Unit Vb – Heart

Chapter 19

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Fig. 19.1 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

CO2 O2

Pulmonary circuit

O2-poor,
CO2-rich O2-rich,
blood CO2-poor
blood

Systemic circuit

CO2
O2
Fig. 19.2
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Sternum
Posterior
3rd rib
Lungs

Diaphragm Thoracic Pericardial

vertebra cavity

Left
Right
ventricle
ventricle
Interventricular
(a)
Sternum septum

(b) Anterior

Aorta

Pulmonary
Superior
trunk
vena cava
Base of
Right lung
heart

Parietal
pleura (cut)

Pericardial
sac (cut) Apex
of heart

Diaphragm
(c)
Fig. 19.3

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Pericardial
cavity

Pericardial sac:
Fibrous layer
Serous layer

Epicardium

(b)

Myocardium
Endocardium
Epicardium

Pericardial sac

(a) (c)
Fig. 19.4 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Fat in interventricular
sulcus

Left ventricle

Right ventricle

Anterior interventricular
artery

(a) Anterior view, external anatomy

Superior vena cava
Base of heart

Inferior vena cava

Interatrial septum Right atrium

Left atrium
Opening of coronary sinus

Right AV valve
Left AV valve
Trabeculae carneae

Coronary blood vessels

Right ventricle
Tendinous cords
Papillary muscles
Left ventricle
Epicardial fat
Endocardium
Myocardium
Interventricular septum
Epicardium
Apex of heart

(b) Posterior view, internal anatomy

(a, b): © McGraw-Hill Education
Fig. 19.5 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Aortic arch Ligamentum

arteriosum

Ascending
Superior vena cava aorta

Left pulmonary
artery
Branches of the
right pulmonary
Pulmonary trunk
artery

Left pulmonary
Right pulmonary
veins
veins

Left auricle

Right auricle

Right atrium

Coronary sulcus

Anterior
Right ventricle
interventricular
sulcus
Inferior vena cava
Left ventricle

Apex of heart
(a) Anterior view

Aorta

Left pulmonary
artery Superior
vena cava

Right pulmonary
Left pulmonary artery
veins
Right pulmonary
veins
Left atrium

Coronary sulcus

Right atrium
Coronary sinus

Inferior vena cava

Fat
Posterior
Left ventricle interventricular
sulcus
Apex of heart

Right ventricle

(b) Posterior view

 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
Fig. 19.6

(a)

(b)
a, b: Photo and illustration by Roy Schneider, University of Toledo. Plastinated heart model for illustation courtesy of Dr. Carlos Baptista, University of Toledo
Fig. 19.7 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Left ventricle

Interventricular
septum

Right ventricle

(b)
Aorta

Right pulmonary Left pulmonary artery

artery

Superior vena cava Pulmonary trunk

Right pulmonary Left pulmonary veins

veins

Interatrial Pulmonary valve

septum Left atrium
Right atrium Aortic valve
Fossa ovalis Left AV valve
Pectinate muscles
Left ventricle
Right AV valve

Papillary muscle
Interventricular septum
Tendinous cords
Endocardium
Trabeculae carneae
Myocardium
Right ventricle
Inferior vena cava Epicardium

(a)
Fig. 19.8
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Left AV
(mitral) valve

Right AV
(tricuspid) valve

Fibrous
skeleton
Openings to
coronary arteries

Aortic
valve

Pulmonary
valve

(a) (b)

Tendinous
cords

Papillary
muscle

(c)
b: © Biophoto Associates/Science Source; c: © McGraw-Hill Education
Fig. 19.9

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10
1 Blood enters right atrium from superior
and inferior venae cavae.

2 Blood in right atrium flows through right

Aorta
Left pulmonary AV valve into right ventricle.
11 artery
3 Contraction of right ventricle forces
5 5 pulmonary valve open.

9 4 Blood flows through pulmonary valve

Pulmonary trunk
Superior into pulmonary trunk.
vena cava
4 Left pulmonary 5 Blood is distributed by right and left
6
veins pulmonary arteries to the lungs, where it
Right 6
unloads CO2 and loads O2 .
pulmonary
veins Left atrium
1 6 Blood returns from lungs via pulmonary
Aortic valve
veins to left atrium.
7
3 Left AV valve
7 Blood in left atrium flows through left AV
Right valve into left ventricle.
atrium 8
Left ventricle 8 Contraction of left ventricle (simultaneous with
Right AV 2
step 3 ) forces aortic valve open.
valve
9 Blood flows through aortic valve into
Right
ascending aorta.
ventricle

Inferior 10 Blood in aorta is distributed to every organ in

vena cava 11 the body, where it unloads O2 and loads CO2.

11 Blood returns to right atrium via venae cavae.

Fig. 19.10 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Left coronary Great cardiac

Right artery (LCA) vein
coronary Circumflex
artery Left auricle
(reflected) branch of
(RCA) LCA
Circumflex Coronary Right coronary
Small branch sinus artery (RCA)
Cardiac of LCA
vein Left marginal
branch of Right marginal
Great cardiac
LCA branch of RCA
vein
Right
marginal Left marginal Posterior
Anterior interventricular
branch vein
interventricular branch of RCA
of RCA branch of LCA
Posterior
interventricular
vein
(a) Anterior view (b) Posterior view

(c)
c: © SPL/Science Source
 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
Fig. 19.11
Striations

Nucleus

Intercalated discs

(a)

Striated myofibril Glycogen Nucleus Mitochondria Intercalated

discs

(b)

Intercellular space

Desmosomes
Fascia adherens
Gap junctions

(c)
a: © Ed Reschke
Fig. 19.12

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1 SA node fires.

2 Excitation spreads through

Right atrium 1 2 atrial myocardium.
Sinoatrial node
(pacemaker) Left 3 AV node fires.
atrium
2 Subendocardial
Atrioventricular 3 Conducting 4 Excitation spreads down AV
node network bundle.
Bundle
Atrioventricular branches 5 Subendocardial conducting
bundle 4 network distributes excitation
5
through ventricular
myocardium.

Subendocardial
conducting network
Fig. 19.13

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+10
0
Membrane potential (mV)

–10 Ca2+ –Na+ K+ outflow

Action
inflow
–20 potential

–30 Threshold

–40

–50 Pacemaker
potential
–60 Slow Na+
inflow
–70

0 .4 .8 1.2 1.6
Time (seconds)
Fig. 19.14

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3 1 Voltage-gated Na+ channels open.

Plateau
+20 4 2 Na+ inflow depolarizes the membrane
and triggers the opening of still more Na+
channels, creating a positive feedback
0 Action cycle and a rapidly rising membrane voltage.
Membrane potential (mV)

5
potential
3 Na+ channels close when the cell
Myocardial depolarizes, and the voltage peaks at
–20
relaxation nearly +30 mV.

4 Ca2+ entering through slow Ca2+

–40 2 Myocardial channels prolongs depolarization of
contraction membrane, creating a plateau. Plateau falls
slightly because of some K+ leakage, but most
–60 Absolute K+ channels remain closed until end of
refractory plateau.
period 5 Ca2+ channels close and Ca2+ is transported
–80 1 out of cell. K+ channels open, and rapid K+
outflow returns membrane to its resting
potential.
0 .15 .30
Time (seconds)
Fig. 19.15
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0.8 second

R R

+1

PQ ST
segment segment
Millivolts

T wave
P wave

PR Q
interval S

QT
interval QRS interval

–1

Atria Ventricles Atria Ventricles

contract contract contract contract
Fig. 19.16
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Key
Wave of
depolarization
R
Wave of
repolarization

P P

Q
S

1 Atria begin depolarizing. 4 Ventricular depolarization complete.

T
P P

Q
S

2 Atrial depolarization complete. 5 Ventricular repolarization begins at apex and

progresses superiorly.

R R

P T
P

Q Q
S

3 Ventricular depolarization begins at apex and 6 Ventricular repolarization complete; heart is

progresses superiorly as atria repolarize. ready for the next cycle.
Fig. 19.17

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(a) Sinus rhythm (normal) (c) Atrial fibrillation

P P P P

(b) Ventricular fibrillation (d) Heart block

(e) Premature ventricular contraction

Fig. 19.18 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

1 Volume
increases

2 Pressure
decreases

3 Air flows in P1
P2 > P1

Pressure gradient
P2
(a)

1 Volume
decreases

2 Pressure
increases

3 Air flows out P1

P2 < P1
Pressure gradient
P2
(b)
Fig. 19.19 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Atrium

Atrioventricular
valve

Ventricle

Atrioventricular valves open Atrioventricular valves closed

(a)

Aorta

Pulmonary
artery

Semilunar
valve

Semilunar valves open Semilunar valves closed

(b)
Fig. 19.20
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Diastole Systole Diastole

120 Aortic
pressure
100

Pressure (mm Hg)

80 Aortic
valve Aortic valve
Left opens closes
60 ventricular (dicrotic notch)
pressure
AV
40 valve AV
Left atrial closes valve
20 pressure opens

120 End-diastolic

volume (mL)
Ventricular
volume

90

60 End-systolic volume
R R

T
P P
ECG

Q Q
S S

Heart
sounds

S2 S3 S1 S2 S3 S1

Phase of 1a 1b 1c 2 3 4 1a 1b 1c 2
cardiac cycle

0 .2 .4 .6 .8 .2 .4
Time (seconds)

Ventricular filling
2 3 4
1a Rapid filling 1c Atrial systole Isovolumetric Ventricular Isovolumetric
1b Diastasis contraction ejection relaxation
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Fig. 19.21
1 Right ventricular
output exceeds left
ventricular output.
2 Pressure backs up.

3 Fluid accumulates in
pulmonary tissue. 1

2
3

(a) Pulmonary edema

1 Left ventricular
output exceeds right
ventricular output.
2 Pressure backs up.

3 Fluid accumulates in
systemic tissue.

2 1

(b) Systemic edema

Table 19.1
Table 19.2
Fig. 19.22

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(a) Lumen Artery wall

(c)

(b) Lumen Complicated plaque Artery wall

a: © Ed Reschke/Getty Images; b: © Ed Reschke; c: © Custom Medical Stock Photo/Newscom