Vital Signs: Pulse & Heart Rate

Video 1.1: Basic Heart Anatomy

The Heart’s Location within the Thoracic Cavity

- The heart is a hollow, muscular, cone-shaped organ
o General location
a. Positioned in the mediastinum

b. within the pericardial cavity

c. between the pleural cavities

o enclosed by the pericardium

a. function –anchors & protects the heart

- Esophagus and trachea are posterior to the heart

The Heart’s Internal Structure

- 4 chambers, or compartments
o Two superior chambers, or atria

o Two inferior chambers, or ventricles

o To prevent mixing of blood between chambers-- interatrial septum and

interventricular septum

 Ventricular walls are thicker than atrial walls because they are responsible for
pumping blood into the systemic and pulmonary circulations

o Right atrium
 Receives deoxygenated blood from the body from three vessels
1. Superior vena cava

2. Inferior vena cava

3. Coronary sinus

 From the right atrium, blood goes to the right ventricle

o Right ventricle
 Pumps deoxygenated blood into the pulmonary trunk
 o Left atrium
 receives oxygenated blood via the pulmonary veins m

o Left ventricle
 Pumps oxygenated blood into the aorta

 Left ventricular walls are thicker than right ventricular walls because they
need to contract with more force in order to send blood throughout the
systemic circulation

- The systemic circulation supplies the tissues and organs of the body with oxygenated blood
o the newly deoxygenated blood returns to the right atrium by the superior vena cava,
inferior vena cava, and coronary sinus

Video 1.2a: Your Beating Heart

The Heart at a Microscopic Level
- 2 functional units (syncytia):
o the atrial syncytium

o the ventricular syncytium

o Atria contract, then ventricles contract, then the heart relaxes

- Two types of cells in the heart wall

o Contracting cells

o Cells that generate an electrical signal

 Form the cardiac conduction system:

 Occurs in each heartbeat

The Cardiac Conduction System

- Starts at the sinoatrial node (SA node)

o Location:

o Part of the cardiac conduction system that generates an electrical signal most rapidly
o Spreads signal over entire atrial syncytium causing atrial contraction
- Signal spreads to the atrioventricular node (AV node)

- Signal passes through the atrioventricular bundle (AV bundle)

 - Signal arrives in the interventricular septum
o Passes through two bundle branches (right and left)

- At apex, the fibers branch extensively, forming Purkinje fibers

- Electrocardiograms (ECGs) assess the cardiac conduction system

o Determine if electrical activity of the heart is working properly

Video 1.2b: ECG Demo

- ECGs are devices we use to detect the electrical activity in the heart
o Electrodes are placed on the body

 2 upper limb leads

 2 lower limb leads

 6 precordial leads

 Allows you to look at the heart from 12 different angles-> can pinpoint
location of abnormality, if present

- The current arising from the SA node is a positive current, called depolarization
o The positive current passes through the atrial walls
o A negative current restores the electrical potential of the atrium back to normal after
the passing of the positive current, this is called repolarization

- Normal Sinus Rhythm

o P wave: first wave

o QRS complex: second group of waves

 Consists of the Q, R, S waves

o T Wave: third wave

 o Isoelectric lines –occur when there is no change occurring in the electrical state of the
heart (i.e., no depolarization or repolarization is occurring)

 Between P wave and QRS complex

 Between QRS complex and T wave

Video 1.3a: Heart Valves, Part 1

- Heart valves ensure that blood flows in one direction through the heart
o Composed of dense, fibrous connective tissue
o covered in endocardium-

- Heart has 4 valves- organized as two pairs

o Atrioventricular valves (AV valves)
 Location:

 tricuspid valve

 mitral valve:

 Close when ventricles contract and the pressure in the ventricles exceeds pressure
in the atria

 chordae tendinae:

 papillary muscles contract along with ventricles, creating tension in

the chordae tendinae, preventing the free edges of the valves from
swinging upward into the atria

 Open after ventricular relaxation, when atrial pressure exceeds ventricular pressure

o Semilunar valves (SL valves)

Video 1.3b, Heart Valves, Part 2

- Blood passes from right ventricle to the pulmonary trunk and from the left ventricle into the
aorta
o Semilunar valves:
 pulmonic valve

 aortic valve
  When closed, the cusps fall into the center of the pulmonary trunk and aorta
to prevent backflow of blood from the vessel into the ventricle
 When the ventricles contract, pressure in them increases- when ventricular
pressure exceeds pressure in the aorta and pulmonary trunk, the semilunar valves open
 When the ventricles relax, pressure drops- when the ventricular pressure falls
below the pressure in the aorta and pulmonary trunk, the semilunar valves close

Movement of valves during the cardiac cycle

- When the heart is relaxed

o the semilunar valves are closed and the AV valves are open

 blood is coming back to the right atrium through the superior vena cava,
inferior vena cava and coronary sinus

 On the left side, blood is returning to the heart from the pulmonary veins
from the lungs

- Atria contract
o Pressure in atria increases

- Atria relax, ventricles contract

o Pressure in ventricles exceeds pressure in atria

o Pressure continues to climb as ventricles continue to contract -> ventricular pressure

exceeds pressure in aorta and pulmonary trunk

- Ventricles stop contracting, start to relax

- Cycle repeats
- When valves close, they cause vibrations to occur in the blood that’s passing through the
heart
o Vibrations are carried to the body’s surface and can be heard with a stethoscope
o sound one:
 o sound two:

Video 1.3c, Assessing Heart Rate Demo

- Auscultation:

- The heart is positioned deep to the sternum, slightly to the left of the midline in the chest
cavity
o the apex:
 Location:

 Orientation:

 point of maximal impulse- the most accurate place to check heart rate

- Feeling the heart rate, or palpating, assesses the number of beats per minute
- Auscultation allows assessment of heart rate as well as heart sounds
o Heart sounds include sound one and sound two, usually called S1 an S2
 S1

 S2

- Physicians often auscultate in multiple locations to assess heart sounds related to the specific
valves
o aortic valve:

o pulmonic valve:

o tricuspid valve:

o mitral valve:

- If a valve does not close all of the way, it will make a swishing sound
- If a valve does not open all of the way, it will make a clicking sound

Video 1.4a, The Cardiac Cycle, Part 1

Electrical Changes During the Cardiac Cycle

- Conduction system:

o Starts at the SA node

 Excitation of the atria creates the P-wave on an ECG
 o Signal sent to the AV node
 Delayed for 1/10th of a second—

o Passed to AV bundle
 The only electrical connection between the atrial syncytium and ventricular
syncytium

o Excitation of the ventricles creates the QRS complex on an ECG

o Heart relaxes, ventricles repolarize

 Creates the T wave on the ECG

- These electrical signals create changes in the contracting cells, triggering muscle contraction

Video 1.4b: The Cardiac Cycle, Part 2

Pressure Changes During the Cardiac Cycle

- Pressure changes in the heart cause the valves to open and close, to prevent backflow of
blood
o The P wave on an ECG is followed closely by an increase in atrial pressure
 atrial contraction, atrial systole

 After atrial systole, the atria contract and pressure remains low
o The QRS complex on an ECG is followed almost immediately by an increase in
ventricular pressure
 The period of ventricular contraction is called ventricular systole

 When ventricular pressure exceeds aortic pressure, the semilunar valves open

 Once this pressure peaks, the ventricles stop contracting

o Pressure in ventricles falls below the pressure in the aorta and
pulmonary trunk
  The ventricles continue to relax and ventricular pressure continues to
fall
o When this pressure falls below atrial pressure, the AV valves
open
o The period when the ventricles are relaxed is called ventricular
diastole –during this phase, ventricles fill with blood

Ventricular Volume During the Cardiac Cycle

- Ventricular volume is fairly high during relaxation, or diastole

- During atrial systole- a little more blood is pushed into the ventricles, so the volume
increases slightly

- Ventricles contract, pressure increases and volume decreases

o Blood is being ejected to the aorta and pulmonary trunk
o AV valves open and ventricular volume begins to increase again

Heart Sounds During the Cardiac Cycle

o Heart sound one indicates the start of ventricular systole

o Heart sound two indicates start of ventricular diastole

Video 1.4c: Assessing Pulse Demo

- Heart rate:

- Pulse:

o We assess pulse in elastic arteries, which can distend and retract

o Pulse and heart rate are typically the same in a person with healthy cardiovascular
function, but could be different if someone has poor peripheral circulation or arterial
disease

Locations to assess pulse:

- carotid artery

- brachial artery (at the antecubital fossa)

- radial artery
 - femoral artery

- dorsalis pedis

- posterior tibial

Video 1.5: Cardiac Output

- Need to keep blood circulating through the body to supply the cells with oxygen and
nutrients and to carry away metabolic waste products
- Cardiac Output (CO) = the volume of blood ejected per minute

o Influenced by heart rate (HR) and stroke volume (SV)

o CO = HR x SV

- Stroke volume: the volume of blood ejected during a single heartbeat

o End diastolic volume (EDV):

o End systolic volume (ESV):

o Stroke volume = EDV - ESV

- Cardiac output can be increased or decreased to meet the needs of the body

- The autonomic nervous system plays a role in regulating cardiac output

o Two branches: parasympathetic and sympathetic

 sympathetic division:

 in the heart, the sympathetic nervous system innervates SA node, AV

node and the contractile cells of the myocardium

 when activated, causes the SA node to depolarize more quickly and

can shorten the delay at the AV node

o tachycardia = HR > 100 bpm

 sympathetic activation also causes contractile cells of myocardium to

contract more forcefully -> leads to increased stroke volume
 parasympathetic division:

 in the heart, the parasympathetic nervous system innervates the SA

node & the AV node
 parasympathetic nervous system slows the SA node’s rate of self-
excitation

o parasympathetic signals are carried to the SA node by the vagus

nerve

o bradycardia = HR < 60 bpm