ANATOMY OF THE HEART

Layers of the Heart

The heart muscle has three layers and they are as follows:

 Epicardium. The epicardium or the visceral and outermost layer is actually a part of the heart
wall.

 Myocardium. The myocardium consists of thick bundles of cardiac muscle twisted and whirled
into ringlike arrangements and it is the layer that actually contracts.

 Endocardium. The endocardium is the innermost layer of the heart and is a thin, glistening
sheet of endothelium hat lines the heart chambers.

Chambers of the Heart

The heart has four hollow chambers, or cavities: two atria and two ventricles.

 Receiving chambers. The two superior atria are primarily the receiving chambers, they play a
lighter role in the pumping activity of the heart.

 Discharging chambers. The two inferior, thick-walled ventricles are the discharging chambers,
or actual pumps of the heart wherein when they contract, blood is propelled out of the heart and
into the circulation.

 Septum. The septum that divides the heart longitudinally is referred to as either the
interventricular septum or the interatrial septum, depending on which chamber it separates.

Associated Great Vessels

The great blood vessels provide a pathway for the entire cardiac circulation to proceed.

 Superior and inferior vena cava. The heart receives relatively oxygen-poor blood from the
veins of the body through the large superior and inferior vena cava and pumps it through the
pulmonary trunk.

 Pulmonary arteries. The pulmonary trunk splits into the right and left pulmonary arteries, which
carry blood to the lungs, where oxygen is picked up and carbon dioxide is unloaded.

 Pulmonary veins. Oxygen-rich blood drains from the lungs and is returned to the left side of the
heart through the four pulmonary veins.

 Aorta. Blood returned to the left side of the heart is pumped out of the heart into the aorta from
which the systemic arteries branch to supply essentially all body tissues.

Cardiac Circulation Vessels

Although the heart chambers are bathed with blood almost continuously, the blood contained in the heart
does not nourish the myocardium.

 Coronary arteries. The coronary arteries branch from the base of the aorta and encircle the heart
in the coronary sulcus (atrioventricular groove) at the junction of the atria and ventricles, and
these arteries are compressed when the ventricles are contracting and fill when the heart is
relaxed.

 Cardiac veins. The myocardium is drained by several cardiac veins, which empty into an
enlarged vessel on the posterior of the heart called the coronary sinus.

Blood Vessels

Blood circulates inside the blood vessels, which form a closed transport system, the so-called vascular
system.

 Arteries. As the heart beats, blood is propelled into large arteries leaving the heart.

 Arterioles. It then moves into successively smaller and smaller arteries and then into arterioles,
which feed the capillary beds in the tissues.

 Veins. Capillary beds are drained by venules, which in turn empty into veins that finally empty
into the great veins entering the heart.

Tunica - Except for the microscopic capillaries, the walls of the blood vessels have three coats or tunics.

 Tunica intima. The tunica intima, which lines the lumen, or interior, of the vessels, is a thin layer
of endothelium resting on a basement membrane and decreases friction as blood flows through
the vessel lumen.

 Tunica media. The tunica media is the bulky middle coat which mostly consists of smooth
muscle and elastic fibers that constrict or dilate, making the blood pressure increase or decrease.

 Tunica externa. The tunica externa is the outermost tunic composed largely of fibrous connective
tissue, and its function is basically to support and protect the vessels.

Arterial Branches of the Ascending Aorta

The aorta springs upward from the left ventricle of heart as the ascending aorta.

 Coronary arteries. The only branches of the ascending aorta are the right and left coronary
arteries, which serve the heart.

The Pathway of the Conduction System

The conduction system occurs systematically through:

 SA node. The depolarization wave is initiated by the sinoatrial node.

  Atrial myocardium. The wave then successively passes through the atrial myocardium.

 Atrioventricular node. The depolarization wave then spreads to the AV node, and then the atria
contract.

 AV bundle. It then passes rapidly through the AV bundle.

 Bundle branches and Purkinje fibers. The wave then continues on through the right and left
bundle branches, and then to the Purkinje fibers in the ventricular walls, resulting in a contraction
that ejects blood, leaving the heart.

Cardiac Cycle and Heart Sounds

In a healthy heart, the atria contract simultaneously, then, as they start to relax, contraction of the
ventricles begin.

 Systole. Systole means heart contraction.

 Diastole. Diastole means heart relaxation.

 Cardiac cycle. The term cardiac cycle refers to the events of one complete heart beat, during
which both atria and ventricles contract and then relax.

 Length. The average heart beats approximately 75 times per minute, so the length of the cardiac
cycle is normally about 0.8 second.

 Mid-to-late diastole. The cycle starts with the heart in complete relaxation; the pressure in the
heart is low, and blood is flowing passively into and through the atria into the ventricles from the
pulmonary and systemic circulations; the semilunar valves are closed, and the AV valves are
open; then the atria contract and force the blood remaining in their chambers into the ventricles.

 Ventricular systole. Shortly after, the ventricular contraction begins, and the pressure within the
ventricles increases rapidly, closing the AV valves; when the intraventricular pressure is higher
than the pressure in the large arteries leaving the heart, the semilunar valves are forced open, and
blood rushes through them out of the ventricles; the atria are relaxed, and their chambers are
again filling with blood.

 Early diastole. At the end of systole, the ventricles relax, the semilunar valves snap shut, and for
a moment the ventricles are completely closed chambers; the intraventricular pressure drops and
the AV valves are forced open; the ventricles again begin refilling rapidly with blood, completing
the cycle.

 First heart sound. The first heart sound, “lub”, is caused by the closing of the AV valves.

 Second heart sound. The second heart sound, “dub”, occurs when the semilunar valves close at
the end of systole.

Cardiac Output
Cardiac output is the amount of blood pumped out by each side of the heart in one minute. It is the
product of the heart rate and the stroke volume.

 Stroke volume. Stroke volume is the volume of blood pumped out by a ventricle with each
heartbeat.

 Regulation of stroke volume. According to Starling’s law of the heart, the critical factor
controlling stroke volume is how much the cardiac muscle cells are stretched just before they
contract; the more they are stretched, the stronger the contraction will be; and anything that
increases the volume or speed of venous return also increases stroke volume and force of
contraction.

 Factors modifying basic heart rate.The most important external influence on heart rate is the
activity of the autonomic nervous system, as well as physical factors (age, gender, exercise,
and body temperature).

PHYSIOLOGY OF CIRCULATION

A fairly good indication of the efficiency of a person’s circulatory system can be obtained by taking
arterial blood and blood pressure measurements.

Cardiovascular Vital Signs

Arterial pulse pressure and blood pressure measurements, along with those of respiratory rate and body
temperature, are referred to collectively as vital signs in clinical settings.

 Arterial pulse. The alternating expansion and recoil of an artery that occurs with each beat of the
left ventricle creates a pressure wave-a pulse- that travels through the entire arterial system.

 Normal pulse rate. Normally, the pulse rate (pressure surges per minute) equals the heart rate, so
the pulse averages 70 to 76 beats per minute in a normal resting person.

 Pressure points. There are several clinically important arterial pulse points, and these are the
same points that are compressed to stop blood flow into distal tissues during hemorrhage,
referred to as pressure points.

 Blood pressure. Blood pressure is the pressure the blood exerts against the inner walls of the
blood vessels, and it is the force that keeps blood circulating continuously even between
heartbeats.

 Blood pressure gradient. The pressure is highest in the large arteries and continues to drop
throughout the systemic and pulmonary pathways, reaching either zero or negative pressure at the
venae cavae.

 Measuring blood pressure. Because the heart alternately contracts and relaxes, the off-and-on
flow of the blood into the arteries causes the blood pressure to rise and fall during each beat, thus,
two arterial blood pressure measurements are usually made: systolic pressure (the pressure in the
arteries at the peak of ventricular contraction) and diastolic pressure (the pressure when the
ventricles are relaxing).
  Peripheral resistance. Peripheral resistance is the amount of friction the blood encounters as it
flows through the blood vessels.

 Neural factors. The parasympathetic division of the autonomic nervous system has little or no
effect on blood pressure, but the sympathetic division has the major action of causing
vasoconstriction or narrowing of the blood vessels, which increases blood pressure.

 Renal factors. The kidneys play a major role in regulating arterial blood pressure by altering
blood volume, so when blood pressure increases beyond normal, the kidneys allow more water to
leave the body in the urine, then blood volume decreases which in turn decreases blood pressure.

 Temperature. In general, cold has a vasoconstricting effect, while heat has a vasodilating effect.

 Chemicals. Epinephrine increases both heart rate and blood pressure; nicotine increases blood
pressure by causing vasoconstriction; alcohol and histamine cause vasodilation and decreased
blood pressure.

 Diet. Although medical opinions tend to change and are at odds from time to time, it is generally
believed that a diet low in salt, saturated fats, and cholesterol help to prevent hypertension, or
high blood pressure.

Blood Circulation Through the Heart

The right and left sides of the heart work together in achieving a smooth flowing blood circulation.

 Entrance to the heart. Blood enters the heart through two large veins, the inferior and superior
vena cava, emptying oxygen-poor blood from the body into the right atrium of the heart.

 Atrial contraction. As the atrium contracts, blood flows from the right atrium to the right
ventricle through the open tricuspid valve.

 Closure of the tricuspid valve. When the ventricle is full, the tricuspid valve shuts to prevent
blood from flowing backward into the atria while the ventricle contracts.

Ventricle contraction. As the ventricle contracts, blood leaves the heart through the pulmonic valve, into
the pulmonary artery and to the lungs where it is oxygenated.
  Oxygen-rich blood circulates. The pulmonary
vein empties oxygen-rich blood from the lungs
into the left atrium of the heart.

 Opening of the mitral valve. As the atrium

contracts, blood flows from your left atrium into
your left ventricle through the open mitral valve.

 Prevention of backflow. When the ventricle is

full, the mitral valve shuts. This prevents blood
from flowing backward into the atrium while the
ventricle contracts.

 Blood flow to systemic circulation. As the

ventricle contracts, blood leaves the heart through
the aortic valve, into the aorta and to the body.

Capillary Exchange of Gases and Nutrients

Substances tend to move to and from the body cells according to their concentration gradients.

 Capillary network. Capillaries form an intricate network among the body’s cells such that no
substance has to diffuse very far to enter or leave a cell.

 Routes. Basically, substances leaving or entering the blood may take one of four routes across the
plasma membranes of the single layer of endothelial cells forming the capillary wall.

 Lipid-soluble substances. As with all cells, substances can diffuse directly through their plasma
membranes if the substances are lipid-soluble.

 Lipid-insoluble substances. Certain lipid-insoluble substances may enter or leave the blood
and/or pass through the plasma membranes within vesicles, that is, by endocytosis or exocytosis.

 Intercellular clefts. Limited passage of fluid and small solutes is allowed by intercellular clefts
(gaps or areas of plasma membrane not joined by tight junctions), so most of our capillaries have
intercellular clefts.

 Fenestrated capillaries. Very free passage of small solutes and fluid is allowed by fenestrated
capillaries, and these unique capillaries are found where absorption is a priority or where
filtration occurs.
Reference:
- https://nurseslabs.com/cardiovascular-system-anatomy-physiology/
- Seeleys. Anatomy and Physiology.
-

PROGNOSIS
Most individuals diagnosed with hypertension will have increasing blood pressure (BP) as they age.
Untreated hypertension is notorious for increasing the risk of mortality and is often described as a silent
killer. Mild to moderate hypertension, if left untreated, may be associated with a risk of atherosclerotic
disease in 30% of people and organ damage in 50% of people within 8-10 years after onset. Patients with
resistant hypertension are also at higher risk for poor outcomes, particularly those with certain
comorbidities (eg, chronic kidney disease, ischemic heart disease). Patients with resistant hypertension
who have lower BP appear to have a reduced risk for some cardiovascular events (eg, incident stroke,
coronary heart disease, or heart failure).

Reference:
- https://www.medscape.com/answers/241381-7618/what-is-the-prognosis-of-
hypertension-high-blood-pressure
PATHOPHYSIOLOGY