Anatomy and physiology of the heart

The heart is a musculo-hollow organ with role of aspiro-repulsive pump of the

blood. It is located in the inferior mediastinum, it is taper(conical form),
reddish brown colour, capacity of 500-700cm3 and weighs about 300g. It has
an external and internal configuration and a structure. External configuration
shows three faces (sternocostal, diaphragmatic and pulmonary), a border
(right), a base inferior and left oriented. Outside are interventricular,
interatrial and atrioventricular grooves. Heart wall structure reveals three
tunics: endocardium, myocardium and epicardium. The endocardium is the
intern layer of the heart and continue with vessels intimate coming or going
from the heart.
The myocardium
The myocardium contains two types of muscle cells: adult type (involved in
the contraction of the heart) and embryonic (involved in the generation of
cardiac automaticity). Myocardium adult is similar to skeletal muscle
striations, but behaves as a syncytium because of presence of contacts
between myocardial cells, which allow the propagation of the depolarization
in all cells. Functionally, it looks like the smooth muscle in its involuntary and
rhythmic activity.
Contractile myocardium
Adult atrial myocardium is thin and contains two layers, superficial and deep,
common to both atriums. Adult ventricular myocardium is thicker and is
compound of three layers, superficial, medium and deep. Myocardium has a
small core, many myofibrils, a developed endothelial reticulum, mitochondria
and abundant sarcoplasmic. Myocardium didnt make a duty of oxygen
(does not produce energy from glycogen). Atrial myocardium is completely
separate from the ventricular; the only anatomical and functional
relationship between them is the embryonic myocardium.
It is described at atrial level the existence of specialized beam pulse in
preferred leadership of the pulse in one direction:

Anterior interatrial Bachmann beam - connecting AD and AS

Middle Wenckebach beam - goes directly to the AV node
Thorel rear beam - reaches the AV node, but gives branches to the left
atrium and

These bundles do not contain embryonary cells, driving pulse explained by

the architectural arrangement, greater thickness and butt disposal
contractile fibers in the composition.
Embryonic myocardium plays a role in the generation and transmission of
compression stimulus . Is compound of:

sinoatrial node (SA) Keith-Flack - present in the wall of the right atrium
(AD) near the orifice of the superior venae cavae (VCS)
atrioventricular node (AV) Aschoff-Tawara - located in the right atrium,
above the right atrioventricular orifice.
atrioventricular bundle Hiss - the only way of connection between the
atriums and ventricles. Leaves from the AV node,
crossing the
interventricular septum and divides into two branches: the left and
right which descending into respectively ventricles.
Purkinje network represent the ramification of bundle Hiss branches,
made the connection with adult myocardium and transmit contraction
impulses from top to bottom and from endocardium to epicardium.
Purkinje network isnt nerve impulse center (not produce automatism).

The epicardium
Epicardium represent the visceral leaf of the serous pericardium. The
pericardium is the fibrous sac which surrounding the heart and big vessels.It
is compound of two layers:
superficial - fibrous pericardium
deep - serous pericardium, consisting of two leafs: visceral (lining the heart
and big vessels) and parietal (lining the deep front of fibrous pericardium).
Internal configuration of the heart
Internal configuration of the heart reveals its tetracameral structure: right
and left atrium, right and left ventricle.
Atriums have thinner walls, smaller capacity, didnt have papillary muscles
and they are relatively cubical. Are separated by interatrial septum and both
communicate with homonymous ventricles by atrioventricular orifice.
Atrioventicular orifice presents funnel valves called cusps (bicuspid or mitral
valve at left orifice and tricuspid valve at right orifice), with peak oriented to
the ventricle and the base to the atrium. Peak continues with chordae
tendineae of papillary muscles in ventricle.

In the right atrium are opening orifices of the upper and lower vena cava,
coronary sinus and right atrioventricular orifice. In the left atrium are
opening orifices of the four pulmonary veins and the left atrioventricular
orifice.
Ventricles have thicker walls (due to pump function they perform), higher
capacity and pyramid form. Are separated by interventricular septum, which
has a muscular lower portion extended and an membranous upper portion
lower.
The internal surface of the ventricles is irregular due to the presence of the
projecting formations called the chordae tendineae (which are arranged in
the longitudinal axis of the heart and are subendocardial muscle) and
papillary muscles.
The tendineae chordae are attached to one end of the papillary muscle and
the other with the atrioventricular valves, preventing reflection of valves in
the atrium during ventricular systole. The base of ventricles is corresponding
with atrioventricular orifice on each side. Both ventricles present, near
atrioventricular orifice, an arterial orifice by leaving large vessels.
Arterial orifices are covered by three semilunar valves (sigmoid), the
"Swallow".
The vasculature of the heart is provided by two coronary arteries that
originate from the ascending aorta. Collaterals that are leaving are terminal
type (didnt mix with neighboring branches). If the blood flow stops through
these collaterals, the cardiac territory, due to lack of oxygen and nutrients, it
finally necrosis and appears heart failure. Venous blood is collected by veins
and finally arrive in the coronary sinus which opens into the right atrium.
Extrinsic innervation of the heart is double: sympathetic and
parasympathetic (nerve X). It come true through the agency of cardiac
plexus situated below the aortic arch.
Sympathetic fibers from the cervical sympathetic chain (originating in the
lateral medullary horns T1-T5) through the cervical cardiac nerves (upper,
middle and lower) and thoracic cardiac nerves (originating in marrow T4-T5
and synapse in thoracic ganglias).
Parasympathetic fibers comes from nerv X by the upper and lower
cervical cardiac branches.
The properties of the myocardium are:

Excitability

Rhythmicity

Conductivity

Contractility

Tonicity.

Excitability is the property of the myocardium to respond specifically by a

contraction to an appropriate stimulus (intensity greater than or equal to the
threshold). Stimulus with lower intensity to the threshold does not cause a
contraction. Heart present the particularity of being excitable only in
relaxation phase (diastole) and inexcitable in contraction phase (systole). In
systole, the heart is in the absolute refractory period (regardless of the
intensity of the stimulus, there isnt a contraction). Increased frequency
stimulus not causes the appearance of muscular tetanus, which is very
important in the normal activity of the heart.
Rhythmicity is the property of heart to self-generated nerve impulses that
produce propagates potentials of action. Also, this property is manifested if
the heart is removed from the body or if nerve and humoral influences
extrinsic are interrupted, under irrigation with liquid adequate. The
morphological support of regularity is excitoconductor system.
Keith Flack SA node has a frequency pulse of 100-110/min. Resting heart rate
is influenced by nerve X, which decreases by a factor of 60-80 / min.
Aschoff Tawara AV node has a permanent discharge frequency of 40/min, but
isnt assert normally due to the increased frequency of node sinoatrial.
Hiss beam that divides into two branches, right and left, download 25
pulses / minute. Automatism may be influenced by various factors:
temperature, pH, Na, K, Ca, Mg, vagal acetylcholine, adrenaline.
Conductivity is the property of the myocard to direct excitation into its
whole mass. Excitation leaves the SA node and propagates as a front of
radial waves of nearby atria. Arriving at the atrioventricular node, the
impulse delay (physiological) 0.12 seconds, the time required for
achievement of atrial systole. Therefrom the wave propagates through the

Hiss beam and Purkinje network to ventricles, causing systole.

Contractility is the property of the myocardium to contract under the action
of a stimulus adequate .The myocardial contraction is called systole and
relaxation is called diastole. Cardiac contraction includes mechanical
changes of contractile apparatus that runs in stages: coupling excitation
with contraction and contraction itself.
Tonicity is the state of semi myocardial contraction during diastole, which
persists after denervation or removing the heart from the body.