Human Cardiovascular System

HUMAN ANATOMY
chapter 15
cardiovascular system – the heart
FAMADOR ORGE GENALDO,MD

Chapter 15 – the heart
• Almost 400 years ago, scientists established that the heart’s
pumping action maintains the continuous circulation of blood
throughout the body.
• Our current understanding of the detailed function of this
amazing pump, its regulation, and modern treatments for
heart disease is, in comparison, very recent.
• The heart of a healthy 70 kg person pumps approximately
7200 L (approximately 1900 gallons) of blood each day at a
rate of 5 L/min.
• For most people, the heart continues to pump for more than
75 years.
• During periods of vigorous exercise, the amount of blood
pumped per minute increases dramatically, but the person’s
life is in danger if the heart loses its ability to pump blood for
even a few minutes.
• Cardiology is the medical specialty concerned with
diagnosing and treating heart disease.
• 20.1 Functions of the
Heart
• The heart is actually two
pumps in one.
• The R side of the heart
receives blood from the
body and pumps blood
through the pulmonary
circulation.
• It carries blood to the lungs
and returns it to the L side
of the heart.
Heart
• In the lungs, exchange of
gases occur.
• CO2 diffuses from the
blood into the lungs, and
O2 diffuses from the lungs
into the blood.
Heart
• The L side of the heart
pumps blood through the
systemic circulation.
• It delivers O2 and
nutrients to all the
remaining tissues of the
body.
Heart
• From those tissues, CO2
and other waste products
are carried back to the R
side of the heart.
• 20.1 Functions of the Heart
• The following are the functions of the heart:
o 1. Generating blood pressure.
• Contractions of the heart generate blood pressure, which is
responsible for moving blood through the blood vessels.
• 2. Routing blood.
o The heart separates the pulmonary and systemic
circulations and ensures better oxygenation of the blood
flowing to the tissues.
• 20.1 Functions of the Heart
o 3. Ensuring one-way blood flow.
• The valves of the heart ensure a one-way flow of blood
through the heart and blood vessels.
o 4. Regulating blood supply.
• The rate and force of heart contractions change to meet the
metabolic needs of the tissues, which vary depending on
such conditions as rest, exercise, and changes in body
position.
• 20.2 Size, Shape, and
Location of the Heart
• The adult heart is shaped
like a blunt cone and is
approximately the size of a
closed fist.
• It has an average mass of
250 g in females and 300 g
in males.
• It is larger in physically
active adults than in other
healthy adults.
• The heart generally
decreases in size after
approximately age 65.
• Especially in people who
are not physically active.
• The blunt, rounded point of
the heart is the apex.
• The larger, flat part at the
opposite end of the heart is
the base.
• The heart is located in the
mediastinum.
• It is a midline partition of
the thoracic cavity.
• It also contains the
trachea, the esophagus,
the thymus, and associated
structures.
• It is important for health
professionals to know the
location of the heart in the
thoracic cavity.
• Positioning a stethoscope
to hear the heart sounds
and positioning electrodes
to record an ECG from
chest leads depend on this
knowledge.
• Effective cardiopulmonary
resuscitation (CPR) also
depends on a reasonable
knowledge of the position of
the heart.
• The heart lies obliquely in
the mediastinum.
• Its base is directed
posteriorly and slightly
superiorly.
• While the its apex is
directed anteriorly and
slightly inferiorly.
• The apex is also directed to
the L.
• So that approximately 2/3
of the mass of the heart
lies to the L of the midline
of the sternum.
• The base of the heart is
located deep to the
sternum.
• It extends to the 2nd
intercostal space.
• The apex is located deep to
the 5th intercostal space.
• Approximately 7–9 cm to
the L of the sternum and
medial to the
midclavicular line.
• It is a perpendicular line
that extends down from the
middle of the clavicle.
• 20.3 Anatomy of the
Heart
• Pericardium
• The pericardium, or
pericardial sac, is a
double-layered, closed sac
that surrounds the heart.
• It consists of 2 layers:
o fibrous pericardium -
outer
o serous pericardium -
inner
• 20.3 Anatomy of the Heart
• Pericardium
• The outer layer consists of
a tough, fibrous
connective tissue called
the fibrous pericardium.
• While the inner layer has a
thin, transparent of simple
squamous epithelium
called the serous
pericardium.
• Pericardium
• The fibrous pericardium
prevents overdistension of
the heart .
• It anchors it within the
mediastinum.
• Pericardium
• Superiorly, the fibrous
pericardium is continuous
with the connective tissue
coverings of the great
vessels.
• While inferiorly it is attached
to the surface of the
diaphragm.
• Pericardium
• The part of the serous
pericardium lining the
fibrous pericardium is the
parietal pericardium.
• And the part covering the
heart surface is the visceral
pericardium, or
epicardium.
• Pericardium
• The parietal and visceral
portions of the serous
pericardium are continuous
with each other where the
great vessels enter or leave
the heart.
• Pericardium
• The pericardial cavity is
the space between the
visceral and parietal
pericardia.
• It is filled with a thin layer of
serous pericardial fluid.
• The fluid helps reduce
friction as the heart moves
within the pericardial sac.
• Pericardium
• Even though the
pericardium contains
fibrous connective tissue,
it can accommodate
changes in heart size by
gradually enlarging.
• The pericardial cavity can
also increase in volume to
hold a significant volume of
pericardial fluid.
• Heart Wall
• The heart wall is composed
of 3 layers of tissue:
o epicardium
o myocardium
o endocardium.
• The epicardium or visceral
pericardium, is a thin
serous membrane that
constitutes the smooth, outer
surface of the heart.
• Heart Wall
• The serous pericardium is
called the epicardium
when considered a part of
the heart.
• While it is the visceral
pericardium when
considered a part of the
pericardium.
• Heart Wall
• The thick, middle layer of
the heart, the myocardium
is composed of cardiac
muscle cells.
• It is responsible for the
heart’s ability to contract.
• Heart Wall
• The smooth, inner surface
of the heart chambers is
called the endocardium.
• It consists of simple
squamous epithelium over
a layer of connective tissue.
• The smooth, inner surface
allows blood to move easily
through the heart.
• Heart Wall
• The endocardium also
covers the surfaces of the
heart valves.
• The interior surfaces of the
atria are mainly flat.
• But the interior of both
auricles and a part of the
RA wall contain muscular
ridges called pectinate
muscles.
• Heart Wall
• The pectinate muscles of
the RA are separated from
the larger, smooth portions
of the atrial wall by a ridge
called the crista terminalis.
• Heart Wall
• The interior walls of the
ventricles contain larger,
muscular ridges and
columns called trabeculae
carneae.
• External Anatomy and
Coronary Circulation
• The heart consists of four
chambers:
o R and L atria
o R and L ventricles
• The thin-walled atria form
the superior and posterior
parts of the heart.
• While the thick-walled
ventricles form the anterior
and inferior portions.
• Flaplike auricles are
extensions of the atria that
can be seen anteriorly
between each atrium and
ventricle.
• Several large veins carry
blood to the heart:
o the superior vena cava
o the inferior vena cava
• They carry blood from the
body to the RA
o four pulmonary veins

• They carry blood from the
lungs to the LA.
• In addition, the smaller
coronary sinus carries
blood from the walls of the
heart to the RA.
• Two arteries exit the heart:
o the aorta
o the pulmonary trunk
• The aorta carries blood
from the LV to the body
• While the pulmonary
trunk carries blood from
the RV to the lungs.
• A large coronary sulcus
runs obliquely around the
heart.
• It separates the atria from
the ventricles.
• Two more sulci extend
inferiorly from the coronary
sulcus.
• It indicates the division
between the R and L
ventricles.
• The anterior
interventricular sulcus is
on the anterior surface of
the heart.
• While the posterior
interventricular sulcus is
on the posterior surface of
the heart.
• In a healthy, intact heart,
the sulci are covered by
adipose tissue.
• They can only be seen
when this tissue is
removed.
• The major arteries
supplying blood to the
tissue of the heart lie within
the coronary sulcus and
interventricular sulci on
the surface of the heart.
• The R and L coronary
arteries exit the aorta.
• It is just above the point
where the aorta leaves the
heart and lie within the
coronary sulcus.
• The R coronary artery is
usually smaller in diameter
than the left one.
• It does not carry blood as
much as the L coronary
artery.
• The major branch of the L
coronary artery is called
the anterior
interventricular artery, or
the L anterior descending
artery.
• It extends inferiorly in the
anterior interventricular
sulcus and supplies blood
to most of the anterior part
of the heart.
• The L marginal artery
branches from the L
coronary artery to supply
blood to the lateral wall of
the LV.
• The circumflex artery
branches from the L
coronary artery.
• It extends around to the
posterior side of the heart
in the coronary sulcus.
• Its branches supply blood
to much of the posterior
wall of the heart.
• The R coronary artery lies
within the coronary sulcus.
• It extends from the aorta
around to the posterior
part of the heart.
• A larger branch of the R
coronary artery is called
the R marginal artery.
• Other branches supply
blood to the lateral wall of
the RV.
• A branch of the R coronary
artery is called the
posterior interventricular
artery.
• It lies in the posterior
interventricular sulcus.
• It supplies blood to the
posterior and inferior part
of the heart.
• Most of the myocardium
receives blood from more
than one arterial branch.
• If one artery becomes
blocked, the areas primarily
supplied by that artery may
still receive some blood
through other arterial
branches and
anastomoses.
• Furthermore, there are
many anastomoses, or
direct connections, either
between branches of a
given artery or between
branches of different
arteries.
• Aerobic exercise tends to
increase the density of
blood vessels supplying
blood to the myocardium,
as well as the number and
extent of the anastomoses.
• Consequently, aerobic
exercise increases the
chance that a person will
survive the blockage of a
small coronary artery.
• The blockage of larger
coronary blood vessels still
has the potential to
permanently damage large
areas of the wall of the
heart.
• The major vein draining the
tissue on the L side of the
heart is the great cardiac
vein.
• While a small cardiac vein
drains the R margin of the
heart.
• These the great and small
cardiac veins converge
toward the posterior part of
the coronary sulcus.
• They empty into a large
venous cavity called the
coronary sinus.
• The coronary sinus in turn
empties into the RA.
• A number of smaller veins
empty into the cardiac
veins, into the coronary
sinus, or directly into the
right atrium.
• Blood flow through the
coronary blood vessels is
not continuous.
• When the cardiac muscle
contracts, blood vessels in
the wall of the heart are
compressed, and blood
does not readily flow
through them.
• When the cardiac muscle
is relaxing, the blood
vessels are not com-
pressed, and blood flow
through the coronary
blood vessels resumes.
• In a resting person, blood
flowing through the
coronary arteries gives up
approximately 70% of its
oxygen.
• In comparison, blood
flowing through arteries to
skeletal muscle gives up
only about 25% of its
oxygen.
• The percentage of oxygen
the blood releases to
skeletal muscle can
increase to 70% or more
during exercise.
• Because the percentage of
oxygen delivered to cardiac
muscle is near its maximum
at rest, it cannot increase
substantially during
exercise.
• Therefore, cardiac muscle
requires blood to flow
through the coronary
arteries at a higher rate
than its resting level in order
to provide an adequate
oxygen supply during
exercise.
• Heart Chambers and
Valves.
• Right and Left Atria
• The RA has three major
openings:
o the superior vena cava
o the inferior vena cava
• They receive blood from the
body.
o the coronary sinus
• It receives blood from the
heart itself.
Valves
• The LA has four relatively
uniform openings that
receive blood from the four
pulmonary veins from the
lungs.
• The two atria are
separated from each other
by the interatrial septum.
Valves
• The fossa ovalis is a
slight, oval depression on
the right side of the
septum marking the former
location of the foramen
ovale.
• Foramen ovale is an
opening between the RA
and LA in the embryo and
the fetus.
Valves
• In the fetal heart, this
opening allows blood to
flow from the R to the LA
and bypass the pulmonary
circulation.
Valves.
• Right and Left Ventricles
• The atria open into the
ventricles through
atrioventricular canals.
Valves.
• Each ventricle has one
large, superiorly placed
outflow route near the
midline of the heart.
• The RV opens into the
pulmonary trunk.
• While the LV opens into the
aorta.
Valves.
• Right and Left Ventricles
• The two ventricles are
separated from each other
by the interventricular
septum.
• It has a thick, muscular part
toward the apex and a thin,
membranous part toward
the atria.
Valves.
• The wall of the LV is much
thicker, compared with that
of the RV.
• The thicker wall of the
ventricle allows for
stronger contractions to
pump blood through the
systemic circulation.
Valves.
• Atrioventricular Valves
• An atrioventricular valve
is in each atrioventricular
canal and is composed of
cusps, or flaps.
• AV valves allow blood to
flow from the atria into the
ventricles but prevent
blood from flowing back
into the atria.
Valves.
• The AV valve between the
RA and the RV has three
cusps and is therefore
called the tricuspid valve.
• While the AV valve
between the LA and the
LV has two cusps and is
therefore called the
bicuspid valve, or mitral
valve.
Valves.
• Each ventricle contains
cone-shaped, muscular
pillars called papillary
muscles.
• These muscles are
attached by thin, strong
connective tissue strings
called chordae tendineae
to the cusps of the AV
valves.
Valves.
• The papillary muscles
contract when the
ventricles contract and
prevent the valves from
opening into the atria by
pulling on the chordae
tendineae attached to the
valve cusps.
Valves.
• Blood flowing from the
atrium into the ventricle
pushes the valve open into
the ventricle.
• However, when the
ventricle contracts, blood
pushes the valve back
toward the atrium.
• The atrioventricular canal
is closed as the valve
cusps meet.
Valves.
• Within the aorta and
pulmonary trunk are the
aortic semilunar and
pulmonary semilunar
valves, respectively.
Valves.
• Each valve consists of
three pocketlike semilunar
cusps.
• The free inner borders
meet in the center of the
artery to block blood flow.
• Blood flowing out of the
ventricles pushes against
each valve, forcing it open.
Valves.
• However, when blood flows
back from the aorta or
pulmonary trunk toward the
ventricles, it enters the
pockets of the cusps.
• Causing them to meet in
the center of the aorta or
pulmonary trunk.
• Thus, closing them and
keeping blood from flowing
back into the ventricles.
• 20.4 Route of Blood Flow
Through the Heart
• Even though it is more
convenient to discuss
blood flow through the
heart one side at a time, it
is important to understand
that both atria contract at
about the same time and
both ventricles contract at
about the same time.
Through the Heart
• Blood enters the RA from
the systemic circulation,
which returns blood from all
the tissues of the body.
• Most of the blood in the RA
then passes into the RV as
the ventricle relaxes
following the previous
contraction.
Through the Heart
• Contraction of the RV
pushes blood against the
tricuspid valve, forcing it
closed.
• While pushing blood
against the pulmonary
semilunar valve, forcing it
open.
• Thus, allowing blood to
enter the pulmonary
trunk.
Through the Heart
• The pulmonary trunk
branches to form the
pulmonary arteries.
• They carry blood to the
lungs, where CO2 is
released and O2 is picked
up.
• Blood returning from the
lungs enters the LA
through the four
pulmonary veins.
Through the Heart
• The blood passing from
the LA to the LV opens the
bicuspid valve.
• Contraction of the LA
completes LV filling.
Through the Heart
• Contraction of the LV
pushes blood against the
bicuspid valve, closing it,
• While pushing blood
against the aortic
semilunar valve, opening
it and allowing blood to
enter the aorta.
Through the Heart
• Blood flowing through the
aorta is distributed to all
parts of the body.
• Except to the parts of the
lungs supplied by the
pulmonary blood vessels.
• Conducting System of
the Heart
• A conducting system
relays action potentials
through the heart.
• This system consists of
modified cardiac muscle
cells that form two nodes
and a conducting bundle.
• Conducting System
• The two nodes are
contained within the walls
of the RA and are named
according to their position
in the atrium.
• The sinoatrial (SA) node
is medial to the opening of
the superior vena cava.
• While the atrioventricular
(AV) node is medial to the
right AV valve.
• The AV node gives rise to
a conducting bundle of the
heart, the atrioventricular
(AV) bundle or the bundle
of His.
• This bundle passes
through a small opening in
the fibrous skeleton to
reach the interventricular
septum.
• The bundle of His will
divide to form the right and
left bundle branches.
• They will extend beneath
the endocardium on each
side of the interventricular
septum to the apex of
both the R and the L
ventricles.
• The inferior terminal
branches of the bundle
called Purkinje fibers.
• They are large-diameter
cardiac muscle fibers.
• They have fewer myofibrils
than most cardiac muscle
cells and do not contract
forcefully as other cardiac
muscles.
• Intercalated disks are well
developed between the
Purkinje fibers and contain
numerous gap junctions.
• As a result of these
structural modifications,
action potentials travel
along the Purkinje fibers
much more rapidly than
through other cardiac
muscle tissue.
• Cardiac muscle cells have
the intrinsic capacity to
spontaneously generate
action potentials for
contraction.
• The cells of the SA node
spontaneously generate
action potentials at a greater
frequency than other
cardiac muscle cells.
• Thus these cells are called
the pacemaker of the heart.
• The SA node is made up of
specialized, small-
diameter cardiac muscle
cells that merge with the
other cardiac muscle cells
of the RA.
• Once action potentials
are produced, they spread
from the SA node to
adjacent cardiac muscle
fibers of the atrium.
• Preferential pathways
conduct action potentials
from the SA node to the
AV node at a greater
velocity than they are
transmitted in the
remainder of the atrial
muscle fibers.
• However, such pathways
cannot be distinguished
structurally from the
remainder of the atrium.
• Thus, it is the activity of the
SA node that causes the
heart to contract
spontaneously and
rhythmically.
• When the heart beats
action potentials to travel
from the SA node to the
AV node.
• Within the AV node, action
potentials are propagated
to the remainder of the
conducting system.
• From the AV node action
potentials will pass to the
AV bundle of His.
• Then action potentials pass
through the left and right
bundle branches and
through the individual
Purkinje fibers.
• Purkinje fibers penetrate
the myocardium of the
ventricles.
• The first part of the
ventricular myocardium
that is stimulated is the
inner wall of the
ventricles near the apex.
• This is because of the
arrangement of the
conducting system in the
ventricles.
• Thus, ventricular
contraction begins at the
apex and progresses
throughout the ventricles
toward the base of the
heart.
• The spiral arrangement of
muscle layers in the wall of
the heart results in a
wringing action.
• During the process, the
distance between the apex
and the base of the heart
decreases and blood is
forced upwards from the
apex toward the great
vessels at the base of the
heart.
end of chapter 15
cardiovascular system: the heart
FAMADOR ORGE GENALDO MD
Family Medicine – Army General Hospital
Doctor of Medicine – UV Gullas College of Medicine
Bachelor of Science in Biology – University of San Carlos
fgenaldo@yahoo.com
FB account: Famador Orge Genaldo
• Review Questions:
• 1. Fluids flow through a pipe only if they are forced to do so.
The force is commonly produced by a pump, which
increases the pressure of the liquid at the pump above the
pressure in the pipe. The pump in the cardiovascular
system is the heart. Coming from the systemic circulation,
the blood flows in this direction:
• 2. The cardiovascular system is made up of a pump, the
heart, responsible for the distribution of blood all throughout
the systemic circulation. The heart has four chambers with
valves in between chambers to prevent backflow. This is the
valve between the RA and the RV made up of three cusps
or leaflets:
• 3. The cardiovascular system is made up of a pump, the
heart, responsible for the distribution of blood all throughout
the systemic circulation. The heart has four chambers with
valves in between chambers to prevent backflow. This is the
valve between the LA and the LV made up of two cusps or
leaflets:
• 4. The heart has four chambers with valves in between
chambers to prevent backflow. These valves are attached to
these thin, strong, connective tissue strings at their free
margins of the cusps:
• 5. The cardiac muscle in the wall of the heart is thick and
metabolically very active and therefore requires ample
blood supply. These blood vessels provide pathway for
blood through the heart wall:
• 6. Cardiac muscles can contract without neural stimulations.
Contractions of the atria and the ventricles is coordinated by
specialized cardiac muscle cells in the heart wall that form
the conduction system of the heart. This is the pace maker
of the heart:
• 7. Other cells in the conduction system are also capable of
producing action potentials spontaneously. The resulting
heart rate is much slower than normal. This heart beats will
result when action potentials originate in an area other than
the SA node:
• 8. Cardiac muscle cells are bound end-to-end and laterally
to adjacent cells by specialized cell-to-cell contacts called
the intercalated discs. These are the specialized membrane
structures in the intercalated discs which allow cytoplasm to
flow freely between cells:
• 9. The surface of the interior walls of the ventricles are
modified by these ridges and columns of cardiac muscles:
• 10. The valves of the heart and the aorta prevents the
backflow of blood. These valves separate between the LV
and the aorta allowing one-way flow of blood goin to the
systemic circulation:

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HUMAN ANATOMY

FAMADOR ORGE GENALDO,MD

o four pulmonary veins

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