4 Fluids and Transport Fundamentals of Anatomy & Physiology Unit Frederic H. Martini PowerPoint® Lecture Slides prepared by Professor Albia Dugger, Miami–Dade College, Miami, FL Professor Robert R. Speed, Ph.D., Wallace Community College, Dothan, AL Copyright © 2005 Pearson Education, Inc., publishing as Benjamin Cummings

Chapter 20: The Heart

How are the cardiovascular system and heart organized?

Organization of the Cardiovascular System PLAY The Heart: Anatomy Figure 20–1

The Pulmonary Circuit Carries blood to and from gas exchange surfaces of lungs

The Systemic Circuit Carries blood to and from the body

Alternating Circuits Blood alternates between pulmonary circuit and systemic circuit

3 Types of Blood Vessels Arteries: Veins: Capillaries: carry blood away from heart Veins: carry blood to heart Capillaries: networks between arteries and veins

Capillaries Also called exchange vessels Exchange materials between blood and tissues Dissolved gases, nutrients, wastes

4 Chambers of the Heart 2 for each circuit: left and right: ventricles and atria

4 Chambers of the Heart Right atrium: Right ventricle: collects blood from systemic circuit Right ventricle: pumps blood to pulmonary circuit

4 Chambers of the Heart Left atrium: Left ventricle: collects blood from pulmonary circuit Left ventricle: pumps blood to systemic circuit

Where is the heart located and what are its general features?

Anatomy of the Heart Located directly behind sternum InterActive Physiology: Cardiovascular System: Anatomy Review: The Heart PLAY Figure 20–2a

Anatomy of the Heart Great veins and arteries at the base Pointed tip is apex Figure 20–2c

Relation to Thoracic Cavity Figure 20–2b

Relation to Thoracic Cavity Surrounded by pericardial sac Between 2 pleural cavities In the mediastinum

What is the structure and function of the pericardium?

The Pericardium Double lining of the pericardial cavity Figure 20–2c

2 Layers of Pericardium Parietal pericardium: Visceral pericardium: outer layer forms inner layer of pericardial sac Visceral pericardium: inner layer of pericardium

Structures of Pericardium Pericardial cavity: Is between parietal and visceral layers contains pericardial fluid Pericardial sac: fibrous tissue surrounds and stabilizes heart

Pericarditis An infection of the pericardium

Superficial Anatomy of the Heart 4 cardiac chambers Figure 20–3

Atria Thin-walled Expandable outer auricle

Sulci Coronary sulcus: Anterior and posterior interventricular sulci: divides atria and ventricles Anterior and posterior interventricular sulci: separate left and right ventricles contain blood vessels of cardiac muscle

What are the layers of the heart wall?

The Heart Wall Figure 20–4

3 Layers of the Heart Wall Epicardium: outer layer Myocardium: middle layer Endocardium: inner layer

Epicardium Visceral pericardium Covers the heart

Myocardium Muscular wall of the heart Concentric layers of cardiac muscle tissue

Cardiac Muscle Cells Figure 20–5

Cardiac Muscle Cells Intercalated discs: interconnect cardiac muscle cells secured by desmosomes linked by gap junctions convey force of contraction propagate action potentials

Characteristics of Cardiac Muscle Cells Small size Single, central nucleus Branching interconnections between cells Intercalated discs

Cardiac Cells vs. Skeletal Fibers Table 20-1

What is the path of blood flow through the heart, and what are the major blood vessels, chambers, and heart valves?

Internal Anatomy PLAY 3D Panorama of the Heart Figure 20–6a

Atrioventricular (AV) Valves Connect right atrium to right ventricle and left atrium to left ventricle Permit blood flow in 1 direction: atria to ventricles PLAY The Heart: Valves

Septa Interatrial septum: Interventricular septum: separates atria separates ventricles

The Vena Cava Delivers systemic circulation to right atrium Superior vena cava: receives blood from head, neck, upper limbs, and chest Inferior vena cava: receives blood from trunk, and viscera, lower limbs

Coronary Sinus Cardiac veins return blood to coronary sinus Coronary sinus opens into right atrium

Foramen Ovale Before birth, is an opening through interatrial septum Connects the 2 atria Seals off at birth, forming fossa ovalis

Pectinate Muscles Contain prominent muscular ridges On anterior atrial wall And inner surfaces of right auricle

Cusps Fibrous flaps that form bicuspid (2) and tricuspid (3) valves Free edges attach to chordae tendineae from papillary muscles of ventricle Prevent valve from opening backward

Right Atrioventricular (AV) Valve Also called tricuspid valve Opening from right atrium to right ventricle Has 3 cusps Prevents backflow PLAY The Heart: Blood Flow

Trabeculae Carneae Muscular ridges on internal surface of right ventricle Includes moderator band: ridge contains part of conducting system coordinates contractions of cardiac muscle cells

The Pulmonary Circuit Conus arteriosus (superior right ventricle) leads to pulmonary trunk Pulmonary trunk divides into left and right pulmonary arteries Blood flows from right ventricle to pulmonary trunk through pulmonary valve Pulmonary valve has 3 semilunar cusps

Return from Pulmonary Circuit Blood gathers into left and right pulmonary veins Pulmonary veins deliver to left atrium Blood from left atrium passes to left ventricle through left atrioventricular (AV) valve 2-cusp bicuspid valve or mitral valve

The Left Ventricle Holds same volume as right ventricle Is larger; muscle is thicker, and more powerful Similar internally to right ventricle, but does not have moderator band

The Left Ventricle Systemic circulation: blood leaves left ventricle through aortic valve into ascending aorta ascending aorta turns (aortic arch) and becomes descending aorta

Left and Right Ventricles Have significant structural differences Figure 20–7

Structure of Left and Right Ventricles Right ventricle wall is thinner, develops less pressure than left ventricle Right ventricle is pouch-shaped, left ventricle is round

The Heart Valves One-way valves prevent backflow during contraction Figure 20–8

Atrioventricular (AV) Valves Between atria and ventricles Blood pressure closes valve cusps during ventricular contraction Papillary muscles tense chordae tendineae: prevent valves from swinging into atria

Regurgitation Failure of valves Causes backflow of blood into atria

Semilunar Valves Pulmonary and aortic tricuspid valves Prevent backflow from pulmonary trunk and aorta into ventricles Have no muscular support 3 cusps support like tripod

Aortic Sinuses At base of ascending aorta Prevent valve cusps from sticking to aorta Origin of right and left coronary arteries

Carditis An inflammation of the heart Can result in valvular heart disease (VHD): e.g., rheumatic fever

KEY CONCEPT (1 of 3) The heart has 4 chambers: 2 for pulmonary circuit: right atrium and right ventricle 2 for systemic circuit: left atrium and left ventricle

KEY CONCEPT (2 of 3) Left ventricle has a greater workload Is much more massive than right ventricle, but the two chambers pump equal amounts of blood

KEY CONCEPT (3 of 3) AV valves prevent backflow from ventricles into atria Semilunar valves prevent backflow from aortic and pulmonary trunks into ventricles

Connective Tissue Fibers of the Heart Physically support cardiac muscle fibers Distribute forces of contraction Add strength and prevent overexpansion of heart Elastic fibers return heart to original shape after contraction

The Fibrous Skeleton 4 bands around heart valves and bases of pulmonary trunk and aorta Stabilize valves Electrically insulate ventricular cells from atrial cells

How is the heart supplied with blood?

Blood Supply to the Heart Coronary circulation Figure 20–9

Coronary Circulation Coronary arteries and cardiac veins Supplies blood to muscle tissue of heart

Coronary Arteries Left and right Originate at aortic sinuses High blood pressure, elastic rebound force blood through coronary arteries between contractions

Right Coronary Artery Supplies blood to: right atrium portions of both ventricles cells of sinoatrial (SA) and atrioventricular nodes marginal arteries (surface of right ventricle) posterior interventricular artery

Left Coronary Artery Supplies blood to: left ventricle left atrium interventricular septum

Cardiac Veins (1 of 3) Great cardiac vein: drains blood from area of anterior interventricular artery into coronary sinus

Cardiac Veins (2 of 3) Anterior cardiac vein: empties into right atrium

Cardiac Veins (3 of 3) Posterior cardiac vein, middle cardiac vein, and small cardiac vein: empty into great cardiac vein or coronary sinus

The Cardiac Cycle Figure 20–11

The Heartbeat A single contraction of the heart The entire heart contracts in series: first the atria then the ventricles

2 Types of Cardiac Muscle Cells Conducting system: controls and coordinates heartbeat Contractile cells: produce contractions

The Cardiac Cycle Begins with action potential at SA node transmitted through conducting system produces action potentials in cardiac muscle cells (contractile cells) InterActive Physiology: Cardiovascular System: Cardiac Action Potential PLAY

Electrocardiogram (ECG) Electrical events in the cardiac cycle can be recorded on an electrocardiogram (ECG)

What is the difference between nodal cells and conducting cells; what are the components and functions of the conducting system of the heart?

The Conducting System Figure 20–12

The Conducting System A system of specialized cardiac muscle cells: initiates and distributes electrical impulses that stimulate contraction Automaticity: cardiac muscle tissue contracts automatically

Structures of the Conducting System Sinoatrial (SA) node Atrioventricular (AV) node Conducting cells

Conducting Cells Interconnect SA and AV nodes Distribute stimulus through myocardium In the atrium: internodal pathways In the ventricles: AV bundle and bundle branches

Prepotential Also called pacemaker potential Resting potential of conducting cells: gradually depolarizes toward threshold SA node depolarizes first, establishing heart rate

Heart Rate SA node generates 80–100 action potentials per minute Parasympathetic stimulation slows heart rate AV node generates 40–60 action potentials per minute

Impulse Conduction through the Heart Figure 20–13

The Sinoatrial (SA) Node In posterior wall of right atrium Contains pacemaker cells Connected to AV node by internodal pathways Begins atrial activation (Step 1)

The Atrioventricular (AV) Node In floor of right atrium Receives impulse from SA node (Step 2) Delays impulse (Step 3) Atrial contraction begins

The AV Bundle In the septum Carries impulse to left and right bundle branches: which conduct to Purkinje fibers (Step 4) And to the moderator band: which conducts to papillary muscles

4. The Purkinje Fibers Distribute impulse through ventricles (Step 5) Atrial contraction is completed Ventricular contraction begins

Abnormal Pacemaker Function Bradycardia: abnormally slow heart rate Tachycardia: abnormally fast heart rate

Ectopic Pacemaker Abnormal cells Generate high rate of action potentials Bypass conducting system Disrupt ventricular contractions

What electrical events are associated with a normal electrocardiogram?

The Electrocardiogram Figure 20–14b

Electrocardiogram (ECG or EKG) A recording of electrical events in the heart Obtained by electrodes at specific body locations Abnormal patterns diagnose damage

Features of an ECG P wave: QRS complex: T wave: atria depolarize ventricles depolarize T wave: ventricles repolarize

Cardiac Arrhythmias Abnormal patterns of cardiac electrical activity

KEY CONCEPT (1 of 3) Heart rate is normally established by cells of SA node Rate can be modified by autonomic activity, hormones, and other factors

KEY CONCEPT (2 of 3) From the SA node, stimulus is conducted to AV node, AV bundle, bundle branches, and Purkinje fibers before reaching ventricular muscle cells

KEY CONCEPT (3 of 3) Electrical events associated with the heartbeat can be monitored in an electrocardiogram (ECG)

Contractile Cells Purkinje fibers distribute the stimulus to the contractile cells, which make up most of the muscle cells in the heart

What events take place during an action potential in cardiac muscle?

Action Potentials in Skeletal and Cardiac Muscle Figure 20–15

Resting Potential Of a ventricular cell: Of an atrial cell: about —90 mV Of an atrial cell: about —80 mV

3 Steps of Cardiac Action Potential Rapid depolarization: voltage-regulated sodium channels (fast channels) open

3 Steps of Cardiac Action Potential As sodium channels close: voltage-regulated calcium channels (slow channels) open balance Na+ ions pumped out hold membrane at 0 mV plateau

3 Steps of Cardiac Action Potential Repolarization: plateau continues slow calcium channels close slow potassium channels open rapid repolarization restores resting potential

Timing of Refractory Periods Length of cardiac action potential in ventricular cell: 250–300 msecs 30 times longer than skeletal muscle fiber long refractory period prevents summation and tetany

What is the importance of calcium ions to the contractile process?

Calcium and Contraction Contraction of a cardiac muscle cell is produced by an increase in calcium ion concentration around myofibrils

2 Steps of Calcium Ion Concentration 20% of calcium ions required for a contraction: calcium ions enter cell membrane during plateau phase

2 Steps of Calcium Ion Concentration Arrival of extracellular Ca2+: triggers release of calcium ion reserves from sarcoplasmic reticulum

Intracellular and Extracellular Calcium As slow calcium channels close: intracellular Ca2+ is absorbed by the SR or pumped out of cell Cardiac muscle tissue: very sensitive to extracellular Ca2+ concentrations

What events take place during the cardiac cycle, including atrial and ventricular systole and diastole?

The Cardiac Cycle The period between the start of 1 heartbeat and the beginning of the next Includes both contraction and relaxation InterActive Physiology: Cardiovascular System: The Cardiac Cycle PLAY

2 Phases of the Cardiac Cycle Within any 1 chamber: systole (contraction) diastole (relaxation)

Blood Pressure In any chamber: Blood flows from high to low pressure: rises during systole falls during diastole Blood flows from high to low pressure: controlled by timing of contractions directed by one-way valves

Phases of the Cardiac Cycle Figure 20–16

4 Phases of the Cardiac Cycle Atrial systole Atrial diastole Ventricular systole Ventricular diastole

Cardiac Cycle and Heart Rate At 75 beats per minute: cardiac cycle lasts about 800 msecs When heart rate increases: all phases of cardiac cycle shorten, particularly diastole

Pressure and Volume in the Cardiac Cycle 8 steps in the cardiac cycle Figure 20–17

8 Steps in the Cardiac Cycle Atrial systole: atrial contraction begins right and left AV valves are open

8 Steps in the Cardiac Cycle Atria eject blood into ventricles: filling ventricles

8 Steps in the Cardiac Cycle Atrial systole ends: AV valves close ventricles contain maximum volume end-diastolic volume (EDV)

8 Steps in the Cardiac Cycle Ventricular systole: isovolemic ventricular contraction pressure in ventricles rises AV valves shut

8 Steps in the Cardiac Cycle Ventricular ejection: semilunar valves open blood flows into pulmonary and aortic trunks Stroke volume (SV) = 60% of end-diastolic volume

8 Steps in the Cardiac Cycle Ventricular pressure falls: semilunar valves close ventricles contain end-systolic volume (ESV), about 40% of end-diastolic volume

8 Steps in the Cardiac Cycle Ventricular diastole: ventricular pressure is higher than atrial pressure all heart valves are closed ventricles relax (isovolumetric relaxation)

8 Steps in the Cardiac Cycle Atrial pressure is higher than ventricular pressure: AV valves open passive atrial filling passive ventricular filling cardiac cycle ends PLAY The Heart: Cardiac Cycle

Heart Failure Lack of adequate blood flow to peripheral tissues and organs due to ventricular damage

How do heart sounds relate to specific events in the cardiac cycle?

Heart Sounds Figure 20–18b

4 Heart Sounds S1: S2: S3, S4: loud sounds produced by AV valves produced by semilunar valves S3, S4: soft sounds blood flow into ventricles and atrial contraction

Positioning the Stethoscope To detect sounds of each valve Figure 20–18a

Heart Murmur Sounds produced by regurgitation through valves

What is cardiac output, and what factors influence it?

Cardiodynamics The movement and force generated by cardiac contractions InterActive Physiology: Cardiovascular System: Cardiac Output PLAY

Important Cardiodynamics Terms End-diastolic volume (EDV) End-systolic volume (ESV) Stroke volume (SV): SV = EDV — ESV

Important Cardiodynamics Terms Ejection fraction: the percentage of EDV represented by SV Cardiac output (CO): the volume pumped by each ventricle in 1 minute

Stroke Volume Volume (ml) of blood ejected per beat Figure 20–19

Cardiac Output Cardiac output (CO) ml/min = Heart rate (HR) beats/min  Stroke volume (SV) ml/beat

Adjusting to Conditions Cardiac output: adjusted by changes in heart rate or stroke volume Heart rate: adjusted by autonomic nervous system or hormones Stroke volume: adjusted by changing EDV or ESV

What variables influence heart rate?

Autonomic Innervation Figure 20–21 (Navigator)

Autonomic Innervation (1 of 4) Cardiac plexuses: innervate heart Vagus nerves (X): carry parasympathetic preganglionic fibers to small ganglia in cardiac plexus

Autonomic Innervation (2 of 4) Cardiac centers of medulla oblongata: cardioacceleratory center: controls sympathetic neurons (increase heart rate) cardioinhibitory center: controls parasympathetic neurons (slow heart rate)

Autonomic Innervation (3 of 4) Cardiac reflexes: Cardiac centers monitor: baroreceptors (blood pressure) chemoreceptors (arterial oxygen and carbon dioxide levels) Cardiac centers adjust cardiac activity

Autonomic Innervation (4 of 4) Autonomic tone: dual innervation maintains resting tone by releasing Ach and NE fine adjustments meet needs of other systems

Autonomic Pacemaker Regulation Figure 20–22

Autonomic Pacemaker Regulation (1 of 3) Sympathetic and parasympathetic stimulation: greatest at SA node (heart rate) Membrane potential of pacemaker cells: lower than other cardiac cells

Autonomic Pacemaker Regulation (2 of 3) Rate of spontaneous depolarization depends on: resting membrane potential rate of depolarization

Autonomic Pacemaker Regulation (3 of 3) ACh (parasympathetic stimulation): slows the heart NE (sympathetic stimulation): speeds the heart

Atrial Reflex Also called Bainbridge reflex Adjusts heart rate in response to venous return Stretch receptors in right atrium: trigger increase in heart rate through increased sympathetic activity

Hormonal Effects on Heart Rate Increase heart rate (by sympathetic stimulation of SA node): epinephrine (E) norepinephrine (NE) thyroid hormone

What variables influence stroke volume?

Hormones and Contractility Many hormones affect heart contraction Pharmaceutical drugs mimic hormone actions: stimulate or block beta receptors affect calcium ions e.g., calcium channel blockers

How are adjustments in stroke volume and cardiac output coordinated at different levels of activity?

Factors Affecting Heart Rate and Stroke Volume Figure 20–24

Heart Rate Control Factors Autonomic nervous system: sympathetic and parasympathetic Circulating hormones Venous return and stretch receptors

KEY CONCEPT (1 of 2) Cardiac output: the amount of blood pumped by the left ventricle each minute adjusted by the ANS in response to: circulating hormones changes in blood volume alterations in venous return

KEY CONCEPT (2 of 2) Most healthy people can increase cardiac output by 300–500%

The Heart and Cardiovascular System Cardiovascular regulation: ensures adequate circulation to body tissues Cardiovascular centers: control heart and peripheral blood vessels

The Heart and Cardiovascular System Cardiovascular system responds to: changing activity patterns circulatory emergencies

SUMMARY (1 of 7) Organization of cardiovascular system: pulmonary and systemic circuits 3 types of blood vessels: arteries, veins, and capillaries

SUMMARY (2 of 7) 4 chambers of the heart: left and right atria left and right ventricles

SUMMARY (3 of 7) Pericardium, mediastinum, and pericardial sac Coronary sulcus and superficial anatomy of the heart Structures and cells of the heart wall

SUMMARY (4 of 7) Internal anatomy and structures of the heart: septa, muscles, and blood vessels Valves of the heart and direction of blood flow Connective tissues of the heart

SUMMARY (5 of 7) Coronary blood supply Contractile cells and the conducting system: pacemaker calls, nodes, bundles, and Purkinje fibers

SUMMARY (6 of 7) Electrocardiogram and its wave forms Refractory period of cardiac cells Cardiac cycle: atrial and ventricular systole and diastole

SUMMARY (7 of 7) Cardiodynamics: Control of cardiac output stroke volume and cardiac output Control of cardiac output