Conduction System of the Heart

The conducting system of the heart consists of cardiac muscle cells and conducting fibers
(not nervous tissue) that are specialized for initiating impulses and conducting them rapidly
through the heart (see the image below). They initiate the normal cardiac cycle and
coordinate the contractions of cardiac chambers. Both atria contract together, as do the
ventricles, but atrial contraction occurs first.
The conducting system provides the heart its automatic rhythmic beat. For the heart to pump
efficiently and the systemic and pulmonary circulations to operate in synchrony, the events in
the cardiac cycle must be coordinated.

Heart Sound
Heart sounds are the
noises generated
by the beating heart
and the resultant
flow of blood through it. Specifically,
the sounds reflect
the turbulence created when the heart valves snap shut. In cardiac auscultation,
an examiner may use a stethoscope to listen for these unique and distinct
sounds that provide important auditory data regarding the condition of the heart.
In healthy adults, there are two normal heart sounds often described as a lub and
a dub (or dup), that occur in sequence with each heartbeat. These are the first
heart sound (S1) and second heart sound (S2), produced by the closing of the AV
valves and semilunar valves, respectively. In addition to these normal sounds, a
variety of other sounds may be present including heart murmurs, adventitious
sounds, and gallop rhythms S3 and S4.

Heart murmurs are generated by turbulent flow of blood, which may occur inside
or outside the heart. Murmurs may be physiological (benign) or pathological
(abnormal). Abnormal murmurs can be caused by stenosis restricting the
opening of a heart valve, resulting in turbulence as blood flows through it.
Abnormal murmurs may also occur with valvular insufficiency (regurgitation),
which allows backflow of blood when the incompetent valve closes with only
partial effectiveness. Different murmurs are audible in different parts of the
cardiac cycle, depending on the cause of the murmur.

Structure and Function: The Blood Vessels

The cardiovascular system includes three types of blood vessel: arteries, veins,
and capillaries. Placed end to end, they would circle the Earth nearly four times.
The smallest vessels, the capillaries, make up 98 per cent of this length. The
largest artery, the aorta,
emerges from the
heart and branches into a
network of
progressively smaller arteries
that carry blood to every part of
the body. The smallest
arteries join capillaries, which in
turn join a network of tiny
veins that merge into larger vein
as they return blood to the
heart.

Arteries inside the skull

This contrast X-ray shows the arteries that lie under the skull and supply blood to the back of
the brain.

Structure of a vein
Veins have thin walls that enable them to expand and hold large volumes of blood when the
body is at rest. Large veins contain one-way valves to stop blood from flowing the wrong
way.

The smallest vessels

Arteries branch into progressively smaller vessels (arterioles) that eventually join tiny
capillaries, which have walls that are only one cell thick. Capillaries join small veins
(venules), which gradually merge into larger veins.

Structure of an artery
Arteries have thick, muscular, elastic walls that can resist the wave of high-pressure blood
pumped with each heartbeat.
Bulk Flow: Filtration and Reabsorption
Capillary fluid movement may occur as a result of three processes:

diffusion (colloid osmotic pressure)

transcytosis

filtration

Starling's equation only refers to fluid movement across the capillary membrane that occurs
as a result of filtration. The Starling equation illustrates the role of hydrostatic and colloid
osmotic forces (the so-called Starling forces) in the movement of fluid across capillary
membranes. Modern evidence shows that in most cases venular blood pressure exceeds the
opposing pressure, thus maintaining a positive outward force. This indicates that capillaries
are normally in a state of filtration along their entire length.
The blood is filtered by nephrons, which are the functional units of the kidneys. Each
nephron begins in a renal corpuscle, which is composed of a glomerulus enclosed in a
Bowman's capsule. Cells, proteins, and other large molecules are filtered out of the
glomerulus by a process of ultrafiltration, leaving an ultrafiltrate that resembles plasma
(except that the ultra-filtrate has negligible plasma proteins) to enter the Bowman's space.
Filtration is driven by Starling forces.

Tubular Secretion
Tubular reabsorption is the process by which solutes and water are removed from the tubular
fluid and transported into the blood. It is called reabsorption (and not absorption) because
these substances have already been absorbed once (particularly in the intestines).
Reabsorption is a two-step process beginning with the active or passive extraction of
substances from the tubule fluid into the renal interstitium (the connective tissue that
surrounds the nephrons), and then the transport of these substances from the interstitium into
the bloodstream. These transport processes are driven by Starling forces, diffusion, and active
transport.