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Chapter 15
Lecture Outline
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I. Structure of the Heart

A.Structure of the Heart

Four chambers
a.Right atrium: receives deoxygenated blood from the
body
b.Left atrium: receives oxygenated blood from the lungs
c.Right ventricle: pumps deoxygenated blood to the
lungs
d.Left ventricle: pumps oxygenated blood to the body

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Pulmonary and Systemic Circulations

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Left atrium

Superior
vena cava
Right atrium

O2

Pulmonary artery
CO2

Pulmonary vein

Capillaries

Lung

O2

O2

CO2

CO2
Tricuspid valve
Right ventricle
Inferior
vena cava

Aortic
semilunar
valve
O2

Bicuspid valve
Left ventricle
Aorta

CO2

Capillaries
Tissue cells

Path of blood ow
Vena cavae (SVC, IVC) RA RV
Pulmonary trunk Lungs (Pulmonary circulation) Pulmonary veins
LA LV
Aorta Systemic circulation
Vena cavae

Valves of the Heart

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Blood ow throughout the body

Pressure dierence
Highest pressure in left ventricle and the lowest pressure in right
atrium

Cardiac Cycle and Pressures

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Heart Sounds
Produced by closing valves
a.Lub = closing of AV valves; occurs at ventricular systole, rst
heart sound
b.Dub = closing of semilunar valves; occurs at ventricular
diastole, second heart sound

Cardiac murmur
Abnormal heart sound
Systolic
Diastolic

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Heart failure
Definition When heart as a pump is insufficient to
meet the metabolic requirements of tissues

Right heart failure

Systemic symptoms
Edema, ascites
Enlarged liver, spleen
Swollen feet, ankles
Nausea
Swollen internal jugular veins

Left hear failure

Fluid accumulation in lungs
Shortness of breath
Orthopnea
Coughing, foaming sometimes
Tiredness
weakness

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Valvular dysfunction
Endocardial disorders damage heart valves
Changes can lead to :
Valvular Stenosis = too narrow
Valvular Regurgitation = too leaky
(or insuciency or incompetence)

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Mitral Stenosis
Most common of all valve disorders
Usually the result of rheumatic fever or bacterial endocarditis
During healing the orice narrows, the valves become brous and fused
Get decreased ow from LA to LV during lling
Results in hypertrophy of LA
increased pulmonary vascular pressures; pressures increase through LA into
lung
pulmonary congestion
lung tissue changes to accommodate increased pressures
increased pressure in pulmonary artery
increased pressure in right heart
right heart failure

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Aortic Stenosis
Three common causes:
Rheumatic heart disease -Streptococcus infection damage by
bacteria and auto-immune response
Congenital malformation
Degeneration resulting from calcication

Blood ow obstructed from LV into aorta during systole

Causes increased work of LV
LV dilation & hypertrophy as compensation
prolonged contractions as compensation
Finally heart overwhelmed, increased pressures in
LA, then lungs, left heart failure

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Mitral Prolapse & Regurgitation

Mitral valve prolapse (bulge)
Caused by rheumatic heart disease, infective
endocarditis,
Permits backow of blood from the LV into the LA
during ventricular systole
Loud pansystolic murmur that radiates into the back
and axilla
Left heart failure or right heart failure rst?
What kind of murmur?
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Tetralogy of Fallot
Most common cause of blue baby syndrome.
Tetralogy of Fallot has four key features.
obstruction from the right ventricle to the lungs (pulmonary
stenosis) are the most important
Also, the aorta lies directly over the ventricular septal defect,
overriding aorta
A ventricular septal defect (a hole between the ventricles)
and the right ventricle develops thickened muscle, right
ventricular hypertrophy

Electrical Activity of the Heart

Automaticity automatic nature of the heartbeat
Sinoatrial node (SA node) - pacemaker; located in
right atrium
AV node and Purkinje bers are secondary pacemakers
of ectopic pacemakers; slower rate than the sinus
rhythm

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Pacemaker potential
a.A slow, spontaneous depolarization; also called
diastolic depolarization between heartbeats
b.At 40mV, voltage-gated Ca2+ channels open,
triggering action potential and contraction.
c.Repolarization occurs with the opening of voltagegated K+ channels.

Pacemaker & Action Potentials

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+20
K+ channels
Voltage-gated
Ca2+
channels

Millivolts

60

Pacemaker potentials
(HCN channels)

Time

Myocardial action potentials

a.Cardiac muscle cells have a resting potential of 85mV.
b.They are depolarized to threshold by action potentials
from the SA node.
c.Voltage-gated Na+ channels (fast Na+) open,
d.Due to balance between slow inux of Ca2+ and eux of
K+
e.More K+ are opened, and repolarization occurs.
f.Long plateau prevents summation and tetanus

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Action Potential in a Myocardial Cell

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Conduction System of the Heart

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Interatrial
septum

Interventricular septum

Blood vessels
Types of blood vessels
a.Arteries
b.Arterioles
c.Capillaries
d.Venules
e.Veins

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Atherosclerosis

Most common form of arteriosclerosis (hardening of the arteries)

a.Contributes to 50% of the deaths due to heart attack and stroke
b.Plaques protrude into the lumen and reduce blood ow.
c.Plaques form in response to damage done to the endothelium of a
blood vessel.
d.Risked factors include smoking, high blood pressure, diabetes, high
cholesterol

Atherosclerosis
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Thrombus

Plaque

(a)
Cholesterol
crystals
Fat

Ulceration
Endothelium
Smooth
muscle cells
Lumen
of vessel
Tunica media
(b)
a: Biophoto Associates/Photo Researchers

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Fluid Filtration

Arteriole

Venule

Blood hydrostatic pressure (BHP, i.e.

BP) : outforce
Interstitial Fluid hydrostatic pressure
(IFHP): inforce
Blood colloid osmotic pressure
(BCOP): inforce
Interstitial uid osmotic pressure
(IFOP) : outforce
Netforce = outforce - inforce

Edema
Increase outforce
blood pressure (hypertension)
Interstitial uid osmotic pressure (allergy)
Decrease inforce
Blood colloid osmotic pressure (allergy, liver disorders, malnutrition)
Interstitial Fluid hydrostatic pressure (rare)

Edema
a.Excessive accumulations of interstitial uids
b.May be the result of:
1)High arterial blood pressure
2)Venous obstruction
3)Leakage of plasma proteins into interstitial space
4)Myxedema (excessive production of mucin in extracellular spaces caused by
hypothyroidism)
5)Decreased plasma protein concentration
6)Obstruction of lymphatic drainage

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Severe Edema of Elephantiasis

Constituents of blood

Red Blood Cell Antigens and Blood

Typing
Antigens: found on the surface of cells to help immune system
recognize self cells
Antibodies: secreted by lymphocytes in response to foreign cells
ABO system: antigens on erythrocyte cell surfaces
a.Type A - has the A antigen
b.Type B - has the B antigen
c.Type AB - has both the A and B antigens
d.Type O - has neither the A nor the B antigen

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Rh factor
a.Antigen D
b.Rh-positive has the antigen
c.Rh-negative does not have the antigen; will not have antibodies
unless exposed to Rh+ either through a blood transfusion or
pregnancy

Blood Type

Genotype

Phenotype

Antigen

Antibody

Ao, AA

Anti-B

Bo, BB

Anti-A

oo

None

Anti A & Anti B

AB

AB

AB

A & B

None

Rh +

DD, Dd

None

Rh -

dd

None

None

None

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ABO Blood Typing

Blood typing

A+

O+

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AB-

Blood Transfusion
Rule 1: Always get type specic blood
Rule 2: No new antigen to recipient

Hemolytic Disease of the Newborn

Occurs if Rh- mother has formed antibodies and is pregnant with
second Rh+ child
Anti-D antibodies can cross placenta

Prevention
RhoGAM given to pregnant Rh- women
Binds fetal agglutinogens in her blood so she will not form anti-D
antibodies

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Hemolytic Disease of the Newborn

leaves

Rh- mother

Rh
antigen

Second
Rh+ fetus

Rh+ fetus
Uterus

Anti-D
antibody

Amniotic sac
and chorion
Placenta

(a) First pregnancy

(b) Between pregnancies

(c) Second pregnancy

Rh antibodies attack fetal blood causing severe anemia and toxic brain syndrome

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