Chapter 6

THE CIRCULATORY SYSTEM

 The Heart
• The heart is a roughly cone-shaped hollow
muscular organ. It is about 10 cm long and is
about the size of the owner’s fist.
• It weighs about 225 g in women and is heavier
in men (about 310 g).
Position
• The heart lies in the thoracic cavity in the
mediastinum (the space between the lungs).
• It lies obliquely, a little more to the left than
the right, and presents a base above, and an
apex below. The apex is about 9 cm to the left
of the midline at the level of the 5th intercostal
space, and slightly nearer the midline.
• The base extends to the level of the 2nd rib
Organs associated with the heart
• Inferiorly – the apex rests on the central
tendon of the diaphragm
• Superiorly – the great blood vessels, i.e.
the aorta, superior vena cava, pulmonary
artery and pulmonary veins
• Posteriorly – the oesophagus, trachea,
left and right bronchus, descending
aorta, inferior vena cava and thoracic
vertebrae
• Laterally – the lungs – the left lung
overlaps the left side of the heart
• Anteriorly – the sternum, ribs and
intercostal muscles
Structure
• The heart wall
The heart wall is composed of three layers of tissue: pericardium,
myocardium and endocardium.
Pericardium
• The pericardium is the outermost
layer (the fibrous pericardium) and is
made up of two sacs. The outer sac
consists of fibrous tissue and the
inner (serous pericardium) of a
continuous double layer of serous
membrane.
• The outer fibrous sac is continuous
with the tunica adventitia of the
great blood vessels above and is
adherent to the diaphragm below. Its
inelastic, fibrous nature prevents
overdistension of the heart.
• The outer layer of the serous membrane, the parietal pericardium, lines the
fibrous sac. The inner layer, the visceral pericardium, or epicardium, which is
continuous with the parietal pericardium, is adherent to the heart muscle.
• A similar arrangement of a double membrane forming a closed space is seen
also with the pleura, the membrane enclosing the lungs
• The serous membrane consists of
flattened epithelial cells. It secretes
serous fluid into the space between the
visceral and parietal layers, which allows
smooth movement between them when
the heart beats.
• The space between the parietal and
visceral pericardium is only a potential
space (In anatomy, a potential space is a
space that can occur between two
adjacent structures that are normally
pressed together).
• In health the two layers lie closely
together, with only the thin film of serous
fluid between them.
 Myocardium
• The myocardium is composed of specialized
cardiac muscle found only in the heart.
• It is not under voluntary control but is
striated, like skeletal muscle. Each fiber (cell)
has a nucleus and one or more branches.
• The ends of the cells and their branches are
in very close contact with the ends and
branches of adjacent cells. Microscopically
these ‘joints’, or intercalated discs, are
thicker, darker lines than the striations.
• This arrangement gives cardiac muscle the
appearance of being a sheet of muscle
rather than a very large number of individual
cells
• Because of the end-to-end continuity of
the fibers, each one does not need to
have a separate nerve supply.
• When an impulse is initiated it spreads
from cell to cell via the branches and
intercalated discs over the whole ‘sheet’
of muscle, causing contraction.
• The ‘sheet’ arrangement of the
myocardium enables the atria and
ventricles to contract in a coordinated
and efficient manner.
• Running through the myocardium is also
the network of specialized conducting
fibers responsible for transmitting the
heart’s electrical signals
• The myocardium is thickest at the apex and thins out towards the
base. This reflects the amount of work each chamber contributes to
the pumping of blood. It is thickest in the left ventricle, which has the
greatest workload.

• Specialized muscle cells in the walls of the atria secrete atrial

natriuretic peptide (hormone that lower blood pressure and to
control electrolyte homeostasis).
 Fibrous tissue in the heart
• The myocardium is supported by a
network of fine fibers that run through all
the heart muscle. This is called the
fibrous skeleton of the heart.
• In addition, the atria and the ventricles
are separated by a ring of fibrous tissue,
which does not conduct electrical
impulses
• Consequently, when a wave of electrical
activity passes over the atrial muscle, it
can only spread to the ventricles through
the conducting system that bridges the
fibrous ring from atria to ventricles
Endocardium
• This lines the chambers and valves
of the heart.
• It is a thin, smooth, membrane
that permits smooth flow of blood
inside the heart.
• It consists of flattened epithelial
cells, and it is continuous with the
endothelium lining the blood
vessels.
 Interior of the heart
• The heart is divided into a right and left side by the
septum, a partition consisting of myocardium
covered by endocardium.
• blood cannot cross the septum from one side to
the other. Each side is divided by an
atrioventricular valve into the upper atrium and
the ventricle below.
• The atrioventricular valves are formed by double
folds of endocardium strengthened by a little
fibrous tissue.
• The right atrioventricular valve (tricuspid valve)
has three flaps or cusps and the left
atrioventricular valve (mitral valve) has two cusps.
• Flow of blood in the heart is one way; blood enters
the heart via the atria and passes into the
ventricles below.
• The valves between the atria and ventricles
open and close passively according to
changes in pressure in the chambers.
• They open when the pressure in the atria is
greater than that in the ventricles. During
ventricular systole (contraction) the pressure
in the ventricles rises above that in the atria
and the valves snap shut, preventing
backward flow of blood.
• The valves are prevented from opening
upwards into the atria by tendinous cords,
called chordae tendineae, which extend from
the inferior surface of the cusps to little
projections of myocardium into the
ventricles, covered with endothelium, called
papillary muscles
 Flow of blood through the heart
• The two largest veins of the body, the superior
and inferior venae cavae, empty their
contents into the right atrium.
• This blood passes via the right atrioventricular
valve into the right ventricle, and from there
is pumped into the pulmonary artery or trunk
(the only artery in the body which carries
deoxygenated blood).
• The opening of the pulmonary artery is
guarded by the pulmonary valve, formed by
three semilunar cusps. This valve prevents the
backflow of blood into the right ventricle
when the ventricular muscle relaxes.
• After leaving the heart the pulmonary
artery divides into left and right pulmonary
arteries, which carry the venous blood to
the lungs where exchange of gases takes
place: carbon dioxide is excreted and
oxygen is absorbed
• Two pulmonary veins from each lung carry
oxygenated blood back to the left atrium.
Blood then passes through the left
atrioventricular valve into the left
ventricle, and from there it is pumped into
the aorta, the first artery of the general
circulation.
• The opening of the aorta is guarded by the
aortic valve, formed by three semilunar
cusps
• From this sequence of events it
can be seen that the blood passes
from the right to the left side of
the heart via the lungs, or
pulmonary circulation
• However, it should be noted that
both atria contract at the same
time and this is followed by the
simultaneous contraction of both
ventricles.
• The muscle layer of the walls of the atria is thinner than that of the
ventricles. This is consistent with the amount of work they do.
• The Atria propel the blood only through the atrioventricular valves
into the ventricles, whereas the ventricles actively pump the blood to
the lungs and round the whole body.
• The pulmonary trunk leaves the heart from the upper part of the
right ventricle, and the aorta leaves from the upper part of the left
ventricle.
• Blood supply to the heart (the coronary circulation)
 Arterial supply
• The heart is supplied with arterial blood by
the right and left coronary arteries, which
branch from the aorta immediately distal to
the aortic valve
• The coronary arteries receive about 5% of
the blood pumped from the heart, although
the heart comprises a small proportion of
body weight.
• This large blood supply, especially to the left
ventricle, highlights the importance of the
heart to body function.
• The coronary arteries traverse the heart,
eventually forming a vast network of
capillaries
Venous drainage
• Most of the venous blood is collected into a number of cardiac veins
that join to form the coronary sinus, which opens into the right atrium.
• The remainder passes directly into the heart chambers through little
venous channels.
 Conducting system of the heart
• The heart possesses the property of autorhythmicity, which means it
generates its own electrical impulses and beats independently of nervous
or hormonal control, i.e. it is not reliant on external mechanisms to initiate
each heartbeat.
• However, it is supplied with both sympathetic and parasympathetic
autonomic nerve fibers, which increase and decrease respectively the
intrinsic heart rate.
• In addition, the heart responds to a number of circulating hormones,
including adrenaline (epinephrine) and thyroxine
• Small groups of specialized neuromuscular cells in the myocardium initiate
and conduct impulses, causing coordinated and synchronized contraction of
the heart muscle
 Sinoatrial node (SA node)
• This small mass of specialized cells
lies in the wall of the right atrium
near the opening of the superior vena
cava.
• The sinoatrial cells generate these
regular impulses because they are
electrically unstable.
• This instability leads them to
discharge (depolarize) regularly,
usually between 60 and 80 times a
minute.
• This depolarization is followed by recovery (repolarization), but
almost immediately their instability leads them to discharge again,
setting the heart rate.
• Because the SA node discharges faster than any other part of the
heart, it normally sets the heart rate and is called the pacemaker of
the heart.
• Firing of the SA node triggers atrial contraction.
 Atrioventricular node (AV node)
• This small mass of neuromuscular tissue
is situated in the wall of the atrial
septum near the atrioventricular valves.
• Normally, the AV node merely transmits
the electrical signals from the atria into
the ventricles.
• There is a delay here; the electrical
signal takes 0.1 of a second to pass
through into the ventricles.
• This allows the atria to finish contracting
before the ventricles start.
• The AV node also has a secondary pacemaker function and takes over
this role if there is a problem with the SA node itself, or with the
transmission of impulses from the atria.

• Its intrinsic firing rate, however, is slower than that set by the SA node
(40–60 bpm).
Atrioventricular bundle (AV bundle or bundle of His)
• This is a mass of specialized fibers that
originate from the AV node.
• The AV bundle crosses the fibrous ring that
separates atria and ventricles then, at the
upper end of the ventricular septum, it
divides into right and left bundle branches.
• Within the ventricular myocardium the
branches break up into fine fibers, called the
Purkinje fibers.
• The AV bundle, bundle branches and Purkinje
fibers transmit electrical impulses from the
AV node to the apex of the myocardium
where the wave of ventricular contraction
begins, then sweeps upwards and outwards,
pumping blood into the pulmonary artery
and the aorta.
Nerve supply to the heart
• The heart is influenced by autonomic
(sympathetic and parasympathetic)
nerves originating in the cardiovascular
center in the medulla oblongata.
• The vagus nerves (parasympathetic)
supply mainly the SA and AV nodes and
atrial muscle. Parasympathetic
stimulation reduces the rate at which
impulses are produced, decreasing the
rate and force of the heartbeat.
• The sympathetic nerves supply the SA
and AV nodes and the myocardium of
atria and ventricles. Sympathetic
stimulation increases the rate and force
of the heartbeat.
The cardiac cycle
• At rest, the healthy adult heart is likely to beat at a rate of 60–80
bpm. During each heartbeat, or cardiac cycle, the heart contracts and
then relaxes. The period of contraction is called systole and that of
relaxation, diastole
• Stages of the cardiac cycle
• Taking 74 bpm as an example, each cycle lasts about 0.8 of a second
and
• consists of:
• atrial systole – contraction of the atria
• ventricular systole – contraction of the ventricles
• complete cardiac diastole – relaxation of the atria and ventricles.
• The superior vena cava and the
inferior vena cava transport
deoxygenated blood into the right
atrium at the same time as the four
pulmonary veins bring oxygenated
blood into the left atrium.
• The atrioventricular valves are open
and blood flows passively through to
the ventricles.
• The SA node triggers a wave of
contraction that spreads over the
myocardium of both atria, emptying
the atria and completing ventricular
filling (atrial systole 0.1 s).
• When the electrical impulse reaches the AV node it is slowed down, delaying
atrioventricular transmission.
• This allows the atria to finish emptying into the ventricles before the
ventricles begin to contract.
• After this brief delay, the AV node triggers its own electrical impulse, which
quickly spreads to the ventricular muscle via the AV bundle, the bundle
branches and Purkinje fibers.
• This results in a wave of contraction which sweeps upwards from the apex of
the heart and across the walls of both ventricles pumping the blood into the
pulmonary artery and the aorta (ventricular systole 0.3 s).
• The high pressure generated during
ventricular contraction is greater than
that in the aorta and forces the
atrioventricular valves to close,
preventing backflow of blood into the
atria.

• After contraction of the ventricles

there is complete cardiac diastole, a
period of 0.4 seconds, when atria and
ventricles are relaxed.
• During this time the myocardium
recovers in preparation for the next
heartbeat, and the atria refill in
preparation for the next cycle
• The valves of the heart and of the great vessels open and close according to the
pressure within the chambers of the heart.
• The AV valves are open while the ventricular muscle is relaxed during atrial filling
and systole.
• When the ventricles contract there is a rapid increase in the pressure in these
chambers, and when it rises above atrial pressure the atrioventricular valves close.
• When the ventricular pressure rises above that in the pulmonary artery and in the
aorta, the pulmonary and aortic valves open and blood flows into these vessels.
• When the ventricles relax and the pressure within them falls, the reverse process
occurs.
• First the pulmonary and aortic valves close, then the atrioventricular valves open
and the cycle begins again. This sequence of opening and closing valves ensures
that the blood flows in only one direction
• the walls of the aorta and other elastic arteries stretch and recoil in response to
blood pumped into them.
Heart sounds
• The individual is not usually conscious of his heartbeat
• There are four heart sounds, each corresponding to a particular event
in the cardiac cycle.
• The first two are most easily distinguished, and sound through the
stethoscope like “lub dup”.
• The first sound, ‘lub’, is fairly loud and is due to the closure of the
atrioventricular valves. This corresponds with the start of ventricular
systole.
• The second sound, ‘dup’, is softer and is due to the closure of the
aortic and pulmonary valves. This corresponds with ventricular
diastole
Electrical changes in the heart
• The apparatus used is an electrocardiograph and the tracing is an
electrocardiogram (ECG).
• The normal ECG tracing shows five waves which, by convention, have
been named P, Q, R, S and T
• The P wave arises when the impulse from
the SA node sweeps over the atria (atrial
depolarization).
• The QRS complex represents the very rapid
spread of the impulse from the AV node
through the AV bundle and the Purkinje
fibers and the electrical activity of the
ventricular muscle (ventricular
depolarisation).
• Note the delay between the completion of
the P wave and the onset of the QRS
complex. This represents the conduction of
the impulse through the AV node, which, as
was explained earlier, is much slower than
conduction elsewhere in the heart, and
allows atrial contraction to finish completely
before ventricular contraction starts.
• The T wave represents the relaxation of
the ventricular muscle (ventricular
repolarisation).
• Atrial repolarization occurs during
ventricular contraction, and so is not
seen because of the larger QRS
complex.
• The ECG described above originates
from the SA node and is known as sinus
rhythm. The rate of sinus rhythm is 60
to 100 beats per minute.
• A faster heart rate is called tachycardia
and a slower heart rate, bradycardia.
Cardiac output
• The cardiac output is the amount of blood ejected from each ventricle
every minute.
• The amount expelled by each contraction of each ventricle is the
stroke volume.
• Cardiac output is expressed in liters per minute (l/min) and is
calculated by multiplying the stroke volume by the heart rate
(measured in beats per minute):
• In a healthy adult at rest, the stroke volume is approximately 70 ml and if the
heart rate is 72 per minute, the cardiac output is 5 l/minute.

• This can be greatly increased to meet the demands of exercise to around 25

l/minute, and in athletes up to 35 l/minute.

• This increase during exercise is called the cardiac reserve.

• When increased blood supply is needed to meet increased tissue

requirements of oxygen and nutrients, heart rate and/or stroke volume can
be increased
Heart rate
• The heart rate determines cardiac output. If heart rate rises, cardiac
output increases, and if it falls, cardiac output falls too

Factors affecting heart rate

• Gender
• Autonomic (sympathetic and parasympathetic) nerve activity
• Age
• Circulating hormones, e.g. adrenaline (epinephrine), thyroxine
• Activity and exercise
• Temperature
• Emotional states
Blood vessels
• Blood vessels vary in structure, size and function, and there are
several types: arteries, arterioles, capillaries, venules and veins
Arteries and arterioles
• These are the blood vessels that transport blood away from the heart.
They vary considerably in size and their walls consist of three layers of
tissue :

• tunica adventitia or outer layer of fibrous tissue

• tunica media or middle layer of smooth muscle and elastic tissue
• tunica intima or inner lining of squamous epithelium called
endothelium.

• The amount of muscular and elastic tissue varies in the arteries

depending upon their size and function.
• In the large arteries, sometimes called elastic arteries, the tunica media
consists of more elastic tissue and less smooth muscle.
• This allows the vessel wall to stretch, absorbing the pressure wave
generated by the heart as it beats.
• These proportions gradually change as the arteries branch many times and
become smaller until in the arterioles (the smallest arteries) the tunica
media consists almost entirely of smooth muscle.
• This enables their diameter to be precisely controlled, which regulates the
pressure within them.
• Systemic blood pressure is mainly determined by the resistance these tiny
arteries offer to blood flow, and for this reason they are called resistance
vessels.
• Arteries have thicker walls than veins to withstand the high pressure of
arterial blood.
 Anastomoses and end-arteries
• Anastomoses are arteries that form a link between main arteries
supplying an area, e.g. the arterial supply to the palms of the hand, the
brain, the joints

• If one artery supplying the area is occluded, anastomotic arteries

provide a collateral circulation.

• This is most likely to provide an adequate blood supply when the

occlusion occurs gradually
• End-arteries are the arteries with no anastomoses or those beyond the
most distal anastomosis, e.g. the branches from the circulus arteriosus
(circle of Willis) in the brain or the central artery to the retina of the
eye.
• When an end artery is occluded the tissues it supplies die because
there is no alternative blood supply.
Capillaries and sinusoids
• The smallest arterioles break up into a number of minute vessels called
capillaries.
• Capillary walls consist of a single layer of endothelial cells sitting on a
very thin basement membrane, through which water and other small
molecules can pass.
• Blood cells and large molecules such as plasma proteins do not normally
pass through capillary walls.
• The capillaries form a vast network of tiny vessels that link the smallest
arterioles to the smallest venules. Their diameter is approximately that of
an erythrocyte (7 μm).
• The capillary bed is the site of exchange of substances between the
blood and the tissue fluid, which bathes the body cells.
• Entry to capillary beds is guarded by rings of smooth muscle (precapillary
sphincters) that direct blood flow.

• Hypoxia (low levels of oxygen in the tissues), or high levels of tissue

wastes, indicating high levels of activity, dilate the sphincters and increase
blood flow through the affected beds.
• In certain places, including the liver and bone marrow, the capillaries are
significantly wider and leakier than normal.
• These capillaries are called sinusoids and because their walls are incomplete
and their lumen is much larger than usual, the blood flows through them
more slowly under less pressure and can come directly into contact with the
cells outside the sinusoid wall.
• This allows much faster exchange of substances between the blood and the
tissues, useful, for example, in the liver, which regulates the composition of
blood arriving from the gastrointestinal tract.
Veins and venules
• Veins are blood vessels that return blood at low pressure to the heart.
• The walls of the veins are thinner than those of arteries but have the
same three layers of tissue.
• They are thinner because there is less muscle and elastic tissue in the
tunica media, because veins carry blood at a lower pressure than
arteries.
• When cut, the veins collapse while the thicker-walled arteries remain
open.
• When an artery is cut blood spurts at high pressure while a slower,
steady flow of blood escapes from a vein.
• Some veins possess valves, which prevent
backflow of blood, ensuring that it flows
towards the heart
• They are formed by a fold of tunica intima
and strengthened by connective tissue.
The cusps are semilunar in shape with the
concavity towards the heart.
• Valves are abundant in the veins of the
limbs, especially the lower limbs where
blood must travel a considerable distance
against gravity when the individual is
standing.
• They are absent in very small and very
large veins in the thorax and abdomen
• Valves are assisted in maintaining one-way flow by skeletal muscles
surrounding the veins

• The smallest veins are called venules

• Veins are called capacitance vessels because they are distensible, and
therefore have the capacity to hold a large proportion of the body’s
blood.

• This allows the vascular system to absorb (to an extent) sudden

changes in blood volume, such as in haemorrhage; the veins can
recoil, helping to prevent a sudden fall in blood pressure.
 Blood pressure
• Blood pressure is the force or pressure that the blood exerts on the walls
of the blood vessels.

• Systemic arterial blood pressure maintains the essential flow of blood

into and out of the organs of the body.

• Keeping blood pressure within normal limits is very important. If it

becomes too high, blood vessels can be damaged, causing clots or
bleeding from sites of blood vessel rupture.

• If it falls too low, then blood flow through tissue beds may be
inadequate. This is particularly dangerous for such essential organs as the
heart, brain or kidneys.
• The systemic arterial blood pressure, usually called simply arterial
blood pressure, is the result of the discharge of blood from the left
ventricle into the already full aorta.

• Blood pressure varies according to the time of day, the posture,

gender and age of the individual.

• Blood pressure falls at rest and during sleep. It increases with age and
is usually higher in women than in men
Systolic and diastolic pressure
• When the left ventricle contracts and pushes blood into the aorta, the
pressure produced within the arterial system is called the systolic
blood pressure. In adults it is about 120 mmHg.
• When complete cardiac diastole occurs and the heart is resting
following the ejection of blood, the pressure within the arteries is
much lower and is called diastolic blood pressure.
• In an adult this is about 80 mmHg. The difference between systolic
and diastolic blood pressures is the pulse pressure.
• Arterial blood pressure is measured with a sphygmomanometer and
is usually expressed with the systolic pressure written above the
diastolic pressure:
 Elasticity of arterial walls
• There is a considerable amount of elastic
tissue in the arterial walls, especially in
large arteries.
• Therefore, when the left ventricle ejects
blood into the already full aorta, the aorta
expands to accommodate it, and then
recoils because of the elastic tissue in the
wall.
• This pushes the blood forwards, into the
systemic circulation. This distension and
recoil occurs throughout the arterial
system.
• During cardiac diastole the elastic recoil of
the arteries maintains the diastolic
pressure
Factors determining blood pressure
• Blood pressure is determined by cardiac output and peripheral
resistance.
• Change in either of these parameters tends to alter systemic blood
pressure, although the body’s compensatory mechanisms usually
adjust for any significant change.
Cardiac output
Cardiac output is determined by the stroke volume and the heart rate. An
increase in cardiac output raises both systolic and diastolic pressures. An increase
in stroke volume increases systolic pressure more than it does diastolic pressure.
Peripheral or arteriolar resistance
Constriction and dilation of the arterioles are the main determinants of
peripheral resistance. Vasoconstriction causes blood pressure to rise and
vasodilation causes it to fall. When elastic tissue in the tunica media is replaced
by inelastic fibrous tissue as part of the ageing process, blood pressure rises.
Autoregulation
The organs of the body are capable of adjusting blood flow and blood pressure in
their own local vessels independently of systemic blood pressure. This property is
called autoregulation, and protects the tissues against swings in systemic
pressures. It is especially important in the kidneys, which can be damaged by
increased pressure and in the brain
Control of blood pressure (BP)
Blood pressure is controlled in two ways:

• short-term control, on a moment-to-moment basis, which mainly

involves the baroreceptor reflex, discussed below, and also
chemoreceptors and circulating hormones

• long-term control, which involves regulation of blood volume by the

kidneys and the renin–angiotensin– aldosterone system
Short-term blood pressure regulation
The cardiovascular center (CVC) is a collection of interconnected neurons
in the medulla and pons of the brain stem. The CVC receives, integrates
and coordinates inputs from:
• baroreceptors (pressure receptors)
• chemoreceptors
• higher centers in the brain.

The CVC sends autonomic nerves (both sympathetic and parasympathetic)

to the heart and blood vessels. It controls BP by slowing down or speeding
up the heart rate and by dilating or constricting blood vessels. Activity in
these fibers is essential for control of blood pressure
 Baroreceptors
• These are nerve endings sensitive to pressure changes (stretch) within the
vessel, situated in the arch of the aorta and in the carotid sinuses, and are the
body’s principal moment-to-moment regulatory mechanism for controlling
blood pressure.

• A rise in blood pressure in these arteries stimulates the baroreceptors,

increasing their input to the CVC.

• The CVC responds by increasing parasympathetic nerve activity to the heart;

this slows the heart down.

• At the same time, sympathetic stimulation to the blood vessels is inhibited,

causing vasodilation. The net result is a fall in systemic blood pressure
• Conversely, if pressure within the aortic arch and carotid sinuses falls, the
rate of baroreceptor discharge also falls.

• The CVC responds by increasing sympathetic drive to the heart to speed it

up. Sympathetic activity in blood vessels is also increased, leading to
vasoconstriction.

• Both these measures counteract the falling blood pressure.

• Baroreceptor control of blood pressure is also called the baroreceptor

reflex
 Chemoreceptors
• These are nerve endings situated in the carotid and aortic bodies, and
are primarily involved in control of respiration.
• They are sensitive to changes in the levels of carbon dioxide, oxygen and
the acidity of the blood (pH)
• Rising blood CO2, falling blood O2 levels and/or falling pH all indicate
failing tissue perfusion.
• When these changes are detected by the chemoreceptors, they send
signals to the CVC, which then increases sympathetic drive to the heart
and blood vessels, pushing blood pressure up to improve tissue blood
supply. Because respiratory effort is also stimulated, blood oxygen levels
rise as well.
• Chemoreceptor input to the CVC influences its output only when
severe disruption of respiratory function occurs or when arterial BP
falls to less than 80 mmHg.

• Similar chemoreceptors are found on the brain surface in the medulla

oblongata, and they measure carbon dioxide/oxygen levels and pH of
the surrounding cerebrospinal fluid.

• Changes from normal activate responses similar to those described

above for the aortic/carotid receptors.
Higher centers in the brain
• Input to the CVC from the higher centers is influenced by emotional
states such as fear, anxiety, pain and anger that may stimulate
changes in blood pressure.
• The hypothalamus in the brain controls body temperature and
influences the CVC, which responds by adjusting the diameter of
blood vessels in the skin – an important mechanism in determining
heat loss and retention
 Pulse
• The pulse is a wave of distension and
elongation felt in an artery wall each time the
left ventricle ejects blood into the system.
• Each contraction of the left ventricle forces
about 60 to 80 milliliters of blood through the
already full aorta and into the arterial system.
• The aortic pressure wave is transmitted
through the arterial system and can be felt at
any point where a superficial artery can be
pressed gently against a bone
• The number of pulse beats per minute
normally represents the heart rate and varies
considerably in different people and in the
same person at different times.
Information that may be obtained from the pulse includes:

• the rate at which the heart is beating

• the regularity of the heartbeat – the intervals between beats should
be equal
• the volume or strength of the beat – it should be possible to compress
the artery with moderate pressure, stopping the flow of blood; the
compressibility of the blood vessel gives some indication of the blood
pressure and the state of the blood vessel wall
• the tension – the artery wall should feel soft and pliant under the
fingers.
Factors affecting the pulse
• In health, the pulse rate and the heart rate are identical. In certain
circumstances, the pulse may be less than the heart rate. This may
occur, for example, if:

• the arteries supplying the peripheral tissues are narrowed or blocked

and the blood therefore is not pumped through them with each
heartbeat.

• There is some disorder of cardiac contraction, e.g. atrial fibrillation

and the heart is unable to generate enough force, with each
contraction, to circulate blood to the peripheral arteries