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Vital Signs: Pulse & Heart Rate

Video 1.1: Basic Heart Anatomy


The Hearts Location within the Thoracic Cavity
- The heart is a hollow, muscular, cone-shaped organ
o General location
a. Positioned in the mediastinum
b. within the pericardial cavity
c. between the pleural cavities
o

enclosed by the pericardium


a. function anchors & protects the heart

Esophagus and trachea are posterior to the heart

The Hearts Internal Structure


- 4 chambers, or compartments
o Two superior chambers, or atria
o

Two inferior chambers, or ventricles

To prevent mixing of blood between chambers-- interatrial septum


and interventricular septum

Ventricular walls are thicker than atrial walls because they are
responsible for pumping blood into the systemic and pulmonary
circulations

Right atrium
Receives deoxygenated blood from the body from three vessels
1. Superior vena cava
2. Inferior vena cava
3. Coronary sinus

From the right atrium, blood goes to the right ventricle

Right ventricle

Left atrium
receives oxygenated blood via the pulmonary veins m

Left ventricle
Pumps oxygenated blood into the aorta

Pumps deoxygenated blood into the pulmonary trunk

Left ventricular walls are thicker than right ventricular walls


because they need to contract with more force in order to send
blood throughout the systemic circulation

The systemic circulation supplies the tissues and organs of the body with
oxygenated blood
o the newly deoxygenated blood returns to the right atrium by the
superior vena cava, inferior vena cava, and coronary sinus

Video 1.2a: Your Beating Heart


The Heart at a Microscopic Level
- 2 functional units (syncytia):
o the atrial syncytium

the ventricular syncytium

Atria contract, then ventricles contract, then the heart relaxes

Two types of cells in the heart wall


o Contracting cells
o

Cells that generate an electrical signal

Form the cardiac conduction system:


Occurs in each heartbeat

The Cardiac Conduction System


-

Starts at the sinoatrial node (SA node)


o Location:
o
o

Part of the cardiac conduction system that generates an electrical


signal most rapidly
Spreads signal over entire atrial syncytium causing atrial contraction

Signal spreads to the atrioventricular node (AV node)

Signal passes through the atrioventricular bundle (AV bundle)

Signal arrives in the interventricular septum


o Passes through two bundle branches (right and left)

At apex, the fibers branch extensively, forming Purkinje fibers

Electrocardiograms (ECGs) assess the cardiac conduction system


o Determine if electrical activity of the heart is working properly

Video 1.2b: ECG Demo


- ECGs are devices we use to detect the electrical activity in the heart
o Electrodes are placed on the body

2 upper limb leads

2 lower limb leads

6 precordial leads

Allows you to look at the heart from 12 different angles-> can


pinpoint location of abnormality, if present

The current arising from the SA node is a positive current, called


depolarization
o The positive current passes through the atrial walls
o A negative current restores the electrical potential of the atrium back
to normal after the passing of the positive current, this is called
repolarization

Normal Sinus Rhythm


o

P wave: first wave

QRS complex: second group of waves


Consists of the Q, R, S waves

T Wave: third wave

Isoelectric lines occur when there is no change occurring in the


electrical state of the heart (i.e., no depolarization or repolarization is
occurring)

Between P wave and QRS complex

Between QRS complex and T wave

Video 1.3a: Heart Valves, Part 1


-

Heart valves ensure that blood flows in one direction through the heart
o Composed of dense, fibrous connective tissue
o covered in endocardium-

Heart has 4 valves- organized as two pairs


o Atrioventricular valves (AV valves)
Location:

tricuspid valve

mitral valve:

Close when ventricles contract and the pressure in the


ventricles exceeds pressure in the atria

chordae tendinae:

papillary muscles contract along with ventricles,


creating tension in the chordae tendinae, preventing the
free edges of the valves from swinging upward into the
atria

Open after ventricular relaxation, when atrial pressure exceeds


ventricular pressure

Semilunar valves (SL valves)

Video 1.3b, Heart Valves, Part 2


- Blood passes from right ventricle to the pulmonary trunk and from the left
ventricle into the aorta
o Semilunar valves:
pulmonic valve

aortic valve

When closed, the cusps fall into the center of the pulmonary
trunk and aorta to prevent backflow of blood from the vessel
into the ventricle
When the ventricles contract, pressure in them increases- when
ventricular pressure exceeds pressure in the aorta and
pulmonary trunk, the semilunar valves open
When the ventricles relax, pressure drops- when the ventricular
pressure falls below the pressure in the aorta and pulmonary
trunk, the semilunar valves close

Movement of valves during the cardiac cycle


-

When the heart is relaxed


o the semilunar valves are closed and the AV valves are open

blood is coming back to the right atrium through the superior


vena cava, inferior vena cava and coronary sinus

On the left side, blood is returning to the heart from the


pulmonary veins from the lungs

Atria contract
o Pressure in atria increases

Atria relax, ventricles contract


o Pressure in ventricles exceeds pressure in atria

Pressure continues to climb as ventricles continue to contract ->


ventricular pressure exceeds pressure in aorta and pulmonary trunk

Ventricles stop contracting, start to relax

Cycle repeats
When valves close, they cause vibrations to occur in the blood thats passing
through the heart
o Vibrations are carried to the bodys surface and can be heard with a
stethoscope
o sound one:
o

sound two:

Video 1.3c, Assessing Heart Rate Demo


- Auscultation:
-

The heart is positioned deep to the sternum, slightly to the left of the midline
in the chest cavity
o the apex:
Location:

Orientation:

point of maximal impulse- the most accurate place to check


heart rate

Feeling the heart rate, or palpating, assesses the number of beats per
minute
Auscultation allows assessment of heart rate as well as heart sounds
o Heart sounds include sound one and sound two, usually called S1 an
S2
S1

S2

Physicians often auscultate in multiple locations to assess heart sounds


related to the specific valves
o aortic valve:

pulmonic valve:

tricuspid valve:

mitral valve:

If a valve does not close all of the way, it will make a swishing sound
If a valve does not open all of the way, it will make a clicking sound

Video 1.4a, The Cardiac Cycle, Part 1


Electrical Changes During the Cardiac Cycle
- Conduction system:

Starts at the SA node


Excitation of the atria creates the P-wave on an ECG

Signal sent to the AV node


Delayed for 1/10th of a second

Passed to AV bundle
The only electrical connection between the atrial syncytium and
ventricular syncytium

Excitation of the ventricles creates the QRS complex on an ECG

Heart relaxes, ventricles repolarize


Creates the T wave on the ECG

These electrical signals create changes in the contracting cells, triggering


muscle contraction

Video 1.4b: The Cardiac Cycle, Part 2


Pressure Changes During the Cardiac Cycle

Pressure changes in the heart cause the valves to open and close, to prevent
backflow of blood
o The P wave on an ECG is followed closely by an increase in atrial
pressure
atrial contraction, atrial systole

After atrial systole, the atria contract and pressure remains low
The QRS complex on an ECG is followed almost immediately by an
increase in ventricular pressure
The period of ventricular contraction is called ventricular
systole

When ventricular pressure exceeds aortic pressure, the


semilunar valves open

Once this pressure peaks, the ventricles stop contracting


o Pressure in ventricles falls below the pressure in the
aorta and pulmonary trunk

The ventricles continue to relax and ventricular pressure


continues to fall
o When this pressure falls below atrial pressure, the AV
valves open
o The period when the ventricles are relaxed is called
ventricular diastole during this phase, ventricles
fill with blood

Ventricular Volume During the Cardiac Cycle


-

Ventricular volume is fairly high during relaxation, or diastole

During atrial systole- a little more blood is pushed into the ventricles, so the
volume increases slightly

Ventricles contract, pressure increases and volume decreases


o Blood is being ejected to the aorta and pulmonary trunk
o AV valves open and ventricular volume begins to increase again

Heart Sounds During the Cardiac Cycle


o Heart sound one indicates the start of ventricular systole
o

Heart sound two indicates start of ventricular diastole

Video 1.4c: Assessing Pulse Demo


-

Heart rate:

Pulse:
o
o

We assess pulse in elastic arteries, which can distend and retract


Pulse and heart rate are typically the same in a person with healthy
cardiovascular function, but could be different if someone has poor
peripheral circulation or arterial disease

Locations to assess pulse:


- carotid artery
-

brachial artery (at the antecubital fossa)

radial artery

femoral artery

dorsalis pedis

posterior tibial

Video 1.5: Cardiac Output


- Need to keep blood circulating through the body to supply the cells with
oxygen and nutrients and to carry away metabolic waste products
- Cardiac Output (CO) = the volume of blood ejected per minute
o
o
-

Influenced by heart rate (HR) and stroke volume (SV)


CO = HR x SV

Stroke volume: the volume of blood ejected during a single heartbeat


o

End diastolic volume (EDV):

End systolic volume (ESV):

Stroke volume = EDV - ESV

Cardiac output can be increased or decreased to meet the needs of the body

The autonomic nervous system plays a role in regulating cardiac output


o

Two branches: parasympathetic and sympathetic


sympathetic division:

in the heart, the sympathetic nervous system innervates


SA node, AV node and the contractile cells of the
myocardium

when activated, causes the SA node to depolarize more


quickly and can shorten the delay at the AV node
o

tachycardia = HR > 100 bpm

sympathetic activation also causes contractile cells of


myocardium to contract more forcefully -> leads to
increased stroke volume

parasympathetic division:

in the heart, the parasympathetic nervous system


innervates the SA node & the AV node
parasympathetic nervous system slows the SA nodes rate
of self-excitation
o

parasympathetic signals are carried to the SA node by


the vagus nerve

bradycardia = HR < 60 bpm