Heart

Function
1. Generating blood pressure 2. Routing blood 3. Ensuring one way blood flow 4. Regulating blood supply The heart is located in thoracic cavity between the lung. Heart has shape of blunt cone and slight larger than closed fist. Blunt round portion is the apex, located at level of 5th ICS Midclavicular line.. Larger flat portion at posterior end of the cone is base, located deep to sternum, extend to 2nd ICS left. Reason for locating the heart a) placing a stethoscope to find heart sound, electrocardiogram and perform CPR:

Anatomy of Heart
a) Pericardial Cavity- surround the heart b) Pericardium or Pericardial Sac- double layer closed sac that surround the heart and anchor the mediastinum consist of 1.) Fibrous pericardium- consist of tough, fibrous outer connective tissue 2.) Serous pericardium- inner layer of flat epithelial cell a. Pariental pericardium- lines the visceral pericardium b. visceral pericardium- cover the heart surface between the pericardial and visceral contain pericardial fluid which help to reduce friction.

External Anatomy
a.) Right and Left Atria-located at the base of the heart b.) Right and Left Ventricle- extend from the base towards the apex c.) Coronary Sulcus- separate atria from ventricle, one extend inferior from sulcus on anterior surface, the other one on posterior surface.
6 Large vein carry blood to the heart a.) Superior and Inferior vena cava- carry blood to right atrium. b.) Four pulmonary vein- carry blood from lung to the left atrium. c.) Two Artery pulmonary trunk and pulmonary artery.

Blood Supply to the Heart

Coronary Artery- supply blood to the wall of the heart from the base of the aorta. a.) Left coronary artery- from the left side of the aorta, supply anterior wall and most left ventricle. b.) Right coronary artery- from the right side of the aorta, supply wall of right ventricle. c.) Cardiac vein- drain blood from the cardiac muscle, where blood from the cardiac muscle is carried to coronary sinus then to right atrium, also small cardiac vein drains directly to right atrium.

Heart Chamber and Internal Anatomy

Heart is a muscular pump consist of four chambers
a.) Right and Left Atria- received blood from the vein and function as reservoir, where blood is collected.

When atria contract, it force the blood to the ventricle to complete ventricular filling.
Right atrium with two opening, superior and inferior vena cava, a large vein enters the heart from different body part. Left Atrium- has four opening that received the four pulmonary vein from the lung. Both separate by interatrial septum. b.) Right and Left Ventricle- major pumping chamber, they eject blood to artery and flow into circulation. Right Ventricle open to pulmonary trunk and Left ventricle open into aorta. Both separate by interventricular septum.

Heart Valve
Atrioventricular valve 1. Tricuspid valve- valve between right atrium and ventricle. 2. Bicuspid (mitral) valve- valve between left atrium and ventricle. Function: allows blood from atria into ventricle and prevent from flowing back. When ventricle contract- blood push the valve back towards the atrium When ventricle relax- blood flow from atria into ventricle. Papillary Muscle- cone shape muscular pillar on ventricle. Chordae Tendinae- thin strong connective string that attach to the muscle. Semilunar valve 1. Aortic and Pulmonic valve- contain three pocket like semilunar cup. When ventricle relax blood flow back from aorta or pulmonary trunk towards ventricle. When ventricle contract blood flow out of ventricle, it will push each valve.

Skeleton of Heart- fibrous ring around AV and Semilunar valve.

Function: provide support for the valve, serve as electric insulator and give rigid site of attachment for cardiac muscle. Route of blood flow through the heart. Blood from systemic circulation will go to SVC, IVC and some from coronary sinus blood go to RA then flow to RV.RA contract to complete ventricular filling RV contract to push blood against tricuspid valve and force to close, pressure of RV increaseforce pulmonary valve to open and blood flow to pulmonary trunk branch to form pulmonary artery which carry blood to lung, where oxygen picked up and carbon dioxide release blood return to pulmonary vein blood in LA then passes the LV where LA contract to

complete ventricle filling and force bicuspid to closed then LV pressure increase force the aortic valve to open and blood flow to aorta distribute to different part of the body.

Heart Wall
-composed of three layer of tissue a.) Epicardium (Visceral Pericardium) - thin serous membrane forming the smooth outer surface of the heart, consist of layer of connective tissue and fat. b.) Myocardium- thick middle layer of heart compose of muscle cell and ability of heart to contract. c.) Endocardium- smooth inner surface of heart chamber, allow blood to move easily through the heart.

Cardiac Muscle
Elongated muscle cell, branding cell contain one, occasional two nuclei that centrally located. Muscle contain action and myosin organized to form sarcomere, which joined by myofibril. Action and myosin is responsible for muscle contraction and give muscle a striated appearance. Cardiac Muscle- provide adequate oxygen supply thus it is not develop a significant oxygen debt. Cardiac muscle organized to bundle or sheet, where cell are bound end to end and lateral to adjacent cell by intercalated disc. This cell fit together greatly increase contact between them.

Electrical Activity of the Heart

1.

Cardiac Muscle has a platen phase which prolong the action potential, where conduction is cell to cell thus the rate of conduction is slower. Permiability changes due to voltage gate channel opening and closing during an action potential in cardiac muscle. Depolarization Phase - Na channel open- Na diffuse inside the cell. - K channel closed- decrease permiability of K in cell membrane. - Ca channel begin to open- slowly increase the permiability of Ca, diffuse into cell and cause deplorization.

2.) Early Reproduction and Plateau Phase - Na channel closed- diffusion of Na stop - Some K channel open- cause early repolarization - Plateau phase occurs as Ca channel open, cause diffuse of Ca into cell membrane. 3.) Final Repolarization - Ca channel close, many K channel open - Cardiac muscle exhibit refractory period, it last about about same length of prolonged action potential, allow muscle to contract and relax to take place.

Conduction System of Heart

1.) SA-node - pacemaker of the heart, located superior wall of right atrium that produce action potential faster rate than other arc of heart. Has a larger number of Ca channel, once RMP establish Ca channel open and begin to diffuse causes depolarization. - Depolarization stimulate additional Ca and Na channel to open and cause both depolarization. 2.) Atrioventricular node- located on lower right atrium, where action potential reach AV node, spread slowly into bundle of specialized cell called Atrioventricular bundle. Slow rate of action potential is conducted here to allow atria to complete their contraction before action potential delivered to ventricle. 3.) Left and Right Bundle branch- where action potential are transmitted through AV bundle, then divides into two branches called right and left bundle branch. 4.) Purkinje fiber- pass to apex of the heart and extend to cardiac muscle, subsequently action potential are rapidly deliver to all cardiac muscle of ventricle.

Electrocardiogram
Action potential conducted through the heart during cardiac cycle produce electrical current that can be measure at the surface of the body. Action potential conducted during cardiac cycle can be measure by placing electrode on surface and attach to recording device that defect Electrical change in cardiac muscle. The record of these electrical event is electrocardiogram. a. P wave- atrial depolarization b. QRS complex- ventricular depolarization c. T wave- ventricular repolarization PQ or PR interval- time between P wave and beginning of QRS complex. QT interval beginning of QRS complex to end of T wave. Cardiac Cycle- repetitive pumping process from outset of cardiac contraction and end with next contraction.

Pump
a. Atria- act primer pump, they complete the filling of ventricle with blood. b. Ventricle- act power pump, they produce force that cause blood to flow from pulmonary and Systemic Circulation.

Event of Cardiac Cycle

1. Systole- ventricle contract, push blood toward atria cause AV valve to close and when pressure increase in ventricle, the semilunar valve open to eject blood into pulmonary trunk and aorta. 2.) Beginning of Ventricular Diastole- pressure in ventricular decrease, semi-lunar valve close and prevent blood from flowing back to ventricle. AV valve open an d blood flow direct from atria to ventricle. 3.) End of Ventricular Diastole- atria contract then relax to complete their filling. Heart Sound First heart sound- lower pitch than 2nd sound- result from closure of AV valve. Second heart sound- closure of semi-lunar valve.

Regulation of Heart Function

CO = SV x HR CO = Volume of blood pump by either ventricle of heart each minute. SV = Volume of blood pump per ventricle each time the heart contract. HR = number of times heart contract each minute. Intrinsic Regulation- mechanism contain within the heart contract. a. Venous return- amount of blood that return to the heart. b. Pre load degree which ventricular wall stretch at end of diastole. -an increase VR, will increase preload thus increase CO. c. Afterload- the pressure against which ventricle must pump blood.

Extrinsic Regulation- mechanism external to the heart. Baroreceptor reflex- maintain homeostasis in response to change in blood pressure. Example: aorta and carotid artery. Example increase in BP- detect by baroreceptor (aorta and carotid artery) cardio regulatory center. a. Stimulate the heart decrease HR and decrease SV b. Adrenal gland decrease the release Epinephrine decrease HR and decrease SV