CARDIOVASCULAR SYSTEM

CVS includes heart and blood vessels. Heart pumps blood into blood vessels. Blood vessels circulate
the blood throughout the body.
ANATOMY OF HEART
Location
 Heart is a hollow cone shaped muscular organ, lies in the mediastinum.
 It is about 6cm thick, 12 cm long and 9cm wide at its base. It weighs about 250g in adult female and 300g
in adult male.
 The tip of the left ventricle forms the apex of the heart. Atria (mostly left atrium) of the heart forms the
base of the heart.
 Heart has different surfaces and borders (margins).
 The anterior surface is located deep to the sternum and ribs whereas the inferior surface rests on the
diaphragm.
 The right border faces the right lung. The left border also called the pulmonary border, faces the left lung.
Layers of heart
Heart wall consists of 3 layers,
Pericardium (outer layer)
Myocardium (middle layer)
Endocardium (inner layer)
1) Pericardium:
It is the membrane that surrounds and protects the heart. The pericardium consists of two layers:
 Fibrous pericardium
 Serous pericardium
a) Fibrous pericardium
Outer layer of pericardium, made up of tough, dense irregular connective tissue.
It prevents over stretching of the heart, provides protection and anchors the heart in the mediastinum.
b) Serous pericardium
The inner layer of pericardium. It is thinner, more delicate and consists of an outer parietal layer and
inner visceral layer, also called the epicardium.
The space between these two layers is called pericardial cavity which contains a thin lubricating watery
fluid called pericardial fluid, secreted by pericardial cells.
Pericardial fluid reduces friction between the layers of the serous pericardium as the heart moves.
Function: It provides a smooth, slippery texture to the outer most surface of the heart.
2) Myocardium
Middle layer of the heart wall, made up of the cardiac muscle tissue.
It is striated and involuntary in nature.
Function: It is responsible for pumping action of the heart.
3) Endocardium
Innermost layer of the heart wall.
It is a thin layer of endothelium overlying a thin layer of connective tissue.
Functions:
o It provides a smooth lining for the chambers of the heart and covers the valves of the heart.
o It also allows smooth flow of blood in the heart.
o The smooth endothelial lining minimizes surface friction as blood passes through the heart and blood
vessels.
 Chambers of the heart
 The heart has four chambers. The two superior receiving chambers are the atria and the two inferior
pumping chambers are the ventricles.
 The paired atria receive blood from blood vessels called veins while the ventricles eject the blood from the
heart into blood vessels called arteries.
 On the anterior surface of each atrium is a wrinkled pouch like structure called an auricle (resemble to a
dog’s ear).
 On the surface of the heart are a series of grooves, called sulci that contain coronary blood vessels and a
variable amount of fat.
Right atrium:
 It forms the upper right border of the heart, about 2–3 mm in thickness.
 It receives blood from 3 veins: the superior vena cava, inferior vena cava, and coronary sinus.
 The inside of the posterior wall is smooth; the inside of the anterior wall is tough due to the
presence of pectinate muscles.
 Between the RA and LA is a thin partition called the interatrial septum.
 An oval depression called the fossa ovalis is present in this septum
.
 Blood passes from the RA into the RV through a valve that is called the tricuspid valve (consists of three
leaflets or cusps).
 It is also called the right atrioventricular (AV) valve.
Right ventricle
 The RV is about 4–5 mm in thickness. The inside of the RV contains a series of ridges called trabeculae
carneae
 The tricuspid valve are connected to tendon called chordae tendineae which are connected to papillary
muscles.
 Between the RV and LV there is septum called the interventricular septum.
 Blood passes from the RV through the pulmonary valve into a large artery called the pulmonary trunk,
which divides into right and left pulmonary arteries and carries blood to the lungs for purification.
Left Atrium
 It forms most of the base of the heart, about 2-3mm in thickness
 It receives blood from the lungs through four pulmonary veins.
 Both the anterior wall and posterior walls are smooth.

 Blood passes from the LA into the LV through the bicuspid valve (consists of two leaf lets or cusps. It is
also called as mitral valve or left atrioventricular valve.
Left Ventricle
 The LV is the thickest chamber of the heart, about 10–15 mm in thickness.
 It forms the apex of the heart connected to chordate tendinae which in turn is connected to papillary muscles.
 Blood passes from the LV through the aortic valve into the aorta.
 Heart valves
 Special type of structure in heart that prevent the back flow of blood is known as valve.
 Valves are composed of dense connective tissue which is covered by endocardium.
 Valves are opened and closed in response to the contraction or relaxation of heart.
 They ensure the flow of blood in one direction and prevents its back flow.
 There are two groups of valves

1. Atrioventricular valve
- Its names indicate the location of valves, that is valves located between the atria and ventricles.
- Valves are cusp like structure
- During the ventricle contraction blood may not goes from ventricle to atrium because valve have special
type of opening and closing structure
- During the closing time papillary muscles are also contracted so it prevents the back flow of blood from
ventricles to atrium.
- It is mainly subdivided in to two types:
Tricuspid Valves (Right atrioventricular valve)
- This valve located between the right atrium and right ventricle.
- It consist three cups that’s why it is known as tricuspid valves.
Bicuspid Valves (Left atrioventricular valve or mitral valve):
- This valve located between the left atrium and left ventricle.
- It consist two cups so it is known as bicuspid valves also known as mitral valve
2. Semilunar valve
- Located in the two arteries leaving the heart.
- These valves consist three Semilunar (half moon like) cups.
It is further subdivided in to:
i) Pulmonary Semilunar valve:
 It passes the blood from right ventricle to pulmonary artery (lungs) during opening stage.
ii) Aortic Semilunar valve:
 It passes the blood from left ventricle to aorta during opening condition.
FUNCTIONS OF HEART
Heart performs multiple functions.
1. It pumps blood through four chambers (a pair of atria and ventricles) to carry out the functions of the
cardiovascular system.
2. Right side of the heart receives deoxygenated blood from the body tissues into the right atrium.

3. Left side of the heart receives oxygenated blood from the lungs into the left atrium.
4. It also facilitates the removal of waste products and carbon dioxide from the body by transporting
deoxygenated blood to the lungs where it gets purified.
BLOOD VESSELS- Arterial system and venous system of the heart
Blood vessels are close conducting vessels/ channels that help blood flow to and from the heart and also
allow the exchange of nutrients and debris in the body cells.
Structure of blood vessels
All the blood vessels (except capillaries) are made up of 3 layers or tunics:
I. Tunica intima / interna
 Innermost layer, closely contact with blood
 Composed of 3 components- endothelium, basement membrane, and internal elastic lamina.
a) Endothelium:
 Made up of single layer of flattened squamous epithelial tissues
 Forms inner lining of the heart and blood vessels
 Smooth surface of this layer facilitates efficient blood flow
b) Basement membrane:
 Made up of collagen fibres
 Provides tensil strength to the blood vessels and supportive base of endothelium
c) Internal elastic lamina:
 Made up of thin sheet of elastic fibres
 Allows the movement of material from tunica intima to tunica media
II. Tunica media:
 Made up of smooth muscle and elastic fibres.
 smooth muscle contraction help in regulation blood flow and blood pressure
III. Tunica externa/tunica adventitia:
 Outer most layer, Made up of fibrous connective tissue.
 Provide support and protection to blood vessels
 Direct contact with the surrounding tissues and helps to attach the blood vessels to tissues.
TYPES OF BLOOD VESSELS
Blood flows through the following blood vessels:
1. Aorta and arteries, 2. Arterioles, 3. Capillaries, 4. Venules, 5. Vein
Arterial system
Consists of the aorta, arteries and arterioles
 Aorta, arteries and arterioles
 Aorta is the largest artery, carry blood away from the heart and distribute it to various body tissues.
Divided into ascending aorta, arch of aorta and discending aorta.
 Thicker walls than veins due to the presence of thick tunica media.
 Arterioles: Small sized arteries that regulate blood flow into capillary networks.
 Aorta, arteries and arterioles have two laminae of elastic tissues:
i. External elastic lamina between tunica adventitia and tunica media
ii. Internal elastic lamina between tunica media and tunica intima
Capillaries
 Smallest blood vessels that allow exchange of substance between blood and interstitial fluid.
 Characterized by the presence of tunica interna only, 5-10μm in diameter.
Venous system
 Walls of the veins and venae cavae are made up of
Inner endothelium
Middle elastic tissues and smooth muscles
Outer fibrous connective tissue layer.
 In the veins and venae cavae, the elastic tissue is less but the smooth muscle fibers are more.
 From the capillaries, venous system starts and it includes venules, veins and venae cavae.6
Venules: The smallest blood vessels that carry blood from capillaries to veins. Diameter is about 20μ. They
are of two types: post capillary venules and muscular venules.
Veins
 Venules are continued as veins that carry blood to the heart. Diameter 0.5-3mm.
 Tunica interna and tunica media are thinner than arteries.
 Lack internal and external elastic lamina.
 Tunica externa is thicker than other two layers and made up of collagen and elastic fibres.
 Contain valves that regulate blood flow and volume.
 Veins form superior and inferior venae cavae, which have a diameter of about 30 mm.
 CIRCULATRY SYSTEM OF BLOOD THROUGH HEART:
1) Pulmonary circulation:
-In the body system, cells receive O2 from blood and give CO2 in to blood. So blood become
deoxygenate.
-These Deoxygenated blood reaches right atrium through Superior venacava, Inferior venacava and
coronary sinus.
-Right atrium flow this deoxygenated blood in to right ventricle with the help of tricuspid valves.
-Right ventricle pumps blood in to pulmonary trunk via pulmonary Semilunar valve.
-The pulmonary trunk divided in to right pulmonary artery and left pulmonary artery, the right pulmonary
artery gives blood to right lungs and left pulmonary artery gives blood to left lungs.
-These arteries then divides into capillaries around the air sacs in lungs.
-Exchange of gas occurs here where oxygen reaches blood and CO2 reaches the air.
-Oxygenated blood then reaches left atrium through pulmonary vein which then flows to left ventricle via
atrioventricular vlave (bicuspid)
-This then reaches body parts via aorta throgh aortic semilunar valve

2) Systemic Circulation:
 In the lungs blood become oxygenated means it gain O2 and loss CO2.
 Now, the oxygenated blood returns in to heart through pulmonary veins.
 Then pulmonary veins pass blood in to left atrium which pumps blood in to left ventricle with
the help of bicuspid valve.
 Then blood enters in to aorta with the help aortic semilunar valve.
 Finally, bloods flows in systemic circulation from aorta and reach near to each and every cells
of the body and gives O2 and take CO2.
 Again the deoxygenated blood flow trough pulmonary circulation.
 So systemic circulation is the blood vessels that supply oxyegenated blood throghout the body
parts except lungs
 It include all arteries and veins

3) Coronary Circulation:
Coronary arteries:
-It supplies the oxygenated blood to the heart.
-It arises from the ascending aorta and divided in to left and right coronary branches.
The left coronary artery:
-The left coronary artery pass inferior to left auricle and divided in to the anterior interventricular
and circumflex branches.
-The anterior interventricular branch or left anterior descending (LAD) arteries enter in to the
anterior interventricular sulcus and supplies oxygenated blood to the walls of both ventricles and the
interventricular septum.
-The circumflex branch lies in the coronary sulcus and distributes oxygenated blood to the walls of
the left ventricle and left atrium.
 The right coronary artery:
-The right coronary arteries branches supply blood to the right atrium.
-It continues inferior to the right auricle and divided in to the posterior interventricular and marginal
branches.
-The posterior interventricular branches enter in to the posterior interventricular sulcus and supply
the oxygenated blood in to two ventricles and the interventricular septum.
-The marginal branch in the coronary sulcus transports oxygenated blood tothe myocardium of the
right ventricle.
Coronary Vein:

 After delivering the oxygen and nutrients to the heart, the blood receives waste and
carbon dioxide.
 It then drains in to a large vascular sinus or coronary sinus on the posterior surface of the
heart.
 Coronary sinus empties deoxygenated bloods into the right atrium.

CARDIAC CYCLE
Cardiac cycle is defined as the series of events that takes place during each heartbeat. It features contraction
of atria and ventricles followed by their relaxation. The period of contraction is called systole and the period
of relaxation is called diastole. Average heart rate in adult is 75 beats/min. Therefore one cardiac cycle lasts
about 0.8sec.
Events of cardiac cycle:
Cardiac cycle consists of 4 events:
1. Atrial systole, 2. Ventricular systole, 3. Atrial diastole ,4. Ventricular diastole
1. Atrial systole
 It refers to contraction of atria which lasts for 0.1 sec.
 It is initiated by SA node depolarization which causes depolarization of atria leading to atrial contraction.
 As the atria contract, they eject blood into their respective ventricles. Each atrium ejects 25ml of blood
into the ventricle.
2. Ventricular systole It refers to contraction of ventricles, which lasts for 0.3sec.
 Ventricular depolarization initiates ventricular systole. It consist of two subevents:
a. Isovolumetric ventricular contraction period
 It lasts for 0.05sec. As ventricular systole starts, the AV and SL valves are closed due to increase in
ventricular pressure.
 The length of cardiac muscle fiber is constant during ventricular contraction (isometric). Since, all 4 valves
are closed, the volume of blood in each ventricle remains the same (isovolumic). This is the isovolumetric
contraction period.
b. Rapid ejection and slow ejection period
 During this period, ventricles contract, the pressure inside the ventricles to rise sharply.
 This causes rapid ejection of blood into their respective arteries leaving the heart. It is called rapid
ejection period, which lasts for about 0.15sec.
 As the pressure decreases, blood is ejected at a slower rate. This is called slow ejection period, which
lasts for 0.10sec.
3. Atrial diastole
 It refers to relaxation of atria, which lasts for 0.7 sec.
 After atrial systole, the atrial diastole starts. Simultaneously, ventricular systole also starts. (ie. When
ventricles are contracting, atria get relaxed).
 During this period, atria are filled with blood. AV valves remain closed and, myocardium prepare itself for
the next heartbeat. After this atria enter into systolic period.
4. Ventricular diastole
 It refers to relaxation of ventricles. It lasts for 0.5 sec.
 It occurs in response to ventricular repolarization. Simultaneously, atrial systole starts (ie. When atria are
contracting, ventricles get relaxed)
 It consists of following subevents:
a. Prediastolic period
 The first stage of ventricular diastole. It lasts for 0.04sec.
 During this period, blood tries to move back into respective ventricles. This is prevented by the sudden
closure of SL valves.
b. Isovolumetric relaxation period
 During this period, both AV and SL valves remain closed ie, heart relaxes completely during this period
and no blood pumped into the ventricles or arteries.
 It lasts for 0.08sec. Since all 4 valves are closed, the volume of blood in the ventricles remain same. Hence,
this period is called isovolumetric relaxation period.
c. Rapid filling period
 AV valves open and blood from atria is pumped into ventricles rapidly. It lasts for 0.05sec. (70% filling
takes place)
d. Slow filling period
 As the pressure in the atria decreases, blood is slowly pumped into the ventricles and called filling period.
 It lasts for 0.23 sec. (20% filling takes place).
e. Overlap period of ventricular diastole and atrial systole (Last rapid filling period)
 When the ventricular relaxation is about to stop, atrial contraction starts. This overlap of ventricular
diastole and atrial systole occurs for about 0.1 sec.
 Atria pumps blood into the ventricles rapidly.
 The above cycle of events for each heart beat is called cardiac cycle.
HEART SOUNDS
Heart sounds are the sounds produced by mechanical activities of heart during each cardiac cycle.
Auscultation is the act of listening to the heart sounds by means of a stethoscope. Heart sounds are
produced by:
1. Flow of blood through cardiac chambers
2. Contraction of cardiac muscle
3. Closure of valves of the heart.
During cardiac cycle, 4 heart sounds are produced in a normal heart but only two sounds can be heard
through a stethoscope.
1. First heart sound
2. Second heart sound
3. Third heart sound
4. Fourth heart sound.
1. First heart sound
It is heard during ventricular systole due to the closure of AV valves. Through stethoscope, it can heard as a
LUBB sound. It is louder, sharper, longer and easily distinguishable from other sounds.
2. Second sound
It is heard during ventricular diastole due to the closure of semilunar valves. Through stethoscope, it can be
heard as DUBB sound. It is softer and shorter than the first sound.
3. Third sound
It is produced during ventricular diastole due to the rapid flow of blood from atria to ventricles through AV
valves. This sounds is not loud enough to be heard through stethoscope.
4. Fourth sound
It is produced during atrial systole. Due to the active contraction of atria, rapid filling of ventricles occurs
thereby generating the fourth sound. Like third sound, fourth sound is also not audible enough to be heard
through stethoscope.
Heart sounds are heard over four cardiac areas on the chest wall
a) Mitral area: Sounds are heard over heart apex, 5th intercostal space at midclavicular line
b) Tricuspid area: left 5th intercostal space at left sternal border
c) Aortic area:2nd intercostal space at right sternal border
d) Pulmonary area: 2nd intercostal space at left sternal border
ELECTROCARDIOGRAM (ECG)
ECG is a graphical recording of electrical changes that occurs during each heartbeat due to the passage of
cardiac impulse. It is Graphical representation of electrical activity of heart. The instrument used to record
the electrical changes is called electrocardiograph.
WAVES OF NORMAL ECG
 ECG shows 5 characteristic waves: P, Q, R, S and T waves.
 P, R, T waves shows upward deflection (positive waves)
 Q and S waves shows downward deflection (negative waves)

1. P wave
It is a small upward deflection on the ECG. It represents atrial depolarization, which spreads from the SA
node through contractile fibers in both atria.
2. QRS complex
Begins as a downward deflection, continues as a large, upright, triangular wave, and ends as a downward
wave. It represents rapid ventricular depolarization, as the action potential spreads through AV bundle
and purkinjee fibres from AV node.
3. T wave
It is a dome-shaped upward deflection. It represents ventricular repolarization and occurs just as the
ventricles are starting to relax.
INTERVALS /SEGMENTS OF ECG
Time gap between the waves of an ECG is called interval /segments
 PQ intervals: Time gap between the starting of P wave and starting of QRS complex. It represents the
time required for the action potential to travel through the components of conduction system.
 Q-T interval: Time gap between starting of QRS complex and the end of the T wave. It represents the
time from the beginning of ventricular depolarization to the end of ventricular repolarization.
 S-T segment: Time interval between the end of the S wave and the beginning of T wave It represents
the ventricular depolarization time during the plateau phase of the action potential.
BLOOD PRESSURE
It is defined as lateral pressure exerted by the blood on the walls of BVs. The pressure is exerted when blood
flows through the arteries, so it is otherwise called as arterial blood pressure.
Normal value is 120/80 mmHg.
Arterial BP is expressed in four different terms:
1) Systolic blood pressure
2) Diastolic blood pressure
3) Pulse pressure
4) Mean arterial blood pressure
1) Systolic blood pressure (SBP): It is defined as the maximum pressure exerted in the arteries during
systole of heart.
Normal SBP: 120mmHg (110mmHg to 140 mmHg).
2) Diastolic blood pressure (DBP): It is defined as the minimum pressure exerted in the arteries during
diastole of heart.
Normal DBP: 80 mmHg (60 mmHg to 80 mm Hg).
3) Pulse pressure: Pulse pressure is the difference between the SBP and DBP.
Pulse pressure = SBP-DBP = 120 – 80 = 40
Normal pulse pressure=40mmHg
4) Mean arterial blood pressure: It is the average pressure existing in the arteries.
Mean arterial blood pressure = Diastolic pressure + 1/3 of pulse pressure
FACTORS AFFECTING BP
Some factors are necessary to maintain normal BP. These factors are called local factors, mechanical factors
or determinants of blood pressure.

i. Cardiac output
 It is the quantity of blood pumped by the heart in one minute.
 When C.O is increases, the systolic pressure is increased, when C.O is decreases the systolic pressure is
decreased.
 C.O is increases in muscular exercise, emotional conditions, etc.
 In conditions like myocardial infarction, the C.O decreases, resulting in fall in systolic pressure.
ii. Heart rate: Marked alteration in the heart rate affects the BP by altering C.O
iii. Peripheral resistance
 It is the resistance offered to the blood flow at the periphery. Resistance is offered at arterioles (resistant
vessels).
 PR maintains diastolic pressure. So Diastolic pressure is directly proportional to PR When PR
increases, DP is increased.
iv. Blood volume
 It is the total amount of blood in circulation.
 BP is directly proportional to blood volume. When BP increases BV is increased
v. Viscosity of Blood
 BP is directly proportional to the viscosity of blood.
 When viscosity of blood increases, the frictional resistance is increased and this increases the pressure.
vi. Elasticity of blood vessels
 BP is inversely proportional to the elasticity of blood vessels.
 Due to elastic property, the BVs are distensible and are able to maintain the pressure. When the elastic
property is lost, the BVs become rigid and pressure increases
vii. Diameter of blood vessels
 Arterial BP is inversely proportional to the diameter of BV.
 If the diameter decreases (narrowing of lumen), the peripheral resistance increases, leading to increase
in the BP
REGULATION OF BP
Arterial BP varies even under physiological conditions. Four regulatory mechanisms to maintain the blood
pressure within normal limits.
A. Nervous mechanism or short term regulatory mechanism
B. Renal mechanism or long term regulatory mechanism
C. Hormonal mechanism
D. Local mechanism
A. Nervous mechanism or short term regulatory mechanism
 When the pressure is altered, nervous system brings the pressure back to normal within few minutes.
Hence, it is called short term regulation.
 In nervous mechanism, regulation of BP through the vasomotor centres, it includes:
a. Baroreceptor mechanism
b. Chemoreceptor mechanism
 Baroreceptor mechanism
These are the receptors, give response to change in blood pressure. These are also called pressoreceptors,
which is situated in the carotid sinus and wall of the aorta

 Chemoreceptor mechanism
These are the receptors, giving response to change in chemical constituents of blood. ie,. Changes in blood
level of O2, CO2, and H.

B. Renal mechanism or long term regulatory mechanism

 The renal mechanism regulate BP slowly in several days/months/years. Hence, it is called long term
regulation.
 Kidneys regulate blood pressure by renin-angiotensin mechanism. (RAS)
C. Hormonal mechanism
Many hormones are involved in the regulation of BP.

D. Local mechanism for regulation of BP

The local substances regulate the BP by vasoconstriction or vasodilatation

DETERMINATION OF BP
BP is usually measured by an instrument called sphygmomanometer.
Methods used to measure BP:
1. Palpatory method 2. Auscultatory method
Principle
 Hydrostatic pressure exerted by the blood on the wall of the blood vessel is called BP.
 Contractions of ventricles generate BP. It is highest in the aorta and large systemic arteries.
 In a resting adult, BP increases to 120mmHg during systole and drops to about 80mmHg due to diastole
(ventricular relaxation)
1. Palpatory method
 The pressure cuff is wrapped around the upper arm above the elbow joint at the heart level.
 Feel the radial pulse at the wrist and inflate the rubber bag to increase the pressure up to 200mmHg till
pulse stops.
 Now deflate the cuff slowly, till one feels the reappearance of the radial pulse.
 The reading is recorded in the sphygmomanometer when the radial pulse restarts. This gives systolic BP.
2. Auscultatory method
 The pressure cuff is wrapped around the upper arm above the elbow joint at the heart level.
 Place the chest piece of stethescope over the brachial artery.
 Inflate the cuff rapidly pressure is raised to 200mmHg. The brachial artery gets occluded and no sounds
can be heard.
 Now gradually lower the cuff pressure till a sharp tapping sound is heard.
 The cuff pressure at which the sound is heard first, gives a measure of systolic BP
 The pressure in the cuff is further lowered, the sound becomes disappears. This gives diastolic BP.
 Express the BP as systolic BP/diastolic BP (mmHg). Take 2-3 readings.
DISORDERS OF CVS
VASCULAR DISORDERS
Hypertension
Hypotension
Atherosclerosis
CARDIAC DISORDERS
Myocardial infarction
Angina pectoris
Congestive heart failure
Cardiac arrhythmia
1. Hypertension: It is defined as an increase in arterial blood pressure above normal. BP is said to be
normal if the SBP is 120mmHg and DBP is 80mmHg. If the SBP is more than 150 mmHg and DBP is more
than 90 mm Hg, it is considered as hypertension.
2. Hypotension: It is defined as a decrease in arterial BP below normal ie, SBP is less than 100mmHg and
DBP is less than 60mmHg in adult.
3. Arteriosclerosis: it is the hardening or stiffening of artery walls

4. Atherosclerosis: It is the narrowing of arteries. This condition is mainly due to the deposition of fats
within the walls of arteries resulting in decreased blood supply to body parts. It is a type of arteriosclerosis
5. Angina pectoris: It is chest pain occurring due to reduced blood flow to the heart muscle (myocardial
ischemia). Myocardial ischemia occurs due to narrowing of coronary arteries
6. Myocardial infarction: It is the irreversible necrosis of heart muscle due to prolong ischemia. It occurs
when the vessel supplying the myocardium remains completely occluded from 15- 20minutes.
7. Congestive heart failure: It is defined as the inefficiency of the heart to pump sufficient amount of
oxygenated blood to the organs of the body to meet metabolic demands.
8. Cardiac arrhythmia: It refers to irregular heartbeat or disturbance in normal rhythm of the heart. It
occurs due to the abnormal impulse formation and conduction in the heart.