Chapter 12

Cardiovascular System:
The Heart

Reporters:
Azuga, Andrea
Balbalosa, John Christopher
Mateo, Pinky
Vidal, Ziraili Oriel
Introduction
The Heart
Functions:

1. Generating blood pressure

2. Routing blood

3. Ensuring one-way blood flow

4. Regulating blood supply

Types of Circulation
1. Pulmonary Circulation –
pumps deoxygenated blood
from the right side of the heart
to the lungs and oxygenated
blood back to the left side of
the heart.

2. Systemic Circulation – pumps

oxygenated blood from the left
side of the heart to different
parts of the body and
deoxygenated blood back to
the left side of the heart.
Size, Form, and Location of
the Heart
The heart is approximately the size
of a closed fist

Apex – blunt, rounded point of the

heart
Base – larger, flat part at the
opposite end of the heart
Mediastinum – central portion of
the thoracic cavity
Pericardial cavity – cavity that
surrounds the heart
Why is it important to know
the location of the heart?
- Stethoscope placement

- Electrocardiograms

- Cardiopulmonary resuscitation
(CPR)
Anatomy
of the
Heart
 Pericardium
- The pericardium- is a membrane, or sac, that surrounds your heart
- The heart lies in the pericardial cavity.
Two layers of pericardium:
1). Fibrous pericardium- is the outer layer of the
pericardium and is composed of tough, fibrous connective tissue.
2). Serous pericardium - is the inner layer and consists of flat epithelial cells with thin layer

of connective tissue.
Composed of two parts:
● parietal pericardium- lines the fibrous pericardium
● visceral pericardium- covers the heart surface
 Pericardium
-The pericardial cavity, located between the visceral and parietal pericardia, is
filled with a thin layer of pericardial fluid produced by the serous pericardium.
DISORDERS OF THE PERICARDIUM:
● Pericarditis - is an inflammation of the serous pericardium. The
cause is frequently unknown, but it can result from infection, diseases of connective
tissue, or damage due to radiation treatment for cancer.
● Cardiac tamponade- is a potentially fatal condition in which fluid or blood
accumulates in the pericardial cavity and compresses the heart from the outside.
Pericardium
 External Anatomy

● Right and left atria- are located at the base of the heart
● Right and left ventricles- extend from the base of the heart
toward the apex
● Coronary sulcus - extends around the heart, separating the atria
from the ventricles.
● Anterior interventricular sulcus- is on the anterior surface of
the heart
●Posterior interventricular sulcus- is on the posterior surface of
the heart
 External Anatomy

● Superior vena cava and inferior vena cava- carry blood from the body
to the right atrium.
● Pulmonary veins- carry blood from the lungs to the left atrium
● Pulmonary trunk- a short artery transporting deoxygenated blood
from the heart towards the lungs
● Pulmonary arteries- transport deoxygenated blood from the right side
of the heart to the lungs for oxygenation
● Aorta- carries blood to the rest of the body
Heart Chambers and Internal Anatomy
 Heart Chambers and Internal Anatomy

Four chambers:
●right atrium
● left atrium
● right ventricle
● left ventricle
 Heart Chambers and Internal Anatomy

Right and Left Atria

- Blood enters the atria of the heart through blood vessels called
veins.

FUNCTION: primarily as reservoirs, where blood returning from veins

collects before it enters the ventricles.

The right atrium receives blood from three major openings:

superior vena cava, inferior vena cava, and coronary sinus.
 Heart Chambers and Internal Anatomy

- The left atrium receives blood through the four

pulmonary veins, which drain blood from the lungs.

● The two atria are separated from each other by a

partition called the
interatrial (between the atria) septum.
 Heart Chambers and Internal Anatomy

Right and Left Ventricle

-The ventricles of the heart are its major pumping chambers.
-They eject blood into the arteries and force it to flow through the
circulatory system.
●Right ventricle pumps blood into the pulmonary trunk
●Left ventricle pumps blood into the aorta
- two ventricles are separated from each other by the muscular
interventricular (between the ventricles) septum
 Heart Chamber and Internal Anatomy

Right and Left Ventricle

- The wall of the left ventricle is thicker than the wall of the right
ventricle.

Left Ventricle- contracts, the pressure increases to approximately 120

mmHg.
Right Ventricle- contracts, the pressure increases to approximately 24
mmHg or one-fifth of the pressure in the left ventricle.
What is a heart valve?
• Your heart is a muscle that
pumps blood throughout your
body. Heart valves are parts of
your heart that act like doors.
They open and close to let blood
flow from one area of your heart
to another. They help ensure that
blood moves at the right time
and in the correct direction. As
the valves open and close, they
create two sounds, which are
your heartbeat.
• The Valves of the Heart
are present in 2 pairs:
- (a) A pair of
Atrioventricular valves,
bring blood to
ventricles.
- (b) A pair of Semilunar
valves, drain blood
from the ventricles.
 Antrioventricular Valves
•  The left and right atria communicate
with the left and right ventricles via left
and right atrioventricular orifices,
respectively.
• The atrioventricular valves are located
between the atria and the ventricles.
They close during the start of ventricular
contraction (systole), producing the first
heart sound.
• The left and right atrioventricular orifices
are guarded by the left and right
atrioventricular valves respectively:
– A. TRICUSPID VALVE(RIGHT AV VALVE)
– B. BICUSPID OR MITRAL VALVE(LEFT AV
VALVE)
Surface Anatomy of the Heart Valves
The Surface markings of the heart
valves are as follows
• The tricuspid valve lies behind the right
half of the sternum opposite the 4th
intercostal space.
• The bicuspid valve lies behind the left half
of the sternum opposite the 4th costal
cartilage.
• The pulmonary valve lies behind the
medial end of the third left costal
cartilage and the adjoining part of the
sternum.
• The aortic valve lies behind the left half of
the sternum opposite the 3rd intercostal
space.
 AV Valves
•  The mitral and tricuspid valves are
supported by the attachment of fibrous
cords (chordae tendineae) to the free
edges of the valve cusps.
• The chordae tendineae are attached to
papillary muscles, located on the
interior surface of the ventricles
• The papillary muscles prevent the
prolapse of atrio-ventricular valves into
the atria during ventricular systole.
• The rupture of a papillary muscle will
enable the prolapse of the affected cusp
to take place into the atrium at every
systole.
 A. Right atrioventricular valve (tricuspid valve) 

• As the name indicates it is 3 cusps

anterior, posterior and septal, which
is located against the 3 walls of the
ventricle.
• located between the right atrium
and the right ventricle (right
atrioventricular orifice).
• It consists of three cusps (anterior,
septal and posterior), with the base
of each cusp anchored to a fibrous
ring that surrounds the orifice.
• The tricuspid valve can admit the
tips of 3 fingers.
 B. Left atrioventricular valve
(bicuspid/mitral valve)
• located between the left atrium and the
left ventricle (left atrioventricular
orifice).
• It is also known as the bicuspid valve
because it has two cusps (anterior and
posterior).
• Like the tricuspid valve, the base of
each cusp is secured to fibrous ring that
surrounds the orifice.
• As the name indicates it is 2 cusps a
larger anterior/aortic cusp and a smaller
posterior cusp.
• The mitral/bicuspid valve can admit the
tips of 2 fingers.
 SEMILUNAR VALVES
• The left and right ventricles pump out blood
via pulmonary and aortic orifices,
respectively.
• Each of these orifices is guarded by 3
semilunar cusps thus these are referred to as
semilunar valves.
• Both aortic and pulmonary valves are quite
similar to every other in structure and
functions.
• Every valve has 3 cusps that are connected
directly to the wall of aorta/pulmonary trunk.
– (Note: these don’t have fibrous ring quite
similar to tricuspid and mitral valves)
• The cusps of semilunar valves are open and
stretched during ventricular systole and
closed during ventricular diastole to prevent
regurgitation of the blood into the ventricle
 Structure
• The pulmonary and aortic valves have a
similar structure. The sides of each valve
leaflet are attached to the walls of the
outflow vessel, which is slightly dilated
to form a sinus.
• Semilunar valves are formed of 
connective tissues. They are located at
the end of the pulmonary artery and the
aorta at their intersection with
the left and right ventricles. They protect
the point of attachment of the
pulmonary artery and aorta with the
ventricles, thus, preventing the blood to
flow in the wrong direction. As a result
of their fusion, a small part of the
arterial wall is considered a ventricular
structure.
Pulmonary valve
• located between the right ventricle and the
pulmonary trunk (pulmonary orifice).
• The valve consists of three cusps:
– Left, Right and Anterior
• Blood passes from from right atrium to right
ventricle & follows U-shaped path to pass through
pulmonary orifice.
Aortic valve
• located between the left ventricle and the ascending
aorta (aortic orifice).
• The aortic valve consists of three cusps:
– Right, Left and Posterior.
• The left and right aortic sinuses mark the origin of
the left and right coronary arteries.
• As blood recoils during ventricular diastole, it fills
the aortic sinuses and enters the coronary arteries to
supply the myocardium.
ROUTE OF BLOOD FLOW THROUGH THE
HEART
What is the role of blood flow
through the heart?
Blood flow is described for the
right and then the left side of the
heart, it is important to understand
that both atria contract at the same
time, and both ventricles contract
at the same time. This concept is
most important when considering
the electrical activity, pressure
changes, and heart sounds.
1 Blood enters the right atrium from
the systemic circulation through the
superior and inferior venae cavae, and
from heart muscle through the
coronary sinus.
2 Most of the blood flowing into the
right atrium flows into the right
ventricle while the right ventricle
relaxes following the previous
contraction.
3 Following right atrial contraction, the
right ventricle begins to contract. This
contraction pushes blood against the
tricuspid valve, forcing it closed.
4 The pulmonary trunk branches to
form the right and left pulmonary
arteries, which carry blood to the lungs,
where CO2 is released and O2 is picked
up
5 oxygenated blood the left atrium
through the four pulmonary veins.
6 Most of the blood flowing into the
left atrium passes into the left
ventricle while the left ventricle
relaxes following the previous
contraction.
7 Following left atrial contraction, the
left ventricle begins to contract. This
contraction pushes blood against the
bicuspid valve, forcing it closed.
8 Blood flowing through the aorta is
distributed to all parts of the body,
except to those parts of the lungs
supplied by the pulmonary blood
vessels.
BLOOD SUPPLY TO THE HEART
WHAT IS THE BLOOD
SUPPLY TO THE HEART?
The right and left coronary arteries supply
blood to your heart. They're the first
branches off the aorta, which is the main
artery in your body. These arteries and their
branches supply all parts of the heart
muscle with blood.
BLOOD SUPPLY TO THE HEART
CORONARY ARTERIES
• The coronary arteries originate from the base of the aorta,
just above the aortic semilunar valves.
• The left coronary artery originates on the left side of the
aorta. It has three major branches:
- The anterior interventricular artery lies in the anterior
interventricular sulcus.
- The circumflex artery extends around the coronary sulcus
on the left to the posterior surface of the heart.
- And the left marginal artery extends inferiorly along the
lateral wall of the left ventricle from the circumflex artery.
• The right coronary artery originates on the right side of the
aorta. It extends around the coronary sulcus on the right to
the posterior surface of the heart and gives rise to the
posterior interventricular artery, which lies in the posterior
interventricular sulcus.
• The right marginal artery extends inferiorly along the
lateral wall of the right ventricle. The right coronary artery
and its branches supply most of the wall of the right
ventricle.
 CARDIAC VEINS
• Cardiac Veins The cardiac veins
drain blood from the cardiac
muscle. Their pathways are
nearly parallel to the coronary
arteries, and most of them
drain blood into the coronary
sinus, a large vein located
within the coronary sulcus on
the posterior aspect of the
heart. Blood flows from the
coronary sinus into the right
atrium. Some small cardiac
veins drain directly into the
right atrium.
Histology
of the
Heart
Heart Wall

• The heart wall is composed of three layers of tissue:

Epicardium
Myocardium
Endocardium
Epicardium
• Also called the visceral pericardium.
• A thin serious membrane forming the outer smooth surface of the
heart.
• It consist of simple squamous epithelium overlying a layer of loose
connective tissue and adipose tissue.
Myocardium
• Is the thick middle layer of the heart that composed of
cardiac muscle cells.
• The myocardium is responsible for contraction of the heart
cambers.
Endocardium
• Is the smooth inner surface of the heart which consists of simple
squamous epithelium over a layer of connective tissue.
• It allows blood to move easily through the heart.
• The heart valves are formed by folds of endocardium that include a
thick layer of connective tissue.

• The surfaces of the interior walls of the ventricles are modified by

ridges and columns of cardiac muscle called trabeculae.
Cardiac muscle
• Cardiac muscle tissue is found ONLY in the heart.
• Cardiac muscle cells are elongated, branching cells that contain one, or
occasionally two, centrally located nuclei.
• Cardiac muscle cells contain actin and myosin myofilaments
organized to form sarcomeres, which are joined end-t-end to form
myofibrils.
• Actin and Myosin myofilaments are responsible for muscle
contraction.
• Cardiac muscle cells are called
cardiomyocytes (or cardiocytes).

• These cells make up the myocardium,

the muscle layer of the heart.
Skeletal muscle contracts on a voluntary basis
(when you consciously want it to move).

Cardiac muscle contracts on an involuntary basis

(without your conscious control) via the
autonomic nervous system.
Skeletal muscle is long and cylindrical
in shape. It contains multiple nuclei that are
scattered around the peripheral portion of
the muscle cells.

Cardiac muscle is shorter with an irregular,

branched appearance. It contains only
1-2 nuclei, which are located near the center
of the cell.
• Cardiac muscle cells are joined together by something called
intercalated discs, which are absent in skeletal muscle tissue.

These intercalated discs form an

interlocking zigzag connection between
the individual cardiac muscle cells.

They consist of three types of cell junctions:

desmosomes, fasciae adherens, and gap junctions.
• Desmosomes act as binders during contraction, supporting the
filaments in adjoining cardiac cells to prevent separation.
• Fasciae adherens work to connect and bind cardiac muscle cells by
adhering to the actin filaments.
• Gap junctions are the channels between adjoining cardiac cells that
allow for the rapid passage of ions from once cell to the next, resulting
in depolarization and contraction, which causes cardiac muscle cells to
contract simultaneously
Electrical Activity
of the
Heart
Action Potentials in Cardiac Muscle
Phases:
Phase 0 - Depolarization phase
Phase 1 – Initial Repolarization
Phase 2 – Plateau Phase
Phase 3 – Rapid Repolarization
Phase 4 – Resting Potential
Conduction System of Heart
Specialized cardiac muscle cells form
the conduction system of the heart.
It is the network of nodes, cells and
signals that controls your heartbeat.
Each time your heart beats, electrical
signals travel through your heart.
These signals cause different parts of
your heart to expand and contract.
The Conduction System is composed of the:
- Sinoatrial (SA) Node
- Atrioventricular (AV) Node
- Atrioventricular (AV) bundle or
Bundle of His
- Right and Left bundle branches
- Purkinje Fibers
Conduction System of Heart
Sinoatrial (SA) Node
- Heart’s pacemaker
- Initiates heart contraction
- Located in the superior wall of the right
atrium
- Produces action potentials at a faster rate
than other areas of the heart
- Has a larger number of Ca2+ channels
than other cells in the heart
Atrioventricular (AV) Node
- Located in the lower portion of the right
atrium
- Action potentials spread slowly when they
reach the AV node and transmit into the
Atrioventricular (AV) Bundle.
- The slow rate of action potential
conduction allows the atria to complete
contraction before action potentials are
delivered to the ventricles
Conduction System of Heart
The AV bundle divides into two branches of
conducting tissue, called the left and right
bundle branches.

Purkinje fibers
- Located at the tips of the left and right
bundle branches
- Small bundles of conducting tissue
Conduction System of Heart
Complications of the Conduction System
Ectopic beat Defibrillation is thus used to stop the
- Action potentials originate in an area other process of fibrillation.
than the SA node It basically restarts the heart.
- Causes very small portions of the heart to
contact rapidly and independently of all
other areas. This condition is called
fibrillation.
Fibrillation is fatal.
- Reduces heart output to a few milliliters of
blood per minute.
- Unless stopped, the person dies in a few
minutes.
Electrocardiogram

Electrocardiogram (ECG/EKG)
- The record of electrical events in the heart

Consists of:
- P wave (Atrial depolarization)
- QRS complex (Ventricular depolarization)
- T wave (Ventricular repolarization)
Cardiac Cycle
Cardiac Cycle
• The term cardiac muscle refers to repetitive pumping process that
begins with the onset of cardiac muscle contraction.
• Pressure changes produced within the heart chambers as a result of
cardiac muscle contraction move blood from areas as of higher
pressure to areas of low pressure.
• Atria act as primer pump because they complete the filling of the
ventricles with blood.
• Ventricles act as power pumps because they produce the major force
that causes blood to flow through the pulmonary and systemic
circulations.
• Atrial systole refers to contraction
of two atria.
• Ventricular systole refers to contraction
of the two ventricles.
• Atrial diastole refers to relaxation
of the two atria.
• Ventricular diastole refers to relaxation
of the two ventricles.
1. Blood returning to the heart first enters the atria. Since the AV valves are open, blood flows into the
ventricles, filling them to approximately 70% of their volume.
2. Atrial systole – The atria contract, forcing additional blood to flow into the ventricles to complete their
filling. The semilunar valves remain closed.
3. Ventricular systole – at the beginning of ventricular systole, contraction of the ventricles pushes blood
toward the atria, causing AV valves to close as the pressure in the ventricles begins to increase.
4. As ventricular systole continues, the increasing pressure in the ventricles exceeds the pressure in the
pulmonary trunk and aorta, the semilunar valves are forced open, and blood is ejected into the
pulmonary trunk and aorta.
5. Ventricular diastole – At the beginning of ventricular diastole, the pressure in the ventricle decreases
below the pressure in the aorta and pulmonary trunk. The semilunar valves close and prevent blood
from flowing back into the ventricles. As diastole continues, the pressure continues to decline in the
ventricles until atrial pressure are greater than ventricular pressures. Then the AV valves open, and
blood flows directly from the atria into the relaxed ventricles.
Sounds of the
Heart
Heart Sound

Stethoscope - originally developed to listen to the sounds of the lungs

and heart and is now used to listen to other sounds of the body as well.

TWO TYPES OF HEART SOUND:

1. Syllable Lubb- first heart sound
2. Dupp- second heart sound
● The first heart sound has a lower pitch than the second.
Heart Sound
Ventricular systole- occurs between the first and second heart sounds.
Ventricular diastole- occurs between the second heart sound and the
first heart sound of the next beat.

● Heart valve does not close completely and thus is called an

incompetent valve.
● Abnormal heart sounds called murmurs
● When the opening of a valve is narrowed, or stenosed a swishing
sound precedes closure of the
stenosed valve.
Heart Sound
Regulation of
Heart Function
Effects of Aging
on the Heart
 How Your Heart Changes with Age

• People age 65 and older are much more likely than

younger people to suffer a heart attack, to have a
stroke, or to develop coronary heart disease
(commonly called heart disease) and heart failure.
Heart disease is also a major cause of disability,
limiting the activity and eroding the quality of life of
millions of older people.
• Aging can cause changes in the heart and blood
vessels. For example, as you get older, your heart
can't beat as fast during physical activity or times of
stress as it did when you were younger. However,
the number of heartbeats per minute (heart rate) at
rest does not change significantly with normal aging.
• Heart disease develops
when plaque builds up in
the coronary arteries,
reducing blood flow to your
heart muscle. Over time,
the heart muscle can
become weakened and/or
damaged, resulting in heart
failure. Heart damage can
be caused by heart attacks,
long-standing hypertension
and diabetes, and chronic
heavy alcohol use.
Check Your Blood Pressure
• As you get older, it's important for you to
have your blood pressure checked
regularly, even if you are healthy. This is
because aging changes in your arteries
can lead to hypertension. You may feel
fine but, if not treated, high blood
pressure could lead to stroke and
problems with your heart, eyes, brain, and
kidneys. To manage high blood pressure,
exercise, dietary changes, and reducing
your salt intake can help, but as aging
changes in the arteries often cause high
blood pressure in older age, medication is
often necessary. It is not uncommon to
need more than one medication to
control your blood pressure.
Signs of Heart Disease
Early heart disease often doesn't have symptoms or the symptoms
may be barely noticeable. That's why regular checkups with your
doctor are important. Contact your doctor right away if you feel
any chest pain, pressure, or discomfort. However, chest pain is a
less common sign of heart disease as it progresses, so be aware of
other symptoms. Tell your doctor if you have:
• Pain, numbness, and/or tingling in the shoulders, arms, neck,
jaw, or back
• Shortness of breath when active, at rest, or while lying flat
• Chest pain during physical activity that gets better when you
rest
• Lightheadedness
• Dizziness
• Headaches
• Cold sweats
• Nausea/vomiting
• Tiredness or fatigue
• Swelling in the ankles, feet, legs, stomach, and/or neck
• Reduced ability to exercise or be physically active
What Can I Do to Prevent Heart Disease?
There are many steps you can take to keep your
heart healthy.
• Try to be more physically active. Talk with your
doctor about the type of activities that would be
best for you. If possible, aim to get at least 150
minutes of physical activity each week. Every day
is best. It doesn't have to be done all at once.
• Start by doing activities you enjoy—brisk walking,
dancing, bowling, bicycling, or gardening, for
example. Avoid spending hours every day sitting.
•  If you smoke, quit. Smoking is the leading cause
of preventable death.
• Follow a heart-healthy diet. Choose foods that are
low in saturated fats, added sugars, and salt. As
we get older, we become more sensitive to salt,
which can cause swelling in the legs and feet. Eat
plenty of fruits, vegetables, and foods high in fiber,
like those made from whole grains.
• Keep a healthy weight. Balancing the calories you
eat and drink with the calories burned by being