Respiratory System

Functions of the Respiratory System

1. Oxygen supplier. The job of the
respiratory system is to keep the body
constantly supplied with oxygen.
2. Elimination. Elimination of carbon
dioxide.
3. Gas exchange. The respiratory system
organs oversee the gas exchanges that
occur between the blood and the external
environment.
4. Passageway. Passageways that allow air
to reach the lungs.
5. Humidifier. Purify, humidify, and warm
incoming air.

Anatomy of the Respiratory System

The organs of the respiratory system include the nose, pharynx, larynx, trachea, bronchi, and their smaller
branches, and the lungs, which contain the alveoli.
Nose
•Nostrils. During breathing, air enters the nose by passing through the
nostrils, or nares.
•Nasal cavity. The interior of the nose consists of the nasal cavity, divided
by a midline nasal septum.
•Olfactory receptors. The olfactory receptors for the sense of smell are
located in the mucosa in the slitlike superior part of the nasal cavity, just
beneath the ethmoid bone.
•Respiratory mucosa. The rest of the mucosal lining, the nasal cavity
called the respiratory mucosa, rests on a rich network of thin-walled veins
that warms the air as it flows past.
•Mucus. In addition, the sticky mucus produced by the mucosa’s glands
moistens the air and traps incoming bacteria and other foreign debris, and
lysozyme enzymes in the mucus destroy bacteria chemically.
•Ciliated cells. The ciliated cells of the nasal mucosa create a gentle
current that moves the sheet of contaminated mucus posteriorly toward the
throat, where it is swallowed and digested by stomach juices.
•Conchae. The lateral walls of the nasal cavity are uneven owing to three
mucosa-covered projections, or lobes called conchae, which greatly
increase the surface area of the mucosa exposed to the air, and also increase
the air turbulence in the nasal cavity.
•Palate. The nasal cavity is separated from the oral cavity below by a
partition, the palate; anteriorly, where the palate is supported by bone, is the
hard palate; the unsupported posterior part is the soft palate.
•Paranasal sinuses. The nasal cavity is surrounded by a ring of paranasal
sinuses located in the frontal, sphenoid, ethmoid, and maxillary bones;
theses sinuses lighten the skull, and they act as a resonance chamber for
speech.
Pharynx
•Size. The pharynx is a muscular passageway about 13 cm (5 inches) long
that vaguely resembles a short length of red garden hose.
•Function. Commonly called the throat, the pharynx serves as a common
passageway for food and air.
•Portions of the pharynx. Air enters the superior portion, the
nasopharynx, from the nasal cavity and then descends through the
oropharynx and laryngopharynx to enter the larynx below.
•Pharyngotympanic tube. The pharyngotympanic tubes, which drain the
middle ear open into the nasopharynx.
•Pharyngeal tonsil. The pharyngeal tonsil, often called adenoid is located
high in the nasopharynx.
•Palatine tonsils. The palatine tonsils are in the oropharynx at the end of
the soft palate.
•Lingual tonsils. The lingual tonsils lie at the base of the tongue.

Larynx
The larynx or voice box routes air and food into the proper channels and plays a role in speech.
• Structure. Located inferior to the pharynx, it is formed by eight rigid hyaline cartilages and a spoon-shaped flap
of elastic cartilage, the epiglottis.
• Thyroid cartilage. The largest of the hyaline cartilages is the shield-shaped thyroid cartilage, which protrudes
anteriorly and is commonly called Adam’s apple.
• Epiglottis. Sometimes referred to as the “guardian of the airways”, the epiglottis protects the superior opening
of the larynx.
• Vocal folds. Part of the mucous membrane of the larynx forms a pair of folds, called the vocal folds, or true
vocal cords, which vibrate with expelled air and allows us to speak.
• Glottis. The slitlike passageway between the vocal folds is the glottis.

Trachea
•Length. Air entering the trachea or windpipe from the larynx travels
down its length (10 to 12 cm or about 4 inches) to the level of the fifth
thoracic vertebra, which is approximately midchest.
•Structure. The trachea is fairly rigid because its walls are reinforced with
C-shaped rings of hyaline cartilage; the open parts of the rings abut the
esophagus and allow it to expand anteriorly when we swallow a large piece
of food, while the solid portions support the trachea walls and keep it
patent, or open, in spite of the pressure changes that occur during breathing.
•Cilia. The trachea is lined with ciliated mucosa that beat continuously and
in a direction opposite to that of the incoming air as they propel mucus,
loaded with dust particles and other debris away from the lungs to the
throat, where it can be swallowed or spat out.

Main Bronchi
• Structure. The right and left main (primary) bronchi are formed by the division of the trachea.
• Location. Each main bronchus runs obliquely before it plunges into the medial depression of the lung on its own
side.
• Size. The right main bronchus is wider, shorter, and straighter than the left.
Lungs

• Location. The lungs occupy the entire thoracic cavity except for the most central area, the mediastinum, which
houses the heart, the great blood vessels, bronchi, esophagus, and other organs.
• Apex. The narrow, superior portion of each lung, the apex, is just deep to the clavicle.
• Base. The broad lung area resting on the diaphragm is the base.
• Division. Each lung is divided into lobes by fissures; the left lung has two lobes, and the right lung has three.
• Pleura. The surface of each lung is covered with a visceral serosa called the pulmonary, or visceral pleura and
the walls of the thoracic cavity are lined by the parietal pleura.
• Pleural fluid. The pleural membranes produce pleural fluid, a slippery serous secretion which allows the lungs
to glide easily over the thorax wall during breathing movements and causes the two pleural layers to cling
together.
• Pleural space. The lungs are held tightly to the thorax wall, and the pleural space is more of a potential space
than an actual one.
• Bronchioles. The smallest of the conducting passageways are the bronchioles.
• Alveoli. The terminal bronchioles lead to the respiratory zone structures, even smaller conduits that eventually
terminate in alveoli, or air sacs.
• Respiratory zone. The respiratory zone, which includes the respiratory bronchioles, alveolar ducts, alveolar
sacs, and alveoli, is the only site of gas exchange.
• Conducting zone structures. All other respiratory passages are conducting zone structures that serve as conduits
to and from the respiratory zone.
• Stroma. The balance of the lung tissue, its stroma, is mainly elastic connective tissue that allows the lungs to
recoil passively as we exhale.

The Respiratory Membrane

• Wall structure. The walls of the alveoli are composed largely of a single, thin layer of squamous epithelial cells.
• Alveolar pores. Alveolar pores connecting neighboring air sacs and provide alternative routes for air to reach
alveoli whose feeder bronchioles have been clogged by mucus or otherwise blocked.
• Respiratory membrane. Together, the alveolar and capillary walls, their fused basement membranes, and
occasional elastic fibers construct the respiratory membrane (air-blood barrier), which has gas (air) flowing past
on one side and blood flowing past on the other.
• Alveolar macrophages. Remarkably efficient alveolar macrophages sometimes called “dust cells”, wander in
and out of the alveoli picking up bacteria, carbon particles, and other debris.
• Cuboidal cells. Also scattered amid the epithelial cells that form most of the alveolar walls are chunky cuboidal
cells, which produce a lipid (fat) molecule called surfactant, which coats the gas-exposed alveolar surfaces and
is very important in lung function.
 Physiology of the Respiratory System
The major function of the respiratory system is to supply the body with oxygen and to dispose of carbon dioxide.
To do this, at least four distinct events, collectively called respiration, must occur.

Respiration
- Pulmonary ventilation. Air must move into and out of the lungs so that gasses in the air sacs are continuously
refreshed, and this process is commonly called breathing.
- External respiration. Gas exchange between the pulmonary blood and alveoli must take place.
- Respiratory gas transport. Oxygen and carbon dioxide must be transported to and from the lungs and tissue
cells of the body via the bloodstream.
- Internal respiration. At systemic capillaries, gas exchanges must be made between the blood and tissue cells.

Mechanics of Breathing
Rule. Volume changes lead to pressure changes, which lead to the flow of gasses to equalize pressure.
- Inspiration. Air is flowing into the lungs; chest is expanded laterally, the rib cage is elevated, and the
diaphragm is depressed and flattened; lungs are stretched to the larger thoracic volume, causing the
intrapulmonary pressure to fall and air to flow into the lungs.
- Expiration. Air is leaving the lungs; the chest is depressed and the lateral dimension is reduced, the rib cage is
descended, and the diaphragm is elevated and dome-shaped; lungs recoil to a smaller volume, intrapulmonary
pressure rises, and air flows out of the lung.
- Intrapulmonary volume. Intrapulmonary volume is the volume within the lungs.
- Intrapleural pressure. The normal pressure within the pleural space, the intrapleural pressure, is always
negative, and this is the major factor preventing the collapse of the lungs.
- Nonrespiratory air movements. Nonrespiratory movements are a result of reflex activity, but some may be
produced voluntarily such as cough, sneeze, crying, laughing, hiccups, and yawn.
Respiratory Volumes and Capacities
- Tidal volume. Normal quiet breathing moves approximately 500 ml of air into and out of the lungs with each
breath.
- Inspiratory reserve volume. The amount of air that can be taken in forcibly over the tidal volume is the
inspiratory reserve volume, which is normally between 2100 ml to 3200 ml.
- Expiratory reserve volume. The amount of air that can be forcibly exhaled after a tidal expiration, the
expiratory reserve volume, is approximately 1200 ml.
- Residual volume. Even after the most strenuous expiration, about 1200 ml of air still remains in the lungs and it
cannot be voluntarily expelled; this is called residual volume, and it is important because it allows gas exchange
to go on continuously even between breaths and helps to keep the alveoli inflated.
- Vital capacity. The total amount of exchangeable air is typically around 4800 ml in healthy young men, and this
respiratory capacity is the vital capacity, which is the sum of the tidal volume, inspiratory reserve volume, and
the expiratory reserve volume.
- Dead space volume. Much of the air that enters the respiratory tract remains in the conducting zone
passageways and never reaches the alveoli; this is called the dead space volume and during a normal tidal
breath, it amounts to about 150 ml.
- Functional volume. The functional volume, which is the air that actually reaches the respiratory zone and
contributes to gas exchange, is about 350 ml.
- Spirometer. Respiratory capacities are measured with a spirometer, wherein as a person breathes, the volumes
of air exhaled can be read on an indicator, which shows the changes in air volume inside the apparatus.

Respiratory Sounds
- Bronchial sounds. Bronchial sounds are produced by air rushing through the large respiratory passageways
(trachea and bronchi).
- Vesicular breathing sounds. Vesicular breathing sounds occur as air fills the alveoli, and they are soft and
resemble a muffled breeze.

External Respiration, Gas Transport, and Internal Respiration

1. External respiration. External respiration or pulmonary gas exchange involves the oxygen being loaded and
carbon dioxide being unloaded from the blood.
2. Internal respiration. In internal respiration or systemic capillary gas exchange, oxygen is unloaded and
carbon dioxide is loaded into the blood.
3. Gas transport. Oxygen is transported in the blood in two ways: most attaches to hemoglobin molecules inside
the RBCs to form oxyhemoglobin, or a very small amount of oxygen is carried dissolved in the plasma; while
carbon dioxide is transported in plasma as bicarbonate ion, or a smaller amount (between 20 to 30 percent of
the transported carbon dioxide) is carried inside the RBCs bound to hemoglobin.

Control of Respiration
Neural Regulation
- Phrenic and intercostal nerves. These two nerves regulate the activity of the respiratory muscles, the
diaphragm, and external intercostals.
- Medulla and pons. Neural centers that control respiratory rhythm and depth are located mainly in the medulla
and pons; the medulla, which sets the basic rhythm of breathing, contains a pacemaker, or self-exciting
inspiratory center, and an expiratory center that inhibits the pacemaker in a rhythmic way; pons centers appear to
smooth out the basic rhythm of inspiration and expiration set by the medulla.
- Eupnea. The normal respiratory rate is referred to as eupnea, and it is maintained at a rate of 12 to 15
respirations/minute.
- Hyperpnea. During exercise, we breathe more vigorously and deeply because the brain centers send more
impulses to the respiratory muscles, and this respiratory pattern is called hyperpnea.
- Non-neural Factors Influencing Respiratory Rate and Depth
- Physical factors. Although the medulla’s respiratory centers set the basic rhythm of breathing, there is no
question that physical factors such as talking, coughing, and exercising can modify both the rate and depth of
breathing, as well as an increased body temperature, which increases the rate of breathing.
- Volition (conscious control). Voluntary control of breathing is limited, and the respiratory centers will simply
ignore messages from the cortex (our wishes) when the oxygen supply in the blood is getting low or blood pH is
falling.
- Emotional factors. Emotional factors also modify the rate and depth of breathing through reflexes initiated by
emotional stimuli acting through centers in the hypothalamus.
- Chemical factors. The most important factors that modify respiratory rate and depth are chemical- the levels of
carbon dioxide and oxygen in the blood; increased levels of carbon dioxide and decreased blood pH are the most
important stimuli leading to an increase in the rate and depth of breathing, while a decrease in oxygen levels
become important stimuli when the levels are dangerously low.
- Hyperventilation. Hyperventilation blows off more carbon dioxide and decreases the amount of carbonic acid,
which returns blood pH to normal range when carbon dioxide or other sources of acids begin to accumulate in
the blood.
- Hypoventilation. Hypoventilation or extremely slow or shallow breathing allows carbon dioxide to accumulate
in the blood and brings blood pH back into normal range when blood starts to become slightly alkaline.
 Cardiovascular System
The Functions of the Heart
1. Managing blood supply. Variations in the rate and force of heart contraction match blood flow to the changing
metabolic needs of the tissues during rest, exercise, and changes in body position.
2. Producing blood pressure. Contractions of the heart produce blood pressure, which is needed for blood flow
through the blood vessels.
3. Securing one-way blood flow. The valves of the heart secure a one-way blood flow through the heart and
blood vessels.
4. Transmitting blood. The heart separates the pulmonary and systemic circulations, which ensures the flow of
oxygenated blood to tissues.

Anatomy of the Heart

The cardiovascular system can be compared to a muscular pump equipped with one-way valves and a system of
large and small plumbing tubes within which the blood travels.

Heart Structure and Functions

The modest size and weight of the heart give few hints of its incredible strength.

Weight. Approximately the size of a person’s

fist, the hollow, cone-shaped heart weighs
less than a pound.
Mediastinum. Snugly enclosed within the
inferior mediastinum, the medial cavity of the
thorax, the heart is flanked on each side by the
lungs.
Apex. It’s more pointed apex is directed
toward the left hip and rests on the diaphragm,
approximately at the level of the fifth
intercostal space.
Base. Its broad posterosuperior aspect, or
base, from which the great vessels of the body
emerge, points toward the right shoulder and
lies beneath the second rib.
Pericardium. The heart is enclosed in a
double-walled sac called the pericardium and
is the outermost layer of the heart.
Fibrous pericardium. The loosely fitting
superficial part of this sac is referred to as the
fibrous pericardium, which helps protect the
heart and anchors it to surrounding structures
such as the diaphragm and sternum.
Serous pericardium. Deep to the fibrous
pericardium is the slippery, two-layer serous
pericardium, where its parietal layer lines the
interior of the fibrous pericardium.
Layers of the Heart
The heart muscle has three layers and they are as follows:
1. Epicardium. The epicardium or the visceral and outermost layer is actually a part of the heart wall.
2. Myocardium. The myocardium consists of thick bundles of cardiac muscle twisted and whirled into ringlike
arrangements and it is the layer that actually contracts.
3. Endocardium. The endocardium is the innermost layer of the heart and is a thin, glistening sheet of
endothelium hat lines the heart chambers.

Chambers of the Heart

The heart has four hollow chambers, or cavities: two atria and two ventricles.
• Receiving chambers. The two superior atria are primarily the receiving chambers, they play a lighter role in the
pumping activity of the heart.
• Discharging chambers. The two inferior, thick-walled ventricles are the discharging chambers, or actual pumps
of the heart wherein when they contract, blood is propelled out of the heart and into the circulation.
• Septum. The septum that divides the heart longitudinally is referred to as either the interventricular septum or
the interatrial septum, depending on which chamber it separates.
Associated Great Vessels
The great blood vessels provide a pathway for the entire cardiac circulation to proceed.
• Superior and inferior vena cava. The heart receives relatively oxygen-poor blood from the veins of the body
through the large superior and inferior vena cava and pumps it through the pulmonary trunk.
• Pulmonary arteries. The pulmonary trunk splits into the right and left pulmonary arteries, which carry blood to
the lungs, where oxygen is picked up and carbon dioxide is unloaded.
• Pulmonary veins. Oxygen-rich blood drains from the lungs and is returned to the left side of the heart through
the four pulmonary veins.
• Aorta. Blood returned to the left side of the heart is pumped out of the heart into the aorta from which the
systemic arteries branch to supply essentially all body tissues.
Heart Valves
The heart is equipped with four valves, which allow blood to flow in only one direction through the heart
chambers.

•Atrioventricular valves. Atrioventricular or AV valves

are located between the atrial and ventricular chambers
on each side, and they prevent backflow into the atria
when the ventricles contract.

•Bicuspid valves. The left AV valve- the bicuspid or

mitral valve, consists of two flaps, or cusps, of
endocardium.

•Tricuspid valve. The right AV valve, the tricuspid

valve, has three flaps.

•Semilunar valve. The second set of valves, the

semilunar valves, guards the bases of the two large
arteries leaving the ventricular chambers, thus they are
known as the pulmonary and aortic semilunar valves.
Cardiac Circulation Vessels
Although the heart chambers are bathed with blood almost continuously, the blood contained in the heart does not
nourish the myocardium.
• Coronary arteries. The coronary arteries branch from the base of the aorta and encircle the heart in the
coronary sulcus (atrioventricular groove) at the junction of the atria and ventricles, and these arteries are
compressed when the ventricles are contracting and fill when the heart is relaxed.
• Cardiac veins. The myocardium is drained by several cardiac veins, which empty into an enlarged vessel on the
posterior of the heart called the coronary sinus.

Blood Vessels
Blood circulates inside the blood vessels, which form a closed transport system, the so-called vascular system.
• Arteries. As the heart beats, blood is propelled into large arteries leaving the heart.
• Arterioles. It then moves into successively smaller and smaller arteries and then into arterioles, which feed the
capillary beds in the tissues.
• Veins. Capillary beds are drained by venules, which in turn empty into veins that finally empty into the great
veins entering the heart.
Tunics
Except for the microscopic capillaries, the walls of the blood vessels have three coats or tunics.
1.Tunica intima. The tunica intima, which lines the lumen, or
interior, of the vessels, is a thin layer of endothelium resting on a
basement membrane and decreases friction as blood flows through
the vessel lumen.
2.Tunica media. The tunica media is the bulky middle coat which
mostly consists of smooth muscle and elastic fibers that constrict or
dilate, making the blood pressure increase or decrease.
3.Tunica externa. The tunica externa is the outermost tunic
composed largely of fibrous connective tissue, and its function is
basically to support and protect the vessels.

Major Arteries of the Systemic Circulation

The major branches of the aorta and the organs they serve are listed next in sequence from the heart.
A. Arterial Branches of the Ascending Aorta
The aorta springs upward from the left ventricle of heart as the ascending aorta.
- Coronary arteries. The only branches of the ascending aorta are the right and left coronary arteries, which serve
the heart.

B. Arterial Branches of the Aortic Arch

The aorta arches to the left as the aortic arch.
- Brachiocephalic trunk. The brachiocephalic trunk, the first branch off the aortic arch, splits into the right
common carotid artery and right subclavian artery.
- Left common carotid artery. The left common carotid artery is the second branch off the aortic arch and it
divides, forming the left internal carotid, which serves the brain, and the left external carotid, which serves
the skin and muscles of the head and neck.
- Left subclavian artery. The third branch of the aortic arch, the left subclavian artery, gives off an important
branch- the vertebral artery, which serves part of the brain.
- Axillary artery. In the axilla, the subclavian artery becomes the axillary artery.
- Brachial artery. the subclavian artery continues into the arm as the brachial artery, which supplies the arm.
- Radial and ulnar arteries. At the elbow, the brachial artery splits to form the radial and ulnar arteries, which
serve the forearm.
C. Arterial Branches of the Thoracic Aorta
The aorta plunges downward through the thorax, following the spine as the thoracic aorta.
- Intercostal arteries. Ten pairs of intercostal arteries supply the muscles of the thorax wall.
D. Arterial Branches of the Abdominal Aorta
Finally, the aorta passes through the diaphragm into the abdominopelvic cavity, where it becomes the abdominal
aorta.
- Celiac trunk. The celiac trunk is the first branch of the abdominal aorta and has three branches: the left gastric
artery supplies the stomach; the splenic artery supplies the spleen, and the common hepatic artery supplies
the liver.
- Superior mesenteric artery. The unpaired superior mesenteric artery supplies most of the small intestine and
the first half of the large intestine or colon.
- Renal arteries. The renal arteries serve the kidneys.
- Gonadal arteries. The gonadal arteries supply the gonads, and they are called ovarian arteries in females
while in males they are testicular arteries.
- Lumbar arteries. The lumbar arteries are several pairs of arteries serving the heavy muscles of the abdomen
and trunk walls.
- Inferior mesenteric artery. The inferior mesenteric artery is a small, unpaired artery supplying the second half
of the large intestine.
- Common iliac arteries. The common iliac arteries are the final branches of the abdominal aorta.

Major Veins of the Systemic Circulation

Major veins converge on the vena cava, which enter the right atrium of the heart.
A. Veins Draining into the Superior Vena Cava
Veins draining into the superior vena cava are named in a distal-to-proximal direction; that is, in the same
direction the blood flows into the superior vena cava.
- Radial and ulnar veins. The radial and ulnar veins are deep veins draining the forearm; they unite to form the
deep brachial vein, which drains the arm and empties into the axillary vein in the axillary region.
- Cephalic vein. The cephalic vein provides for the superficial drainage of the lateral aspect of the arm and
empties into the axillary vein.
- Basilic vein. The basilic vein is a superficial vein that drains the medial aspect of the arm and empties into the
brachial vein proximally.
- Median cubital vein. The basilic and cephalic veins are joined at the anterior aspect of the elbow by the median
cubital vein, often chosen as the site for blood removal for the purpose of blood testing.
- Subclavian vein. The subclavian vein receives venous blood from the arm through the axillary vein and from
the skin and muscles of the head through the external jugular vein.
- Vertebral vein. The vertebral vein drains the posterior part of the head.
- Internal jugular vein. The internal jugular vein drains the dural sinuses of the brain.
- Brachiocephalic veins. The right and left brachiocephalic veins are large veins that receive venous drainage
from the subclavian, vertebral, and internal jugular veins on their respective sides.
- Azygos vein. The azygos vein is a single vein that drains the thorax and enters the superior vena cava just before
it joins the heart.
B. Veins Draining into the Inferior Vena Cava
The inferior vena cava, which is much longer than the superior vena cava, returns blood to the heart from all body
regions below the diaphragm.
- Tibial veins. The anterior and posterior tibial veins and the fibular vein drain the leg; the posterior tibial veins
becomes the popliteal vein at the knee and then the femoral vein in the thigh; the femoral vein becomes the
external iliac vein as it enters the pelvis.
- Great saphenous veins. The great saphenous veins are the longest veins in the body; they begin at the dorsal
venous arch in the foot and travel up the medial aspect of the leg to empty into the femoral vein in the thigh.
- Common iliac vein. Each common iliac vein is formed by the union of the external iliac vein and the internal
iliac vein which drains the pelvis.
- Gonadal vein. The right gonadal vein drains the right ovary in females and the right testicles in males; the left
gonadal veins empties into the left renal veins superiorly.
- Renal veins. The right and left renal veins drain the kidneys.
- Hepatic portal vein. The hepatic portal vein is a single vein that drains the digestive tract organs and carries this
blood through the liver before it enters the systemic circulation.
- Hepatic veins. The hepatic veins drain the liver.
 Physiology of the Heart
As the heart beats or contracts, the blood makes continuous round trips- into and out of the heart, through the rest
of the body, and then back to the heart- only to be sent out again.
Intrinsic Conduction System of the Heart
The spontaneous contractions of the cardiac muscle cells occurs in a regular and continuous way, giving rhythm to
the heart.
Cardiac muscle cells. Cardiac muscle cells can and do
contract spontaneously and independently, even if all
nervous connections are severed.
Rhythms. Although cardiac muscles can beat
independently, the muscle cells in the different areas of
the heart have different rhythms.
Intrinsic conduction system. The intrinsic conduction
system, or the nodal system, that is built into the heart
tissue sets the basic rhythm.
Composition. The intrinsic conduction system is
composed of a special tissue found nowhere else in the
body; it is much like a cross between a muscle and
nervous tissue.
Function. This system causes heart muscle
depolarization in only one direction- from the atria to the
ventricles; it enforces a contraction rate of
approximately 75 beats per minute on the heart, thus the
heart beats as a coordinated unit.
Sinoatrial (SA) node. The SA node has the highest rate
of depolarization in the whole system, so it can start the
beat and set the pace for the whole heart; thus the term
“pacemaker“.
Atrial contraction. From the SA node, the impulse
spread through the atria to the AV node, and then the
atria contract.
Ventricular contraction. It then passes through the AV
bundle, the bundle branches, and the Purkinje fibers,
resulting in a “wringing” contraction of the ventricles
that begins at the heart apex and moves toward the atria.
Ejection. This contraction effectively ejects blood
superiorly into the large arteries leaving the heart.

The Pathway of the Conduction System

The conduction system occurs systematically through:
1. SA node. The depolarization wave is initiated by the sinoatrial node.
2. Atrial myocardium. The wave then successively passes through the atrial myocardium.
3. Atrioventricular node. The depolarization wave then spreads to the AV node, and then the atria contract.
4. AV bundle. It then passes rapidly through the AV bundle.
5. Bundle branches and Purkinje fibers. The wave then continues on through the right and left bundle branches,
and then to the Purkinje fibers in the ventricular walls, resulting in a contraction that ejects blood, leaving the
heart.
Cardiac Cycle and Heart Sounds
In a healthy heart, the atria contract simultaneously, then, as they start to relax, contraction of the ventricles begin.
Systole. Systole means heart contraction.
Diastole. Diastole means heart relaxation.
- Cardiac cycle. The term cardiac cycle refers to the events of one complete heart beat, during which both atria
and ventricles contract and then relax.
- Length. The average heart beats approximately 75 times per minute, so the length of the cardiac cycle is
normally about 0.8 second.
- Mid-to-late diastole. The cycle starts with the heart in complete relaxation; the pressure in the heart is low, and
blood is flowing passively into and through the atria into the ventricles from the pulmonary and systemic
circulations; the semilunar valves are closed, and the AV valves are open; then the atria contract and force the
blood remaining in their chambers into the ventricles.
- Ventricular systole. Shortly after, the ventricular contraction begins, and the pressure within the ventricles
increases rapidly, closing the AV valves; when the intraventricular pressure is higher than the pressure in the
large arteries leaving the heart, the semilunar valves are forced open, and blood rushes through them out of the
ventricles; the atria are relaxed, and their chambers are again filling with blood.
- Early diastole. At the end of systole, the ventricles relax, the semilunar valves snap shut, and for a moment the
ventricles are completely closed chambers; the intraventricular pressure drops and the AV valves are forced
open; the ventricles again begin refilling rapidly with blood, completing the cycle.
— First heart sound. The first heart sound, “lub”, is caused by the closing of the AV valves.
— Second heart sound. The second heart sound, “dub”, occurs when the semilunar valves close at the end of
systole.

Cardiac Output
Cardiac output is the amount of blood pumped out by each side of the heart in one minute. It is the product of the
heart rate and the stroke volume.
- Stroke volume. Stroke volume is the volume of blood pumped out by a ventricle with each heartbeat.
- Regulation of stroke volume. According to Starling’s law of the heart, the critical factor controlling stroke
volume is how much the cardiac muscle cells are stretched just before they contract; the more they are
stretched, the stronger the contraction will be; and anything that increases the volume or speed of venous return
also increases stroke volume and force of contraction.
- Factors modifying basic heart rate.The most important external influence on heart rate is the activity of the
autonomic nervous system, as well as physical factors (age, gender, exercise, and body temperature).

Physiology of Circulation
A fairly good indication of the efficiency of a person’s circulatory system can be obtained by taking arterial blood
and blood pressure measurements.
Cardiovascular Vital Signs
Arterial pulse pressure and blood pressure measurements, along with those of respiratory rate and body
temperature, are referred to collectively as vital signs in clinical settings.
- Arterial pulse. The alternating expansion and recoil of an artery that occurs with each beat of the left ventricle
creates a pressure wave-a pulse- that travels through the entire arterial system.
- Normal pulse rate. Normally, the pulse rate (pressure surges per minute) equals the heart rate, so the pulse
averages 70 to 76 beats per minute in a normal resting person.
- Pressure points. There are several clinically important arterial pulse points, and these are the same points that are
compressed to stop blood flow into distal tissues during hemorrhage, referred to as pressure points.
- Blood pressure. Blood pressure is the pressure the blood exerts against the inner walls of the blood vessels, and it
is the force that keeps blood circulating continuously even between heartbeats.
- Blood pressure gradient. The pressure is highest in the large arteries and continues to drop throughout the
systemic and pulmonary pathways, reaching either zero or negative pressure at the venae cavae.
- Measuring blood pressure. Because the heart alternately contracts and relaxes, the off-and-on flow of the blood
into the arteries causes the blood pressure to rise and fall during each beat, thus, two arterial blood pressure
measurements are usually made: systolic pressure (the pressure in the arteries at the peak of ventricular
contraction) and diastolic pressure (the pressure when the ventricles are relaxing).
- Peripheral resistance. Peripheral resistance is the amount of friction the blood encounters as it flows through the
blood vessels.
- Neural factors. The parasympathetic division of the autonomic nervous system has little or no effect on blood
pressure, but the sympathetic division has the major action of causing vasoconstriction or narrowing of the blood
vessels, which increases blood pressure.
- Renal factors. The kidneys play a major role in regulating arterial blood pressure by altering blood volume, so
when blood pressure increases beyond normal, the kidneys allow more water to leave the body in the urine, then
blood volume decreases which in turn decreases blood pressure.
- Temperature. In general, cold has a vasoconstricting effect, while heat has a vasodilating effect.
- Chemicals. Epinephrine increases both heart rate and blood pressure; nicotine increases blood pressure by
causing vasoconstriction; alcohol and histamine cause vasodilation and decreased blood pressure.
- Diet. Although medical opinions tend to change and are at odds from time to time, it is generally believed that a
diet low in salt, saturated fats, and cholesterol help to prevent hypertension, or high blood pressure.
Blood Circulation Through the Heart
The right and left sides of the heart work together in achieving a smooth flowing blood circulation.
I. Entrance to the heart. Blood enters the heart through
two large veins, the inferior and superior vena cava,
emptying oxygen-poor blood from the body into the
right atrium of the heart.
II. Atrial contraction. As the atrium contracts, blood flows
from the right atrium to the right ventricle through the
open tricuspid valve.
III. Closure of the tricuspid valve. When the ventricle is
full, the tricuspid valve shuts to prevent blood from
flowing backward into the atria while the ventricle
contracts.
IV. Ventricle contraction. As the ventricle contracts, blood
leaves the heart through the pulmonic valve, into the
pulmonary artery and to the lungs where it is
oxygenated.
V. Oxygen-rich blood circulates. The pulmonary vein
empties oxygen-rich blood from the lungs into the left
atrium of the heart.
VI. Opening of the mitral valve. As the atrium contracts,
blood flows from your left atrium into your left ventricle
through the open mitral valve.
VII. Prevention of backflow. When the ventricle is full, the
mitral valve shuts. This prevents blood from flowing
backward into the atrium while the ventricle contracts.
VIII.Blood flow to systemic circulation. As the ventricle
contracts, blood leaves the heart through the aortic valve,
into the aorta and to the body.
Capillary Exchange of Gases and Nutrients
Substances tend to move to and from the body cells according to their concentration gradients.
- Capillary network. Capillaries form an intricate network among the body’s cells such that no substance has to
diffuse very far to enter or leave a cell.
- Routes. Basically, substances leaving or entering the blood may take one of four routes across the plasma
membranes of the single layer of endothelial cells forming the capillary wall.
- Lipid-soluble substances. As with all cells, substances can diffuse directly through their plasma membranes if
the substances are lipid-soluble.
- Lipid-insoluble substances. Certain lipid-insoluble substances may enter or leave the blood and/or pass through
the plasma membranes within vesicles, that is, by endocytosis or exocytosis.
- Intercellular clefts. Limited passage of fluid and small solutes is allowed by intercellular clefts (gaps or areas
of plasma membrane not joined by tight junctions), so most of our capillaries have intercellular clefts.
- Fenestrated capillaries. Very free passage of small solutes and fluid is allowed by fenestrated capillaries, and
these unique capillaries are found where absorption is a priority or where filtration occurs.