The Heart

Ken M. Fonghe M.D.

ANY Department


Heart

The heart is a pair of valved muscular pumps

combined in a single organ

The general shape and orientation of the heart

are that of a pyramid that has fallen over and is
resting on one of its sides.

laced in the thoracic cavity! the ape" of this

pyramid pro#ects for$ard! do$n$ard! and to the
left! $hereas the base is opposite the ape" and
faces in a posterior direction

The heart is a hollo$ muscular organ that is

some$hat pyramid shaped and lies $ithin the
pericardium in the mediastinum

%t is connected at its base to the great blood

vessels but other$ise lies free $ithin the
pericardium.

Although the fibromuscular frame$or& and

conduction tissues of these pumps are
structurally inter$oven! each pump 'the so(
called )right* and )left* hearts+ is physiologically
separate! and is interposed in series at different
points in the double circulation.


,ardiac -rientation

The sides of the pyramid consist of.

a diaphragmatic 'inferior+ surface on

$hich the pyramid rests/

an anterior 'sternocostal+ surface

oriented anteriorly/

a right pulmonary surface/

a left pulmonary surface

The sternocostal surface is formed mainly by the right

atrium and the right ventricle! $hich are separated
from each other by the vertical atrioventricular groove.
The right border is formed by the right atrium/ the left
border! by the left ventricle and part of the left auricle.
The right ventricle is separated from the left ventricle
by the anterior interventricular groove.

The diaphragmatic surface of the heart is formed

mainly by the right and left ventricles separated by the
posterior interventricular groove. The inferior surface
of the right atrium! into $hich the inferior vena cava
opens! also forms part of this surface.

The ape" of the heart! formed by the left ventricle! is

directed do$n$ard! for$ard! and to the left. %t lies at
the level of the fifth left intercostal space! 0.1 in. '2
cm+ from the midline. %n the region of the ape"! the
ape" beat can usually be seen and palpated in the
living patient.

The sternocostal surface is formed mainly by the right

atrium and the right ventricle! $hich are separated
from each other by the vertical atrioventricular groove.
The right border is formed by the right atrium/ the left
border! by the left ventricle and part of the left auricle.
The right ventricle is separated from the left ventricle
by the anterior interventricular groove.

The diaphragmatic surface of the heart is formed

mainly by the right and left ventricles separated by the
posterior interventricular groove. The inferior surface
of the right atrium! into $hich the inferior vena cava
opens! also forms part of this surface.

The ape" of the heart! formed by the left ventricle! is

directed do$n$ard! for$ard! and to the left. %t lies at
the level of the fifth left intercostal space! 0.1 in. '2
cm+ from the midline. %n the region of the ape"! the
ape" beat can usually be seen and palpated in the
living patient.

The base of the heart! or the posterior surface! is formed mainly by the left atrium! into $hich open the four pulmonary
veins. The base of the heart lies opposite the ape".

Note that the base of the heart is called the base because the heart is pyramid shaped/ the base lies opposite the
ape". The heart does not rest on its base/ it rests on its diaphragmatic 'inferior+ surface.


The base of the heart is 3uadrilateral and
directed posteriorly. %t consists of.
the left atrium/
a small portion of the right atrium/
the pro"imal parts of the great veins
'superior and inferior venae cavae and the
pulmonary veins+


ericardium

The pericardium is a fibroserous sac that encloses the heart and the roots of the great vessels.

%ts function is to restrict e"cessive movements of the heart as a $hole and to serve as a lubricated container in $hich the
different parts of the heart can contract.

The pericardium lies $ithin the middle mediastinum! posterior to the body of the sternum and the second to the si"th costal
cartilages and anterior to the fifth to the eighth thoracic vertebrae.

Fibrous ericardium

The fibrous pericardium is the strong fibrous part of the sac. %t is firmly attached belo$ to the central
tendon of the diaphragm. %t fuses $ith the outer coats of the great blood vessels passing through itnamely!
the aorta! the pulmonary trun&! the superior and inferior venae cavae! and the pulmonary veins. The
fibrous pericardium is attached in front to the sternum by the sternopericardial ligaments.

4erous ericardium

The serous pericardium lines the fibrous pericardium and coats the heart. %t is divided into parietal and
visceral layers

the parietal layer lines the inner surface of the fibrous

the visceral layer (epicardium) of serous pericardium

adheres to the heart and forms its outer covering.


ericardial ,avity

The slitli&e space bet$een the parietal and visceral layers is referred to as the pericardial cavity

Normally! the cavity contains a small amount of tissue fluid '56 or 51716 m8+! the pericardial fluid! $hich acts as a lubricant
to facilitate movements of the heart.


ericardial Fluid

56(16 m8

pale yello$ and clear

rotein. A value greater than 0.6 g9d8 has a sensitivity of 2:; for e"udative effusions! but a specificity of only <<; $hich
significantly limits its usefulness. Thus! total protein has no discriminating po$er in pericardial diagnosis ' Meyers! 522: +.

=lucose. ericardial glucose levels less than >6 mg9d8 have a diagnostic accuracy of only 0>; in identifying pericardial
e"udates ' Meyers! 522: +. ?alues less than @6 mg9d8 'A <.<< mmol98+ are common in bacterial! tuberculous! rheumatic! or
malignant effusions.

pH. ericardial fluid pH may be mar&edly decreased 'A :.56+ in rheumatic or purulent pericarditis. Malignancy! uremia!
tuberculosis! and idiopathic disorders may have moderate decreases in the range of :.<6(:.06 ' Kindig! 52B0 +.

8ipids. 4eparation of true chylous from pseudochylous effusions may be facilitated by triglyceride and cholesterol
measurements! as $ell as lipoprotein electrophoresis for chylomicrons

CnDymes. A pericardial fluidlactate dehydrogenase '8D+ level greater than <66 E98 has been suggested as a cutoff for
pericardial e"udates ' Furgess! <66<a +. Moreover! the measurement of 8D and creatine &inase in postmortem pericardial
fluid $ithin @B hours of death may be useful in establishing acute myocardial in#ury in cases $here such in#ury is suspected
but cannot be established by the usual histologic methods ' 8una! 52B< / 4te$art! 52B@ +. ericardial fluid levels of ,K(MF!
myoglobin! and troponin % in postmortem pericardial fluid are also significantly increased in patients $ith myocardial in#ury
' ereD(,arceles! <66@ +.


Gight Atrium

The right atrium consists of a main

cavity and a small outpouching! the
auricle.

-n the outside of the heart at the

#unction bet$een the right atrium and
the right auricle is a vertical groove! the
sulcus terminalis! $hich on the inside
forms a ridge! the crista terminalis.

The main part of the atrium that lies

posterior to the ridge is smooth $alled
and is derived embryologically from the
sinus venosus.

The part of the atrium in front of the

ridge is roughened or trabeculated by
bundles of muscle fibers! the musculi
pectinati! $hich run from the crista
terminalis to the auricle.


-penings into the Gight Atrium

The superior vena cava opens into the upper part of the
right atrium/ it has no valve. %t returns the blood to the
heart from the upper half of the body. The inferior vena
cava 'larger than the superior vena cava+ opens into the
lo$er part of the right atrium/ it is guarded by a
rudimentary! nonfunctioning valve. %t returns the blood to
the heart from the lo$er half of the body.

The coronary sinus! $hich drains most of the blood from

the heart $all! opens into the right atrium bet$een the
inferior vena cava and the atrioventricular orifice. %t is
guarded by a rudimentary! nonfunctioning valve.

The right atrioventricular orifice lies anterior to the inferior

vena caval opening and is guarded by the tricuspid
valve.

Many small orifices of small veins also drain the $all of

the heart and open directly into the right atrium.


Fetal Gemnants

The fossa ovalis is a shallo$ depression! $hich is the site of the foramen ovale in the fetus

The anulus ovalis forms the upper margin of the fossa. The floor of the fossa represents the persistent septum primum of
the heart of the embryo! and the anulus is formed from the lo$er edge of the septum secundum


Gight ?entricle

communicates $ith the right atrium through the

atrioventricular orifice and $ith the pulmonary trun&
through the pulmonary orifice

e"tends from the right atrioventricular 'tricuspid+ orifice

nearly to the cardiac ape"

ascends to the left to become the infundibulum! or

conus arteriosus! reaching the pulmonary orifice and
supporting the cusps of the pulmonary valve

thic&er than those of the right atrium

The pro#ecting ridges give the ventricular $all a spongeli&e appearance and are &no$n as trabeculae carneae

The first type comprises the papillary muscles! $hich pro#ect in$ard! being attached by their bases to the
ventricular $all/ their apices are connected by fibrous chords 'the chordae tendineae+ to the cusps of the
tricuspid valve 'Fig. 0(0:+.

The second type is attached at the ends to the ventricular $all! being free in the middle. -ne of these! the
moderator band! crosses the ventricular cavity from the septal to the anterior $all. %t conveys the right
branch of the atrioventricular bundle! $hich is part of the conducting system of the heart.

The third type is simply composed of prominent ridges

8eft Atrium

4ituated behind the right atrium and forms the greater part of the base or the posterior surface of the heart

Fehind it lies the obli3ue sinus of the serous pericardium! and the fibrous pericardium separates it from the esophagus

The interior of the left atrium is smooth! but the left auricle possesses muscular ridges as in the right auricle


-penings of the 8eft Atrium

The four pulmonary veins! t$o from each

lung! open through the posterior $all and
have no valves.

The left atrioventricular orifice is guarded

by the mitral valve.

The t$o thic&er($alled ventricles consist of three interdigitating muscle layers.

the deep sinospiral

the superficial sinospiral

superficial bulbospiral muscles

Components of the myocardium. The outer muscle
layers pull the apex of the heart toward the base. The
inner circumferential layers constrict the lumen,
particularly of the left ventricle.


8eft ?entricle

,ommunicates $ith the left atrium through the atrioventricular orifice and $ith the aorta through the aortic orifice

The $alls of the left ventricle are three times thic&er than those of the right ventricle. 'The left intraventricular blood pressure
is si" times higher than that inside the right ventricle.+

%n cross section! the left ventricle is circular/ the right is crescentic because of the bulging of the ventricular septum into the
cavity of the right ventricle.

There are $ell(developed trabeculae carneae! t$o large papillary muscles! but no moderator band. The part of the ventricle
belo$ the aortic orifice is called the aortic vestibule.


?alves

Tricuspid valve

ulmonary valve

Ficuspid valve

Aortic valve


Tricuspid valve

The right atrioventricular orifice is closed during

ventricular contraction by the tricuspid valve 'right
atrioventricular valve+! $hich is so(named because it
usually consists of three cusps or leaflets

The base of each cusp is secured to the fibrous ring

that surrounds the atrioventricular orifice. This fibrous
ring helps to maintain the shape of the opening. The
cusps are continuous $ith each other near their
bases at sites termed commissures.

The naming of the three cusps! the anterior! septal!

and posterior cusps! is based on their relative
position in the right ventricle. The free margins of the
cusps are attached to the chordae tendineae! $hich
arise from the tips of the papillary muscles.


Ficuspid ?alve

The left atrioventricular orifice opens into the posterior

right side of the superior part of the left ventricle. %t is
closed during ventricular contraction by the mitral valve
(left atrioventricular valve)! $hich is also referred to as
the bicuspid valve because it has t$o cusps! the anterior
and posterior cusps

The bases of the cusps are secured to a fibrous ring

surrounding the opening, and the cusps are
continuous with each other at the commissures. The
coordinated action of the papillary muscles and
chordae tendineae is as described for the right
ventricle.


ulmonary
?alve

The pulmonary valve guards

the pulmonary orifice and
consists of three semilunar
cusps formed by folds of
endocardium $ith some
connective tissue enclosed.

At the ape" of the

infundibulum! the outflo$ tract
of the right ventricle! the
opening into the pulmonary
trun& is closed by the
pulmonary valve

The cusps are named the

left! right and anterior
semilunar cusps! relative to
their fetal position before
rotation of the outflo$ trac&s
from the ventricles is
complete.

Cach cusp forms a poc&et(li&e sinus(a dilation in the $all of the initial portion of the pulmonary trun&. After ventricular
contraction! the recoil of blood fills these pulmonary sinuses and forces the cusps closed. This prevents blood in the
pulmonary trun& from refilling the right ventricle.


Aortic valve
The aortic vestibule! or outflo$ tract of the left ventricle! is
continuous superiorly $ith the ascending aorta.
The opening from the left ventricle into the aorta is closed by
the aortic valve.
This valve is similar in structure to the pulmonary valve. %t
consists of three semilunar cusps $ith the free edge of each
pro#ecting up$ard into the lumen of the ascending aorta
Fet$een the semilunar cusps and the $all of the ascending
aorta are poc&et(li&e sinuses(the right! left! and posterior
aortic sinuses. The right and left coronary arteries originate
from the right and left aortic sinuses. Fecause of this! the
posterior aortic sinus and cusp are sometimes referred to as
the noncoronary sinus and cusp.
osition of the tricuspid and pulmonary valves. F. Mitral cusps $ith valve open.
,. Mitral cusps $ith valve closed. D. 4emilunar cusps of the aortic valve. C.
,ross section of the ventricles of the heart. F. ath ta&en by the blood through
the heart. =. ath ta&en by the cardiac impulse from the sinuatrial node to the
ur&in#e net$or&. H. Fibrous s&eleton of the heart.


Aortic valve

The aortic vestibule! or outflo$ tract of the left ventricle!

is continuous superiorly $ith the ascending aorta.

The opening from the left ventricle into the aorta is

closed by the aortic valve.

This valve is similar in structure to the pulmonary valve. %t

consists of three semilunar cusps $ith the free edge of
each pro#ecting up$ard into the lumen of the ascending
aorta

Fet$een the semilunar cusps and the $all of the

ascending aorta are poc&et(li&e sinuses(the right! left!
and posterior aortic sinuses. The right and left
coronary arteries originate from the right and left aortic
sinuses. Fecause of this! the posterior aortic sinus and
cusp are sometimes referred to as the noncoronary
sinus and cusp.
osition of the tricuspid and pulmonary valves. F. Mitral cusps $ith valve open.
,. Mitral cusps $ith valve closed. D. 4emilunar cusps of the aortic valve. C.
,ross section of the ventricles of the heart. F. ath ta&en by the blood through
the heart. =. ath ta&en by the cardiac impulse from the sinuatrial node to the
ur&in#e net$or&. H. Fibrous s&eleton of the heart.

The functioning of the aortic valve is similar to that of the pulmonary valve $ith one important additional process. as blood
recoils after ventricular contraction and fills the aortic sinuses! it is automatically forced into the coronary arteries because
these vessels originate from the right and left aortic sinuses.

%nteratrial septum

%nterventricular septum


8ayers of the Heart Hall

The endocardium, a simple squamous epithelium and underlying subendothelial connective tissue, lines the lumen of the
heart.

The thick middle layer of the heart (the myocardium) is composed of cardiac muscle cells.

Epicardium, the outermost layer of the heart wall, is also called the visceral layer of the pericardium (composed of a
simple squamous epithelium known as a mesothelium).


,ardiac 4&eleton
The cardiac s&eleton! composed of dense connective tissue! includes three main components.
The annuli fibrosi, formed around the base of the aorta! pulmonary artery! and the atrioventricular orifices
The trigonum fibrosum, formed primarily in the vicinity of the cuspal area of the aortic valve
The septum membranaceum, constituting the upper portion of the interventricular septum
%n addition to providing a structural frame$or& for the heart and attachment sites for the cardiac muscle! the cardiac s&eleton
provides a discontinuity bet$een the myocardia of the atria and ventricles! thus ensuring a rhythmic and cyclic beating of the heart!
controlled by the conduction mechanism of the atrioventricular bundles.


,oronary ,irculation

Arterial

?enous


Gight ,oronary Artery
right aortic sinus of the ascending aorta I right coronary artery I atrial branch sinu-atrial nodal branch SA node
right marginal branch ape of the heart
small branch to the atrioventricular node before giving off
its final ma!or branch, the posterior interventricular
branch, which lies in the posterior interventricular sulcus.
The right coronary artery supplies the right atrium and right
ventricle, the sinu-atrial and atrioventricular nodes, the
interatrial septum, a portion of the left atrium, the
posteroinferior one-third of the interventricular septum, and
a portion of the posterior part of the left ventricle.


8eft ,oronary Artery

left aortic sinus of the ascending aorta I left coronary

artery I t$o terminal branches. anterior interventricular
and the circumfle"

the anterior interventricular branch

(left anterior descending artery-
"A#)! $hich continues around the left
side of the pulmonary trun& and
descends obli3uely to$ard the ape" of
the heart in the anterior interventricular
sulcus ( during its course! one or t$o
large diagonal branches may arise
and descend diagonally across the
anterior surface of the left ventricle

the circumfle branch! $hich courses

to$ard the left! in the coronary sulcus
and onto the base9diaphragmatic
surface of the heart and usually ends
before reaching the posterior
interventricular sulcus(a large branch!
the left marginal artery! usually arises
from it and continues across the
rounded obtuse margin of the heart.
The distribution pattern of the left coronary artery enables it to
supply most of the left atrium and left ventricle! and most of the
interventricular septum! including the atrioventricular bundle
and its branches.


4everal ma#or variations in the basic distribution patterns of the coronary arteries occur.
The distribution pattern described for both right and left coronary arteries is the most common and consists of a
right dominant coronary artery. This means that the posterior interventricular branch arises from the right
coronary artery. The right coronary artery therefore supplies a large portion of the posterior $all of the left
ventricle and the circumfle" branch of the left coronary artery is relatively small.
%n contrast! in hearts $ith a left dominant coronary artery! the posterior interventricular branch arises from an
enlarged circumfle" branch and supplies most of the posterior $all of the left ventricle.
Another point of variation relates to the arterial supply to the sinu(atrial and atrioventricular nodes. %n most cases!
these t$o structures are supplied by the right coronary artery. Ho$ever! vessels from the circumfle" branch of the
left coronary artery occasionally supply these structures.


,ardiac ?eins

The coronary sinus receives four ma#or tributaries.

the great cardiac vein

Middle cardiac vein

4mall cardiac vein

posterior cardiac vein

The great cardiac vein begins at the apex of the heart. It ascends in
the anterior interventricular sulcus, where it is related to the anterior
interventricular artery and is often termed the anterior
interventricular vein. Reaching the coronary sulcus, the great
cardiac vein turns to the left and continues onto the
base/diaphragmatic surface of the heart. t this point, it is associated
with the circumflex branch of the left coronary artery. Continuing
along its path in the coronary sulcus, the great cardiac vein gradually
enlarges to form the coronary sinus, which enters the right atrium
The middle cardiac vein (posterior interventricular
vein) begins near the apex of the heart and ascends in the
posterior interventricular sulcus toward the coronary sinus.
It is associated with the posterior interventricular branch of
the right or left coronary artery throughout its course.
The small cardiac vein begins in the lower anterior section of
the coronary sulcus between the right atrium and right ventricle.
It continues in this groove onto the base/diaphragmatic surface
of the heart where it enters the coronary sinus at its atrial end. It
is a companion of the right coronary artery throughout its course
and may receive the right marginal vein. This small vein
accompanies the marginal branch of the right coronary artery
along the acute margin of the heart. If the right marginal vein
does not !oin the small cardiac vein, it enters the right atrium
directly.
The posterior cardiac vein lies on the posterior surface
of the left ventricle !ust to the left of the middle cardiac
vein. It either enters the coronary sinus directly or !oins
the great cardiac vein.


-ther ,ardiac ?eins

The anterior veins of right ventricle 'anterior cardiac veins) are small veins that arise on the anterior surface of the right
ventricle. They cross the coronary sulcus and enter the anterior $all of the right atrium. They drain the anterior portion of the
right ventricle. The right marginal vein may be part of this group if it does not enter the small cardiac vein.

A group of smallest cardiac veins 'venae cordis minimae or veins of Thebesius) have also been described. Draining
directly into the cardiac chambers! they are numerous in the right atrium and right ventricle! are occasionally associated $ith
the left atrium! and are rarely associated $ith the left ventricle.


8ymphatics

brachiocephalic nodes! anterior to the brachiocephalic veins/

tracheobronchial nodes! at the inferior end of the trachea

,onduction 4ystem

the sinu(atrial node '4A+

the atrioventricular node 'A?+

the atrioventricular bundle $ith its right and left bundle branches

the subendocardial ple"us of conduction cells 'the ur&in#e fibers+

4A node

%mpulses begin

the cardiac pacema&er

superior end of the crista terminalis at the #unction of the superior vena cava and the right atrium

#unction bet$een the parts of the right atrium derived from the embryonic sinus venosus and the atrium proper.

The e"citation signals generated by the sinu(atrial node spread across the atria! causing the muscle to contract.


A? node

near the opening of the coronary sinus! close to the attachment of the septal cusp of the tricuspid valve! and $ithin the
atrioventricular septum

near the opening of the coronary sinus, close to the attachment of the septal cusp of the tricuspid valve, and within
the atrioventricular septum


A? bundle

direct continuation of the atrioventricular node

follo$s along the lo$er border of the membranous part of the interventricular septum before splitting into right and left
bundles

The right bundle branch continues on the

right side of the interventricular septum to$ard
the ape" of the right ventricle. From the
septum it enters the septomarginal trabecula
to reach the base of the anterior papillary
muscle. At this point! it divides and is
continuous $ith the final component of the
cardiac conduction system! the
subendocardial ple"us of ventricular
conduction cells or ur&in#e fibers. This
net$or& of specialiDed cells spreads
throughout the ventricle to supply ventricular
musculature including the papillary muscles

The left bundle branch passes to the left

side of the muscular interventricular septum
and descends to the ape" of the left ventricle.
Along its course it gives off branches that
eventually become continuous $ith the
subendocardial pleus of conduction cells
($ur%in!e fibers). As $ith the right side! this
net$or& of specialiDed cells spreads the
e"citation impulses throughout the ventricle.


%nnervation

4ympathetic 'cervical and upper portions of

thoracic sympathetic ganglia+

arasympathetic 'vagus+

Franches from both the parasympathetic and

sympathetic systems contribute to the
formation of the cardiac pleus.

This ple"us consists of a superficial part!

inferior to the aortic arch and bet$een it and
the pulmonary trun&! and a deep part!
bet$een the aortic arch and the tracheal
bifurcation.
The postganglionic sympathetic fibers
terminate on the sinuatrial and
atrioventricular nodes! on cardiac muscle
fibers! and on the coronary arteries.
Activation of these nerves results in
cardiac acceleration! increased force of
contraction of the cardiac muscle! and
dilatation of the coronary arteries.
The postganglionic parasympathetic fibers
terminate on the sinuatrial and
atrioventricular nodes and on the coronary
arteries. Activation of the parasympathetic
nerves results in a reduction in the rate
and force of contraction of the heart and a
constriction of the coronary arteries.


C"citation 7 ,ontraction ,oupling
of the ,ardiac Muscle

Action potential spreads into the interior of

cardiac muscle fiber! along the membrane of T
tubules. The T tubule action potentials act on
sarcoplasmic reticulum I ,alcium is released
into the myofibril $hich catalyDes chemical
reaction that promotes the pulling9sliding
action of actin and myosin filaments I
contraction


Extra calcium ions also diffuses into the sarcoplasm from the T tubules themselves at the time
of the action potential.
Openings of the T tubules pass directly through the cardiac cell membrane into the extracellular
spaces surrounding the cell, allowing the samce extracellular fluid that is in cardiac muscle
interstitium to percolate through the T tubules as well.(non in the skeletal muscle) the
contraction of cardiac muscle is affected by the extracellular calcium.
!t the end of the plateau, the influx of calcium is shut off, the calcium in the sarcoplasm is
pumped back into the sarcoplasmic reticulum and into the T tubules"extracellular fluid, them the
contraction ceases until the new action potential occurs.
M


Duration of ,ontraction

6.< seconds in atrial muscle

6.0 seconds in ventricular muscle

#ardiac muscle begins to contract a few milliseconds after
the action potential begins and continues to contract until
a few milliseconds after the action potential ends.


Action otentials of ,ardiac
Muscle

?entricle. about ave 561 m?

Gise from (B1m? to about

<6m? 'in bet$een beats+

After the initial spi&e! the

membrane remains
depolariDed for about 6.<
second! e"hibiting a plateau!
follo$ed at the end of plateau
by repolariDation.

The presence of plateau in the action potential

causes ventricular contraction to last as much
as 51 times as long in cardiac muscle as in
s&eletal muscle.


Hhat ,auses the long potential
and the lateauJ

,alcium 7 4odium ,hannels 'slo$+

Decrease of the permeability of the potassium

ions after the onset of action potential


?elocity of 4ignal ,onduction in
,ardiac Muscle

Atrial and ventricular fibers. 6.0 7 6.1 m9s or

about 59<16 the velocity of the very large
nerve fibers and 5956 the velocity of s&eletal
muscle fiber.

ur&in#e fibers. @ m9s

The normal refractory

period of the ventricle
is 6.<1 7 6.06 seconds

Gelative refractory
period 'ventricle+. 6.61
seconds

Atrial muscle. 6.51

seconds


,ardiac ,ycle

Are cardiac events from the beginning of one

heartbeat to the beginning of the ne"t.

assage of impulse from atria to ventricles.

more than 6.5 second I to allo$ atria to
pump ahead of ventricular contraction!
therefore pumping the blood to the ventricles
before the stronger ventricular contraction
begins.

The atria $ill serve as primer pumps

%sovolumetric contraction

Fegins at diastole

The atria filled the ventricle $ith blood 'end 7

diastolic volume. 5@6cc+

-n e"citation! the ventricle contracts! the

pressure rises! and the valves close.

4ince valves are closed! no blood can be

e#ected from the ventricles 'isovolumetric+


?entricular C#ection

The aortic valve opens $hen the left

ventricular pressure e"ceeds the pressure of
the aorta.

Flood is e#ected into the aorta! the volume of

the left ventricle is decreased.

The volume remaining in the left ventricle is

called end 7 systolic volume.


%sovolumetric rela"ation

The ventricle rela"es.

Hhen the ventricular pressure decreases to

less than aortic pressure! the aortic valve
closes.

All valves are closed I volume is constant

'isovolumetric+


?entricular filling

-nce the ventricular pressure decreases to

less than atrial pressure I the A? valve opens
I ventricular filling up to about 5@6cc


Fran& 7 4tarling 8a$

The greater the heart muscle is stretched! the

greater the force of contraction! thus the
greater the 3uantity of blood pumped into the
aorta.

Hithin physiologic limits! the heart pumps all

the blood retured to it by the $ay of the veins.




ressure ,hanges in the Atria

a $ave. atrial contraction

Gight atrium. @ 7 > mmHg

8eft atrium. : 7 B mmHg

c $ave. slight bac&flo$ of blood into the atria

at the onset of ventricular contraction but
mainly by bulging of the A? valves bac&$ard
to the atria due to increasing pressure of the
ventricles

v $ave. slo$ flo$ of the blood into the atria

from the veins


Than& youKKK