Heart Muscle

Right Heart pumps the blood through the lungs Left Heart pumps the blood through the peripheral organs

Basic Anatomy Interatrial septum Interventricular septum Tricuspid valve Bicuspid valve Semilunar valves

What happens when the right or left ventricle weakens?

What causes the characteristic lub-dub sound?

Pulmonary Circuit involves the right ventricle which pumps deoxygenated blood to the lungs Systemic Circuit involves the left ventricle and the remainder of the arteries, capillaries and veins of the body Coronary circulation supplies blood to the myocardium (right and left coronary arteries)

Embolus clot Ischemia - blood deficiency in myocardial cells Angina pectoris - chest pain that accompanies ischemia Myocardial infarction heart attack

Sinoatrial node or pacemaker typically depolarizes spontaneously at the rate of 70-80 times per minute, causing the atria to contract Impulses from SA Node pass to the Atrioventricular Node, Atrioventricular bundle and finally to the conduction myofibers or Purkinje fibers

Innervation of the Heart

Sympathetic impulses accelerate heart action Parasympathetic impulses decelerate heart action

Cardiac Cycle
Diastole phase of relaxation

Systole phase of contraction

LATE DIASTOLE. Atria and ventricles are relaxed. AV valves are open, and the semilunar valves are closed. Blood is flowing from the atria to the ventricles, with 65% to 75% of ventricular filling occurring before the end of this phase.

Cardiac Cycle
Diastole phase of relaxation

Systole phase of contraction

ATRIAL SYSTOLE. The atria contract and pump the additional 25% to 35% of the blood into the ventricles.

Cardiac Cycle
Diastole phase of relaxation

Systole phase of contraction

VENTRICULAR SYSTOLE. At the beginning of the ventricular contraction, the AV valves close, causing the first lub sound. Semilunar valves open and ventricular ejection begins. (70-90 mL/beat = stroke volume)

Cardiac Cycle
Diastole phase of relaxation

Systole phase of contraction

EARLY DIASTOLE. As the ventricles begin to relax, the pressure drops rapidly. The semilunar valves close, preventing the backflow into the ventricles causing the second dub sound. Then, AV valves open and blood begins to flow from atria to the ventricles.

CARDIAC OUTPUT = stroke volume X heart rate

Note: Normal heart rate is 55 to 90 beats per minute

SITES OF CARDIAC AUSCULTATION

Ventricular repolarization

Depolarization of the atria

Electrocardiogram (ECG)

P atrial depolarization QRS ventricular depolarization T ventricular repolarization

ARRHYTHMIA refers to deviations from normal heart rate or from normal electrical activity of the conduction system. a. Rate Arrhythmia Bradycardia slow heart rate of fewer than 55 bpm which may be caused by excessive vagal (parasympathetic) stimulation, decreased body temperature or certain drug Tachycardia a rapid heart rate of more than 90 bpm, may be caused by excessive sympathetic stimulation, increased body temperature or drugs such as caffeine

b.

Conduction Arrhythmia Abnormal rhythmicity of the SA node Shift of pacemaking function from the SA node to another part of the heart (ectopic pacemaker or ectopic focus) may be caused by ischemia or localized heart damage, dilation of atria due to hypertension, toxic irritants like nicotine, caffeine, alcohol; lack of sleep, anxiety, extremes in body temperature, departures from normal body pH Abnormal pathway or blockage of impulses in the conduction system

Physiology of Cardiac Muscle

THREE TYPES OF CARDIAC MUSCLE 1. Atrial Muscle Contract in much the same way as skeletal 2. Ventricular Muscle muscle except that the duration of contraction is much longer 3. Specialized excitatory and conductive muscle fibers. Contract only weakly because they contain few contractile fibers, instead, they exhibit rhythmicity and varying rates of conduction, providing an excitatory system for the heart

Physiologic Anatomy of Cardiac Muscle

Cardiac Muscles are striated muscles Cardiac Muscles have typical myofibrils that contain actin and myosin filaments almost identical to those found in skeletal muscles Filaments in cardiac muscles interdigitate and slide along each other during contraction in the same manner as occurs in skeletal muscle
Figure 1. Structure of the heart and course of blood flow through the heart chambers

Physiologic Anatomy of Cardiac Muscle

CARDIAC MUSCLE AS A SYNCYTIUM Intercalated discs cell membrane that separate individual cardiac muscle cells from one another Cell membranes fuse with one another in such a way that they form permeable communicating junctions (gap junctions) that allow relatively free diffusion of ions ATRIAL SYNCYTIUM [action potentials can be conducted from AS to VS by way of the atrioventricular (A-V) bundle] VENTRICULAR SYNCYTIUM
Figure 2. (a) micrograph of heart muscle tissue (b) cardiac muscle tissue showing intercalated disks

Action Potential in Cardiac Muscle

EVENT ASSOCIATED IN ACTION POTENTIAL GENERATION

a. Stimulus (chemical-electrical-mechanical) is sufficient to alter the resting membrane potential of a particular region of the membrane b. The membranes permeability to sodium ions increases at the point of stimulation c. Sodium ions rapidly move into the cell through the membrane d. As sodium ions move into the cell, the transmembrane potential reaches zero (the membrane becomes locally depolarized) e. Sodium ions continue to move inward, and the inside of the membrane becomes positively charged relative to the outside (reverse polarization) f. Reverse polarization at the original site of stimulation results in a local current that acts as a stimulus to the adjacent region of the membrane.

EVENT ASSOCIATED IN ACTION POTENTIAL GENERATION

g. At the point originally stimulated, the membranes permeability to sodium decreases, and its permeability to potassium increases. h. Potassium ions rapidly move outward, again making the outside of the membrane positive in relation to the inside (repolarization) i. Sodium and potassium pumps transport sodium ions back out of, and potassium ions back into, the cell.

EVENT ASSOCIATED IN ACTION POTENTIAL GENERATION

g. At the point originally stimulated, the membranes permeability to sodium decreases, and its permeability to potassium increases. h. Potassium ions rapidly move outward, again making the outside of the membrane positive in relation to the inside (repolarization) i. Sodium and potassium pumps transport sodium ions back out of, and potassium ions back into, the cell. (RESTING MEMBRANE POTENTIAL) Note: the resting membrane potential of normal cardiac muscle is about -85 to -95 mV and about 90 to -100 mV in the specialized conductive fibers