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Unit 4Fluids and TransportFluids and Transport
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Chapter 20: The Heart
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How are the cardiovascular system and heart organized?
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The Heart: AnatomyPLAYPLAY
Figure 20–1
Organization of the Cardiovascular System
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The Pulmonary Circuit
• Carries blood to and from gas exchange surfaces of lungs
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The Systemic Circuit
• Carries blood to and from the body
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Alternating Circuits
• Blood alternates between pulmonary circuit and systemic circuit
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3 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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Capillaries
• Also called exchange vessels • Exchange materials between blood
and tissues• Dissolved gases, nutrients, wastes
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4 Chambers of the Heart
• 2 for each circuit:– left and right:
• ventricles and atria
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4 Chambers of the Heart
• Right atrium:– collects blood from systemic circuit
• Right ventricle:– pumps blood to pulmonary circuit
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4 Chambers of the Heart
• Left atrium:– collects blood from pulmonary circuit
• Left ventricle:– pumps blood to systemic circuit
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Where is the heart located and what are its
general features?
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Anatomy of the Heart
• Located directly behind sternum
InterActive Physiology: Cardiovascular System: Anatomy Review: The HeartPLAYPLAY
Figure 20–2a
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Figure 20–2c
Anatomy of the Heart
• Great veins and arteries at the base• Pointed tip is apex
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Relation to Thoracic Cavity
Figure 20–2b
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Relation to Thoracic Cavity
• Surrounded by pericardial sac• Between 2 pleural cavities • In the mediastinum
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What is the structure and function of the pericardium?
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Figure 20–2c
The Pericardium
• Double lining of the pericardial cavity
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2 Layers of Pericardium
1. Parietal pericardium:– outer layer– forms inner layer of pericardial sac
2. Visceral pericardium:– inner layer of pericardium
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Structures of Pericardium
• Pericardial cavity:– Is between parietal and visceral
layers – contains pericardial fluid
• Pericardial sac: – fibrous tissue– surrounds and stabilizes heart
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Pericarditis
• An infection of the pericardium
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Superficial Anatomy of the Heart
• 4 cardiac chambers
Figure 20–3
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Atria
• Thin-walled• Expandable outer auricle
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Sulci
• Coronary sulcus:– divides atria and ventricles
• Anterior and posterior interventricular sulci:– separate left and right ventricles– contain blood vessels of cardiac
muscle
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What are the layers of the heart wall?
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The Heart Wall
Figure 20–4
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3 Layers of the Heart Wall
• Epicardium:– outer layer
• Myocardium:– middle layer
• Endocardium:– inner layer
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Epicardium
• Visceral pericardium • Covers the heart
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Myocardium
• Muscular wall of the heart• Concentric layers of cardiac
muscle tissue• Atrial myocardium wraps around
great vessels• 2 divisions of ventricular
myocardium
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2 Divisions of Ventricular Myocardium
• Superficial ventricular muscles:– surround ventricles
• Deep ventricular muscles:– spiral around and between ventricles
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Cardiac Muscle Cells
Figure 20–5
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Cardiac Muscle Cells
• Intercalated discs:– interconnect cardiac muscle cells– secured by desmosomes – linked by gap junctions– convey force of contraction – propagate action potentials
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Characteristics of Cardiac Muscle Cells
1. Small size2. Single, central nucleus3. Branching interconnections
between cells4. Intercalated discs
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Cardiac Cells vs. Skeletal Fibers
Table 20-1
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What is the path of blood flow through the heart, and what are the major
blood vessels, chambers, and heart valves?
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Internal Anatomy
3D Panorama of the HeartPLAYPLAY
Figure 20–6a
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Atrioventricular (AV) Valves
• Connect right atrium to right ventricle and left atrium to left ventricle
• Permit blood flow in 1 direction: – atria to ventricles
The Heart: ValvesPLAYPLAY
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Septa
• Interatrial septum:– separates atria
• Interventricular septum:– separates ventricles
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The Vena Cava
• Delivers systemic circulation to right atrium
• Superior vena cava:– receives blood from head, neck,
upper limbs, and chest• Inferior vena cava:
– receives blood from trunk, and viscera, lower limbs
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Coronary Sinus
• Cardiac veins return blood to coronary sinus
• Coronary sinus opens into right atrium
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Foramen Ovale
• Before birth, is an opening through interatrial septum
• Connects the 2 atria• Seals off at birth, forming fossa
ovalis
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Pectinate Muscles
• Contain prominent muscular ridges • On anterior atrial wall • And inner surfaces of right auricle
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Cusps
• Fibrous flaps that form bicuspid (2) and tricuspid (3) valves
• Free edges attach to chordae tendineae from papillary muscles of ventricle
• Prevent valve from opening backward
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Right Atrioventricular (AV) Valve
• Also called tricuspid valve• Opening from right atrium to right
ventricle • Has 3 cusps• Prevents backflow
The Heart: Blood FlowPLAYPLAY
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Trabeculae Carneae
• Muscular ridges on internal surface of right ventricle
• Includes moderator band:– ridge contains part of conducting
system– coordinates contractions of cardiac
muscle cells
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The Pulmonary Circuit
• Conus arteriosus (superior 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 3 semilunar cusps
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Return from Pulmonary Circuit
• 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
• 2-cusp bicuspid valve or mitral valve
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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
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The Left Ventricle
• 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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Left and Right Ventricles
• Have significant structural differences
Figure 20–7
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Structure of 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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The Heart Valves
• One-way valves prevent backflow during contraction
Figure 20–8
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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
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Regurgitation
• Failure of valves• Causes backflow of blood into atria
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Semilunar Valves
• Pulmonary and aortic tricuspid valves
• Prevent backflow from pulmonary trunk and aorta into ventricles
• Have no muscular support• 3 cusps support like tripod
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Aortic Sinuses
• At base of ascending aorta • Prevent valve cusps from sticking
to aorta• Origin of right and left coronary
arteries
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Carditis
• An inflammation of the heart• Can result in valvular heart disease
(VHD): – e.g., rheumatic fever
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KEY CONCEPT (1 of 3)
• The heart has 4 chambers:– 2 for pulmonary circuit:
• right atrium and right ventricle
– 2 for systemic circuit:• left atrium and left ventricle
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KEY CONCEPT (2 of 3)
• Left ventricle has a greater workload
• Is much more massive than right ventricle, but the two chambers pump equal amounts of blood
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KEY CONCEPT (3 of 3)
• AV valves prevent backflow from ventricles into atria
• Semilunar valves prevent backflow from aortic and pulmonary trunks into ventricles
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Connective Tissue Fibers of the Heart
1. Physically support cardiac muscle fibers
2. Distribute forces of contraction3. Add strength and prevent
overexpansion of heart4. Elastic fibers return heart to
original shape after contraction
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The Fibrous Skeleton
• 4 bands around heart valves and bases of pulmonary trunk and aorta
• Stabilize valves • Electrically insulate ventricular
cells from atrial cells
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How is the heart supplied with blood?
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Blood Supply to the Heart• Coronary circulation
Figure 20–9
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Coronary Circulation
• Coronary arteries and cardiac veins
• Supplies blood to muscle tissue of heart
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Coronary Arteries
• Left and right• Originate at aortic sinuses• High blood pressure, elastic
rebound force blood through coronary arteries between contractions
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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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Left Coronary Artery
• Supplies blood to:– left ventricle– left atrium– interventricular septum
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Left Coronary Artery
• 2 main branches:– circumflex artery – anterior interventricular artery
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Arterial Anastomoses
• Interconnect anterior and posterior interventricular arteries
• Stabilize blood supply to cardiac muscle
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Cardiac Veins (1 of 3)
• Great cardiac vein:– drains blood from area of anterior
interventricular artery into coronary sinus
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Cardiac Veins (2 of 3)
• Anterior cardiac vein:– empties into right atrium
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Cardiac Veins (3 of 3)
• Posterior cardiac vein, middle cardiac vein, and small cardiac vein:– empty into great cardiac vein or
coronary sinus
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Figure 20–11
The Cardiac Cycle
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The Heartbeat
• A single contraction of the heart• The entire heart contracts in
series:– first the atria– then the ventricles
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2 Types of Cardiac Muscle Cells
• Conducting system: – controls and coordinates heartbeat
• Contractile cells:– produce contractions
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InterActive Physiology: Cardiovascular System: Cardiac Action PotentialPLAYPLAY
The Cardiac Cycle
• Begins with action potential at SA node– transmitted through conducting
system– produces action potentials in cardiac
muscle cells (contractile cells)
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Electrocardiogram (ECG)
• Electrical events in the cardiac cycle can be recorded on an electrocardiogram (ECG)
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What is the difference between nodal cells and
conducting cells; what are
the components and functions of the
conducting system of the heart?
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Figure 20–12
The Conducting System
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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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Structures of the Conducting System
• Sinoatrial (SA) node• Atrioventricular (AV) node • Conducting cells
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Conducting Cells
• Interconnect SA and AV nodes• Distribute stimulus through
myocardium• In the atrium:
– internodal pathways
• In the ventricles:– AV bundle and bundle branches
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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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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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Figure 20–13
Impulse Conduction through the Heart
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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 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 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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4. The Purkinje Fibers
• Distribute impulse through ventricles (Step 5)
• Atrial contraction is completed• Ventricular contraction begins
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Abnormal Pacemaker Function
• Bradycardia:– abnormally slow heart rate
• Tachycardia:– abnormally fast heart rate
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Ectopic Pacemaker
• Abnormal cells • Generate high rate of action
potentials• Bypass conducting system• Disrupt ventricular contractions
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What electrical events are associated with a
normal electrocardiogram?
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The Electrocardiogram
Figure 20–14b
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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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Features of an ECG
• P wave:– atria depolarize
• QRS complex:– ventricles depolarize
• T wave:– ventricles repolarize
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Time Intervals
• 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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Cardiac Arrhythmias
• Abnormal patterns of cardiac electrical activity
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KEY CONCEPT (1 of 3)
• Heart rate is normally established by cells of SA node
• Rate can be modified by autonomic activity, hormones, and other factors
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KEY CONCEPT (2 of 3)
• From the SA node, stimulus is conducted to AV node, AV bundle, bundle branches, and Purkinje fibers before reaching ventricular muscle cells
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KEY CONCEPT (3 of 3)
• Electrical events associated with the heartbeat can be monitored in an electrocardiogram (ECG)
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Contractile Cells
• Purkinje fibers distribute the stimulus to the contractile cells, which make up most of the muscle cells in the heart
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What events take place during an action
potential in cardiac muscle?
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Action Potentials in Skeletal and Cardiac Muscle
Figure 20–15
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Resting Potential
• Of a ventricular cell:– about —90 mV
• Of an atrial cell:– about —80 mV
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3 Steps of Cardiac Action Potential
1. Rapid depolarization: – voltage-regulated sodium channels
(fast channels) open
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3 Steps of Cardiac Action Potential
2. As sodium channels close:– voltage-regulated calcium channels
(slow channels) open– balance Na+ ions pumped out– hold membrane at 0 mV plateau
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3 Steps of Cardiac Action Potential
3. Repolarization: – plateau continues– slow calcium channels close– slow potassium channels open– rapid repolarization restores resting
potential
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The Refractory Periods
• Absolute refractory period:– long – cardiac muscle cells cannot respond
• Relative refractory period:– short– response depends on degree of
stimulus
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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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What is the importance of calcium ions to
the contractile process?
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Calcium and Contraction
• Contraction of a cardiac muscle cell is produced by an increase in calcium ion concentration around myofibrils
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2 Steps of Calcium Ion Concentration
1. 20% of calcium ions required for a contraction:
– calcium ions enter cell membrane during plateau phase
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2 Steps of Calcium Ion Concentration
2. Arrival of extracellular Ca2+:– triggers release of calcium ion
reserves from sarcoplasmic reticulum
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Intracellular and Extracellular Calcium
• 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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What events take place during the cardiac cycle,
including atrial and ventricular systole and
diastole?
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The Cardiac Cycle
• The period between the start of 1 heartbeat and the beginning of the next
• Includes both contraction and relaxation
InterActive Physiology: Cardiovascular System: The Cardiac CyclePLAYPLAY
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2 Phases of the Cardiac Cycle
• Within any 1 chamber:– systole (contraction)– diastole (relaxation)
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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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Phases of the Cardiac Cycle
Figure 20–16
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4 Phases of the Cardiac Cycle
1. Atrial systole2. Atrial diastole3. Ventricular systole 4. Ventricular diastole
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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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Pressure and Volume in the Cardiac Cycle
• 8 steps in the cardiac cycle
Figure 20–17
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8 Steps in the Cardiac Cycle
1. Atrial systole: – atrial contraction begins– right and left AV valves are open
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8 Steps in the Cardiac Cycle
2. Atria eject blood into ventricles:– filling ventricles
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8 Steps in the Cardiac Cycle
3. Atrial systole ends: – AV valves close– ventricles contain maximum volume– end-diastolic volume (EDV)
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8 Steps in the Cardiac Cycle
4. Ventricular systole:– isovolemic ventricular contraction– pressure in ventricles rises– AV valves shut
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8 Steps in the Cardiac Cycle
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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8 Steps in the Cardiac Cycle
6. Ventricular pressure falls:– semilunar valves close– ventricles contain end-systolic
volume (ESV), about 40% of end-diastolic volume
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8 Steps in the Cardiac Cycle
7. Ventricular diastole: – ventricular pressure is higher than
atrial pressure– all heart valves are closed– ventricles relax (isovolumetric
relaxation)
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8 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 CyclePLAYPLAY
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Heart Failure
• Lack of adequate blood flow to peripheral tissues and organs due to ventricular damage
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How do heart sounds relate to specific events
in the cardiac cycle?
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Heart Sounds
Figure 20–18b
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4 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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Figure 20–18a
Positioning the Stethoscope
• To detect sounds of each valve
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Heart Murmur
• Sounds produced by regurgitation through valves
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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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What is cardiac output, and what factors
influence it?
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Cardiodynamics
• The movement and force generated by cardiac contractions
InterActive Physiology: Cardiovascular System: Cardiac OutputPLAYPLAY
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Important Cardiodynamics Terms
• End-diastolic volume (EDV)• End-systolic volume (ESV)• Stroke volume (SV):
SV = EDV — ESV
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Important Cardiodynamics Terms
• Ejection fraction:– the percentage of EDV represented
by SV
• Cardiac output (CO):– the volume pumped by each ventricle
in 1 minute
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Stroke Volume
• Volume (ml) of blood ejected per beat
Figure 20–19
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Cardiac Output
• Cardiac output (CO) ml/min = • Heart rate (HR) beats/min • Stroke volume (SV) ml/beat
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Overview: Control of Cardiac Output
Figure 20–20 (Navigator)
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Adjusting to Conditions
• 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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What variables influence heart rate?
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Autonomic Innervation
Figure 20–21 (Navigator)
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Autonomic Innervation (1 of 4)
• Cardiac plexuses:– innervate heart
• Vagus nerves (X):– carry parasympathetic preganglionic
fibers to small ganglia in cardiac plexus
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Autonomic Innervation (2 of 4)
• Cardiac centers of medulla oblongata:– cardioacceleratory center:
• controls sympathetic neurons (increase heart rate)
– cardioinhibitory center: • controls parasympathetic neurons (slow
heart rate)
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Autonomic Innervation (3 of 4)
• Cardiac reflexes: – Cardiac centers monitor:
• baroreceptors (blood pressure)• chemoreceptors (arterial oxygen and
carbon dioxide levels)
• Cardiac centers adjust cardiac activity
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Autonomic Innervation (4 of 4)
• Autonomic tone: – dual innervation maintains resting
tone by releasing Ach and NE– fine adjustments meet needs of other
systems
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Autonomic Pacemaker Regulation
Figure 20–22
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Autonomic Pacemaker Regulation (1 of 3)
• Sympathetic and parasympathetic stimulation:– greatest at SA node (heart rate)
• Membrane potential of pacemaker cells:– lower than other cardiac cells
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Autonomic Pacemaker Regulation (2 of 3)
• Rate of spontaneous depolarization depends on:– resting membrane potential– rate of depolarization
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Autonomic Pacemaker Regulation (3 of 3)
• ACh (parasympathetic stimulation):– slows the heart
• NE (sympathetic stimulation):– speeds the heart
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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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Hormonal Effects on Heart Rate
• Increase heart rate (by sympathetic stimulation of SA node):– epinephrine (E)– norepinephrine (NE)– thyroid hormone
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What variables influence stroke volume?
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Factors Affecting Stroke Volume
• Changes in EDV or ESV
Figure 20–23 (Navigator)
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2 Factors Affect EDV
1. Filling time: – duration of ventricular diastole
2. Venous return: – rate of blood flow during ventricular
diastole
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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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EDV, Preload, 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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The Frank–Starling Principle
• As EDV increases, stroke volume increases
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Physical Limits
• Ventricular expansion is limited by:– myocardial connective tissue– the fibrous skeleton– the pericardial sac
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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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3 Factors that Affect ESV
1. Preload:– ventricular stretching during diastole
2. Contractility:– force produced during contraction, at a
given preload
3. Afterload:– tension the ventricle produces to open
the semilunar valve and eject blood
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Contractility
• Is affected by:– autonomic activity – hormones
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Autonomic Activity
• Sympathetic stimulation:– NE released by postganglionic fibers
of cardiac nerves– epinephrine and NE released by
adrenal medullae– causes ventricles to contract with
more force– increases ejection fraction and
decreases ESV
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Autonomic Activity
• Parasympathetic activity:– acetylcholine released by vagus
nerves– reduces force of cardiac contractions
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Hormones and Contractility
• Many hormones affect heart contraction
• Pharmaceutical drugs mimic hormone actions: – stimulate or block beta receptors– affect calcium ions e.g., calcium
channel blockers
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Afterload
• Is increased by any factor that restricts arterial blood flow
• As afterload increases, stroke volume decreases
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How are adjustments in stroke volume and cardiac
output coordinated at different levels of
activity?
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Factors Affecting Heart Rate and Stroke Volume
Figure 20–24
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Heart Rate Control Factors
1. Autonomic nervous system: – sympathetic and parasympathetic
2. Circulating hormones3. Venous return and stretch
receptors
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Stroke Volume Control Factors
• EDV:– filling time– rate of venous return
• ESV:– preload– contractility– afterload
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Cardiac Reserve
• The difference between resting and maximal cardiac output
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KEY CONCEPT (1 of 2)
• Cardiac output:– the amount of blood pumped by the
left ventricle each minute– adjusted by the ANS in response to:
• circulating hormones• changes in blood volume • alterations in venous return
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KEY CONCEPT (2 of 2)
• Most healthy people can increase cardiac output by 300–500%
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The Heart and Cardiovascular System
• Cardiovascular regulation:– ensures adequate circulation to body
tissues
• Cardiovascular centers:– control heart and peripheral blood
vessels
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The Heart and Cardiovascular System
• Cardiovascular system responds to:– changing activity patterns– circulatory emergencies
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SUMMARY (1 of 7)
• Organization of cardiovascular system:– pulmonary and systemic circuits
• 3 types of blood vessels:– arteries, veins, and capillaries
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SUMMARY (2 of 7)
• 4 chambers of the heart:– left and right atria– left and right ventricles
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SUMMARY (3 of 7)
• Pericardium, mediastinum, and pericardial sac
• Coronary sulcus and superficial anatomy of the heart
• Structures and cells of the heart wall
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SUMMARY (4 of 7)
• Internal anatomy and structures of the heart:– septa, muscles, and blood vessels
• Valves of the heart and direction of blood flow
• Connective tissues of the heart
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SUMMARY (5 of 7)
• Coronary blood supply• Contractile cells and the
conducting system:– pacemaker calls, nodes, bundles, and
Purkinje fibers
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SUMMARY (6 of 7)
• Electrocardiogram and its wave forms
• Refractory period of cardiac cells• Cardiac cycle:
– atrial and ventricular– systole and diastole
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SUMMARY (7 of 7)
• Cardiodynamics:– stroke volume and cardiac output
• Control of cardiac output