CARDIOVASCULAR

SYSTEM

Bekti Safarini
 Cardiovascular system :
- Heart
- Blood vessels

Function of the system are :

- The delivery of oxigen and nutrients to the organs
and tissues of the body
- The removal of waste products from the organs
and tissues of the body
- Transport the hormones and the distribution of
heart around of the body
 The Heart
Muscular pumps which
pushes blood
around the body in the
blood vessels
The blood flows in the blood
vessels throughall the part
of the body carrying oxigen
and removing carbon dioxide
and waste products
Location of Heart in Thorax

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

HEART

1 Edge of superior vena

cava
2. Right atrium
3. Aortic arch
4. Edge of main
pulmonary artery
5. Left atrial appendage
6. Left ventricle
 Superimposed on the frontal view.
 The major structure is the heart.
 Pericardium and heart is inseparable on plain film views.
 Review the heart for overall size and shape.
 Rough yardstick - cardiac-thoracic ratio
 Widest diameter of the heart /widest width of the thoracic cage( inner
aspect of rib to rib).
 > 50%
 Check
 Calcifications
 Pneumopericardium
 Pneumomediastinum
 Sutures
 Prosthetic valves etc.,
 You may have overlooked on the general survey of the entire
mediastinum.
Lateral view of heart

1. Trachea
2. Right Ventricle
3. Left Ventricle
4. Left Atrium
5. Right Pulmonary
Artery
Aorta
Pulmonary artery
1. Carina
2. Left Main Stem
Bronchus
3. Descending Aorta
4. Main Pulmonary Artery
5.Aorticopulmonary
Window
6. Arch of Aorta
 Main pulmonary artery
 Straight or
 Convex (most commonly in young females).
 "middle mogul" - when convex
 Upper "mogul" - aortic knob
 Lower mogul - left ventricle.
 Left pulmonary artery- branching of main pulmonary artery
 Right pulmonary artery-
 Proximal- not seen, ( buried in the mediastinum)
 Branches can see ( as the right hilum)
Blood vesseles in the lung
Pulmonary arteries, Lateral view

1. Trachea
2. Right Ventricle
6 3. Left Ventricle
4. Region of left Atrium
5. Right Pulmonary Artery
6. Left Pulmonary Artery
Pulmonary artery

 Right pulmonary artery

 Ovoid branching structure- easily seen,
 Just anterior to the air column of the trachea and
main bronchi.
 Left pulmonary artery
 Never seen as clearly as the right
 Unless markedly enlarged.
 Curved shadow, similar to the aorta
 just behind the air column
The function of the heart
How does the heart work?
 The heart has 2 sides :
- Left side pumping at the same
time but work like
separate pumps
- right side
 Has 4 chambers :
- atrium on each side

- ventricle
 Has 2 stage:
- Sistole : when the ventricles arecontracting
- Diastole : when the ventricles are relaxing
 There are valves in the heart to stop the flowing
backwards
 The wall heart consists of 3 layers
 The heart muscle is supplied with by the coronary
arteries
 Cross section of the heart

The right side : is thin wall and pump blood out from the heart
lungs Pulmonary circulation
The left side : is thicker walls and pumps the blood  the rest of the
body  Systemic circulation
Two circulatory paths

Systemic

Pulmonary
The heart pumps blood in 2
stages
Stage 1 :
atrium (each side) fills with
blood (at same time) 
contract  the blood is forced
through valves  ventricles
Stage 2 :
ventricles are full  contract
forces the blood out of
ventricles  arteries
 the organs
The blood from the right side
 the lungs
The bloods from the left side
 organs and tissues of the body

The cardiac chambers,valves and circulation

 Each time the ventricles contract this can be felt as
pulse
 The heart valves closing after each stage of the
cardiac cycle can be heard as heart sound on listening
to the heart with stethoscope
 Normal pulse: 70 / minute
 But if any disease of heart affects the cycle the heart
rate may become either fast or slow or irreguler
 The heart has valve to stop the blood flowing
backwards
 There are valves between the atrium and ventricles
 When atrium contracts the valves openblood flow
into the ventricles
 When the ventricles contracts the valve closes 
the blood flows into the body rather than back into
the atrium
 The atrioventricular valves are
- Tricuspid valve : on the right side
- Mitral valve : on the left side
 The valves between the ventricles and
arteries are aortic and pulmonary valves
 If a heart valve becomes thickened and
stiff  the blood is no longer able to
flow freely through it  stenosis
 If a valve become leaky  backflow of
the blood regurgitation
 Both condition cause a turbulent flow 
a heart murmur
The heart has 3 layers
- The endocardium : inner layer
- The myocardium : muscular wall
- The pericardium : outer layer
• Epicardium (most superficial)
– Visceral pleura
Heart Wall
• Myocardium (middle layer)
– Cardiac muscle
– Contracts
• Endocardium (inner)
– Endothelium
How does heart muscle
– Lines the heart get blood supply?
– 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

• Cardiac Veins
– Coronary Sinus (largest)
– Many branches feed into sinus
– Sit in Coronary Sulcus

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

 Above is a diagram of the coronary arteries
 The blood supply to the heart is from the coronary
arteries
 The arteries which supply the heart branch from aorta
 If these arteries become diseased the heart may not receive enough oxygen
to function properly  chest pain
Heart Innervation

 Heart receives visceral motor

innervation
 Sympathetic (speeds up)
 Parasympathetic (slows down)

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

 Fetal Circulation
•No circulation to lungs
•Foramen ovale
•Ductus arteriosum
•Circulation must go to placenta
•Umbilical aa., vv.

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

 Adult remnants of fetal circulation

Adult Fetus
Fossa ovale Foramen ovale

Ligamentum arteriosum Ductus arteriosus

Medial umbilical ligaments Umbilical aa.(within fetus)

Round ligament (ligamentum teres) Umbilical v.(within fetus)

of liver

Ligamentum venosum Ductus venosus

Medial umbilical ligament Umbilical cord (leaving fetus)

 The Blood Vessels

 The other component of the cardiovacular system

 Carry the blood from the heart every cell in the body
 The artery:
- muscular with thick walls ant
- carry the blood away from heart
- almost always oxigenated
 The veins :
- thinner walled
- carry blood back towards the heart
- almost always deoxygenated
 Artery/Vein differences
Arteries (aa.) Veins (vv.)
Direction of Blood Away from Heart Blood to Heart
flow

Pressure Higher Lower

Walls THICKER: Tunica media THINNER: Tunica externa

thicker than tunica externa thicker than tunica media

Lumen Smaller Larger

Valves No valves Valves (see next)

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

Larry M. Frolich, Ph.D.,Human Anatomy
 Walls of Arteries and Veins
• Tunica externa
– Outermost layer
– elastin and collagen
– Strengthens, Anchors
• Tunica media
– Middle layer
– Circular Smooth Muscle
– Vaso-constriction/dilation
• Tunica intima
– Innermost layer
– Endothelium
– Minimize friction
• Lumen
 elastic arteries
large vein
muscular arteries
medium-sized vein
arterioles
venules
capillaries

Arteries – ALWAYS carry blood away from heart

Veins – ALWAYS return blood to heart,
contain about 2/3 body's blood at any given time
 Largest, conducting arteries – lead directly
from heart, subject to high pressures

Superior & inferior Pulmonary trunk & aorta

vena cava and their
tributaries and their major branches
  2 - 9 mm  ~ 4 mm
External and internal External and internal
jugular, brachial & carotids, brachial & femoral
femoral veins arteries
 ~ 10-50 µm  ~ 30 µm
GREAT VESSELS
•Aorta
•IVC, SVC
•Pulmonary Trunk
•Pulmonary Veins

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

Examination of Heart

 Chest x- ray
 Echocardiography
 Angiography
 Cardiac catheterization
 Doppler ultrasound
 Chest x -ray

Heart and great vessels on the PA view

Heart on the lateral view
Plain Film Radiography
 Heart size on PA chest—method utilized
most commonly
 Cardiothoracic ratio—an adult heart,

whose transverse cardiac diameter

measures more than half of the greatest
internal diameter of the chest, is
considered enlarged (radiologically the
transverse diameter is affected greater
than the vertical diameter).
 Cardiothoracic Ratio—Pitfalls
 Portable AP vs. PA films
 Depth of respiration—inspiration vs. expiration
 Thoracic deformity—pectus excavatum; in the elderly
 Pulmonary diseases that depress the diaphragm
(emphysema)
 Abdominal diseases that elevate the diaphragm
(hepatomegaly, ascites, pregnancy)
 Obesity
AP PA
Inspiration PA chest in the same patient as previous slide
Patients with chronic obstructive pulmonary disease (COPD) usually have a narrow heart due to the hyperinflated
lungs