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

Fig. 9.9
• 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;
 Energy Requirements

• Oxygen Utilization By the Heart

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

b. 10-30% from lactate and glucose

• Efficiency of Cardiac Contracton

a. Most of the chemical energy is converted to heat

b. 20-25% max. efficiency of the normal heart
c. 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%
 Ventricular Function Curves :
Another Way of Expressing the Frank-Starling Mechanism

9.10 Left and right ventricular function curves Fig. 9.11 Normal right and left ventricular output
 Control by the ANS

• Excitation by the Sympathetic Nerves

a. Stimulation can increase heart rate from 70 bpm

to 180-200 bpm
b. Increases the force of contraction two-fold
c. Increases the volume pumped and the ejection
pressure
d. Inhibition decreases the heart rate and strength
of contraction
 ANS Control (cont.)

• Parasympathetic (Vagal) Stimulation

a. Strong stimulation will stop the heart for a few

seconds; then 20-40 bpm
b. Decrease the strength of contraction 20-30%
c. Distributed mainly to the atria
Fig. 9.12 Cardiac sympathetic and parasympathetic nerves
Fig. 9.13 Effect on the cardiac output curve of different degrees
of sympathetic and parasympathetic stimulation
Effects of Potassium and Calcium Ions on Heart Function

• Potassium Ions

a. Excess causes the heart to become flaccid and

dilated and slows heart rate
b. Excess can block conduction through the AV bundle
c. Contraction becomes progressively weaker

• Calcium Ions

a. Excess causes the heart to go to spastic contractions

b. Deficiency causes flaccidity
c. Regulated within a narrow range so seldom
important clinically
 Effect of Temperature on Heart Function

• Effects of Temperature

a. Increase body temperature increases heart rate

b. Decrease body temp. decreases heart rate
c. Contractile strength enhanced by moderate
increases in temperature
d. Prolonged elevation eventually causes weakness