Chapter 20 THE CARDIOVASCULAR SYSTEM: THE HEART

1. Chapter 20THE CARDIOVASCULAR SYSTEM: THE HEART Lecture Outline

2. INTRODUCTION • The cardiovascular system consists of the blood, heart, and blood vessels. • The heart is the pump that circulates the blood through an estimated 60,000 miles of blood vessels. • The study of the normal heart and diseases associated with it is known as cardiology. Principles of Human Anatomy and Physiology, 11e

3. Chapter 20The Cardiovascular System: The Heart • Heart pumps over 1 million gallons per year. • Over 60,000 miles of blood vessels Principles of Human Anatomy and Physiology, 11e

4. ANATOMY OF THE HEART Principles of Human Anatomy and Physiology, 11e

5. ANATOMY OF THE HEART Principles of Human Anatomy and Physiology, 11e

6. Location of the heart • The heart is situated between the lungs in the mediastinum with about two-thirds of its mass to the left of the midline (Figure 20.1). • Because the heart lies between two rigid structures, the vertebral column and the sternum, external compression on the chest can be used to force blood out of the heart and into the circulation. (Clinical Application) Principles of Human Anatomy and Physiology, 11e

7. Heart Location • Heart is located in the mediastinum • area from the sternum to the vertebral column and between the lungs Principles of Human Anatomy and Physiology, 11e

8. Heart Orientation • Apex - directed anteriorly, inferiorly and to the left • Base - directed posteriorly, superiorly and to the right • Anterior surface - deep to the sternum and ribs • Inferior surface - rests on the diaphragm • Right border - faces right lung • Left border (pulmonary border) - faces left lung Principles of Human Anatomy and Physiology, 11e

9. Heart Orientation • Heart has 2 surfaces: anterior and inferior, and 2 borders: right and left Principles of Human Anatomy and Physiology, 11e

10. Surface Projection of the Heart • Superior right point at the superior border of the 3rd right costal cartilage • Superior left point at the inferior border of the 2nd left costal cartilage 3cm to the left of midline • Inferior left point at the 5th intercostal space, 9 cm from the midline • Inferior right point at superior border of the 6th right costal cartilage, 3 cm from the midline Principles of Human Anatomy and Physiology, 11e

11. Pericardium • The heart is enclosed and held in place by the pericardium. • The pericardium consists of an outer fibrous pericardium and an inner serous pericardium (epicardium. (Figure 20.2a). • The serous pericardium is composed of a parietal layer and a visceral layer. • Between the parietal and visceral layers of the serous pericardium is the pericardial cavity, a potential space filled with pericardial fluid that reduces friction between the two membranes. • An inflammation of the pericardium is known as pericarditis. Associated bleeding into the pericardial cavity compresses the heart (cardiac tamponade) and is potentially lethal (Clinical Application). Principles of Human Anatomy and Physiology, 11e

12. Pericardium • Fibrous pericardium • dense irregular CT • protects and anchors the heart, prevents overstretching • Serous pericardium • thin delicate membrane • contains • parietal layer-outer layer • pericardial cavity with pericardial fluid • visceral layer (epicardium) Principles of Human Anatomy and Physiology, 11e

13. Layers of the Heart Wall • The wall of the heart has three layers: epicardium, myocardium, and endocardium (Figure 20.2a). • The epicardium consists of mesothelium and connective tissue, the myocardium is composed of cardiac muscle, and the endocardium consists of endothelium and connective tissue (Figure 20.2c). • Myocarditis is an inflammation of the myocardium. • Endocarditis in an inflammation of the endocardium. It usually involves the heart valves. Principles of Human Anatomy and Physiology, 11e

14. Layers of Heart Wall • Epicardium • visceral layer of serous pericardium • Myocardium • cardiac muscle layer is the bulk of the heart • Endocardium • chamber lining & valves Principles of Human Anatomy and Physiology, 11e

15. Muscle Bundles of the Myocardium • Cardiac muscle fibers swirl diagonally around the heart in interlacing bundles Principles of Human Anatomy and Physiology, 11e

16. Chambers and Sulci of the Heart (Figure 20.3). • Four chambers • 2 upper atria • 2 lower ventricles • Sulci - grooves on surface of heart containing coronary blood vessels and fat • coronary sulcus • encircles heart and marks the boundary between the atria and the ventricles • anterior interventricular sulcus • marks the boundary between the ventricles anteriorly • posterior interventricular sulcus • marks the boundary between the ventricles posteriorly Principles of Human Anatomy and Physiology, 11e

17. Chambers and Sulci Anterior View Principles of Human Anatomy and Physiology, 11e

18. Chambers and Sulci Posterior View Principles of Human Anatomy and Physiology, 11e

19. Right Atrium • Receives blood from 3 sources • superior vena cava, inferior vena cava and coronary sinus • Interatrial septum partitions the atria • Fossa ovalis is a remnant of the fetal foramen ovale • Tricuspid valve • Blood flows through into right ventricle • has three cusps composed of dense CT covered by endocardium Principles of Human Anatomy and Physiology, 11e

20. Right Ventricle • Forms most of anterior surface of heart • Papillary muscles are cone shaped trabeculae carneae (raised bundles of cardiac muscle) • Chordae tendineae: cords between valve cusps and papillary muscles • Interventricular septum: partitions ventricles • Pulmonary semilunar valve: blood flows into pulmonary trunk Principles of Human Anatomy and Physiology, 11e

21. Left Atrium • Forms most of the base of the heart • Receives blood from lungs - 4 pulmonary veins (2 right + 2 left) • Bicuspid valve: blood passes through into left ventricle • has two cusps • to remember names of this valve, try the pneumonic LAMB • Left Atrioventricular, Mitral, or Bicuspid valve Principles of Human Anatomy and Physiology, 11e

22. Left Ventricle • Forms the apex of heart • Chordae tendineae anchor bicuspid valve to papillary muscles (also has trabeculae carneae like right ventricle) • Aortic semilunar valve: • blood passes through valve into the ascending aorta • just above valve are the openings to the coronary arteries Principles of Human Anatomy and Physiology, 11e

23. Myocardial Thickness and Function • The thickness of the myocardium of the four chambers varies according to the function of each chamber. • The atria walls are thin because they deliver blood to the ventricles. • The ventricle walls are thicker because they pump blood greater distances (Figure 20.4a). • The right ventricle walls are thinner than the left because they pump blood into the lungs, which are nearby and offer very little resistance to blood flow. • The left ventricle walls are thicker because they pump blood through the body where the resistance to blood flow is greater. Principles of Human Anatomy and Physiology, 11e

24. 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 Principles of Human Anatomy and Physiology, 11e

25. Thickness of Cardiac Walls Myocardium of left ventricle is much thicker than the right. Principles of Human Anatomy and Physiology, 11e

26. HEART VALVES AND CIRCULATION OF BLOOD • Valves open and close in response to pressure changes as the heart contracts and relaxes. Principles of Human Anatomy and Physiology, 11e

27. Fibrous Skeleton of Heart • (Figure 20.5). Dense CT rings surround the valves of the heart, fuse and merge with the interventricular septum • Support structure for heart valves • Insertion point for cardiac muscle bundles • Electrical insulator between atria and ventricles • prevents direct propagation of AP’s to ventricles Principles of Human Anatomy and Physiology, 11e

28. Atrioventricular Valves Open • A-V valves open and allow blood to flow from atria into ventricles when ventricular pressure is lower than atrial pressure • occurs when ventricles are relaxed, chordae tendineae are slack and papillary muscles are relaxed Principles of Human Anatomy and Physiology, 11e

29. Atrioventricular Valves Close • A-V valves close preventing backflow of blood into atria • occurs when ventricles contract, pushing valve cusps closed, chordae tendinae are pulled taut and papillary muscles contract to pull cords and prevent cusps from everting Principles of Human Anatomy and Physiology, 11e

30. Semilunar Valves • SL valves open with ventricular contraction • allow blood to flow into pulmonary trunk and aorta • SL valves close with ventricular relaxation • prevents blood from returning to ventricles, blood fills valve cusps, tightly closing the SL valves Principles of Human Anatomy and Physiology, 11e

31. Heart valve disorders • Stenosis is a narrowing of a heart valve which restricts blood flow. • Insufficiency or incompetence is a failure of a valve to close completely. • Stenosed valves may be repaired by balloon valvuloplasty, surgical repair, or valve replacement. Principles of Human Anatomy and Physiology, 11e

32. Valve Function Review Which side is anterior surface? What are the ventricles doing? Principles of Human Anatomy and Physiology, 11e

33. Valve Function Review Ventricles contract, blood pumped into aorta and pulmonary trunk through SL valves Atria contract, blood fills ventricles through A-V valves Principles of Human Anatomy and Physiology, 11e

34. Blood Circulation • Two closed circuits, the systemic and pulmonic • Systemic circulation • left side of heart pumps blood through body • left ventricle pumps oxygenated blood into aorta • aorta branches into many arteries that travel to organs • arteries branch into many arterioles in tissue • arterioles branch into thin-walled capillaries for exchange of gases and nutrients • deoxygenated blood begins its return in venules • venules merge into veins and return to right atrium Principles of Human Anatomy and Physiology, 11e

35. Blood Circulation (cont.) • Pulmonary circulation • right side of heart pumps deoxygenated blood to lungs • right ventricle pumps blood to pulmonary trunk • pulmonary trunk branches into pulmonary arteries • pulmonary arteries carry blood to lungs for exchange of gases • oxygenated blood returns to heart in pulmonary veins Principles of Human Anatomy and Physiology, 11e

36. Blood Circulation • Blood flow • blue = deoxygenated • red = oxygenated Principles of Human Anatomy and Physiology, 11e

37. Coronary Circulation • The flow of blood through the many vessels that flow through the myocardium of the heart is called the coronary (cardiac) circulation; it delivers oxygenated blood and nutrients to and removes carbon dioxide and wastes from the myocardium (Figure 20.8b). • When blockage of a coronary artery deprives the heart muscle of oxygen, reperfusion may damage the tissue further. This damage is due to free radicals. Drugs that lessen reperfusion damage after a heart attack are being developed . Principles of Human Anatomy and Physiology, 11e

38. Coronary Circulation • Coronary circulation is blood supply to the heart • Heart as a very active muscle needs lots of O2 • When the heart relaxes high pressure of blood in aorta pushes blood into coronary vessels • Many anastomoses • connections between arteries supplying blood to the same region, provide alternate routes if one artery becomes occluded Principles of Human Anatomy and Physiology, 11e

39. Coronary Arteries • Branches off aorta above aortic semilunar valve • Left coronary artery • circumflex branch • in coronary sulcus, supplies left atrium and left ventricle • anterior interventricular art. • supplies both ventricles • Right coronary artery • marginal branch • in coronary sulcus, supplies right ventricle • posterior interventricular art. • supplies both ventricles Principles of Human Anatomy and Physiology, 11e

40. Coronary Veins • Collects wastes from cardiac muscle • Drains into a large sinus on posterior surface of heart called the coronary sinus • Coronary sinus empties into right atrium Principles of Human Anatomy and Physiology, 11e

41. Histology of Cardiac Muscle • Compared to skeletal muscle fibers, cardiac muscle fibers are shorter in length, larger in diameter, and squarish rather than circular in transverse section (Figure 20.9). • They also exhibit branching (Table 4.4B). • Fibers within the networks are connected by intercalated discs, which consist of desmosomes and gap junctions • Cardiac muscles have the same arrangement of actin and myosin, and the same bands, zones, and Z discs as skeletal muscles. • They do have less sarcoplasmic reticulum than skeletal muscles and require Ca+2 from extracellular fluid for contraction. Principles of Human Anatomy and Physiology, 11e

42. Cardiac Muscle Histology • Branching, intercalated discs with gap junctions, involuntary, striated, single central nucleus per cell Principles of Human Anatomy and Physiology, 11e

43. Cardiac Myofibril Principles of Human Anatomy and Physiology, 11e

44. Conduction System of Heart Coordinates contraction of heart muscle. Principles of Human Anatomy and Physiology, 11e

45. Myocardial ischemia and infarction • Reduced blood flow through coronary arteris may cause ischemia. Ischemia cuases hypoxia and may weaken the myocardial cells. Ischemia is often manifested through angina pectoris. • A complete obstruction of flow in a coronary artery may cause myocardial infarction (heart attack). • Tissue distal to the obstruction dies and is replaced by scar tissur. • Treatment may involve injection of thrombolytic agents, coronary angioplasty, or coronary artery bypass grafts. • While it was long thought that cardiac muscle lacked stem cells, recent studies five evidence for replacement of heart cells. It appears that stem cells in the blood can migrate to the heart and differentiate into myocardial cells. Principles of Human Anatomy and Physiology, 11e

46. Autorhythmic Cells: The Conduction System • Cardiac muscle cells are autorhythmic cells because they are self-excitable. They repeatedly generate spontaneous action potentials that then trigger heart contractions. • These cells act as a pacemaker to set the rhythm for the entire heart. • They form the conduction system, the route for propagating action potential through the heart muscle. Principles of Human Anatomy and Physiology, 11e

47. Conduction System of Heart Coordinates contraction of heart muscle. Principles of Human Anatomy and Physiology, 11e

48. Conduction • Components of this system are the sinoartrial (SA) node (pacemaker), atrioventricular (AV) node, atrioventricular bundle (bundle of His), right and left bundle branches, and the conduction myofibers (Purkinje fibers) (Figure 20.10) • Signals from the autonomic nervous system and hormones, such as epinephrine, do modify the heartbeat (in terms of rate and strength of contraction), but they do not establish the fundamental rhythm. Principles of Human Anatomy and Physiology, 11e

49. Autorhythmic Cells Cells fire spontaneously, act as pacemaker and form conduction system for the heart SA node cluster of cells in wall of Rt. Atria begins heart activity that spreads to both atria excitation spreads to AV node AV node in atrial septum, transmits signal to bundle of His AV bundle of His the connection between atria and ventricles divides into bundle branches & purkinje fibers, large diameter fibers that conduct signals quickly Conduction System of Heart Principles of Human Anatomy and Physiology, 11e

50. Rhythm of Conduction System • SA node fires spontaneously 90-100 times per minute • AV node fires at 40-50 times per minute • If both nodes are suppressed fibers in ventricles by themselves fire only 20-40 times per minute • Artificial pacemaker needed if pace is too slow • Extra beats forming at other sites are called ectopic pacemakers • caffeine & nicotine increase activity Principles of Human Anatomy and Physiology, 11e