Heart (2): Innervation, Vasculature & Valves

Innervation to The Heart

Conducting System (initiator)
1. initiate heart contracts (70-90 b/m) 2. conduct impulse to ventricles

Autonomic System (external affecter)

or heart rate

Conducting System
Sino-Atrial node (SA node) Atrio-Ventricular node (AV node) Atrio-Ventricular Bundle & branches (bundle of His) Purkinje fibers (subendocardial plexus)

S-A Node (The Pacemaker)

Site of contraction initiation stellate cells (P-cells) Modified cardiac myocytes Rt. Atrium: upper part, anterolateral to SVC Impulse spreads from SA node through atrial walls to: AV node

A-V Node
The pulse conductor Lower part of atrial septum (above septal cusp)

Conduct pulse to ventricles through AV bundle

AV bundle (septum) Right (moderator) & Left bundle branches Purkinje fibers

Autonomic Innervation
To SA & AV nodes

Sympathetic (sympathetic trunk):

increase heart rate increase force of contraction dilatation of coronary artery

Parasympathetic (vagus nerve):

decrease heart rate reduce force of contraction constriction of coronary artery

Arterial Supply
Coronary arteries: Right & Left (larger) From ascending aorta & just above the valve

Right Coronary Artery

Between pulmonary trunk & Rt. Auricle Rt. AV groove (Posteriorly) anastomose with Lf. Coronary Branches: 1. Rt. Marginal artery 2. Post. interventricular (85-90%) 3. SA nodal (60 - 65%) 4. AV nodal

Left Coronary Artery

Larger but shorter Arises between pulmonary trunk & lf. Auricle

Divides to: 1. ant. interventricular a. 2. circumflex a 3. SA nodal (35 - 40%) through which branch?

Ant. Interventricular Artery

LAD: Left Anterior Descending Pass in ant. intervent. Groove turns around the apex anastomose with post. intervent. artery Gives rise to diagonal artery (lateral)

Circumflex Artery
Pass in left AV groove winding around the heart in a circle anastomoses with Rt. coronary posteriorly
Gives rise to left marginal artery

Venous Drainage
3 main veins Coronary Sinus
1. Great: Ant. 2. Middle: Post. 3. Small: Rt. Margin

Additional: 4. Ant. cardiac veins 5. venae cordis minimae

(open directly into heart chambers)

Angina Pectoris
Angina = G, strangling, Pectoris= L, chest Severe chest pain due to O2 shortage to the heart wall (ischemic heart disease) Cause: Partial obstruction or spasm of a coronary artery (arteriosclerosis) Symptoms: chest discomfort (pressure, heaviness or tightness) substernal pain specially after ? referred pain over the left arm, neck & lower jaw

Complication: Infarction (death of a part of myocardium)

Myocardial Infarction
Interruption of bld. Supply to a part of the heart leading to death of heart muscle on that region.

Known as: Heart Attack

Cause: complete block of a coronary artery (thrombosis) Symptoms: chest pain (as in angina) dyspnea Rx.: Coronary bypass surgery

Heart Valves
4 valves:
- 2 semilunar: Aortic & Pulmonary - 2 A-V: Tricuspid & Mitral

Semilunar Valves
Pulmonary:
3 semilunar cusps (2 ant. & 1 post.)
Cusp: folding of endocardium with C.T. inside

Sinus: space behind each cusp

Aortic :

similar to pulmonary

2 post. & 1 ant. cusps

Tricuspid Valve
Rt. A-V orifice 3 cusps: 1. ant. 2. post.

3. septal

Attached to papillary m. through Chordae tendineae

Chordae of each P.M. are connected to adjacent parts of 2 cusps

Mitral Valve
Left A-V orifice 2 cusps (bicuspid): Ant. & Post.

Similar attachments & fxn. as tricuspid valve

Auscultation of Heart Valves

(Read Your Textbook For Complete Details)

Mitral (M) Tricuspid (T) Aortic (A)

Pulmonary (P)

Heart Position
Behind the sternum & slightly to the left strong sounds = left to the sternum Dextrocardia: The heart is on the right side of the chest heart sounds = right to the sternum