Cardiovascular System The Heart

- Composed of the Heart and the

Vasculature, the Arteries and the
Veins
- Vasculature – arrangement of blood
vessels
- Arteries carry blood away from the
heart, and Veins carry that blood back
to the heart
- Its primary function is transportation
- Distributing oxygen and nutrients
throughout the body while removing
waste like carbon dioxide.
- Oxygen is absorbed into the
bloodstream through alveoli in the
lungs, where it diffuses in as carbon
dioxide is exhaled.
- The Heart generates the force
necessary to circulate blood, acting as
a transport vehicle that carries
essential substances like hormones, - The heart is approximately the size of
nutrients, and waste products, a person's fist
thereby maintaining body - Located in the medial section of the
homeostasis. Blood vessels serve as thoracic cavity, specifically in the
the pathways that distribute this inferior mediastinum.
blood throughout the entire body,
- It is flanked on each side by the lungs.
ensuring efficient delivery and waste
removal. - The apex (sharp point) of the heart is
directed downward and rests atop
the diaphragm.
- The base (broader part) lies beneath
the second rib and under the
shoulder.
- Major arteries emerge from the base,
making the heart appear like an
inverted triangle, with the apex
pointing downward.

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 The heart is enclosed in a sac called the
pericardium, which consists of three layers:

• Fibrous pericardium (outermost layer):

o Protects the heart and anchors it
to surrounding structures,
ensuring it stays in place between
the lungs.
• Serous pericardium (inner layers):
o Composed of two layers:
Anteriorly (in front of the heart): ▪ Parietal layer: The outer
- The body of the sternum and layer of the serous
adjoining costal cartilages. pericardium.
▪ Visceral layer: The inner
- The left lung and pleura (covering the
layer that adheres directly
apex).
to the heart, forming part
Posteriorly (behind the heart): of the epicardium.
- The esophagus.
Pericardial fluid is located between the
- The descending thoracic aorta.
parietal and visceral layers, providing
Superiorly (above the heart): lubrication to reduce friction as the heart
- The bifurcation of the main beats.
pulmonary trunk, where it splits into
the left and right pulmonary arteries.
Inferiorly (below the heart):
- The diaphragm.
Laterally (on each side of the heart):
- The lungs and pleura.

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The heart wall consists of several layers:

• Pericardium: The outer protective sac.

o Serous pericardium: Contains
the parietal and visceral layers,
with the visceral layer also known
as the epicardium.
o Pericardial space: The area
between the parietal and visceral
layers, containing pericardial fluid
for lubrication.
• Myocardium:
o The muscular middle layer
responsible for the heart's
contractions.
o Composed of cardiac muscle
tissue.
• Endocardium:
o The innermost layer of the heart.
o A thin, glistening sheet of
endothelium that lines the heart
chambers, providing a smooth
surface for blood flow returning
to the myocardium.

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• The myocardium consists of thick Structure of the Heart
bundles of cardiac muscle arranged
in twisted, ring-like patterns. The heart's structure includes:
• These ring-like arrangements allow
the heart to contract effectively, • Apex: The pointed end of the heart.
directing the force of the heartbeat in • Base: The superior portion of the
a specific direction. heart, where the atria are located.
• Instead of beating in a spreading o Right atrium: Receives
manner, the heart pumps by deoxygenated blood from
clenching inward, propelling blood the body.
throughout the body. o Left atrium: Receives
• Myocardial cells are interconnected oxygenated blood from the
by intercalated discs, which contain: lungs.
o Desmosomes: Provide • Ventricles:
structural support. o Right ventricle: Pumps
o Gap junctions: Allow ions to deoxygenated blood to the
flow freely between muscle lungs.
fibers. o Left ventricle: Pumps
• When one cardiac muscle cell is oxygenated blood to the rest
stimulated, the electrical impulse of the body.
spreads rapidly across all cardiac
muscle cells, ensuring that they Major blood vessels connected to the heart
contract simultaneously. include:

• Superior vena cava and inferior

vena cava: Carry deoxygenated
blood from the body to the right
atrium.
• Pulmonary veins: Return
oxygenated blood from the lungs to
the left atrium.
o Right pulmonary veins:
Drain the right lung.
o Left pulmonary veins: Drain
the left lung.
• Pulmonary trunk: Transports
deoxygenated blood from the right
ventricle to the lungs for gas
exchange.

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 • Aorta: The major artery that carries
oxygenated blood from the left
ventricle to the body, branching into:
o Brachiocephalic trunk:
Supplies blood to the upper
torso and arms.
o Left common carotid
artery: Supplies blood to the
head and neck.

The heart is divided by the septum into right

and left halves.

The heart consists of four chambers:

• Upper cavities (Atria):

o Right Atrium: Receives
deoxygenated blood from the
body.
o Left Atrium: Receives
oxygenated blood from the
lungs.
Opening the heart allows for a clearer view • Lower cavities (Ventricles):
of its internal structures: o Right Ventricle: Pumps
deoxygenated blood to the
• Right Atrium: Receives lungs.
deoxygenated blood from the body. o Left Ventricle: Pumps
• Tricuspid Valve: Located below the oxygenated blood to the rest
right atrium, it regulates blood flow of the body.
into the right ventricle.
• Right Ventricle: Pumps This division ensures proper separation and
deoxygenated blood to the lungs. flow of oxygenated and deoxygenated
• Left Atrium: Receives oxygenated blood.
blood from the lungs.
• Left Ventricle: Pumps oxygenated
blood to the rest of the body.
• Septum: The wall dividing the heart
into left and right sides, preventing
mixing of oxygenated and
deoxygenated blood.

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 2 Chambers of The Heart

• Atria:
o Located superiorly in the heart.
o Serve as the receiving
chambers:
▪ Right atrium receives
deoxygenated blood
from the vena cava.
▪ Left atrium receives
oxygenated blood from
the lungs.
o Function:
▪ Contract to push blood
The septum enables the heart to function as into the ventricles.
a double pump, preventing the mixing of • Ventricles:
oxygenated and deoxygenated blood. o Located inferiorly, with thicker
walls to handle greater pressure.
• Interatrial Septum: Divides the atria o Function as the actual pumps of
into left (oxygenated) and right the heart:
(deoxygenated). ▪ Right ventricle pumps
• Interventricular Septum: Divides blood to the lungs for
the ventricles into left (oxygenated) oxygenation.
and right (deoxygenated). ▪ Left ventricle pumps
blood into the aorta to
Double Pump Function: supply the rest of the
body.
• One half of the heart pumps • Pressure Dynamics:
deoxygenated blood to the o The ventricles generate the most
pulmonary circulation (to the lungs force needed for blood
for oxygenation). circulation.
• The other half pumps oxygenated
blood into the systemic circulation
(to the rest of the body).

This arrangement ensures efficient

circulation and oxygen delivery throughout
the body.

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 • Bicuspid Valve (also known as the
Mitral Valve):
o Located on the left side of the
heart.
o Has two cusps.

Valves in the Heart:

• Allow blood to flow in one direction

through the heart chambers.
• Ensure blood travels:
o From the atria to the
ventricles.
o Out of the heart through the
great arteries (pulmonary
artery and aorta).
• Prevent backflow of blood into the
heart.

Atrioventricular Valves:

• Located between the atria and

ventricles on each side.
• Prevent backflow of blood into the
atria when ventricles contract.
• Supported by chordae tendineae
(tendon-like cords).
o These cords hold the valve
cusps in place.

Types of Atrioventricular Valves:

• Tricuspid Valve:
o Located on the right side of
the heart.
o Has three cusps (flaps).

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Bicuspid Valve (Mitral Valve): Deoxygenated Blood Flow:

• Located on the left side of the heart. • Right Atrium:

• Also referred to as the mitral valve. o Receives deoxygenated
blood from the inferior and
Tricuspid Valve: superior vena cava.
• Right Ventricle:
• Found on the right side of the heart. o Blood flows from the right
• Contains three cusps. atrium into the right ventricle.
o Blood then passes through
Chordae Tendineae: the pulmonary arteries.
• Lungs:
• Known as heart strings. o Blood is transported to the
• Hold the valve cusps in place. lungs for gas exchange
• Provide support to the valves during (oxygenation).
the heart's contractions.
Blood Vessel Classification:
Consequences of Weakened Chordae
Tendineae: • Arteries:
o Carry blood away from the
• If the chordae tendineae weaken or heart.
snap: • Veins:
o Valves may be unable to close o Carry blood towards the
properly. heart.
o This can lead to
regurgitation (backflow of Oxygenated Blood Flow:
blood).
• Pulmonary Veins:
o Oxygen-rich blood from the
lungs enters the left atrium.
• Left Ventricle:
o Blood travels down from the
left atrium into the left
ventricle.
o The left ventricle pumps
oxygenated blood out into
the aorta.
• Systemic Circulation:
o From the aorta, blood is
distributed to the rest of the
body.

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 - Provides oxygenated blood from the left
ventricle to all body tissues via arteries.
o Delivers oxygen through
capillaries to body tissues.

Coronary Circulation:

- Supplies blood to the heart muscle

(myocardium).
- Coronary arteries branch from the base
of the aorta:

Right Coronary Artery:

- Supplies the right atrium and ventricle.

- Major branches:
o Posterior Interventricular
Circulation Types
Artery (supplies ventricular
Pulmonary Circulation: walls).
o Marginal Artery (supplies walls
- Transports deoxygenated blood from the of the right atrium and ventricle).
right ventricle to the lungs.
- Facilitates gas exchange, returning
oxygenated blood to the left atrium.

Systemic Circulation:

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Left Coronary Artery: o Under involuntary control.

- Supplies the left atrium and ventricle.

- Major branches:
o Circumflex Artery (supplies the • Nucleus:
atria and left ventricle). o Each cell has a single, centrally
o Anterior Interventricular Artery located nucleus.
(supplies ventricular walls). • Cell Membrane:
- Cardiac Veins drain deoxygenated blood o Surrounded by a membrane
into the coronary sinus, which empties called the sarcolemma.
into the right atrium, allowing blood to
be oxygenated again in the lungs. Intercalated Discs:

Heart Physiology • Contain gap junctions that enable

synchronized contraction of
cardiomyocytes, allowing the heart to
pump effectively as a unit.

This structure and organization facilitate

efficient cardiac muscle contraction and
coordination essential for heart function.

Sarcolemma

• The plasma membrane of

cardiomyocytes (cardiac muscle
cells).
• Specialization: Contains T tubules,
Myocytes (Cardiac Cells): enhancing its function.

• Structure:
o Striated and branched.
o Contain numerous mitochondria
for energy production.

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T Tubules: Sarcomere: The Functional Unit of
Cardiomyocyte Contraction
• Structure: Highly branched
invaginations of the sarcolemma. Definition:
• Function:
o Excitation-Contraction • A sarcomere is the fundamental unit of
Coupling: Facilitate the rapid contraction in cardiomyocytes, defined as
spread of electrical impulses the region between two Z lines.
(action potentials) across the
cardiac muscle. Z Lines:
o Action Potential: Initiation
and regulation of muscle • The structural boundaries of a sarcomere,
contractions. serving as anchor points for the
o Resting Membrane myofilaments.
Potential: Help maintain the
cell's resting state. Myofilaments:
o Signal Transduction:
Important for communication • Thin Filaments: Composed of actin.
within the heart muscle • Thick Filaments: Composed of myosin.
during contraction and
relaxation. Contraction Mechanism:

• Sliding Filament Theory: Actin filaments

slide over myosin filaments during
contraction.
• As actin filaments move toward each
other, the sarcomere shortens, leading to
muscle contraction.

Result of Contraction:

• The distance between the Z lines

decreases, causing the cardiac muscle to
shorten and contract effectively.

Interaction:

• The contraction results from chemical

and physical interactions between actin
and myosin, initiated during excitation-
contraction coupling.

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This process is essential for the heart's Understanding action potentials is
pumping action, allowing it to efficiently fundamental to grasping how electrical
circulate blood throughout the body. signals propagate through cardiac tissue,
leading to muscle contraction and overall
Action Potentials in Cardiac Cells heart function.

Definition:

• Action potentials are rapid changes in

the voltage across a cell membrane,
essential for communication in nerve
and muscle cells.

Mechanism:

• Action potentials occur through a

sequence of voltage changes caused
by the movement of ions across the
membrane.

Membrane Voltage:

• The voltage (or potential) of the

membrane at any moment is Phases of Cardiac Muscle Action
influenced by: Potential
o The relative concentration
of ions inside (intracellular) Phase 0 (Depolarization):
and outside (extracellular) the
cell. • Stimulus and Membrane Potential:
o The permeability of the cell Cardiac cells are stimulated, causing
membrane to different ions depolarization, where the membrane
(e.g., sodium, potassium, potential becomes more positive.
calcium). • Initial State: The resting membrane
potential starts at around -80 mV.
Role in Cardiac Function: • Positive Shift: The membrane
potential rapidly increases to around
• Action potentials are crucial in +40 mV.
directing cardiac cells to contract, • Mechanism:
enabling coordinated heartbeats and o Fast Sodium Channels open,
effective blood pumping. allowing a rapid influx of
sodium ions (Na⁺) into the
cell.

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 o This influx causes the rapid action potential neither increases nor
rise in membrane potential, decreases significantly.
initiating the depolarization • Mechanism:
phase. o Calcium Channels Open:
Calcium (Ca²⁺) channels open,
Depolarization is essential for cardiac allowing a significant influx of
muscle contraction, as it triggers further calcium ions into the cell. This
phases of the action potential and enables influx helps to maintain the
coordinated contraction of heart muscle membrane potential at a
cells. positive level.
o Closure of Fast Potassium
Phase 1 (Initial Repolarization) Channels: The fast potassium
channels close, reducing
• Peak and Initial Dip: At the peak of potassium (K⁺) efflux, which
depolarization, the membrane would normally make the
potential is around +40 mV. membrane potential more
• Initial Repolarization: The process negative.
begins to bring the membrane • Result: The balance between calcium
potential back toward its resting entering the cell and the decreased
state. exit of potassium maintains the
• Mechanism: plateau, keeping the membrane
o Closure of Fast Sodium potential stable and positive for a
Channels: The channels that longer duration.
allowed sodium (Na⁺) influx
during depolarization start to Phase 3 (Rapid Repolarization)
close, halting further
increase in membrane • Rapid Repolarization: This phase is
positivity. where the membrane potential
o Potassium (K⁺) Efflux: returns to a more negative state,
Potassium ions begin to exit approaching the resting membrane
the cell through open potential.
potassium channels, • Mechanism:
contributing to the slight dip o Closure of Calcium
in membrane potential as it Channels: Calcium (Ca²⁺)
starts to become more channels close, stopping the
negative. influx of calcium ions.
o Opening of Slow Potassium
Phase 2 (Plateau) Channels: Slow potassium
(K⁺) channels open, allowing
• Plateau Phase: This phase is potassium ions to exit the cell
characterized by a stabilized rapidly.
membrane potential, where the

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 • Result: The increased efflux of
potassium causes the membrane The heart's conduction system ensures
potential to become more negative, coordinated and efficient contraction by
bringing it back down towards the transmitting electrical impulses in a specific
resting membrane potential. sequence:

Phase 4 (Resting Membrane Potential) Sinoatrial (SA) Node:

• Resting State: This is when the o Known as the pacemaker of

cardiac cell returns to its resting the heart.
membrane potential, which is o Sets the normal rhythm by
typically between -80 and -90 initiating electrical impulses.
millivolts. o A Specialized plump of
• Stabilization: Myocardial conductive Cells
o Potassium channels remain Located in the superior
open, maintaining the resting portion of the right atrium.
potential. o Has the highest inherent
o Sodium and calcium channels depolarization rate, spreading
are closed. impulses throughout the
• Importance: This phase prepares the heart to establish the sinus
cardiac cell for the next action rhythm.
potential, ensuring it is ready for the
next cycle of depolarization and Atrioventricular (AV) Node:
contraction.
o A specialized clump of
Myocardial conductive cells
found in the inferior part of
the right atrium.
o Acts as a gateway that delays
the electrical impulse,
preventing it from traveling
directly to the ventricles.
o This delay before the AV
node depolarizes allows the
atria to finish contracting and
empty blood into the
ventricles before they
contract, ensuring effective
blood flow.

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 The conduction system's structure ensures
that the atria contract first, filling the
Atrioventricular (AV) Bundle: ventricles with blood. Then, after a brief
pause, the ventricles contract, pumping
o Also known as the Bundle of blood to the lungs or the rest of the body.
His. This sequential contraction is crucial for
o Receives impulses from the maintaining the heart's efficiency and
AV node and transmits them ensuring proper circulation.
down the interventricular
septum.
o Ensures that the impulse The conduction pathway of the heart follows
moves in one direction from these steps to ensure efficient and
atria to ventricles. synchronized contraction:

Purkinje Fibers: 1. Rest State:

o The SA node and the rest of
o The AV bundle branches into the conduction system are at
fibers that spread throughout rest.
the ventricles. 2. Initiation by SA Node:
o These fibers rapidly transmit o The SA node initiates an
impulses, allowing the action potential, marked by
ventricles to contract small arrows that show the
simultaneously and efficiently. impulse spreading
throughout the atria.
3. Delay at the AV Node:
o Once the impulse reaches the
AV node, there's a 100-
millisecond delay. This delay
allows the atria to finish
pumping blood into the
ventricles before the signal
continues.
o The delay ensures that the
atria complete their
contraction before the
ventricles start contracting.
4. Transmission to the AV Bundle:
o After the delay, the impulse is
transmitted to the AV bundle
(Bundle of His) and then
downwards.
5. Spread to the Purkinje Fibers:

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 o The impulse travels through necessary to circulate blood throughout the
the AV bundle and into the body.
Purkinje fibers, causing the
ventricles to contract
simultaneously.

This sequence allows the heart to function

efficiently, ensuring that blood is pumped
from the atria to the ventricles and then out
to the lungs or the rest of the body in a
coordinated manner.

The Cardiac Cycle

The sequence of events during one complete

heartbeat, encompassing both atrial and
ventricular contraction and relaxation. Here
are the key points:
In the cardiac cycle, there are five phases,
1. Heartbeat Frequency: each detailing which chamber is actively
o The average heartbeat rate is filling or pumping blood and the status of the
approximately 75 beats per heart valves.
minute.
o Each cardiac cycle lasts about 0.8 Phase 1: Atrial Diastole and Ventricular
seconds. Filling
2. Phases of the Cardiac Cycle:
o Systole: The phase when the • Chamber Activity:
heart contracts to pump blood o The atria are relaxing, allowing
out. them to fill with blood.
o Diastole: The phase when the o At the same time, the ventricles
heart relaxes to fill with blood. are passively filling with blood.
3. Blood Pressure: • Valve Status:
o Systolic Pressure: Higher o The atrioventricular (AV) valves
pressure when the heart (e.g., tricuspid and mitral valves)
contracts. are open, permitting blood flow
o Diastolic Pressure: Lower from the atria to the ventricles.
pressure when the heart relaxes. o The semilunar valves (e.g., aortic
and pulmonary valves) remain
The alternating contraction (systole) and closed to prevent blood from
relaxation (diastole) are responsible for the exiting into the great arteries.
heartbeat sounds and the pumping action • Blood Flow and Pressure:

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 o With the atria relaxed and the atria (from Phase 1) into the
pressure low, blood flows ventricles.
passively from the atria into the o This ensures that the ventricles
ventricles. are filled with as much blood as
o Blood returning from the lungs possible before they contract.
(into the left atrium) and from the
body (into the right atrium) This phase is crucial for maximizing
naturally flows down into the ventricular filling and preparing the heart for
ventricles due to the low pressure the next stages of the cardiac cycle.
and open AV valves.
In Phase 3 of the cardiac cycle, known as
This passive filling phase is crucial for Isovolumetric Contraction, the following
ensuring the ventricles are adequately filled occurs:
before the next contraction.
Phase 3: Isovolumetric Contraction
In Phase 2 of the cardiac cycle, known as
Atrial Systole, the atria contract to • Chamber Activity:
complete the filling of the ventricles: o The ventricles begin to contract,
while the atria are relaxing. This
Phase 2: Atrial Systole initial contraction of the ventricles
generates pressure.
• Chamber Activity: • Valve Status:
o The atria contract, increasing the o Both the atrioventricular (AV)
pressure within them. This valves (tricuspid and mitral
contraction pushes the remaining valves) and the semilunar valves
blood from the atria into the (aortic and pulmonary valves) are
ventricles. closed during this phase.
• Valve Status: • Pressure and Volume:
o The atrioventricular (AV) valves o As the ventricles contract, the
(tricuspid and mitral valves) pressure builds, but it is not yet
remain open, allowing the blood sufficient to open the semilunar
to flow from the atria into the valves.
ventricles. o Because all valves are closed, the
o The semilunar valves (aortic and volume of blood in the ventricles
pulmonary valves) are still closed remains constant, hence the term
to ensure the blood stays within "isovolumetric."
the heart and is directed towards • Significance:
the ventricles. o This phase is essential as it
• Blood Flow and Pressure: prepares the heart for the next
o The contraction of the atria phase of the cardiac cycle, where
increases the pressure, forcing the pressure in the ventricles will
any remaining blood from the eventually rise enough to open

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 the semilunar valves and allow higher pressure to overcome the
blood to be ejected into the aorta elevated pressure in the aorta and
and pulmonary artery. pulmonary artery. This increased
workload on the heart can lead to
This phase is a brief yet critical period in complications over time.
which the ventricles generate the necessary • Key Concept:
pressure to move blood out of the heart. o The pressure in the ventricles
must be greater than the pressure
In Phase 4 of the cardiac cycle, known as in the circulation to facilitate
Ventricular Systole, the following occurs: effective ejection of blood.

Phase 4: Ventricular Systole This phase is essential for the delivery of

oxygenated blood throughout the body,
• Chamber Activity: marking a critical point in the cardiac cycle
o The ventricles have fully where the heart does its main job of pumping
contracted. blood.
• Valve Status:
o The atrioventricular (AV) valves In Phase 5 of the cardiac cycle, known as
are closed to prevent blood from Isovolumetric Relaxation, the following
flowing back into the atria. occurs:
o The semilunar valves (aortic and
pulmonary valves) are open, Phase 5: Isovolumetric Relaxation
allowing blood to exit the heart.
• Pressure Dynamics: • Chamber Activity:
o As the ventricles contract, the o The ventricles are relaxing after
pressure within them rises contraction, allowing for the next
significantly, exceeding the phase of the cardiac cycle.
pressure in the major vessels • Valve Status:
(aorta and pulmonary artery). o Both the semilunar valves and
o This pressure increase enables the atrioventricular (AV) valves are
blood to flow out of the ventricles closed. This prevents any blood
and into the circulation. from entering or leaving the
• Blood Ejection: ventricles, which is critical for this
o This phase is crucial as it phase.
represents the moment when the • Pressure Dynamics:
heart empties blood into the o During isovolumetric relaxation,
systemic and pulmonary the pressure in the ventricles
circulation. decreases, but the volume of
• Clinical Relevance: blood remains the same. This is
o In patients with hypertension the key aspect of "isovolumetric,"
(high blood pressure), the meaning the volume is constant
ventricles must generate even while the heart muscle relaxes.

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• Transition:
o Once the ventricles are fully
relaxed, the heart prepares to fill
with blood again, transitioning
back to Phase 1 (Atrial Diastole).
o As the heart continues to relax,
the atria will fill with blood,
preparing for the next contraction
cycle.
• Cycle Continuation:
o This phase is essential for
completing the cardiac cycle.
Once the heart has fully relaxed, it
allows the atria to fill with blood
again, initiating the next
heartbeat.

Summary of Cardiac Cycle Phases:

Electrocardiogram (ECG)
1. Atrial Diastole / Ventricular Filling:
Atria relax, filling with blood. • Definition:
2. Atrial Systole: Atria contract, o An ECG is a test that records the
pushing blood into ventricles. electrical activity of the heart,
3. Isovolumetric Contraction: providing a visual representation
Ventricles contract with closed valves; of heart function over time.
no blood flow occurs. • Purpose:
4. Ventricular Systole: Ventricles fully o The ECG traces electrical impulses
contract, ejecting blood into generated by the heart,
circulation. specifically tracking the activity
5. Isovolumetric Relaxation: Ventricles from the Sinoatrial (SA) node to
relax with closed valves; preparing for the Atrioventricular (AV) node,
the next cycle. and down through the bundle
branches of the conduction
This cyclical nature of the cardiac cycle system.
ensures that blood is continuously pumped o It assesses how well the heart’s
throughout the body, maintaining effective electrical system is functioning
circulation and oxygen delivery. and whether there are any
abnormalities in the heart's
rhythm or electrical conduction.
• Mechanism:
o The electrical impulses stimulate
the heart's four chambers (two

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 atria and two ventricles) to o It reflects the action
contract and relax in a potential (AP) initiated in the
coordinated manner, ensuring sinoatrial (SA) node, which is
effective blood flow throughout the heart's natural pacemaker.
the body. o The P wave signifies that the
• Clinical Relevance: atria are becoming electrically
o Studying the ECG allows active and preparing to
healthcare providers to identify contract.
potential issues within the • Important Concepts:
conduction system, which can be o Resting Membrane
influenced by various heart Potential (RMP): The
diseases or conditions. baseline electrical state of the
o ECGs are essential for diagnosing atrial muscle cells before
arrhythmias, myocardial depolarization.
infarctions, and other cardiac o MOTAS: This may refer to a
conditions. mnemonic to remember the
• Understanding the ECG Trace: sequence or importance of
o It’s crucial to interpret the peaks the electrical activity and
and troughs (waves) in the ECG contraction in the heart.
trace, which correlate to different o Atrial Depolarization: This is
phases of the cardiac cycle: the initial step in the cardiac
▪ P Wave: Atrial cycle where the atria fill with
depolarization blood and contract to push
(contraction). blood into the ventricles.
▪ QRS Complex:
Ventricular depolarization QRS Complex in the Electrocardiogram
(contraction). (ECG)
▪ T Wave: Ventricular
repolarization (relaxation). • Definition:
o The QRS complex consists of
P Wave in the Electrocardiogram (ECG) three components: Q wave, R
wave, and S wave. It
• Definition: represents the rapid
o The P wave represents the depolarization of the
depolarization of both the left ventricles.
and right atria, indicating the • Key Points:
electrical activity that leads to o The QRS complex occurs in
atrial contraction. rapid succession, hence the
• Key Points: term "complex."
o The P wave corresponds to o It indicates the spread of the
the atrial contraction phase electrical impulse through
in the cardiac cycle.

20
 the ventricles, causing activity indicated by the QRS
ventricular contraction. complex.
o The impulse travels from the o The electrical impulse that
atrioventricular (AV) node causes ventricular contraction
down the bundle of His and (depicted by the QRS
into the Purkinje fibers, complex) is followed by a
which facilitate coordinated period of relaxation and
contraction of the ventricles. recovery captured by the T
• Components of the QRS Complex: wave.
o Q Wave: The initial downward • Relation to Other Waves:
deflection representing the o The T wave follows the QRS
early depolarization of the complex, indicating that after
ventricles. the ventricles contract (QRS),
o R Wave: The subsequent they must repolarize (T wave)
upward spike, indicating to prepare for the next
strong depolarization as the heartbeat.
impulse spreads rapidly o This sequence of
through the ventricles. depolarization and
o S Wave: The downward repolarization is critical for
deflection following the R maintaining a coordinated
wave, representing the and effective cardiac cycle.
completion of ventricular
depolarization.

T Wave in the Electrocardiogram (ECG)

• Definition:
o The T wave follows the QRS
complex and represents
ventricular repolarization,
the process where the
ventricles recover from
depolarization.
• Key Points:
o The T wave is crucial for
understanding the heart's
recovery phase after
contraction.
o It signifies the return of the
ventricles to their resting
state following the electrical

21
Understanding Normal and Irregular ECG heart's conduction system or
Patterns other underlying conditions.
• Monitoring Heart Rate:
• Normal ECG Characteristics: o In lab activities where you
o A typical ECG has distinct measure heart rates, it’s
waves: the P wave, QRS essential to observe the
complex, and T wave. rhythm over a complete
o The rhythm is regular, with minute.
equal spacing (squares) o Counting for a shorter
between each QRS complex, duration (like 15 or 30
indicating a consistent seconds) might not capture
heartbeat. the full variability of the heart
o This regular rhythm reflects a rate, especially if the
healthy conduction system, heartbeat is irregular.
where electrical impulses o Always multiply the counted
travel smoothly from the SA beats by four (for 15 seconds)
node through the AV node or two (for 30 seconds) to
and into the ventricles. estimate beats per minute,
• ECG Wave Descriptions: but be cautious about
o P Wave: Represents atrial potential irregularities.
depolarization (activation of
the atria).
o QRS Complex: Indicates
ventricular depolarization
(activation of the ventricles).
o T Wave: Shows ventricular
repolarization (recovery
phase after contraction).
• Variations in Heart Rate:
o Tachycardia: When the heart
beats faster, the spaces
between the QRS complexes
shorten.
o Bradycardia: A slower heart
rate results in increased
spacing between the QRS
complexes.
o Irregular Heartbeat: The
distance between QRS
complexes varies, indicating
potential issues with the

22
 can increase heart rate
during stress or
exercise.
▪ Hormones, such as
adrenaline, can also
increase heart rate.
o Stroke Volume Control:
▪ Influenced by blood
volume (the total
amount of blood in
the circulatory system)
and vascular
resistance (the
Cardiac Output Overview resistance blood
encounters as it flows
1. Definition of Cardiac Output: through the vessels).
o Cardiac output (CO) is the
amount of blood pumped Frank-Starling Law of the Heart
out by each side of the heart
per minute. 1. Definition:
o It is calculated using the o The Frank-Starling law
formula: describes the relationship
between venous return and
the heart's ability to contract.
o It states that increased
venous return leads to a
2. Understanding Stroke Volume: greater filling of the heart's
o Stroke volume is the volume chambers, resulting in a
of blood ejected by the stronger contraction and
ventricles with each more blood being pumped
heartbeat. out.
o It reflects the efficiency of the 2. Mechanism:
heart's pumping ability. o Venous Return: The volume
3. Regulators of Heart Rate and of blood returning to the
Stroke Volume: heart through the veins.
o Heart Rate Control: o Physiological Response:
▪ Controlled by nerve ▪ When venous return
impulses from the increases (e.g., after
brain. fluid intake or IV
▪ Involves the fluids), the heart's
autonomic nervous chambers fill with
system (ANS) which more blood.

23
 ▪ This increased volume Factors Influencing Stroke Volume
causes the cardiac
muscle fibers to 1. Frank-Starling Law:
stretch. o Predicts stroke volume based
▪ As a result, the heart on venous return and heart
contracts more filling.
forcefully, enhancing o More venous return (preload)
the stroke volume leads to stronger heart
during systole. contractions.
3. Importance: 2. Preload:
o The mechanism is crucial for o Definition: The volume of
maintaining cardiac output, blood returning to the heart,
especially during situations affecting the heart's filling
where blood volume changes, during relaxation (diastole).
such as: o Determinants:
▪ Increased hydration ▪ Heart Rate: Faster
(e.g., drinking a lot of heart rates can
water). increase preload by
▪ Administration of IV shortening the filling
fluids in a medical time.
setting. ▪ Volume Increase:
o Summary: More filling during Transfusions or IV
diastole leads to stronger fluids increase venous
contractions during systole, return, leading to a
ensuring efficient blood higher preload and
circulation throughout the stroke volume.
body. 3. Contractility:
o Definition: The heart's ability
to generate tension and
contract.
o Influencing Factors:
▪ Stretch of the cardiac
muscle fibers.
▪ Calcium ion
concentration in
cardiac cells.
▪ Sympathetic nervous
system stimulation
and hormones.
o Application:
▪ In older patients,
decreased

24
 contractility leads to a o Causes include severe
lower stroke volume, infections, vascular blockages,
explaining reduced or congenital malformations.
physical capability o Increased pressure in the
compared to younger pulmonary vessels makes it
individuals. difficult for the heart to push
4. Summary: blood into the lungs, further
o Increased preload (due to decreasing stroke volume.
blood volume or faster heart 4. Analogy:
rate) enhances stroke volume. o Imagine a pipe system: if
o Improved contractility also pressure in the pipes is high,
raises stroke volume, vital for adding more force to push
physical exertion and overall fluid through could lead to
cardiovascular function. burst pipes.
o This analogy illustrates how
Afterload and Its Impact on Stroke increased afterload affects the
Volume cardiovascular system,
emphasizing the need for
1. Definition of Afterload: proper blood pressure
o The pressure the ventricles management.
must overcome to eject blood
into the aorta and pulmonary
trunk.
o Determined by the blood
pressure in these arteries,
acting against the semilunar
valves. Factors Influencing Cardiac Output
2. Effects of Increased Afterload:
o Greater afterload makes it 1. Heart Rate Control:
harder for the ventricles to o Regulated by two main factors:
pump blood. o Autonomic Nervous System
o As a result, stroke volume (ANS): Activated during
decreases. emotional or physical stress.
o Example: In a hypertensive ▪ Stimulates the sinoatrial
patient, the increased arterial (SA) node and cardiac
pressure opposes the heart’s muscles.
effort to eject blood, reducing ▪ Leads to increased heart
stroke volume. rate during activities like
3. Pulmonary Hypertension: exercise.
o Defined as elevated blood
pressure in the pulmonary
arteries.

25
 o Hormones and Ions: individuals mature,
▪ Epinephrine approaching adult
(Adrenaline): Released levels (60–100 beats
during stress or danger per minute).
(fight-or-flight response). o Gender:
▪ Increases heart ▪ Females usually have
rate and cardiac faster heart rates than
output, enhancing males.
oxygen delivery to ▪ Average heart rates:
tissues. ▪ Females: 70–
▪ Thyroxine: A thyroid 80 beats per
hormone that also boosts minute
heart rate and ▪ Males: 64–72
contractility. beats per
2. Impact of Increased Heart Rate: minute
o Raises stroke volume, allowing ▪ Higher core body
more oxygenated blood to temperature in
circulate. females contributes to
o Essential for meeting the body’s a faster heart rate.
increased oxygen demands 2. Exercise:
during exercise. o Physical activity increases
3. Calcium's Role in Cardiac Function: heart rate to meet the body’s
o Calcium Ions: Crucial for heart oxygen demands.
muscle contraction. 3. Body Temperature:
▪ Low Calcium Levels: Can o Elevated body temperature
depress the heartbeat, (e.g., during fever) boosts
potentially leading to heart rate by increasing the
cardiac arrest. metabolic rate of heart cells.
▪ High Calcium Levels: Can o Expect increased heart rate in
cause prolonged febrile patients due to
contractions, risking heart heightened metabolic activity.
failure.

Factors Influencing Heart Rate

1. Physical Factors:
o Age:
▪ Infants and children
typically have faster
heart rates.
▪ Heart rate gradually
decreases as

26
 3. Heart Auscultation Areas:
o Aortic Area: Right side of the
sternum in the second
intercostal space (for listening
to the aorta).
o Pulmonic Area: Left side of
the sternum in the second
intercostal space (for listening
to pulmonary arteries).
o Erb's Point: Left side of the
sternum in the third
intercostal space (best for
listening to ventricles).
o Tricuspid Area: Left side of
the sternum in the fourth
intercostal space (for listening
to the tricuspid valve).
Examining the Heart: o Mitral Area: Left side of the
Auscultation sternum in the fifth intercostal
space at the midclavicular line
1. Definition: (to assess the mitral valve's
o Auscultation: A physical function).
examination technique used 4. Importance of Auscultation:
to listen to internal sounds of o Helps in assessing whether
the body, particularly the the heart valves are
heart, lungs, and functioning properly.
gastrointestinal system, using o Detects abnormal heart
a stethoscope. sounds or murmurs that
2. Stethoscope Components: indicate underlying cardiac
o Earpieces and Tubing: Basic conditions.
components for sound
transmission.
o Bell: Smaller part used for
low-pitched sounds (ideal for
Korotkoff sounds when
measuring blood pressure).
o Diaphragm: Larger part used
for normal and some
abnormal high-pitched
sounds.

27
 ▪ Cause: Closure of the
aortic and pulmonary
valves at the
beginning of diastole.
▪ Timing: Occurs at the
end of systole and the
beginning of diastole.
o S3 (Third Heart Sound):
▪ Description: Soft
sound, often
described as
"Kentucky."
▪ Significance: Not
normally heard in all
patients; typically
Heart Sounds and Their audible in children or
Significance pregnant women.
▪ Clinical Relevance: If
1. Definition of Heart Sounds: heard in adults, it may
o Heart Sounds: Audible indicate ventricular
rhythmic vibrations of the dysfunction.
heart, typically detected o S4 (Fourth Heart Sound):
through a stethoscope placed ▪ Description: Low-
on the chest or back during a pitched sound, often
diagnostic examination. referred to as
2. Types of Heart Sounds: "Tennessee."
o S1 (First Heart Sound): ▪ Significance: Usually
▪ Description: Low- inaudible in healthy
pitched, slightly individuals; may be
prolonged "lub." heard in cases of
▪ Cause: Closure of the ventricular
atrioventricular (AV) dysfunction or
valves (mitral and increased resistance
tricuspid) at the to filling.
beginning of systole.
▪ Timing: Occurs just
after the beginning of
systole.
o S2 (Second Heart Sound):
▪ Description: Higher-
pitched "dub."

28
 3. Clinical Importance of exchange of water, nutrients,
Auscultation: oxygen, and waste products
o Detection of Abnormalities: between blood and tissues.
Auscultation helps identify They connect arteries and
abnormal heart sounds, which veins.
can indicate issues with heart
valves or ventricular function. These vessels work together to ensure proper
o Regular Check-Ups: circulation and nutrient exchange within the
Healthcare providers body.
routinely auscultate the heart
during check-ups to assess Blood Vessel Function and Blood Flow
heart health and detect
potential problems. • Transportation of Nutrients: Blood
vessels work together to transport
nutrients to different organs in the
body.
• Blood Propulsion: As the heart
beats, it propels blood into the large
arteries, starting with the aorta.
• Branching into Arterioles: The
arteries branch into smaller blood
vessels called arterioles.
• Capillary Exchange: Arterioles drain
into capillaries, where the exchange
Blood Vessels of nutrients and waste occurs
between blood and tissues.
1. Types of Blood Vessels: • Return to the Heart: After the
o Arteries: Carry oxygenated exchange:
blood away from the heart to o Blood drains from capillaries
the body's tissues (except into venules.
pulmonary arteries, which o Venules merge into veins.
carry deoxygenated blood to o All veins eventually lead to the
the lungs). vena cava.
o Veins: Return deoxygenated • To the Heart: Blood then flows from
blood from the body tissues the vena cava into the right atrium
back to the heart (except of the heart, continuing the
pulmonary veins, which carry circulatory process.
oxygenated blood from the
lungs to the heart).
o Capillaries: Microscopic
vessels that facilitate the

29
Microcirculation Overview o Resulting tissue can become
hypoxic, meaning it
experiences decreased
oxygen levels.

Key Points

• Microcirculation is crucial for

delivering nutrients and oxygen to
tissues.
• Proper regulation of arteriole
constriction is essential for
maintaining adequate tissue
oxygenation.

• Definition: Microcirculation refers to

the flow of blood from an arteriole to
a venule through a capillary bed.
• Process:
o The terminal arteriole
branches into 10 to 20
capillaries.
o Blood flow in the capillary bed
is regulated by the
constriction of the terminal
arteriole.
• Gas and Nutrient Exchange:
o In the capillaries, nutrients
and gases are exchanged.
o This exchange occurs when
arterioles are dilated
(relaxed).
• Constricted Arterioles:
o If arterioles are constricted,
no exchange takes place.

30
Veins and Blood Return o Lack of muscle contraction
leads to increased pressure in
• Function: the legs, causing veins to
o Veins carry blood back to the dilate and blood to pool.
heart. • Risk Groups:
o Unlike arteries, veins do not o Employees in retail or grocery
have their own pump; they stores who stand for long
rely on other mechanisms for periods are particularly
blood return. susceptible.
• Valves:
o Larger veins contain valves to Key Points
prevent backflow of blood.
o Example: Femoral vein in the • Veins rely on skeletal muscle activity
legs. and respiratory pressure changes to
return blood to the heart.
Mechanisms Supporting Venous Return • Proper function of vein valves and
muscle contraction is crucial to
1. Skeletal Muscle Pump: prevent complications like varicose
o Action: As surrounding veins.
skeletal muscles contract (e.g.,
during walking or running), Microscopic Anatomy of Blood
they help "milk" blood
Vessels
through the veins toward the
heart.
o Importance: Prevents venous
blood pooling in the legs.
2. Respiratory Pump:
o Action: During inhalation and
exhalation, pressure changes
in the thoracic cavity assist in
pulling blood into the right
atrium.
o Effect: The pressure change
enhances venous return
during breathing.

Implications of Inactivity

• Varicose Veins:
o Caused by prolonged periods
of standing without
movement.

31
Three Main Layers:

1. Tunica Intima:
o Innermost layer, directly in
contact with blood.
o Composed of:
▪ Endothelium: A type
of squamous
epithelium.
▪ Loose Connective
Tissue: Provides
support.
o Smooth surface is essential
for reducing blood pressure.
o Contains Internal Elastic Differences Between Arteries
Lamina in arteries (absent in and Veins
veins) to support size
Feature Arteries Veins
changes.
Pressure Higher pressure Lower pressure
2. Tunica Media:
o Middle layer, thicker in Direction
Carry blood away Carry blood
arteries than in veins. of Blood
from the heart toward the heart
Flow
o Contains smooth muscle and
elastic fibers. Wall Thicker walls (due to
Thinner walls
o Responsible for regulating Thickness higher pressure)
blood pressure through Lumen
Smaller lumen Wider lumen
constriction and relaxation. Size
o External Elastic Lamina is Thicker tunica media
Tunica Thinner tunica
present in arteries (absent in (contains elastic
Media media
veins) to maintain shape after fibers)
dilation. Expand and stretch
Less elastic, more
3. Tunica Externa (Adventitia): Elasticity during systole, recoil
compliant
o Outermost layer composed of during diastole
collagen fibers. No valves (due to Valves present in
o Thicker in veins compared to Valves pressure from the larger veins to
arteries, providing structural heart) prevent backflow
support. Tunica Thinner tunica Thicker tunica
Externa externa externa

32
Key Points:

• Functionality:
o Arteries are designed to
withstand and accommodate
the high pressure of blood
being pumped from the heart.
The elastic fibers in the tunica
media allow for expansion
and recoil, which helps
maintain blood pressure
during diastole.
o Veins, on the other hand,
operate under lower pressure Capillaries
and need valves to assist
venous return against gravity, • Structure:
particularly in the legs. The o Thin Walls: Capillaries consist
thicker tunica externa of only one layer of
provides additional structural endothelial cells, making
support. their walls extremely thin.
• Blood Pressure Dynamics: o Red Blood Cells (RBCs): The
o Blood pressure in veins is micrograph typically shows
usually too low to effectively RBCs traveling through the
return blood to the heart, capillaries, highlighting their
especially when moving role in oxygen transport.
against gravity. The presence • Function:
of valves helps ensure o Exchange of Substances:
unidirectional flow back to the The thin walls of capillaries
heart, maintaining proper facilitate the efficient
circulation. exchange of substances (like
oxygen, nutrients, and waste
products) between blood and
tissues. This is essential for
microcirculation, where
blood flows from arterioles to
venules through capillary
beds.

33
Key Points: Gross Anatomy of Blood Vessels (Arteries)
Key Structures:
• The single-cell thickness of capillary
walls is crucial for diffusion, allowing 1. Great Vessels:
nutrients and gases to move freely in o Aorta: The main artery from
and out of the bloodstream. the heart that branches into
• Their structure is adapted for their various arteries.
primary role in the body’s 2. Cerebral Supply:
microcirculation, ensuring that all o Carotid Arteries: Supply
tissues receive adequate oxygen and blood to the brain.
nutrients while removing waste 3. Upper Limb Supply:
products effectively. o Subclavian Artery: Supplies
blood to the shoulder and
Gross Anatomy of Blood Vessels arm.
o Axillary Artery: Supplies
blood to the armpit and
upper arm.
o Brachial Artery: Supplies
blood to the upper arm.
o Radial and Ulnar Arteries:
Supply blood to the forearm
and hand.
4. Lower Limb Supply:
o Common Iliac Artery:
Branches into arteries
supplying the pelvis and legs.
o External Iliac Artery:
Supplies blood to the lower
limbs.
o Femoral Artery: Supplies
blood to the thigh.
o Popliteal Artery: Supplies
blood to the knee area.

34
 Key Veins in the Arms:

• Median Cubital Vein:

o This is the primary vein used
for venipuncture (drawing
blood) in the arms.
o Located in the antecubital
fossa (the crease of the
elbow).
• Ulnar Vein:
o Drains the ulnar side of the
forearm (medial aspect).
• Radial Vein:
o Drains the radial side of the
forearm (lateral aspect).
• Digital Veins:
o Located on the dorsum of
the hand.
o Can also serve as a site for
venipuncture if necessary.

Importance for Medical Technologists:

• Understanding the anatomy of veins

in the arms is crucial for performing
blood draws accurately and safely.
• Familiarity with these veins aids in
selecting appropriate sites for
Gross Anatomy of Blood Vessels (Veins) venipuncture, minimizing discomfort,
and reducing the risk of
Veins and Their Correspondence to complications.
Arteries
Summary:
• Veins are responsible for draining
blood from specific areas of the • Veins serve as counterparts to
body supplied by corresponding arteries, draining areas supplied by
arteries. corresponding arteries.
• Key veins in the arms, particularly the
median cubital vein, are essential for
medical technologists as they are
commonly used for blood collection.

35
Physiology of Circulation Summary:

• Monitoring arterial pulse and blood

pressure is essential for assessing
circulatory system efficiency. The
heart rate typically ranges from 60 to
100 beats per minute, influenced by
various physiological and emotional
factors.

Pressure Points for Pulse Measurement

1. Definition:
o Pressure points are locations
where arteries are close to the
body surface, allowing for
easy palpation of pulsations.
2. Clinical Significance:
o These points are crucial for
measuring heart rate and can
be compressed to stop blood
flow during significant blood
1. Arterial Pulse: loss (hemorrhage).
o Definition: Arterial pulses are 3. Common Pressure Points:
the result of the alternating o Common Carotid Artery:
expansion and recoil of an Located in the neck;
artery with each heartbeat, commonly used for pulse
creating a pressure wave. assessment.
o Significance: Pulses provide o Brachial Artery: Located in
important information about the upper arm; used for blood
the efficiency of the pressure measurement and
circulatory system. pulse counting.
2. Normal Heart Rate: o Radial Artery: Located at the
o Average Resting Heart Rate: wrist; commonly used for
70 to 76 beats per minute. assessing heart rate.
o Normal Range: 60 to 100 o Point of Maximal Impulse:
beats per minute. Auscultation of the heart to
o Factors Influencing Heart count heart rate.
Rate: 4. Example:
▪ Physical activity o In the event of a cut below the
▪ Postural changes brachial artery in the lower
▪ Emotional states arm, pressure applied to the

36
 brachial artery can help stop seconds and multiply by 4 to
the bleeding while allowing get the beats per minute.
for pulse assessment. o For those still learning to
differentiate between regular
Summary: and irregular heart rates, it’s
safer to count for 60 seconds
Pressure points facilitate pulse measurement to ensure accuracy.
and are critical in emergency situations to 4. Normal Heart Rate:
control bleeding. Common sites for pulse o A normal resting heart rate
assessment include the common carotid, ranges from 60 to 100 beats
brachial, and radial arteries. per minute.
o Bradycardia: Heart rate
below 60 beats per minute
(slow heart rate).
o Tachycardia: Heart rate
above 100 beats per minute
(fast heart rate).

Blood Pressure

• Blood pressure is the force exerted by

circulating blood on the walls of
blood vessels, particularly arteries, as
Measuring Pulse/Heart Rate the heart alternates between
contraction (systole) and relaxation
1. Common Site: (diastole).
o The radial pulse is most
Systolic and Diastolic Pressure:
commonly used for
measuring heart rate.
• Systolic Pressure:
2. Technique:
o The higher pressure in the
o Use the pads of your index
arteries during heart
and middle fingers to locate
contraction (systole).
the pulse.
o Often remembered as
o Avoid using your thumb, as
"systolic starts with S for sky"
it has its own pulse, which
(higher).
can lead to inaccurate
• Diastolic Pressure:
readings.
o The lower pressure in the
3. Counting Duration:
arteries during heart
o If the heart rate is regular,
relaxation (diastole).
you can count for 15

37
 o Remembered as "diastolic
starts with D for dirt" (lower).
Influencing Factors:
Measurement:
Cardiac Output:
• Blood pressure is measured in
millimeters of mercury (mmHg). • Increases with higher heart rate or
• It is reported as a fraction, with increased stroke volume (the amount
systolic pressure as the numerator of blood ejected with each
and diastolic pressure as the heartbeat).
denominator (e.g., 120/80 mmHg). • Affects blood pressure directly; as CO
increases, blood pressure tends to
Historical Context: rise.

• Blood pressure was traditionally Peripheral Resistance

measured using
sphygmomanometers filled with • the amount of friction or resistance to
mercury. flow the blood encounters as it flows
• Due to health concerns regarding through the blood vessels.
mercury, modern devices often use
aneroid sphygmomanometers, but Factors Influencing Peripheral Resistance:
the unit mmHg is still in common use.
• Blood Vessel Diameter:
Factors and Components Affecting Blood o The size of the blood vessel's
Pressure lumen (the hollow part
through which blood flows) is
Blood Pressure Equation: a significant factor.
o Vasoconstriction:
1. When blood vessels
constrict (narrow),
peripheral resistance
increases.
• Blood pressure is influenced by two
2. This results in higher
primary factors:
blood pressure as the
o Cardiac Output (CO): The
heart must work
amount of blood pumped by
harder to push blood
the left ventricle of the heart
through the narrower
per minute.
space.
o Peripheral Resistance (PR):
The friction or resistance that
blood encounters as it flows
through the blood vessels.

38
 o Vasodilation: peripheral resistance, thus
1. When blood vessels raising blood pressure.
dilate (widen),
peripheral resistance Blood Vessel Diameter
decreases.
2. This leads to lower 1. Principle of Diameter and Pressure:
blood pressure as the o The concept that applies to
blood flows more blood vessels is similar to a
easily through the fluid-filled pipe:
larger lumen. ▪ Smaller Diameter:
• Blood Viscosity: Increased resistance
o Refers to the thickness or results in higher
stickiness of blood. pressure for the same
o Higher Viscosity: volume of fluid
1. Increased levels of red (blood) flowing
blood cells or plasma through.
proteins can raise ▪ Larger Diameter:
blood viscosity. Decreased resistance
2. Thicker blood leads to lower
encounters more pressure for the same
resistance, resulting in volume of blood.
elevated blood 2. Atherosclerosis:
pressure. o In conditions like
o Lower Viscosity: atherosclerosis, where fatty
1. Diluted blood (fewer plaques block arteries, the
red blood cells or effective diameter of the
proteins) flows more blood vessels decreases.
easily, reducing o This results in increased
resistance and pressure within those arteries
lowering blood due to the restricted flow,
pressure. leading to potential
• Total Vessel Length: complications like
o The longer the total length of hypertension.
blood vessels, the greater the 3. Vasoconstriction:
resistance encountered. o Definition: The narrowing of
o As body weight increases, blood vessels, particularly
additional blood vessels are from the tunica media layer,
formed, which can lead to which reduces the lumen's
higher total vessel length. diameter.
o Increased vessel length o Causes of Vasoconstriction:
contributes to higher

39
 ▪ Epinephrine and o Higher Viscosity: Increased
Norepinephrine: resistance to flow, making it
These hormones are more difficult for blood to
released during stress move through the circulatory
(fight or flight system.
response), leading to o Lower Viscosity: Easier flow
vasoconstriction and of blood, requiring less
increased blood pressure to maintain
pressure. circulation.
▪ Cold Temperatures: 3. Analogy:
Cold exposure can o Water vs. Shake:
stimulate ▪ Water: Easy to sip
vasoconstriction to through a straw due to
conserve body heat. low viscosity.
▪ Blood Loss: In ▪ Fruit Shake: More
response to significant viscous, requiring
blood loss, more effort (suction)
vasoconstriction helps to move through a
maintain blood thinner straw,
pressure and directs analogous to how
blood flow to vital thicker blood requires
organs. greater pressure to
4. Clinical Implication: flow.
o For medical technologists, 4. Conditions Increasing Blood
understanding how Viscosity:
vasoconstriction affects blood o Hyperlipidemia: Elevated
flow is crucial during cholesterol and fat levels in
procedures like venipuncture. the blood can increase
o If a patient is anxious or viscosity, leading to higher
fearful, the blood vessels may peripheral resistance.
constrict, making it more o Dehydration: Reduced
difficult to access veins for plasma volume relative to red
blood draw. blood cells increases blood
viscosity, making it thicker
Blood Viscosity and more resistant to flow.

oBlood viscosity refers to the

thickness or stickiness of
blood, affecting how easily it
flows through blood vessels.
2. Impact on Blood Flow:

40
Blood Vessel Length pressures to maintain blood flow,
increasing the risk of hypertension
• Concept: Longer blood vessels create (high blood pressure), especially in
more resistance to blood flow. older adults.
• Analogy:
o Short Hose: A 1-meter hose Other Factors
requires less pressure to push
water through. Neural Factors:
o Long Hose: A 3-meter hose
requires significantly more • Sympathetic Nervous System:
pressure to achieve the same o Role: Activates the body's "fight
flow, analogous to longer or flight" response.
blood vessels needing higher o Vasoconstriction: When scared
pressure to maintain or in danger, this response leads
circulation. to vasoconstriction (narrowing of
blood vessels).
Blood Vessel Elasticity: ▪ Purpose: Redirects blood
flow to vital organs (brain,
• Healthy Arteries: heart, kidneys) to ensure
o Elastic arteries can expand to they receive adequate
absorb the pressure from the oxygen and nutrients
heart's contractions (systole) during stress.
and maintain blood flow
during relaxation (diastole). Diet:
• Arteriosclerosis:
o Definition: A condition where
• High Salt Intake:
o Can lead to increased blood
arteries become stiff and less
elastic due to calcification and pressure by causing the body to
hardening. retain more water, which raises
o Causes:
blood volume and pressure.
▪ Aging: Natural
Chemical Influences:
progression leading to
loss of elasticity.
• Alcohol:
▪ Poor Diet: High
o Moderate consumption can
cholesterol and
decrease blood pressure;
unhealthy eating
however, excessive intake may
habits can contribute
have the opposite effect.
to early-onset
• Histamine:
arteriosclerosis.
o Released during allergic
• Impact: Reduced elasticity means
reactions, it can cause blood
arterial walls must endure higher

41
 vessels to dilate, potentially angiotensin-converting
lowering blood pressure. enzyme (ACE) from the lungs.
• Nicotine:
o Found in cigarettes, it causes Actions of Angiotensin II:
vasoconstriction, leading to
increased blood pressure. • Vasoconstriction:
o Directly narrows the lumen of
blood vessels, increasing
blood pressure.
o Helps redirect blood flow
from less vital tissues to
essential organs (heart, brain,
kidneys) during low blood
volume states.
• Aldosterone Release:
o Stimulates the adrenal glands
to release aldosterone.
o Aldosterone's Role:
1. Increases kidney
Renal Factors Affecting Blood reabsorption of
Pressure sodium and water.
2. Reduces urine output,
Renin-Angiotensin System: conserving fluid to
counteract
• Components: Composed of renin dehydration and low
(from kidneys) and angiotensin (from blood pressure.
liver and brain).
• Trigger: Activated during a drop-in
blood pressure or fluid volume (e.g.,
dehydration, blood loss).

Process:

• Renin Release:
o The kidneys release renin,
which activates
angiotensinogen (produced
by the liver) into angiotensin I.
• Conversion to Angiotensin II:
o Angiotensin I is converted to
angiotensin II by the

42
 1. Decreased Blood Volume: • Sympathetic Response: Physical
o Stimulates the kidneys to activity and postural changes prompt
conserve water and salt. sympathetic activation, crucial for
o Results in increased blood maintaining blood pressure stability.
volume, which enhances • Chemical Factors: Certain
stroke volume (SV) and substances can exacerbate blood
cardiac output (CO). pressure through increased
2. Sympathetic Nervous System resistance and viscosity.
Activation:
o Exercise activates sympathetic
centers, leading to increased
heart rate and cardiac output.
o This elevation contributes to
increased blood pressure.
3. Postural Changes:
o Effect of Position: Blood
pressure tends to decrease
when lying down.
o Response to Standing Up:
Sudden changes (e.g.,
standing up) activate
baroreceptors in the neck and
brain, triggering
vasoconstriction to maintain
blood pressure.
4. Chemical Influences:
o Substances Causing
Vasoconstriction: Chemicals
like epinephrine and nicotine
can increase peripheral
resistance and blood
viscosity.
o Increased peripheral
resistance contributes to
elevated arterial blood
pressure.

Key Points:

• Fluid Conservation: Conserving fluid

increases blood volume and,
subsequently, blood pressure.

43
 By following these guidelines, you can ensure
an accurate blood pressure reading.

To estimate systolic blood pressure, follow

these steps:

1. Determine Usual Blood Pressure:

o If the patient knows their
usual blood pressure (e.g.,
120/80 mmHg), add 30
mmHg to the systolic value
(120 mmHg), resulting in an
inflation target of 150
mmHg.
To properly measure blood pressure, follow 2. Palpatory Method for First-Time
these steps: Patients:
o If it’s the patient's first blood
1. Position the Arm at Heart Level: pressure reading, use the
o Ensure the patient’s arm is at palpatory method to estimate
heart level by resting it on a the systolic pressure.
chair or table. o Palpate the Radial Artery:
2. Align the Inflatable Bladder: ▪ Use your fingers to
o The center of the inflatable feel the radial pulse on
bladder should be placed one wrist.
over the brachial artery. o Inflate the Cuff:
o Blood pressure cuffs often ▪ Inflate the cuff until
have an arrow labeled “artery” the radial pulse can no
to help position it correctly longer be felt.
over the brachial artery. ▪ Note the pressure at
3. Placement of the Cuff: which the pulse
o The lower edge of the cuff disappears (e.g., 110
should be approximately 2.5 mmHg).
cm (2 finger widths) above 3. Add 30 mmHg:
the antecubital fossa (the o After determining when the
crease in the elbow). radial pulse is no longer felt,
4. Secure the Cuff: add 30 mmHg to that value
o Ensure the cuff is snug and to set your target for
secure around the arm. measuring systolic pressure.
o Slightly flex the patient’s arm For example, if the pulse
at the elbow to improve disappears at 110 mmHg,
comfort and accuracy. inflate the cuff to 140 mmHg.

44
 o Slowly release the pressure
from the cuff and listen for the
4. Deflate the Cuff: first sound (systolic pressure)
o Deflate the cuff completely and the point at which the
and wait 15 to 30 seconds sounds disappear (diastolic
before proceeding to pressure).
measure blood pressure.

These steps ensure accurate estimation of

systolic pressure, especially for patients
unfamiliar with their baseline blood pressure.

To properly measure blood pressure using a

stethoscope, follow these steps:

1. Position the Stethoscope:

o Place the bell of the
stethoscope over the brachial
artery, which is located just
above the elbow crease
(antecubital fossa).
2. Choosing the Correct Side:
o Ensure that you’re using the
bell of the stethoscope, which
is designed for low-pitched
sounds.
3. Understanding the Sounds:
o When measuring blood
pressure, you will listen for
Korotkoff sounds, which are
low-pitched sounds created
as blood flows through the To identify the systolic blood pressure
artery when the cuff pressure accurately, follow these steps:
is released.
4. Inflate the Cuff: 1. Inflate the Cuff:
o Inflate the cuff to the o Inflate the cuff rapidly to the
predetermined systolic target level determined earlier
pressure (based on previous (e.g., 160 mmHg).
estimations), ensuring that 2. Deflate Slowly:
the stethoscope is in place to o Gradually deflate the cuff at a
capture the sounds. rate of 2 to 3 mmHg per
5. Deflate the Cuff Gradually: second. This allows you to

45
 carefully monitor the changes
in blood flow.
3. Listen for Korotkoff Sounds:
o As you deflate the cuff, listen
for the first sounds you hear
through the stethoscope.
These sounds indicate the
return of blood flow into the
artery after being occluded.
4. Identify the Systolic Pressure:
o The point at which you hear at
least two consecutive beats
(Korotkoff sounds) is
recorded as the systolic
blood pressure. For example,
if the first sounds are heard at
around 120 or 130 mmHg,
that is noted as the systolic
reading.
5. Note the Sounds:
o The sounds you hear are a
result of turbulent flow as
blood rushes back into the
artery. These sounds are
crucial for determining the
systolic pressure accurately.

To identify the diastolic blood pressure,

follow these steps:

1. Continue Deflating the Cuff:

o After noting the systolic
pressure, keep deflating the
cuff slowly.

46
 2. Listen for Sound Changes: o Indicates low blood pressure,
o As you deflate, listen carefully which may lead to symptoms
for the sounds through the like dizziness, fainting, or
stethoscope. The sounds will shock.
initially continue but will 2. Normotension:
gradually become muffled. o A normal blood pressure is
3. Identify the Disappearance Point: generally classified as systolic
o Continue listening until the pressure ranging from 90 to
sounds become completely 140 mmHg.
muffled and eventually o Indicates a healthy and stable
disappear. blood pressure level.
o To confirm this 3. Hypertension:
disappearance, keep deflating o Classified as a systolic blood
the cuff until the pressure pressure higher than 140
drops an additional 10 to 20 mmHg.
mmHg below the point o This condition can increase
where the sounds last the risk of heart disease,
occurred. stroke, and other health
4. Record the Diastolic Pressure: complications.
o Once no sounds are audible,
deflate the cuff completely to Hypertension Overview
zero. The point at which the
sounds disappeared is noted • Definition: Hypertension is defined
as the diastolic blood as high blood pressure, typically
pressure. greater than 140/90 mmHg.
5. Understanding the Flow: • Seriousness: It can lead to significant
o At diastolic pressure, the health complications if left untreated.
artery is no longer •
compressed, allowing blood
to flow freely without Complications of Hypertension
turbulence, which is why no
sounds are heard through the 1. Endothelial Damage:
stethoscope. o High pressure can damage
endothelial cells lining
To summarize the classifications of blood arteries and veins.
pressure: o Long-term damage may lead
to conditions such as:
1. Hypotension: ▪ Myocardial
o Defined as a systolic blood Infarction: Heart
pressure lower than 90 attack due to reduced
mmHg. blood flow.

47
 ▪ Aneurysms: increases resistance and blood
Weakened areas in pressure.
blood vessels that
may burst due to
constant high
pressure.
▪ Stroke: Increased risk
due to damage in
cerebral blood vessels.

Risk Factors for Hypertension

1. Older Age: Atherosclerosis becomes

more common with age.
2. Genetics: Family history of
hypertension increases individual risk.
3. Obesity:
o Increased body fat leads to
Pathophysiology of Hypertension
longer blood vessels, raising
pressure.
1. Genetic Influences:
o Fatty plaques can form in
o Family history is significant; if
blood vessels, narrowing their
both parents have
diameter and increasing
hypertension, the likelihood
pressure.
of developing it increases.
4. Physical Inactivity: Lack of exercise
2. Environmental Factors:
contributes to higher blood pressure.
o Environmental influences can
5. High Salt Diet:
mitigate genetic
o Salt retains water, increasing
predisposition.
blood volume and pressure.
o Healthy lifestyle choices (diet,
6. Excessive Alcohol Consumption:
sleep, exercise) can help
o While low amounts may lower
prevent hypertension even
blood pressure, excessive
with genetic risks.
intake can raise it.

Mechanisms
3. Pathophysiological Mechanisms:
• Fluid Retention: High salt intake
o Renal Sodium Homeostasis:
leads to water retention, increasing
▪ Inadequate sodium
blood volume and stroke volume,
excretion leads to
thus raising blood pressure.
sodium retention.
• Vessel Diameter: Narrowing of
blood vessels due to fatty plaques

48
 ▪ This causes an
increase in plasma and
extracellular fluid
(ECF) volume, raising
cardiac output.
o Vascular Constriction:
▪ Chronic stress can
trigger a constant
fight-or-flight
response, leading to
constricted arteries.
▪ This results in
increased vascular
reactivity, which raises
peripheral resistance.
o Smooth Muscle Growth:
▪ Genetic factors can
affect smooth muscle
structure and growth,
resulting in increased
vessel wall thickness. Atherosclerosis
▪ Thicker vessel walls
1. Definition:
decrease the lumen
o Atherosclerosis is the
size, further increasing
narrowing of blood vessels
total peripheral
due to the accumulation of
resistance.
fatty and fibrous deposits,
4. Overall Impact:
known as plaques, on the
o The combination of increased
vessel walls.
cardiac output and peripheral
2. Difference from Arteriosclerosis:
resistance leads to elevated
o Arteriosclerosis: Refers to
blood pressure, resulting in
the calcification of elastic
hypertension.
fibers in the arterial walls,
leading to hardening and loss
of elasticity.
o Atherosclerosis: Specifically
involves plaque buildup,
which is composed of fatty
tissues and other cellular
debris.
3. Pathophysiology:

49
 oNormal arteries have a larger o Outcome: Leads to coronary
lumen, allowing for better heart disease, which may
blood flow and lower result in:
pressure. ▪ Angina: Chest pain
o As plaques accumulate, the caused by reduced
lumen narrows, leading to: blood flow to the
▪ Increased Blood heart muscle, often
Pressure: The experienced during
narrowing increases physical exertion or
resistance, which stress.
raises blood pressure. 3. Carotid Artery Disease:
▪ Reduced Blood Flow: o Location: Plaque buildup in
Thicker arterial walls the carotid arteries located in
result in decreased the neck.
blood flow, limiting o Outcome: Decreased blood
oxygen and nutrient supply to the brain, increasing
delivery to tissues. the risk of:
4. Consequences: ▪ Transient Ischemic
o The diminished blood flow Attacks (TIAs):
can lead to various Temporary periods of
complications, including: symptoms similar to
▪ Ischemia (reduced those of a stroke.
blood supply) in ▪ Strokes: Permanent
tissues. loss of brain function
▪ Increased risk of heart due to a lack of blood
attacks and strokes supply.
due to obstructed 4. Peripheral Artery Disease (PAD):
blood flow. o Location: Blockages in
arteries that supply blood to
Effects of Atherosclerosis the legs.
o Outcome: Patients may
1. Blockage Consequences: experience:
o Atherosclerosis can lead to ▪ Claudication: Pain in
significant blockages in blood the legs during
vessels, affecting various physical activities,
organs and systems. such as walking, due
2. Coronary Heart Disease: to insufficient oxygen
o Location: Blockage in the reaching the muscles.
coronary arteries that supply 5. Chronic Kidney Disease:
blood to the heart. o Location: Blockages in the
arteries supplying blood to
the kidneys.

50
 o Outcome: Reduced blood o Worsening Effect: Diabetes
flow can lead to kidney can accelerate the
damage and eventually progression of
chronic kidney disease. atherosclerosis, further
contributing to cardiovascular
Causes of Atherosclerosis complications.

1. Plaque Formation: Reducing the Risk of Atherosclerotic

o Begins with damage to the Cardiovascular Disease (ASCVD)
inner lining of arteries,
allowing for the accumulation 1. Understand Your Risk:
of fatty deposits. o Utilize risk calculators
2. High Cholesterol and Triglycerides: available from organizations
o Source: Primarily derived like the American Heart
from a diet high in fatty and Association.
oily foods. o Be aware of family history
o Effect: Elevated levels (e.g., parents or siblings with
contribute to plaque hypertension, high
formation and can lead to cholesterol, or coronary artery
further endothelial damage. disease).
3. High Blood Pressure: 2. Adopt a Heart-Healthy Diet:
o Impact: Hypertension can o Focus on:
destroy endothelial cells over ▪ Fruits and vegetables
time, creating an environment ▪ Whole grains
conducive to plaque ▪ Legumes
development. ▪ Lean sources of
o Feedback Loop: protein (e.g., seafood
Atherosclerosis can and poultry)
exacerbate high blood o Limit:
pressure due to narrowed ▪ Full-fat dairy products
arteries. ▪ Red and processed
4. Smoking and Vaping: meats
o Role: Both smoking and 3. Exercise Regularly:
vaping significantly increase o Aim for a consistent exercise
the risk of atherosclerosis, routine to enhance
particularly in the aorta and cardiovascular health.
coronary arteries. 4. Eliminate Tobacco:
o Consequence: The presence o Prioritize complete cessation
of fatty deposits is more likely of tobacco products rather
near the heart, leading to a than just reducing usage.
higher risk of heart attack. 5. Limit Alcohol Consumption:
5. Diabetes:

51
 o Drink alcohol in moderation
or avoid it altogether.
6. Maintain a Healthy Weight: 2. Pathophysiology:
o Monitor weight in relation to o Ruptured Plaque: A ruptured
height to ensure it falls within cholesterol plaque from
a healthy range. atherosclerosis leads to a
7. Manage Existing Health blockage in the coronary
Conditions: arteries.
o Take prescribed medications o Oxygen Deprivation: The
for high cholesterol or blockage prevents oxygen
diabetes as directed to and nutrients from reaching
maintain overall health and the myocardium (heart
reduce cardiovascular risks. muscle), causing tissue death.
o Disruption of Conduction:
Acute Myocardial Infarction (Heart Damage to the myocardium
Attack) can also affect the heart's
conduction system, impeding
the transmission of electrical
signals necessary for muscle
contraction.
3. Consequences:
o If the conduction system is
compromised, neighboring
muscle tissues may not
receive signals to contract,
potentially leading to cardiac
arrest.
o This interruption in the heart's
ability to function effectively
can result in fatal outcomes.
4. Prevention:
o Emphasize a healthy lifestyle
and diet, as previously
discussed, to reduce the risk
1. Definition: of developing conditions that
o An acute myocardial can lead to acute myocardial
infarction (MI) is the medical infarction.
term for a heart attack,
characterized by the death of
myocardial tissue due to
restricted blood flow.

52