CVS 1: THE HEART

CHARLES C. MONSADA, RN, MD

DE LA SALLE HEALTH SCIENCES INSTITUTE
HS-ANA-102: FOUNDATIONS TO HUMAN ANATOMY AND PHYSIOLOGY
FEBRUARY 2018
 OBJECTIVES
 At the end of the session, the learners will be able to:
 Describe the heart as to its shape, size and external features
 Describe the functions of the various structures of the heart
 Describe how the blood is circulated through the heart, lungs
and the systemic circulation
 Identify and describe the different specialized circulatory
systems
 Identify the principal arteries and veins of the body.
 Describe the conductions system of the heart
 Discuss the basic diseases of the cardiovascular system
The
CARDIOVASCULAR
System

1.Heart
2.Blood Vessels
3.Blood
FUNCTIONS OF THE CIRCULATORY
SYSTEM
The heart is the pump that circulates blood to all
parts of the body
Arteries, veins, and capillaries transport the
blood
Blood carries oxygen and nutrients to the
cells and carries waste products away
Lymph system returns excess fluid from the tissues
the circulation
MAJOR BLOOD CIRCUITS

Blood leaves the heart through arteries and

returns by veins
Blood circulation routes
– General or system circulation
– Cardiopulmonary circulation
Changes in the composition of circulating
blood
THE HEART

A hollow cone-shaped muscular organ

About 5 inches long and 3.5 inches wide
Weighs about 1 pound
Located in the thoracic cavity; the apex
of the heart lies on the diaphragm and
points to the left of the body
 Size: FIST; <1 lb

Base
• Beneath
the 2nd rib

Apex
• Beneath the
5th ICS MCL
 Location
Mediastinal Cavity

Rest on the diaphragm

THE HEART

After 4 to 5 minutes without blood flow,

brain cells are irreversibly damaged
Can hear the heartbeat through a
stethoscope
Cardiac arrest
Cardiopulmonary resuscitation (CPR)
Coverings

Parietal Pericardium Visceral

With 20-30 ml of serous fluid which protects

the heart from trauma & friction
Layers
EPICARDIUM

MYOCARDIUM

ENDOCARDIUM
 Structures of the Heart

Associated
GREAT
VESSELS
 1. Atria
Chambers 2. Ventricles

Septum

Largest, high pressured &

most muscular
CHAMBERS

Separated into right and left halves by the

septum; then each half separated into an
upper and lower chamber
Upper chambers
– Left and right atria
CHAMBERS

Lower chambers
–Left and right ventricles
Valves keep blood flowing in one
direction
VALVES

Atrioventricular valves
– Tricuspid valve (separates the right atria and right
ventricle)
– Bicuspid or mitral valve (separates the left atria and left
ventricle)
Semilunar valves
– Pulmonary semilunar valve (opening of the pulmonary
arteries)
– Aortic semilunar valve (opening of the aorta)
 1. Atrioventricular
Valves 2. Semilunar
 mitral valve

tricuspid
valve

aortic valve pulmonic valve

Structures that prevent backflow of blood

Flaps/cusps

Chordae tendineae

Papillary muscles
PHYSIOLOGY OF THE HEART

Double pump
Right heart
–Deoxygenated blood
Left heart
–Oxygenated blood
 Blood Flow

From CS, SVC & IVC

to RA to RV via Tv.

From RV, to PT to PA via

Pv.

From PA to LUNGS to PV
to LA to RV via Bv.

From LV, to Aorta via Av.

Circulatory Pathway
 Blood Supply LMCA
-L side of the heart

Circumflex
- lateral wall &
posterior wall of LV
- Occasionally:
interventricular
septum & SA/AV
nodes

RCA LAD
-R side of the heart - anterior wall
-Inferior wall of the LV - apex
-Posterior septal wall - anterior VS of LV
-SA & AV nodes
 Left Main Coronary Artery

Circumflex
Right Coronary Artery

LAD
HEART RATE AND CARDIAC OUTPUT

Normal adult rate is between 72 and 80 beats

per minute
Cardiac output=stroke volume x heart rate
Calculating the cardiac output
Exercise increases cardiac output
• Depolarization
• Repolarization

(2) Phases:
1. Systole
2. Diastole
HEART SOUNDS

Valves make sounds when they close

Called lubb dupp sounds
Lubb
– Tricuspid and bicuspid valves (S1)
Dupp
– Aortic and pulmonary valves (S2)
CONDUCTION SYSTEM

Electrical impulses cause rhythmic beating

of the heart
Sinoatrial (SA) node or pacemaker
Atrioventricular (AV) node
Bundle of His
Purkinje fibers
 Properties:
1. Automaticity
2. Excitability
3. Conductivity
Pacemaker
of the heart 4. Refractoriness

Terminal Point in
the conduction
system

Conduction System
ECG OR EKG

The electrocardiogram is a device to record

the electrical activity of the heart
Systole
– Contraction
Diastole
– Relaxation
 Ventricular
R Depolarization

Atrial Ventricular
Depolarization P T Repolarization

S
EFFECTS OF AGING

Heart muscle fibers replaced by fibrous

tissue
Heart valves increase in thickness
Cardiac output decreases
Changes become more significant when
elderly person becomes physically or
mentally stressed
PREVENTION OF HEART DISEASE

• Heart disease is the leading cause of death for both

men and women in the US
– Coronary heart disease

• Risk factors
• Steps to lower risk or prevent heart disease
• Blood cholesterol levels and triglycerides
DIAGNOSTIC TESTS – NON-INVASIVE

Angiography
Cardiac MRI
Coronary calcium scoring/heart scan
Echocardiography
Electrocardiogram
Diagnostic Tests – Noninvasive

Exercise stress tests

Holter monitor
MUGA (multiple gated acquisition
scan)
Nuclear perfusion
Diagnostic Tests – Invasive

Cardiac catheterization
IVUS (intravascular coronary
ultrasound)
TEE
Diagnostic Tests – Blood Tests

Arterial blood gases

BNP
Lipid panel
C-reactive protein
Cardiac Troponin T
Diseases of the Heart –
Common Symptoms

Arrhythmia
Bradycardia
Tachycardia
Murmurs
Mitral valve prolapse
Diseases of the Coronary Artery

Coronary artery disease (CAD)

Angina pectoris
Myocardial infarction
Infectious Diseases of the Heart

Pericarditis
Myocarditis
Endocarditis
Rheumatic heart disease
Heart Failure

When the ventricles of the heart are

unable
to contract effectively and blood pools in
the heart
Symptoms depend on which ventricle
fails
Heart Failure
Left ventricle failure
–Dyspnea (shortness of breath)
Right ventricle failure
–Engorgement of organs, edema of the legs and
feet, and ascites
Congestive Heart Failure

Similar to heart failure

Left-sided failure – pulmonary edema
Right-sided failure – fluid buildup
throughout body
Treatment
Rhythm/Conduction Defects
Heart block
– First-degree block
– Second-degree block
– Third-degree block or complete heart block
Premature contractions
– Atrial fibrillation
– PVCs
– Ventricular fibrillation
Types of Heart Surgery

Angioplasty
Cardiac stents
Coronary bypass
Transmyocardial laser revascularization
Heart Transplants
Used as a last resort
Histocompatibility
Organ rejection
Medical Highlights
Pacemaker
Cardiac resynchronization therapy
Defibrillator
Heart pumps