1. PowerPoint ® Lecture Slide Presentation by Patty Bostwick-Taylor, Florence-Darlington Technical College Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings PART A 11 The Cardiovascular System

2. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Cardiovascular System  A closed system of the heart and blood vessels  The heart pumps blood  Blood vessels allow blood to circulate to all parts of the body  The function of the cardiovascular system is transportation - it delivers oxygen and nutrients and removes carbon dioxide and other waste products

3. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart  Location  Thorax between the lungs in the inferior mediastinum – medial cavity of the thorax  Orientation  Pointed apex directed toward left hip – where you would place a stethoscope  Base points toward right shoulder  About the size of your fist and weighs less than a pound

4. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart Figure 11.1a–b

5. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart Figure 11.1c

6. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart Figure 11.2a

7. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Coverings  Pericardium—a double-walled sac  Fibrous pericardium is loose and superficial  Serous membrane is deep to the fibrous pericardium and composed of two layers  Visceral pericardium  Next to heart; also known as the epicardium  Parietal pericardium  Outside layer that lines the inner surface of the fibrous pericardium  Serous fluid fills the space between the layers of pericardium

8. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Anatomy

9. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Heart Wall Figure 11.2b

10. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Heart Wall  Three layers  Epicardium - Outside layer  This layer is the visceral pericardium  Connective tissue layer  Myocardium - Middle layer  Mostly cardiac muscle twisted and whorled into ringlike arrangement  The layer that actually contracts  Called the skeleton of the heart  Endocardium - Inner layer  Endothelium that lines heart chambers  Continuous with blood vessels leaving & entering the heart

11. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Homeostatic Imbalance: Pericarditis  Inflammation of the pericardium  Results in decrease of serous fluid  Cause pericardial layers to stick together forming painful adhesions  Interferes with heart movement

12. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Heart Wall Figure 11.2b

13. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Heart Wall Figure 11.2c

14. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Review Questions 1  Where is the location of the heart in the thorax?  What is the major function of the heart?  What is the heart enclosed by?  Name the two layers of the pericardial sac?  Name the 3 layers of the heart wall  What is and what causes pericarditis?

15. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Chambers  Right and left side act as separate pumps  Four hollow chambers  2 Atria  Receiving chambers – not important in pumping activity of heart  Blood flows in from veins under low pressure  Right atrium  Left atrium  2 Ventricles  Discharging chambers – actual pumps of the heart  Right ventricle  Left ventricle

16. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Chambers Figure 11.2c

17. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Differences in Right and Left Ventricles Figure 11.4

18. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Septa  Septum divides the heart longitudinally  Interventricular septum - Separates the two ventricles  Interatrial septum - Separates the two atria

19. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Chambers Figure 11.2c

20. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Valves  Allow blood to flow in only one direction to prevent backflow  Four valves  Atrioventricular (AV) valves—between atria and ventricles  Bicuspid (mitral) valve (left side of heart)  Tricuspid valve (right side of heart)  Anchored in place by chordae tendinae (“heart strings”)  Open during heart relaxtion and closed during ventricular contrations

21. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Valves  Semilunar valves—between ventricle and artery  Pulmonary semilunar valve  Aortic semilunar valve  Closed during heart relaxation but open during ventricular contraction Notice these valves operate opposite of one another to force a one-way path of blood through the heart

22. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings **Homeostatic Imbalance  Faulty Valves – heart can function with “leaky” valves as long as damage is not too great  Incompetent valve – forces heart to pump and repump same blood because valves don’t close properly & blood backflows  Valvular stenosis – valve flaps become stiff often because of repeated endocarditis (bacterial infection of the endocardium)  Forces heart to contract more vigorously increasing workload  Faulty valve replaced with synthetic valve, cryopreserved human valve, or chemically treated porcine valve (pig heart valve)

23. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Valves Figure 11.2c

24. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 11.5a, step 1 Blood returning to the atria, puts pressure against AV valves; the AV valves are forced open Ventricles Operation of the AV valves AV valves open (a)

25. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 11.5a, step 2 Blood returning to the atria, puts pressure against AV valves; the AV valves are forced open As the ventricles fill, AV valve flaps hang limply into ventricles Ventricles Operation of the AV valves AV valves open (a)

26. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 11.5a, step 3 Blood returning to the atria, puts pressure against AV valves; the AV valves are forced open As the ventricles fill, AV valve flaps hang limply into ventricles Atria contract, forcing additional blood into ventricles Ventricles Operation of the AV valves AV valves open (a)

27. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 11.5a, step 4 Ventricles contract, forcing blood against AV valve flaps (a)

28. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 11.5a, step 5 Ventricles contract, forcing blood against AV valve flaps AV valves close AV valves closed (a)

29. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 11.5a, step 6 Ventricles contract, forcing blood against AV valve flaps AV valves close Chordae tendineae tighten, preventing valve flaps from everting into atria AV valves closed (a)

30. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 11.5b, step 1 As ventricles contract and intraventricular pressure rises, blood is pushed up against semilunar valves, forcing them open Aorta Pulmonary trunk Semilunar valve open Operation of the semilunar valves (b)

31. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 11.5b, step 2 As ventricles contract and intraventricular pressure rises, blood is pushed up against semilunar valves, forcing them open Aorta Pulmonary trunk Semilunar valve open Semilunar valve closed As ventricles relax, and intraventricular pressure falls, blood flows back from arteries, filling the leaflets of semilunar valves and forcing them to close Operation of the semilunar valves (b)

32. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Valves

33. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Review questions 2 1.What are the receiving chambers of the heart? the discharging? 2. Why might a thrombus in a coronary artery cause a sudden death? 3. Why are heart valves important? 4. What is another name for chordae tendinae?

34. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Systemic and Pulmonary Circulations  Systemic circulation  Blood flows from the left side of the heart through the body tissues and back to the right side of the heart  Pulmonary circulation  Blood flows from the right side of the heart to the lungs and back to the left side of the heart

35. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Systemic and Pulmonary Circulations Figure 11.3

36. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Associated Great Vessels  Arteries  Aorta - Leaves left ventricle  Pulmonary arteries - Leave right ventricle  Veins  Superior and inferior venae cavae - Enter right atrium  Pulmonary veins (four) - Enter left atrium

37. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Associated Great Vessels Figure 11.2c

38. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Blood Flow Through the Heart  Superior and inferior venae cavae dump blood into the right atrium  From right atrium, through the tricuspid valve, blood travels to the right ventricle  From the right ventricle, blood leaves the heart as it passes through the pulmonary semilunar valve into the pulmonary trunk  Pulmonary trunk splits into right and left pulmonary arteries that carry blood to the lungs

39. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Blood Flow Through the Heart  Oxygen is picked up and carbon dioxide is dropped off by blood in the lungs  Oxygen-rich blood returns to the heart through the four pulmonary veins  Blood enters the left atrium and travels through the bicuspid valve into the left ventricle  From the left ventricle, blood leaves the heart via the aortic semilunar valve and aorta

40. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Systemic and Pulmonary Circulations Figure 11.3

41. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Blood Flow

42. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Coronary Circulation  Blood in the heart chambers does not nourish the myocardium  The heart has its own nourishing circulatory system consisting of  Coronary arteries—branch from the aorta to supply the heart muscle with oxygenated blood  Cardiac veins—drain the myocardium of blood  Coronary sinus—a large vein on the posterior of the heart, receives blood from cardiac veins  Blood empties into the right atrium via the coronary sinus

43. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings ** Homeostatic Imbalance  Angina Pectoris – crushing chest pain caused by oxygen deprivation of the myocardium  Infarct – caused by prolonged oxygen deprivation where heart cells die  Myocardial infarction – “heart attack” or “coronary”

44. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings II. Physiology of the Heart  Intrinsic conduction system (nodal system)  Heart muscle cells contract, without nerve impulses, in a regular, continuous way

45. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Conduction System  Special tissue sets the pace – similar to cross between muscle & nervous tissue  Sinoatrial node = SA node (“pacemaker”), is in the right atrium  Atrioventricular node = AV node, is at the junction of the atria and ventricles  Atrioventricular bundle = AV bundle (bundle of His), is in the interventricular septum  Bundle branches are in the interventricular septum  Purkinje fibers spread within the ventricle wall muscles

46. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Heart Contractions Figure 11.6

47. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Heart Contractions  Contraction is initiated by the sinoatrial node (SA node)  Sequential stimulation occurs at other autorhythmic cells  Force cardiac muscle depolarization in one direction—from atria to ventricles

48. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Heart Contractions  Once SA node starts the heartbeat  Impulse spreads to the AV node  Then the atria contract  At the AV node, the impulse passes through the AV bundle, bundle branches, and Purkinje fibers  Blood is ejected from the ventricles to the aorta and pulmonary trunk as the ventricles contract

49. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Heart Contractions Figure 11.6

50. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Heart Contractions  Tachycardia—rapid heart rate over 100 beats per minute  Bradycardia—slow heart rate less than 60 beats per minutes

51. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings **Homeostatic Imbalance  Heart block – when the AV node is damaged allowing the ventricles to beat at their own slower rate  Ischemia – lack of adequate blood supply which leads to fibrillation- rapid uncoordinated shudddering of heart muscles  Pacemaker will need to be inserted to correct this condition.

52. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Pacemaker implant

53. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Cardiac Cycle  In a healthy heart, atria contract simultaneously  Atria relax, then ventricles contract  Systole = contraction  Diastole = relaxation

54. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Filling Heart Chambers: Cardiac Cycle Figure 11.7 Atrial contraction Mid-to-late diastole (ventricular filling) Ventricular systole (atria in diastole) Early diastole Isovolumetric contraction phase Ventricular ejection phase Isovolumetric relaxation Ventricular filling Left atrium Right atrium Left ventricle Right ventricle

55. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Filling Heart Chambers: Cardiac Cycle Figure 11.7, step 1a Mid-to-late diastole (ventricular filling) Ventricular filling Left atrium Right atrium Left ventricle Right ventricle

56. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Filling Heart Chambers: Cardiac Cycle Figure 11.7, step 1b Atrial contraction Mid-to-late diastole (ventricular filling) Ventricular filling Left atrium Right atrium Left ventricle Right ventricle

57. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Filling Heart Chambers: Cardiac Cycle Figure 11.7, step 2a Atrial contraction Mid-to-late diastole (ventricular filling) Ventricular systole (atria in diastole) Isovolumetric contraction phase Ventricular filling Left atrium Right atrium Left ventricle Right ventricle

58. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Filling Heart Chambers: Cardiac Cycle Figure 11.7, step 2b Atrial contraction Mid-to-late diastole (ventricular filling) Ventricular systole (atria in diastole) Isovolumetric contraction phase Ventricular ejection phase Ventricular filling Left atrium Right atrium Left ventricle Right ventricle

59. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Filling Heart Chambers: Cardiac Cycle Figure 11.7, step 3 Atrial contraction Mid-to-late diastole (ventricular filling) Ventricular systole (atria in diastole) Early diastole Isovolumetric contraction phase Ventricular ejection phase Isovolumetric relaxation Ventricular filling Left atrium Right atrium Left ventricle Right ventricle

60. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Cardiac Cycle  Cardiac cycle—events of one complete heart beat  Mid-to-late diastole—blood flows from atria into ventricles  Ventricular systole—blood pressure builds before ventricle contracts, pushing out blood  Early diastole—atria finish refilling, ventricular pressure is low

61. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Heart Sounds  When using a stethoscope you hear two distinct sounds in a cardiac cycle.  These heart sounds are described by two syllables “lub” and “dup”  The “lub” is caused by the closing of the AV valves (bicuspid and tricuspid)  The “dup” occurs when the semilunar valves close.

62. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings ** Homeostatic Imbalance - Murmurs  Murmur – abnormal or unusual heart sounds  Fairly common in young children (and some elderly people) with perfectly healthy hearts probably due to thin heart walls.  Outside of these groups a murmur may indicate a valve problem.

63. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Regulation of Heart Rate  Increased heart rate  Sympathetic nervous system  Crisis stressors (physical or emotional trauma, high body temp.)  Low blood pressure  Hormones can also increase heart rate  Epinephrine  Thyroxine  Exercise – working muscles generate heat which increases heart rate by boosting metabolism

64. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings The Heart: Regulation of Heart Rate  Decreased heart rate  Parasympathetic nervous system slow and steady the heart giving it time to rest.

65. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Cardiac Output Regulation Figure 11.8

66. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings ** Homeostatic Imbalance  Congestive heart failure – when the pumping efficiency of the heart is depressed so that circulation is inadequate to meet tissue needs.  A progressive condition that may be caused by coronary atherosclerosis (blockage of coronary vessels with fatty buildup), persistent high blood pressure or multiple myocardial infarctions

67. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Congestive Heart Failure (CHF)  Each side can fail independently  If the left side fails it is pulmonary congestion because the right side continues to send blood to the lungs but the left side can not discharge blood into systemic circuclation  Lungs become swollen with blood, pressure increases and fluid leaks into lung tissue causing pulmonary edema  If untreated the patient suffocates

68. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Congestive Heart Failure (CHF)  If the right side fails peripheral congestion occurs as blood backs up in the systemic circulation  Edema is most noticeable in distal parts of the body; feet, ankles, and fingers become swollen and puffy  Failure of one side puts a greater strain on the other side and eventually the whole heart fails