cardiology powerpoint

Cardiology

Mediastinum• Extends from sternum to the spine• Where heart sits• Sits on top of diaphragm• Pericardium covers heart

Pericardium• Fibrous – superficial part• Made of dense, irregular CT• Protects heart and anchors to medistinum• Serous – deep part that forms double layer around the heart• Parietal layer – outer layer that is fused to fibrous PC• Epicardium (visceral layer) – inner layer that covers the surface of

the heart• Pericardial fluid – fluid between layers that reduces friction as the

heart beats

Layers• Endocardium• Smooth lining of the heart, chambers, valves and vessels• Inner layer

• Myocardium• Middle layer of cardiac mm tissue

• Epicardium• Visceral layer• Outermost

Chambers• Two Atria• Auricles for increased volume

• Two Ventricles• Sulci• Blood vessels and fat• Create boundary between chambers

Right Atrium• Receives blood from superior vena cava, inferior vena cava,

and coronary sinus• Interatrial septum – between atria• Foramen ovale = fetal heart opening between atria• Fossa Ovalis = remnant of foramen ovale• Tricuspid valve – allows passage of blood from right atrium

into right ventricle• Posterior wall = smooth while auricle and anterior wall rough

= ridges calls pectinate muscles

Right Ventricle• Forms most of anterior surface• Pulmonary valve = passes into pulmonary trunk to the arteries

which carry blood to lungs• Interventricular septum separates two ventricles• Trabeculae carnae = cardiac mm fibers part of conduction• Chordae tendinae = connected to cusps of tricuspid

Left Atrium• Forms most of base of heart• Receives blood through pulmonary veins• bicuspid/mitral valve = blood from left atrium to left ventricle

Left Ventricle• Forms Apex of heart• Trabeculae carnae• Chordae tendinae• Aortic valve = left ventricle into aorta• Ductus Arteriosus = fetal temporary blood vessel; closes after

birth; shunts blood from pulmonary trunk into aorta; remnant called ligamentum arteriosum

Heart Valves• Valves open/close in response to pressure changes in the

chambers• Prevent blood from traveling backwards aka ONE WAY• MTAP• Atrioventricular valves (AV):• Tricuspid/bicuspic (mitral)

• Open pointing their ends into ventricles when atrial pressure is HIGHER than ventricle pressure

• Papillary muscles relaxed while chordae are slack• During ventricular contraction the valves are closed, and papillary

muscles tighten to contract chordae• Regurgitation occurs when valve(s) are damaged

Cont…• Semilunar valves• Aortic/pulmonic

• Made of three crescent moon shaped cusps• Allow ejection of blood and prevent backflow• Open when ventricular pressure exceeds aortic• Flows into pulmonary trunk and aorta

• LEFT SIDE = SYSTEMIC• RIGHT SIDE = PULMONARY

• Left side receives oxygen rich blood from lungs then pumps it out to the body

• Right side receives oxygen deficient blood and sends it to the lungs for oxygenation

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Figure 18.10 Anatomical differences between the right and left ventricles.

Rightventricle

Interventricularseptum

Leftventricle

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Coronary Circulation• Functional blood supply to heart muscle itself• Delivered when heart relaxed• Left ventricle receives most blood supply

• Arterial supply varies among individuals• Contains many anastomoses (junctions)• Provide additional routes for blood delivery• Cannot compensate for coronary artery occlusion

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Coronary Circulation: Arteries

• Arteries arise from base of aorta• Left coronary artery branches anterior

interventricular artery and circumflex artery• Supplies interventricular septum, anterior ventricular

walls, left atrium, and posterior wall of left ventricle

• Right coronary artery branches right marginal artery and posterior interventricular artery• Supplies right atrium and most of right ventricle

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Aorta

Superiorvena cava

Anastomosis(junction ofvessels)

Rightatrium

Rightcoronaryartery

Rightventricle

Rightmarginalartery

Posteriorinterventricularartery

Anterior interventricularartery

Leftventricle

Circumflexartery

Leftcoronaryartery

Left atrium

Pulmonarytrunk

The major coronary arteries

Figure 18.11a Coronary circulation.

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Coronary Circulation: Veins

• Cardiac veins collect blood from capillary beds• Coronary sinus empties into right atrium;

formed by merging cardiac veins• Great cardiac vein of anterior interventricular sulcus• Middle cardiac vein in posterior interventricular sulcus• Small cardiac vein from inferior margin

• Several anterior cardiac veins empty directly into right atrium anteriorly

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Figure 18.11b Coronary circulation.

Superiorvena cava

Anteriorcardiacveins

Smallcardiac vein Middle cardiac vein

Coronarysinus

Greatcardiacvein

The major cardiac veins

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Figure 18.5d Gross anatomy of the heart.

Aorta

Left pulmonary artery

Left pulmonary veins

Auricle of left atriumLeft atrium

Great cardiac vein

Posterior vein ofleft ventricleLeft ventricle

Apex

Superior vena cava

Right pulmonary arteryRight pulmonary veins

Right atrium

Inferior vena cava

Coronary sinusRight coronary artery(in coronary sulcus)Posterior interventricularartery (in posteriorinterventricular sulcus)Middle cardiac veinRight ventricle

Posterior surface view

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Homeostatic Imbalances• Angina pectoris• Thoracic pain caused by fleeting deficiency in blood delivery to

myocardium• Cells weakened

• Myocardial infarction (heart attack)• Prolonged coronary blockage• Areas of cell death repaired with noncontractile scar tissue

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Microscopic Anatomy of Cardiac Muscle• Cardiac muscle cells striated, short, branched, fat,

interconnected, 1 (perhaps 2) central nuclei

• Connective tissue matrix (endocardium) connects to cardiac skeleton• Contains numerous capillaries

• T tubules wide, less numerous; SR simpler than in skeletal muscle

• Numerous large mitochondria (25–35% of cell volume)

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Figure 18.12a Microscopic anatomy of cardiac muscle.

NucleusIntercalated

discsCardiac

muscle cell Gap junctions Desmosomes

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Microscopic Anatomy of Cardiac Muscle• Intercalated discs - junctions between cells - anchor cardiac

cells • Desmosomes prevent cells from separating during contraction• Gap junctions allow ions to pass from cell to cell; electrically

couple adjacent cells• Allows heart to be functional syncytium

• Behaves as single coordinated unit

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Cardiac Muscle Contraction• Three differences from skeletal muscle:• ~1% of cells have automaticity (autorhythmicity)

• Do not need nervous system stimulation• Can depolarize entire heart

• All cardiomyocytes contract as unit, or none do• Long absolute refractory period (250 ms)

• Prevents tetanic contractions

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Energy Requirements• Cardiac muscle• Has many mitochondria

• Great dependence on aerobic respiration• Little anaerobic respiration ability

• Readily switches fuel source for respiration• Even uses lactic acid from skeletal muscles

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Homeostatic Imbalance• Ischemic cells anaerobic respiration lactic acid • High H+ concentration high Ca2+ concentration

• Mitochondrial damage decreased ATP production• Gap junctions close fatal arrhythmias

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Heart Physiology: Electrical Events• Heart depolarizes and contracts without nervous system

stimulation• Rhythm can be altered by autonomic nervous system

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Heart Physiology: Setting the Basic Rhythm• Coordinated heartbeat is a function of• Presence of gap junctions• Intrinsic cardiac conduction system

• Network of noncontractile (autorhythmic) cells• Initiate and distribute impulses coordinated depolarization and

contraction of heart

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Pacemaker (Autorhythmic) Cells• Have unstable resting membrane potentials

(pacemaker potentials or prepotentials) due to opening of slow Na+ channels• Continuously depolarize

• At threshold, Ca2+ channels open • Explosive Ca2+ influx produces the rising phase of

the action potential• Repolarization results from inactivation of Ca2+

channels and opening of voltage-gated K+ channels

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Action Potential Initiation by Pacemaker Cells

• Three parts of action potential:• Pacemaker potential

• Repolarization closes K+ channels and opens slow Na+ channels ion imbalance

• Depolarization• Ca2+ channels open huge influx rising phase of action potential

• Repolarization• K+ channels open efflux of K+

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Figure 18.14 Pacemaker and action potentials of pacemaker cells in the heart. Slide 1

1

2

3

2

3

1

Mem

bra

ne p

ote

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V)

+10

0

–10

–20

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–50–60

–70

Time (ms)

Actionpotential

Threshold

Pacemakerpotential

1

2

3

Pacemaker potential This slow depolarization is due to both opening of Na+ channels and closing of K+ channels. Notice that the membrane potential is never a flat line.

Depolarization The action potential begins when the pacemaker potential reaches threshold. Depolarization is due to Ca2+ influx through Ca2+

channels.

Repolarization is due to Ca2+ channels inactivating and K+ channels opening. This allows K+ efflux, which brings the membrane potential back to its most negative voltage.

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1 1

+10

0

–10

–20

–30

–40

–50–60

–70

Time (ms)

Actionpotential

Threshold

Pacemakerpotential

1 Pacemaker potential This slow depolarization is due to both opening of Na+ channels and closing of K+ channels. Notice that the membrane potential is never a flat line.

Mem

bra

ne p

ote

nti

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1

2 2

1

+10

0

–10

–20

–30

–40

–50–60

–70

Time (ms)

Actionpotential

Threshold

Pacemakerpotential

1

2



channels.

Mem

bra

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nti

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1

2

3

2

3

1

Mem

bra

ne p

ote

nti

al (m

V)

+10

0

–10

–20

–30

–40

–50–60

–70

Time (ms)

Actionpotential

Threshold

Pacemakerpotential

1

2

3



channels.

Repolarization is due to Ca2+ channels inactivating and K+ channels opening. This allows K+ efflux, which brings the membrane potential back to its most negative voltage.

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Sequence of Excitation• Cardiac pacemaker cells pass impulses, in order, across heart

in ~220 ms• Sinoatrial node • Atrioventricular node • Atrioventricular bundle • Right and left bundle branches • Subendocardial conducting network (Purkinje fibers)

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Heart Physiology: Sequence of Excitation• Sinoatrial (SA) node• Pacemaker of heart in right atrial wall

• Depolarizes faster than rest of myocardium• Generates impulses about 75X/minute (sinus rhythm)

• Inherent rate of 100X/minute tempered by extrinsic factors

• Impulse spreads across atria, and to AV node

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Heart Physiology: Sequence of Excitation• Atrioventricular (AV) node• In inferior interatrial septum• Delays impulses approximately 0.1 second

• Because fibers are smaller diameter, have fewer gap junctions• Allows atrial contraction prior to ventricular contraction

• Inherent rate of 50X/minute in absence of SA node input

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Heart Physiology: Sequence of Excitation• Atrioventricular (AV) bundle

(bundle of His)• In superior interventricular septum• Only electrical connection between atria and ventricles

• Atria and ventricles not connected via gap junctions

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Heart Physiology: Sequence of Excitation• Right and left bundle branches• Two pathways in interventricular septum• Carry impulses toward apex of heart

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Heart Physiology: Sequence of Excitation• Purkinje fibers (Subendocardial conducting network)• Complete pathway through interventricular septum into apex and

ventricular walls• More elaborate on left side of heart• AV bundle and subendocardial conducting network depolarize

30X/minute in absence of AV node input• Ventricular contraction immediately follows from apex toward

atria

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Figure 18.15a Intrinsic cardiac conduction system and action potential succession during one heartbeat.

The sinoatrial (SA) node (pacemaker)generates impulses.

1

The impulsespause (0.1 s) at theatrioventricular(AV) node.

2

The atrioventricular(AV) bundleconnects the atriato the ventricles.

3

The bundle branches conduct the impulses through the interventricular septum.

4

The subendocardialconducting networkdepolarizes the contractilecells of both ventricles.

5

Superior vena cava Right atrium

Left atrium

Subendocardialconductingnetwork(Purkinje fibers)

Inter-ventricularseptum

Anatomy of the intrinsic conduction system showing the sequence ofelectrical excitation

Internodal pathway

Slide 1

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1


Left atrium




Slide 2

Internodal pathway

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1


2


Left atrium




Slide 3

Internodal pathway

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1


2


3


Left atrium




Slide 4

Internodal pathway

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1


2


3


4


Left atrium




Slide 5

Internodal pathway

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1


2


3


4

The subendocardialconducting networkdepolarizes the contractilecells of both ventricles.

5


Left atrium




Slide 6

Internodal pathway

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Pacemaker potential

SA node

Atrial muscle

AV node

Ventricularmuscle

Plateau

Pacemakerpotential

0 100 200 300 400

Milliseconds

Comparison of action potential shape atvarious locations

Figure 18.15b Intrinsic cardiac conduction system and action potential succession during one heartbeat.

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Homeostatic Imbalances

•Defects in intrinsic conduction system may cause• Arrhythmias - irregular heart rhythms• Uncoordinated atrial and ventricular

contractions• Fibrillation - rapid, irregular

contractions; useless for pumping blood circulation ceases brain death• Defibrillation to treat

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Homeostatic Imbalances

•Defective SA node may cause• Ectopic focus - abnormal pacemaker• AV node may take over; sets junctional

rhythm (40–60 beats/min)• Extrasystole (premature contraction)• Ectopic focus sets high rate• Can be from excessive caffeine or

nicotine

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Homeostatic Imbalance

• To reach ventricles, impulse must pass through AV node•Defective AV node may cause• Heart block• Few (partial) or no (total) impulses reach

ventricles• Ventricles beat at intrinsic rate – too slow for life

• Artificial pacemaker to treat

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Extrinsic Innervation of the Heart• Heartbeat modified by ANS via cardiac centers in medulla

oblongata• Sympathetic rate and force• Parasympathetic rate • Cardioacceleratory center – sympathetic – affects SA, AV nodes,

heart muscle, coronary arteries• Cardioinhibitory center – parasympathetic – inhibits SA and AV

nodes via vagus nerves

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The vagus nerve(parasympathetic)decreases heart rate.

Dorsal motor nucleusof vagus

Cardioinhibitorycenter

Cardioaccele-ratory center

Medulla oblongata

Sympathetictrunkganglion

Thoracic spinal cordSympathetic trunk

Sympathetic cardiacnerves increase heart rateand force of contraction.

AVnode

SAnode

Parasympathetic fibers Sympathetic fibers Interneurons

Figure 18.16 Autonomic innervation of the heart.

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Electrocardiography• Electrocardiogram (ECG or EKG)• Composite of all action potentials generated by nodal and

contractile cells at given time• Three waves:• P wave – depolarization SA node atria• QRS complex - ventricular depolarization and atrial repolarization• T wave - ventricular repolarization

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Sinoatrialnode

Atrioventricularnode

QRS complex

Ventriculardepolarization

Atrialdepolarization

Ventricularrepolarization

P-RInterval

S-TSegment

Q-TInterval

0 0.2 0.4 0.6 0.8Time (s)

R

Q

S

P T

Figure 18.17 An electrocardiogram (ECG) tracing.

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Figure 18.18 The sequence of depolarization and repolarization of the heart related to the deflection waves of an ECG tracing. Slide 1

SA node

AV node

R

P T

QS

Atrial depolarization, initiated by the SA node, causes the P wave.

1

R

P T

QS

With atrial depolarization complete, the impulse is delayed at the AV node.

2

R

P T

QS

Ventricular depolarization begins at apex, causing the QRS complex. Atrial repolarization occurs.

3

R

P T

QS

R

P T

QS

SQ

P T

R

Ventricular depolarization is complete.4

5

6

Ventricular repolarization begins at apex, causing the T wave.

Ventricular repolarization is complete.

Depolarization Repolarization

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Figure 18.18 The sequence of depolarization and repolarization of the heart related to the deflectionwaves of an ECG tracing.

Slide 2

SA node R

P T

QS

Depolarization

Repolarization


1

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Slide 3

AV node R

P T

QS

SA node R

P T

QS

Depolarization

Repolarization


2


1

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Slide 4

R

P T

QS


3

AV node R

P T

QS


2

SA node R

P T

QS


1

Depolarization

Repolarization

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Slide 5

R

P T

QS

Ventricular depolarization is complete.

Depolarization

Repolarization

4

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Slide 6

R

P T

QS


5

R

P T

QS


Depolarization

Repolarization

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Slide 7

SQ

P T

R

Ventricular repolarization is complete.6

R

P T

QS


5

R

P T

QS


Depolarization

Repolarization

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Figure 18.18 The sequence of depolarization and repolarization of the heart related to the deflection waves of an ECG tracing. Slide 8

SA node

AV node

R

P T

QS


1

R

P T

QS


2

R

P T

QS


3

R

P T

QS

R

P T

QS

SQ

P T

R


5

6


Ventricular repolarization is complete.

Depolarization Repolarization

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Normal sinus rhythm.

Junctional rhythm. The SA node is nonfunctional, P waves areabsent, and the AV node paces the heart at 40 –60 beats/min.

Second-degree heart block. Some P waves are not conductedthrough the AV node; hence more P than QRS waves are seen. Inthis tracing, the ratio of P waves to QRS waves is mostly 2:1.

Ventricular fibrillation. These chaotic, grossly irregular ECGdeflections are seen in acute heart attack and electrical shock.

Figure 18.19 Normal and abnormal ECG tracings.

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Electrocardiography• P-R interval• Beginning of atrial excitation to beginning of ventricular

excitation• S-T segment• Entire ventricular myocardium depolarized

• Q-T interval• Beginning of ventricular depolarization through ventricular

repolarization

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Heart Sounds• Two sounds (lub-dup) associated with closing of heart valves• First as AV valves close; beginning of systole• Second as SL valves close; beginning of ventricular diastole• Pause indicates heart relaxation

• Heart murmurs - abnormal heart sounds; usually indicate incompetent or stenotic valves

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Aortic valve soundsheard in 2nd intercostalspace at right sternalmargin

Pulmonary valvesounds heard in 2ndintercostal space at leftsternal margin

Mitral valve soundsheard over heart apex(in 5th intercostal space)in line with middle ofclavicle

Tricuspid valve soundstypically heard in rightsternal margin of 5thintercostal space

Figure 18.20 Areas of the thoracic surface where the sounds of individual valves can best be detected.

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Mechanical Events: The Cardiac Cycle• Cardiac cycle• Blood flow through heart during one complete heartbeat: atrial

systole and diastole followed by ventricular systole and diastole• Systole—contraction • Diastole—relaxation• Series of pressure and blood volume changes

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Phases of the Cardiac Cycle• 1. Ventricular filling—takes place in mid-to-late diastole• AV valves are open; pressure low • 80% of blood passively flows into ventricles• Atrial systole occurs, delivering remaining 20%• End diastolic volume (EDV): volume of blood in each ventricle at

end of ventricular diastole

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Phases of the Cardiac Cycle• 2. Ventricular systole• Atria relax; ventricles begin to contract • Rising ventricular pressure closing of AV valves• Isovolumetric contraction phase (all valves are closed)• In ejection phase, ventricular pressure exceeds pressure in large

arteries, forcing SL valves open• End systolic volume (ESV): volume of blood remaining in each

ventricle after systole

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Phases of the Cardiac Cycle• 3. Isovolumetric relaxation - early diastole• Ventricles relax; atria relaxed and filling• Backflow of blood in aorta and pulmonary trunk closes SL valves

• Causes dicrotic notch (brief rise in aortic pressure as blood rebounds off closed valve)

• Ventricles totally closed chambers• When atrial pressure exceeds that in ventricles AV valves open;

cycle begins again at step 1

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Electrocardiogram

Heart sounds

Left heartQRS

P T P

1st 2nd

Dicrotic notch120

Aorta

Left ventricle

Left atriumAtrial systole

80

40

0

Pre

ssure

(m

m H

g)

EDV

SV

ESV

120

50

Ventr

icula

rvolu

me (

ml)

Atrioventricular valves

Aortic and pulmonary valves

Phase

Open Closed Open

Closed Open Closed

1 2a 2b 3 1

Left atriumRight atriumLeft ventricleRight ventricle

Ventricularfilling

Atrialcontraction

Isovolumetriccontraction phase

Ventricularejection phase

Isovolumetricrelaxation

Ventricularfilling

Ventricular filling(mid-to-late diastole)

Ventricular systole(atria in diastole)

Early diastole

1 2a 2b 3

Figure 18.21 Summary of events during the cardiac cycle.

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Cardiac Output (CO)• Volume of blood pumped by each ventricle in one minute• CO = heart rate (HR) × stroke volume (SV)• HR = number of beats per minute• SV = volume of blood pumped out by one ventricle with each

beat• Normal – 5.25 L/min

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Cardiac Output (CO)

• At rest• CO (ml/min) = HR (75 beats/min) SV (70 ml/beat) = 5.25 L/min• CO increases if either/both SV or HR increased• Maximal CO is 4–5 times resting CO in nonathletic

people• Maximal CO may reach 35 L/min in trained athletes• Cardiac reserve - difference between resting and

maximal CO

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Regulation of Stroke Volume• SV = EDV – ESV• EDV affected by length of ventricular diastole and venous

pressure• ESV affected by arterial BP and force of ventricular contraction

• Three main factors affect SV:• Preload• Contractility• Afterload

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Regulation of Stroke Volume

• Preload: degree of stretch of cardiac muscle cells before they contract (Frank-Starling law of heart)• Cardiac muscle exhibits a length-tension relationship• At rest, cardiac muscle cells shorter than optimal

length• Most important factor stretching cardiac muscle is

venous return – amount of blood returning to heart• Slow heartbeat and exercise increase venous return • Increased venous return distends (stretches) ventricles and

increases contraction force

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Regulation of Stroke Volume

• Contractility—contractile strength at given muscle length, independent of muscle stretch and EDV• Increased by• Sympathetic stimulation increased Ca2+ influx more

cross bridges• Positive inotropic agents • Thyroxine, glucagon, epinephrine, digitalis, high extracellular

Ca2+

• Decreased by negative inotropic agents• Acidosis, increased extracellular K+, calcium channel

blockers

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Figure 18.23 Norepinephrine increases heart contractility via a cyclic AMP secondmessenger system.

a

b c

Norepinephrine

β1-Adrenergicreceptor G protein (Gs)

Adenylate cyclase

GDP

ATP is convertedto cAMP

Ca2+Extracellular fluid

Ca2+

channel

Cytoplasm

Phosphorylates plasmamembrane Ca2+

channels, increasingextracellular Ca2+ entry

Phosphorylates SR Ca2+ pumps, speedingCa2+ removal and relaxation, making moreCa2+ available for release on the next beat

Active proteinkinase

Ca2+

Ca2+ uptake pump

Sarcoplasmicreticulum (SR)

Inactive proteinkinase

Phosphorylates SR Ca2+ channels, increasingintracellular Ca2+ release

Ca2+

binds

toTroponin

Enhancedactin-myosininteraction

SR Ca2+

channel Cardiac muscle

force and velocity

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Regulation of Stroke Volume• Afterload - pressure ventricles must overcome to eject blood• Hypertension increases afterload, resulting in increased ESV

and reduced SV

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Regulation of Heart Rate• Positive chronotropic factors increase heart rate• Negative chronotropic factors decrease heart rate

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Autonomic Nervous System Regulation• Sympathetic nervous system activated

by emotional or physical stressors• Norepinephrine causes pacemaker to

fire more rapidly (and increases contractility)• Binds to β1-adrenergic receptors HR • contractility; faster relaxation• Offsets lower EDV due to decreased fill time

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Autonomic Nervous System Regulation• Parasympathetic nervous system opposes sympathetic effects • Acetylcholine hyperpolarizes pacemaker cells by opening K+

channels slower HR• Little to no effect on contractility

• Heart at rest exhibits vagal tone• Parasympathetic dominant influence

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Autonomic Nervous System Regulation• Atrial (Bainbridge) reflex - sympathetic reflex initiated by

increased venous return, hence increased atrial filling• Stretch of atrial walls stimulates SA node HR• Also stimulates atrial stretch receptors, activating sympathetic

reflexes

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Figure 18.22 Factors involved in determining cardiac output.

Exercise (bysympathetic activity, skeletal muscle andrespiratory pumps;

see Chapter 19)

Heart rate (allows more

time forventricular

filling)

Bloodborneepinephrine,

thyroxine,excess Ca2+

Exercise, fright, anxiety

Venousreturn Contractility

Sympatheticactivity

Parasympatheticactivity

EDV(preload) ESV

Strokevolume

Cardiacoutput

Heartrate

Initial stimulus

Physiological response

Result

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Chemical Regulation of Heart Rate • Hormones• Epinephrine from adrenal medulla increases heart rate and

contractility• Thyroxine increases heart rate; enhances effects of

norepinephrine and epinephrine• Intra- and extracellular ion concentrations (e.g., Ca2+ and K+)

must be maintained for normal heart function

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Homeostatic Imbalance• Hypocalcemia depresses heart• Hypercalcemia increased HR and contractility• Hyperkalemia alters electrical activity heart block and

cardiac arrest• Hypokalemia feeble heartbeat; arrhythmias

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Other Factors that Influence Heart Rate• Age• Fetus has fastest HR

• Gender• Females faster than males

• Exercise• Increases HR

• Body temperature• Increases with increased temperature

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Homeostatic Imbalances• Tachycardia - abnormally fast heart rate (>100 beats/min)• If persistent, may lead to fibrillation

• Bradycardia - heart rate slower than 60 beats/min• May result in grossly inadequate blood circulation in nonathletes• May be desirable result of endurance training

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Homeostatic Imbalance• Congestive heart failure (CHF)• Progressive condition; CO is so low that blood circulation

inadequate to meet tissue needs• Reflects weakened myocardium caused by

• Coronary atherosclerosis—clogged arteries• Persistent high blood pressure• Multiple myocardial infarcts• Dilated cardiomyopathy (DCM)

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Homeostatic Imbalance• Pulmonary congestion• Left side fails blood backs up in lungs

• Peripheral congestion• Right side fails blood pools in body organs edema

• Failure of either side ultimately weakens other• Treat by removing fluid, reducing afterload, increasing

contractility

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Developmental Aspects of the Heart• Embryonic heart chambers• Sinus venosus• Atrium• Ventricle• Bulbus cordis

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Figure 18.24 Development of the human heart.

Day 20: Endothelial tubes begin to fuse.

4a

4

3

2

1

Tubularheart

Day 22:Heart starts pumping.

Arterial end

Ventricle

Ventricle

Venous end

Day 24: Heart continues to elongate and starts to bend.

Arterial end

Atrium

Venous end

Day 28: Bending continues as ventricle moves caudally and atrium moves cranially.

Aorta

Superiorvena cava

Inferiorvena cava

Ductusarteriosus

Pulmonarytrunk

Foramenovale

Ventricle

Day 35: Bending is complete.

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Developmental Aspects of the Heart• Fetal heart structures that bypass pulmonary circulation• Foramen ovale connects two atria

• Remnant is fossa ovalis in adult • Ductus arteriosus connects pulmonary trunk to aorta

• Remnant - ligamentum arteriosum in adult• Close at or shortly after birth

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Developmental Aspects of the Heart• Congenital heart defects• Most common birth defects; treated with surgery• Most are one of two types:

• Mixing of oxygen-poor and oxygen-rich blood, e.g., septal defects, patent ductus arteriosus

• Narrowed valves or vessels increased workload on heart, e.g., coarctation of aorta

• Tetralogy of Fallot• Both types of disorders present

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Figure 18.25 Three examples of congenital heart defects.

Occurs inabout 1 in every500 births

Ventricular septal defect.The superior part of theinter-ventricular septum failsto form, allowing blood to mixbetween the two ventricles.More blood is shunted fromleft to right because the leftventricle is stronger.

Narrowedaorta


Coarctation of the aorta.A part of the aorta isnarrowed, increasing theworkload of the left ventricle.


Tetralogy of Fallot.Multiple defects (tetra =four): (1) Pulmonary trunktoo narrow and pulmonaryvalve stenosed, resulting in(2) hypertrophied rightventricle; (3) ventricularseptal defect; (4) aortaopens from both ventricles.

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Age-Related Changes Affecting the Heart• Sclerosis and thickening of valve flaps• Decline in cardiac reserve• Fibrosis of cardiac muscle• Atherosclerosis

cardiology powerpoint

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