1 CARDIOVASCULAR SYSTEM.ppt
- 1. THE CARDIOVASCULAR SYSTEM: THE HEART ANATOMY 1
- 2. 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
- 4. 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
- 5. 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 5
- 6. PERICARDIAL LAYERS OF THE HEART 6 Figure 18.2
- 7. 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
- 8. 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 8
- 9. 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 9
- 10. EXTERNAL HEART: ANTERIOR VIEW 10 Figure 18.4b
- 11. 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 11
- 12. 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 12
- 13. EXTERNAL HEART: POSTERIOR VIEW 13 Figure 18.4d
- 14. GROSS ANATOMY OF HEART: FRONTAL SECTION 14 Figure 18.4e
- 15. 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 15
- 16. 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 16
- 17. 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 17
- 18. THICKNESS OF CARDIAC WALLS 18 Myocardium of left ventricle is much thicker than the right.
- 21. 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 21
- 22. PATHWAY OF BLOOD THROUGH THE HEART AND LUNGS 22 Figure 18.5
- 23. 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 23
- 26. 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 26
- 27. 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 27
- 31. SEMILUNAR VALVE FUNCTION 31 Figure 18.10
- 33. 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 33 InterActive Physiology®: Cardiovascular System: Anatomy Review: The Heart PLAY
- 34. MICROSCOPIC ANATOMY OF HEART MUSCLE 34 Figure 18.11
- 35. 18 THE CARDIOVASCULAR SYSTEM: THE HEART PHYSIOLOGY 35
- 36. 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 36
- 37. 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 37
- 38. PACEMAKER AND ACTION POTENTIALS OF THE HEART 38 Figure 18.13
- 39. HEART PHYSIOLOGY: SEQUENCE OF EXCITATION • Sinoatrial (SA) node generates impulses about 75 times/minute • Atrioventricular (AV) node delays the impulse approximately 0.1 second 39
- 40. 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 40
- 41. HEART PHYSIOLOGY: SEQUENCE OF EXCITATION 41 Figure 18.14a
- 42. HEART EXCITATION RELATED TO ECG 42 Figure 18.17
- 43. EXTRINSIC INNERVATION OF THE HEART • Heart is stimulated by the sympathetic cardioacceleratory center • Heart is inhibited by the parasympathetic cardioinhibitory center 43 Figure 18.15
- 44. 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 44 InterActive Physiology®: Cardiovascular System: Intrinsic Conduction System PLAY
- 46. 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) 46
- 47. 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 47
- 48. 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 48
- 49. 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 49
- 50. 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 50 InterActive Physiology®: Cardiovascular System: Cardiac Cycle PLAY
- 51. PHASES OF THE CARDIAC CYCLE 51 Figure 18.20
- 52. 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 52
- 53. CARDIAC OUTPUT: EXAMPLE • CO (ml/min) = HR (75 beats/min) x SV (70 ml/beat) • CO = 5250 ml/min (5.25 L/min) 53
- 54. 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 54
- 55. 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 55
- 56. 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 56
- 57. PRELOAD AND AFTERLOAD 57 Figure 18.21
- 58. 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 58
- 59. EXTRINSIC FACTORS INFLUENCING STROKE VOLUME • Agents/factors that decrease contractility include: • Acidosis • Increased extracellular K+ • Calcium channel blockers 59
- 60. CONTRACTILITY AND NOREPINEPHRINE • Sympathetic stimulation releases norepinephrine and initiates a cyclic AMP second-messenger system 60 Figure 18.22
- 61. REGULATION OF HEART RATE • Positive chronotropic factors increase heart rate • Caffeine • Negative chronotropic factors decrease heart rate • Sedatives 61
- 62. 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 Nerver was cut, the heart would lose its tone. Thus, increasing the heart rate by 25 beats per minute. 62
- 63. 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 63
- 64. 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 64 InterActive Physiology®: Cardiovascular System: Cardiac Output PLAY
- 65. FACTORS INVOLVED IN REGULATION OF CARDIAC OUTPUT 65 Figure 18.23
- 66. 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 66
- 67. DEVELOPMENTAL ASPECTS OF THE HEART 67 Figure 18.24
- 68. 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 68
- 69. EXAMPLES OF CONGENITAL HEART DEFECTS 69 Figure 18.25
- 70. AGE-RELATED CHANGES AFFECTING THE HEART • Sclerosis and thickening of valve flaps • Decline in cardiac reserve • Fibrosis of cardiac muscle • Atherosclerosis 70
- 71. 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 71
- 72. 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 72
- 73. 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 73
- 74. BY-PASS GRAFT 74