Chapter 1

Anatomy & Physiology

1
 Objectives
˜ Describe the location of the heart.
˜ Distinguish between the apex and base of the heart.
˜ Identify and describe the chambers of the heart and
the vessels that enter or leave each.
˜ Explain stroke volume and ejection fraction.
˜ Describe the structure and location of the
pericardium, epicardium, myocardium, and
endocardium.
˜ Name and identify the location of the atrioventricular
(AV) and semilunar (SL) valves.

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 Objectives
˜ Explain atrial kick.
˜ Discuss the function of the chordae tendineae and
papillary muscles.
˜ Explain how heart sounds are created and their
clinical significance.
˜ Beginning with the right atrium, describe blood flow
through the normal heart and lungs to the systemic
circulation.
˜ Identify the phases of the cardiac cycle.
˜ Name the primary branches and areas of the heart
supplied by the right and left coronary arteries.

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 Objectives
˜ Define the terms acute coronary syndrome,
chronotropy, inotropy, and dromotropy.
˜ Compare and contrast the effects of sympathetic and
parasympathetic stimulation of the heart.
˜ Name the primary neurotransmitter of the
sympathetic and parasympathetic divisions of the
autonomic nervous system.
˜ Describe the effects of stimulation of alpha-receptors,
beta-1-receptors, beta-2-receptors, and dopaminergic
receptors.
˜ Identify and define the components of cardiac output.

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 Location of the Heart
˜ Hollow muscular organ

˜ Lies in the space

between the lungs
(mediastinum) in the
chest

˜ 2/3 lies to left of midline

of sternum

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 Location of the Heart
˜ Apex (lower portion)

˜ Base (upper portion)

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 Size and Shape of the Heart
˜ Cone-shaped muscular organ

˜ Adult heart is:

Ø roughly 5 inches (12 cm) long
Ø roughly 3.5 inches (9 cm) wide
Ø roughly 2.5 inches (6 cm) thick
Ø roughly the size of a fist

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 Heart Chambers
˜ Heart is divided into
four chambers
Ø Two upper chambers =
right and left atria
Ø Two lower chambers =
right and left ventricles

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 Two Functional Pumps
˜ Right side of the heart
Ø Low-pressure system
Ø Pumps venous blood
to lungs

˜ Left side of the heart

Ø High-pressure system
Ø Pumps arterial blood
to systemic circulation

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 Two Functional Pumps
˜ Stroke volume

˜ Ejection fraction

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 Surfaces of the Heart

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 Layers of the Heart Wall
˜ The heart wall is made up of three tissue
layers:
Ø Endocardium
Ø Myocardium
Ø Epicardium

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 Layers of the Heart Wall
˜ Endocardium
Ø Innermost layer
Ø Lines heart’s inner chambers
Ø Continuous with innermost layer of vessels

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 Layers of the Heart Wall
˜ Myocardium
Ø Middle layer
Ø Thick, muscular layer
Ø Responsible for pumping action

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 Layers of the Heart Wall
˜ Epicardium
Ø Also called visceral layer of serous pericardium
Ø External layer of heart
Ø Contains blood capillaries, lymph capillaries, nerve
fibers, and fat

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 Layers of the Heart Wall
˜ Pericardium
Ø Parietal pericardium – rough outer layer
Ø Serous pericardium
Ø Pericardial space contains serous fluid

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 Cardiac Muscle
˜ Heart walls formed by cardiac muscle fibers
Ø Sarcolemma
Ø Myofibrils

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 Cardiac Muscle
˜ Each sarcomere contains two types of
filaments: actin and myosin

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 Cardiac Muscle
˜ Cardiac muscle fibers fit together at junctions
called intercalated disks
Ø Intercalated disks form gap junctions
Ø Function as electrical connections
Ø Allow cells to conduct electrical impulses rapidly

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 Heart Valves

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 Heart Valves
˜ Heart contains four valves
Ø Two sets of atrioventricular (AV) valves
Ø Two sets of semilunar valves

˜ Function
Ø Ensure blood flows in one direction through heart
chambers
Ø Prevent backflow of blood

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 Atrioventricular (AV) Valves
˜ AV valves separate
atria from ventricles

˜ Tricuspid valve
Ø Lies between right
atrium and right
ventricle
Ø Three separate
leaflets

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 Atrioventricular (AV) Valves
˜ Mitral (bicuspid) valve
Ø Has only two cusps
Ø Lies between left atrium and left ventricle

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 Atrioventricular (AV) Valves
˜ Cusps of AV valves are attached to chordae
tendineae
Ø “Heart strings”
Ø Originate from papillary muscles
Ø Serve as anchors

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 Semilunar Valves
˜ Prevent backflow of blood from the vessels
into the ventricles during diastole
Ø Pulmonic valve
Ø Aortic valve

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 Heart Sounds
˜ First heart sound (S1)
Ø Closure of tricuspid and
mitral (AV) valves
Ø “Lubb” in “lubb-dupp”

˜ Second heart sound (S2)

Ø Closure of pulmonic and
aortic (semilunar) valves
Ø “Dupp” in “lubb-dupp”

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 Third Heart Sound (S3)
˜ Associated with ventricular filling
Ø Considered normal in healthy persons younger
than 40 years of age
Ø S1-S2-S3 sequence is called a ventricular gallop
or gallop rhythm
• Ken-tuck-y
• (S1)-(S2)-(S3)

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Blood Flow Through the Heart

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 Cardiac Cycle
˜ Systole
Ø Period during which the
chamber is contracting
and blood is being
ejected

RA, right atrium; RV, right ventricle;

LA, left atrium; LV, left ventricle;
Ao, aorta; PA, pulmonary artery

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 Cardiac Cycle
˜ Diastole
Ø Period of relaxation
during which the
chamber is filling

RA, right atrium; RV, right ventricle;

LA, left atrium; LV, left ventricle;
Ao, aorta; PA, pulmonary artery

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 Atrial Systole and Diastole
˜ Atrial diastole
Ø Blood enters the right atrium
Ø Right atrium fills and distends
• Tricuspid valve opens and the right ventricle fills
• Same sequence occurs a split second earlier in the left
heart
Ø Left atrium receives blood from pulmonary veins
• Mitral valve opens as the left atrium fills
• Blood flows into the left ventricle
˜ Atrial systole
Ø Atrial kick

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 Ventricular Systole and Diastole
˜ Ventricular systole
Ø Blood is propelled through the systemic and
pulmonary circulation
Ø SL valves close

˜ Ventricular diastole
Ø Ventricles begin to passively fill with blood

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 Coronary Arteries

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 Coronary Veins

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 Acute Coronary Syndromes
˜ Arteriosclerosis
Ø Chronic disease of arterial system characterized
by abnormal thickening and hardening of vessel
walls

˜ Atherosclerosis
Ø A form of arteriosclerosis
Ø Thickening and hardening of vessel walls are
caused by a buildup of fatty-like deposits
Ø Buildup results in ↓ blood flow (ischemia)

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 Atherosclerosis
˜ Any artery in the body can develop
atherosclerosis

˜ Coronary artery involvement

Ø Angina (chest pain)

˜ Involvement of arteries of legs

Ø Peripheral vascular disease

˜ Involvement of carotid arteries

Ø TIA

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 Angina Pectoris
˜ Chest discomfort or other related symptoms
caused by myocardial ischemia

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 Common Terms
Patients use to Describe Angina
˜ “Heaviness” ˜ “Burning”
˜ “Pressing” ˜ “Grip-like”
˜ “Suffocating” ˜ “A band across my
˜ “Squeezing” chest”
˜ “Strangling” ˜ “A weight in the
˜ “Constricting” center of my chest”
˜ “Bursting” ˜ “A vise tightening
around my chest”

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Common Sites for Anginal Discomfort

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 Myocardial Ischemia
˜ Imbalance between the metabolic needs of
the myocardium (demand) and the flow of
oxygenated blood to it (supply)

˜ Reduce oxygen demand

Ø Rest
Ø Medications

˜ Increase blood flow

Ø Nitroglycerin
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 Myocardial Injury
˜ Injured cells will die unless blood flow is
quickly restored

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 Myocardial Infarction
˜ Tissue death

˜ Infarcted cells
Ø Cannot respond to an electrical stimulus
Ø Do not provide any mechanical function

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 Heart Rate

Autonomic Nervous System

Sympathetic Parasympathetic

“Fight or Flight” “Rest and Digest”

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 Chronotropic Effect
˜ Refers to a change in heart rate
Ø A positive chronotropic effect refers to an increase
in heart rate
Ø A negative chronotropic effect refers to a decrease
in heart rate

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 Inotropic Effect
˜ Refers to a change in myocardial contractility
Ø A positive inotropic effect results in an increase in
myocardial contractility
Ø A negative inotropic effect results in a decrease in
myocardial contractility

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 Dromotropic Effect
˜ Refers to a change in the speed of
conduction through the AV junction
Ø A positive dromotropic effect results in an increase
in AV conduction velocity
Ø A negative dromotropic effect results in a
decrease in AV conduction velocity

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 Baroreceptors
˜ Also called “pressoreceptors”
Ø Specialized nerve tissue
Ø Found in internal carotid arteries/aortic arch
Ø Detect changes in blood pressure

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 Chemoreceptors
˜ Located in internal carotid arteries and aortic
arch

˜ Detect and respond to changes in:

Ø Oxygen content of blood
Ø pH
Ø Carbon dioxide tension

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 Parasympathetic Stimulation
˜ Major parasympathetic
nerves are the vagus
nerves
Ø One on each side of the
body
Ø Vagus nerves innervate
heart at SA and AV
nodes

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 Parasympathetic Stimulation

˜ Primary
neurotransmitter =
acetylcholine

˜ Main effect =
slowing of heart rate

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 Sympathetic Stimulation

˜ Impulses sent from

accelerator center
in medulla travel
along sympathetic
fibers

˜ Primary
neurotransmitter =
norepinephrine

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 Receptor Sites
˜ Alpha-1 ˜ Beta-2
Ø Eyes, blood vessels, Ø Bronchial smooth
bladder, male reproductive muscle
organs Ø Skeletal blood vessels

˜ Alpha-2 ˜ Dopamine
Ø Digestive system Ø Renal, mesenteric, and
Ø Peripheral nervous system visceral blood vessels

˜ Beta-1
Ø Heart, kidneys

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The Heart as a Pump

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 Venous Return
˜ Most important factor determining amount of
blood pumped by heart

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 Blood Pressure
˜ Blood pressure
Ø Force exerted by circulating blood volume on walls
of arteries

˜ Peripheral vascular resistance

BP = cardiac output (CO) × peripheral vascular resistance

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 Cardiac Output
˜ Volume of blood ejected from the heart over 1
minute

˜ Cardiac output (CO) equals stroke volume

(SV) multiplied by heart rate (HR)
Ø CO = SV × HR

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 Stroke Volume
˜ Amount of blood ejected during one
contraction

˜ Dependent on:
Ø Preload
Ø Afterload
Ø Myocardial contractility

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 Preload
˜ Preload is the force exerted by the walls of
the ventricles at the end of diastole

˜ The volume of blood returning to the heart

(venous return) influences preload
Ø Hypovolemia = decreases preload
Ø Heart failure = increases preload

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 Frank-Starling Law of the Heart

˜ Up to a limit, the more

a myocardial muscle
is stretched, the
greater the force of
contraction (and
stroke volume)
Ø Influenced by preload
and afterload

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 Afterload
˜ The pressure or resistance against which the
ventricles must pump to eject blood
Ø Increased afterload usually means an increase in
the work of the heart

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 Cardiac Output
˜ Affected by change in heart rate OR stroke
volume

˜ Factors that influence heart rate

˜ Factors that affect stroke volume

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 Decreased Cardiac Output
˜ Cold, clammy skin ˜ Changes in mental
˜ Color changes in status
skin, mucous ˜ Changes in blood
membranes pressure
˜ Dyspnea ˜ Dysrhythmias
˜ Orthopnea ˜ Fatigue
˜ Crackles (rales) ˜ Restlessness

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Questions?

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