THE

CARDIOVASCULAR
SYSTEM contd

Dr. Cecelia Waugh-Hall

 About 83 % of the
population contain Rh factor
in their red blood cells i.e.
are Rh+

Why is an Rh incompatibility so
dangerous when ABO incompatibility
is not during pregnancy?
Most anti-A or anti-B antibodies are of the IgM

class (large molecules) and these do not cross

the placenta.
In fact, an Rh/type O mother carrying an
Rh+/type A, B, or AB foetus is resistant to
sensitisation to the Rh antigen.

Her anti-A and anti-B antibodies destroy any

foetal cells that enter her blood before they can
elicit anti-Rh antibodies in her.

Rh incompatibility during
pregnancy (cont.)
This phenomenon has led to an effective
preventive measure to avoid Rh
sensitisation.
Shortly after each birth of an Rh+ baby,
the mother is given an injection of anti-Rh
antibodies (or Rhogam).
These passively acquired antibodies
destroy any foetal cells that got into her
circulation before they can elicit an active
immune response in her.

Haemolytic Disease of the

Newborn (HDN) AKA
Erythroblastosis Foetalis or
Rhesus Disease
If not treated, the Rhesus antibodies
in the mother, after dealing with the
invading cells, may then pass back
across the placenta into the fetal
circulation, where they become
attached to the fetal red blood cells!

Hemolytic Disease of
the Newborn (HDN)
If blood from
Rh+ fetus
contacts Rhmother
during birth,
anti-Rh
antibodies are
made
Affect is on second Rh+ baby

Copyright 2009, John Wiley & Sons, Inc.

HDN may lead to

Jaundice - accumulation of
chemicals ('bile pigments')
formed by the breakdown of
haemoglobin
Enlarged liver and spleen.
In severe cases - tissue
swelling all over the body (fluid
leaking out of blood vessels).
Anaemia!

Blood Clotting

Haemostasis
Haemostasis is the balance between
bleeding and clotting (thrombosis). It
is achieved by the following
components in the blood:
1. Blood vessel wall
2. Platelets
3. Clotting proteins or factors
4. Fibrinolytic system
5. Naturally occurring anticoagulants.

Blood Clotting
Blood Clotting - complex series of
events involving the interaction of
the injured blood vessel, blood cells
called platelets, and over 20
differentproteinswhich also
circulate in the blood.
The mechanism itself follows a precise
order.

The purpose of the blood

clotting or coagulation
system is two-fold:

1. Keep blood in the fluid state such that

it circulates.

2. Prevent leakage of blood whenever

there is an injury to the blood vessel wall
or from normal wear and tear, by sealing
defects in the vessel wall or
endothelium.

Haemostasis
Injury to vessel
wall / endothelium

Vasoconstrictio
n

Platelets activated
Become adhesive

Coagulation
cascade
inactive
proenzymes
convert
to
active
enzymes

Fibrin & Platelet

Plug stops bleeding

Blood Clotting
Blood Clotting is one of three
mechanisms that reduce the
loss of blood from broken
blood vessels.
Vascular Spasm
Platelet Plug Formation
Blood Clotting
(Coagulation)

 Vascular Spasm- The smooth

muscle in blood vessel walls
contracts immediately the blood
vessel is broken. This response
reduces blood loss for some
time, while the other hemostatic
mechanisms become active.

 Platelet Plug Formation- When

blood platelets encounter a
damaged blood vessel they form a
"platelet plug" to help to close the
gap in the broken blood vessel. (The
key stages of this process are
calledplatelet adhesion,platelet
release reaction,andplatelet
aggregation).

Platelet
Plug
Formatio
n

Red blood cell

Red blood cell

Platelet
Platelet

Collagen fibers
Collagen fibers
and damaged
endothelium
and damaged

endothelium

Platelet adhesion

adhesion
1 Platelet
1
1

Liberated ADP,
Liberated ADP,
serotonin, and
serotonin, and
thromboxane A2

thromboxane A2

Platelet release
reaction

22 Platelet
22
release reaction

Platelet plug
33

Platelet aggregation

PLATELETS aka thrombocytes

Flattened, membrane-enclosed enzyme
packets
Formed from Megakaryocytes (mega =
big; karyon = nucleus)- gradually shed
their cytoplasm as platelets ~4000
- then nucleus is engulfed by phagocytes
for recycling
Platelets circulate for 10 12 days then
are removed by phagocytes in liver and
spleen

Histology of
Megakaryocyt
es and
Platelet
Formation

Figure 20.6

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Platelet activation also induces

large morphological changes
- membrane lipids rearrange
- phosphatidyl serine which is usually on the
inner membrane of the platelet,
flips out to outer membrane where it plays
a role in binding prothrombin.

phosphatidyl serine

unactivate

fully activated

 Thrombocytopenia <80,000/ul
indicates excessive platelet
destruction or inadequate
production
- bleeding along digestive tract, within the
skin, occasionally in the CNS

Thrombocytosis may exceed

1,000,000/ul accelerated
platelet formation
- infection, inflammation, or cancer

Blood Clotting
Blood clotting (coagulation) is the process
by which (liquid) blood is transformed into a
solid state.
This blood clotting is a complex process
involving many clotting factors (incl. calcium
ions, enzymes, platelets, damaged tissues)
activating each other.

Cascade of reactions in which each

clotting factor activates the next in a
fixed sequence resulting in fibrin

Haemostasis
Injury to vessel
wall / endothelium

Vasoconstrictio
n

Platelets activated
Become adhesive

Coagulation
cascade
inactive
proenzymes
convert
to
active
enzymes

Fibrin & Platelet

Plug stops bleeding

Blood Clotting
The three stages of this process
are:
Formation ofProthrombinase
Prothrombinconverted into
Thrombin
Fibrinogenconverted
toFibrin

Blood Clotting
1. Formation ofProthrombinase
Intrinsic System - initiated by liquid blood
making contact with a foreign surface Activators
are either in direct contact with blood or contained
within the blood (complex).

Extrinsic System - initiated by liquid blood making

contact with damaged tissue. Fewer steps than
intrinsic and occurs rapidly.
Tissue factor (TF) or thromboplastin leaks into the
blood from cells outside blood vessels.

(a) Extrinsic pathway

Tissue trauma

(b) Intrinsic pathway

Blood trauma
Damaged
endothelial cells
expose collagen
fibers

Tissue
factor
(TF)

Damaged
platelets

Activated XII
Activated
platelets

Ca2+

Ca2+

+
Platelet
phospholipids
Activated X
Activated X
V

Ca2+

Ca2+

V +

PROTHROMBINASE
(c) Common
pathway
Ca2+

Prothrombin
(II)

THROMBIN 2
Ca2+

XIII

Fibrinogen
(I)

Activated XIII

Loose fibrin
threads

STRENGTHENED 3
FIBRIN THREADS

Clotting
factors
Both Intrinsic and Extrinsic
System involve interactions
between CF.

- Soluble plasma proteins

- most made in liver

These coagulation factors

have individual names but are
often referred to by a
standardized set of Roman Numerals
-

Coagulation Factors
Factor Number
I
II
III
IV
Va
VII
VIII
IX
X
XI

Common Name
Fibrinogen
Prothrombin
Tissue Factor
Ca2+
Proaccelerin
Proconvertin
Antihemophilic Factor
Christmas Factor
Stuart Factor
Plasma thromboplastin

antecedent

XII

Hageman factor

Blood Clotting
2. Prothrombinconverted into the
enzymeThrombin
Prothrombinase (formed in stage 1.)
with Ca 2+ converts prothrombin,
which is a plasma protein that is
formed in the liver, into the
enzymethrombin.

Blood Clotting
3. Fibrinogen(soluble)
converted toFibrin(insoluble)
In turn, thrombin with Ca2+
converts fibrinogen (which is also a
plasma protein synthesized in the
liver) into fibrin.
Fibrin is insoluble and forms the
threads that bind the clot.

Blood Clotting

Structure of a Blood Clot

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

THE
CARDIOVASCULAR
SYSTEM -

Organs

How does this system work?

pulmonary
vein

lungs

pulmonary
artery

head & arms

aorta
main
vein

Right

Left
liver

digestive system
kidneys
legs

Cardiovascular System

Our Cardiovascular system is a

double-circulatory system.
Lungs

the right side

the left side

of the system

of the system

deals with

deals with

deoxygenate

oxygenated

d blood.

blood.

Body cells

The Heart
The heart is a cone-shaped, muscular
organ located between the lungs
behind the sternum.
The heart muscle forms the
myocardium, with tightly interconnect
cells of cardiac muscle tissue.
The pericardium is the outer
membranous sac with lubricating
fluid.

Location of Heart in Thorax

Larry M. Frolich, Ph.D.,Human

Anatomy

 The heart has four chambers: two upper,

thin-walled atria, and two lower, thickwalled ventricles.
The septum is a wall dividing the right
and left sides.
Atrioventricular valves occur between
the atria and ventricles the tricuspid
valve on the right and the bicuspid valve
on the left; both valves are reenforced by
chordae tendinae attached to muscular
projections within the ventricles.

The Heart
This is a vein. It
brings blood from the
body, except the
lungs.

2
atria
2
ventricles

These are arteries.

They carry blood
away from the
heart.

Coronary
arteries, the
hearts own
blood supply

The heart has four chambers

now lets look inside the heart

The Heart
Artery to Lungs
Vein from Head and
Body

Right
Atrium
tricuspid
valve

Right Ventricle

Artery to Head and Body

Vein from Lungs

Left Atrium
Semilunar
valve

Left Ventricle

Passage of Blood
Through the Heart
Blood follows this sequence through the
heart: superior and inferior vena
cava right atrium tricuspid
valve right ventricle pulmonary
semilunar valve pulmonary trunk
and arteries to the lungs
pulmonary veins leaving the lungs
left atrium bicuspid valve left
ventricle aortic semilunar valve
aorta to the body.

Path of blood through the

heart

How does the Heart work?

STEP ONE
blood from the
body

blood from
the lungs

The heart beat begins

when the heart muscles
relax and blood flows
into the atria.

How does the Heart work?

STEP
TWO
The atria then
contract and the
valves open to allow
blood into the
ventricles.

How does the Heart work?

STEP
The valves close to stop
THREE
blood flowing
backwards.
The ventricles contract
forcing the blood to
leave the heart.
At the same time, the
atria are relaxing and
once again filling with
blood.

The cycle then repeats

Blood from the heart gets

around
the body through blood
There are 3vessels
types of blood
vessels
a.

ARTERY

b.

VEIN

c.

CAPILLARY

Walls of Arteries and Veins

Tunica
externa
Outermost layer
CT w/elastin and
collagen
Strengthens, Anchors

Tunica media
Middle layer
Circular Smooth
Muscle
Vasoconstriction/dilation

Tunica

Larry M. Frolich, Ph.D.,Human Anatomy

 Epicardium (most
superficial)
Heart
Visceral pleura
Myocardium (middle layer) Wall
Cardiac muscle
How does
Contracts
heart muscle
Endocardium (inner)
get blood
Endothelium on CT
supply?
Lines the heart
Creates the valves

Larry M. Frolich, Ph.D.,Human

Anatomy

Blood supply to heart

wall
Rt and Lft Coronary Arteries
Branch from Ascending Aorta
Have multiple branches along heart
Sit in Coronary Sulcus
Coronary Heart Disease (CAD)
Cardiac Veins
Coronary Sinus (largest)
Many branches feed into sinus
Sit in Coronary Sulcus

Coronary artery
circulation

CAD

CAD

The ARTERY
Arteries carry blood away from
the heart.
the elastic fibres
allow the artery to
stretch under
pressure

thick muscle
and elastic
fibres

the thick muscle

can contract to
push the blood
along.

The Arteries
Arteries and arterioles take blood
away from the heart.
The largest artery is the aorta.
The middle layer of an artery wall
consists of smooth muscle that can
constrict to regulate blood flow and
blood pressure.
Arterioles can constrict or dilate,
changing blood pressure.

The

CAPILLARY

Capillaries link Arteries with

Veins
they exchange
materials
between the
blood and other
body cells.

the wall of
a capillary
is only one
cell thick

The exchange of
materials between
the blood and the
body can only
occur through

The Capillaries
Capillaries have walls only one cell
thick to allow exchange of gases and
nutrients with tissue fluid.
Capillary beds are present in all
regions of the body but not all capillary
beds are open at the same time.
Contraction of a sphincter muscle
closes off a bed and blood can flow
through an arteriovenous shunt that
bypasses the capillary bed.

Anatomy of a capillary
bed

The VEIN
Veins carry blood towards the
heart.

veins have valves

which act to stop
the blood from
going in the
wrong direction.

thin
muscle
and elastic

body muscles surround the

veins so that when they
contract to move the body,
they also squeeze the veins
and push the blood along

The Veins
Venules drain blood from capillaries,
then join to form veins that take
blood to the heart.
Veins have much less smooth
muscle and connective tissue than
arteries.
Veins often have valves that prevent
the backward flow of blood when
closed.
Veins carry about 70% of the bodys
blood and act as a reservoir during
hemorrhage.

Blood
vessels

Artery/Vein differences
Arteries (aa.)
Direction Blood Away from
of flow
Heart
Pressure Higher

Veins (vv.)
Blood to Heart
Lower

Lumen

THICKER: Tunica
media thicker than
tunica externa
Smaller

THINNER: Tunica
externa thicker
than tunica media
Larger

Valves

No valves

Valves (see next)

Walls

Larry M. Frolich,
Ph.D.,Human Anatomy

Blood Flow
The beating of the heart is
necessary to homeostasis
because it creates pressure that
propels blood in arteries and the
arterioles.
Arterioles lead to the capillaries
where nutrient and gas exchange
with tissue fluid takes place.

Blood Flow in Arteries

Blood pressure due to the pumping
of the heart accounts for the flow of
blood in the arteries.
Systolic pressure is high when the
heart expels the blood.
Diastolic pressure occurs when the
heart ventricles are relaxing.
Both pressures decrease with
distance from the left ventricle
because blood enters more and
more arterioles and arteries.

Cross-sectional area as it
relates to blood pressure
and velocity

Blood Flow in
Capillaries
Blood moves slowly in capillaries
because there are more capillaries
(smaller) than arterioles.
This allows time for substances to
be exchanged between the blood
and tissues.

Blood Flow in Veins

Venous BP alone is too low to
promote adequate blood return
Venous blood flow is dependent upon:
1) skeletal muscle contraction,
2) presence of valves in veins, and
3) respiratory movements.
Compression of veins causes blood to
move forward past a valve that then
prevents it from returning backward.

Factors Aiding Venous

Return
Respiratory pump pressure
changes created (thoracic & abdominal)
during breathing suck blood toward the
heart by squeezing local veins
Muscular pump contraction of
skeletal muscles milk blood toward
the heart
- Valves prevent backflow during venous
return

SUMMARY
Copy And Complete The Following;
away
Arteries take blood
______ from the heart. The walls of an
artery are made up of thick
_________ walls and elastic
muscula
r
fibres. Veins carry blood ________ the heart and also have
toward
s link arteries and veins, and have a
valves. The _________
capillarie
one
cell thick wall. Blood is made up of four main things
s

plasma
______, the liquid part of the blood; Red Blood Cells to
oxyge
carry ______; White Blood cells to protect
the body from
n
disease and _________ to help blood clot.platele
ts

Have a great
(productive)

weekend!