By : Febriniwati Rifdi, SSiT, M.

Biomed
Capter 3

1
 15.1: INTRODUCTION

• The heart pumps 7,000 liters of blood through the body each
day
• The heart contracts 2.5 billion times in an average lifetime
• The heart and all blood vessels make up the cardiovascular
system
• The blood vessels make up two circuits:
• Pulmonary circuit
• Systemic circuit

2
 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Systemic circuit delivers oxygen to all Deoxygenated blood Pulmonary circuit eliminates carbon
body cells and carries away wastes. dioxide via the lungs and oxygenates the
Oxygenated blood blood.

Oxygenated Deoxygenated
O2 O2
blood pumped to blood pumped
CO2 all body tissues to lungs via CO2 CO2
via aorta pulmonary arteries
O2
CO2 O2
CO2
CO2 CO2 O2
O2 Alveolus
O2
O2
CO2

Oxygenated blood returns

to heart via pulmonary veins
Deoxygenated blood returns
to heart via venae cavae Left atrium
Right atrium Left ventricle
Right ventricle

3
15.2: STRUCTURE OF THE HEART

• The heart is a hollow, cone-shaped, muscular pump

• There are four chambers:
• Two atria (for blood storage)
• Two ventricles (one low pressure pump and one high
pressure pump)

4
Ruang Jantung
 Dua atrium yg menerima darah dari vena – vena.
 Atrium kanan : dibagian depan jantung,
memompakan darah ke atas masuk ke arteri
pulmonalis.
 Atrium kiri : bentuk persegi, mengalirkan darah ke
ventrikel kiri
 Dua ventrikel yg memompakan darah ke arteri –
arteri
 Ventrikel kiri : memompakan darah ke aorta
Ventrikel kanan :
5
 SIZE AND LOCATION OF THE HEART
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display.

• The heart size varies with body size

• The heart lies in the thoracic cavity
• The average size of the heart is:
• 14 cm long
• 9 cm wide
• The heart is:
• Posterior to the sternum
• Medial to the lungs
• Anterior to the vertebral column
• The base lies beneath the 2nd rib
• The apex at the 5th intercostal space
• It lays just above the diaphragm
0 1 2 3 4 5 cm
© McGraw-Hill Companies, Inc./Photo and dissection by Christine Eckel 6
 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Base of heart
Sternum

Heart
Apex of heart

Diaphragm

7
COVERINGS OF THE HEART

• The coverings of the heart include the pericardium:

• Fibrous pericardium
• Visceral pericardium
• Parietal pericardium
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Right lung Left lung

Superior Aorta
vena cava
Pulmonary trunk

Diaphragm Auricle of left atrium

Fibrous pericardium
Auricle of right Cut edge of
atrium parietal pericardium
Heart (covered by
visceral pericardium)

Right Left ventricle

ventricle
Anterior interventricular
sulcus 8

Pericardial cavity
WALL OF THE HEART

• The heart wall has three distinct layers:

• Epicardium (outer layer) Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or

• Myocardium (middle layer) display.

• Endocardium (inner layer)

Pericardial
cavity
Parietal
pericardium
Fibrous
pericardium

Endocardium
Coronary
Myocardium blood vessel
Epicardium
(visceral pericardium)

9
10
HEART CHAMBERS AND VALVES

• The heart is divided into four chambers:

• Atrium kanan:
• Receives blood from the:
• Inferior vena cava
• Superior vena cava
• Coronary sinus
• Ventrikel kanan
• Receives blood from the right atrium
• Atrium kiri
• Receives blood from the pulmonary veins
• Ventrikel kiri
• Receives blood from the left atrium
11
12
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Aorta

Superior vena cava Left pulmonary

artery
Right pulmonary
Pulmonary trunk
artery
Left pulmonary
Right pulmonary
veins
veins
Left atrium
Right atrium Mitral (bicuspid) valve
Chordae tendineae
Pulmonary valve Left ventricle
Tricuspid valve Papillary muscle
Right ventricle Interventricular
septum
Inferior vena cava

(a)
Aorta
Superior vena cava
Left pulmonary
Aortic valve artery
Right pulmonary Pulmonary trunk
artery Left pulmonary
Right pulmonary veins
veins Left atrium
Mitral (bicuspid)
Right atrium valve
Opening of coronary Chordae tendineae
sinus Left ventricle
Tricuspid valve Papillary muscle
Right ventricle Interventricular
septum
Inferior vena cava
(b)

13

(c) c: © The McGraw-Hill Companies, Inc.

 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or
display.

Right
atrium

Cusps of
tricuspid
valve
Chordae
tendineae

Interventricular
septum

Papillary
muscles

Muscular
ridges

© McGraw-Hill Higher Education, Inc./University of Michigan Biomedical Communications

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or
display.

14
© McGraw-Hill Higher Education, Inc./University of Michigan Biomedical Communications
 SKELETON OF THE HEART

• The fibrous rings, together with other masses of dense

connective tissue in the portion of the septum between the
ventricles (interventricular septum), constitute the skeleton of
the heart Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Pulmonary valve Aortic

valve
Opening of
left coronary
artery
Tricuspid
valve

Mitral valve

Fibrous skeleton Posterior 15

PATH OF BLOOD THROUGH THE
HEART
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Systemic
Tissue cells
capillaries

CO2
Superior
vena cava
O2
Pulmonary
Alveolus artery
CO2 CO2
Alveolar Alveolar
capillaries capillaries
O2
O2

Alveolus

Pulmonary
veins

Right atrium
Left atrium
Tricuspid valve Mitral valve
Pulmonary valve Left ventricle
Right ventricle Aortic valve
Inferior vena cava Aorta

CO2 O2
16
Systemic Tissue cells
capillaries
Blood from systemic circuit

Venae cavae and

coronary sinus

Right atrium
Tricuspid valve

Right ventricle
Pulmonary valve

Pulmonary trunk

Pulmonary arteries

Alveolar capillaries (lungs)

Pulmonary veins

Left atrium
Mitral valve

Left ventricle
Aortic valve

Aorta 17

Blood to systemic circuit

BLOOD SUPPLY TO THE HEART

• The left and right coronary arteries supply blood to the

tissues of the heart
Aorta

Right coronary artery Left coronary artery

Posterior Anterior
Marginal Circumflex
interventricular interventricular
artery artery
artery artery

Myocardial Myocardial Myocardial Myocardial

capillaries in capillaries in capillaries in capillaries in
ventricular walls of right walls of left ventricular
walls atrium and right atrium and left walls
ventricle ventricle

Cardiac veins

Coronary sinus 18

Right atrium
 Aorta

Part of
aorta
removed
Aortic
valve
cusps

Right coronary
artery

Opening of
left coronary
artery

19
 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Aorta
Superior vena cava

Right pulmonary Left pulmonary artery

artery Pulmonary trunk
Right pulmonary Left pulmonary veins
veins Left auricle
Left coronary artery
Right auricle
Great cardiac vein
Right coronary
artery Anterior interventricular artery
Anterior cardiac vein (left anterior descending artery)
Small cardiac vein Left ventricle
Inferior vena cava
Right ventricle Apex of the heart
(a)

Superior vena cava

Aorta Right pulmonary
artery
Left pulmonary artery
Left pulmonary
veins
Right pulmonary
Left auricle
veins
Circumflex artery
Cardiac vein Left atrium
Right atrium
Inferior vena cava
Coronary sinus
Middle cardiac vein
Left ventricle Posterior interventricular
artery
(b) Right ventricle 20
Apex of the heart
 HEART ACTIONS

• The heart chambers function in coordinated fashion

• Heart actions are regulated so that atria contract (atrial
systole) while ventricles relax (ventricular diastole); followed
by ventricles contract (ventricular systole) while atria relax
(atrial diastole)
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Pulmonary Pulmonary
Aortic
valve closed valve open Aortic
valve closed
valve open
RA
LA
Atrial systole
Atrial diastole

Ventricular
Tricuspid LV systole
Tricuspid
and mitral Ventricular
RV and mitral
valves open diastole
valves closed
21
(a) (b)
CARDIAC CYCLE

• During a cardiac cycle, the pressure in the heart chambers rise and falls
• In atrial systole and ventricular diastole:
• Blood flows passively into the ventricles
• The remaining 30% of blood is pushed into the ventricles
• The A-V valves open and the semilunar valves close
• The ventricles relax
• This causes an increase in ventricular pressure
• In ventricular systole and atrial diastole:
• The A-V valves close
• The chordae tendinae prevent the cusps of the valves from bulging
too far into the atria
• The atria relax
• The blood flows into atria
• The ventricular pressure increases and opens the semilunar valves
• The blood flows into pulmonary trunk and aorta 22
BUNYI JANTUNG

• A heart beat through a stethoscope sounds like “lubb-dupp”

• The “lubb”
• The first heart sound
• It occurs during ventricular systole
• The A-V valves are closing

•The “dupp”
• The second heart sound
• It occurs during ventricular diastole
• The pulmonary and aortic semilunar valves are closing

• A murmur – abnormal heart sound from the cusps not

23
completely closing
Aortic area Pulmonary area

Tricuspid Mitral area

area

24
CARDIAC MUSCLE FIBERS

• Cardiac muscle fibers form a functional syncytium

• This is a mass of cells that function as a unit
• Two such areas exist in the heart:
• In the atrial walls called the atrial syncytium
• In the ventricular walls called the ventricular syncytium

25
 CARDIAC CONDUCTION SYSTEM
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display.

• Clumps or strands of specialized SA node

cardiac muscle tissue which initiate and

Atrial syncytium
distribute impulses throughout the
myocardium
Junctional fibers
• The cardiac conduction system
coordinates the events of the cardiac AV node
cycle
AV bundle

Bundle branches

Purkinje fibers
26

Ventricular syncytium
 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or
display.
Interatrial septum

Left
bundle
SA node branch
AV node

Junctional
fibers
AV bundle

Right bundle
branch

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reproduction or display.

Purkinje fibers
Interventricular
septum

Myocardial
muscle fibers

(a) (b)

27
REGULATION OF THE CARDIAC
CYCLE
• The SA node controls the heart rate
• There are also sympathetic and parasympathetic fibers that control the
heart rate as well
• There are also regulatory reflex centers that influence heart rate
• Additional factors that may influence heart rate include:
• Physical exercise
• Body temperature
• Concentration of various ions including:
• Potassium
• Calcium
• Parasympathetic impulses decrease heart action
• Sympathetic impulses increase heart action
• Cardiac center regulates autonomic impulses to the heart

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 Kecil darah dari jantung ventrikel dekstra valvula
semilunaris arteri pulmonalis paru – paru kiri dan
kanan vena pulmonalis.
Kes : Jantung ( ventrikel kanan ) paru – paru jantung
(atrium kiri )
 Besar darah dari jantung bagian ventrikel sinistra
vulvula semilunaris aorta arteri arteriola kapiler
vena venolus vena kava atrium dekstra.
kes : jantung ( ventrikel kiri ) seluruh
jaringan tubuh jantung ( atrium kanan )

PEREDARAN DARAH
30
BLOOD VESSELS

 The blood vessels are organs of the cardiovascular

system
 The blood vessels form a closed circuit to and from the
heart
 The blood vessels include:
• Arteries - carry blood away from the ventricles of
the heart
• Arterioles - receive blood from the arteries and
carry blood to the capillaries
• Capillaries - sites of exchange of substances
between the blood and the body cells
• Venules - receive blood from the capillaries 31

• Veins - carry blood toward the atria of the heart

 Artery Vein

Lumen

Valve

Endothelium of
tunica interna

Connective tissue
(elastic and collagenous fibers)

Tunica media

Tunica externa

(a) (b)

Endothelium
of tunica
interna

Lumen Middle layer

(tunica
media)
Outer layer
(tunica
externa)

(c)
ARTERIES AND ARTERIOLES

• Arteries:
• Thick strong wall (three layers or tunics)
• Endothelial lining
• Middle layer of smooth muscle and elastic tissue
• Outer layer of connective tissue
• Carries blood under relatively high pressure
• Arterioles:
• Thinner wall than an artery (three layers or tunics)
• Endothelial lining
• Middle and outer layers are thinned
• Some smooth muscle tissue
• Small amount of connective tissue
33
• Helps control blood flow into a capillary
 Arteriole

Smooth
muscle cell

Endothelium

Precapillary
sphincter

Capillary
34
CAPILLARIES

• Capillaries are the smallest diameter blood vessels

• They connect the smallest arteriole and the smallest venule
• They are extensions of the inner lining of arterioles
• The walls are endothelium only
• They are semi-permeable
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Metarteriole (forming arteriovenous

shunt)

Precapillary
sphincter

Arteriole
Capillaries
Venule

35
Artery Vein

Blood flow Blood flow

 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Tissue fluid
Nucleus of
Endothelial cell endothelial
cell
Endothelial
cell cytoplasm
Lumen of
Slit capillary
Cell junction

(b)
Tissue fluid

Capillary

(a)

36
(c)
b,c, : © Don. W. Fawcett/Visuals Unlimited
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Arteriole

Capillary

Venule
37
© Don. W. Fawcett/Visuals Unlimited
 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Lymphatic
capillary Tissue
cells

Outward force,
Blood
Net outward including Net inward Blood
flow Outward force, pressure Capillary hydrostatic pressure
from including flow to
11 mm Hg pressure 8 mm Hg venule
arteriole hydrostatic
Inward force 16 mm Hg Inward force of
pressure osmotic pressure
of osmotic
35 mm Hg 24 mm Hg
pressure
24 mm Hg
Net force at arteriolar end Net force at venular end
Outward force, including hydrostatic pressure = 35 mm Hg Outward force, including hydrostatic pressure = 16 mm Hg
Inward force of osmotic pressure = 24 mm Hg Inward force of osmotic pressure = 24 mm Hg
Net outward pressure = 11 mm Hg Net inward pressure = 8 mm Hg

38
VENULES AND VEINS

• Venule:
• Microscopic vessels that continue from the capillaries
and merge to form veins
• Thinner walls than arterioles
• Less smooth muscle and elastic tissue than arteriole
• Veins:
• Thinner walls than arteries (three layers or tunics)
• Middle wall poorly developed
• Many have flap-like valves
• Carry blood under relatively low pressure
• Function as blood reservoirs
39
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display. display.
100

90

80

Percent distribution
70

60 Large
50 veins

40
Toward 30 Small
veins
heart 20 and
venules
10

0
Systemic Lungs Heart Systemic Capillaries
veins 10–12% 8–11% arteries 4–5%
(a) (b) 60–70% 10–12%

40
41
15.5: BLOOD PRESSURE

• Blood pressure is the force the blood exerts against the inner
walls of the blood vessels

42
ARTERIAL BLOOD PRESSURE

• Arterial blood pressure:

• Rises when the ventricles contract
• Falls when the ventricles relax
• Systolic pressure is the maximum pressure during
ventricular contraction
• Diastolic pressure is the minimum pressure when the
ventricles relax

43
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Temporal a.
Facial a.
Carotid a.

Brachial a.

Radial a.
Femoral a.

Popliteal a.

Posterior tibial a. 44
Dorsalis pedis a.
 FACTORS THAT INFLUENCE
ARTERIAL BLOOD PRESSURE
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Blood volume Heart rate Stroke volume

increases increases increases

Blood pressure increases

Blood viscosity Peripheral resistance

increases increases
45
CONTROL OF BLOOD PRESSURE

• Blood pressure (BP) is determined by cardiac output (CO)

and peripheral resistance (PR) according to this relationship:
BP = CO x PR
• Maintenance of blood pressure requires regulation of these
two factors Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Increased blood pressure

Decreased heart rate Decreased stroke volume

Decreased cardiac output Decreased peripheral resistance

Blood pressure maintained

Increased cardiac output Increased peripheral resistance

Increased heart rate Increased stroke volume

46

Decreased blood pressure

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Cardiac output increases Rising blood pressure

Blood pressure rises Stimulation of baroreceptors in

aortic arch and carotid sinuses

Baroreceptors in aortic arch and

carotid sinuses are stimulated Sensory impulses to vasomotor center

Sensory impulses to cardiac center Vasomotor center inhibited

Parasympathetic impulses to heart Less frequent sympathetic impulses

to arteriole walls

SA node inhibited
Vasodilation of arterioles

Heart rate decreases

Decreased peripheral resistance

Blood pressure returns 47

Blood pressure returns toward normal
toward normal
 VENOUS BLOOD FLOW
• Blood pressure decreases as the blood moves through the
arterial system and into the capillary network, so little
pressure remains at the venular ends of the capillaries
• Only partly a direct result Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or
To heart display.

of heart action
• Dependent on:
• Skeletal muscle contraction To heart

• Breathing Relaxed skeletal

muscle

• Venoconstriction Vein Valve open

Contracted
skeletal muscle
Vein

Valve closed

48
CENTRAL VENOUS PRESSURE

• All veins, except those returning to the heart from the lungs,
drain into the right atrium
• This is therefore pressure in the right atrium
• Factors that influence it alter flow of blood into the right
atrium
• It effects pressure within the peripheral veins
• A weakly beating heart increases central venous pressure
• An increase in central venous pressure causes blood to back
up into the peripheral veins
• This can lead to peripheral edema

49