ANATOMY AND PHYSIOLOGY

Heart Is the organ that supplies blood and oxygen to all parts of the body, It is about the size of a clenched fist, weighs about 10.5 ounces and is shaped like a cone. The heart is located in the chest cavity just posterior to the breastbone, between the lungs and superior to the diaphragm. The heart is surrounded by a fluid filled sac called the pericardium. Blood is pumped away from the heart through arteries and returns to the heart through veins. The major artery of the body is the aorta and the major veins of the body are the vena cavae. Heart wall The three layers of the heart are as follows: epicardium, outermost layer, myocardium, the cardiac muscle, endocardium, the endothelium. The heart is enclosed by the pericardium which consists of two layers: visceral pericardium (inner layer) and parietal pericardium (outer layer). Epicardium Is the outer layer of the wall of the heart, It is composed of connective tissue covered by epithelium. Is also known as the visceral pericardium .Provides an outer protective layer for the heart. Myocardium Stimulates heart contractions to pump blood from the ventricles and relaxes the heart to allow the atria to receive blood. These contractions produce what is known as a heartbeat. The beating of the heart drives the cardiac cycle which pumps blood to cells and tissues of the body. Endocardium Is the inner layer of the heart, It consists of epithelial tissue and connective tissue Lines the inner cavities of the heart, covers heart valves and is continuous with the inner lining of blood vessels. Chambers of the heart The four chambers of the heart are as follows: right atrium, right ventricle, left atrium, and left ventricle. Right atrium receives venous blood returning to the heart via superior and inferior vena cavae. Right ventricle receives venous blood from the right atrium, and ejects this blood into the lungs via the pulmonary artery. Left atrium receives oxygenated blood from the four pulmonary veins and serves as a reservoir during ventricular systole. Left ventricle receives blood from the left atrium and ejects blood into the systemic arterial circulation via the aorta. Valves of the heart The two types of cardiac valves are the atrio ventricular valves and semilunar valve. The AV valves are the tricuspid valve and bicuspid valve (mitral) valve. The tricuspid valve is located between the right atrium and right ventricle. The mitral valve is located between the left atrium and left ventricle. The AV valves are held in place by the chordae tendinae cordis,which in turn are anchored to the ventricular wall by the papillary muscles. The chorda tendinae cordis supports the AV valves during ventricular systole to prevent valvular prolapse into the atrium.

The semilunar valves are the aortic valve and the pulmonic valve. The aortic valve lies between the left ventricle and the aorta. The pulmonic valve lies between the right ventricle and pulmonary artery. These valves open during ventricular systole, and they close during ventricular diastole.

Coronary Arteries The coronary arteries originate from the aorta, behind the cusps of the aortic valve in an area known as Valsalvas sinus. The two main coronary arteries are the left coronary artery and the right coronary artery. The left coronary artery divides in two branches namely the circumflex coronary artery and the left anterior descending artery. The circumflex coronary artery supplies the following: left atrium, posterior lateral surface of the left ventricle. The left anterior descending artery supplies anterior wall of left ventricle, the anterior interventricular septum, the anterior papillary muscles and apex of the heart. The right coronary artery supplies the right atrium, right ventricle, a portion of the septum, SA node, AV node, and inferior portion of the left ventricle. Coronary artery blood flow to the myocardium occurs during diastole, when coronary vascular resistance is reduced. During diastole, blood enters the coronary artery, which is called diastolic filling. Cardiac cycle The two phases of the cardiac cycle are diastole and systole. Relaxation and filling of the atria and ventricles occur during diastole. Contraction and emptying of the atria and ventricles occur during systole.

Physiologic Changes in the Heart with Aging 1. Decrease myocardial contractility. This reduces cardiac reserve. 2. General thickening of endocardium and valves. The valves tend to become rigid and incompetent. Heart murmurs develop. 3. Conducting fibers are replaced by fibrous tissue. This reduces the effectiveness of pacemaker cells, decreases conductivity and leads to dysrhythmias