Lecture 22:

Cardiac Anatomy
Circulation
BIOL212 10.27.2021
11/1
Muscle Fibers of the Heart

● The heart walls are composed primarily of spirally arranged cardiac muscle
fibers

○ Endothelium, myocardium, and epicardium

● Cardiac muscle fibers are interconnected by intercalated discs: form functional

syncytia

○ Desmosomes and gap junctions

● Heart is enclosed by the pericardial sac

○ Consists of a fibrous covering and secretory lining

Question: Use QR10.27.1
What part of the nervous system can alter your heart rate?
9.2 Electrical Activity of the Heart

● Automaticity: the heart contracts rhythmically as a result of action potentials

that it generates by itself

○ Contractile cells: 99% of the cardiac muscle cells do the mechanical work of pumping

○ Autorhythmic cells: initiate and conduct the action potentials responsible for contraction of
working cells
Cardiac Autorhythmic Cells

● Pacemaker potential in autorhythmic cells

○ Complex interactions of several different ionic mechanisms are responsible for pacemaker
potential

● Action potential in autorhythmic cells

○ Rising phase of the action potential occurs in response to activation of a long-lasting,

voltage-gated Ca2+ channel
The Sinoatrial Node

● The sinoatrial node (SA node) is the normal pacemaker of the heart

○ SA node

○ Atrioventricular node

○ Bundle of His (i.e., atrioventricular bundle)

○ Purkinje fibers

● Normal and abnormal pacemaker activity

○ Rates of slow depolarization and action potentials generated differ

Cardiac Excitation and Contraction

● The spread of cardiac excitation is coordinated to ensure efficient pumping

○ Atrial excitation and contraction should be complete before ventricular contraction onset

○ Excitation of cardiac muscle fibers should be coordinated to ensure each heart chamber
contracts as a unit to pump efficiently

○ The pair of atria and pair of ventricles should be functionally coordinated so that both
members of the pair contract simultaneously
Atrial and Ventricular Excitation and
Conduction
● Atrial excitation

○ Interatrial pathway

○ Internodal pathway

● Conduction between the atria and the ventricles

○ AV nodal delay

● Ventricular excitation

○ Ventricular conduction system is crucial for hastening spread of excitation in ventricles

Action Potential and Calcium

● The action potential of cardiac contractile cells shows a characteristic

plateau

○ Plateau phase: membrane potential is maintained close to this peak positive level for several
hundred milliseconds

● Calcium entry from the ECF

○ Induces a much larger Ca2+ release from the sarcoplasmic reticulum

Getting an Overview of Electrical Activity

● A long refractory period prevents tetanus of cardiac muscle

○ Sustained, maximal contraction

● ECG is a record of the overall spread of electrical activity through the heart

○ Electrical activity present in body fluids from the cardiac impulse that reaches the body
surface
 Lead I: Right
arm to left
aVR: right arm arm aVL: left arm

Lead II: Lead III:

Right arm to Left arm to
left leg left leg

aVF: left leg

Ground electrode

(a) Limb leads (b) Chest leads

The ECG Record

● Different parts of the ECG record can be correlated to specific cardiac

events

○ P wave, QRS complex, and T wave

● The ECG can detect abnormal heart rates and rhythms and heart muscle
damage

○ Abnormalities in rate

○ Abnormalities in rhythm

○ Cardiac myopathies
 SA node
fires

P wave =
Atrial depolarization

One normal heartbeat

TP segment = PR segment =
0 0.2 0.4
Time during which AV nodal delay
0.6 0.8
ventricles are
relaxing and filling Time (seconds)
R

200 msec
Recorded potential
T
P P

Q
S

PR ST TP
segment segment segment

T wave =
Ventricular QRS complex =
repolarization Ventricular depolarization
(atria repolarizing
simultaneously)

ST segment =
Time during which
ventricles are
contracting and
emptying
9.4 Cardiac Output and Its Control

● Cardiac output depends on heart rate and stroke volume

○ Volume of blood pumped by each ventricle per minute

● Heart rate is determined primarily by autonomic influences on the SA node

○ Effect of parasympathetic and sympathetic stimulation on the heart

○ Control of heart rate

Stroke Volume

● Stroke volume is determined by the extent of venous return and by

sympathetic activity

○ Intrinsic control: related to the extent of venous return

○ Extrinsic control: related to the extent of sympathetic stimulation of the heart

Controlling Stroke Volume

● Increased end-diastolic volume results in increased stroke volume

○ Intrinsic control of stroke volume: heart’s inherent ability to vary SV

○ Frank–Starling law of the heart: intrinsic relationship between EDV and SV

○ Advantages and mechanism of the cardiac length–tension relationship

Stroke Volume and Cardiac Output

● Sympathetic stimulation increases the contractility of the heart

○ Contractility: strength of contraction at any given EDV

● Summary of factors affecting stroke volume and cardiac output

○ Stroke volume can be graded by varying the initial length of the muscle fibers and varying
the extent of sympathetic stimulation
High Blood Pressure

● High blood pressure increases the workload of the heart

○ Afterload: workload imposed on the heart after contraction has begun

■ Sustained extra workload placed on the heart can eventually cause pathological
changes in the heart that lead to heart failure
Heart Failure

● A failing heart cannot pump out enough blood

○ Heart failure (HF): inability of CO to keep pace with the body’s demands for supplies and
removal of wastes

■ Systolic and diastolic

○ Defect in systolic heart failure

■ Prime defect is decreased cardiac contractility

Types of Heart Failure

● Compensatory measures for systolic heart failure

○ Sympathetic stimulation

○ Retention of salt and water by kidneys to expand blood volume

● Decompensated systolic heart failure

○ Forward and backward failure

● Diastolic heart failure

○ Heart failure with preserved ejection fraction

9.5 Nourishing the Heart Muscle

● The heart receives most of its blood supply through the coronary circulation
during diastole

○ Matching of coronary blood flow to heart muscle’s O2 needs

■ Coronary blood flow is adjusted in response to changes in the heart’s O 2

requirements

○ Nutrient supply to the heart

■ The heart can tolerate wide variations in its nutrient supply

Atherosclerotic Coronary Artery Disease

● Atherosclerotic coronary artery disease can deprive the heart of essential

O2

○ Vascular spasm: abnormal spastic constriction that transiently narrows the coronary vessels

○ Development of atherosclerosis: progressive, degenerative arterial disease

■ Leads to occlusion of affected vessels, reducing blood flow through them

 Collagen-rich Lumen Plaque
smooth muscle
Normal blood cap of plaque Plaque
vessel wall

Lipid-rich core
of plaque
Endothelium
Complications of Atherosclerosis

● Thromboembolism

● Peripheral artery disease

● Angina pectoris

● Heart attack