2. The adult heart weighs about 280 grams (10 oz.) At rest, the heart pumps out about 80 millimeters (2.6 oz) of blood with each beat. 2.02 Understand the functions and disorders of the circulatory system 2

3. The heart beats, on average, 70 times each minute at rest. This means all the blood is circulated (goes round the body once) in about one minute.

4. During strenuous exercise the heart can pump six to eight times the amount of blood that it pumps at rest.

5. Functions Pump Blood transport system around body Carries O2 and nutrients to cells, carries away waste products Lymph system – returns excess tissue fluid to general circulation

6. 2.02 Understand the functions and disorders of the circulatory system 6 Functions of the heart It’s a PUMP What do pumps do? How does this relate to heart function?

7. 2.02 Understand the functions and disorders of the circulatory system 7 Hear the beat!

8. LUBB SOUND – heard first and made when the tricuspid & bicuspid valves close This is the S1 sound – heard loudest at apex of heart DUPP SOUND- heard 2 nd – shorter & high pitched – caused by the semi lunar valves in aorta and pulmonary artery closing 2.02 Understand the functions and disorders of the circulatory system 8

9. Structure – Circulatory system involves: Heart Arteries Veins Capillaries Blood and lymph are part of circulatory system

10. Major Blood Circuits General (Systemic) circulation Cardiopulmonary circulation - to the lungs & back to the heart -to all the body (organs & systems)

12. The Heart Muscular organ Size of a closed fist Weighs 12-13 oz Location –thoracic cavity APEX – conical tip, lies on diaphragm, points left Stethoscope – instrument used to hear the heartbeat

13. Structure Hollow, muscular, double pump that circulates blood At rest = 2 oz blood with each beat, 5 qts./min., 75 gallons per hour Ave = 72 beats per minute 100,000 beats per day

14. Layers of the heart PERICARDIUM – double layer of fibrous tissue that surrounds the heart

15. MYOCARDIUM – cardiac muscle tissue

16. ENDOCARDIUM – smooth inner lining of heart

17. SEPTUM – partition (wall) that separates right half from left half

18. Superior vena cava and inferior vena cava – bring deoxygenated blood to right atrium Pulmonary artery – takes blood away from right ventricle to the lungs for O2 Pulmonary veins – bring oxygenated blood from lungs to left atrium Aorta – takes blood away from left ventricle to rest of the body

19. Chambers and Valves SEPTUM divides into R and L halves Upper chambers – RIGHT ATRIUM and LEFT ATRIUM Lower chambers – RIGHT VENTRICLE and LEFT VENTRICLE

20. Four heart valves permit flow of blood in one direction: 1.TRICUSPID VALVE – between right atrium and right ventricle 2.BICUSPID (MITRAL) VALVE – between left atrium and left ventricle 3. & 4. Semilunar valves are located where blood leaves the heart - PULMONARY SEMILUNAR VALVE and AORTIC SEMILUNAR VALVE

22. PHYSIOLOGY OF THE HEART The heart is a double pump. When the heart beats… Right Heart Deoxygenated blood flows into heart from vena cava  right atrium  tricuspid valve  right ventricle  pulmonary semilunar valve  pulmonary artery  lungs (for oxygen)

23. Left Heart Oxygenated blood flows from lungs via pulmonary veins  left atrium  mitral valve  left ventricle  aortic semilunar valve  aorta  general circulation (to deliver oxygen) http://www.smm.org/studio3d/julie/hearthome.htm

25. Blood Supply to the Heart – from CORONARY ARTERIES Heart Sounds = lubb dupp http://sln.fi.edu/biosci/monitor/heartbeat.html

26. 2.02 Understand the functions and disorders of the circulatory system 26 It’s electric! Discuss the function of the heart’s conduction system.

27. Control of Heart Contractions SA (sinoatrial) NODE = PACEMAKER Located in right atrium SA node sends out electrical impulse Impulse spreads over atria, making them contract

29. Travels to AV Node AV (atrioventricular) NODE Conducting cell group between atria and ventricle Carries impulse to bundle of His

30. BUNDLE OF HIS Conducting fibers in septum Divides into R and L branches to network of branches in ventricles (Purkinje fibers) PURKINJE FIBERS Impulse shoots along Purkinje fibers causing ventricles to contract

31. ELECTROCARDIOGRAM (EKG or ECG) Device used to record the electrical activity of the heart. SYSTOLE = contraction phase DIASTOLE = relaxation phase Baseline of EKG is flat line

33. P = atrial contraction QRS = ventricular contract T = ventricular relaxation

34. HOLTER MONITOR – 24 hour EKG

35. CARDIOPULMONARY CIRCULATION – heart and lungs SYSTEMIC CIRCULATION – from the heart to the tissues and cells, then back to the heart

36. As the Blood Flows Deoxygenated Blood from Body Tissue  Superior/inferior vena cava  Right Atrium  Tricuspid Valve opens  Right Ventricle  Pulmonic Valve  Pulmonary Artery  Both Lungs 

37. CO2 - O2 exchange Alveolar via Pulmonary Veins  Left Atrium  Mitral Valve Opens  Left Ventricle  Aortic Valve Opens  Aorta - Transporting Oxygenated Blood to Body Cells http://www.dgs.k12.il.us/heart.htm http://www.dgs.k12.il.us/heart.htm

38. ARTERIOLES – small arteries VENULES – small veins

40. Systemic Circulation AORTA – largest artery in the body First branch is coronary artery Aortic arch Many arteries branch off the descending aorta

41. Blood Vessels ARTERIES Carry oxygenated blood away from the heart to the capillaries Elastic, muscular and thick-walled Transport blood under very high pressure

42. CAPILLARIES Smallest blood vessels, can only be seen with a microscope Connect arterioles with venules Walls are one-cell thick and extremely thin – allow for selective permeability of nutrients, oxygen, CO2 and metabolic wastes

43. VEINS Carry deoxygenated blood away from capillaries to the heart Veins contain a muscular layer, but less elastic and muscular than arteries Thin walled veins collapse easily when not filled with blood VALVES – permit flow of blood only in direction of the heart JUGULAR vein – located in the neck

44. Blood Pressure Surge of blood when heart pumps creates pressure against the walls of the arteries SYSTOLIC PRESSURE – measured during the contraction phase DIASTOLIC PRESSURE – measured when the ventricles are relaxed Average systolic = 120 Average diastolic = 80

45. PULSE – alternating expansion and contraction of an artery as blood flows through it. Pulse sites: BRACHIAL CAROTID RADIAL POPLITEAL PEDAL FEMORAL TEMPORAL

46. Diseases of the Heart ARRHYTHMIA (or dysrrhythmia) – any change from normal heart rate or rhythm

47. BRADYCARDIA – slow heart rate (<60 bpm)

48. TACHYCARDIA – rapid heart rate (>100 bpm)

49. 2.02 Understand the functions and disorders of the circulatory system 49 Circulatory disorders Murmurs

50. MURMURS – indicates defect in heart valve – valves fail to close properly, causing gurgling or hissing sound.

51. 2.02 Understand the functions and disorders of the circulatory system 51 Circulatory disorders Coronary artery disease

52. MITRAL VALVE PROLAPSE – mitral valve closes imperfectly – symptoms occur in response to stress, including fatigue, PALPITATIONS (heart feels like it is racing) headache, chest pain, and anxiety.

53. Infectious Diseases of the Heart Cause = virus or bacteria Treatment = antibiotics

54. PERICARDITIS – inflammation of outer membrane covering the heart – symptoms are chest pain, cough, dyspnea (difficulty breathing), tachycardia, and fever.

55. MYOCARDITIS – inflammation of heart muscle – symptoms the same as pericarditis

56. ENDOCARDITIS – inflammation of the membrane that lines the heart and covers the valves, causes rough spots in the endocardium which may lead to the development of a thrombus

57. Coronary Artery Disease ANGINA PECTORIS – chest pain, caused by lack of oxygen to heart muscle, treat with nitroglycerin to dilate coronary arteries

58. 2.02 Understand the functions and disorders of the circulatory system 58 Circulatory disorders Myocardial infarction

59. MYOCARDIAL INFARCTION MI or heart attack Lack of blood supply to myocardium causes damage Due to blockage of coronary artery or blood clot atherosclerosis – plaque build- up on arterial walls, or arteriosclerosis – loss of elasticity and thickening of wall.

60. Amount of damage depends on size of area deprived of oxygen Symptoms – severe chest pain radiating to left shoulder, arm, neck and jaw. Also nausea, diaphoresis, dyspnea. Immediate medical care is critical Rx – bedrest, oxygen, medication Morphine for pain, tPA to dissolve clot Anticoagulant therapy to prevent further clots from forming Angioplasty and by-pass surgery may be necessary

62. 2.02 Understand the functions and disorders of the circulatory system 62 Circulatory disorders Heart failure

63. CONGESTIVE HEART FAILURE Ventricles unable to contract effectively and blood pools in the heart Edema in lower extremities Blood backs up into lungs Rx – drugs to strengthen heart beat (digoxin) and Diuretics to reduce fluid

64. 2.02 Understand the functions and disorders of the circulatory system 64 Circulatory disorders Pulmonary edema

65. Heart failure – left side of heart does not pump effectively Rt. Side pumps effectively, but left cannot keep up with blood being delivered. Blood backs up into lungs, increasing pressure in those vessels Once pressure reaches certain point, fluid leaks out of vessels into lung tissue and even air spaces

66. Heart Surgery ANGIOPLASTY – procedure to help open clogged vessels – may also be called “balloon surgery.”

67. CORONARY BY-PASS usually, a healthy vein from the leg removed and attached before and after the coronary obstruction, creating an alternate route for blood supply to the myocardium.

72. HEART TRANSPLANT Why? Irreparably damaged myocardium, valves or blood vessels, or baby/child with congenital heart defect Problem? Histocompatibility Rx? Immunosuppressants Artificial hearts? First used in 1982. What is the current status? http://www.smm.org/studio3d/julie/hearthome.htm http://www.smm.org/studio3d/julie/hearthome.htm (watch surgery)

74. PACEMAKERS Demand pacemaker – fires only when heart rate drops below programmed minimum

75. http://www.smm.org/studio3d/julie/heartho me.htm watch Heart Matehttp://www.smm.org/studio3d/julie/heartho me.htm

76. STENT Tiny, expandable stainless steel tube that holds coronary artery open following angioplasty http://www.cardiologyassociates.net/patientinfo_edu.asp?fs=2 (click to view animation – watch stent)

77. CPR – cardiopulmonary resuscitation, used in the presence of cardiac arrest

78. DEFIBRILLATION – electrical shock to bring the heart back to a normal rhythm.

79. AED – automated external defibrillator

80. HEART BLOCK – disturbance in electrical conductivity of the heart beat

81. 2.02 Understand the functions and disorders of the circulatory system 81 Circulatory disorders Aneurysm

82. Disorders of the Blood Vessels ANEURYSM – ballooning of an artery, thinning and weakening

83. 2.02 Understand the functions and disorders of the circulatory system 83 Circulatory disorders Peripheral vascular disease

84. ATHEROSCLEROSIS – fatty deposits form on walls of arteries

85. Carotid endarterectomy

89. 2.02 Understand the functions and disorders of the circulatory system 89 Circulatory disorders Arteriosclerosis

90. ARTERIOSCLEROSIS – arterial walls thicken, lose elasticity. Causes narrowing of blood vessel opening

91. PHLEBITIS – inflammation of lining of vein, accompanied by clotting of blood – symptoms are edema, pain and redness

92. EMBOLISM – traveling blood clot

93. VARICOSE VEINS – swollen, distended veins – heredity or due to posture, prolonged periods of standing, physical exertion, age and pregnancy

94. 2.02 Understand the functions and disorders of the circulatory system 94 Circulatory disorders Varicose veins Prevention –Wear sunscreen –Elevate legs when resting –Wear elastic support stockings –Eating fiber diets –Exercise –Weight control

95. HEMORRHOIDS - varicose rectal veins

96. HYPOTENSION – low blood pressure, systolic <100

97. HYPERTENSION High blood pressure “silent killer” – usually no symptoms Condition leads to strokes, heart attacks, and kidney failure 140/90 or higher Higher in African-Americans and post- menopausal women Risk factors = smoking, overweight, stress, high fat diets, family history Treatment = relaxation, low fat diet, exercise, weight loss, medication

99. 2.02 Understand the functions and disorders of the circulatory system 99 Circulatory disorders Transient ischemic attack

100. Diagnostic Tests CARDIAC CATHETERIZATION – catheter fed into heart, dye injected, x-rays taken as dye moves through coronary arteries http://www.cardiologyassociates.net/patientinfo_edu.asp?fs=2 Click watch animation – cardiac catheterization

101. http://www.cardiologyassociates.net/patientinfo_edu.asp?fs=2 http://www.cardiologyassociates.net/patientinfo_edu.asp?fs=2 (CLICK TO VIEW ANIMATION – ANGIOPLASTY) ANGIOGRAM – x-ray of a blood vessel using dye

102. ELECTROCARDIOGRAM – electrical tracing of the heart