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20 - Napa Valley College · Copyright © 2009 Pearson Education, Inc., publishing as Pearson...
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Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
C h a p t e r
20
The Heart
PowerPoint® Lecture Slides
prepared by Jason LaPres
Lone Star College - North Harris
Copyright © 2009 Pearson Education, Inc.,
publishing as Pearson Benjamin Cummings
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
Introduction to Cardiovascular System
The Pulmonary Circuit
Carries blood to and from gas exchange surfaces of
lungs
The Systemic Circuit
Carries blood to and from the body
Blood alternates between pulmonary circuit and
systemic circuit
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Introduction to Cardiovascular System
Three Types of Blood Vessels
Arteries
Carry blood away from heart
Veins
Carry blood to heart
Capillaries
Networks between arteries and veins
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Introduction to Cardiovascular System
Capillaries
Also called exchange vessels
Exchange materials between blood and
tissues
Materials include dissolved gases, nutrients,
wastes
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Introduction to Cardiovascular System
Figure 20–1 An Overview of the Cardiovascular System.
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Introduction to Cardiovascular System
Four Chambers of the Heart
Right atrium
Collects blood from systemic circuit
Right ventricle
Pumps blood to pulmonary circuit
Left atrium
Collects blood from pulmonary circuit
Left ventricle
Pumps blood to systemic circuit
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Figure 20–2c
Anatomy of the Heart
Great veins and arteries at the base
Pointed tip is apex
Surrounded by pericardial sac
Sits between two pleural cavities in the
mediastinum
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Anatomy of the Heart
Figure 20–2a The Location of the Heart in the Thoracic Cavity
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Figure 20–2c
Anatomy of the Heart
The Pericardium
Double lining of the pericardial cavity
Parietal pericardium
Outer layer
Forms inner layer of pericardial sac
Visceral pericardium
Inner layer of pericardium
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Anatomy of the Heart
The Pericardium
Pericardial cavity
Is between parietal and visceral layers
Contains pericardial fluid
Pericardial sac
Fibrous tissue
Surrounds and stabilizes heart
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Anatomy of the Heart
Figure 20–2b The Location of the Heart in the Thoracic Cavity
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Anatomy of the Heart
Figure 20–c2 The Location of the Heart in the Thoracic Cavity
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Anatomy of the Heart
Superficial Anatomy of the Heart
Atria
Thin-walled
Expandable outer auricle (atrial appendage)
Sulci
Coronary sulcus: divides atria and ventricles
Anterior interventricular sulcus and posterior
interventricular sulcus:
– separate left and right ventricles
– contain blood vessels of cardiac muscle
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Anatomy of the Heart
Figure 20–3a The Superficial Anatomy of the Heart
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Anatomy of the Heart
Figure 20–3a The Superficial Anatomy of the Heart
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Anatomy of the Heart
Figure 20–3b The Superficial Anatomy of the Heart
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Anatomy of the Heart
Figure 20–3c The Superficial Anatomy of the Heart
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Anatomy of the Heart
The Heart Wall
Epicardium (outer layer)
Visceral pericardium
Covers the heart
Myocardium (middle layer)
Muscular wall of the heart
Concentric layers of cardiac muscle tissue
Atrial myocardium wraps around great vessels
Two divisions of ventricular myocardium
Endocardium (inner layer)
Simple squamous epithelium
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Anatomy of the Heart
Figure 20–4 The Heart Wall
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Anatomy of the Heart
Cardiac Muscle Tissue
Intercalated discs
Interconnect cardiac muscle cells
Secured by desmosomes
Linked by gap junctions
Convey force of contraction
Propagate action potentials
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Anatomy of the Heart
Figure 20–5 Cardiac Muscle Cells
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Anatomy of the Heart
Figure 20–5 Cardiac Muscle Cells
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Anatomy of the Heart
Figure 20–5 Cardiac Muscle Cells
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Anatomy of the Heart
Characteristics of Cardiac Muscle Cells
Small size
Single, central nucleus
Branching interconnections between cells
Intercalated discs
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Anatomy of the Heart
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Anatomy of the Heart
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Anatomy of the Heart
Internal Anatomy and Organization
Interatrial septum: separates atria
Interventricular septum: separates ventricles
Atrioventricular (AV) valves
Connect right atrium to right ventricle and left atrium to left
ventricle
The fibrous flaps that form bicuspid (2) and tricuspid (3)
valves
Permit blood flow in one direction: atria to ventricles
The Heart: Valves
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Anatomy of the Heart
The Right Atrium
Superior vena cava
Receives blood from head, neck, upper limbs, and chest
Inferior vena cava
Receives blood from trunk, viscera, and lower limbs
Coronary sinus
Cardiac veins return blood to coronary sinus
Coronary sinus opens into right atrium
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Anatomy of the Heart
The Right Atrium
Foramen ovale
Before birth, is an opening through interatrial
septum
Connects the two atria
Seals off at birth, forming fossa ovalis
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Anatomy of the Heart
The Right Atrium
Pectinate muscles
Contain prominent muscular ridges
On anterior atrial wall and inner surfaces of right
auricle
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Anatomy of the Heart
Figure 20–6a-b The Sectional Anatomy of the Heart.
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Anatomy of the Heart
Figure 20–6a-b The Sectional Anatomy of the Heart.
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Anatomy of the Heart
The Right Ventricle
Free edges attach to chordae tendineae
from papillary muscles of ventricle
Prevent valve from opening backward
Right atrioventricular (AV) Valve
Also called tricuspid valve
Opening from right atrium to right ventricle
Has three cusps
Prevents backflow
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Anatomy of the Heart
The Right Ventricle
Trabeculae carneae
Muscular ridges on internal surface of right (and
left) ventricle
Includes moderator band:
– ridge contains part of conducting system
– coordinates contractions of cardiac muscle cells
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Anatomy of the Heart
The Pulmonary Circuit
Conus arteriosus (superior end of right ventricle)
leads to pulmonary trunk
Pulmonary trunk divides into left and right
pulmonary arteries
Blood flows from right ventricle to pulmonary trunk
through pulmonary valve
Pulmonary valve has three semilunar cusps
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Anatomy of the Heart
The Left Atrium
Blood gathers into left and right pulmonary
veins
Pulmonary veins deliver to left atrium
Blood from left atrium passes to left ventricle
through left atrioventricular (AV) valve
A two-cusped bicuspid valve or mitral valve
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Anatomy of the Heart
The Left Ventricle
Holds same volume as right ventricle
Is larger; muscle is thicker and more powerful
Similar internally to right ventricle but does not have
moderator band
Systemic circulation
Blood leaves left ventricle through aortic valve into
ascending aorta
Ascending aorta turns (aortic arch) and becomes
descending aorta
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Anatomy of the Heart
Figure 20–6c The Sectional Anatomy of the Heart.
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Anatomy of the Heart
Structural Differences between the Left
and Right Ventricles
Right ventricle wall is thinner, develops less
pressure than left ventricle
Right ventricle is pouch-shaped, left ventricle
is round
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Anatomy of the Heart
Figure 20–7 Structural Differences between the Left and Right
Ventricles
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Anatomy of the Heart
Figure 20–7 Structural Differences between the Left and Right
Ventricles
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Anatomy of the Heart
The Heart Valves
Two pairs of one-way valves prevent backflow
during contraction
Atrioventricular (AV) valves
Between atria and ventricles
Blood pressure closes valve cusps during ventricular
contraction
Papillary muscles tense chordae tendineae: prevent valves
from swinging into atria
Figure 20–8
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Anatomy of the Heart
The Heart Valves
Semilunar valves
Pulmonary and aortic tricuspid valves
Prevent backflow from pulmonary trunk and aorta
into ventricles
Have no muscular support
Three cusps support like tripod
Figure 20–8
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Anatomy of the Heart
Aortic Sinuses
At base of ascending aorta
Sacs that prevent valve cusps from sticking to
aorta
Origin of right and left coronary arteries
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Anatomy of the Heart
Figure 20–8a Valves of the Heart
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Anatomy of the Heart
Figure 20–8b Valves of the Heart
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Anatomy of the Heart
Figure 20–8c Valves of the Heart
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Anatomy of the Heart
Connective Tissues and the Cardiac
(Fibrous) Skeleton
Physically support cardiac muscle fibers
Distribute forces of contraction
Add strength and prevent overexpansion of heart
Elastic fibers return heart to original shape after
contraction
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Anatomy of the Heart
The Cardiac (Fibrous) Skeleton
Four bands around heart valves and bases of
pulmonary trunk and aorta
Stabilize valves
Electrically insulate ventricular cells from atrial
cells
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Anatomy of the Heart
The Blood Supply to the Heart = Coronary
Circulation
Coronary arteries and cardiac veins
Supplies blood to muscle tissue of heart
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Anatomy of the Heart
The Coronary Arteries
Left and right
Originate at aortic sinuses
High blood pressure, elastic rebound forces
blood through coronary arteries between
contractions
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Anatomy of the Heart
Right Coronary Artery
Supplies blood to
Right atrium
Portions of both ventricles
Cells of sinoatrial (SA) and atrioventricular nodes
Marginal arteries (surface of right ventricle)
Posterior interventricular artery
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Anatomy of the Heart
Left Coronary Artery
Supplies blood to
Left ventricle
Left atrium
Interventricular septum
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Anatomy of the Heart
Two main branches of left coronary artery
Circumflex artery
Anterior interventricular artery
Arterial Anastomoses
Interconnect anterior and posterior interventricular
arteries
Stabilize blood supply to cardiac muscle
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Anatomy of the Heart
The Cardiac Veins
Great cardiac vein
Drains blood from area of anterior interventricular artery into
coronary sinus
Anterior cardiac veins
Empties into right atrium
Posterior cardiac vein, middle cardiac vein, and
small cardiac vein
Empty into great cardiac vein or coronary sinus
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Anatomy of the Heart
Figure 20–9a Coronary Circulation
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Anatomy of the Heart
Figure 20–9b Coronary Circulation
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Anatomy of the Heart
Figure 20–9c Coronary Circulation
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Anatomy of the Heart
Figure 20–10 Coronary Circulation and Clinical Testing
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The Conducting System
Heartbeat
A single contraction of the heart
The entire heart contracts in series
First the atria
Then the ventricles
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The Conducting System
Two Types of Cardiac Muscle Cells
Conducting system
Controls and coordinates heartbeat
Contractile cells
Produce contractions that propel blood
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The Conducting System
The Cardiac Cycle
Begins with action potential at SA node
Transmitted through conducting system
Produces action potentials in cardiac muscle cells (contractile
cells)
Electrocardiogram (ECG)
Electrical events in the cardiac cycle can be recorded on an
electrocardiogram (ECG)
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The Conducting System
Figure 20–11 An Overview of Cardiac Physiology
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The Conducting System
A system of specialized cardiac muscle
cells
Initiates and distributes electrical impulses
that stimulate contraction
Automaticity
Cardiac muscle tissue contracts automatically
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The Conducting System
Structures of the Conducting System
Sinoatrial (SA) node - wall of right atrium
Atrioventricular (AV) node - junction between
atria and ventricles
Conducting cells - throughout myocardium
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The Conducting System
Conducting Cells
Interconnect SA and AV nodes
Distribute stimulus through myocardium
In the atrium
Internodal pathways
In the ventricles
AV bundle and the bundle branches
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The Conducting System
Prepotential
Also called pacemaker potential
Resting potential of conducting cells
Gradually depolarizes toward threshold
SA node depolarizes first, establishing heart
rate
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The Conducting System
Figure 20–12 The Conducting System of the Heart
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The Conducting System
Heart Rate
SA node generates 80–100 action potentials
per minute
Parasympathetic stimulation slows heart rate
AV node generates 40–60 action potentials
per minute
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The Conducting System
The Sinoatrial (SA) Node
In posterior wall of right atrium
Contains pacemaker cells
Connected to AV node by internodal
pathways
Begins atrial activation (Step 1)
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The Conducting System
Figure 20–13 Impulse Conduction through the Heart
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The Conducting System
The Atrioventricular (AV) Node
In floor of right atrium
Receives impulse from SA node (Step 2)
Delays impulse (Step 3)
Atrial contraction begins
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The Conducting System
Figure 20–13 Impulse Conduction through the Heart
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The Conducting System
Figure 20–13 Impulse Conduction through the Heart
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The Conducting System
The AV Bundle
In the septum
Carries impulse to left and right bundle
branches
Which conduct to Purkinje fibers (Step 4)
And to the moderator band
Which conducts to papillary muscles
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The Conducting System
Figure 20–13 Impulse Conduction through the Heart
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The Conducting System
Purkinje Fibers
Distribute impulse through ventricles (Step 5)
Atrial contraction is completed
Ventricular contraction begins
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The Conducting System
Figure 20–13 Impulse Conduction through the Heart
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The Conducting System
Abnormal Pacemaker Function
Bradycardia: abnormally slow heart rate
Tachycardia: abnormally fast heart rate
Ectopic pacemaker
Abnormal cells
Generate high rate of action potentials
Bypass conducting system
Disrupt ventricular contractions
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The Conducting System
Electrocardiogram (ECG or EKG)
A recording of electrical events in the heart
Obtained by electrodes at specific body
locations
Abnormal patterns diagnose damage
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The Conducting System
Features of an ECG
P wave
Atria depolarize
QRS complex
Ventricles depolarize
T wave
Ventricles repolarize
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The Conducting System
Time Intervals Between ECG Waves
P–R interval
From start of atrial depolarization
To start of QRS complex
Q–T interval
From ventricular depolarization
To ventricular repolarization
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The Conducting System
Figure 20–14a An Electrocardiogram: Electrode Placement for Recording a Standard ECG
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The Conducting System
Figure 20–14b An Electrocardiogram: An ECG Printout
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The Conducting System
Contractile Cells
Purkinje fibers distribute the stimulus to the
contractile cells, which make up most of the
muscle cells in the heart
Resting Potential
Of a ventricular cell: about –90 mV
Of an atrial cell: about –80 mV
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The Conducting System
Figure 20–15 The Action Potential in Skeletal and Cardiac Muscle
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The Conducting System
Figure 20–15 The Action Potential in Skeletal and Cardiac Muscle
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The Conducting System
Refractory Period
Absolute refractory period
Long
Cardiac muscle cells cannot respond
Relative refractory period
Short
Response depends on degree of stimulus
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The Conducting System
Timing of Refractory Periods
Length of cardiac action potential in
ventricular cell
250–300 msecs:
– 30 times longer than skeletal muscle fiber
– long refractory period prevents summation and tetany
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The Conducting System
The Role of Calcium Ions in Cardiac
Contractions
Contraction of a cardiac muscle cell is
produced by an increase in calcium ion
concentration around myofibrils
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The Conducting System
The Role of Calcium Ions in Cardiac
Contractions
20% of calcium ions required for a contraction
Calcium ions enter plasma membrane during plateau phase
Arrival of extracellular Ca2+
Triggers release of calcium ion reserves from sarcoplasmic
reticulum
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The Conducting System
The Role of Calcium Ions in Cardiac
Contractions
As slow calcium channels close
Intracellular Ca2+ is absorbed by the SR
Or pumped out of cell
Cardiac muscle tissue
Very sensitive to extracellular Ca2+ concentrations
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The Conducting System
The Energy for Cardiac Contractions
Aerobic energy of heart
From mitochondrial breakdown of fatty acids and
glucose
Oxygen from circulating hemoglobin
Cardiac muscles store oxygen in myoglobin
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The Cardiac Cycle
Cardiac cycle = The period between the
start of one heartbeat and the beginning of
the next
Includes both contraction and relaxation
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The Cardiac Cycle
Phases of the Cardiac Cycle
Within any one chamber
Systole (contraction)
Diastole (relaxation)
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The Cardiac Cycle
Figure 20–16 Phases of the Cardiac Cycle
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The Cardiac Cycle
Blood Pressure
In any chamber
Rises during systole
Falls during diastole
Blood flows from high to low pressure
Controlled by timing of contractions
Directed by one-way valves
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The Cardiac Cycle
Cardiac Cycle and Heart Rate
At 75 beats per minute
Cardiac cycle lasts about 800 msecs
When heart rate increases
All phases of cardiac cycle shorten, particularly
diastole
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The Cardiac Cycle
Eight Steps in the Cardiac Cycle
1. Atrial systole
Atrial contraction begins
Right and left AV valves are open
2. Atria eject blood into ventricles
Filling ventricles
3. Atrial systole ends
AV valves close
Ventricles contain maximum blood volume
Known as end-diastolic volume (EDV)
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The Cardiac Cycle
Figure 20–17 Pressure and Volume Relationships in the Cardiac Cycle
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The Cardiac Cycle
Eight Steps in the Cardiac Cycle
4. Ventricular systole
Isovolumetric ventricular contraction
Pressure in ventricles rises
AV valves shut
5. Ventricular ejection
Semilunar valves open
Blood flows into pulmonary and aortic trunks
Stroke volume (SV) = 60% of end-diastolic volume
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The Cardiac Cycle
Figure 20–17 Pressure and Volume Relationships in the Cardiac Cycle
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The Cardiac Cycle
Eight Steps in the Cardiac Cycle
6. Ventricular pressure falls
Semilunar valves close
Ventricles contain end-systolic volume (ESV), about 40%
of end-diastolic volume
7. Ventricular diastole
Ventricular pressure is higher than atrial pressure
All heart valves are closed
Ventricles relax (isovolumetric relaxation)
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The Cardiac Cycle
Figure 20–17 Pressure and Volume Relationships in the Cardiac Cycle
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The Cardiac Cycle
Eight Steps in the Cardiac Cycle
8. Atrial pressure is higher than ventricular
pressure
AV valves open
Passive atrial filling
Passive ventricular filling
Cardiac cycle ends
The Heart: Cardiac Cycle
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The Cardiac Cycle
Figure 20–17 Pressure and Volume Relationships in the Cardiac Cycle
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The Cardiac Cycle
Heart Sounds
S1
Loud sounds
Produced by AV valves
S2
Loud sounds
Produced by semilunar valves
S3, S4
Soft sounds
Blood flow into ventricles and atrial contraction
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The Cardiac Cycle
Heart Murmur
Sounds produced by regurgitation through
valves
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The Cardiac Cycle
Figure 20–18 Heart Sounds
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Cardiodynamics
The movement and force generated by cardiac
contractions
End-diastolic volume (EDV)
End-systolic volume (ESV)
Stroke volume (SV)
SV = EDV – ESV
Ejection fraction
The percentage of EDV represented by SV
Cardiac output (CO)
The volume pumped by left ventricle in 1 minute
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Cardiodynamics
Figure 20–19 A Simple Model of Stroke Volume
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Cardiodynamics
Cardiac Output
CO = HR X SV
CO = cardiac output (mL/min)
HR = heart rate (beats/min)
SV = stroke volume (mL/beat)
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Cardiodynamics
Factors Affecting Cardiac Output
Cardiac output
Adjusted by changes in heart rate or stroke volume
Heart rate
Adjusted by autonomic nervous system or hormones
Stroke volume
Adjusted by changing EDV or ESV
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Cardiodynamics
Figure 20–20 Factors Affecting Cardiac Output
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Cardiodynamics
Factors Affecting the Heart Rate
Autonomic innervation
Cardiac plexuses: innervate heart
Vagus nerves (X): carry parasympathetic preganglionic fibers
to small ganglia in cardiac plexus
Cardiac centers of medulla oblongata:
– cardioacceleratory center controls sympathetic
neurons (increases heart rate)
– cardioinhibitory center controls parasympathetic
neurons (slows heart rate)
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Cardiodynamics
Autonomic Innervation
Cardiac reflexes
Cardiac centers monitor:
– blood pressure (baroreceptors)
– arterial oxygen and carbon dioxide levels
(chemoreceptors)
Cardiac centers adjust cardiac activity
Autonomic tone
Dual innervation maintains resting tone by
releasing ACh and NE
Fine adjustments meet needs of other systems
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Cardiodynamics
Figure 20–21 Autonomic Innervation of the Heart
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Cardiodynamics
Effects on the SA Node
Sympathetic and parasympathetic stimulation
Greatest at SA node (heart rate)
Membrane potential of pacemaker cells
Lower than other cardiac cells
Rate of spontaneous depolarization depends on
Resting membrane potential
Rate of depolarization
ACh (parasympathetic stimulation)
Slows the heart
NE (sympathetic stimulation)
Speeds the heart
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Cardiodynamics
Figure 20–22 Autonomic Regulation of Pacemaker Function
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Cardiodynamics
Atrial Reflex
Also called Bainbridge reflex
Adjusts heart rate in response to venous
return
Stretch receptors in right atrium
Trigger increase in heart rate
Through increased sympathetic activity
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Cardiodynamics
Hormonal Effects on Heart Rate
Increase heart rate (by sympathetic
stimulation of SA node)
Epinephrine (E)
Norepinephrine (NE)
Thyroid hormone
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Cardiodynamics
Factors Affecting the Stroke Volume
The EDV: amount of blood a ventricle contains at the
end of diastole
Filling time:
– duration of ventricular diastole
Venous return:
– rate of blood flow during ventricular diastole
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Cardiodynamics
Preload
The degree of ventricular stretching during
ventricular diastole
Directly proportional to EDV
Affects ability of muscle cells to produce
tension
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Cardiodynamics
The EDV and Stroke Volume
At rest
EDV is low
Myocardium stretches less
Stroke volume is low
With exercise
EDV increases
Myocardium stretches more
Stroke volume increases
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Cardiodynamics
The Frank–Starling Principle
As EDV increases, stroke volume increases
Physical Limits
Ventricular expansion is limited by
Myocardial connective tissue
The cardiac (fibrous) skeleton
The pericardial sac
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Cardiodynamics
End-Systolic Volume (ESV)
The amount of blood that remains in the
ventricle at the end of ventricular systole is
the ESV
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Cardiodynamics
Three Factors That Affect ESV
Preload
Ventricular stretching during diastole
Contractility
Force produced during contraction, at a given preload
Afterload
Tension the ventricle produces to open the semilunar valve
and eject blood
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Cardiodynamics
Contractility
Is affected by
Autonomic activity
Hormones
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Cardiodynamics
Effects of Autonomic Activity on Contractility
Sympathetic stimulation
NE released by postganglionic fibers of cardiac nerves
Epinephrine and NE released by suprarenal (adrenal)
medullae
Causes ventricles to contract with more force
Increases ejection fraction and decreases ESV
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Cardiodynamics
Effects of Autonomic Activity on
Contractility
Parasympathetic activity
Acetylcholine released by vagus nerves
Reduces force of cardiac contractions
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
Cardiodynamics
Hormones
Many hormones affect heart contraction
Pharmaceutical drugs mimic hormone actions
Stimulate or block beta receptors
Affect calcium ions (e.g., calcium channel
blockers)
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
Cardiodynamics
Afterload
Is increased by any factor that restricts arterial
blood flow
As afterload increases, stroke volume
decreases
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Cardiodynamics
Figure 20–23 Factors Affecting Stroke Volume
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
Cardiodynamics
Heart Rate Control Factors
Autonomic nervous system
Sympathetic and parasympathetic
Circulating hormones
Venous return and stretch receptors
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
Cardiodynamics
Stroke Volume Control Factors
EDV
Filling time
Rate of venous return
ESV
Preload
Contractility
Afterload
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
Cardiodynamics
Cardiac Reserve
The difference between resting and maximal
cardiac output
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
Cardiodynamics
The Heart and Cardiovascular System
Cardiovascular regulation
Ensures adequate circulation to body tissues
Cardiovascular centers
Control heart and peripheral blood vessels
Cardiovascular system responds to
Changing activity patterns
Circulatory emergencies
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
Cardiodynamics
Figure 20–24 A Summary of the Factors Affecting Cardiac Output