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!6789:; )* < %6: !7;=>?@7ABCD7; 0EA9:F5 %6: ":7;9
":7;9 #G79?FE
ApproxlmaLely Lhe slze of your flsL
LocaLlon
Superlor surface of dlaphragm
LefL of Lhe mldllne
AnLerlor Lo Lhe verLebral column, posLerlor Lo Lhe sLernum
":7;9 !?@:;>GH
erlcardlal physlology
roLecLs and anchors hearL
revenLs overfllllng
":7;9 !?@:;>GH
erlcardlal anaLomy
llbrous perlcardlum
Serous perlcardlum (separaLed by perlcardlal cavlLy)
Lplcardlum (vlsceral layer)
":7;9 I7DD
Lplcardlum - vlsceral layer of Lhe serous perlcardlum
Myocardlum - cardlac muscle layer formlng Lhe bulk of Lhe hearL
llbrous skeleLon of Lhe hearL - crlsscrosslng, lnLerlaclng layer of connecLlve Llssue
Lndocardlum - endoLhellal layer of Lhe lnner myocardlal surface
&J9:;G7D ":7;95 47K?; /:AA:DA ?L 96: ":7;9 M#G9:;>?; />:NO
8eLurnlng blood Lo Lhe hearL
Superlor and lnferlor venae cavae
8lghL and lefL pulmonary velns
Conveylng blood away from Lhe hearL
ulmonary Lrunk, whlch spllLs lnLo rlghL and lefL pulmonary arLerles
Ascendlng aorLa (Lhree branches) - brachlocephallc, lefL common caroLld, and subclavlan arLerles
&J9:;G7D ":7;95 /:AA:DA 9679 0C88DEP,;7>G 96: ":7;9 M#G9:;>?; />:NO
ArLerles - rlghL and lefL coronary (ln aLrlovenLrlcular groove), marglnal, clrcumflex, and anLerlor
lnLervenLrlcular
velns - small cardlac veln, anLerlor cardlac veln, and greaL cardlac veln
&J9:;G7D ":7;95 47K?; /:AA:DA ?L 96: ":7;9 M$?A9:;>?; />:NO
8eLurnlng blood Lo Lhe hearL
8lghL and lefL pulmonary velns
Superlor and lnferlor venae cavae
Conveylng blood away from Lhe hearL
AorLa
8lghL and lefL pulmonary arLerles
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&J9:;G7D ":7;95 /:AA:DA 9679 0C88DEP,;7>G 96: ":7;9 M$?A9:;>?; />:NO
ArLerles - rlghL coronary arLery (ln aLrlovenLrlcular groove) and Lhe posLerlor lnLervenLrlcular arLery
(ln lnLervenLrlcular groove)
velns - greaL cardlac veln, posLerlor veln Lo lefL venLrlcle, coronary slnus, and mlddle cardlac veln
R;?AA #G79?FE ?L ":7;95 S;?G97D 0:B9>?G
lronLal secLlon showlng lnLerlor chambers and valves
Ma[or vessels leadlng Lo and from Lhe hearL
#9;>7 ?L 96: ":7;9
ALrla are Lhe recelvlng chambers of Lhe hearL
Lach aLrlum has a proLrudlng aurlcle
ecLlnaLe muscles mark aLrlal walls
8lood enLers rlghL aLrla from superlor and lnferlor venae cavae and coronary slnus
8lood enLers lefL aLrla from pulmonary velns
/:G9;>BD:A ?L 96: ":7;9
venLrlcles are Lhe dlscharglng chambers of Lhe hearL
aplllary muscles and Lrabeculae carneae muscles mark venLrlcular walls
8lghL venLrlcle pumps blood lnLo Lhe pulmonary Lrunk
LefL venLrlcle pumps blood lnLo Lhe aorLa
$796N7E ?L TD??= 96;?CH6 96: ":7;9 7G= 2CGHA
8lghL aLrlum ! Lrlcuspld valve ! rlghL venLrlcle
8lghL venLrlcle ! pulmonary semllunar valve ! pulmonary arLerles ! lungs
Lungs ! pulmonary velns ! lefL aLrlum
LefL aLrlum ! blcuspld valve ! lefL venLrlcle
LefL venLrlcle ! aorLlc semllunar valve ! aorLa
AorLa ! sysLemlc clrculaLlon
!?;?G7;E !>;BCD79>?G
Coronary clrculaLlon ls Lhe funcLlonal blood supply Lo Lhe hearL
CollaLeral rouLes lnsure blood dellvery Lo hearL even lf ma[or vessels are occluded
":7;9 /7D@:A
PearL valves lnsure unldlrecLlonal blood flow Lhrough Lhe hearL
ALrlovenLrlcular (Av) valves lle beLween Lhe aLrla and Lhe venLrlcles
Av valves prevenL backflow lnLo Lhe aLrla when venLrlcles conLracL
Chordae Lendlneae anchor Av valves Lo paplllary muscles
AorLlc semllunar valve lles beLween Lhe lefL venLrlcle and Lhe aorLa
ulmonary semllunar valve lles beLween Lhe rlghL venLrlcle and pulmonary Lrunk
Semllunar valves prevenL backflow of blood lnLo Lhe venLrlcles
4>B;?AB?8>B ":7;9 4CABD: #G79?FE
Cardlac muscle ls sLrlaLed, shorL, faL, branched, and lnLerconnecLed
ConnecLlve Llssue endomyslum acLs as boLh Lendon and lnserLlon
lnLercalaLed dlscs anchor cardlac cells LogeLher and allow free passage of lons
PearL muscle behaves as a funcLlonal syncyLlum
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!7;=>7B 4CABD: !?G9;7B9>?G
PearL muscle:
ls sLlmulaLed by nerves and self-exclLable (auLomaLlclLy)
ConLracLs as a unlL
Pas a long (230 ms) absoluLe refracLory perlod
Cardlac muscle conLracLlon ls slmllar Lo skeleLal muscle conLracLlon
":7;9 $6EA>?D?HE5 -G9;>GA>B !?G=CB9>?G 0EA9:F
AuLorhyLhmlc cells:
lnlLlaLe acLlon poLenLlals
Pave unsLable resLlng poLenLlals called !"#$%"&$' !)*$+*,"-.
use calclum lnflux (raLher Lhan sodlum) for rlslng phase of Lhe acLlon poLenLlal
":7;9 $6EA>?D?HE5 0:VC:GB: ?L &JB>979>?G
SlnoaLrlal (SA) node generaLes lmpulses abouL 73 Llmes/mlnuLe
ALrlovenLrlcular (Av) node delays Lhe lmpulse approxlmaLely 0.1 second
lmpulse passes from aLrla Lo venLrlcles vla Lhe aLrlovenLrlcular bundle (bundle of Pls)
Av bundle spllLs lnLo Lwo paLhways ln Lhe lnLervenLrlcular sepLum (bundle branches)
8undle branches carry Lhe lmpulse Loward Lhe apex of Lhe hearL
urkln[e flbers carry Lhe lmpulse Lo Lhe hearL apex and venLrlcular walls
&J9;>GA>B -GG:;@79>?G ?L 96: ":7;9
PearL ls sLlmulaLed by Lhe sympaLheLlc cardloacceleraLory cenLer
PearL ls lnhlblLed by Lhe parasympaLheLlc cardlolnhlblLory cenLer
&D:B9;?B7;=>?H;786E
LlecLrlcal acLlvlLy ls recorded by elecLrocardlogram (LCC)
wave corresponds Lo depolarlzaLlon of SA node
C8S complex corresponds Lo venLrlcular depolarlzaLlon
1 wave corresponds Lo venLrlcular repolarlzaLlon
ALrlal repolarlzaLlon record ls masked by Lhe larger C8S complex
!7;=>7B !EBD:
Cardlac cycle refers Lo all evenLs assoclaLed wlLh blood flow Lhrough Lhe hearL
SysLole - conLracLlon of hearL muscle
ulasLole - relaxaLlon of hearL muscle
$67A:A ?L 96: !7;=>7B !EBD:
venLrlcular fllllng - mld-Lo-laLe dlasLole
PearL blood pressure ls low as blood enLers aLrla and flows lnLo venLrlcles
Av valves are open Lhen aLrlal sysLole occurs
venLrlcular sysLole
ALrla relax
8lslng venLrlcular pressure resulLs ln closlng of Av valves
lsovolumeLrlc conLracLlon phase
venLrlcular e[ecLlon phase opens semllunar valves
lsovolumeLrlc relaxaLlon - early dlasLole
venLrlcles relax
8ackflow of blood ln aorLa and pulmonary Lrunk closes semllunar valves
ulcroLlc noLch - brlef rlse ln aorLlc pressure caused by backflow of blood reboundlng off semllunar
valves
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":7;9 0?CG=A
PearL sounds (lub-dup) are assoclaLed wlLh closlng of hearL valves
!7;=>7B .C98C9 M!.O 7G= ':A:;@:
CC ls Lhe amounL of blood pumped by each venLrlcle ln one mlnuLe
CC ls Lhe producL of hearL raLe (P8) and sLroke volume (Sv)
P8 ls Lhe number of hearL beaLs per mlnuLe
Sv ls Lhe amounL of blood pumped ouL by a venLrlcle wlLh each beaL
Cardlac reserve ls Lhe dlfference beLween resLlng and maxlmal CC
!7;=>7B .C98C95 &J7F8D:
CC (ml/mln) = P8 (73 beaLs/mln) x Sv (70 ml/beaL)
CC = 3230 ml/mln (3.23 L/mln)
':HCD79>?G ?L 09;?X: /?DCF:
Sv = end dlasLollc volume (Luv) mlnus end sysLollc volume (LSv)
Luv = amounL of blood collecLed ln a venLrlcle durlng dlasLole
LSv = amounL of blood remalnlng ln a venLrlcle afLer conLracLlon
S7B9?;A #LL:B9>GH 09;?X: /?DCF:
reload - amounL venLrlcles are sLreLched by conLalned blood
ConLracLlllLy - cardlac cell conLracLlle force due Lo facLors oLher Lhan Luv
AfLerload - back pressure exerLed by blood ln Lhe large arLerles leavlng Lhe hearL
S;7GX+097;D>GH 27N ?L 96: ":7;9
reload, or degree of sLreLch, of cardlac muscle cells /$0)'$ Lhey conLracL ls Lhe crlLlcal facLor
conLrolllng sLroke volume
Slow hearLbeaL and exerclse lncrease venous reLurn Lo Lhe hearL, lncreaslng Sv
8lood loss and exLremely rapld hearLbeaL decrease Sv
$;:D?7= 7G= #L9:;D?7=
&J9;>GA>B S7B9?;A -GLDC:GB>GH 09;?X: /?DCF:
ConLracLlllLy ls Lhe lncrease ln conLracLlle sLrengLh, lndependenL of sLreLch and Luv
lncrease ln conLracLlllLy comes from:
lncreased sympaLheLlc sLlmull
CerLaln hormones
Ca
2+
and some drugs
AgenLs/facLors LhaL decrease conLracLlllLy lnclude:
Acldosls
lncreased exLracellular poLasslum
Calclum channel blockers
!?G9;7B9>D>9E 7G= Y?;:8>G:86;>G:
SympaLheLlc sLlmulaLlon releases noreplnephrlne and lnlLlaLes a cycllc AM second-messenger
sysLem
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':HCD79>?G ?L ":7;9 '79:5 #C9?G?F>B Y:;@?CA 0EA9:F
SympaLheLlc nervous sysLem (SnS) sLlmulaLlon ls acLlvaLed by sLress, anxleLy, exclLemenL, or exerclse
arasympaLheLlc nervous sysLem (nS) sLlmulaLlon ls medlaLed by aceLylchollne and opposes Lhe SnS
nS domlnaLes Lhe auLonomlc sLlmulaLlon, slowlng hearL raLe and causlng vagal Lone
T7>G[;>=H: ':LD:J
8alnbrldge (aLrlal) reflex - a sympaLheLlc reflex lnlLlaLed by lncreased blood ln Lhe aLrla
Causes sLlmulaLlon of Lhe SA node
SLlmulaLes barorecepLors ln Lhe aLrla, causlng lncreased SnS sLlmulaLlon
!6:F>B7D ':HCD79>?G ?L 96: ":7;9
1he hormones eplnephrlne and Lhyroxlne lncrease hearL raLe
lnLra- and exLracellular lon concenLraLlons musL be malnLalned for normal hearL funcLlon
S7B9?;A -G@?D@:= >G ':HCD79>?G ?L !7;=>7B .C98C9
"?F:?A979>B -F[7D7GB:A
Pypocalcemla - reduced lonlc calclum depresses Lhe hearL
Pypercalcemla - dramaLlcally lncreases hearL lrrlLablllLy and leads Lo spasLlc conLracLlons
PypernaLremla - blocks hearL conLracLlon by lnhlblLlng lonlc calclum LransporL
Pyperkalemla - leads Lo hearL block and cardlac arresL
1achycardla - hearL raLe over 100 beaLs/mln
8radycardla - hearL raLe less Lhan 60 beaLs/mln
!?GH:A9>@: ":7;9 S7>DC;: M!"SO
CongesLlve hearL fallure (CPl), caused by:
Coronary aLherosclerosls
lncreased blood pressure ln aorLa
Successlve myocardlal lnfarcLs
ullaLed cardlomyopaLhy (uCM)
,:@:D?8F:G97D #A8:B9A ?L 96: ":7;9
Lmbryonlc hearL chambers
Slnus venous
ALrlum
venLrlcle
8ulbus cordls
leLal hearL sLrucLures LhaL bypass pulmonary clrculaLlon
loramen ovale connecLs Lhe Lwo aLrla
uucLus arLerlosus connecLs pulmonary Lrunk and Lhe aorLa
#H:+':D79:= !67GH:A #LL:B9>GH 96: ":7;9
Sclerosls and Lhlckenlng of valve flaps
uecllne ln cardlac reserve
llbrosls of cardlac muscle
ALherosclerosls