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Mediastinum: location of the heart; encloses the heart

base:
superior, flat, wide end
directed toward the right shoulder
apex:
inferior, pointed end towards the left hip (L. Ventricle)
rests on diaphragm
point of maximal intensity (PMI); where the heart comes in contact with chest
wall (between 5th and 6th ribs)
sternal costal:
mostly between R. ventricle and R. atria
the hear is the in the center of the chest, but 2/3 of the hearts bulk is on the left
side of the midsternal line (beats to the left)
left border: formed by L. ventricle, partly L. atrium
superior border: great vessels enter and leave the atria (superior vena cava & aorta)
pericardium: double-walled sac that encloses the heart (fibrous and serous membranes)
fibrous pericardium: attaches to the thoracic wall; superficial part of this ^ sac
tough, dense connective tissue layer
protects the heart
anchors it to surrounding structures
prevents overfilling of the heart with blood
serous pericardium:
think, slippery, two-layer serous membrane
deep to the fibrous pericardium
composed of both parietal layer and visceral layer
parietal layer:
lines the internal surface of the fibrous pericardium
at the base (superior) margin of the heart, it attaches to the large arteries exiting
the heart, and then turn inferiorly and continues over the external heart surface as
visceral layer (epicardium)
visceral layer:
thin, transparent serous tissue forming the outer layer (covering) of the heart wall

pericardial cavity:
between the parietal and visceral layers
slitlike; contains a film of serous fluid (pericardial fluid)
serious fluid (pericardial fluid) allows serous membrane to glide smoothly past
one another during heart activity; allows heart to work in friction-free
environment
Epicardium/visceral pericardium (serous membrane):
lines the outside of the myocardium
often infiltrated with fat, especially in older people.
Myocardium:
composed mainly of cardiac muscle and forms the bulk of the heart
it is the layer that contracts
involuntary, striated
the branching cardiac muscle cells are tethered (tied) to one another by
crisscrossing connective tissue fibers and arranged in spiral or circular bundles
interlacing bundles effectively link all parts of the heart together
CT fibers from a dense network, the fibrous skeleton of the heart: reinforces the
myocardium internally and anchors that cardiac muscle fibers.
fibrous skeleton of the heart: composed of collagen and elastic fibers
Endocardium:
thin layer of simple squamous epithelium resting on a thin layer of CT
located on the inner myocardial surface
lines the heart chambers and covers the fibrous skeleton of the valves
continuous with the endothelial linings of the blood vessels leaving and entering
the heart
interatrial septum: separates the atria
interventricular septum: separates the ventricles
Atria: The receiving chambers
receiving chambers of circulating blood; upper chambers of the heart that receive
blood, from the body into the right atrium, or from the lungs into the left atrium
Auricles: appendages of the atrium; increase atrial volume
pectinate muscles: muscle bundles on the anterior portion of the right atrium
crista terminalis: C-shaped ridge that separates posterior and anterior regions of
the right atrium
left atrium is mostly smooth and pectinate muscles are found only in the auricle
fossa ovalis: marks the spot where (foramen ovale) existed in the fetal heart;
seen as an indentation on the interatrial septum (wall that separates the atria)

Blood enters the Right Atrium via three veins: superior, inferior vena cava and coronary
sinus (receives deoxygenated blood)
Superior vena cava: returns blood from the body regions superior to the diaphragm
Inferior vena cava: returns blood from body areas below the diaphragm
Coronary sinus: collects blood draining from the myocardium.
The Left Atrium receives the four pulmonary veins posteriorly, which transport blood
from the lungs back to the heart
Ventricles: Discharging Chambers
the pumps of the heart
different from each other by the thickness of muscle mass (left ventricle is
thicker)
right ventricle pumps into pulmonary trunk-> right and left pulmonary arteries
-> through the lungs
left ventricle pumps into aorta -> then throughout the entire body
trabeculae carneae: irregular muscle ridges marking the internal walls of each
ventricular chamber
coronary arteries are the first branches off the aorta to receive blood from the
heart
chordae tendineae: strings of CT that connect the papillary muscles to the heart
valves (together they keep the valve flaps from slipping out of place (prolapsing))
Coronary sulcus/atrioventriclar groove: encircles the junction of the atria and
ventricles like a crown; separates atria from ventricles and houses coronary
sinues (vein)
anterior interventricular sulcus and posterior interventricular sulcus
separates the right and left ventricles and contains coronary blood vessels.
Pulmonary circuit: blood vessels that carry blood to and from the lungs
serves gas exchange
blood returning from the body is oxygen-poor and carbon dioxide-rich
O2-poor blood returns from the body through the Right Atrium => passes into
Right Ventricle, which pumps into the lungs via => pulmonary trunk. Left and
Right pulmonary arteries carry deoxygenated blood into the lungs where gas
exchange occurs (O2 picks up, CO2 drops off). Oxygenated blood is carried by
the pulmonary veins back to the left atria and passes into the left ventricle,
which pumps in into the aorta.
25/10mmHg: short, low-pressure circuit
Systemic circuit:
O2-rich blood enters left side of heart from left atria into left ventricle into the
aorta. The first to receive blood as it passes from the ascending aorta into the
aortic arch are the left and right coronary arteries.

120/80 mmHg: long high pressure circuit


left ventricle is circular in shape and walls are about 3 times as thick as the right
ventricle; encounters about five times as much resistance as pulmonary circuit;
also more powerful than right ventricle

Coronary Circulation: nutrition to the heart


1.
functional blood supply of the heart; shortest circulation in the body
Right and Left coronary arteries supply all the myocardium; blood flows into
these vessels when the heart is relaxed and stops when the heart contracts
Left coronary artery: runs toward the left side of the heart and branches into
anterior interventricular artery, which travels into interventricular sulcus and
supplies the interventricular septum and anterior walls of both ventricles.
Circumflex artery: supplies the left atrium and the posterior walls of the left
ventricles
Right coronary artery: runs toward the right side of the heart and branches into
right marginal artery, which servers the myocardium of the lateral right side of
the heart, and posterior interventricular artery, which runs to the heart apex
and supplies the posterior ventricular walls.
2.

Deoxygenated blood is collected by all the cardiac veins


Great cardiac vein: drains the anterior aspect of the heart (found in the anterior
interventricular sulcus)
Middle cardiac vein: drains the posterior aspect of the heart (and is found in the
posterior interventricular sulcus)
small and anterior cardiac veins drain the right atrium and ventricle
Coronary Sinus: large vessel formed from joining of the great, middle and small
veins. They drain into the coronary sinus on the posterior wall, and then into the
right atrium.

Antrioventricular Valves:
connects the atria and ventricles
prevent backflow into the atria when the ventricles are contracting
right AV valve (tricuspid valve) has 3 flexible cusps (flaps of endocardium
reinforced by connective tissue cores).
left AV valve (bicuspid or mitrial valve) has 2 flaps
chordae tendineae: collagen cords attached to each AV valve flap, which are also
attached to papillary muscles (extensions of ventricle wall). This prevents flaps
(cusps) from being blown upward into the atria.
Semilunar Valves:
between junction of the L. ventricle and aorta, and the R. ventricle and pulmonary
trunk

prevents back flow into the ventricles


aortic semilunar valve is between the left ventricle and the aorta
pulmonary semilunar valve is between the right ventricle and the pulmonary
trunk
during ventricular contractions these valves are open
when the ventricles relax, the backflow of blood fills the cusps and closes them
(back down toward the ventricles)

Cardiac Muscle Fibers:


striated and contracts by the sliding filament mechanism
short, fat, branched, and interconnected
each fiber contains one or at most two large, pale, centrally located nuclei
intercalated discs: contain gap junctions and desmosomes
desmosomes prevent adjacent cells from separating during contraction
gap junctions allows ions to pass from cell to cell, transmitting current across the
entire heart
coupling gap junctions helps increase conduction and allows the cell to heave as
though it was a single unit- functional syncynctium
Large mitochondria account for 25-35% of the volume of cardiac cells and gives
them high resistance to fatigue
T-tubules are wider and fewer than those of skeletal muscle, and enter at Z lines,
not A-I band junctions
sarcoplasmic reticulum is simple and lacks the large terminal cisternae
no triads
dependency on O2 is high because the heart relies on aerobic respiration almost
exclusively
cardiac muscle will use fatty acids more effectively than other cells in the body to
form ATP
Mechanism and Events of Contraction:
Difference between cardiac and skeletal muscle
Means of Stimulation:
skeletal muscle fiber must be stimulated to contract by a nerve ending
cardiac muscle cells are self-excitable; can initiate their own depolarization
and that of the rest of the heart as well in a spontaneous and rhythmic way.
Organ versus motor unit contraction:
in skeletal muscle all cells of a given motor unit are stimulated and contract
at the same time. Impulses do not spread from cell to cell
The heart either contracts as a unit or doesn't contract at all, because gap
junctions (functional syncynctium) tie all cardiac muscle cells together into a
single contractile unit

depolarization wave travels across the heart from the cell to cell via ion
passage through the gap junctions
Length of absolute refractory period:
cardiac muscle cells have long refractory period (250-300ms); to prevent
"tetanic" contractions, which would stop the heart's pumping action
skeletal muscle cells have refractory period of (1-2ms)
Cardiac muscle contraction:
1) Action potential: across cell membranes
1% cardiac fibers are autorhythmi- ability to depolarize spontaneously and thus
pace the heart
2) Depolarization:
opens a few voltage-gated fast Na+ channels in the sarcolemma, allowing Na+ to
enter.
Causes positive feedback cycle that cause potential to go from -90 mV to +30 mV
depolarization wave down the T tubules causes sarcoplasmic reticulum to release
Ca+ into sacroplasm
3) Free Ca+ activate sliding mechanism
Excitation-contraction coupling occurs as Ca+ provides the signal (via troponin
binding) for cross bridge activation
Conduction system of the heart:
Autonomic nervous system:
innervates the heart, but only to modify its rate (increase or decrease). It does not
initiate contraction
contraction and relaxation sequences occur because of gap junctions, and the
intrinsic cardiac conducting system
Autorhythmic cardiac cells (nerve-like non contractile cells)
unstable resting potential (pacemaker potentials or prepotentials: initiate
the action potentials that spread throughout the heart to trigger its rhythmic
contractions) that continuously depolarizes, drifting slowly toward threshold
these cells are found in the intrinsic conduction system
impulses pass across the heart in order from: sinoatrial (SA) node ->
atrioventricular (AV) node -> antrioventricular bundle -> right and left
bundle branches -> Purkinje fibers (ventricular walls)
Atrial contraction (mechanical): Sinoatrial node (SA pace maker, sinus
rhythm-determines rhythm) depolarizes, electrical wave spreads through both
atria via gap junctions, and then atrial contraction occurs.

Ventricular contraction (after ventricular depolarization): starts in apex in a


twist-type fashion towards atria, specifically to eject blood.

Arrhythmias:
irregular beat( atria and ventricles beat in an uncoordinated manner), may lead to
fibrillation.
Fibrillation: irregular and fast, atria and ventricles out of phase with each other, as well
as areas within each chamber.
heart block: damage to AV node (interferes with the ability of the ventricles to receive
pacing impulses
incomplete block: 1st and 2nd degree, due to bundle branch block (damage to one or
both bundle branches)
complete block: 3rd degree, due to damage of the AV node
Electrocardiography
electrical currents generated in and transmitted through the heart spread
throughout the body and can be detected with electrocardiograph
Electrocardiograph: a recording of electrical excitation changes accompanying
cardiac cycle
Three distinguishable waves (or deflections) are seen on an ECG: P wave, QRS
complex, and T wave
P wave: lasts about 0.08 s and results from the movement of the depolarization
wave from SA node through the atria. Atrial depolarization
QRS wave (complex): results from L. and R. ventricular depolarization and
precedes ventricular contraction.
T wave: caused by ventricular repolarization and lasts about 0.16 s. Since
repolarization is slower than depolarization the T wave is more spread out and has
lower amplitude than QRS wave.
P-Q interval: time from beginning of atrial excitation to the beginning of
ventricular excitation.
S-T segment: from end of S wave to beginning of T wave; when action potential
of the ventricular myocytes are in their plateau phases, the entire ventricular
myocardium is depolarized.
Q-T interval: time: 0.38s; is the period from the beginning of ventricular
depolarization through ventricular repolarization.
Cardiac Cycle: one complete heartbeat, which consists of systole and diastole of both
atria and systole and diastole of both ventricles
Systole is the contraction of the heart
Diastole is the relaxation of the heart

Period of ventricular filling:


pressure in the heart is low
both atria and ventricles are relaxed, blood is returning from entire body to R.
atria, from lungs to L atria and on through the respective ventricles
ventricles fill 70-80%
atria will depolarize (P wave), then contraction will occur causing a sudden
increase in atrial pressure, which delivers the remaining 20-30% of blood to fill
the ventricles; atria is in diastole for remainder of cardiac cycle
Ventricular systole (atria in diastole)
ventricular depolarization will cause contraction of ventricles, increase in the
pressure within them, and cause closure of AV valves
isovolumetric contraction: the split-second period when ventricles are
completely closed chambers and the blood volume in the chambers remains
constant as the ventricles contract
isovlumetric contraction will increase the pressure in the ventricles very quickly
until SL valves are forced open and blood is expelled from ventricles into the
aorta and pulmonary trunk- ventricular ejection phase
pressure in aort: 120mm/Hg; in the pulmonary trunk: 25mm/Hg
Isovolumetric relaxation phase: (early ventricular diastole)
ventricular pressure drops, allowing back flow of blood in aorta and pulmonary
trunk back toward the heart closing the semilunar valves (SL)
all valves are closed again: isovolumetric relaxation
continued relaxation of ventricles will allow AV valves to drop open due to
increase blood in atria, causing an increase in pressure in the aorta- dicrotic notch
(seen on ECG)
average heart rate is 75 beats per min
each cardiac cycle requires .8s
the atria contract and ventricles relax: .1 s
ventricles contract and atria relax: .3s
for .4 s the entire heart is in relaxation-known as the quiescent period
one complete cycle: atria are in systole for 0.1 s, and diastole for 0.7 sec; ventricles are in
systole for 0.3 sec, and in diastole for 0.5

Heart Sounds- associated with closing of the heat valves


first sound occurs as the AV valve closes- point when ventricular pressure rises
above atrial pressure (beginning of ventricular systole) - lub (louder, longer)
second sound occurs as the SL valves snap shut at the beginning of the ventricular
relaxation (diastole) dup (short, sharp)
Cardiac Output- determined by the amount of blood pumped by a ventricle per beat
product of heart rate and stroke volume
Stroke Volume (SV) - the volume of blood pumped out by one ventricle with each
beat.
the amount of blood ejected by each ventricle per systole is 70 ml/beat, and heart
rate is approximately 75 beats per min.
C0(ml/min.)=HR x SV; increase heart or volume = increase in CO and vice versa
Regulation of stroke volume( heart usually pumps out about 60% of blood)
end diastolic volume (EDV): the amount of blood that collects in a ventricle during
diastole;
determined by how long ventricular diastole lasts and by venous pressure
normally about 120 ml
end systolic volume (ESV): the volume of blood remaining in a ventricle after it has
contracted.
50 ml, determined by arterial pressure and force of contraction of the ventricle
Stroke Volume (SV) = EDV- ESV
Frank Starling Law of the Heart:
preload- degree to which cardiac muscle cells are stretched just before they contract
critical factor controlling SV
contraction is more forceful when muscle fibers have been stretched
causes increase in EDV

Contractility: contractile strength achieved at a given muscle length


increase in contractility is due to a greater Ca influx into the cytoplasm from
extracellular fluid and the SR.
enhanced contractility results in ejection of more blood from the heart (greater
SV), hence a lower ESV.
increased sympathetic innervation (epinephrine) increases contractility of the
heart; serve not only intrinsic conduction but the entire heart
norepinephrine or epinephrine binding initiates a cyclic AMP second-messenger
system that increases Ca entry, which promotes more cross bridge binding and
enhances ventricular contractility.
Afterload:
the pressure that must be overcome for the ventricles to eject blood
back-pressure exerted by arterial blood on the aorta; 80 mm Hg (in pulmonary
trunk = 20 mm Hg)
this pressure must be overcome by the ventricular pressure
can increased ESV
not a major determinant of stroke volume in healthy individuals
important in people with hypertension because it reduces the ability of the
ventricles to eject blood.
Regulation of the Heart Rate:
when blood volume drops, SV declines and CO is maintained by increasing HR
and contractility
Autonomic nervous system:
most extrinsic important control system of heart rate
there are two centers found within the medulla
1) cardioacceleratory center (CAC)
contains sympathetic fibers that travel down spinal tracts and exit
via cardiac (accelerator) nerves (T1-T5) to innervate SA and AV
nodes, and some of the myocardium
they release norepi and epi which increase heart rate and strength
of contraction
2) cardioinhibitory center (CIC):
decrease HR and strength of contraction
contains parasympathetic fibers which reach the heart through the
Vagus N. (CN X), innervates the SA and AV node, and some of the
myocardium
releasing acetylcholine which decrease heart rate and strength of
contraction

- both divisions are constantly at work, with the parasympathetic system more
predominant: this is called vagal tone (keeps HR down)
Baroreceptors/pressoreceptors; nerve cells capable of responding to BP changes and can
affect the rate of the heart
3 reflex pathways:
Carotid sinus reflex: found in the bifurcation of the common carotid artery, with
increased systemic arterial pressure it causes carotid sinus to stretch (baroreceptors),
stimulates CIC and decreases heart rate and strength of contraction, lowering blood
pressure
aortic reflex:
(in aortic arch) increased systemic arterial pressure, stretches aortic arch,
stimulates CIC, decreases heart rate and strength of contraction, decreasing blood
pressure
atrial (Bainbridge) reflex:
junction of R atria and venae cavae and L atria and pulmonary veins
sympathetic reflex due to increased venous return, increased atrial pressure,
stretches atrial wall, SA node directly affects CAC, increasing heart rate and
strength of contraction, increasing blood pressure and decreasing congestion in
veins, atria and pulmonary circulation