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The Heart

B. Pimentel, M.D.
University of Makati – College of Nursing
Function

1. Generate blood pressure
2. Routing blood
3. Ensuring one way blood flow
4. Regulating blood supply
The Heart

The heart lies obliquely in the mediastinum of the thoracic cavity.
 Base directed posteriorly and slightly superiorly
 Deep to the sternum and extends to the 2nd intercostal space
 Apex directed anteriorly and slightly inferiorly
 2/3 of the hearts mass lies to the left of midline
 Approximately 9 cm. to the left of the sternum and is deep to the fifth
intercostal space.
Size - approx. the size of a closed fist
Shape - like a blunt cone, the blunt rounded point of the heart is the apex,
and the larger opposite end is the base
ANATOMY OF THE HEART
Pericardium
ANATOMY OF THE HEART
Pericardium

 Fibrous pericardium - tough, fibrous connective tissue, outer
layer
 Prevents over distention and anchors the mediastinum

 Superiorly it is continuous with the connective tissue of

the great vessels, and inferiorly attached to the surface of
the diaphragm
ANATOMY OF THE HEART
Pericardium

 Serous pericardium - thin transparent inner layer

 Parietal pericardium - part of the serous pericardium that
lines the fibrous pericardium

 Visceral pericardium (Epicardium) - part of the serous
pericardium that covers the heart surface
ANATOMY OF THE HEART
Pericardium

Pericardial cavity - between the parietal and visceral
pericardium

Pericardial fluid - thin layer of serous fluid which reduces
friction of the beating heart
ANATOMY OF THE HEART
Heart Wall

Epicardium - thin serous membrane of the outer surface of the
heart

Myocardium - thick middle layer composed of cardiac muscle

Endocardium - simple squamous epithelium over a layer of
connective tissue, continuous with all blood vessels of the
body.
ANATOMY OF THE HEART
Pericardium
ANATOMY OF THE HEART
External Anatomy

2 atria and 2 ventricles

Atria - form the superior and posterior portions of the heart
 Interarterial septum - separates the left and right atria

Ventricles - the anterior and inferior portions and are thick
walled
 Interventricular septum - separates the right and left ventricles.
ANATOMY OF THE HEART
External Anatomy

Auricoventricular sulcus (Coronary sulcus) - runs obliquely
around the heart separating the atria and ventricles

Interventricular sulcus - divides the heart into right and left
halves (anterior and posterior)

 The major arteries supplying the coronary tissue lie within
the coronary and interventricular sulci
ANATOMY OF THE HEART
External Anatomy
ANATOMY OF THE HEART
External Anatomy
ANATOMY OF THE HEART
External Anatomy (Blood Vessels)

6 veins
Superior and Inferior vena cava
– carry blood to the right
atrium

Pulmonary vein (4) – carry
blood from the lungs to the
left atrium
ANATOMY OF THE HEART
External Anatomy (Blood Vessels)

2 arteries

Pulmonary trunk – from the
right ventricle and divides
into left and right
pulmonary artery

Aorta – from the left ventricle
ANATOMY OF THE HEART
External Anatomy (Blood Vessels)
ANATOMY OF THE HEART
External Anatomy
(Coronary circulation)

Right and left coronary arteries – from the base of the aorta
above the semilunar valves
 Left coronary artery is usually dominant over the right
 Anterior interventricular artery or the left anterior descending artery
supplies blood to most of the anterior wall of the heart and the left
ventricle
 Left marginal artery supplies the lateral wall of the left ventricle
 Circumflex artery extends around to the posterior surface and
supplies most of the posterior surface
ANATOMY OF THE HEART
External Anatomy
(Coronary circulation)

 Right coronary artery
 Right marginal artery supplies the lateral wall of the right ventricle.
 Posterior interventricular artery supplies blood to parts of the
inferior and posterior parts of the heart

At rest, coronary arteries provide the heart muscle with 70% of
its oxygen vs. 25% in skeletal muscles
ANATOMY OF THE HEART
External Anatomy
(Coronary circulation)

Great cardiac vein drains blood from the left side of the heart.

Small cardiac vein drains the right margin of the heart.

Coronary sinus a large venous cavity that the veins converge
toward the posterior part of the heart and empties into the
right atrium
ANATOMY OF THE HEART
External Anatomy
(Coronary circulation)
ANATOMY OF THE HEART
Internal Anatomy (Heart Chambers)

Right and left atrium – functions as a reservoir of blood;
collects blood from veins before it enters the ventricles

 Right atrium – receives blood from the superior and inferior
vena cava
 Left atrium – receives blood from the pulmonary veins
ANATOMY OF THE HEART
Internal Anatomy (Heart Chambers)

Left and right ventricles – eject and force blood to flow
through the circulatory system; blood from the atria drains
into these chambers

 Right ventricle – opens into the pulmonary trunk
 Left ventricle – opens into the aorta; thicker wall
ANATOMY OF THE HEART
Heart Wall

Musculi pectinati - muscular ridges in the interior of auricles
and part of right atria.

Crista terminalis - separates the musculi pectinati from the
smooth walls of the atria.

Trabecullae carneae - large muscular ridges of the ventricles.
ANATOMY OF THE HEART
Heart Wall (left ventricle)
ANATOMY OF THE HEART
Heart Wall (right ventricle)
ANATOMY OF THE HEART
Internal Anatomy (Heart Valves)

Atrioventricular valves - Between the right atrium and right ventricles and
between the left atrium and left ventricle
 Tricuspid valve - 3 cusps, between the right atrium and right ventricle
 Bicuspid valve - two cusps, between the left atrium and left ventricle, also
known as the mitral valve

 Contain papillary muscle in each ventricle, cone shaped muscular pillars.
Attached to thin strong connective tissue cords called Chordae tendinae. The
chordae tendinae attach to the cusps of the valves. When the papillary muscles
contract, prevents the valves from opening.
ANATOMY OF THE HEART
Internal Anatomy (Heart Valves)
ANATOMY OF THE HEART
Internal Anatomy (Heart Valves)

Semilunar valves
 Aortic valve - between the left ventricle and the aorta.
 Pulmonary valve - between the right ventricle and the
pulmonary artery.
ANATOMY OF THE HEART
Internal Anatomy (Heart Valves)

Does that look like valve to
you?....

Where is the pulmonary
valve?
ANATOMY OF THE HEART
Internal Anatomy (Heart Valves)
BLOOD FLOW
HEART CONTRACTION
Action Potential
HEART CONTRACTION
Action Potential
(Cardiac muscle vs. Skeletal muscle)
ELECTRICAL ACTIVITY
Action Potential (Cardiac Muscle)
ELECTRICAL ACTIVITY
Action Potential (Cardiac Muscle)

 Depolarization phase
 Na channels open
 K channels close
 Ca channels begin to open

 Early repolarization phase
 Na channels close
 K channels begin to open
ELECTRICAL ACTIVITY
Action Potential (Cardiac Muscle)

 Plateau phase
 Ca channels are open

 Final repolarization phase
 Ca channels close
 K channels open
ELECTRICAL ACTIVITY
Action Potential (Cardiac Muscle)
ELECTRICAL ACTIVITY
Action Potential (Cardiac Muscle)
ELECTRICAL ACTIVITY
Conduction system

Sinoatrial node (SA Node) is medial to the opening of the
superior vena cava. Action potentials travel across the wall
of the atrium to the atrioventricular node (AV Node) located
medial to the right atrioventricular valve.

Action potentials pass through the AV node and along the
atrioventricular bundle, which extends from the AV node
into the interventricular septum.
ELECTRICAL ACTIVITY
Conduction system

The AV bundle divides into right and left bundle branches, the
action potential descends to the apex of the heart along the
bundle branches.

Action potentials are carried by Purkinje fibers from the bundle
branches up along the ventricular walls.
ELECTRICAL ACTIVITY
Conduction system
ELECTRICAL ACTIVITY
Conduction system
ELECTROCARDIOGRAM (EKG)

A measurement of the action potentials of the myocardium
during the cardiac cycle.
A typical EKG consists of a series of three distinguishable
waves called deflection waves.
 P wave - results from the movement of the depolarization wave
from the SA node through the atria, approx. 0.1 sec the atria
contract
 QRS complex - results from ventricular depolarization and precedes
ventricular contraction. Atrial repolarization is obscured by this
wave.
 T wave - ventricular repolarization
ELECTROCARDIOGRAM (EKG)
CARDIAC CYCLE

The repetitive pumping process that begins with onset of
cardiac muscle contraction and ends with the beginning of
the next contraction.

Systole – to contract
Diastole – to dilate
CARDIAC CYCLE

1. Systole: Period of Isovolumic Contraction. Ventricular
contraction causes the AV valves to close, which is the
beginning of ventricular systole. The semilunar valves
were closed in the previous diastole and remain closed
during this period. The volume of blood in the ventricles
does not change.

2. Systole: Period of Ejection. Continued ventricular contraction
pushes blood out of the ventricles causing semilunar valves
to open.
CARDIAC CYCLE

3. Diastole: Period of Isovolumic Relaxation. Blood flowing
back toward relaxed ventricles causes the semilunar valves to
close, which is the beginning of diastole. The AV valves are
also closed

4. Diastole: Passive Ventricular Filling. The AV valves open and
blood flows into the relaxed ventricles, accounting for most of
the ventricular filling.

5. Diastole: Active Ventricular Filling. The atria contract and
complete ventricular filling.
CARDIAC CYCLE

End diastolic volume – ventricles are filled with 120 to 130 ml of
blood during the previous ventricular diastole.

End systolic volume – the volume decreases to 50 to 60 ml at the
end of ejection.

Stroke volume – the volume of blood pumped during each heart
beat (cardiac cycle), is equal to end diastolic volume minus end
systolic volume.
HEART SOUNDS

Heart sounds are produced by valves closing.
1st heart sound
 Low pitched sound “lubb” caused by vibration of AV valves and the
surrounding fluid as the valves close at the beginning of ventricular
systole
2nd heart sound
 Higher pitched sound “dupp” closure of the aortic and pulmonary valves,
at the beginning of ventricular diastole.
3rd heart sound
 Occasionally heard, caused by blood flowing in a turbulent fashion into
the ventricles, near the end of the 1st third of diastole.
CARDIAC
CYCLE
REGULATION OF THE HEART

Intrinsic – does not depend on either neural or hormonal
regulation

Extrinsic – involves neural and hormonal influence
REGULATION OF THE HEART
(Intrinsic)

Venous return – the amount of blood that flows into the right
atrium during diastole
Preload – the extent to which the ventricular walls are stretched
 An increased preload causes an increase in cardiac output
 Decreased preload, decreased cardiac output.
 Starling’s Law of the Heart
REGULATION OF THE HEART
(Intrinsic)

Afterload – the pressure the ventricles must produce to
overcome the pressure of the aorta and move blood into the
aorta. Heart is very sensitive to changes in afterload as
compared with preload
REGULATION OF THE HEART
(Extrinsic)

Parasympathetic
 Parasympathetic control is via the vagus nerve.
 Stimulation is inhibitory to heart rate. Can decrease heart
rate by 20 to 30 beats/minute.

Sympathetic
 Nerve fibers originate in thoracic region.
 Stimulation increases heart rate and force of contraction
REGULATION OF THE HEART
(Extrinsic)

Hormonal Control
 Adrenal medulla releases norepinephrine and epinephrine.
 Increases the rate and force of contraction.
 Occurs in response to increased physical activity, emotional
excitement, or stress.
 Epinephrine takes a longer time to act on the heart compared
with sympathetic stimulation, but the effect lasts longer.
HEART AND HOMEOSTASIS

1. Barorecptor reflexes – Stretch receptors located in the
internal carotid arteries and the aorta.
 Detect changes in blood pressure and result in changes in heart rate
and in force of contraction.

1. Increased blood pressure decreases sympathetic stimulation
and increases parasympathetic stimulation

2. Decreased BP, decreases parasympathetic stimulation and
increases sympathetic stimulation
Effect of Extracellular
Ion Concentration

Ions that affect cardiac muscle function are the same as those
responsible for action potentials in other electrically excitable
tissues.
 Increased Potassium causes the heart rate and stroke volume to
decrease.
 Increase in Potassium causes heart block which is loss of the functional
conduction action potentials through the conduction system of the heart.
 Increase in Calcium increases force of contraction and reduce
heart rate.
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