Anatomy and Physiology

 Is about 4.8 inches tall and 3.35 inches wide

 Weighs about .68 lb. in men and .56 lb. in women
 Beats about 100,000 times per day
 Beats 2.5 billion time in an average 70 yr. lifetime
 Pumps about 2000 gallons of blood each day
 Circulates blood completely 1000 times each day
 Pumps blood through 62,000 miles of vessels
 Suffers 7.2 mil. CAD deaths worldwide each year
 The heart resides in the pericardium
o A loose membranous sac.
 Epicardium
◦ Continuous with the pericardium

 Myocardium
◦ Composed of bands of involuntary striated
muscle fibers

 Endocardium
◦ Thin layer of tissue lining the inside of the heart
 Atria

◦ Thin-walled upper chambers

◦ Separated by atrial septum

◦ Right side of septum has oval depression, fossa

ovalis cordis, remnant of the foramen ovale

◦ Act as receiving chamber for blood returning from

the body and lungs
Left atrium
Fossa ovalis cordis
Right atrium
Atrial septum

Epicardium
Myocardium
Endocardium
 Ventricles

◦ Lower chambers which make up the bulk of the

muscle mass of the heart

◦ Left ventricle 2/3 larger than right ventricle

◦ Right ventricle is a thin-walled and oblong, like

pocket attached to left ventricle
 Ventricles

◦ Contraction of left ventricle pulls in right

ventricle, aiding its contraction (termed left
ventricular aid)

◦ Separated by intraventricular septum

Superior vena cava

Inferior vena cava

Right ventricle

Left ventricle

Intraventricular septum
 Tricuspid valve

◦ Separates right atrium from right ventricle

 Pulmonic semilunar valve

◦ Separates right ventricle from pulmonary artery

 Bicuspid (mitral) valve

◦ Separates left atrium from left ventricle

 Aortic semilunar valve

◦ Separates left ventricle from aorta

Blood flow from right ventricle to lungs Blood flow from left ventricle to aorta
 Chordae tendineae cordis

◦ Anchor free ends of A-V valves to papillary

muscles

◦ Prevent A-V valves from pushing upward into atria

during ventricular contraction
Pulmonic semilunar valve
Aortic semilunar valve
Bicuspid (mitral) valve
Tricuspid valve
Chordae tendineae cordis
Papillary muscles
 Brachiocephalic artery Left subclavian artery
Superior vena cava Left common carotid artery
Aorta
Pulmonary Artery to right
lung Pulmonary artery to left lung
Pulmonary veins from Pulmonary veins from left
right lung lung
  Arises from root of the aorta

Anterior Descending Artery

Left Coronary Artery
Right Coronary Artery

Posterior Descending Artery

Circumflex Artery
1) Blood enters the heart through the inferior and superior vena
cava, flowing into the right atrium.
2) The blood passes through the tricuspid valve into the right
ventricle.
3) It then passes through the pulmonic semilunar valve, entering
the pulmonary artery of the pulmonary circulation.
4) It flows through the pulmonary bed of the right and left lungs to
the pulmonary vein, reentering the heart at the left atrium.
5) It then flows through the bicuspid valve into the left ventricle.
6) Passing through the aortic semilunar valve, the blood enters the
aorta and systemic vascular system.
 Anterior descending artery

◦ Supplies anterior sulcus and apex

◦ “Widow maker” heart attack

 Circumflex artery

◦ Supplies posterior side of left ventricle

 Together supply most of left ventricle, left
atrium, 2/3 of intra ventricular septum, half
of intra atrial septum, and part of right atrium
 Posterior descending artery

◦ Supplies posterior intraventricular sulcus

 Has numerous smaller branches

Supplies anterior and posterior portions of
right ventricular myocardium, right atrium,
sinus node, posterior 1/3 of intraventricular
septum, and portion of base of right ventricle
 Closely parallel the arterial system

 Some coronary venous blood enters the

heart through the Thebesian veins

◦ Thebesian veins empty directly into all chambers

thus creating some venous admixture lowering
Pa02
 Large, highly elastic, low resistance to blood
flow

 Small muscular arterioles of varying

resistance
 Transport blood away from the heart

 Generally contain oxygenated blood

Exception: pulmonary artery

 Composed of three layers

◦ Tunica adventitia (external layer)
◦ Tunica media (thickest layer)
◦ Tunica intima (thinnest layer)
 Tunica adventitia
◦ Consists of connective tissue surrounding
collagenous and elastic fibers
◦ Supports and protects the vessel
◦ Contains lymphatic vessels and nerve
fibers
◦ Has fine vessels that provide its blood
supply
 Tunica media
◦ Thickest layer
◦ Composed of concentrically arranged
smooth muscle and elastic fibers
◦ Nerve fibers of tunica adventitia terminate
in tunica media
 Tunica intima
◦ Thinnest layer of the artery
◦ Consists of the epithelium – flat layer of
simple squamous cells
◦ Common to all blood vessels including the
endocardium
 Large arteries are termed conductance or elastic
arteries because the tunica media has less smooth
muscle and more elastic fibers
 Medium sized arteries are termed the nutrient arteries
because they control the flow of blood to the various
regions of the body
 Arterioles have a thin tunica intima and adventitia, but a
thick tunica media composed almost entirely of smooth
muscle and control blood flow to the capillary bed
◦ Called resistance vessels because they control the rate
that the blood leaves the arterial tree , control arterial
blood volume and thereby blood pressure
Aortic knob
Brachial
Aorta

Radial

Ulnar

Femoral

Anterior tibial
Peroneal artery
Posterior tibial
Circle of Willis

Internal carotids
External carotids
Common carotids
Vertebral arteries
  Microcirculation
 Maintains constant environment for the cells and
tissues
 Exchange of nutrients, gases, and wastes

The blood does not directly come in contact with

the parenchymal cells and tissues in the body,
but constituents of the blood first exit the micro
vascular exchange blood vessels to become
interstitial fluid, which comes into contact with
the parenchymal cells of the body. Lymph is
the fluid that is formed when interstitial fluid
enters the initial lymphatic vessels of the
lymphatic system
 Pre-capillary sphincter valves
◦ Smooth muscle rings at the proximal end of the
capillary

◦ Contraction decreases blood flow

◦ Relaxation increases blood flow

◦ Responsive to local changes in PaO2, PaCO2, pH,

and temperature

◦ Called exchange vessels because they are the

site of gas, fluid, nutrient, and waste exchange
 Transport deoxygenated blood back to the heart – exception:
pulmonary vein
 Composed of the same layers as arteries, but are thinner
 Called capacitance or reservoir vessels because 70% to 75% of
the blood volume is contained in the venous system
 Peripheral veins contain one-way valves.
◦ Valves are formed by duplication of endothelial lining
◦ Found in veins >2mm in diameter
◦ Are in areas subjected to muscular pressure, arms/legs
◦ Prevent retrograde flow of blood
 Mechanisms aiding venous return to the
heart:
◦ Sympathetic venous tone
◦ Skeletal muscle pumping or “milking” combined
with the one-way valves
◦ Cardiac suction
◦ Thoracic pressure differences created by
respiratory efforts (thoracic pump)
 Consists of formed elements (cells)
suspended & carried in plasma (fluid part)
 Total blood volume: 60-80 mL/kg of body
weight
 Plasma is straw-colored liquid consisting of
90% H20 & dissolved solutes
◦ Includes ions, metabolites, hormones, antibodies,
proteins
 Constitute 7-9% of plasma
 Three types of plasma proteins: albumins,
globulins, & fibrinogen
◦ Albumin accounts for 60-80%
 Creates colloid osmotic pressure that draws H20 from
interstitial fluid into capillaries to maintain blood
volume & pressure
 Globulins carry lipids
◦ Gamma globulins are antibodies
 Fibrinogen serves as clotting factor
◦ Converted to fibrin when clotting blood
◦ Serum is fluid left when blood clots
 Composed of erythrocytes (RBCs) &
leukocytes (WBCs)
 RBCs are flattened biconcave discs
◦ Generated in the red bone marrow by the
process of erythropoiesis from the
hemocytoblast, a common stem cell
◦ Shape provides increased surface area for
diffusion
◦ Lack nuclei & mitochondria
◦ Has semi-permeable membrane
◦ Contains hemoglobin molecule that
transports oxygen
◦ Approx. 30 trillion in the body
 Is the formation of blood cells from stem
cells in marrow (myeloid tissue) & lymphoid
tissue
◦ RBC’s increase in number above normal with
chronic hypoxia
 Erythropoiesis is formation of RBCs
◦ Stimulated by erythropoietin (EPO) from kidney
 Leukopoiesis is formation of WBCs
◦ Stimulated by variety of cytokines
 2.5 million RBCs
created daily
 Lifespan of 120 days
 Old RBCs removed
from blood by
phagocytic cells in
liver, spleen, & bone
marrow
◦ Iron recycled back into
hemoglobin
production
 Have nucleus, mitochondria, & amoeboid
ability
 Formed in the myeloid tissue
 Can squeeze through capillary walls
(diapedesis)
◦ Granular leukocytes help detoxify foreign
substances & release heparin
 Include eosinophils, basophils, & neutrophils
 Agranular
leukocytes are
phagocytic &
produce
antibodies
 Include lymphocytes
& monocytes
 Specialized type of blood cell
 Fragments into small irregular pieces of
protoplasm called thrombocytes and platelets
 Have no nucleus
 Have a granular cytoplasm
 Function in clot formation
 Are smallest of formed
elements, lack nucleus
 Constitute most of mass of
blood clots
 Release serotonin to
vasoconstrict & reduce blood
flow to clot area
 Secrete growth factors to
maintain integrity of blood
vessel wall
 Survive 5-9 days
 RBC’s – Males: 4.6 - 6.2 x 10 /mm
Females: 4.2 – 5.4 x 10 /mm
• Hb – Males: 13.5 – 16.5 g/dl
Females: 12 – 15 g/dl
• Hematocrit – Males: 42 – 54%
Females: 38 – 47%
• Leukocytes – 4500 – 11,500/mm
 Neutrophils: 40 – 75%
 Eosinophils: 0 – 6%
 Monocytes: 2 – 10%
 Basophils: 0 – 1%
 Megakaryocyte: 150,000 – 400,000/mm
 Systolic pressure

◦ Pressure during contraction phase of heart

◦ Normal value: 90 – 140 mmHg

 Diastolic pressure

◦ Pressure during relaxation phase of heart

◦ Normal value: 60 – 90 mmHg

 Mean arterial pressure (MAP)

◦ Average pressure in the arterial system over a

given time

◦ Normal value: 80 – 100 mmHg

 Mean arterial pressure

MAP = (2 x diastolic pressure) + (systolic pressure)

3
A MAP of approximately 60 mmHg is necessary to
perfuse coronary arteries, brain, kidneys.
 Reflects right atrial pressure
 Influenced by changes in right ventricular
function
 Measured with catheter placed in superior
vena cava just above right atrium
 Purpose
◦ Assess blood volume status
◦ Administration of fluids
◦ Sampling of blood
◦ Measurement of SvO2
◦ Assessment of right ventricular pre-load

 Normal value
o CVP: < 6 mmHg
o Right atrial pressure (RAP): 2-6 mmHg
 Used to assess filling pressure of the left side
of heart
 Measured by flow-directed, balloon-tipped
catheter
 Measures
◦ Pulmonary artery pressures – systolic, diastolic,
mean
◦ Right ventricular preload (via right atrial pressure)
◦ Right ventricular afterload (via PA systolic pressure)
 Normal values

◦ Pulmonary artery pressure, systolic: 20-30 mmHg

◦ Pulmonary artery pressure, diastolic: 6-15 mmHg
◦ Pulmonary artery pressure, mean: 10-20 mmHg
◦ Pulmonary artery wedge pressure, mean:
4-12 mmHg
 Total amount of blood pumped by the heart
per minute

 Cardiac Output = Heart Rate x Stroke

Volume

 Normal value – 5L/min

 Cardiac Index

◦ Volume of blood pumped by the heart per

minute divided by body surface area

CI = CO
BSA
Normal range: 2.5 - 4.0 L/min per square meter

Low values can indicate cardiogenic shock

 Amount of blood ejected from the ventricle
with each ventricular systole

 End-systolic volume (ESV)

◦ Volume remaining after systole

 End-diastolic volume (EDV)

◦ Volume to which the ventricles fill during

diastole

 SV = EDV – ESV

 Normal value: 60 – 130 ml/beat

 Ejection fraction (EF)

◦ Proportion of EDV ejected on each stroke

EF = SV
EDV

◦ Normal value – 64%

 Preload

◦ Initial stretch of the ventricle

◦ The greater the preload, the greater the tension

on contraction
 Afterload

◦ Force against which the heart must pump.

◦ In clinical practice, left ventricular afterload

equals systemic vascular resistance.
 Contractility

◦ Amount of systolic force exerted by heart muscle at any

given preload.

◦ Increases in contractility leads to higher EF, lower end

systolic volume, and higher stroke volume

◦ Decreases in contractility lead to lower ejection fraction,

higher end systolic volume, and decreased stroke volume.
 Contractility

Inotropism: any factor which affects the

contractility of the heart

◦ Positive inotropism

 Higher stroke volumes for a given preload:

indicating an increase in contractility

◦ Negative inotropism

 Decreased stroke volumes for a given preload;

indicates a decrease in contractility
 Heart rate

 Autonomic nervous system

o Sympathetic: fight or flight: HR, RR, BP, pupil

dilation and bronchodilation

o Parasympathetic: rest and digest

 Heart Rate
◦ Cardiac output directly proportional to heart
rate

 Relationship exists up to 160 to 180

beats/min

 Filling time for ventricles insufficient at

higher rates
 Sum of all frictional forces opposing blood flow
through the vascular circulation.

 SVR = Mean Aortic Pressure-Right Atrial Pressure

Cardiac Output
◦ Mean Aortic Pressure - use systolic pressure (normal mean = 90mmhg)
◦ Right Atrial Pressure - use central venous pressure (normal mean =
4mmhg)
◦ Cardiac Output normal mean = 5L/min.

 Normal value: 15 – 20 mmHg/L/min

 Cardiac anatomy
◦ Layers of the heart
◦ Chambers of the heart
◦ Valves
◦ Coronary arteries
 Blood flow through the heart
 Arterial system
◦ Structure of artery
◦ Purpose
◦ Major arteries
 Venous system
◦ Structure of system
◦ Purpose
◦ Aids to venous flow
 Capillary system
◦ Structure of system
◦ Purpose
 Composition of blood
 Plasma proteins
 Types of cells, functions, normal values,
abnormalities
◦ Erythrocytes
◦ Leukocytes
◦ Megakaryocytes
◦ Platelets
◦ Hemoglobin
◦ Hematocrit
 Definition, normal values, and formula (if
applicable)
◦ Systemic vascular resistance
◦ Systolic pressure
◦ Diastolic pressure
◦ Mean arterial pressure
◦ Cardiac output and index
◦ Stroke volume, esv, edv, ef
 Factors affecting stroke volume