The Heart

-4 Chambers (in a mammal)

-Beats on its own even if taken out of the human body
-Pumps blood throughout the body; works 24/7
-Heart is posterior to the sternum
-Heart has an apex (bottom part) and a base (is on the top)

-Great vessels are behind the manubrium and majority of the heart sits behind the
body of the sternum
-If heart is in the wrong direction, the lung should be in the wrong direction
-Pericardium has two layers: parietal pericardium and visceral pericardium as well
as a fibrous pericardium. Surface of the heart is of SEROUS membrane/visceral
pericardium (makes heart shiny and slippery by making serous fluid); parietal
captures serous fluid and is continuous with the visceral pericardial fluid. Fibrous
pericardium (outermost), parietal, space around organs (visceral pericardium).

-Heart has pericardial fluid to prevent abrasion and friction between heart and
other organs around it. Heart is anchored to the diaphragm.

-Complications after open heart surgery: pericardium may be inflamed and fluid
may accumulate to compress the heart and it wont beat so well=cardiac tarpenade?

-Pericardium surrounds heart (double layer of fat) has outer fibrous layer and inner
serous layer, which is further divided into parietal and visceral components. The
fibrous is made of dense connective tissue to support and anchor the heart. Fibrous
is continuous with connective tissue around other structures in the region.

-Shiny layer within fibrous is the parietal layer of serous pericardium. Visceral layer
of the serous pericardium forms the outermost layer of the hard wall and is called
the epicardium. The space between the parietal and visceral layers of the serous
pericardium is the pericardial cavity, which has serous fluid. It lubricates the heart.

*Cardiac Tissue
-Cardiac myocytes: a (heart) muscle cell; the heart is feeding all the time and the
cells contract.
-Visceral pericardium on surface of heart; deep to that is the myocardium and that is
the muscle; and the myocytes are wrapped in FASCICLES but the fascicles are
circularly and spirally arranged.
-The heart has circular fascicles and are in the upper two chambers (atria); they
contract and they squeeze down to push blood downwards towards the apex. But
the fascicles within the ventricles are spirally arranged so when they contract, they
TWIST. They twist from the apex up towards the base!



-Inside lining of the heart=endocardium; it is a simple squamous epithelium.
Connective tissue=fibroelastic skeleton of the heart.

-Functions of the fibroelastic skeleton: gives the heart structure and it anchors heart
in place, prevents your valves from moving around or shifting every contraction.
Prevents heart from overstretching.

-300 beats per minute=fibrillation
-Enlarged heart=is like a pair of overstretched socks; its enlarged due to
overstretching=poor elastic recoil. This leads to congestive heart failure.
-surrounding all cells=fibroelastic skeleton.

-The actual cells, like skeletal muscles, are multinucleated; but much shorter (dont
run whole muscle length), branched (unlike skeletal cells), striated (like skeletal
muscle cells), heart also has sarcomeres, tropomyosin, etc.
+Intercalated disks: helps anchor cells to each other; they have gap junctions to
allow for cell contents to pass. These contents are various electrolytes, ions like Ca
and Na, K. This means that cardiac myocytes work like dominoes with
contraction=they can communicate due to gap junctions.

-Superficial most layer=parietal per, serous, visceral, myo, endo
-epicardium=visceral

-the blood that goes through your heart doesnt keep your heart alive; blood coming
from elsewhere keeps your heart alive. Left side=oxygen rich blood. Hearts
alternative blood source=in coronary arteries.

-Coronary arteries: supply nourishment to the myocardium; provide 02 rich blood
to the heart and are highly branched!
-Cardiac veins=drain blood from outside the heart
-Coronary sulcus=where coronary arteries run; groove between atria and ventricle
-Shallower groove between two ventricles=interventricular sulcus
-The coronary arteries have names: 2 main arteries that come off the aorta: right
coronary artery and left coronary artery, both branch out: branch of right=marginal
artery->posterior side of the heart branch->terminates into interventricular sulcus-
>posterior interventricular artery

-left coronary artery->behind pulmonary trunk->splits into->circumflex artery(goes
down left side of the heart) OR the anterior interventricular artery (goes down to
the anterior interventricular sulcus)

-Two terms: stenosis and ischemia=result of stenosis=insufficient blood flow=leads
to myocardial infarction (MI)=heart attack (know these terms regarding coronary
arteries);
+Treatment options for stenosis: cardiac catheterization (angioplasty) and
CABBAGE=coronary artery bypass graft
-Cardiac Veins=drain blood; drain into the coronary sinus which empties into the
right atrium. Oxygen poor-venous side of the heart.

-Cardiac veins: small, middle, and the great cardiac vein
-Great Cardiac Vein: alongside anterior interventricular artery; it goes around next
to the circumflex artery (left side of the heart) and empties into the coronary sinus.

-Middle Cardiac vein runs along posterior interventricular artery

-R and L coronary arteries bring 02 blood; (Of RCA) Marginal artery=supplies R
ventricle and travels towards apex; RCA terminates at the posterior interventricular
artery=brings blood into R and L ventricle

-LCA=brings 02 rich blood to left side of the heart, branches from the aorta; one of
its branches, Anterior inteventricular artery gives off arterial branches that supply
both ventricles; circumflex follows coronary sulcus and supplies both L atrium and L
ventricle.

-Venous drainage is collected into the coronary sinus on the posterior surface of the
heart on the coronary sulcus.
-Great Cardiac Vein: lies near the anterior interventricular artery; gets blood from
both ventricles; travels from apex towards coronary sinus
-Small cardiac vein: drains right margin of the heart
-Middle Cardiac vein: gets venous blood from both ventricles

-Right atrium walls you open up: has pectinate muscles to strengthen it
-Right ventricle: you open up and you see trabeculae carnae (meaty trabeculae); soft
spongy bone; gives this ventricle extra strength
-A wall that separates the two ventricles=interventricular septum (keeps blood from
mixing)
-Between two atria is a wall called interatrial septum.
-Heart strings=chordae tendonae; anchors the heart valve into the papillary muscle
-Left side=02 rich blood; Right side=02 poor blood

-Muscle cells that dont contract=1% of your myocardia=electrical cells of the
heart=autorhythmic cells.
+many are found in the walls of the heart; generates heartbeats
+Electrical signals go down to the AV node, between the R A and RV. These signals
are sent through more cells called the AV bundle, which goes through the
interventricular septum, where autorhythmic cells split to form bundle branches.
When they reach the apex, the bundle branches continue along the lateral side of the
ventricle and those cells are Purkinje fibers.

-Nerves that run along medulla oblongata can control heart rate and contractions!


-PMO=Paetent foreamen ovale=its been closed=keeps blood going
unidirectional=separation of oxygenated blood
+not closed=blood can cross atria

-Paetent ductus arteriosis=goes from pulmonary arc to aorta; you get less blood
going to lungs and more to your system?

-Holes close up how? Disconnection from umbilicus=momentary drop in
BP=collapses the vessels and close off the opening=seal off flap

-Ductus arteriosis=when its open; ligamentum arteriosum -when its closed in
adults

Heart Valves

-At rest, blood flows into the atria and down to ventricle and then the atria contract
and push the blood down to ventricles and then the ventricles contract and push
blood up through pulmonary trunk through lungs and through the aorta through
systemic circuit. Atria contract simultaneously and so do ventricles.

-When blood is pushed up out of the heart but isnt pushed back to the atria due to
valves. When the heart is done pushing blood up, valves close to prevent backflow.

-4 valves: 1 in each chamber; AV valves between atria and ventricles; semilunar:
point where blood leaves ventricles; right side semilunar separates right V from
pulmonary trunk, left side semilunar separates LV and the aorta.

-Semilunar valves=pulmonary semilunar/aortic semilunar
-AV valves have names: RAtrioventricular valve=tricuspid; LAV=bicuspid (mitral)

-LAB RAT=Left Atrium Bicuspid, Right Atrium Tricuspid
-Label 19.15?

-Pulmonary and aortic semilunar=have three cusps
-Pulmonary trunk is anterior to the aorta
-Bicuspid=has two cusps; the flaps are made differently
-There is a split second when all valves are closed but in reality they arent all closed

-When a heart is in diastole (rest)=no chamber contracting, blood fills chamber
through from atria to ventricles, AV valves opened and semilunar valves are closed.
When heart is relaxed, ventricle access is closed.

-In systole, ventricles are contracting so valve to the atria are closed; blood is getting
pushed out of the heart.


-Cusps are anchored via chordae tendonae to the papillary muscles
-Because the lungs and aorta dont produce pressure, theres not a lot of pressure
going back to the heart, so they dont need to have chordae tendonae

-Closing of the valves sound: the first closing of the valve=LUB=AV valves
closing=ventricular contraction; second sound=semilunar valve closing=close
before atrium contracts=end of contraction

-if lub WERE dub, what valve fails to close=AV valve so blood is going back to the
atrium everytime her ventricles contract

-A prolapse=inverted, leaky valve
-Whistling sound=valve not closing all the way; roaring sound=incompetent valve

-If the sound occurs between the beginning and end of contraction not due to valves,
whats the problem? Maybe a hole between your ventricles=ventricular septal defect

-Transposition of the great vessels=aorta and pulmonary trunk are transposed; this
can be fixed in utero or upon birth via surgery
+so rich blood comes from the lungs to the heart=problem=no blood going to the
body

-semilunar valves prevent backflow from?
-AV valves prevent backflow from?