BASE
heart (cvs) • the larger, flat part at the opposite end of the heart
Components of Cardiovascular System
• Blood
• The Heart
• Blood Vessels
functions of heart
• Generates blood pressure
○ Contractions of the heart generate blood
pressure
• Routes blood
○ The heart separates the pulmonary and
systemic circulations, which ensures the
flow of oxygen-rich blood to tissues.
• Ensures one-way blood flow
○ The valves of the heart ensure a one-way
flow of blood through the heart and blood
vessels.
• Regulates blood supply
○ Changes in the rate and force of heart
contraction match blood flow to the
changing metabolic needs of the tissues
during rest, exercise, and changes in body
position.
Heart Characteristics
• Shape – blunt cone
• Size - size of a closed fist and weighs 250 g in
female, 300g in male; ↓ in size after age 65, esp.
in physically inactive people
• Location - in the mediastinum between the two
pleural cavities that surround the lungs.
• Orientation - apex (bottom) towards left side
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• located deep to the sternum and extends to the level
of the second intercostal spa
APEX
• The blunt, rounded point of the heart
• directed to the left
• The details about the location & shape of the heart are
important for:
○ Heart sounds
○ ECG placement
○ CPR administration
Heart Coverings
Pericardium / Pericardial sac
• A sac that anchors and protects heart
• Keeps the heart contained in the chest cavity
• Prevents the heart from over expanding when blood
volume increases.
• Limits heart motion.
○ Fibrous pericardium - tough, fibrous connective
tissue outer layer
○ Serous pericardium - the inner layer of flat
epithelial cells, with a thin layer of connective tissue
○ Parietal pericardium - portion of the serous
pericardium lining the fibrous pericardium
○ Visceral pericardium/ Epicardium - the portion
covering the heart surface
• Pericardial cavity
○ located between the visceral and parietal pericardia
○ filled with a thin layer of pericardial fluid produced by
the serous pericardium.
○ The pericardial fluid helps reduce friction as the heart
moves within the pericardium.
Heart Wall Layers
• Epicardium / Visceral pericardium
○ a thin, serous membrane forming the smooth outer
surface of the heart
○ consists of simple squamous epithelium overlying a
layer of loose connective & adipose tissue
○ Function: provides an outer protective layer for the
heart
 • Myocardium Ventricles
○ thick, middle layer composed of cardiac • Discharging/pumping chambers of the heart
muscle cells • The lower two chambers of the heart are called the left
○ Function: responsible for contraction of the ventricle and the right ventricle.
heart chambers ○ Right Ventricle: Receives blood from the right atrium
• Endocardium and pumps it to the pulmonary artery.
○ the smooth inner layer of the heart ○ Left Ventricle: Receives blood from the left atrium
chambers and pumps it to the aorta.
○ Function: allows blood to move easily • Interventricular septum - separates right and left
through the heart ventricles
• Each ventricle contains cone-shaped, muscular pillars called
papillary muscles.
• Chordae tendineae - thin, strong, connective tissue
strings that attach papillary muscles to the free margins of
the cusps of the atrioventricular valves.
• When the ventricles contract, the papillary muscles contract
and prevent the valves from opening into the atria by
pulling on the chordae tendineae attached to the valve
• cusps.

Heart valves
• Flap-like structures that ensure one-way flow of blood
• Four in number
○ Two atrioventricular valves
○ Two semilunar valves
• Atrioventricular valves
○ They are located between the atria and the ventricles
○ The Mitral valve/bicuspid valve is located between
• 4 chambers
the left atrium and the left ventricle.
○ Left atrium (LA)
➢ Function: Prevents the back flow of blood as it
○ Right atrium (RA)
is pumped from the left atrium to the left
○ Left ventricle (LV)
ventricle.
○ Right ventricle (RV)
○ The Tricuspid valve is located between the right
• Coronary sulcus
atrium and the right ventricle.
○ Separates atria from ventricles
➢ Function: Prevents the back flow of blood as it
• Interventricular sulci is pumped from the right atrium to the right
○ Separates right and left ventricles ventricle.
• Semilunar valves
○ The Aortic semilunar valve is located between the
left ventricle and the aorta.
➢ Function: prevents the back flow of blood as it
is pumped from the left ventricle to the aorta.
○ The Pulmonary semilunar valve is located between
the right ventricle and the pulmonary artery.
•
➢ Function: prevents the back flow of blood as it
is pumped from the right ventricle to the
pulmonary artery

Atria
• Receiving chambers of the heart
• The upper two chambers of the heart are called
the left atrium and the right atrium. •
• Function primarily as reservoirs, where blood
returning from veins collects before it enters the
ventricles.
○ Right Atrium: Receives blood returning to
the heart from the superior and inferior
vena cava.
○ Left Atrium: Receives blood returning to the
heart from the pulmonary veins
• Interatrial septum - separates right and left atria

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 Blood a Through the Heart
• The right side works as the pulmonary circuit
pumps
○ Blood flows from the systemic vessels to the
right atrium and from the right atrium to the
right ventricle. From the right ventricle,
blood flows to the pulmonary trunk and
from the pulmonary trunk to the lungs.
• The left side works as the systemic circuit pumps
○ From the lungs, blood flows through the
pulmonary veins to the left atrium, and from
the left atrium, blood flows to the left
ventricle. From the left ventricle, blood
flows into the aorta and then through the
systemic vessels.

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Right atrium
• Receives blood from 3 places
○ Superior vena cava drains blood above
diaphragm (head, neck, thorax, upper limbs)
○ Inferior vena cava drains blood below
diaphragm (abdominopelvic cavity and
lower limbs)
○ Coronary sinus drains blood from
myocardium
Right ventricle
• Opens into pulmonary trunk
Pulmonary trunk
• Splits into right and left pulmonary arteries
Pulmonary arteries
• Carry blood away from heart to lungs
Pulmonary veins
• 4 openings that receive blood from lungs
Left atrium
• receives blood from pulmonary veins
Left Ventricle
• opens into aorta
• thicker, contracts more forcefully
Aorta
• carries blood from left ventricle to body
Blood Supply to the Heart
Coronary arteries
• Supply blood to the wall of the heart
• Originate from the base of the aorta, just above
the aortic semilunar valves
Left coronary artery
• Anterior interventricular artery lies in the anterior
interventricular sulcus
• Circumflex artery extends around the coronary
sulcus on the left to the posterior surface of the
heart
• Left marginal artery extends inferiorly along the
lateral wall of the left ventricle from the circumflex
artery.
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• Right coronary artery
○ Originates on right side of the aorta
• Supply blood to most of the wall of the right ventricle.
○ Posterior interventricular artery lies in the posterior
interventricular sulcus.
○ Right marginal artery extends inferiorly along the
lateral wall of the right ventricle.
Action Potentials in Cardiac Muscle
• Changes in the permeability of the cell membrane produce
action potentials.
• Action potentials in cardiac muscle are prolonged compared
to those in skeletal muscle and have a:
○ Depolarization phase (Na+)
○ Plateau phase (period of slow repolarization) (Ca++)
○ Repolarization phase (K+)
• Prolonged action potential and refractory period allow
cardiac muscle to contract and relax almost completely
before another action potential can be produced.
• The long refractory period in cardiac muscle prevents
tetanic contractions from occurring, thus ensuring a rhythm
of contraction and relaxation for cardiac muscle.
• Refractory period – the period of time, in which the
cardiac cell is unable to initiate another action potential for
some duration of time
Conduction System of Heart
What is it?
• contraction of atria and ventricles by cardiac muscle cells
• made up of sinoatrial node, atrioventricular node,
atrioventricular bundle, right and left bundle branches, and
Purkinje fibers
• SA node produces action potentials that are propagated
over the atria to the AV node.
• AV node and the atrioventricular bundle conduct action
potentials to the ventricles.
• The right and left bundle branches conduct action
potentials from the atrioventricular bundle through
Purkinje fibers to the ventricular muscle.
 • Cardiac Cycle: the repetitive pumping process that begins
with the onset of cardiac muscle contraction and ends with
the beginning of the next contraction
• Cardiac muscle contractions produce pressure changes
within heart chambers.
• Pressure changes are responsible for blood movement.
• Blood moves from areas of high to low pressure.
•
Systole vs Diastole
• Systole and Diastole
○ When used alone, they refer to ventricular
contraction or relaxation.
○ The ventricles contain more cardiac muscle than the
atria and produce far greater pressures, which force
blood to circulate throughout the vessels of the body.

Sinoatrial (SA) node • Atrial systole - contraction of the two atria

• Normal pacemaker of the heart • Ventricular systole - contraction of the two ventricles
• Located in the upper wall of the right atrium • Atrial diastole - relaxation of the two atria
• Cells of the SA node have more voltage-gated ca2+ • Ventricular diastole - relaxation of the two ventricles
channels than do other areas of the heart.
• If unable to function, another area, such as the av Heart sounds
node, becomes the pacemaker → to much slower • Stethoscope was originally developed to listen to the
than normal heart rate. sounds of the lungs and heart and is now used to listen to
• Ectopic beat - results from an action potential that other sounds of the body as well
originates in an area of the heart other than the SA •First heart sound can be represented by the syllable lubb,
node. and the second by dupp
Electrocardiogram (ECG) • Lubb - has a lower pitch than the second; occurs at the
• Record of electrical events within the heart beginning of ventricular systole and results from closure of
• Can be used to detect abnormal heart rates or the AV valves
rhythms, abnormal conduction pathways, • Dupp - occurs at the beginning of ventricular diastole and
hypertrophy or atrophy of the heart, and the results from closure of the semilunar valves
approximate location of damaged cardiac muscle
• Uses electrodes that are placed on the body
• Murmurs
surface and attached to a recording device can
○ Abnormal heart sounds that are usually the result of
detect the small electrical changes resulting from
faulty valves
the action potentials in all of the cardiac muscle
➢ Incompetent valve fails to close tightly
cells.
➢ Blood leaks through the valve when it is closed
• Normal ecg contains:
○ p wave (atrial depolarization)
○ qrs complex (ventricular depolarization)
○ t wave (ventricular repolarization).
PQ interval
• The time between the beginning of the P wave and
the beginning of the QRS complex
• Commonly called the PR interval because the Q •
wave is very small.
• In this interval, the atria contract and begin to
relax.
• At the end of the interval, the ventricles begin to
depolarize.
QT interval
• extends from the beginning of the QRS complex to
the end of the T wave and represents the length of Regulation of Heart Function
time required for ventricular depolarization and • Stroke volume
repolarization ○ Volume of blood pumped per ventricle each time the
heart contracts
Cardiac Cycle ○ 70 ml/beat
• The right and left halves of the heart can be • Heart rate
viewed as two separate pumps. ○ Number of times the heart contracts each minute
• Atria: act as primer pumps because they complete ○ 72 beats/min.
the filling of the ventricles with blood • Cardiac output (CO)
• Ventricles: act as power pumps because they ○ Volume of blood pumped by either ventricle of the
produce the major force that causes blood to flow heart each minute
through the pulmonary and systemic circulations ○ Slightly more than 5 L/min.
○ Co = SV x HR

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 Intrinsic Regulation of Heart
• Regulation mechanisms contained within the heart • Baroreceptors
Venous return
• The amount of blood that returns to heart
Preload
• The degree to which the ventricular walls are
stretched at end of diastole
○ A greater preload causes the cardiac output
to increase because stroke volume
increases.
•
Afterload
• The pressure against which the ventricles must
pump blood.
• People suffering from hypertension have an
increased afterload since their aortic pressure is
elevated during contraction of the ventricles. The
heart must do more work to pump blood from the • Endocarditis
left ventricle into the aorta, which increases the
workload on the heart and can eventually lead to
heart failure.
Starling’s law of the heart
• The relationship between preload and stroke
volume
• As venous return increases, resulting in an
increased preload, cardiac output increases.
• Conversely, if venous return decreases, resulting in
a decreased preload, the cardiac output decreases.
•
Nervous Regulation: Baroreceptor Reflex
○ Stretch receptors that monitor blood pressure in the
aorta and in the wall of the internal carotid arteries,
which carry blood to the brain.
○ Changes in blood pressure result in changes in the
stretch of the walls of these blood vessels and
changes in the frequency of action potentials
produced by the baroreceptors
Baroreceptor Reflex
○ Mechanism of the nervous system which regulates
heart function
○ Detects changes in blood pressure.
○ If blood pressure increases suddenly, the reflex
causes a decrease in heart rate and stroke volume
○ If blood pressure decreases suddenly, the reflex
causes an increase in heart rate and stroke volume.
Chemical Regulation: Chemoreceptor Reflex
• Chemicals can affect heart rate and stroke volume
• Epinephrine and norepinephrine from adrenal medulla can
increase heart rate and stroke volume
• Excitement, anxiety, anger an increase cardiac output
• Depression can decrease cardiac output
• Medulla oblongata has chemoreceptors for changes in ph
and CO2 levels
• Changes in the extracellular conc. Of K+, ca2+, and na+
affect cardiac function
Inflammation of Heart Tissue
○ Inflammation of the endocardium; affects the valves
more severely than other areas of the endocardium;
may lead to scarring, causing stenosed or
incompetent valves
• Pericarditis
○ Inflammation of the pericardium
• Cardiomyopathy
○ Disease of the myocardium of unknown cause or
occurring secondarily to other disease; results in
weakened cardiac muscle, causing all chambers of the
heart to enlarge; may eventually lead to congestive
heart failure
• Rheumatic heart disease
○ Results from a streptococcal infection in young
people; toxin produced by the bacteria can cause
rheumatic fever several weeks after the infection that
can result in rheumatic endocarditis

Reduced Blood Flow to Cardiac Muscle

• Coronary heart disease
○ Reduces the amount of blood the coronary arteries
Extrinsic Regulation of Heart can deliver to the myocardium
• refers to mechanisms external to the heart, such • Coronary thrombosis
as either nervous or chemical regulation. ○ Formation of blood clot in a coronary artery
• Sympathetic stimulation increases stroke volume • Myocardial infarction
and heart rate; parasympathetic stimulation ○ Damaged cardiac muscle tissue resulting from lack of
decreases heart rate. blood flow to the myocardium; often referred to as a
heart attack

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 Congenital Heart Diseases
Septal defect
• Hole in the septum between the left and right
sides of the heart, allowing blood to flow from one
side of the heart to the other and greatly reducing
the heart’s pumping effectiveness
Patent ductus arteriosus
• Ductus arteriosus fails to close after birth, allowing
blood to flow from the aorta to the pulmonary
trunk under a higher pressure, which damages the
lungs; also, the left ventricle must work harder to
maintain adequate systemic pressure
• Regulation mechanisms contained within the heart

Stenosis of the heart valves

• Narrowed opening through one or more of the
heart valves; aortic or pulmonary semilunar
stenosis increases the heart’s workload; bicuspid
valve stenosis causes blood to back up in the left
atria and lungs, resulting in edema of the lungs;
tricuspid valve stenosis results in similar blood
flow problems and edema in the peripheral tissues
Cyanosis
• Symptom of inadequate heart function in babies
with congenital heart disease; the infant’s skin
appears blue because of low O2 levels in the blood
in peripheral blood vessels

Angioplasty
• procedure that opens blocked blood vessels
Stent
• structures are inserted to keep vessels open and
relieve obstruction
Bypass
• procedure that reroutes blood away from blocked
arteries

• By age 70, cardiac output has often decreased by

one-third.
• Hypertrophy of the left ventricle can cause
pulmonary edema.
• Decrease in the maximum heart rate by 30–60%
by age 85 leads to decreased cardiac output.
• The aortic semilunar valve can become stenotic or
incompetent.
• Coronary artery disease and congestive heart
failure can develop.
• Aerobic exercise improves the functional capacity
of the heart at all ages.

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