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The pericardium surrounds the heart Fibrous pericardium: supports the heart and some protection Serous pericardium (parietal /visceral layer)
Epicardium: visceral layer of the serous pericardium. Myocardium: composed of cardiac muscle. Endocardium: squamous epithelium (known as "endothelium).
Heart is composed of 4 chambers (2 atria and 2 ventricles) Atria are somewhat weak (~20%) compared to ventricles 2 pumps or 2 circuits Right side pumps de-oxygenated (pulmonary) blood Left side pumps oxygenated blood (systemic) blood
Outflow valves
Aortic and pulmonary valves control outflow In contrast of AV valves, outflow valves have firm cusps (semi lunar) Valves open on ventricular ejection and act like sails preventing backflow.
Similar in structure to skeletal muscle, but different as well 1) Electrical connection with other cells 2) Fibers are shorter 3) Fibers tend to branch often 4) Have only 1 nucleus. 5) Some myocytes have the ability to spontaneously depolarize and contract
The heart is an electrical organ able to conduct current orderly through it. SA node: sino arterial node is a pace maker for the atria Current travels from SA node to atrial ventricular node (AV) From AV node to purkinje fibers
Frontal plane
Left atrium
Right atrium 1 SINOATRIAL (SA) NODE 2 ATRIOVENTRICULAR (AV) NODE 3 ATRIOVENTRICULAR (AV) BUNDLE (BUNDLE OF HIS) 4 RIGHT AND LEFT BUNDLE BRANCHES Right ventricle Left ventricle
- shorter-lasting A.P.s than follower cells. - localized to SA node (~ 75/min), AV node ~0.2 sec after SA
> 99% of cardiac cells are follower cells: - incapable of generating their own A.P.s - all electrically interconnected by gap junctions - relatively long-lasting A.P.s
intercalated disks
Heart is organized into two electrical syncytia - atrial syncytium - ventricular syncytium -connected electrically by the A-V bundle (specialized fibres) -this allows the atria and ventricles to contract uniformly and in synchrony
An ECG: measures electrical changes on the surface of the body due to electrical activity of myocardium. ECG recordings: can quantify and correlate, electrically, the mechanical activities of the heart.
Thus heart health
Depolarization and
atrial repolarization S-T segment - time it takes to empty the ventricles before they repolarize (the T wave)
0.2
0.4
0.6
0.8
Seconds Repolarization of 5 Repolarization of 5 ventricular contractile ventricular contractile fibers fibers produces produces T T wave wave
0.6
P Q 0
Cardiac Conduction
The stroke volume (SV) is the volume of blood ejected from the left (or right) ventricle every beat. The cardiac output (CO) is the SV x heart rate (HR).
On average, a persons entire blood volume flows through the pulmonary and systemic circuits each minute.
Systolic BP is the higher pressure measured during left ventricular systole when the aortic valve is open. Diastolic BP is the lower pressure measured during left ventricular diastole when the valve is closed.
The cardiac reserve (4-5x resting value) is the difference between the CO at rest and the maximum CO The cardiac output is affected by changes in SV,
The contractility of the ventricle The resistance in the blood vessels (aorta) or valves (aortic valve, when damaged) the heart is pumping into
The more the heart muscle is stretched (filled) before contraction (preload), the more forcefully the heart will contract.
Heart does not rely on outside nerves for its basic rhythm Modulation of heart rate via sympathetic and parasympathetic innervation
The role of autonomic nervous system input is to regulate changes in blood pressure, blood flow, and blood volume to maintain enough cardiac output to provide for all organs at all times (if possible).
-increases the heart rate and the strength of myocardiac contraction Various hormones also affect heart rate
Parasympathetic activity slows the heart from its native rate of 100 bpm to about 70-80 in the average adult.
ANS Innervation
Neuronal inputs (types): Arterial Baroreceptors, Arterial Chemoreceptors, and CNS sensors
1) Arterial Baroreceptors really are stretch receptors, very rapid sensors. - localized in 2 specific areas: A) Carotid sinus baroreceptors located in the wall of each internal carotid artery (known as the carotid sinus)
B) Aortic arch baroreceptors at the branch point of the subclavian artery from the systemic aorta
Glossopharyngeal nerve (IX) branch innervates carotid sinus Vagus nerve (X) branch innervates aortic arch
Respiratory center
Very strong signal
Increase in ventilation
Activate vasoconstriction Activates cardio-acceleration Activates veno-constriction Mechanism kicks in when MAP is less than 80 mm Hg
3.Central Nervous System Ischemic Response (cerebral ischemia) Decreased blood flow to the vasomotor center causing "nutritional" deficiency (O2 + glucose lack/CO2 + lactic acid excess) -the last ditch response
Consequences: - vasomotor center responds by stimulating maximum vasoconstriction, venoconstriction, & cardioacceleration -massive increase in MAP - MAP can rise to over 350 mm Hg and blood flow to most organs is completely shut down!!
Cushing reaction: usually seen in the terminal stages of acute head injury and may indicate imminent brain herniation
-occurs when cerebrospinal fluid pressure increases (usually due to brain swelling), thereby reducing blood flow to the brain (remember PT)
Renin-angiotensin-aldosterone system - When JGA (of kidney) detect low filtrate interpreted as low blood pressure
Compliance
DirectADH, renin-angiotensin
This graph illustrates the time course & potency of various active & passive controls on MAP
Circulation
Blood flows from root of aorta to left and right coronary arteries
LCA to anterior interventricular and circumflex branches RCA to marginal and posterior atrioventricular branches
Coronary