CARDIOVASCULAR

ANATOMY & PHYSIOLOGY

HEART: hallow muscular organ that is somewhat pyramidal in shape and lies within
the pericardium in the mediastinum.
Surfaces of the Heart
Anterior cardiac surface/ Sternocostal surface
o Formed by right atrium & ventricle
o Separated by vertical atrioventricular groove
o Right ventricles occupies most of the anterior surface
Inferior cardiac surface/ Diaphragmatic surface
o Formed by the right & left ventricle
o Separated by interventricular groove
Posterior cardiac surface/ Base surface
o Formed mainly by left atrium
o Directed upward, backward, and to the right
o Base of the heart: right and left 2nd interspaces close to the sternum
Point of meeting between right ventricle and pulmonary artery
Apex of the heart
o Formed by left ventricle
o Directed downward, forward, and to the left
o 5th left intercostals spaces and 3 in. (7-9 cm) from the midline
o Generate apical impulse/ point of maximal impulse (PMI)
The heart rest on the Inferior surface/ Diaphragmatic surface
Borders of the Heart
Right border
o Formed by the right atrium
o 3rd right costal cartilage inch(1.3 cm) from the edge of the sternum
to 6th right costal
Left border
o Formed by left auricle (superiorly) and left ventricle (inferiorly)
o 2nd left costal cartilage inch(1.3 cm) from the edge of the sternum to
the apex beat of the heart
Inferior border
o Formed mainly by right ventricle, also right atrium
o Lies below the junction of sternum and xiphoid process xiphisternal
joint
o 6th left costal cartilage inch(1.3 cm) from the edge of the sternum to
the apex beat of the heart
Superior border
o Roots of great vessels
o 2nd left costal cartilage inch(1.3 cm) from the edge of the sternum to
3rd right costal cartilage inch(1.3 cm) from the edge of the sternum
Borders are important when examining radiograph of the heart
Chamber of the Heart
Right atrium
o Junction between right auricle and right atrium is a vertical groove
Outside sulcus terminalis
 Inside crista terminalis
o Posterior wall of right atrium is rougher then the anterior wall
Due to the presence of bundles of muscle fibers musculi
pectinati
o Superior vena cava drains the blood from the upper half of the body
to the heart
Has no valve
o Inferior vena cave drains blood from the lower half of the body to the
heart
Has a rudimentary, nonfunctioning valve
o Coronary sinus drains most blood from the heart wall
Has a rudimentary, nonfunctioning valve
Opens between inferior vena cava and atrioventricular orifice
Right ventricle
o Communicate with:
Right atrium: atroventricular orifice tricuspid valve
Pulmonary trunk: pulmonary orifice pulmonary valve
o Infundibulum funnel-shape area at which the cavity approaches the
pulmonary orfice
o Trabeculae carneae projecting ridges of muscle bundles that give the
ventricular wall a sponge-like appearance
Papillary muscle base attach at the base of ventricular wall;
apices attach to the cups of tricuspid via chordate tendinae
Moderator band free middle; crosses the ventricular cavity
from the septal to the anterior wall
o Tricuspid valve guard the atrioventricular orifice
Anterior lies anteriorly
Septal lies against ventricular septum
Inferior lies inferiorly
When the ventricle contracts, the papillary contract and prevent
the cusps from being forced into the atrium
o Pulmonary valve- guard the pulmonary orifice
3 semilunar cusps form by folds of endocardium with some
connective tissue enclosed
The attachment of the cusps to the arterial wall preventing it to
prolapsing into the ventricle
Left atrium
o Interior is smooth; muscular ridges in the right auricle
o 4 pulmonary veins 2 from each lungs
No valve
o Left atrioventricular mitral valve
Left ventricle
o Communicates:
Left atrium: atrioventricular orifice mitral valve
Aorta: aortic orifice aortic valve
o Walls 3x thicker than those of the right ventricle
o Cross section: left circular; right crescentic
o Aortic vestibule part of ventricle below the aortic orifice
 o Mitral valve guard the atrioventricular orifice
2 cusps: 1 anterior & 1 posterior
Attachment of chordate tendineae and papillary muscle
o Aortic valve guard the aortic orifice
Bulges of aortic wall aortic sinus
Anterior right coronary artery
Posterior left coronary artery
Tricuspid and Mitral valves atrioventricular valves
Aortic and Pulmonic valves semilunar valves
As the heart valves closes, the heart sound arises from vibration emanating
by:
o Leaflet
o Adjacent cardiac structure
o Flow of blood
Events in the Cardiac Cycles
Systole is the period of ventricular contraction.
o After the ventricle ejects much of its blood into the aorta, the pressure
levels off and starts to fall.
Diastole is the period of ventricular relaxation.
o Late in diastole, ventricular pressure rises slightly during inflow of
blood from atrial contraction.
During systole, the semilunar valves open, allowing ejection of blood from the
ventricle to the aorta and pulmonary trunk. The atrioventricular valves close,
preventing regurgitation of the blood to the atria.
During diastole, the semilunar valves close, preventing regurgitation of the
blood to the ventricle. The atrioventricular valves open, ejecting blood from
the atria to the ventricles.
Dichrotic notch pressure generate by the semilunar valves during the
closing of the valves
Cycle:
o Diastole-pressure in the blood filled left atrium slightly exceeds those
of left ventricle, causing blood to flow from the left atrium to the left
ventricle through the opening of mitral valve. Atrial contraction gives
slight increase in both left atrium and left ventricle
o Systole-left ventricle contract and ventricular pressure exceeds that of
the atrium which closes the mitral valve. The closing of the mitral
valve causing first heart sound (S1)
o As the pressure of the ventricular rise, it eventually will exceed those
of the aorta, causing opening of the aortic valve.
Normal maximal left ventricular pressure corresponds to
systolic blood pressure
Pathologic opening of the aorta accompany by early systolic
ejection sound (Ej)
o As the left ventricular ejects most of its blood, the pressure will
decrease and the aortic valve will close. The closing of the aortic valve
will generate the 2nd heart sound (S2)
o Diastole-left ventricular pressure will eventually drop below the left
atrial pressure, causing the opening of the mitral valve.
 Normal silent process
Pathologic generate a sound called the opening snap (OS). Ex:
mitral stenosis
o As the mitral valve opens, there will be a rapid filling of the left
ventricular
Normal children and young adults: rapid deceleration of
column blood against the ventricular wall will generate 3 rd heart
sound (S3)
Pathologic: older adults, S3 is termed S3 gallop, maybe due to
change ventricular compliance
o 4th heart sound marks the atrial contraction
Normal not usually heard
Pathologic precedes the S1, due to the change in ventricular
compliance

Splitting of heart sound

o While the above events happen, similar changes also occurs in the
right side of the heart, involving right atrium, right ventricle, tricuspid
valve, pulmonary valve, and pulmonary trunk.
o The right sided events usually occurs later than the left sided events
cause possible presence of 2 discernable components:
A2 aortic valve closing
P2 pulmonary valve closing
o During expiration, the 2 sound are indiscernible
o During inspiration, the 2 sound are more discernable
o Current explanation: increase capacitate in the pulmonary vascular
bed during inspiration prolongs ejection of blood from right
ventricle delaying closure of pulmonary valve (P2)
o Location:
A2 precordium
P2 2nd and 3rd interspaces close to the sternum
S1,mitral apex and precordium
S1,tricuspid lower left sternal angle
Heart murmurs
o Has longer duration then that of heart sound
o Stenotic valve has narrow opening that will cause a characteristic
murmur
o Regurgitant murmur caused by incomplete closing of valve, which
lead to retrograde flowing/pumping of blood
o To identify, we must know:
Best area to auscultate
Timing during systole and diastole
Qualities
Relationship between auscultory findings and chest wall
o Sounds and murmurs heard best at cardiac apex
o Arising from tricuspid valve lower sternal border
 o Arising from pulmonary valve right 2nd and 3rd interspaces, close to
the sternal border
o Arising from aortic valve anywhere from right 2nd interspace to
cardiac apex
Conduction System
Sinus node/ sinoatrial node (SA node) located at the right atria. Superior
posterolateral wall of the right atrium immediately below and slightly lateral
to the opening of the superior vena cava
o Sinus node is the pacemaker of the heart, simply because they are
self-exciting cells with impulse discharge rate considerably fastest
o Automatically discharge impulse about 60-100/minutes
o Travels to atrioventricular nodes via anterior, middle, and posterior
intermodal pathway
o Travels to the left atrium via anterior interatrial band
Atioventricular node (AV node) located at posterior wall of the atrium
immediately behind the tricuspid valve and adjacent to the opening of the
coronary sinus
o The conduction here is delayed by the AV node and the adjacent
conductive fibers in order to give atrium time to empty their blood to
the ventricle
o Bundle of His bundles of AV node fibers that penetrate the
atrioventricular fibrous tissue and projects downward
o Separated to left and right bundle branch (purkinjes fibers)
Purkinjes fibers has a very rapid transmission 1.5-4.0 m/sec
o Enables it to transmit the impulses to all the ventricular muscle in
average of 0.03 sec (endocardium) and 0.06 sec (epicardium)
Control of heart rhythmicity and impulse conduction
o Parasympathetic nerves: located mainly in the SA node and AV node
Stimulation by hormone acetylcholine
First: decrease the rate of rhythm of the SA node
Second: decreases the excitability of the AV node, thereby
slowing the transmission of the cardiac impulse
Mechanism:
Greatly increases the permeability of the potassium ion
Will cause the leaking of potassium ion extracellularly
Increase negativity intracellular
SA node: Longer time will be required for inward-leaking
of sodium rendering longer time to reach the threshold
AV node: longer delay and decrease excitability rendering
slow transmission of impulse to the bundles and ventricle
After 5-20 seconds absence of transmission from AV node, the
purkinjes fibers will initiate its own impulse to the ventricle
muscles ventricular escape
o Sympathetic nerve: distributed to all parts of the heart (ventricular
muscle mainly)
Stimulate by hormone Norepinephrine
First: increase the rate of sinus nodal discharge
 Second: increases the rate of conduction as well as the level of

excitability inall portions of the heart
Third: increases greatly the force of contraction of all the cardiac
musculature
Mechanism:
Increase permeability of sodium and calcium ion
Increase the positivity intracelullarly
Decrease the time required to reach the threshold
SA node: Accelerating self excitation increase heart rate
AV node: easier for the action potential to excite the
following fibers
Electrocardiogram (ECG) mechanism
The Heart as Pump