1. THE
CARDIOVASCULAR
SYSTEM

2. CONTENTS
 Introduction
 Circulatory system
 Diseases related to circulatory system
 Lymphatic system
 Diseases related to Lymphatic system
 Summary
 References

3. Introduction
 The cardiovascular system is divided for descriptive
purposes into two main parts.
• The circulatory system.
• The lymphatic system.
 The circulatory system consist of the heart, which acts
as a pump, the blood vessels and the blood.
 The lymphatic system consist of lymph nodes
the lymph vessels and the lymph.
 The two systems communicate with one another and
are intimately associated.

4. The circulatory system
 The heart pumps blood into two anatomically separate
systems of blood vessels.
• The pulmonary circulation.
• The systemic circulation.
 The right side of the heart pumps blood to the lungs(the
pulmonary circulation) where gas exchange occurs.
 The left side of the heart supplies the blood into
the systemic circulation, which supplies blood to
the rest of the body.

5. The blood vessels:
 The heart pumps the blood into
vessels that vary in structure, size and
function and there are several types:
Arteries, arterioles, capillaries, venules
and veins
The walls of the blood vessel are
made up of three layers of tissue:
•Tunica adventitia
•Tunica media
•Tunica intima

6. Control of blood vessel diameter
 When nervous activity is
increased the smooth muscle of
tunica media contracts and
thickens; this process is called
vasoconstriction.
 Decreased nerves stimulation
relaxes the smooth muscle
thinning the vessel wall and
enlarging the lumen . This
process is called
Vasodilatation.

7. The Heart:
 The heart is roughly cone-shaped
hollow muscular organ.
 The heart lies in the thoracic cavity in
the mediastinum (the space between the Courtesy
lungs).
 The heart is composed of three layers
of tissue;
• Pericardium: is made up of two sacs
the outer sac consist of fibrous tissue
and inner of a continuous double
layer of serous membrane.

8. • myocardium : is composed of specialized cardiac muscle
found only in heart.
• endocardium: This lines the chamber and valves of the
heart. It is a thin smooth glistening membrane that permits
smooth flow of the blood inside the heart.
 The heart is supplied with arterial blood by the right and left
coronary arteries, the arteries receive about 5% of blood
pumped from heart.

9. Interior of the heart
 The heart is divided into right and left
side by the septum.
 Each side is divided by an
atrioventricular valve into an upper
chamber, The atrium and a lower
chamber, The ventricle.
The right atrioventricular valve is
tricuspid valve and the left
atrioventricular valve is mitral valve.

10. The valves between the atria and ventricles open
and close passively according to changes in pressure
in chambers.
The opening of the pulmonary artery is guarded by
the pulmonary valve and the opening of aorta is
guarded by the aortic valve.

11. Conducting system of the heart
 Small group of specialized
neuromuscular cells in the myocardium
initiate and conduct impulses, causing
coordinated and synchronized
contraction of the heart muscle .
Sinoatrial node (SA node)
•Mass of specialized cells
•Lies in the wall of right atrium
•Is the pacemaker of heart
•Firing of SA node causes atrial
contraction.

12.  Atrioventricular node (AV node)
• situated in the wall of atrial septum near the
atrioventricularvalve
• conducts the impulse that arrive from SA node, passes it
through AV bundle and purkinje fibres which in turn convey
the impulse to the ventricle.

13. Pulmonary circulation and systemic circulation :
 In the pulmonary circulation the blood
circulates from the right ventricle of the heart
to the lungs and back to the left atrium.
In lungs, carbon dioxide is excreted and
oxygen is absorbed.
The pulmonary artery carries deoxygenated
blood to the lungs.
Two pulmonary veins leave each lung returning oxygenated blood to left atrium.
During the ventricular systole the blood is forced into aorta, the first artery of
general circulation which carries it to different organs of the body and returns to
right atrium by superior and inferior vena cavae.

14. Fetal circulation:

15. D ISORDERS OF THE
CIRCULATORY SYSTEM

16. Diseases of the blood vessels
 Atheroma : Atheromatous
plaques are patchy changes that
develop in tunica intima of arteries.
 Arteriosclerosis: progressive
degeneration of arterial walls,
associated with ageing. Atheroma Arteriosclerosis
 Varicose Veins: Veins bulge
with pools of blood when they fail
to circulate the blood properly.
These visible and bulging veins,
called varicose veins.
Varicose vein and spider vein

17. Diseases of heart
Myocardial infarction
Commonly known as a heart attack, is
the interruption of blood supply to a part
of the heart, causing heart cells to die.
 This is most commonly due to
occlusion (blockage) of a coronary
artery following the rupture of
a vulnerable atherosclerotic plaque, in the
wall of an artery.
The resulting ischemia(restriction in blood supply) and oxygen
shortage, if left untreated for a sufficient period of time, can cause
damage or death (infarction) of heart muscle tissue (myocardium)

18. Symptoms
chest anxiety pain, shortness of breath nausea, vomiting,
palpitations, sweating
Risk factors
Diabetes , Tobacco smoking, Hypercholesterolemia ,Low HDL
High Triglycerides, High blood pressure, Family history of ischaemic
heart disease ,Obesity, age, Stress and Alcohol

19. Diagnostic Test
ECG (Electrocardiogram)
An ECG is a simple test that detects and records the heart's
electrical activity. The test shows how fast the heart is beating and
its rhythm (steady or irregular). An ECG also records the strength
and timing of electrical signals as they pass through each part of
the heart.
Blood Tests
Commonly used blood tests include troponin tests, CK or CK–MB
tests, and serum myoglobin tests.
Coronary Angiography
Coronary angiography is a test that uses dye and special x rays to
show the insides of your coronary arteries. This test often is done
during a heart attack to help find blockages in the coronary
arteries.

20. Treatment
Certain treatments usually are started right away if a heart attack is
suspected, even before the diagnosis is confirmed. These include:
•Oxygen therapy
•Aspirin to thin the blood and prevent further blood clotting
•Nitroglycerin to reduce heart's workload and improve blood flow through
the coronary arteries
•Treatment for chest pain.
Once the diagnosis of a heart attack is confirmed or strongly suspected,
doctors start treatments to try to promptly restore blood flow to the heart. The
two main treatments are "clot-busting" medicines and angioplasty, a
procedure used to open blocked coronary arteries

21. Medicines
Beta blockers. Beta blockers decrease heart's workload.
ACE( angiotensin converting enzyme) inhibitors.
• ACE inhibitors lower blood pressure and reduce strain on heart.
• They also help slow down further weakening of the heart muscle.
Anticoagulants. Anticoagulants, or "blood thinners," prevent blood clots
from forming in arteries. These medicines also keep existing clots from getting
larger.
Anti clotting medicines. Anti clotting medicines stop platelets from
clumping together and forming unwanted blood clots. Examples of anti clotting
medicines include aspirin and clopidogrel.

22. Angioplasty
•Angioplasty is a nonsurgical procedure that opens blocked or narrowed
coronary arteries.
•A thin, flexible tube with a balloon or other device on the end is threaded
through a blood vessel to the narrowed or blocked coronary artery.
•Once in place, the balloon is inflated to compress the plaque against the wall
of the artery. This restores blood flow through the artery.
•During the procedure, a small mesh tube called a stent is put in the artery.
The stent helps prevent blockages in the artery in the months or years after
angioplasty.
Coronary artery bypass grafting (CABG)
• May be used to treat a heart attack. During CABG, a surgeon removes a
healthy artery or vein from body.
•The artery or vein is then connected, or grafted, to the blocked coronary
artery.
•The grafted artery or vein bypasses (that is, goes around) the blocked
portion of the coronary artery.
•This provides a new route for blood to flow to the heart muscle

23. Angina Pectoris
 Is chest pain or discomfort that occurs if an
area of heart muscle doesn't get enough oxygen-
rich blood.
 Angina may feel like pressure or squeezing in
chest. The pain also can occur in shoulders, arms,
neck, jaw, or back.
 Angina isn't a disease; it's a symptom of an underlying heart problem.
Angina pain may even feel like indigestion.
Angina usually is a symptom of coronary heart disease (CHD )
Types of Angina: stable, unstable, variant (Prinzmetal's), and microvascular.

24. Stable Angina
• It occurs when the heart is working harder than usual.
• Stable angina has a regular pattern
Unstable Angina
•Unstable angina doesn't follow a pattern
•Unstable angina also can occur with or without physical exertion, and
rest or medicine may not relieve the pain.
Variant (Prinzmetal's) Angina
•Variant angina is rare.
• A spasm in a coronary artery causes this type of angina.
•Variant angina usually occurs while at rest, and the pain can be
severe.
• It usually happens between midnight and early morning.
Microvascular Angina
•Microvascular angina can be more severe and last longer than other
types of angina.
• Medicine may not relieve this type of angina

25. Diagnostic Tests
EKG (Electrocardiogram)
Stress Testing
Chest X Ray
Coronary Angiography and Cardiac Catheterization
Blood Tests

26. Treatment
Nitrates :
For aborting or terminating angina attack , sublingual GTN (glyceryl trinitrate)
tablet or spray is taken.
The major action of nitrate is direct nonspecific smooth muscle relaxation.
Hence when there is an angina attack due to narrowing of coronary
artery, nitrates help the vascular smooth muscle to relax thereby dilating the
vessel and increasing the blood flow to that particular area.
The GTN tablet may be crushed under teeth and spread over buccal mucosa
It acts within 1-2 min because of direct absorption in the systemic circulation
bypassing the liver.

27. β Blockers:
Certain hormones such as epinephrine (adrenaline) non epinephrine
and other such hormones act on the β receptors of various body tissue
and produce stimulative effect.
The effect of these hormones on the heart is more forceful contraction
of the heart muscle.
β blockers are the agents that block the action of these hormones on
the receptors of the body tissue.
Thus leading to decrease heart rate, decrease force of contraction and
decrease cardiac output .
Examples of β blockers are metoprolol, propranolol etc.

28. Congestive Cardiac Failure
Is a condition in which the heart
can’t pump enough blood to meet
the body’s needs
 In some cases, the heart can’t fill
with enough blood. In other
cases, the heart can’t pump blood to
the rest of the body with enough
force
 Right-side heart failure occurs if the heart can’t pump enough
blood to the lungs to pick up oxygen. Left-side heart failure occurs
if the heart can’t pump enough oxygen-rich blood to the rest of
the body.

29. Right sided (congestive) failure:
•The right ventricle fails when the pressure developed within it is
less than the force needed to push blood through the lungs.
•When the ventricles is not emptying completely the right atrium
and vena cavae become congested with blood.
•The organs affected are liver, spleen kidney. Oedema of limbs
usually follows.
Left sided( left ventricular ) failure:
•This occurs when the pressure developed in the left ventricle by
the contracting myocardium is less than the pressure in the aorta
and the ventricle cannot pump out all the blood it receives.
•This leads to dilatation atrium increase in pulmonary blood
pressure and eventually to congestion in lungs leading to
pulmonary oedema.

30. Causes of Congestive Heart Failure
Coronary artery disease
High blood pressure (hypertension)
Longstanding alcohol abuse
Disorders of the heart valves
Unknown (idiopathic) causes, such as after recovery from
myocarditis
Less common causes include viral infections of the stiffening of
the heart muscle, thyroid disorders, disorders of the heart
rhythm, and many others.

31. Treatment
Digoxin:
These are glycosidic drugs having cardiac inotropic property i.e.
they increase the force of contraction of the myocardial muscle.
They increase the myocardial contractibility in failing heart without
proportionate increase in the oxygen consumption .
Since they increase the force of contraction there is more complete
emptying of the failing , dilated ventricles thereby increasing the
efficiency of the heart.

32. Diuretics:
Diuretics help in treating the symptoms of the CHF.
They help to keep the fluid from building up in lungs and other tissues by
promoting the flow of fluid through kidney thus preventing the pulmonary
oedema and oedema in any other parts of the body.
Examples of diuretics are furosemide(lasix),
bumetamide(bumex) etc.
Vasodilators __ ACE inhibitors, nitrates
β blockers ___ metorolol etc.

33. Following devices may be recommended for certain
patients with heart failure:
•A pacemaker to help treat slow heart rate or other signaling
problem.
•A biventricular pacemaker to help both side of heart contract
at same time.
Surgery and medication can repair underlying causes of
heart failure, however once the heart’s ability to pump blood
is severely, permanently impaired no surgery can repair the
damage, the only alternative remain is a heart transplant

34. Other disorders related to
heart includes
 Mitral valve stenosis
 Rheumatic heart disease
 Infective endocarditis
 Cardiac arrhythmias
 Congenital abnormalities

35. Diseases related to blood pressure
 Hypertension or high blood
pressure is a condition in which
the blood pressure in the
arteries is chronically elevated.
Blood pressure is the force of
blood that is pushing up against
the walls of the blood vessels.
If the pressure is too high, the heart has to work harder
to pump, and this could lead to organ damage and several illnesses
such as heart attack, stroke, heart failure, aneurysm, or renal failure.

36. The normal level for blood pressure is below 120/80, where
120 represents the systolic measurement (peak pressure in the
arteries) and 80 represents the diastolic measurement
(minimum pressure in the arteries).
Blood pressure between 120/80 and 139/89 is called
prehypertension (to denote increased risk of hypertension), and
a blood pressure of 140/90 or above is considered
hypertension.
Hypertension may be classified as essential or secondary.
•Essential hypertension is the term for high blood pressure with
unknown cause. It accounts for about 95% of cases.
•Secondary hypertension is the term for high blood pressure
with a known direct cause, such as kidney disease, tumors,
or birth control pills.

37. What causes hypertension?
Though the exact causes of hypertension are usually unknown, there are
several factors that have been highly associated with the condition. These
include:
•Smoking
•Obesity or being overweight
•Diabetes
•Sedentary lifestyle
•Lack of physical activity
•High levels of salt intake (sodium sensitivity)
•Insufficient calcium, potassium, and magnesium consumption
•Vitamin D deficiency
•High levels of alcohol consumption
•Stress
•Aging
•Medicines such as birth control pills
•Genetics and a family history of hypertension
•Chronic kidney disease
•Adrenal and thyroid problems or tumors

38. Treatment
ACE inhibitors- Captopril, enalapril. Ramipril.
Diuretics--- furosemide, amiloride.
Beta blockers– Metoprolol, propranolol
Vasodilators — Hydralazine
Calcium channel blockers--- Verapamil, Lacidipine

39. Clinical trial
Morphine In Acute Myocardial Infarction (MIAMI)
This study is currently recruiting participants.
Verified on January 2010 by French Cardiology Society
First Received on August 20, 2010. Last Updated on June 21, 2011
Sponsor French Cardiology Society
Institute National de la Santé Et de la
Collaborator:
Recherche Médicale, France
Information provided by: French Cardiology Society
ClinicalTrials.gov Identifier: NCT01186445
The purpose of this study is to determine
whether intracoronary injection of
morphine chlorhydrate is effective to limit
Purpose ischemia-reperfusion lesion during
percutaneous coronary angioplasty in
patients with acute myocardial infarction
(AMI).

40. Study Type: Interventional
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Study Design:
Masking: Double Blind (Subject, Caregiver,
Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Evaluation of the Cardioprotective Effect
of Intracoronary Injection of Morphine
Official Title:
During Reperfusion in Acute Myocardial
Infarction
Condition Acute Myocardial Infarction
Drug: morphine chlorhydrate
intervention
Drug: saline solution
Phase Phase III

41. The Lymphatic System
Components of lymphatic
system
 Lymph fluid
• Intermediary between blood
in capillary and tissues
 Lymphatic organs
• Lymph nodes
• Tonsils
• Spleen
• Thymus
 Lymph vessels

42. Functions of lymphatic system
 Returns excess interstitial fluid to circulatory
system
 Absorption of fat and fat soluble vitamins from
GI system
 Defense against invading pathogens and
disease

43. Lymph
 90% of fluid that leaves capillaries is returned
the 10% that does not return becomes part of the
interstitial fluid.
 Similar in composition to plasma
•Without erythrocytes and large protein molecules
•Contains lymphocytes, granulocytes, water,
respiratory gases, nutrients, hormones, ions, urea

44. Lymphatic Vessels
Not found in nails, hair.
 Form an extensive system that flows one way toward
the heart
 Several types of lymphatic vessels
• Lymphatic capillaries
• Lymphatic collecting vessels
•Lymphatic trunks
• Lymphatic ducts

45. Movement of Lymph
 There is no “pump” like in circulatory system
 Very low pressure
 Flow accomplished because of three factors
– Skeletal muscle pump
– Respiratory pump
– Valves prevent backflow
 Failure to move lymph results in accumulation of interstitial
fluid (edema)

46. Lymph Nodes
 Situated in between two lymphatic
collecting vessels are lymph nodes
 Nodes serve as filters to capture
foreign material or abnormal cells
(cancer)
 Site of lymphocyte production
 Can become inflamed/ engorged with infectious material
 Can be found in large clusters in inguinal, cervical, and axillae

47. Lymphoid Organ: Spleen
 Largest lymphoid organ
 Primary purpose is to
remove aged RBCs
 Provides a place to screen
for pathogenic agents
 Stores large amount of
RBCs that can be accessed
during periods of stress

48. Thymus
Found in superior mediastinum
 Produces lymphocytes
 Does not directly fight antigens
 Can be considered an endocrine
organ because it produces the
hormone thymosin.
Thymosin stimulates production of lymphoid cells
 Largest in infancy and early childhood
 Atrophys as we age

49. D ISORDER OF LYMPHATIC
SYSTEM
Lymphadentis: An inflammatory condition of the lymph nodes, usually
the result of systemic neoplastic disease, bacterial infection, or other
inflammatory condition. The nodes may be enlarged, hard, smooth or
irregular, red, and may feel hot.
Lymphangitis : An inflammation of one or more lymphatic
vessels, usually resulting from an acute streptococcal infection of one of the
extremities. It is characterized by fine red streaks extending from the
infected area to the axilla or groin, and by fever, chills, headache, and
myalgia. The infection may spread to the bloodstream.
 Lymphedema: A primary or secondary disorder characterized by the
accumulation of lymph in soft tissue and swelling, caused by
inflammation, obstruction, or removal of lymph channels
Splenomegaly: This is enlargement of the spleen usually due to
infection, circulatory disorders, blood disease etc.

50. Summary
Circulatory system
Cardiovascular system
Lymphatic system
The heart
Circulatory system The blood vessels
The blood
The lymph
Lymphatic system The lymphatic vessels
The lymphoid organs

51. Atheroma
Related to blood vessel , arteriosclerosis, varicose vein
Disorders of circulatory Myocardial infarction, angina
Related to heart
system pectoris, congestive heart
failure, mitral valve
stenosis, etc
Related to blood
pressure Hypertension and
hypotension
Lymphadentis Lymphangitis Lymphedema
Disorders of the lymphatic
system Splenomegaly

52. References
•Anne waugh, allison grant “Anatomy and physiology in health and
illness”10th edition .
•http://www.nlm.nih.gov/medlineplus/heartdiseases.html
•http://www.dherbs.com/articles/lymphatic-system-disorders
•http://en.wikipedia.org/wiki/Circulatory_system
•http://www.healthcare-online.org/Cardiovascular_Diseases.htm
•http://www.mayoclinic.com/health/heart-disease
• KD Tripathi “ essentials of medical pharmacology” 5th edition.