Comprehensive presentation on Cardiovascular system. It covers the Anatomy and Physiology of CV system. It covers the Related Terms i.e Cardiac Output etc It covers major diseases related to CV systems . .............YOU will FIND it USEFUL...................

1. Nouman Azmat Minhas
Senior Professional Services Representative
Pfizer Pakistan LTD.
Base Town - Rawalpindi
Presented By :-

4. Cardio  Heart
Vascular  Vessels
A system in which blood is pumped by
heart, and through vessels blood
circulates to all parts of body.

7. • Pulmonary Circulation:
Circulation takes place between the heart and
lungs.
• Coronary Circulation:
Blood circulates to the heart muscles
• Systemic Circulation:
Blood circulates from heart to all parts of the
body.

9. • – Pumps or pushes blood through body
• - Routes blood travels
• – Carries important “ * stuff * ” through
body
* Stuff – includes oxygen, food, & waste

11. The average adult has about FIVE liters of blood inside of
their body, which makes up 7-8% of their body weight.
Blood is living tissue that carries oxygen and nutrients to
all parts of the body, and carries carbon dioxide and other
waste products back to the lungs, kidneys and liver for
disposal. It also fights against infection and helps heal
wounds, so we can stay healthy.
There are about one billion red blood cells in two to three
drops of blood. For every 600 red blood cells, there are about
40 platelets and one white cell.

12. Blood temperature is about 38 C.
PH range is about 7.35 To 7.45 (slightly alkaline).

13. • Plasma
Liquid part of blood
• Red Blood Cells
They carry oxygen
to all parts of the
body

14. • White Blood Cells
Fight and kill
germs that may
enter your
bloodstream

15. • Platelets
–Form “scabs”
when you cut
yourself
–Helps stop the
bleeding

16. Blood Type
Antigen
on RBC
Antibodies
In Plasma
Can Receive
Blood From
Can Donate To
A A B O , A A , AB
B B A O , B B , AB
AB A , B
Neither
A nor B O, A,B,AB AB
O
Neither A
nor B
A , B O O,A,B,AB

17. • Scientists sometimes study Rhesus
monkeys to learn more about the human
anatomy because there are certain
similarities between the two species.
While studying Rhesus monkeys, a
certain blood protein was discovered.
This protein is also present in the blood
of some people. Other
people, however, do not have the protein.
• The presence of the protein, or lack of
it, is referred to as the Rh (for Rhesus)
factor.
• If your blood does contain the
protein, your blood is said to be Rh
positive (Rh+). If your blood does not
contain the protein, your blood is said to
be Rh negative (Rh-).
A+ A-
B+ B-
AB+ AB-
O+ O-

19. A blood transfusion is a procedure in which blood is given to a patient through an
intravenous (IV) line in one of the blood vessels. Blood transfusions are done to replace
blood lost during surgery or a serious injury. A transfusion also may be done if a person’s
body can't make blood properly because of an illness.
Who can give you blood?
People with TYPE O blood are called
Universal Donors, because they can give
blood to any blood type.
People with TYPE AB blood are called
Universal Recipients, because they can
receive any blood type.
Rh +  Can receive + or -
Rh -  Can only receive -
Universal Donor
Universal Recipient

21. Arteries and arterioles carry blood away from
heart
Capillaries site of exchange
Venules, veins return blood to heart

29. • Hollow, muscular organ
• 300 grams (size of a fist)
• found in chest between lungs
• 4 chambers
• surrounded by membrane called Pericardium
• Pericardial space is fluid-filled to nourish and
protect the heart.

30. • Hold out your hand and make a fist. If one is a kid, heart is
about the same size as the fist, and if one is an adult, it's
about the same size as two fists. the heart weighs a mere
300 grams.
• Heart beats about 100,000 times in one day, about 35
million times in a year and moves 7200 liters (1900 gallons)
of blood every day. During an average lifetime, the human
heart will beat more than 2.5 billion times.
• If we give a tennis ball a good, hard squeeze. We're using
about the same amount of force uur heart uses to pump
blood out to the body. Even at rest, the muscles of the heart
work hard--twice as hard as the leg muscles of a person
sprinting.

31. • Pumps blood through 62,000 miles of vessels
• Suffers 7.2 mil. CAD deaths worldwide each
year

33. • The heart is enclosed in a sac called
Pericardial Sac containing Pericardial
Fluid to provide protection to the Heart
• The Heart wall consist of three layers
–Endocardium
–Myocardium
–Epicardium

35. • Adjacent cardiac muscle cells connected by
intercalated discs
• Forms atrial and ventricular syncytia, action
potential spreads throughout myocardium so
atria contract as a single unit, ventricles
contract as a single unit (a fraction of a
second later)

37. • Myogenic: cardiac muscle cells can
contract without direct stimulation
from CNS
• Neurogenic: autonomic nervous system
can change heart rate

38. • Action potential
– Rapid depolarization (fast Na+ channels)
– Plateau phase (slow Ca+2 channels)
– Repolarization (slow K+ channels)
*plateau phase makes action potential in cardiac
muscle much longer (~300 msec) than action
potential in skeletal muscle (~100 msec)

40. • 4 valves, located in fibrous skeleton
between atria and ventricles
• 2 atrioventricular valves (AV valves)
– Right AV valve = tricuspid valve
– Left AV valve = bicuspid v. = mitral v.
• 2 semilunar valves
– Pulmonary semilunar valve
– Aortic semilunar valve

41. • Atrioventricular valves, prevent blood flowing
back into atria during ventricular contraction
• Tricuspid valve = right AV valve
• Bicuspid valve = mitral valve = left AV valve
• Attached to edges of AV valves are chordae
tendineae (dense regular CT)
• Papillary muscles pull on chordae tendineae
during ventricular contraction to hold valve
closed against the high pressure in the
ventricles

42. • Between ventricles and the large blood
vessels that leave the ventricles
(pulmonary trunk, aorta)
• 3 flaps each, no chordae tendineae or
papillary muscles needed

48. • The heart is two pumps that work
together, right (pulmonary) and left
(systemic) half
• Repetitive, sequential contraction (systole)
and relaxation (diastole) of heart chambers
• Blood moves through circulatory system
from areas of higher to lower pressure.
– Contraction of heart produces the
pressure

50. • Coronary circulation is the functional blood
supply to the heart muscle itself
• Collateral routes ensure blood delivery to
heart even if major vessels are occluded

53. • Heart contracts as a unit
• Atrial and ventricular syncytia help conduct
electrical signals through the heart
• Sinoatrial (S-A) node is continuous with atrial
syncytium
• S-A node cells can initiate impulses on their
own; activity is rhythmic

56. • Sympathetic and parasympathetic nervous
systems
• Parasympathetic: from medulla oblongata
(vagus nerve)
• Nerve branches to S-A and A-V nodes, and
secretes acetylcholine (slows rate)
• Parasympathetic activity can increase (slow
heart rate) or decrease (increase heart rate)

57. • Sympathetic nervous system
through celiac plexus to heart secretes
norepinephrine.
increases force of contractions
• Cardiac control center in medulla oblongata
maintains balance between the two
• Normally both sympathetic and parasympathetic
function at a steady background level

60. • 12 leads (3 bipolar and 9 unipolar)
• P wave – atrial depolarization – lasts 0.08s
(0.1s to atrial contraction)
• QRS complex – ventricular depolarization
– size dependant – lasts 0.08s
• T wave – ventricular repolarization – lasts
0.16s

62. • Enlarged R may be enlarged ventricles
• Flattened T may mean cardiac ischemia
• Prolonged Q-T interval may be ventricular
arrhythmias
• Absent or flattened P may be atrial
fibrillation
• No QRS with every P is “heart block”
(normally 1:1 whole number ratio)

63. SA node generates impulse;
atrial excitation begins
Impulse delayed
at AV node
Impulse passes to
heart apex; ventricular
excitation begins
Ventricular excitation
complete
SA node AV node Purkinje
fibers
Bundle
branches

65. • Generates blood pressure
• Routes blood
– Heart separates pulmonary and systemic
circulation
• Ensures one-way blood flow
– Heart valves ensure one-way flow

66. • Regulates blood supply
– Changes in contraction rate and force match blood
delivery to changing metabolic needs
– Most healthy people can increase cardiac output
by 300–500%
• Heart failure is the inability of the heart to
provide enough blood flow to maintain normal
metabolism

68. • Peripheral Resistance
• Cardiac Output
• Blood Pressure
• Heart Rate
• Stroke Volume
• Pre load
• After load
• Contractility

69. • The resistance exerted by walls of the arteries &
arterioles to passage of blood
• Total Peripheral Resistance (TPR) - the sum of all
forces that oppose blood flow
– Length of vasculature (L)
– Blood viscosity (V)
– Vessel radius (r)
TPR = ( 8 ) ( V ) ( L )
( Λ ) ( r 4 )

70. Cardiac Output: Volume of blood pumped
from the left ventricle per minute
Heart Rate: Number of times the heart
contracts per minute
Stroke Volume: Amount of blood pumped
out by the left ventricle per beat
Cardiac output =heart rate x stroke volume

72. BP = CO x PR
• Pressure exerted by blood on the
arterial walls
• A result of pumping action of heart
(CO) & resistance offered by
arteries to blood flow (PR)

73. • Systolic Blood Pressure (SBP)
pressure measured in brachial artery
during systole (ventricular emptying and
ventricular contraction period)
• Diastolic Blood Pressure (DBP)
pressure measured in brachial artery
during diastole (ventricular filling and
ventricular relaxation)

76. (EDV) volume of the left ventricle at the end of diastole
dependent on venous return & compliance (“stretch
ability”) of ventricle
Load on the heart created by volume of blood
injected into the LV by the LA, (I.e., at the end of
ventricular diastole) and that it must eject with
each contraction.

77. Resistance to ventricular emptying during systole or
The amount of pressure the left ventricle must generate to
squeeze blood into the aorta. In a healthy heart this is
synonymous with Aortic Pressure & Mean Arterial
Pressure (MAP)
Mean Arterial Pressure (MAP) "average" pressure
throughout the cardiac cycle against the walls of the
proximal systemic arteries (aorta)
estimated as: .33(SBP - DBP) + DBP

79. The squeezing contractile force that the heart can
develop at a given preload
Regulated by:
• Sympathetic nerve activity (most influential)
• Catecholamines (epinephrine norepinephrine)
• Amount of contractile mass
• Drugs

80. End Diastolic Volume (EDV)
Volume at the end of diastole
(end of ventricular filling). In a
healthy heart this is directly
proportional to venous return
End Systolic Volume (ESV)
Volume at the end of systole
(end of ventricular contraction)
Stroke Volume (SV) = EDV - ESV
Ejection Fraction (EF) = SV
EDV
Left ventricular norm for EF at Rest: approximately 62%
Left Ventricular norms for Max Exercise: approximately 80%
NOTE: Resting Ejection
Fraction (EF) is the best
indicator of both heart
performance and heart
disease prognosis

82. Control of renin secretion:
• Mechanical
• Ionic
• NE release
Plays a major role in the regulation of
hemodynamics and water and electrolyte
balance via its circulating hormone, angiotensin
II.
Renin: rate-limiting enzyme in angiotensin II production

83. Blood Pressure
Rises
Vasoconstriction
- +
A schematic portrayal of the homeostatic roles of the renin-angiotensin system
Blood Volume
Rises
Renin
Release
Na+ Retention
Aldosterone
Secretion
Na+ Depletion
Blood Volume
Falls
Blood Pressure
Falls
Angiotensin
Formation

84. Controls Body Fluid
Balance and Associated
Regulation Mechanisms and
Pathways

88. • 1. SMOKING
• 2. HYPERLIPIDAEMIA
• 3. HIGH SALT INTAKE
• 4. HOMOCYSTEINAEMIA
• 5. LACK OF EXERCISE
• 6. OBESITY
• 7. DIABETES
• 8. ALCOHOL
• 9. GENETIC

90. Chronically elevated blood pressure:
Systolic > 140 mmHg
Diastolic > 90 mmHg
90% of unknown cause – Essential Hypertension
Invariably associated with an increase in
peripheral resistance

91. Hypertension is a risk factor for atherosclerosis:
High B.P. damages the endothelial cells lining
blood vessels promoting formation of
atherosclerotic plaque
Extra strain on heart as must pump blood against
Increased peripheral resistance, LVH develops.
Eventually LV cannot meet work load - output
declines. If output from right side of heart remains
constant - pulmonary oedema develops, oxygen
exchange declines –
heart further weakened Congestive Heart Failure

94. • ACE inhibitors
• ATII antagonists
• Diuretics
• -adrenoceptor
blockers
• a1-adrenoceptor
blockers
• Ca2+ channel
blockers
MONOTHERAPY
• Centrally acting
antihypertensives
• Guanethidine
• Minoxidil
• Hydralazine
Drugs used only in
combination

95. Active molecules:
Captopril, Lisinopril, Enalaprilat
Prodrugs:
Enalapril, Benazepril, Fosinopril, Quinapril(Accupril),
Ramipril, Moexipril, Spirapril
Beneficial effects in:
Hypertension
CHF

96. • Hypotension
• Renal
insufficiency
• Cough
• Hyperkalemia
• Hyperreninemia
• Ageusia
• Skin rash
• Proteinuria
• Neutropenia

97. Losartan,Valsartan, Candesartan, *sartan
Non-peptide competitive inhibitors of AT1 receptors.
Block ability of angiotensins II and III to stimulate
pressor and cell proliferative effects.
 Antihypertensive effects
 Cell growth effects
 Lack of “bradykinin” effects
Renin Inhibitors

99. Sources: liver and diet
Uses in body: molecule from which steroid
hormones and bile manufactured,
component of cell membranes
Transport in blood:
high density lipoproteins (HDL)
low density lipoproteins (LDL)
(not VLDL--those are chylomicrons)

100. atheromas (smooth muscle cell proliferation)+sclerosis
(proliferation of fibrous connective tissue)
1. Injury to artery wall by invasion of LDLs, oxidized cholesterol,
free radicals, high blood pressure, chemicals from fat cells, or
bacterial-induced inflammation.
2. Endothelial cells recruit WBCs to site
3. WBCs attack LDL site and form fatty streak
4. Proliferation of smooth muscle cells and fibrous connective
tissue
5. Ca++ deposited and “hardens” vessel
6. Plaque= LDL, muscle cells, fibrous tissue, Ca++, WBCs

101. Artery less distensible due to plaque:
1. Reduced ability to produce nitric oxide
2. Ca++ makes plaque hard
3. Fibrous tissue less distensible than normal
And…
1. Blockage can reduce or cut off blood flow
2. Plaque’s rough edges can stimulate clot formation

104. Most strokes occur when arteries are
blocked by blood clots or by the gradual
build-up of plaque and other fatty deposits.
Some strokes can be caused by arteries
rupturing when weak spots on the blood
vessel wall break.

105. Stroke is the third most common
cause of death in developed countries.
It is higher in black African than in
Caucasian, more common in males
and uncommon below the age of 40
years.

106. • age >55 years
• Male
• Black
• Hypertension
• Diabetes
• a family history of stroke.

107. • Previous stroke
• High cholesterol
• High blood pressure
• heart disease
• atrial fibrillation
• Carotid artery disease

108. • Sudden numbness or weakness of the
face, arm or leg especially on one side of
the body
• Sudden confusion, trouble speaking or
understanding
• Sudden trouble seeing in one or both
eyes
• Sudden trouble walking, dizziness, loss of
balance or coordination
• Sudden severe headache with no known
cause.

110. • Also known as MI or Heart Attack
• It Is the nacrosis of an area of Heart tissue due
to an interrupted Blood supply.
• MI may result from a blood clot in one of the
coronary artery.

112. LOSS OF PUMPING
CORONARY THROMBOSIS
MYOCARDIAL INFARCTION

113. • Hypertension
• Angina Pectoris
• CHOLESTEROL
• Smoking
• Obesity
• Black
MYOCARDIAL INFARCTION
RISK FACTORS