1. Heart outline pulmonary & systemic circulation
location of heart in thorax
pericardium
external anatomy of heart
internal anatomy of heart
coronary circulation
CAD, angina and heart attacks
heart valves
conduction system of heart
EKG’s

2. Pulmonary circuit Systemic circuit
artery
vein
artery
vein
CO2 O2
Systemic
circuit

3. CPR, xyphoid process
Auscultating the heart….where? Press down 4-5 cm

4. T9

5. Looking at left side of heart
Looking at right side of heart

7. Pericardial cavity
For you only – already did

8. Visceral pericardium Myocardium Endocardium
Fibrous pericardium
Parietal pericardium
Visceral pericardium
Myocardium
Endocardium
Cardiomyopathy: heart muscle disease
Extrinsic (mostly coronary art issues – lack of oxygen to muscle)
Intrinsic (drug & alcohol toxicity, hep C, genetic)
Genetic issues: thickened, stiff or spongy muscle – young athletes with heart failure
Hypertrophic cardiomyopathy…
Epicardium = visceral pericardium
+ adipose
cardiomyopathy

9. Pericarditis = inflammation of the pericardium
Inflammation: infection, cancer, trauma, radiation, auto-immune, no cause
Symptoms: chest pain, fever, increased heart rate, none
Constrictive pericarditis: severe pericarditis, pericardium sticks together, heart can’t expand – breath shortness, tired, edema…
Pericarditis = inflammation of the pericardium
peri = ? cardi = ? -itis = inflammation

10. Fibrous skeleton: collagen & elastic fibers between chambers & around valves
structural support
prevents valves from
being overly distended
anchors myocardium
electrical “insulator” between atria
and ventricles

11. Superior vena cava PV Inferior vena cava Anterior View aorta
Pulmonary artery PV
Right atrium LA
Right ventricle LV
Inferior vena cava
Anterior View

12. Left atrium RA
Use model
Left ventricle RV
Posterior view

13. Chambers of the Heart 4 chambers 2 upper atria (atria = entry hall)
(auricle = little ear)
2 lower ventricles
(ventricles = little bellies)
Auricle

14. Right atrium SVC Coronary Sinus (opening) Pectinate muscle
PFO – 15% of adults, can get bigger
Fossa ovalis
IVC
Right AV orifice

15. Right ventricle Pulmonary valve Trabeculae carneae Tricuspid valve
Papillary muscle with tendinous cords

16. Left ventricle Aortic valve Mitral (bicuspid) valve Papillary muscles
with chordae tendineae
Trabeculae carneae
Thrombi form on walls of left ventricle with certain types of heart disease – stroke or VA

17. Right atrium & ventricle
Left atrium & ventricle

18. Coronary circulation Deep to epicardium
Symp and para innervation (sym dilates)

19. Coronary circulation RCA Coronary sinus LCA (Under auricle) RCA
L & R coronary artery = directly off aorta just distal to aortic valves
Coronary sinus = drains into right atrium

21. Coronary sinus
R & L coronary arteries
Aortic valve

22. Fig. 20.12 Coronary artery disease (CAD)
narrowing of coronary arteries
leading cause of death in US
Atherosclerosis
fatty plaque on arterial walls

23. By-pass Graft

24. Myocardial infarction (MI)
dead tissue areas in myocardium
caused by interruption of blood flow
cardiac muscles cells don’t regenerate
replaced by scar tissue
scarred or ischemic cardiac muscle can’t pump or conduct electrical impulses
arrhythmias (ventricular fibrillation)
Angina pectoris (chest pain)

25. Referred pain:
Organ & skin pain fibers travel to the spinal
cord together
Organ pain misinterpreted as skin pain
(referred pain)

26. Aortic valve
(semilunar valve)
Pulmonary valve
(semilunar valve)
Bicuspid or Mitral
valve
Tricuspid
valve

27. Atrioventricular (AV) valves
Semilunar valves
aortic & pulmonary valves
each has 3 cusps (no tendinous cords)
close when pressure in ventricles falls
Atrioventricular (AV) valves
tricuspid and bicuspid (Mitral)
tricuspid = 3 cusps, bicuspid = 2
connected to papillary muscle via tendinous cords
close when pressure in ventricles increases

28. Cardiac Cycle = 1 heartbeat
Diastole = relaxation
Systole = contraction

29. Atrioventricular Valves Open
Ventricles = diastole
Atria = systole
(atrial pressure > ventricle pressure)

30. Atrioventricular Valves Close
Ventricles = systole
Atria = diastole
Ventricle pressure > atrial pressure
A-V valves close preventing backflow of blood into atria

31. What are the ventricles doing in A?
Valve Function Review A B
TP slide
What are the ventricles doing in A?
Is blood flowing into the coronary arteries in A or B?

32. Murmurs – any abnormal heart sound
Stenosis – narrowing of valve orifice
Congenital, rheumatic fever
Mitral most common (aortic)
Insufficiency or regurgitation – incomplete closure of valve
Many causes (MI, RF, HF, prolapse)
Aortic and mitral most common
Prolapse: most common valve disease
CT diseases or genetic
Rheumatic fever - strepA
Stenosis – mitral = rheumatic fever, aortic = congenital, RF, calcification disease of elderly
Causes LV hypertrophy, LV failure (angina, dyspnea)
insufficiency (blood regurgitates – murmur): mitral = MI, RF, HF, prolapse
Nodules can form on valve, scar and shorten, CT or PM get diseased
(AIDS and anti-parkinson drugs cause valve diseases)
Pulmonary and tricuspid valves: uncommon stenosis>regurgitation (tricuspid w/RF)

33. Cardiac Cycle = 1 heartbeat
How does the heart beat?
Cardiac Cycle = 1 heartbeat

34. Conduction System of Heart
SA node – AV node – AV bundle of His (between ventricles) – Purkinje fibers
How does your heart rate change?
Nervous control (ANS)
hormones
drugs
Need to coordinate contractions
SA node: 100/min ANS innervated (para keeps it slower)
AV node: ANS innervated
Ventricles can beat on own (20-30/min – too slow)
AV node can be an ectopic focus
Most ectopic foci beat too slowly to sustain life
Beta blockers – block sym response during MI
Heart block: electrical signals blocked
Bundle branch block or total heart block
Ectopic focus
Arrhythmia: irregular heart beat
Fibrillations: uncoordinated contractions

35. EKG = electrocardiogram
Recording electrical currents in heart
P wave
atrial contraction
P to Q interval
time for impulse to travel from SA node to AV node
QRS complex
ventricular contraction
T wave
ventricular relaxation

36. Heart failure Impairment of the heart to fill or pump
a sufficient amount of blood through
the body
right side
peripheral edema
ascites
jugular venous distention
left side
dyspnea (shortness of breath)
orthopnea
pulmonary edema