20 THE HEART Every cell relies on the surrounding interstitial fluid for oxygen, nutrients, and waste dis- posal. The composition of the interstitial fluid in tissues throughout the body is kept sta- ble through continuous exchange between the peripheral tissues and the bloodstream, Yet blood can help maintain homeostasis only as long as it stays in motion. If blood re- ‘mains stationary, its oxygen and nutrient supplies are quickly exhausted, its capacity to absorb wastes is soon saturated, and neither hormones nor white blood cells ean reach their intended targets. Thus, all the functions ofthe cardiovascular system ultimately de pend on the heart. Unlike most other muscles, the heart never rests. This extraordinary organ beats ap- proximately 100,000 times each day, pumping roughly 8000 liters of blood—enough to fill forty 55-gallon drums, or 8800 quart-sized milk cartons. Try transferring a gallon of water by using a squeeze pump, and you'll appreciate just how hard the heart has to work to keep you alive. We begin this chapter by examining the structural features that enable the heart to perform so reliably. We will then consider the physiological mechanisms that regulate cardiac activity to meet the body’s constantly changing demands. sn nN RL EE 20-1 THE ORGANIZATION OF THE CARDIOVASCULAR SYSTEM Objective = Describe the organization of the cardiovascular system and of the heart. Blood flows through a network of blood vessels that extend between the heart and pe- ripheral tissues, Those blood vessels can be subdivided into a pulmonary circuit, which carries blood to and from the gas exchange surfaces of the lungs, and a systemic circuit which transports blood to and from the rest of the body (Figure 20-1e). Each circuit be- gins and ends at the heart, and blood travels through these circuits in sequence. For ex- ample, blood returning to the heart from the systemic circuit must complete the pulmonary circuit before reentering the systemic circuit. Blood is carried away from the heart by arteries, or efferent vessels, and returns to the heart by way of veins, or afferent vessels. Small, thin-walled vessels called capillaries in- terconnect the smallest arteries and the smallest veins. Capillaries are called exchange vessels, because their thin walls permit the exchange of nutrients, dissolved gases, and. ‘waste products between the blood and surrounding tissues. 683BIBEGS4) cusavten 20 THe sean "= Trace the flow of blood through the heart, identifying the major blood vessels, chambers, and heart valves. © Identify the layers of the heart wall. BULMONARY CIRCUT SYSTEMIC GROUT HB systemic arteries |B Pulmonary arteries HB Pumonary veins HB systemic veins ' Describe the vascular supply to the heart. Capitaries inlungs Captaris in trunk and lower limbs FIGURE 20-1 An Overview of the Cardiovascular System. Driven by the pumping of the heart, blood flows through separate pulmonary and systemic circuits. Each circuit begins and ends atthe heart and Contains arteries, capillaries, and vein. Despite its impressive workload, the heart is a small organ, roughly the size of a clenched fist. The heart contains four muscular chambers, two associated with each circuit. The right atrium (A- ‘rum; chamber; plural, atria) receives blood from the systemic cir- cuit and passes it to the right ventricle (VEN-tri-kl litle belly), ‘which pumps blood into the pulmonary circuit. The leftatrium col- lects blood from the pulmonary circuit and emptis it into the left ventricle, which then contracts, ejecting blood into the systemic cir- ‘cuit. When the heart beats, the atria contract, and then the ventricles contract. The two ventricles contract at the same time and eject equal volumes of blood into the pulmonary and systemic circuits. a a A A 20-2 ANATOMY OF THE HEART Objectives ® Describe the location and general features of the heart. ® Describe the structure of the pericardium, and explain its functions. CCapitaries in head, nck, upper limbs The heart is located near the anterior chest wall, directly posterior to the sternum (Figure 20-2ae), The great veins and arteries are connected to the superior end of the heart at the attached base. The base sits posterior to the sternum at the level ofthe third costal cartilage, centered about 1.2 ‘em (0.5 in.) to the left side. The inferior, pointed tip of the heart isthe free apex (A-peks). A typical adult heart mea- sures approximately 12.5 em (5 in.) from the base to the apex, which reaches the fifth intercostal space approximate- |y7.5 cm (3in,) to the left of the midline. A midsagital sec- tion through the trunk does not divide the heart into two equal halves, because (1) the center of the base lies slightly to the left ofthe midline, (2) a line drawn between the cen- ter of the base and the apex points further to the left, and. (3) the entire heat is otated tothe left around this line, so that the right atrium and right ventricle dominate an ante- rior view of the heart. ‘The heart, surrounded by the pericardial (peri-KAR- dé-al) cavity, sits in the anterior portion of the medi- astinum, The mediastinum, the region between the two pleural cavities, also contains the thymus, esophagus, and trachea, > p.22 Figure 20-2be is a sectional view that il+ lustrates the position of the heart relative to other struc~ tures in the mediastinum. OTHE PERICARDIUM The lining ofthe pericardial cavity i called the pericardium. To visualize the relationship between the heart and the pericardial cavity, imagine pushing your fist toward the center of a large balloon (Figure 20-2ce). The balloon represents the pericardi- tum, and your fist is the heart. Your wrist, where the balloon folds back on itself, corresponds to the base of the heart, to which the great vessels, the largest veins and arteries in the body, are attached. The air space inside the balloon corresponds to the pericardial cavity. ‘The pericardium is lined by a delicate serous membrane that can be subdivided into the visceral pericardium and the parietal pericardium. The visceral pericardium, or epicardium, covers the outer surface of the heart and adheres closely to it; the parietal pericardium lines the inner surface of the pericardial sac, which surrounds the heart (Figure 20-2ce). The pericardial sac, or {fibrous pericardium, which consists of a dense network of collagen fibers, stabilizes the position of the heart and associated vessels within the mediastinum. ‘The small space between the parietal and visceral surfaces is the pericardial cavity. It normally contains 10-20 ml of pericardial ‘luid, secreted by the pericardial membranes. This fluid acts as a lubricant, reducing friction between the opposing surfaces as the heartbeats20-2 Anatomy of te Heat [CSS Aorta (segment Mediastinum a) Lot pleura caviy| Lot (ea) pulmonary Fight pleural ‘cavlty Fight pulmonary ‘tery mon Fight pulmonary Peat Superior vena Lat atrium cava Lett ventricle Pericardial Cut edge of Fight cavity arta tram ight Pericarcal cavity contang pericarcum ventricle Parietal Epicarcum (sceral et Pericarcium pericardium) Fibrous tissue of pericardial sac leer Wrist (conesponds nee Arcola") part: te base of heart) visceral parcardium) tes pericardium Mesothelium ‘ie space {corresponds to pericardial cavity) Outer wal Cut edge of epicardium (visceral pericardium) commie to diaphragm (ecorg Peder parietal percardism) 4) — Batoon © FIGURE 20-2 The Location of the Heart in the Thoracic Cavity. The heart is situated in the anterior pat ofthe mediastinum, immediately posterior tothe sternum. (@) An anterior view ofthe open chest cauity, showing the postion ofthe heart and major ‘vessels relative tothe lungs. () A siperior view of the hear and other organs in the mediastinum with the tissues ofthe lungs ‘removed to reveal the biood vessels and airways. (c) The relationship between the heart and the pericardial cavity, compare with the fistand-telloon example. [IEG rises 74s, 76a Pathogens can infect the pericardium, producing the con- [© SUPERFICIAL ANATOMY OF THE HEART dition pericarditis, The inflamed pericardial surfaces rub 7 against one another, producing a distinctive scratching sound, (7s four cardinc chambers can baa be Atentibed ina euperticia ‘The pericardial irritation and inflammation also commonly re- view of the heart (Figure 20-3e), The two atria have relatively sult in an increased production of pericardial fluid. Fluid then thin muscular walls and are highly expandable. When not filled collects in the pericardial cavity, restricting the movement of the with blood, the outer portion of each atrium deflates and be- hheart. This condition, called’ cardiac tamponade (tam-po- comes a lumpy, wrinkled flap. This expandable extension of an NAD; tampon, plug) can also be caused by traumatic injuries, atrium is called an atrial appendage, or an auricle (AW-ri-kl such as gunshot wounds, that produce bleeding into the peri uri, ear) because it reminded early anatomists of the external cardial cavity. EE torecton and inlammation ofthe HeartCHAPTER 20 THE HEART Descending Asconding aorta rae LUgamentun Suan anercsum Left pulmonary Auricle of card hata Puronary tn Aurcle oftet atriom Ascending Pulmonary ‘funk Auricle of ‘et aia Pericarium Pericardium Superior Auricle ‘fright ‘rum FIGHT Fat in coronary a. Sucve Percarium ——_arteroh Leer fused to” interventricular ENTRICLE Fatin anterior - ™ — inteventiclar seus {@) Anterior sternocostal surface Left pulmonary artery ots Fight pulmonary Left pulmonary veins a Superior Fatin ‘coronary sulcus corofary Feat in posterior Interventieular sulcus (©) Posterior surtace car (Figure 20-3ae). The coronary suleus, a deep groove, marks the border between the atria and the ventricles. The anterior in- terventricular sulcus and the posterior interventricular sulcus, shallower depressions, mark the boundary between the eft and right ventricles (Figure 20-3a,be). 7 (6) Position of the heart FIGURE 20-3, ‘The Superficial Anatomy of the Heart. (a) Nisjor ‘anatomical features on the anterior surface, (b) Major landmarks on the posterior surface. Coronary arteries (which supply the heart itself) are shown in red; coronary veins are shown in blue. (e) An anterior view of the chest, showing the position ofthe heart relative to the chest wall ‘The connective tissue of the epicardium at the coronary and interventricular sulci generally contains substantial amounts of fat. In fresh or preserved hearts, this fat must be stripped away to expose the underlying grooves. These sui also contain the arter- ies and veins that supply blood to the cardiac muscle.OTHE HEART WALL AA section through the wal ofthe heart reveal three distinct lay- es: an outer epicardium, a middle myocardium, and an inner endocardium. Figures 20—4ae illustrate these thre layers 1. The epicardium is the visceral pericardium that covers the ‘outer surface of the heat. This serous membrane consists of an «exposed mesothelium and an underlying layer of loose connec- tive tissue that is attached to the myocardium. 2. The myocardium, or muscular wall of the heart, forms both atria and ventricles. This layer contains cardiac muscle tissue, blood vessels, and nerves. The myocardium consists of concen- tric layers of cardiac muscle tissue. The atrial myocardium con- tains muscle bundles that wrap around the atria and form figure cights that passthrough the interatrial septum (Figure 20-dbe) Superficial ventricular muscles wrap around both ventricles, deeper muscle layers spiral around and between the ventricles toward the apex. 3. The inner surfaces of the hear, including those of the heart valves, are covered by the endocardium, a simple squamous ep- ithelium that is continuous with the endothelium of the at- tached blood vessels. FIGURE 20-4 The Heart Wall. (a) A ciagremmatic section through the heart wall, showing the relative positions of the epicardium, myocardium, and endocardium. (b) Cardiac muscle tissue forms Concentric layers that wrap around the aria and spiral within the walls of the ventricles 20-2 Anotony ofthe eet [67 Cardiac Muscle Tissue Recall from Chapter 10 that cardiac muscle cells are interconnected by intercalated discs (Figure 20-Sa,be). = p.>28 Atan intercalat- cd disc, the interlocking membranes of adjacent cells are held to- gether by desmosomes and linked by gap junctions (Figure 20-5ce). Intercalated discs convey the force of contraction from cell to cell and propagate action potentials. Table 20-1 (p. 690) provides a quick review of the structural and functional differences between cardiac muscle cells and skeletal muscle fibers. Among the histologi- ‘al characteristics of cardiac muscle cells that differ from those of skeletal muscle fibers are (1) a small size (2) a single, centrally locat- ced nucleus; (3) branching interconnections between cell; and (4) the presence of intercalated discs. INTERNAL ANATOMY AND ORGANIZATION ‘This section walks you through the major landmarks and struc- tures visible on the interior surface of the heart. In a sectional view, you can see that the right atrium communicates with the right ventricle and the left atrium with the left ventricle. The atria EPICAROIUM (visceral pericardium)CHAPTER 20. THE HEART are separated by the interatrial septum (septum, wall) the ventei- cles are separated by the much thicker interventricular septum (Figure 20-6a,ce). Each septum is @ muscular partition. Atrio- ventricular (AV) valves, folds of fibrous tissue, extend into the ‘openings between the atria and ventricles. These valves permit blood flow in one direction only: from the atria to the ventricles. The Right Atrium ‘The right atrium receives blood from the systemic circuit through the two great veins: the superior vena cava (VE-na KA-vuh; plural, venae cavae) and the inferior vena cava, The superior vena cava, ‘which opens into the posterior and superior portion of the right atrium, delivers blood to the right atrium from the head, neck, upper limbs, and chest. The inferior vena cava, which opens into the posterior and inferior portion of the right atrium, carries blood to the right atrium from the rest ofthe trunk, the viscera, and the lower limbs. The cardiac veins of the heart return blood to the coronary sinus, a large, thin-walled vein that opens into the right atrium inferior to the connection with the superior vena cava. ‘The opening ofthe coronary sinus lies near the posterior edge of the interatrial septum. From the fifth week of embryonic develop- ‘ment until birth, the foramen ovale, an oval opening, penetrates the interatrial septum and connects the two atria, The foramen ovale permits blood flow from the right atrium to the left atrium Intecaated ‘ise FIGURE 20-5 ‘The Heart Wall and Cardiac Muscle Cells. (@) Sectional and (8) diagrammatic views of cardiac muscle tissue. (LM X 575) (¢) The structure of an intercalated disc while the lungs are developing before birth. At birth, the foramen ‘ovale closes, and the opening will be permanently sealed off within three months of delivery. The fossa ovalis, a small, shallow depres- sion, persists at this ste in the adult heart (Figure 20-6a,ce). Ifthe foramen ovale does not close, blood will flow from the left atrium {nto the right atrium rather than the opposite way, because, after birth, blood pressure in the pulmonary circuit is lower than that in the systemic circuit. We will consider the physiological effects of this condition in Chapter 21. EEE embryology Summary 15: The Deve: ‘The posterior wall ofthe right atrium and the interatril septum have smooth surfaces. In contrast, the anterior atrial wall and the inner surface of the auricle contain prominent muscular ridges called the pectinate muscles (pectin, comb), or musculi pectinati (Figure 20-6a.e). Cardiac muscle cel (intact Intorcalates Gap junction Zines bound to opposing call memeranes Desmosomes