Anatomy and Physiology of the Heart Size and mass of the heart - The heart has a length, width,

height, and thickness of 12cm, 9cm, and 6cm respectively. It has a mass of 250g for females, and 300g for males. This is because generally, most of the males have more muscle mass than the females. Location of the heart - The heart is located in the thoracic cavity between the lungs. Being in the mediastinum, the trachea, esophagus, and other structures are near it. The base of the heart is located deep to the sternum and extends to the level of the second intercostal space (7-9cm to the left of the sternum) to the left of the sternum near the midclavicular line. Meanwhile, the apex is directed anteriorly and slightly inferiorly. It is also directed to the left. It lies on the left of the midline sternum. Pericardium - The pericardium serves as the covering of the heart. It also has other parts. The fibrous pericardium,
composed of tough inelastic, dense irregular connective tissue serves as its outer covering. It provides protection and anchorage of the heart. The deeper serous pericardium is a thinner, more delicate membrane which forms a double layer. The outer cover of this double layer is the parietal layer. The inner layer is the visceral. Between these layers is the pericardial cavity, in which the pericardial fluid lies. This fluid lubricates and decreases the stress in the heart as it beats. Layers of the heart

As for the layers of the heart, there are three to begin with. The first and outermost layer is the epicardium. This layer is also the visceral layer of the pericardium. The middle part of the walls is called the myocardium. This is the muscular part of the heart composed of cardiac muscles, responsible for pumping blood to the circulation. The innermost part is the endocardium, which provides cover for the valves of the heart.

(Heart Wall layers)

Chambers of the heart

There are four chambers to be exact. These chambers are the left and right atrium and the left and right ventricle. The right atrium forms the right border of the heart and receives blood from three veins which are the superior and inferior vena cava, and the coronary sinus. These three veins carry deoxygenated blood from the circulation and the heart itself respectively. Its posterior and anterior walls are different. The posterior wall is smooth; the anterior wall is rough due to the presence the muscular ridges called the pectinate muscles. It pumps the heart to the tricuspid valve. The Right ventricle forms The right ventricle forms most of the anterior surface of the heart. Compared to the left ventricle, it has a thinner wall because of its lesser workload. It passes the deoxygenated blood to the pulmonary valve to the left and right pulmonary arteries to reach the pulmonary circulation. After which, the blood becomes oxygenated. The left atrium is the destination of the blood after passing through the pulmonary circulation and the pulmonary vein. This atrium pumps the oxygenated blood through the mitral valve to the left ventricle. The left atrium and the right atrium is separated by the interatrial septum, in which the fossa ovalis is present (the former foramen ovale). The left ventricle, compared to the right ventricle has a more dense muscle mass and more workload. This is because this ventricle pumps all of the oxygenated blood to the whole circulation through the aortic valve, then to the aorta. Also some of the blood circulates because of the force from this ventricle to the coronary arteries.

(Chambers of the heart) Heart Valves

The heart valves are classified into two, the atrioventricular valves and the semilunar valves. This valves prevent regurgitation and also serves as a barier from one part to another. These valves would open because of the pressure exerted by the atrium and the ventricles. The atrioventricular valves are attached to the cordae tendinae, which is pulled by the papillary muscles to close. When the ventricles are relaxed, so are the papillary muscles. The chordate tendinae are slack and blood moves from a higher pressure n the atria to a lower pressure in the ventricles. The opening of the valves is closed by the blood and at the same time by the papillary muscles. These valves are the mitral and the tricuspid valve. The Semilunar valves allow ejection of the blood from the heart into the arteries. The pressure resulting from the ventricular contractions open these valves. As these ventricles relax, blood starts to flow back, therefore, after closing, the valve is tightened by the blood that is pushing back to the ventricle, therefore preventing regurgitation.

(Heart Valves) Coronary Circulation - As much as the whole of the body needs blood, the heart also requires some blood to maintain itself. That is the purpose of the Coronary arteries and veins. - The coronary arteries provide oxygenated blood to the myocardium. It is divided into the left and right coronary arteries, branching out from the ascending aorta. The left coronary artery provides oxygenated blood to the anterior interventricular and circumflex branches. The right coronary artery supplies small branches to the right atrium and is further divided into the posterior interventricular branch, that follows the posterior interventricular sulcus and supplies the walls of the two ventricles with oxygenated blood, and the marginal branches, which supply to the myocardium of the right ventricle. - The Coronary veins are the ones responsible for rerouting the deoxygenated blood from the myocardium to the right atrium through the means of the coronary sinus. For the blood to

get to the coronary sinus, the great cardiac vein (draining from the left and right ventricles and left atrium), the Middle cardiac vein (draining from the left and right ventricles), small cardiac vein (draining from the right atrium and right ventricle) and the anterior cardiac veins (drains from the right ventricle) collects the blood to circulate back to the right atrium.

(Coronary Circulation) Autorhytmic fibers of the heart - The autorhytmic fibers are responsible for giving the heart its own conduction system. Because of the presence of these fibers, the heart may continue to beat even though it is removed from the body. It is composed of the Sinoarterial (SA) node, Atrioventricular (AV) node, Bundle of His, Right and left bundle branches, and Right and the Purkinje fibers. The Action potentials pass through these to get to the whole heart - The action potential starts at the SA node, located in the right atrial wall just inferior and lateral to the opening of the superior vena cava. They repeatedly depolarize to the threshold spontaneously. These action potentials propagate throughout both atria via gap junction in the intercalated discs of the heart muscles fibers. This causes the atria to contract. - As the action potential conducts through the cardiac muscle, it reaches the AV node, which is located in the interatrial septum. After this, it passes to the Bundle of His. Then conducting to the ventricles, thereby having contact with the left and right bundle branches that is located at the interventricular septum near the apex of the heart.

The Purkinje fibers serve as the last medium of conduction wherein it conducts the action potentials from the apex upward.

(Autorhytmic Fibers of the heart) Action potential and contraction of the contractile fibers - The action potential of the heart is facilitated through the movement of Na+, K+, and Ca2+. Rapid depolarization occurs due to the Na inflow when voltage-gated fast Na channels open. Then the plateau, the maintained depolarization, occurs due to Ca2+ inflow when voltagegated slow Ca2+ channels open and K+ outflow when some K+ channels open. Electrocardiogram - An electrocardiogram is a recording of the action potentials produced b the heart muscles during each heartbeat. It is seen with the use of the electrocardiograph using electrodes positioned on the arms and legs and six positions on the chest. Each limb and chest electrode records slightly different electrical activity because of its relative difference to the position of the heart. Through these it is possible to determine if the conducting pathway is normal, if the heart is enlarged, if some regions of the heart is damaged, and the cause of chest pain. - The first wave (P wave) represents atrial depolarization whch spread from the SA node through contractile fibers in both atria. The second wave (QRS complex) represents rapid ventricular depolarization. The third wave (T wave) indicates ventricular repolarization. - The ECG is analyzed through the deviations in the intervals and segments. The P-Q interval is the time from the beginning of the P wave to the beginning of the QRS complex. It represents the conduction time from the beginning of atrial excitation to the beginning of ventricular excitation. - The S-T segment, which begins at the end of the S wave and ends in the beginning of the T wave, represents time when the ventricular contractile fibers are depolarized during the plateau phase of the action potential.

The Q-T interval extends from the start of start of the QRS complex to the end of the T wave. It is the time from the beginning of ventricular depolarization to the end of the ventricular repolarization.

(PQRST waves) Cardiac cycle - The cardiac cycle is the summation of all the events in a single heart beat. In the essence of this, it consists of the systole and diastole of the atria plus systole and diastole of the ventricles. - During the atrial systole, the atria are contracting. While they contract, the ventricles relax. This is caused by the depolarization of the SA node that causes the atrial depolarization. Atrial depolarization causes the atria to contract, thereby exerting pressure on the blood within, forcing the blood through the open AV ventricles. The end of the atrial systole will also end the ventriculare diastole. After this, each ventricle would contain about 130 mL at the end of the diastole. The 130 mL is called the end-diastolic volume (EDV). - During the ventricular systole, the atria are relaxed and the ventricles are contracting. Atrial diastole occurs. Ventricular depolarization causes ventricular systole which creates the QRS complex . As it begins, pressure rises inside the ventricles, shutting the AV valves by pushing them shut. As this happens, the isovolumetric contraction happens wherein the cardiac muscles contract but the heart is not shortening yet. No changes in the measurement of the heart through contraction are evident. After this, the pressure rises sharply because of the contractions of the ventricles, therefore surpassing the aortic pressure, therefore opening the aortic valve, eliciting ventricular ejection. As the blood is ejected from the left ventricle, there would be a remaining 60 mL of blood which is called the end-systolic volume (ESV). - During the relaxation period, both the ventricles and the atria are relaxed for about 0.4 seconds. This happens after ventricular repolarization occurs. This relaxation decreases the

pressure within the chambers and blood from the pulmonary trunk and the aorta flow back towards the regions of the lower pressure. The flowing blood is catched by the valves, therefore, securing it and preventing regurgitation. After the closure of the semilunar valves, there is a brief interval when ventricular blood volume does not change because all the valves are closed. This is called the isovolumetric relaxation. The relaxation causes the pressure to further decrease and the AV valves open, and ventricular filling begins. At the end of the relaxation period, the ventricles are about three-quarters full. The P wave would appear in the ECG, signaling another cardiac cycle.

(Cardiac Cycle)