1. The Heart

2. What is the Human Heart?
It is an electro-mechanical muscular pump receiving blood from all parts of the body and pumps blood back to them.
It measures about 12 cm in length and 8.5 cm width
Weighs about 300 grams in men and 250 grams in women
Beats about 100,000 times per day
Beats 2.5 billion times in an average 70 yr. lifetime
Pumps about 9000 litres of blood each day
Circulates blood completely 1000 times each day

3. Where is the heart situated?
It is situated in the thorax (chest cage) to the left side of the chest
The lungs are its neighbours
It is guarded by the ribs.

4. What Does the Heart Do?
Its function is to receive deoxygenated [‘impure’] blood through veins
Send it to the lungs for oxygenation [‘purification’]
Collect oxygenated [‘purified’] blood from lungs
Pump oxygenated [‘purified] blood into the rest of the body through the arteries

5. How Does the Heart Look From the Outside?

6. What roles do various parts of the heart play?
The heart has two veins flowing into the right atrium carrying deoxygenated (‘impure’) blood from various parts of the body called:
Superior Vena Cava (SVC)
Inferior Vena Cava (IVC)
SVC drains head, neck & upper limbs
IVC drains blood from the thoracic & abdominal organs and the lower limbs
SVC and IVC drain into the right atrium (RA)
There is a valve allowing unidirectional flow between the RA & RV called tricuspid valve (TV)
SVC RA TV
IVC

7. What roles do various parts of the heart play?
Blood then enters the right ventricle (RV) from the RA across TV
The RV pumps blood to the lungs via pulmonary artery (PA).
The main pulmonary artery (MPA) or the pulmonary trunk divides into two i.e. Left pulmonary artery (LPA) and right pulmonary artery (RPA) thereby carrying blood to the left and right lungs respectively.
There is a unidirectional valve between RV and PA known as the pulmonary valve (PV)
SVC
LPA
RPA
MPA RA PV TV RV
IVC

8. What roles do various parts of the heart play?
Blood is then oxygenated (‘purified’) in the lungs.
Flow of blood from lungs back to the heart is through four pulmonary veins (PV) known as left upper (LAPV), left lower (LLPV), right upper (RUPV) and right lower (RLPV) pulmonary veins respectively
Blood from the PV flows into the left atrium (LA)
There is a unidirectional valve separating LA from left ventricle (LV) called the mitral valve (MV)
SVC
LPA
RPA
RUPV
MPA
LUPV
LLPV
RLPV LA RA PV MV TV RV
IVC

9. What roles do various parts of the heart play?
Blood enters LV through MV
Oxygenated (‘pure’) blood is pumped out of the LV to the rest of the body into the main artery called aorta (AO).
There exists an unidirectional valve between LV and AO known as the Aortic valve (AV)
The atria are separated from each-other by a muscular wall known as inter-atrial septum (IAS)
The ventricles are separated from each-other by a muscular wall known as inter-ventricular septum (IVS)
SVC AO
LPA
RPA
MPA
LUPV
RUPV
LLPV
RLPV LA RA PV AV MV TV
IVS LV RV
IVC AO

10. The Left Ventricle & the arterial system is a high pressure – high resistance circuit.
The right sided chambers and lungs are a low pressure – low resistance.

11. How does the Inside of the Heart Look?

12. How Does the heart pump? It is first electrically activated.
The impulse forming point of the heart is known as the Sino-atrial (SA) node
The impulse of activation then passes through the atria
Then on to the Atrio-ventricular (AV) node
The impulse is delayed at the AV node for a few hundredths of a second (nodal delay) and then passes to the bundle of His
The bundle of His divides into left & right branches, activating the corresponding ventricles.
The muscle fibres of the ventricles are supplied by Purkinje fibres.

13. How can heart’s electrical activity be captured on paper?
The graphic representation of heart’s electrical activity is known as the electrocardiogram (ECG / EKG)

14. What happens to the heart after it is electrically activated?
Electrical activation triggers mechanical action i.e. contraction. In other words it is the electrical activation that activate the muscle to contract in an orderly & rhythmic manner.
Thereby enabling reception & distribution of blood
 Slides that follow will explain heart’s mechanical action

15. Blood Flows Into the Heart…
Form the veins and then on to SVC and IVC
svc
Enters RA RA
Tricuspid Valve opens TV RV
Blood then enters the Right Ventricle Atria Contract
IVC

16. Then….Into the Lungs Exits the heart through the Pulmonary Valve
Ventricles Contract
LPA
RPA
MPA
Enters Pulmonary Trunk PV
Then Into Lungs

17. Blood Returns to Heart From Lungs enters Pulmonary veins.
Enters Heart in Left Atrium PV PV PV PV LA
Mitral valve opens
Blood flows into Left Ventricle
Atria contract MV LV

18. Then …Pumped Back Into the Body
Ventricles contract
Blood flows through Aortic Valve.
AO Arch
Blood enters Ascending Aorta (coronary arteries i.e. arteries supplying the heart are at the aortic root)
Asc. Ao
Aortic Arch (arteries supplying head and upper limbs are situated here) AV LV
Descending Aorta (thoracic, abdominal organs & lower limbs are thus supplied)
Des. AO

19. The Normal Heart and Regional Circulation
Lungs
The Normal Heart and Regional Circulation
Anterior Cutaway View
Pulmonary Valve
Aorta
Superior Vena Cava
Left Pulmonary Artery
Left Pulmonary Veins
Left Atrium
Right Pulmonary Artery
Aortic
Valve
Mitral Valve
Right Pulmonary Veins
Tricuspid Valve
Inferior Vena Cava
Septum

20. Blood Supply to the Heart
Heart is supplied by coronary arteries.
They have their origin just above the aortic root. [Aortic root is the area of the aorta just above the aortic valve i.e. the point of attachment of aorta to the heart]
There are two of coronary arteries i.e. the left and right
The left main coronary artery (LMCA) bifurcates into two i.e. the left anterior descending (LAD) and left circumflex (LCx)
The right coronary artery (RCA) continues as such and gives off its branches.
Majority of the venous drainage of the heart is from the corresponding coronary veins which drain into the coronary sinus which empties into RA

21. Paths of Circulation

22. Paths of Circulation Pulmonary Circuit Systemic Circuit
Consists of vessels that carry blood from the heart to the lungs and back to the heart
Systemic Circuit
Carries blood from the heart to all other parts of the body and back again
Includes coronary circulation (supplies the heart)

23. Pulmonary Circuit Right Ventricle Pulmonary Trunk
Right and Left Pulmonary Arteries
Capillary Networks associated with walls of alveoli (air sacs in lungs where gas exchange occurs between air and blood)
Pulmonary Venules
Pulmonary veins – 2 from each lung
Left atrium

24. Systemic Circuit Left Atrium (oxygenated blood) To Left Ventricle
Aorta and its branches that lead to all body tissues
Accompanying system of veins returns blood to Right Atrium

25. The Normal Heart and Regional Circulation
Lungs
The Normal Heart and Regional Circulation
Anterior Cutaway View
Pulmonary Valve
Aorta
Superior Vena Cava
Left Pulmonary Artery
Left Pulmonary Veins
Left Atrium
Right Pulmonary Artery
Aortic
Valve
Mitral Valve
Right Pulmonary Veins
Tricuspid Valve
Inferior Vena Cava
Septum

26. Blood Vessels

27. Blood Vessels
They are a closed circuit of tubes that carry blood from heart to cells and back
They include: arteries, arterioles, capillaries, venules, and veins
100,000 Km of blood vessels in the body (2 ½ times around the world)

28. Arteries
Strong elastic vessels adapted for carrying blood away from the heart under high pressure
Subdivide into progressively thinner tubes and give rise to arterioles (finer branched tubes that connect artery to capillary)
Walls of artery consist of 3 layers
Arterioles have 3 layers similar to arteries, but thin as they approach capillaries.

29. Internal Structure of Arteries
Tunica intima
(endothelium)
Elastic membrane
Tunica media
External
elastic
lamina
Tunica externa
(adventitia)
Artery
Courtesy Servier

30. Tunica Intima (Interna)
Innermost layer
Composed of endothelium (squamous epithelium) and collagenous and elastic connective tissue
Helps prevent blood clotting by providing a smooth surface that allows blood cells and platelets to flow through without being damaged.
Secretes chemical substances that inhibit platelet aggregation (thereby preventing establishment of blood clots)
May help regulate blood flow by secreting substances that dilate or constrict blood vessels.

31. Tunica Media Middle layer Bulk of arterial wall Comprises of
- Smooth muscle fibers encircling it
- Thick layer of elastic connective tissue

32. Tunica Adventitia (Externa)
Outer layer
Connective tissue with irregularly organized elastic and collagen fibers
Attaches the artery to surrounding tissues.

33. Nerve Supply to Blood Vessels
Sympathetic branches of the autonomic nervous system use vasomotor fibers to innervate smooth muscle in artery and arteriole walls
Vasoconstriction: vasomotor impulses stimulate contraction which reduces diameter of vessel
Vasodilation: vasomotor impulses are inhibited, muscle fibers relax and diameter of vessel increases.
Changes in diameter of vessels greatly influence blood flow and pressure.

34. Capillaries Smallest-diameter blood vessels
Connect the smallest arterioles and smallest venules
Composed of extensions of the inner linings of arterioles in that their walls are endothelium
Thin walls form semipermeable layer through which substances in blood are exchanged with tissue fluid surrounding body cells

35. Capillaries
Osmotic Pressure: force due to salts etc. in the blood that brings water into vessel.
Blood Pressure: force exerted by the heart in contractions.
BP changes as the arteries get further away from heart.
OP remains the same.
Difference between BP & OP determines materials movement in or out of vessel.

36. Capillaries Arterial end Venous end Osmotic 21 Osmotic 21 BP15 BP 30
Diff: 6
Inward
Diff: 9
Outward

37. Capillaries
At arterial end: nutrients, oxygen etc. move from vessel to cells.
At venous end: waste, carbon dioxide etc. move from cells to vessel.
But not all fluid moves into the vessels.
A third vessel found along vein, Lymphatic Vessel.

38. Exchanges in capillaries
Gases, nutrients, and metabolic by-products are exchanged by diffusion, filtration and osmosis
Diffusion
Substances diffuse down concentration gradient.
Plasma proteins remain in blood. Too large to diffuse through membrane pores and also are not soluble in the lipid portion of capillary cell membranes.

39. Venules and Veins
Venules: microscopic vessels that continue from capillaries and merge to from veins.
Veins: carry blood back to the atria following pathways that roughly parallel arteries.

41. Veins Have Valves arteries dont!
Tunica intima
(endothelium)
Valve
Elastic membrane
Tunica media
Tunica externa
(adventitia)
Vein
Courtesy Servier

42. Venous Valves Found in many veins, especially in lower limbs
Project inward from the lining
Composed of 2 leaflets that close if blood begins to back up in a vein.
Aid in returning blood to the heart (open if flow is toward the heart)

43. Veins as Blood Reservoirs
In a hemorrhage accompanied by a drop in arterial pressure, sympathetic nerve impulses reflexively stimulate venous constriction of the walls.
This helps maintain blood pressure by returning more blood to the heart.
Normal flow can be maintained when even as much as 25% volume is lost.