Anatomy and Physiology of the Heart

(3hours)
The hearth generates the pressure necessary for blood circulation. This
chapter provides a comprehensive discussion of the functions, parts and process
that take place in the heart.
Intended Learning Outcomes:

At the completion of this coverage, the students shall be able to:

1. Discuss the functions of the heart
2. Identify the chambers, major vessels and valves in the heart
3. Discuss pulmonary and systemic circulation
4. Discuss the electrical conductivity of the heart

Specific Instructions in the completion of this Chapter:

1. Set your learning goals. At the end of this module you are expected to attain the
Intended Learning Outcomes stated above.
2. Prepare the following materials:
a. Anatomy and Physiology textbooks and other references
b. Notebook, bond papers and writing materials
c. Coloring materials
3. Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read and
understand before answering the activities. You are also given an electronic copy of this
module along with other materials such as video clips t further assist you.
4. As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking. Read the instructions carefully, and write
your answers to the space provided after each module

Key Terms

Pulmonary circulation
Systemic circulation
Heart valves
Chambers
Electrical conductivity
Let’s Start!

Lesson 2: The Heart

A. Functions of the Heart
1. Generating blood pressure
 Required for blood flow through the blood vessels
2. Routing blood
 Two pumps, moving blood through the pulmonary and systemic circulations
3. Regulating blood supply
 Adjusts blood flow by changing the rate and force of heart contractions as
needed
4. Ensuring One way blood flow

B. Size, Form, and

location of the Heart
 Size: app size of a
closed fist
 Form: Shaped like a blunt
cone, with an apex and a base
 Apex: blunt
rounded point of the heart
Directed anteriorly
and slightly inferiorly
 Base: larger, flat
part
Directed
posteriorly and lightly
superiorly
 Location: thoracic cavity
between two pleural cavities that
surrounds the lungs
 2/3 of the heart’s mass
lies to the left of the midline of
the sternum
 The heart is surrounded
by its own cavity: Pericardial cavity
 Lies obliquely in the mediastinum

C. Anatomy of the Heart

 The heart consists of two atria and two ventricles
 Pericardium: a double-walled sac around the heart composed of
 A superficial fibrous pericardium
 A deep two-layer serous pericardium:
 The parietal layer lines the internal surface of the fibrous pericardium
 The visceral layer lines the surface of the heart
 They are separated by the fluid-filled (pericardial fluid) pericardial cavity
External Anatomy
  Each atrium has a flap called an auricle
 The coronary sulcus separates the atria from the ventricles
Anterior Interventicular Sulcus
Posterior Interventicular Sulcus
 6 large veins carry blood to the heart:
– SVC, IVC- Carry blood from the body to the R atrium
– 4 Pulmonary veins- carry blood from the lungs to the left atrium
 2 arteries/ Great arteries/ Great Vessels- Carry blood away from the ventricles of the
heart
– Pulmonary trunk- 2 pulmonary arteries- carry blood to the lungs from R ventricle
– Aorta- carries blood to the different parts of the body from the left ventricle.
Heart Chambers and Internal Anatomy
 The interatrial septum separates the atria from each other
 The interventricular septum separates the ventricles

Atria
 Receiving chambers of the heart
 Each atrium has a protruding auricle
 Pectinate muscles mark atrial walls
 Veins entering the right atrium carry blood to the heart from the systemic circulation
1. Inferior vena cava
2. Superior vena cava
3. Coronary sinus
 Veins entering the left atrium carry blood to the heart from the pulmonary circulation
1. Four pulmonary veins

Ventricles
 Discharging chambers of the heart/ Pumping chambers of the heart
 Pulmonary trunk exits the right ventricle carrying blood to the pulmonary
circulation
 Aorta exits the left ventricle carrying blood to the systemic circulation

Heart valves
 Ensure unidirectional
blood flow through the
heart
 Atrioventricular (AV)
valves lie between the
atria and the ventricles
 AV valves prevent
backflow into the atria
when ventricles
contract
 Tricuspid valve:
separates the right
atrium and ventricle
  Bicuspid valve:
separates the left
atrium and ventricle
 Semilunar valves
prevent backflow of
blood into the
ventricles
 Aortic semilunar valve:
lies between the left
ventricle and the aorta
 Pulmonary semilunar
valve: lies between
the right ventricle and
pulmonary trunk

 Chordae tendineae
anchor AV valves to papillary muscles
 Cardiac Skeleton: consist mainly of fibrous rings that surrounds the
atrioventricular and semilunar valves and give them solid support

Route of Blood Flow through the Heart

Blood Supply to the Heart
 2 Coronary arteries branch off the aorta to supply the heart
o Left Coronary Artery: 3 branches:
Supply much of the anterior wall of the heart and most of the left ventricle
– Anterior Interventricular Artery
– Circumflex Artery
– Left Marginal Artery
o Right Coronary Artery: 3 branches:
Supply most of the wall of the right ventricle
– Posterior Interventricular Artery
– Right Marginal Artery
 Blood returns from the heart tissues to the right atrium through coronary sinus
and cardiac veins

Let’s Do This!
Draw the heart, color and label its parts, and trace the blood circulation in the systemic
and pulmonary route. Put your answer in a short bond paper.

D. Histology of the Heart

Heart Wall
 The heart wall has three layers:
Epicardium
  Visceral layer of the serous pericardium (visceral pericardium)
 Provides protection against the friction of rubbing organs

Myocardium
 Cardiac muscle layer forming the bulk of the heart
 Responsible for contraction
Endocardium
 Endothelial layer over crisscrossing, interlacing layer of connective tissue
 Inner endocardium reduces the friction resulting from the passage of blood through
the heart
E. Electrical Activity of the Heart
Action Potentials
 After depolarization and partial repolarization, a plateau phase is reached, during
which the membrane potential only slowly repolarizes
 The opening and closing of voltage-gated ion channels produce the action
potential
 The movement of Na+ through Na+ channels causes depolarization
 During depolarization, K+ channels close and Ca2+ channels begin to open
 Early repolarization results from closure of the Na + channels and the
opening of some K+ channels
 The plateau exists because Ca2+ channels remain open
 The rapid phase of repolarization results from the closure of the Ca 2+
channels and the opening of many K+ channels

Refractory Periods
Absolute refractory period
– Cardiac muscle cells are insensitive to further stimulation
Relative refractory period
– Stronger than normal stimulation can produce an action potential
 Cardiac muscle has a prolonged depolarization and thus a prolonged absolute
refractory period, which allows time for the cardiac muscle to relax before the
next action potential causes a contraction
 Autorhythmicity of Cardiac Muscle
 Some cardiac muscle cells are autorhythmic because of the spontaneous
development of a prepotential
 Prepotential: slowly developing local action potential
 The sinoatrial (SA) node is the pacemaker of the heart
 Collection of cardiac muscle cells capable of spontaneously generating action
potentials
 The prepotential results from the movement of Na+ and Ca 2+ into the SA
node cells
 The duration of the prepotential determines heart rate
Conducting System of the Heart
 The sinoatrial (SA) node and the
atrioventricular (AV) node are in the right
atrium
 The AV node is connected to the bundle
branches in the interventricular septum
by the AV bundle
 The bundle branches give rise to Purkinje
fibers, which supply the ventricles
 The SA node initiates action potentials,
which spread across the atria and cause
them to contract
 SA node generates
impulses about 75 times/minute
 Action potentials are slowed in the AV
node, allowing the atria to contract and
blood to move into the ventricles
 AV node delays the impulse
approximately 0.11 seconds
 Then the action potentials passes from
atria to ventricles via the atrioventricular
bundle
 AV bundle splits into two pathways in the interventricular septum (bundle branches)
 Bundle branches carry the impulse toward the apex of the heart
 Purkinje fibers carry the impulse to the heart apex and ventricular walls

Electrocardiogram (ECG)
 Records only the electrical activities of the heart
 P wave corresponds to depolarization of the atria (SA node)
 QRS complex corresponds to ventricular depolarization
 T wave corresponds to ventricular repolarization
 PQ interval (PR interval) correspond to the time between the beginning of P wave
and the beginning of QRS complex
 During PQ interval atria contract and begin to relax
 End of PQ interval the ventricles begin to depolarize
 QT interval extends from the beginning of QRS complex to the end of the T wave and
represents the length of time required for ventricular depolarization and
repolarization.
 Based on the magnitude of the ECG waves and the time between waves, ECGs can
be used to diagnose heart abnormalities

F. Cardiac Cycle
 Repetitive contraction and relaxation of the heart chambers
Overview of Systole and Diastole
 Atrial systole is contraction of the atria
 Ventricular systole is contraction of the ventricles
  Atrial diastole is relaxation of the atria
 Ventricular diastole is relaxation of the ventricles
At the beginning of cardiac cycle
 Atria and Ventricles are relaxed
 AV valves open
 Semilunar valves are closed
 Blood returning to the heart enters atria first
 Blood flow into ventricles through open AV valves, filling 70% approximately of their
volume
Atrial Systole
 The atria contract, forcing additional blood to flow into the ventricles to complete their
filling. Semilunar Valves remained closed
Ventricular Systole
 At the beginning of ventricular systole, contraction of ventricles pushes blood toward the
atria, causing the AV valves to close as the pressure begins to increase.
 As ventricular systole continues, the increasing pressure in the ventricles exceeds the
pressure in the pulmonary trunk and aorta, the semilunar valves are forced open, and
blood is ejected into the pulmonary trunk and aorta.
Ventricular Diastole
 At the beginning, the pressure in the ventricles decrease below the pressure in the aorta
and pulmonary trunk. The semilunar valves close and prevent blood from flowing back
into the ventricles.
 As diastole continues, pressure continues to decline in the ventricles until the atrial
pressures are greater than ventricular pressures. Then AV valves open, blood flows
directly from atria to the relaxed ventricles. During previous ventricular systole, atria
were relaxed and blood collected in them. When ventricles relax and AV valves open,
blood flows into ventricles and fill again

G. Heart Sounds
 Heart sounds (lub-dup) are associated with closing of heart valves
 First sound occurs as AV valves close and signifies beginning of systole
 Second sound occurs when SL valves close at the beginning of ventricular
diastole
 Murmurs are abnormal heart sounds as a result of faulty valves

H. Regulation of Heart Function

 CO is the product of heart rate (HR) and stroke volume (SV)
 HR is the number of heart beats per minute
 SV is the amount of blood pumped out by a ventricle with each beat
 CO (ml/min) = HR (72 beats/min) x SV (70 ml/beat)
 CO = 5040 ml/min (~5 L/min)
 Venous return is the amount of blood returning to the heart
 Increased venous return increases stroke volume by increasing end-diastolic volume
 Increased force of contraction increases stroke volume by decreasing end-systolic
volume
Intrinsic Regulation
– Refers to mechanism contained within the heart itself
– Modifies stroke volume through the functional characteristics of cardiac muscle
cells
– Starling’s law of the heart describes the relationship between preload and the
stroke volume of the heart
– Preload is the degree to which the ventricular walls are stretched at the end of
the diastole
– An increased preload causes the cardiac muscle fibers to contract with a greater force
and produce a greater stroke volume
– Afterload is the pressure against which the ventricles must pump blood.

Extrinsic Regulation
– Modifies heart rate and stroke volume through nervous and hormonal mechanisms
 The cardioregulatory center in the medulla oblongata regulates the parasympathetic and
sympathetic nervous control of the heart
 Epinephrine and norepinephrine are released into the blood from the adrenal medulla as
a result of sympathetic stimulation. They increase the rate and force of heart
contraction
– Parasympathetic stimulation is supplied by the vagus nerve
 Decreases heart rate.
 Postganglionic neurons secrete acetylcholine, which increases membrane
permeability to K. Hyperpolarization of the plasma membrane increases the
duration of the prepotential
– Sympathetic stimulation is supplied by the cardiac nerves
Increases heart rate and the force of contraction (stroke volume)
Postganglionic neurons secrete norepinephrine, which increases membrane
permeability to Ca2+. Depolarization of the plasma membrane decreases the
duration of the prepotential
– Effect of Blood Pressure
Baroreceptors monitor blood pressure and the cardioregulatory center modifies
heart rate and stroke volume
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
Teacher’s Insight
Heart Valves play great role in maintaining one direction flow of blood to the
heart. When the pressure increases in the ventricles, it stimulate the contraction of the
papillary muscle which leads to the pulling of the chordae tendinae and closure of the
leaflets. This prevents the blood from flowing back. When valves don’t function, it results
into regurgitation or back flow which may lead to congestion in the systemic and
pulmonary circulation.