Cardiac Anatomy

Fundamental of Cardiovascular Pathophysiology
Learning Objectives
• Understand Heart Anatomy and Pathophysiology
• Pathophysiology And Physical Manifestations Of:-
▪ Atherosclerotic disease (IHD, stroke, PVD)
▪ Heart rhythm and conduction disorders (tachy/brady arrhythmia, conduction
defects)
▪ Structural abnormalities of the heart (grown up congenital heart disease
GUCH, valve disease)
▪ Heart muscle disorders (infective, inflammatory, acute and chronic heart
failure, cardiogenic shock)
Heart Anatomy and Pathophysiology
• The circulatory system is also called the cardiovascular system where cardio
refers to the heart and vascular refers to the blood vessels.
• Heart: pumps blood.
• Blood vessels: carry blood to the body and return it back to the heart again.
Anatomical position:
The heart lies in the mediastinum (middle region of the thorax)
▪ Anterior: Behind the body of the sternum

▪ Posterior: the heart rests against the body of the 5th to the
8th thoracic vertebrae
▪ Upper border: lies just below the second rib

▪ The apex: the space between 5th and 6 the ribs, on a line
with the midpoint of the left clavicle
The heart is four chambered muscular organ.
Size and Shape:
The heart is a four chambered muscular organ Its size is close to the person's closed fist
▪ At birth: the heart is transverse and appears large in proportion to the diameter of the chest
▪ Between puberty and 25 years: the heart attains its adult shape and weight (310g for
male, 225g for female)
▪ In adult: the shape of the heart tend to resemble that of the chest (In tall individuals it tends
to be elongated, in stocky individuals it has greater width)
Coverings of the heart:
The heart is covered by a special covering, called: pericardium
The pericardium consists of 2 parts:
A fibrous portion: (making the sac itself)

It is an inelastic sac around the heart
A serous portion: (line the sac)

Coverings of the heart:
A serous portion: (line the sac)
It consists of 2 layers:
A. Parietal layer- lining inside the fibrous pericardium

B. Visceral layer-adhering to the outside of the heart
Between the visceral and parietal layer is the pericardial space
Pericardial space contains 10 to 15ml of pericardial fluid secreted by

serous membrane
Heart coverings provide protection against friction (as long as serous
cavity continues to produce lubricating serous fluid)
Structure of the heart:
Wall of the heart (3 walls)
1.Epicardium " serous pericardium"
It is the visceral layer of the serous pericardium
2.Myocardium
The bulk of the heart wall. It is thick, contractile, middle layer of specially arranged cardiac
muscle. Cardiac muscle tissue is composed of many branching cells called-intercalated disks
Function:
Stimulate the contraction of the heart muscles. Compression of the heart cavities and the blood
within them, with great force
Structure of the heart:
Wall of the heart (3 walls)
3.Endocardium
A delicate layer lining the interior of the

myocardial wall.
The endothelium lines the heart and
continues to line the blood vessels.
Chambers of the heart
The heart is formed of 4 chambers:
Two upper: atria
Two lower: ventricles
The left chambers are separated from the

right ones by an extension of heart wall
called: septum
Atria
They are the two superior chambers of the

heart
The left and right atria are separated by

interatrial septum
They are called the receiving chambers (as

they receive blood from veins)
Auricle: earlike flap protruding from each

atrium
Function of Atria
1. Blood storage
2. Atrial walls contain stretch receptors
that monitor the change in atrial pressure
and initiate several regulatory
cardiovascular reflexes
3. Certain atria cells secrete Atrial
natriuretic peptide (favoring Na+ and
water by the kidney)
Ventricular
▪ They are the two lower chambers of the heart

▪ The left and right ventricles are separated by interventricular
septum o They are called the pumping chambers (as they pump
blood to the arteries)
▪ The myocardium of each ventricle is thicker than the
myocardium of the atria because more force is needed to pump
blood a farther distance
▪ The myocardium of the left ventricle is thicker than the right
ventricle because left ventricle pushes the blood through most
vessels of the body, whereas the right ventricle pushes the
blood to nearby pulmonary vessels
Function Ventricular
Pumping chambers
Valves of the heart

The heart valves are structures that permit the flow
of the blood in one direction only, which allow the
heart to act as a pump that forces the continuous
flow of blood in one direction
Valves of the heart

Atrioventricular valves:
▪ They guard the opening between the atria and the ventricles
▪ They allow the blood to flow from atria to ventricles and prevent it
from flowing back up from the ventricle to atria.
Right atrioventricular valve:

It is formed of 3 flaps (cups) so it is called tricuspid valve
Left atrioventricular valve:

It is formed of 2 flaps (cusps) so it is called bicuspid valve -It is also
called mitral valve
Valves of the heart

Semi lunar valves:
They are pocket like flaps extending from the lining of the
pulmonary artery and aorta (Pulmonary valve& Aortic valve)
They prevent the flow back of the blood into the ventricles
from the pulmonary artery and aorta
Skeleton of the heart:
It is a set of connected rings

Functions:
▪ They serve as a semi rigid support for the heart valves
▪ They serve as attachment of the cardiac muscle of the

myocardium
▪ They serve as electrical barrier between the myocardium of

the atria and the myocardium of the ventricles (ventricle
contract separately from the atria)
Blood Supply To The Heart:

Coronary arteries
The myocardial muscles receive blood through
Right coronary artery & Left coronary artery
They both come from the aorta.
The ventricles receive blood from branches of right and left coronary arteries
The atria receive blood from small branch of corresponding coronary artery
The most abundant blood goes to the myocardium of the left ventricles as the left
ventricle does the most work and so needs oxygen and nutrients

Cardiac Veins
▪ The veins follow a course closely parallel to the course of the coronary arteries.
▪ After going through cardiac veins, the blood enters the coronary sinus to drain into
right atrium

Coronary Circulation:
Aorta
Right Coronary Artery Left Coronary Artery
Marginal Branch Posterior Descending Anterior Descending Circumflex

Myocardium Heart apex & Interventricul Left atrium &
of the lateral posterior ar septum & posterior of
right side of ventricular anterior wall the ventricles
the heart wall of ventricles
Venous drainage of the heart
Capillary Beds of Myocardium
Venous blood collected by cardiac veins
Greater Cardiac V Middle Cardiac V Small Cardiac V Anterior Cardiac V
Myocardium Heart apex & Interventricul Left atrium &

of the lateral posterior ar septum & posterior of
right side of ventricular anterior wall the ventricles
the heart wall of ventricles
re ctly
Di
Coronary Sinus Right Atrium
• Blood Supply To The Heart:
Coronary Circulation
Factors Affecting Coronary Circulation:
A. Metabolic Factors:
B. Mechanical Factors:
C. Neural Factors:
A. Metabolic Factors:
▪ Coronary blood flow (CBF) is directly proportional to O2 requirement

▪ O2 lack causes ATP breakdown liberating adenosine causing VD
▪ CO2, K+, H+ prostaglandins and NO contribute to VD
B. Mechanical Factors:
▪ Coronary vessels are compressed during systole leading to reduction in CBF

(especially in left ventricle)
▪ Tachycardia, decreases CBF due to shortening of diastolic period
C. Neural Factors:
▪ Sympathetic stimulation causes coronary VC (which tends to decrease CBF)

▪ But this effect is opposed by the increase cardiac activity leading to excessive
formation of metabolites leading to coronary VD
Nerve Supply
▪ Conduction system of the heart is made up of modified

cardiac muscle
It generates and distribute the heart own rhythmic contractions
1. The sympathetic nerves are accelerator nerves arise from

upper thoracic regions of spinal cord
2. The parasympathetic emerge from medulla oblongata to
vagus nerve
▪ Most fibers end at SA node (pacemaker) Some fibers end at

AV node & in the atrial myocardium
Types of cardiac muscle fibers:
A. Contractile cardiac muscle fibers (99%) Forming atria & ventricles

B. Autorythmic cardiac muscle fibers (1%) Forming pacemaker and conduction fibers
Specialized in generation, conduction and distribution of cardiac impulses (action
potential) that stimulate the contractile muscle fibers
Properties of cardiac muscles
Syncytium:
If one fiber is stimulated the entire myocardial unit contract

A. Excitability
The ability of cardiac muscle fibers to respond to adequate

stimuli Response is depolarization (action potential
generation) Depolarization increases with increase
intracellular Ca++ Cardiac action potential

B. Autorythmycity
▪ The ability of spontaneous generation of action potentials independent of extrinsic stimuli

▪ Contractile muscle fibers do not normally generate an action potential This is the function of the
conduction system

C. Conductivity
▪ It is the ability of the cardiac muscle to transmit action potential from one fiber to the adjacent
one

D. Contractility
▪ It is the ability of cardiac muscle fibers to contract
▪ It refers to the force generated by myocardial contraction

Blood Vessels
Types of blood vessels:
1. Arteries:
2. Capillaries:
3. Veins:
Blood Vessels
1. Arteries:
A) Elastic arteries : aorta
B) Muscular arteries: brachial, gastric
C) Arterioles "resistance vessels”
D) Met arterioles "Connecting vessels"
Blood Vessels
2. Capillaries:
A) Continuous capillaries
B) Fenestrated capillaries
C) Sinusoid
Blood Vessels
3. Veins:
A) Veins
B) Venules
C) Venous sinus
Structure of blood vessels
Arteries Veins
Carry blood away from the heart and toward carry blood away from the capillaries and toward
capillaries the heart
Thick tunica media (elastic fibers) Thin tunica media (elastic fibers)
Thin tunica externa (connective tissue) Thick tunica externa (connective tissue)
No valves Have valves to prevent pooling of blood in the
extremities
Largest vessel is the aorta Have valves to prevent pooling of blood in the
extremities
Major Blood Vessels
Circulatory routes:
The circulation means the blood flow through vessels arranged to form
a circuit.
I. Systemic circulation
II. Pulmonary circulation
III. Hepatic Portal Circulation
IV. Fetal Circulation
Major Blood Vessels
I. Systemic circulation
It conducts the blood flow from the heart (left ventricle) to all parts of the body
and back again to the heart (right atrium)
Ascending aorta Arteries to tissues and organs of the body🡪 Arterioles🡪 Capillaries
(exchange of substances occurs between the blood and cells)🡪Blood flow out from
each organ by veinules🡪 Veins🡪 Inferior superior vena cava🡪 Right atrium🡪 To start
Systemic circulation
Major Blood Vessels
II. Pulmonary circulation:
The venous blood moves from the right atrium to The right ventricle
Pulmonary artery 🡪Lung arterioles 🡪Lung capillaries 🡪Exchange of gases
Major Blood Vessels
Veins from spleen, stomach, pancreas, gallbladder, and intestine pour their blood
into hepatic portal vein to the liver where blood mingles with arterial blood in the
capillaries and is eventually drained from the liver by hepatic veins that join inferior
vena cava.
Major Blood Vessels
Advantages to detouring blood to the liver
1- Removing excess glucose from the blood and storing it in the form of
glycogen(thus blood returning to heart carries moderate level of glucose )
2- Removing toxic molecules such as alcohol by detoxification

**If hepatic portal circulation or venous return from liver in interfered, venous
drainage from most of abdominal organs is necessarily obstructed also.
Increase capillary pressure will account for the occurrence of abdominal
bloating (Ascites)
Major Blood Vessels
Fetal blood secures oxygen from maternal blood instead of from lungs and
digestive organs
Additional blood vessels in the fetus to carry the fetal blood from maternal blood to
fetal blood, these structures are umbilical arteries, umbilical vein and the ductus
venosus
Major Blood Vessels
1. Umbilical arteries: extensions from internal iliac arteries and carry fetal blood
to the placenta
2. The placenta: structure attached to the uterine wall were oxygen and other
substances exchange takes place in
3. Umbilical vein: returns oxygenated blood from the placenta, it enters the fetal
body through umbilicus till reaching the undersurface of the liver then continue
to ductus venosus
Major Blood Vessels
4. Ductus venousus: continuation of umbilical vein along the undersurface of the
liver it drains into the inferior vena cava
5. The foramen ovale: is an opening in the septum between the right and left
atria. A valve at the opening of IVC into the right atrium direct most of the
blood to the left atrium so that it bypasses the fetal lungs
6. The ductus arteriosus: a small vessel connecting the pulmonary artery with the
descending thoracic aorta (it enables another portion of the blood to detour
into the systemic circulation without going through the lungs)
Systemic Arteries
The aorta:
It is the major artery that serves as a major trunk for all systemic arterial system
The ascending aorta:
The first few centimeters of the aorta, it conducts the blood upward out of the left ventricle
The ascending aorta branches to give rise to the coronary arteries
The arch of aorta "aortic arch"
The arch of aorta is formed by the turn of the aorta 180 degree
The descending aorta
The arterial blood is conducted down by the descending aorta.
The thoracic aorta
When the descending aorta passes down to the thoracic cavity
The abdominal aorta
Systemic Arteries
The thoracic aorta
When the descending aorta passes down to the thoracic cavity
The abdominal aorta
When the descending aorta passes down the abdominal cavity.
The right main branches from the arch of aorta
The brachiocephalic artery branches to form the subclavian artery and right common carotid
The left main branches from the arch of aorta
The left subclavian and the left common carotid directly branch from the arch
Head and Neck
Head and Neck
Arteries of the Upper Extremities
Veins of the Upper Extremities
Arteries of the Lower Extremities
Veins of the Lower Extremities
Arteries of Abdomen Region
Physiology
Hemodynamic
• It is a term that describe a collection of mechanisms that influence the dynamic
circulation of blood
• The circulation is the only means by which cells can receive materials needed for
the survival and can have their wastes removed
• The greater the activities of any part of the body, the greater the volume of blood
circulating through it.
• The blood must be shifted from less active tissues to more active tissues
The Heart as A pump
• The four chambers of the heart and their valves make up two pumps:
The left pump (left side of the heart)
The right pump (right side of the heart)
▪High pressure system
Left ventricle
Systemic arterial system
▪Low pressure system
Systemic veins
Pulmonary vessels
Heart chambers other than left ventricle
Conduction System
• Conduction system of the heart is formed of:
1. Sino atrial (SA) node
2. Atrioventricular (AV)node
3. AV bundle (bundle of Hiss)
4. Subendocardial branches (Purkinje fibers)
Electrical Passway
Electrocardiogram
• ECG Waves
1. P waves represent
depolarization of the atria
2. QRS complex represent the
depolarization of the
ventricles, and the
repolarization of the atria
3. T waves reflects the
repolarization of the
ventricles
Cardiac Cycle
*It means the complete

heartbeat, or pumping cycle
*It consists of contraction

(systole) and relaxation
(diastole) of both atria and
ventricles.
Cardiac Cycle
Atrial Systole:
▪ The contracting force of the atria completes the emptying of the blood out of the
atria into the ventricles.
▪ Atrioventricular valve open in this phase
▪ The semi lunar valves are closed
(so, the blood does not reenter from pulmonary artery or aorta)
▪ P wave in ECG
Cardiac Cycle
Isovolumetric Ventricular Contraction:
(Having the same measured volume)
▪ It is the period between the ventricular systole and the opening of the semilumar
valves
▪ Ventricular volume remain constant
▪ The pressure increases rapidly
▪ R wave in ECG
▪ It is the cause of the appearance of first heart sound
Cardiac Cycle
Rapid Ejection:
▪ The semi lunar valves open
▪ The blood is ejected from the heart when the pressure gradient in the ventricles
exceeds the pressure in the pulmonary artery and aorta
▪ Rapid ejection(initial shorter phase) is characterized by marked increase in aortic
and ventricular pressure and aortic flow
Cardiac Cycle
Isovolumetric Ventricular Relaxation:
▪ Reduced ejection ( later longer phase) is characterized by less decrease in ventricular
volume
▪ A considerable quantity of blood called residual volume normally remains in the
ventricles may exceed that ejected during systole " Residual volume "
▪ It is the period between the closure of semi lunar valves and the opening of the
atrioventricular valves
▪ The atrioventricular valve do not open until the pressure in the atrial chambers
increase above that in the relaxing ventricles
▪ The result is a dramatic fall in the intraventricular pressure but no change in volume
▪ The second heart sound is heard during this period
Cardiac Cycle
Passive Ventricular Filling:
▪ Return of venous blood increases the interatrial pressure
▪ This force the atrioventricular valve to open
▪ The blood rushes into the relaxing ventricles (0.1 sec)
▪ The result is dramatic increase in ventricular volume
▪ "Diastases" a term describing slow ventricular filling at the end of ventricular
diastole
▪ Diastasis last for 0.2 sec it is characterized by a gradual increase in ventricular
pressure and volume
Heart Sound
▪ The heart makes certain typical sounds described as "lubb-dupp"
▪ The first, or systolic, (long and low) sound is caused primarily by contraction of
ventricles and closing of AV valve
▪ The second, or diastolic, (short and sharp) sound is caused by the closure of semi
lunar valve
Primary principle of circulation
▪ Blood circulates for the same reason that any fluid flows:
▪ The primary principle of fluid flow (derived from Newton's law):

1. The fluid does not flow when the pressure is the same throughout
2. A fluid flows only when its pressure is higher in one area than in another (it flows from
higher pressure to lower pressure)
▪ The blood flows because of the concentration gradient.

Primary principle of circulation
Example:
A typical blood pressure in the
aorta,
When the left ventricles contracts
pumping blood into it is 120
mmHg When the left ventricle
relaxes it is 80 mmHg
Cardiovascular Centers
• Vasoconstrictor centers (VCC)
✔Generalized VC
✔Adrenal medullae secretion of
catecholamines
✔Increase heart contractility
• Vasodilator centers (VDC)
✔Generalized VD through inhibiting
VCC Cardiac centers (cardiac
inhibitory center) Exciting vagus
nerves which decreases HR and
atrial contractility
Arterial Blood Pressure
▪ It is the force exerted by the blood on the arterial walls
▪ According to principles of circulation, High pressure in the arteries should be
maintained to keep blood flow through the cardiovascular system
Increase blood volume tends to increase arterial
pressure
Decrease blood volume tends to decrease arterial
pressure
▪ Factors determining arterial blood pressure:

Cardiac output
Peripheral resistance
Arterial Blood Pressure
Stretch receptors in aortic and carotid arch
Aortic nerve to vagus Carotid sinus nerve to glossopharyngeal
Medulla
Cardiovascular system
Cardiac Output
• It is the amount of flow that flows out of the heart per unit of time
The resting cardiac output to systemic arteries is 5000ml/min
Stroke volume (SV)
It is the volume of blood pumped out of the ventricle by each beat
Heart rate (HR)
It is the number of beats per minute
CO (volume/min) = SV(volume/beat) x HR (beat/min)

Cardiac Output
▪Factor affecting on the stroke volume
SV=EDV-ESV
End Diastolic Volume (EDV): Amount of blood in the ventricle at the

end of diastole
End Systolic Volume (ESV):Amount of blood in the ventricle at end of

systole
Cardiac Output
• Mechanical Factors:
Starling's law:
Within limits, the longer and more stretchable
(preload) the fibers of the heart at the beginning of
the contraction, the stronger is the contraction
End diastolic volume (EDV) “Preload”
After load
Norepinepherine secreted from the sympathetic
fibers in the cardiac nerve o Epinephrine released
into the blood from the adrenal medulla, can both
increase the strength of contraction of the
myocardium
Stress and exercise can trigger these neural and
endocrine responses
Cardiac Output
▪Factor affecting Heart Rate
▪ The ratio of sympathetic and parasympathetic impulses reaching

the SA node per minute
▪ Cardiac Pressoreflexes:
They are receptors sensitive to change in blood pressure
(baroreceptors)
They are located in 2 places near the heart

In the aorta Aortic baroreceptors In the carotid sinus Carotid
baroreceptors
Cardiac Output
1- Nervous Factors
2- Chemical factors
3- Direct effect on SA node
Cardiac Output
1- Nervous Factors
A- Supra spinal factors:
B- Reflexes initiated from CVS
1- Marey's reflex
2- Bainbridge reflex
3- Reflex from left ventricle
C- Reflexes initiated from extra vascular structures

1- From Lung
2- Skeletal
3- Skin
Cardiac Output
▪ Factor affecting Heart Rate
2- Chemical factors
A. Changes in arterial blood gases
1. Oxygen lack HR
2. CO2 ,H+ excess
B. Effect of hormones and drugs

3. Catecholamine (Marey's reflex)
4. Thyroxin (Bainbridge reflex)
5. Atropine (blocking parasym. effect)
6. Histamine potent VD, drop ABP (Marey;s reflex)
7. Bile salts decrease HR by inhibiting SA node &activating CIC
Cardiac Output
3- Direct Effect From SA Node

A. Physical Factor: increase body temperature increase in HR
B. Mechanical Factors: right atrial distention excite SA node leading to
tachycardia (Bainbridge reflex)
C. Chemical Factors:SA node directly excited by mild
hypoxia,catecholamine,thyroxine…
Peripheral Resistance
• It means the resistance that to blood flow imposed by the force of
friction between blood and the wall of the vessels Friction develops
from:-
1) Blood viscosity
2) Diameter of arterioles and capillaries
1) Blood viscosity:
▪ The proportion of RBCs (Hematocrit)

▪ The protein molecules found in the blood
“Anemia or hemorrhage decrease blood viscosity which may be a crucial factor in

lowering peripheral resistance and arterial pressure to a point of circulatory failure”
2) Diameter of arterioles and capillaries:-
The vasomotor mechanism:
A- Vasomotor Pressoreflexes
1. Increase in blood pressure
2. Decrease in blood pressure
B- Vasomotor chemo reflexes

C- Medullary ischemic reflex
Venous Return to the Heart
• It is the amount of blood that is returned to the heart by way of veins
Stress – relaxation effect:
It occurs when a change in blood vessel diameter, adapt to the new pressure to keep
the blood flowing
When blood pressure drops...Elasticity of the veins adapts its diameter to lower
pressure, to maintain the blood flow and venous return
When the blood pressure rises... Elasticity of the veins allow them to expand and
adapt to higher blood pressure to maintain normal blood flow
Ortho static effect:
The pull of gravity on venous blood when the person is sitting or standing tends to
cause a decrease in venous return
• Venous Pump
• It is a factor that can overcome the influence of gravity, and maintain
the pressure gradient necessary to keep blood moving into central
veins
1) Respiratory pump
2) Skeletal muscle pump
3) One way valve in the veins
Venous Pump
1) Respiratory pump
• Inspiration increases the
pressure gradient between
peripheral and central veins
• This is done by decreasing
central venous pressure&
increasing peripheral venous
pressure
Venous Pump
2) Skeletal muscle pump
• It promotes venous return by
squeezing veins through a
contracting muscle squeezing
the blood toward the heart
3) One way valve in the veins

Total blood volume:
The more the total blood volume of blood the greater the volume of blood returned to the
heart.
Capillary exchange and total blood volume:
The movement of fluid (and solutes contained in the fluid) back and forth across a capillary wall
depend on outward and inward directing forces
Arterial end:
Osmotic pressure is small (generating small inwardly directed forces) o Hydrostatic pressure
promotes the outward movement of fluids
Osmotic pressure promotes osmosis of water back into the plasma o Hydrostatic pressure is
small (as it is dissipated with the loss of water)
10% of the fluid is recovered by the lymphatic system and returned to venous blood before it
reaches the heart.
Minute volume of blood
The volume of blood circulating through the body per minute
Mean arterial pressure- central venous pressure
Minute volume=
Resistance
Velocity of Blood Flow
The velocity of a liquid slows in the areas with the larger cross section
Blood flows more slowly in the arterioles than in the arteries
Because the total cross section of arterioles is greater than the total cross section
of arteries
Blood flow is slower in the capillaries is slower than arterioles
Because the total cross section of capillaries together is greater than that of
arterioles
Pulse
Pulse is defined as alternate expansion and recoil of an artery
▪Factors responsible for the existence of a pulse that can be felt:
1. Intermittent injection of blood from the heart into the aorta which
alternately increases and decreases the pressure in that vessel.
2. The elasticity of the arterial walls which allows them to expand with each
injection of blood and then recoil
▪Each pulse starts with ventricular contraction and proceeds as a wave
of expansion throughout the arteries

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Fundamental of Cardiovascular Pathophysiology

▪ Anterior: Behind the body of the sternum

▪ Upper border: lies just below the second rib

The pericardium consists of 2 parts:

A fibrous portion: (making the sac itself)

A serous portion: (line the sac)

A. Parietal layer- lining inside the fibrous pericardium

Pericardial space contains 10 to 15ml of pericardial fluid secreted by

Wall of the heart (3 walls)

A delicate layer lining the interior of the

The heart is formed of 4 chambers:

Two upper: atria

Two lower: ventricles

The left chambers are separated from the

They are the two superior chambers of the

The left and right atria are separated by

They are called the receiving chambers (as

Auricle: earlike flap protruding from each

▪ They are the two lower chambers of the heart

Valves of the heart

Valves of the heart

Right atrioventricular valve:

Left atrioventricular valve:

Valves of the heart

Skeleton of the heart:

It is a set of connected rings

▪ They serve as a semi rigid support for the heart valves

▪ They serve as attachment of the cardiac muscle of the

▪ They serve as electrical barrier between the myocardium of

Blood Supply To The Heart:

Right coronary artery & Left coronary artery

They both come from the aorta.

Blood Supply To The Heart:

Blood Supply To The Heart:

Marginal Branch Posterior Descending Anterior Descending Circumflex

Myocardium Heart apex & Interventricul Left atrium &

Factors Affecting Coronary Circulation:

Factors Affecting Coronary Circulation:

▪ Coronary blood flow (CBF) is directly proportional to O2 requirement

Factors Affecting Coronary Circulation:

▪ Coronary vessels are compressed during systole leading to reduction in CBF

Factors Affecting Coronary Circulation:

▪ Sympathetic stimulation causes coronary VC (which tends to decrease CBF)

▪ Conduction system of the heart is made up of modified

1. The sympathetic nerves are accelerator nerves arise from

▪ Most fibers end at SA node (pacemaker) Some fibers end at

Types of cardiac muscle fibers:

A. Contractile cardiac muscle fibers (99%) Forming atria & ventricles

Properties of cardiac muscles

Properties of cardiac muscles

The ability of cardiac muscle fibers to respond to adequate

Properties of cardiac muscles

▪ The ability of spontaneous generation of action potentials independent of extrinsic stimuli

Properties of cardiac muscles

Properties of cardiac muscles

▪ It is the ability of cardiac muscle fibers to contract

▪ It refers to the force generated by myocardial contraction

2- Removing toxic molecules such as alcohol by detoxification

*It means the complete

*It consists of contraction