The Cardiovascular System:

The Heart
Anatomy

Chapter 18, Cardiovascular System

18
1

Heart Anatomy

Approximately the size of your fist

Location
Superior surface of diaphragm
Left of the midline
Anterior to the vertebral column, posterior to the
sternum

Chapter 18, Cardiovas

Heart Anatomy

Chapter 18, Cardiovas

Figure 18.1

Coverings of the Heart: Anatomy

Pericardium a double-walled sac around the

heart composed of:
1. A superficial fibrous pericardium
2. A deep two-layer serous pericardium
a. The parietal layer lines the internal surface of
the fibrous pericardium
b. The visceral layer or epicardium lines the
surface of the heart

They are separated by the fluid-filled

pericardial cavity
Chapter 18, Cardiovas

Coverings of the Heart: Physiology

The Function of the Pericardium:

Protects and anchors the heart
Prevents overfilling of the heart with blood
Allows for the heart to work in a relatively frictionfree environment

Chapter 18, Cardiovas

Pericardial Layers of the Heart

Chapter 18, Cardiovas

Figure 18.2

Heart Wall
Epicardium visceral layer of the serous
pericardium
Myocardium cardiac muscle layer forming the
bulk of the heart
Fibrous skeleton of the heart crisscrossing,
interlacing layer of connective tissue
Endocardium endothelial layer of the inner
myocardial surface
Chapter 18, Cardiovas

External Heart: Major Vessels of the Heart

(Anterior View)

Vessels returning blood to the heart include:

1. Superior and inferior venae cavae

2. Right and left pulmonary veins

Vessels conveying blood away from the heart include:

1. Pulmonary trunk, which splits into right and left
pulmonary arteries
2. Ascending aorta (three branches)
a.

Brachiocephalic

b. Left common carotid

c.

SubclavianChapter
arteries18, Cardiovas

External Heart: Vessels that Supply/Drain the

Heart (Anterior View)

Arteries right and left coronary (in atrioventricular

groove), marginal, circumflex, and anterior
interventricular arteries
Veins small cardiac, anterior cardiac, and great
cardiac veins

Chapter 18, Cardiovas

External Heart: Anterior View

Chapter 18, Cardiovas

Figure 18.4b

10

External Heart: Major Vessels of the Heart

(Posterior View)

Vessels returning blood to the heart include:

1. Right and left pulmonary veins
2. Superior and inferior venae cavae

Vessels conveying blood away from the heart

include:
1. Aorta
2. Right and left pulmonary arteries
Chapter 18, Cardiovas

11

External Heart: Vessels that Supply/Drain the

Heart (Posterior View)

Arteries right coronary artery (in atrioventricular

groove) and the posterior interventricular artery (in
interventricular groove)
Veins great cardiac vein, posterior vein to left
ventricle, coronary sinus, and middle cardiac vein

Chapter 18, Cardiovas

12

External Heart: Posterior View

Chapter 18, Cardiovas

13

Figure 18.4d

Gross Anatomy of Heart: Frontal Section

Chapter 18, Cardiovas

Figure 18.4e

14

Atria of the Heart

Atria are the receiving chambers of the heart

Each atrium has a protruding auricle
Pectinate muscles mark atrial walls
Blood enters right atria from superior and inferior
venae cavae and coronary sinus
Blood enters left atria from pulmonary veins
Chapter 18, Cardiovas

15

Ventricles of the Heart

Ventricles are the discharging chambers of the heart
Papillary muscles and trabeculae carneae muscles
mark ventricular walls
Right ventricle pumps blood into the pulmonary
trunk
Left ventricle pumps blood into the aorta

Chapter 18, Cardiovas

16

Myocardial Thickness and Function

Thickness of myocardium varies according to the function of the

chamber
Atria are thin walled, deliver blood to adjacent ventricles
Ventricle walls are much thicker and stronger
right ventricle supplies blood to the lungs (little flow resistance)
left ventricle wall is the thickest to supply systemic circulation

Chapter 18, Cardiovas

17

Thickness of Cardiac Walls

Myocardium of left ventricle is much thicker than the right.

Chapter 18, Cardiovas

18

Atrial Septal Defect

Chapter 18, Cardiovas

19

Ventricular Septal Defect

Chapter 18, Cardiovas

20

Pathway of Blood Through the Heart and

Lungs
Right atrium tricuspid valve right ventricle
Right ventricle pulmonary semilunar valve
pulmonary arteries lungs
Lungs pulmonary veins left atrium
Left atrium bicuspid valve left ventricle
Left ventricle aortic semilunar valve aorta
Aorta systemic circulation
Chapter 18, Cardiovas

21

Pathway of Blood Through the Heart and

Lungs

Chapter 18, Cardiovas

Figure 18.5

22

Coronary Circulation

Coronary circulation is the functional blood supply

to the heart muscle itself
Collateral routes ensure blood delivery to heart
even if major vessels are occluded

Chapter 18, Cardiovas

23

Coronary Circulation: Arterial Supply

Chapter 18, Cardiovas

24

Figure 18.7a

Coronary Circulation: Venous Supply

Chapter 18, Cardiovas

25

Figure 18.7b

Heart Valves
Heart valves ensure unidirectional blood flow
through the heart
Atrioventricular (AV) valves lie between the atria
and the ventricles
AV valves prevent backflow into the atria when
ventricles contract

Chordae tendineae anchor AV valves to papillary

muscles
Chapter 18, Cardiovas

26

Heart Valves
Semilunar valves prevent backflow of blood into the
ventricles
Aortic semilunar valve lies between the left
ventricle and the aorta
Pulmonary semilunar valve lies between the right
ventricle and pulmonary trunk

Chapter 18, Cardiovas

27

Heart Valves

Chapter 18, Cardiovas

Figure 18.8a, b

28

Heart Valves

Chapter 18, Cardiovas

Figure 18.8c, d

29

Atrioventricular Valve Function

Chapter 18, Cardiovas

Figure 18.9

30

Semilunar Valve Function

Chapter 18, Cardiovas

Figure 18.10

31

Mitral Valve Prolapse

Chapter 18, Cardiovas

32

Microscopic Anatomy of Heart Muscle

Cardiac muscle is striated, short, fat, branched, and
interconnected
The connective tissue endomysium acts as both
tendon and insertion
Intercalated discs anchor cardiac cells together and
allow free passage of ions
Heart muscle behaves as a functional syncytium
PLAY

InterActive Physiology:
Cardiovascular System: Anatomy Review: The Heart

Chapter 18, Cardiovas

33

Microscopic Anatomy of Heart Muscle

Chapter 18, Cardiovas

34

Figure 18.11

The Cardiovascular System:

The Heart
Physiology

Chapter 18, Cardiovascular System

18
35

Cardiac Muscle Contraction

Heart muscle:
Is stimulated by nerves and is self-excitable
(automaticity)
Contracts as a unit
Has a long (250 ms) absolute refractory period

Cardiac muscle contraction is similar to skeletal

muscle contraction
Chapter 18, Cardiovas

36

Heart Physiology: Intrinsic Conduction

System
Autorhythmic cells:
Initiate action potentials
Have unstable resting potentials called pacemaker
potentials
Use calcium influx (rather than sodium) for rising
phase of the action potential

Chapter 18, Cardiovas

37

Pacemaker and Action Potentials of the Heart

Chapter 18, Cardiovas

38

Figure 18.13

Heart Physiology: Sequence of Excitation

Sinoatrial (SA) node generates impulses about 75

times/minute
Atrioventricular (AV) node delays the impulse
approximately 0.1 second

Chapter 18, Cardiovas

39

Heart Physiology: Sequence of Excitation

Impulse passes from atria to ventricles via the

atrioventricular bundle (bundle of His)

AV bundle splits into two pathways in the

interventricular septum (bundle branches)

1. Bundle branches carry the impulse toward the

apex of the heart
2. Purkinje fibers carry the impulse to the heart
apex and ventricular walls
Chapter 18, Cardiovas

40

Heart Physiology: Sequence of Excitation

Chapter 18, Cardiovas

41

Figure 18.14a

Heart Excitation Related to ECG

Chapter 18, Cardiovas

Figure 18.17

42

Extrinsic Innervation of the Heart

Heart is stimulated
by the sympathetic
cardioacceleratory
center
Heart is inhibited by
the parasympathetic
cardioinhibitory
center
Chapter 18, Cardiovas

43

Figure 18.15

Electrocardiography
Electrical activity is recorded by electrocardiogram
(ECG)
P wave corresponds to depolarization of SA node
QRS complex corresponds to ventricular
depolarization
T wave corresponds to ventricular repolarization
Atrial repolarization record is masked by the larger
QRS complex
PLAY

InterActive Physiology:
Cardiovascular System: Intrinsic Conduction System

Chapter 18, Cardiovas

44

Electrocardiography

Chapter 18, Cardiovas

Figure 18.16

45

Heart Sounds

Heart sounds (lub-dup) are associated with closing

of heart valves
First sound occurs as AV valves close and signifies
beginning of systole (contraction)
Second sound occurs when SL valves close at the
beginning of ventricular diastole (relaxation)

Chapter 18, Cardiovas

46

Cardiac Cycle

Cardiac cycle refers to all events associated with

blood flow through the heart
Systole contraction of heart muscle
Diastole relaxation of heart muscle

Chapter 18, Cardiovas

47

Phases of the Cardiac Cycle

Ventricular filling mid-to-late diastole

Heart blood pressure is low as blood enters atria
(passively) and flows into ventricles
AV valves are open, then atrial systole occurs

Chapter 18, Cardiovas

48

Phases of the Cardiac Cycle

Ventricular systole (contraction)
Atria relax
Rising ventricular pressure results in closing of AV
valves
Isovolumetric contraction phase
Ventricular ejection phase opens semilunar valves

Chapter 18, Cardiovas

49

Phases of the Cardiac Cycle

Isovolumetric relaxation early diastole
Ventricles relax
Backflow of blood in aorta and pulmonary trunk
closes semilunar valves

Dicrotic notch brief rise in aortic pressure caused

by backflow of blood rebounding off semilunar
valves
PLAY

InterActive Physiology:
Cardiovascular System: Cardiac Cycle

Chapter 18, Cardiovas

50

Phases of the Cardiac Cycle

Chapter 18, Cardiovas

Figure 18.20

51

Cardiac Output (CO) and Reserve

Cardiac Output is the amount of blood pumped by
each ventricle in one minute
CO is the product of heart rate (HR) and stroke
volume (SV)
HR is the number of heart beats per minute
SV is the amount of blood pumped out by a
ventricle with each beat

Cardiac reserve is the difference between resting

and maximal CO
Chapter 18, Cardiovas

52

Cardiac Output: Example

CO (ml/min) = HR (75 beats/min) x SV (70 ml/beat)

CO = 5250 ml/min (5.25 L/min)

Chapter 18, Cardiovas

53

Regulation of Stroke Volume

SV = end diastolic volume (EDV) minus end

systolic volume (ESV)
EDV = amount of blood collected in a ventricle
during diastole
ESV = amount of blood remaining in a ventricle
after contraction

Chapter 18, Cardiovas

54

Factors Affecting Stroke Volume

Preload amount ventricles are stretched by

contained blood
Contractility cardiac cell contractile force due to
factors other than EDV
Afterload back pressure exerted by blood in the
large arteries leaving the heart

Chapter 18, Cardiovas

55

Frank-Starling Law of the Heart

Preload, or degree of stretch, of cardiac muscle cells
before they contract is the critical factor controlling
stroke volume
Slow heartbeat and exercise increase venous return
to the heart, increasing SV
Blood loss and extremely rapid heartbeat decrease
SV

Chapter 18, Cardiovas

56

Preload and Afterload

Chapter 18, Cardiovas

57

Figure 18.21

Extrinsic Factors Influencing Stroke Volume

Contractility is the increase in contractile strength,

independent of stretch and EDV
Increase in contractility comes from:
Increased sympathetic stimuli
Certain hormones
Ca2+ and some drugs

Chapter 18, Cardiovas

58

Extrinsic Factors Influencing Stroke Volume

Agents/factors that decrease contractility include:

Acidosis
Increased extracellular K+
Calcium channel blockers

Chapter 18, Cardiovas

59

Contractility and Norepinephrine

Sympathetic
stimulation
releases
norepinephrine
and initiates a
cyclic AMP
secondmessenger
system
Chapter 18, Cardiovas

60

Figure 18.22

Regulation of Heart Rate

Positive chronotropic factors increase heart rate

Caffeine

Negative chronotropic factors decrease heart rate

Sedatives

Chapter 18, Cardiovas

61

Regulation of Heart Rate: Autonomic Nervous

System
Sympathetic nervous system (SNS) stimulation is activated
by stress, anxiety, excitement, or exercise
Parasympathetic nervous system (PNS) stimulation is
mediated by acetylcholine and opposes the SNS
PNS dominates the autonomic stimulation, slowing heart
rate and causing vagal tone
If the Vagus Nerver was cut, the heart would lose its
tone. Thus, increasing the heart rate by 25 beats per
minute.
Chapter 18, Cardiovas

62

Atrial (Bainbridge) Reflex

Atrial (Bainbridge) reflex a sympathetic reflex

initiated by increased blood in the atria
Causes stimulation of the SA node
Stimulates baroreceptors in the atria, causing
increased SNS stimulation

Chapter 18, Cardiovas

63

Chemical Regulation of the Heart

The hormones epinephrine and thyroxine increase

heart rate
Intra- and extracellular ion concentrations must be
maintained for normal heart function

PLAY

InterActive Physiology:
Cardiovascular System: Cardiac Output

Chapter 18, Cardiovas

64

Factors Involved in Regulation of Cardiac

Output

Chapter 18, Cardiovas

Figure 18.23

65

Congestive Heart Failure (CHF)

Congestive heart failure (CHF) is caused by:
Coronary atherosclerosis
Persistent high blood pressure
Multiple myocardial infarcts
Dilated cardiomyopathy (DCM) main pumping
chambers of the heart are dilated and contract
poorly
Chapter 18, Cardiovas

66

Developmental Aspects of the Heart

Chapter 18, Cardiovas

Figure 18.24

67

Developmental Aspects of the Heart

Fetal heart structures that bypass pulmonary

circulation
Foramen ovale connects the two atria
Ductus arteriosus connects pulmonary trunk and
the aorta

Chapter 18, Cardiovas

68

Examples of Congenital Heart Defects

Chapter 18, Cardiovas

Figure 18.25

69

Age-Related Changes Affecting the Heart

Sclerosis and thickening of valve flaps

Decline in cardiac reserve
Fibrosis of cardiac muscle
Atherosclerosis

Chapter 18, Cardiovas

70

Congestive Heart Failure

Causes of CHF
coronary artery disease, hypertension, MI, valve disorders,
congenital defects
Left side heart failure
less effective pump so more blood remains in ventricle
heart is overstretched & even more blood remains
blood backs up into lungs as pulmonary edema
suffocation & lack of oxygen to the tissues
Right side failure
fluid builds up in tissues as peripheral edema
Chapter 18, Cardiovas

71

Coronary Artery Disease

Heart muscle receiving
insufficient blood supply
narrowing of vessels--atherosclerosis, artery
spasm or clot
atherosclerosis--smooth
muscle & fatty deposits in
walls of arteries

Treatment
drugs, bypass graft,
angioplasty, stent

Chapter 18, Cardiovas

72

Clinical Problems
MI = myocardial infarction
death of area of heart muscle from lack of O2
replaced with scar tissue
results depend on size & location of damage
Blood clot
use clot dissolving drugs streptokinase or t-PA & heparin
balloon angioplasty
Angina pectoris
heart pain from ischemia (lack of blood flow and oxygen ) of
cardiac muscle
Chapter 18, Cardiovas

73

By-pass Graft

Chapter 18, Cardiovas

74

Percutaneous Transluminal Coronary

Angioplasty

Chapter 18, Cardiovas

75

Artificial Heart

Chapter 18, Cardiovas

76