Physical Therapy for
Cardiovascular disorders
RHPT 482
Credit hours: 2T+1C
Course Instructor: Ahmad Osailan
Course Description
• The course is designed to teach and perform
clinical practice for the management of CVD.
Anatomy and physiology of the
cardiovascular system
• Objectives :
• Be familiar with the anatomy of the heart and
vascular system
 Size of the heart
 Location of the heart
 Layers of the heart
 Chambers of the heart
 Vascular system and its layers
 Brief physiology of cardiovascular system
Cardiovascular system
• Consist of :
Heart
Blood vessels
Lymphatic
Overview of the heart
• Heart Definition: “a pump that moves the entire
body volume to and from the lungs and tissues.”
• In Humans, Heart is 250 g in Male to 350 in
Female. (Size of a fist)
• It produces ~ 5 Litres of Blood every minute
• Myogenic: ability to generate its own contraction
Location of the heart
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posterior to sternum
medial to lungs
anterior to vertebral column
base lies beneath 2nd rib
apex at 5th intercostal space
lies upon diaphragm
• posterior to sternum
• medial to lungs
• anterior to vertebral
column
• base lies beneath 2nd
rib
• apex at 5th intercostal
space
• lies upon diaphragm
Heart Structure
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Consist of :
Pericardium
Walls of the heart
Four champers
Four valves
Covering of the Heart
• Pericardium:
• Def: Is a fibrous sac surrounds the heart and
roots of great vessels.
• Divided to :
• Serous pericardium: smooth inner
• Fibrous pericardium: Tough fibrous tissue
outer
pericardiun
Serous
pericardium
Parietal
layer
Fibrous
pericardium
Visceral
layer
Pericardium
• Serous pericardium
Parietal layer: lines the
inside of fibrous
pericardium
Visceral layer: adheres
to the surface of the
heart.
• Fibrous pericardium:
Protects the heart and
serous membrane
Heart Wall layers
• Epicardium: outer
layer
• Myocardium: Middle
layer
• Endocardium: Inner
layer
Endocardium
• Inner lining
• Smooth (Endothelial) surface that permits
blood to move easily through the heart
• Continuous with lining of blood vessels
Myocardium
• Middle layer made of cardiac muscle
(Myocardium)
• Forms the bulk of the heart wall
• Contains the septum- a thick muscular wall
that completely separates the blood in the
right side of the heart from the blood in the
left side.
Epicardium
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Protective, outer layer of the heart wall
same as the visceral pericardium
The coronary blood vessels that nourish
the heart wall are located here
Champers of the Heart
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Heart has Four Champers
2 atria (atrium) 2 ventricles
2 atria separated by interatrial septum
2 ventricles separated by interventricular
septum.
Champers
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Right Atrium
Thinner wall than
ventricles
Receives deoxygenated
blood from vena cava
Passes blood through
tricuspid valve into right
ventricle
Right Ventricle
• Thicker wall than atria
• Comprises most of
anterior surface of heart
• Circulates deoxygenated
blood to lungs through
the pulmonic valve into
pulmonary trunk
Left atrium
• Receives freshly
oxygenated blood
from pulmonary vein
• Passes blood to left
ventricle through
mitral valve
Left ventricle
• Receives blood from
left atrium
• Thickest myocardial
wall
• Forms apex of heart
• Sends blood to
systemic circulation
via aorta
Valves of the heart
• Function- prevent blood
from flowing backwards
• Responds to changes in
pressure
• Two types of valves in
heart
 Atrioventricular valves
(AV)
 Semi-lunar valves
• Semilunar valves
• Located at exit of ventricles, originiate from
endothelial lining of veins
• Heart contains two semilunar valves
• Pulmonic
• Aortic (Frequently damaged by Htn)
Atrioventricular Valves
• Valve cusps are
connected to papillary
muscles
• Chordae tendineae tiny
collagen cords
• that anchor cusps of
valve to papillary muscles
Atrioventricular Valves
• Left AV valve (Mitral,
bicuspid)
• Contains 2 cusps
• Subject to abuse
• Right AV valve (Tricuspid)
• Contains 3 cusps
• Not subjected to great
abuses
Blood circulation
• There are 2
circulatory
pathways:
Pulmonary circuit
Systemic circuit
Blood circulation
• Pulmonary circuit:
Deoxygented Blood received by Right Atrium
from Superior and inferior vena cava-> pass
through Tricuspid V-> Right Ventricle ->
through Pulmonary V -> pulmonary trunk ->
pulmonary arteries -> R + L Lung.
Blood Circulation
• Systemic Circuit:
Oxygenated blood returns from lungs to heart
through -> pulmonary veins -> Left Atrium ->
pass through Mitral V -> Left ventricle -> pass
through Aortic V -> aortic arch -> whole body
Blood Vessels
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Function:
Distribution of blood
Exchange of materials with tissues
Return of blood to heart
• Structure:
• Most have 3 layers surrounding a hollow
lumen
Blood Vessels
• Arteries
Veins
• Arteriole
Venule
• Capillary network
General structure of Blood Vessels
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Arteries and Veins Have 3 Tunics:
Tunica Externa ( Adventetia )
Tunica Media
Tunica Intema
• Capillaries composed of endothelium ( tunica
intema)
Blood vessels
• Tunica Intema:
• Inner smooth layer
• Simple squamous
epithelium
• Continous with
endocardium
• Present in all vessels
Blood Vessels
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Tunica Media:
Layer of smooth Muscles
Contain Elastin
Supplied by Sympathetic
division of ANS
• Area of vasoconstriction
and Vasodilatation
Blood Vessels
• Tunica Externa
• Layer of Connective tissue
• Elastic and has collagen fibres
Arteries
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Characteristics:
Thick walled
Lots of Elastin in all tunics
Stretchable wall to recoil and propel blood
Withstand and regulate BP Fluctuations
Veins
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Characteristics:
Thin walled
Lumen is larger than arteries
Less stretchable than arteries
Capillaries
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Characteristics :
Smallest vessel
Large enough for 1red cell
One tunica only (tunica intema)
Very thin, Why?
Blood supply to heart
Coronary arteries
• 2 Main Coronary
Arteries
•Right CA- branches into
some marginal arteries;
supplies RV and
posterior of heart
•Left CA- branches into
• AIA (LAD) and
• circumflex; supplies LV
Arterial supply to heart
• Originates from the base of aortic artery
• Only 5% of ejected blood is received through
to innervate the heart (Myocardium)
• Many branches directed to the Left ventricle,
Why?
• Coronary arteries traverse the heart forming a
vast network of capillaries
Venous drainage
• Transport
deoxygenated
blood to coronary
sinus
• Coronary Sinus
drains into RA
Discussion
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Which chamber among ventricles is thicker?
Which one is thicker among blood vessels?
How many layers surrounding the heart?
How many valves and what is the type of each
one?
• How many Circuit in cardiovascular system?
Physiology of cardiovascular system
• Mainly the heart is a pumping machine.
• To pump it require force to generate
contraction.
• Since the heart is mainly composed of cardiac
muscles (myocyte),
• it has similar functions and structure like
skeletal muscles with some variations
Myocyte
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Characteristics:
Striated cells
Short cells
Mononucleus (one nucleus only)
Very large mitochondria (Many ATP)
Has intercalated disks
Types of cells in the heart
• 2 types:
1. Contracting cells (Myocytes)
- concept of Actin and myosin for contraction
- depends on presence of Ca
- action potential is 30X longer than skeletal
Muscles
2. Conducting cells (intercalated disks, SA
node…)
Conduction system
• Non-contractile cells,
• self-excitable,
• generate spontaneous action potentials,
• Trigger heart contractions.
Conduction system is located in:
SA node
AV node
AV bundle
Purkinje fibres
Conduction system
• Three potential areas capable of beginning
cardiac conduction
• SA Node- Located in right atria; 60-100 bpm
• AV Node- Located at AV junction; 40-60 bpm
• Ventricular System- Ventricles; < 40
How Heart beat is initiated
• Through Action potential of SA node
How the myocardium is contracting
• Through action potential of cardiac muscles
Cardiac cycle
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What is cardiac cycle:
Is a series of events occur when heart beats
Mainly consist of:
Systole period: Ventricles contract
Diastole Period: Ventricles relaxed
Duration: last for 0.8 Seconds
Cardiac Cycle
Cardiac output
• Cardiac output: is the amount of blood
pumped by each ventricle in one minute
• CO= HR x SV
• Heart rate: is the number of beats per minute
• Stroke volume: is the amount of blood
pumped by one ventricle with each beat.
Stroke Volume
• SV= End Diastolic volume – End systolic
volume
• EDV= amount of blood in a ventricle during
diastole before contraction
• ESV= amount of blood remaining in a ventricle
after contraction.
• Ejection Fraction (EF): percentage of blood
ejected from a ventricle.
Regulation of Heart rate
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Chemicals. Na, K
Autonomic nervous system
Positive chronotropic factors. HR
Atropine Dopamine Epinephrine
Negative chronotropic factors. HR
Beta blockers such as Acetylcholine
Digoxin
Discussion
How the blood is travelling through Heart
chambers?
What is Early filling and atrial filling?
How to detect the electrical activity of the
heart?