Chapter 1

Anatomy
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Anterior View of the Heart

• The right ventricle
(RV) dominates the
anterior view.

• Most of the anterior

surface of the
ventricles consists of
the RV surface.
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Key Point
 Although the RV dominates this visual view,
the left ventricle (LV) dominates the
electrical view.
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The Heart as a Pump

The heart consists of four main chambers: Two atria and two
ventricles.
The left ventricle empties
into the peripheral
circulatory system.
The right ventricle
empties into the
pulmonary system.
 Veins bring blood to
the heart.
 Arteries take blood
away from the heart.
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There Are Four Pumps in a Sequence

Two small primer pumps = ATRIA Purpose is to push a
small amount of blood into the two larger pumps = VENTRICLES
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The Electrical Conduction System

Main function = To create an
electrical impulse and transmit it
to the rest of the myocardium

This is an electrochemical
process that creates electrical
energy, picked up by the
electrodes in an ECG.
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Things to Keep in Mind About the

Conduction System
 Actually inside the heart walls
 Atrial myocytes are innervated by
direct contact from one cell to
another.
 Internodal pathways transmit the
impulse from the SA node to the
AV node.
 Purkinje system is the final
component—innervates
myocardial cells.
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Pacemaker Function
The Pacemaker:
 Dictates the rate at which the heart will cycle through its
pumping action to circulate the blood
 Creates an organized beating of all cardiac cells in a
specialized sequence
 Sets the pace of all other cells that will follow
SA node:
 The main area that acts as the heart’s pacemaker.
 Controls the beat based on information it receives from the
nervous, circulatory, and endocrine systems.
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Pacemaker Settings
SA node 60–100 BPM

Atrial cells 55–60 BPM

AV node 45–50 BPM

Bundle of His 40–45 BPM

Bundle branch 40–45 BPM

Purkinje cells 35–40 BPM

Myocardial cells 30–35 BPM

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Sinoatrial (SA) Node

 Heart’s main pacemaker

 Found in the wall of the right
atrium at its junction with the
superior vena cava
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Internodal Pathways
• Main purpose is to transmit the pacing
impulse from the SA node to the AV
node
• Found in the walls of the right atrium and
inter-atrial septum
• There are three pathways:
 Anterior
 Middle
 Posterior

• Bachmann bundle: Small tract of

specialized cells that transmits impulses
through the inter-atrial septum
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Atrioventricular (AV) Node

 Located in the wall of the right
atrium next to the opening of the
coronary sinus, the largest vein of
the heart, and the septal leaflet of
the tricuspid valve
 Responsible for slowing down
conduction from atria to ventricles
long enough for atrial contraction
 Helps maintain output of heart at
the maximum level
 Always supplied by right coronary
artery
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The Bundle of His

 Starts at the AV node

 Found partially in right
atrium, and interventricular
septum
 The ONLY route of
communication between the
atria and ventricles
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Left Bundle Branch (LBB)

 Begins at the end of bundle
of His
 Travels through
interventricular septum
 First area to depolarize
 Ends at beginning of left
anterior (LAF) and left
posterior fascicles (LPF)
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Right Bundle Branch (RBB)

 Also starts at bundle of His
 Gives rise to fibers that
innervate RV and right face
of interventricular septum
 Terminates in Purkinje fibers
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Left Anterior Fascicle (LAF)

 Travels through the left
ventricle to the Purkinje
cells
 Single-stranded
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Left Posterior Fascicle

 Fan-like structure leading to
Purkinje cells
 Very difficult to block because
it is so widely distributed
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Purkinje System
• Made up of individual cells
just beneath endocardium
• Directly innervates
myocardial cells
• Initiates ventricular
depolarization cycle