1. Fundamentals of Anatomy & Physiology Frederic H. Martini Unit 4 Fluids and Transport Copyright © 2005 Pearson Education, Inc., publishing as Benjamin Cummings PowerPoint ® Lecture Slides prepared by Professor Albia Dugger, Miami–Dade College, Miami, FL Professor Robert R. Speed, Ph.D., Wallace Community College, Dothan, AL

2. Chapter 20: The Heart

3. How are the cardiovascular system and heart organized?

4. The Heart: Anatomy PLAY Figure 20–1 Organization of the Cardiovascular System

5. The Pulmonary Circuit  Carries blood to and from gas exchange surfaces of lungs

6. The Systemic Circuit  Carries blood to and from the body

7. Alternating Circuits  Blood alternates between pulmonary circuit and systemic circuit

8. 3 Types of Blood Vessels  Arteries: carry blood away from heart  Veins: carry blood to heart  Capillaries: networks between arteries and veins

9. Capillaries  Also called exchange vessels  Exchange materials between blood and tissues  Dissolved gases, nutrients, wastes

10. 4 Chambers of the Heart  2 for each circuit: left and right:  ventricles and atria

11. 4 Chambers of the Heart  Right atrium: collects blood from systemic circuit  Right ventricle: pumps blood to pulmonary circuit

12. 4 Chambers of the Heart  Left atrium: collects blood from pulmonary circuit  Left ventricle: pumps blood to systemic circuit

13. Where is the heart located and what are its general features?

14. Anatomy of the Heart  Located directly behind sternum InterActive Physiology: Cardiovascular System: Anatomy Review: The Heart PLAY Figure 20–2a

15. Figure 20–2c Anatomy of the Heart  Great veins and arteries at the base  Pointed tip is apex

16. Relation to Thoracic Cavity Figure 20–2b

17. Relation to Thoracic Cavity  Surrounded by pericardial sac  Between 2 pleural cavities  In the mediastinum

18. What is the structure and function of the pericardium?

19. Figure 20–2c The Pericardium  Double lining of the pericardial cavity

20. 2 Layers of Pericardium 1.Parietal pericardium: outer layer forms inner layer of pericardial sac 2.Visceral pericardium: inner layer of pericardium

21. Structures of Pericardium  Pericardial cavity: Is between parietal and visceral layers contains pericardial fluid  Pericardial sac: fibrous tissue surrounds and stabilizes heart

22. Pericarditis  An infection of the pericardium

23. Superficial Anatomy of the Heart  4 cardiac chambers Figure 20–3

24. Atria  Thin-walled  Expandable outer auricle

25. Sulci  Coronary sulcus: divides atria and ventricles  Anterior and posterior interventricular sulci: separate left and right ventricles contain blood vessels of cardiac muscle

26. What are the layers of the heart wall?

27. The Heart Wall Figure 20–4

28. 3 Layers of the Heart Wall  Epicardium: outer layer  Myocardium: middle layer  Endocardium: inner layer

29. Epicardium  Visceral pericardium  Covers the heart

30. Myocardium  Muscular wall of the heart  Concentric layers of cardiac muscle tissue

31. Cardiac Muscle Cells Figure 20–5

32. Cardiac Muscle Cells  Intercalated discs: interconnect cardiac muscle cells secured by desmosomes linked by gap junctions convey force of contraction propagate action potentials

33. Characteristics of Cardiac Muscle Cells 1.Small size 2.Single, central nucleus 3.Branching interconnections between cells 4.Intercalated discs

34. Cardiac Cells vs. Skeletal Fibers Table 20-1

35. What is the path of blood flow through the heart, and what are the major blood vessels, chambers, and heart valves?

36. Internal Anatomy 3D Panorama of the Heart PLAY Figure 20–6a

37. Atrioventricular (AV) Valves  Connect right atrium to right ventricle and left atrium to left ventricle  Permit blood flow in 1 direction: atria to ventricles The Heart: Valves PLAY

38. Septa  Interatrial septum: separates atria  Interventricular septum: separates ventricles

39. The Vena Cava  Delivers systemic circulation to right atrium  Superior vena cava: receives blood from head, neck, upper limbs, and chest  Inferior vena cava: receives blood from trunk, and viscera, lower limbs

40. Coronary Sinus  Cardiac veins return blood to coronary sinus  Coronary sinus opens into right atrium

41. Foramen Ovale  Before birth, is an opening through interatrial septum  Connects the 2 atria  Seals off at birth, forming fossa ovalis

42. Pectinate Muscles  Contain prominent muscular ridges  On anterior atrial wall  And inner surfaces of right auricle

43. Cusps  Fibrous flaps that form bicuspid (2) and tricuspid (3) valves  Free edges attach to chordae tendineae from papillary muscles of ventricle  Prevent valve from opening backward

44. Right Atrioventricular (AV) Valve  Also called tricuspid valve  Opening from right atrium to right ventricle  Has 3 cusps  Prevents backflow The Heart: Blood Flow PLAY

45. Trabeculae Carneae  Muscular ridges on internal surface of right ventricle  Includes moderator band: ridge contains part of conducting system coordinates contractions of cardiac muscle cells

46. The Pulmonary Circuit  Conus arteriosus (superior right ventricle) leads to pulmonary trunk  Pulmonary trunk divides into left and right pulmonary arteries  Blood flows from right ventricle to pulmonary trunk through pulmonary valve  Pulmonary valve has 3 semilunar cusps

47. Return from Pulmonary Circuit  Blood gathers into left and right pulmonary veins  Pulmonary veins deliver to left atrium  Blood from left atrium passes to left ventricle through left atrioventricular (AV) valve  2-cusp bicuspid valve or mitral valve

48. The Left Ventricle  Holds same volume as right ventricle  Is larger; muscle is thicker, and more powerful  Similar internally to right ventricle, but does not have moderator band

49. The Left Ventricle  Systemic circulation: blood leaves left ventricle through aortic valve into ascending aorta ascending aorta turns (aortic arch) and becomes descending aorta

50. Left and Right Ventricles  Have significant structural differences Figure 20–7

51. Structure of Left and Right Ventricles  Right ventricle wall is thinner, develops less pressure than left ventricle  Right ventricle is pouch-shaped, left ventricle is round

52. The Heart Valves  One-way valves prevent backflow during contraction Figure 20–8

53. Atrioventricular (AV) Valves  Between atria and ventricles  Blood pressure closes valve cusps during ventricular contraction  Papillary muscles tense chordae tendineae: prevent valves from swinging into atria

54. Regurgitation  Failure of valves  Causes backflow of blood into atria

55. Semilunar Valves  Pulmonary and aortic tricuspid valves  Prevent backflow from pulmonary trunk and aorta into ventricles  Have no muscular support  3 cusps support like tripod

56. Aortic Sinuses  At base of ascending aorta  Prevent valve cusps from sticking to aorta  Origin of right and left coronary arteries

57. Carditis  An inflammation of the heart  Can result in valvular heart disease (VHD): e.g., rheumatic fever

58. KEY CONCEPT (1 of 3)  The heart has 4 chambers: 2 for pulmonary circuit:  right atrium and right ventricle 2 for systemic circuit:  left atrium and left ventricle

59. KEY CONCEPT (2 of 3)  Left ventricle has a greater workload  Is much more massive than right ventricle, but the two chambers pump equal amounts of blood

60. KEY CONCEPT (3 of 3)  AV valves prevent backflow from ventricles into atria  Semilunar valves prevent backflow from aortic and pulmonary trunks into ventricles

61. Connective Tissue Fibers of the Heart 1.Physically support cardiac muscle fibers 2.Distribute forces of contraction 3.Add strength and prevent overexpansion of heart 4.Elastic fibers return heart to original shape after contraction

62. The Fibrous Skeleton  4 bands around heart valves and bases of pulmonary trunk and aorta  Stabilize valves  Electrically insulate ventricular cells from atrial cells

63. How is the heart supplied with blood?

64. Blood Supply to the Heart  Coronary circulation Figure 20–9

65. Coronary Circulation  Coronary arteries and cardiac veins  Supplies blood to muscle tissue of heart

66. Coronary Arteries  Left and right  Originate at aortic sinuses  High blood pressure, elastic rebound force blood through coronary arteries between contractions

67. Right Coronary Artery  Supplies blood to: right atrium portions of both ventricles cells of sinoatrial (SA) and atrioventricular nodes marginal arteries (surface of right ventricle) posterior interventricular artery

68. Left Coronary Artery  Supplies blood to: left ventricle left atrium interventricular septum

69. Cardiac Veins (1 of 3)  Great cardiac vein: drains blood from area of anterior interventricular artery into coronary sinus

70. Cardiac Veins (2 of 3)  Anterior cardiac vein: empties into right atrium

71. Cardiac Veins (3 of 3)  Posterior cardiac vein, middle cardiac vein, and small cardiac vein: empty into great cardiac vein or coronary sinus

72. Figure 20–11 The Cardiac Cycle

73. The Heartbeat  A single contraction of the heart  The entire heart contracts in series: first the atria then the ventricles

74. 2 Types of Cardiac Muscle Cells  Conducting system: controls and coordinates heartbeat  Contractile cells: produce contractions

75. InterActive Physiology: Cardiovascular System: Cardiac Action Potential PLAY The Cardiac Cycle  Begins with action potential at SA node transmitted through conducting system produces action potentials in cardiac muscle cells (contractile cells)

76. Electrocardiogram (ECG)  Electrical events in the cardiac cycle can be recorded on an electrocardiogram (ECG)

77. What is the difference between nodal cells and conducting cells; what are the components and functions of the conducting system of the heart?

78. Figure 20–12 The Conducting System

79.  A system of specialized cardiac muscle cells: initiates and distributes electrical impulses that stimulate contraction  Automaticity: cardiac muscle tissue contracts automatically

80. Structures of the Conducting System  Sinoatrial (SA) node  Atrioventricular (AV) node  Conducting cells

81. Conducting Cells  Interconnect SA and AV nodes  Distribute stimulus through myocardium  In the atrium: internodal pathways  In the ventricles: AV bundle and bundle branches

82. Prepotential  Also called pacemaker potential  Resting potential of conducting cells: gradually depolarizes toward threshold  SA node depolarizes first, establishing heart rate

83. Heart Rate  SA node generates 80–100 action potentials per minute  Parasympathetic stimulation slows heart rate  AV node generates 40–60 action potentials per minute

84. Figure 20–13 Impulse Conduction through the Heart

85. The Sinoatrial (SA) Node  In posterior wall of right atrium  Contains pacemaker cells  Connected to AV node by internodal pathways  Begins atrial activation (Step 1)

86. The Atrioventricular (AV) Node  In floor of right atrium  Receives impulse from SA node (Step 2)  Delays impulse (Step 3)  Atrial contraction begins

87. The AV Bundle  In the septum  Carries impulse to left and right bundle branches: which conduct to Purkinje fibers (Step 4)  And to the moderator band: which conducts to papillary muscles

88. 4. The Purkinje Fibers  Distribute impulse through ventricles (Step 5)  Atrial contraction is completed  Ventricular contraction begins

89. Abnormal Pacemaker Function  Bradycardia: abnormally slow heart rate  Tachycardia: abnormally fast heart rate

90. Ectopic Pacemaker  Abnormal cells  Generate high rate of action potentials  Bypass conducting system  Disrupt ventricular contractions

91. What electrical events are associated with a normal electrocardiogram?

92. The Electrocardiogram Figure 20–14b

93. Electrocardiogram (ECG or EKG)  A recording of electrical events in the heart  Obtained by electrodes at specific body locations  Abnormal patterns diagnose damage

94. Features of an ECG  P wave: atria depolarize  QRS complex: ventricles depolarize  T wave: ventricles repolarize

95. Cardiac Arrhythmias  Abnormal patterns of cardiac electrical activity

96. KEY CONCEPT (1 of 3)  Heart rate is normally established by cells of SA node  Rate can be modified by autonomic activity, hormones, and other factors

97. KEY CONCEPT (2 of 3)  From the SA node, stimulus is conducted to AV node, AV bundle, bundle branches, and Purkinje fibers before reaching ventricular muscle cells

98. KEY CONCEPT (3 of 3)  Electrical events associated with the heartbeat can be monitored in an electrocardiogram (ECG)

99. Contractile Cells  Purkinje fibers distribute the stimulus to the contractile cells, which make up most of the muscle cells in the heart

100. What events take place during an action potential in cardiac muscle?

101. Action Potentials in Skeletal and Cardiac Muscle Figure 20–15

102. 3 Steps of Cardiac Action Potential 1.Rapid depolarization: voltage-regulated sodium channels (fast channels) open

103. 3 Steps of Cardiac Action Potential 2.As sodium channels close: voltage-regulated calcium channels (slow channels) open balance Na + ions pumped out hold membrane at 0 mV plateau

104. 3 Steps of Cardiac Action Potential 3.Repolarization: plateau continues slow calcium channels close slow potassium channels open rapid repolarization restores resting potential

105. Timing of Refractory Periods  Length of cardiac action potential in ventricular cell: 250–300 msecs  30 times longer than skeletal muscle fiber  long refractory period prevents summation and tetany

106. What is the importance of calcium ions to the contractile process?

107. Calcium and Contraction  Contraction of a cardiac muscle cell is produced by an increase in calcium ion concentration around myofibrils

108. 2 Steps of Calcium Ion Concentration 1.20% of calcium ions required for a contraction: calcium ions enter cell membrane during plateau phase

109. 2 Steps of Calcium Ion Concentration 2.Arrival of extracellular Ca 2+ : triggers release of calcium ion reserves from sarcoplasmic reticulum

110. Intracellular and Extracellular Calcium  As slow calcium channels close: intracellular Ca 2+ is absorbed by the SR or pumped out of cell  Cardiac muscle tissue: very sensitive to extracellular Ca 2+ concentrations

111. What events take place during the cardiac cycle, including atrial and ventricular systole and diastole?

112. The Cardiac Cycle  The period between the start of 1 heartbeat and the beginning of the next  Includes both contraction and relaxation InterActive Physiology: Cardiovascular System: The Cardiac Cycle PLAY

113. 2 Phases of the Cardiac Cycle  Within any 1 chamber: systole (contraction) diastole (relaxation)

114. Blood Pressure  In any chamber: rises during systole falls during diastole  Blood flows from high to low pressure: controlled by timing of contractions directed by one-way valves

115. Phases of the Cardiac Cycle Figure 20–16

116. 4 Phases of the Cardiac Cycle 1.Atrial systole 2.Atrial diastole 3.Ventricular systole 4.Ventricular diastole

117. Cardiac Cycle and Heart Rate  At 75 beats per minute: cardiac cycle lasts about 800 msecs  When heart rate increases: all phases of cardiac cycle shorten, particularly diastole

118. Pressure and Volume in the Cardiac Cycle  8 steps in the cardiac cycle Figure 20–17

119. 8 Steps in the Cardiac Cycle 1.Atrial systole: atrial contraction begins right and left AV valves are open

120. 8 Steps in the Cardiac Cycle 2.Atria eject blood into ventricles: filling ventricles

121. 8 Steps in the Cardiac Cycle 3.Atrial systole ends: AV valves close ventricles contain maximum volume end-diastolic volume (EDV)

122. 8 Steps in the Cardiac Cycle 4.Ventricular systole: pressure in ventricles rises AV valves shut

123. 8 Steps in the Cardiac Cycle 5.Ventricular ejection: semilunar valves open blood flows into pulmonary and aortic trunks

124. 8 Steps in the Cardiac Cycle 6.Ventricular pressure falls: semilunar valves close

125. 8 Steps in the Cardiac Cycle 7.Ventricular diastole: ventricular pressure is higher than atrial pressure all heart valves are closed ventricles relax

126. 8 Steps in the Cardiac Cycle 8.Atrial pressure is higher than ventricular pressure: AV valves open passive atrial filling passive ventricular filling cardiac cycle ends The Heart: Cardiac Cycle PLAY

127. Heart Failure  Lack of adequate blood flow to peripheral tissues and organs due to ventricular damage

128. How do heart sounds relate to specific events in the cardiac cycle?

129. Heart Sounds Figure 20–18b

130. 4 Heart Sounds  S 1 : loud sounds produced by AV valves  S 2 : loud sounds produced by semilunar valves  S 3, S 4 : soft sounds blood flow into ventricles and atrial contraction

131. Figure 20–18a Positioning the Stethoscope  To detect sounds of each valve

132. Heart Murmur  Sounds produced by regurgitation through valves

133. What is cardiac output, and what factors influence it?

134. Cardiodynamics  The movement and force generated by cardiac contractions InterActive Physiology: Cardiovascular System: Cardiac Output PLAY

135. Important Cardiodynamics Terms  End-diastolic volume (EDV)  End-systolic volume (ESV)  Stroke volume (SV): SV = EDV — ESV Stroke Volume is the ml/beat

136. Important Cardiodynamics Terms  Cardiac output (CO): the volume pumped by each ventricle in 1 minute CO (ml/min)=SV (ml/beat) x HR(bts/min)

137. Stroke Volume  Volume (ml) of blood ejected per beat Figure 20–19

138. Cardiac Output  Cardiac output (CO) ml/min =  Heart rate (HR) beats/min   Stroke volume (SV) ml/beat

139. Adjusting to Conditions  Cardiac output: adjusted by changes in heart rate or stroke volume  Heart rate: adjusted by autonomic nervous system or hormones  Stroke volume: adjusted by changing EDV or ESV

140. What variables influence heart rate?

141. Autonomic Innervation Figure 20–21 (Navigator)

142. Autonomic Innervation (1 of 4)  Cardiac plexuses: innervate heart  Vagus nerves (X): carry parasympathetic preganglionic fibers to small ganglia in cardiac plexus

143. Autonomic Innervation (2 of 4)  Cardiac centers of medulla oblongata: cardioacceleratory center:  controls sympathetic neurons (increase heart rate) cardioinhibitory center:  controls parasympathetic neurons (slow heart rate)

144. Autonomic Innervation (3 of 4)  Cardiac reflexes: Cardiac centers monitor:  baroreceptors (blood pressure)  chemoreceptors (arterial oxygen and carbon dioxide levels)  Cardiac centers adjust cardiac activity

145. Autonomic Innervation (4 of 4)  Autonomic tone: dual innervation maintains resting tone by releasing Ach and NE fine adjustments meet needs of other systems

146. Autonomic Pacemaker Regulation  ACh (parasympathetic stimulation): slows the heart  NE (sympathetic stimulation): speeds the heart

147. Hormonal Effects on Heart Rate  Increase heart rate (by sympathetic stimulation of SA node): epinephrine (E) norepinephrine (NE) thyroid hormone

148. What variables influence stroke volume?

149. Hormones and Contractility  Many hormones affect heart contraction  Pharmaceutical drugs mimic hormone actions: stimulate or block beta receptors affect calcium ions e.g., calcium channel blockers

150. How are adjustments in stroke volume and cardiac output coordinated at different levels of activity?

151. Factors Affecting Heart Rate and Stroke Volume Figure 20–24

152. Heart Rate Control Factors 1.Autonomic nervous system: sympathetic and parasympathetic 2.Circulating hormones 3.Venous return and stretch receptors

153. KEY CONCEPT (1 of 2)  Cardiac output: the amount of blood pumped by the left ventricle each minute adjusted by the ANS in response to:  circulating hormones  changes in blood volume  alterations in venous return

154. KEY CONCEPT (2 of 2)  Most healthy people can increase cardiac output by 300–500%

155. The Heart and Cardiovascular System  Cardiovascular regulation: ensures adequate circulation to body tissues  Cardiovascular centers: control heart and peripheral blood vessels

156. The Heart and Cardiovascular System  Cardiovascular system responds to: changing activity patterns circulatory emergencies

157. SUMMARY (1 of 7)  Organization of cardiovascular system: pulmonary and systemic circuits  3 types of blood vessels: arteries, veins, and capillaries

158. SUMMARY (2 of 7)  4 chambers of the heart: left and right atria left and right ventricles

159. SUMMARY (3 of 7)  Pericardium, mediastinum, and pericardial sac  Coronary sulcus and superficial anatomy of the heart  Structures and cells of the heart wall

160. SUMMARY (4 of 7)  Internal anatomy and structures of the heart: septa, muscles, and blood vessels  Valves of the heart and direction of blood flow  Connective tissues of the heart

161. SUMMARY (5 of 7)  Coronary blood supply  Contractile cells and the conducting system: pacemaker calls, nodes, bundles, and Purkinje fibers

162. SUMMARY (6 of 7)  Electrocardiogram and its wave forms  Refractory period of cardiac cells  Cardiac cycle: atrial and ventricular systole and diastole

163. SUMMARY (7 of 7)  Cardiodynamics: stroke volume and cardiac output  Control of cardiac output