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Cardiovascular System: The Heart

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Title: Cardiovascular System: The Heart


1
Cardiovascular System The Heart
  • Dr. Michael P. Gillespie

2
Cardiovascular System
  • Blood
  • Heart
  • Blood vessels

3
Heart
  • 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.

4
Heart
  • 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.

5
Size 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.

6
Location
  • 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.

7
Anatomical 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.

8
Anatomical Landmarks
  • Inferior surface rests upon diaphragm.
  • Right border faces the right lung.
  • Left border (pulmonary border) faces the left
    lung.

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10
Cardiopulmonary 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).

11
Pericardium
  • 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.

12
Layers 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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14
Chambers Of The Heart
  • Atria superior chambers.
  • Auricle pouchlike structure.
  • Ventricles inferior chambers.
  • Sulci grooves on the surface of the heart that
    contain blood vessels.

15
Chambers 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).

16
Chambers 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.

17
Chambers 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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20
Myocardial 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.

21
Fibrous 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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23
Atrioventricular (AV) Valves
  • Tricuspid and bicuspid valves.
  • When the valve is open, the pointed cusps point
    into the ventricle.

24
Atrioventricular (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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26
Semilunar (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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28
Heart 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.

29
Heart 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.

30
Heart 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.

31
Systemic 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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34
Coronary 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.

35
Coronary Arteries
  • Two coronary arteries, right and left coronary
    arteries, branch from the ascending aorta and
    supply oxygenated blood to the myocardium.

36
Coronary Arteries
  • Left coronary artery branches into
  • Anterior interventricular or left anterior
    descending LAD (supplies ventricle walls).
  • Circumflex branches (supplies left ventricle and
    left atrium).

37
Coronary 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).

38
Coronary 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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40
Reperfusion 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.

41
Histology Of Cardiac Muscle Tissue
  • Cardiac muscle fibers are shorter in length and
    less circular than skeletal muscle fibers.
  • Cardiac muscle fibers exhibit branching.

42
Histology 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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44
Regeneration 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.

45
Autorhythmic 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.

46
Sequence 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.

47
Sequence 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.

48
Pacemaker
  • 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.

49
Pacemaker
  • 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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51
Ectopic 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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53
Refractory Period
  • In cardiac muscle tissue, the refractory period
    lasts longer than the contraction period.
  • This prevents tetanus (maintained contraction).

54
Electrocardiogram (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.

55
Electrocardiogram (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.

56
Electrocardiogram (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.

57
Typical 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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59
Changes 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).

60
Stress Electrocardiogram (Stress Test)
  • Elevate the hearts response to stress.
  • Narrowed coronary arteries may carry adequate
    blood supply at rest, but not during exercise.

61
Changes 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.

62
Changes 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.

63
Terminology
  • 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).

64
Heart 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.

65
Heart 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.

66
Heart 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.

67
Heart 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.

68
Congestive 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.

69
Regulation 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.

70
Terminology
  • 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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72
Disorders Of The Heart
  • Coronary artery disease (CAD).
  • Arteriosclerosis and atherosclerosis.

73
Disorders Of The Heart
  • Myocardial ischemia and infarction.
  • Hypoxia.
  • Angina pectoris.

74
Disorders Of The Heart
  • Congenital defects.
  • Coarctation of the aorta.
  • Patent ductus arteriosus.
  • Septal defect.
  • Atrial and ventricular.
  • Tetralogy of Fallot.

75
Disorders Of The Heart
  • Arrhythmias irregularity of the heart rhythm.
  • Heart block.
  • Flutter and fibrillation.
  • Ventricular premature contraction.

76
Medical 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.
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