CHAPTER 17: THE HEART

HEART
 A muscular organ that is essential for life because it pumps blood through the body
 The heart contracts forcefully to pump blood through the blood vessels of the body
 HEALTHY ADULT (5 L/ min), VIGOROUS EXERCISE (20 L/ min)

FUNCTIONS OF THE HEART

1. GENERATING BLOOD PRESSURE

 Caused by contractions of the heart
2. ROUTING BLOOD
 Heart pumps move the blood through the pulmonary circulation and systemic
circulations
 PULMONARY CIRCULATION-heart to lungs then back to the heart
 SYSTEMIC CIRCULATION-heart to body then back to the heart
3. REGULATING BLOOD SUPPLY
 Change in rate and force of heart contraction match blood flow

LOCATION, SHAPE AND SIZE OF THE HEART

 Electrocardiogram (ECG) and Cardiopulmonary Resuscitation (CPR)
 Heart has a blunt cone shape and is located in the thoracic cavity between the lungs
 MEDIASTINUM-midline partition of the heart, trachea, esophagus, and associated structures
 APEX-rounded point of the cone located deep to the 5 th intercostals space
 BASE-opposite end of the cone located deep to the sternum

ANATOMY OF THE HEART

PERICARDIUM
 PERICARDIAL CAVITY-surrounds the heart
 PERICARDIUM or PERICARDIAL SAC-forms the pericardial cavity; consists of
>FIBROUS PERICARDIUN-tough fibrous connective tissue that anchors the heart within
the mediastinum
>SEROUS PERICARDIUM-simple squamous epithelium overlying a layer of loose
connective tissue and fat
 PARIETAL PERICARDIUM-part of the serous pericardium lining the fibrous pericardium
 VISCERAL PEICARDIUM-part covering the heart surface
 PERICARDIAL FLUID-fluid in the pericardial cavity produced by the serous pericardium that helps
reduce friction
HEART WALL
 Three layers:
a.) EPICARDIUM (Visceral Pericardium)-thin serous membrane forming the smooth outer
surface of the heart
b.) MYOCARDIUM-thick middle layer of the heart composed of cardiac muscle cells and is
responsible for contractions of the heart chambers
c.) ENDOCARDIUM-inner surface of the heart chambers
 TRABECULAE CARNEAE-modifies ridges and columns of the cardiac muscles in the interior walls
of the ventricles
 PECTINATE MUSCLES-smaller, muscular ridges found in portions of the atria

EXTERNAL ANATOMY
 Four chambers of the Heart:
a.) TWO ATRIA-located at the base of the heart
b.) TWO VENTRICLES-base of the heart toward the apex
 AURICLES-flaplike extensions of the atria
 SULCUS-groove on the surface of the heart containing blood vessels and fat
 CORONARY SULCUS-extends around the heart, separating the atria from the ventricles
 Two sulci that indicate the division between the right and left ventricles:
a.) ANTERIOR INTERVENTRICULAR SULCUS-inferior from the coronary sulcus on the anterior
surface of the heart
b.) POSTERIOR INTERVENTRICULAR SULCUS-inferior from the coronary sulcus on the
posterior surface of the heart
 Six large veins that carry blood to the heart:
a.) SUPERIOR AND INFERIOR VENA CAVA-carry blood from the body to the right atrium
b.) FOUR PULMONARY VEINS-carry blood from the lungs to the left atrium
 PULMONARY TRUNK and the AORTA exit the heart
 PULMONARY TRUNK- splits into the right and left PULMONARY ARTERIES
 PULMONARY ARTERIES-carry blood to the lungs
 AORTA-carries blood to the rest of the body

HEART CHAMBERS
 RIGHT ATRIUM:
a.) SUPERIOR & INFERIOR VENA CAVA-receive the blood from the body
b.) CORONARY SINUS-recieves blood from the heart itself
 LEFT ATRIUM:
a.) Four openings that receive blood from the four pulmonary veins from the lungs
 INTERATRIAL SEPTUM-separates the two atria
 FOSSA OVALIS-slight oval depression marks the former location of the FORAMEN OVALE
 FORAMEN OVALE-opening between the left and right atria in the embryo and fetus
 VENTRICLES:
a.) RIGHT VENTRICLE-opens into the pulmonary trunk
b.) LEFT VENTRICLE-opens into the aorta
 INTERVENTRICULAR SEPTUM-separates the two ventricles
HEART VALVES
 Formed by folds of endocardium; allow blood to flow
 ATRIOVENTRICULAR (AV) VALVE –located between each atrium and its ventricle
 TRICUSPID VALVE-three cusps between the right atrium and the right ventricle
 BICUSPID or MITRAL VALVE-two cusps between the lest atrium and the left ventricle

PAPILLARY MUSCLES
 Cone-shaped, muscular pillars contained in each ventricles
 CHORDAE TENDINEAE-thin, strong connective tissue strings
 SEMILUNAR VALVES-carry blood away from the ventricles
 AORTIC SEMILUNAR VALVE-in the aorta
 PULMONARY SEMILUNAR VALVE-in the pulmonary trunk

1.) The bicuspid valve is open. The cusps of the valve are pushed by the blood into the ventricle,
and blood flows into the ventricle. The chordate tendineae are relaxed.
2.) The aortic semilunar valve is closed. The cusps of the valve overlap as they are pushed by the
blood in the aorta toward the ventricle. Backflow of blood into the ventricle is prevented.
3.) The bicuspid valve is closed. The cusps of the valve overlap as they are pushed by the blood
toward the left atrium. The chordate tendineae are tensed. Backflow of blood into the atrium is
prevented.
4.) The aortic semilunar valve is open. The cusps of the valve are pushed by the blood toward the
aorta, and blood flows into the aorta.

ROUTE OF BLOOD FLOW THROUGH THE HEART

1.) Superior and Inferior Vena Cava 8.) Lung tissue (pulmonary circulation)
2.) Right Atrium 9.) Pulmonary veins
3.) Tricuspid Valve 10.)Left atrium
4.) Right Ventricle 11.)Bicuspid valve
5.) Pulmonary semilunar valve 12.)Left ventricle
6.) Pulmonary trunk 13.)Aortic semilunar valve
7.) Pulmonary arteries 14.)Aorta

BLOOD SUPPLY TO THE HEART

 CORONARY CIRCULATION-supplies cardiac muscle with blood
 LEFT CORONAY ARTERY-from the left side of the aorta; has two major branches:
a.) ANTERIOR INTERVENTRICULAR ARTERY-branches supply the left atrium
b.) CIRCUMFLEX ARTERY
 RIGHT CORONARY ARTERY-from the right side of the aorta; supply the right atrium, right
ventricle, and part of the left posterior ventricle
a.) POSTERIOR INTERVENTRICULAR ARTERY
 CARDIAC VEINS-drain blood from the cardiac muscle
 CORONARY SINUS-a large vein located within the coronary sulcus on the posterior aspect of the
heart
HISTOLOGY OF THE HEART

FIBROUS SKELETON OF THE HEART

 Consists of a plate of fibrous connective tissue between the atria and ventricles
 FIBROUS RINGS-located around the atrioventricular and semilunar valves and provides a solid
support for them.

CARDIAC MUSCLE
 CARDIAC MUSCLE CELLS-elongated, branching cells containing one, or occasionally two,
centrally located nuclei; contain ACTIN and MYOSIN myofilaments organized to form
SARCOMERES
 ACTIN & MYOSIN-responsible for muscle contraction and gives cardiac muscle a striated
appearance
 MYOFIBRILS-sarcomeres joined end to end
 TRANSVERSE (T) TUBULES-extend into the interior of the cells, associated with the
SARCOPLASMIC RETICULUM
 ADENOSIN TRIPHOSPHATE (ATP)-provides the energy for muscle contraction
 INTERCALATED DISKS-specialized cell-to-cell contacts; prevent cells from pulling apart
 ELECTRICAL SYNAPSES-allow action potential to pass easily from one cell to another

ELECTRICAL ACTIVITY OF THE HEART

1. Depolarization Phase
 Voltage-gated Na channels open
 Voltage-gated K channels close
 Voltage-gated Ca channels begin to open
2. Early repolarization and plateau phases
 Voltage-gated Na channels close
 Some voltage-gated K channels open, causing early repolarization
 Voltage-gated Ca channels are open, producing the plateau by slowing further
repolarization
3.Final Repolarization Phase
 Voltage-gated Ca channels close
 Many voltage-gated K channels open

REFRACTORY PERIODS
 ABSOLUTE REFRACTORY PERIOD-depolarization to final repolarization; completely insensitive
 RELATIVE REFRACTORY PERIOD-last part of the final repolarization; sensitive to stimulation

AUTORHYTHMICITY OF CARDIAC MUSCLE

 AUTORHYTHMIC-stimulates itself (auto) to contract at regular intervals (rhythmic)
 SINOATRIAL NODE-collection of cardiac muscle cells capable of spontaneously generating action
potentials; pacemaker of the heart
 HEART RATE-number of beats per minute
 PREPOTENTIAL-a slowly developing local potential
CONDUCTIING SYSTEM OF THE HEART
1.) Action potentials originate in the sinoatrial (SA) node and travel across the wall of the atrium
from the SA node to the atrioventricular (AV) node.
2.) Action potentials pass through the AV node and along the atrioventricular (AV) bundle, which
extends from the AV node, through the fibrous skeleton, into the interventricular septum.
3.) The AV bundle divides into right and left bundle branches, and action potentials descend to the
apex of each ventricle along the bundle branches.
4.) Action potentials are carried by the Purkinje fibers from the bundle branches to the ventricular
walls.

ELECTROCARDIOGRAM
 Record the summed effect of all the action potentials in the heart
 P wave-depolarization of the atria
 QRS complex-depolarization of the ventricles; repolarization of the atria
 T wave-repolarization of the ventricles
 PQ interval or PR interval-P wave to the beginning of the QRS complex
 QT interval-QRS complex to the end of the T wave

CARDIAC CYCLE
 Repetitive pumping process
 PRIMER PUMP-the atrium; complete the filling of the ventricles with blood
 POWER PUMP-the ventricle; produce the major force that causes blood to flow through the
pulmonary and systemic circulations

OVERVIEW OF SYSTOLE AND DIASTOLE

 ATRIAL SYSTOLE-refers to contraction of the two atria
 VENTRICULAR SYSTOLE-contraction of the two ventricles
 ATRIAL DIASTOLE-relaxation of the two atria
 VENTRICULAR DIASTOLE-relaxation of the two ventricles

EVENTS OCCURING DURING VENTRCULAR SYSTOLE

1.) Ventricular depolarization produces the QRS complex and initiates the contraction of the
ventricles, which increases ventricular pressure. The AV valves close, the semilunar valves open,
and blood is ejected from the blood.
2.) The volume of the blood n a ventricle just before it contracts is the end diastolic volume. The
volume of blood after contract is the end systolic volume.

EVENTS OCCURING DURING VENTRICULAR DIASTOLE

1.) Ventricular repolarization produces the T wave and the ventricles relax. Blood flowing back
toward the relaxed ventricles closes the semilunar valves. The AV valves open and blood flows
into the ventricles.
2.) Approximately 70% of ventricular filling occurs when blood flows from the higher pressure in the
veins and atria to the lower pressure in the relaxed ventricles.
AORTIC PRESSURE CURVE
 SYSTOLIC PRESSURE-maximum value of aortic pressure
 DIASTOLIC PRESSURE-minimum value of aortic pressure
 DICROTIC NOTCH-double-beating; when increased pressure caused by a recoil is large, a double
pulse can be felt

HEART SOUNDS
 FIRST HEART SOUND-a low pitched sound, often described as a “lubb” sound.
 SECOND HEART SOUND-a higher-pitched sound often describes as “dupp” sound
 SYSTOLE-the time between the first and second heart sound
 DIASTOLE-time between the second heart sound and the next first heart sound
 MURMURS-abnormal heart sounds that is usually a result of faulty valves
 STENOSED-opening of a valve that is narrowed
 INCOMPETENT VALVE-increase the work load of the heart; hypertrophy

MEAN ARTERIAL BLOOD PRESSURE

 Blood flows from areas of higher pressure to areas of low pressure
 VENOUS RETURN-amount of blood returning to the heart from the peripheral circulation that
causes increase in end-diastolic volume during exercise
 CARDIAC RESERVE-Difference between maximum cardiac output and cardiac output when a
person is at rest. The greater a person’s cardiac reserve, the greater his capacity of doing
exercise

MAP=CO X PR
 MEAN ARTERIAL PRESSURE-average pressure in the aorta
 CARDIAC OUTPUT-amount of blood pumped by the heart per minute
 PERIPHERAL RESISTANCE-total resistance against which blood must be pumped

CO=HR X SV
 CARDIAC OUTPUT-amount of blood pumped by the heart per minute
 HEART RATE-number of times the heart beats (contracts) per minute
 STROKE VOLUME-volume of blood pumped during each heartbeat (cardiac cycle). Beats per
minute (bpm)

STROKE VOLUME
 End diastolic volume (125 mL) – End systolic volume (55 mL)= Stroke volume (70 mL)

STROKE VOLUME DURING EXERCISE

 End diastolic volume (145 mL) – End systolic volume ( 30 mL)= Stroke volume (115 mL)
REGULATION OF THE HEART
 Intrinsic and extrinsic regulatory control cardiac output

INTRINSIC REGULATION OF THE HEART

 Modifies stroke volume through the normal functional characteristics of cardiac muscle cells
 STARLING’S LAW OF THE HEART-force of contraction of cardiac muscle is a function of the length
of its muscle fibers at the end of diastole; the greater the ventricular filling, the greater the
stroke volume produced by the heart
 PRELOAD-degree to which the ventricular walls are stretched at the end of diastole
 AFTERLOAD-pressure against which the ventricles must pump blood
 Can be modified by depolarization and hyperpolarization
 HYPERPOLARIZATION-moves the membrane potential further from threshold
 DEPOLARIZATION-moves the membrane potential closer to threshold

EXTRINSIC REGULATION OF THE HEART

 Modifies heart rate and stroke volume through neural and hormonal mechanisms
 NEURAL CONTROL OF THE HEART-results from sympathetic and parasympathetic reflexes
 HORMONAL CONTROL OF THE HEART-comes from epinephrine and norepinephrine secreted
from the adrenal medulla
 Parasympathetic stimulation is supplied by the vagus nerve; decreases heart rate
 Sympathetic stimulation is supplied by the cardiac nerve; increases heart rate

THE HEART AND HOMEOSTASIS

EFFECT OF BLOOD PRESSURE

 BARORECEPTOR REFLEXES-detect changes in blood pressure and produce changes in heart rate
and in the force of contraction.
 BARORECEPTORS-sensory receptors of the baroreceptors that are stretch receptors located in
the walls of certain large arteries
 CARDIOREGULATORY CENTER-located within the medulla oblongata of the brain which receives
and integrates action potentials from baroreceptors
 ADRENAL MEDULLARY MECHANISM-release of epinephrine and norepinephrine from the renal
gland
 In response to a decrease in blood pressure, the baroreceptor reflexes increase heart rate and
stroke volume. When blood pressure increases, the baroreceptor reflexes decrease heart rate
and stroke volume

EFFECTS OF pH, CARBON DIOXIDE, AND OXYGEN

 CHEMORECEPTORS-sensory receptors responding to chemicals, such as oxygen, carbon dioxide,
and H. primarily sensitive to blood oxygen levels are found in the carotid and aortic bodies
 Medullary chemoreceptors monitor blood pH and carbon dioxide levels.
 Chemoreceptors are not important for the normal regulation of the heart, but are important in
the regulation of respiration and blood vessel constriction
EFFECTS OF IONS AND BODY TEMPERATURE
 Increased extracellular K decrease heart rate and stroke volume. Decreased extracellular K
decrease heart rate
 Increased extracellular Ca increase stroke volume and decrease heart rate. Decreased
extracellular Ca levels produce the opposite effect
 Heart rate increases when body temperature increases, and it decreases when body
temperature decreases

EFFECTS OF AGING ON THE HEART

 Aging results in gradual changes in the function of the heart, which are minor under resting
conditions but are more significant during exercise