Cardiovascular system

• It is about 12 cm (5 in.) long, 9 cm (3.5 in.) wide at its broadest point, and 6
cm thick, with an average mass of 250 g (8 oz) in adult females and 300 g (10
oz) in adult males.

• The heart rests on the diaphragm, near the midline of the

thoracic cavity.

• The heart lies in the mediastinum, an anatomical region that

extends from the sternum to the vertebral column, from the
first rib to the diaphragm, and between the lungs.

• The pointed apex is formed by the tip of the left ventricle (a lower chamber of
the heart) and rests on the diaphragm.

• The base of the heart is opposite the apex and is its posterior
aspect. It is formed by the atria (upper chambers) of the
heart, mostly the left atrium
Pericardium

• The membrane that surrounds and protects the heart is the

pericardium.

• It confines the heart to its position in the mediastinum, while allowing sufficient
freedom of movement for vigorous and rapid contraction.

• The pericardium consists of two main parts: (1) the fibrous pericardium and (2) the
serous pericardium.

• The superficial fibrous pericardium is composed of tough, inelastic, dense irregular

connective tissue.

• It resembles a bag that rests on and attaches to the diaphragm; its open end is fused to
the connective tissues of the blood vessels entering and leaving the heart.
• The fibrous pericardium prevents overstretching of the heart, provides
protection, and anchors the heart in the mediastinum.

• The deeper serous pericardium is a thinner, more delicate membrane

that forms a double layer around the heart

• The outer parietal layer of the serous pericardium is fused to the fibrous pericardium.
The inner visceral layer of the serous pericardium, which is also called the epicardium
is one of the layers of the heart wall and adheres tightly to the surface of the heart.
• Between the parietal and visceral layers of the serous pericardium is a thin film of
lubricating serous fluid.

• This slippery secretion of the pericardial cells, known as pericardial fluid, reduces
friction between the layers of the serous pericardium as the heart moves.

• The space that contains the few milliliters of pericardial fluid is called the pericardial
cavity.
 Layers of the Heart Wall
• The wall of the heart consists of three layers: the epicardium (external layer), the
myocardium (middle layer), and the endocardium (inner layer).

• The epicardium is composed of two tissue layers.

• The outermost, is called the visceral layer of the serous pericardium. This thin,
transparent outer layer of the heart wall is composed of
mesothelium. Beneath the mesothelium is a variable layer of
delicate fibroelastic tissue and adipose tissue.

• The adipose tissue predominates and becomes thickest over the

ventricular surfaces, where it houses the major coronary and cardiac
vessels of the heart.

• The epicardium imparts a smooth, slippery texture to the outermost surface of the
heart. The epicardium contains blood vessels, lymphatics, and vessels that supply
• The middle myocardium is responsible for the pumping action of the heart and is
composed of cardiac muscle tissue. It makes up approximately 95% of the
heart wall.

• Although it is striated like skeletal muscle, the cardiac muscle is

involuntary like smooth muscle.

• The innermost endocardium (within) is a thin layer of endothelium overlying a thin

layer of connective tissue.

• It provides a smooth lining for the chambers of the heart and covers the valves of the
heart.

• The smooth endothelial lining minimizes the surface friction as blood passes through
the heart. The endocardium is continuous with the endothelial lining of the large
blood vessels attached to the heart.
 Chambers of the Heart

• The heart has four chambers. The two superior receiving chambers are the atria and
the two inferior pumping chambers are the ventricles.

• The paired atria receive blood from blood vessels returning blood to the heart, called
veins, while the ventricles eject the blood from the heart into blood vessels called
arteries.

• On the anterior surface of each atrium is a wrinkled pouchlike structure called an

auricle.

• On the surface of the heart are a series of grooves, called sulci that contain coronary
blood vessels and a variable amount of fat
• Each sulcus marks the external boundary between two chambers
of the heart.

• The deep coronary sulcus encircles most of the heart and marks
the external boundary between the superior atria and inferior
ventricles.

• The anterior interventricular sulcus is a shallow groove on the

anterior surface of the heart that marks the external boundary
between the right and left ventricles on the anterior aspect of the
heart.

• This sulcus continues around to the posterior surface of the heart as the posterior
inter-ventricular sulcus, which marks the external boundary between the
ventricles on the posterior aspect of the heart
Right Atrium

• The right atrium forms the right surface of the heart and
receives blood from three veins: the superior vena cava, inferior
vena cava, and coronary sinus.

• The right atrium is about 2–3 mm (0.08–0.12 in.) in average thickness. The
anterior and posterior walls of the right atrium are very different. The inside of the
posterior wall is smooth; the inside of the anterior wall is rough due to the
presence of muscular ridges called pectinate muscles.

• Between the right atrium and left atrium is a thin partition called the interatrial
septum.

• Blood passes from the right atrium into the right ventricle through a valve that is
called the tricuspid valve, because it consists of three cusps .
• It is also called the right atrioventricular valve.

• The valves of the heart are composed of dense connective tissue covered by
endocardium.

• Right Ventricle

• The right ventricle is about 4–5 mm (0.16–0.2 in.) in average thickness and forms
most of the anterior surface of the heart. The inside of the right ventricle contains a
series of ridges formed by raised bundles of cardiac muscle fibers called trabeculae
carneae.

• The cusps of the tricuspid valve are connected to tendon like cords, the chordae
tendineae. which in turn are connected to cone-shaped trabeculae carneae called
papillary muscles.
• Internally, the right ventricle is separated from the left ventricle by a partition
called the interventricular septum.

• Blood passes from the right ventricle through the pulmonary valve
(pulmonary semilunar valve) into a large artery called the pulmonary
trunk, which divides into right and left pulmonary arteries and carries blood
to the lungs.

Left Atrium

• The left atrium is about the same thickness as the right atrium and forms most
of the base of the heart.

• It receives blood from the lungs through four pulmonary veins. Like the right
atrium, the inside of the left atrium has a smooth posterior wall. The anterior
wall of the left atrium also is smooth.
Blood passes from the left atrium into the left ventricle through
the bicuspid (mitral) valve.

Left Ventricle

• The left ventricle is the thickest chamber of the heart, averaging 10–15 mm
(0.4–0.6 in.), and forms the apex of the heart.

• Like the right ventricle, the left ventricle contains trabeculae carneae and has
chordae tendineae that anchor the cusps of the bicuspid valve to papillary
muscles.

• Blood passes from the left ventricle through the aortic valve (aortic semilunar
valve) into the ascending aorta
 Myocardial Thickness and Function

The thickness of the myocardium of the four chambers varies according to each chamber’s function.

The thin-walled atria deliver blood under less pressure into the adjacent ventricles. Because the ventricles
pump blood under higher pressure over greater distances, their walls are thicker.

Both ventricles eject equal amount of blood simultaneously, the right side has a much smaller workload. It
pumps blood a short distance to the lungs at lower pressure, and the resistance to blood flow is small.
 Heart Valves and Circulation of Blood

Valves open and close in response to pressure changes as the heart contracts and relaxes.

Operation of the Atrioventricular Valves

• When an AV valve is open, the rounded ends of the cusps project into the ventricle. When the
ventricles are relaxed, the papillary muscles are relaxed, the chordae tendineae are slack, and blood
moves from a higher pressure in the atria to a lower pressure in the ventricles through open AV valves.

• When the ventricles contract, the pressure of the blood drives the cusps upward until their edges meet
and close the opening.

• If the AV valves or chordae tendineae are damaged, blood may regurgitate (flow back) into the atria
when the ventricles contract.
 Operation of the Semilunar Valves

• The aortic and pulmonary valves are known as the semilunar (SL) valves.

• The SL valves allow ejection of blood from the heart into arteries but prevent backflow of blood into the ventricles.

• The free borders of the cusps project into the lumen of the artery. When the ventricles contract, pressure builds up
within the chambers.

• The semilunar valves open when pressure in the ventricles exceeds the pressure in the arteries, permitting ejection of
blood from the ventricles into the pulmonary trunk and aorta.

• As the ventricles relax, blood starts to flow back toward the heart. This back flowing blood fills the valve cusps, which
causes the free edges of the semilunar valves to contact each other tightly and close the opening between the ventricle
and artery.
 Systemic and Pulmonary Circulations

• In postnatal (after birth) circulation, the heart pumps blood into two closed circuits with each beat—
systemic circulation and pulmonary circulation.

• The left side of the heart is the pump for systemic circulation; it receives bright red oxygenated
(oxygen-rich) blood from the lungs. The left ventricle ejects blood into the aorta.

• From the aorta, the blood divides into separate streams, entering progressively smaller systemic
arteries that carry it to all organs throughout the body—except for the air sacs (alveoli) of the lungs,
which are supplied by the pulmonary circulation.

• In systemic tissues, arteries give rise to smaller-diameter arterioles, which finally lead into extensive
beds of systemic capillaries.

• Exchange of nutrients and gases occurs across the thin capillary walls. Blood unloads O2 (oxygen) and
picks up CO2 (carbon dioxide).
• In most cases, blood flows through only one capillary and then enters a systemic venule. Venules carry
deoxygenated
(oxygen-poor) blood away from tissues and merge to form larger systemic veins. Ultimately blood flows
back to the right atrium.

• The right side of the heart is the pump for pulmonary circulation; it receives all of the dark-red
deoxygenated blood returning from the systemic circulation.

• Blood ejected from the right ventricle flows into the pulmonary trunk, which branches into pulmonary
arteries that carry blood to the right and left lungs.

• In pulmonary capillaries, blood unloads CO2, which is exhaled, and picks up O2 from inhaled air. The
freshly oxygenated blood then flows into pulmonary veins and returns to the left atrium.
 Histology of Cardiac Muscle Tissue

• Compared with skeletal muscle fibers, cardiac muscle fibers are shorter in length and less circular in transverse
section.

• They also exhibit branching, which gives individual cardiac muscle fibers a “stair-step” appearance.

• Cardiac muscle fiber is 50–100 µm long and has a diameter of about 14 µm.

• Usually one centrally located nucleus is present, although an occasional cell may have two nuclei. The ends of
cardiac muscle fibers connect to neighboring fibers by irregular transverse thickenings of the sarcolemma called
intercalated discs.

• The discs contain desmosomes, which hold the fibers together, and gap junctions, which allow muscle action
potentials to conduct from one muscle fiber to its neighbors.

• Gap junctions allow the entire myocardium of the atria or the ventricles to contract as a single, coordinated unit.
• Mitochondria are larger and more numerous in cardiac muscle fibers than in skeletal muscle fibers. In a cardiac
muscle fiber, they take up 25% of the cytosolic space; in a skeletal muscle fiber only 2% of the cytosolic space is
occupied by mitochondria.

• Cardiac muscle fibers have the same arrangement of actin and myosin, and the same bands, zones, and Z discs, as
skeletal muscle fibers.

• The transverse tubules of cardiac muscle are wider but less abundant than those of skeletal muscle; the one transverse
tubule per sarcomere is located at the Z disc.
 Autorhythmic Fibers: The Conduction System

• An inherent and rhythmical electrical activity is the reason for the heart’s lifelong beat. The source of
this electrical activity is a network of specialized cardiac muscle fibers called autorhythmic fibers
(self-excitable).

• Autorhythmic fibers repeatedly generate action potentials that trigger heart contractions.

• During embryonic development, only about 1% of the cardiac muscle fibers become autorhythmic
fibers; these relatively rare fibers have two important functions:

• They act as a pacemaker, setting the rhythm of electrical excitation that causes contraction of the heart.

• They form the cardiac conduction system, a network of specialized cardiac muscle fibers that provide
a path for each cycle of cardiac excitation to progress through the heart.

• The conduction system ensures that cardiac chambers become stimulated to contract in a coordinated
manner, which makes the heart an effective pump.
 Cardiac action potentials propagate through the conduction system in the following sequence

• Cardiac excitation normally begins in the sinoatrial (SA) node, located in the right atrial wall just
inferior and lateral to the opening of the superior vena cava.

• SA node cells do not have a stable resting potential. They repeatedly depolarize to threshold
spontaneously.

• The spontaneous depolarization is a pacemaker potential. When the pacemaker potential reaches
threshold, it triggers an action potential.

• Each action potential from the SA node propagates throughout both atria via gap junctions in the
intercalated discs of atrial muscle fibers. Following the action potential, the two atria contract at the
same time.

• By conducting along atrial muscle fibers, the action potential reaches the atrioventricular (AV) node,
located in the interatrial septum, anterior to coronary sinus.

• At the AV node, the action potential slows considerably as a result of various differences in cell
structure in the AV node. This delay provides time for the atria to empty their blood into the ventricles.
• From the AV node, the action potential enters the atrioventricular (AV) bundle (also known as the
bundle of His).

• This bundle is the only site where action potentials can conduct from the atria to the ventricles.

• After propagating through the AV bundle, the action potential enters both the right and left bundle
branches.

• The bundle branches extend through the interventricular septum toward the apex of the heart.

• Finally, the large-diameter Purkinje fibers rapidly conduct the action potential beginning at the apex
of the heart upward to the remainder of the ventricular myocardium.

• Then the ventricles contract, pushing the blood upward toward the semilunar valves.

• On their own, autorhythmic fibers in the SA node would initiate an action potential about every 0.6
second, or 100 times per minute.

• Thus, the SA node sets the rhythm for contraction of the heart—it is the natural pacemaker
• This rate is faster than that of any other autorhythmic fibers.

• Because action potentials from the SA node spread through the conduction system and stimulate other
areas before the other areas are able to generate an action potential at their own, slower rate, the SA
node acts as the natural pacemaker of the heart.

• Nerve impulses from the autonomic nervous system (ANS) and blood-borne hormones (such as
epinephrine) modify the timing and strength of each heartbeat, but they do not establish the
fundamental rhythm.

• In a person at rest, for example, acetylcholine released by the parasympathetic division of the ANS
slows SA node pacing to about every 0.8 second or 75 action potentials per minute.
 Action Potential and Contraction of Contractile Fibers
• The action potential initiated by the SA node travels along the conduction system
and spreads out to excite the “working” atrial and ventricular muscle fibers, called
contractile fibers.
• Depolarization:

• Unlike autorhythmic fibers, contractile fibers have a stable resting membrane

potential that is close to -90 mV.

• When a contractile fiber is brought to threshold by an action potential from

neighboring fibers, its voltage-gated fast Na⁺ channels open.

• These sodium ion channels are referred to as “fast” because they open very rapidly in
response to a threshold-level depolarization.
• Opening of these channels allows Na⁺ inflow because the cytosol of contractile fibers is electrically
more negative than interstitial fluid and Na⁺ concentration is higher in interstitial fluid.

• Inflow of Na⁺ down the electrochemical gradient produces a rapid depolarization. Within a few
milliseconds, the fast Na ⁺ channels automatically inactivate and Na ⁺ inflow decreases.

• Plateau

• The next phase of an action potential in a contractile fiber is the plateau, a period of maintained
depolarization. It is due in part to opening of voltage-gated slow Ca2 ⁺.

• The next phase of an action potential in a contractile fiber is the plateau, a period of maintained
depolarization.

• It is due in part to opening of voltage-gated slow Ca2 ⁺ channels in the sarcolemma. When these
channels open, calcium ions move from the interstitial fluid into the cytosol.

• This inflow causes even more Ca2⁺ to pour out of the sarcoplasmic reticulum into the cytosol through
additional Ca2⁺ channels in the sarcoplasmic reticulum membrane.
• The increased Ca2⁺ concentration in the cytosol ultimately triggers contraction.

• Several different types of voltage-gated K⁺ channels are also found in the sarcolemma of a contractile
fiber.

• Just before the plateau phase begins, some of these K⁺ channels open, allowing potassium ions to leave
the contractile fiber. Therefore, depolarization is sustained during the plateau phase because Ca2 ⁺ inflow
just balances K ⁺ outflow.

• The plateau phase lasts for about 0.25 sec, and the membrane potential of the contractile fiber is close to 0
mV.
• Repolarization

• The recovery of the resting membrane potential during the repolarization phase of a cardiac action
potential resembles that in other excitable cells.

• After a delay (which is particularly prolonged in cardiac muscle), additional voltage-gated K ⁺ channels
open.

• Outflow of K restores the negative resting membrane potential (-90 mV). At the same time, the calcium
channels in the sarcolemma and the sarcoplasmic reticulum are closing, which also contributes to
repolarization.

• In muscle, the refractory period is the time interval during which a second contraction cannot be triggered.

• The refractory period of a cardiac muscle fiber lasts longer than the contraction itself. As a result, another
contraction cannot begin until relaxation is well under way.
• Some of the blood in the aorta flows into the coronary arteries,
which branch from the ascending aorta and carry blood to the heart
wall. The remainder of the blood passes into the arch of the aorta
and descending aorta (thoracic aorta and abdominal aorta).
• As each chamber of the heart contracts, it pushes a volume of blood
into a ventricle or out of the heart into an artery.

• Valves open and close in response to pressure changes as the heart

contracts and relaxes. Each of the four valves helps ensure the
oneway flow of blood by opening to let blood through and then
closing to prevent its backflow.