STRUCTURES OF THE HEART

The heart is four-chambered hollow organ located within the thoracic cavity in
an area known as the mediastinum ,The apex is an inferior cone-shaped portion of the heart; it is
the location of the apical pulse or point of maximal impulse , which is reflective of left ventricular
function; it is located at the left fifth intercostal space at the mid-clavicular line .

The atria or upper chambers

The right atrium receives deoxygenated blood from the systemic circulation
via the superior vena cava and inferior vena cava.The left atrium receives oxygen-rich blood from
the pulmonary system via the pulmonary vein
The atria are separated from each other by the interatrial septum
They are thin walled as compared to ventricles; they contract minimally to
push blood to the ventricles in comparison to the force needed by the ventricles to move blood out
to body tissues
The ventricles or lower chambers
The right ventricle receives blood from the right atrium and sends it to the
pulmonary system via the pulmonary artery to be oxygenated.
The left ventricle receives oxygenated blood from the left atrium and sends it
to the systemic circulation via the aorta
They are separated from each other by an interventricular septum..Papillary muscles are bundles
of muscle fibers that project into the ventricles and allow heart valves to operate

Major structures of the heart are separated by valves

Upper and lower heart chambers are separated by atrioventricular (AV) valves.a.The right atrium
is separated from the right ventricle by the tricuspid valve. The left atrium is separated from the
left ventricle by the bicuspid valve, more commonly called the mitral valve.

The right ventricle is separated from the pulmonary artery by the pulmonic valve,The left ventricle
is separated from the aorta by the aortic valve.

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 Tissue layers of heart
1. Pericardial membrane: sac that surrounds the heart; contains three layers
a. Fibrous pericardium layer is outermost and composed of connective tissue that extends to cover
blood vessels that enter the heart as well as the diaphragm
b.Parietal pericardium layer lines the fibrous pericardium; is composed of
serous tissue
c.Visceral pericardium is a serous layer of membrane that adheres to the heart;
also called the epicardium
2. Myocardium: middle layer of heart made of cardiac muscle and responsible for
contractile functions of the heart; muscle fibers in this layer are arranged in bundles that
connect the chambers of the heart together
3. Endocardium: innermost layer of heart that actually lines the heart's chambers
and valves; made up of squamous epithelium, which lies on a connective tissue
layer; also is continuous with the endothelial lining of blood vessels

Pathway of blood through the heart

1. Deoxygenated blood enters the right atrium via the superior and inferior vena cava;
moves from the right atrium through the tricuspid valve into the right ventricle
2. Right ventricle contracts to push blood through the pulmonic valve into pulmonary arteries
to travel to the lungs
3. Blood is reoxygenated in the lungs and returns to the left atrium via the pulmonary veins
4. Left atrium contracts to push blood through the mitral valve into the left ventricle;
contraction of this ventricle forces blood through the aortic valve into the aorta.

CARDIAC CONDUCTION
A. Cardiac muscle properties
1. Consists of striated muscle like skeletal muscle; unlike skeletal muscle, cardiac muscle does not need to
be stimulated to contract; this property is called automaticity .

2. Automaticity: property by which cardiac muscle can initiate and distribute contractile impulses
continuously or automatically; occurs because the cell membranes of cardiac muscle cells are able
to initiate action potentials that spread to produce cardiac contraction.

Activity of the heart is produced by the electrical system within; activity is controlled by
specialized areas that have ability to initiate heart's electrical activity .
1. Sinoatrial (SA) node is an area of specialized tissue located in the right atrium;
it initiates the heartbeat and is referred to as the pacemaker
2. Impulse generated by the SA node is conducted via internodal pathways to the
atrioventricular (AV) node located in the interatrial septum
3. Impulse travels to bundle of His, located in the intraventricular septum at the junc

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tion of atria and ventricles, and continues through the right and left bundle branches
4. Once through the septum, the impulse continues through the ventricular walls
via Purkinje fibers
5. This activity produces alterations in cell membranes that cause changes in permeability and
movement of sodium, potassium, and calcium ions across membranes to produce changes in
electrical charge; this results in cardiac contraction.

CORONARY CIRCULATION
Coronary arteries arise from the aorta and supply heart tissue with oxygenated blood.
There is a left circulation and right circulation to the heart muscle itself.

1. Left main coronary artery bifurcates (splits) to form the left anterior descending
(LAD) and circumflex arteries, which supply the left ventricle and the anterior
portion of the intraventricular septum
2. Right coronary artery (RCA) supplies the right ventricle and continues on to
become the posterior descending artery (PDA), which supplies blood to the posterior wall of
heart; the RCA has two branches:
a.Marginal artery supplies the myocardium of the right heart
b.Posterior interventricular artery supplies the apex and back walls of the ventricles

Coronary arteries and the main branches of each are located in the epicardium

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and send branches into the myocardial and endocardial layers to deliver blood
during diastole
After oxygenated blood enters the capillary beds within the myocardium to pro
vide oxygen and nourishment, deoxygenated blood is collected into cardiac vein.

Several cardiac veins empty into an enlarged vessel on the posterior wall of the
heart known as a coronary sinus; veins that feed the coronary sinus are the great
cardiac vein, middle cardiac vein, and small cardiac vein.Several anterior cardiac veins enter the
anterior right atrium.

Blood flow to the heart muscle is controlled by heart rate, pressure in great vessels (aorta),
metabolic factors of heart muscle (oxygen deprivation), disease processes such as
arteriosclerosis, as well as the tone of muscle within the blood vessels themselves

BLOOD VESSELS
A. Arteries
Carry oxygenated blood via a system of branching blood vessels to capillary
beds where exchange of gases and nutrients takes place Branching begins with body's great
arteries that arise from the aorta.

The smallest of arterial branches are called arterioles, which progress to capillary beds. The only
exception to this is the pulmonary artery, which carries deoxygenated
blood from the right ventricle to the pulmonary capillaries. Arterial blood flow is pulsatile,
increasing with systole and decreasing during diastole

A. Veins.
Carry deoxygenated blood via a system of blood vessels; these begin at the cap
illary beds and are called venules. Venules merge together to form progressively larger blood
vessels that eventually return deoxygenated blood to the heart via the superior vena cava (upper
body) and inferior vena cava (lower body).
The only exception is the pulmonary vein, which carries oxygenated blood frompulmonary
capillaries to the left ventricleVeins in the periphery have valves that prevent backflow and
pooling of blood in those blood vessels.

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