An-Najah National University

Faculty of Medicine
Division of Physiology, pharmacology and Toxicology
Medical physiology one
7102201
Dr. Azza Isleem, MD, PhD
Dr. Heba Salah, PhD
Dr. Abdalrahman Al Aqra’a, MD, Msc.

Cardiovascular Physiology
2nd Part
Heart valves and
heart sounds
 Heart Valves
1. The atrioventricular valves:
Located between the atrium and ventricle of each
side, and prevent the flow of the blood from
ventricle to atrium

AV valves Consist of:

1- Cusps: infolding of the endocardium
2- Chordae tendineae: anchors the cusps to the wall
of the ventricles
3- Papillary muscle ……. Function???

There are 2 AV valves:

1- Bicuspid (mitral): between left atrium and left
ventricle
2- Tricuspid: between right atrium and right
ventricle
Heart Valves
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 Heart Valves
2. Aortic and pulmonary artery valves:

• The closure of the A-V valves is much softer than the

semilunar valve.

• The velocity of blood ejection through the small opening of

aortic and pulmonary valves is far greater than that through
the much larger A-V

• The edges of the aortic and pulmonary valves are subjected

to much greater mechanical abrasion than are the A-V valves
because of the rapid closure and rapid ejection

• The aortic and pulmonary valves are not supported by the

chordae tendineae. The aortic and pulmonary valves must be
constructed with an especially strong yet very pliable fibrous
tissue base to withstand the extra physical stresses.
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 Heart Valves

The opening and closure of

these valves is a passive
process
 Heart sound
• Knowing the orientation of cardiac apex and
base is important for applying good physical
exam.

• Auscultation of heart can be properly applied

when we know the exact location of the apex
and the base of the heart.

• Placing the stethoscope on the apex of the heart

(fifth intercostal space) enables us to auscultate
the mitral valve the best, while placing it on the
right second intercostal space near the sterna
margin enables us to auscultate the aortic
valve.

• Placing the stethoscope in second left

intercostal space enables us to auscultate the
pulmonary valve
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 Heart Sounds
•The sound is generated by closure of the valve and not by
the opening of the valves

•Mechanism of heart sound: vibration of the taut valves

immediately after closure, along with vibration of the adjacent
walls of the heart, major vessels around the heart and the
surrounding fluids

S1: it indicates the beginning of the

ventricular contraction

•S1: Character of auscultation:

1) Area: apex
2) Pitch and relatively long-
lasting (about 0.14 second)
3) Together with apex impulse
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 Heart Sounds
• S2: Vibration of the closure of AV, PV, during
the beginning of ventricular diastole, it
indicates the beginning of ventricular diastole.
It is a rapid snap because these valves close
rapidly

• S2: Character of auscultation

1. Area: loudest at the
base
2. Pitch and short
lasting (about 0.11
second)
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S3:
• Low pitch sound coincides with the phase of rapid
ventricular filling after the opening of the AV valves
(middle third of the diastole)
• S3 could be a normal finding in children, young
adult and during pregnancy.
• Could be pathological after the age of 40 indicating
systolic heart failure .
• S3 best heard at the apex

• Gallop rhythm (lub-dub-dum)

 Heart Sounds

S4:
• It represents atrial contraction sound

• It is soft and low pitched sound best heard at the apex

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• It is always pathological due to force atrial contraction that try to compensate
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 Work Output of the heart
The stroke work output of the heart is the amount of energy that the
heart converts to work during each heartbeat while pumping blood into
the arteries.

Minute work output is the total amount of energy converted to work in 1

minute; this is equal to the stroke work output times the heart rate per
minute.

Component of the work output:

1. Energy required o move the blood from low pressure veins to high
pressure arteries (external work)
2. Work required to accelerate the blood to its velocity of ejection
through aortic and pulmonary valve
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 Graphical analysis of the ventricular pumping
End diastolic pressure of the ventricle on
curve ……

The systolic pressure curve is determined

by recording the systolic pressure
achieved during ventricular contraction at
each volume of filling

Filling of ventricles up to 150 ml does

not increase greatly the diastolic pressure

Above 150 ml, the ventricular diastolic

pressure increases rapidly, why

At a ventricular volume of 150 to 170 ml

the systolic pressure reaches a maximum
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 Graphical analysis of the ventricular pumping

- A greater increase in the diastolic volume decreases

the systolic pressure, why?

- The maximum systolic pressure for the normal left

ventricle is between 250 and 300 mm Hg, but this
varies widely.

- The maximum systolic pressure in right ventricles is

between 60 and 80 mm Hg.
 Graphical analysis of the ventricular pumping
volume pressure diagram
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The shaded area represents the net external work output of the ventricle
during its contraction cycle.
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 Ventricular pumping
Oxygen utilization by the heart:
• 70 to 90% of energy required by the heart is normally derived from
oxidative metabolism of fatty acids with about 10 to 30 percent coming
from other nutrients, especially lactate and glucose.

• Less than 1% of the total energy liberated is provided by anaerobic

• metabolism, this can be increased to 10% under hypoxic condition

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Efficiency of cardiac contraction: .

• it is the ration of work output to total chemical energy expenditure.

1¥ Maximum efficiency of the normal heart is between 20 and 25 percent. In
heart failure, this can decrease to as low as 5 to 10 percent.

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 Regulation of heart pumping

At rest, the heart pumps only 4 to 6 liters of blood each minute.

During strenuous exercise, the heart may be required to pump four to seven
times this amount.

The basic means by which the volume pumped by the heart is regulated are:
1. intrinsic cardiac regulation of pumping in response to changes in
volume of blood flowing into the heart and
2. control of heart rate and strength of heart pumping by the autonomic
nervous system.
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 Intrinsic regulation of heart
pumping
• the amount of blood pumped by the heart each minute is
normally determined almost entirely by venous return.

• This intrinsic ability of the heart to adapt to increasing

volumes of inflowing blood is called the Frank Starling
mechanism of the heart

• the greater the heart muscle is stretched during filling, the

greater is the force of contraction and the greater the
quantity of blood pumped into the aorta.

• Stretching of the right atrial wall directly increases the

heart rate by 10 to 20 percent

• Explanation of the Frank-Starling

Mechanism?
 ①µ

In @
He.

Within a normal physiologic range, the more the myocardial fibers are stretched,
the greater the tension in the muscle fibers and the greater force of contraction of
the ventricle when stimulated. The Frank-Starling relationship is the observation
that ventricular output increases as preload (end-diastolic pressure) increases.
(Anthony V. Delicce et al 2021)
 *

Effect of potassium and calcium ions ECGI &

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Effect of Potassium Ions:

1. causes the heart to become dilated and flaccid and also slows the heart
rate.
2. block conduction of the cardiac impulse from the atria to the ventricles
through the A-V bundle.

Causes??

Effect of Calcium ion:

• Hypercalcemia: causes the heart to go toward spastic contraction
• Hypocalcemia: causes heart flaccidity.
 Effect of temperature on heart function
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• Increased body temperature greatly increases the heart rate, sometimes
to double the normal rate.

• This effect result from the fact that heat increases the permeability of the
cardiac muscle membrane to ions that control heart rate, resulting in
acceleration of the self-excitation process.

• Contractile strength of the heart often is enhanced temporarily by a

moderate increase in temperature

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