BHARATI VIDYAPEETH (DEEMDED TO BE UNIVERSITY),

COLLEGE OF NURSING,
PUNE
PRACTICE TEACHING
ON
CORONARY CIRCULATION,
CONDUCTION SYSTEM OF HEART AND
CARDIAC CYCLE

SUPERVISED BY
Mrs Shubhangi Borude
BVCON, PUNE

PRESENTED BY:
MS. LOMA R WAGHMARE
F.Y. MSC NURSING (student)
BVCON, PUNE

TOPIC: Coronary circulation, conduction system of heart and cardiac cycle

DATE OF CLINICAL TEACHING: 11.03.21

TIME:

NAME OF GROUP: F. Y. BSc (Nursing)

NAME OF THE EVALUATOR: Mrs. Shubhagi Borude

OBJECTVES

General objectives:

At the end of the practice teaching the students will gain knowledge on Coronary circulation, conduction system of heart and
cardiac cycle and use it in clinical practice.

Specific objectives:

By the end of the class students will be able to

 Elicit the coronary circulation of heart

 Describe the normal conduction system of heart
 Discuss the cardiac cycle

METHOD
 OBJECTIVES TIME CONTENT OF STUDENT AV AIDS EVALUATION
TEACHING ACTIVITY

2 min INTRODUCTION: Questioning Guess the Sound Students are

topic and effect able to identify
The human heart is a muscular organ that is about the size answer the topic for
of a fist. It pumps blood through a set of connections presentation
between arteries and veins, known as the cardiovascular
system. It involves systemic and pulmonary circulation.

The heart is the key organ of the cardiovascular system –

1. Elicit the the body’s transport system for blood. A muscle that
coronary contracts rhythmically and autonomously, it works in
circulation conjunction with an extensive network of blood vessels
of heart running throughout the body. Basically, the heart is a pump
ensuring the continuous circulation of blood in the body.

The heart weighs around 350g and is roughly the size of

an adult’s clenched fist. It is enclosed in the mediastinal
cavity of the thorax between the lungs, and extends
downwards on the left between the second and fifth
intercostal space. If one draws an imaginary line from the
middle of the left clavicle down to below the nipple, this is
where the most forceful part of the heart, the apex beat,
can be felt.

1. Elicit the 15 CORONARY CIRCULATION: Lecture and Listening PPT & Students
coronary min The heart itself requires a richly oxygenated blood supply Discussion and taking chart
circulation to support its activity. This is delivered via the right and left notes
of heart coronary arteries, which lie on the epicardium and
penetrate the myocardium with deeper branches to supply
this highly active layer of muscle.

The right and left coronary arteries arise from vascular

openings at the base of the aorta, called the coronary
Ostia. The left coronary artery runs towards the left side of
the heart, dividing into the left anterior descending artery
and the left circumflex artery. The right coronary artery
runs down the right side of the heart dividing into the
marginal artery (lateral part of the right-hand side of the
heart) and posterior descending artery (supplying the
posterior part of the heart)

The coronary arteries provide an intermittent supply of

blood to the heart, predominantly when the heart is relaxed
(during diastole), as the entrance to the coronary arteries
is open at that point of the cardiac cycle. Table 1 shows
which regions of the heart are supplied by which coronary
arteries.

The venous drainage system of the heart uses the

coronary veins, which follow a course similar to that of the
coronary arteries. The coronary sinus is a collection of
coronary veins (small, middle, great and oblique veins, left
marginal vein and left posterior ventricular vein) that drain
into the RA at the posterior aspect of the heart. Two thirds
of the cardiac venous blood is returned to the heart via the
coronary sinus, while one third is returned directly into the
heart (with the anterior cardiac veins opening directly into
the RA and the smallest coronary veins into all four
chambers).

Table 1: CORONARY ARTERIES AND REGIONAL BLOOD

SUPPLY TO THE HEART

CORONARY ARTERIES ANATOMICAL REGIONS OF

THE HEART SUPPLIED BY
IT

Right coronary artery Inferior aspect

Left anterior descending Anteroseptal and

artery anteroapical aspect

Left circumflex artery Anterolateral aspect

The venous drainage system of the heart uses the

coronary veins, which follow a course similar to that of the
coronary arteries. The coronary sinus is a collection of
coronary veins (small, middle, great and oblique veins, left
marginal vein and left posterior ventricular vein) that drain
into the RA at the posterior aspect of the heart. Two thirds
of the cardiac venous blood is returned to the heart via the
coronary sinus, while one third is returned directly into the
heart (with the anterior cardiac veins opening directly into
the RA and the smallest coronary veins into all four
chambers)

Fig1: Vascular supply to the heart: Arterial supply

Fig1: Vascular supply to the heart: Venous drainage
2. describe the 15 CONDUCTION STSTEM OF HEART: Lecture Listening PPT Students are
normal min and taking able to discuss
conduction The heart is able to contract on its own because it contains notes the conduction
system of specialized cardiac muscle tissue that spontaneously system of
heart forms impulses and transmits them to the myocardium to heart
initiate contraction.

Fig.1 Electrical System of the heart

Fig 2: Conduction System, a series of specialized Cardiac
Muscle Cell

COMPONENTS:

The conducting system of the heart is composed of the

following 5 components:

1. Sinuatrial node (SA node).

2. Atrioventricular node (AV node).

3. Atrioventricular bundle (of His).

4. Left and right branches of bundle (of His).

5. Subendocardial Purkinje fibres.

. SINUATRIAL NODE (SA NODE OR NODE OF KEITH

FLACK)

 It is a small horseshoe-shaped mass having

specialized myocardial fibers, situated in the wall of
the right atrium in the upper part of sulcus
terminalis just below the opening of superior vena
cava.
 It is called pacemaker of the heart since it
generates impulses (about 70/minute).
 It initiates the contraction of cardiac muscle
producing heartbeat.
 The rate at which the SA node generates impulses
is influenced by the autonomic nervous system: •
Sympathetic nervous system – increases firing rate
of the SA node, and thus increases heart rate. •
Parasympathetic nervous system – decreases firing
rate of the SA node, and thus decreases heart rate.
 The flow of impulses causes contraction of the atria
from superior to inferior, forcing blood into the
ventricles. At the same time, the impulses are
carried to the atrioventricular node (AV node).
 There is a brief time delay as the impulses pass
slowly through the AV node, which allows time for
the ventricles to fill with blood

ATRIOVENTRICULAR NODE (AV NODE/NODE OF

TAWARA)

 It is smaller compared to the SA node. – located in

the right atrium near the junction with the
interventricular septum near the opening of the
coronary sinus.
 It conducts the cardiac impulse to the ventricle by
the atrioventricular bundle.
 After the electrical impulses spread across the atria,
they converge at the AV node.
 The AV node acts to delay the impulses by
approximately 120ms, to ensure the atria have
enough time to fully eject blood into the ventricles
before ventricular systole.
 The wave of excitation then passes from the
atrioventricular node into the atrioventricular bundle.

ATRIOVENTRICULAR BUNDLE (OF HIS):

 It begins from AV node, crosses the AV ring and

runs along the inferior part of the membranous part
of the interventricular septum where it divides into
the right and left branches extending inferiorly to the
interventricular septum and superior to the lateral
walls of the ventricles.
 sSince the skeleton (fibrous framework) of the heart
separates the muscles of atria from the muscles of
the ventricles, the bundle of His is the only means of
 conducting impulses from the atria to the ventricles.
 The atrioventricular bundle (bundle of His) is a
continuation of the specialized tissue of the AV
node, and serves to transmit the electrical impulse
from the AV node to the Purkinje fibres of the
ventricles.
 It descends down the membranous part of the
interventricular septum, before dividing into two
main bundles:
Right bundle branch – conducts the impulse to the
Purkinje fibres of the right ventricle
Left bundle branch – conducts the impulse to the
Purkinje fibres of the left ventricle.

LEFT AND RIGHT BRANCHES OF THE BUNDLE (OF

HIS)

 The right branch enters down the right side of the

interventricular septum and after that becomes
subendocardial on the right side of the septum.
 A large part of it continues in the septomarginal
trabeculum (moderator band) to reach the anterior
papillary muscle and anterior wall of the ventricle.
Its Purkinje fibres then spread out underneath the
endocardium.
 The left branch descends on the left side of the
ventricular septum, divides into Purkinje fibres that
are distributed to the septum and left ventricle.
PURKINJE FIBRES:

 The Purkinje fibres (sub-endocardial plexus of

conduction cells) are a network of specialized cells.
They are abundant with glycogen and have
extensive gap junctions.
 These cells are located in the subendocardial
surface of the ventricular walls, and are able to
rapidly transmit cardiac action potentials from the
atrioventricular bundle to the myocardium of the
ventricles. – This rapid conduction allows
coordinated ventricular contraction (ventricular
systole) and blood is moved from the right and left
ventricles to the pulmonary artery and aorta
respectively.

OVERVIEW OF HEART CONDUCTION:

The sequence of electrical events during one full

contraction of the heart muscle:

- An excitation signal (an action potential) is created

by the sinoatrial (SA) node.
- The wave of excitation spreads across the atria,
causing them to contract.
- Upon reaching the atrioventricular (AV) node, the
signal is delayed.
- It is then conducted into the bundle of His, down the
 interventricular septum.
- The bundle of His and the Purkinje fibres spread the
wave impulses along the ventricles, causing them to
contract.

2. Discuss 10 CARDIAC CYCLE Lecture Take notes Students are

the min able to discuss
cardiac DEFINITION: cardiac cycle
cycle “Cardiac cycle refers to the sequence of events that take
place when the heart beats.”

WHAT IS CARDIAC CYCLE?

The cardiac cycle attributes to a comprehensive heartbeat

from its production to the commencement of the next beat.
It comprises diastole, the systole, and the intervening
pause. The occurrence of a cardiac cycle is illustrated by a
heart rate, which is naturally indicated as beats per minute.
A healthy human heart beats 72 times per minute which
states that there are 72 cardiac cycles per minute. The
cardiac cycle involves a complete contraction and
relaxation of both the atria and ventricles and the cycle last
approximately 0.8 seconds.

CARDIAC CYCLE DIAGRAM:

The diagram below represents the different phases of the

cardiac cycle. The atrial systole, ventricular diastole,
ventricular systole and ventricular diastole are clearly
mentioned in the cardiac cycle diagram given below.

Fig 3: Cardiac Cycle

CARDIAC CYCLE PHYSIOLOGY:

The human heart consists of four chambers, comprising

left and right halves. Two upper chambers include left and
right atria; lower two chambers include right and left
ventricles.  The key function of the right ventricle is to
pump deoxygenated blood through the pulmonary arteries
and pulmonary trunk to the lungs. While the left ventricle is
responsible for pumping newly oxygenated blood to the
body through the aorta.
CARDIAC CYCLE PHASES:

Following are the different phases that occur in a cardiac

cycle:

a. Atrial Diastole: In this stage, chambers of the heart

are calmed. That is when the aortic valve and
pulmonary artery closes and atrioventricular
valves open, thus causing chambers of the heart to
relax.
b. Atrial Systole: At this phase, blood cells flow from
atrium to ventricle and at this period, atrium
contracts.
c. Isovolumic Contraction: At this stage, ventricles
begin to contract. The atrioventricular valves, valve,
and pulmonary artery valves close, but there won’t
be any transformation in volume.
d. Ventricular Ejection: Here ventricles contract and
emptying. Pulmonary artery and aortic valve close.
e. Isovolumic Relaxation: In this phase, no blood
enters the ventricles and consequently, pressure
decreases, ventricles stop contracting and begin to
relax. Now due to the pressure in the aorta –
pulmonary artery and aortic valve close.
f. Ventricular Filling Stage: In this stage, blood flows
from atria into the ventricles. It is altogether known
as one stage (first and second stage). After that,
they are three phases that involve the flow of blood
to the pulmonary artery from ventricles.
 DURATION OF CARDIAC CYCLE:

 In a normal person, a heartbeat is 72 beats/minute.

So, the duration of one cardiac cycle can be
calculated as:
 1/72 beats/minute=.0139 minutes/beat
 At a heartbeat 72 beats/minute, duration of each
cardiac cycle will be 0.8 seconds.

Duration of different stages of the cardiac cycle is given

below:

 Atrial systole: continues for about 0.1 seconds

 Ventricular systole: continues for about 0.3 seconds
 Atrial diastole: continues for about 0.7 seconds
 Ventricular diastole: continues for about 0.5 second

2 min CONCLUSION:
In conclusion coronary circulation supplies blood to the
heat. Conduction system is important to pump the blood to
all parts of the body

BIBLIOGRAPHY:
 https://byjus.com/biology/cardiac-cycle/
 https://www.nursingtimes.net/clinical-archive/
cardiovascular-clinical-archive/cardiac-system-1-
anatomy-and-physiology-29-01-2018/
 http://eknygos.lsmuni.lt/springer/675/51-79.pdf
 Peate, Ian; Nair, Muralitharan. Fundamentals of
 Anatomy and Physiology for Student
Nurses Hoboken, NJ: Wiley-Blackwell, 2011
 Montague S.E., Watson R., Herbert R.. Physiology
for nursing practice, 3rd edn. Edinburgh: Churchill
Livingstone, 2005
 Marieb, Elaine N. Essentials of Human Anatomy &
Physiology. Pearson, Boston, 2015