Cardiovascular System: The Heart

Chapter 19 – Lecture Notes

to accompany

Anatomy and Physiology: From Science to Life

textbook by
Gail Jenkins, Christopher Kemnitz, Gerard Tortora
 Chapter Overview
19.1 Location & Anatomy
19.2 Heart Chambers
19.3 Heart Valves
19.4 Heart Functions
19.5 Cardiac Conduction System
19.6 ECG
19.7 Cardiac Cycle
19.8 Cardiac Output
 Essential Terms
cardiology
• study of the cardiovascular system
apex of heart
• bottom point of heart formed by ventricles
base of heart
• formed by atria, broad superior surface
ventricles
• muscular chambers of the heart that eject blood
atria
• collecting chambers of the heart that contract to
fill the ventricles
 Introduction
• heart beats about 100,000 times
every day or about 35 million beats
per year
• left side pumps to systemic circuit
• right side pumps to pulmonary circuit
 Concept 19.1

Location & Heart

Anatomy
 Heart Anatomy
• size ~ 12cm long, 9cm wide at broadest
part (5” x 3.5”)
• average mass 250g (8 oz) in females
• average mass 300g (10 oz) in males
• rests on diaphragm
• near midline of thoracic cavity
– 2/3 of to left of midline
• in mediastinum
• between lungs
• base is directed posteriorly and to right
• apex
 PERICARDIUM
1. fibrous pericardium
– dense, irregular connective tissue
– functions
• protect and anchor
serous pericardium
2. parietal pericardium
– fused to the fibrous pericardium
3. visceral pericardium
– also called epicardium
pericardial cavity of the serous pericardium
is filled with pericardial fluid
 Heart Wall
1. epicardium
– visceral layer of serous pericardium
2. myocardium
– cardiac muscle
• involuntary
• branched cells
– intercalated discs
– gap junctions
– Desmosomes

3. endocardium
– continuous through out cardiovascular
system
 Concept 19.2

Heart Chambers
 Right Atrium (RA)
• receives blood from
1. superior vena cava
2. inferior vena cava
3. coronary sinus
• posterior wall is smooth
• anterior wall is rough with pectinate
muscles that extend into auricle
• divided from left atrium by thin partition
called interatrial septum
– oval depression in septum called fossa
ovalis
• remnant of foramen ovale
• blood leaves RA through tricuspid valve
Figure 19.4a
Figure 19.4b
Figure 19.4c
 Right Ventricle (RV)
• receives blood from right atrium
• forms most of the anterior surface of
heart
• contains trabeaculae carneae
– raised bundles of cardiac muscle
• cusps of tricuspid valve connected to
chordae tendineae
• chordae tendineae connected to cone-
shaped trabeaculae carneae called
papillary muscles
• divided from left ventricle by
interventricular septum
• blood ejected to pulmonary valve to
pulmonary trunk en route to lungs for
gas exchange
Figure 19.3a
Figure 19.3b
Figure 19.3c
 Left Atrium (LA)
• receives blood from lungs
– through 4 pulmonary veins
• structurally similar to right atrium
• blood passes to left ventricle through
the bicuspid (mitral) valve
 Left Ventricle (LV)
• receives blood from LA
• through bicuspid valve
• internal structures similar to RV
– trabeaculae carneae
– chordae tendineae
– papillary muscles
– interventricular septum
• blood ejected into aorta
– some aortic blood travels to coronary arteries
– remainder passes to arch of aorta
– fetal life blood passes from pulmonary trunk to
aorta (bypassing lungs) through ductus
arteriosus (closes shortly after birth)
Figure 19.4a
Figure 19.4b
Figure 19.4c
Figure 19.1a
Figure 19.1b
 Myocardium
• atrial walls are thinnest
• right ventricle thinner than left ventricle
– pumps blood shorter distance
• left ventricle walls thickest
• right and left ventricles pump same volume
of blood with each beat
Figure 19.4a
Figure 19.4b
Figure 19.4c
Concept 19.3

Heart Valves
 Valves Of The Heart
Ensure one way flow through the heart
• Atrioventricular Valves
– between the atria & the ventricles
– right side - tricuspid value
– left - bicuspid or mitral valve
– chordae tendineae to papillary muscles
• Semilunar Valves
– at the beginning of the arteries that leave the heart
– 3 cusps per valve
– pulmonary semilunar valve
– aortic semilunar valve
Concept 19.4

Circulation
Systemic and Pulmonary Circulation
• systemic circulation
– left side of the heart
– receives from lungs
– pumps to aorta & body tissues
– oxygenated blood
• pulmonary circulation
– right side of the heart
– receives blood from the body tissues (veins)
– pumps to pulmonary trunk & lungs
– deoxygenated blood
Figure 19.6
 Coronary Circulation
• functional blood supply of the heart
• arteries arise from base of aorta and encircle
heart in atrioventricular groove
• Left coronary artery
– runs toward left side of heart
– divides into anterior interventricular artery
– supplies blood to interventricular septum and anterior
walls of both ventricles
• Right coronary artery
– runs toward right side of heart
– divides into marginal artery and posterior
interventriculary artery
• Marginal artery serves lateral myocardium of right side
• Other serves heart apex and posterior ventricular walls
Figure 19.7a
Figure 19.7b
Figure 19.7c
 Coronary Veins
• AKA coronary sinus
– great cardiac vein (anterior)
– middle cardiac vein (posterior)
– small cardiac vein
– anterior cardiac veins
Figure 19.7a
Figure 19.7b
Figure 19.7c
 Concept 19.5

Cardiac Conduction
 Anatomy of Cardiac Conduction System
• excitation begins at SA node (100/min_
• arrives at AV node located in interatrial
septum, is slowed down (75/min)
• Action Potential flows to AV bundle
• then enters right and left bundle branches
traveling upward
• final AP arrives at Purkinje fibers
contracting ventricular myocardium from
apex up ejecting blood through semilunar
valves
Figure 19.8
 CONDUCTION SYSTEM
Sequence of excitation
1. sinoatrial (SA) node - spreads to both atria
• 90 - 100 action potentials per minute
2. atrioventricular (AV) node
• 40 -50 action potentials per minute
3. atrioventricular (AV) bundle (bundle of His)
• 20-40 action potentials per minute
4. right & left bundle branches
• in the interventricular septum
5. Purkinje fibers
• conduction myofibers
http://www.youtube.com/watch?v=gvLe2hSi84s
Figure 10.17a
Figure 10.17b
Figure 10.17c
 Concept 19.6

Electrocardiogram
ECG or EKG
 Electrocardiography
• recording of AP transmission through the
cardiac conduction system
• electrodes placed on body surface
– arms and legs and six positions on chest
• graphed as series of up and down waves
produced during each heartbeat
• instrument called electrocardiograph
– produces 12 different tracings
 ECG Waves
• P wave
– atrial depolarization
• QRS complex
– ventricular depolarization
– onset of ventricular contraction
• T wave
– ventricular repolarization
– just before ventricles start to relax
• atrial repolarization usually not visible
– masked by larger QRS complex
Figure 19.9
 ECG Waves & Heart Activity
• Systole
– contraction
• Diastole
– relaxation
Figure 19.10
Concept 19.7

Cardiac Cycle
 CARDIAC CYCLE
• All events associated with one heartbeat
• two atria contract (atrial systole)
– while two ventricles relax (ventricular diastole)
• two ventricles contract (ventricular systole)
– while two atria relax (atrial diastole)
 Pressure & Volume Changes
Resting heart rate - about 75 beats/min.
– each beat approximately 0.8 seconds
0.4 seconds relaxation period
– greatest variation in timing is here
0.1 seconds atria contract
0.3 seconds atria relax & ventricles contract
Figure 19.11
 Atrial Systole
1. SA node depolarization
2. causes atrial systole forcing blood through
AV valves into ventricles
3. Ventricles fill
• EDV measure just prior to ventricle contraction
• approximately 130mL
 Ventricular Systole
4. ventricles contract as atria relax
5. pushes blood against AV valves forcing
them shut
• all valves shut for an instant
6. when pressure in ventricles exceed
pressure in arteries both SL valves open
and blood is ejected from ventricles
7. resting body volume of blood ejected is
about 70mL (just over half of EDV)
• ESV is about 60mL
 Relaxation Period
8. ventricular repolarization
• T wave in ECG
9. causes ventricular diastole
1. ventricles relax
2. chamber pressure drops
3. blood flows from pulmonary trunk and aorta back
toward ventricles SL valves close
4. isovolmetric relaxation
• all four valves closed
10. when ventricular pressure less than atrial
pressure AV valves open & ventricle fill
• occurs without atrial systole
11. another cardiac cycle begins at atrial
depolarization (P wave)
 Heart Sounds
• Auscultation
– act of listening to heart sounds
• Sound of heart valves closing
• four sounds but only two loud enough to
hear by stethoscope (S1 and S2)
• S1 = lubb = long, booming sound AV valves
closing
• S2 = dupp = short, sharp sound SL valves
closing
• S3 blood turbulence during ventricular filling
• S4 blood turbulence during atrial systole
Figure 19.12a
Figure 19.12b
 Concept 19.8

Cardiac Output
 Cardiac Output
• Cardiac output equals stroke volume times
heart rate
• CO = SV x HR
• difference between resting and maximal
cardiac output is called cardiac reserve
• Stroke volume equals the amount of blood
in ventricle during diastole (EDV) minus
the amount of blood in ventricle after it has
contracted (ESV)
• SV = EDV - ESV
 Regulation of Stroke Volume
1. Preload
– degree of stretch of ventricles before
contracting
– Frank-Starling law of the heart
• the greater the stretch - the greater the
contraction (within limits)
• stretch is due to blood in the ventricles at the
end of diastole (EDV)
 Regulation of Stroke Volume
2. Contractility
– forcefulness of contraction of individual fibers
– increased contractility (positive inotropic)
• direct consequence of greater Ca2+ influx
• Glucagon, thyroxine, epinephrine
– decrease contractility (negative inotropic)
• acidosis
• rising extracellular potassium
• calcium channel blockers
3. Afterload
– pressure that must be exceeded before ejection
begins
– pressure at semilunar valves of large arteries
 Control of Heart Rate
• cardiovascular center of medulla oblongata
• sensory inputs:
– movement as monitored by proprioceptors
increase input to cardiovascular center
– chemical changes in the blood, monitored by
chemoreceptors
– blood pressure changes , monitored by
baroreceptors
 Control of Heart Rate
sympathetic effect
• cardiac accelerator nerves
– Release of NOR that bind to beta 1 receptors
1. increases spontaneous firing of SA & AV nodes
2. increases Ca++ to contractile fibers
parasympathetic effect
• vagus nerve
– Release of acetylecholine
1. causes hyperpolarization (open K+ channels)
2. slows spontaneous depolarization of intrinsic fibers
3. PNS activation may be persistent in some grief and
depression conditions
 Chemical Regulation of Heart Rate
1. Hormonal effects
– EPI & NOR, and thyroid hormones
• all increase heart activity
2. Cations
– Na+
• high levels block Ca2+ inflow, Decrease Na 
Increased HR  cardiac defibrillation
– K+
• high levels block AP generation, Increased K 
Decreased HR
– Ca2+
• high blood levels increase heart rate and activity
• low levels depress heart activity
 Other Factors
Resting Heart rate influenced by:
• age
• gender
• physical fitness
– bradycardia may be exhibited
– strong effective slow beats under 60bpm
• body temperature
– increased temperature increases rate
– decreased temperature decreases rate
End Chapter 19