The Heart

(See an anatomy book and chapter 9 of G&H)

The Cardiovascular System

What are the components?

Functions of the Heart

Blood vessels

Arteries- away from heart Veins- toward heart

Pulmonary circuitblood to lungs Systemic blood to organs of the body

Includes heart and lung wall tissues

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Location

Base- inferior border of second rib Apex- rests on diaphragm and in between 5th and 6th rib Tilts to the left and anteriorly

Pericardial Membranes (3 total) and Heart wall

Fibrous skeleton- anchoring, structural support, and electrical insulation

Atria

Right:

Left:

Auricle Smooth wall (posterior) Pectinate muscles Crista terminalis Fossa ovalis Coronary sinus, IVC, SVC openings Right AV valve
Mostly smooth with pectinate muscle Left AV valve
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What vessels lead into each atria? Describe the blood these vessels are carrying

ventricles

Trabeculae Carneae Papillary muscles Chordae tendineae Valves

Valves

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Sulci and Vessels

Coronary sulcus Interventricular sulci (anterior and posterior) Cardiac vessels

Arteries veins

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Blood Flow

Pulmonary vs systemic circuit

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Lub-Dub Sounds

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Conductive System of the Heart-Myogenic (72bpm)

Muscle, not Nerves that are autorhythmic! Sinoatrial nodepacemaker Internodal bundles Atrioventricular node Atrioventricular bundles (bundle of His) Bundle branches Purkinje fibers

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Innervation by Autonomic Nervous System

Alter rate and Force only! Visceral sensory Parasympathetic- (Vagus)slow down (20bpm or even stop)- SA would normally beat at 100bpm- but vagal tone slows down. Sympathetic speed up (230bpm) Hypothalamus and Amygdala and Medulla Oblongata Most dense at SA and AV node

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Review of Heart Muscle

Cardiocytes Branch Intercalated discsinterdigitating folds, mechanical junctions (desmosomes) and electrical junctions (gap junctions).
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Fetal Circulation

Foramen ovale- right to left shunt. Most of the blood goes through here. Ductus arteriosusright to left shunt.

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Blood Flow within the Fetal Heart

Right atrium Foramen ovale (Most of the blood) Right ventricle Left ventricle Left atrium

Pulmonary trunk

Ductus arteriosus

Aorta

Pulmonary circuit

Systemic circuit
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Birth

Prostaglandin levels drop Baby breathes- lowers pressure in pulmonary circuit Umbilical cord is clamped and cut and increases systemic pressure Foramen ovale closes and becomes fossa ovalis Ductus arteriosus closes and becomes ligamentum arteriosum (oxygen content is signal for vessel to close)
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Foramen Ovale

Fossa Ovalis

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Ductus Arteriosus

Ligamentum Arteriosum
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PDA- patent ductus arteriosus

Left to right shunt Blood flows back to lungs repeatedly- why? Net CO decreases so blood vol. increase and CO goes back toward normal Left and right ventricular hypertrophy Characteristic cyanosis of baby

Pulmonary veins

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Tetralogy of Fallot

Blue Babies Right to left shunt Tetralogy of Fallot is made up of 4 heart defects

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Physiologic considerations

Electrical features to know

Cardiac muscle fibers: branched, with intercalated disks. Gap junctions. Low resistance (1/400) pathway for electrical spread from cell to cell. functional syncitium Two types of fibers in the heart: specialized (or leading cells and contractile (or following cells.) Autorhythmicity; intrinsic to the specialized cells. AP is generated within these cells (membrane feature) not from nerves or hormones. intrinsic rhythm Nerves, hormones can modify rate or force.
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Physiologic considerations

Mechanical (contraction) features to know: 4 chambers, septa, valves Non-conductive connective tissue skeleton, wringing action. In ventricles direction is propelling blood from apex toward base. Systole = period of contraction and emptying Diastole = period of relaxation and filling Specify which chamber, as atrial and ventricular events are not the same. Show this! Ohms law: Pressure difference = flow x resistance Pressures generated in rt and left sides are different (more later.) Valves: damage can lead to stenosis and/or regurgitation
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Physiologic considerations

Vasculature: Normal circuit is A,a,c,v,V Arteries: thick wall, narrower lumen than veins of same outer diameter. Muscular and elastic. Stretch and recoil, give back potential for kinetic energy. Arterioles: resistance vessels; precapillary sphincters. Capillaries: exchange vessels, thin wall, simple squamous endothelium, diffusion. Venules: thin walled, more elastic Veins: Capacitance vessels, hold large volume of blood supply
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Physiologic considerations

Right/left side differences:

In series circuit, R to L and around again. Same amt of blood pushed by each side, cardiac output. CO=6L/min at rest. R side (pulmonary circuit) pushes blood to lungs; low resistance circuit L side (systemic circuit) pushes blood to all organs in head, torso and limbs, ie. The system; high resistance circuit. In summary, same amt of blood, but with different resistance, require different pressures. MAP on L side = 100 mm Hg; MAP on R side =10 mm Hg 29

Series Circuit

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