1. Memmler’s The Human Body in Health and Disease 11th edition
Chapter 14
The Heart and Heart Disease

2. Circulation and the Heart
Continuous one-way circuit of the blood vessels
Propelled by heart

3. Location of the Heart Between the lungs
Left of the midline of the body
In mediastinum
Apex pointed toward left

4. Structure of the Heart Three tissue layers
Endocardium lines heart’s interior
Myocardium is thickest layer; the heart muscle
Epicardium is thin outermost layer

5. The Pericardium The sac that encloses the heart
Fibrous pericardium holds heart in place
Serous membrane
Parietal layer
Pericardial cavity
Visceral layer (epicardium)

6. Layers of the heart wall and pericardium
Layers of the heart wall and pericardium. The serous pericardium covers the heart and lines the fibrous pericardium.
ZOOMING IN
• Which layer of the heart wall is the thickest?

7. Question: Which layer of the heart is the heart muscle? a. epicardium b. myocardium c. pericardium

8. Answer: b. myocardium

9. Checkpoint 14-1: What are the names of the innermost, middle, and outermost layers of the heart?
Checkpoint 14-2: What is the name of the sac that encloses the heart?

10. Special Features of the Myocardium
Cardiac muscles
Are lightly striated (striped)
Have single nucleus cells
Are controlled involuntarily
Have intercalated disks
Have branching muscle fibers

11. Divisions of the Heart Double pump
Right side pumps blood low in oxygen to the lungs
Pulmonary circuit
Left side pumps oxygenated blood to remainder of body
Systemic circuit

12. Four Chambers Right atrium
Receives low-oxygen blood returning from body tissue through superior vena cava and inferior vena cava
Left atrium
Receives high-oxygen blood from lungs
Right ventricle
Pumps blood from right atrium to lungs
Left ventricle
Pumps oxygenated blood to body

13. The heart as a double pump
The heart as a double pump. The right side of the heart pumps blood through the pulmonary circuit to the lungs to be oxygenated; the left side of the heart pumps blood through the systemic circuit to all other parts of the body.
ZOOMING IN
• What vessel carries blood into the systemic circuit?

14. The heart and great vessels.
ZOOMING IN
• Which heart chamber has the thickest wall?

15. Checkpoint 14-3: The heart is divided into four chambers
Checkpoint 14-3: The heart is divided into four chambers. What is the upper receiving chamber on each side called? What is the lower pumping chamber called?

16. Question: Which chamber of the heart receives oxygenated blood coming in from the lungs in the pulmonary veins? a. right atrium b. left ventricle c. left atrium

17. Answer: c. left atrium (upper left chamber)

18. Four Valves Atrioventricular valves Entrance valves
Right atrioventricular (AV) valve (tricuspid valve)
Left atrioventricular (AV) valve (bicuspid valve)
Semilunar valves
Exit valves
Pulmonary valve
Aortic valve

19. Valves of the heart (superior view from anterior, atria removed)
Valves of the heart (superior view from anterior, atria removed). (A) When the heart is relaxed (diastole), the AV valves are open and blood flows freely from the atria to the ventricles. The pulmonary and aortic valves are closed. (B) When the ventricles contract, the AV valves close and blood pumped out of the ventricles opens the pulmonary and aortic valves. ZOOMING IN • How many cusps does the right AV valve have? The left?

20. Pathway of blood through the heart.
Blood from the systemic circuit enters the right atrium (1) through the superior and inferior venae cavae, flows through the right AV (tricuspid) valve (2), and enters the right ventricle (3). The right ventricle pumps the blood through the pulmonary (semilunar) valve (4) into the pulmonary trunk, which divides to carry blood to the lungs in the pulmonary circuit.
Blood returns from the lungs in the pulmonary veins, enters the left atrium (5), and flows through the left AV (mitral) valve (6) into the left ventricle (7). The left ventricle pumps the blood through the aortic (semilunar) valve (8) into the aorta, which carries blood into the systemic circuit.

21. Checkpoint 14-4: What is the purpose of valves in the heart?

22. Blood Supply to the Myocardium
Coronary circulation
Right coronary artery
Left coronary artery
Coronary sinus

23. Blood vessels that supply the myocardium
Blood vessels that supply the myocardium. Coronary arteries and cardiac veins are shown. (A) Anterior view. (B) Posterior view.

24. Opening of coronary arteries in the aortic valve (anterior view)
Opening of coronary arteries in the aortic valve (anterior view). (A) When the left ventricle contracts, the aortic valve opens. The valve cusps prevent filling of the coronary arteries. (B) When the left ventricle relaxes, backflow of blood closes the aortic valve and the coronary arteries fill.

25. Checkpoint 14-5: The myocardium must have its own vascular system to supply it with blood. What name is given to this blood supply to the myocardium?

26. Function of the Heart
Left and right sides of heart work together in cardiac cycle (heartbeat)
Systole (active phase, contraction)
Diastole (resting phase)

27. The cardiac cycle.
ZOOMING IN • When the ventricles contract, what valves close? What valves open?

28. Cardiac Output Calculating cardiac output Cardiac output (CO)
Stroke volume (SV)
Heart rate (HR)
CO = HR 3 SV

29. Checkpoint 14-6: The cardiac cycle consists of an alternating pattern of contraction and relaxation. What name is given to the contraction phase?
Checkpoint 14-7: Cardiac output is the amount of blood pumped by each ventricle in 1 minute. What two factors determine cardiac output?

30. The Heart’s Conduction System
Electrical energy stimulates heart muscle
Nodes
Sinoatrial (SA) node (pacemaker)
Atrioventricular (AV) node
Specialized fibers
Atrioventricular bundle (bundle of His)
Purkinje fibers (conduction myofibers)
Intercalated disks

31. Conduction system of the heart
Conduction system of the heart. The sinoatrial (SA) node, the atrioventricular (AV) node, and specialized fibers conduct the electrical energy that stimulates the heart muscle to contract.
ZOOMING IN
• What parts of the conduction system do the internodal pathways connect?

32. The Conduction Pathway
Sinus rhythm
Sinoatrial (SA) node
Atria
Atrioventricular (AV) node
Internodal pathways
Bundle of His
Bundle branches and Purkinje fibers
Ventricles

33. Checkpoint 14-8: The heartbeat is started by a small mass of tissue in the upper right atrium. This structure is commonly called the pacemaker, but what is its scientific name?

34. Control of the Heart Rate
Influences that allow heart to meet changing needs rapidly
Autonomic nervous system (ANS)
Sympathetic nervous system
Parasympathetic system
Cranial nerve X

35. Variations in Heart Rates
Bradycardia
Tachycardia
Sinus arrhythmia
Premature beat (extrasystole)

36. Heart Sounds
Lub
Dup
Murmurs
Organic
Functional

37. Checkpoint 14-9: What system exerts the main influence on the rate and strength of heart circulation?
Checkpoint 14-10: What is a heart murmur?

38. Question: What is the medical term for a heart rate of more than 100 beats/min? a. bradycardia b. hypercardia c. tachycardia

39. Answer: c. tachycardia

40. Heart Disease
Most common cause of death in industrialized countries is heart and circulatory system disease

41. Classifications of Heart Disease
Anatomical classification
Endocarditis
Myocarditis
Pericarditis
Causative factors classification
Congenital heart disease
Rheumatic heart disease
Coronary artery disease
Heart failure

42. Congenital Heart Disease
Congenital heart disease often results from fetal development defects
Atrial septal defect
Patent (open) ductus arteriosus
Ventricular septal defect
Coarctation of the aorta
Tetralogy of Fallot

43. Checkpoint 14-11: What is congenital heart disease?

44. Rheumatic Heart Disease
Streptococci release toxins during infection
Antibodies that combat toxin also attack heart valves
Heart valves become inflamed
Valve cusps thicken and harden
Pulmonary congestion occurs

45. Checkpoint 14-12: What types of organisms cause rheumatic fever?

46. Coronary Artery Disease
Coronary arteries can degenerate
Myocardial infarction
Creatine kinase released upon any muscle damage. Tests for certain forms of CK indicate whether an MI occurred.
Angina pectoris
Abnormalities of heart rhythm
Treatment of heart attacks

47. Checkpoint 14-13: Narrowing or blockage of the vessels that supply the heart muscle causes coronary artery disease. What degenerative process commonly causes narrowing of these vessels?

48. Question: What is the name of the fatty substance that builds up inside the vessel walls in atherosclerosis? a. plaque b. lumen c. thrombus

49. Answer: a. plaque

50. Heart Failure Heart is unable to pump sufficient blood
Heart chambers enlarge
Blood backs up into lungs
Ventricular muscles have decreased ability
Fluid accumulates in lungs, liver, abdomen, legs

51. The Heart in the Elderly
How the heart can age
Heart shrinks
Decreased contraction strength
Valves become less flexible
Murmur develops
Cardiac output decreases
Abnormal rhythms
Heart block

52. Prevention of Heart Disease
Risk factors that cannot be modified
Age
Gender
Heredity
Body type
Risk factors that can be modified
Smoking
Physical inactivity
Weight
Diet
Blood pressure
Diabetes, gout

53. Heart Studies Stethoscope Electrocardiograph (ECG or EKG) Electrodes
Catheterization
Fluoroscope
Echocardiography (ultrasound cardiography)
Oscilloscope

54. Checkpoint 14-14: What do ECG and EKG stand for?

55. Treatment of Heart Disease
Medical approaches
Surgical approaches
Combined approaches

56. Medications Digitalis Nitroglycerin
Beta-adrenergic blocking agents (beta-blockers)
Antiarrhythmic agents
Slow calcium-channel blockers
Anticoagulants
Aspirin

57. Correction of Arrhythmias
Artificial pacemaker
Set rate
Only when heart skips beat
Adjustable pacing rate
Implantable cardioverter-defibrillator (ICD)

58. Heart Surgery Coronary artery bypass graft (CSBG) Angioplasty
Valve replacement
Surgical transplantation of heart or heart and lungs
Artificial heart

59. Checkpoint 14-15: What technique is used to open a restricted coronary artery with a balloon catheter?

60. Question: The technique to restore normal heartbeat by either electric shock or drugs is known as: a. defibrillation b. cardioversion c. ablation

61. Answer: b. cardioversion

62. End of Presentation