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Microanatomy of Human

Heart: A Brief Review

Ns. Adam Astrada, BSN

Heart: Cell to cell and

its construction

The pouch

The muscle

The lumen

The skeleton

The electricity: the heart of heart

The receptors

The hearts transportation: coronary

The sick heart

Broken heart syndrome

Hearts Spareparts

The Pericardium

Layers of Pericardium
Fibrous pericardium:

dense connective tissue rigid, attached to diaphragm

support the heart

prevent the heart from overstreching

isolating the heart from other mediastinal organs

Preservation of endothoracic pressure crucial for atrial filling

Layers of Pericardium
Serous pericardium:
Parietal & Viceral layers

Parietal attached
to fibrous layer
Viceral also
called epicardium,
fat deposition found
in this layer

The pericardial cavity and fluid

Between parietal and viceral

layer pericardial space and

Pericardial fluid:

Is a product of plasma
ultrafiltration mainly
lymphatic capilary

to prevent friction of the

beating heart (lubrication) and
sticking of layers

A. Full thickness of
consisted of wavy
collagen (yellow)
and short fibrin
B. Blood vessels
shown between
collagen fiber
C. Viceral
epicardium) Single
layer of mesothelial
cells are lining on
collagen fiber and
adipose tissue
D. Viceral
pericardium. Single
layer of mesothelial

The muscular heart: Myocardium

Epicardium serous pericardium, fat deposition foun beneath it which

varies among individuals

Myocardium 95% of heart structure, resembles skeletal muscle yet

branched and more nuclei in a single cell

Myocardium has been modified to be able to relay electrical stimulus to

its neigbooring cells through gap junctions

The thickest muscle wall found in left ventricle

A condition of cardiac muscle hypertrophy in right ventricle is called

Right Heart Failure, if it occurs in both side of ventricles, called
Congestive Heart Failure

The lumen: Endocardium

Is a continum of
endothelial lining in blood

Smooth lining to reduce

friction between blood
cells and heart tissue,
thus preventing blood clot
formation within heart

Heart valves are part of

endothelium, infection to
this tissue causing

The skeleton

A dense fibrouse connective tissue,

forming rings in the lining of four

Provide solid anchor and structure

for heart valves,

Prevents overstretching during heart


and as insulator for impulses

between atria and ventricles

The electricity: pace maker cells and

purkinje fibers

Pace maker cells: Sinoatrial (SA)

node, atrioventricular (AV) node,
and purkinje fibers

Those cells are able to produce

spontaneous electrical impulses
in certain frequency: SA 60100 times/min, AV 40-60
times/min, Purkinje 20-35

Impulses produced by these cells

cause myocardium to contract
with the mechanism like skeletal

The receptors

Hearts work is influence by autonomous nervous system and certain reseptors to

adapt human activity changes

Autonompus nervous system simpathetic and parasimpathetic stimulation through

proprioreceptors when the body detect increased activity or emotions, such as when
threatened, fear, or excited and receptors

Proprioreceptors monitor muscle and joint movements

Simpathetic innvervated from medula oblongata to thoracal branch and finally to

SA node releasing norepinephrine to -1 receptor incrasing heart rate

Parasimpathetic innervated from vagus (X) nerve to SA and AV nodes, and atrium
releasing acetylcholine (ACh) slowing heart rate

Chemoreceptors when there is chemical changes: ion influx or hormones

stimulation adrenaline and noradrenaline

Baroreceptors found in aortic arch and carotid artery

Coronary circulation

Coronary crown

Two main braches: left and right coronary arteries, originate from
foramen of ascending aorta

Ventricles, particularly left ventricle, recieve more coronary artery

supply than atria

Because coronary arteries have no anastomoses, blockage od any artery

can cause fatal consequences myocardial infarction

Coronary veins drain into coronary sinus at the posterior of heart and
eventually to right atrium

Coronary artery and vein

Blood Pressure
Regulatory Mechanism
Ns. Adam Astrada, BSN
March 23rd 2016

Factors affecting blood pressure

Heart rate

Stroke volume

Systemic vascular resistance size of lumen, blood viscosity, total blood vessel

Blood volume

Blood pressure highest in aorta and systemic arteies

Sistole blood pressure when ventricles contract
Diastole blood pressure when ventricles fully relaxed
Mean arterial pressure (MAP) estimation of average arterial pressure
MAP = diastolic BP + 1/3 (sistolic diastolic)

Blood Pressure Regulatory Center

Medula oblongata as center

for blood pressure control
cardiovascular center

This center recieves input

from higher brain regions
and sensory receptors

Higer brain regions

cerebral cortex, lymbic
system, and hypothalamus

Sensory receptors
baroreceptors, and chemical

The mechanism: Neuronal


Via negative feedback mechanism that occurs as

two reflexes: baroreceptors and chemoreceptors

Baroreceptors carotid sinus reflex and aortic

arch reflex

When blood pressure increased

a. widens carotid sinuses carotid baroreceptors

stimulation glassopharyngeal nerve IX
medula oblongata parasypatic stimulation and
simpatic supression heart rate, vascular
resistance, stroke volume BP back to normal
b. Aortic baroreceptors stimulation vagus (X) nerve
medula oblongata parasypatic stimulation
and simpatic supression heart rate, vascular
resistance, stroke volume BP back to normal

The mechanism: Neuronal regulation

When BP falls baroreceptors stretched lessly IX and X nerves

medula oblongata simpatic stimulated, parasimpatic supressed
heart rate, vascular resistance, stroke volume and adrenal medula
releases adrenaline and noradrenaline BP back to normal

The mechanism: Neuronal regulation

by chemoreceptors

Chemoreceptors located close to baroreceptors at carotid sinus and

aortic arch

Chemoreceptors detect chnages in blood of O2, CO2, and H+

Hypoxia, acidosis, and hypercapnea will stimulate CV center in medula

oblongata to stimulate vasoconstriction incrasing BP

This receptor also relaying input to repiratory center in brain stem to

adjust rate of breathing

The mechanism: Hormonal regulation

Renin Angiotensin Aldosterone System (RAAS)

Decreased bloodflow in kidney stimulate juxtaglumerulus releasing Renin

also, Renin Angiotensin Enzyme (ACE)converts Angiotensin I to Angiotensin II
systemic vasoconstriction
Angiotensin II also stimulate Aldosterone increases Na resorbtion
increased blood volume raising BP

Epinephine and norepinephrine by renal medula cortex vasoconstriction

and increase heart rate increase BP

Antidiuretic hormone (ADH) (vasopessin) by posterior lobe of pituitary gland

increase water resorbtion from kidney tubules to bloodstream increasing

Atrial natriouretic peptide by atria promote urine output

Embryology of Heart
Ns Adam Astrada, BSN

Primitive heart

1st heart beat day 22 of gestation

Ket: Gambar (b):

1: Sinus venosus

4: Bulbus cordis

2: Atrium

4a: Trunctus

3: Ventrikel primitif

Fetal circulation
Ns Adam Astrada, BSN

Right before birth (full-term)

After birth