Heart

- Muscular organ that is essential for life because it pumps blood through the body

Cardiovascular system
- Heart, blood vessels, and the blood.
- The heart of a healthy adult pumps approximately 5 liters of blood per minute
- The heart continues to pump for more than 75 years.
- Two pumps in one:
o The right side of the heart pumps blood to the lungs and back to the left side of the heart
through vessels of the pulmonary circulation
o The left side of the heart pumps blood to all other tissues of the body and back to the
right side of the heart through vessels of the systemic circulation

Functions of the heart

1. Generating blood pressure
2. Routing blood
3. Ensuring one-way blood flow
4. Regulating blood supply

Size, Form, and Location of the Heart

- Shaped like a blunt cone and is approximately the size of a closed fist
- Larger in physically active adults
- Generally decreases in size after approximately age 65
- Apex: blunt, rounded point of the heart
- Base: larger, flat part at the opposite end of the heart
- Located in the thoracic cavity between the 2 pleural cavities that surround the lungs
- Mediastinum: midline partition that is formed by the heart, trachea, esophagus, and associated
structures.
- Pericardial cavity: heart’s own cavity

- It is important to know the location and shape of the heart because it enables health professionals
to accurately place a stethoscope to hear the heart sounds, to place chest leads for an
electrocardiogram, or to administer cardiopulmonary resuscitation (CPR)
o CPR – emergency procedure that maintains blood flow in the body if a person’s heart
stops
- Lies obliquely in the mediastinum
- The apex is directed to the left, approximately 2/3 of the heart’s mass lies to the left of the
midline of the sternum

Anatomy of the Heart

Pericardium
 Pericardial Cavity
- Where the heart lies
- Formed by the peridardium
  Pericardium
- Also known as pericardial sac
- Surrounds the heart and anchors it within the mediastinum
2 layers of pericardium:
 Fibrous pericardium
- Outer layer
- Tough, fibrous connective tissue
 Serous pericardium
- Inner layer
- Consists of flat epithelial cells with a thin layer of connective tissue
The serious pericardium consists of 2 parts that are continuous with each other where the great vessels
enter or leave the heart
 Parietal pericardium
- Lines the fibrous pericardium
 Visceral pericardium
- Also known as epicardium
- Covers the heart surface
The pericardial cavity is located between the visceral and parietal pericardia
 Pericardial fluid
- A thin layer inside that fills the pericardial cavity
- Produced by the serous pericardium
- Helps reduce friction as the heart move within the pericardium

External Anatomy
  Atria
- Consists a right and left atria
- Located at the base of the heart
 Ventricles
- Right and left ventricles
- Extend from the base of the heart toward the apex
 Coronary sulcus
- Extends around the heart, separating the atria from the ventricles
- Two grooves (sulci) indicate the division between the right and left ventricles, extend
inferiorly from the coronary sulcus
 Anterior interventricular sulcus
- Extends inferiorly from the coronary sulcus on the anterior surface of the
heart
 Posterior intraventricular sulcus
- Extends inferiorly from the coronary sulcus on the posterior surface of
the heart
Six large veins carry blood to the atria of the heart
 Superior vena cava and inferior vena cava
- Carry blood from the body to the right atrium
 Four pulmonary veins
- Carry blood from the lungs to the left atrium

 2 arteries often called the great vessels or great arteries

- Carry blood away from the ventricles of the heart
 Pulmonary trunk
- Arising from the right ventricle
- Splits into right and left pulmonary arteries
  Pulmonary Arteries
- Right and left
- Carries blood to the rest of the body
 Aorta
- Arising from the left ventricle
- Carries blood to the rest of the body

Heart Chambers and Internal Anatomy

The heart is a muscular group consisting of four chambers: the right and left atria and the right and left
ventricles
Right and Left Atria
- Blood enters the atria through blood vessels called veins.
 Atria
- Functions as reservoirs where blood returning from veins collects before it enters the
ventricles
- Contraction; forces blood into the ventricles to complete ventricular filling
 Right Atrium
- Receives blood from 3 major openings:
1. Superior vena cava
- Drain blood from most of the body
2. Inferior vena cava
- Drain blood from most of the body
3. Coronary sinus
- Drains blood from most of the heart muscle
 Left Atrium
- Receives blood through the 4 pulmonary veins, which drain blood from the lungs
 Interatrial septum
- Partition that separates the 2 atria

Right and Left Ventricles

- Major pumping chambers
- Eject blood into the arteries and force it to flow through the circulatory system
 Right ventricle
- Pumps blood into the pulmonary trunk
- Contracts; pressure increases to 1/5 of the pressure of the left ventricle
- Moves blood to the smaller pulmonary circulation
 Left ventricle
- Pumps blood into the aorta
- Its wall is thicker than the right ventricle
- Its wall contracts more forcefully and generates a greater blood pressure.
- Contracts; pressure increases to 120 mmHg
- Moves blood to the larger systemic circulation
  Intraventricular septum
- Separates the 2 ventricles

Heart Valves
- Maintains the one-way flow of blood through the heart chambers
2 types of heart valves:
 Atrioventricular Valves (AV)
- Located between each atrium and ventricle
- Allow blood to flow from the atria into the ventricles but prevent it from flowing back into
the atria
- Ventricles relax; the atria forces the AV valves to open
- Ventricles contract; blood flows toward the atria and causes the AV valves to close
 Tricuspid valve
- AV valve between the right atrium and the right ventricle
- Has 3 cusps
 Bicuspid valve
- Or mitral valve
- AV valve between the left atrium and left ventricle
- Has 2 cusps
Papillary muscles
- In the ventricles
- Cone-shaped, muscular pillars
- Attached by a thin, strong, connective tissue strings called chordae tendieae to the free
margins of the cusps of AV valves
- Ventricles contract; papillary muscles contract to prevent valves from opening into the
atria by pulling on the chorea tendineae attached to the cusps

 Semilunar Valves
- Located between each ventricle and its associated great artery
 Pulmonary semilunar valve
- Located between the right ventricle and the pulmonary trunk
 Aortic semilunar valve
- Located between the eft ventricle and aorta

Cardiac skeleton
- Fibrous skeleton
- A plate of connective tissue consists mainly of fibrous rings that surround the AV and
semilunar valve and give them solid support
- Electrical insulation between the atria and ventricles
- Provides a rigid attachment site for cardiac muscle

Route of Blood Flow through the Heart

(refer to notebook)
Blood Supply to the Heart

The cardiac muscle in the wall of the heart is thick and metabolically very active and therefore requires
an ample of blood supply. Coronary arteries and cardiac veins provide the pathway for blood through the
heart wall.

Coronary Arteries
2 coronary arteries supply blood to the wall of the heart.
- Originate from the base of the aorta, just above the AV valves
 Left coronary artery
- Originates on the left side of the aorta
- The branches supply much of the anterior wall of the heart and most of the left ventricle
- Has 3 major branches
1. Anterior interventricular artery
 Lies in the anterior ventricular sulcus
2. Circumflex artery
 Extends around the coronary sulcus on the left to the posterior surface of the
heart
3. Left marginal artery
 Extends inferiorly along the lateral wall of the left ventricle from the circumflex
artery
  Right coronary artery
- Originates on the right side of the aorta
- Supply most of the wall of the right ventricle
- Extends around the coronary sulcus on the right to the posterior surface of the heart and
gives rise to the posterior interventricular artery
 Posterior interventricular artery
- Lies in the posterior interventricular sulcus
 Right marginal artery
- Extends inferiorly along the lateral wall of the right ventricle

Cardiac Veins
- Drain blood from the cardiac muscle
- Pathways are nearly parallel to coronary arteries
- Most of them drain blood into coronary sinus
- Some small cardiac veins drain directly into the right atrium
 Coronary sinus
- Large vein within the coronary sulcus on the posterior aspect of the heart
- Blood flows from coronary sins into the right atrium

Histology of the Heart

Heart Wall

Composed of 3 layers of tissues

1. Epicardium
- Also called the visceral pericardium
- Thin, serous membrane forming the smooth outer surface of the heart
- Consists of simple squamous epithelium overlying a layer of loose connective tissue and
adipose tissue
2. Myocardium
- Thick middle layer composed of cardiac muscle cells
- Responsible for contractions of the heart chambers
3. Endocardium
- Smooth inner surface of the heart chambers
- Consists of simple squamous epithelium over a layer of connective tissue
- Allows blood to move easily through the heart
- Heart valves: folds of endocardium that include a thick layer of connective tissue

 Trabeculae Carneae
- Ridges and columns of cardiac muscle that are modified from the surfaces of the interior
walls of the ventricles

Cardiac Muscle
Cardiac Muscle Cells
 - Elongated , branching cells
- Contain 1 or 2 centrally located nuclei
- Contain actin and myosin myofilaments organized to form sarcomeres, which are joined
end-to-end o form myofibrils
 Actin and myosin – responsible for muscle contractions, gives the cardiac muscle
a striated or banded appearance but are less regularly arranged and less
numerous.
- Relies on Ca2+ and ATP for contraction (p. 326)
- Have many mitochondria which produce ATP at a rapid rate
- Cannot develop a significant oxygen deficit
- Organized into spiral bundles or sheets
- Bound end-to-end and laterally to adjacent cells by specialized cell-to-cell contacts called
intercalated disks
 Membranes are highly folded
 Adjacent cells fit together, increasing the contact between them and preventing
cells from pulling apart
- Gap junctions: specialized cell membrane structures in the intercalated disks that allow
cytoplasm to flow freely between cells. This enables action potentials to pass quickly and
easily from one cell to the next.
- Cardiac cells of the atria or ventricles contract at nearly the same time

Electrical Activity of the Heart

Action Potentials in Cardiac Muscle
(p. 327)
- Action potentials in cardiac muscle take approximately 200 to 500 ms to complete
- Action potentials in cardiac muscle can spread from 1 cell to adjacent cell though gap junctions at
intercalated disks
1. Depolarization phase
2. Plateau phase
- Period of slow repolarization
3. Repolarization phase
- Rapid
- Achieve its maximum repolarization and returns to the resting membrane potential

- Action potentials exhibit refractory period.

Conduction System of the Heart

- Cardiac muscle can contract without neural stimulation
 Conduction system of the heart
- Contraction of the atria and ventricles is coordinated by specialized cardiac muscle cells in the
heart wall
- All cells produce spontaneous action potentials
 Sinoatrial node (SA node)
- Heart’s pacemaker
 - Located at the superior wall of the right atrium and initiates contraction of the
heart
- Action potentials originate here then spread to the right and left atria causing
them to contract
- Produces action potentials at a faster rate than other areas of the heart
- Has larger number of Ca2+ channels
- Na+ and Ca2+ channels spontaneously open and close at a rhythmic rate
- Heart rate can be affected by certain drugs: calcium channel blocking agents
 Atrioventricular node (AV node)
- Located in the lower portion of the right atrium
- Action potentials spread slowly and then into a bundle of specialized muscle
called atrioventricular bundle.
- Allows atria to complete contraction before action potentials are delivered to the
ventricles
- AV bundle divides into 2 branches of conducting tissue: left and right bundle
branches
 Purkinje fibers
- Formed by the conducting tissue at the tips of the left and right bundle branches
- Pass to the apex of the heart and extend to the cardiac muscle of the ventricle
walls

Ectopic beat
- When action potentials originate in an area of the heart other than the SA node
- May cause very small portions of the heart to contract rapidly and independently of all other areas
Fibrillation
- Reduces the output of the heart to only a few milliliters of blood per minute when it occurs in the
ventricles
- To stop the process; defibrillation
Defibrillation
- Apply a strong electrical shock to the chest region
- The shock causes simultaneous depolarization of all cardiac muscle fibers
- SA node can recover and produce action potentials before any other area of the heart
- Normal pattern of action potential generation and the normal rhythm of contraction are
reestablished.
Electrocardiogram

- Electrical currents that can be measured at the surface of the body

- Electrodes placed on the body surface
- Detect small electrical changes resulting from the action potentials in all of the cardiac muscle
cells.
- Records the electrical events or ECG or EKG
- Painless, nonsurgical, and easy to record

 P wave
- From depolarization of the atrial myocardium
- Beginning; precedes the onset of atrial contraction
 QRS complex
- Consists of 3 individual waves: Q, R, and S waves
- From depolarization of the ventricles
- Beginning; precedes ventricular contraction
 T wave
- Represents repolarization of the ventricles
- Beginning; precedes ventricular relaxation

Wave that represents repolarization of the atria; cannot be seen because it occurs during QRS complex
 PQ interval
- Time between beginning of P wave and beginning of QRS complex
- Commonly called as the PR interval; Q wave is very small
- Atria contract and begin to relax
- At the end: ventricles begin to depolarize
 QT interval
- Extends from the beginning of QRS complex to the end of the T wave
- Represents the length of time required for ventricular depolarization and repolarization