Cardiac Anatomy

and Physiology
Iris Ken R. Rico, OTRP
Lecturer
 OUTLINE:
 Introduction
 Functions of the Heart
 Size, Form, and Location of the Heart
 Anatomy of the Heart
 Pericardium
 External Anatomy
 Heart Chambers and Internal Anatomy
 Right and Left Atria
 Right and Left Ventricles
 Heart Valves
 Atrioventricular valves
• Tricupsid valve
• Mitral valve
 Semi-lunar valves
• Aortic valve
• Pulmonic valve
 Route of Blood Flow Through the Heart
 Blood Supply to the Heart
 Histology of the Heart
 Heart Wall
 Cardiac Muscle
 Electrical Activity of the Heart
 Action Potentials in Cardiac Muscle
 Conduction System of the Heart
 Electrocardiogram
 Cardiac Cycle
 Heart sounds
 Regulation of Heart Function
 Intrinsic Regulation of the Heart
 Extrinsic Regulation of the Heart
 Control of the Heart by Sympathetic and Parasympathetic
Nerves
 Excitation of the Heart by Sympathetic Nerves
 Parasympathetic (Vagal) Stimulation of the Heart
 Effect of Potassium and calcium Ions on heart Function
 Effect of Potassium Ions
 Effect of Calcium Ions
 Effect of Temperature on Heart Function
 Systems Pathology
 Effects of Aging on the Heart
FUNCTIONS OF THE HEART

Generating blood pressure.

Routing blood.
Ensuring one-way blood flow.
Regulating blood supply.
SIZE, FORM, AND
LOCATION OF THE
HEART
 Blunt cone and size of a closed fist
 > age 65
 Location
 Mediastinum = heart, trachea, esophagus
 Knowledge on the shape and location of the heart
 Lies obliquely in the mediastinum, with its base directed
posteriorly and slightly superiorly and the apex directed
anteriorly and slightly inferiorly
 Apex = directed to the left, approximately 2/3 pf the
heart’s mass, lies left of the midline of the sternum, deep
to the left 5th ICS, approximately 7-9 cm to the left of the
sternum near the midclavicular line
 Base = located deep to the sternum and extends to the
level of the 2nd ICS
 Size/dimensions
 At rest and during exercise
ANATOMY OF THE
HEART
Pericardium

Pericardial cavity
Pericardium or pericardial sac
Two layers:
Fibrous pericardium
Serous pericardium
Parietal pericardium
Visceral pericardium or Epicardium
Pericardial fluid
External Anatomy

Atria (R/L)
Ventricles
Coronary sulcus
Anterior ventricular sulcus
Posterior interventicular sulcus
6 veins that carry blood to the heart
Pulmonary trunk and aorta
Heart Chambers and Internal Anatomy

Right (pulmonic) pump: circulates blood to

the lungs

Left (systemic) pump: circulates blood to

the body
Right Atrium
Thin muscle wall
Most blood flow into the right atrium during
inspiration when RA pressure drops below that
in IVC and SVC (higher to lower pressure)
High flow; low pressure system
Function: Receives unoxygenated blood from
the venous system
Inflow: Superior and inferior vena cava
Outflow: Tricuspid valve
Left Atrium

Slightly thicker than the right atrium

Breathing does not affect filling
Function: Receives oxygenated blood from the
lungs
Inflow: 4 Pulmonic veins
Outflow: Mitral (Bicuspid) valve
Normal filling pressure: 4-12mmHg
Right Ventricle

Function: Delivers unoxygenated blood to the

lungs
Inflow: Tricuspid valve
Outflow: Pulmonic valve
Four muscular bands:
Infundibulum septum
Parietal band
Septal band
Moderator band
Normal systolic pressure: 15– 28mmHg
End diastolic pressure: 0-8mmHg
Left Ventricle

Function: Delivers oxygenated blood to the

body
Inflow: Mitral valve
Outflow: Aortic valve
Normal systolic pressure: 120mmHg (100-140)
End diastolic pressure: 4-12mmHg
Cardiac Skeleton

 Anulus fibrosus – firm anchor to which most of

the heart’s muscles and valves are attached
Gives structure to the heart and acts as an insulator
to ensure that electrical impulses move through the
AV node and bundle only
Consists of tough fibrous rings surrounding the AV
valves, and the bases of the aortic and the
pulmonary trunks connected by the tendon of the
conus
Heart Valves

Atrioventricular valve
Tricuspid valve
Bicuspid or mitral valve

Semilunar valve
Aortic valve
Pulmonary valve
Papillary muscles – contract when
ventricle walls contract
Do not help the valves to close
Pull vanes inward toward the ventricles to
prevent bulging too far backward toward the
atria
Chordae tendinae – connect valve leaflet
to papillary muscles in the ventricles
 Route of Blood
Flow through the
Heart
Blood Supply to the
Heart
Coronary Arteries

Left coronary artery – originates from the

left side of the aorta
3 branches:
Anterior interventricular artery – lies in the anterior
interventricular sulcus
Circumflex artery – extends around the coronary
sulcus on the left to the posterior surface of the heart
Left marginal artery – extends inferiorly along the
lateral wall of the left coronary artery
 Right coronary artery – originates on the right
side of the aorta and extends around the
coronary sulcus on the right to the posterior
interventricular sulcus
 2 branches:
Posterior interventricular artery – lies in the posterior
interventricular sulcus
Right marginal artery – extends inferiorly along the
lateral wall of the right ventricle
 Resting person – heart gives approximately 70%
of its oxygen
Cardiac Veins

Drain blood form the cardiac muscle

Pathways nearly parallel to the coronary
arteries and most drain blood into the
coronary sinus (large vein located within
the coronary sulcus on the posterior
aspect of the heart)
Some drain directly into the right atrium
HISTOLOGY OF
THE HEART
Heart Wall

Epicardium or visceral pericardium

Myocardium
Endocardium
Trabeculae carnea
Cardiac Muscle

Cardiac muscle cell

3 major types of cardiac muscle
Atrial muscle
Ventricular muscle
Excitatory and conducive muscle fibers
Specialized fibers that contract only feebly because
of few contractile fibrils
Physiologic Anatomy
 ELECTRICAL
ACTIVITY OF THE
HEART
Action Potentials in Cardiac Muscle

105 millivolts
After the initial spike, the membrane remains
depolarized for about ___ second in atrial
muscle and ____ second in ventricular muscle
exhibiting a plateau followed by repolarization
Depolarization phase
Early repolarization phase
Plateau phase
Final repolarization phase
What causes the long action potential
and plateau?
2 types of channels
Fast sodium channels
Slow calcium channels
Immediately after the onset of action
potential, permeability of cardiac muscle
for potassium ions decreases about
fivefold
Conduction System of the Heart

Sinoatrial node
Atrioventricular node
Atrioventricular bundle
Right and left bundle branches
Purkinje fibers
Sinoatrial node
Pacemaker of the Heart
Is a small flattened, ellipsoidal strip of specialized
muscle about ___ millimeters wide, ___millimeters
long, and ___ millimeter thick
Located in the superior posterolateral wall of the
right atrium immediately below and slightly lateral to
the opening of the SVC
Generates the normal rhythmical impulse
Sinus nodal fibers connect directly with the atrial
muscle fibers
Ectopic pacemaker
Stokes-Adam syndrome
Atrioventricular node

Located in the posterior wall of the right atrium

immediately behind the tricuspid valve and
adjacent opening of the coronary sinus
Delay transmission of impulse from atria to
ventricles to allow time for atria to empty their
blood into the ventricles before ventricular
contraction begins
Discharge at an intrinsic rhythmical rate
Atrioventricular bundle

Composed of multiple small fascicles passing

through the fibrous tissue separating the atria
from the ventricles
Delay from A-V node to bundle is about 0.13
second
Right and left bundle branches
Purkinje fibers
Very large fibers
Transmit velocity about 6 times that in usual
ventricular muscle and 150 times that in some
A-V nodal fibers
Rapid transmission of action potential
Discharge at an intrinsic rhythmical rate
Electrocardiogram

Recording device that detect the small

electrical changes resulting form the
action potentials in all of the cardiac
muscle cells
Normal ECG consists of:
P wave
Atrial depolarization
QRS complex
Ventricular depolarization
T wave
Ventricular repolarization
 PQ/PR interval – beginning of the P wave and
beginning of QRS complex
Atria contract and begin to relax
End – ventricle begin to depolarize
Normal PQ interval is 0.16 second sometimes
called the PR interval cause the Q wave is
frequently absent
 QT interval – beginning of the QRS complex to
the end of the T wave
Represents the length of time required for
ventricular depolarization and repolarization
0.35 second
CARDIAC CYCLE
Beginning of one heartbeat to the
beginning of the next beat
Includes systole, diastole, and a short
pause called diastasis cordis
Duration depends on heart rate
Entire heart rests for 0.4 seconds
Components of cardiac event:

Ventricular systole
Isometric contraction phase
Rapid ejection phase
Slow ejection phase
Ventricular diastole
Isometric interval phase
Atrial systole phase
Slow ventricular filling phase
Rapid ventricular filling phase
Isometric contraction phase
• Isovolumetric contraction phase = all valves closed and
no ejection of blood
• Beginning of ventricular contraction
• Increase in pressure = AV close
• Atria fills with blood
• Tension is increasing in the muscle but no shortening of
the muscle fibers is occuring
Rapid ejection phase

• Left ventricular pressure exceeds 80mmHg and right

ventricular pressure exceeds 8mmHg = aortic and
pulmonic valves open
• Pouring of blood from atria to ventricles
• 70% emptied during first third of ejection period
Slow ejection phase

• Remaining 30% of blood in the ventricle is emptied

during 2/3 of ejection phase
Isometric interval phase

• A.K.A. - Isovolumetric interval phase

• Relaxation phase and is the beginning of diastole
• Ventricular pressure lower than in the aorta and
pulmonary artery = momentary backflow of blood and
closure of semilunar valves (2nd heart sound)
• Ventricular pressure drops to 00mmHg
Rapid ventricular filling phase

• Ventricular pressure falls below atrial pressure = AV

valves open, blood rushes rapidly from atria to ventricles
Slow ventricular filling phase

• Diastasis or the last part of diastole

• Small amount drain from the lungs and peripheral
circulation into the atria and added to ventricles
• Towards ends= depolarization of atria begins
Atrial systole phase

• Atrial contraction or atrial kick

• 25% more blood to the ventricle during last phase of
ventricular systole
HEART SOUNDS
Stethoscope
First heart sound – “Lubb”
Lower pitch
Occurs at the beginning of ventricular systole
and results form closure of the AV valves
Second heart sound - “Dub”
Occurs at the beginning of ventricular systole
and results from closure of semilunar valves
Murmurs
REGULATION OF
HEART FUNCTION
 Cardiac output (CO) – volume of blood puped by
either ventricle of the heart each minute
CO = SV x HR
 Stroke volume (SV) – volume of blood pumped
per ventricle each time the heart contracts
 Heart rate – number of times the heart contracts
each minute
 Resting conditions – 72 beats/min , SV = 70 mL/
beat, CO – 5040 mL/min
 Athletes - higher SV and lower HR
4 Interrelated factors that govern cardiac
output:

Preload
Afterload
Contractility
Heart rate
Preload
 Ventricular filling
Influenced by the total volume of circulating blood
> venous return > stretch of myocardial fibers
FRANK-STARLING’S LAW = the greater the
myocardial stretch, the greater the force of
contraction
Afterload
Resistance to ejection of blood
Amount of tension the ventricles must develop to
eject the blood through the semilunar valves
Resistance against which the heart must pump the
blood to all parts of the body
Factors causing higher that normal resistance:
• Systemic and pulmonary arterioles
• Increased blood viscosity
• Pulmonary valve stenosis
Contractility

Refers to changes in the force of myocardial

contraction and is a function of the interaction
between the contractile elements
Depends on:
• Amount of contractile proteins
• Presence of ATP and calcium
• Sympathetic stimulation
• Pharmacologic agents
Heart Rate
Influenced by many factors:
• Exercise
• Person’s physical size
• Age
• Gender differences
• Hypotension and hypertension
• ANS via sympathetic and parasympathetic branches
Extrinsic Regulation of the Heart

 Refers to mechanisms external to the heart, such as either hormonal or

nervous regulation
 Baroreceptors
 Plays an important role in regulating the function of the heart
 Are stretch receptors that monitor pressure in the aorta and in the wall
of the internal carotid arteries, which carry blood to the brain
 Changes in blood pressure result in changes in the stretch of the walls
of the blood vessels leading to changes in the frequency of action
potentials produced by baroreceptors
 Chemoreceptors
 Emotions influence heart function by increasing sympathetic
stimulation of the heart in response to exercise, excitement, anxiety,
or anger and by increasing parasympathetic stimulation in response
to depression
 Alterations in body fluid levels of cardon dioxide, pH, and ion
concentrations, as well as changes in body temperature, influence
heart function
Control of the Heart by Sympathetic
and Parasympathetic Nerves

Excitation of the Heart by Sympathetic

Nerves
Strong = increase heart rate from the normal 70
beats for minute to 180 to 200 and rarely 250
beats per minute
Increase force of contraction, increasing the
volume of blood pumped and increasing the
ejection pressure
Increases cardiac output tp twofold to threefold
Parasympathetic (Vagal) Stimulation of
the Heart
Strong = stop heartbeat for a few seconds, but
then the heart usually escapes and beats at a
rate of 20 to 40 beats per minute, 40 % normal
Decrease the strength of heart contraction by
20 to 30%
Decrease heart rate rather than to decrease
greatly the strength of heart contraction
Effect of Potassium and Calcium
Ions on heart Function
Effect of Potassium Ions
Excess potassium
Large quantities = block conduction from atria
to ventricles through the A-V bundle
Elevation to only 8 to 12 mEq/L
Effect of Calcium Ions
Opposite the effect of potassium ions
Effect of Temperature on Heart
Function
 Increased temperature = increased heart rate
 Decreased temperature = decreased heart rate
 Near death due to hypothermia
 Heat
 Contractile strength = enhanced temporarily by a
moderate increase in temperature, but
prolonged elevation exhausts metabolic system
of the heart and causes weakness
EFFECTS OF AGING ON THE HEART

 Gradual changes in function

 Age 70 = decreases approximately 1/3
 Hypertrophy of the left ventricle = increase pressure in
the aorta against which the left ventricle must pump
 Greater amount time to contract and relax, decrease in
maximum heart rate
 Changes in connective tissue of the heart valves = less
flexible and calcium deposits develop
 Increased in cardiac arrhythmias
 Development of CAD and heart failure
 Aerobic exercise
Thank You!