St ruc tu re an d F un cti on o f t he C ar dio vas cu lar S ys te m

A. Structures of the heart – a hallow organ, the hart lies in the mediastinum (i.e., space between the two lungs) and rests on the
diaphragm.
1. Pericardium – the heart is encased in the pericardium, a thin, membranous sac that has a visceral layer in contact
with the heart and an outer parietal layer. The space between pericardial layers contains 20 to 30 ml of serous fluid,
which protects the heart from trauma and friction.
2. Heart wall – the heart wall is specialized muscle tissue consisting of three tissue layers:
a. Epicardium – the thin, serous outer layer
b. Myocardium – the thick, muscular middle layer
c. Endocarium – the smooth inner layer that comes in contact with blood.
3. Heart chambers – a membranous muscular septum divides the heart into two distinct sides. Each side contains two
chambers an atrium and a ventricle
a. The right atrium – a low-pressure chamber, receives systemic venous blood through the superior vena
cava, inferior vena cava, and coronary sinus.
b. The right ventricle – another low-pressure chamber, receives blood from the right atrium through the
tricuspid valve during ventricular diastole. It then ejects deoxygenated blood through the pulmonic valve
into the pulmonary artery and into pulmonary circulation during ventricular systole.
c. The left atrium – a low-pressure chamber, receives oxygenated blood returning from the lung through
four pulmonary veins.
d. The left ventricle – a high-pressure chamber, receives blood from the left atrium through the mitral valve
during ventricular diastole. It then ejects oxygenated blood through the aortic valve into the aorta and
into systemic circulation during ventricular systole.
4. Heart valves – connects the chambers and outflow tracts. The two types of heart valves are atrioventrivular valves
and semilunar valves.
a. Atrioventricular (AV) valves – separates the atria from ventricles.
- The tricuspid valve (contains the cusps, or leaflets) is located between the right atrium and
ventricle.
- The mitral valve (a bicuspid valve with two cusps) is located between the left atrium and ventricle
b. The semilunar valves (each containing three cusps) are located between each ventricle and its
corresponding artery.
- The pulmonic valve is located between the right ventricle and pulmonary artery
- The aortic valve is located between the left ventricle and aorta.
c. Papillary muscles – muscle bundles on the ventricular walls, and chor da e ten di na e, fibrous band
extending from the papillary muscles to the valve cusps, keep the valves closed during systole. This
maintains unidirectional blood flow through the AV valves and prevents backflow of blood
5. The cardiac conduction system consists of specialized cardiac cells that initiate or propagate electrical impulses
throughout the myocardium as a precursor to cardiac muscle contraction.
a. Electrical pathways
- The sinoatrial (SA) node, located at the junction of the right atrium and the superior vena cava,
functions as the pacemaker for the myocardium, initiating rhythmic electrical impulses at an
intrinsic rate of 60 to 100 impulses per minute.
- The AV node, located in the septal wall of the right atrium, receives impulses from the SA node and
relays them to the ventricles
- The Bundle of His, a bundle of specialized muscle fibers in the myocardial septum, conducts
impulses from the AV node. The bundle of His divides into right and left branches.
• The right bundle branch (RBB) conducts impulses down the right side of the septum
• The left bundle branch (LBB) conducts impulses into right and left fascicles that fan out
into the left ventricular muscle
• The RBB and the LBB terminate in the Pu rk inje fibers , which propagate electrical
impulses into the endocardium and on to the myocardium
b. Electrical impulse activity. Electrical impulses traveling through the cardiac conduction system can be
measured and recorded by electrocardiography.
- Phases of the electrocardiogram (ECG) are labeled P, Q, R, S, and T.
• The P wave represents atrial depolarization
• The PR interval represents the time from the beginning of the atrial depolarization
• The QRS complex represents ventricular depolarization
• The T wave represents ventricular repolarization
 - Normal sinus rhythm
• Heart rate is 60 to 100 beats per minute
• P waves precede each QRS complex
• PR interval is 0.12 to 0.2 second
• QRS complex is 0.04 to 0.1 second
• Conduction is forward and cyclical through the conduction system
• Rhythm is regular with no abnormal delay
6. The coronary arteries supply the heart with blood from branches that originate in the right or left sinus of Valsalva of
the aortic valve cusps.
a. The right coronary artery supplies blood to the right heart wall
b. The left main coronary artery, which divides into the left anterior descending coronary artery and the
circumflex artery, supplies most of the blood to the left heart wall.
B. Functions of the heart – The heart has electrophysiologic, mechanical, and neurologic properties that coordinate to produce
effective myocardial contraction and pumping of blood.
1. Cardiac Output (CO) is defined as the volume of blood ejected by each ventricle in 1 minute: CO = SV (Stroke
Volume) x HR (heart rate)
a. Stroke volume – is the amount of blood ejected by the left ventricle with each heartbeat. Several factors
influence CO indirectly by affecting the SV.
- Preload, the end-diastolic filling volume of the ventricle, increases by increased returning volume to
ventricle
- Afterload, the resistance to left ventricular ejection, increases by increased systemic arterial
pressure.
b. Heart rate – is the number of heartbeats per minute. Normal is 60 to 100 beats/minute

2. Cardiac cycle – each complete heartbeat, or cardiac cycle, consists of two phases in response to electrical
stimulation.
a. Systole – is the contraction phase. It is triggered by depolarization of cardiac muscle cells, which involves
a transient change in sodium and potassium ion concentration inside and outside the cell.
b. Diastole – is the relaxation (filling) phase. Immediately after depolarization is completed, the process
reverses itself, resulting in repolarization and a return to the resting state.

3. Heart sounds result from vibrations caused by valve closure and ventricular filling
a. The first heart sound (S1) is associated with tricuspid and mitral valve closure
b. The second heart sound (S2) is associated with aortic and pulmonic valve closure
c. The third heart sound (S3) known as ventricular gallop, is often normal in persons younger than age 30
but pathologic in older persons and occurs during the rapid ventricular filling stage of diastole.
d. The fourth heart sound (S4) or atrial gallop, is linked to resistance to ventricular filling, as in hypertrophy
or injury of the ventricular wall
4. Neurologic factors regulating heart function
a. Sympathetic Nervous System stimulation – with release of norepinephrine, results in arteriolar
vasoconstriction, increased heart rate, and a positive inotropic effect
b. Parasympathetic Nervous System stimulation – with release of acetylcholine, results in decreased heart
rate and slowed AV conduction
c. The response of chemoreceptors, located in the carotid and aortic bodies, to decreased O2 and increased
CO2 concentrations is to increased the heart rate
d. The response of baroreceptors, located in the aortic arch, carotid sinus, vena cava, pulmonary arteries,
and atria, is to decrease or increase heart rate, resulting in blood pressure changes.

DIA GN OS TIC A ND L AB OR ATORY S TUD IES

1. White Blood Cell (WBC) count can detect signs of infection
2. Lipid profile examines cholesterol (LDL and HDL) and triglycerides
3. Cardiac enzymes examine the levels of creatinine phosphokinase, troponin, and lactate dehydrogenase
4. Blood coagulation studies examine prothrombin time and partial thromboplastin time
5. Chest radiograph can determine heart size and silhouette and visualize the pulmonary system
6. ECG evaluates the heart’s electrical activity
7. Holter monitoring (ambulatory ECG) allows for 24-hour continuous measurement of the heart’s electrical activity
8. Exercise ECG (graded exercise test) evaluates electrical activity during physical stress; a chemical-induced ECG stress test is
used if the client is unable to walk or bike for a long period of time
9. Echocardiography yields information about cardiac structure (especially valvular) and function
10. Radionuclide testing evaluates ventricular function and myocardial blood flow and detects areas of myocardial damage.
Radionuclide testing includes positron emission tomography, multiple-gated acquisition, and thallium scanning
11. Cardiac catheterization enables measurement of chamber pressures and oxygen saturation
12. Arteriography visualizes coronary arteries with injections of radio opaque contrast media
13. Ventriculography visualizes ventricles with injection of radio opaque media
14. Central venous pressure reflects filling pressure of the right ventricle and helps assess cardiac function and intravascular
volume status
15. Pulmonary artery pressure and pulmonary artery wedge pressure measure left heart pressures
16. Arterial line allows continuous monitoring of peripheral arterial pressures