VALVES OF THE HEART

2 Atrioventricular Valves
➢ Mitral Valve - found in your left side of the
heart, and in connection between in your
left atrium and in your left ventricle
➢ Tricuspid Valve - valve found between in
your right atrium and right ventricle
2 Semilunar Valves
➢ Aortic Valve - found in between your left
ventricle going to your aorta.
➢ Pulmonic Valve - connection between
your left atrium and your pulmonary tract.
• These valves ensure a forward direction or
one-way flow of blood during closing of
BLOOD FLOW: Systemic and Pulmonary
valves.
circulation
• Prevents backflow of blood during
closing of valves.
SYSTEMIC CIRCULATION:
• Significant during auscultation (what you
• Pumps in the left side of the heart.
hear during auscultation is actually the
• It circulates oxygenated blood from the
backflow and it is not the contraction of the
heart around the body into the tissues
heart)
before it is returned to the heart.
• From the aorta, the blood divides into
How does valves function?
separate streams, entering progressively
• During the time you need to have a blood
smaller Systemic Arteries that carry it to all
flow, from left atrium to left ventricle the
organs throughout the body—except for the
valve would open, the blood will push the
alveoli.
two cusps of the bicuspid valve towards
• In systemic tissues, arteries give rise to
the left ventricle when that happens your
Arterioles, which finally lead into extensive
chordae tendineae will slack (maluwag)
beds of Systemic Capillaries where gas and
while your papillary muscles are relaxed,
nutrients exchange occurs.
this allows opening of your valve, when
• Lastly, it enters a Systemic Venule. This
there is a sufficient or complete blood
carries deoxygenated blood away from
within your ventricle, the pressure of the
tissues and merge to form larger systemic
blood will now push the cusps towards the
veins that lead blood flows back to the right
left atrium, during this time you bicuspid
atrium.
valves is now closed, so the blood that will
go to your aorta sooner will also push the
PULMONARY CIRCULATION:
cusps to close, and by this time your
chordae tendineae is now taut (nahila) • Pumps in the right side of the heart.
while your papillary muscles is • Receives all the deoxygenated blood from
contracted. the systemic circulation.
• Your chordae tendineae and your
• Blood ejected from the right ventricle flows
papillary muscles serve as reinforcement into the Pulmonary Trunk, which branches
of your valves. into Pulmonary Arteries that carry blood to
• Note that this happens on all of your
the right and left lungs.
valves.
 • Gas exchange in Pulmonary Capillaries.
• Lastly, the oxygenated blood flows into
pulmonary veins and returns to the left
atrium.
- It is directed superiorly, slightly anteriorly, and
to the right.
- The beginning of the ascending aorta is
posterior to the pulmonary trunk and right
auricle and ends at the level of the sternal
angle, where it becomes the arch of the aorta.

➢ Aortic Sinus- it rises into your right coronary

artery and left coronary artery

➢ Right coronary artery & Left coronary Artery-

both of them are a blood supply for
myocardium and epicardium.

Why is there no endocardium?

• Endocardium- it relies on the diffusion of

blood on the chambers.
BLOOD FLOW CYCLE: • Endocardium lines the chamber and valves
of the heart so the blood from there directly
supplies your endocardium through
diffusion that is why it does not rely on the
coronary arteries.

ARCH OF AORTA
- 4-5 cm (almost 2 in.) in length and is the
continuation of the ascending aorta.
- It is directed superiorly and posteriorly to
the left and then inferiorly.
- It emerges from the pericardium posterior
to the sternum at the level of the sternal
angle.

AORTA DESCENDING AORTA

- Aka Thoracic aorta
It is subdivided into three branches: - 20 cm (8 in.) long and is a continuation of the
1. Ascending aorta arch of the aorta.
2. Arch of aorta - As it descends, it moves closer to the midline
3. Descending aorta and extends through an opening in the
diaphragm (aortic hiatus), which is located
anterior to the vertebral column at the level of
ASCENDING AORTA the intervertebral disc between the twelfth
- 5 cm (2 in.) in length and begins at the aortic thoracic and first lumbar vertebrae.
valve.
CORONARY CIRCULATION
- It only supplies the myocardium
epicardium of the heart.
CORONARY ARTERIES
- myocardium own network of blood vessels
- cardiac circulation
- supply oxygenated blood to the
myocardium.
Subdivided into two:
• Left coronary artery
- Left Anterior Descending Artery (LADA)/
Anterior interventricular branch
- Circumflex Branch
• Right Coronary Artery
- Posterior Interventricular branch
- Marginal Branches
CORONARY VEINS
- it carries deoxygenated blood from the
myocardium and empties them into the
chambers of the heart.
- It drains in your Coronary sinus/ Vascular
sinus
Coronary sinus- it has an opening or
communication with the right atrium where it
collects the majority of the cardiac venous blood.
The principal tributaries carrying blood into
the coronary sinus are the following:
• Great Cardiac Vein- drains Left Coronary Artery
• Middle Cardiac Vein- drains Right Coronary
Artery (specifically posterior Interventricular
branch)
• Small Cardiac Vein- drains the Artery of both
Right Atrium & Right Ventricle
• Anterior Cardiac Veins- drain Right Ventricle
and open directly to Right Atrium
BLOOD SUPPLY OF THE HEART
Left Coronary Artery
and • passes inferior to the left auricle and
divides into the anterior interventricular
and circumflex branches.
Anterior Interventricular branch OR Left
Anterior Descending Artery (LADA)
- Is in the anterior interventricular sulcus and
supplies oxygenated blood to the walls
of both ventricles (the left and right
ventricle) and interventricular septum
and apex.
Circumflex
- lies in the coronary sulcus and distributes
oxygenated blood to the walls of the left
ventricle and left atrium.
- Supplies the inferior lateral wall of the left
ventricle and supplies the 40% of the SA
node.
LEFT CORONARY ARTERY
- Left coronary artery (larger than the right
coronary artery)
- lot of supply within the left coronary artery
- supplies the MAJOR PART OF THE HEART
- supplies MAJORITY OF THE LEFT
ATRIUM
- supplies SMALL AREA OF RIGHT
INTERVENTRICULAR GROOVE
- supplies anterior 2/3 of ventricular
septum
- supplies RIGHT AND LEFT BUNDLE
BRANCHES – properties of the electrical
conductivity of the heart
PATHWAY OF LEFT CORONARY ARTERY
- rerises in the aortic sinus- POSTERIOR
AORTIC SINUS (ascending aorta) >>
passes b/w pulmonary trunk and left
auricle >> atrioventricular groove >>
 further subdivided into circumflex branch
and LADA
2 BRANCHES
• LADA/ Left Anterior interventicular
(descending) branch- supplies the wall of
the RIGHT and LEFT ventricle and
interventicular septum and apex.
• Circumflex- supplies the inferior lateral
wall of the left ventricle and supplies the
40% of the SINUATRIAL node (60% from
right coronary artery)
RIGHT CORONARY ARTERY
• Supplies small branches (atrial branches) to
the right atrium and continues to the right
auricle and ultimately divides into two
branches
• Supplies all of the parts in the right atrium,
60% of the Sinoatrial node, Atrioventricular
node and a small part of HIS
Subdivided into two branches:
• Posterior descending artery/posterior
interventricular branch of right coronary
artery
- Follows the posterior interventricular sulcus
and supplies the walls of the two ventricles
with oxygenated blood
- Supplies the inferior wall of the right and
left ventricle (small part)
- Posterior descending artery crosses left
ventricle; majority tho supplies the right
ventricle.
• Marginal branch
- Runs along the right margin of the heart
and transports oxygenated blood to the
wall of the right ventricle
- Supplies the myocardium of the right
ventricle
Pathway:
- Arises from anterior aortic sinus
- ascending aorta >> pulmonary trunk & right
auricle >> descend towards the right
atrioventricular groove >> inferior border
of the heart as well as posterior >>
anastomoses left anterior ascending artery
VENOUS DRAINAGE OF THE HEART
Great Cardiac Vein
• Drains Left Anterior Coronary Artery, it
drains specifically The Left Anterior
Descending Artery
Middle Cardiac Vein
• It is in posterior part as well as the Right
Circumflex Artery, so it drains Marginal
Branch of Right Posterior Circumflex Artery
Small Cardiac Vein
• It drains from Right Atrium and Right
Ventricle
Anterior Cardiac Vein
• It drains specifically the Right Ventricle; it
has an opening in Right Atrium
Coronary Sinus
• Near the opening of the Inferior Vena Cava,
it has a communication with Right Atrium.
• It is the Drainage of the Coronary
Circulation
PHYSIOLOGY OF CARDIAC MUSCLE
The heart is composed of three major types of
cardiac muscles:
• Atrial muscle
• Ventricular muscle
(The atrial and ventricular are almost the same
way as the skeletal muscle, except the duration of
contraction is much longer)
• Excitatory and conductive muscle fibers
o Contract feebly because they
contain few contractile fibrils
o They exhibit automatic rhythmical
electrical discharge in the form of
action potentials or conduction of
the action potentials of the heart
▪ Providing an excitatory
system (controls the
 rhythmical beating of the
heart)
CARDIAC MUSCLE ANATOMY
• Cardiac muscle is striated
• Cardiac muscle has myofibrils:
o Actin
o Myosin
• Left ventricle
o Organized into complex muscle
fibers that run in different reactions
o Subepicardial (outer) layer
▪ Spirals in the leftward
direction
o Subendocardial (inner) layer
▪ Spirals in the opposite
direction
(causing clockwise rotation of the apex of
the heart and counterclockwise rotation of
the base of the left ventricle)
Cardiac muscle is a Syncytium
• Many heart muscle cells in which the
cardiac muscle cells are so interconnected
that when one cell becomes excited, the
action potential rapidly spreads to all of
them
• Intercalated disc
o The dark areas crossing the cardiac
muscle fibers
o They are cell membranes that
separate individual cardiac muscle
cells from one another
(cardiac muscle fibers are made up of many
individual cells connected in series and in parallel
with one another)
• The heart is composed of 2 syncytia:
o Atrial syncytium: constitutes the
walls of the two atria
o Ventricular syncytium: constitutes
the walls of the two ventricles
(The atria are separated from the ventricles by
fibrous tissues that surrounds the atrioventricular
valvular openings between the atria and ventricles)
• A-V bundle
o A bundle of conductive fibers
several millimeters in diameter
o Specialized conductive system
Action potentials in cardiac muscle
• Intracellular potential rises from a very
negative value between beats, about -85
millivolts, to a slightly positive value about
+20 millivolts during each beat
• Phases of Cardiac muscle action potential
o It summarizes the phases of the
action potential in cardiac muscle
and the ion flows that occur during
each phase
o Phase 0
▪ Depolarization phase
▪ Influx of sodium ions
▪ Charge of the membrane
reaches +20
o Phase 1
▪ Initial repolarization phase
▪ Sodium channel closed but
fast
▪ Potassium voltage gated
channel is still open (efflux
of the K+)
o Phase 2
▪ Phase of plateau
▪ Maintain depolarization
▪ Calcium channel opens
(influx of calcium)
▪ Closed K+ channel
o Phase 3
▪ Repolarization
▪ Closed calcium channel
▪ Open K+ (slow channel)
efflux of potassium
o Phase 4
▪ Resting membrane potential
▪ -90 mv (AV node)
Autorhythmic fibers
• Generate action potential and produces
electrical excitation (conducting system)
Velocity of signal conduction in cardiac muscle
 • excitatory action potential signal along
both atrial and ventricular muscle fibers is
about 0.3 to 0.5 m/sec or about 1/250 the
velocity in very large nerve fibers
• about 1/10 the velocity in skeletal muscle
fibers
Refractory period of cardiac muscle
• Cardiac muscle is refractory to
restimulation during the action potential
• Refractory period: the interval time, during
which a normal cardiac impulse cannot re-
excite an already excited area of cardiac
muscle
• Ventricle: 0.25 to 0.30 second
o Which is about the duration of the
prolonged plateau action potential
• Atrial: 0.15 second
Excitation-contraction coupling
• A mechanism whereby the action potential
causes the myofibrils of muscle to contract.
Duration of Contraction
• Cardiac muscles begin to contract a few
milliseconds after the action potential
begins
• Continues to contract until a few
milliseconds after the action potential ends
Control of the heart by the sympathetic and
parasympathetic nerves
Cardiac Muscle
• The cardiac events that occur from the
beginning of one heartbeat to the
beginning of the next
• Each cycle is initiated by the spontaneous
generation of an action potential in the
sinus node
• Diastole and systole
o The total duration of the cardiac
cycle, including systole and
diastole, is the reciprocal of the
heart rate
• (Refer to the picture)
o Top three curves: show the
pressure changes in aorta, left
ventricle, and left atrium
o Fourth curve: depicts the changes
in left ventricular volume
o Fifth curve: depicts the
electrocardiogram
o Sixth curve: depicts a
phonocardiogram
▪ Which is a recording of the
sounds produced by the
heart mainly by the heart
valve as it pumps
• Increasing heart rate decreases duration of
cardiac cycle
o When heart rate increases => the
duration of each cardiac cycle
decreases including the contraction
and relaxation phases
• The pumping effectiveness of the heart also
is controlled by the sympathetic and
parasympathetic (vagus) nerves
o Which abundantly supply the heart
• Parasympathetic nerves: slows the rhythm
and diminish the rate of conduction of
impulses
o Strong stimulation of the
parasympathetic nerve fibers in the
vagus nerves to the heart can stop
the heartbeat for a few seconds
 o Then the heart usually “escapes”
and beats at a rate of 20 to 40
beats/min as long as the
parasympathetic stimulation
continues
• Sympathetic nerves: increases the rate of
conduction
o Strong sympathetic stimulation can
increase the heart rate in young
adult humans from the normal rate
of 70 beats/min up to 180 to 200
beats/min and rarely 250 beats/min
o It doubles the force of heart
contraction => increasing the
volume of blood pumped and
increasing the ejection pressure
o Increase the maximum cardiac
output as much as twofold to
threefold
SINOATRIAL NODE
- Termed as the “natural pacemaker”
because of its low resting membrane
potential.
- Primarily found at the superior
posterolateral wall of the right atrium and
slightly below the superior vena cava.
- Resting membrane potential: (-55) to (-60)
mV
- It is easily excitable, depolarized and its
threshold is spontaneous. These are
because it has:
• Fast Sodium Channels
• L-type Calcium Channels (Slow sodium-
calcium channels allows a plateau or a
longer duration of depolarization in the
sinoatrial node.) - it is opened when the
resting membrane potential reaches (-40)
mV.
• Potassium Channels- it is less negative
meaning its resting membrane potential
can easily be changed into depolarized or
can easily reach the threshold.
• When the threshold is reached, the action
potential can now propagate towards the
atrioventricular node.
INTERNODAL PATHWAYS
- Located in between the SA node and AV
node.
- Delay the transmission of electrical
charges from the SA node to the AV node.
• Remember that when there is
depolarization there is muscle contraction
meaning during the time that there is
depolarization in the SA node and
internodal pathways, the atrium will start to
contract to release blood towards the right
atrium.
• If there is no delay, the left ventricle will
immediately send a small amount of blood
to the pulmonary trunk. Minimal amounts of
blood will cause insufficient blood flow in
the systemic circulation.
ATRIOVENTRICULAR NODE
- Found in the posterior wall of the right
atrium and behind the tricuspid valve.
- Compared to the SA node, AV node is
slower in conduction due to decrease in
gap junctions.
- Interconnected with the AV bundle
branches.
- Its speed of conduction in cardiac muscle is
slower which adds sufficient time for the
atria to empty their blood into the ventricle.
- When the right atrium contracts, the left
atrium also contracts.
- When the ventricles contract, both of them
contract.
ATRIOVENTRICULAR BUNDLE (BUNDLE OF
HIS)
Subdivided into left and right bundle
branches:
• The right bundle branches pass down on
the right side of the ventricular septum.
• The left bundle branches pierce the septum
and passes down on its left side beneath
the endocardium.

- Connects the myocardium of the atria to

the myocardium of the ventricles
▪ Cardiac impulse can now travel
from the atria to the ventricles.
- Connected to the purkinje fibers.

PURKINJE FIBERS

• Extend from the Atrioventricular bundle

towards the apex of the heart and
distributing towards the ventricles
• Larger in diameter
• More glycogen (more stored energy)
• Fewer myofibrils (since primary goal is only
to conduct electrical discharges
• No intercalated disc
• Allows rapid spread of action potential
from the apex towards the rest of the
myocardium