA)
- substances that can activate plasminogen
- found in many body tissues and is liberated into the
blood after a vascular injury.
• ANTICOAGULANT DRUG

- a substance that delays, suppresses, or

prevents blood clotting
- Example: Heparin or warfarin
• FIBRINOLYSIS - dissolution of the clot
- involved in normal
coagulation
 FIBRINOLYSIS

When a clot is formed, plasminogen is incorporated into the

clot

Both body tissues and blood contain substances that can

activate plasminogen to plasmin

Once plasmin is formed, it can dissolve the clot by digesting

fibrin threads
CLOTTING IN BLOOD
VESSELS
KEY TERMS

• ATHEROSCLEROSIS - accumulation of fatty substances on arterial

walls
• THROMBOSIS - clotting in an unbroken blood vessel

• THROMBUS - the clot itself

• EMBOLUS - A thrombus, bubble of air, fat from broken bones, or a
piece of debris transported by the bloodstream
- often form in veins
• PULMONARY EMBOLISM - a condition where embolus is lodged in the
lungs
 CLOTTING IN BLOOD VESSELS

• The endothelial surfaces of a blood vessel may be roughened

as a result of atherosclerosis , trauma, or infection.
• Clots may also form in blood vessels when blood flows too
slowly
• Massive emboli in the lungs may result in right ventricular
failure and death in a few minutes or hours.
• An embolus that blocks blood flow to the brain, kidney, or
heart, can cause a stroke, kidney failure, or heart attack,
 CLINICAL CONNECTION

• ASPIRIN
- inhibits vasoconstriction and platelet aggregation
- reduces the chance of thrombus formation
- reduces the risk of transient ischemic attacks (TIA), strokes, myocardial
infarction, and blockage of peripheral arteries
• THROMBOLYTIC AGENTS
- chemical substances that are injected into the body
- help dissolve blood clots
- directly or indirectly activate plasminogen

• STREPTOKINASE
- first thrombolytic agent approved in 1982 for dissolving clots in
the coronary arteries of the heart

• A genetically engineered version of human tissueplasminogen

activator (tPA) is used to treat both heart attacks and brain
attacks (strokes) that are caused by blood clots
BLOOD GROUPS
AND
BLOOD TYPES
 BLOOD GROUPS AND BLOOD TYPES

• AGGLUTINOGENS - proteins existing on the surface of every

red blood cells in the body
• BLOOD GROUPS - categories of blood base on the presencew
or absence of certain antigens
• BLOOD TYPES - there can be many blood types in a blood
group
• There are at least 24 blood groups and more than 100
antigens that can be detected on the surface of red blood
 BLOOD GROUPS

A.) ABO Blood Group

• Is based on two antigens called A and B
• Is soluble antigens of the ABO type appear in saliva and other
body fluids
• Plasma contains antibodies termed anti-A and anti-B antibodies
• We do not have antibodies that react with our own antigens,
but we do have antibodies for any antigens that our RBCs lack.
BLOOD TYPES
1.) TYPE A
- People whose RBCs display only antigen A
2.) TYPE B
- Those who have only antigen B
3.) TYPE AB
- Individuals who have both A and B antigens
- “ Universal recipients”
4.) TYPE O
- those who have neither antigen A nor B
- “ universal donor”
 BLOOD GROUPS

B.) Rh BLOOD GROUP

• So named because the Rh antigen, called Rh
factor, was first found in the blood of the rhesus
monkey
• Plasma does not
BLOOD contain anti-Rh antibodies
TYPES
1.) Rh positive - people whose RBCs have the Rh
antigen
2.) Rh negative - those who lack the Rh antigen in
their RBCs
 TRANSFUSIONS
• HEMOLYSIS - natural process where the body destroys older RBCs
that are inefficient
• TRANSFUSION
- The transfer of whole blood or blood components (red blood cells
only or plasma only) into the bloodstream
-Most often given to alleviate anemia or when blood volume is low
- In an incompatible blood transfusion, antibodies in the recipient’s
plasma bind to the antigens on the donated RBCs.
 TYPING AND CROSS-MATCHING BLOOD FOR
TRANSFUSION

• In the procedure for ABO blood typing, single drops of blood are
mixed with different antisera
*ANTISERA- solutions that contain antibodies
• One drop of blood is mixed with anti-A serum, which contains
anti-A antibodies that will agglutinate (clump together) red
blood cells that possess A antigens
• Another drop is mixed with anti-B serum, which contains anti-B
antibodies that will agglutinate red blood cells that possess B
antigens
TYPE A - If the red blood cells agglutinate only when mixed with
anti-A serum
TYPE B - If the red blood cells agglutinate only when mixed with
anti-B serum
TYPE AB - if both drops agglutinate
TYPE O - if neither drop agglutinates
 LIFESTYLE AND BLOOD CIRCULATION
1.) QUIT SMOKING
- Smoking increases blood fibrinogen levels which
triggers the clotting of blood

2.) EXERCISE REGULARLY

- Regular physical activity increases plasma volume which
constitute to a thinner or more dilute blood and therefore
lowering the risk of blood clotting
3. ) COPE EFFECTIVELY WITH STRESS
- Prolonged mental stress impairs fibrinolysis by decreasing the
activity of tissue plasminogen activator (tPA), which helps break
down fibrinogen

4.) EAT A HEART-HEALTHY DIET

- People with high blood cholesterol levels exhibit disturbances in
coagulation, fibrinolysis, and platelet behavior

-Lowering blood lipid levels by diet or drug therapy reduces the risk
of blood clot formation
COMMON
DISORDERS
 COMMON DISORDERS

1)ANEMIA
- a condition in which the oxygen-carrying capacity of blood is reduced
- characterized by reduced numbers of RBCs or a decreased amount of
hemoglobin in the blood
- may also be caused by chemotherapy for cancer treatment
- SYMPTOMS: fatigue, pale skin, intolerant to cold, shortness of breath
 TYPES
a.) Iron-deficiency anemia
-the most prevalent kind of anemia
-caused by inadequate absorption of iron, excessive loss of iron,
or insuficient intake of iron
- Women are at greater risk for iron-defificiency anemia due to monthly menstrual
blood loss

b. ) Pernicious anemia
- caused by insuficient hemopoiesis resulting from an inability of the stomach to
produce intrinsic factor (needed for absorption of dietary vitamin B12)

c.) Hemorrhagic anemia

- due to an excessive loss of RBCs through bleeding resulting from large wounds,
stomach ulcers, or especially heavy menstruation
d.) hemolytic anemia
- RBC plasma membranes rupture prematurely
- can be hereditary or caused by outside agents such as parasites, toxins, or antibodies from
incompatible transfused blood

e.) Thalassemia
- is a group of hereditary hemolytic anemias in which there is an abnormality in one or more
of the four polypeptide chains of the hemoglobin molecule.
- occurs primarily in populations from countries bordering the Mediterranean Sea

f.) Aplastic anemia

-results from destruction of the red bone marrow caused by toxins, gamma radiation, and
certain medications that inhibit enzymes needed for hemopoiesis

*Synthetic Erythropoietin is given to patients to increase the oxygen-

carrying capacity of the blood
 COMMON DISORDERS

2. SICKLE CELL DISEASE

- The RBCs of a person with sickle cell disease (SCD) contain Hb-S
*Hb-S - an abnormal kind of hemoglobin
- Any activity that reduces the amount of oxygen in the blood (vigorous exercise) may
produce a sickle-cell crisis

- SYMPTOMS: Worst anemia, Pain in the abdomen and long bones of the limbs, fever
and shortness of breath, jaundice, fatigue, fever
 COMMON DISORDERS

3.) HEMOLYTIC DISEASE OF THE NEWBORN (HDN)

- a problem that results from Rh incompatibility between a mother and her
fetus
- can be prevented by giving all Rh women an injection of anti Rh antibodies
called anti-Rh gamma globulin (RhoGAM) soon after every delivery,
miscarriage, or abortion
 COMMON DISORDERS
4.)LEUKEMIA
- a group of red bone marrow cancers in which abnormal white blood cells
multiply uncontrollably

- In most leukemias, the cancerous white blood cells spread to the lymph
nodes, liver, and spleen, causing them to enlarge

- SYMPTOMS: fatigue, intolerance to cold, and pale skin, weight loss, fever,
night sweats, excessive bleeding, and recurrent infections
THE CARDIOVASCULAR
SYSTEM: HEART
STRUCTURE AND ORGANIZATION OF THE
HEART
Location and Coverings of the Heart
-The heart is situated between the two lungs in the
thoracic cavity, with about two-thirds of its is lying
to the of the body’s midline.
-The pointed end is called apex is formed by the tip
of the left ventricle (lower chamber of the heart) and
base of the heart is formed by the atria (upper
chamber of the heart).
 STRUCTURE AND ORGANIZATION OF THE
HEART
Pericardium- the membrane that surrounds the heart and hold it in place and it consists of two parts which are the
fibrous pericardium and the serous pericardium
• The outer fibrous pericardium is a tough, inelastic, dense irregular connective tissue that prevents overstretching
of the heart, protection and anchors the heart in place.
• The inner serous pericardium is thinner membrane that forms double layer around the heart which also holds
your heart in place and protects heart from infection.
 STRUCTURE AND ORGANIZATION OF THE
HEART
HEART WALL
The wall of the heart is composed of three layers: epicardium (external layer),
myocardium (middle layer), and endocardium (inner layer).
Epicardium is a serous membrane that forms the innermost layer of the pericardium
and the outer surface of the heart.
Myocardium is the heart muscles line or the middle layer of heart walls.
Endocardium is the thin, smooth membrane which lines the inside of the chambers of
the heart and forms the surface of the valves.
 STRUCTURE AND ORGANIZATION OF THE
HEART
CHAMBERS OF HEART
 The heart contains four chambers. The two
upper chambers are the atria and the two lower
chambers are the ventricles. The upper chambers,
the right and left atria receive incoming blood
while the lower chambers, the right and left
ventricles pumps blood out of the heart. The heart
valves serve as the gates at the chamber opening
and they keep blood flowing in the right direction.
 STRUCTURE AND ORGANIZATION OF THE
HEART
GREAT VESSELS OF THE HEART
The great vessels of the heart are aorta, Aorta is the largest artery in the body. It carries
pulmonary arteries, pulmonary veins, oxygenated blood
superior vena cava, inferior vena cava Pulmonary arteries receive deoxygenated blood from the
right ventricle and deliver it to the lungs for gas exchange to
take place.
Pulmonary veins receive oxygenated blood from the
lungs, delivering it to the left side of the heart to be pumped
back around the body.
Superior vena cava receives deoxygenated blood from the
upper body, delivering it to the right atrium.
Inferior vena cava receives deoxygenated blood from the
lower body, delivering it back to the heart.
 STRUCTURE AND ORGANIZATION OF THE
HEART
VALVES OF THE HEART
Tricuspid valve sits between the heart’s two
right chamber and these valves flaps open to
let blood flow from the upper right chamber
to lower right chamber.
Mitral valve has flaps that open and close
once during each heart.
Aortic valve is the main out flow valve for
the left part of the heart.
Pulmonary valve control the blood flow in
the heart.
 BLOOD FLOW AND BLOOD SUPPLY OF THE
HEART
BLOOD FLOW THROUGH THE HEART
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 the 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 tissue
through the aorta.
 BLOOD FLOW AND BLOOD SUPPLY OF THE HEART

BLOOD SUPPLY OF THE HEART

The heart receives its own supply of
blood from a network of arteries, called
the coronary arteries. Two major coronary
branch off from the aorta near the point
where the aorta and the left ventricle
meet. Right coronary artery supplies the
right atrium and the right ventricle with
blood.
 CONDUCTION SYSTEM OF THE HEART

The heart conduction system is the network of nodes, cells and signals
that controls your heartbeat. Each time your heart beats, electrical
signals travel through your heart. These signals cause different parts of
your heart to expand and contract.
ELECTROCARDIOGRAM

An electrocardiogram (ECG) is

one of the simplest and fastest tests
used to evaluate the heart. Electrodes
(small, plastic patches that stick to
the skin) are placed at certain spots
on the chest, arms, and legs. The
electrodes are connected to an ECG
machine by lead wires.
 THE CARDIAC CYCLE

The cardiac cycle is the performance of the human heart from the beginning
of one heartbeat to the beginning of the next. Cardiac cycle divide into three
phases.
1. Relaxation period -The relaxation period begins at the end of a
cardiac cycle when the ventricles start to relax and all four chambers are in
diastole.
2. Atrial systole (contraction) - lasts about 0.1 seconds - both atria
contract and force the blood from the atria into the ventricles.
 THE CARDIAC CYCLE

3. Ventricular systole (contraction) - The QRS complex in the ECG indicates ventricular
depolarization, which leads to contraction of the ventricles. Ventricular contraction pushes blood
against the AV valves, forcing them shut. As ventricular contraction continues, pressure inside the
chambers quickly rises. When left ventricular pressure surpasses aortic pressure and right
ventricular pressure rises above the pressure in the pulmonary trunk, both semi lunar valves open,
and ejection of blood from the heart begins. Ejection continues until the ventricles start to relax.

Heart Sounds - The sound of the heartbeat comes primarily from turbulence in blood flow created
by the closure of the valves, not from the contraction of the heart muscle.
 CARDIAC OUTPUT

The volume of blood ejected per minute from the left ventricle into the aorta is called the cardiac
output.

Regulation of Stroke Volume

Although some blood is always left in the ventricles at the end of their contraction, a
healthy heart pumps out the blood that has entered its chambers during the previous diastole. The more
blood that returns to the heart during diastole, the more blood that is ejected during the next systole.
Three factors regulate stroke volume and ensure that the left and right ventricles pump equal volumes
of blood.
 CARDIAC OUTPUT

Regulation of Stroke Volume

1.The degree of stretch in the heart before it contracts - Within limits, the more the heart is stretched as it fills
during diastole, the greater the force of contraction during systole, a relationship known as the Frank–Starling law
of the heart. The situation is somewhat like stretching a rubber band: The more you stretch the heart, the more
forcefully it contracts.
2. 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.
3. The pressure required to eject blood from the ventricles- The semi lunar valves open and ejection of blood
from the heart begins when pressure in the right ventricle exceeds the pressure in the pulmonary trunk and when
the pressure in the left ventricle exceeds the pressure in the aorta.
 CARDIAC OUTPUT

Regulation of Heart Rate

Control of cardiac output and blood pressure. If left to itself, the senatorial node would set a
constant heart rate of about 100 beats/min. However, tissues require different volumes of blood flow
under different conditions. During exercise, for example, cardiac output rises to supply working tissues
with increased amounts of oxygen and nutrients.
1. Autonomic Regulation of Heart Rate- Autonomic Regulation of Heart Rate The nervous
system regulation of the heart originates in the cardiovascular (CV) center in the medulla oblongata.
This region of the brain stem receives input from a variety of sensory receptors and from higher brain
centers, such as the limbic system and cerebral cortex.
 CARDIAC OUTPUT

Regulation of Heart Rate

2. 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
 CARDIAC OUTPUT

Regulation of Heart Rate

3. Other Factors in Heart Rate Regulation - Age, gender, physical fitness, and body
temperature also influence resting heart rate. A newborn baby is likely to have a resting heart rate over
120 beats per minute; the rate then declines throughout childhood to the adult level of 75 beats per
minute. Adult females generally have slightly higher resting heart rates than adult males, although
regular exercise tends to bring resting heart rate down in both sexes.
 COMMON DISORDERS

Coronary Artery Disease - Coronary artery disease (CAD) is a serious medical problem that affects
about 7 million people and causes nearly 750,000 deaths in the United States each year. CAD is
defined as the effects of the accumulation of atherosclerotic plaques (described shortly) in coronary
arteries that lead to a reduction in blood flow to the myocardium. Some individuals have no signs or
symptoms, others experience angina pectoris (chest pain), and still others suffer a heart attack.
• Atherosclerosis is a progressive disease characterized by the formation in the walls of large- and
medium sized arteries of lesions called atherosclerotic plaques.
• To understand how atherosclerotic plaques develop, you will need to know about molecules
produced by the liver and small intestine called lipoproteins.
 COMMON DISORDERS

 Myocardial Ischemia and Infarction - Partial obstruction of blood flow in the coronary arteries may cause myocardial
ischemia. Usually, ischemia causes hypoxia (reduced oxygen supply), which may weaken cells without killing them.
Angina pectoris which literally means “strangled chest,” is a severe pain that usually accompanies myocardial ischemia.
Typically, sufferers describe it as a tightness or squeezing sensation, as though the chest were in a vise. The pain
associated with angina pectoris is often referred to the neck, chin, or down the left arm to the elbow.
• Silent myocardial ischemia, ischemic episodes without pain, is particularly dangerous because the person has no
forewarning of an impending heart attack.
• A complete obstruction to blood flow in a coronary artery may result in a myocardial infarction or MI, commonly called
a heart attack. Infarction means the death of an area of tissue because of interrupted blood supply. Because the heart tissue
distal to the obstruction dies and is replaced by non contractile scar tissue, the heart muscle loses some of its strength.
 COMMON DISORDERS

 Congenital Defects - A defect that exists at birth (and usually before) is a congenital defect. Among the several
congenital defects that affect the heart are the following:
• In patent ductus arteriosus, the ductus arteriosus (temporary blood vessel) between the aorta and the pulmonary
trunk, which normally closes shortly after birth, remains open.
• Atrial septal defect (ASD) is caused by incomplete closure of the interatrial septum. The most common type
involves the foramen ovale, which normally closes shortly after birth.
• Ventricular septal defect (VSD) is caused by an incomplete closure of the interventricular septum.
• Tetralogy of Fallot is a combination of four defects: an interventricular septal defect, an aorta that emerges from
both ventricles instead of from the left ventricle only, a narrowed pulmonary semi lunar valve, and an enlarged
right ventricle.
 COMMON DISORDERS

 Arrhythmias - The usual rhythm of heartbeats, established by the SA node, is called normal sinus rhythm.
The term arrhythmia or dysrhythmia refers to an abnormal rhythm as a result of a defect in the conduction
system of the heart. The heart may beat irregularly, too fast, or too slowly. Symptoms include chest pain,
shortness of breath, lightheadedness, dizziness, and fainting.
Types of Arrhythmias
• Supraventricular tachycardia (SVT) is a rapid but regular heart rate (160–200 beats per minutes) that
originates in the atria. The episodes begin and end suddenly and may last from a few minutes to many hours.
• Heart block is an arrhythmia that occurs when the electrical pathways between the atria and ventricles are
blocked, slowing the transmission of nerve impulses. The most common site of blockage is the atrioventricular
node, a condition called atrioventricular (AV) block.
 COMMON DISORDERS

Types of Arrhythmias
• Atrial premature contraction (APC) is a heartbeat that occurs earlier than expected and briefly interrupts the
normal heart rhythm. It often causes a sensation of a skipped heartbeat followed by a more forceful
heartbeat.
• Atrial flutter consists of rapid, regular atrial contractions (240–360 beats/min) accompanied by an
atrioventricular (AV) block in which some of the nerve impulses from the SA node are not conducted
through the AV node.
• Atrial fibrillation (AF) is a common arrhythmia, affecting mostly older adults, in which contraction of the
atrial fibers is asynchronous (not in unison) so that atrial pumping ceases altogether. The atria may beat 300
to 600 beats per minute.
 COMMON DISORDERS

Types of Arrhythmias
• Ventricular premature contraction (VPC). Another form of arrhythmia arises when an ectopic focus a
region of the heart other than the conduction system, becomes more excitable than normal and causes an
occasional abnormal action potential to occur.
• Ventricular tachycardia (VT) is an arrhythmia that originates in the ventricles and is characterized by four
or more ventricular premature contractions. It causes the ventricles to beat too fast (at least 120 beats/min).
• Ventricular fibrillation (VF) is the most deadly arrhythmia, in which contractions of the ventricular fibers
are completely asynchronous so that the ventricles quiver rather than contract in a coordinated way. As a
result, ventricular pumping stops, blood ejection ceases, and circulatory failure and death occur unless
there is immediate medical intervention.
THE CARDIOVASCULAR
SYSTEM: BLOOD VESSELS
AND CIRCULATION
 BLOOD VESSEL STRUCTURE AND
FUNCTION
Five types of blood vessels:
Arteries (Two large arteries are the aorta and pulmonary trunk)
Arterioles
Capillaries
Veins The average adult has over 60,000
Venules miles of blood vessels in their body.
 DISTRIBUTION OF BLOOD VOLUME

• Systematic arteries and arterioles 15%

• Systematic veins and venules 60%
• Systematic capillaries 5%
• Pulmonary blood vessels 12%
• Heart chambers 8%

Veins and venules contain so much blood, thus certain veins serve as blood
reservoirs from which stored blood can be diverted to other parts of the body
 ARTERIES AND ARTERIOLES

The lumen is the hollow space through which the blood flows.
Three layers surrounding the lumen:
• Tunica internal
• Tunica media
• Tunica external
• Vasoconstriction  decrease in the size of • Vasodilatation  increase in the size of the
the lumen lumen
 CAPILLARIES

Connect arterioles and venules

AKA: exchange vessels permit exchange of nutrients and waste between body cells and
blood
Areas with high metabolic requirements have extensive capillary networks

* muscles, liver, kidneys, nervous system

Areas with very low metabolic requirements lack capillaries

*cornea and lens of the eye, nails, hair follicles, cuticles, cartilage
 STRUCTURE OF CAPILLARIES

Walls consist of single layer of endothelial cells

Precapillary sphincters rings of smooth muscle at meeting

point of capillary to arteriole.

 CAPILLARY EXCHANGE

Two methods of exchange

• Diffusion
• Bulk Flow
 CAPILLARY EXCHANGE: DIFFUSION
• Oxygen and nutrients  down the gradient into interstitial fluid and then into body cells
• Carbon dioxide and waste  down the gradient from interstitial fluids into the blood for removal
• Glucose
• Amino acids
• Hormones
• Plasma proteins usually remain in blood; too large to pass through
Exceptions: Sinusoids the smallest blood vessels in the liver have very large gaps in between their endothelial
cells to allow proteins (fibrinogen, main clotting protein, and albumin) to enter bloodstream
• Other areas are very selective: Blood-brain barrier refers to the tightness of endothelial layer found in brain;
allows only a few substances to enter and leave
CAPILLARY EXCHANGE: BULK FLOW
(FILTRATION AND REABSORPTION)
 VENULES AND VEINS

Capillaries unite to form venules (small veins)

Venules receive blood from capillaries and empty it into veins
Veins return blood to the heart
 STRUCTURE OF VENULES AND VEINS

Venules
• little veins; walls thinner at capillary end, thicker as they progress toward heart
Veins
• structural similar to arteries; middle and inner layers thinner than arteries, outer
layers are the thickest
Generally, lumen of veins wider than that of corresponding artery
 Inner layer forms valves to prevent backflow of blood

Varicose veins
Weak venous valves
Gravity forces blood backwards
through the valve increasing venous
blood pressure
Increased pressure pushes the vein’s wall
outward
Veins receive repeated overloads, walls lose
elasticity, stretch become flabby
 Blood flows out of a vein slowly and more rapidly out of an artery

WHY should you not start an IV in an artery???

 VENOUS RETURN

Volume of blood flowing back to heart through veins, occurs through

pressure generated in three ways:
• Contractions of the heart
• Skeletal muscle pump
• Respiratory pump
CONTRACTIONS OF THE HEART
SKELETAL MUSCLE PUMP
RESPIRATORY PUMP
 BLOOD FLOW THROUGH BLOOD
VESSELS
From areas of higher pressure to areas of lower pressure
• greater the pressure difference the greater the blood flow

Contractions of the ventricles generate blood pressure (BP)

Blood pressure is the measure of pressure exerted by blood on the walls of a

blood vessel
• highest in the aorta and large systemic arteries
 SYSTOLIC VERSUS DIASTOLIC

Systolic (contraction) measures maximum arterial pressure occurring during

contraction of the left ventricle of the heart
• Average = 120mm Hg
• High end begins = 140mmHg
Diastolic (relaxation) measures arterial pressure during the interval between
heartbeats
• Average = 80mm Hg
• High end begins = 90mmHg
 RESISTANCE

Vascular resistance  opposition to blood flow due to friction between blood and the walls of blood vessels
• Increase in vascular resistance = increase in BP
• Decrease in vascular resistance = decease in BP

 Vascular resistance is dependent upon:

• Size of the blood vessel (lumen)
• Smaller means greater resistance to blood flow; alternates between vasoconstriction and vasodilation
• Blood viscosity
• Ratio of RBCs to plasma volume
• Higher viscosity = higher resistance
• Total blood vessel length
• Resistance increase with total length
• Longer the length = greater contact between vessel wall and blood
REGULATION OF BLOOD PRESSURE AND BLOOD
FLOW
Role of the Cardiovascular Center
• Cardiovascular Center (CV) in the medulla oblongata regulates heart rate and stroke
volume
 HORMONAL REGULATION OF BLOOD PRESSURE AND
BLOOD FLOW
 (RAA system):
 HORMONAL REGULATION OF BLOOD PRESSURE
AND BLOOD FLOW
 Epinephrine and norepinephrine
 HORMONAL REGULATION OF BLOOD PRESSURE
AND BLOOD FLOW
 Antidiuretic hormone (ADH)
 HORMONAL REGULATION OF BLOOD PRESSURE
AND BLOOD FLOW
 Atrial natriuretic peptide (ANP)
 CIRCULATORY ROUTES

Blood vessels are organized in circulatory routes that carry blood throughout the body

Two main circulatory routes

• Systemic
• Pulmonary
 SYSTEMIC CIRCULATION

Arteries and arterioles carry blood containing oxygen and nutrients from left
ventricle to systemic capillaries throughout body
Veins and venules carry blood containing carbon dioxide and waste to the right
atrium
Blood that leaves the aorta and travels through systemic arteries is bright red
Blood moves through the capillaries, loses oxygen and takes on carbon dioxide
becoming dark red in color
 PULMONARY CIRCULATION

When deoxygenated blood returns to the heart from the systemic route, it is
pumped out the right ventricle through the pulmonary artery into the right lung
where it loses CO2.
Blood moves into the left lung, picks up O2, and then returns to left atrium of
heart, to once again go through systemic circulation.
 HEPATIC PORTAL CIRCULATION

• Hepatic portal vein carries blood from one capillary network to another, namely from the
GI to the liver. In the liver substances from the GI tract are processed before pushed out
the hepatic vein into the inferior vena cava for circulation throughout the body
FETAL CIRCULATION
 CHECKING CIRCULATION

Pulse  occurs through the alternate expansion and elastic recoil of an artery after
each contraction and relaxation of the left ventricle
• Normal range for pulse rate/heart rate- 70 to 80 beats per minute at rest

• Tachycardia  rapid resting heart or pulse rate over 100 beats/minute

• Bradycardia  slow resting heart or pulse rate under 60 beats/minute
 MEASUREMENT OF BLOOD PRESSURE

 Blood pressure in clinical terms is the pressure in the arteries generated by the left ventricle during systole and
the pressure remaining in the arteries when the ventricle is in diastole
• BP is usually measured on the brachial artery in the left arm using a sphygmomanometer

 Systole refers to the contraction of the heart

• The first sound heard corresponds to systolic blood pressure (SBP), force with which blood is pushing against arterial
walls during ventricular contraction.
• The last faint sound hear corresponds to diastolic blood pressure (DBP), force exerted by the remaining blood in arteries
during ventricular relaxation.
 Normal blood pressure of a young adult male is 120mmHg systolic and 80mmHg diastolic.
• In females the blood pressure is 8 to 10mmHg lower.
 COMMON DISORDERS

HYPERTENSION – it is the most common disorder affecting the heart and blood vessels and is
the major cause of heart failure, kidney disease, and stroke.

CATEGORY SYSTOLIC(mm Hg) DIASTOLIC (mm Hg)

Normal Less than 120 Less than 80
Pre- hypertension 120-139 or 80-89
Stage 1 hypertension 140- 159 or 90-99
Stage 2 hypertension Greater than 160 or Greater than 100
 COMMON DISORDERS

Ways on How to Prevent Hypertension

 Lose weight
 Limit alcohol intake
 Exercise
 Reduce intake of sodium (salt)
 Maintain recommended dietary intake of potassium, calcium, and magnesium
Don’t smoke
 Manage stress
 COMMON DISORDERS

SHOCK – is a failure of the cardiovascular system to deliver enough O2 and

nutrients to meet cellular metabolic needs.

• Common causes of shock include loss of body fluids, as occurs in hemorrhage,

dehydration, burns, excessive vomiting, diarrhea, or sweating.
 COMMON DISORDERS

ANEURYSM – is a thin, weakened section of wall of an artery or a vein that bulges

outward, forming a balloon like sac.

Common causes
• Atherosclerosis
• Syphilis
• Congenital blood vessel defects
• Trauma