Title: Cardiovascular System: The Heart
1Cardiovascular System The Heart
2Cardiovascular System
- Blood
- Heart
- Blood vessels
3Heart
- Propels the blood through the blood vessels to
reach all of cells of the body. - It circulates the blood through an estimated
100,000 km (60,000 miles) of blood vessels.
4Heart
- It beats 100,000 times every day (35 million
beats / year). - It pumps about 5 liters (5.3 qt) each minute and
14,000 liters (3,600 gal) each day. - Cardiology the study of the normal heart and
diseases associated with it.
5Size And Shape
- About the size of a closed fist.
- Cone-shaped.
- 12cm (5 in.) Long, 9cm (3.5 in.) Wide, and 6cm
(2.5 in.) Thick. - 250g (8 oz) in adult females and 300g (10 oz) in
adult males.
6Location
- Lies in the mediastinum (a mass of tissue between
the sternum and the vertebral column). - 2/3 of the mass is left of midline.
- A cone lying on its side.
7Anatomical Landmarks
- The apex (pointed end) is directed anteriorly,
inferiorly, and to the left. - The base (broad portion) is directed posteriorly,
superiorly, and to the right. - Anterior surface deep to sternum ribs.
8Anatomical Landmarks
- Inferior surface rests upon diaphragm.
- Right border faces the right lung.
- Left border (pulmonary border) faces the left
lung.
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10Cardiopulmonary Resuscitation (CPR)
- External pressure (compression) can be used to
force blood out of the heart and into the
circulation. - CPR is utilized when the heart suddenly stops
beating. - Cardiac compressions with artificial ventilation
of the lungs keeps oxygenated blood circulating
until the heart can be restarted. - Self CPR (coughing).
11Pericardium
- Pericardium membrane that surrounds and
protects the heart. - Fibrous pericardium tough, inelastic, dense
irregular CT. Prevents overstretching of the
heart. - Serous pericardium thinner, more delicate
layer. - Parietal layer.
- Visceral layer (epicardium) adheres to the
heart. - Pericardial fluid lies in between these two
layers in the pericardial cavity.
12Layers Of The Heart Wall
- Epicardium (visceral layer of the serous
pericardium). - Myocardium cardiac muscle tissue.
- Endocardium smooth lining of the chambers of
the heart and valves (continuous with blood
vessels).
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14Chambers Of The Heart
- Atria superior chambers.
- Auricle pouchlike structure.
- Ventricles inferior chambers.
- Sulci grooves on the surface of the heart that
contain blood vessels.
15Chambers Of The Heart
- Right atrium receives blood from three veins
superior vena cava, inferior vena cava, and
coronary sinus. - Tricuspid valve.
- Pectinate muscles.
- Interatrial septum.
- Fossa ovalis depression (remnant of foramen
ovale).
16Chambers Of The Heart
- Right ventricle receives blood from right
atrium. - Trabeculae carneae bundles of cardiac muscle
tissue. - Chordae tendineae connects to the cusps of the
tricuspid valve which are connected to papillary
muscles. - Interventricular septum.
- Pulmonary valve into pulmonary arteries.
17Chambers Of The Heart
- Left atrium receives blood from the lungs
through the pulmonary veins. - Bicuspid (mitral) valve.
- Left ventricle receives blood from left atrium.
- Trabeculae carneae bundles of cardiac muscle
tissue. - Chordae tendineae connects to the cusps of the
bicuspid valve which are connected to papillary
muscles. - Aortic valve into the ascending aorta (largest
artery).
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20Myocardial Thickness
- The function of the individual chambers
determines their thickness. - The atria pump blood a short distance and
consequently have thinner walls than the
ventricles. - The left ventricle pumps blood a greater distance
than the right at higher pressures and has a
thicker wall.
21Fibrous Skeleton Of The Heart
- Dense CT rings that surround the valves and
prevent overstretching. - Provides insertion points for bundles of cardiac
muscle fibers.
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23Atrioventricular (AV) Valves
- Tricuspid and bicuspid valves.
- When the valve is open, the pointed cusps point
into the ventricle.
24Atrioventricular (AV) Valves
- When atrial pressure is higher than ventricular
pressure the valves open (the papillary muscles
are relaxed and the chordae tendinae is slack. - When the ventricles contract the pressure forces
the AV valves closed. The papillary muscles
close concurrently. - Damaged valves allow regurgitation (flow back).
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26Semilunar (SL) Valves
- The aortic and pulmonary valves.
- The SL valves open when the pressure in the
ventricles exceeds the pressure in the arteries.
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28Heart Valve Disorders
- Stenosis (narrowing) failure of the heart valve
to open fully. - Insufficiency (incompetence) failure of a valve
to close fully. - Mitral stenosis due to scar formation of a
congenital defect.
29Heart Valve Disorders
- Mitral insufficiency backflow of blood from the
left ventricle to the left atrium. - Mitral valve prolapse (MVP) one or both cusps
protrude into the left atrium during ventricular
contraction. - Aortic stenosis the aortic valve is narrowed.
30Heart Valve Disorders
- Aortic insufficiency backflow of blood from the
aorta into the left ventricle. - Rheumatic fever an acute systemic inflammatory
disease. Antibodies produced to destroy the
bacteria attack and inflame the CT of joints,
heart valves and other organs.
31Systemic And Pulmonary Circulations
- Two closed systems.
- The output of one becomes the input of another
with each beat of the heart.
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34Coronary Circulation
- The myocardium has its own blood vessels, the
coronary circulation. - The coronary arteries branch from the ascending
aorta and encircle the heart. - When the heart is contracting the coronary
arteries are squeezed shut. - When the heart is relaxed, the high pressure from
the aorta pushes blood into the coronary arteries
and from the arteries to the coronary veins.
35Coronary Arteries
- Two coronary arteries, right and left coronary
arteries, branch from the ascending aorta and
supply oxygenated blood to the myocardium.
36Coronary Arteries
- Left coronary artery branches into
- Anterior interventricular or left anterior
descending LAD (supplies ventricle walls). - Circumflex branches (supplies left ventricle and
left atrium).
37Coronary Arteries
- Right coronary artery branches into
- Atrial branches (supplies right atrium).
- Posterior interventricular branch (supplies the
two ventricles). - Right marginal branch (supplies the right
ventricle).
38Coronary Veins
- The great cardiac vein (anterior) and the middle
cardiac vein (posterior) drain into the coronary
sinus. - Coronary Sinus a large bascular sinus on the
posterior surface of the heart.
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40Reperfusion Damage
- Reperfusion is reestablishing the blood flow to
the heart muscle after a blockage of a coronary
artery. - Reperfusion damages the tissue further due to the
formation of oxygen free radicals from the
reintroduced oxygen.
41Histology Of Cardiac Muscle Tissue
- Cardiac muscle fibers are shorter in length and
less circular than skeletal muscle fibers. - Cardiac muscle fibers exhibit branching.
42Histology Of Cardiac Muscle Tissue
- Usually one centrally located nucleus is present,
although it may occasionally have two nuclei. - Intercalated disc connect neighboring fibers.
- The discs contain desmosomes, which hold the
fibers together. - Mitochondria are larger and more numerous in
cardiac muscle fiber. - Gap junctions allow for propagation of action
potentials.
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44Regeneration Of Heart Cells
- Infarcted (dead) cardiac muscle tissue is
replaced with non-contractile fibrous scar
tissue. - A lack of stem cells limits the ability of the
heart to repair damage. - Some stem cells from the blood migrate into the
heart tissues and differentiate into functional
muscle cells and endothelial cells.
45Autorhythmic Fibers The Conduction System
- Autorhythmic fibers are self-excitable and
maintain the hearts continuous beating. - Act as a pacemaker, setting the rhythm of
electrical excitation that causes contraction of
a heart. - Form a conduction system, that provides a path
for the cycle of cardiac excitation through the
heart.
46Sequence Of Cardiac Conduction
- Sinoatrial (SA) node undergo spontaneous
depolarization (pacemaker potential) propagates
through the atria through gap junctions. - Atrioventricular (AV) node (bundle of his) site
where action potentials are conducted from the
atria to the ventricles.
47Sequence Of Cardiac Conduction
- Right and left bundle branches propagate action
potentials through the ventricles and the
interventricular septum to the apex of the heart. - Purkinje fibers conduct the action potentials
from the apex, through the remainder of the
ventricles stimulating contraction.
48Pacemaker
- The SA node regulates the pace of the heart.
- At rest, it contracts approximately 100 time per
minute. - Nerve impulses from the ANS and blood born
hormones (epinephrine) modify the timing and
strength of each heartbeat.
49Pacemaker
- Acetylcholine from the ANS slows the heart rate
to about 75 bpm. - If the SA node becomes damaged, the AV node can
pick up the job However, at a slower rate (40
60 bpm). - If both nodes are damaged, an artificial
pacemaker sends out electrical currents to
stimulate the heart to contract.
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51Ectopic Pacemaker
- If a site other than the SA node becomes
self-excitable, it becomes an ectopic pacemaker. - It make operate occasionally, producing extra
beats, or for a period of time. - Triggers
- Caffeine, nicotine, electrolyte imbalances,
hypoxia, and toxic reactions to drugs.
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53Refractory Period
- In cardiac muscle tissue, the refractory period
lasts longer than the contraction period. - This prevents tetanus (maintained contraction).
54Electrocardiogram (ECG or EKG)
- As action potentials propagate through the heart,
they generate electrical currents that can be
detected on the surface of the body. - An electrocardiogram is a recording of these
signals. - An electrocardiograph is the instrument used to
record the signals.
55Electrocardiogram (ECG or EKG)
- Electrodes are positioned on the arms and legs
(limb leads) and at six positions on the chest
(chest leads). - 12 different tracings are produced from different
combinations of leads.
56Electrocardiogram (ECG or EKG)
- If these tracings are compared to one another and
to a normal tracing, it is possible to determine
the following - If the conducting pathway is abnormal.
- If the heart is enlarged.
- If certain regions of the heart are damaged.
57Typical Lead II Record
- Three clearly recognizable waves appear with each
heartbeat. - P wave atrial depolarization.
- QRS complex rapid ventricular depolarization.
- T wave ventricular repolarization.
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59Changes In Wave Size
- Large P waves enlargement of the atrium.
- Large Q waves myocardial infarction.
- Large R waves enlarged ventricles.
- Flat T wave insufficient oxygen.
- Large T wave hyperkalemia (high blood K
levels).
60Stress Electrocardiogram (Stress Test)
- Elevate the hearts response to stress.
- Narrowed coronary arteries may carry adequate
blood supply at rest, but not during exercise.
61Changes In Time Span Between Waves
- Time spans between waves are called intervals or
segments. - P-Q interval time between the beginning of the
P wave and the beginning of the QRS complex. - The P-Q interval represents the time required for
an action potential to travel through the atria,
AV node and remaining fibers of the conduction
system.
62Changes In Time Span Between Waves
- The P-Q interval lengthens when the action
potentials must travel around scar tissue from
rheumatic fever. - The S-T segement is elevated in acute myocardial
infarction and depressed when the heart receives
insufficient oxygen. - The Q-T interval may be lengthened by myocardial
damage, myocardial ischemia, or conduction
abnormalities.
63Terminology
- Systole the phase of contraction.
- Diastole the phase of relaxation.
- Cardiac cycle all of the events associated with
one heartbeat (systole and diastole of the atria
and systole and diastole of the ventricles).
64Heart Sounds
- Auscultation listening to sounds within the
body (performed with a stethoscope). - During each cardiac cycle there are 4 heart
sounds, but in a normal heart, only the first and
second heart sounds (S1 and S2) are loud enough
to be heard with a stethoscope.
65Heart Sounds
- The first sound (S1), described as a lubb sound,
is louder and longer than the second. - Caused by closure of the AV valves after
ventricular systole begins. - The second sound (S2), described as dupp sound,
is shorter and not as loud as S1. - Caused by closure of the semilunar valves as
ventricular diastole begins.
66Heart Sounds
- S3 is due to blood turbulence from rapid
ventricular filling. - S4 is due to blood turbulence during atrial
systole. - S3 and S4 are not normally heard.
67Heart Murmurs
- A heart murmur is an abnormal sound consisting of
a clicking, rushing, or gurgling noise that is
heard before, between, or after the normal heart
sounds. It can also mask the normal heart
sounds. - Some heart murmurs are innocent However, they
usually represent a valve disorder.
68Congestive Heart Failure
- In CHF, the heart is a failing pump.
- Causes include coronary artery disease,
congenital defects, long-term high blood pressure
(increases afterload), myocardial infarctions,
valve disorders. - Pulmonary edema left ventricle fails first.
- Peripheral edema right ventricle fails first.
69Regulation Of Heart Rate
- Autonomic regulation of heart rate.
- Proprioceptors, chemoreceptors, baroreceptors.
- Cardiac accelerator nerves.
- Chemical regulation of heart rate.
- Hormones (epinephrine, norepinephrine, and
thyroid hormones) accelerate the heart rate. - Cations.
70Terminology
- Tachycardia elevated resting heart rate.
- Bradycardia a resting heart rate under 60 bpm.
- Hypothermia lowering of the body temperature,
which slows the heart rate.
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72Disorders Of The Heart
- Coronary artery disease (CAD).
- Arteriosclerosis and atherosclerosis.
73Disorders Of The Heart
- Myocardial ischemia and infarction.
- Hypoxia.
- Angina pectoris.
74Disorders Of The Heart
- Congenital defects.
- Coarctation of the aorta.
- Patent ductus arteriosus.
- Septal defect.
- Atrial and ventricular.
- Tetralogy of Fallot.
75Disorders Of The Heart
- Arrhythmias irregularity of the heart rhythm.
- Heart block.
- Flutter and fibrillation.
- Ventricular premature contraction.
76Medical Terminology
- Angiocardiography x-ray examination of the
heart and great vessels with radiopaque dye. - Cardiac arrest.
- Cardiomegaly.
- Cor pulmonale (CP) ventricular hypertrophy from
disorders that bring about hypertension in the
pulmonary circulation. - Palpitation.