Unit 5 Heart

Chapter
20
The Heart
PowerPoint Lecture Slides

prepared by Jason LaPres
Lone Star College - North Harris
Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
Copyright 2009 Pearson Education, Inc.,

publishing as Pearson Benjamin Cummings
Introduction to Cardiovascular System

The Pulmonary Circuit
Carries blood to and from gas exchange surfaces of
lungs
The Systemic Circuit

Carries blood to and from the body
Blood alternates between pulmonary circuit and

systemic circuit

Three Types of Blood Vessels
Arteries
Carry blood away from heart
Veins
Carry blood to heart
Capillaries
Networks between arteries and veins

Capillaries
Also called exchange vessels
Exchange materials between blood and
tissues
Materials include dissolved gases, nutrients,
wastes
Figure 201 An Overview of the Cardiovascular System.


Four Chambers of the Heart
Right atrium
Collects blood from systemic circuit
Right ventricle
Pumps blood to pulmonary circuit
Left atrium
Collects blood from pulmonary circuit
Left ventricle
Pumps blood to systemic circuit
Anatomy of the Heart

Great veins and arteries at the base
Pointed tip is apex
Surrounded by pericardial sac
Sits between two pleural cavities in the
mediastinum
Figure 202c
Figure 202a The Location of the Heart in the Thoracic Cavity


The Pericardium
Double lining of the pericardial cavity
Parietal pericardium
Outer layer
Forms inner layer of pericardial sac
Visceral pericardium
Inner layer of pericardium
Figure 202c
Figure 202b The Location of the Heart in the Thoracic Cavity

Figure 20c2 The Location of the Heart in the Thoracic Cavity


Superficial Anatomy of the Heart
Atria
Thin-walled
Expandable outer auricle (atrial appendage)
Sulci
Coronary sulcus: divides atria and ventricles
Anterior interventricular sulcus and posterior
interventricular sulcus:
separate left and right ventricles
contain blood vessels of cardiac muscle
Figure 203a The Superficial Anatomy of the Heart

Figure 203c The Superficial Anatomy of the Heart


The Heart Wall
Epicardium (outer layer)
Visceral pericardium
Covers the heart
Myocardium (middle layer)

Muscular wall of the heart
Concentric layers of cardiac muscle tissue
Atrial myocardium wraps around great vessels
Two divisions of ventricular myocardium
Endocardium (inner layer)

Simple squamous epithelium
Figure 204 The Heart Wall

Cardiac Muscle Tissue
Intercalated discs
Interconnect cardiac muscle cells
Secured by desmosomes
Linked by gap junctions
Convey force of contraction
Propagate action potentials
Figure 205 Cardiac Muscle Cells

Figure 205 Cardiac Muscle Cells


Characteristics of Cardiac Muscle Cells
Small size
Single, central nucleus
Branching interconnections between cells
Intercalated discs

Internal Anatomy and Organization
Interatrial septum: separates atria
Interventricular septum: separates ventricles
Atrioventricular (AV) valves
Connect right atrium to right ventricle and left atrium to left
ventricle
The fibrous flaps that form bicuspid (2) and tricuspid (3)
valves
Permit blood flow in one direction: atria to ventricles

The Right Atrium
Superior vena cava
Receives blood from head, neck, upper limbs, and chest
Inferior vena cava

Receives blood from trunk, viscera, and lower limbs
Coronary sinus
Cardiac veins return blood to coronary sinus
Coronary sinus opens into right atrium

The Right Atrium
Foramen ovale
Before birth, is an opening through interatrial
septum
Connects the two atria
Seals off at birth, forming fossa ovalis
Figure 206a-b The Sectional Anatomy of the Heart.

Figure 206a-b The Sectional Anatomy of the Heart.


The Right Ventricle
Free edges attach to chordae tendineae
from papillary muscles of ventricle
Prevent valve from opening backward
Right atrioventricular (AV) Valve

Also called tricuspid valve
Opening from right atrium to right ventricle
Has three cusps

Prevents backflow

The Pulmonary Circuit
Conus arteriosus (superior end of right ventricle)
leads to pulmonary trunk
Pulmonary trunk divides into left and right
pulmonary arteries
Blood flows from right ventricle to pulmonary trunk
through pulmonary valve

Pulmonary valve has three semilunar cusps

The Left Atrium
Blood gathers into left and right pulmonary
veins
Pulmonary veins deliver to left atrium

Blood from left atrium passes to left ventricle
through left atrioventricular (AV) valve

A two-cusped bicuspid valve or mitral valve

The Left Ventricle
Holds same volume as right ventricle
Is larger; muscle is thicker and more powerful
Systemic circulation
Blood leaves left ventricle through aortic valve into
ascending aorta
Ascending aorta turns (aortic arch) and becomes
descending aorta

Structural Differences between the Left
and Right Ventricles
Right ventricle wall is thinner, develops less
pressure than left ventricle
Right ventricle is pouch-shaped, left ventricle
is round
Figure 207 Structural Differences between the Left and Right

Ventricles
Figure 207 Structural Differences between the Left and Right

Ventricles

The Heart Valves
Two pairs of one-way valves prevent backflow
during contraction
Atrioventricular (AV) valves
Between atria and ventricles
Blood pressure closes valve cusps during ventricular
contraction
Papillary muscles tense chordae tendineae: prevent valves
from swinging into atria
Figure 208

The Heart Valves
Semilunar valves
Pulmonary and aortic tricuspid valves
Prevent backflow from pulmonary trunk and aorta

into ventricles
Have no muscular support
Three cusps support like tripod
Figure 208
Figure 208a Valves of the Heart

Figure 208b Valves of the Heart


The Blood Supply to the Heart = Coronary
Circulation
Coronary arteries and cardiac veins
Supplies blood to muscle tissue of heart

The Coronary Arteries
Left and right
Originate at aortic sinuses
High blood pressure,
elastic rebound
forces blood through coronary arteries between
contractions

Two main branches of left coronary artery
Circumflex artery
Anterior interventricular artery
Arterial Anastomoses
Interconnect anterior and posterior
interventricular arteries
Stabilize blood supply to cardiac muscle
Figure 209a Coronary Circulation

Figure 2010 Coronary Circulation and Clinical Testing

The Conducting System

Heartbeat
A single contraction of the heart
The entire heart contracts in series
First the atria
Then the ventricles

Two Types of Cardiac Muscle Cells
Conducting system
Controls and coordinates heartbeat
Contractile cells/ Auto rhythmic cells

Produce contractions that propel blood
99 % of the cells in the heart
Circulatory System
Heart
Dual pump
Right and left sides of heart function as two
separate pumps
Chapter 9 Cardiac Physiology

Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Blood Flow Through and Pump Action of the Heart


The Cardiac Cycle
Begins with action potential at SA node
Transmitted through conducting system
Produces action potentials in cardiac muscle cells (contractile
cells)

Structures of the System
Sinoatrial (SA) node - wall of right atrium
Atrioventricular (AV) node - junction between
atria and ventricles

Bundle of His through the septum
Purkinje fibres branches from His to the

ventricle walls

Spread of Cardiac Excitation


Prepotential
Also called pacemaker potential
Resting potential of conducting cells
Gradually depolarizes toward threshold
SA node depolarizes first, establishing heart
rate
Figure 2012 The Conducting System of the Heart


Heart Rate
SA node generates 80100 action potentials
per minute
Parasympathetic stimulation slows heart rate
AV node generates 4060 action potentials
per minute

The Sinoatrial (SA) Node
In posterior wall of right atrium
Contains pacemaker cells
Connects to interartial pathway
& Connected to AV node by internodal
pathways
Begins atrial activation (Step 1)

Figure 2013 Impulse Conduction through the Heart


The Atrioventricular (AV) Node
In floor of right atrium
Receives impulse from SA node (Step 2)
Delays impulse (Step 3)
AV nodal delay
Ensures maximum filling of ventricle before
Atrial contraction begins

In order to complete ventricular filling



Bundle of His
In the septum
Carries impulse to left and right bundle
branches
Which conduct to Purkinje fibers (Step 4)
The signal is sent bottom then up so that the large

muscles of the ventricle contract & not just the top
half


Purkinje Fibers
Distribute impulse through ventricles (Step 5)
Atrial contraction is completed
Ventricular contraction begins
Which forces blood up into the arteries


Abnormal Pacemaker Function
Bradycardia: abnormally slow heart rate
Tachycardia: abnormally fast heart rate
Ectopic pacemaker
Abnormal cells
Generate high rate of action potentials
Bypass conducting system

Disrupt ventricular contractions
Electrocardiogram (ECG)
Record of overall spread of electrical activity through heart
Represents
Records part of electrical activity induced in body fluids by
cardiac impulse that reaches body surface
Not direct recording of actual electrical activity of heart
Records overall spread of activity throughout heart during

depolarization and repolarization
Not a recording of a single action potential in a single cell at a
single point in time
Comparisons in voltage detected by electrodes at two

different points on body surface, not the actual potential

Features of an ECG
P wave
Atria depolarize
QRS complex
Ventricles depolarize
T wave
Ventricles repolarize

Time Intervals Between ECG Waves
PR interval
From start of atrial depolarization
To start of QRS complex
QT interval
From ventricular depolarization
To ventricular repolarization
Figure 2014b An Electrocardiogram: An ECG Printout


Contractile Cells
Purkinje fibers distribute the stimulus to the
contractile cells, which make up most of the
muscle cells in the heart

Resting Potential
Of a ventricular cell: about 90 mV
Of an atrial cell: about 80 mV
Figure 2015 The Action Potential in Cardiac Muscle

Figure 2015 The Action Potential in Skeletal and Cardiac Muscle


Contractile Cells
Purkinje fibers distribute the stimulus to the
contractile cells, which make up most of the
muscle cells in the heart

Resting Potential
Of a ventricular cell: about 90 mV
Of an atrial cell: about 80 mV
Figure 2015 The Action Potential in Skeletal and Cardiac Muscle


Abnormal Pacemaker Function
Bradycardia: abnormally slow heart rate
Tachycardia: abnormally fast heart rate
Ectopic pacemaker
Abnormal cells
Generate high rate of action potentials
Bypass conducting system

Disrupt ventricular contractions

Electrocardiogram (ECG or EKG)
A recording of electrical events in the heart
Obtained by electrodes at specific body
locations
Abnormal patterns diagnose damage

Features of an ECG
P wave
Atria depolarize
QRS complex
Ventricles depolarize
T wave
Ventricles repolarize

Time Intervals Between ECG Waves
PR interval
From start of atrial depolarization
To start of QRS complex
QT interval
From ventricular depolarization
To ventricular repolarization
Figure 2014a An Electrocardiogram: Electrode Placement for

Recording a Standard ECG
Figure 2014b An Electrocardiogram: An ECG Printout


Refractory Period
Absolute refractory period
Long
Cardiac muscle cells cannot respond
Relative refractory period

Short
Response depends on degree of stimulus

Timing of Refractory Periods
Length of cardiac action potential in
ventricular cell
250300 msecs:
30 times longer than skeletal muscle fiber
long refractory period prevents summation and tetany

The Role of Calcium Ions in Cardiac
Contractions
Contraction of a cardiac muscle cell is
produced by an increase in calcium ion
concentration around myofibrils

Contractions
20% of calcium ions required for a contraction
Calcium ions enter plasma membrane during plateau phase
Arrival of extracellular Ca2+

Triggers release of calcium ion reserves from sarcoplasmic
reticulum

Contractions
As slow calcium channels close
Intracellular Ca2+ is absorbed by the SR
Or pumped out of cell
Cardiac muscle tissue

Very sensitive to extracellular Ca2+ concentrations

The Energy for Cardiac Contractions
Aerobic energy of heart
From mitochondrial breakdown of fatty acids and
glucose
Oxygen from circulating hemoglobin
Cardiac muscles store oxygen in myoglobin
The Cardiac Cycle

Cardiac cycle = The period between the
start of one heartbeat and the beginning of
the next
Includes both contraction and relaxation
The Cardiac Cycle

Phases of the Cardiac Cycle
Within any one chamber
Systole (contraction)
Diastole (relaxation)
The Cardiac Cycle
Figure 2016 Phases of the Cardiac Cycle

The Cardiac Cycle

Blood Pressure
In any chamber
Rises during systole
Falls during diastole
Blood flows from high to low pressure

Controlled by timing of contractions
Directed by one-way valves
The Cardiac Cycle

Cardiac Cycle and Heart Rate
At 75 beats per minute
Cardiac cycle lasts about 800 msecs
When heart rate increases

All phases of cardiac cycle shorten, particularly
diastole
The Cardiac Cycle

Eight Steps in the Cardiac Cycle
1. Atrial systole
Atrial contraction begins
Right and left AV valves are open
2. Atria eject blood into ventricles
Filling ventricles
3. Atrial systole ends
AV valves close
Ventricles contain maximum blood volume
Known as end-diastolic volume (EDV)
The Cardiac Cycle

4. Ventricular systole
Isovolumetric ventricular contraction
Pressure in ventricles rises
AV valves shut
5. Ventricular ejection
Semilunar valves open
Blood flows into pulmonary and aortic trunks
Stroke volume (SV) = 60% of end-diastolic volume
The Cardiac Cycle

6. Ventricular pressure falls
Semilunar valves close
Ventricles contain end-systolic volume (ESV), about 40%
of end-diastolic volume
7. Ventricular diastole
Ventricular pressure is higher than atrial pressure
All heart valves are closed
Ventricles relax (isovolumetric relaxation)
The Cardiac Cycle

8. Atrial pressure is higher than ventricular
pressure
AV valves open
Passive atrial filling
Passive ventricular filling
Cardiac cycle ends
The Cardiac Cycle

Heart Sounds
S1
Loud sounds
Produced by AV valves
S2
Loud sounds
Produced by semilunar valves
S3, S4
Soft sounds
Blood flow into ventricles and atrial contraction
The Cardiac Cycle

Heart Murmur
Sounds produced by regurgitation through
valves
The Cardiac Cycle
Figure 2018 Heart Sounds

Cardiodynamics
The movement and force generated by cardiac
contractions
End-diastolic volume (EDV)
End-systolic volume (ESV)
Stroke volume (SV)

SV = EDV ESV
Ejection fraction
The percentage of EDV represented by SV
Cardiac output (CO)

The volume pumped by left ventricle in 1 minute
Cardiodynamics
Figure 2019 A Simple Model of Stroke Volume

Cardiodynamics
Cardiac Output
CO = HR X SV
CO = cardiac output (mL/min)
HR = heart rate (beats/min)
SV = stroke volume (mL/beat)

Cardiodynamics
Factors Affecting Cardiac Output
Cardiac output
Adjusted by changes in heart rate or stroke volume
Heart rate
Adjusted by autonomic nervous system or hormones
Stroke volume
Adjusted by changing EDV or ESV
Cardiodynamics
Figure 2020 Factors Affecting Cardiac Output

Cardiodynamics
Factors Affecting the Heart Rate
Autonomic innervation
Cardiac plexuses: innervate heart
Vagus nerves (X): carry parasympathetic preganglionic fibers
to small ganglia in cardiac plexus

Cardiac centers of medulla oblongata:
cardioacceleratory center controls sympathetic
neurons (increases heart rate)
cardioinhibitory center controls parasympathetic
neurons (slows heart rate)
Cardiodynamics
Autonomic Innervation
Cardiac reflexes
Cardiac centers monitor:
blood pressure (baroreceptors)
arterial oxygen and carbon dioxide levels
(chemoreceptors)
Cardiac centers adjust cardiac activity

Autonomic tone
Dual innervation maintains resting tone by
releasing ACh and NE
Fine adjustments meet needs of other systems
Cardiodynamics
Figure 2021 Autonomic Innervation of the Heart

Cardiodynamics
Effects on the SA Node
Sympathetic and parasympathetic stimulation
Greatest at SA node (heart rate)
Membrane potential of pacemaker cells

Lower than other cardiac cells
Rate of spontaneous depolarization depends on

Resting membrane potential
Rate of depolarization
ACh (parasympathetic stimulation)

Slows the heart
NE (sympathetic stimulation)
Speeds the heart
Cardiodynamics
Atrial Reflex
Also called Bainbridge reflex
Adjusts heart rate in response to venous
return
Stretch receptors in right atrium
Trigger increase in heart rate
Through increased sympathetic activity
Cardiodynamics
Hormonal Effects on Heart Rate
Increase heart rate (by sympathetic
stimulation of SA node)
Epinephrine (E)
Norepinephrine (NE)
Thyroid hormone
Cardiodynamics
Factors Affecting the Stroke Volume
The EDV: amount of blood a ventricle contains at the
end of diastole
Filling time:
duration of ventricular diastole
Venous return:
rate of blood flow during ventricular diastole
Cardiodynamics
Preload
The degree of ventricular stretching during
ventricular diastole
Directly proportional to EDV

Affects ability of muscle cells to produce
tension
Cardiodynamics
The EDV and Stroke Volume
At rest
EDV is low
Myocardium stretches less
Stroke volume is low
With exercise
EDV increases
Myocardium stretches more
Stroke volume increases
Cardiodynamics
The FrankStarling Principle
As EDV increases, stroke volume increases
Physical Limits
Ventricular expansion is limited by
Myocardial connective tissue
The cardiac (fibrous) skeleton
The pericardial sac
Cardiodynamics
End-Systolic Volume (ESV)
The amount of blood that remains in the
ventricle at the end of ventricular systole is
the ESV
Cardiodynamics
Three Factors That Affect ESV
Preload
Ventricular stretching during diastole
Contractility
Force produced during contraction, at a given preload
Afterload
Tension the ventricle produces to open the semilunar valve
and eject blood
Cardiodynamics
Contractility
Is affected by
Autonomic activity
Hormones
Cardiodynamics
Effects of Autonomic Activity on Contractility
Sympathetic stimulation
NE released by postganglionic fibers of cardiac nerves
Epinephrine and NE released by suprarenal (adrenal)
medullae
Causes ventricles to contract with more force
Increases ejection fraction and decreases ESV
Cardiodynamics
Effects of Autonomic Activity on
Contractility
Parasympathetic activity
Acetylcholine released by vagus nerves
Reduces force of cardiac contractions
Cardiodynamics
Hormones
Many hormones affect heart contraction
Pharmaceutical drugs mimic hormone actions
Stimulate or block beta receptors
Affect calcium ions (e.g., calcium channel
blockers)
Cardiodynamics
Afterload
Is increased by any factor that restricts arterial
blood flow
As afterload increases, stroke volume
decreases
Cardiodynamics
Heart Rate Control Factors
Autonomic nervous system
Sympathetic and parasympathetic
Circulating hormones
Venous return and stretch receptors
Cardiodynamics
Stroke Volume Control Factors
EDV
Filling time
Rate of venous return
ESV
Preload
Contractility
Afterload
Cardiodynamics
Cardiac Reserve
The difference between resting and maximal
cardiac output
Cardiodynamics
The Heart and Cardiovascular System
Cardiovascular regulation
Ensures adequate circulation to body tissues
Cardiovascular centers
Control heart and peripheral blood vessels
Cardiovascular system responds to

Changing activity patterns
Circulatory emergencies

Unit 5 Heart

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Chapter

PowerPoint Lecture Slides

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Copyright 2009 Pearson Education, Inc.,

Introduction to Cardiovascular System

The Systemic Circuit

Blood alternates between pulmonary circuit and

Introduction to Cardiovascular System

Introduction to Cardiovascular System

Introduction to Cardiovascular System

Figure 201 An Overview of the Cardiovascular System.

Introduction to Cardiovascular System

Anatomy of the Heart

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Anatomy of the Heart

Figure 202a The Location of the Heart in the Thoracic Cavity

Anatomy of the Heart

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Anatomy of the Heart

Figure 202b The Location of the Heart in the Thoracic Cavity

Anatomy of the Heart

Figure 20c2 The Location of the Heart in the Thoracic Cavity

Anatomy of the Heart

Anatomy of the Heart

Figure 203a The Superficial Anatomy of the Heart

Anatomy of the Heart

Figure 203c The Superficial Anatomy of the Heart

Anatomy of the Heart

Myocardium (middle layer)

Two divisions of ventricular myocardium

Endocardium (inner layer)

Anatomy of the Heart

Figure 204 The Heart Wall

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Anatomy of the Heart

Anatomy of the Heart

Figure 205 Cardiac Muscle Cells

Anatomy of the Heart

Figure 205 Cardiac Muscle Cells

Anatomy of the Heart

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Anatomy of the Heart

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Anatomy of the Heart

Inferior vena cava

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Anatomy of the Heart

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Anatomy of the Heart

Figure 206a-b The Sectional Anatomy of the Heart.

Anatomy of the Heart

Figure 206a-b The Sectional Anatomy of the Heart.

Anatomy of the Heart

Right atrioventricular (AV) Valve

Has three cusps

Anatomy of the Heart

through pulmonary valve

Anatomy of the Heart

Pulmonary veins deliver to left atrium

through left atrioventricular (AV) valve

Anatomy of the Heart

Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Anatomy of the Heart

Anatomy of the Heart