Anatomy of the Heart

The cardiovascular system can be compared to a muscular pump equipped with

one-way valves and a system of large and small plumbing tubes within which
the blood travels.

Heart Structure and Functions

The modest size and weight of the heart give few hints of its incredible
strength.
  Weight. Approximately the size of a person’s fist, the hollow, cone-
shaped heart weighs less than a pound.
 Mediastinum. Snugly enclosed within the inferior mediastinum, the
medial cavity of the thorax, the heart is flanked on each side by
the lungs.
 Apex. It’s more pointed apex is directed toward the left hip and rests
on the diaphragm, approximately at the level of the fifth intercostal
space.
 Base. Its broad posterosuperior aspect, or base, from which the great
vessels of the body emerge, points toward the right shoulder and lies
beneath the second rib.
 Pericardium. The heart is enclosed in a double-walled sac called the
pericardium and is the outermost layer of the heart.
 Fibrous pericardium. The loosely fitting superficial part of this sac is
referred to as the fibrous pericardium, which helps protect the heart
and anchors it to surrounding structures such as
the diaphragm and sternum.
 Serous pericardium. Deep to the fibrous pericardium is the slippery,
two-layer serous pericardium, where its parietal layer lines the interior
of the fibrous pericardium.

Layers of the Heart

The heart muscle has three layers and they are as follows:

 Epicardium. The epicardium or the visceral and outermost layer is

actually a part of the heart wall.
 Myocardium. The myocardium consists of thick bundles of
cardiac muscle twisted and whirled into ringlike arrangements and it is
the layer that actually contracts.
  Endocardium. The endocardium is the innermost layer of the heart
and is a thin, glistening sheet of endothelium hat lines the heart
chambers.

Chambers of the Heart

The heart has four hollow chambers, or cavities: two atria and two ventricles.

 Receiving chambers. The two superior atria are primarily the

receiving chambers, they play a lighter role in the pumping activity of
the heart.
 Discharging chambers. The two inferior, thick-walled ventricles are
the discharging chambers, or actual pumps of the heart wherein when
they contract, blood is propelled out of the heart and into the
circulation.
 Septum. The septum that divides the heart longitudinally is referred to
as either the interventricular septum or the interatrial septum,
depending on which chamber it separates.

Associated Great Vessels

The great blood vessels provide a pathway for the entire cardiac circulation to
proceed.

 Superior and inferior vena cava. The heart receives

relatively oxygen-poor bloodfrom the veins of the body through the
large superior and inferior vena cava and pumps it through
the pulmonary trunk.
 Pulmonary arteries. The pulmonary trunk splits into the right and left
pulmonary arteries, which carry blood to the lungs, where oxygen is
picked up and carbon dioxide is unloaded.
  Pulmonary veins. Oxygen-rich blood drains from the lungs and is
returned to the left side of the heart through the four pulmonary veins.
 Aorta. Blood returned to the left side of the heart is pumped out of the
heart into the aorta from which the systemic arteries branch to supply
essentially all body tissues.

Heart Valves

The heart is equipped with four valves, which allow blood to flow in only one
direction through the heart chambers.
  Atrioventricular valves. Atrioventricular or AV valves are located
between the atrial and ventricular chambers on each side, and they
prevent backflow into the atria when the ventricles contract.
 Bicuspid valves. The left AV valve- the bicuspid or mitral valve,
consists of two flaps, or cusps, of endocardium.
 Tricuspid valve. The right AV valve, the tricuspid valve, has three
flaps.
 Semilunar valve. The second set of valves, the semilunar valves,
guards the bases of the two large arteries leaving the ventricular
chambers, thus they are known as the pulmonary and aortic semilunar
valves.

Cardiac Circulation Vessels

Although the heart chambers are bathed with blood almost continuously, the
blood contained in the heart does not nourish the myocardium.

 Coronary arteries. The coronary arteries branch from the base of the
aorta and encircle the heart in the coronary sulcus (atrioventricular
groove) at the junction of the atria and ventricles, and these arteries
are compressed when the ventricles are contracting and fill when the
heart is relaxed.
 Cardiac veins. The myocardium is drained by several cardiac veins,
which empty into an enlarged vessel on the posterior of the heart
called the coronary sinus.

Blood Vessels

Blood circulates inside the blood vessels, which form a closed transport system,
the so-called vascular system.
  Arteries. As the heart beats, blood is propelled into large arteries
leaving the heart.
 Arterioles. It then moves into successively smaller and smaller
arteries and then into arterioles, which feed the capillary beds in the
tissues.
 Veins. Capillary beds are drained by venules, which in turn empty
into veins that finally empty into the great veins entering the heart.

Tunics

Except for the microscopic capillaries, the walls of the blood vessels have three
coats or tunics.

 Tunica intima. The tunica intima, which lines the lumen, or interior, of
the vessels, is a thin layer of endothelium resting on a basement
membrane and decreases friction as blood flows through the vessel
lumen.
 Tunica media. The tunica media is the bulky middle coat which mostly
consists of smooth muscle and elastic fibers that constrict or dilate,
making the blood pressure increase or decrease.
  Tunica externa. The tunica externa is the outermost tunic composed
largely of fibrous connective tissue, and its function is basically to
support and protect the vessels.

Major Arteries of the Systemic Circulation

The major branches of the aorta and the organs they serve are listed next in
sequence from the heart.

Arterial Branches of the Ascending Aorta

The aorta springs upward from the left ventricle of heart as the ascending aorta.

 Coronary arteries. The only branches of the ascending aorta are the
right and left coronary arteries, which serve the heart.

Arterial Branches of the Aortic Arch

The aorta arches to the left as the aortic arch.

 Brachiocephalic trunk. The brachiocephalic trunk, the first branch off

the aortic arch, splits into the right common carotid
artery and right subclavian artery.
 Left common carotid artery. The left common carotid artery is the
second branch off the aortic arch and it divides, forming the left
internal carotid, which serves the brain, and the left external
carotid, which serves the skin and muscles of the head and neck.
 Left subclavian artery. The third branch of the aortic arch, the left
subclavian artery, gives off an important branch- the vertebral
artery, which serves part of the brain.
 Axillary artery. In the axilla, the subclavian artery becomes the
axillary artery.
 Brachial artery. the subclavian artery continues into the arm as the
brachial artery, which supplies the arm.
 Radial and ulnar arteries. At the elbow, the brachial artery splits to
form the radial and ulnar arteries, which serve the forearm.

Arterial Branches of the Thoracic Aorta

The aorta plunges downward through the thorax, following the spine as the
thoracic aorta.

 Intercostal arteries. Ten pairs of intercostal arteries supply the

muscles of the thorax wall.

Arterial Branches of the Abdominal Aorta

Finally, the aorta passes through the diaphragm into the abdominopelvic cavity,
where it becomes the abdominal aorta.
  Celiac trunk. The celiac trunk is the first branch of the abdominal
aorta and has three branches: the left gastric artery supplies
the stomach; the splenic artery supplies the spleen, and
the common hepatic artery supplies the liver.
 Superior mesenteric artery. The unpaired superior mesenteric
artery supplies most of the small intestine and the first half of the
large intestine or colon.
 Renal arteries. The renal arteries serve the kidneys.
 Gonadal arteries. The gonadal arteries supply the gonads, and they
are called ovarian arteries in females while in males they
are testicular arteries.
 Lumbar arteries. The lumbar arteries are several pairs of arteries
serving the heavy muscles of the abdomen and trunk walls.
 Inferior mesenteric artery. The inferior mesenteric artery is a small,
unpaired artery supplying the second half of the large intestine.
 Common iliac arteries. The common iliac arteries are the final
branches of the abdominal aorta.

Major Veins of the Systemic Circulation

Major veins converge on the venae cavae, which enter the right atrium of the
heart.
Veins Draining into the Superior Vena Cava

Veins draining into the superior vena cava are named in a distal-to-proximal
direction; that is, in the same direction the blood flows into the superior vena
cava.

 Radial and ulnar veins. The radial and ulnar veins are deep veins
draining the forearm; they unite to form the deep brachial vein,
which drains the arm and empties into the axillary vein in the axillary
region.
 Cephalic vein. The cephalic vein provides for the superficial drainage
of the lateral aspect of the arm and empties into the axillary vein.
 Basilic vein. The basilic vein is a superficial vein that drains the
medial aspect of the arm and empties into the brachial
vein proximally.
 Median cubital vein. The basilic and cephalic veins are joined at the
anterior aspect of the elbow by the median cubital vein, often chosen
as the site for blood removal for the purpose of blood testing.
 Subclavian vein. The subclavian vein receives venous blood from the
arm through the axillary vein and from the skin and muscles of the
head through the external jugular vein.
  Vertebral vein. The vertebral vein drains the posterior part of the
head.
 Internal jugular vein. The internal jugular vein drains the
dural sinuses of the brain.
 Brachiocephalic veins. The right and left brachiocephalic veins are
large veins that receive venous drainage from the subclavian,
vertebral, and internal jugular veins on their respective sides.
 Azygos vein. The azygos vein is a single vein that drains the thorax
and enters the superior vena cava just before it joins the heart.

Veins Draining into the Inferior Vena Cava

The inferior vena cava, which is much longer than the superior vena cava,
returns blood to the heart from all body regions below the diaphragm.

 Tibial veins. The anterior and posterior tibial veins and the fibular
vein drain the leg; the posterior tibial veins becomes the popliteal
vein at the knee and then the femoral vein in the thigh; the femoral
vein becomes the external iliac vein as it enters the pelvis.
 Great saphenous veins. The great saphenous veins are the longest
veins in the body; they begin at the dorsal venous arch in the foot
and travel up the medial aspect of the leg to empty into the femoral
vein in the thigh.
 Common iliac vein. Each common iliac vein is formed by the union of
the external iliac vein and the internal iliac vein which drains the pelvis.
 Gonadal vein. The right gonadal vein drains the right ovary in females
and the right testicles in males; the left gonadal veins empties into the
left renal veins superiorly.
 Renal veins. The right and left renal veins drain the kidneys.
 Hepatic portal vein. The hepatic portal vein is a single vein that
drains the digestive tract organs and carries this blood through
the liver before it enters the systemic circulation.
 Hepatic veins. The hepatic veins drain the liver.
 Physiology of the Heart

As the heart beats or contracts, the blood makes continuous round trips- into
and out of the heart, through the rest of the body, and then back to the heart-
only to be sent out again.

Intrinsic Conduction System of the Heart

The spontaneous contractions of the cardiac muscle cells occurs in a regular and
continuous way, giving rhythm to the heart.

 Cardiac muscle cells. Cardiac muscle cells can and do contract

spontaneously and independently, even if all nervous connections are
severed.
 Rhythms. Although cardiac muscles can beat independently, the
muscle cells in the different areas of the heart have different rhythms.
 Intrinsic conduction system. The intrinsic conduction system, or
the nodal system, that is built into the heart tissue sets the basic
rhythm.
 Composition. The intrinsic conduction system is composed of a special
tissue found nowhere else in the body; it is much like a cross between
a muscle and nervous tissue.
 Function. This system causes heart muscle depolarization in only one
direction- from the atria to the ventricles; it enforces a contraction rate
of approximately 75 beats per minute on the heart, thus the heart
beats as a coordinated unit.
 Sinoatrial (SA) node. The SA node has the highest rate of
depolarization in the whole system, so it can start the beat and set
the pace for the whole heart; thus the term “pacemaker“.
 Atrial contraction. From the SA node, the impulse spread through
the atria to the AV node, and then the atria contract.
  Ventricular contraction. It then passes through the AV bundle, the
bundle branches, and the Purkinje fibers, resulting in
a “wringing” contraction of the ventricles that begins at the heart
apex and moves toward the atria.
 Ejection. This contraction effectively ejects blood superiorly into the
large arteries leaving the heart.

The Pathway of the Conduction System

The conduction system occurs systematically through:

 SA node. The depolarization wave is initiated by the sinoatrial node.

 Atrial myocardium. The wave then successively passes through the
atrial myocardium.
 Atrioventricular node. The depolarization wave then spreads to the
AV node, and then the atria contract.
 AV bundle. It then passes rapidly through the AV bundle.
 Bundle branches and Purkinje fibers. The wave then continues on
through the right and left bundle branches, and then to the Purkinje
fibers in the ventricular walls, resulting in a contraction that ejects
blood, leaving the heart.

Cardiac Cycle and Heart Sounds

In a healthy heart, the atria contract simultaneously, then, as they start to

relax, contraction of the ventricles begin.

 Systole. Systole means heart contraction.

 Diastole. Diastole means heart relaxation.
 Cardiac cycle. The term cardiac cycle refers to the events of one
complete heart beat, during which both atria and ventricles contract
and then relax.
  Length. The average heart beats approximately 75 times per minute,
so the length of the cardiac cycle is normally about 0.8 second.
 Mid-to-late diastole. The cycle starts with the heart in
complete relaxation; the pressure in the heart is low, and blood is
flowing passively into and through the atria into the ventricles from the
pulmonary and systemic circulations; the semilunar valves are closed,
and the AV valves are open; then the atria contract and force the blood
remaining in their chambers into the ventricles.
 Ventricular systole. Shortly after, the
ventricular contraction begins, and the pressure within the ventricles
increases rapidly, closing the AV valves; when the intraventricular
pressure is higher than the pressure in the large arteries leaving the
heart, the semilunar valves are forced open, and blood rushes through
them out of the ventricles; the atria are relaxed, and their chambers
are again filling with blood.
 Early diastole. At the end of systole, the ventricles relax, the
semilunar valves snap shut, and for a moment the ventricles are
completely closed chambers; the intraventricular pressure drops and
the AV valves are forced open; the ventricles again
begin refilling rapidly with blood, completing the cycle.
 First heart sound. The first heart sound, “lub”, is caused by the
closing of the AV valves.
 Second heart sound. The second heart sound, “dub”, occurs when
the semilunar valves close at the end of systole.

Cardiac Output

Cardiac output is the amount of blood pumped out by each side of the heart in
one minute. It is the product of the heart rate and the stroke volume.

 Stroke volume. Stroke volume is the volume of blood pumped out by

a ventricle with each heartbeat.
  Regulation of stroke volume. According to Starling’s law of the
heart, the critical factor controlling stroke volume is how much the
cardiac muscle cells are stretched just before they contract; the more
they are stretched, the stronger the contraction will be; and anything
that increases the volume or speed of venous return also
increases strokevolume and force of contraction.
 Factors modifying basic heart rate.The most important external
influence on heart rate is the activity of the autonomic nervous
system, as well as physical factors(age, gender, exercise, and body
temperature).

Physiology of Circulation

A fairly good indication of the efficiency of a person’s circulatory system can be

obtained by taking arterial blood and blood pressure measurements.

Cardiovascular Vital Signs

Arterial pulse pressure and blood pressure measurements, along with those of
respiratory rate and body temperature, are referred to collectively as vital signs
in clinical settings.

 Arterial pulse. The alternating expansion and recoil of an artery that

occurs with each beat of the left ventricle creates a pressure wave-a
pulse- that travels through the entire arterial system.
 Normal pulse rate. Normally, the pulse rate (pressure surges per
minute) equals the heart rate, so the pulse averages 70 to 76 beats
per minute in a normal resting person.
 Pressure points. There are several clinically important arterial pulse
points, and these are the same points that are compressed to stop
blood flow into distal tissues during hemorrhage, referred to as
pressure points.
 Blood pressure. Blood pressure is the pressure the blood exerts
against the inner walls of the blood vessels, and it is the force that
keeps blood circulating continuously even between heartbeats.
 Blood pressure gradient. The pressure is highest in the large
arteries and continues to drop throughout the systemic and pulmonary
pathways, reaching either zero or negative pressure at the venae
cavae.
 Measuring blood pressure. Because the heart alternately contracts
and relaxes, the off-and-on flow of the blood into the arteries causes
the blood pressure to rise and fall during each beat, thus, two arterial
blood pressure measurements are usually made: systolic
pressure (the pressure in the arteries at the peak of ventricular
contraction) and diastolic pressure (the pressure when the ventricles
are relaxing).
 Peripheral resistance. Peripheral resistance is the amount of friction
the blood encounters as it flows through the blood vessels.
 Neural factors. The parasympathetic division of the
autonomic nervous system has little or no effect on blood pressure, but
the sympathetic division has the major action of
causing vasoconstriction or narrowing of the blood vessels, which
increases blood pressure.
 Renal factors. The kidneys play a major role in regulating arterial
blood pressure by altering blood volume, so when blood pressure
increases beyond normal, the kidneys allow more water to leave the
body in the urine, then blood volume decreases which in turn
decreases blood pressure.
 Temperature. In general, cold has a vasoconstricting effect,
while heat has a vasodilating effect.
 Chemicals. Epinephrine increases both heart rate and blood
pressure; nicotineincreases blood pressure by causing
vasoconstriction; alcohol and histamine cause vasodilation and
decreased blood pressure.
  Diet. Although medical opinions tend to change and are at odds from
time to time, it is generally believed that a diet low in salt, saturated
fats, and cholesterol help to prevent hypertension, or high blood
pressure.

Blood Circulation Through the Heart

The right and left sides of the heart work together in achieving a smooth flowing
blood circulation.

 Entrance to the heart. Blood enters the heart through two large
veins, the inferior and superior vena cava, emptying oxygen-poor
blood from the body into the right atrium of the heart.
 Atrial contraction. As the atrium contracts, blood flows from the right
atrium to the right ventricle through the open tricuspid valve.
 Closure of the tricuspid valve. When the ventricle is full, the
tricuspid valve shuts to prevent blood from flowing backward into the
atria while the ventricle contracts.
 Ventricle contraction. As the ventricle contracts, blood leaves the
heart through the pulmonic valve, into the pulmonary artery and to
the lungs where it is oxygenated.
 Oxygen-rich blood circulates. The pulmonary vein empties oxygen-
rich blood from the lungs into the left atrium of the heart.
 Opening of the mitral valve. As the atrium contracts, blood flows
from your left atrium into your left ventricle through the open mitral
valve.
 Prevention of backflow. When the ventricle is full, the mitral valve
shuts. This prevents blood from flowing backward into the atrium while
the ventricle contracts.
 Blood flow to systemic circulation. As the ventricle contracts, blood
leaves the heart through the aortic valve, into the aorta and to the
body.
Capillary Exchange of Gases and Nutrients

Substances tend to move to and from the body cells according to their
concentration gradients.

 Capillary network. Capillaries form an intricate network among the

body’s cells such that no substance has to diffuse very far to enter or
leave a cell.
 Routes. Basically, substances leaving or entering the blood may take
one of four routes across the plasma membranes of the single layer of
endothelial cells forming the capillary wall.
 Lipid-soluble substances. As with all cells, substances can
diffuse directly through their plasma membranes if the substances are
lipid-soluble.
 Lipid-insoluble substances. Certain lipid-insoluble substances may
enter or leave the blood and/or pass through the plasma membranes
within vesicles, that is, by endocytosis or exocytosis.
 Intercellular clefts. Limited passage of fluid and small solutes is
allowed by intercellular clefts (gaps or areas of plasma membrane not
joined by tight junctions), so most of our capillaries have intercellular
clefts.
 Fenestrated capillaries. Very free passage of small solutes and fluid
is allowed by fenestrated capillaries, and these unique capillaries are
found where absorption is a priority or where filtration occurs.