The Cardiovascular System:

The Heart
Anatomy

1
 Heart Anatomy
• Approximately the size of your fist
• Location
– Superior surface of diaphragm
– Left of the midline
– Anterior to the vertebral column, posterior to the
sternum

2
Heart Anatomy

3
 Coverings of the Heart: Anatomy
• Pericardium – a double-walled sac around
the heart composed of:
1. A superficial fibrous pericardium
2. A deep two-layer serous pericardium
a. The parietal layer lines the internal surface of the
fibrous pericardium
b. The visceral layer or epicardium lines the surface of
the heart
• They are separated by the fluid-filled pericardial
cavity

4
Coverings of the Heart: Physiology
• The Function of the Pericardium:
– Protects and anchors the heart
– Prevents overfilling of the heart with blood
– Allows for the heart to work in a relatively friction-
free environment

Chapter 18, Cardiovascular System 5

Pericardial Layers of the Heart

6
 Heart Wall
• Epicardium – visceral layer of the serous
pericardium
• Myocardium – cardiac muscle layer forming
the bulk of the heart
• Fibrous skeleton of the heart – crisscrossing,
interlacing layer of connective tissue
• Endocardium – endothelial layer of the inner
myocardial surface

7
 External Heart: Major Vessels of the
Heart (Anterior View)
• Vessels returning blood to the heart include:
1. Superior and inferior venae cavae
2. Right and left pulmonary veins
• Vessels conveying blood away from the heart include:
1. Pulmonary trunk, which splits into right and left
pulmonary arteries
2. Ascending aorta (three branches) –
a. Brachiocephalic
b. Left common carotid
c. Subclavian arteries
Chapter 18, Cardiovascular System 8
 External Heart: Vessels that
Supply/Drain the Heart (Anterior View)

• Arteries – right and left coronary (in

atrioventricular groove), marginal, circumflex,
and anterior interventricular arteries
• Veins – small cardiac, anterior cardiac, and
great cardiac veins

Chapter 18, Cardiovascular System 9

External Heart: Anterior View

Chapter 18, Cardiovascular System

Figure 10
18.4b
 External Heart: Major Vessels of the
Heart (Posterior View)
• Vessels returning blood to the heart include:
1. Right and left pulmonary veins
2. Superior and inferior venae cavae
• Vessels conveying blood away from the heart
include:
1. Aorta
2. Right and left pulmonary arteries

Chapter 18, Cardiovascular System 11

 External Heart: Vessels that
Supply/Drain the Heart
(Posterior View)
• Arteries – right coronary artery (in
atrioventricular groove) and the posterior
interventricular artery (in interventricular
groove)
• Veins – great cardiac vein, posterior vein to
left ventricle, coronary sinus, and middle
cardiac vein
Chapter 18, Cardiovascular System 12
External Heart: Posterior View

Chapter 18, Cardiovascular System 13

Figure 18.4d
Gross Anatomy of Heart: Frontal
Section

Chapter 18, Cardiovascular System

Figure 14
18.4e
 Atria of the Heart
• Atria are the receiving chambers of the heart
• Each atrium has a protruding auricle
• Pectinate muscles mark atrial walls
• Blood enters right atria from superior and
inferior venae cavae and coronary sinus
• Blood enters left atria from pulmonary veins

Chapter 18, Cardiovascular System 15

 Ventricles of the Heart
• Ventricles are the discharging chambers of the
heart
• Papillary muscles and trabeculae carneae
muscles mark ventricular walls
• Right ventricle pumps blood into the pulmonary
trunk
• Left ventricle pumps blood into the aorta

Chapter 18, Cardiovascular System 16

 Myocardial Thickness and Function

Thickness of myocardium varies according to the function of the

chamber
Atria are thin walled, deliver blood to adjacent ventricles
Ventricle walls are much thicker and stronger
– right ventricle supplies blood to the lungs (little flow resistance)
– left ventricle wall is the thickest to supply systemic circulation

Chapter 18, Cardiovascular System 17

 Thickness of Cardiac Walls

Myocardium of left ventricle is much thicker than the right.

Chapter 18, Cardiovascular System 18

Atrial Septal Defect

Chapter 18, Cardiovascular System 19

Ventricular Septal Defect

Chapter 18, Cardiovascular System 20

 Pathway of Blood Through the Heart
and Lungs
• Right atrium  tricuspid valve  right ventricle
• Right ventricle  pulmonary semilunar valve 
pulmonary arteries  lungs
• Lungs  pulmonary veins  left atrium
• Left atrium  bicuspid valve  left ventricle
• Left ventricle  aortic semilunar valve  aorta
• Aorta  systemic circulation

Chapter 18, Cardiovascular System 21

Pathway of Blood Through the Heart
and Lungs

Chapter 18, Cardiovascular System

Figure2218.5
 Coronary Circulation
• Coronary circulation is the functional blood
supply to the heart muscle itself
• Collateral routes ensure blood delivery to
heart even if major vessels are occluded

Chapter 18, Cardiovascular System 23

Coronary Circulation: Arterial Supply

Chapter 18, Cardiovascular System 24

Figure 18.7a
Coronary Circulation: Venous Supply

Chapter 18, Cardiovascular System 25

Figure 18.7b
 Heart Valves
• Heart valves ensure unidirectional blood flow
through the heart
• Atrioventricular (AV) valves lie between the
atria and the ventricles
– AV valves prevent backflow into the atria when
ventricles contract
• Chordae tendineae anchor AV valves to papillary
muscles

Chapter 18, Cardiovascular System 26

 Heart Valves
• Semilunar valves prevent backflow of blood
into the ventricles
• Aortic semilunar valve lies between the left
ventricle and the aorta
• Pulmonary semilunar valve lies between the
right ventricle and pulmonary trunk

Chapter 18, Cardiovascular System 27

Heart Valves

Chapter 18, Cardiovascular System

Figure 18.8a,
28
b
Heart Valves

Chapter 18, Cardiovascular System

Figure 18.8c,
29
d
Atrioventricular Valve Function

Chapter 18, Cardiovascular System

Figure3018.9
Semilunar Valve Function

Chapter 18, Cardiovascular System

Figure 31
18.10
Mitral Valve Prolapse

Chapter 18, Cardiovascular System 32

 Microscopic Anatomy of Heart Muscle
• Cardiac muscle is striated, short, fat, branched,
and interconnected
• The connective tissue endomysium acts as both
tendon and insertion
• Intercalated discs anchor cardiac cells together
and allow free passage of ions
• Heart muscle behaves as a functional syncytium

Chapter 18, Cardiovascular System 33

Microscopic Anatomy of Heart Muscle

Chapter 18, Cardiovascular System 34

Figure 18.11
The Cardiovascular System:
The Heart
Physiology

35
 Cardiac Muscle Contraction
• Heart muscle:
– Is stimulated by nerves and is self-excitable
(automaticity)
– Contracts as a unit
– Has a long (250 ms) absolute refractory period
• Cardiac muscle contraction is similar to
skeletal muscle contraction

Chapter 18, Cardiovascular System 36

Heart Physiology: Intrinsic Conduction
System
• Autorhythmic cells:
– Initiate action potentials
– Have unstable resting potentials called pacemaker
potentials
– Use calcium influx (rather than sodium) for rising
phase of the action potential

Chapter 18, Cardiovascular System 37

Pacemaker and Action Potentials of
the Heart

Chapter 18, Cardiovascular System 38

Figure 18.13
 Heart Physiology: Sequence of
Excitation
• Sinoatrial (SA) node generates impulses about
75 times/minute
• Atrioventricular (AV) node delays the impulse
approximately 0.1 second

Chapter 18, Cardiovascular System 39

 Heart Physiology: Sequence of
Excitation
• Impulse passes from atria to ventricles via
the atrioventricular bundle (bundle of His)
– AV bundle splits into two pathways in the
interventricular septum (bundle branches)
1. Bundle branches carry the impulse toward the
apex of the heart
2. Purkinje fibers carry the impulse to the heart
apex and ventricular walls

Chapter 18, Cardiovascular System 40

Heart Physiology: Sequence of
Excitation

Chapter 18, Cardiovascular System 41

Figure 18.14a
Heart Excitation Related to ECG

Chapter 18, Cardiovascular System

Figure 42
18.17
 Extrinsic Innervation of the Heart
• Heart is stimulated
by the
sympathetic
cardioacceleratory
center
• Heart is inhibited
by the
parasympathetic
cardioinhibitory
center

Chapter 18, Cardiovascular System 43

Figure 18.15
 Electrocardiography
• Electrical activity is recorded by
electrocardiogram (ECG)
• P wave corresponds to depolarization of SA node
• QRS complex corresponds to ventricular
depolarization
• T wave corresponds to ventricular repolarization
• Atrial repolarization record is masked by the
larger QRS complex

Chapter 18, Cardiovascular System 44

Electrocardiography

Chapter 18, Cardiovascular System

Figure 45
18.16
 Heart Sounds
• Heart sounds (lub-dup) are associated with
closing of heart valves
– First sound occurs as AV valves close and signifies
beginning of systole (contraction)
– Second sound occurs when SL valves close at the
beginning of ventricular diastole (relaxation)

Chapter 18, Cardiovascular System 46

 Cardiac Cycle
• Cardiac cycle refers to all events associated
with blood flow through the heart
– Systole – contraction of heart muscle
– Diastole – relaxation of heart muscle

Chapter 18, Cardiovascular System 47

 Phases of the Cardiac Cycle
• Ventricular filling – mid-to-late diastole
– Heart blood pressure is low as blood enters atria
(passively) and flows into ventricles
– AV valves are open, then atrial systole occurs

Chapter 18, Cardiovascular System 48

 Phases of the Cardiac Cycle
• Ventricular systole (contraction)
– Atria relax
– Rising ventricular pressure results in closing of AV
valves
– Isovolumetric contraction phase
– Ventricular ejection phase opens semilunar valves

Chapter 18, Cardiovascular System 49

 Phases of the Cardiac Cycle
• Isovolumetric relaxation – early diastole
– Ventricles relax
– Backflow of blood in aorta and pulmonary trunk
closes semilunar valves
• Dicrotic notch – brief rise in aortic pressure
caused by backflow of blood rebounding off
semilunar valves

Chapter 18, Cardiovascular System 50

Phases of the Cardiac Cycle

Chapter 18, Cardiovascular System

Figure 51
18.20
 Cardiac Output (CO) and Reserve
• Cardiac Output is the amount of blood
pumped by each ventricle in one minute
– CO is the product of heart rate (HR) and stroke
volume (SV)
• HR is the number of heart beats per minute
• SV is the amount of blood pumped out by a ventricle
with each beat
• Cardiac reserve is the difference between
resting and maximal CO

Chapter 18, Cardiovascular System 52

 Cardiac Output: Example
• CO (ml/min) = HR (75 beats/min) x SV (70
ml/beat)
• CO = 5250 ml/min (5.25 L/min)

Chapter 18, Cardiovascular System 53

 Regulation of Stroke Volume
• SV = end diastolic volume (EDV) minus end
systolic volume (ESV)
– EDV = amount of blood collected in a ventricle
during diastole
– ESV = amount of blood remaining in a ventricle
after contraction

Chapter 18, Cardiovascular System 54

 Factors Affecting Stroke Volume
• Preload – amount ventricles are stretched by
contained blood
• Contractility – cardiac cell contractile force
due to factors other than EDV
• Afterload – back pressure exerted by blood in
the large arteries leaving the heart

Chapter 18, Cardiovascular System 55

 Frank-Starling Law of the Heart
• Preload, or degree of stretch, of cardiac muscle
cells before they contract is the critical factor
controlling stroke volume
• Slow heartbeat and exercise increase venous
return to the heart, increasing SV
• Blood loss and extremely rapid heartbeat
decrease SV

Chapter 18, Cardiovascular System 56

Preload and Afterload

Chapter 18, Cardiovascular System 57

Figure 18.21
 Extrinsic Factors Influencing Stroke
Volume
• Contractility is the increase in contractile
strength, independent of stretch and EDV
• Increase in contractility comes from:
– Increased sympathetic stimuli
– Certain hormones
– Ca2+ and some drugs

Chapter 18, Cardiovascular System 58

 Extrinsic Factors Influencing Stroke
Volume
• Agents/factors that decrease contractility
include:
– Acidosis
– Increased extracellular K+
– Calcium channel blockers

Chapter 18, Cardiovascular System 59

 Contractility and Norepinephrine
• Sympathetic
stimulation
releases
norepinephrine
and initiates a
cyclic AMP
second-
messenger
system

Chapter 18, Cardiovascular System 60

Figure 18.22
 Regulation of Heart Rate
• Positive chronotropic factors increase heart
rate
– Caffeine
• Negative chronotropic factors decrease heart
rate
– Sedatives

Chapter 18, Cardiovascular System 61

 Regulation of Heart Rate: Autonomic
•
Nervous System
Sympathetic nervous system (SNS) stimulation is activated
by stress, anxiety, excitement, or exercise
• Parasympathetic nervous system (PNS) stimulation is
mediated by acetylcholine and opposes the SNS
– PNS dominates the autonomic stimulation, slowing heart
rate and causing vagal tone
• If the Vagus Nerve was cut, the heart would lose its
tone. Thus, increasing the heart rate by 25 beats per
minute.

Chapter 18, Cardiovascular System 62

 Atrial (Bainbridge) Reflex
• Atrial (Bainbridge) reflex – a sympathetic
reflex initiated by increased blood in the atria
– Causes stimulation of the SA node
– Stimulates baroreceptors in the atria, causing
increased SNS stimulation

Chapter 18, Cardiovascular System 63

 Chemical Regulation of the Heart
• The hormones epinephrine and thyroxine
increase heart rate
• Intra- and extracellular ion concentrations must
be maintained for normal heart function

Chapter 18, Cardiovascular System 64

Factors Involved in Regulation of
Cardiac Output

Chapter 18, Cardiovascular System

Figure 65
18.23
 Congestive Heart Failure (CHF)
• Congestive heart failure (CHF) is caused by:
– Coronary atherosclerosis
– Persistent high blood pressure
– Multiple myocardial infarcts
– Dilated cardiomyopathy (DCM) – main pumping
chambers of the heart are dilated and contract
poorly

Chapter 18, Cardiovascular System 66

Developmental Aspects of the Heart

Chapter 18, Cardiovascular System

Figure 67
18.24
 Developmental Aspects of the Heart
• Fetal heart structures that bypass pulmonary
circulation
– Foramen ovale connects the two atria
– Ductus arteriosus connects pulmonary trunk and
the aorta

Chapter 18, Cardiovascular System 68

Examples of Congenital Heart Defects

Chapter 18, Cardiovascular System

Figure 69
18.25
 Age-Related Changes Affecting the
Heart
• Sclerosis and thickening of valve flaps
• Decline in cardiac reserve
• Fibrosis of cardiac muscle
• Atherosclerosis

Chapter 18, Cardiovascular System 70

 Congestive Heart Failure
• Causes of CHF
– coronary artery disease, hypertension, MI, valve disorders,
congenital defects
• Left side heart failure
– less effective pump so more blood remains in ventricle
– heart is overstretched & even more blood remains
– blood backs up into lungs as pulmonary edema
– suffocation & lack of oxygen to the tissues
• Right side failure
– fluid builds up in tissues as peripheral edema

Chapter 18, Cardiovascular System 71

Coronary Artery Disease
• Heart muscle receiving
insufficient blood supply
– narrowing of vessels---
atherosclerosis, artery
spasm or clot
– atherosclerosis--smooth
muscle & fatty deposits in
walls of arteries

• Treatment
– drugs, bypass graft,
angioplasty, stent

Chapter 18, Cardiovascular System 72

 Clinical Problems
• MI = myocardial infarction
– death of area of heart muscle from lack of O2
– replaced with scar tissue
– results depend on size & location of damage
• Blood clot
– use clot dissolving drugs streptokinase or t-PA & heparin
– balloon angioplasty
• Angina pectoris
– heart pain from ischemia (lack of blood flow and oxygen )
of cardiac muscle

Chapter 18, Cardiovascular System 73

By-pass Graft

Chapter 18, Cardiovascular System 74

Percutaneous Transluminal Coronary
Angioplasty

Chapter 18, Cardiovascular System 75

Artificial Heart

Chapter 18, Cardiovascular System 76