Circulates blood
Also has endocrine function (produces hormone)
Parietal layer
o Parietal layer does NOT cover the body wall
Visceral layer or epicardium
2 components:
1) Cardiac muscle
2) Fibrous skeleton of the heart
Myo = muscle
Has to contract from the bottom and work its way up that way it
doesnt pinch itself off
Flow of Blood:
Blood Comes/enter in through the inferior and superior vena cava then
enters right atrium travels through the right AV valve into the right
ventricle from right ventricle it travels through the pulmonic valve into
the pulmonary trunk (then it come through the lungs and enters the
pulmonary veins) from the pulmonary veins blood enters the left atrium
then goes through the left AV valve into the left ventricle from the left
ventricle goes through the aortic valve into the aorta
Anterior and posterior divided by a C-shaped ridge called the crista terminalis
Interatrial septum has a shallow depression called the fossa ovalis remnant of the
foramen ovale
The intratrial septum has a hole embryonically that is known as the
foramen ovale, when your born its called the fossa ovalis why do we
have it? Embryos dont breathe, but you want blood to go from left to
the right side of heart skipping the lungs
In the fetus the RIGHT side generates more pressure.
Left side of heart at rest generates 7x more pressure than the right
side.
Kids with hole in heart usually the fossa ovalis just didnt close off
But if it closes off too soon the baby will die in utero
4 pulmonary veins
Ventricles Internal:
Ventricles Structure:
Ventricles Flow:
The heart receives very little nourishment from the blood going through the circuits
Myocardium is to thick to be served by the blood going through the heart
Provides O2 to the heart itself
Coronary artery bypass graft (CABG) done when there is a problem
with coronary circulation
ON TEST:
o Myocardium compresses the arteries
o The open aortic valve blocks the entrances to the coronary arteries
Coronary sinus
o Great cardiac vein
o Middle cardiac vein
o Small cardiac vein
Dont have to remember all these veins except for the anterior cardiac
vein
Anterior cardiac vein also drains directly into the right atrium.
Atrioventricular valves
o Tricuspid
o Bicuspid or mitral
Semilunar valves
o Aortic semilunar
o Pulmonary semilunar
Picture is important, look and see the aortic valve is right in the middle.
Top is anterior, bottom is posterior. The most anterior structure is the
pulmonary trunk
Also acceptable to say right and left AV valve
Big difference between sets of valves AV valves are leaflets attached
to chordae tendineae. Pressure closes them
Semilunar valves are CUSPS, there are no strings attached to them.
Blood closes them (they fill up with blood)
Prevents backflow into the atria when the ventricles are contracting
Closes with building pressure
Chordae tendinae an anchoring cable
Papillary muscle the anchor the chordae tendinae is attached to
Act to keep valves closed
Ventricle fills with blood and starts to contract, -- pressure gets higher
and the valves come up together and shut
The chordae tendineae prevents the valve from opening up the other
way would cauue a murmur or regurgitation
Right side
Three flexible cusps
Left side
Two flexible cusps
Mitral valve prolapse usually seen in women late teens, early 20s.
Cardinal sign is hearing a clicking sound. Midsystolic click (heard in the
middle of the heart sounds). Doesnt cause any problems.
Striated
Cells are short, fat, branched, and interconnected
Intercellular space is filled with loose connective tissue matrix that acts as
a tendon and an insertion
Membranes interlock with adjacent fibers junctions are called intercalated discs
Intercalated discs contain desmosomes and gap junction
Myocardium acts as a single coordinated unit! Heart contracts by an
organ, the whole organ contracts at the same time. WIL BE ON TEST!!!
Desmosomes are seen in areas of high mechanical stress, it anchors
Means of Stimulation
Organ vs Motor Unit Contraction
Refractory Period
Excitation-Coupling
Skeletal lasts 250ms slower d/t the alternating motor units contracting
Cardiac lasts 1 2ms
Refractory period is shorter in heart than skeletal muscle
After you fire an action potential there is a refractory period where it
cant fire any more
membrane potential right after firing off one, but it immediately starts
to depolarize immediately on its own
Your HR is dependent on how fast the SA node fires off action
potentials
1) Sinoatrial node
2) Atrioventricular node
3) Atrioventricular bundle
4) Right and left bundle branches
5) Purkinje fibers
Sequence of events where SA node finally starts and were it ends up
Intranodial pathway
Crescent shaped
Located in the right atrial wall just inferior to the entrance of the vena cava
The hearts pacemaker
Produces sinus rhythm
If someone has a Regular HR, then it is known as having normal sinus
rhythm (NSR).
In sinus rhythm denotes that the SA node is running the show.
CANT have both because the heart wouldnt beat, you would die if it
happens)
Buddle branches first point where you see contraction of muscle. First
see the septum contract so that it doesnt move to the left or right
(since on side is stronger than the other) to get the most amount blood
out.
But no matter how hard the ventricles contracts it wont get ALL the
blood out
Complete the pathways through the interventricular septum, heart apex, and ventricular
walls in that order
Also supplies the papillary muscles Papillary muscle contract and hold the
valve so it doesnt pop open
Sympathetic
Parasympathetic
Cardioacceleratory center
T1 T5 level
Norepinephrine from the adrenal medulla
Vagus nerve
Innervates the sinoatrial and atrioventricular node
Decreases the heart rate
Questionably decreases contractility
Equally important as last slide
Innervates the SA and AV node so it decreases the HR
Vagal response HR and respiratory drop and pt passes our
Systole contraction
Diastole rest/filling
o Thing of diastole in terms of filling filling the ventricle but also
the coronary arteries
Cardiac cycle is EXTEREMLY!!!! Important for understanding
Talk about BP:
Anything over 140 hypertension, and anything over 80 is too high
Can see some pt with high systole and normal diastole isolted systolic
hypertension normally seen in elderly
Treating high BP the FIRST thing you do is take away sodium. Other
risk factor is obesity.
Hypertension is a silent killer, if they get symptoms like headache they
are getting ready to die.
Only see high blood pressure in elderly is U.S. with salt intake
Mid-to-late diastole
Pressure in the ventricle is low
Blood is flowing passively
Ventricular filling is mid to late diastole because the atria have to fill
first
Remember 70% of the ventricle fills passively
Filling time the amount that goes into the heart
1) how much blood is coming back to the heart
2) the BIG consideration is how much time the heart has to fill. Long
diastole = more blood in the heart
What determines the length of diastole? HR, the faster the HR the less
filling time and vice versa
Early diastole
Ventricles relax
Remaining blood is the end systolic volume (ESV)
Ventricle contracted, then it stopped and relaxes. But when the
ventricles contract it CANNOT push out all the blood. About 40% are
left behind = the end systolic volume
Cardiac Output
Regulation of Stroke Volume
Stroke volume the amount of blood that is pushed out with one
contraction. Very easy calculation. Larger the stroke volume, the more
blood the heart packed into the aorta. The more it packs, the more it
stretches, and the higher the blood pressure
Stroke volume
____________
EDV
50%
40%
30%
20%
Is normal,
wont see very many problems,
will start to see symptoms,
really interfering with life,
And if in the teens you arent doing a whole lot (cant even get out of
bed)
The difference between the end diastolic volume (EDV) and the end systolic volume
(ESV)
Taking a break from PowerPoint:
From last slide, goes with it:
o Congestive heart failure = pump failure. The heart is failing to
deliver enough blood out versus how much came in
o So youre bringing a lot of blood IN but you arent pushing it OUT
o Most difficult concept: Pump failure shows up backwards! In CHF,
not worried about blood going into aorta (not the problem), you
can have isolated congested heart failure, on the left side, or
right side only, or on both sides.
o What you are going to see is either the lungs fill with fluid, or
swelling in the feet.
o If you have isolated left sided CHF, where is the fluid going to
back up? To the left (in the lungs, filled with fluid)
o If there is a problem on the right, right isolated CHF fluid builds
up in the extremities
o You can have isolated right sided HF, for a long period of time,
but you CANT have isolated left sided HF for a long period of time
d/t the left backing up to the right, it will keep backing up until it
is over on the right
o What would be the reason that there would be isolated right side
congestive heart failure only? Have to think about is where blood
goes. How blood passes through the heart. Blood from R side
side goes into the lungs, from L goes into the aorta (rest of
body).
o Why would you only have R sided only? Pulmonary hypertension
or because the lungs are still for other reason.
o If it is in the right side, the problem is actually with the lungs.
o If blood doesnt want to travel to the lungs, and there is swelling
in the feet this is called Cor pulmonale
Preload
Contractility
Afterload
Regulate stroke volume: their terminology makes it very difficult to
understand
= increased contractility
Preload the more blood you put in the heart the stronger the
contraction that is preload
Hormones
o Glucagon produced by pancreas (also produced insulin) glucagon
does the opposite of insulin. If blood sugar starts to drop
increase of putting out insulin it puts out glucagon (positive
inotrope)
o Thyroxine thyroid hormone
o Epinephrine what is coming from sympathetic response
Drugs
o Digitalis Digitalis similar but not the same as digoxin.
WILL HAVE TO KNOW LIST for test!!!
o Aminophylline also known as Theodore was a drug used for
asthma. But is is a positive inotrope, it makes the heart beat
harder. Not longer used.
Electrolytes
o Excessive hydrogen (acidosis)
o Extracellular potassium
Drugs
o Calcium channel blockers
o Beta blockers
Acidosis negative inotrope
Extracellular potassium stops the heart and CABG
Calcium channel blockers because calcium causes in increase in
contractility
Beta (adrenergic) blockers blocking the neurotransmitter/hormone
epinephrine (positive inotrope)
What are the 2 things major factors in determining how much O2 is
used
1) HR and
2) Contractility
If pt has coronary artery disease not adequate O2 to the heart. Two
thing syou want to control are HR and contractility, so you would use
abeta blocker
Practical applications:
o CHF too much blood to the heart not pumping enough.
Wouldntt give positive inotrope because the heart would then
sue too much O2 by increasing its contractility.
o Heres the big thing! By decreasing contractility with beta
blocker you can prevent a 2nd heart attack by 50%! If the beta
blocker starts to cause CHF then you have to back off of it.