HEART & BLOOD VESSELS

TERMS
Cardiovascular system- heart, blood, blood vessels
Pulmonary circulation- (right side of the) heart pumps to the lungs & back to the left side of
the heart
Systemic circulation- (left side of the) heart pumps blood to all other tissues in body & back
to right side of the heart
FUNCTIONS OF HEART
- Generates blood pressure
- Routes blood
- Ensures one-way blood flow
- Regulates blood supply
SIZE, FORM, & LOCATION OF HEART
Adult heart is shaped like a blunt cone, with a size approximately similar to a closed fist
- Heart size decreases after the age 65, or with inactive physical activity
- The blunt, rounded point of the heart is called the apex
- the larger, flat part of the heart is called the base
- located in the thoracic cavity between two pleural cavities that surround lungs
- mediastinum is made up of the heart, trachea, esophagus, and associated structures
that make up a midline partition
- has its own cavity, called the pericardial cavity
- heart lies obliquely at an angle in the mediastinum
- base is directed posteriorly and slightly superiorly, located deep in sternum
extending to second intercostal space
- apex is directed anteriorly and slightly inferiorly, leaning towards the left so approx.
2/3 of the heart is to he left of midline of sternum
ANATOMY OF THE HEART
Pericardium
- makes up the pericardial cavity that surrounds the heart
- also known as the pericardial sac
- composed of two layers”
1. fibrous pericardium- outer layer made up of tough, fibrous connective tissue
2. serous pericardium- inner layer made up of flat epithelial cells with a thin layer of
connective tissue [ divided into two: parietal pericardium (lining fibrous
pericardium) and visceral pericardium (covering the heart’s surface) ]

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 - parietal and visceral pericardia are continuous with each other where great vessels
enter or leave
- pericardial cavity is found between visceral and parietal pericardia, filled with a thin
layer of pericardial fluid provided by serous pericardium
- pericardial fluid helps reduce friction as heart moves within pericardium

External Anatomy
- right and left atria are found at base of heart
- right and left ventricles extend from base to apex of heart
- coronary sulcus separates atria from ventricles (include two sulci that extend
inferiorly from this to separate two ventricles:)
• anterior interventricular sulcus extends inferiorly from coronary sulcus to
anterior surface of heart
• posterior interventricular sulcus extends inferiorly from coronary sulcus to
posterior surface of heart
- 6 large veins carry blood to atria of heart:
1. Superior vena cava- carries blood from body to right atrium
2. Inferior vena cava- carries blood from body to right atrium
3. 4 pulmonary veins- carry blood from lungs to left atrium
- 2 arteries carry blood away from ventricles:
1. Pulmonary trunk- arises form left ventricle and splits into right and left
pulmonary arteries; carries blood to the lungs
2. Aorta- arises from left ventricle; carries blood to the body

Heart Chambers & Internal Anatomy

1. Right and Left Atria
- Veins bring in deoxygenated blood to atria
- Acts as reservoirs where blood returning from veins build up before entering
ventricles
- Atria contractions force blood into ventricles
- Right atrium receives blood from inferior vena cava, superior vena cava (both drain
blood from most of the body), & coronary sinus (drains blood from heart muscle)
- Left atrium receives blood from the 4 pulmonary veins which drain blood from lungs
- both atria are separated by interatrial septum

2. Right and Left Ventricles

- Major pumping chambers of the heart
- Eject blood into arteries and force it to flow to circulatory system
- Atria opens to ventricles, where each ventricle has one large outflow route superiorly
located near midline of heart

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 - Right ventricle pumps blood into pulmonary trunk
- Left ventricle pumps blood into aorta
- Both ventricles are separated by interventricular ventricle
- Wall of left ventricle is thicker, which contracts more forcefully (increasing pressure
to approx. 120 mmHg) and generates greater blood pressure
- When right ventricle contracts, pressure increases to 1/5 that of left ventricle
- Both ventricles pump nearly the same volume of blood
- Higher pressure generated by left ventricle moves blood to systemic circulation
- Lower pressure generated by right ventricle to smaller pulmonary circulation

Heart Valves
- Maintains one-way blood flow
- 2 types:
1. Atrioventricular (AV) valve
- located between each atrium and ventricle, and has three cusps between right
atrium and right ventricle (tricuspid valve) and two cusps between left atrium
and left ventricle (bicuspid valve or mitral valve)
- allow blood to flow form atria to ventricle without backflow
- each ventricle has papillary pillars (cone-shaped muscular pillars) that are
attached by thin, strong, connective tissue strings called chordae tendinae to free
margins of cusps of AV valve
- when ventricles relax, atria forces AV valve to open
- when ventricles contract, blood flows toward atria causing AV valve to close
where papillary pillars contract by pulling on chordae tendinae to prevent AV
valve from opening
2. Semilunar valve
- located between each ventricle and its associated artery
- between the right ventricle and pulmonary trunk is the pulmonary semilunar
valve
- between left ventricle and aorta is the aortic semilunar valve
- each valve has three semilunar cusps
- when ventricles relax, pressure in aorta and pulmonary trunk are higher than
ventricles, causing blood to flow toward ventricles to fill up cusps to bulge and
meet in the middle of arteries to close vessels and prevent back flow
- when ventricles contract, pressure in ventricles forces semilunar valves to open
- cardiac skeleton is a plate of connective tissue that surround AVs and semilunar valves to
give solid support, as well as electrical insulation between atria and ventricles

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Route of Blood Flow throughout Heart
- Both atria contract at the same time, just as both ventricles contract at the same time
1. Blood enters right atrium via superior & inferior vena cava, and coronary sinus
2. Right ventricle relaxes from precious contraction, allowing blood to flow in from
right atrium
3. Right atrium contracts to push enough blood towards right ventricle to complete
right ventricular filling
4. Right ventricle begins to contract, pushing blood against tricuspid valve, forcing it
to close
5. When pressure in right ventricle increases, pulmonary semilunar valve opens for
blood to flow into pulmonary trunk
6. Right ventricle relaxes, causing lowered pressure in the right ventricle and increased
pressure in pulmonary trunk
7. Backflow of blood causes pulmonary semilunar valve to close
8. Pulmonary trunk branches out to right and left pulmonary arteries, where
deoxygenated blood become oxygenated
9. Pulmonary veins carry oxygenated blood from lungs to left atrium
10. Left ventricle relaxes from previous contraction, allowing blood to flow in from left
atrium
11. Left atrium contracts to push enough blood towards left ventricle to complete left
ventricular filling
12. Left ventricle begins to contract, pushing blood against bicuspid valve, forcing it to
close
13. When pressure in left ventricle increases, aortic semilunar valve opens for blood to
flow into aorta
14. Left ventricle relaxes, causing lowered pressure in left ventricle and increased
pressure in aorta
15. Backflow of blood causes aortic semilunar valve to close
16. Blood flowing through aorta now gets distributed to all parts of the body except
some parts of the lungs

Blood Supply to the Heart

1. Coronary Arteries
- Supply blood to wall of the heart
- Originate from base of aorta, above semilunar valves
- Left coronary artery originates on left side of aorta and has 3 major branches:
a. Anterior interventricular artery- lies anterior to interventricular sulcus

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 b. Circumflex artery- extends around coronary sulcus on left side to posterior of
heart
c. Left marginal artery- extends inferiorly along atrial wall of left ventricle from circumflex
artery
- Branches of left coronary artery supply much of anterior wall of heart and most of
left ventricle
- Right coronary artery originates on ride side of aorta
- Extends around coronary sulcus on right side to posterior of heart
- Has 2 branches:
a. Posterior interventricular artery- lies posterior to interventricular sulcus
b. Right marginal artery- extends inferiorly along lateral wall of right ventricle
- branches of right coronary artery supply most of wall of right ventricle
2. Cardiac Veins
- Drain blood from cardiac muscle
- Pathways are nearly parallel to coronary arteries
- Most drain blood in coronary sinus, which then flows to right atrium
- Some small cardiac veins flow directly into right atrium

Histology of Heart
Heart Wall
- Heart wall is composed of three layers of tissue:
1. Epicardium- also known as visceral pericardium; thin, serous membrane forming
smooth outer surface of heart that consists of simple squamous epithelium
overlying loose connective and adipose tissue
2. Myocardium- the thick middle layer of the heart that is responsible for
contractions of heart chambers; made up of cardiac muscle cells
3. Endocardium- smooth inner surface of heart chambers which allows blood to
move easily through heart, and forms heart valves that include thick layer of
connective tissue; consists of simple squamous epithelium over a layer of
connective tissue

Cardiac Muscle
- Organized into spiral bundles that twist when cardiac muscle cells contract,
compressing contents of heart chambers
- Bound end-to-end and laterally to adjacent cells by intercalated disks, whose
membranes are highly folded to prevent cells from pulling apart
- Specialized cell membrane structures in intercalated disks called gap junctions allow
cytoplasm to flow freely between cells, allowing action potentials to pass easily from
one cell to another

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ELECTRICAL ACTIVITY OF THE HEART
Action Potentials in Cardiac Muscle
- Similar to action potentials in skeletal muscles and neurons, but has a slow
repolarization period that delays action potential
- Takes approx. 200-500 milliseconds to complete, as compared to that of the skeletal
muscle which only takes 2 milliseconds
- Can spread from one cell to adjacent cells through gap junctions
1. Rapid depolarization occurs from sodium ions diffusing into the cell
2. Depolarization stimulates calcium ions to diffuse into cell (contributing to overall
depolarization)
3. At peak of depolarization, sodium channels close and small number of potassium
channels open
4. Exit of potassium ions are counteracted by the continuous entrance of calcium ions
5. Plateau phase (slow repolarization) is initiated the moment calcium ions flow into the
cell, in which its slow diffusion makes action potentials last longer
6. Plateau phase ends, repolarization begins when calcium channels close and large
number of potassium channels open
- Exhibits a refractory period that allows cardiac muscle to contract and relax almost
completely before another action potential is produced, which ensures a rhythm of
contraction and relaxation

Conduction System of the Heart

- All cells of conduction system can produce spontaneous action potentials
- Is comprised of 5 parts:
1. Sinoatrial (SA) Node
- functions as the heart’s pacemaker where action potentials originate to spread
all over left and right atria, causing them to contract
- produces action potentials faster than other areas and have more calcium
channels
- sodium and calcium channels spontaneously open and close at a rhythmic rate
2. Atrioventricular (AV) Node
- action potentials spread slowly through AV node then into the atrioventricular
bundle made up of specialized cardiac muscle cells that conduct action potentials
faster)
- slow rate of action potential in AV node allows atria to complete contraction
before action potentials are delivered to ventricles
- AV bundle projects through fibrous connective tissue that separates atria from
ventricle
3. Left and Right Bundle Branches
- divisions of the AV bundle
4. Purkinje fibers
- bundles of conducting tissue at tips of left and right bundle branches
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 - pass to the apex of heart and extend to cardiac muscle in ventricle walls
- ectopic beats occur when action potential originates from other areas other than SA
node

Electrocardiogram
- Commonly known as ECG
- Records electrical events in heart
- Used to detect abnormal heart rates or rhythms, abnormal pathways, hypertrophy or
atrophy, and approximate damaged location of cardiac muscle
- Normal ECG has P wave (atrial depolarization), QRS complex (ventricular
depolarization), and a T wave (ventricular repolarization)
- Atrial contraction occurs during PQ interval, ventricles contract and relax during QT
interval

CARDIAC CYCLE
- Refers to repetitive pumping process that begins with onset cardiac muscle
contraction and ends with the beginning of another contraction
- Atrial systole refers to contraction of the two atria
- Ventricular systole refers to contraction of two ventricles
- Atrial diastole refers to relaxation of the two atria
- Ventricular diastole refers to relaxation of two ventricles
1. Atria and ventricles are relaxed, AV valves are open and semilunar valves are closed ;
blood returning to heart enters atria, and flows to ventricle (filling it up to 70% its
volume)
2. Atrial systole occurs, where atria contract, forcing additional blood to flow into
ventricles to complete ventricular filling; semilunar valves remain closed
3. Ventricular systole occurs, where AV valves close as pressure increases
4. Increasing pressure exceeds pressure in pulmonary trunk and aorta, thus forcing
semilunar valves open to eject blood into respective arteries
5. Ventricular diastole occurs, where pressure in ventricles decrease below pressure of
arteries, which close semilunar valves
6. Pressure declines in ventricles until atrial pressures are greater again, thus opening
AV valves to let blood flow in again

HEART SOUNDS
- Two main heart sounds:
1. Lubb- first heart sound; lower in pitch than the 2nd; occurs at beginning of
ventricular systole resulting from the closure of the AV valves

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 2. Dupp- seconds heart sound; occurs at beginning of ventricular diastole resulting
from the closure of the semilunar valves
- Ventricular systole occurs between 1 st and 2nd heart sound
- Ventricular diastole occurs between 3nd heart sound and 1 st heart sound of next beat
- There is less time between 1 st and 2nd heart sounds compared to 2nd and 1st heart
sound of next beat due to ventricular diastole lasting longer than ventricular systole
- if heart valves do not close completely, it becomes an incompetent valve
- heart murmurs occur as a result of faulty valves (swishing sound is heard after valve
closes due to stenosed valve)

REGULATION OF HEART FUNCTION

- cardiac output (CO) is the blood volume to assess heart’s function
- stroke volume (SV) is the blood volume pumped per ventricle each time heart
contracts
- heart rate (HR) is the number of times heart contracts each minute
-cardiac output can be calculated in this way:
CO (mL/min)= SV (mL/beat) x HR (beat/min)

Intrinsic Regulation of the Heart

-refers to mechanisms contained within heart itself
- amount of blood in ventricles at end of ventricular diastole determines degree to which
cardiac muscle fibers are stretched
- Preload is degree to which ventricular walls are stretched at end of diastole
- Venous return is amount of blood that returns to heart
- if venous return ↑, ↑ preload, ↑ stroke volume (and vice versa)
- relationship between venous return and SV is called Starling’s law of the heart
- Afterload refers to pressure against which ventricles must pump blood

Extrinsic Regulation of the Heart

- refers to mechanisms external to heart
- has two types:
1. Nervous Regulation (Baroreceptor Reflex)
- nerve influences of heart activity are carried through autonomic nervous system
– baroreceptor reflex is a mechanism of NS that regulates heart function

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 – baroreceptors are stretch receptors that monitor blood pressure in aorta and in
wall of internal carotid arteries
– changes in blood pressure results in changes of action potentials produced by
baroreceptors
– medulla oblongata is cardioregulatory center, which controls action potential
frequencies
- ↑ BP, ↑ action potential, resulting to ↑ parasympathetic regulation, ↓ sympathetic
stimulation (overall effect: ↓ HR and SV; ↓ BP) and vice versa
2. Chemical Regulation (Chemoreceptor Reflex)
– epinephrine and norepinephrine are released in response to exercise, emotional
excitement, etc that also influence heart function
– medulla oblongata is sensitive to changes in pH and CO 2 levels
– chemoreceptors in medulla oblongata influence cardioregulatory center
– cardioregulatory center controls frequency of action potentials in
parasympathetic neurons that decrease HR
– cardioregulatory center also controls frequency of action potentials in
sympathetic neurons which increase HR and SV

BLOOD VESSELS
FUNCTIONS
- Carries blood
- Exchanges nutrients, waste, and gas products in tissues
- Transports substances
- Helps regulate blood pressure
- Directs blood flow to tissues
GENERAL FEATURES OF BLOOD VESSEL STRUCTURE
- Three types of blood vessels:
1. Arteries
2. Capillaries
3. Veins
- Blood vessel consists of three layers:
1. Tunica intima (innermost layer)- composed of an endothelium, of simple
squamous epithelial cells, a basement membrane, & a small amount of connective
tissue (in muscular arteries, tunic also contains layer of thin elastic connective
tissue)
2. Tunica media (middle layer)- composed of smooth muscle cells arranged circularly
around blood vessel with elastic and collagen fibers (in muscular arteries, tunic
has a layer of elastic connective tissue forming outer layer of tunic)
3. Tunica adventitia (outermost layer)- composed of dense connective tissue that
becomes loose connective tissue toward outer portion of blood vessel wal

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