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Seeley's Essentials of Anatomy & Physiology Chapter 12

Fundamental Human Form and Function (University at Buffalo)

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Ch. 12: Heart

● Functions of the Heart

○ Generating Blood Pressure
○ Routing Blood
■ Separates pulmonary and systemic circulations
● Pulmonary Circulation: right side of heart pumps blood to
lungs and back to the left side of the heart
● Systemic Circulation: left side of heart pumps blood to all
other tissues of body and back to right side of heart
○ Ensuring One-Way Blood Flow
○ Regulating Blood Supply

● Size, Form, and Location of the Heart

○ Apex: blunt, rounded point of heart (directed anterior and inferior)
○ Base: flat end of heart (directed posterior and superior)
○ Mediastinum: middle wall of thorax; consists of trachea, esophagus,
thymus, heart, and other structures
○ Heat lies obliquely in mediastinum → ⅔ of heart lies to the left of
the midline of the sternum
● Anatomy of the Heart
○ Pericardium
■ Tissues that surround the heart and anchor it within mediastinum
● Fibrous Pericardium: outer, tough layer of fibrous
connective tissue
● Serous Pericardium: inner, thin layer of epithelial cells
○ Parietal Pericardium → outer surface of serous
pericardium
○ Visceral Pericardium → inner surface of serous
pericardium; covers surface of heart
■ Pericardial Fluid: produced by serous pericardium; located in
pericardial cavity to reduce friction

○ External Anatomy
■ Left and right atria are located at base of heart
■ Left and right ventricles extend from base to apex
■ Coronary Sulcus: separates atria from ventricles
■ Anterior Interventricular Sulcus: extends inferiorly from coronary
sulcus on anterior surface of heart
■ Posterior Interventricular Sulcus: extends inferiorly from the
coronary sulcus on posterior surface of heart
■ 6 veins carry blood to the heart

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● Superior Vena Cava & Inferior Vena Cava carry blood from
body to right atrium
● Pulmonary Trunk splits into right and left pulmonary arteries
○ Carry blood to the lungs
● Aorta carries blood to rest of body from left ventricle

○ Heart Chambers & Internal Anatomy

■ Heart is a muscular pump, 4 chambers: Right & Left Atria and the
Right and Left Ventricles
● Right & Left Atria
○ Separated by interarterial septum
○ Atria of the heart receive blood from vein
○ Function as reservoirs → blood returning from
veins collects before it enters the ventricles
■ Minimal contraction of atria forces blood into
ventricles to complete ventricular filling
○ Right Atrium
■ Receives blood from 3 openings
● Superior Vena Cava
○ Drains blood from above
diaphragm
● Inferior Vena Cava
○ Drains from below diaphragm
● Coronary Sinus
○ Drains blood from myocardium
○ Left Atrium
■ Receives blood from 4 pulmonary veins
● Drain blood from the lungs

● Right & Left Ventricles

○ Heart’s major pumping chambers
■ Eject blood into arteries and force it to flow
through the circulatory system
○ Separated by the interventricular septum
○ Each ventricle has papillary muscles attached by
chordae tendinae
○ Right Ventricle
■ Pumps blood into pulmonary trunk
● Pulmonary Semilunar Valve
(surrounded by cardiac skeleton →
support and insulation)
○ Left Ventricle
■ Pumps blood into aorta
● Aortic Valve (surrounded by cardiac
skeleton → support and insulation)

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■ Thicker wall than right ventricle

■ Contracts stronger and higher blood pressure
than right ventricle (has to cover more distance
throughout body)
● Heart Valves
○ Ensure one-way blood flow
○ Atrioventricular (AV) Valves are located between right
atrium and the right ventricle, as well as between the
left atrium and the left ventricle
○ AV valve between right atrium and right ventricle =
Tricuspid Valve
○ AV valve between left atrium and left ventricle =
Bicuspid Valve (Mitral Valve)
○ AV valves allow blood to flow from atria into ventricles,
but prevent it from flowing back into atria
■ When ventricles relax, high pressure in atria
causes AV valves to open
■ When ventricles contract, blood flows towards
atria and causes AV valves to close
● Semilunar Valves
○ Pulmonary: base of pulmonary trunk
○ Aortic: base of aorta
○ Route of Blood Flow Through the Heart
■ Both atria contract at the same time, both ventricles contract at the
same time
Blood Flow

■ Blood enters right atrium from systemic circulation via superior and
inferior venae cavae and from heart muscle via coronary sinus
■ Most of blood flowing into right atrium flows into right ventricle,
while right ventricle relaxes after previous contraction
■ Before end of ventricular relaxation, right atrium contracts, blood is
pushed into right ventricle
■ After right atrial contraction, right ventricle contracts, blood is
pushed against Tricuspid Valve which forces it closed
■ Pulmonary Semilunar Valve is forced open, blood flows into
pulmonary trunk, pressure in pulmonary trunk becomes higher than
in right ventricle
■ Backflow of blood forces Pulmonary Semilunar Valve to close
■ Pulmonary trunk branches to form right and left pulmonary arteries,
which carry blood to lungs in which CO2 is released and O2 is
picked up
■ Blood returning from lungs enter left atrium via 4 pulmonary veins
■ Most of blood flowing into left atrium passes into left ventricle while
left ventricle relaxes after previous contraction

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■ Before end of ventricular relaxation, left atrium contracts, blood is

pushed into left ventricle
■ After left atrial contraction, left ventricle contracts, blood is pushed
against Mitral Valve which forces it closed
■ Aortic Semilunar Valve is forced open, blood flows into aorta
(tension on chordae tendinae is highest at this point), blood is
distributed to all parts of the body besides lungs
■ As left ventricle relaxes, pressure drops and aortic pressure
becomes higher
■ Backflow of blood forces Aortic Semilunar Valve to close

● Blood Supply to the Heart

○ Cardiac muscle in the wall of the heart is thick and metabolically active
○ 2 coronary arteries supply blood to the wall of the heart, originate from the
base of the aorta
■ Left Coronary Artery (3 branches) → supplies blood to
anterior wall of heart and left ventricle
● Anterior Interventricular Artery
● Circumflex Artery
● Left Marginal Artery
■ Right Coronary Artery → supplies right ventricle
● Posterior Interventricular Artery
● Right Marginal Artery
○ Blood flowing through coronary arteries is greatest when ventricles of
heart are relaxed and contraction of cardiac muscle does not compress
coronary arteries
○ Blood flowing into other arteries of the body is highest during contraction
of the ventricles
○ Cardiac Veins
■ Drain blood from cardiac muscle into coronary sinus
■ Blood flows from coronary sinus into the right atrium
● Some small cardiac veins drain directly into right atrium

○ Pulmonary Circuit → O2 poor, CO2 rich

○ Systemic Circuit → O2 rich, CO2 poor

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● Histology of the Heart

○ Heart Wall
■ 3 layers of tissue: Epicardium, myocardium, endocardium
■ Epicardium (Visceral Pericardium): thin, serous membrane
forming the smooth outer surface of heart.
● Simple squamous epithelium overlying loose connective
tissue and adipose tissue (fat)
■ Myocardium: thick, middle layer of heart composed of cardiac
muscle
● Cardiac muscle cells → responsible for contraction of
heart chambers
■ Endocardium: smooth, inner layer (similar to epicardium)
● Simple squamous epithelium over layer of connective tissue
● Allows blood to move through the heart easily
● Folds of endocardium form heart valves
■ Surfaces on the interior walls of the ventricles are modified by
trabeculae carneae → columns of cardiac muscle
● Attach to papillary muscles
● Cardiac Muscle
○ Elongated, branching cells
○ Contain 1 centrally located nucleus
○ Rich in mitochondria
○ Contain actin and myosin myofilaments to form organized sarcomeres
which form myofibrils
■ Banded appearance
■ Less arranged than skeletal muscle, however
○ Relies on calcium and ATP for contraction
■ Calcium ions enter cardiac muscle cells in response to action
potentials and activate process of contraction
■ ATP production depends on O2 availability
● Cardiac muscles are rich in mitochondria, producing ATP at
a rapid rate
● Cannot develop a large oxygen deficit
○ Intercalated discs connect cells

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● Electrical Activity of the Heart

○ Action Potentials in Cardiac Muscle
■ Exhibit depolarization followed by repolarization, just like
skeletal muscle → pacemaker potential
■ A period of slow repolarization greatly prolongs the action potential
● Take longer than skeletal muscle action potentials
● Conducted from cell to cell (unlike skeletal muscle)
■ In cardiac muscle, each AP consists of a depolarization phase,
followed by the slow repolarization phase called the Plateau Phase
● At the end of the Plateau Phase, a rapid repolarization
phase occurs
■ During final repolarization phase, membrane potential achieves its
maximum degree of repolarization and returns to RMP
■ Opening and closing of membrane channels is responsible for
conducting APs
● Rapid depolarization due to opened voltage-gated
Na+ channels which allow Na+ to diffuse into cell →
depolarization
● Stimulates opening of voltage-gated Ca2+ channels which
allow Ca2+ to diffuse into cell
● At peak of depolarization, Na+ channels close, some K+
channels open, Ca2+ channels remain open
○ The exit of K+ from the cell is counteracted by
continued inflow of Ca2+ → plateau phase
● Ca2+ channels close after plateau phase and repolarization
phase begins as they close
● Many K+ channels open, allowing K+ to move out of the cell
■ APs in cardiac muscle exhibit refractory period (lasts as long as
plateau phase)
● Prevents tetanic contractions in the heart
● Keeps a steady rhythm

○ Conduction System of the Heart

■ Cardiac muscle contracts without neural stimulations →
intrinsic rhythms
■ All the cells of the conduction system are able to produce
spontaneous APs
■ SA node, AV node, AV bundle, right and left bundle branches, and
Purkinje fibers constitute the conduction system of the heart

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■ Sinoatrial (SA) node (in Right Atrium) functions as heart’s

pacemaker
● Initiates contraction of heart
● Produced APs at a faster rate than other areas
○ Has a higher number of Ca2+ channels than other
cells
■ Atrioventricular (AV) node transfers AP from SA to AV bundle
■ AV bundle divides into left and right bundle branches
● Tips of branches have conducting tissue which form bundles
known as Purkinje Fibers
○ Purkinje Fibers pass to apex of the heart and then
extend to the cardiac muscle of the ventricle walls
■ The AV bundle, branches, and Purkinje Fibers have specialized
cardiac muscle fibers which conduct APs better than other cardiac
muscle fibers
■ After the ventricles relax, another AP originates in the SA node
■ If SA node is unable to function, another area like the AV node
becomes the pacemaker
● Ectopic Beat: when APs originate in area of the heart other
than the SA node

○ Electrocardiogram: graphic record of the heart’s electrical currents

obtained w/ electrodes; diagnoses cardiac abnormalities

■ P Wave: depolarization of atrial myocardium

● Beginning of P Wave precedes onset of atrial contraction
■ QRS Complex: depolarization of the ventricles
● Beginning of QRS Complex precedes ventricular contraction
■ T Wave: repolarization of ventricles
● Beginning of T Wave precedes ventricular relaxation
■ PQ Interval: time between depolarization of the atria and
depolarization of the ventricles
■ QT Interval: represents length of time needed for ventricular
depolarization and repolarization
● Long-QT Syndrome → increases time between
contraction and resetting → lethal (heart seizes →
tetany)

● Cardiac Cycle: repetitive pumping action which includes contraction & relaxation
○ Right and left halves of heart can be viewed as two separate pumps
○ Each pump consists of a primer pump (atrium) and a power pump
(ventricle)
■ Atria complete filling of ventricles w/ blood
■ Ventricles produce major force that causes blood to flow through
pulmonary and systemic circulations
○ Cardiac contractions produce pressure changes within heart chambers

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○ Pressure changes are responsible for blood movement (high to low)

○ Atrial Systole: contraction of atria
○ Ventricular Systole: contraction of ventricles
○ Atrial Diastole: relaxation of atria
○ Ventricular Diastole: relaxation of ventricles
○ Cardiac Cycle Steps:
■ Atrial Systole
■ Ventricular Systole (Atrial diastole and next collection of blood)
■ Semilunar valves forced open due to high pressure in ventricles,
blood is ejected into pulmonary trunk and aorta
■ Ventricular Diastole
■ When ventricles relax and AV valves open, blood flows into the
ventricles again for next fill

● Heart Sounds
○ Stethoscope: instrument used to hear sounds of the body
■ Two main heart sounds:
● Lubb: low pitch (first sound)
○ Occurs at beginning of ventricular systole
○ Results from closure of AV valves
● Dupp: high pitch (second sound)
○ Occurs at beginning of ventricular diastole
○ Results from closure of semilunar valves
■ Valves do not make sounds when they open
○ Murmurs: abnormal heart sounds
■ Result from faulty valves
■ Swishing sound after valve closes → opening of a valve may
be narrowed (stenosed)
● Regulation of Heart Function
○ Cardiac Output (CO): volume of blood pumped by either ventricle of heart
each minute (5 L/min)
○ Stroke Volume (SV): volume of blood pumped per ventricle each time the
heart contracts (70 mL/beat)
○ Heart Rate (HR): number of times heart contracts each minute (72
beats/min)
○ Athletes tend to have a higher stroke volume and lower heart rate
○ Non-athletes tend to have lower stroke volume and higher heart rate
○ Intrinsic Regulation of the Heart
■ Intrinsic regulation refers to mechanisms contained within the heart
itself
■ Force of contraction produced by cardiac muscle is related to the
degree of stretch of cardiac muscle fibers
■ Amount of blood in ventricles at end of ventricular diastole
determines the degree to which cardiac muscle fibers are stretched
■ Venous Return: amount of blood that returns to the heart

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■ Preload: degree to which ventricular walls are stretched at the end

of diastole
■ If Venous Return increases, heart fills to a greater volume
and further stretches the cardiac muscle fibers → increased
preload
● Cardiac muscle fibers will then contract with a greater force,
increasing stroke volume
○ Relationship between preload and stroke volume is
called Starling’s Law of the Heart
■ Influences cardiac output
■ Afterload: pressure against which the ventricles must pump blood
● Higher in people w/ hypertension (aortic pressure is elevated
during contraction of the ventricles)
○ Heart must do more work to pump blood →
may lead to heart failure

○ Extrinsic Regulation of the Heart

■ Refers to mechanisms external to the heart, like nervous or
chemical regulation
● Nervous Regulation: Baroreceptor Reflex
○ Carried through the autonomic nervous system
(both sympathetic and parasympathetic nerve
fibers innervate heart → effect SA node)
■ Sympathetic stimulation causes HR and SV to
increase
■ Parasympathetic stimulation causes HR and
SV to decrease
○ Baroreceptor Reflex: automatic response to a
stimulus; does not require conscious thought
■ Regulates heart function
■ Baroreceptor: stretch receptor that monitors
blood pressure in aorta and wall of internal
carotid arteries
■ Cardioregulatory Center: area within Medulla
Oblongata that receives sensory input and
controls sympathetic/parasympathetic
stimulation of heart
● Chemical Regulation: Chemoreceptor Reflex
○ Epinephrine and norepinephrine released from
adrenal medulla in response to exercise, excitement,
or stress also influence heart’s function
○ Epinephrine and norepinephrine bind to
receptor proteins on cardiac muscle → cause
increased HR and SV

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○ Medulla oblongata of brain also contains

chemoreceptors that are sensitive to changes in pH
and CO2 levels
■ A decrease in pH (caused by increase in CO2)
results in sympathetic stimulation of heart
■ Depression can decrease cardiac output
■ Changes in extracellular concentration of K+, Ca2+, and Na+ which
influence other electrically-excitable tissues can also affect cardiac
muscle function
● Excess of extracellular K+ causes decrease in HR and SV
○ Can block AP conduction → death
● Excess of Ca2+ causes heart to contract arhythmically
○ Decrease in HR and SV

● Effects of Aging on the Heart

○ Cardiac output decreases
○ Hypertrophy (enlargement) of the left ventricle → gradual
increase in pressure in the aorta (afterload), due to a decrease in
the aorta’s elasticity, against which the left ventricle must pump
○ Max HR decreases
○ Connective tissue of heart valves become less flexible
■ Stenosed aortic semilunar valve
○ Cardiac arrhythmias
■ Decreased number of cardiac cells in SA node

● Heart Attack
○ Thrombus: blood clot blocks coronary blood vessel and causes heart
attack
■ Daily aspirin can prevent this by thinning blood
○ Infarct: area that dies from lack of O2

● Heart Procedures
○ Angioplasty: procedure that opens blocked blood vessels
○ Stent: structures inserted to keep vessels open (wire mesh)
○ Bypass: procedure reroutes blood away from blocked arteries

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