Physiology of the Heart

As the heart beats, or contracts, the blood makes continuous round trips into and
out of the heart, through the rest of the body, and then back to the heart--- only to be sent
out again. Unlike skeletal muscle cells, which must be stimulated by nerve impulses
before they will contract, cardiac muscle cells can do and contract spontaneously and
independently, even if all nervous connections are severed.

The muscle cells in different areas of the heart have different rhythms:

Atrial cells

 60 beats per minute

Ventricular cells

 20-40 beats per minute

Two (2) systems that act to regulate heart activity

I. Autonomic nervous system

 Acts like brakes and gas pedals to decrease or increase the heart rate,
depending on which division is activated.

II. Intrinsic conduction system (nodal system)

 Sets the basic rhythm of the beating heart. It consist of auto rhythmic cardiac
cells that initiate and distribute impulses (action potentials) throughout the
heart. (interactivephysiology.com).

1. Composed of special tissue, much like between muscle and nervous tissue.
2. Causes depolarization
3. Contraction rate of 75 beats per minute

Components:

a) Sinoatrial (SA) node

 Often called as pacemaker
b) Atrioventricular (AV) node
c) Atrioventricular bundle
 Bundle of His
d) Bundle branches
Process of contraction:

SA node impulse spread through atria AV node, atria contracts (impulse is

briefly delayed to give time to atria to finish contracting) passes rapidly through
AV bundle Bundle branches Purkinje fibers ejects blood into
large arteries leaving the heart.

Heart block – any damage to the AV node can partially or totally block the ventricles from
the control of SA node.

Ischemia – lack of adequate blood supply to the heart muscle, may lead to;

Fibrillation – a rapid, uncoordinated quivering of the ventricles; unable to pump any blood.
Tachycardia – a rapid heart rate (over 100 beats per minute).
Brachycardia – a heart rate slower than normal (less than 60 beats per minute).

CARDIAC CYCLE AND HEART SOUNDS

Contraction and relaxation of the ventricles (unless otherwise stated):

1. Systole – contraction
2. Diastole – relaxation

Cardiac cycle

- Refers to the events of one complete heartbeat, during which both atria and
ventricles contract and then relax.

Five (5) periods in cardiac cycle:

1. Atrial diastole (ventricular filling)

 The heart is completely relaxed
2. Atrial systole
 The ventricles remain diastole as the atria contract
3. Isovolumetric contraction
 Atrial systole end and, and ventricular systole begins
4. Ventricular systole (ejection phase)
 The ventricles continue to contract, causing the intraventricular pressure to
surpass the pressure in the major arteries leaving the heart.
5. Isovolumetric relaxation
 As ventricular diastolic begins, the pressure in the ventricles falls below
that in the major arteries, and the semi-lunar valves close to prevent
 backflow into the ventricles. For another moment, the ventricles are
completely closed chambers and intraventicular pressure continues to
decrease.

CARDIAC OUTPUT

Is the product of heart rate (HR), or the number of heart beats (bpm= beats per
minute), and the stroke volume (SV), which is the amount of blood pumped from the
ventricle per beat;

Thus, CO= HR (75 beats/min) x SV (70ml/beat), Adult

blood
CO= 5250 ml/min= 5.25L/min volume is
about
Values for cardiac output are usually denoted as L/min. (Wikipedia.org). 6,000 ml

REGULATION STROKE VOLUME

Is intrinsically controlled by preload (the degree to which the ventricles are stretched
prior to contracting). An increase in the volume or speed of venous return will increase
preload and, through the Starling’s law of the heart, will increase stroke volume.

FACTORS MODIFYING BASIC HEART RATE

1. Neural (ANS) controls
2. Hormones and ions
3. Physical factors

Charmen D. Ronda
BSN-1 Queen of Apostles