The Heart

Guyton Unit III

Ch 9
Dr. Ebaa Alzayadneh
 Valves (cont.)
• Function of the Papillary Muscles-attach to the AV
valves by the chordae tendineae; prevent the valves
from bulging back into the atria

• Aortic and Pulmonary Artery Valves

a. due to high pressures in the arteries at the end of systole

cause the semilunar valves to snap closed, in contrast to the
much softer closure of AV.
b. Because of smaller openings the velocity of flow is
greater than with the AV valves
b. Due to rapid ejection and closure, is Subject to greater
mechanical abrasion than AVs
c. No chordae tendineae to prevent
• Relationship of Heart Sounds to Heart Beating

a. First sound is closure of the AV valves (low

pitch-long)
b. Second sound is closure of the SL valves(high
pitch-short)Lub-Dub
c. Third: rapid filling of ventricles (v low)

• Work Output of the Heart

a. Stroke work output-amount of energy the heart

converts to work during each heartbeat
b. Minute work output-total amount of energy
converted to work in one minute(SWO*HR)
c. Volume-pressure work and kinetic energy of
blood flow(B mass*V2)
 Graphic Analysis of Ventricular Pumping

Fig. 9.8 Relationship between left ventricular volume and intraventricular pressure during diastole and systole.
Heavy red lines indicate the volume pressure diagram (EW-external work).
 Volume-Pressure Diagram During the Cardiac Cycle

• Phase I: Period of Filling

• Phase II: Period of Isovolumic Contraction

• Phase III: Period of Ejection

• Phase IV: Period of Isovolumic Relaxation

• Preload-the degree of tension on cardiac muscle
when it begins to contract; usually is the end-
diastolic pressure when the ventricle has filled

• Afterload-pressure in the aorta leading from the

ventricle;
EW: represents the net external work output of the ventricle during its contraction
cycle. In experimental studies of cardiac contraction, this diagram is used for
calculating cardiac work output.
 Energy Requirements
• Oxygen Utilization By the Heart

a. 70-90% from the oxidative metabolism of fatty acids

b. 10-30% from lactate and glucose
c. oxygen consumption(OC) of the heart and the chemical energy
expended during contraction are directly related to EW
d. OC has also been shown to be proportional to ( tension-­time
index).
e. tension during contraction is proportional to pressure times the
diameter of the ventricle.
• Efficiency of Cardiac Contraction
a. Most of the chemical energy is converted to heat
WO/Energy exp= efficiency of the normal heart (20-25% max).
As low as 5-10% in heart failure
 Regulation of Heart Pumping

• Intrinsic Regulation of Heart Pumping—Frank-Starling

Mechanism-intrinsic ability of the heart to adapt to
increasing volumes of inflowing blood

a. Within physiologic limits, the heart pumps all the

blood that returns to it by way of the veins
b. Muscle stretches and brought to optimal degree of
overlap for contraction
c. Stretch of the right atrial muscle increases the heart
rate by 10-20%