Cardiovascular

Anatomy
& Physiology
Adhytya Pratama Ahmadi
M u t h i a S y a r i f a Ya n i

N a r a s u m b e r : d r. D i a n Z a m r o n i , S p J P ( K )
 To the wonders of
Cardiovascular System

The Heart pumps blood which continuously

move throughout the body in two separate
vascular loops
- the pulmonary,
- and systemic circulation

Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016
 The Heart:
Topography
Holotopia
Sceletopia
Mediastinum superius
Syntopia

Mediastinum anterius

Mediastinum posterius

Mediastinum medius

Liem IK. Anatomy of the Heart. Course Material [slides]. Jakarta: Universitas Indonesia; 2021
 The Heart:
Topography
Holotopia
Linea parasternalis Sceletopia
3rd - 5th rib Syntopia

3rd rib

Oblique:
From cartilage of 5th rib to the
5th intercostal space of left
hemithorax

Apex: 5th intercostal space (midclavicular line) to

the 3rd rib (parasternal line)

Liem IK. Anatomy of the Heart. Course Material [slides]. Jakarta: Universitas Indonesia; 2021
 The Heart:
Topography
Holotopia
Sceletopia
Syntopia

Anterior: Timus, Sternum, ribs

Superior: The Great Vessels

Lateral: Pleura

Inferior: Diaphragm

Posterior: Bronchus, Trachea, Esophagus, Nerves,

Blood vessels

Liem IK. Anatomy of the Heart. Course Material [slides]. Jakarta: Universitas Indonesia; 2021
The Heart:
Pericardium
& Walls
Inner to Outer

Serous Pericardium
Fibrous Pericardium

Contains Pericardial fluid

- Endocardium (thin, inner layer, consist of endothelium)

- Myocardium (middle layer, bulk of the heart wall, cardiac muscle)
Liem IK. Anatomy of the Heart. Course Material [slides]. Jakarta: Universitas Indonesia; 2021
- Epicardium (thin, external layer, covers the heart)
Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016
 The Heart:
Internal Structures

Right Atrium
Crista terminalis
A muscular ridge in RA, separates the right atrial free wall into a smooth-walled
posterior and coronary sinus
and a muscular anterior region (lined by pectinate muscles).

R i g h t Ve n t r i c l e
Right-anterior structure comprised of an inlet, and trabecular
- Inlet: Tricuspid annulus  insertions of papillary muscles
- Trabecular: attachments of papillary muscles  the ventricular apex
and about halfway along the anterior wall
Parietal band: separates the TV and PV

Valentin F, Harrington RA, Narula J, Zubin J. Eapen. Hurst's the heart. 2017.
Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016
Loukas M, et.al. The clinical anatomy of the crista terminalis, pectinate muscles and the teniae sagittalis.
Annals of anatomy.2008
 The Heart:
Internal Structures

Left Atrium
Contains orifices for 4 Pulmonary veins that lies on: posterolateral (left Pulm
veins) and posteromedial (right pulm veins) aspects of atrial cavity

L e f t Ve n t r i c l e
LV is made up of:
• Inlet portion (mitral valve apparatus)
• Subaortic outflow portion
• Finely trabeculated apical zone
Normally, LV free-wall and septal thickness is 3X the thickness of RV
Because rightward bulging of the ventricular septum,
• the LV chamber appears circular in cross section,
• RV chamber has a crescentic appearance

Lilly LS. Pathophysiology of heart disease. 6th ed. Philadelphia: Wolters Kluwer;2016.
Tortora GJ, Derrickson BH. Principles of anatomy and physiology. 15th ed. John Wiley & Sons; 2017.
 The Heart: Skeleton

Cardiac skeleton is made up of Fibrous connective

tissue  electrically isolate the atria from
ventricles.
Contains four major valve annuli.
Also contains the membranous septum, aortic
intervalvular, right and left fibrous trigones.
Right fibrous trigones = central fibrous body,
welds together the aortic, mitral, and tricuspid
valves (LARGEST & STRONGEST component of
cardiac skeleton).

Valentin F, Harrington RA, Narula J, Zubin J. Eapen. Hurst's the heart. 2017.
Tortora GJ, Derrickson BH. Principles of anatomy and physiology. 15th ed. John Wiley & Sons; 2017.
 The Heart: Valves
Ensure one-way flow of blood

A t r i o v e n t r i c u l a r Va l v e s
Comprised of five components (ie, annulus, leaflets,
commisures, chordae tendinae, and papillary muscles).

Tricuspid: Three leaflets:

• Ant. leaflet (largest & most mobile)
• Post. leaflet (smallest)
• Septal leaflet (least mobile)

Mitral: Two leaflets

Ant. leaflet (largest + semicircular)  separates inflow and
outflow & also form part of the outflow tract (unlike its right-
sided counterpart).
.Forms a complete fibrous ring

Tortora GJ, Derrickson BH. Principles of anatomy and physiology. 15th ed. John Wiley & Sons; 2017.
 The Heart: Valves
Ensure one-way flow of blood

S e m i l u n a r Va l v e s
Composed of three components (ie, annulus, cusps, and
commisures)
AVASCULAR

Pulmonary Valves
are separated by infundibular muscle/ parietal band

Aortic Valve
Is continuous with mitral valve
Forms a complete fibrous ring

Netter, Frank H. Atlas of Human Anatomy. Philadelphia, PA: Saunders/Elsevier, 2019.

Raaymakers SA, Radiologic and Imaging Sciences - Echocardiography Grand Valley State University (Presentation
Materials). 2019
 The Heart:
Vascularization

LCA &RCA arise from left and right aortic sinuses, respectively
RCA arises nearly perpendicular from aorta.
LCA arises at an acute angle.
50-60% first branch of RCA is conus artery.
≥70% post. desc. Artery arises from distal RCA
LCA  LM  LAD and LCX, sometimes branches to ramus intermedius

Valentin F, Harrington RA, Narula J, Zubin J. Eapen. Hurst's the heart. 2017.
Tortora GJ, Derrickson BH. Principles of anatomy and physiology. 15th ed. John Wiley & Sons; 2017.
 The Heart:
Vascularization

Artery that crosses cardiac crux and give rises to the

posterior descending branch represent the dominant
coronary artery.
Dominance is right in 70% of human hearts, left 10%,
and shared in 20%.
Regional coronary artery supply is divided into 16 LV
segment, that can be used to:
• evaluate regional abnormalities,
• Assess transmural infarct size.

Valentin F, Harrington RA, Narula J, Zubin J. Eapen. Hurst's the heart. 2017.
 The Heart:
Vascularization

• Coronary venous circulation is comprised of coronary

sinus, cardiac veins and thebesian venous system.
• The principal tributaries:
• Great cardiac veins,
• Middle cardiac veins,
• Small cardiac veins,
• Anterior cardiac veins.
• Thebesian veins: tiny vascular channel directly from
ventricular cavity through muscle fibers located just
beneath the endocardium.

Valentin F, Harrington RA, Narula J, Zubin J. Eapen. Hurst's the heart. 2017.
Tortora GJ, Derrickson BH. Principles of anatomy and physiology. 15th ed. John Wiley & Sons; 2017.
Paulsen F. 2013. Sobotta Atlas of Human
Anatomy
Cardiovascular
Physiology
 The Heart:
Electrical Activity

Two specialized cardiac muscle cells:

Autorhytmic cells specialized for initiating and
conducting the AP, do not contract
Contractile cells 99% of cardiac muscle cells, do not
initiate AP, do mechanical work of pumping

Contraction of cardiac muscle cells is triggered by Action

Potential (AP) sweeping across the muscle cell membranes

The heart contracts rhytmically as a result of AP that it

generates by itselfautorhytmicity or automaticity

Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016.
 The Heart:
Electrical Activity

The autorhytmic/pacemaker cells display pacemaker activity

slow depolarization until threshold reached
Pacemaker potential an autorhytmic cell membrane’s slow
drift to threshold
This is mainly an act of the funny or If channels which open at
hyperpolarization (at the end of repolarization) influx of Na+
These cause repeated or cyclic initiation of APtriggering
depolarization in all myocardial cells contraction of the heart

Tortora GJ, Derrickson BH. Principles of anatomy and physiology. 15th ed. John Wiley & Sons; 2017
Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016.
The Heart:
Electrical Activity

Normal Pacemaker Rate in the Heart:

• SA node: 70-80x/min
• AV node: 40-60x/min
• Bundle HIS and Purkinje fibers: 20-40x/min

Overdrive Supression: If a pacemaker cell is driven

above its usual firing rate, membrane becomes
hyperpolarized and thus preventing its intrinsic
depolarizing current into arising another AP

Elaine N. Marieb, Patricia Brady Wilhelm, Jon Mallatt.. Human anatomy 6th ed. Pearson Education, 2012.
Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016.
The Heart:
Electrical Activity

Non-pacemaker Action Potential

- Membrane remains at rest until excited by
propagated AP from pacemaker cells
- Phase 2 (plateau) unique to cardiac muscle cells,
mainly by the opening of Slow L-type Ca Channel
- The cells are unexcitable during phase 0, 1, 2, and
part of phase 3  refactory period
- This is a protective mechanism so that the heart has
time to fill up blood and prevent tetanic contraction
like that of skeletal muscles

Tortora GJ, Derrickson BH. Principles of anatomy and physiology. 15th ed. John Wiley & Sons; 2017
 The Heart:
Conduction System

Lilly LS. Pathophysiology of heart disease. 6th ed. Philadelphia: Wolters Kluwer;2016.
 The Heart:
Excitation-Contraction
Coupling

Cardiac E-C Coupling: The cascade of biological

processes that begins with the cardiac action potential
and ends with myocyte contraction and relaxation.
1) Ca2+ entry into myocyte
2) Calcium-induced calcium release (CICR)
3) Ca2+ binding to TN-C
4) Myosin phosphorylation
5) SERCA activity
6) Ca2+ efflux

Klabunde, Richard E. Cardiovascular Physiology Concepts. Philadelphia, PA: Lippincott Williams & Wilkins/Wolters Kluwer, 2012.
The Electrocardiogram
Is the record of the overall spread
of electrical activity throughout the heart

Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016.
The Cardiac Cycle

Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016.
Silverthorn D.U, Human Physiology an integrated approach. 5th ed. NY: Pearson; 2015.
The Cardiac Physiology

Cardiac Physiology - Anatomy and Physiology | OpenStax [Internet]. Openstax.org. 2021 [cited 4 November 2021].
Available from: https://openstax.org/books/anatomy-and-physiology/pages/19-4-cardiac-physiology
The Cardiac Physiology:
Stroke Volume

Preload Afterload Inotropy

Klabunde, Richard E. Cardiovascular Physiology Concepts. Philadelphia, PA: Lippincott Williams & Wilkins/Wolters Kluwer, 2012.
The Cardiac Physiology:
Stroke Volume

Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016.
The Blood Vessels: Arteries

Cardiac Physiology - Anatomy and Physiology | OpenStax [Internet]. Openstax.org. 2021 [cited 4 November 2021].
Available from: https://openstax.org/books/anatomy-and-physiology/pages/19-4-cardiac-physiology
The Blood Vessels: Capillaries

Cardiac Physiology - Anatomy and Physiology | OpenStax [Internet]. Openstax.org. 2021 [cited 4 November 2021].
Available from: https://openstax.org/books/anatomy-and-physiology/pages/19-4-cardiac-physiology
The Blood Vessels: Veins

Cardiac Physiology - Anatomy and Physiology | OpenStax [Internet].

Openstax.org. 2021 [cited 4 November 2021]. Available from:
https://openstax.org/books/anatomy-and-physiology/pages/19-4-cardiac-
physiology
The Blood Pressure

Silverthorn D.U, Human Physiology an integrated approach. 5th ed. NY: Pearson; 2015.
Cardiac Physiology - Anatomy and Physiology | OpenStax [Internet]. Openstax.org. 2021 [cited 4 November 2021].
Available from: https://openstax.org/books/anatomy-and-physiology/pages/19-4-cardiac-physiology
The Blood Pressure: Resistance

Sherwood L. Human physiology from cells to systems. 9th ed. USA: Cengage Learning; 2016.
The Blood Vessels:
Capillary Exchange

Cardiac Physiology - Anatomy and Physiology | OpenStax [Internet]. Openstax.org. 2021 [cited 4 November 2021].
Available from: https://openstax.org/books/anatomy-and-physiology/pages/19-4-cardiac-physiology