Chapter 19: The Heart

10/25/2013 5:19:00 PM

Overview of the Cardiovascular System Cardiovascular system- consists of the heart and the blood vessels The Pulmonary and Systemic Circuits o Pulmonary circuit- carries blood to the lungs for gas exchange and returns it to the heart Right half of the heart receives blood that has circulated through the body and picked up carbon dioxide. Pumps blood into the pulmonary trunk which divides into pulmonary arteries They transport blood to the air sacs (alveoli) of the lungs where carbon dioxide is unloaded and oxygen is picked up Blood flows through pulmonary veins to the left side of the heart o Systemic circuit- supplies blood to every organ of the body including other parts of the lungs and the wall of the heart itself Left side of the heart Blood leaves through the aorta and passes through aortic arch which has arteries that supply the head, neck and upper limbs. Aorta travels through the thoracic and abdominal cavities and issues smaller arteries to the other organs before branching into the lower limbs After circulating through the body the deoxygenated blood returns to the right side of the heart via the superior and inferior vena cava.

Position, Size, and Shape of the Heart o Thoracic cavity in the mediastinum between the lungs and deep to the sternum. o Base- broad superior portion of the heart which is the point of attachment for the great vessels o Apex- inferior end of the part that tapers to a blunt point and is immediately above the diaphragm The Pericardium

o Pericardium- double-walled sac that encloses the heart o Pericardial sac (parietal pericardium)- outer wall that has a tough, superficial fibrous layer of dense irregular connective tissue and a thin, deep serous layer. o Visceral pericardium- the serous layer at the base of the heart that turns inward and is equivalent to the epicardium of the heart wall o Pericardial cavity- space between the parietal and visceral membranes o Pericardial fluid- fluid that is in the pericardial cavity that lubricates the membranes and allows the heart to beat with minimal friction Gross Anatomy of the Heart The Heart Wall o 3 layers Epicardium- serous membrane of the external heart surface Simple squamous Some places it has a layer of adipose Myocardium- between the epicardium and the endocardium and made of cardiac muscle Thickest layer Performs the work of the heart Endocardium- lines the interior of the heart chambers Simple squamous No adipose Covers valve surfaces o Fibrous skeleton-framework of collagenous and elastic fibers Functions Provides structural support for the heart Anchors the cardiocytes and gives them something to pull against Electrical insulation between the atria and the ventricles

May aid in refilling the heart with blood after each beat

The Chambers o 4 chambers Right and left atria- thin-walled receiving chambers for blood returning to the heart by way of the great veins Right and left ventricles- pumps that eject blood into the arteries and keep it flowing around the body Coronary (atrioventricular) sulcus- encircles the heart near the base and separates the atria above from the ventricles below Interventricular septum- muscular vertical wall between the ventricles

The Valves o Cusps-fibrous flaps of tissue that is found on each valve and are covered with endocardium o Atrioventricular (AV) valves- regulate the openings between the atria and ventricles o Papillary muscles- found on the floor of the ventricle they prevent the AV valves from flipping inside out of bulging into the atria when the ventricles contract o Semilunar valves- regulate the flow of blood from the ventricles into the great arteries o Pulmonary valve- controls the opening from the right ventricle into the pulmonary trunk o Aortic valve- controls the opening from the left ventricle into the aorta

The Coronary Circulation o Coronary circulation- blood vessels of the heart wall that distribute blood to every muscle cell o Arterial Supply Left coronary artery- travels through the coronary sulcus under the left auricle and divides into 2 branches

Anterior interventricular branch- supplies blood to both ventricles and the anterior 2/3 of the interventricular septum Circumflex branch- supplies blood to the left atrium and posterior wall of the left ventricle Right coronary artery- supplies the right atrium and sinoatrial node (pacemaker) Right marginal branch- supplies the lateral aspect of the right atrium and ventricle Posterior interventricular branch- supplies the posterior walls of both ventricles as well as the posterior portion of the interventricular septum Myocardial infarction- heart attack Collateral circulation- can supply the heart tissue with blood if the primary route becomes obstructed Coronary arteries the flow peaks when the heart relaxes Contraction of the myocardium compresses the arteries and obstructs blood flow When the ventricles contract, the aortic valve is

forced open and its cusps cover the openings to the coronary arteries blocking blood from flowing into them When they relax, blood in the aorta briefly surges back toward the heart. o Venous Drainage Venous drainage- route by which blood leaves an organ Some coronary blood empties directly into the heart chambers (5-10%) The rest of the coronary blood returns to the right atrium by Great cardiac vein- collects blood from the anterior aspect of the heart and carries it from the ape toward the coronary sulcus, then arcs around the left side of the heart and empties into the coronary sinus

Posterior interventricular (middle cardiac) vein- collects blood from the posterior aspect of the heart and carries blood from the apex upward then drains into the same sinus Left marginal vein- travels from a point near the apex up the left margin and empties into the coronary sinus Coronary sinus- large transverse vein in the coronary sulcus on the posterior side of

Cardiac

the heart that collects blood from all three above and empties blood into the right atrium. Muscle and the Cardiac Conduction System Heart beats about 75 bpm Autorhythmic- each cell pulses by itself Structure of Cardiac Muscle o Striated o Cardiocytes (cardiomyocytes)- short, thick, branched cells o Intercalated discs- thick connections that join cardiocytes end to end 3 distinctive features not found in skeletal muscle Interdigitating folds-plasma membrane at the end of the cell is folded. The folds of adjoining cells interlock with each other and increase the surface area of intercellular contact Mechanical junctions- cells are tightly joined by the fascia adherens and desmosomes. They prevent the contracting cardiocytes from pulling apart Electrical junctions- intercalated discs have gap junctions that allow ions to flow from the cytoplasm of one cardiocyte directly into the next. Metabolism of Cardiac Muscle o Uses aerobic respiration to make ATP The Conduction System

o Cardiac conduction system- internal pacemaker and nervelike conduction pathways that go through the myocardium and coordinate the heartbeat o It generates and conducts rhythmic electrical signals in this order Sinoatrial (SA) node- a patch of modified cardiocytes in the right atrium. This is the pacemaker that initiates each heartbeat and determines the heartbeat Signals from the SA node spread through the atria Atrioventricular (AV) node- acts as an electrical gateway to the ventricles. The fibrous skeleton acts as an insulator to prevent currents from getting to the ventricles by any other route. Atrioventricular (AV) bundle- pathway by which signals leave the AV node Purkinje fibers- nervelike processes that arise from the lower end of the bundle branches and distribute the electrical excitation to the cardiocytes of the ventricles. Nerve Supply to the Heart

o Sympathetic Increases heart rate and contraction strength and dilates the coronary arteries to increase myocardial blood flow o Parasympathetic Reduces the heart rate Electrical and Contractile Activity of the Heart Systole- contraction Diastole- relaxation The Cardiac Rhythm o Sinus rhythm- normal heartbeat triggered by the SA node Normal = 70-80 bpm o Premature ventricular contraction (extrasystole)- extra heartbeat caused by stimuli that made the other parts of the conduction system fire before the SA node does o Ectopic focus- any region of spontaneous firing other than the SA node

o Nodal rhythm- slower heartbeat (40-50 bpm) produced by the AV node o Arrhythmia- any abnormal cardiac rhythm o Heart block- failure of any part of the cardiac conduction system to transmit signals Pacemaker Physiology o Pacemaker potential- gradual depolarization of the SA node cells o Each depolarization of the SA node sets of one heartbeat o SA node typically fires every 0.8 second The Electrocardiogram o Electrocardiogram (ECG or EKG)- moving paper chart that records the signals of the heart o P wave- produced when a signal from the SA node spreads through the atria and depolarizes them. Atrial systole o QRS complex- produced when the signal from the AV node spreads through the ventricular myocardium and depolarizes the muscle Depolarization of the ventricles

o T wave- generated by ventricular repolarization Blood Flow, Heart Sounds, and the Cardiac Cycle Cardiac cycle- one complete contraction and relaxation of all four heart chambers. Principles of Pressure and Flow o Pressure-impels a fluid to move o Resistance- opposes the flow Measurement of Pressure o Pressure is measured by a manometer o Sphygmomanometer- a calibrated mercury manometer with its open end attached to an inflatable pressure cuff wrapped around the arm and measures blood pressure Pressure Gradients and Flow o Pressure gradient- different pressures at different points o Fluids flow down their pressure gradient Heart Sounds o Auscultation- listening to sounds made by the body

Phases of the Cardiac Cycle o Ventricular filling Diastole First 1/3 is rapid ventricular filling, when the blood enters especially quickly Second 1/3, called diastasis is slower filling Last 1/3, atrial systole completes the filling process End-diastolic volume- how much blood in the heart after the ventricular filling o Isovolumetric contraction Atria repolarize, relax and remain in diastole Ventricles depolarize, generate the QRS complex and begin to contract Heart sound S1 occurs from the left ventricle at the beginning of this phase Doesnt eject blood o Ventricular ejection Ejection of blood begins when ventricular pressure exceeds arterial pressure and forces semilunar valves open Ventricles dont expel all their blood Stroke volume- amount of blood ejected Ejection fraction- percentage of the end-diastolic volume ejected End systolic volume- amount of blood remaining behind EDV SV = ESV o Isovolumetric relaxation Early ventricular diastole when the T wave ends and the ventricles begin to expand Overview of Volume Changes o Both ventricles eject the same amount of blood even though pressure in the left is 5x greater than the pressure in the right ventricle o Equal output is essential to homeostasis o Left ventricle failure

 Shortness of breath Suffocation o Right ventricle failure Enlargement of the liver Ascites- a pooling of fluid in the abdominal cavity Distension of the jugular veins Swelling of the fingers, ankles and feet o Congestive heart failure- fluid accumulation in either circuit due to insufficiency of ventricular pumping commonly caused by myocardial infarction, chronic hypertension, valvular Cardiac defects, and congenital defects in cardiac anatomy Output Cardiac output- amount of blood ejected by each ventricle in 1 minute CO = HR x SV Cardiac output varies with bodys state of activity Cardiac reserve- difference between the maximum and resting cardiac output Heart Rate o Tachycardia- persistent, resting adult heart rate above 100 bpm Heart rate raises with stress, anxiety, drugs, heart disease or fever Also rises when theres a drop in SV, so loss of blood or damage to the myocardium o Bradycardia- persistent, resting adult heart rate below 60 bpm Typically occurs during sleep and in endurance-trained athletes Hypothermia o Positive chronotropic agents- factors that raise heart rate o Negative chronotropic agents- factors that lower heart rate o Chronotropic Effects of the Autonomic Nervous System Sympathetic Fibers release norepinephrine Causes cAMP which opens a calcium channel

This accelerates depolarization of the SA node and speeds up the heart Parasympathetic Inhibitory effects on the SA and AV nodes Ach binds to receptors and opens K+ gates K+ leaves cells, the become hyperpolarized and fire less frequently Heart beat slows Vagal tone- steady background firing rate of the vagus nerves Proprioceptors- muscles and joints provide info on changes in physical activity so heart can increase output even before metabolic demands rise Baroreceptors- pressure sensors in the aorta and internal carotid arteries that send continual signals to the medulla. They inform medulla of increase or decrease in the blood pressure so the medulla either issues sympathetic or parasympathetic output Chemoreceptors- occur in aortic arch, carotid arteries,

and the medulla oblongata and are sensitive to blood pH, CO2 and O2 levels. Chemoreflexes and baroreflexes o Chronotropic Effects of Chemicals Potassium has the greatest chronotropic effect Calcium affects hear rate. Excess = slower heartbeat. Deficiency = quicker heartbeat Stroke Volume o 3 variables Preload- amount of tension in the ventricular myocardium immediately before it begins to contract Frank-Starling law of the heart- Stroke volume is proportional to the end-diastolic volume Ventricles eject as much blood as they receive. The more they are stretched, the harder they contract on the next beat

Contractility- how hard the myocardium contracts for a given preload Calcium has a strong positive inotropic effect, it increases the strength of each contraction of the heart. Afterload- sum of all forces a ventricle must overcome before it can eject blood Blood pressure in the aorta and pulmonary trunk immediately distal to the semilunar valves affect the afterload most.

10/25/2013 5:19:00 PM

10/25/2013 5:19:00 PM