The 2nd most important organ of the body

The pericardium surrounds the heart Fibrous pericardium: supports the heart and some protection Serous pericardium (parietal /visceral layer)

Epicardium: visceral layer of the serous pericardium. Myocardium: composed of cardiac muscle. Endocardium: squamous epithelium (known as "endothelium).

Heart is composed of 4 chambers (2 atria and 2 ventricles) Atria are somewhat weak (~20%) compared to ventricles 2 pumps or 2 circuits Right side pumps de-oxygenated (pulmonary) blood Left side pumps oxygenated blood (systemic) blood

2 Atrioventricular valves (AV)

The right AV valve (aka tricuspid valve) opens

into the right ventricle.

The left AV valve (bicuspid or mitral valve)

opens into the right ventricle.

Outflow valves

Aortic and pulmonary valves control outflow In contrast of AV valves, outflow valves have firm cusps (semi lunar) Valves open on ventricular ejection and act like sails preventing backflow.

Cardiac muscle (myocytes)

Similar in structure to skeletal muscle, but different as well 1) Electrical connection with other cells 2) Fibers are shorter 3) Fibers tend to branch often 4) Have only 1 nucleus. 5) Some myocytes have the ability to spontaneously depolarize and contract

The heart is an electrical organ able to conduct current orderly through it. SA node: sino arterial node is a pace maker for the atria Current travels from SA node to atrial ventricular node (AV) From AV node to purkinje fibers

Frontal plane

Left atrium

Right atrium 1 SINOATRIAL (SA) NODE 2 ATRIOVENTRICULAR (AV) NODE 3 ATRIOVENTRICULAR (AV) BUNDLE (BUNDLE OF HIS) 4 RIGHT AND LEFT BUNDLE BRANCHES Right ventricle Left ventricle

Anterior view of frontal section

< 1% of cardiac cells are pacemaker cells:

- unstable, higher resting potentials.

Guyton and Hall

- shorter-lasting A.P.s than follower cells. - localized to SA node (~ 75/min), AV node ~0.2 sec after SA

> 99% of cardiac cells are follower cells: - incapable of generating their own A.P.s - all electrically interconnected by gap junctions - relatively long-lasting A.P.s
intercalated disks

Heart is organized into two electrical syncytia - atrial syncytium - ventricular syncytium -connected electrically by the A-V bundle (specialized fibres) -this allows the atria and ventricles to contract uniformly and in synchrony

An ECG: measures electrical changes on the surface of the body due to electrical activity of myocardium. ECG recordings: can quantify and correlate, electrically, the mechanical activities of the heart.
Thus heart health

The major deflections and intervals in a normal ECG include:

P wave - atrial depolarization

P-Q interval ventricles filling

QRS wave - ventricular

Depolarization and
atrial repolarization S-T segment - time it takes to empty the ventricles before they repolarize (the T wave)

T wave- ventricle repolarize

1 Depolarization of atrial contractile fibers produces P wave

Ventricular diastole (relaxation)

Action potential in SA node

0 0.2 Seconds P 2 Atrial systole (contraction)

0.2

0.4

0.6

0.8

Seconds Repolarization of 5 Repolarization of 5 ventricular contractile ventricular contractile fibers fibers produces produces T T wave wave

0 0.2 Seconds 3 Depolarization of ventricular contractile fibers produces QRS complex

0.2 0.4 Seconds

0.6

4 Ventricular systole (contraction)

P Q 0

0.2 0.4 Seconds

0 0.2 0.4 Seconds

Cardiac Conduction

Poll: Any questions ? (no "single" question wi...

The stroke volume (SV) is the volume of blood ejected from the left (or right) ventricle every beat. The cardiac output (CO) is the SV x heart rate (HR).

In a resting male, CO = 70mL/beat x 75 beats/min = 5.25L/min.

On average, a persons entire blood volume flows through the pulmonary and systemic circuits each minute.

Systolic BP is the higher pressure measured during left ventricular systole when the aortic valve is open. Diastolic BP is the lower pressure measured during left ventricular diastole when the valve is closed.

The cardiac reserve (4-5x resting value) is the difference between the CO at rest and the maximum CO The cardiac output is affected by changes in SV,

heart rate, or both.

3 important factors that affect SV :

The amount of ventricular filling before contraction (called the preload)

The contractility of the ventricle The resistance in the blood vessels (aorta) or valves (aortic valve, when damaged) the heart is pumping into

(called the afterload)

The more the heart muscle is stretched (filled) before contraction (preload), the more forcefully the heart will contract.

Starlings Law of the heart (also important in ciruculation)

Heart does not rely on outside nerves for its basic rhythm Modulation of heart rate via sympathetic and parasympathetic innervation

The role of autonomic nervous system input is to regulate changes in blood pressure, blood flow, and blood volume to maintain enough cardiac output to provide for all organs at all times (if possible).

Sympathetic nerves are present throughout the

atria and ventricles.

-increases the heart rate and the strength of myocardiac contraction Various hormones also affect heart rate

Parasympathetic activity slows the heart from its native rate of 100 bpm to about 70-80 in the average adult.

ANS Innervation

Neuronal inputs (types): Arterial Baroreceptors, Arterial Chemoreceptors, and CNS sensors
1) Arterial Baroreceptors really are stretch receptors, very rapid sensors. - localized in 2 specific areas: A) Carotid sinus baroreceptors located in the wall of each internal carotid artery (known as the carotid sinus)

B) Aortic arch baroreceptors at the branch point of the subclavian artery from the systemic aorta

Active Controls on Arterial Blood Pressure: 1. Arterial Baroreceptors

Glossopharyngeal nerve (IX) branch innervates carotid sinus Vagus nerve (X) branch innervates aortic arch

2. Arterial Chemoreceptors (located in carotid bifurcation):

- Do not monitor arterial blood pressure directly

- Respond to changes in O2 availability.

-Interpret low O2 values as low ventilation and low blood flow

Respiratory center
Very strong signal

Sends impulses to the vasomotor center

Increase in ventilation

Activate vasoconstriction Activates cardio-acceleration Activates veno-constriction Mechanism kicks in when MAP is less than 80 mm Hg

3.Central Nervous System Ischemic Response (cerebral ischemia) Decreased blood flow to the vasomotor center causing "nutritional" deficiency (O2 + glucose lack/CO2 + lactic acid excess) -the last ditch response

Consequences: - vasomotor center responds by stimulating maximum vasoconstriction, venoconstriction, & cardioacceleration -massive increase in MAP - MAP can rise to over 350 mm Hg and blood flow to most organs is completely shut down!!

Cushing reaction: usually seen in the terminal stages of acute head injury and may indicate imminent brain herniation

Dr. James Heilman

-occurs when cerebrospinal fluid pressure increases (usually due to brain swelling), thereby reducing blood flow to the brain (remember PT)

Hormonal control of Blood pressure

ADH (vasopressin) mechanism - response is started in the hypothalamus when it detects low blood pressure (Hangover hormone) - ADH - released from pituitary: (1) powerful vasoconstrictor (2) reduces or stops urine production. (3) creates thirst drive.

Renin-angiotensin-aldosterone system - When JGA (of kidney) detect low filtrate interpreted as low blood pressure

- renin is an enzyme released into circulating blood

-renin cleaves angiotensinogen (plasma globulin) to angiotensin I. - Angiotensin Converting Enzyme (ACE) in endothelium of pulmonary vessels converts angiotensin I to angiotensin II, the active form.

- malfunction of this system is a common cause of hypertension renal hypertension.

Compliance

DirectADH, renin-angiotensin

This graph illustrates the time course & potency of various active & passive controls on MAP

Poll: How is my pace now? (more than one answe...

Circulation

Blood supply to heart muscles:

Blood flows from root of aorta to left and right coronary arteries

LCA to anterior interventricular and circumflex branches RCA to marginal and posterior atrioventricular branches

However there are many variations

 Coronary

veins all collect into the coronary sinus

on the back part of the heart:

The coronary sinus empties

into the right atrium

joining the oxygen-depleted blood from the rest of the body.

Next lecture: Chp 21