The Cardiovascular System: The Heart

I Intro: Heart is center of cardiovascular system

A. Study of normal heart + diseases = cardiology B. Pumps @ 6,000 quarts of blood in a day

II Location & size

A. between the lungs, w/in the mediastinum B. 2/3 of mass found left of midline C. @ 12 cm long, 9 cm wide

III. Pericardium
A. membrane-surrounds/ protects Pericardial cavity filled w/pericardial fluid; reduces friction

Pericardium and Heart Wall

IV. Heart Wall

A. 3 layers- epicardium, myo, & endo

V Chambers of the Heart

A. Interatrial septum separates atria 1. has fossa ovalis
a. Remnant of foramen ovale

B. Interventricular septum- separates ventricles

Structure of the Heart

C. 2 atria (atrium) (upper chambers)

1. auricles- on surface- increases the capacity of each atria

D. 2 Ventricles (lower chambers)

1. Trabeculae carneae ridges - raised bundles of cardiac muscle fiber
Part of conduction system of the heart

2. l. ventricle- thickest walled chamber /forms apex- pumps blood to the entire body

Internal Anatomy of the Heart

 A. Valves- prevent backflow of blood

VI Heart Valves

1. Atrioventricular (AV) valves- between atria & ventricles a. Tricuspid (r) bicuspid aka mitral (l) valves

2. Chordae tendinae & papillary muscles keep flaps of valves pointing in the direction of blood flow & prevent blood from backing up into atria

 3. Semilunar valves

- prevent blood flowing back into the heart as it leaves

a. for lungs from r ventricle- pulmonary semilunar valve b. for body from l ventricle- aortic semilunar valve

Coronary Circulation

VII. Fetal Circulation

A. Path of blood 1. placenta accepts blood without O2 from the fetus through blood vessels that leave the fetus through umbilical arteries. 2. As blood goes through the placenta it picks up O2 & returns to the fetus via the umbilical vein 3. travels through the fetal liver & enters the right side of the heart.

 4. from r. atria through the foramen ovale to l. atrium 5. through bicuspid valve to l. ventricle and out the aorta 6. Blood coming back from the fetuss body enters the r. atrium through tricuspid valve to the r. ventricle 7. Most of the blood that leaves the r. ventricle in the fetus bypasses the lungs through the ductus arteriosus.

(In the developing fetus, the ductus arteriosus (DA), connecs the pulmonary artery to the descending aorta. It allows most of the blood from the right ventricle to bypass the fetus's fluid-filled nonfunctioning lungs)
8. The ductus arteriosus sends low O2 blood to the organs in the lower half of the fetal body & allows for it to leave the fetus through the umbilical arteries and get back to the placenta to pick up oxygen.

VII. The Electric Pathway

A. Autorythmicity 1. cardiac muscle contracts on its own B. Pacemaker cells 1. create electrical impulses at regular intervals a. SA node (power station): 70 -80 impulses/min b. AV node (substation): 40 60 beats/min - C. other structures include:
AV bundle (bundle of His), r & l bundle branches, Purkinje fibers

Frontal plane

Left atrium Right Right atrium atrium 1 SINOATRIAL (SA) NODE 2 ATRIOVENTRICULAR (AV) NODE 3 ATRIOVENTRICULAR (AV) BUNDLE (BUNDLE OF HIS) 4 RIGHT AND LEFT BUNDLE BRANCHES Right Right ventricle ventricle Left ventricle

5 PURKINJE FIBERS
Anterior view of frontal section

IX. Electrocardiogram
A. Impulse conduction through the heart generates electrical currents that can be detected at the body surface. B. ECG or EKG recording of electrical changes through each heart beat

C. Waves of an EKG
1. P wave- -corresponds to contraction of the atria 2. QRS correlates to ventricles contracting

3. T wave- represents preparation for the next series

X The Cardiac Cycle

A. In each cardiac cycle, the atria & ventricles alternately contract & relax; forcing blood from hi to lo pressure B. ave heart beats @ 75 bpm; normal cardiac cycle @ 0.8 sec C. systole: phase of contraction diastole: phase of relaxation 1 cardiac cycle consists of systole & diastole of both aria + systole & diastole of both ventricles

D. Age, gender, ions (electrolytes) , hormones (ex Epinephrine), history of exercise, & body temperature can affect heart rat 1. Lo K+- weak heartbeat 2. Hi Ca+2 - can prolong heart muscle contractions so long, the heart stops beating

D. Cardiac cycle
1. When the right ventricle is full of blood it contracts (systole); blood goes thru PSL valve 2. blood picks up O2 in lungs; getting rid of CO2 3. blood comes back from lungs into LA ; which fills; blood flows into LV which fills; then contracts (systole)

E. Heart Sounds Auscultation 1. Sound of heartbeat comes primarily from blood turbulence caused by closing of heart valves
2. 1st sound: lub AV valves close (longer/louder) 2nd sound: dup SL valves close 3. Heart murmur- abnormal sound (clicking, rushing, gurgling) that is heard before, between, or after the normal heart sounds - very common in children not a concern - may represent a valve disorder in adults

 XI. Heart Problems/DiseasesA. Pericarditis B. Polycythemia C. Congestive Heart Failure D. Myocardial Infarction E. Myocardial Ischemia F. Stenosis G. Mitral Valve Prolapse H. Coronary Artery Disease

I. Patent Ductus Arteriosis J. Atrial Septal Defect K. Ventricular Septal Defect L. Tetralogy of Fallot M. AV block N. Atrial flutter O. Atrial fibrillation P. Ventricular fibrillation

XII Heart Disease

A. Risk factors 1. Blood cholesterol level 2. blood pressure 3. Cigarette smoking 4. Obesity- extra 300 km capillaries for each pound of fat 5. lack of regular exercise 6. diabetes mellitus 7. family history (genetic predisposition)

Part II: Blood Vessels

I Types: A. Arteries (hi in O2)- arterioles B. veins (lo in O2)- venules C. capillaries- exchange vessels -diameter of .008 mm thick (slightly larger than a single red blood cell) - only one cell thick - allow diffusion of O2 & nutrients into cells & CO2 & waste out of cells - present near almost every body cell; # varies w/metabolic activity..greater activity/ greater capillary network & vice versa..

Veins
# of wall layers 3

arteries
3

valves
direction of blood wall thickness

yes
Toward heart thinner

no
Away from heart thicker

Blood pressure
type of blood Lumen size

lower

higher

lo O2
Larger

hi O2
smaller

Arteries, Capillaries, and Venule

Blood Distribution

II. Blood Pressure

A. Systolic BP highest pressure attained in arteries during ventricular contraction (systole) B. Diastolic BP lowest arterial pressure during ventricular relaxation (diastole) C. Disorders: 1.Hypertension high BP can cause heart failure reduce sodium, increase exercise, limit alcohol, lose weight manage stress, dont smoke 2. Hypotension low BP can cause symptoms of dizziness and
fainting. In severe cases -can be life-threatening causes of low blood pressure can range from dehydration to serious medical or surgical disorders.

III. heart rate

A. Pulse: 1. normal female: 72- 80 bpm - male: 64- 72 bpm B. Counting the Pulse 1. measureable at: Brachial, Carotid, Femoral, Pedal, Popliteal, Radial arteries C. Tachycardia higher than normal D. Bradycardia lower than normal

Part III..Blood
I. Study of blood: Hematology II. Functions: A. Transports O2, nutrients, cellular waste products, & hormones throughout the body 1. O2 from lungs 2. nutrients from dig system (sm intestine) 3. hormones from endocrine glands

B. Aids in distribution of heat 1. absorbs heat from skeletal musclesspreads it throughout body/ can radiate excess heat out through the skin C. Helps maintain homeostasis 1. Regulates acid/base balance (pH) 2. regulates electrolyte levels D. Protects against invasion & infection by pathogens & toxins

III. Blood Composition

A. Blood plasma (@ 55%) water, nutrients, salts, hormones, plasma proteins (albumin, fibrinogen, globulins, prothrombin) B. Formed elements
1. Red blood cells (RBCs) or erythrocytes a. - no nucleus b. - created by bone marrow erythropoiesis c. - hemoglobin helps - transport O2 from lungs to cell d. - help transport CO2 from cells to lungs -

e. - sickle cell anemia genetic disease- prob w/

hemoglobin structure

f. - Live @ 120 days/wear & tear- Production = destruction with at least 2 million new RBCs per second reticulocyte count: determines anemia
hematocrit: % of RBCs in whole blood
Males @ 47 % (40-54%) females @ 42% ( 38-46%)

 2. White blood cells (WBCs) or leukocytes a. have nuclei, no hemoglobin b. types: - neutrophils- immune defense (phagocytosis) - eosinophils- defense against parasites - basophils inflammatory response - monocytes- immune defense (phagocytosis) - lymphocytes antibody production

c. have surface proteins - 1. major histocompatibility antigens (MHC)unique to each person (except identical twins) used to ID tiss 2. tissue typing- tissue compatibility between donor & recipient d. WBCs live for only a few hours or a few days e. made in bone marrow 3. Platelets- (thrombocytes) funct in - blood clotting 5-9 day life span; old/dead platelets removed by macrophages in liver & spleen - hemophilia- X- linked genetic disease (little or no clotting factor) excessive bleeding

Formed Elements of Blood

Shapes of RBC and Hemoglobin

Circulation for about 120 days

3
Amino acids Reused for protein synthesis Fe3+ Transferrin Fe3+ Transferrin

Globin

4 2 Heme 9 1 Red blood cell

death and phagocytosis Biliverdin Bilirubin

6
Ferritin Bilirubin

Fe3+
+ Globin + Vitamin B12 + Erythopoietin

10
Kidney Bilirubin

11

Liver

Small intestine

13
Macrophage in spleen, liver, or red bone marrow Urine Urobilin

8 Erythropoiesis in
red bone marrow

12

Urobilinogen Stercobilin Feces

Bacteria

Key:
in blood in bile

Large 14 intestine

Types of White Blood Cells

platelets

IV Stem cell transplants

A. Bone marrow transplant
Recipient's red bone marrow replaced entirely by healthy, noncancerous cells to establish normal blood cell counts Takes 2-3 weeks to begin producing enough WBCs to fight off infections Graft-versus-host-disease transplanted red bone marrow may produce T cells that attack host tissues

 B. Cord-blood transplant
Stem cells obtained from umbilical cord shortly before birth Easily collected and can be stored indefinitely Less likely to cause graft-versus-host-disease

V. Blood Groups and Blood Types

A. Agglutinogens surface of RBCs contain genetically determined assortment of antigens B. Blood group based on presence or absence of various antigens C. At least 24 blood groups and more than 100 antigens
1. ABO and Rh

 1. Based on A and B antigens

D. ABO Blood Group

Type A blood has only antigen A (most common) Type B blood has only antigen B Type AB blood has antigens A and B
Universal recipients neither anti-A or anti-B antibodies

Type O blood has neither antigen

Universal donor

2. if wrong blood type is given- serious harm/death may occur

Antigens and Antibodies of ABO Blood Types

VI Vascular & Hematology related problems

A. Anemia B. Arteriosclerosis C. Atherosclerosis D. Aneurysm E. Embolism F. Leukemia