Chapter 12 Heart

1
Chapter 12
Heart
Lecture Outline
Se e le y ’ s ESSENTI ALS O F Ana t om y & Phys i ol ogy Tenth Edition
Cinnamon Vanputte, Jennifer Regan Andrew Russo
© 2019 McGraw-Hill Education

2
The Cardiovascular System 1
The heart is a muscular organ that is essential for

life because it pumps blood through the body.
The heart is a member organ of the
cardiovascular system, which consists of the
heart, blood vessels, and blood.
The heart of a healthy adult, at rest, pumps
approximately 5 liters (L) of blood per minute.
For most people, the heart continues to pump at
approximately that rate for more than 75 years.
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Figure 12.1
4
The heart is a member organ of the cardiovascular

system, which consists of the heart, blood vessels,
and blood.
The heart is actually two pumps in one, with the
heart’s right side pumping to the lungs and back to
the left side of the heart through vessels of the
pulmonary circulation.
The left side of the heart pumps blood to all other
tissues of the body and back to the right side of the
heart through vessels of the systemic circulation.
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The Circulatory System
Figure 12.2
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Functions of the Heart

1. Generates blood pressure
2. Routes blood
3. Ensures one-way blood flow
4. Regulates blood supply

7
Heart Characteristics
Size:
size of a fist and weighs
less than 1 lb.
Location:
between lungs in
thoracic cavity
Orientation:
apex (bottom) towards
left side
Figure 12.3
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Heart External Anatomy 1
A coronary sulcus (groove) extends around the

heart, separating the atria from the ventricles.
Two grooves, or sulci, which indicate the division
between the right and left ventricles, extend
inferiorly from the coronary sulcus.
The anterior interventricular sulcus extends
inferiorly from the coronary sulcus on the
anterior surface of the heart.

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The posterior interventricular sulcus extends

inferiorly from the coronary sulcus on the
posterior surface of the heart.
The superior vena cava and inferior vena cava
carry blood from the body to the right atrium, and
four pulmonary veins carry blood from the lungs
to the left atrium.
Two arteries, often called the great vessels or
great arteries, carry blood away from the
ventricles of the heart.
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The pulmonary trunk, arising from the right

ventricle, splits into the right and left pulmonary
arteries, which carry blood to the lungs.
The aorta arising from the left ventricle, carries
blood to the rest of the body.

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Surface Anatomy of the Heart 1
Figure 12.5a
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Surface Anatomy of the Heart 2
Figure 12.5c
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Pericardia
Pericardium:
double-layered sac that
anchors and protects heart
Parietal pericardium:
membrane around heart’s
cavity
Visceral pericardium:
membrane on heart’s
surface
Pericardial cavity:
space around heart
Figure 12.4
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Heart Wall
Epicardium:
• surface of heart (outside)
Myocardium:
• thick, middle layer
composed of cardiac
muscle
Endocardium:
• smooth, inner surface
Figure 12.12
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The Heart Wall

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Heart Chambers
Four Chambers:
• left atrium (LA)
• right atrium (RA)
• left ventricle (LV)
• right ventricle (RV)
Coronary sulcus:
• separates atria from ventricles

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The Atria
Superior chambers
Holding chambers
Small, thin walled
Contract minimally to push blood into ventricles
Interatrial septum:
• separates right and left atria

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Ventricles
Inferior chambers
Pumping chambers
Thick, strong walled
Contract forcefully to propel blood out of heart
Interventricular septum:
• separates right and left ventricles

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Internal Anatomy of the Heart
Figure 12.6
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Atrioventricular Heart Valves

Valves between the atria and ventricles
Tricuspid valve:
• AV valve between RA and RV
• 3 cusps
Bicuspid valve (mitral):
• AV valve between LA and LV
• 2 cusps

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Valvular Control
Each ventricle contains cone-shaped, muscular
pillars called papillary muscles.
These muscles are attached by strong,
connective tissue strings called chordae
tendineae to the free margins of the cusps of
the atrioventricular valves.
When the ventricles contract, the papillary
muscles contract and prevent the valves from
opening into the atria by pulling on the chordae
tendineae attached to the valve cusps.
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Semilunar Heart Valves

The semilunar valves have three half-moon
shaped cusps, and are valves between the
pulmonary trunk and aorta.
Pulmonary valve:
• between RV and pulmonary trunk
Aortic valve:
• between LV and aorta

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Blood Flow through Heart 2
Figure 12.10
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1. RA
2. Tricuspid valve
3. RV
4. Pulmonary semilunar valve
5. Pulmonary trunk
6. Pulmonary arteries
7. Lungs
8. Pulmonary veins
9. LA
10. Bicuspid valve
11. LV
12. Aortic semilunar valve
13. Aorta
14. Body
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Heart Valves 1
Figure 12.7
© 2019 McGraw-Hill Education (a) ©VideoSurgery/Science Source; (b) ©Oktay Ortakcioglu/iStock/360/Getty Images RF
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Heart Valves 2
Figure 12.8
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Cardiac Skeleton 1
A plate of connective tissue, sometimes called

the cardiac skeleton, or fibrous skeleton,
consists mainly of fibrous rings that surround
the atrioventricular and semilunar valves and
give them solid support.
This connective tissue plate also serves as
electrical insulation between the atria and the
ventricles and provides a rigid attachment site
for cardiac muscle.

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Cardiac Skeleton 2
Figure 12.9
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Blood Supply to the Heart 1
Coronary arteries:
• supply blood to heart wall
• originate from base of aorta (above aortic
semilunar valve)
Left coronary artery:
• has 3 branches
• supply blood to anterior heart wall and left
ventricle

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Right coronary artery:

• originates on right side of aorta
• supply blood to right ventricle
Cardiac veins:
• drain blood from the cardiac muscle
• parallel to the coronary arteries
• most drain blood into the coronary sinus
• from the coronary sinus into the right atrium
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Figure 12.11
36

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Cardiac Muscle
1 centrally located
nucleus
Branching cells
Rich in mitochondria
Striated (actin and
myosin)
Ca2+ and ATP used for
contractions
Intercalated disks
connect cells
Figure 12.12
© 2019 McGraw-Hill Education (b) ©Ed Reschke
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Figure 12.10
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Action Potentials in Skeletal and
Cardiac Muscle
Figure 12.14
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Cardiac Muscle Action Potentials 1
Changes in membrane channels’ permeability

are responsible for producing action potentials
and is called pacemaker potential.
1. Depolarization phase:
• Na+ channels open
• Ca2+ channels open
2. Plateau phase:
• Na+ channels close
• Some K+ channels open
• Ca2+ channels remain open
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Cardiac Muscle Action Potentials 2
3. Repolarization phase:
• K+ channels are open
• Ca2+ channels close
Plateau phase prolongs action potential by
keeping Ca2+ channels open.
In skeletal muscle action potentials take 2 msec,
in cardiac muscle they take 200-500 msec.

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Ion Channels and Action Potentials

43

44

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Learning Outcomes
1. Explain the structure and function of the
conduction system of the heart;
2. Describe the waves of an electrocardiogram, and
relate each of them to contractions of the heart;
3. Describe the cardiac cycle and the relationship
among the contraction of each of the chambers, the
pressure in each of the chambers, the phases of the
electrocardiogram, and the heart sounds.

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4. Describe intrinsic and extrinsic regulation of

the heart.
5. Give the conditions for which the major heart
medications and treatments are administered.

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Figure 12.10
48
Conduction System of Heart 1
Contraction of the atria and ventricles is

coordinated by specialized cardiac muscle cells
in the heart wall that form the conduction
system of the heart.
All the cells of the conduction system can
produce spontaneous action potentials.
The conduction system of the heart includes the
sinoatrial node, atrioventricular node,
atrioventricular bundle, right and left bundle
branches, and Purkinje fibers.
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Conduction System of the Heart
Figure 12.15
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Action Potential Path through Heart

1. SA node
2. AV node (atrioventricular)
3. AV bundle
4. Right and Left Bundle branches
5. Purkinje fibers

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Sinoatrial node (SA node):

• in RA
• where action potential originates
• functions as pacemaker
• large number of Ca2+ channels

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Atrioventricular node (AV node):

• located in the lower portion of the right atrium
• action potentials from SA node sent to this node
• action potentials spread slowly through it
• slow rate of action potential conduction allows the
atria to complete their contraction before action
potentials are delivered to the ventricles

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Atrioventricular bundle:
• action potentials from AV node travel to AV bundle
• AV bundle divides into a left and right bundle branches

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Purkinje Fibers
• at the tips of the left and right bundle branches, are
Purkinje fibers
• Purkinje fibers pass to the apex of the heart and then
extend to the cardiac muscle of the ventricle walls
• action potentials are rapidly delivered to all the cardiac
muscle of the ventricles

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Electrocardiogram
Figure 12.16
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ECG SET-UP

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Electrocardiogram (EKG)
ECG (EKG)
• record of electrical events in heart
• diagnoses cardiac abnormalities
• uses electrodes
• contains P wave, QRS complex, T wave

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Components of ECG/EKG
P wave:
• depolarization of atria
QRS complex:
• depolarization of ventricles
• contains Q, R, S waves
T wave:
• repolarization of ventricles

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Cardiac Cycle 3
Figure 12.17
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Cardiac Cycle 3
Figure 12.17
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Cardiac Cycle 3
Figure 12.17
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Cardiac Cycle 3
Figure 12.17
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Cardiac Cycle 3
Figure 12.17
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Cardiac Cycle 3
Figure 12.17
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Events of the Cardiac Cycle
Figure 12.18
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Figure 12.18
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Figure 12.18
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Cardiac Cycle 1
The cardiac cycle is a summative description of

all the events that occur during one single
heartbeat.
The heart is a two sided pump, with the atria
being primers for pumps and the ventricles
being the actual pumps.

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Heart Chamber Contractions

Cardiac muscle contractions produce pressure
changes within heart chambers.
Pressure changes are responsible for blood
movement.
Blood moves from areas of high to low pressure.

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Cardiac Cycle 2
Atrial systole:
• contraction of atria
Ventricular systole:
• contraction of ventricles
Atrial diastole:
• relaxation of atria
Ventricular diastole:
• relaxation of ventricles
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Heart Sounds
Heart sounds are produced due to the closure
of heart valves.
A stethoscope is used to hear heart sounds
The first heart sound makes a ‘lubb’ sound.
The second heart sound makes a ‘dupp’ sound.
The first heart sound is due to the closure of the
atrioventricular valves.
The second heart sound is due to the closure of
the semilunar valves.
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Heart Valve Locations for Auscultation
Figure 12.19
© 2019 McGraw-Hill Education ©Juice Images/Alamy RF
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Regulation of Heart Function 2
Cardiac Output:
• volume of blood pumped by a ventricle in 1 min.
• 5 Liters/min.
Cardiac output equals stroke volume multiplied by
heart rate
CO = SV x HR

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Regulation of Heart Function 1
Stroke Volume:
• volume of blood pumped per ventricle per contraction
• 70 milliliters/beat
Heart Rate:
• number of heart beats in 1 min.
• 72 beats/min.

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Intrinsic Regulation of the Heart 1
Intrinsic regulation refers to the mechanisms

contained within the heart itself that control
cardiac output.
Venous return:
• the amount of blood that returns to heart
Preload:
• the degree ventricular walls are stretched at end of
diastole
Venous return, preload, and stroke volume are
related to each other
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Intrinsic Regulation of the Heart 2
Starlings Law of the Heart:

• The greater the preload, the stronger or higher
stroke volume
• influences cardiac output
• Example - exercise increases venous return, preload,
stroke volume, and cardiac output
After load:
• pressure against which ventricles must pump blood

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Extrinsic Regulation of Heart

Extrinsic regulation refers to mechanisms external
to the heart, such as either nervous or chemical
regulation.
Nervous system control of the heart occurs
through the sympathetic and parasympathetic
divisions of the autonomic nervous system.
influences of heart activity are carried through the
autonomic nervous system.
Both sympathetic and parasympathetic nerve
fibers innervate the SA node.
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Baroreceptor Reflex 2
Figure 12.20
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Baroreceptor Reflex 1
The baroreceptor reflex is a mechanism of the

nervous system that plays an important role in
regulating heart function.
Baroreceptors:
• monitor blood pressure in the aorta and carotid
arteries
• changes in blood pressure cause changes in
frequency of action potentials
• involves the medulla oblongata
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Chemoreceptor Reflex—pH
Figure 12.21
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Chemoreceptor Reflex 1
The chemoreceptor reflex involves chemical

regulation of the heart.
Chemicals can affect heart rate and stroke
volume.

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Chemoreceptor Reflex 2
Chemical actions:
• epinephrine and norepinephrine from the adrenal
medulla can increase heart rate and stroke volume
• excitement, anxiety, and anger can increase cardiac
output
• depression can decrease cardiac output
• medulla oblongata has chemoreceptors for changes
in pH and CO2
• K+, Ca2+, and Na+ affect cardiac function

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Summary of Extrinsic Regulation
Figure 12.22
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Heart Disease
Coronary Artery Disease
• due to decrease blood supply to the heart
• coronary arteries are narrowed for some reason
Myocardial Infarction (heart attack)
• due to closure of one or more coronary arteries
• area(s) of cardiac muscle lacking adequate blood
supply die, and scars (infarct)

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Heart Procedures
Angioplasty:
• procedure opens blocked blood vessels
Stent:
• structures inserted to keep vessels open
Bypass:
• procedure reroutes blood away from blocked arteries

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1

Cinnamon Vanputte, Jennifer Regan Andrew Russo

© 2019 McGraw-Hill Education

The Cardiovascular System 1

The heart is a muscular organ that is essential for

The Cardiovascular System 2

The Cardiovascular System 3

The heart is a member organ of the cardiovascular

The Circulatory System

Functions of the Heart

© 2019 McGraw-Hill Education

Heart External Anatomy 1

A coronary sulcus (groove) extends around the

© 2019 McGraw-Hill Education

Heart External Anatomy 2

The posterior interventricular sulcus extends

Heart External Anatomy 3

The pulmonary trunk, arising from the right

© 2019 McGraw-Hill Education

Surface Anatomy of the Heart 1

Surface Anatomy of the Heart 2

The Heart Wall

© 2019 McGraw-Hill Education

© 2019 McGraw-Hill Education

© 2019 McGraw-Hill Education

© 2019 McGraw-Hill Education

Internal Anatomy of the Heart

Atrioventricular Heart Valves

© 2019 McGraw-Hill Education

Semilunar Heart Valves

© 2019 McGraw-Hill Education

Blood Flow through Heart 2

Blood Flow through Heart 1

© 2019 McGraw-Hill Education

© 2019 McGraw-Hill Education

© 2019 McGraw-Hill Education

© 2019 McGraw-Hill Education

A plate of connective tissue, sometimes called

© 2019 McGraw-Hill Education

Blood Supply to the Heart 1

© 2019 McGraw-Hill Education

Blood Supply to the Heart 2

Right coronary artery:

Blood Supply to the Heart 3

© 2019 McGraw-Hill Education

Blood Flow through Heart 2

Cardiac Muscle Action Potentials 1

Changes in membrane channels’ permeability

Cardiac Muscle Action Potentials 2

© 2019 McGraw-Hill Education

Ion Channels and Action Potentials

© 2019 McGraw-Hill Education

Ion Channels and Action Potentials

© 2019 McGraw-Hill Education

Ion Channels and Action Potentials

© 2019 McGraw-Hill Education

© 2019 McGraw-Hill Education

4. Describe intrinsic and extrinsic regulation of

© 2019 McGraw-Hill Education

Blood Flow through Heart 2

Conduction System of Heart 1

Contraction of the atria and ventricles is

Conduction System of the Heart