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SYSTEM
Francel A. Diaz, M.D.
I. Anatomy of the Heart
6
Heart Anatomy
7
Heart Anatomy
8
Coverings of the Heart: Anatomy
Pericardium – a double-walled sac around the
heart composed of:
1. A superficial fibrous pericardium
2. A deep two-layer serous pericardium
a. The parietal layer lines the internal surface of
the fibrous pericardium
b. The visceral layer or epicardium lines the
surface of the heart
They are separated by the fluid-filled
pericardial cavity
9
Coverings of the Heart: Physiology
10
Pericardial Layers of the Heart
11
Heart Wall
14
External Heart: Anterior View
15
External Heart: Major Vessels of the Heart
(Posterior View)
17
External Heart: Posterior View
18
Gross Anatomy of Heart: Frontal Section
19
Atria of the Heart
20
Ventricles of the Heart
21
Myocardial Thickness and Function
22
Thickness of Cardiac Walls
23
Atrial Septal Defect
24
Ventricular Septal Defect
25
Pathway of Blood Through the Heart and
Lungs
Right atrium tricuspid valve right ventricle
Right ventricle pulmonary semilunar valve
pulmonary arteries lungs
Lungs pulmonary veins left atrium
Left atrium bicuspid valve left ventricle
Left ventricle aortic semilunar valve aorta
Aorta systemic circulation
26
Pathway of Blood Through the Heart and
Lungs
27
Coronary Circulation
28
Coronary Circulation: Arterial Supply
29
Coronary Circulation: Venous Supply
30
Heart Valves
31
Heart Valves
32
Heart Valves
33
Heart Valves
34
Atrioventricular Valve Function
35
Semilunar Valve Function
36
Mitral Valve Prolapse
37
Microscopic Anatomy of Heart Muscle
38
Microscopic Anatomy of Heart Muscle
39
Figure 18.11
The Cardiovascular System:
The Heart
Physiology
40
Cardiac Muscle Contraction
Heart muscle:
Is stimulated by nerves and is self-excitable
(automaticity)
Contracts as a unit
Has a long (250 ms) absolute refractory period
42
Heart Physiology: Intrinsic Conduction
System
Autorhythmic cells:
Initiate action potentials
Have unstable resting potentials called pacemaker
potentials
Use calcium influx (rather than sodium) for rising
phase of the action potential
43
Pacemaker and Action Potentials of the Heart
44
Heart Physiology: Sequence of Excitation
45
Heart Physiology: Sequence of Excitation
46
Heart Physiology: Sequence of Excitation
47
Heart Excitation Related to ECG
48
Extrinsic Innervation of the Heart
Heart is stimulated
by the sympathetic
cardioacceleratory
center
Heart is inhibited by
the parasympathetic
cardioinhibitory
center
49
Figure 18.15
Electrocardiography
Electrical activity is recorded by electrocardiogram
(ECG)
P wave corresponds to depolarization of SA node
QRS complex corresponds to ventricular
depolarization
T wave corresponds to ventricular repolarization
Atrial repolarization record is masked by the larger
QRS complex
50
Electrocardiography
51
Heart Sounds
52
Cardiac Cycle
53
Phases of the Cardiac Cycle
54
Phases of the Cardiac Cycle
55
Phases of the Cardiac Cycle
56
Phases of the Cardiac Cycle
57
Cardiac Output (CO) and Reserve
59
Regulation of Stroke Volume
60
Factors Affecting Stroke Volume
61
Frank-Starling Law of the Heart
62
Preload and Afterload
63
Extrinsic Factors Influencing Stroke Volume
64
Extrinsic Factors Influencing Stroke Volume
65
Contractility and Norepinephrine
Sympathetic
stimulation
releases
norepinephrine
and initiates a
cyclic AMP
second-
messenger
system
66
Regulation of Heart Rate
67
Regulation of Heart Rate: Autonomic Nervous
System
68
Atrial (Bainbridge) Reflex
69
Chemical Regulation of the Heart
70
Factors Involved in Regulation of Cardiac
Output
71
Congestive Heart Failure (CHF)
72
Age-Related Changes Affecting the Heart
74
Congestive Heart Failure
Causes of CHF
coronary artery disease, hypertension, MI, valve disorders,
congenital defects
Left side heart failure
less effective pump so more blood remains in ventricle
heart is overstretched & even more blood remains
blood backs up into lungs as pulmonary edema
suffocation & lack of oxygen to the tissues
Right side failure
fluid builds up in tissues as peripheral edema
75
Coronary Artery Disease
Treatment
drugs, bypass graft,
angioplasty, stent
76
Clinical Problems
MI = myocardial infarction
death of area of heart muscle from lack of O2
replaced with scar tissue
results depend on size & location of damage
Blood clot
use clot dissolving drugs streptokinase or t-PA & heparin
balloon angioplasty
Angina pectoris
heart pain from ischemia (lack of blood flow and oxygen )
of cardiac muscle
77
By-pass Graft
78
Percutaneous Transluminal Coronary
Angioplasty
79
Artificial Heart
80