CARDIAC ANATOMY, PHYSIOLOGY,

AND CARDIAC CYCLE

AYU PUSPITA SARI
FUNCTIONAL ANATOMIC OF THE HEART
Superior and
Inferior
Venae Cavae
All other
tissue of the Right Atrium
body

Right
Aorta
Ventricle

Pulmonary
Left Ventricle
Artery

Left Atrium Lungs

Pulmonary
veins
 NORMAL CARDIAC STRUCTURE AND
FUNCTION
• CARDIAC ANATOMY AND HISTOLOGY
• BASIC ELECTROPHYSIOLOGY
• EXCITATION – CONTRACTION COUPLING
 PERICARDIUM
• Two layers: a strong outer fibrous layer and an inner
serosal layer.
• The inner serosal layer adheres to the external wall of
the heart and is called the visceral pericardium.
• The visceral pericardium reflects back on itself and
lines the outer fibrous layer, forming the parietal
pericardium.
• The space between the visceral and parietal layers
contains a thin film of pericardial fluid that allows the
heart to beat in a minimal-friction environment
 PERICARDIUM
• The pericardium appears to serve three
functions:
(1) it fixes the heart within the mediastinum
and limits its motion,
(2) it prevents extreme dilatation of the heart
during sudden rises of intracardiac volume,
and
(3) it may function as a barrier to limit the
spread of infection from the adjacent lungs.
SURFACE ANATOMY OF THE HEART
• Shaped roughly like a cone
• Four muscular chambers.
• The right and left ventricles are the main
pumping chambers.
• The less muscular right and left atria deliver
blood to their respective ventricles.
• The apex : the tip of the left ventricle, which
points inferiorly, anteriorly, and to the left.
• The base or posterior surface : the atria, mainly
the left, and lies between the lung hila.
SURFACE ANATOMY OF THE HEART
• The anterior surface : Right atrium and
ventricle.
• Because the left atrium and ventricle lie more
posteriorly, they form only a small strip of this
anterior surface.
• The inferior surface (diaphragmatic surface) :
both ventricles, primarily the left. (Fig. 1.2).
SURFACE ANATOMY OF THE HEART
• The right border : Right Atrium, Superior and
Inferior venae cavae.
• The inferior border : mainly by the Right
Ventricle (>>>), Left Ventricle (<<<) near the
apex.
• The left border : Left Ventricle and a portion
of the Left Atrium
• The superior border : both Atria
• Two basic “rules” of normal cardiac anatomy :
(1) right-sided structures lie mostly anterior to
their left-sided counterparts, and
(2) atrial chambers are located mostly to the
right of their corresponding ventricles.
 INTERNAL STRUCTURE OF THE HEART
• 4 major valves in the normal heart direct blood
flow in a forward direction and prevent backward
leakage.
• Atrioventricular valves (tricuspid and mitral)
separate the atria and ventricles
• Semilunar valves (pulmonic and aortic) separate
the ventricles from the great arteries
• All 4 heart valves are attached to the fibrous
cardiac skeleton.
• The cardiac skeleton also serves as a site of
attachment for the ventricular and atrial muscles.
• Endocardium : single layer of endothelial cells,
• Subendocardial tissue : fibroblast, elastic and
collagenous fibers, veins, nerves, and branches of
the conducting system
• Myocardium : the thickest layer, a bundles of
cardiac muscle cells
• External to myocardium : a layer of connective
tissue and adipose tissue through which pass the
larger blood vessels and nerves that supply the
heart muscle
• Epicardium = Visceral pericardium
 RIGHT ATRIUM (RA) AND RIGHT
VENTRICLE (RV)
• Vena Cavae return de-oxygenated blood from systemic
veins to RA
• Coronary Sinus carries venous return from the
coronary arteries
• Tricuspid valve : located in the floor of RA and opens
into the RV.
• Moderator band : a large trabeculae carnae, carries a
component of right bundle branch of the conducting
system to ventricle muscle.
• Three Papillary muscle
• Chorda tendineae
• Contraction of the papillary muscles prior to
other regions of the ventricle tightens the
chordae tendineae, helping to align and
restrain the leaflets of the tricuspid valve as
they are forced closed.
• This action prevents blood from regurgitating
into the right atrium during ventricular
contraction.
• Pulmonic valve : leads to the pulmonary artery,
consists of three cusps attached to a fibrous ring.
• During relaxation of the ventricle, elastic recoil of
the pulmonary arteries forces blood back toward
the heart, distending the valve cusps toward one
another.
• This action closes the pulmonic valve and
prevents regurgitation of blood back into the
right ventricle.
 LEFT ATRIUM AND VENTRICLE
• Entering the posterior half of the left atrium
are the four pulmonary veins (Fig. 1.5). The
wall of the left atrium is about 2 mm thick,
being slightly greater than that of the right
atrium.
• The mitral valve opens into the left ventricle
through the inferior wall of the left atrium.
• The cavity : approximately cone shaped and
longer than that of the right ventricle. In a
healthy adult heart, the wall thickness is 9 to
11 mm, LV = 3x RV
• The LV (see Fig. 1.5B) contains 2 large papillary
muscles, larger, and their chordae tendineae
are thicker than in RV
 CARDIAC VESSELS
• CORONARY ARTERIES
– The heart muscle is supplied with oxygen and
nutrients by the right and left coronary arteries,
which arise from the root of the aorta just above
the aortic valve cusps. After their origin, these
vessels pass anteriorly, one on each side of the
pulmonary artery.
• CORONARY VEINS
– Return blood from myocardial capillaries to the RA
• Right Coronary artery (RCA) :
– Posterior descending artery : supply blood to inferior and
posterior walls of ventricles and posterior 1/3
interventricular septum
– Av nodal artery
• Left Main Coronary Arteries :
– LeftAnteriorDescending (LAD) coronary artery :
• Septal branches that supply anterior 2/3 septum interventricular
• Apical portion of anterior papillary muscle
• Diagonal branches that supply anterior surface of LV
– The circumflex artery :
• Obtuse marginal branches that supply the lateral and posterior
wall of LV
 IMPULSE – CONDUCTING SYSTEM
• Consist of Specialized cells that iniate the heart-beat and
electrically coordinate of the heart chambers
• SA : located to the right of Superior Vena Cava entrance,
normally initiates the electrical impules for contraction.
• AV : lies beneath endocardium in the infero-posterior part
of interatrial septum
• Bundle of His : perforates the interventricular septum
posteriorly  RBB and LBB
• Purkinje fibers : to the ventricular muscle
• Bundle his – Purkinje system transmitted first to the
papillary muscle and then throghout walls of ventricles 
To prevent regurgitation of blood flow through
Atrioventicular valves
Impulse – Conducting System
 CARDIAC INNERVATION
• Both Parasympathetic and Sympathetic afferent and efferent nerves.
• Preganglionic sympathetic neurons :
from upper 5-6 Thoracic levels of Spinal Cord synapse with second-
order neurons in the cervical sympathetic ganglia  Traveling within
the cardiac nerves  these fibers terminate in the heart and great
vessels.
• Preganglionic parasympathetic fibers :
in the dorsal motor nucleus of the medulla  pass as branches of
the vagus nerve to the heart and great vessels  synapse with
second-order neurons located in ganglia within these structures.
• A rich supply of vagal afferents from the inferior and posterior
aspects of the ventricles mediates important cardiac reflexes,
• The abundant vagal efferent fibers to the SA and AV nodes are active
in modulating electrical impulse initiation and conduction.
 HISTOLOGY
VENTRICULAR
MYOCARDIAL
CELLS
ION MOVEMENT AND CHANNELS :
ENERGETICS
PERMEABILITY
RESTING POTENTIAL
 THE CARDIAC CYCLE

• CARDIAC CYCLE
• HEART SOUNDS
– FIRST HEART SOUND (S1)
– SECOND HEART SOUND (S2)
– EXTRA SYSTOLIC HEART SOUNDS
– EXTRA DIASTOLIC HEART SOUNDS
 WHAT IS A CARDIAC CYCLE?
• The cardiac cycle consists of precisely timed
electrical and mechanical events that are
responsible for rhythmic atrial and ventricular
contractions.
• Mechanical systole = phase ventricular
contraction
• Mechanical diastole = phase of ventricular
relaxation and filling
NORMAL CARDIAC CYCLE
 JVP AND ASSESSMENT OF RIGHT
HEART FUNCTION
With no structures impeding blood flow between the internal jugular (IJ) veins and the
superior vena cava and right atrium (RA), the height of the IJ venous column (termed
the “jugular venous pressure,” or JVP) is an accurate representation of the RA
pressure. Thus, the JVP provides an easily obtainable measure of right-heart function.
Typical fluctuations in the jugular venous pulse during the cardiac cycle, manifested
by oscillations in the overlying skin, are shown in the figure (notice the similarity to
the left atrial pressure tracing in Fig. 2.1).
• There are two major upward components, the a and v waves, followed by
two descents, termed x and y.
• The x descent = pressure decline following the a wave,
• The a wave = transient venous distension caused by back pressure from
RA contraction.
• The v wave = to passive filling of the RA from the systemic veins during
systole, when the tricuspid valve is closed.
• The y descent = Opening of the tricuspid valve in early diastole allows
blood to rapidly empty from the RA into the right ventricle; that fall in RA
pressure corresponds to the y descent.
 TECHNIQUE TO MEASURE JVP
• The JVP is measured as the maximum vertical height of the internal jugular vein (in cm) above
the center of the right atrium, and in a normal person is < 9 cm. Because the sternal angle is
located approximately 5 cm above the center of the RA, the JVP is calculated at the bedside
by adding 5 cm to the vertical height of the top of the IJ venous column above the sternal
angle.
• The right IJ vein is usually the easiest to evaluate because it extends directly upward from the
RA and superior vena cava.
• First, observe the pulsations in the skin overlying the IJ with the patient supine and the head
of the bed at about a 45 angle. Shining a light obliquely across the neck helps to visualize the
pulsations. The former is medial to, or behind, the sternocleidomastoid muscle, whereas the
external jugular is usually more lateral.
• If the top of the IJ column is not visible at 45, the column of blood is either too low (below
the clavicle) or too high (above the jaw) to be measured in that position. In such situations,
the head of the bed must be lowered or raised, respectively, so that the top of the column
becomes visible. As long as the top can be ascertained, the vertical height of the JVP above
the sternal angle will accurately refl ect RA pressure, no matter the angle of the head of the
bed.
HEART SOUND
THANK YOU