Let it beat!

The Heart

Vascular System
o Arteries o Veins o Capillaries

The PUMP

Anatomy of the Heart

Heart chambers:
Left & right atria. Left & right ventricles.

Heart valves:
Atrioventricular valves:
Right: Tricuspid. Left: Bicuspid/Mitral

Semilunar valves
Right: Pulmonary valve.

Anatomy of the Heart

Cardio-pulmonary circulation.

Venae cavae. Right atrium. Right ventricle. Pulmonary artery. Pulmonary vein. Left atrium. Left ventricle. Aorta.

The Heart Valves

Four types of valves regulate blood flow through your heart:

Cardiac Muscle Tissue

Striated Mono-nucleated Branching Joined by intercalated discs. Communicate via gap junctions ~1% forms conducting system

Cardiac Muscle Tissue

Cardiac Muscle Fibers

Cardiac contain myofibrils consisting of typical sarcomeres. Adjacent cardiac cells are connected by intercalated discs containing desmosomes and gap junctions, which convey the force of contraction from cell to cell and conduct action potentials. Cardiac muscle has abundant mitochondria and depends primarily on aerobic respiration to form ATP.

ELECTRICAL PROPERTIES OF CARDIAC MUSCLE

Resting membran potential = -90 mV Initial depolarization is due Na+ influx through rapidly opening Na+ channel (overshoot) Ca2+ influx through more slowly opening Ca2+ channels produces the plateau phase, repolarization is due to net K+ efflux. Depolarization lasts about 2 ms, but the plateau phase and repolarization last 200 ms or more

Action potential of the cardiac muscle

MECHANICAL PROPERTIES OF CARDIAC MUSCLE

The contractile response of cardiac muscle begins just after the start of depolarization and last about 1.5 times as long as action potential During depolarization and half of repolarization cardiac muscle cannot be excited again its in its absolute refractory periode, therefore tetanus cant occur in cardiac muscle Compared to skeletal muscle, cardiac muscle has a longer refractory period

ACTION POTENTIAL OF CARDIAC MUSCLE

Autorythmicity cells of cardiac muscle

Noncontractile cardiac muscle cells exhibit automaticity and rhythmicity and can independently initiate action potentials. Such cells have an unstable resting potential called a pacemaker potential that gradually depolarizes drifting toward threshold for firing. These cells comprise the intrinsic conduction system of the heart.

POTENTIAL CARDIAC PACEMAKER

The structures that make up the conduction system are the sinoatrial node (SA node), the internodal atrial pathways, the atrioventricular node (AV node), the bundle of His and its branches and the Purkinje system The action potentials in SA and AV nodes are largely due to Ca2+, with little contribution by Na+ influx

PACEMAKER POTENTIAL
Fastest cells located in SA node (100/minute). SA node sets pace. Bundle of His can provide ectopic pacemaker (2540/min)

Pacemaker and Action Potentials of the Heart

Figure 18.13

Intrinsic Conducting System

Sinoatrial node.
Electrical pace maker.

Atrioventricular node.
Receives impulses originating from SA node.

Bundle of His
Electrical link between atria and ventricles.

Purkinje fibres.
Distribute impulses to ventricles.

This system coordinates the depolarization and ensures the heart beats as one.

Sinoatrial Node Atrioventricular Node

Cardiac Conductive System

Excitability (Irritability) : Ability of cardiac muscle cells to respond to an external stimulus (chemical, electrical, mechanical) Conductivity : Ability of cardiac cell to receive an electrical stimulus and conduct that impulse to an adjacent cell

Cardiac Conductive System

Automaticity : Ability of cardiac pacemaker cells to spontaneously initiate an electrical impulse Contractility : Ability of cardiac cells to shorten, causing muscle contraction in response to electrical stimulus

 The cardiovascular system is composed of blood, blood vessels and the heart. Our heart beats nearly 100,000 times daily. Blood vessels are fractionated into a pulmonary circuit and systemic circuit. Artery:vessels that carry blood away from the heart. Usually oxygenated vein: vessels that carry blood towards the heart. Usually deoxygenated. Capillaries: a small blood vessel that allow diffusion of gases, nutrients and wastes between plasma and interstitial fluid.

Heart Sounds
Heard with aid of stethoscope. Two sounds/vibration can be heard. Caused by closure of valves. First sound:

Soft low pitched sound: closure of AV valves. Occurs at onset of systole.

Second sound:
Louder sound: closure of aortic and pulmonary valves. Onset of diastole and isovolumetric relaxation.

ELECTROCARDIOGRAM
Because the body fluids are good conductors, fluctuations in potential that represent the algebraic sum of action potentials of myocardial fibers can be recorded extracellularly The record of these potential fluctuations during cardiac cycle is the electrocardiogram (ECG)

STANDARD LEADS
Einthovens triangle : a triangle with the heart at its center 1. Bipolar : I (left arm right arm), II (right arm - left leg), III (left arm left leg) 2. Unipolar (V): Precordial (V1 - V6), Augmented limb (aVR, aVL, aVF)

Relationship of limb and chest leads

The chest leads look at the heart across the horizontal plane The limb leads look at the heart in a vertical plane Leads aVR, aVL and aVF look from three separate directions Leads I, II and III are summation of potential differences between limb leads

aVR

aVL
V6

V5

II
V1 V2 V4 V3

III

aVF

The limb leads

Positioning the limb leads

RA

LA

Yellow

Red

Position of the electrodes for limb leads Right wrist aVR Left wrist aVL Left leg aVF Right leg (earth)

RL
Black

LL
Green

The chest leads

Sternomanubrial joint - Angle of Louis

V1 - 4th ICS RSE V2 - 4th ICS LSE V3 - midway between V2 & V4 V4 - 5th ICS MCL V5 - 5th ICS AAL V6 - 5th ICS MAL

V1

V2

V3

V4

V5

V6

Electrocardiogram (EGC)

ELECTROCARDIOGRAM

A recording of electrical activities in the heart The P wave reflects atrial depolarization. The QRS complex indicates ventricular depolarization. T wave indicates ventricular repolarization. Segmen PR : Perlambatan AV node ST Segmen : Waktu yang diperlukan ventrikel berkontraksi dan mengosongkan dirinya TP : Waktu yang diperlukan ventrikel berelaksasi dan mengisi diri

R
P Q S T

R
P Q S T

The Cardiac Cycle

Period between start of one heart beat and the start of the next

Period of ventricular contraction. Blood ejected from heart. Diastole: Period of ventricular relaxation. Blood filling.

Systole:

Systole

Iso-volumetric contraction:
Contraction begins but valves still closed. Tension develops but no shortening of cells. Pressure builds up.

Ventricular ejection:
Pventricles > Paortic/pulmonary trunk. Semilunar valves open (aortic and pulmonary). Muscle cells shorten. Blood expelled: end systolic volume (ESV) remains.

Diastole

Iso-volumetric relaxation:
Ventricles begin to relax. Semilunar valves and AV valves all closed. Ventricular volume remains unchanged.

Ventricular filling :
Patria > Pventricles. Mitral valve (left) and tricuspid valve (right) open. Ventricle begin to fill (80% complete). Atrial contraction completes filling. Volume achieved: end diastolic volume (EDV)

THE CARDIAC CYCLE

DIASTOLE

LATE DIASTOLE

ISOMETRIC VENTRICULAR RELAXATION

ATRIAL SYSTOLE

VENTRICULAR EJECTION

ISOMETRIC VENTRICULAR CONTRACTION

Human Cardiovascular System

The cardiac cycle. During early diastole, all chambers are relaxed and the ventricles begin filling with blood. At the end of diastole, the atria contract and the ventricles are filled with blood. During systole, the ventricles contract, ejecting blood from the heart.

Cardiac Cycle
Operation of Cardiac Valves Four Phases of Cardiac Cycle EKG, LV Volume, LA Pressure, LV Pressure, Aortic Pressure, and Cardiac Sounds During Cardiac Cycle

Operation of Cardiac Valves

LA
Mitral Valve PLA < PLV PLA > PLV Closed Open

LV
Aortic Valve PLV < PAO PLV > PAO

Aorta
Closed Open

EKG and LV Volume

T EKG EndDiastolic Volume (EDV) EndSystolic Volume IVR (ESV)

QRS

Active Filling Passive Filling

Filling

IVC

Ejection

EDV ESV = Stroke Volume

Left Ventricular Pressure (120/0 mmHg)

T 120

QRS

Atrial Contraction

Aortic Valve Closes at 100 Opens at mmHg 80 mmHg

0 mmHg
IVR Filling IVC Ejection

Aortic Pressure (120/80 mmHg)

T 120 80 Aortic blood Flow to circulation continues despite zero ventricular output IVR Filling IVC Aortic Valve Closes at 100 Opens at mmHg 80 mmHg

QRS

0 mmHg

Ejection

Left Atrial Pressure (7/0 mmHg)

T 120 V wave (venous return) a wave (atrial Contraction) C wave (ventricular contraction)

QRS

0 mmHg
IVR Filling IVC Ejection

Heart Sounds
Heard with aid of stethoscope. Two sounds/vibration can be heard. Caused by closure of valves. First sound:

Soft low pitched sound: closure of AV valves. Occurs at onset of systole.

Second sound:
Louder sound: closure of aortic and pulmonary valves. Onset of diastole and isovolumetric relaxation.

EJECTION

ISOVOLUMETRIC CONTRACTION

ISOVOLUMETRIC RELAXATION RAPID INFLOW DIASTASIS ATRIAL SYSTOLE

PRESSURE (mmHg)

AORTIC PRESSURE

ATRIAL PRESSURE

VENTRICLE PRESSURE
VOLUME (ml)

ECG
PHONOCARDIOGAM

SYSTOLE

DIASTOLE

SYSTOLE

Let it beat!