1. Chapter 13
Anatomy of the Heart

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State Standards
35) Outline the structure and functions of the anatomy of the cardiovascular system, paying special attention to the musculature of the walls, the chambers, and the valves of the heart and blood vessels. Locate and demonstrate the circulation of blood through the heart; describe the phases and importance of the cardiac cycle and how heart rate and cardiac output relate to one another. Listen to heart sounds, either digitally or with a stethoscope, to identify the normal and abnormal sounds made during the cardiac cycle. Explain the causes for abnormal sounds encountered.
36) **Differentiate among the systemic, coronary, hepatic portal, pulmonary, cerebral, and fetal circulation systems, formulating an original hypothesis on possible changes in physiology and pathology in response to new environments and/or stimuli.
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Objectives
The student will be able to…
describe the functions of the Circulatory System
describe the structure of the heart
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4. Cardiovascular System and Homeostasis
Maintaining proper homeostasis in the body is dependent on the continuous and controlled movement of blood through thousands of miles of capillaries that permeate every tissue and cell of the body.
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Quick Write activity
2 sentences describing at least 1 other body system that is linked to the cardiovascular system. How do these 2 systems work together?
Be prepared to share with the class
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6. FUNCTIONS OF THE CIRCULATORY SYSTEM IN HOMEOSTASIS
Heart pumps and circulates blood to all parts of the body
Blood vessels circulate blood between the heart and cells of the body
Blood carries oxygen and nutrients to cells and carries away wastes
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7. Discussion
Applying what you know about blood from our lectures over hematology, what component of blood makes the transfer of oxygen to the tissues possible?
*** We have now covered our first objective
SWBAT describe the functions of the circulatory system.
By show of thumbs are you comfortable with this objective?

8. What makes up the CIRCULATORY SYSTEM?
Heart
Arteries
Veins
Capillaries
Blood
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The Heart
What is the typical size of a human heart?
What body cavity is the heart located in?
Describe the position of the heart compared to the lungs with medical directional terms
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THE HEART
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STRUCTURE OF THE HEART
The heart is a hollow, muscular, double pump
Pericardium - double layer of fibrous tissues surrounding heart
Myocardium - cardiac muscle tissue
Endocardium - Smooth inner lining
Septum - Muscular wall separating heart into two halves
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Layers of the Heart
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Discussion
Pericardial fluid is located between the layers surrounding the heart, theorize the purpose of this fluid.
Place the layers of the heart in order from innermost to outermost.
What directional terms describe the 2 halves of the heart?
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STRUCTURE OF THE HEART
Four chambers of the heart
Right atrium
Left atrium
Right ventricle
Left ventricle
Draw this square “heart” in your notes and label the 4 chambers
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Discussion
What divides the heart into right and left sides?
Why are the hearts left and right sides opposite of normal left and right?
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STRUCTURE OF THE HEART
Four valves divide the chambers of the heart and permit blood flow in only one direction
Open and close during contraction of the heart
Tricuspid valve
Bicuspid (mitral) valve
Pulmonary valve
Aortic valve
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Discussion
What is the purpose of heart valves? What do they prevent? Why do we not want this?
Applying what you know about medical terminology, which valve has 3 flaps?
**We have now covered our 2nd objective
SWBAT describe the structure of the heart.
By show of thumbs how comfortable are you with this objective?
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20. VESSELS OF THE HEART Structures leading to and from the heart:
Vena cava (superior and inferior)
Delivers oxygen poor blood back to the heart from the head and neck (superior) and lower body (inferior)
Pulmonary artery
Carries oxygen poor blood to the lungs to pick up oxygen
Pulmonary veins
Carries oxygen rich blood back to the left atrium
Aorta
Carries oxygen rich blood out of the heart to the body

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Vessels of the Heart
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Activity
We will now complete the draw a heart step by step activity.
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23. Physiology of the Heart
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24. Physiology of the Heart
State Standards
35)Outline the structure and functions of the anatomy of the cardiovascular system, paying special attention to the musculature of the walls, the chambers, and the valves of the heart and blood vessels. Locate and demonstrate the circulation of blood through the heart; describe the phases and importance of the cardiac cycle and how heart rate and cardiac output relate to one another. Listen to heart sounds, either digitally or with a stethoscope, to identify the normal and abnormal sounds made during the cardiac cycle. Explain the causes for abnormal sounds encountered.

25. © 2004 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives
Students will be able to…
Describe the flow of blood through the heart.
Describe the types of circulation in the circulatory system
Determine the Cardiac Output of the heart and how it relates to Blood pressure
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26. Blood flow Through the Heart
Right Side of the Heart
Deoxygenated blood from the body
Sends blood to the lungs to pick up 02
Left Side of the Heart
Oxygenated blood from the lungs
Sends oxygenated blood to the body
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28. Quick Write: Path of Blood Flow
Take a moment and write the step by step flow of blood through the heart. Start at the Superior and Inferior Vena Cava. Include all the atria, valves, ventricles, and vessels.
***We have now covered our first objective
SWBAT describe the blood flow through the heart
By show of thumbs, how comfortable are you with this objective?
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29. PHYSIOLOGY OF THE HEART
Two major functions occur with each heart beat
Systemic circulation
Right heart: Blood is taken to the lungs for oxygen
Left heart: Blood is taken from lungs to be circulated throughout body
Coronary circulation
The heart receives its blood supply from the coronary artery
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Coronary Circulation
Coronary Circulation
Brings oxygenated blood to the heart muscle
Two branches encircle heart muscle
Left and right coronary arteries that branch into capillaries that goes to all heart tissue
Deoxygenated blood returns through the coronary veins to the coronary sinus.
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32. Discussion
Why would the heart need its own blood supply separate from blood circulating around the body?
What happens to the heart tissues if this blood flow is disrupted?

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Systemic Circulation
The heart is the main organ responsible for circulating the blood throughout the body efficiently
Blood leaves the heart through arteries and returns to the heart from veins
Gas exchange happens in the tissues by way of the capillaries
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Discussion
Applying what you know about blood and what you just learned about the function of arteries and veins, which type of vessel carries oxygenated blood? Deoxygenated blood?
Which type of vessel would have a pulse that you can feel? Why?
***We have now covered our second objective.
SWBAT to describe the types of circulation in the cardiovascular system.
By show of thumbs how comfortable are you?
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36. PHYSIOLOGY OF THE HEART
Stroke volume:
Amount of blood ejected with each beat of the heart (usually 60ml)
Cardiac output:
The amount of blood ejected from heart per minute
Stroke volume x heart rate=cardiac output
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Discussion
Calculate the following Cardiac Outputs.
SV of 6ml, HR of 89
SV of 8ml, HR of 53
SV of 6ml, HR of 74
How should you be labeling your answers?
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38. Cardiac Output and Blood pressure
Cardiac Output and blood pressure are directly related.
An increase in cardiac output results in an increased blood pressure.
Discussion
Where do you measure blood pressure?
What tools do we need?
****We have now met our last objective…
SWBAT determine the Cardiac Output of the heart and how it relates to Blood pressure
Show of thumbs?

39. Activity
Complete Station 4 Blood pressure in the cardiac lab activities tab located on the class website.
Follow the directions, I will be walking around and instructing you as well.
Individually Color and label the blood flow through the heart diagram (make sure that deoxygenated areas are blue and oxygenated areas are red)
Exit Ticket: Complete these review questions
Station 4
13.What is blood pressure and how is it measured?
14.Why is high blood pressure a health concern?

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Heart Sounds
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41. © 2004 Delmar Learning, a Division of Thomson Learning, Inc.
Heart Sounds
State Standards
35)Outline the structure and functions of the anatomy of the cardiovascular system, paying special attention to the musculature of the walls, the chambers, and the valves of the heart and blood vessels. Locate and demonstrate the circulation of blood through the heart; describe the phases and importance of the cardiac cycle and how heart rate and cardiac output relate to one another. Listen to heart sounds, either digitally or with a stethoscope, to identify the normal and abnormal sounds made during the cardiac cycle. Explain the causes for abnormal sounds encountered
© 2004 Delmar Learning, a Division of Thomson Learning, Inc.

42. © 2004 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives
Students will be able to…
Determine the mechanism of how heart sounds are made
Determine the best places to hear heart sounds
Determine normal vs. abnormal heart sounds
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SOUNDS OF THE HEART
Lubb dupp sounds - Sounds made by the valves during the cardiac cycle
Lubb - sound made when the tricuspid and bicuspid valves close between the atria and ventricles
Dupp - Caused by semilunar valves in the aorta and the pulmonary artery closing
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44. © 2004 Delmar Learning, a Division of Thomson Learning, Inc.
Heart Sounds
Lubb
1st sound heard (closing of the tricuspid and bicuspid valves)
Referred to as S1 and heard loudest at the apex of the heart.
Discussion:
Where is the apex of the heart?
Point to it on your own chest.
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46. Heart Sounds
Dubb
2nd sound (closing of the pulmonary valves and the aortic valves) S2
Discussion
Where are the pulmonary and aortic valves located in relation to the apex of the heart? Use medical directional terms.
***We have now met our first 2 objectives
SWBAT Determine the mechanism of how heart sounds are made and determine the best places to hear heart sounds
Show of thumbs?

47. .

48. Normal Heart Sounds Video
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49. Abnormal Heart Sounds Murmurs Turbulent blood flow in the heart
Due to improper closing of the valves S3
The third heart sound or S3 is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds (S1 and S2). S3 is associated with heart failure.

50. Abnormal Heart Sounds Continued
The fourth heart sound or S4 is an extra heart sound that occurs immediately before the normal two "lub-dub" heart sounds (S1and S2)
It is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff ventricle
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Abnormal Heart Sounds
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52. Discussion
Using Hash marks for the heart sounds how would you illustrate S3?
How would you illustrate S4?
*** We have now met all of our objectives…
SWBAT determine normal vs. abnormal heart sounds
By show of thumbs, how comfortable are you?

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Activity
With a Partner Complete the Station 2 heart sounds activity in the cardiac lab located on the class website.
Exit Ticket: Individually Complete these review questions
Station 2
6. What are you actually hearing when you listen to the heartbeat?
7. What creates each sound S1 and S2
8. Did you hear any extra sounds will listening to your partner?
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54. Conduction System of the Heart
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55. Conduction System of the Heart
State Standard
37) **Describe each part of the conduction system of the heart and its related function. Interpret an electrocardiograph (ECG) of a normal sinus rhythm, identifying the P, Q, R, S, and T waves with an explanation of the electrical and mechanical event of each. Identify ECG strips with explanation of sinus, junctional, and ventricular arrhythmias.
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Objectives
Students will be able to…
-Label the SA node and AV node and their function
Identify the components of an EKG and what part of the cardiac cycle they result from
Interpret a normal EKG
Identify abnormal EKG’s
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57. CONTROL OF HEART CONTRACTIONS
Pacemaker (sinoatrial node)
Conducting cells found at the opening of the superior vena cava that control heart muscle contractions
Sends out electrical impulses that begin and regulate the heart
The impulse spreads out causing contraction
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SA Node
Discussion
What portion of the heart does the SA node make contract?
When this area contracts, where does the blood flow to?
Right side?
Left side ?
Draw a basic heart shape and illustrate the conduction of the SA node
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AV node
The impulse from the SA node eventually reaches the AV node
The AV node is stimulated and sends out electrical impulses through the “bundle of His”
This divides into left and right
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62. Discussion
What part of the heart contracts when the AV node is stimulated?
This contraction causes the blood to move from ____ to _____ on the right side and _____ to _____ on the left side.
Draw a basic heart shape and illustrate the conduction of the impulse
***We have now met our first objective…
SWBAT label the SA node and AV node and their function
Show thumbs?

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Diagnostic Tests
Electrocardiogram (EKG) (ECG)
a machine is used to record the activity (impulses) of the heart
Records contraction (systole)
Records relaxation (diastole)
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Parts of an EKG
Baseline-flat line that separates the various waves (when no current)
P wave –represents atrial contraction
QRS wave- represents ventricle contraction
T wave- represents ventricle relaxation
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67. Discussion What are EKGs used to diagnose?
What would be represented by a flat line with no PQRST waves?
Draw a representation of an EKG wave in your notes.
***We have now met our 2nd objective…
SWBAT Identify the components of an EKG and what part of the cardiac cycle they result from

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Reading an EKG
First you count the Heart Rate using the ECG read out
To do this you find a R wave that falls on a bold line and count backwards to the next R wave that falls on a bold line.
Counting sequence is (300, 150, 100, 75,60,500
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READING AN EKG
Determine if the rate is regular.
You can do this by looking at the spaces between the R waves. Are they all the same?
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Check out that P wave
Present?
Regular?
One P wave for each QRS wave?
Smooth, rounded, upright?
All similar shape?
Discussion
What does a P wave represent?
What does is mean if there is not one?
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73. Check out the QRS wave complex
Is it present?
Is there one for every p wave?
Are they vertical?
Are they regularly spaced?
Discussion
What does the QRS wave represent?
If there isn’t one what does that mean?
**We have now met our last objectives…
SWBAT Interpret a normal EKG and Identify abnormal EKG’s

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Activity
With a partner complete the EKG reading activity, making sure to answer the questions throughout.
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Diseases of the Heart
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Diseases of the Heart
State Standard
38) **Develop an informational fact sheet on diseases of the cardiovascular system. Include in the fact sheet the definition of the disease, the signs and symptoms, diagnostic procedures, underlying causation, clinical manifestations, evaluation, and treatment.
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77. © 2004 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives
Students will be able to..
Identify common diseases and disorders of the heart
Identify symptoms and treatments for common diseases
Create a fact sheet over a chosen disorder
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78. © 2004 Delmar Learning, a Division of Thomson Learning, Inc.
DISEASES OF THE HEART
Common symptoms of heart disease
Arrhythmia
Bradycardia
Tachycardia
Murmurs
Mitral valve prolapse
Briefly define each of these p
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DISEASES OF THE HEART
Coronary Artery disease (CAD)
Narrowing of the arteries that supply oxygen and nutrients to the heart
Leads to…
Angina pectoris - severe chest pain from inadequate oxygen to heart
Where does this pain radiate to?
How is this pain typically described?
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Discussion
What is typically causing the arteries to narrow in this condition?
What measure can someone put in place to decrease their risk of Coronary Artery Disease?
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Diseases of the Heart
Myocardial infarction (heart attack) - caused by lack of blood supply to heart muscle.
Causes heart muscle to die
Symptoms include angina pectoris
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Discussion
Applying what you know about the anatomy of the heart, what branch of artery is blocked with an MI?
Describe what the typical patient suffering from an MI would look like.
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85. DISEASES OF THE HEART Infectious diseases of the heart Pericarditis
Inflammation of the outer membrane covering the heart
Myocarditis
Inflammation of the heart muscle
Endocarditis
Inflammation of the lining on the inside of the heart and valves
Rheumatic heart disease
Inflammation of the inner lining of the heart, damages the mitral valve, often seen in children.

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87. Discussion
Illustrate these conditions by drawing a basic heart shape for each and shading in the portion that has inflammation.
Research the root cause of Rheumatic Fever.
What would be important to educate parents over to prevent developing rheumatic fever?

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DISEASES OF THE HEART
Prevention of heart disease
Not smoking
Regular exercise
Maintaining ideal weight
Estrogen replacement therapy
Reduction of triglyceride and cholesterol levels
Maintaining normal blood pressure
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89. © 2004 Delmar Learning, a Division of Thomson Learning, Inc.
DISEASES OF THE HEART
Heart Failure-ventricles do not pump blood efficiently causing it to pool in the heart
Congestive heart failure- similar to heart failure but includes edema in lower extremities, and blood that backs up into the lung vessels
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Discussion
Applying what you know about blood and its components, what could develop when blood pools and sits in one place?
Which ventricle (left or right) would be effected when you have symptoms of shortness of breath?
*hint which side takes oxygenate blood from the lungs to the body
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92. © 2004 Delmar Learning, a Division of Thomson Learning, Inc.
TYPES OF HEART SURGERY
Angioplasty (balloon surgery)-flattens blockages in a clogged vessel p. 254
Coronary bypass- detour around a clog p. 255
Cardiac stints- hold open a vessel p. 254
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HEART TRANSPLANTS
Heart transplant is needed when individual’s heart can no longer function properly
Organ rejection may occur even when tissue type is matched
Immunosuppressants are drugs used to suppress recipient’s immune system from rejecting donor organ
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94. © 2004 Delmar Learning, a Division of Thomson Learning, Inc.
Discussion
What type of incision would be needed for these procedures? Angioplasty- Bypass- Stint-
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95. Activity
Today we will be following state standard 38 with a partner and creating a…. 38) **Develop an informational fact sheet on diseases of the cardiovascular system. Include in the fact sheet the definition of the disease, the signs and symptoms, diagnostic procedures, underlying causation, clinical manifestations, evaluation, and treatment. Choose 2 diseases (1 that we discussed in lecture and 1 that we did not discuss, you will teach the class about the new disease)

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Heart Dissection
See Pig heart dissection activity
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OBJECTIVES
The student will demonstrate understanding of the physiology of the heart by
Calculating cardiac output
Determining the connection between cardiac output and blood pressure
Demonstrating taking blood pressures
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