Cardiovascular System

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Blood:
Blood is a specialized connective tissue composed of cells and liquid intracellular elements which circulates a closed system of vessels of cardiovascular system.
Composition of blood:
BLOOD

Cells (45%) Plasma (55%)


RBC WBC Platelets Solid (10%) Liquid (90%)

Organic Inorganic
Na+, K+, Ca++, Mg++, CI-

Plasma protein Non protein Others
Albumin Creatinine Cholestorol
Globulin Urea Phaspolipid
Fibrinogen Uric acid Glucose
Prothrombin

Stages of blood cell production (erythropoiesis):
Pluripotent uncommitted haemopoietic steam cell

Unipotent committed haemopoietic steam cell

Pronormoblast

Early normoblast

Intermediate normoblast

Late normoblast

Reticulocyte (Nucleus disappears)

RBC (Red Blood Cell)

Normal values of blood:
RBC: 4.5 – 5.5 million/ cubic millimeter of blood
WBC: 4000 - 11000 cubic millimeter of blood
Platelets: 1.5 – 5 lakh/ cubic millimeter of blood

Blood cell production:
Before birth:
Up to two months – in the yolk sac of embryo.
Up to seven months – liver
Seven months to term – bone marrow
After birth:
Up to seven years – bone marrow of all bones
After five years – bone marrow of all flat bones & bone marrow of all end of long bones

Plasma protein:
The protein which is present in plasma is called plasma protein.
Normal values:
6.4 – 8.4 gm/100 ml of blood
Albumin – 4.8 gm %
Globulin – 2.4 gm %
Fibrinogen - 0.3 gm %
Prothrombin – 0.03 gm %
Functions of plasma protein:
It produces colloidal osmotic pressure (Al).
It produces immunity (Gl).
It takes part in blood clotting (Fi & Pr).
It acts a vehicle to transport hormone, vitamin, iron, Cu & drugs etc.
It produces blood viscosity (Al)
It acts as a buffer to maintain acid base balance.

Classification of WBC:
WBC


Granulocyte Agranulocyte
Neutrophils Lymphocyte
Esonophils Monocyte
Basophils

Differential count of WBC:
Neutrophils – 40-75 %
Lymphocyte – 20 – 45 %
Monocyte - 2 – 10 %
Esonophils – 1- 6 %
Basophils – 0 – 1 %
Absolute count of WBC:
If the total Absolute count is 10,000:
Neutrophils – 4000-7500
Lymphocyte – 2000 – 4500
Monocyte - 200 – 1000
Esonophils – 100- 600
Basophils – 0 – 100

Functions of blood cells:
Functions of RBC:
It transports respiratory gases from lungs to tissue and vice versa.
It contains Hb.
It acts as a buffer to maintain acid base balance.
It contains antigen.
Functions of WBC:
It acts as a phagocytosis (Mo & Ne).
It produces scavenging action (Ne).
It produces defensive mechanism against allergy (Es).
It produces Heparin, which prevents blood clotting within vessels (Ba).
It produces immunity.

Functions of Platelet:
It takes part in coagulation of blood.
It helps in Haemostasis.


Blood groups:
Before transfusion of blood to a person, it is necessary to determine the blood types of the recipient's blood and blood type of the donor so that the blood can be appropriately matched, this known as blood groups.
The major blood groups are:
A
B
O
AB
Rh blood groups:
Rh + ve
Rh – ve

Hazards of mismatched blood transfusion:
Immediate hazards
Shivering and restlessness
Nausea and vomiting
Increase rate of pulse and respiration
Chest and back pain
Fall of blood pressure
Delayed hazerds:
Inapparent haemolysis
Post-transfusion jaundice
Haemoglobinaemia
Uraemia

Anaemia:
Anaemia is a clinical condition characterized by pale coloration of the skin and mucous membrane due to qualitative and quantitative deficiency of haemoglobin bellow the lower limit of peripheral blood in respect of age and sex.
Etiological classification of anaemia:
Blood loss anaemia:
Acute: e.g. Acidental haemorrhage
Choronic: e.g. GIT bleeding, menstrual bleeding
Decrease blood production:
Iron deficiency anaemia
Vitamin B12 anaemia – Megaloblastic anaemia
Folic acid anaemia - Megaloblastic anaemia
Bone marrow aplasia – Aplastic anaemia
Excess breakdown of RBC – Haemolytic anaemia






Differences between Plasma and Serum:
Features
Plasma
Serum
Definition
The non-fluid portion of blood.
The fluid portion of blood after removal of clot of coagulated blood
Colour
Yellowish
Straw
Clotting factors
All are present
Fibrinogen & prothrombin, factors V &Vlll are present
Amount of serotonin
Low
High

Hemoglobin (Hb):
It is the conjugated protein. It is the red pigment of RBC.
Composition:
Haem: Fe (Iron)
Globin: protein
Normal values:
Male (adult) : 13 - 18 gm %
Female (adult) : 11.5 - 16.5 gm%
Children : 11.5 - 14.5 gm%
Infant : 11- 13 gm %
Functions of Hb:
It transports respiratory gases (O2 &CO2).
It acts as a buffer to maintain acid base balance.
It stores Iron & Protein.
It produces different pigment like bile pigment.


Blood circulation:
Blood circulation is a complete circuit which carries blood from the whole body tissue to serve needs of the tissue.
Blood circulation is divided into:
Systemic or greater circulation
Pulmonary or lesser circulation

Describe the circulation of blood:


Common causes of anaemia in Bangladesh:
Frequent pregnancies
Excessive menstrual bleeding
Hook worm infestation
Malnutrition
Peptic ulcer
Piles


ESR (Erythrocyte Sedimentation Rate):
ESR means Erythrocyte Sedimentation Rate.
When a simple of blood is mixed with a suitable anticoagulant and is allowed to stand vertically in a narrow tube, red blood cells gradually settle down to the bottom living the clear plasma above. The rate at which this sedimentation of red blood cells takes place in first hour is known as Erythrocyte Sedimentation Rate.
Methods for determination of Erythrocyte Sedimentation Rate:
Wintrobe's method
Westyergen's method
Causes of increased ESR:
Multiple myeloma
Malignant lymphoma
Tuberculosis
Connective tissue disease
Myocardial infraction


Junctional tissue of the heart:
The cardiac conductive system consists of myocardium that is specialized for initation and conduction of the cardiac impulse. This is called junctional tissue of the heart.
The cardiac conductive system is organized into four basis components:
Sinu-atrial node (SA node)
Atrioventricular node (AV node)
Atrioventricular bundle with its right and left branches
Purkinje fibres

Blood pressure:
Blood pressure is the force of pressure exerted by the blood on the walls of the blood vessels.
Blood pressure is exerted when the blood flows through the arteries.
Blood pressure = cardiac output × total peripheral resistance.
Different types of blood pressure with normal values:
Systolic blood pressure – 120mmHg (range: 105-135mmHg)
Diastolic blood pressure – 80mmHg (range: 60-90mmHg)
Pulse pressure – 40mmHg
Mean arterial pressure -93mmHg (range: 90-100mmHg)


Factors determining blood pressure:
Cardiac output
Heart rate
Peripheral resistance
Blood volume
Venous return
Elasticity of blood vessels
Viscosity of blood flows
Viscosity of blood

Cardiac output:
Cardiac output is the amount of blood that is ejected from the heart per minute.
Calculation:
Cardiac output is the product of stroke volume and heart rate. It is expressed in liters per minute.
Cardiac output = Stroke volume × Heart rate
= 70 × 72
= 5 L/min (approx)
Factors regulating cardiac output:
Venous return
Force of contraction of heart rate
Heart rate
Peripheral resistance
Arterial pressure
Stroke volume:
The amount of blood expelled by each contraction of the ventricles is the stroke volume.
Cardiac cycle:
The cardiac events that occur from the beginning of one heart rate to the beginning of the next are called the cardiac cycle.
The aorta:
The aorta is the great arterial trunk that receives oxygenated blood from the right ventricle and distributes it to all parts of the body.
Pulse/Heart rate:
The pulse is a wave of distension and elongation felt in the arterial wall due to the pressure changes during ventricular systole and diastole.
Normal range: 60 -80/min (average: 72/min)
Factors affecting the pulse/heart rate:
Sex
Age
Activity & exercise
Temperature
Emotional states
Circulating hormone




Bradycardia:
A slow heart rate of fewer than 60 beats per minute is called Bradycardia.
Causes of Bradycardia:
Myocardial infarction
Sinus node disease
Hypothermia
Drugs: β-blockers: Digoxin, Verapamil.

Tachycardia:
A fast heart rate of more than 100 beats per minute is called Tachycardia.
Causes of Tachycardia:
Increase body temperature
Anaemia
Anxiety
Heart failure
Drugs: Bronchodialators
Blood coagulation:
It is the process by which soluble fibrinogen is converted to soluble fibrin thread.
Steps of coagulation:
Formation of prothrombin activator.
Conversion of prothrombin to thrombin.
Conversion of fibrinogen to fibrin thread
Factors of coagulation:
Factor 1: Fibrinogen
Factor 2: Prothrombin
Factor 3: Tissue thromboblastin
Factor 4: Ca++ (Ionized calcium)
Factor 5: Labile factor
Factor 6: Omitted
Factor 7: Stable factor
Factor 8: Anti hemophilic factor
Factor 9: Christmas factor
Factor 10: Stuart prowor factor
Factor 11: Anti hemophilic factor-C
Factor 12: Anti hemophilic factor-D
Factor 13: Fibrin stabilizing factor


Contact info:


Jahedul Islam
Pharmacy department
Mobile no:
01623631452