Chapter 18 - The Heart Study Guide: Save Date: Wednesday, March 25, 2009 4:18:00 PM

Chapter 18 The Heart Study Guide Part 1
Wednesday March 25, 2009
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Chapter 18 The Heart

Study Guide
Location of the heart
Mediastinum is the body cavity between the lungs where the heart lies
About two-thirds of the heart is to the left of the midline
Apex of the heart points to the left hip and contacts the chest wall. This is where
it is easiest to feel the heart beat.
Structures around the heart
Fibrous pericardium dense connective tissue layer protects and anchors the heart and
prevents overfilling
Serous pericardium double-walled membranes within the fibrous pericardium
Serous fluid is between the layers
Inflammation between the layers can create painful adhesions
Excess fluid from inflammation can actually inhibit pumping. This is
cardiac tamponade
The heart is a pair of pumps working in a coordinated way
The right side pumps blood to the lungs - pulmonary circuit
The left side pumps blood to the body - systemic circuit
Cardiac muscle
cells are interconnected by connective tissue fibers that form a fibrous skeleton of
the heart. The fibers and muscles are arranged in spiraling bundles. This
arrangement creates a wringing action of the heart when it contracts.
Wringing action of the ventricles ejects blood superiorly into the arteries leaving
the ventricles
Chambers of the heart
Atria deoxygenated blood from the body enters the right atrium. Oxygenated blood
from the lungs enters the left atrium. The two atria are relatively small and have
relatively thin walls.
Ventricles the right ventricle pumps blood to the lungs and is relatively thin-walled
The left ventricle pumps blood to the body and is much more thick-walled.
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Valves
Tricuspid or right atrioventricular valve connects the right atrium to the right
ventricle
Left atrioventricular valve is also called the bicuspid or mitral valve. It
connects the left atrium to the left ventricle.
Semilunar valves - have three cusps or cup-like structures
Pulmonary semilunar valve - leads from the right ventricle to the
pulmonary trunk (artery)
Aortic semilunar valve - leads from the left ventricle to the body
Definitions of artery and vein
Artery takes blood away from the chambers of the heart
Vein - brings blood back to the chambers of the heart
When you look at the heart as it beats, contraction of the two sides is almost
simultaneous (left side leads slightly)
The two atria fill with blood
When pressure increases enough the AV valves open
Ventricles begin to fill with blood
Contraction of the atria sends more blood through
The valves close
There is a pause that
Gives the atrioventricular valves time to close
And is the hearts only chance to rest
The ventricles contract and propel blood into the large blood vessels at the heart
Trace the path of a single drop of blood through the heart
Dont lose sight of the overall purpose to send oxygenated blood to the body.
The heart collects blood from the body (both above and below the heart), sends it
to the lungs for oxygen, and then distributes it to the body.
Deoxygenated blood from the superior and inferior vena cava enter the right
atrium
When there is enough pressure, the tricuspid valve opens and lets blood flow
into the right ventricle.
The right atrium contracts to push more blood through.
Papillary muscles connected to chordae tendinae pull the tricuspid valve
closed
The right ventricle contracts and sends blood through the pulmonary semilunar valves to the pulmonary artery and to the lungs. As the ventricle relaxes,
pressure drops and blood flows backwards through the pulmonary artery to
close the semilunar valve.


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Blood returns from the lungs through the pulmonary veins

The pulmonary veins empty into the left atrium
When there is enough pressure, the bicuspid (mitral) valve opens and lets blood
flow into the left ventricle.
The left atrium contracts to push more blood through.
Papillary muscles connected to chordae tendinae pull the bicuspid valve
closed.
The left ventricle contracts, forcing blood through the aortic semilunar valve to
the aorta and to the body. As the ventricle relaxes, pressure drops and blood
flows backwards through the aorta to close the semilunar valve.
Note for study: For the lecture test, you are responsible for all the information
above. For the quiz on tracing a single drop of blood through the heart, the
minimum you must include to avoid losing points is the structures below.
1. Begin with blood returning from the body through the superior and
inferior vena cavae
2. right atrium
3. tricuspid valve (or right atrioventricular valve)
4. right ventricle
5. pulmonary semilunar valve
6. pulmonary trunk (artery)
7. pulmonary veins
8. left atrium
9. bicuspid (mitral or left atrioventricular valve)
10. left ventricle
11. aortic semilunar valve
12. aorta
Diastole and Systole
Diastole is a general term for relaxation of either atria or ventricles.
Systole is a general term for contraction of either atria or ventricles.
When speaking of diastolic and systolic pressure of the heart, these terms refer to the
ventricles.
Ventricular diastole is diastolic blood pressure.
Ventricular systole produces the systolic blood pressure.


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Cardiac output
Some blood remains in the ventricle after it contracts
The cardiac output is the difference between the amount of blood that enters (end
diastolic) and the amount that is left (end systolic)
Usually, output is constant
Factors that affect output
Exercise because it returns more blood to the right atrium
Strength of cardiac muscle contraction is strongest
when cardiac muscle is stretched (because contractile
proteins have the most overlap at a certain level of
stretching)
Anything that increases resistance to flow especially back
pressure due to stiff valves or arteriosclerosis at the aorta
Anything that increases heart rate without increasing the
strength of a contraction, especially heart arrhythmias
The heart itself must be supplied with blood
Right and left coronary arteries branch at the base of the aorta and become
Anterior and posterior interventricular coronary arteries supply blood to the heart itself.
The coronary sinus is a vein that drains blood from the myocardium into the right atrium.
Angiogenesis the creation of new blood vessels - can occur to compensate for poor
flow
Importance of stress tests
Stress tests can find blockage before it kills
A radiotracer such as thallium can reveal blockage
Abnormal flow that only appears during exercise is
probably blockage
Abnormal flow appearing during rest and exercise may
be due to scar tissue
Angina pectoris transient insufficient oxygen may be due to stress- induced
spasms of arteries, physical exertion
Myocardial infarction oxygen deficit kills some cells. Heart cells are probably
amitotic. Noncontractile scar tissue forms.
Layers of the heart wall (under the fibrous pericardium)
The visceral layer of the serous pericardium
Endocardium epithelial tissue covers valves too and is continuous with epithelial
lining of the blood vessels leaving the heart
Myocardium the muscular layer
Intercalated discs consist of two kinds of junctions
Desmosomes are protein rivets that help distribute stress
Gap junctions connect muscle cells with protein tunnels and help the heart act as
a coordinated unit

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Anatomy of nodes autorhythmic or pacemaker cardiac cells

All muscle cells of the heart are excitable. They communicate by action potentials
- nerve impulses. Some specialized noncontractile cells the nodes set the rhythm of
contractions. Pacemakers are autorhythmic and not contractile. That is they
spontaneously go through depolarization and repolarization at a certain pace.
Depolarization when a cardiac muscle cell is stimulated by another cardiac cell or by
the nervous system, it becomes very permeable to sodium and calcium. This influx of
sodium and calcium makes the cell membrane more positive. This influx of sodium and
calcium spreads from cell to cell it is the way cardiac muscle cells communicate. When
the membrane reaches a threshold positive charge, the membrane becomes more
permeable to potassium and repolarization occurs - potassium flows out of the cell
making it more negative until the muscle cell reaches its resting charge.
In the heart, it takes a little longer to initiate a new influx of sodium and calcium. That is,
the heart has a longer refractory period when it can not initiate a new impulse at the
same point. This slowness helps coordinate contractions.
SA node sinoatrial node is located in the right atrium near the superior vena cava. It
determines heart rate normally. Normal rhythm is called sinus rhythm.
AV node is located in the right atrium just above the tricuspid valve near the septum
between atria.
Bundle of His (AV bundle) located superiorly between the ventricles
Purkinje fibers complete the path through the interventricular septum and then turn
superiorly into the ventricular walls
Sequence of activation of pacemaker cells
Beat starts at SA node in the right atrial wall just inferior to superior vena cava.
Excitation (depolarization) spreads across the two atria.
The AV in the inferior part of interatrial septum delays the impulse allowing atria to
finish contracting before ventricles contract. The AV has smaller fibers and fewer gap
junctions.
Bundle of His superior part of interventricular septum distributes to lower ventricle
Bundle of His (atrioventricular bundle) divides into two branches that travel down the
septum. Excitation follows the two branches of the bundle of His (bundle branches) and
travels to the apex of the heart.
Purkinje distribute the signal up the ventricles from the apex.
EKG electrocardiogram or ECG (K is from the Greek kardia) This is a graph that
represents the overall, net electrical changes in the heart due to changes of ions (action
potentials).
The P wave represents depolarization of the atria - depolarization immediately precedes
contraction.
The QRS wave represents depolarization of the ventricles.
The T wave represents repolarization of the ventricles.
Repolarization of the atria is masked by the larger QRS wave.

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In the case of a defective SA node, the AV node, which has a much slower intrinsic beat
may direct the rhythm of the heart. Or an ectopic (in the wrong place) node may develop.
Ectopic nodes can develop even when the SA node is functioning
Damage to the AV node is called heart block because the AV node is the only point of
communication between the atria and the ventricles.
Arrhythmias
Atrial flutter an ectopic pacemaker in the right atrium results in about 300 beats/min
for atria and about 150/min for the ventricles. Atrial flutter may be the result of heart
damage such as congestive heart failure or may occur in an otherwise healthy heart.
Chances of having atrial flutter increase with age. Atrial flutter can be treated with drugs
- beta blockers or calcium blockers - or by ablating the abnormal circuit.
Atrial fibrillation is a dangerous condition that renders the heart useless as a pump.
An electric shock is used to depolarize the entire myocardium and to re-establish normal,
or sinus rhythm.
Factors that affect the heart rate and/or strength of contractions

Notice that these two factors are normally inter-related. If you increase heart rate
without increasing the strength of contractions, then the cardiac output (volume of blood
leaving the heart with each beat) is less with each beat.
The main factor that affects strength of contraction and heart rate is the amount of
blood returning to the heart. Normally, this increase in blood flowing into the heart
occurs during exercise. Stretching the heart muscle slightly causes it to contract with
greater force.
Bainbridge effect is a sympathetic nervous system response to increased venous
return and atrial stretching. Atrial stretch receptors activate the
sympathetic
nervous system and increase both heart rate and the strength of
contractions.
Sympathetic and parasympathetic nervous systems
Both stimulate the heart continuously
Sympathetic increases and parasympathetic decreases heart rate.
The parasympathetic usually dominates and slows the SA node to about
75 beats/min. When the vagus nerve, a parasympathetic nerve, is cut, the
heart beats at about 100 beats/min
The heart is said to have vagal tone because the vagus nerve of the
parasympathetic nervous system usually regulates heart beat
Epinephrine - from the adrenal medulla - and norepinephrine - from the
sympathetic nervous system - increase heart rate and the strength of contractions
Thyroxine increases the effect of epinephrine and norepinephrine on the heart
Chronic hyperthyroidism leads to a weakened heart.


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Ion concentrations affect heart

Calcium is involved in action potentials and as a signal for contraction
within individual cells
Potassium - potassium outflow occurs during repolarization
Too little or too much of either can lead to weak or irregular heart beats
Back pressure from the aorta, for instance due to arteriosclerosis, reduces stroke
volume and the heart compensates by increasing contractility and heart rate.
Heat
Higher body temperatures increase heart rate by increasing metabolic
rates of cardiac cells. A high fever produces a rapid, weak heart beat.
Abnormally fast heart rate is tachycardia - over 100 beats/min
Slow heart rate under 60 beats/minute is bradycardia - can be due to cold or due to
endurance exercise
Normal heart rate 72 -80 beats/min for women and slightly slower for men
Congestive heart failure

Normally, equal volumes of blood are pumped by the right and left heart
Failure of one side results in fluid build-up of the other system.
Failure of the right side results in systemic fluid build-up and swollen ankles, feet and
fingers
Failure of left side results in pulmonary congestion


Chapter 18 - The Heart Study Guide: Save Date: Wednesday, March 25, 2009 4:18:00 PM

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Chapter 18 The Heart Study Guide Part 1

Wednesday March 25, 2009