The Heart

The Heart
B. Pimentel, M.D.
University of Makati – College of Nursing
Function
1. Generate blood pressure

2. Routing blood
3. Ensuring one way blood flow
4. Regulating blood supply
The Heart
The heart lies obliquely in the mediastinum of the thoracic cavity.

 Base directed posteriorly and slightly superiorly
 Deep to the sternum and extends to the 2nd intercostal space
 Apex directed anteriorly and slightly inferiorly
 2/3 of the hearts mass lies to the left of midline
 Approximately 9 cm. to the left of the sternum and is deep to the fifth
intercostal space.
Size - approx. the size of a closed fist
Shape - like a blunt cone, the blunt rounded point of the heart is the apex,
and the larger opposite end is the base
ANATOMY OF THE HEART
Pericardium
Pericardium
 Fibrous pericardium - tough, fibrous connective tissue, outer

layer
 Prevents over distention and anchors the mediastinum
 Superiorly it is continuous with the connective tissue of
the great vessels, and inferiorly attached to the surface of

the diaphragm
Pericardium
 Serous pericardium - thin transparent inner layer
 Parietal pericardium - part of the serous pericardium that

lines the fibrous pericardium
 Visceral pericardium (Epicardium) - part of the serous

pericardium that covers the heart surface
Pericardium
Pericardial cavity - between the parietal and visceral

pericardium
Pericardial fluid - thin layer of serous fluid which reduces

friction of the beating heart
Heart Wall
Epicardium - thin serous membrane of the outer surface of the

heart
Myocardium - thick middle layer composed of cardiac muscle
Endocardium - simple squamous epithelium over a layer of

connective tissue, continuous with all blood vessels of the
body.
Pericardium
External Anatomy
2 atria and 2 ventricles
Atria - form the superior and posterior portions of the heart

 Interarterial septum - separates the left and right atria
Ventricles - the anterior and inferior portions and are thick

walled
 Interventricular septum - separates the right and left ventricles.
External Anatomy
Auricoventricular sulcus (Coronary sulcus) - runs obliquely

around the heart separating the atria and ventricles
Interventricular sulcus - divides the heart into right and left

halves (anterior and posterior)
 The major arteries supplying the coronary tissue lie within

the coronary and interventricular sulci
External Anatomy
External Anatomy
External Anatomy (Blood Vessels)
6 veins
Superior and Inferior vena
cava – carry blood to the
right atrium
Pulmonary vein (4) – carry

blood from the lungs to the
left atrium
2 arteries
Pulmonary trunk – from the

right ventricle and divides
into left and right
pulmonary artery
Aorta – from the left ventricle

External Anatomy
(Coronary circulation)
Right and left coronary arteries – from the base of the aorta
above the semilunar valves
 Left coronary artery is usually dominant over the right
 Anterior interventricular artery or the left anterior descending artery
supplies blood to most of the anterior wall of the heart and the left
ventricle
 Left marginal artery supplies the lateral wall of the left ventricle
 Circumflex artery extends around to the posterior surface and
supplies most of the posterior surface
External Anatomy
 Right coronary artery

 Right marginal artery supplies the lateral wall of the right ventricle.
 Posterior interventricular artery supplies blood to parts of the
inferior and posterior parts of the heart
At rest, coronary arteries provide the heart muscle with 70% of

its oxygen vs. 25% in skeletal muscles
External Anatomy
Great cardiac vein drains blood from the left side of the heart.
Small cardiac vein drains the right margin of the heart.
Coronary sinus a large venous cavity that the veins converge

toward the posterior part of the heart and empties into the
right atrium
External Anatomy
Internal Anatomy (Heart Chambers)
Right and left atrium – functions as a reservoir of blood;

collects blood from veins before it enters the ventricles
 Right atrium – receives blood from the superior and inferior

vena cava
 Left atrium – receives blood from the pulmonary veins
Internal Anatomy (Heart Chambers)
Left and right ventricles – eject and force blood to flow

through the circulatory system; blood from the atria drains
into these chambers
 Right ventricle – opens into the pulmonary trunk

 Left ventricle – opens into the aorta; thicker wall
Heart Wall
Musculi pectinati - muscular ridges in the interior of auricles

and part of right atria.
Crista terminalis - separates the musculi pectinati from the

smooth walls of the atria.
Trabecullae carneae - large muscular ridges of the ventricles.

Heart Wall (left ventricle)
Heart Wall (right ventricle)
Internal Anatomy (Heart Valves)
Atrioventricular valves - Between the right atrium and right ventricles and
between the left atrium and left ventricle
 Tricuspid valve - 3 cusps, between the right atrium and right ventricle
 Bicuspid valve - two cusps, between the left atrium and left ventricle,
also known as the mitral valve
 Contain papillary muscle in each ventricle, cone shaped muscular pillars.

Attached to thin strong connective tissue cords called Chordae tendinae.
The chordae tendinae attach to the cusps of the valves. When the papillary
muscles contract, prevents the valves from opening.
Semilunar valves
 Aortic valve - between the left ventricle and the aorta.
 Pulmonary valve - between the right ventricle and the
pulmonary artery.
Does that look like valve to

you?....
Where is the pulmonary

valve?
BLOOD FLOW
HEART CONTRACTION
Action Potential
HEART CONTRACTION
Action Potential
(Cardiac muscle vs. Skeletal muscle)
ELECTRICAL ACTIVITY
Action Potential (Cardiac Muscle)
ELECTRICAL ACTIVITY
 Depolarization phase
 Na channels open
 K channels close
 Ca channels begin to open
 Early repolarization phase

 Na channels close
 K channels begin to open
ELECTRICAL ACTIVITY
 Plateau phase
 Ca channels are open
 Final repolarization phase

 Ca channels close
 K channels open
ELECTRICAL ACTIVITY
ELECTRICAL ACTIVITY
ELECTRICAL ACTIVITY
Conduction system
Sinoatrial node (SA Node) is medial to the opening of the

superior vena cava. Action potentials travel across the wall
of the atrium to the atrioventricular node (AV Node) located
medial to the right atrioventricular valve.
Action potentials pass through the AV node and along the

atrioventricular bundle, which extends from the AV node
into the interventricular septum.
ELECTRICAL ACTIVITY
Conduction system
The AV bundle divides into right and left bundle branches, the
action potential descends to the apex of the heart along the
bundle branches.
Action potentials are carried by Purkinje fibers from the bundle

branches up along the ventricular walls.
ELECTRICAL ACTIVITY
Conduction system
ELECTRICAL ACTIVITY
Conduction system
ELECTROCARDIOGRAM (EKG)
A measurement of the action potentials of the myocardium

during the cardiac cycle.
A typical EKG consists of a series of three distinguishable
waves called deflection waves.
 P wave - results from the movement of the depolarization wave
from the SA node through the atria, approx. 0.1 sec the atria
contract
 QRS complex - results from ventricular depolarization and
precedes ventricular contraction. Atrial repolarization is obscured
by this wave.
 T wave - ventricular repolarization
ELECTROCARDIOGRAM (EKG)
CARDIAC CYCLE
The repetitive pumping process that begins with onset of

cardiac muscle contraction and ends with the beginning of
the next contraction.
Systole – to contract
Diastole – to dilate
CARDIAC CYCLE
1. Systole: Period of Isovolumic Contraction. Ventricular

contraction causes the AV valves to close, which is the
beginning of ventricular systole. The semilunar valves
were closed in the previous diastole and remain closed
during this period. The volume of blood in the ventricles
does not change.
2. Systole: Period of Ejection. Continued ventricular

contraction pushes blood out of the ventricles causing
semilunar valves to open.
CARDIAC CYCLE
3. Diastole: Period of Isovolumic Relaxation. Blood flowing

back toward relaxed ventricles causes the semilunar valves
to close, which is the beginning of diastole. The AV
valves are also closed
4. Diastole: Passive Ventricular Filling. The AV valves open

and blood flows into the relaxed ventricles, accounting for
most of the ventricular filling.
5. Diastole: Active Ventricular Filling. The atria contract and

complete ventricular filling.
CARDIAC CYCLE
End diastolic volume – ventricles are filled with 120 to 130 ml

of blood during the previous ventricular diastole.
End systolic volume – the volume decreases to 50 to 60 ml at

the end of ejection.
Stroke volume – the volume of blood pumped during each

heart beat (cardiac cycle), is equal to end diastolic volume
minus end systolic volume.
HEART SOUNDS
Heart sounds are produced by valves closing.

1st heart sound
 Low pitched sound “lubb” caused by vibration of AV valves and the
surrounding fluid as the valves close at the beginning of ventricular
systole
2nd heart sound
 Higher pitched sound “dupp” closure of the aortic and pulmonary
valves, at the beginning of ventricular diastole.
3rd heart sound
 Occasionally heard, caused by blood flowing in a turbulent fashion
into the ventricles, near the end of the 1st third of diastole.
CARDIAC
CYCLE
REGULATION OF THE HEART
Intrinsic – does not depend on either neural or hormonal

regulation
Extrinsic – involves neural and hormonal influence

(Intrinsic)
Venous return – the amount of blood that flows into the right
atrium during diastole
Preload – the extent to which the ventricular walls are stretched
 An increased preload causes an increase in cardiac output
 Decreased preload, decreased cardiac output.
 Starling’s Law of the Heart
(Intrinsic)
Afterload – the pressure the ventricles must produce to

overcome the pressure of the aorta and move blood into the
aorta. Heart is very sensitive to changes in afterload as
compared with preload
(Extrinsic)
Parasympathetic
 Parasympathetic control is via the vagus nerve.
 Stimulation is inhibitory to heart rate. Can decrease heart
rate by 20 to 30 beats/minute.
Sympathetic
 Nerve fibers originate in thoracic region.
 Stimulation increases heart rate and force of contraction
(Extrinsic)
Hormonal Control
 Adrenal medulla releases norepinephrine and epinephrine.
 Increases the rate and force of contraction.
 Occurs in response to increased physical activity, emotional
excitement, or stress.
 Epinephrine takes a longer time to act on the heart compared
with sympathetic stimulation, but the effect lasts longer.
HEART AND HOMEOSTASIS
1. Barorecptor reflexes – Stretch receptors located in the

internal carotid arteries and the aorta.
 Detect changes in blood pressure and result in changes in heart
rate and in force of contraction.
2. Increased blood pressure decreases sympathetic

stimulation and increases parasympathetic stimulation
4. Decreased BP, decreases parasympathetic stimulation and

increases sympathetic stimulation
Effect of Extracellular
Ion Concentration
Ions that affect cardiac muscle function are the same as those
responsible for action potentials in other electrically
excitable tissues.
 Increased Potassium causes the heart rate and stroke volume
to decrease.
 Increase in Potassium causes heart block which is loss of the
functional conduction action potentials through the conduction
system of the heart.
 Increase in Calcium increases force of contraction and
reduce heart rate.
Film
LV Aneursymectomy
Addenbrookes’ Hospital (NHS) 2005
Dr. Wittmam
Dr. Mayer
Dr. Gordon

The Heart

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The Heart

Uploaded by

Copyright:

Available Formats

The Heart

1. Generate blood pressure

The heart lies obliquely in the mediastinum of the thoracic cavity.

 Fibrous pericardium - tough, fibrous connective tissue, outer

 Superiorly it is continuous with the connective tissue of

the great vessels, and inferiorly attached to the surface of

 Serous pericardium - thin transparent inner layer

 Parietal pericardium - part of the serous pericardium that

 Visceral pericardium (Epicardium) - part of the serous

Pericardial cavity - between the parietal and visceral

Pericardial fluid - thin layer of serous fluid which reduces

Epicardium - thin serous membrane of the outer surface of the

Myocardium - thick middle layer composed of cardiac muscle

Endocardium - simple squamous epithelium over a layer of

2 atria and 2 ventricles

Atria - form the superior and posterior portions of the heart

Ventricles - the anterior and inferior portions and are thick

Auricoventricular sulcus (Coronary sulcus) - runs obliquely

Interventricular sulcus - divides the heart into right and left

 The major arteries supplying the coronary tissue lie within

Pulmonary vein (4) – carry

Pulmonary trunk – from the

Aorta – from the left ventricle

 Right coronary artery

At rest, coronary arteries provide the heart muscle with 70% of

Small cardiac vein drains the right margin of the heart.

Coronary sinus a large venous cavity that the veins converge

Right and left atrium – functions as a reservoir of blood;

 Right atrium – receives blood from the superior and inferior

Left and right ventricles – eject and force blood to flow

 Right ventricle – opens into the pulmonary trunk

Musculi pectinati - muscular ridges in the interior of auricles

Crista terminalis - separates the musculi pectinati from the

Trabecullae carneae - large muscular ridges of the ventricles.

 Contain papillary muscle in each ventricle, cone shaped muscular pillars.

Does that look like valve to

Where is the pulmonary

 Early repolarization phase

 Final repolarization phase

Sinoatrial node (SA Node) is medial to the opening of the

Action potentials pass through the AV node and along the

Action potentials are carried by Purkinje fibers from the bundle

A measurement of the action potentials of the myocardium

The repetitive pumping process that begins with onset of

1. Systole: Period of Isovolumic Contraction. Ventricular

2. Systole: Period of Ejection. Continued ventricular

3. Diastole: Period of Isovolumic Relaxation. Blood flowing

4. Diastole: Passive Ventricular Filling. The AV valves open

5. Diastole: Active Ventricular Filling. The atria contract and

End diastolic volume – ventricles are filled with 120 to 130 ml

End systolic volume – the volume decreases to 50 to 60 ml at

Stroke volume – the volume of blood pumped during each

Heart sounds are produced by valves closing.

Intrinsic – does not depend on either neural or hormonal

Extrinsic – involves neural and hormonal influence

Afterload – the pressure the ventricles must produce to

1. Barorecptor reflexes – Stretch receptors located in the

2. Increased blood pressure decreases sympathetic

4. Decreased BP, decreases parasympathetic stimulation and

You might also like