21

The Cardiovascular
System: The Heart

Introduction
The heart keeps the blood in motion
The heart beats about 100,000 times per day
The heart pumps about 1.5 millions gallons of
blood per year
The heart pumps between 5 and 30 liters of blood
per minute

An Overview of the Cardiovascular System

The heart is about the size of ones clenched fist
The heart consists of four chambers
Two atria
Two ventricles

The heart pumps blood into two circuits

Pulmonary circuit
Systemic circuit

Figure 21.2a Location of the Heart in the Thoracic Cavity

Trachea
Thyroid gland
Right lung

First rib (cut)

Left lung

Base of
heart
Diaphragm

Parietal pericardium
(cut)

Apex of
heart

Anterior view of the open chest cavity showing the position

of the heart and major vessels relative to the lungs. The
sectional plane indicates the orientation of part (c).

The Pericardium
Pericardium is the serous membrane lining the
pericardial cavity
The pericardial membrane forms two layers
Visceral pericardium (also called the epicardium)
Parietal pericardium
The parietal pericardium is reinforced by a layer
called the fibrous pericardium
The parietal pericardium and fibrous pericardium
constitute the pericardial sac

Figure 21.2b Location of the Heart in the Thoracic Cavity

Cut edge of
parietal pericardium
Pericardial
cavity containing
pericardial fluid

Air space
(corresponds
to pericardial
cavity)

Cut edge of
epicardium
(visceral pericardium)

Fibrous attachment
to diaphragm

Relationships between the heart and the pericardial

cavity. The pericardial cavity surrounds the heart
like the balloon surrounds the fist (right).

Balloon

Structure of the Heart Wall

The walls of the heart consist of three layers:
Epicardium
External surface

Myocardium
Consists of cardiac muscle cells

Endocardium
Internal surface

Structure of the Heart Wall

Characteristics of Cardiac Muscle Cells
Mostly dependent on aerobic respiration
The circulatory supply of cardiocytes is very
extensive
Cardiocytes contract without information coming from
the CNS
Cardiocytes are interconnected by intercalated discs

Structure of the Heart Wall

The Intercalated Discs
Cardiac cells have specialized cell-to-cell junctions
The sarcolemmae of two cardiac cells are bound together by
desmosomes
The intercalated discs bind the myofibrils of adjacent cells
together
Cardiac cells are bound together by gap junctions

Ions move directly from one cell to another

allowing all the sarcomeres to contract as one
unit

Figure 21.3de Histological Organization of Muscle Tissue in the Heart Wall

Cardiac muscle cell

Mitochondria
Gap junction

Intercalated
disc (sectioned)
Intercalated
disc

Z lines bound
to opposing cell
membranes
Desmosomes

Nucleus
Cardiac muscle
cell (sectioned)

The structure of an intercalated disc

Bundles of
myofibrils

Diagrammatic three-dimensional
view of cardiac muscle cells

Intercalated
disc

Structure of the Heart Wall

The Fibrous Skeleton
Each cardiac cell is wrapped in an elastic sheath
Each muscle layer is wrapped in a fibrous sheet
The fibrous sheets separate the superficial layer with
the deep layer muscles
These fibrous sheets also encircle the base of the
pulmonary trunk and ascending aorta

Structure of the Heart Wall

Functions of the Fibrous Skeleton
Stabilizes the position of cardiac cells
Stabilizes the position of the heart valves
Provides support for the blood vessels and nerves in
the myocardium
Helps to distribute the forces of contraction
Helps to prevent overexpansion of the heart
Provides elasticity so the heart recoils after
contraction
Isolates atrial cells from ventricular cells

Orientation and Superficial Anatomy of Heart

The heart lies slightly to the left of midline
Located in the mediastinum
The base is the superior portion of the heart
The apex is the inferior portion of the heart

Orientation and Superficial Anatomy of Heart

The heart sits at an oblique angle
The right border is formed by only the right atrium
The inferior border is formed by the right ventricle

Orientation and Superficial Anatomy of Heart

The four chambers of the heart can be identified by
sulci on the external surface
Interatrial sulcus separates the left and right atria
Coronary Atrioventricular sulcus separates the atria
and the
ventricles
Anterior interventricular sulcus separates the left and
right ventricles
Posterior interventricular sulcus also separates the
left and right ventricles

Figure 21.5a Superficial Anatomy of the Heart, Part I

Left common carotid artery

Left subclavian artery

Arch of aorta

Brachiocephalic trunk

Ligamentum
arteriosum
Descending
aorta

Ascending
aorta

Left pulmonary
artery

Superior
vena cava
Auricle
of right
atrium

Fat in
coronary
sulcus

Pulmonary
trunk
Auricle of
left atrium

RIGHT
ATRIUM

RIGHT
VENTRICLE

LEFT
VENTRICLE

Anterior view of the heart and great

vessels

Fat in
anterior
interventricular
sulcus

Figure 21.5b Superficial Anatomy of the Heart, Part I

Arch of aorta
Left pulmonary artery

Right pulmonary
artery

Left pulmonary veins

Superior
vena cava
LEFT
ATRIUM

Fat in
coronary
sulcus
Coronary
sinus

Right
pulmonary
veins (superior
and inferior)
RIGHT
ATRIUM

LEFT
VENTRICLE

Inferior
vena cava

RIGHT
VENTRICLE

Fat in posterior
interventricular sulcus

Posterior view of the heart and great

vessels

Orientation and Superficial Anatomy of Heart

The left and right atria
Positioned superior to the coronary sulcus
Both have thin walls
Both consist of expandable extensions called
auricles

The left and right ventricles

Positioned inferior to the coronary sulcus
Much of the right ventricle forms the diaphragmatic
surface

Figure 21.6a Superficial Anatomy of the Heart, Part II

Ascending
aorta

Parietal
pericardium

Fibrous
pericardium

Superior
vena cava

Pulmonary
trunk

Auricle of
right atrium

Auricle of
left atrium

RIGHT
ATRIUM
Right coronary
artery

RIGHT
VENTRICLE
LEFT
VENTRICLE

Coronary sulcus
Marginal branch
of right
coronary artery

Anterior
interventricular
sulcus

Parietal pericardium fused to diaphragm

In this photo, the pericardial sac has been

cut and reflected to expose the heart and
great vessels.

Internal Anatomy and Organization of the Heart

A frontal section of the heart reveals:
Left and right atria separated by the interatrial
septum
Left and right ventricles separated by the
interventricular septum
The atrioventricular valves are formed from folds of
endocardium

Internal Anatomy and Organization of the Heart

The Right Atrium
Receives deoxygenated blood via the superior vena
cava, inferior vena cava, and coronary sinus
Consists of pectinate muscles
Contains the fossa ovalis (fetal remnant of the
foramen ovale)

Internal Anatomy and Organization of the Heart

The Right Ventricle
Receives deoxygenated blood from the right atrium
Blood enters the ventricle by passing through the
tricuspid valve (right atrioventricular valve right AV
valve)
The valve is connected to papillary muscles via
chordae tendineae
Since there are three cusps to the valve, the chordae
tendineae are connected to three papillary muscles
Papillary muscles and chordae tendineae prevent valve
inversion when the ventricles contract

Internal Anatomy and Organization of the Heart

The internal surface of the right ventricle consists of:
Trabeculae carneae
Moderator band
Found only in the right ventricle
Muscular band that extends from the interventricular
septum to the ventricular wall
Prevents overexpansion of the thin-walled right ventricle

Pulmonary valve
Leads to the pulmonary trunk, then to the right and left pulmonary
arteries

Figure 21.7b Sectional Anatomy of the Heart, Part I

Left common carotid artery

Brachiocephalic
trunk

Left subclavian artery

Ligamentum arteriosum

Superior
vena cava

Aortic arch

Pulmonary trunk
Pulmonary valve

Right
pulmonary
arteries

Left pulmonary
arteries

Ascending
aorta
Fossa ovalis
Opening of
coronary sinus

LEFT
ATRIUM

Left pulmonary
veins
Interatrial septum
Aortic valve

RIGHT ATRIUM
Pectinate muscles
Conus arteriosus

Cusp of left AV
(mitral) valve
LEFT VENTRICLE

Cusp of right AV
(tricuspid) valve
Chordae tendineae

Interventricular
septum

Papillary muscle
RIGHT VENTRICLE

Trabeculae
carneae

Inferior vena cava

Moderator
band
Descending
aorta

Diagrammatic frontal section through the relaxed heart shows the major
landmarks and the path of blood flow through the atria and ventricles (arrows).

Internal Anatomy and Organization of the Heart

The Left Atrium
Receives oxygenated blood from the lungs via the
right and left pulmonary veins
Does not have pectinate muscles
Blood passes through the bicuspid valve (left
atrioventricular valve bicuspid valve mitral
valve)

Internal Anatomy and Organization of the Heart

The Left Ventricle
Has the thickest wall
Needed for strong contractions to pump blood throughout the
entire systemic circuit
Right ventricle has a thin wall since it only pumps blood
through the pulmonary circuit

Does not have a moderator band

The AV valve has chordae tendineae connecting to the
two cusps and to two papillary muscles

Internal Anatomy and Organization of the Heart

The Left Ventricle (continued)
Blood leaves the left ventricle by passing through the
aortic valves
Blood enters the ascending aorta
Blood then travels to the aortic arch and then to all
body parts (systemic)

Figure 21.7b Sectional Anatomy of the Heart, Part I

Left common carotid artery
Brachiocephalic
trunk

Left subclavian artery

Ligamentum arteriosum

Superior
vena cava

Aortic arch

Pulmonary trunk
Pulmonary valve

Right
pulmonary
arteries

Left pulmonary
arteries

Ascending
aorta
Fossa ovalis
Opening of
coronary sinus

LEFT
ATRIUM

Left pulmonary
veins
Interatrial septum
Aortic valve

RIGHT ATRIUM
Pectinate muscles

Cusp of left AV
(mitral) valve

Conus arteriosus
LEFT VENTRICLE
Cusp of right AV
(tricuspid) valve
Chordae tendineae

Interventricular
septum

Papillary muscle
RIGHT VENTRICLE

Trabeculae
carneae

Inferior vena cava

Moderator
band
Descending
aorta

Diagrammatic frontal section through the relaxed heart shows the major
landmarks and the path of blood flow through the atria and ventricles (arrows).

Internal Anatomy and Organization of the Heart

Structure of the Heart Valves
Each AV valve consists of four parts

Ring of connective tissue that connects to the heart tissue

Cusps
Chordae tendineae
Papillary muscles

Internal Anatomy and Organization of the Heart

Function of the Heart Valves
Papillary muscles relax
Due to the pressure in the atria, the AV valves open
When the ventricles contract, pressure causes the
semilunar valves to open
Also upon contraction, the blood forces the AV
valves closed, thus resulting in blood going through
the semilunar valves

ANIMATION The Heart: Valves

Figure 21.9a Valves of the Heart

Transverse Sections, Superior View, Atria and Vessels Removed

Frontal Sections Through Left Atrium and Ventricle

POSTERIOR
Fibrous
skeleton

Left AV (bicuspid)
valve (open)

Ventricular Diastole

RIGHT
VENTRICLE

Pulmonary
veins

LEFT
VENTRICLE

LEFT
ATRIUM
Left AV
(bicuspid)
valve (open)
Aortic valve
(closed)

Right AV
(tricuspid)
valve (open)

Papillary
muscles
(relaxed)

Aortic valve
(closed)

ANTERIOR

Aortic valve closed

Chordae
tendineae
(loose)

Pulmonary
valve (closed)

When the ventricles are relaxed, the AV valves are open and
the semilunar valves are closed. The chordae tendineae are
loose, and the papillary muscles are relaxed.

LEFT VENTRICLE
(dilated)

Figure 21.9b Valves of the Heart

Transverse Sections, Superior View, Atria and Vessels Removed

Right AV
(tricuspid) valve
(closed)
RIGHT
VENTRICLE

Fibrous
skeleton

Left AV
(bicuspid) valve
(closed)

LEFT
VENTRICLE

Frontal Sections Through Left Atrium and Ventricle

Aorta

Ventricular Systole

Aortic sinus
Aortic valve
(open)

LEFT
ATRIUM
Left AV
(bicuspid)
valve (closed)
Chordae
tendineae
(tense)
Papillary
muscles
(contracted)

Aortic valve
(open)
Pulmonary
valve (open)

Aortic valve open

When the ventricles are contracting, the AV valves

are closed and the semilunar valves are open. In
the frontal section notice the attachment of the left
AV valve to the chordae tendineae and papillary
muscles.

Left ventricle
(contracted)

Internal Anatomy and Organization of the Heart

Coronary Blood Vessels
Supplies blood to the heart muscles
Branches off the ascending aorta near its base
Major coronary vessels
Right coronary artery (RCA)
Left coronary artery (LCA)
Cardiac veins

Internal Anatomy and Organization of the Heart

Right Coronary Artery
Passes between the right auricle and pulmonary trunk
Major branches off the right coronary artery:

Atrial branches
Right marginal branch
Posterior interventricular branch
Conducting system branches

Figure 21.10a Coronary Circulation

Left common carotid

artery
Brachiocephalic
trunk
Pulmonary
trunk

Left subclavian artery

Aortic
arch
LEFT ATRIUM
Left coronary
artery (LCA)

Right
coronary
artery
(RCA)

Circumflex
branch of LCA
Diagonal branch
of LCA

RIGHT
ATRIUM

Anterior
interventricular
branch of LCA
Great cardiac
vein

Atrial
branches
of RCA

RIGHT
VENTRICLE

LEFT
VENTRICLE

Small cardiac
vein
Anterior cardiac
veins
Marginal branch
of RCA

Coronary vessels supplying the

anterior surface of the heart

Figure 21.10c Coronary Circulation

Left common
carotid artery

Brachiocephalic
trunk

Left subclavian artery

Aortic arch

Superior
vena cava
Pulmonary trunk
Pulmonary
valve
Diagonal branch
of LCA

Ascending
aorta
Right auricle
Right coronary
artery

Great
cardiac vein

Anterior cardiac
vein

Anterior
interventricular
branch of LCA

RIGHT ATRIUM
Small cardiac
vein

LEFT
VENTRICLE

Right marginal
branch of RCA
RIGHT VENTRICLE

A cast of the coronary vessels showing the complexity and extent of the coronary circulation. Coronary vessels are also seen in Figure 21.6.

Internal Anatomy and Organization of the Heart

Left Coronary Artery
Major branches off the left coronary artery
Circumflex branch (branches to form the left marginal
branch and the posterior left ventricular branch)
Anterior interventricular branch (branches lead from the
anterior interventricular branch to the posterior
interventricular branch called anastomoses)

Figure 21.10a Coronary Circulation

Left common carotid

artery
Brachiocephalic
trunk
Pulmonary
trunk

Left subclavian artery

Aortic
arch
LEFT ATRIUM
Left coronary
artery (LCA)

Right
coronary
artery
(RCA)

Circumflex
branch of LCA
Diagonal branch
of LCA

RIGHT
ATRIUM

Anterior
interventricular
branch of LCA
Great cardiac
vein

Atrial
branches
of RCA

RIGHT
VENTRICLE

LEFT
VENTRICLE

Small cardiac
vein
Anterior cardiac
veins
Marginal branch
of RCA

Coronary vessels supplying the

anterior surface of the heart

Figure 21.10b Coronary Circulation

Circumflex
branch of LCA

Atrial branch
of LCA

Great cardiac vein

Marginal
branch of LCA
Posterior vein
of left ventricle
LEFT
ATRIUM

Posterior
left ventricular
branch of LCA

Coronary
sinus
LEFT
VENTRICLE

RIGHT
ATRIUM
Small cardiac
vein
RIGHT
VENTRICLE

Right
coronary
artery (RCA)
Right marginal
branch of RCA

Posterior interventricular
branch of RCA

Coronary vessels supplying the

posterior surface of the heart

Middle cardiac
vein

Internal Anatomy and Organization of the Heart

The Cardiac Veins

Posterior vein of the left ventricle

Middle cardiac vein
Small cardiac vein
Anterior cardiac veins
All the above drain into the great cardiac vein

Great cardiac vein drains into the coronary sinus

All the above eventually lead to the right atrium

Figure 21.10b Coronary Circulation

Circumflex
branch of LCA

Atrial branch
of LCA

Great cardiac vein

Marginal
branch of LCA
Posterior vein
of left ventricle
LEFT
ATRIUM

Posterior
left ventricular
branch of LCA

Coronary
sinus
LEFT
VENTRICLE

RIGHT
ATRIUM
Small cardiac
vein
RIGHT
VENTRICLE

Right
coronary
artery (RCA)
Right marginal
branch of RCA

Posterior interventricular
branch of RCA

Coronary vessels supplying the

posterior surface of the heart

Middle cardiac
vein

Figure 21.10d Coronary Circulation

Posterior vein
of left ventricle
LEFT
VENTRICLE
Coronary
sinus

Middle
cardiac
vein
RIGHT
VENTRICLE

RIGHT
ATRIUM

Right marginal
branch of RCA

Spiral scan of the heart showing the coronary veins

and coronary sinus. [Courtesy of Tera Recon, Inc.]

Internal Anatomy and Organization of the Heart

ANIMATION The Heart: Anatomy

The Cardiac Cycle

The cardiac cycle consists of alternate periods of
contraction and relaxation
Contraction is systole
Blood is ejected into the ventricles
Blood is ejected into the pulmonary trunk and the
ascending aorta

Relaxation is diastole
Chambers are filling with blood

The Cardiac Cycle

Cardiac contractions are coordinated by
conducting cells
There are two kinds of conducting cells
Nodal cells
Establish the rate of contractions
Cell membranes automatically depolarize

Conducting fibers
Distribute the contractile stimulus to the myocardium

The Cardiac Cycle

The Sinoatrial and Atrioventricular Nodes
Sinoatrial node (SA node)

Cardiac pacemaker
Embedded in the posterior wall of the right atrium
Determines the rate of heart contractions
Bradycardia: slow heart rate
Tachycardia: rapid heart rate
Impulse travels to the AV node via the internodal
pathways

The Cardiac Cycle

The Sinoatrial and Atrioventricular Nodes
(continued)
Atrioventricular node (AV node)
Sits within the floor of the right atrium
Impulse travels from the AV node to the AV bundle
The AV bundle travels along the interventricular
septum and then divides to form the right and left
bundle branches
The bundle branches send impulses to the Purkinje
fibers
Impulses are then conveyed to the ventricular
myocardium

Figure 21.12a The Conducting System of the Heart

Sinoatrial
(SA) node
Internodal
pathways
Atrioventricular
(AV) node
AV bundle
Left bundle branch
Right bundle branch
Moderator band

Purkinje fibers

The stimulus for contraction is generated by pacemaker cells at

the SA node. From there, impulses follow three different paths
through the atrial walls to reach the AV node. After a brief delay,
the impulses are conducted to the bundle of His (AV bundle), and
then on to the bundle branches, the Purkinje fibers, and the
ventricular myocardial cells.

Figure 21.12b The Conducting System of the Heart

SA node activity and
atrial activation begin.

SA node

Time 0

Stimulus spreads across

the atrial surfaces and
AV node
reaches the AV node.

Elapsed time 50 msec

There is a 100 msec delay

at the AV node. Atrial
contraction begins.

Elapsed time 150 msec

AV
bundle
Bundle
branches

The impulse travels along the

interventricular septum within
the AV bundle and the bundle
branches to the Purkinje fibers
and, via the moderator band,
to the papillary muscles of the
right ventricle.
Moderator
Elapsed time 175 msec
band

The impulse is distributed by

Purkinje fibers and relayed
throughout the ventricular
myocardium. Atrial contraction
is completed, and ventricular
contraction begins.
Elapsed time 225 msec

Purkinje
fibers

The movement of the contractile stimulus through the

heart is shown in STEPS 15.

The Cardiac Cycle

ANIMATION The Heart: Conduction System

Figure 21.12b The Conducting System of the Heart (Part 1 of 2)

SA node activity and

atrial activation begin.

SA node

Time 0

Stimulus spreads across

the atrial surfaces and
reaches the AV node.

AV node

Elapsed time 50 msec

There is a 100 msec delay

at the AV node. Atrial
contraction begins.

Elapsed time 150 msec

AV
bundle

Bundle
branches

The movement of the contractile stimulus through the

heart is shown in STEPS 15.

Figure 21.12b The Conducting System of the Heart (Part 2 of 2)

The impulse travels along the

interventricular septum within
the AV bundle and the bundle
branches to the Purkinje fibers
and, via the moderator band,
to the papillary muscles of the
right ventricle.
Elapsed time 175 msec

Moderator
band

The impulse is distributed by

Purkinje fibers and relayed
throughout the ventricular
myocardium. Atrial contraction
is completed, and ventricular
contraction begins.
Elapsed time 225 msec

Purkinje
fibers

The movement of the contractile stimulus through the

heart is shown in STEPS 15.

Figure 21.11 The Cardiac Cycle

Start

Atrial systole begins:

Atrial contraction forces a small amount
of additional blood into relaxed ventricles.

Atrial systole ends,

atrial diastole
begins
0
800
msec
msec

100
msec

Ventricular
diastolelate:
All chambers are relaxed.
Ventricles fill passively.

e
cul ar sy stol

Cardiac
cycle

Ven
tri

tricul ar d
Ven
ia s
tol
e

Atrial sy stole

le
Atr
ial dia sto

Ventricular systole
first phase:
Ventricular contraction
pushes AV valves
closed but does not
create enough
pressure to open
semilunar valves.

370
msec

Ventricular systole
second phase: As

Ventricular diastoleearly:
As ventricles relax, pressure in ventricles
drops; blood flows back against cusps of
semilunar valves and forces them closed.
Blood flows into the relaxed atria.

ventricular pressure rises

and exceeds pressure
in the arteries, the
semilunar valves
open and blood
is ejected.

The Cardiac Cycle

ANIMATION The Heart: Cardiac Cycle
ANIMATION The Cardiac Cycle: Part 1
ANIMATION The Cardiac Cycle: Part 2
ANIMATION The Cardiac Cycle: Part 3
ANIMATION The Cardiac Cycle: Part 4
ANIMATION The Cardiac Cycle: Part 5

The Cardiac Cycle

Autonomic Control of Heart Rate
The pacemaker sets the heart rate but can be altered
Impulses from the autonomic nervous system
modify the pacemaker activity
Nerves associated with the ANS innervate the:

SA node
AV node
Cardiac cells
Smooth muscles in the cardiac blood vessels

The Cardiac Cycle

Autonomic Control of Heart Rate (continued)
Norepinephrine from the ANS causes:
An increase in the heart rate
An increase in the force of contractions

Acetylcholine from the ANS causes:

A decrease in the heart rate
A decrease in the force of contractions

Figure 21.13 The Autonomic Innervation of the Heart

Vagal nucleus
Cardioinhibitory
center
Cardioacceleratory
center
Medulla
oblongata
Vagus (N X)
Spinal cord

Sympathetic

Sympathetic
preganglionic
fiber
Sympathetic ganglia
(cervical ganglia and
superior thoracic
ganglia [T1T4])
Sympathetic
postganglionic fiber
Cardiac nerve

Parasympathetic
Parasympathetic
preganglionic
fiber
Synapses in
cardiac plexus
Parasympathetic
postganglionic
fibers