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Medical Science
• What is the structure of the heart? (review and extend Year 1)
○ Pericardium
Membrane surrounding and protecting the heart
Fibrous pericardium
□ Tough connective tissue
□ Attached to the diaphragm and great vessels
□ Prevents the overstretching of the heart
Serous pericardium
□ Double layer
□ Between a layer of serous fluid
○ Layers
Epicardium
Myocardium
□ 95% of heart
□ Cardiac muscle
Endocardium
□ Thin layer of endothelium
□ Smooth lining
□ Continuous with endothelial lining of blood vessels
○ Chambers of the heart
4 - left and right atria and ventricles
Atria
□ Smooth posterior walls
□ Right atrium - rough anterior wall, left atrium both walls are smooth
□ Between the right and left there is an interatrial septum
Ventricles
□ Contains trabeculae carnae
□ Papillary muscle attach chordae tendinae to the walls
○ Main Vessels
Superior Vena cava
□ Returns deoxygenated blood from head
□ Opening in the upper back of the right atrium
Inferior vena cava
□ Larger than the SVC
□ Return deoxygenated blood from the lower half of the body
□ Backwards and upwards
□ Guarded by a semilunar valve
Aorta
□ Sends oxygenated blood to body
□ From upper left ventricle
Pulmonary trunk
□ Deoxygenated blood from right ventricle
Pulmonary veins
□ Transport arterial blood to left atrium
□ There are 4 left, right, superior, inferior
□ No valves
• What controls heart rate and the muscle pump? (review and extend year 1)
○ Intrinsic mechanism of the heart - Frank-Starling Mechanism
Amount of blood pump is determined by venous return
The greater the muscle is stretched by filling the greater the force of contraction
and amount of blood pumped into the aorta
Stretch of atrial wall results in the increase of heart rate by 10-20%
○ Nervous control of the heart
Sympathetic
□ Can increase the heart rate from 70 bmp upto 180-200 bpm
□ Can increase the force of contraction by almost double
□ 2-3x the cardiac output
□ Sympathetics keep the resting heart rate up to 30% higher than withough
□ The inhibition of sympathetics can decrease heart rate and cardiac output
by almost 30%
Parasympathetics
□ Strong stimulation can stop the for a few seconds
□ Then the heart over comes and beats 20-40bmp as long as the
parasympathetic stimulation continues
□ Vagal fibres distributed mainly to atria
Decreases the heart rate rather than the force of contraction
Can decrease by 50% or more
Temperature
□ Increased body temperature increases heart rate
□ Decreased body temperature decreased heart rate
• How does the electrical activity of the heart relate to the muscle pump? (cf APs, ionic
changes and excitation-contraction coupling?
○ Ventricular Action Potential
Phase 4
□ Resting potential
Phase 0
□ Following the opening of Na+ channel - dramatic influx of positive ions in the
cells
□ Leads to rapid change in the transmembrane potential which moves
from -90mV and +20mV
□ Depolarisation
Phase 1
□ Na+ channel does not remain open for long as it a voltage fated channel and
closed by the changed transmembrane potential
□ K+ transient outwards channel opens allowing K + out of the cell
□ Transmembrane potential moves towards 0
Phase 2
□ Change in potential causes L-type Ca2+ to open
□ Ca2+channel remains open longer than Na+ channel
□ Prolonged depolarized state of muscle cell membrane to plateau
□ Rise in intracellular Ca2+ causes contraction of myofibrils within the myocyte
through process of excitation coupling
Phase 3
□ High concentration of Ca2+ also leads to the opening of several K+ channels
□ As K+ leaves the cell transmembrane gradient becomes increasingly negative
which closes the L-type Ca2+ channels and repolarisation of myocyte
membrane
○ Excitation-Contraction coupling
Action potentials trigger muscular contraction
At rest free intracellular Ca2+ is <0.1 µmol/L
□ Not a true reflection of the concentration of Ca2+ ions in the myocyte
Following opening of L-type Ca2+ channels there is a release of Ca2+ from the
sarcoplasmic reticulum
After the release from the sarcoplasmic reticulum, free intracellular Ca 2+
concentration can rise thousandfold to around 100µmol/L
□ Binds to troponin complex and activation of the actin-myosin complex which