Option D.

4 The Heart

The heart is composed of cardiac muscle cells which have specialised features that
relates to their function:
■ Cardiac muscle cells contract without stimulation by the central nervous system
(contraction is myogenic)
■ Cardiac muscle cells are branched, allowing for faster signal propagation and
contraction in three dimensions
■ Cardiac muscles cells are not fused together, but are connected by gap junctions
at intercalated discs
■ Cardiac muscle cells have more mitochondria, as they are more reliant on
aerobic respiration than skeletal muscle

These structural features contribute to the unique functional properties of the cardiac
tissue:
■ Cardiac muscle has a longer period of contraction and refraction, which is
needed to maintain a viable heart beat
■ The heart tissue does not become fatigued (unlike skeletal muscle), allowing for
continuous, life long contractions
■ The interconnected network of cells is separated between atria and ventricles,
allowing them to contract separately
Structure of Cardiac Muscle Cells

Cardiac muscle cells are not fused together but are instead connected via gap junctions
at intercalated discs
 ■ This means that while electrical signals can pass between cells, each cell is
capable of independent contraction
■ The coordinated contraction of cardiac muscle cells is controlled by specialised
autorhythmic cells (‘pace makers’)
Atrial Contraction
Within the wall of the right atrium is a specialised cluster of cardiomyocytes which
directs the contraction of heart tissue
■ This cluster of cells is collectively called the sinoatrial node (SA node or SAN)
■ The sinoatrial node acts as a primary pacemaker, controlling the rate at which
the heart beats (i.e. pace 'making’)
■ It sends out electrical signals which are propagated throughout the entire atria via
gap junctions in the intercalated discs
■ In response, the cardiac muscle within the atrial walls contract simultaneously
(atrial systole)

The atria and ventricles of the heart are separated by a fibrous cardiac skeleton
composed of connective tissue
■ This connective tissue functions to anchor the heart valves in place and cannot
conduct electrical signals
■ The signals from the sinoatrial node must instead be relayed through a second
node located within this cardiac skeleton
■ This second node is called the atrioventricular node (or AV node) and
separates atrial and ventricular contractions
■ The AV node propagates electrical signals more slowly than the SA node,
creating a delay in the passing on of the signal
Overview of Atrial Contraction / Systole
The separation of atrial and ventricular contraction is important as it optimises the flow
of blood between the heart chambers
■ The delay in time following atrial systole allows for blood to fill the ventricles
before the atrioventricular valves close
Ventricular Contraction
Ventricular contraction occurs following excitation of the atrioventricular node (located
at the atrial and ventricular junction)
■ The AV node sends signals down the septum via a specialised bundle of
cardiomyocytes called the Bundle of His
■ The Bundle of His innervates Purkinje fibres in the ventricular wall, which causes
the cardiac muscle to contract
■ This sequence of events ensures contractions begin at the apex (bottom), forcing
blood up towards the arteries
Overview of Ventricular Contraction / Systole

Heart Relaxation / Diastole

After every contraction of the heart, there is a period of insensitivity to stimulation (i.e. a
refractory period)
■ This recovery period (diastole) is relatively long, and allows the heart to passively
refill with blood between beats
■ This long recovery period also helps prevent heart tissue becoming fatigued,
allowing contractions to continue for life
The heart contains a number of heart valves which prevent the backflow of blood
■ This ensures the one-way circulation of blood around the body
There are two sets of valves located within the heart:
■ Atrioventricular valves (tricuspid and bicuspid) prevent blood in the ventricles
from flowing back into the atria
■ Semilunar valves (pulmonary and aortic) prevent blood in the arteries from
flowing back into the ventricles

Heart sounds are made when these two sets of valves close in response to pressure
changes within the heart
■ The first heart sound is caused by the closure of the atrioventricular valves at the
start of ventricular systole
■ The second heart sound is caused by the closure of the semilunar valves at the
start of ventricular diastole
Heart Valves and Heart Sounds

The cardiac cycle describes the series of events that take place in the heart over the
duration of a single heart beat
■ It is comprised of a period of contraction (systole) and relaxation (diastole)

The cardiac cycle can be mapped by recording the electrical activity of the heart with
each contraction
■ Activity is measured using a machine called an electrocardiograph to generate
data called an electrocardiogram
■ Hint: In a similar fashion, you use a telegraph (machine) to send a telegram
(data)
Each normal heart beat should follow the same sequence of electrical events:
■ The P wave represents depolarisation of the atria in response to signalling from
the sinoatrial node (i.e. atrial contraction)
■ The QRS complex represents depolarisation of the ventricles (i.e. ventricular
contraction), triggered by signals from the AV node
■ The T wave represents repolarisation of the ventricles (i.e. ventricular relaxation)
and the completion of a standard heart beat
■ Between these periods of electrical activity are intervals allowing for blood flow
(PR interval and ST segment)
Electrical Activity of the Heart

Examples of Heart Conditions

Data generated via electrocardiography can be used to identify a variety of heart
conditions, including:
■ Tachycardia (elevated resting heart rate = >120 bpm) and bradycardia
(depressed resting heart rate = < 40 bpm)
■ Arrhythmias (irregular heart beats that are so common in young people that it is
not technically considered a disease)
 ■ Fibrillations (unsynchronised contractions of either atria or ventricles leading to
dangerously spasmodic heart activity)
Cardiac Rhythm Diagnoses

Cardiac output describes the amount of blood the heart pumps through the circulatory
system in one minute
■ It is an important medical indicator of how efficiently the heart can meet the
demands of the body

There are two key factors which contribute to cardiac output – heart rate and stroke
volume

■ Equation: Cardiac Output (CO) = Heart Rate (HR) × Stroke Volume (SV)
Heart Rate
Heart rate describes the speed at which the heart beats, measured by the number of
contractions per minute (or bpm)
■ Each ventricular contraction forces a wave of blood through the arteries which
can be detected as a pulse
■ The typical pulse rate for a healthy adult is between 60 – 100 beats per minute

Heart rate can be affected by a number of conditions – including exercise, age, disease,
temperature and emotional state
■ Additionally, the body will attempt to compensate for any changes to stroke
volume with a corrective alteration to heart rate

An individual’s heart rate is controlled by both nervous and hormonal signals:

■ Heart rate is increased by the sympathetic nervous system and decreased by
parasympathetic stimulation (vagus nerve)
■ Heart rate can also be increased hormonally via the action of adrenaline /
epinephrine
Blood Pressure
Stroke volume is the amount of blood pumped to the body (from the left ventricle) with
each beat of the heart
■ It is affected by the volume of blood in the body, the contractility of the heart and
the level of resistance from blood vessels
Changes in stroke volume will affect the blood pressure – more blood or more
resistance will increase the overall pressure
■ Blood pressure measurements typically include two readings – representing
systolic and diastolic blood pressures
■ Systolic blood pressure is higher, as it represents the pressure of the blood
following the contraction of the heart
■ Diastolic blood pressure is lower, as it represents the pressure of the blood while
the heart is relaxing between beats

Blood pressure readings will vary depending on the site of measurement (e.g. arteries
have much higher pressure than veins)
■ A typical adult is expected to have an approximate blood pressure in their
brachial artery of 120/80 mmHg to 140/90 mmHg
■ Blood pressure can be affected by posture, blood vessel diameter (e.g.
vasodilation) and fluid retention or loss
Blood Pressure Changes in the Circulatory System

Hypertension
■ Hypertension is defined as an abnormally high blood pressure – either systolic,
diastolic or both (e.g. > 140/90 mmHg)
■ Common causes of hypertension include a sedentary lifestyle, salt or fat-rich
diets and excessive alcohol or tobacco use
 ■ High blood pressure can also be secondary to other conditions (e.g. kidney
disease) or caused by some medications
■ Hypertension itself does not cause symptoms but in the long-term leads to
consequences caused by narrowing blood vessels
Thrombosis
■ Thrombosis is the formation of a clot within a blood vessel that forms part of the
circulatory system
■ Thrombosis occurs in arteries when the vessels are damaged as a result of the
deposition of cholesterol (atherosclerosis)
■ Atheromas (fat deposits) develop in the arteries and significantly reduce the
diameter of the vessel (leading to hypertension)
■ The high blood pressure damages the arterial wall, forming lesions known as
atherosclerotic plaques
■ If a plaque ruptures, blood clotting is triggered, forming a thrombus that restricts
blood flow
■ If the thrombus becomes dislodged it becomes an embolus and can cause
blockage at another site
■ Thrombosis in the coronary arteries leads to heart attacks, while thrombosis in
the brain causes strokes
Causes and Consequences of Coronary Thrombosis

Coronary heart disease (CHD) describes the condition caused by the build up of plaque
within the coronary arteries
■ It is essentially the consequence of atherosclerosis in the blood vessels that
supply and sustain heart tissue

The incidence of coronary heart disease will vary in different populations according to
the occurrence of certain risk factors
 ■ E.g. The incidence of CHD under the age of 65 is substantially higher in
indigenous Australians (versus non indigenous)

There are several risk factors for coronary heart disease (CHD), including:

■ Age – Blood vessels become less flexible with advancing age

■ Genetics – Having hypertension predispose individuals to developing CHD
■ Obesity – Being overweight places an additional strain on the heart
■ Diseases – Certain diseases increase the risk of CHD (e.g. diabetes)
■ Diet – Diets rich in saturated fats, salts and alcohol increases the risk
■ Exercise – Sedentary lifestyles increase the risk of developing CHD
■ Sex – Males are at a greater risk due to lower oestrogen levels
■ Smoking – Nicotine causes vasoconstriction, raising blood pressure

Mnemonic: A Goddess

An artificial pacemaker is a medical device that delivers electrical impulses to the heart
in order to regulate heart rate
■ Modern pacemakers are externally programmable, allowing cardiologists to make
adjustments as required

Artificial pacemakers are typically used to treat one of two conditions:

■ Abnormally slow heart rates (bradycardia)
■ Arrhythmias arising from blockages within the heart’s electrical conduction
system
Artificial Pacemaker
Fibrillation is the rapid, irregular and unsynchronised contraction of the heart muscle
fibres

■ This causes heart muscle to convulse spasmodically rather than beat in concert,
preventing the optimal flow of blood

Fibrillation is treated by applying a controlled electrical current to the heart via a device
called a defibrillator

■ This functions to depolarise the heart tissue in an effort to terminate

unsynchronised contractions
■ Once heart tissue is depolarised, normal sinus rhythm should hopefully be
re-established by the sinoatrial node
ECG Trace of a Patient with Ventricular Fibrillation

Cardiac output describes the volume of blood pumped out of the heart per minute
 ■ It is roughly 5 litres per minute in a typical human adult at rest (it increases to ~25
L/min during heavy exercise)

Blood is distributed to body organs according to physiological requirements and this

distribution changes with exercise:
■ Blood flow to the brain is largely unchanged during exercise (brain is vital and
hence blood flow cannot be altered)
■ Blood flow to the heart wall, muscles and skin is increased (to facilitate improved
oxygenation and heat loss)
■ Blood flow to the kidneys, liver and digestive system is decreased (due to
minimal absorption and excretion)

Blood vessels will vasodilate during exercise to improve circulation and facilitate heat
loss via the skin
■ This moves blood closer to the surface of the skin and is why exercise causes a
person to appear flushed