CHAMBERS OF THE HEART

subject: CARDIOPULMO PT
ANATOMY AND PHYSIOLOGY OF THE HEART

ATRIA
(R) Atrium Openings:
✓SVC - UE
✓IVC - LE
✓Coronary Sinus - Heart
- coronary artery = blood supply
(L) Atrium Openings: 4 pulmonary veins
✔ Interatrial septum
✔ (+) Fossa Ovalis
HEART
SHAPE: Cone-shaped, inverted pyramid Anterior wall (rough) - Pectinate muscles
SIZE: Closed fist (L) atrium - pulmonary vein
LOCATION: Mediastinum - atria is divided by - interatrial septum
BASE: Superiorly, posteriorly and to the R (+) fossa ovalis - depression
- 2nd-3rd rib - foramen ovale
APEX: Inferiorly, anteriorly, and to the L
- 5th rib VENTRICLES
● Trabeculae carneae: rough, raise, or ridges of
LAYERS OF THE HEART TISSUE cardiac mm fibers; cardiac ridges
● Papillary muscle: cone-shaped structure of
trabeculae carneae; contract et. Prevents
regurgitation
● Chordae tendineae - closure of valves
● Interventricular septum

VALVES OF THE HEART

● AV VALVES
✔TRICUSPID
✔BICUSPID
● SL VALVES
✔ AORTIC
SURFACES OF THE HEART
✔ PULMONARY
● ANTERIOR SURFACE
○ AKA: Sternocostal - RA & RV
● POSTERIOR SURFACE
○ AKA: Base - RA & LA
● INFERIOR SURFACE
○ AKA: Diaphragmatic - RV & LV
 ● External common carotid a. - superficial
structures in skull -> TMJ
● Internal common carotid a.
○ MCA - commonly occluded -> UE
(hemiparesis)
SVC, IVC, Coronary sinus -> ® atrium -> tricuspid valve->
○ ACA - asymptomatic -> LE
® ventricle -> pulmonary valve -> pulmonary arteries -> ● ICA largest branch (terminal branch) - MCA
Lungs -> pulmonary veins -> (L) atrium -> mitral valve -> lateral part of parietal, temporal and frontal
(L) ventricle -> aortic valve -> Aorta -> systemic lobes
circulation
BRANCHES OF AORTA
ARCH OF AORTA
● (L) Common carotid artery
● (L) Subclavian artery
● ® Brachiocephalic artery
BRANCHES OF AORTA
- (L) ventricle -> L4 (umbilicus)

● Femoral artery - thigh/ leg

● Popliteal artery - posterior knee
 ● Tibial artery - lower leg/ foot
TWO GREAT CONTROLLING CENTERS OF THE
Aortic sinus or sinus of valsalva -> coronary sinus HEART
● (L) & ® common carotid a. = head & neck
● (L) & ® subclavian a. (Front of clavicle) =
upper limb/ UE

® Brachiocephalic artery
● ® common carotid a.
● ® subclavian a.

CONDUCTING SYSTEM OF THE HEART

1. SA NODE
70-80 bpm/ 60-100 bpm
LOCATION:
✔ RA
✔ Superior septal wall of RA
✔ Near the opening of SVC
Vertebral a. - spine & brain
● Initiate depolarization
Brachial a. - arm & FA
● Generate impulses
Radial a. - radial side / radius
● Primary pacemaker
Ulnar a. - ulnar side/ ulna
● Internodal pathways: fast conduct SA-> AV
● RCA
CORONARY ARTERY
- Coronary sinus 2. AV NODE
- Receiving during diastole 50-60 bpm
LOCATION:
✔ behind the tricuspid valve

● Interatrial septum
● Delay - d/t filling of ventricles
● Heart block - PR interval slow

3. AV BUNDLE
BUNDLE OF HIS
LOCATION:
● LCA - 40%
✔ Interventricular septum
MI- d/t occlusion -> LADA (larger)
- LCA (bigger diameter) = LV - between ventricles
- RCA = SA node -> primary pacemaker Bundle branch:
- ® Purkinje fibers ® ventricle
HEART SOUNDS - (L) Purkinje fibers (L) ventricle
●S1- Lubb, louder, longer, lower in pitch
* Interatrial septum - fossa ovalis
●S2- Dubb, shorter, not as loud as S1
●S3- Rapid filling of ventricles; ventricular gallop
●S4- Atrial systole 4. PURKINJE FIBERS
15-20 bpm
LOCATION:
✔ surrounds the 2 ventricles
- ® & (L) ventricles - signals/contracts
- Toward ventricles
 ● Heart - dec. BF ● First 3rd of Ejection: 70% of blood is ejected by
● Peripheral - inc. BF the ventricles
● Last 2/3 of Ejection: 30% of blood is ejected by
the ventricles
● SL valves: open; AV valves: closed

IV. ISOVOLUMIC RELAXATION

● Blood is in the blood vessels (pulmonary a &
aorta)
● Decreased ventricular pressure
● SL valves: closed; AV valves: closed

● - 85 mV
● - 70 mV
● - 90 mV
● Heart - ECF
PHASE 0 Depolarization
PHASE 1 Initial repolarization
● Decreased influx of Na+
● norepinephrine ● acetylcholine ● Outward current of K+
& epinephrine ● CN 10973; CN
● Thoracolumbar 10 - dec BP PHASE 2 Plateau
T1-L3 ● Craniosacral ● Maintained depolarization
S2-S4 ● Influx current of Ca+
● Urinary bladder - sarcoplasmic reticulum
PHASE 3 Repolarization
CARDIAC CYCLE – Decreased influx of Ca+
I. Period of Rapid Filling of Ventricles – Outward current of K+
● First 3rd of Diastole: 75% of blood PHASE 4 Resting membrane potential (RMP)
● Middle 3rd of Diastole – Charge returns to -85mV
● Last 3rd of Diastole: 25% of blood
● AV valves: open; SL valves: closed HEMODYNAMIC VALUES
- Contract attia - atrial kick/ atrial systole ● SYSTOLIC BP
II. Period of Isovolumic Contraction ○ Highest arterial pressure
● Blood is in the ventricles ● DIASTOLIC BP
● Increased ventricular pressure ○ Lowest arterial pressure
● AV valves: closed; SL valves: closed ● PULSE PRESSURE (peripheral pulse)
○ PP= SBP-DBP
III. Period of Ejection
● Blood is ejected from ventricles ●END DIASTOLIC VOLUME (EDV) - PHASE 1
● LV: >80 mmHg – Amount of blood left after diastole
● RV: >8 mmHg – (N) EDV = 120mL (Preload)
- preload- initial stretching of the heart
●END SYSTOLIC VOLUME - PHASE 4
– Amount of blood left after systole
– (N) ESV = 50mL
●STROKE VOLUME (SV)
– Amount of blood pumped by the ventricles per
contraction
– (N) SV = 70mL
– SV = EDV – ESV
● Influenced by:
o Preload
o Afterload
o Contractility
● CARDIAC OUTPUT
• Amount of blood pumped by the ventricles per
minute
• (N) CO = 4-6L of blood (resting CO)
• CO = SV x HR
- HR - 60-100 bpm
● MEAN ARTERIAL PRESSURE (MAP)
• Arterial pressure with respect to time
• MAP = DBP + 1/3 (PP)
• (N) MAP = 93.33 mmHg
CARDIOVASCULAR RESPONSE TO EXERCISE
MYOCARDIAL OXYGEN SUPPLY AND DEMAND
● Myocardial oxygen supply depends on the:
○ delivery of oxygenated blood through
the coronary arteries
○ the oxygen-carrying capacity of arterial
blood
○ ability of the myocardial cells to extract
oxygen from the arterial blood.
● Myocardial oxygen demand (MVO2) is the
energy cost to the myocardium
● Rate Pressure Product/ Double Product= HR x
SBP
● Used to characterize myocardial performance
● Any total value greater than 10,000 indicates an
increased risk for heart disease.
● The primary mechanism for increasing
myocardial oxygen supply during times of
increased demand is by increased coronary blood
flow (CBF)
NORMAL RESPONSE
● An increase in oxygen uptake occurs with an
increase in external workload
● Failure of the HR to increase with increasing
workloads should be immediately evaluated.
CARDIAC OUTPUT
● Cardiac output is measured by echocardiography.
● VO2max is defined as the highest rate of oxygen
uptake an individual can maintain during intense
activity.
● At maximal rates of work, 80% of the cardiac
output goes to the activated muscles and the skin
BLOOD PRESSURE
● There is a linear increase in systolic blood
pressure to peak values of 200 to 249 mmHg in
normotensive individuals, and the diastolic
pressure value remains near rest level.
● Diastolic pressure can increase more than 10 to
15 mm Hg during the exercise or activity period.
● For each 10% increment of maximal HR, systolic
BP inc 12-15 mmHg
○ Hypertensive exercise response
○ Hypotensive exercise response
POST-EXERCISE HYPOTENSION
○ blood pressure drops below
pre-existing values 2-3 hours post-
exercise
HEART RATE
● Cardiac output and heart rate responses increase
linearly as the workload and VO2 demands
increase
● Patients who exhibit this abnormal heart rate
response have the following characteristics:
○ Low resting heart rate (50 to 70 bpm)
○ Poor physical condition (untrained)
○ Advanced three-vessel coronary artery
disease.
○ Poor exercise tolerance
○ Not using medications
STROKE VOLUME
● Endurance training increases plasma volume,
which elevates the blood volume that returns to
firstly the right heart and after that to the left
ventricle
● The greater amount of blood in circulation causes
an increase in the amount of blood in the LV
when the end-diastolic phase is reached
ABNORMAL RESPONSE ● KOROTKOFF SOUNDS
I- the first faint, clear tapping sounds are detected and
gradually increase in their intensity
II- murmur/swish
III- sounds become crisp and louder than those previously
heard
IV- there is a distinct and abrupt muffling of the sounds
until a soft, blowing quality is heard
V- sounds essentially disappear totally

LOCATION AND AUSCULTATION OF VALVES

ABNORMAL DIASTOLIC BP
● A progressive rise in diastolic pressure with
exercise may indicate severe coronary artery
disease

ABNORMAL SYSTOLIC BP
● Abnormal systolic blood pressure responses are
exhibited by patients with severe ischemia, poor
ventricular function, or a combination of
ischemia and poor ventilation function.

● CARDIAC ASSESSMENT
AUSCULTATION
●Auscultation refers to the technique performed
by a variety of healthcare professionals during a
physical examination in order to listen to the
internal sounds of the body, such as the heart sounds, lung
sounds, and bowel sounds.
● Bruit is an adventitious sound heard in a blood
vessel during auscultation that is caused by
turbulent flow of blood
● Murmurs are abnormal heart sounds commonly
the result of valvular disorders due to the changes
in blood flow around and through the altered
valve.
– Systolic murmur between S1 and S2
– Diastolic murmur as turbulence between S2 and S1
VITAL SIGNS BLOOD PRESSURE
●Blood pressure refers to the force the blood
exerts against a vessel wall. It is measured in
millimeters of mercury (mm Hg)

PULSE
●The pulse is the wave of blood in the artery created by
contraction of the left ventricle during a cardiac cycle
●Rate
– HR: number of pulsations or frequency per minute CAPILLARY REFILL
●Rhythm ●It refers to the amount of time required for refill
– the pattern of pulsations and the intervals between them after compression of a nail bed, and indicated
●Quality perfusion status
– (force, volume) of the pulse refers to the amount of force
created by the ejected blood volume against the arterial SKIN FINDINGS
wall during each ventricular contraction ●Cyanosis, pallor, diaphoresis, edema and
ulceration can indicate a vascular etiology

DYSPNEA

Additional notes:
CARDIOVASCULAR SYSTEM
Main Function: to service the needs of the tissues
To transport to the tissues substances that are essential for
cellular growth and metabolism
● Gasses like Oxygen
● Nutrients like Glucose, Amino Acids, Fatty Acids
● Electrolytes
Pulse points: ● Hormones
– Temporal ● Enzymes
– Carotid Remove to the tissues unwanted substances which are the
– Brachial products of cellular metabolism
– Femoral ● Carbon Dioxide
– Radial ● Creatinine
– Popliteal ● Uric Acid
– Dorsalis pedis ● Urea
 ➔ Components of the Cardiovascular System Sm valves open - pressure in the ventricles is greater than
1. HEART the atria
2. BLOOD VESSELS Sm valves close - pressure in the attia is greater than the
3. BLOOD ventricles

INTERATRIAL SEPTUM ICS - between the ribs

➔ Band of Connective tissue that separates the Two CC - cartilaginous attachment of the ribs
atria (right and left) Erb’s point - (L) 3rd ICS; S1 & S2
INTERVENTRICULAR SEPTUM Cartilage- you cannot hear the hearts sound
➔ Band of Connective tissue that separates the Two
VENTRICLES (right and left) HEART SOUNDS
Stage Sound Description
Apex - LIA (left, inferiorly, anteriorly)
- loc: 5th rib S1 LUB longer, louder, lower
Base - RPS (right, posteriorly, superiorly) “Ventricular in pitch
- loc: 2nd - 3rd Rib systole”

Pericardial cavity/ space - space between parietal and S2 DUB shorter

visceral; contains pericardial fluid
- pericardial fluid - lubricates and reduce the S3 Rapid filling of (+) CHF
ventricles
friction between pericardium and pumping of
(ventricular
heart; (N) = 50mL gallop)

Pericarditis - inflammation of pericardium; dec pericardial S4 Atrial systole (+) MI or HPN

fluid -> angina d/t trauma or infection (atrial gallop) (Tissue is devoid of
blood supply =
Pericardium death)
- protects from trauma and infection also for S3&S4 - phonocardiogram
lubrication
Layers: CARDIAC CONDUCTION SYSTEM
● Fibrous - outer suspend within mediastinum;
STRUCTURE DESCRIPTION
prevents overstretching
● Serous
SA NODE - PRIMARY
○ Visceral - directly covers the heart; PACEMAKER
adhere - RA
○ Parietal - stick on the fibrous
pericardium AV NODE JUNCTIONAL NODE
INTERATRIAL SEPTUM
Layers of the heart
● Endocardium AV BUNDLE AP- atria to ventricles
Bundle of his
○ Inner lines the chambers and valves
● Myocardium BUNDLE BRANCHES: AP spread from right to
○ Thickest, made up of cardiac muscle left and right Left to apex
● Epicardium Interventricular septum
○ Outer wall or layer, corresponds to
visceral layer of serous membrane PURKINJE FIBERS Rapid spread of AP
Largest pacemaker
Apex upward and rest of
Inc pericardial fluid - cardiac tamponade -> cardiac arrest
the myocardium
(nonpainful)

Av valves open - atria have greater pressure than ventricles

- atria is full of blood

Av valves close - atria have lesser pressure than ventricles