the heart -...
TRANSCRIPT
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The Heart
• What does it
generate?
• Why is that so
important?
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• Found in the…
• Apex points at…
• Base points at…
• Sits atop the…
• Medial to…
• Anterior to the…
• Posterior to the…
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Fibrous Pericardium
• Made of…
• Encloses.
• Stabilizes.
• Prevents...
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Parietal & Visceral Serous Pericardium
• Position
• Function
• Pericardial cavity
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3 Layers of the Heart Wall
• Epicardium
• Myocardium
• Endocardium.
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Heart Chambers
• 4 chambers.
• 2 superior atria.
• 2 inferior ventricles.
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Right Ventricle
Pulmonary
Circuit
Left Ventricle
Systemic
Circuit
Left atrium
Right Atrium
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Atria• Superior.
• Receive…
• Separated by…
• Small.
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Right Atrium
• Receives what kind of
blood?
• From which circuit?
• Receives 3 main vessels
– SVC
– IVC
– CS
• Sends blood thru the tricuspid orifice
(past the tricuspid valve) to the…
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Left Atrium
• Receives what kind of
blood?
• From which circuit?
• Receives 4 vessels
– Pulmonary veins
• Sends blood thru the mitral orifice
(past the mitral valve) to the…
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Interatrial Septum
• Function?
• Adult vs. Fetus
• Fossa ovalis.
• Foramen ovale.
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Why do the fetal atria connect?
• What gets skipped?
• Where does fetal gas exchange occur?
• Which direction does blood flow?
• Right atrium BP _______ Left Atrium BP
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Ventricles
• Inferior chambers.
• Pumps.
• Separated by…
• Muscular.
• Trabeculae carneae
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Right Ventricle
• Receives what kind of blood?
• From where?
• Pumps to what circuit?
• Into what vessel?
• Pulmonary semilunar valve
• Tricuspid valve
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Left Ventricle
• Receives what kind of blood?
• From where?
• Pumps to what circuit?
• Into what vessel?
• Aortic semilunar valve
• Mitral valve
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• Volume
• Pressure
• Muscle
Left Ventricle vs. Right Ventricle
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Left Ventricle
Aorta
Systemic Arteries
Systemic Capillaries
Systemic Veins
Venae Cavae
Right Atrium
Systemic
Circuit
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Right Ventricle
Pulmonary Trunk
Pulmonary Arteries
Pulmonary Capillaries
Pulmonary Veins
Left Atrium
Pulmonary
Circuit
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Left Ventricle
Aorta
Systemic Arteries
Systemic Capillaries
Systemic Veins
Venae Cavae
Right Atrium
Systemic &
pulmonary
circuits are
in series
Right Ventricle
Pulmonary Trunk
Pulmonary Arteries
Pulmonary Capillaries
Pulmonary Veins
Left Atrium
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Coronary Circuit
• Special branch of the
systemic circuit.
• Provides blood to…
• All 3 layers require a
blood supply.
– Which layer is the
neediest?
– What does it need?
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Left Ventricle
Aorta
Coronary Arteries
Coronary Veins
Coronary Sinus
Right Atrium
Coronary
Circuit
- A special branch
of the systemic
circuit
Coronary Capillaries
How much blood
enters the coronary
circulation?
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Heart Valves• Function?
• 2 atrioventricular (AV)– Prevent backflow from…
– Tricuspid
– Mitral.
• 2 semilunar– Prevent backflow from…
– Pulmonary
– Aortic.
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• What do these NOT do?
• What do they do?
Papillary Muscles & Chordae Tendineae
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• Tricuspid valve is open when RAP is _______ than RVP.
• Mitral valve is open when LAP is _______ than LVP.
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• Tricuspid valve is closed when RAP is _______ RVP.
• Mitral valve is closed when LAP is _______ LVP.
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Semilunar Valves
• No chordae tendineae
• No papillary muscles.
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Pulmonary valve is open when RVP is _____ Pulmonary Trunk P.
Aortic valve is open when LVP is _____ Aortic P.
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Pulmonary valve is closed when RVP is ____ Pulmonary Trunk P.
Aortic valve is closed when LVP is ____ Aortic P.
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• Location?
• Primary tissue?
• Primary cells?
• Fibrous skeleton
Myocardium
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Fibrous Skeleton of the Heart
• Tissue type?
• Functions?
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Cardiac Contractile Cells
• Function?
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• Desmosomes
• Gap junctions
Intercalated Discs Contain 2 Structures:
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Autorhythmic Cells
• Intrinsic control
• Spontaneous
• Rhythmic
• Electrically linked.
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Autorhythmic Cell Location
1. Sinoatrial node
2. Atrioventricular node
3. Atrioventricular bundle
4. Right/left bundle
branches
5. Purkinje fibers.
1
2
5
3
4
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• From fastest to slowest:– SA node
– AV node
– AV bundle
– Bundle branches
– Purkinje fibers
• Who sets the pace?
Autorhythmic Cell Depolarization Rates
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Why is the “slow-down” in the
AV node significant?
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What makes the signal go
down the septum?
Why doesn’t it go down the
side or front or back?
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• What 2 organ systems are the biggest extrinsic
influence on the heart?
Extrinsic Influence on Heart Activity
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• Cardioacceleratory center
• Cardioinhibitory center
Medullary Cardiac Centers
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• Cardiac sympathetic nerves
• Norepinephrine
• Innervation
Cardioacceleratory center
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• Vagus nerve (CN X)
• Acetylcholine
• Innervation
Cardioinhibitory center
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Resting
parasympathetic
influence on the
heart.
Resting
sympathetic
influence on the
heart.What about during exercise?
Vagal Tone
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• How would a decrease in cardioacceleratory
center activity affect heart rate?
• How does acetylcholine affect the amount of
time in between heart beats?
• How would a vagotomy affect heart rate?
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• All the events associated with one heartbeat.
• Includes systole and diastole of all chambers.
• Pressures and volumes of all 4 chambers
change in a predictable way during each cycle.
Cardiac Cycle
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Ventricular
Filling
Isovolumetric
Relaxation
Isovolumetric
Contraction
Ventricular
Ejection
Phases of the Cardiac Cycle
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Ventricular Filling
• LV volume is…
• Mitral valve is…
• LVP is _______ LAP
• LV is in…
• Aortic valve is…
• LVP is _______ Aortic P.
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• First 80% vs. Last 20%
• End Diastolic Volume.
Ventricular Filling
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• LV contracts and LVP…
• LAP is a lot lower than
Aortic P.
• LUB
Isovolumetric Contraction
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• Mitral valve is…
• Aortic valve is…
• LV volume is…
• LVP is _______ LAP
• LVP is _______ Aortic P
Isovolumetric Contraction
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• LV volume is…
• Aortic valve is…
• LVP is _______ Aortic P
• Mitral valve is…
• LVP is _______ LAP
Ventricular Ejection
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• Is the entire EDV ejected?
• End systolic volume (70mL).
Ventricular Ejection
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• Vol. ejected by a ventricle per cardiac cycle.
• Stroke Volume = End diastolic volume –
End systolic volume
• SV = EDV – ESV
• Stroke volumes of the ventricles must equilibrate!
Stroke Volume
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Isovolumetric Relaxation
• LV relaxes and LVP…
• Aortic P is a lot higher than LAP.
• DUP
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Isovolumetric Relaxation
• Mitral valve is…
• Aortic valve is…
• LV volume is…
• LVP is _______ LAP
• LVP is _______ Aortic P
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Time
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Time
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• Given that:– Aortic Pressure = 82mmHg
– Left Atrium Pressure = 11mmHg
– Left Ventricle Pressure = 61 mmHg and falling
• Answer the following:– The mitral valve is…
– The tricuspid valve is…
– The aortic semilunar valve…
– The pulmonary semilunar valve is…
– LV volume is…
– LA volume is…
– The current phase of the cardiac cycle is…
– The previous phase of the cardiac cycle was…
– The next phase of the cardiac cycle will be…
– The most recent heart sound was caused by…
– The next heart sound will be caused by…
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• Volume of blood pumped by a ventricle per minute.
• Cardiac Output = Heart Rate x Stroke Volume
• Units are mL/min or L/min.
Cardiac Output
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Hector had a cardiac output of 6000 mL and a heart rate of 100 beats/minute. How much blood left his heart during each cardiac cycle?
a) 58.6 mL
b) 62 mL
c) 100 mL
d) 110 mL
e) 120 mL
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Heart rate will increase when…
• Cardioacceleratory activity…
• Cardioinhibitory activity…
• Plasma levels of epinephrine…
• Plasma levels of thyroxine…
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Heart rate will decrease when…
• Cardioacceleratory activity…
• Cardioinhibitory activity…
• Plasma levels of epinephrine…
• Plasma levels of thyroxine…
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• If heart rate increases:
– The time between beats will…
– Filling time will…
– The end diastolic volume will…
• If heart rate decreases:
– The time between beats will…
– Filling time will…
– The end diastolic volume will…
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Regulating Stroke Volume
• Primary influence on stroke volume is:
– Preload
• Other important influences are:
– Contractility
– Afterload
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• Degree of ventricular stretch.
• What stretches the ventricle?
Preload
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More blood returns to the heart.
Ventricular stretch…
Ventricular tension…
Overlap between actin & myosin gets...
Stroke volume…
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• Whatever goes in the heart gets pumped out.
• What’s the relationship btwn SV and EDV?
• How does the FS Law account for the fact that LV and RV have the same average stroke volume?
Frank-Starling Law of the Heart
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Diastolic Volume
Systo
lic F
orc
e
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• As EDV decreases, SV will…
• As HR increases, SV will…
• As venous pressure increases, SV will…
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• Strength of ventricular
squeezing regardless of
how stretched it is.
• in contractility SV to…
• What affects contractility?
Contractility
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• Pressure that the LV
must overcome in order
to open the semilunar
valve and eject blood.
• Aortic blood pressure.
Afterload
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• Will it be easy to open the aortic semilunar valve?
• How would this affect the amount of blood pumped out?
• How would this affect ESV?
Suppose Aortic P is high:
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