Review A &P View suggested videos in guide

Review Core concepts, structure, circulation,

Test your knowledge:

Label heart diagram
Label sequence of cardiac cycle
Take video quiz listed in weekly guide

Core Concepts

Heart = pump

Arteries and veins = circulation

(plumbing)

Capillaries = ____ & ______exchange

Pump with electrical system

 Two stages R & L

 Flow through ______ & _______
 Sequential: ________squeeze blood into
ventricles
 L Atrium provides _____%of cardiac
output
 Coronary arteries = heart’s blood supply

Four heart chambers

Name four chambers:
_________ receive blood from systemic or
pulmonary venous beds, less myocardium,
low pressure
__________ L thicker than R, mean
pressure 15 vs 92
____________ divides ventricles, no blood
flow between RV and LV

R heart: receives __________blood from the body and tissues and then pumps it to the lungs to
pick up _________and dispel carbon dioxide
L heart: receives oxygenated blood returning from the lungs and pumps this blood throughout the
body to supply oxygen and nutrients to the body tissues

A & P Cardiac Summer ‘14 1


Two circulatory systems:
Pulmonary Circulation
 Blood from R heart to lungs
 Arteries: desaturated hemoglobin
 Low or High Pressure? ________
What have the tissues taken from this
blood leaving it
desaturated?_________________
A & P Cardiac Summer ‘14
Cardiac Flow
Extremely simple:
Body to ________to lungs to _____heart to the
Body
More detail:
Body> then by way of __________, Coronary
Sinus to Right Atrium (RA), To Right Ventricle
(RV), then via Pulmonary Arteries, to Left Atrium
(LA) via pulmonary veins to Left Ventricle to body
via Aorta
Detailed Cardiac blood flow..
Body> then by way of ________, Coronary Sinus
to Right Atrium (RA), To RV through ______
Valve, then via Pulmonary Arteries, to LA via
________Valve via pulmonary veins to LV through
MiTral Valve to body via ________ to Aorta
Two circulatory systems:
Systemic circuit:
 Blood from Right or Left heart to body?________
 Saturated hemoglobin
 High pressure or Low Pressure? __________
This blood is Saturated with?____________
*Position of the heart : Where would you
place your stethoscope to listen to heart
sounds?
Investigate/identify four standard points
1
2.
3
4
It may be easier for you to see Flow
in this diagram…. Either way,
become familiar with it
2
Heart Wall Four Heart Valves Great Vessels
___________ membranous sac RA – RV = _______ valve Superior and inferior vena cava
covers heart RV – PA (pulm artery) = Pulmonary artery
__________ main muscle of ________ valve Pulmonary vein
heart LA – LV = ________valve Aorta
_________lines inside of heart LV – Aorta = _______valve
wall, arteries & veins

Identify the layers of the pericardium and heart wall: (there are three for each)
Pericardium _________ _________ _________ Myocardium_______ _________ ____________

Positions of valves----Valves open and close in response to pressure differences

Trabeculae carnae----Note papillary muscles, chordae tendinae (heart strings): keep valves from prolapsing (purpose of
valve = 1 way flow)

Coronary Arteries Describe collateral

 Heart has its own blood vessels circulation
 Major arterial branches, left and right
 Left: Supplies mostly the LV
L main, L anterior descending (supplies
septum and some RV)
 Circumflex (LA and lateral wall of LV)
 Right: mostly posterior heart

Myocardial O2 Demand Cardiac Oxygen Extraction

 MVO2 – myocardial oxygen demand
 with wall stress (high blood pressure) 
with heart rate
 70-75% of oxygen drawn from hemoglobin
from coronary capillaries
 Increasing coronary blood flow is only
means of increasing O2 supply
 Heart extracts maximum amount of oxygen from hemoglobin
 Only way to increase cardiac tissue oxygenation is through
dilation
 Coronary veins have abnormally low saturation compared to
rest of venous return

A & P Cardiac Summer ‘14 3

Cardiac Electrophysiology The Normal Artery: Three Layers
 Electrical impulse cause myocardial tissue *Tunica _____________
fibers to shorten or lengthen? (systole) •Tunica _____________
 Cardiac action potential – impulse can be •Tunica _____________
passed to other myocardial cells
 After short period, myocardial fibers relax
this period is called___________
 Myocardial cells have ability to self fire and
do not need direct connection to nervous
system

Conduction Pathway
Sinoartial (SA) node - atrium
Atrioventricular (AV) node - septum
Bundle of his and bundle branches –
ventricles
Purkinje fibers – rest of myocardium
each node is capable of firing on own
without stimulation

*SA node – AV node conduction

contracts _________, provides “________kick” (_____% of cardiac output)

AV node: Septal and apical myocardial contraction

Action Potiential Electrocardiogram (ECG/EKG)

 Polarization: ion shifts across cell Electrocardiogram (ECG/EKG)
membranes  P -> QRS -> T waves
 P wave = _________depolarization
 Creates voltage difference -  QRS = ventricles are ___________
60millivolts  T = Ventricles _________________
 Depolarization shifts ____ into cells &
______Out
 Threshold for doing this can be
altered by decreased serum K
 Refractory period during
repolarization

Preload and afterload

Definition Factors
The intrinsic ability of the heart to Sympathetic stimulation
Parasympathetic stimulation
increase the extent and force of
Drugs
muscle fiber shortening independent Oxygen
of preload or afterload Heart rate
Ionic environment
Cardiovascular disease

A & P Cardiac Summer ‘14 4

Contractility
 Cardiac muscle increases strength of
contraction when stretched
 End-diastolic volume = blood in ventricles
just before systole occurs
 Preload = filling pressure = volume of blood
in heart
 Think stretching a rubber band and how far
it will travel when released
 Preload Filling pressure
R/T blood volume

 Afterload Resistance to LV systole Factors r/t afterload

 R/T systemic vascular resistance  Outflow obstructions (AS, PS)
 SVR=arterial vasoconstriction  __________resistance
 Î SVR = ÎÎ cardiac workload &  Sympathetic tone of arterial system
 decrease in cardiac output  Blood viscosity
 Aortic insufficiency
Cardiac Output=_______X _______
 Stroke volume – __________________
 Ejection fraction – blood ejected during
Systole, normal 60-75%
 Heart rate – beats/min
 SVR – resistance to flow
 Filing pressures – amount of blood
 CO = blood volume/min ~ 5L/min normal

Antiduirectic hormone
Rennin angiotensin system can increase or decrease blood volume & subsequently blood
pressure?________________
Natriuretic peptides,
adrenonmedullin
Insulin

A & P Cardiac Summer ‘14 5

Neural Regulation of BP
Sympathetic and parasympathetic responses
Total peripheral resistance – mostly arteriole
diameter
Hypothalmic control
Body temp high = vasodilation of arteries and
veins in skin
Body temp low = shunting of blood away
from skin
Baroreceptors in aorta and carotid sinus
Send info to medulla
Effects:
Slow heart rate
Decrease contractility by inhibiting
sympathetic
discharge
Arteriolar and venous dilation (same)
Decrease CO and SVR

Hormonal Regualtion of BP
Renin (kidneys)

Angiotensin I

Angiotensin II

Angiotensin Converting Enzyme 
Aldosterone
Powerful vasoconstrictor = increase
SVR
Reabsorbtion of sodium in kidneys =
increase circulatory volume

Central sympathetic
outflow directed toward
the kidneys, heart, and
peripheral vasculature,
via efferent pathways
leads to volume
retention, increased
cardiac output, and
systemic
vasoconstriction, the
harbingers of
persistently elevated
blood pressure. BNP
indicates brain
natriuretic peptide;
RAAS, renin–
angiotensin–
aldosterone system;
and SNS, sympathetic
nervous system.

A & P Cardiac Summer ‘14 6

An electrocardiogram (EKG, ECG) is a test that measures the electrical signals
that control heart rhythm. The test measures how electrical impulses move
through the heart muscle as it contracts and relaxes.
The electrocardiogram translates the heart's electrical activity into line tracings on
paper. The spikes and dips in the line tracings are called waves.
The ________is a record of the electrical activity through the upper heart
chambers (atria).
The _____ complex is a record of the movement of electrical impulses through
the lower heart chambers (ventricles).
The __ segment shows when the ventricle is contracting but no electricity is
flowing through it. The ST segment usually appears as a straight, level line
between the QRS complex and the T wave.
The T wave shows when the lower heart chambers are resetting electrically and
preparing for their next muscle contraction.

Determining Heart rate:

First: Find a specific R wave that peaks on a heavy black line (our "start" line)
Count off the next three lines after
"300, 150, 100" as "75, 60, 50."

Where the next R wave falls,

determines the rate. It's that simple!

A & P Cardiac Summer ‘14 7

What is the Heart rate here? ________

ECG of atrial fibrillation (top) and normal

sinus rhythm (bottom). The purple arrow
indicates a P wave, which is lost in atrial
fibrillation.

A & P Cardiac Summer ‘14 8