HEART SEROUS PERICARIUM – the thin inner layer of the

pericardium
The heart is a muscular organ that is essential for life because
it pumps blood through the body.
The heart is actually 2 pumps in one.
The right side of the heart pumps blood to the lungs and back
to the left side of the heart through the vessels of the
PULMONARY CIRCULATION
the left side of the heart pumps blood to all the other tissues of
the body and back to the right side of the heart through the
vessels of the SYSTEMIC CIRCULATION
FUNCTION OF THE HEART
1. Generating blood pressure
2. Routing blood
3. Ensuring one-way blood flow
4. Regulating blood supply
SIZE, FORM AND LOACTION OF THE HEART
The heart is located in the thoracic cavity between the lungs
MEDIASTINUM CONTENTS – heart, trachea, esophagus,
associated structures
The adult heart has a shape of a BLUNT CONE and is slightly
larger than a closed fist
The blunt, rounded point or the cone is the APEX
The larger, flat portion at the opposite end of the cone is the
BASE
APEX the most inferior part of the heart and it is directed
anteriorly and to the left
POINT OF MAXIMAL IMPULSE-5th intercostal space left mid
clavicular line
The base is superior and slight posterior
The most superior portion of the base is deep to the 2nd
intercostal space
ANATOMY OF THE HEART
PERICARDIUM
The heart is surrounded by the space called PERICARDIAL
CAVITY, formed by the PERICARDIUM or PERICARDIAL
SAC, which is double-layered closed sac that surrounds the
heart and anchors it within the mediastinum
FIBROUS PERICARCIUM – the tough, fibrous connective
tissue layer of the pericardium
PARIETAL PERICARIUM – the portion of the serous
pericardium lining the fibrous pericardium
VISCERAL PERICARIUM or EPICARDIUM – the portion
covering the heart surface
PERICARDIAL FLUID – located in the pericardial cavity, helps
reduce friction as the heart moves within the pericardial sac
EXTERNAL ANATOMY
The right and left ATRIA are located at the base of the heart
The right and left VENTRICLES extend from the base of the
heart towards the apex
CORONARY SULCUS extends around the heart, separating
the atria from the ventricles
SIX LARGE VEINS CARRY BLOOD TO THE HEART
1. Superior Vena Cava
2. Inferior Vena Cava
3. Pulmonary Veins
4. Pulmonary Trunk
5. Aorta
6. Pulmonary Arteries
BLOOD SUPPLY TO THE HEART
CORONARY ARTERIES
Supply blood to the wall of the heart
Two coronary arteries originate from the base of the aorta, just
above the aortic semilunar valves
LEFT CORONARY ARTERY – supply much of the anterior
wall of the heart and most of the left ventricle
RIGHT CORONARY ARTERY – supply most of the right
ventricle
*Both right and left coronary arteries lie within the
coronary sulcus
In a resting person, blood flowing through the coronary arteries
of the heart gives up approximately 70% of its oxygen. In
skeletal muscle gives up only 25% of its oxygen
The percentage of oxygen the blood releases to skeletal
muscle increases to 70% or more during exercise
The percentage of oxygen the blood releases to cardiac
muscle cannot increase substantially during exercise, it is
dependent on an increased rate of blood flow through the
coronary arteries above its resting level to provide an adequate
oxygen supply during exercise
CARDIAC VEINS
Drains blood from the cardiac muscle
Nearly parallel to the coronary arteries and most blood from
cardiac muscle to the CORONARY SINUS, a large vein
located within the coronary sulcus
*Blood flows from the coronary sinus to the right
atrium
HEART CHAMBERS AND INTERNAL ANATOMY
the heart is a muscular pump consisting of 4 chambers: the 2
ATRIA & the 2 VENTRICLES
Right and Left atria of the heart receives blood from veins
The atria function primarily as reservoirs, where blood
returning from veins collects before it enters the ventricles
Contraction of the atria forces blood into the ventricles to
complete VENTRICULAR FILLING
RIGHT ATRIUM: 2 openings for the superior & inferior vena
cava; in addition, a smaller coronary sinus enters the right
atrium from the wall of the heart
LEFT ATRIUM: 4 openings for the 4 pulmonary veins from the
lungs
*The 2 atria are separated from each other by a
partition consisting of cardiac muscle called INTERATRIAL
SEPTUM
RIGHT AND LEFT VENTRICLES
and prevent the valves from opening into the atria by pulling on
the chordae tendinae.
The aorta and the pulmonary trunk possess AOTIC and
PULMONIC SEMILUNAR VALVES, each valve consists of 3
pocketlike semilunar cusps
When the ventricles contract blood flowing out of the ventricles
pushes against each valve forcing the cusps to open
When the ventricles relax, blood flows back from the aorta or
pulmonary trunk toward the ventricle, it enters the pockets of
the cusps closing the vessels
*A plate of fibrous connective tissue sometimes called
SKELETON OF THE HEART, consisting mainly of fibrous rings
around the AV & SEMILUNAR VALVES provides a solids
support for the valve & site of attachment for the cardiac
muscle
ROUTE OF BLOOD FLOW THROUGH THE HEART
Superior Vena Cava and Inferior Vena Cave
Right Atrium
(Tricuspid Valve)
Right Ventricle
(Pulmonic Valve)
Pulmonary Artery
Lungs

The ventricles of the heart are its major pumping chambers

Pulmonary Vein
They eject blood into the arteries and force it to flow through
the circulatory system
The right ventricle opens into the pulmonary trunk and left Left Atrium
ventricle open into the aorta
(Bicuspid/Mitral Valve)
The 2 ventricles are separated from each other by the
muscular INTERVENTRIULAR SEPTUM Left Ventricle

The wall of the LEFT VENTRICLE is thicker than the wall of (Aortic Valve)
the right ventricle because it generates a greater pressure than Aorta
the right ventricle
HISTOLOGY OF THE HEART
Each ventricles contains cone shaped muscular pillars called
PAPILLARY MUSCLES, there muscles are attached by a thin, The heart wall is composed of 3 layers
strong connective tissue strings called CHORDAE TENDINAE
1. EPICARDIUM
to the free margins of the cusps of atrioventricular valves.
2. MYOCARDIUM
When the ventricles contract, he papillary muscles contract
3. ENDOCARDIUM
EPICARDIUM or VISCERAL PERICARDIUM – a thin serous
membrane forming the smooth outer surface of the heart
- Consist of simple squamous epithelium overlying a
layer of loose connective tissue & fat
MYOCARDIUM – the thick middle layer of the heart; composed
of cardiac muscle cells and is responsible for the ability of the
heart to contract
ENDOCARDIUM – smooth inner surface of the heart chamber;
consists of simple squamous epithelium over a layer of
connective tissue; allows blood to move easily through the
heart
*Each heart valve is formed by a fold of endocardium
with connective tissue between the 2 layers
CARDIAC MUSCLE
Elongated, branching cells that contain one, or occasionally
two, centrally located nuclei
Also contains actin and myosin myofilaments organized to form
sarcomeres, which are joined end to end to form myofilaments
Striations are less regularly arranged and less numerous than
is the case of skeletal muscle
*ATP provides the energy for cardiac muscle
contraction; unlike skeletal muscle, cardiac muscle cannot
develop a significant oxygen debt
Cardiac muscle cells are organized into spiral bundle or sheets
The cells are bound to end to end and laterally to adjacent
cells by specialized cell to cell contact called INTERCALATED
DISK
Specialized cell membrane structures in the intercalated disks
called GAP JUNCTIONS, allowing action potentials to pass
easily from one cell to adjacent cells
ELECTRICAL ACTIVITY OF THE HEART
Action potential in skeletal muscle take about less than 2
milliseconds to complete, action potential in cardiac muscle
take approximately 200-500 milliseconds to complete
Not only does the action potential take longer, but the rate of
conduction of action potential in cardiac muscle is slower than
in skeletal muscle cells and neurons
The prolonged action potential and refractory period allow
cardiac muscle to contract and almost complete relaxation to
take place before another action potential can be produced
*Because of the plateau phase cardiac muscle has a
longer action potential and refractory period
PACE MAKER OF THE HEART
SA node located in the superior wall of the right atrium and
initiates the contraction of the heart
Produces action potentials at a faster rate than other areas of
the heart
Acts as a stimulus to adjacent areas of the heart
Has a larger number of voltage gated calcium channels, as
they open calcium begin to diffuse into the cell and cause
depolarization
*Drugs called CALCIUM CHANNEL BLOCKERS are
used to treat tachycardia and arrhythmia because the block
calcium channels and slow the rate of action potential
production
CONDUCTION SYSTEM OF THE HEART
1. SA node
2. AV node
3. AV Bundle of his
4. Purkinjie Fibers
ELECTROCARDIOGRAM
P-wave – Atrial depolarization
QRS Complex – Ventricular depolarization
T-wave – Ventricular Repolarization
CARDIAC CYCLE
The heart can be viewed as 2 separate pumps represented by
the right and left halves of the heart
Each pump consists of primer pump (ATRIUM), and a power
pump (VENTRICLES)
The atria act as primer pumps because they complete the
filling of the ventricles with blood and the ventricles acts as
power pump because they produce the major force that causes
blood to flow through the pulmonary and systemic circulations
The term CARDIAC CYCLE refers to the repetitive pumping
process that begins with the onset of cardiac muscle
contraction and ends with the beginning of the next contraction
ATRIAL SYSTOLE – refers to the contraction of the two atria
VENTRICULAR SYSTOLE – refers to the contraction of the
ventricles
ATRIAL DIASTOLE – refers to the relaxation or the two atria
VENTRICULAR DIASTOLE – refers to the relaxation of the two
ventricles
 *When the terms systole & diastole are used without
reference to the atria or ventricles, they refer to the ventricular
contraction or relaxation.
THE MAJOR EVENTS OF CARDIAC CYCLE
1. As systole begins, contraction of the ventricles
pushes blood toward the atria, causing the AV valves
to close, the semilunar valves are forced to open, and
blood is ejected into the pulmonary trunk and aorta
2. At the beginning of ventricular diastole, the pressure
in the ventricles decreases. The semilunar valves
close and prevent blood from flowing back into the
ventricles. The pressure continues to decline in the
ventricles until finally the AV valves open and blood
flows directly from the atria into the relaxed ventricles
3. At the end of ventricular diastole, the atria contract
and relax. Atrial systole forces additional blood to flow
into the ventricles to complete their filling. The
semilunar valves remain closed
HEART RATE – the number of times the heart contracts each
minute
*Under resting conditions the heart rate is
approximately 72bpm and the stroke volume is 70 ml/beat;
cardiac output is slightly more than 5l/min
INTRINSIC REGULATION OF THE HEART
Refers to mechanisms contained within the heart itself
The force of contraction produced by cardiac muscle is related
to the degree of stretch of cardiac muscle fibers
The amount of blood in the ventricles at the end of ventricular
diastole determines the degree to which cardiac muscle fibers
are stretched
VENOUS RETURN – the amount of blood that returns to the
heart

HEART SOUNDS PRELOAD – the degree to which the ventricular walls are
stretched at the end of diastole
Two main heart sounds
AFTERLOAD – refers to pressure against which the ventricles
1. First heart sound – represented by the syllable LUBB; must pump blood
has lower pitch; occur at the beginning of ventricular
systole and results from closure of the AV valves *STARLING’S LAW OF THE HEART – increase
2. Second heart sound – represented by DUPP; occurs venous return=increase preload=increase cardiac output
at the beginning of ventricular diastole and results
EXTRINSIC REGULATION OF THE HEART
from closure of the semilunar valves
Refers to mechanism external to the heart such as either
*The valves usually do not make sounds when they open
hormonal or nervous regulation
Clinically, ventricular systole occurs between the 1st and 2nd
SYMPATHETIC – causes increase in heart rate and stroke
heart sound. Ventricular diastole occurs between the 2nd heart
volume
sound and the 1st heart sound of the next beat
PARASYMPATHETIC – causes heart rate decrease
MURMURS – abnormal heart sound usually due to
BARORECEPTORS – stretched receptors that monitors blood
a. INCOMPETENT VALVLE
pressure in the aorta and in the wall of the internal carotid
b. STENOSIS or NARROWED VALVE
arteries
INCOMPETENT VALVE – fails to close tightly and blood leaks
Within the medulla oblongata is a CARDIOREGULATORY
through the valve when it closed; makes a swishing sound
CENTER which receives and integrates action potentials from
immediately after the closure of the valve
the baroreceptors
STENOSIS or NARROWED VALVE – swishing sound
*Excitement, anxiety or anger can affect the
precedes closure of the stenosis valve
cardioregulatory center, resulting in increased sympathetic
REGULATION OF THE HEART FUNCTION stimulation of the heart and increased cardiac output

CARDIAC OUTPUT (CO) – the volume of blood pumped by *Depression increases the parasympathetic causing a
either ventricle of the heart each minute; strove volume (SV) x slight reduction in cardiac output
heart rate (HR)
STROKE VOLUME – volume of blood pumped by the ventricle
each time the heart contracts