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LECTURE 2: THE HEART

Prof. Magidah Alaudi, M.Sc.

Circuits of the Cardiovascular System

Pulmonary circuit
Delivers blood from the right
ventricle of the heart to the
lungs and from the lungs to
the left atrium of the heart
Systemic circuit
Delivers blood from the left
ventricle of the heart to the
rest of the body and collects
blood from the rest of the
body and delivers it to the
right atrium of the heart.

The Pericardium

Visceral pericardium or epicardium


Parietal pericardium
Pericardial fluid

Parietal Pericardium

Pericardial Cavity

Visceral Pericardium

Layers of the Heart

Endocardium
inner layer
simple squamous epithelium (endothelium)

Myocardium
middle layer
cardiac muscle

Epicardium
outer layer
loose connective tissue

Superficial Anatomy of the Heart

The heart consists of four chambers


Two upper chamber called atria
Two lower chambers called ventricles
The two upper and two lower chambers are
separated by atrioventricular valves
Tricuspid Valve
Between RA and RV
Mitral Valve (Bicuspid)
Between LA and LV

The Heart Wall

The heart wall is composed of


three layers:
Epicardium: primarily
composed of Areolar Tissue
and epithelium
Myocardium: primarily
composed of cardiac muscle
tissue
Endocardium: primarily
composed of Areolar Tissue
and endothelium

Internal Anatomy of the heart:


Atria

Right Atrium
Thin walled chambers that receive blood from superior

and inferior vena cava and pumps blood to the right


ventricle
Composed of pectinate muscle

Left Atrium
Thin walled chambers that receive blood from

pulmonary veins and pumps blood to left ventricle

Internal Anatomy of the heart:


Ventricles

Right Ventricle
Thick walled chamber that receives blood from right

atrium and pumps blood to pulmonary artery.

Left Ventricle
Thick walled chamber that receives blood from left

atrium and pumps blood to the Aorta.


Both ventricles are composed of trabeculae carne

The two ventricles are separated from the atria by


atrioventricular (AV) valves
Tricuspid valve separates right atrium from right ventricle
Bicuspid (mitral) valve separates left atrium from left ventricle

Chordae tendineae
Tendinous fibers attached to the cusps of AV valves
It attaches the cusps of atrioventricular valves to papillary

muscles
It prevents the AV valve from reversing into the atria as papillary
muscles contract

Papillary muscle and trabeculae carneae


Muscular projections on the inner wall of ventricles

Blood Flow through the heart

Right atria
receives blood from superior and inferior vena cava and
pumps it to the right ventricle through the tricuspid
valve
Right ventricle
receives blood from right atrium and pumps it toto the
pulmonary artery through the pulmonary semilunar
valve
Pulmonary artery -delivers the blood to the lungs
At the lungs gas exchange occurs
Oxygen diffuses from the alveoli to the capillary and
carbon dioxide diffuses from the capillary to the
alveoli.

Pulmonary Vein
after the gas exchange at the lungs, pulmonary
veins collect the blood and delivers it to the left
atrium.
Left atria
receives blood from pulmonary veins and pumps
it to the left ventricle through the bicuspid valve
(mitral valve)
Left ventricle
receives blood from the left atria and pumps it to
the aorta through the aortic semilunar valve

The aorta branches into smaller arteries and


delivers the blood to the cells throughout the
body.
Brachiocephalic Trunk
Right Subclavian Artery
Right Common Carotid Artery
Left Common Carotid Artery
Left Subclavian Artery

Gas exchange occur between the cell and the


capillaries
Oxygen diffuses from the capillaries to the cell

and carbon dioxide diffuses from the cell to the


capillaries.
After the gas exchange the blood is delivered back

to the heart by superior and inferior vena cava.

Structural Differences in heart


chambers and valves

Compared to the right ventricle the left ventricle is:


More muscular and has thicker wall
Develops higher pressure during contraction
Produces about 6 times more force during
contraction
Round in cross section
Functions of valves
AV valves prevent backflow of blood from the
ventricles to the atria
Semilunar valves prevent backflow of blood from the
pulmonary trunk and aorta to the ventricles.

Sectional Anatomy of the heart

Blood Supply to the Heart

Coronary arteries are the


Coronary arteries supply
first blood vessels to
branch from the aorta
blood to the heart and
Arteries include:
coronary veins collect the
the right and left coronary
blood from the heart
arteries
marginal arteries
anterior and posterior
interventricular arteries

Left Anterior descending

and Posterior descending


(LAD, PDA)
the circumflex artery

Veins include
The great cardiac vein
anterior and posterior cardiac

veins
middle cardiac vein
small cardiac vein

Coronary Circulation

Cardiac Physiology

The Heartbeat

Two classes of cardiac muscle cells


Specialized muscle cells of the
conducting system
Contractile cells

The conducting system

The conducting system includes:


Sinoatrial (SA) node - Pacemaker cells are
located in the SA node
Atrioventricular (AV) node
AV bundle,
bundle branches, and
Purkinje fibers

Impulse conduction through the heart

SA node begins the action potential (AP)


Stimulus spreads to the AV node
Impulse is delayed at AV node
Impulse then travels through ventricular
conducting cells
Then distributed by Purkinje fibers

ECG: Electrocardiogram

ECG is a recording of the electrical events occurring


during the cardiac cycle

Analysis of ECG can reveal:


Condition of conducting system
Effect of altered ion concentration
Size of ventricles
Position of the heart

Electrocardiogram

At an interval of 0.1 second each: (2 small


squares on ECG)
P-wave: atrial depolarization
PR interval: conduction delay through the AV node
(~ 200 msec)
QRS complex: ventricular depolarization (<120
msec)
T wave: ventricular repolarization
When inverted, indicates a recent MI
At an interval of 0.4 second: (10 squares on ECG)
QT interval: mechanical contraction of the
ventricles

An Electrocardiogram

Membrane Potential: difference in electrical impulses between the


external and internal environment of a cell.
Depolarization: positive change in a cell's membrane potential that
causes the cell to become more (+) or less (-)
leads to removal of the charge that developed from all the
negative charges that accumulated on the inner membrane and
positive charges on the outer membrane
(outside) + + + + + + + + + + + + - - - - (inside) - - - - - - - - - - - - ---+++++
Repolarization: change in membrane potential back to its initial
negative state after depolarization of an action potential had
changed it to a positive value
Hyperpolarization: change in membrane potential making it MORE
negative than its original state.

Contractile cells

Resting membrane potential of approximately

90mV
Action potential
Rapid depolarization
A plateau phase unique to cardiac muscle
Calcium channels remain open longer than the
sodium channels
Repolarization
Refractory period follows the action potential

AP in Cardiac Myocytes

The action potential in typical cardiomyocytes is composed


of 5 phases (0-4), beginning and ending with phase 4.
Phase 4: The resting phase
The resting potential in a cardiomyocyte is 90 mV due
to a constant outward leak of K+ through inward
channels.
Na+ and Ca2+ channels are closed at resting
transmembrane potential (TMP).

Phase 0: Depolarization
An action potential triggered in a neighboring cardiomyocyte
or pacemaker cell causes the TMP to rise above 90 mV.
Fast Na+ channels start to open one by one
Na+ leaks into the cell, causing a rise in TMP.

TMP approaches 70mV


the threshold potential in cardiomyocytes

the point at which enough fast Na+ channels have

opened to generate a self-sustaining inward Na+ current.

The large Na+ current rapidly depolarizes the TMP

to 0 mV and slightly above 0 mV for a transient


period of time called the overshoot; fast Na+
channels close (recall that fast Na+ channels are
time-dependent).
L-type (long-opening) Ca2+ channels open
when the TMP is greater than 40 mV and cause a
small but steady influx of Ca2+ down its
concentration gradient.

Phase 1: Early repolarization


TMP is now slightly positive.
Some K+ channels open briefly and an outward
flow of K+ returns the TMP to approximately 0
mV.
Phase 2: The plateau phase
L-type Ca2+ channels are still open and there is a small,

constant inward current of Ca2+.


This becomes significant in the excitation-contraction

coupling process described below.


K+ leaks out down its concentration gradient through

delayed rectifier K+ channels.


These two countercurrents are electrically balanced, and
the TMP is maintained at a plateau just below 0 mV
throughout phase 2.

Phase 3: Repolarization
Ca2+ channels are gradually inactivated.
Persistent outflow of K+, now exceeding Ca2+ inflow,

brings TMP back towards resting potential of 90 mV to


prepare the cell for a new cycle of depolarization.
Normal transmembrane ionic concentration gradients are
restored by returning Na+ and Ca2+ ions to the
extracellular environment, and K+ ions to the cell interior.
The pumps involved include:
Na+ -Ca2+ exchanger
Ca2+ -ATPase
Na+ -K+ -ATPase.

Cardiac Cycle

The period between the start of one


heartbeat and the beginning of the next
During a cardiac cycle
Each heart chamber goes through systole and

diastole
Systole: ventricular contraction
Diastole: ventricular relaxation

Correct pressure relationships are dependent

on careful timing of contractions


Normal blood pressure: 120/80 mmHg

Cardiac Cycle

Sinoatrial (SA) node:


Normal pacemaker of the heart
Located in upper wall of RA
normally generates the action potential (the electrical impulse that initiates

contraction).
excites the right atrium (RA), travels through Bachmanns bundle to excite left

atrium (LA).
The impulse travels through internodal pathways in RA to the atrioventricular

(AV) node.

AV node:
Lower wall of RA
Sends impulses into lower RA and LA

the impulse then travels through the bundle of His and down the bundle branches
fibers specialized for rapid transmission of electrical impulses, on either side

of the interventricular septum.

Right bundle branch (RBB):


depolarizes the right ventricle (RV).
Left bundle branch (LBB):
depolarizes the left ventricle (LV) and interventricular
septum.
Both bundle branches terminate in Purkinje fibers
millions of small fibers projecting throughout the
myocardium.

An organized rhythmic contraction of the heart


requires adequate propagation of electrical
impulses along the conduction pathway.
The impulses in the His-Purkinje system travel
in such a way that papillary muscle contract
before the ventricles
prevents regurgitation of blood flow through
the AV valves.

Heart Sounds

Auscultation listening to heart sound via


stethoscope
Four heart sounds
S1 lubb caused by the closing of the AV valves
S2 dubbcaused by the closing of the semilunar

valves
S3 a faint sound associated with blood flowing
into the ventricles
Prominent in heart murmurs due to backflow of blood

S4 another faint sound associated with atrial

contraction

Stroke Volume and Cardiac


Output

Stroke volume
the volume of blood ejected with each ventricular contraction

Cardiac output
the amount of blood pumped by each ventricle in one minute
Average heart pumps:
Males: 5.6 L/min
Females: 4.9 L/min.

Heart Rate: heart beats/min.


Normal: 72 beats/min.

CO = HR x SV

Abnormal Heart Rates

Bradycardia
slow heart rate; less than 60 beats / min

Tachycardia
rapid heart rate; more than 100 beats / min

Arrhythmias
abnormalities in rhythm
Ventricular Fibrillation
(ventricles contract at an extremely fast rate and are asynchronous; then stop

functioning; can be fatal; can be caused by massive heart attack or electric shock)

Myocardial Infarction (heart attack)


usually due to loss of oxygen to the heart
can be caused by blocked coronary arteries (plaque build up of cholesterol;

LDL bad cholesterol)


abnormal QRS complex

Autonomic Activity

The heart is innervated by sympathetic


and parasympathetic nerves.
Sympathetic stimulation
Positive inotropic effect
Releases NE

Parasympathetic stimulation
Negative inotropic effect
Releases ACh

Medulla Oblongata affect autonomic


innervation

Cardioacceleratory center
activates sympathetic neurons what is the action sympathetics on the

heart?

Cardioinhibitory center
controls parasympathetic neurons what is the action of

parasympathetics on the heart?

Medulla Oblongata centers


receives input and monitors blood pressure and dissolved gas

concentrations which gases?


Baroreceptors located in the wall of the aorta and carotid arteries monitors
blood pressure and sends impulse to the medulla
Adjusts the sympathetic tone accordingly.
The renin-angiotensin-aldosterone (RAS) system is also very important in

maintaining blood pressure


Under renal control

Summary: Regulation of Heart Rate and


Stroke Volume

Sympathetic stimulation increases heart rate


Parasympathetic stimulation decreases heart rate
Circulating hormones, specifically Epi, NE, and T3,
accelerate heart rate
Increased venous return increases heart rate

Clinical View: Heart Murmurs

Most heart murmurs are innocent


Caused by blood flowing through healthy valves in a
healthy heart and do not require treatment.
Heart murmurs can be caused by blood flowing through
a damaged or overworked heart valve.
Heart valve defects may be present at birth or heart
valve disease may result from other illnesses, such as
rheumatic fever, heart attacks, heart disease or infective
endocarditis.

Clinical View:
Types of Heart Valve Diseases

Mitral valve prolapse


Normally your mitral valve closes completely when

your left ventricle contracts, preventing blood from


flowing back into your left atrium.
If part of the valve balloons out so that the valve does
not close properly, you have mitral valve prolapse.
This causes a clicking sound as your heart beats. Often,
this common condition is not serious.
However, in rare cases it leads to bacterial endocarditis
or mitral regurgitation (backward blood flow through
the valve); both can be serious.

Mitral valve or aortic stenosis


Your mitral or aortic valves, both on the left side of

your heart, can become narrowed by scarring from


infections, such as rheumatic fever, or may be narrow at
birth.
Narrowing or constriction is called stenosis.
In mitral valve or aortic stenosis, the heart has to work
harder to pump enough blood to satisfy your body's
oxygen needs.
If untreated, stenosis can wear out your heart and can
lead to heart failure.

Aortic sclerosis
One in three elderly people have a heart murmur

due to the scarring, thickening, or stiffening


(sclerosis) of the aortic valve.
This condition is generally not dangerous;
typically, the valve can function for years after the
murmur is detected.
Aortic sclerosis is usually seen in people with
atherosclerosis, or hardening of the arteries.

Mitral or aortic regurgitation


Regurgitation (backward flow) of blood can

occur with mitral valve prolapse or mitral valve


or aortic stenosis.
To counteract this back flow, the heart must work
harder to force blood through the damaged valve.
Over time, this can weaken and/or enlarge the
heart and can lead to heart failure.

Congenital heart defects


About 25,000 babies are born each year with

heart defects, such as holes in heart walls or


misshapen heart valves.
Many congenital heart defects can be corrected
by surgery.