7/23/2012

Location
Heart lies in the mediastinum behind the sternum 1/3 of bulk of the heart lies to the right of the midline; 2/3 lies to the left Apex lies between the 4th & 5th ribs when lying down and between the 5th and 6th ribs when sitting or standing

7/23/2012

PMI (Point of Maximal Impulse): Midclavicular Line between the 4th and 5th ICS

Pericardium
The heart lies within the pericardium Outer layer of the pericardium is fibrous connective tissue fibrous pericardium Anchors the pericardium to the great vessels, the sternum and diaphragm

7/23/2012

Two inner layers of serous membranesparietal pericardium and visceral pericardium (epicardium) Between the serous membranes is the pericardial space, filled with 15- 50 ml of fluid to reduce friction Fibrous pericardium and parietal pericardium are called the pericardial sac Visceral pericardium is the epicardium The outer fibrous surface gives support, and the inner lining prevents friction as the heart moves within its protecting jacket.

7/23/2012

Heart Wall
Epicardium Myocardium muscular layer Thickest layer Attached to fibrous skeleton of the heart Bands of muscle arranged longitudinally Fibers from one side enter other side Better integration of contractions Pathology of one ventricle can affect the other

7/23/2012

Endocardium Internal lining of squamous epithelium Continuous throughout cardiovascular system

7/23/2012

Four chambers (two pumps)

Right heart acts as a volume pump through low-resistance vessels of the pulmonary system Left heart acts as a pressure pump through high-resistance vessels of the systemic circulation

7/23/2012

Atria
Two upper, thin walled chambers that collect blood returning to the heart Their contraction aids in filling the ventricles Right atrium receives blood from superior and inferior vena cava and coronary sinus Left atrium receives blood from pulmonary veins

Thats me after the autopsy..hehehe

7/23/2012

Ventricles
Thick walled pumping chambers of the heart Make up about 60 % of the mass of the heart and receive most of coronary blood flow Blood from right ventricle enters the pulmonary trunk Blood from left ventricle enters the aorta

7/23/2012

Path of Blood Flow

Vena cavae RA RV Pulmonary trunk Lungs Pulmonary veins LA LV Aorta Systemic circulation Vena cavae

TRACING THE SYSTEMIC CIRCULATION IS SURE FUN TO DO!!!

7/23/2012

Valves
Made of connective tissue covered by endothelium Prevent back flow of blood Open and close passively in response to ventricular contraction Anchored to the annuli fibrosi cordis to prevent dilation during contraction of the heart

10

7/23/2012

Atrioventricular valves
Lie between the atria and ventricles Tricuspid valve on the right Bicuspid or mitral valve on left Anchored against high pressure by the chordae tendineae and papillary muscles

11

7/23/2012

Semilunar Valves
Lie between ventricles and great vessels Pulmonary on right side Aortic on left side

12

7/23/2012

13

7/23/2012

Cardiac Cycle
Sequence of events that compose the repeating pumping action of the heart Typically, systole refers to ventricular contraction and diastole refers to ventricular relaxation If referring to atria, specify atrial systole, etc.

Review
Coronary arteries and cardiac veins note that it is the right coronary artery that supplies blood to the SA and AV nodes

14

7/23/2012

15

7/23/2012

Review
Pressures in chambers: look over the next figure - note especially the pressures in the right atrium central venous pressure, and the pressures in the aorta systemic blood pressure

16

7/23/2012

Cardiac muscle - Myocytes

Contractile fibers Fibers are branched Intercalated discs - contain desmosomes and gap junctions Gap junctions connect cytoplasm of adjoining cells so that the action potentials pass from one cell to the next Cells contract as if one cell - syncytium

17

7/23/2012

Muscle contraction
Striated muscle contains actin and myosin Action potential stimulates release of Ca++ Ca++ binds to troponin Troponin moves the tropomyosin exposing myosin binding sites on the actin Myosin pulls on the actin, filaments slide past each other and muscle shortens

18

7/23/2012

19

7/23/2012

20

7/23/2012

Remember, that unlike skeletal muscle, much of the Ca++ used in cardiac muscle contraction comes from the extracellular fluid.

21

7/23/2012

Conduction System
Conduction system cells are specialized myocardial fibers Heart has autorhythmicity- beats spontaneously at about 100 beats/min Impulse begins at sinoatrial (SA) node or pacemaker sinus rhythm Spreads through atria via conducting myofibers to atrioventricular (AV) node in fibrous skeleton of heart

Signal pauses briefly, for ventricular filling by atrial contraction. Signal continues into ventricle through conduction pathways: AV bundle ( bundle of His) right and left bundle branches Purkinje fibers ventricular contraction (bottom up)

22

7/23/2012

Regulation of Heart Rate

Sympathetic N.S.
Increases heart rate and force of contraction secrete norepinephrine accelerator nerves

Parasympathetic N.S.
Decrease heart rate and force of contraction through the vagus nerve. Sends continuous impulses. Secretes acetylcholine

23

7/23/2012

Electrocardiogram ECG
Measures electrical activity of the heart P wave represents atrial contraction (depolarization) QRS complex represents ventricular contraction (depolarization) T wave represents ventricular relaxation (repolarization)

24

7/23/2012

25

7/23/2012

26

7/23/2012

Cardiac Output
Cardiac Output: SV (ml/beat) X HR (beats/min) = CO(ml/min.) 70 ml X 80 = 5600 ml /min. or 5.6 liters L/min

27

7/23/2012

Factors affecting cardiac performance

Preload: pressure generated at the end of diastole; depends on both heart and vascular system the amount of filling of the ventricle during relaxation Afterload: resistance to ejection during systole; depends on both heart and vascular system - the force that opposes ejection of blood from the heart; for the LV, this is the aortic systolic pressure

28

7/23/2012

29

7/23/2012

(Frank-) Starling Law

Within limits, the greater the stretching of the muscle fibers (preload), the greater the force of contraction. The extra force of contraction is necessary to pump the increased volume of blood from the ventricle. Cardiac output increases

Heart rate: a intrinsic characteristic of the heart tissue that is influenced by nervous and endocrine systems Myocardial contractility: the ability of the heart muscle to contract, the force of contraction - another cardiac tissue characteristic that is influenced by nervous and endocrine systems

30

7/23/2012

Neural reflexes
Bainbridge reflex increased heart rate due to increased right atrial pressure Increased pressure in arteries stimulates a baroreceptor reflex that decreases heart rate.

31

7/23/2012

PRESSURIZED??!!! This is the end of Part One

32