Heart Anatomical Position

The heart:
Sits near the anterior chest wall, directly posterior to the sternum Lies slightly to the left of the midline Sits at an angle to the longitudinal axis of the body Is rotated towards the left side Surrounded by the pericardium in the anterior of the mediastinum
Mediastinum separates the 2 pleural cavities and also contains the esophagus, trachea, and thymus.

Pericardium
Serous membrane lining the pericardial cavity Analogous to a fist in a balloon Subdivided into visceral and parietal pericardium
Visceral layer (brown arrow) is the outer layer of the heart itself a.k.a. the epicardium Parietal layer (red arrow) lines the inner portion of the pericardial sac and is deep to a meshwork of collagen fibers that stabilize the position of the heart

Pericardium
Space btwn the visceral & parietal layers is the pericardial cavity. Normally contains 10-20mL of pericardial fluid secreted by the membranes A variety of pathogens may infect the pericardium, causing pericarditis. Pericardial irritation and inflammation results in an in pericardial fluid production which limits the movement of the heart. Known as cardiac tamponade.

The Heart Wall

3 distinct layers:
Epicardium
Visceral pericardium Consists of an exposed mesothelium underlain by a layer of loose connective tissue

Myocardium
Muscular wall of the heart Contains cardiac muscle tissue, blood vessels, and nerves

Endocardium
Simple squamous epithelium that lines the internal spaces of the heart and covers the valves. Continuous with the endothelium of blood vessels

General Heart Anatomy

Blood vessels can be divided into a pulmonary circuit (between the heart and the gas exchange surfaces of the lungs) and a systemic circuit (between the heart and the rest of the body) Heart contains 4 muscular chambers, 2 associated with each circuit
Right atrium receives deO2 blood from the systemic circuit and passes it to the right ventricle which discharges it into the pulmonary circuit. Left atrium receives O2 blood from the pulmonary circuit and passes it to the left ventricle which discharges it into the systemic circuit

 The 2 atria are superior to the ventricles and mostly posterior Each atrium has a small earlike extension called an auricle which slightly its volume The ventricles are inferior to the atria. The RV constitutes most of the anterior aspect of the heart, while the LV forms the apex and inferoposterior aspect.

 Atria have thin flaccid walls corresponding to their light workload. Why is it light? Right and left atria are separated by the interatrial septum. RA and both auricles exhibit internal ridges of myocardium called pectinate muscles. The thick interventricular septum separates the LV and RV. LV is 2-4x as thick as the RV because of its large workload. Both ventricles exhibit internal muscular ridges known as trabeculae carneae

S E P T U M

LV

RV

Valves
Necessary to ensure oneway flow. Found btwn each atria and each ventricle and btwn each ventricle and its great artery Each consists of 2-3 flaps of connective tissue covered by endothelium Atrioventricular Valves
Tricuspid Valve Btwn RA and RV Bicuspid Valve Btwn LA and LV. A.k.a. mitral valve Stringlike chordae tendineae connect the valve flaps to conical papillary muscles found on the ventricular floor. These function to prevent the valves from bulging (prolapsing) into the atria.

Here, the mitral valve is open as blood flows from the left atrium into the left ventricle. Notice how the chordae tendineae and papillary muscles are relaxed.

Now, the mitral valve is closed as blood flows from the left ventricle into the aorta. What are the chordae tendineae and papillary muscles doing now?

Valves
Semilunar Valves:
Pulmonary Semilunar Valve
Prevents backflow of blood from pulmonary artery into RV

Aortic semilunar valve

Prevents backflow of blood from aorta into LV

Blood Flow back to the Heart

Blood high in CO2 and low in O2 arrives at the RA from 3 vessels:
Superior Vena Cava
Drains head, upper torso, and arms

Inferior Vena Cava

Drains abdomen, pelvis, and legs

Coronary Sinus
Drains coronary circulation

Blood Flow back to the Heart

Blood high in O2 and low in CO2 arrives at the LA from 4 blood vessels
Right superior and right inferior pulmonary veins Left superior and left inferior pulmonary veins

Basic Pathway of Blood Flow

CS SVC IVC Right Atrium Tricuspid Valve Right Ventricle Pulmonary Semilunar Valve

Systemic Capillaries

Pulmonary Trunk

Aorta Aortic Semilunar Valve Left Ventricle

Pulmonary Arteries

Pulmonary Capillaries Bicuspid Valve Left Atrium Pulmonary Veins

Coronary Circulation
Why does the heart require a prodigious amt of O2 and nutrients? Cardiac muscle is not nourished to any extent by the blood flowing thru its chambers, so it has its own network of arteries, capillaries, and veins the coronary circulation 5% of circulating blood is delivered to the heart After the aorta emerges from the LV it gives off 2 branches, the left & right coronary arteries The coronary circulation has many anastomoses where 2 arteries come together and combine their blood flow.
What is the advantage to this?

Blockage of coronary arteries causes ischemia a loss of blood flow. Temporary and reversible ischemia produces a sense of pain known as angina pectoris. Prolonged coronary blockage can lead to myocardial cell death - a myocardial infarction (a.k.a., heart attack or coronary)

 After blood passes thru the coronary capillaries, it enters coronary veins which combine to form the coronary sinus which empties into the RA

Cardiac Conduction System

Autorhythmic cardiac myocytes have the ability to spontaneously depolarize to threshold and fire action potentials. Locations:
Sinoatrial Node Adjacent to the SVC opening in the RA Atrioventricular Node Near the right AV valve at the bottom of the interatrial septum Atrioventricular Bundle Inferior interatrial septum Right & Left Bundle Branches Interventricular septum Purkinje Fibers Distributed throughout the LV and RV

Intrinsic Control of the Heart Rate

Without input from any other cell, the heartbeat originates at the SA node. For this reason, it is known as the hearts pacemaker and its rhythm (sinus rhythm) determines heart rate. The depolarization begun in SA node cells spreads via gap junctions throughout the atria and via the internodal pathway to the AV node. How will the atrial contractile cells respond to depolarization?

Intrinsic Control of the Heart Rate

At the AV node, the impulse is delayed momentarily to allow the atria to complete their contraction before the ventricles contract From the AV node, the impulse travels to the AV bundle. The AV bundle is the ONLY electrical connection btwn the atria and the ventricles. Why is this important? The impulse travels on to the L&R bundle branches and onward to the Purkinje fibers which begin at the heart apex and extend upward thru the ventricles How do the ventricles respond to depolarization? What is significant about the fact that the Purkinje fibers begin at the apex and course upwards?

Conduction Pathologies
Arrhythmia Irregular heart rhythm Fibrillation Condition of rapid and out-of-phase contractions. Why are fibrillating ventricles useless as pumps? Ectopic Focus An abnormal pacemaker. A region of the heart becomes hyperexcitable and generates impulses faster than the SA node. Can also lead to premature contractions or extrasystole (e.g., premature ventricular contraction (PVC)) before the SA node initiates the next contraction Heart Block Any damage to the AV node. Interferes with the transmission of impulses to the ventricles. Can very in severity.

Cardiac Cycle
Period btwn the start of one heartbeat and the beginning of the next For any one chamber in the heart, the cardiac cycle can be divided into 2 phases:
Systole contraction Diastole relaxation

A basic principle that governs the movement of blood thru the heart is that blood will flow from one chamber to the next only if the pressure in the 1st chamber exceeds the pressure in the 2nd

Valve Pathology
Murmur Abnormal heart sound due to a malfunctioning heart valve Valvular Stenosis Valve cusps become stiffened and the opening is constricted by scar tissue. How would this effect the workload of the heart? Mitral Valve Prolapse insufficiency in which one or both mitral valve flaps bulge into the atrium during ventricular systole

Cardiac Output
Volume of blood ejected by each ventricle in 1 minute Cardiac Output = Heart Rate (beats/minute) x Stroke Volume (mL/beat) CO=(HR)(SV) Suppose Tims heart rate was 60bpm, his ESV was 50mL and his EDV was 140mL. What is Tims CO? Cardiac output varies with the bodys state of activity. What do you suppose happens to CO during exercise?

Heart Rate
Tachycardia is a persistent resting HR >100bpm Bradycardia is a persistent resting HR <60bpm

Baroreceptor Reflex
Baroreceptors are pressure sensitive neurons in the aortic arch and carotid sinus.
Why are they found in these 2 locations?

They respond to decreased BP by decreasing cardioinhibitory activity and by increasing both cardioacceleratory activity and the vasoconstrictor center (all in the medulla oblongata)
How would they respond to increased BP?

What type of control is demonstrated by this reflex?