Chapter 17: The Heart 1. Functions of the Heart a.

Generating Blood Pressure -contraction of the heart generates blood pressure, which is required for blood flow through the blood vessels b. Routing Blood- the heart is two pumps- moving blood through the pulmonary and systemic circulations i. Pulmonary- moves blood to and from the lungs. ii. The pulmonary trunk arises from the right ventricle dividing into left and right pulmonary arteries (2 left and 2 right), which project to the lungs where waste is released in the form of carbon dioxide, and blood is oxygenated iii. From the lungs, four pulmonary veins return oxygenated blood to the left atrium (2 left and 2 right) iv. Systemic- flow of blood from the heart through the body back to the heart; delivers oxygen and picks up waste (carbon dioxide) from the tissues of the body 1. Arteries, by definition carry blood away from the heart and Veins, by definition carry blood to the heart 2. In systemic circulation, oxygenated blood from pulmonary circulation enters the left ventricle from the left atria passing through the bicuspid or mitral valve (AV Valve) and exits the LV entering the aorta through the aortic semilunar valve 3. Right and Left coronary arteries branch from the aorta (before aortic arch) to supply the heart 1. The heart is selfish and wants the freshest blood so its arteries branch directly from the aorta to nourish cardiac muscle tissue 2. In coronary circulation blood leaves through cardiac veins and drains into the enlarged coronary sinus on the posterior heart, which empties directly into the right atrium c. Regulates blood supply- in response to the changing metabolic needs of tissues during rest, exercise, changes in body position (changes in rate and force of heart contraction) Location, Shape and Size of the Heart a. The heart lies obliquely in the mediastinum, which is a midline partition formed by the heart, trachea, esophagus, and associated structures i. the heart is deep to the sternum and deep to the left (second to fifth) intercostal spaces (base at approx 2nd intercostal space, and apex at approx 5th) b. Heart is shaped like a blunt cone, with an apex (rounded point- inferior and lateral) resting on the diaphragm and a base (larger, flat portion opposite the cone- superior and medial) i. approximately the size of a fist ii. The base is directly posteriorly and slightly superiorly, and the apex is directly anteriorly and slightly inferiorly (Fig. 17.2 pg 489) iii. Apex is directed left of the mediastinum, so that approx 2/3 of the heart's mass lies to the left of the midline of the sternum Anatomy of the Heart a. Pericardium i. heart is surrounded by the pericardial cavity, formed by the pericardium or the pericardial sac, which is the connective tissue sac (pg. 489, Fig. 17.3) ii. Pericardium has 2 layers, an outer fibrous layer (made of connective tissue) and an inner serous layer ( made of simple squamous epithelium overlaying loose connective tissue and fat) 1. The serous pericardium has two parts: the parietal pericardium lines the fibrous pericardium (lines the cavity), and the visceral pericardium covers the surface of the heart (lining the organ) 2. The pericardial cavity lies between the parietal and visceral pericardia and is filled with a small amount of fluid produced by the serous membranes which helps to reduce friction as the heart moves iii. Heart Wall 1. composed of three layers of tissue : epicardium, myocardium and endocardium 1. epicardium: thin serous membrane forming the smooth outer surface of the heart (synonymous with visceral pericardium) 1. serous membranes: composed of thin layer of simple squamous epithelium lying on loose connective tissue and fat 2. provides protections against friction of rubbing organs 2. myocardium: thick middle layer composed of cardiac muscle cells, responsible for the contractions of heart chambers 1. bulk of tissue is myocardium 3. endocardium: inner surface of heart chambers; simple squamous epithleium over a layer of connective tissue 1. smooth endocardium allows blood to move easily through the heart 2. ventricles have ridges and columns of cardiac muscle called trabeculae carneae ("beams flesh" or fleshy beams)

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Inner surfaces of atria mainly smooth except smaller muscular ridges called pectinate muscles are found in auricles

External Anatomy 1. Heart Chambers 1. The heart has 4 chambers: two atria ("entrance") and two ventricules ("under side") 1. Each atrium has a flap called an auricle seen anteriorly between the atria and ventricles (looks like the flap of a pig ear) 2. sulcus- groove on the surface of the heart containing blood vessels and fat 1. The coronary sulcus separates the atria from the ventricles 2. The interventricular grooves (posterior and anterior) separate left and right ventricles *Systemic Circulation Blood flow--> 1) LV of heart -->2)aorta (branches off to coronary arteries, ascending aorta, aortic arch and descending aorta)--> elastic arteries--> 3) muscular arteries-->4) arterioles--> 5)capillaries *(then exchange between interstitial fluid and blood occurs, and body tissues are nourished)* Deoxygenated blood is sent back to the heart in order to be re-oxygenated through pulmonary circulation *Blood then flows back to the heart from the capillaries-->6) venules-->7)small veins-->8) large veins-->9) to RA of heart Veins- by definition carry blood toward the heart 1. Six large veins carry blood to the heart 1. The inferior vena cava and superior vena cava carry blood from the body to the right atrium 2. Four pulmonary veins carry blood from the lungs to the left atrium 1. Coronary veins also carry blood to heart in coronary circulation and either drain blood into the coronary sinus on the posterior heart, which empties direct into the RA or they empty directly into RA 3. Arteries-carry blood away from the heart 4. can be (1) large elastic arteries with lg. diameters (2)muscular arteries (thick walled with little elastic fibers and abundant smooth muscle) or (3) arterioles (smallest diameter, thin walled) 5. Blood flows from the LV of heart--> aorta-->arteries-->arterioles-->capillaries (where exchange occurs with interstitial fluid of body tissues 6. Blood returns to the heart from the capillaries-->venules-->small veins-->large veins-->to RA of the heart 3. Two arteries, the pulmonary trunk and the aorta exit the heart 1. The pulmonary trunk exits the right ventricle, splitting into left and right pulmonary arteries (4) which carry blood to the lungs to be oxygenated 2. The aorta exits the left ventricle, branching to the coronary arteries, ascending aorta, aortic arch and descending aorta carrying blood to the body tissues Four Chambers of the Heart (pg. 493) 1. Atria: located at the "base" of the heart; the 2 atria receive blood from veins 1. Right Atrium: has 3 major openings through which blood enters--(1)from superior vena cava (2) from inferior vena cava (3) coronary sinus-( heart receives blood from itself) 2. Left Atrium: has 4 major openings that receives blood from the 4 pulmonary veins from the lungs (2 right pulmonary veins from right lung and 2 left pulmonary veins from left lung) 3. 2 atrium separated by the interatrial septum (septum is sufficient in naming) 1. The foramen ovale exists here in the embryo and fetus connecting the two atria, and a slight oval depression, (fossa ovalis) marks the former location of this connection 2. The foramen ovale exists as an opening between the two atria allowing blood to flow from the right to left atrium, bypassing pulmonary circulation in the developing embryo 2. Ventricles: each atria opens into the ventricles separated by an Atrioventricular valve, and each ventricle has one large superiorly placed outflow route near the midline of the heart (separated from the ventricle by a semilunar valve) 1. Right Ventricle: opens into the pulmonary trunk-->4 pulmonary arteries 2. Left Ventricle: opens into the aorta-->coronary artery and descending and ascending arteries 3. The two ventricles are separated from each other by the interventricular septum 4. * http://www.biologycorner.com/anatomy/chap13.html* great review of heart Heart Valves 1. formed by folds of endocardium (innermost tissue layer of heart wall) consisting of a double layer of endocardium with connective tissue in between 2. These valves function to allow blood flood into and out of ventricles, but prevent the back flow of blood 2.

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Atrioventricular valves (AV Valve)- located between each atrium and corresponding ventricle a. tricuspid valve- AV Valve located between the right atrium and right ventricle (has 3 cusps) 1. tricuspid is with the t-right side of heart b. bicuspid valve (or mitral)- AV Valve located between the left atrium and left ventricle 1. ventricles have cone-shaped muscular pillars called papillary muscles attached to the free margins of the cusps of the AV Valves by thin, strong connective tissue strings (chordae tendinae) 2. chordae tendinae = "heart strings" c. Semilunar valves- one is located at the base of the large blood vessels carrying blood away from the ventricles (each has 3 pocket-like semilunar cusps) d. aortic semilunar valve- at the base of aorta separating it from the left ventricle e. pulmonary semilunar valve- at base of the pulmonary trunk separating it from the right ventricle

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Operations of Valves a. The left and right ventricle valves work in the same fashion b. When the left ventricle is relaxed, blood flows from the higher pressured atrium to the lower pressured ventricle, the AV Valve is open, chordae tendinae loose and LV relaxed c. When to ventricle contracts, the papillary muscles contract increasing tension of the chordae tendinae pulling the AV Valve closed i. The volume in the ventricle remains the same because the AV valve is closed but the contracting ventricles causes the pressure to increase greatly ii. Blood would naturally flow back into the lower pressure of the atria but the closed AV Valves prevent this backflow from happening iii. When pressure in the ventricles exceeds the blood vessels exiting the heart (the aorta in the case of the LV), blood pushes on the cusps of the semilunar valves, pushing blood out of them iv. Upon ventricle relaxation, the blood in the aorta would naturally want to flow back into the lower pressure ventricle but the blood flowing back fills up the 3 cusps of the semilunar valve causing the valve to close preventing backflow back into the ventricles Route of Blood Flowing Through the Heart a. Deoxygenated blood from the body flows to the right atrium into the right ventricle and then to the lungs (pulmonary circulation) b. Blood returns from the lungs to the left atrium, enters the left ventricle and is pumped back to the body (systemic circulation) c. Both the atria and both ventricles contract at the same time (even though the blood flow through them is different, the events occur at the same time) Blood Supply to the Heart a. Two coronary arteries (right and left) branch off the aorta to supply the heart (right after base of aorta) b. The cardiac veins drain blood from the cardiac muscle (their pathways are nearly parallel to the coronary arteries) and most of the blood drains into a coronary sinus i. Blood flows from the coronary sinus directly into the right atrium (some small cardiac veins drain directly to the right atrium) ii. coronary sinus is enlarged and can be seen on the posterior heart emptying into the RA 1. Fibrous Skeleton of the Heart 1. consists of a plate of fibrous connective tissue between the atria and ventricles, and this tissue plate forms rings around the valves, thus providing solid support for them 2. the fibrous heart skeleton supports the opening of the heart, provides a point of attachment for heart muscle (papillary muscle) and electrically insulates the atria from the ventricles Cardiac Muscle a. cells are elongated, branching cells that are uninucleate, or occasionally 2 centrally located nuclei b. cells are striated, but less regularly arranged and numerous than skeletal muscle cells c. cells are bound end to end to adjacent cells by intercalated disks, which allow action potentials to move from one cell to the next thus allowing cardiac muscle to function as a unit d. Conduction of Action Potentials and Contraction is similar but not the same as in skeletal muscle cells i. Actin and myosin form sarcomeres (contractile units) ii. The T tubules and sarcoplasmic reticulum are NOT as organized as in skeletal muscle

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Normal contraction depends on extracellular Ca Cardiac muscle cells rely on aerobic respiration for ATP Production, so they have many more mitochondria than other muscle cells and are well supplied with blood vessels Electrical Activity of the Heart a. Action Potentials i. like action potentials in skeletal muscle and neurons, those in cardiac muscle exhibit depolarization followed by repolarization ii. In cardiac muscle, however, a period of slow repolarization greatly prolongs the action potential iii. Each action potential in cardiac muscle consists of: 1. depolarization phase 2. followed by a rapid but partial early repolarization phase 3. followed by a longer and slower plateau phase 4. followed by a more rapid final repolarization phase iv. action potentials are the result of permeability changes of the plasma membrane: 1. depolarization phase: Na+ ion channels open, and Na+ moves into cell causing depolarization 1. Voltage gated K+ channels close (not allowing K+ to move out of cell) -->further depolarization 2+ 2+ 2. Voltage gated Ca begin to open (slowly) so Ca diffuses into cell -->further depolarization 2. early repolarization phase: Na+ channels close, some K+ channels open causing early repolarization 1. movement of Na+ into cell stops 2. there is some movement of K+ out of cell -->small repolarization 2+ 3. plateau phase: Ca continue to open and most are open now 2+ 2+ 1. Ca channels continue opening (because they are slow) and diffusion of Ca into cell counteracts the potential change produced by K+ moving out of cell 2+ 4. final repolarization: Ca begin to close and many K+ channels open 2+ 1. diffusion of Ca into cell decreases and diffusion of K+ out of cell increases causing the membrane potential to repolarize v. Things to remember: +2 1. Na+ and Ca is more abundant out of cell and moves into cell through diffusion when channels open 2. K+ is more abundant inside the cell and moves out of cell through diffusion when channels open 2+ 3. Depolarization: Na+ and Ca move into cell depolarizing the membrane and K+ channels are closed not allowing any of the ion movement to be counteracted 2+ 4. When Na+ channels close and some K+ channels open, K+ moves out of cell to repolarize but Ca is still moving into cell so the repolarization is small 2+ 2+ 5. Ca channels are open and K+ channels are open and the movement of these ions (K+ out and Ca in) cancels each other out causing a plateau phase) 2+ 6. when Ca channels finally close, K+ continues to diffuse out of cell and is able to repolarize the membrane b. Refractory Periods i. absolute refractory period--cardiac muscle cells are insensitive to further stimulation ii. relative refractory period--stronger than normal stimulation can produce an action poetntial iii. *since cardiac muscle has a prolonged depolarization, it also has a prolonged absolute refractory period, which allows time for the cardiac muscle to relax before the next action potential causes a contraction c. Autorythmicity of Cradiac Muscle i. autorythmic: heart is said to be autorythmic because it stimualtes itself to contract at regular intervals 1. if the heart is removed from the body and maintained under physiological conditions with proper nutrients and temperature it will continue to beat ii. some cardiac muscles cells have the ability to generate action potential spontaneously, and these action potentials propagate to other cardiac muscle cells causing them to contact iii. Sinoatrial Node (SA Node)- collection of cardiac muscle cells capable of spontaneously generating action potentials 1. called the "pacemaker of the heart" 2. can spontaneously generate action potentials faster than any other part of the heart 3. generates action potentials causing the heart to contact, thus determining heart rate (bpm) 1. normal heart rate is 60-100 bpm 2. >100 bpm is called 3. <60 bpm is called d. Conducting System of the Heart i. As soon as an action potential ends, the production of the next begins with a slowly developing local potential called a prepotential 1. Na+ ions enter cell through leak channels, causing a small depolarizing voltage change across the membrane, which causes 2+ 2+ voltage gated Ca channels to open and Ca ions move into cell

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This movement of Ca ions into cell causes a larger depolarizing voltage change across the membrane, causing more 2+ voltage gated Ca to open 2+ ii. When the preoperational potential reaches threshold, many voltage gated Ca channels open 2+ iii. unlike other cardiac muscle cells, the movement of Ca into the pacemaker cells is primarily responsible for the depolarization phase of the action potential 2+ iv. Repolarization occurs, as in other cardiac muscle cells, when the Ca channels close and the K+ channels open v. the duration of the prepotential determines heart rate, as the duration of the prepotential decreases, the time between action potentials decreases and the heart rate increases +2 1. ex. epinephrine and norepinephrine increase heart rate by opening voltage gated Ca channels, which decreases the 2+ duration of the prepotential by increasing the movement of Ca into cells e. Conducting i. effective pumping is dependent on coordinated contraction of the atria and ventricles--the atria contract, and blood moves to the ventricles and the ventricles contract--moving blood to the lungs and body ii. the conducting system of the heart, which consists of specialized cardiac muscle cells stimulates the atria and ventricles to contract by relaying action potentials through the heart 1. Sinoatrial Node (SA Node)--located adjacent but medial to the opening of the superior vena cava in the Right Atrium 1. action potentials originating in the SA node spread over the right and left atria causing them to contract 2. some of these action potentials reach the Atrioventricular Node (AV Node), located at the base or lower portion of the Right Atrium 1. action potentials propagate slowly through the AV Node before causing the ventricles to contract, this delay allows the atria to complete their contraction before the ventricles contract 3. AV Node gives rise to the AV Bundle or Bundle of His- which is at the superior end of the interventricular septum 1. fibrous skeleton electrically insulates the atria and ventricles 2. only action potentials transmitted through the conducting system cause the ventricles to contract, allowing contractions to be coordinated 4. Bundle of His divides at the interventricular septum to form the right and left Bundle Branches, which extend to the apex of the heart 5. Many small bundles of Purkinje fibers pass from the tips of the bundle branches to the apex and then extend superiorly to the cardiac muscle of the ventricular walls 6. The AV bundle (Bundle of His), Bundle Branches and Purkinje fibers are composed of specialized cardiac muscle cells which conduct action potentials very rapidly 1. thus ventricular contraction begins at the apex of the heart and progress superiorly through the ventricles which pushes blood superiorly out to the blood vessels (pulmonary trunk or aorta) f. Electrocardiogram i. action potentials conducted through the heart as it contracts and relaxes produce electrical currents that can be measured at the surface of the body, and the record of these electrical events is called an electrocardiogram (ECG or EKG) 1. Depolarization of the atria causes the P wave 2. Depolarization of the ventricles causes the QRS complex 1. Repolarization of the atria happens during the QRS complex (and is masked by the QRS complex on graphing) 3. Repolarization of the ventricles causes the T wave 4. PQ Interval (or PR interval because Q wave is very small)= atria contract and begin to relax ( at the end of PQ interval, the ventricles begin to depolarize) 5. QT Interval length of time for ventricular depolarization and repolarization Cardiac Cycle a. Systole and Diastole i. cardiac cycle is repetitive contractions and relaxation of the heart chambers ii. systole refers to contraction, while diastole refers to relaxation (if atrial or ventricular is not specified, then both refer to the ventricles) iii. During systole (1) AV Valves close (2) pressure increases in the ventricles (3) semilunar valves are forced open and blood flows into the aorta and pulmonary trunk iv. At beginning of diastole (1) pressure in ventricles decreases (2) semilunar valves close, as the result of blood trying to flow back into ventricles and filling up 3 cusps of semilunar valves closing the valve 1. When pressure in ventricles is lower than in the atria, the AV Valves open and blood flows from the atria into the ventricles (most flows passively without aid of atrial contraction, except in exercise etc.) 1. Atrial systole: atria contract and complete the filling of the ventricles b. Events Occurring during Ventricular Systole i. ventricular depolarization produces the QRS complex and initiates contraction of the ventricles

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1. ventricles contracting increases the pressure of the ventricles ii. AV Valves close in contraction and semilunar valves open ejecting blood from ventricles into blood vessels c. Events Occurring during Ventricular Diastole i. Ventricular repolarization produces the T wave and the ventricles relax ii. Blood flowing back toward the relaxed ventricles (lower pressure) from the blood vessels (higher pressure) fills the cusps closing the semilunar valves iii. AV Valves open and blood flows into the ventricles iv. Approximately 70% of the ventricular filling occurs when blood flows from the higher pressure in the veins and atria to the lower pressure in the relaxed ventricles v. Atrial depolarization produces the P wave, the atria contract during the last 1/3 of diastole and complete ventricular filling (remaining ~%30) d. Aortic Pressure Curve i. Contraction of the ventricles (specifically the left) forces blood into the aorta, and the maximum pressure in the aorta is the systolic pressure 1. aorta is the largest artery in the body 2. systolic pressure is approximately 120 mm Hg ii. Elastic recoil of the aorta maintains pressure in the aorta and produces a dicrotic notch- which means "double beating" and it is when an increased pressure caused by recoil is large, a double pulse can be felt decreased elasticity of the aorta with age results in less expansion when blood is injected into it, producing high blood pressure iii. Blood pressure falls in the aorta as blood flows out of the aorta, and the minimum pressure in the aorta is the diastolic pressure 1. diastolic pressure is approximately 80 mm Hg e. Heart Sounds i. closure of the Atrioventricular Valves produces the first low-pitched heart sound caused by a vibration of the valves and surrounding fluid in closure 1. the AV valves close at the beginning of ventricular systole ii. closure of the semilunar valves produces the second higher-pitched ("dupp" or "dubb") heart sound 1. the semilunar valves close at the beginning of ventricular diastole iii. Systole, is therefore approximately the time between the first and second heart sounds iv. Diastole, which lasts somewhat longer is approximately the time between the second heart sound and the next first heart sound 10. Mean Arterial Blood Pressure a. Mean arterial pressure--average bp in the aorta i. adequate blood pressure is needed to ensure delivery of blood to the tissues of the body b. mean arterial pressure (cardiac output) x ( peripheral resistance) i. cardiac output-amount of blood pumped by the heart per minute ii. peripheral resistance-total resistance to blood flow through the vessels c. cardiac output= (heart rate) x (stroke volume) d. stroke volume = (end diastolic volume) - (end systolic volume) i. stroke volume- the amount of blood pumped by the heart per beat ii. venous return is the amount of blood returning to the heart; and an increased venous return increases the stroke volume by increasing the end diastolic volume iii. increased force of contraction increases stroke volume by decreasing end systolic volume 11. Regulation of the Heart a. In order to maintain homeostasis, the amount of blood pumped by the heart must vary dramatically ( for example during exercise cardiac output increases dramatically over resting values. Intrinsic and Extrinsic regulatory mechanisms control cardiac output. b. Intrinsic Regulation i. Intrinsic regulation modifies stroke volume through the functional characteristics of cardiac muscle cells; it does not depend on neural or hormonal regulation ii. Starling's law of the heart describes the relationship between preload and the stroke volume of the heart; an increased preload causes cardiac muscle fibers to contract with a greater force and produce a greater stroke volume 1. as the resting length of a cardiac muscle fiber increases, the force of contraction they produce increases, but past a certain length the force actually decreases (normally not stretched past their point at which they can contract with a maximal force) 2. The amount of blood in the ventricles at the end of ventricular diastole (end-diastolic volume) determined the degree to which the cells are stretched 3. as a result of starlings law, the amount of blood entering the heart (venous return) is equal to the amount of blood leaving the heart (cardiac output) 1. thus when venous return increases--preload, force of contraction, stroke volume and cardiac output all increase

2. vice versa is true when venous return decreases Starling's law has a major influence on cardiac output because venous return is influenced by many factors including exercise (pg.509) iii. Afterload is the pressure against which the ventricles must pump blood 1. afterload influences cardiac output less than preload, but it is still important 2. people with hypertension have an increases aortic pressure and thus an increased afterload making the heart work harder, which can eventually lead to heart failure 3. people with low blood pressure on the other hand have a decreased afterload, and thus less work for the heart c. Extrinsic Regulation i. Extrinsic regulation of the heart modifies heart rate and stroke volume through neural and hormonal mechanisms ii. Neural control comes from the sympathetic and parasympathetic reflexes, and hormonal control comes from norepinephrine and epinephrine secreted in the medulla oblongata, which extrinsically modified heart rate by hyperpolarization or depolarization of the plasma membrane iii. The cardioregulatory center in the medulla oblongata regulates the parasympathetic and sympathetic nervous control of the heart 1. Parasympathetic stimulation is supplied by the vagus nerve (primarily innervating the SA and AV nodes) 1. This stimulation decreases heart rate 2. This is operating under normal conditions, and stimulates and depresses the heart rate (without its operation heart rate would be ~100bpm even resting) and in exercise the withdrawl of this stimulation increases heart rate 3. Postganglionic neurons secrete acetylcholine, which increases the membrane's permeability to K+ thus causing hyperpolarization of the plasma membrane 4. This moves the membrane potential further away from threshold, which increases the prepotential and slows conduction of action potentials (thus heart rate slows) 2. Sympathetic stimulation is supplied by the cardiac nerves (from inferior cervical and upper thoracic chain ganglia and innervate the SA node, AV node, and the myocardium of the atria and ventricles) 1. This stimulation increases the heart rate and the force of contraction (stoke volume) 2. Postganglionic neurons secrete norepinephrine, which increases membrane's permeability to Ca2+ 3. This moves the membrane potential closer to threshold causing a quicker depolarization of the plasma membrane and decreases the duration of the prepotential quickening the conduction of action potentials (thus faster heart rate) 4. norepinephrine and epinephrine secretion into the blood from the adrenal medulla is the result of sympathetic stimulation; they both increases the heart rate and force of contractions 12. The Heart and Homeostasis a. Effects of Blood Pressure i. Baroreceptors in the walls of certain large arteries (i.e. the aorta) monitor blood pressure ii. Within the medualla oblongata is the cardioregulatory center which receives signals (action potentials) from the baroreceptors modifies heart rate and stroke volume iii. The cardioregulatory center controls the action potential frequency in the parasympathetic and sympathetic nerve fibers extending from the brain to the spinal cord to the heart, along with also controlling the release of epinephrine and norepinephrine from the adrenal gland 1. when blood pressure increases, the walls of blood vessels are stretched and baroreceptors are stimulated; an increased frequency of action potentials is sent along the nerve fibers to the medulla oblongata of the brains which responds by increasing parasympathtic stimulation or decreasing sympathetic stimulation to decrease the heart rate and stroke volume, which decreases bp 2. withdrawal of parasympathtic stimulation is primarily responsible for increases in heart rate up to 100bpm, and larger increases result from sympathetic stimulation 3. the baroreceptors, do not maintain blood pressure over the long term and are not involved in chronic hypertension iv. The adrenal meduallary mechanism is the release of epinephrine and norepinephrine from the adrenal gland, this response is triggered usually if the increase or decrease in bp is large v. Fig. 17.8 pg. 511 b. Effect of pH, Carbon Dioxide, and Oxygen i. chemoreceptors are sensory receptors responding to chemicals, such as oxygen, carbon dioxide and H+ 1. These receptors sensitive to blood oxygen levels are found primarily in the carotid and aortic arteries, which are large arteries near the brain and heart which need oxygen to function 2. There are also chemoreceptors sensitive to carbon dioxide and pH changes in the medulla oblongata 3. Only when these levels significantly deviate from the norm do they affect the cardiovascular system; the chemoreceptors are not important in normal regulation of the heart but are more important in blood vessel constriction and respiration c. Effect of Ions and Body Temperature 4.

Changes in the extracellular concentrations of K+ or Ca which influence other excitable tissues, also affect cardiac muscle function ( extracellular Na+ levels rarely deviate enough from the norm to affect cardiac muscle function) 1. Increased extracellular K+ decreases heart rate, and stroke volume 1. causes partial depolarization of the membrane resulting in decreased amplitude of action potentials, affecting the rate at which action potentials are conducted through the AV node producing an AV node block 2+ 2. reduced amplitude of action potentials also results in fewer Ca entering the sarcoplasm of the cell meaning the strength of muscle contraction decreases 2. Decreased extracellular K+ decreases heart rate but doesn't affect stroke volume 1. membrane potential is hyperpolarized, increasing the duration of the prepotential 2+ 3. Increased extracellular Ca decreases heart rate but increases stroke volume 2+ 1. more Ca entering the sarcoplasm of cells means an increase in contraction strength leading to an increase in stroke volume 2+ 2. but, more Ca also reduces the frequency of action potentials in nerve fibers, thus reducing parasympathetic and sympathetic stimulation (indirect effect which decreases heart rate) 2+ 4. Decreased extracellular Ca increases heart rate but decreases stroke volume (opposite effect) 2+ 1. more Ca increases the cell's permeability to Na+ meaning depolarization of the cell happens quicker, and action potential generation is quicker leading to an increased heart rate 2+ 2+ 2. less Ca means a decreased influx of Ca into the sarcoplasm during action potential generation meaning a decreases in the force of contraction--thus decrease in stroke volume 5. Heart rate increases when body temperature increases (i.e. fever) and decreases when body temperature decreases 13. Effects of Aging on the Heart a. aging results in gradual changes in the function of the heart, which are minor under resting conditions but are more significant during exercise b. some age-related changes in the heart include: i. decreased cardiac output ii. decreased heart rate iii. increased cardiac arrhythmias iv. hypertrophy of the left ventricle v. development of incompetent or stenosed valves vi. development of coronary artery disease or heart failure c. Exercise improves the functional capacity of the heart at all ages

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