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Cardiopulmonary resuscitation

Chapte (CPR) is an emergency procedure that maintains

blood flow in the body if a person’s heart stops.

12
The Heart
12.1 Functions of the Heart

1. Generating blood pressure

2. Routing blood

3. Ensuring one-way blood flow

4. Regulating blood supply

12.2 Size, Form, and Location of the Heart

The heart is approximately the size of a closed fist

and is located in the pericardial cavity.

12.3 Anatomy of the Heart

The heart generally decreases in size after
approximately age 65, especially in people who are Pericardium
not physically active.
The heart lies in the pericardial cavity formed by
· The blunt, rounded point of the heart is the apex. pericardium.

· The larger, flat part at the opposite end of the The pericardium is a sac consisting of fibrous and
heart is the base. serous pericardia.

Location Fibrous pericardium

Heart is located in the thoracic cavity between · outer layer of the pericardium
the two pleural cavities that surround the lungs.
Mediastinum. · composed of tough, fibrous connective tissue

The heart is surrounded by its own cavity, the

pericardial cavity.

Serous pericardium
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· inner layer and The right and left atria are located at the base of
the heart,
· consists of flat epithelial cells with a thin layer of
connective tissue and the right and left ventricles to extend from the
base of the heart toward the apex.
two parts:
A groove called the coronary sulcus extends
 parietal pericardium around the heart, separating the atria from the
ventricles. Two additional grooves or sulci extend
· lines the fibrous pericardium inferiorly from the coronary sulcus and indicate the
division between the right and left ventricles.

- anterior interventricular sulcus is on the anterior

 visceral pericardium, or epicardium surface of the heart

· covers the heart surface - posterior interventricular sulcus is on the

posterior surface of the heart

Pericardial cavity
Atria are separated externally from the ventricles by
· located between the visceral and parietal the coronary sulcus.
pericardia
Right and left ventricles are separated externally by
· is filled with a thin layer of pericardial fluid the interventricular sulci.

- produced by the serous pericardium

- helps reduce friction as the heart

moves within the pericardium

External Anatomy
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Right and Left Atria

There are four chambers in the heart. The left and

right atria receive blood from veins and function
mainly as reservoirs. Contraction of the atria
completes ventricular filling.

The right atrium receives blood from three major

openings:
- superior vena cava and the inferior vena
cava drain blood from most of the body
- smaller coronary sinus drains blood
from most of the heart muscle.

The left atrium receives blood through the four

pulmonary veins, which drain blood from the lungs.

The atria are separated internally from each other

by the interatrial septum.

The inferior and superior venae cavae enter the

right atrium. Right and Left Ventricles
The four pulmonary veins enter the left atrium. The ventricles are the main pumping chambers of
the heart.

Right ventricle pumps blood into the pulmonary

The pulmonary trunk exits the right ventricle, and trunk.

the aorta exits the left ventricle. Left ventricle, which has a thicker wall, pumps
blood into the aorta.

The ventricles are separated internally by the

interventricular septum.

Heart Valves

Heart Chambers and Internal Anatomy The heart valves ensure one-way flow of blood.
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two types of heart valves: The left coronary artery originates on the left
side of the aorta.
(1) atrioventricular valves and
It has three major branches: (1) the anterior
(2) semilunar valves. interventricular artery, (2) the circumflex artery, and
(3) the left marginal artery.
An atrioventricular (AV) valve is located between
each atrium and ventricle.  The anterior interventricular artery lies in
the anterior interventricular sulcus;
 The tricuspid valve (three cusps)  the circumflex artery extends around the
separates the right atrium and the right coronary sulcus on the left to the posterior
ventricle, surface of the heart; and
 bicuspid valve (two cusps) separates the  the left marginal artery extends inferiorly
left atrium and the left ventricle. along the lateral wall of the left ventricle
from the circumflex artery.
Each ventricle contains cone-shaped, muscular
pillars called papillary muscles. These muscles
are attached by thin, strong, connective tissue
strings called chordae tendineae to the free The right coronary artery originates on the right
margins of the cusps of the atrioventricular valves. side of the aorta.

Semilunar valve is located between each ventricle It extends around the coronary sulcus on the right
and its associated great artery. to the posterior surface of the heart and gives rise
to the posterior interventricular artery, which lies
 The pulmonary semilunar valve is located in the posterior interventricular sulcus.
between the right ventricle and the
pulmonary trunk. The right marginal artery extends inferiorly along
 The aortic semilunar valve is located the lateral wall of the right ventricle. The right
between the left ventricle and aorta. coronary artery and its branches supply most of the
wall of the right ventricle.
Route of Blood Flow Through the Heart

1. R. Atrium
2. Tricuspid Valve The cardiac veins drain blood from the cardiac
3. R. Ventricle muscle. Blood returns from heart tissue through
4. Pulmonary Semilunar Valve cardiac veins to the coronary sinus and into the
5. Pulmonary Trunk right atrium. Small cardiac veins also return blood
6. Pulmonary Arteries directly to the right atrium.
7. Lungs
8. L. Atrium Coronary sinus, a large vein located within the
9. Bicuspid Valve coronary sulcus on the posterior aspect of the
10. L. Ventricle heart.
11. Aortic Semilunar Valve
12. Aorta
13. Pulmonary Veins
14. Different Parts of the Body

Blood Supply to the Heart

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12.4 Histology of the Heart

Heart Wall

The heart wall consists of the outer epicardium, the

middle myocardium, and the inner endocardium.

Epicardium; visceral pericardium

· is a thin, serous membrane forming the smooth

outer surface of the heart.

· consists of simple squamous epithelium

overlying a layer of loose connective tissue and
adipose tissue.

Myocardium

· is the thick, middle layer of the heart, composed

of cardiac muscle cells.

· responsible for contraction of the heart

chambers.

Endocardium

· smooth inner surface of the heart, which consists

of simple squamous epithelium over a layer of
connective tissue

· allows blood to move easily through the heart.

The surfaces of the interior walls of the ventricles

are modified by ridges and columns of cardiac
muscle called trabeculae carneae.

Cardiac Muscle

1. Cardiac muscle is striated; it depends on ATP for

energy and on aerobic metabolism.

2. Cardiac muscle cells are joined by intercalated

disks that allow action potentials to be propagated
throughout the heart.
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12.5 Stimulation of the Heart 1. The conduction system of the heart is made up
of specialized cardiac muscle cells.
The movement of blood through the heart is
determined by a coordinated sequence of cardiac 2. The SA node produces action potentials that are
muscle contractions: atria contract first, followed by propagated over the atria to the AV node.
ventricular contraction.
3. The AV node and the atrioventricular bundle
conduct action potentials to the ventricles.

Action Potentials in Cardiac Muscle 4. The right and left bundle branches conduct
action potentials from the atrioventricular bundle
1. Action potentials in cardiac muscle are prolonged through Purkinje fibers to the ventricular muscle.
compared to those in skeletal muscle and have a
depolarization phase, a plateau phase, and a 5. An ectopic beat results from an action potential
repolarization phase. that originates in an area of the heart other than the
SA node.
2. The depolarization is due mainly to opening of
the voltage-gated Na+ channels, and the plateau
phase is due to opened voltage-gated Ca2+
channels. Electrocardiogram

Repolarization at the end of the plateau phase is 1. An ECG is a record of electrical events within the
due to the opening of K+ channels for a brief heart.
period.
2. An ECG can be used to detect abnormal heart
3. The prolonged action potential in cardiac rates or rhythms, abnormal conduction pathways,
muscle ensures that contraction and relaxation hypertrophy or atrophy of the heart, and the
occur and prevents tetany. approximate location of damaged cardiac muscle.

4. The SA node located in the upper wall of the 3. A normal ECG consists of a P wave (atrial
right atrium is the normal pacemaker of the heart, depolarization), a QRS complex (ventricular
and cells of the SA node have more voltage-gated depolarization), and a T wave (ventricular
Ca2+ channels than do other areas of the heart. repolarization).

4. Atrial contraction occurs during the PQ interval,

and the ventricles contract and relax during the QT
Conduction System of the Heart interval.

Unlike skeletal muscle that requires neural

stimulation to contract, cardiac muscle can
contract without neural stimulations. Contraction
of the atria and ventricles is coordinated by
specialized cardiac muscle cells in the heart wall
that form the conduction system of the heart.

The conduction system of the heart includes (1) the

sinoatrial node, (2) atrioventricular node, (3)
atrioventricular bundle, (4) the bundle branches,
and (5) Purkinje fibers.
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12.6 Cardiac Cycle

1. Atrial systole is contraction of the atria, and Intrinsic Regulation of the Heart
ventricular systole is contraction of the ventricles.
Atrial diastole is relaxation of the atria, and 1. Intrinsic regulation refers to regulation
ventricular diastole is relaxation of the ventricles. mechanisms contained within the heart.

2. During atrial systole, the atria contract and 2. As venous return to the heart increases, the
complete filling of the ventricles. heart wall is stretched, and the increased stretch of
the ventricular walls is called preload.
3. During ventricular systole, the AV valves close,
pressure increases in the ventricles, the semilunar 3. A greater preload causes the cardiac output to
valves are forced open, and blood flows into the increase because stroke volume increases
aorta and pulmonary trunk. (Starling’s law of the heart).

4. At the beginning of ventricular diastole, pressure 4. Afterload is the pressure against which the
in the ventricles decreases. The semilunar valves ventricles must pump blood.
close to prevent backflow of blood from the aorta
and pulmonary trunk into the ventricles. Extrinsic Regulation of the Heart

5. When the pressure in the ventricles is low 1. Extrinsic regulation refers to nervous and
enough, the AV valves open, and blood flows from chemical mechanisms.
the atria into the ventricles.
2. Sympathetic stimulation increases stroke volume
12.7 Heart Sounds and heart rate; parasympathetic stimulation
decreases heart rate.
The stethoscope was originally developed to listen
to the sounds of the lungs and heart and is now 3. The baroreceptor reflex detects changes in blood
used to listen to other sounds of the body as well. pressure. If blood pressure increases suddenly, the
reflex causes a decrease in heart rate and stroke
1. The first heart sound results from closure of the volume; if blood pressure decreases suddenly, the
AV valves. The second heart sound results from reflex causes an increase in heart rate and stroke
closure of the semilunar valves. volume.

2. Abnormal heart sounds, called murmurs, can 4. Emotions influence heart function by increasing
result from incompetent (leaky) valves or stenosed sympathetic stimulation of the heart
(narrowed) valves.
in response to exercise, excitement, anxiety, or
anger and by increasing parasympathetic
stimulation in response to depression.
12.8 Regulation of Heart Function
5. Alterations in body fluid levels of CO2, pH, and
Cardiac output (volume of blood pumped per ion concentrations, as well as changes in body
ventricle per minute) is equal to the stroke volume temperature, influence heart function.
(volume of blood ejected per beat) times the heart
rate (beats per minute).