THE HEART

Clarence L. Nuval, RMT, MD

HEART
• The pump that circulates blood throughout the body
• Roughly the same size as an individual’s closed fist
• 12 cm long, 9 cm wide, 6 cm thick
• Weighing 250 g in adult females and 300 g in adult males
• Rests on the diaphragm, lies in the mediastinum
HEART
• APEX – formed by the tip of
the left ventricle
• BASE – formed by the atria
• RIGHT SURFACE – faces
right lung; from inferior
surface to base
• LEFT SURFACE – faces left
lung; from base to apex
HEART
• ANTERIOR SURFACE – deep • INFERIOR SURFACE –
to the sternum and ribs between the apex and right
surface and rests mostly on
diaphragm
PERICARDIUM
• The triple-layered membrane
that surrounds and protects
the heart
• Confines the heart to its
position in the mediastinum,
while allowing sufficient
freedom of movement for
vigorous and rapid
contraction
PERICARDIUM
Fibrous pericardium Serous pericardium
• Tough, inelastic, dense
irregular connective
tissue
• Prevents over stretching
of the heart
• Provides protection
• Anchors heart in the
mediastinum
• Thinner more delicate
membrane that forms a
double layer around the
heart
• Composed of outer
parietal layer and inner
visceral layer (also the
epicardium)
LAYERS OF THE HEART WALL
Epicardium
• Outer layer: the visceral layer of the serous pericardium
• Composed of mesothelium
• Inner layer: fibroelastic tissue and adipose tissue

Myocardium
• Composed of cardiac muscle tissue
• Responsible for pumping action of the heart
• 95% of the heart wall

Endocardium
• Thin layer of endothelium overlying a thin layer of connective tissue
• Provides a smooth lining for the chambers of the heart
• Covers the valves of the heart
CHAMBERS OF THE HEART
Atria
• The superior receiving chambers
• Receives blood from veins
• i.e. SVC, IVC, pulmonary vein

Ventricles
• The inferior pumping chambers
• Ejects blood into arteries
• i.e. pulmonary arteries, aorta
CHAMBERS OF THE HEART
RIGHT ATRIUM
Right atrium
• Receives blood from three veins:
• Superior vena cava (SVC)
• Inferior vena cava (IVC)
• Coronary sinus
• Interior of posterior wall – smooth
• Interior of anterior wall – rough, due to presence of pectinate
muscles
CHAMBERS OF THE HEART
RIGHT ATRIUM
Interatrial septum
• A thin partition between the right and left atria
• Contains a prominent oval depression called fossa ovalis

Fossa ovalis
• Remnant of the foramen ovale
• An opening in the interatrial septum of the fetal heart
• Normally closes soon after birth
CHAMBERS OF THE HEART
RIGHT VENTRICLE
Right ventricle
• Receives blood from right atrium
• Interior is formed by trabeculae carneae
• Raised bundles of cardiac muscle fiber that play a role in the
heart’s conduction system
CHAMBERS OF THE HEART
RIGHT VENTRICLE
Interventricular septum
• A thin partition between the right and left ventricles

Chordae tendineae
• Tendonlike cords that connect cusps of the tricuspid valve

Papillary muscles
• Cone-shaped trabeculae carneae that are connected to the
chordae tendinae
CHAMBERS OF THE HEART
LEFT ATRIUM
Left atrium
• Receives blood from the pulmonary veins
• Interior of posterior wall – smooth
• Interior of anterior wall – smooth
• Pectinate muscles are confined to the auricle of the left
atrium
CHAMBERS OF THE HEART
LEFT VENTRICLE
Left ventricle
• Receives blood from the pulmonary veins
• Thickest chamber of the heart
• Also contains trabeculae carneae, chordae tendineae and
papillary muscles
OTHER PARTS OF THE HEART
Auricle
• A wrinkled pouchlike structure on the anterior surface of each
atrium

Sulci
• A series of grooves containing coronary blood vessels and fat
• Mark the external boundary between chambers of the heart
OTHER PARTS OF THE HEART
Coronary sulcus
• Encircles most of the heart
• Marks the boundary between the atria and ventricles

Anterior interventricular sulcus

• Marks the boundary between right and left ventricles on the
anterior aspect of the heart

Posterior interventricular sulcus

• Marks the boundary between the right and left ventricles on the
posterior aspect of the heart
FIBROUS SKELETON OF THE HEART
• Consists of four dense connective tissue rings that surround the
valves of the heart
• Prevents overstretching of the valves
• Serves as point of insertion for bundles of cardiac muscle fibers
• Acts as an electrical insulator between the atria and ventricles
FIBROUS SKELETON OF THE HEART
VALVES OF THE HEART
• Valves open and close in response to pressure changes as the heart
contracts and relaxes.

• Blood moves from an area of higher pressure to an area of lower

pressure unidirectionally.
• I.e. blood flow from atrium to ventricle, and ventricle to the
systemic/pulmonary circulation, but normally never vice versa

• Each of the four valves helps ensure the one-way flow of blood by
opening to let blood through and then closing to prevent its
backflow.
VALVES OF THE HEART
• Atrioventricular valves
• I.e. tricuspid and bicuspid valves
• Allow flow of blood from atria to ventricles

• Semilunar valves
• I.e. aortic and pulmonary valves
• Allow ejection of blood from heart into arteries, and prevent
backflow of blood into ventricles
VALVES OF THE HEART
Tricuspid valve
• Blood passes from the
right atrium to the right
ventricle through this
valve
Bicuspid / Mitral valve
• Blood passes from the
left atrium to the left
ventricle through this
valve

Pulmonary valve Aortic valve

• Blood passes from the • Blood passes from the
right ventricle to the left ventricle to the aorta
pulmonary trunk through through this valve
this valve
VALVES OF THE HEART
• When AV valves open, the rounded ends of the cusps project into the
ventricle.
• Blood moves from an area of high pressure (in the atrium) to an area
of lower pressure (in the ventricles) through open AV valves.
VALVES OF THE HEART
• When the ventricles contract, the pressure that builds up within the
chambers drive the cusps upward until their edges meet and close
the opening.
• Papillary muscles also contract, which pulls on and tightens the
chordae tendineae. This prevents the valves from opening into the
atria.
VALVES OF THE HEART
• The semilunar valves open when pressure in the ventricles exceeds
the pressure in arteries, hence permitting ejection of blood from the
ventricles into the pulmonary trunk and aorta.
• As the ventricles relax, blood starts to flow back toward the heart.
This fills the cusps and closes the opening between the ventricle and
artery.
SYSTEMIC AND PULMONARY
CIRCULATIONS
• The left side of the heart
pumps oxygenated blood into
the systemic circulation,
except the lungs.

• The right side of the heart

pumps deoxygenated blood
into the pulmonary
circulation.
CORONARY CIRCULATION
CORONARY CIRCULATION
• The myocardium’s own network of blood vessels.
• Consists of:
• Coronary arteries
• Branch from the ascending aorta and encircle the heart
• Supply oxygenated blood to the myocardium
• Coronary veins
• Drains the deoxyygenated blood from the myocardium, which
empties into the right atrium
CORONARY CIRCULATION
Left coronary artery
• Anterior interventricular
branch / left anterior
descending (LAD) artery
• Supplies both ventricles

• Circumflex branch
• Supplies the left ventricle
and left atrium
CORONARY CIRCULATION
Right coronary artery
• Atrial branches
• Supplies the right atrium

• Posterior interventricular
branch
• Supplies both ventricles

• Marginal branch
• Supplies the right
ventricle
CORONARY CIRCULATION
• Principal tributaries carrying blood into the coronary sinus:
• Great cardiac vein
• Middle cardiac vein
• Small cardiac vein
• Anterior cardiac vein
HISTOLOGY OF THE HEART
CARDIAC MUSCLES
• Involuntary muscles
• Branched, striated fibers with usually one centrally located
nucleus
• Have Intercalated discs
• Irregular transverse thickenings of the sarcolemma that
connect ends of cardiac muscle fibers together
• Contain desmosomes and gap junctions
THE CONDUCTION SYSTEM
CONDUCTION SYSTEM
Autorhythmic fibers
• The source of the rhythmical electrical activity the keeps the
heart pumping
• Act as a pacemaker
• Form the cardiac conduction system
CONDUCTION SYSTEM
Sinoatrial node
• Start of cardiac excitation
• Sets the rhythm for the
contraction of the heart
• Located in the right atrial
wall, inferior and lateral to the
opening of the SVC
• Repeatedly and
spontaneously depolarises to
threshold = pacemaker
potential
• In effect, the atria contract at
the same time
CONDUCTION SYSTEM
Atrioventricular node
• In the interatrial septum, just
anterior to the opening of the
coronary sinus
• Action potential slows and
provides time for the atria to
empty blood into the
ventricles
CONDUCTION SYSTEM
Atrioventricular bundle
• Bundle of His
• Only site where action
potentials can conduct from
atria to ventricles
CONDUCTION SYSTEM
Right and left bundle branch
• Extends through the
interventricular septum
toward the apex of the heart
CONDUCTION SYSTEM
Purkinje fibers
• Rapidly conduct the action
potential beginning at the
apex of the heart upward to
the remainder of the
ventricular myocardium
• Blood is then pushed from
the ventricles to the
pulmonary veins and aorta
ACTION POTENTIAL IN SA NODE
ACTION POTENTIAL IN SA NODE
1. Spontaneous depolarisation
(pacemaker potential)
2. Depolarisation
3. Repolarisation
ACTION POTENTIAL IN SA NODE
Pacemaker potential
• Triggers the action potential once it
reaches the threshold(-40 mV to -30
mV)
• Na channels open
• Na inflow (“funny currents”)
occurs
• At -50 mV, transient Ca channels
open
• Ca inflow occurs, further
depolarising the cell to -40 mV
• At -40 mV, long-lasting Ca channels
open
• Further Ca inflow occurs, finally
reaching threshold
ACTION POTENTIAL IN SA NODE
Depolarisation
• Long-lasting Ca channels
remain open  Ca inflow
• Hence, achieving
depolarisation
• Na channels and transient Ca
channels start to close
ACTION POTENTIAL IN SA NODE
Repolarisation
• K channels open
• K outflow occurs
• Long-lasting Ca channels
close
• Decreases Ca inflow
• The cycle repeats after cell is
completely repolarised at -60
mV
ACTION POTENTIAL IN VENTRICLES
ACTION POTENTIAL IN VENTRICLES
1. Depolarisation
2. Plateau
3. Repolarisation
ACTION POTENTIAL IN VENTRICLES
Depolarisation
• When a contractile fiber is brought to threshold (-40 mV to -30 mV)
by an action potential (AP), voltage-gated fast Na channels open.
• Na inflow occurs
• = RAPID DEPOLARISATION
• Within a few milliseconds, Na channels inactive and Na inflow
decreases.
ACTION POTENTIAL IN VENTRICLES
Plateau
• A period of maintained depolarisation
• Voltage-gated slow Ca channels in the sarcolemma are open
• Ca inflow occurs
• = CONTRACTION
• Some voltage-gated K channels also open
• K outflow occurs

Depolarisation is sustained because Ca inflow balances K outflow.

ACTION POTENTIAL IN VENTRICLES
Repolarisation
• Recovery of the resting membrane potential (RMP)
• After a delay, additional voltage-gated K channels open
• Outflow restores RMP of -90 mV
• Voltage-gated Ca channels are also closing during this time
ACTION POTENTIAL IN VENTRICLES
Refractory period
• The time interval in which a second contraction cannot be triggered
• Lasts longer than the contraction itself
• Hence, another contraction cannot begin until relaxation occurs