HEART AND

CIRCULATO
RY SYSTEM
SAHEEN SHEIKH
NURSING TUTOR
 INTRODUCTION
 The cardiovascular system is transport
system of body
 It comprises blood, heart and blood vessels.
 The system supplies nutrients to and
remove waste products from various tissue
of body.
 The conveying media is liquid in form of
blood which flows in close tubular system.

Figure 1-2(f)
 CIRCULATION – Pumping of blood through the
entire body by the heart.
Types of circulations
1. Coronary Circulation – the circulation of
blood within the heart.
2. Pulmonary Circulation – the flow of blood
between the heart and lungs.
3. Systemic Circulation – the flow of blood
between the heart and the cells of the body.
 HEART DEFINITION

The heart is a roughly cone shaped muscular, hollow

organ that plays a vital role in the circulatory system.
It is responsible for pumping blood throughout the
blood vessels by repeated rhythmic contractions.
The term Cardiac means “related to heart” and
comes from the Greek word, kardia for “heart”
Interesting facts:
1. Beats around 3 billion times: In a lifetime, the heart
beats approximately 3 billion times.
2. Pumps over 2,000 gallons daily: The heart pumps
around 2,000 gallons (7,571 liters) of blood every day.
3. Weighs around 10 ounces: The adult heart weighs
approximately 10 ounces (283 grams).

 The heart is an incredible organ that plays a vital role

in sustaining life.
 Nature of heart
 Size – As a size of a fist
 Weight – 250 to 300 grams
 Measurement – 12cm long, 9cm wide and 6cm thick
 Location - The heart is located in the thoracic cavity,
which is the space between the lungs in the chest.
 In the Mediastinum – The heart is positioned in the mediastinum
(between the lungs), a compartment in the thoracic cavity that
contains the heart, trachea, esophagus and other structures.
 Behind the sternum – the heart is located behind the sternum
(breast bone) and in front of the spine.
 Between the lungs – the heart is situated between the lungs,
with the left lung being slightly smaller to accommodate the
heart’s position.
 Above the diaphragm – the heart is located above the
diaphragm, a dome shaped muscle that separates the chest cavity
from the abdominal cavity.
 Tilted to the left – The heart is tilted slightly to the left, so that
the apex (bottom) to the [points towards the left side of the chest.
 Relations of Heart
• Superiorly – the aorta, superior vena cava, P
artery and pulmonary vein.
• Inferiorly – the diaphragm
• Anteriorly – the ribs and intercostal
muscles.
• Posteriorly – the esophagus, trachea, left
and right bronchus, descending aorta,
inferior vena cava and thoracic vertebrae
• Laterally – the lungs
 Coverings of the Heart
Pericardium
• The pericardium is a fibroserous sac i.e. double walled sac
which encloses the heart and the roots of great vessels.
• It consists of two main parts:
1. The fibrous pericardium
2. The serous pericardium
• The fibrous pericardium is composed of tough, inelastic,
dense irregular connective tissue.
The functions of fibrous pericardium is to
1. Prevent overstretching of the heart
2. Protection of heart
3. Anchors the heart in the mediastinum
• The serous pericardium is a thinner membrane that
forms a double layer around the heart
– The outer parietal layer: it is fused to the fibrous
pericardium.
– The inner visceral layer is also called the
epicardium helps the layers of the heart wall to
adheres tightly to the surface of the heart.
Relationship of serous pericardium
to heart
• A slippery fluid is present in between the
parietal and visceral layers helps to
give lubrication and reduces friction
while the heart beats is the pericardial
fluid.
• The space between the two layers are called
the pericardial cavity.
The pericardial layers and layers
of the heart wall.
 Layers of the Heart
Wall
The wall of the heart
consists of three layers:-

– The epicardium
(external
layer)

– The myocardium
(middle layer)

– The endocardium
(inner layer)
 EPICARDIUM – The visceral layer of serous pericardium.
 MYOCARDIUM – The musculature of the heart which is of
varying thickness in different chambers.
 ENDOCARDIUM – the smooth muscles lining of the
Myocardium. This layer is folded upon itself to form
various valves of the heart. These cause unidirectional
flow of blood through the heart.
 EXTERNAL FEATURES OF HEART
Apex – Apex of the heart is
exclusively by the left BASE
ventricle.
It is directed downwards to
the left and is palpable in
left fifth intercoastal space
9cm from the midline
especially after running.
Base – Base of the heart is
formed mainly by the left
atrium and partly by the
right atrium. APEX
SURFACES
[Link] surface – Formed by the right
atrium and the right ventricle, partly by the
left ventricle
[Link] surface – Formed mainly by
the left ventricle and partly by the right
ventricle.

BORDERS
Upper border – Formed by the 2 atria.
Inferior border – Formed by the right ventricles.
Right border – Formed by the right atrium.
Left border – Formed by the left ventricle.
 GROOVES OR SULCI
It is a groove on the outer
surface of the heart
marking the division
between the atria and the
ventricles.
1. Atrioventricular sulcus
2. Anterior
interventricular sulcus
3. Posterior
interventricular sulcus
 Blood vessels

 Blood vessels include arteries, veins, and capillaries:

• Arteries: Carry oxygenated blood away from the
heart to the rest of the body.
- It is bright red in color
• Veins: Carry deoxygenated blood from the body back
to the heart.
- It is blue in color
• Capillaries: Connect arteries and veins, and have
thin walls that allow oxygen, carbon dioxide,
nutrients, and waste to pass through.
[Link]

 Atrium
 Ventricles
 Arteries
 Veins
 Valves
 Coronary arteries
 Sulcus
 Coronary sinus
 CHAMBERS OF HEART
Your heart chambers are four
hollow spaces within your
heart.
1. There are two atria (upper
chambers) called your right
atrium and left atrium.
2. There are two ventricles
(lower chambers) called
your right ventricle and
left ventricle.
 RIGHT ATRIUM

 Right atrium receives the entire systemic

blood. It has very thin walls. It forms whole of
right border, part of the base, upper border
and a part of the sternocoastal surface of the
heart.
 The right atrium receives blood from three
veins: the superior vena cava, inferior vena
cava, and coronary sinus.
 The right atrium is about 2–3 mm in thickness.
 The right atrium and left atrium is separated
by interatrial septum. A prominent feature of
this septum is an oval depression called the fossa
ovalis.
 Blood passes from the right atrium into the
right ventricle through a valve that is called the
tricuspid valve, it consists of three leaflets or
cusps.
 Blood passes from right atrium into the right
ventricle through a valve called tricuspid valve also
called as right atrio-ventricular valve.
 Superior Right Auricle
vena cava

Fossa ovalis

inferior vena cava

valve of coronary
sulcus
The cusps of the tricuspid valve are connected
to tendon like cords, the chordae tendineae which
in turn are connected to cone-shaped trabeculae
carneae called papillary muscles.
 Right Ventricle
• The right ventricle is about 4–5 mm in average
thickness and forms most of the anterior surface of the heart.
• The right ventricle contains a series of ridges formed by
bundles of cardiac muscle fibers called trabeculae carneae,
it helps the heart for conduction.
• The right ventricle is separated from the left ventricle by the
interventricular septum.
• Blood passes from the right ventricle through the pulmonary
valve into a large artery called the pulmonary trunk,
which divides into right and left pulmonary arteries
 Left
Atrium
• The left atrium is about the same thickness as
the right atrium and forms most of the base of
the heart.
• It receives blood from the lungs through four
pulmonary veins. It has a smooth anterior and
posterior wall, because pectinate muscles are
confined to the auricle of the left atrium.
• Blood passes from the left atrium into the left
ventricle through the bicuspid (mitral) valve It
is also called the left atrioventricular valve.
Arch of .aorta

Left ventricle
 Left
 The ventricle
left ventricle is the thickest chamber of the heart,
averaging 10–15 mm (0.4–0.6 in.) and forms the apex of the heart.
 Like the right ventricle, the left ventricle contains trabeculae
carneae and has chordae tendineae that anchor the cusps of the
bicuspid valve to papillary muscles.
 Blood passes from the left ventricle through the aortic valve (aortic
semilunar valve) into the ascending aorta from here blood flows
into the coronary arteries, which branch from the ascending aorta
and carry blood to the heart wall.
 The remainder of the blood passes into the arch of the aorta and
descending aorta (thoracic aorta and abdominal aorta).
 Branches of the arch of the aorta and descending aorta carry blood
throughout the body.
 Mitral valve
anterior cusp

Chordae
tendineae
veins
muscle

Trabeculae
carneae

Mitral valve posterior

 Comparison of right and left
atrium
Right atrium left atrium

1 Receives venous blood from body. 1 Receives oxygenated blood from Lung.

2 Pushes blood to Rt ventricle through 2 Pushes blood to Lt ventricle through

tricuspid valve. bicuspid valve.

3 Forms Rt boarder, parts of 3 Forms major part of the heart base

sternocoastal and small part of base of
the heart
 Comparison of right and left ventricle
Right Ventricle left Right Ventricle

1 Thin 1 Thicker
2 Pushes blood only to the lung 2 Pushes blood to entire body except
lung
3 Contains three papillary muscles 3 Contains two papillary muscles
4 Cavity is crescentic 4 Cavity is circular
5 Contains deoxygenated blood 5 Contains oxygenated blood
6 Forms sternocoastal surface 6 Forms diaphragmatic surface
Valves of Heart
 The Tricuspid Valve
• The tricuspid valve consists of three cusps
anterior, septal and inferior
(posterior). These cusps are formed
by a fold of the endocardium and
some connective tissue. The bases of the
cusps attach to the fibrous ring of the
heart skeleton and their free edges
attach to the chordae tendineae
connecting them to the papillary muscles.
 The Mitral Valve
• The mitral valve consists of two cusps
anterior and posterior: its structure
is similar to the tricuspid valve. The
anterior cusp is larger and intervenes
between the atrioventricular and the
aortic orifices. The chordae tendineae
attach the cusps to papillary muscles
as in the tricuspid valve.
 The Pulmonary Valve

• It consists of three semilunar cusps formed by

folds of the endocardium and some connective
tissue. The lower margins of the cusps and
their sides are attached to the arterial wall.
• The pulmonary valve has three cusps: the
anterior cusp (AC), the left cusp (LC), and the
right cusp (RC).
• There are no chordae tendineae or papillary
muscles attached to these valves.
 Pulmonary
Valve

LC RC

Lef Right
t

Left anterior
Right
 The Aortic Valve
• The valves are arranged as one anterior (right)
and two posterior (left and posterior).
• The aortic valve has three cusps: the left
coronary cusp (LCC), the right coronary cusp
(RCC), and the non-coronary cusp (NCC).
• The right coronary artery originates from the
anterior aortic sinus and the left coronary
artery from the left posterior sinus.
 Aortic Pulmonary
Valve Valve
LC RCC
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 Coronary arteries

Your heart receives nutrients through a network of coronary arteries.

These arteries run along your heart’s surface. They serve the heart
itself and include the:
 Left coronary artery: Divides into two branches (the circumflex
artery and the left anterior descending artery).
 Circumflex artery: Supplies blood to the left atrium and the side
and back of the left ventricle.
 Left anterior descending artery (LAD): Supplies blood to the
front and bottom of the left ventricle and the front of the septum.
 Right coronary artery (RCA): Supplies blood to the right
atrium, right ventricle, bottom portion of the left ventricle and
back of the septum.
 Conducting system of heart
 Your heart’s conduction system is like the electrical wiring of a building. It
controls the rhythm and pace of your heartbeat. Signals start at the top of
your heart and move down to the bottom. Your conduction system
includes:
• Sinoatrial (SA) node: Sends the signals that make your heart beat.
• Atrioventricular (AV) node: Carries electrical signals from your heart’s
upper chambers to its lower ones.
• Left bundle branch: Sends electric impulses to your left ventricle.
• Right bundle branch: Sends electric impulses to your right ventricle.
• Bundle of His: Sends impulses from your AV node to the Purkinje fibers.
• Purkinje fibers: Make your heart ventricles contract and pump out blood.
MUSCULATURE OF HEART
 Nerves of heart
The nervous supply to the heart is autonomic, consisting of both
sympathetic and parasympathetic parts. The sympathetic fibres arise from
the pressor centre, while the parasympathetic fibres arise in the depressor
centre.
• The sympathetic nervous system acts on the sinoatrial node, speeding
up the depolarisation rate, and therefore increasing the heart rate.
• The parasympathetic system works in reverse in order to slow the heart
rate down.
• The heart itself has a natural pacemaker, the sinoatrial node, which does
not need a nervous supply to function. If you sever all the nerves to the
heart, then it will continue to beat. In fact, it will beat faster than
normal, since there is normally a parasympathetic supply slowing the
heart down.
 The autonomous nervous system includes
your:
• Sympathetic nervous system (fight or flight
response) makes your SA node work faster,
which increases your heart rate.
• Parasympathetic nervous system (rest and
digest response) makes your SA node work
slower, which decreases your heart rate.
 Basic Principles of cardiac cycle

1. Blood flows from higher to lower

pressure.
2. Contraction increases the pressure.
3. Valves open/close according to pressure
gradients.

[Link]
 Cardiac Cycle
“Cardiac cycle refers to the sequence of events that
take place when the heart beats.”

 A healthy heart that beats 70-75 times a minute

takes about 0.8 seconds to complete each cardiac
cycle.
 Each cardiac cycle consists of two main parts - a
contractive phase called the systole and a
relaxation phase that allows the heart cavities to refill
with blood to be pumped, known as the diastole.
Each part is further divided into two component stages - the
atrial and the ventricular. The atria and ventricles contract at
slightly different times.
The four stages of the cardiac cycle are as follows:
• Atrial systole - about 0.1 seconds
• Ventricular systole - about 0.3 seconds
• Atrial diastole - about 0.7 seconds
• Ventricular diastole - about 0.5 seconds
 The stages of the cardiac cycle are explained
below:
[Link] cycle begins with ventricular diastole, with
both chambers (atria and ventricles) relaxed.
[Link] the end of the ventricular diastole, the
atria on both sides contract in the Atrial systole
stage, pushing more blood into both the
ventricles with pressure.
[Link] the ventricles are fully filled, the Ventricular
systole begins and the ventricle contracts, closing the
mitral and tricuspid valves and the blood is ejected
from the right and left sides into the pulmonary artery
and aorta respectively.
[Link] this time, the atria are in Atrial diastole and relaxed.
[Link] ventricular diastole begins again, the semilunar
valves at the mouth of the pulmonary artery and the
aorta close, preventing backflow and ensuring that the
ventricles receive blood only from the atria before the
next cycle.
Cardiac Cycle Phases

Following are the different phases that occur in a cardiac cycle:

1. 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.
2. Atrial Systole: At this phase, blood cells flow from atrium to
ventricle and at this period, atrium contracts.
3. 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
4. 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.
5. Ventricular Ejection: Here ventricles contract and
emptying. Pulmonary artery and aortic valve close.
6. 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.
 Electric events of cardiac cycle
ECG
Electro cardio graphy

A normal ECG tracing of each component,

segment, and interval is labeled and
corresponds to important electrical events,
demonstrating the relationship between these
events and contraction in the heart.
[Link]
ECG Equipment
 There are five prominent points on the ECG:
a)the P wave,
b)the QRS complex, and
c) the T wave.
[Link] small P wave represents the depolarization of the
atria. The atria begin contracting approximately 25 ms
after the start of the P wave.
[Link] large QRS complex represents the depolarization
of the ventricles, which requires a much stronger
electrical signal because of the larger size of the
ventricular cardiac muscle. The ventricles begin to
contract as the QRS reaches the peak of the R wave.
[Link], the T wave represents the repolarization of the
ventricles, these are in relax phase. The repolarization
of the atria occurs during the QRS complex.
 Cardiac Output

“Cardiac output refers to the volume of blood

pumped out per ventricle per minute.”

Cardiac output is the function of heart rate and stroke

volume.

Cardiac Output is an excellent example to exhibit

the efficiency of the human heart. It is related to
the amount of blood pumped by the heart per
minute. A normal cardiac output would be about
five litres of blood per minute in a healthy
individual.
 The cardiac output comprises 2 vital components:
• Heart rate (HR): It refers to the number of times the
heart beats per minute (bpm).
• Stroke volume (SV): It refers to the quantity of blood
pumped out of each ventricle with every heartbeat.

Cardiac Output Formula

The equation for cardiac output is:

Cardiac Output (CO) = HR x SV
 Factors Determining Cardiac
Output
The following factors determine the cardiac output of a human
heart:
 Venous Return
This is the amount of blood that enters the heart through
the veins per minute. After a certain time interval, the venous
return becomes equal to the cardiac output.
 Force of Contraction
The stroke volume and the cardiac output increases with
the increase in the force of contraction.
 Heart Rate
The cardiac output increases with the increase in heart rate.
Cardiac Output Calculation

For example: If the heart rate is 70 bpm and

stroke volume is 70 ml.

Using the formula: HR X SV

= 70 X 70
= 4900 ml/min
or
4.9 liters per minute.
BLOOD PRESSURE

 Blood pressure is the measurement of the

pressure or force of blood inside your arteries.
Each time your heart beats, it pumps blood
into arteries that carry blood throughout your
body. This happens 60 to 100 times a minute,
24 hours a day. Arteries deliver oxygen and
nutrients to your whole body so it can
function.
 Blood Pressure Readings

 Your blood pressure reading has two measurements:

• Systolic blood pressure (the top/first number): This is
the pressure in your arteries when your heart is beating and
sending blood into your arteries.
• Diastolic blood pressure (the bottom/second
number): This is the pressure in your arteries when your
heart is at rest between heartbeats.
 Providers give the measurements as millimeters of mercury
(mm Hg). They started using these measurements when
instruments to measure blood pressure contained mercury
 Factors affecting Blood pressure
A. PHYSIOLOGICAL FACTORS
1. Cardiac Output (CO): Amount of blood pumped by
the heart.
2. Peripheral Resistance (PR): Opposition to blood
flow in vessels.
3. Blood Volume (BV): Total amount of blood in
circulation.
4. Vascular Compliance (VC): Ability of vessels to
stretch and expand.
5. Hormonal Regulation: Hormones like aldosterone,
adrenaline, and vasopressin.
B. LIFESTYLE FACTORS:
1. Physical Activity: Regular exercise can lower
blood pressure.
2. Diet: High sodium, sugar, and saturated fat
intake can increase blood pressure.
3. Stress: Chronic stress can raise blood pressure.
4. Sleep: Poor sleep quality and duration can
increase blood pressure.
5. Obesity: Excess weight can lead to
hypertension.
C. ENVIRONMENTAL FACTORS:
1. Age: Blood pressure increases with age.
2. Genetics: Family history of hypertension.
3. Environmental Toxins: Exposure to
pollutants, heavy metals.
4. Climate: Extreme temperatures, altitude.
5. Socioeconomic Factors: Low
socioeconomic status, lack of access to
healthcare.
D. PATHOLOGICAL FACTORS:
1. Kidney Disease: Renal failure can lead to
hypertension.
2. Vascular Disease: Atherosclerosis,
vasculitis.
3. Heart Failure: Reduced cardiac output
4. Endocrine Disorders: Thyroid, adrenal
gland issues.
5. Neurological Disorders: Stroke, spinal cord
injury.
E. MEDICATIONS AND SUBSTANCES:
1. Steroids: Corticosteroids can increase blood
pressure.
2. Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs): Can raise blood pressure.
3. Caffeine: Excessive consumption can
increase blood pressure.
4. Nicotine: Tobacco use can raise blood
pressure.
E. OTHER FACTORS:
1. Pregnancy: Blood pressure changes during
pregnancy.
2. Menopause: Hormonal changes can affect
blood pressure.
3. Sleep Apnea: Disrupted breathing during
sleep.
4. Anxiety and Depression: Mental health
conditions.
 Normal: <120/80 mmHg
 NORMAL BP RANGE: 100-139/60-90
 HYPOTENSION: < 100/60
 HYPERTENTION: >140/90

 Note: mmHg = millimeters of mercury.

[Link]
 BLOOD PRESSURE MEASUREMENT
 To measure your blood pressure manually, your provider will:
1. Wrap a special cuff (connected to a gauge or
sphygmomanometer) around your upper arm (above your
elbow).
2. Inflate the cuff to make it tight around your arm. They’ll
squeeze a ball connected to the cuff to do this. This briefly
stops blood flow in your brachial artery by squeezing it. The
gauge should say 200 mmHg at this time.
3. Deflate the cuff (with a valve attached to the cuff) while using
a stethoscope to listen to your blood going through your
brachial artery. Deflating the cuff makes the gauge needle
start to come down.
[Link] for when a pulse starts and look at the
number on the gauge at that time. That’s the
systolic number.
[Link] the valve to loosen the blood pressure cuff so
it stops squeezing your brachial artery.
[Link] at the gauge reading when the cuff deflates
and they hear (through the stethoscope) blood
flowing again. This is the diastolic number.
THANK YOU