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The Heart Functions: 1.

Transports nutrients, hormones, waste materials, respiratory gases using blood by the pumping of the heart. 2. Ensure one way direction of blood flow. 3. Generates Blood Pressure 4. Routing Blood 5. Regulates Blood Supply Anatomy of the Heart  Fist size; Hollow, cone shape; located in the thorax and flanked on each side of the lungs; Apex at 5th intercostals space mid clavicular line; Base is beneath the 2nd rib.

Importance of Knowing the Location of Heart 1. Physical Examination 2. Electrocardiogram (ECG) 3. Cardio Pulmonary Resuscitation (CPR) Covering of the Heart Pericardium   Double sac of serous membrane that ENCLOSES THE HEART. Secretes PERICARDIAL FLUID that allows heart to beat easily without friction. a. Visceral Pericardium or Epicardium – outermost layer; part of heart wall b. Parietal Pericardium – protects the heart and attached it to diaphragm and sternum.

Serosa – General Covering Pericarditis: Inflammation of Pericardium; Decrease of serous fluids that bind Pericardial Layers and interferes their movement. 3 Walls of the Heart (Outer to Inner) 1. Epicardium or Visceral Pericardium (Outermost) 2. Myocardium  Middle Layer that contracts  Bulk of Cardiac muscle reinforced by the Skeleton of the Heart 3. Endocardium  Inner Layer that lines the heart chambers to allow smooth blood flow. 4 Heart Chambers 1. Right Atrium and Left Atrium (Superior Chamber)  “Receiving Chambers”  Blood flows under LOW PRESSURE from the main veins (SVC and IVC) to fill the Ventricles.

2. Right Ventricle and Left Ventricle (Inferior Chamber)  Discharging Chambers; Actual Pumps of heart  When ventricles contract, blood is pumped out from heart and goes into circulation under HIGH PRESSURE. Septum -Divides the heart longitudinally a. Interventricular Septum – divides RV & LV b. Interatrial Septum – divides RA and LA 4 Heart Valves

Prevents backflow of blood; ensure one way direction of flow of blood 1. Atrioventricular Valve  Separates Atrium and Ventricles  Prevents backflow of blood into Atrium when ventricles contract  Opens during heart relaxation and closed when ventricles contract a. Tricuspid Valve or Right AV Valve  Has 3 Cusps ; Prevents backflow of blood from RV to RA b. Bicuspid Valve of Left AV Valve  Has 2 Cusps; Prevents backflow of blood from LV to LA Chordae Tendinae  “heart strings”; white cord that attaches the cusps to ventricle walls

2. Semilunar Valve  Separates Ventricles and Blood Vessel (Artery)  Prevents backflow of blood into Ventricles when heart is relaxing  Closed during heart relaxation and opens when ventricles contract a. Pulmonary Semilunar Valve or Right SV Valve  Separates RV and Pulmonary Trunk  Going to the Lungs b. Aortic Semilunar Valve or Left SV  Separates LV and Aorta  Going to Systemic Circulation at the base of Aorta

Blood Flow through the Heart 1.) First Circuit or Pulmonary Circulation  Function: For Gas Exchange in the Lungs  Blue: Deoxygenated Blood (VEINS) 1. 2. 3. 4. 5. 6. 7. Super Vena Cava and Inferior Vena Cava receives deoxygenated blood from the body. Right Atrium Tricuspid Valve (Right AV Valve) Right Ventricle Pulmonary Semilunar Valve or Right SV Valve (closes to prevent backflow to RV) Pulmonary Trunk Pulmonary Artery

2.) Second Circuit or Systemic Circulation  Function: Supply Oxygen to Body Organs  Red: Oxygenated Blood (ARTERY; Pulmonary Vein is exempted) 8. Lungs (Gas Exchange – Oxygenated Blood) 9. Thru Pulmonary Vein (oxygenated blood back to Heart) 10. Left Atrium (receives oxygenated Blood) 11. Bicuspid Valve or Left SV Valve 12. Left Ventricle 13. Aortic Semilunar Valve or Left SV Valve 14. Aorta 15. Systemic Circulation (Body Organs) Arteries  Capillaries  Veins  SVC and IVC Aorta   Largest artery At the base of aorta (systemic) starts the blood supply to heart muscle (cardiac circulation)

Arterioles  Smallest arteries

Arteries  Largest blood vessel; takes oxygenated blood away from heart

Capillaries  Smallest Blood Vessels

Venules  Smallest veins

Superior and Inferior Vena Cava   Largest veins; Main Veins Carries blood back to heart

CARDIAC CIRCULATION 1. Left and Right Coronary Arteries (oxygenated blood)  Oxygenates and Nourishes the Heart  Fills when heart relaxes  Checked during Andiogram 2. Cardiac Veins (deoxygenated blood) 3. Coronary Sinus (deoxygenated blood)  Enlarged blood vessel at the back of heart  Blood coming from the heart 4. Right Atrium (deoxygenated blood) Conduction System of the Heart 1. Atrial Cells – 60 bpm 2. Ventricular Cells – 20 to 40 bpm 2 Controlling Systems to Regulate Heart Activity 1. Autonomic Nervous System (ANS)  “brakes” and “accelerators” to increase & decrease heart rate 2. Intrinsic Conduction System  Causes muscle depolarization in 1 direction; Sets basic heart rhythm  Normal Contraction: 75 bpm Electrical Impulses 1. Sinoatrial Node (SA Node)  “Pacemaker of Heart” located at Right Atrium; stimulate muscle to contract

2. 3. 4. 5. 6.

Atrioventricular Node (AV Node) Bundle of His Right andLeft bundle branches to Interventricular Septum Purkinje Fibers “Wringing Contractions” of Ventricles

Conditions that Interferes Electrical Impulses 1. 2. 3. 4. 5. 6. Heart Block – impaired transmission of impulse from Atrium to Ventricle. Any Damage to Sinoatrial Node – lowers heart rate Ischemia – lack of oxygen to heart muscle that leads to Fibrillation. Fibrillation – rapid and uncoordinated shuddering of heart muscle. Tachycardia – increased HR (HR > 100 bmp); leads to Fibrillation Bradycardia – decreased HR (HR < 60bmp)

Cardiac Cycle     Events of 1 complete heartbeat when atria and ventricles contract and relax. Systole - heart contraction (ventricles contract) / Diastole - heart relaxes (ventricles relaxes) Average Heart Beat: 75 bpm Cardiac Cycle Length: 0.8 seconds 1. Mid to Late Diastole – heart is in complete relaxation 2. Ventricular Systole – ventricular contraction begins (systole) 3. Early Diastole – ventricles relax Heart Sounds during Cardiac Cycle 1. Lub or S1 (SYSTOLE)  closing of AV valves; ventricles contract  sound is longer and louder 2. Dub or S2 (DIASTOLE)  closing of SV valves ; ventricles relaxes  sound is sharp and short Murmurs – Abnormal heart sound (Swishing sound); Indicates valve problems Cardiac Output    Amount of blood pumped by each side of the heart in one minute. Product of Heart Rate and Stroke Volume (HR x SV) Normal Cardiac Output: 5,000 ml Ex. Heart Rate is 75 bpm / Stroke Volume is 70ml / heart beat = 75 bpm x 70 ml / heart beat = 5,250 ml / min Average Adult Cardiac Output

Stroke Volume   Volume of blood pumped out by a ventricle with each heartbeat Normal Stroke Volume: 5 – 6 L of blood per minute

Regulation of Stroke Volume 1. Starling Law of Heart  The more cardiac muscles is stretched, the stronger contraction. 2. Venous Return  Important factor in stretching of heart muscle.  The amount of blood entering the heart and distending its ventricles. Factors affecting Heart Rate       Increases Heart Rate SNS Stimulation (4’Es) Epinephrine d/t SNS Stimulation Thyroxine Fever / Heat – d/t low BP Loss of Blood or Hypovolemia – d/t to low BP Fetus (highest heart rate of 140 – 160 bpm)       Decreases Heart Rate PNS Stimulation Electrolyte Imbalance Cold Medicine (Cardiotonics) Age – heart rate decreases with age Gender or Sex - after puberty, male pulse rate is lower than females