NAN 1013

Anatomy & Physiology

CIRCULATORY SYSTEM:
HEART

NORSALAWATI ISMAIL

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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

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Heart Anatomy

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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
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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 friction-
free environment

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Pericardial Layers of the Heart

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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
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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. Subclavian arteries 8
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

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External Heart: Anterior View

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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
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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

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External Heart: Posterior View

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Gross Anatomy of Heart: Frontal Section

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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
vena cava and coronary sinus
▪ Blood enters left atria from pulmonary veins

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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

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Thickness of Cardiac Walls

Myocardium of left ventricle is much thicker than the right.

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Atrial Septal Defect

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Ventricular Septal Defect

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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
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Pathway of Blood Through the Heart and Lungs

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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.

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Coronary Circulation: Arterial Supply

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Coronary Circulation: Venous Supply

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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

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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

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Heart Valves

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Heart Valves

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Atrioventricular Valve Function

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Semilunar Valve Function

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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

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Microscopic Anatomy of Heart Muscle

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PHYSIOLOGY OF THE HEART

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Cardiac Muscle Contraction

▪ Heart muscle:
▪ Is stimulated by nerves and is self-excitable
(automaticity)
▪ Contracts as a unit
▪ Cardiac muscle contraction is similar to skeletal
muscle contraction

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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

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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
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Heart Physiology: Sequence of Excitation

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Heart Excitation Related to ECG

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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

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Electrocardiography

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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)

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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

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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

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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

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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

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Phases of the Cardiac Cycle

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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

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Cardiac Output: Example

▪ CO (ml/min)
= HR (75 beats/min) x SV (70 ml/beat)
▪ CO = 5250 ml/min (5.25 L/min)

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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

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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

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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

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Preload and Afterload

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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

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Extrinsic Factors Influencing Stroke Volume

▪ Agents/factors that decrease contractility include:

▪ Acidosis
▪ Increased extracellular K+
▪ Calcium channel blockers

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Regulation of Heart Rate

▪ Positive chronotropic factors increase heart rate

▪ Caffeine
▪ Negative chronotropic factors decrease heart rate
▪ Sedatives

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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.
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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

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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

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