P H A R M A C O L O GY

Anatomy of Heart
This course focuses on the heart and the cardiovascular system. In this

three-part course we explore the anatomy underlying the vital signs so

that you will develop a systematic understanding of how the heart

functions and how it can be influenced by drugs.

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Course Objectives

01 The course is designed for 1st year pharmacutical

students as an introduction to heart anatomy.

At the end of this course, you will be able to develop

02 an integrated understanding about the anatomy of
the heart and how it functions.

The course focuses on cardiovascular pharmacology

03 the fundamental mechanisms of cardiovascular cells

and how drugs influence the heart and vascular
system.

The course includes demonstrations of appropriate

04 techniques for measuring vital signs - heart rate,
blood pressure, respiration rate.
Course structure
Chapter 1
The structure of the heart
• The position of the heart in the thoracic cavity

• Cavities of the heart

• The structure of the heart wall

• The pericardium

• The pacing and conduction system of the heart

• The heart's own blood vessels

Chapter 2
How the heart works
• The role of the heart and the circulatory system

• Vascular structure and function

• Blood circulation

• Main cause of circulatory heart disease

Chapter 3
Regulation of heart function
• Excentric heart regulation

• Measuring heart related vital signs

• Cardiovascular pharmacology
Introduction

➢ The supply of oxygen and nutrients to the tissues of the body is provided by the
01
blood flowing through the blood vessels. The circulatory system ensures the
transport of respiratory gases and nutrients, protection against pathogens, the
internal balance of the body, the so-called maintaining homeostasis.
➢ The center of the circulatory system is the heart, which keeps blood flowing in the
circulatory system. The heart ensures a constant blood flow in the large and small
bloodstream and, together with other factors, the blood pressure required for this,
its valve system allows the blood flow to be redirected, it can adapt to changing
loads through its own regulatory mechanisms and nervous and hormonal effects.
CHAPTER 1

The structure of the heart

The human heart is a four-chambered muscular organ,
shaped and sized roughly like a man's closed fist with
two-thirds of the mass to the left of midline.

The heart is enclosed in a pericardial sac that is lined

with the parietal layers of a serous membrane. The
visceral layer of the serous membrane forms the
epicardium.

• Position of the heart

• Cavities

• The pericardium

• The pacing and conduction system

• Blood vessels

• Vascular structure
CHAPTER 1

Position of the heart

The heart is located in the chest behind the sternum and ribs, in the anterior-lower part
of the mediastinum anterius, to the left of the midline of the chest.

The upward-facing part is the massive (basis cordis), the lower narrower end is the apex
cordis. The imaginary axis of the heart would correspond to a line drawn from the center
of the thorn of the right scapula to the projection point of the apex of the heart. It is
surrounded on both sides by the right and left lungs, below it lies on the tendon plate of
the diaphragm (diaphragma, centrum tendineum). It is in contact with the esophagus at
the back, just behind the left atrium, with the anterior chest wall at the front.
CHAPTER 1

Cavities of the heart

The heart consists of two atria and two chambers. The crown groove (sulcus coronarius) on the
outer surface between the atria and the ventricles marks the boundary.

Right atrium Left atrium

(atrium dextrum) (sinus atrium)
From above, the upper empty The left atrium forms the rearward-
varicose vein (superior vena cava), facing part of the heart, but part of it
from below, the lower empty is also visible on the anterior surface
varicose vein (vena cava inferior) of the heart as a triangular left ear
opens immediately after drilling (auricula sinistra).
through the compartment, and the
The 2 right and 2 left pulmonary
heart's own collecting vessel, the
veins (pulmonary vein) open into the
coronary sinus, opens from
left atrium. From the left atrium, the
behind.
left venous orifice leads to the left
The right atrium travels through ventricle. In this estuary we find the
the right atrioventricular orifice double-pointed sailing key (valva
(right venous orifice) to the right bicuspidalis), also called the mitral
ventricle. valve.

The two atria are separated by a thin

atrial septum (septum interatriale)
that completely separates the two
cavities in an adult.
CHAPTER 1

Cavities of the heart

The heart consists of two atria and two chambers. The crown groove (sulcus coronarius) on the
outer surface between the atria and the ventricles marks the boundary.

Right ventricle Left ventricle

(ventricular dexter) (ventricular sinister)
The right ventricle contacts the The left ventricle rests on the
front wall of the chest and the compartment, forming the apex
compartment. The pulmonary cordis. Next to the left venous orifice
artery (truncus pulmonalis) is the left arterial orifice, above
originates from the upper part of which the ascending aorta departs.
the ventricle.
There are also crescent-shaped or
Blood flow between the pocket keys in this mouth.The
ventricular cavity and the ventricles are separated by the
pulmonary truncus is regulated by ventricular septum (septum
crescent-shaped or pocket valves interventriculare).
(valva semilunaris).
The ventricular hedge is formed by
the wall of the left ventricle.
CHAPTER 1

The structure of the heart wall

• Endocardium
• Myocardium
• Epicardium (pericardium)
CHAPTER 1

The structure of the heart wall

Endocardium Myocardium Epicardium

The heart is covered on the inside Myocardium is made up of The inner or visceral plate of the
by a thin layer called the myocardial tissue . pericardium forms the outermost
endocardium. layer of the heart wall. It is made
The myocardial cells that make up
up of a layer of mesothelial cells,
This forms the boundary between the myocardial tissue are only
below which the part in contact
the heart and the blood within it. special cells found in this organ,
with the heart muscle is made up
they are able to contract quickly
The innermost layer of the of adipose tissue rich in adipose
and vigorously, they are not tired,
endocardium is made up of cells tissue (subepicardial adipose
they work against our will like
in a coherent layer that also cover tissue), which evens out the
smooth muscles, their glycogen
the inner wall of the blood vessels. unevenness of the heart surface.
and lipid content is high.
CHAPTER 1

The pericardium

• The pericardium consists of two plates, the already mentioned inner or visceral plate
(epicardium) and the wall plate.

• The wall plate is made up of strong collagen fibers. It merges with the tendon part of the
compartment at the bottom, loosely attached to the pleura on both sides, bends back into the
visceral plate along the large vessels and covers the large vessels a few cm long, then
continues on the surface of the heart.

• There is a narrow cavity (pericardial cavity) between the plates of the pericardium. This cavity
is really just a virtual gap containing a few drops of fluid that ensures the free, frictionless
movement of the heart.
 CHAPTER 1

Pacing and conduction system of the heart

The heart conduction system is the network of nodes, cells and signals that controls your heartbeat. Each time
your heart beats, electrical signals travel through your heart. These signals cause different parts of your heart to
expand and contract. The expansion and contraction control blood flow through your heart and body.

The cardiac conduction system contains specialized cells and nodes that control your heartbeat:
• Sinoatrial node: the heart’s natural pacemaker. It sends the electrical impulses that start the heartbeat.
The autonomic nervous system controls how fast or slowly your SA node sends electrical signals.
• Atrioventricular node: delays the SA node’s electrical signal. The delay ensures that your atria are empty
of blood before the contraction stops. The atria are the heart’s upper chambers. They receive blood from
your body and empty it into the ventricles.
• Bundle of His: is a branch of fibers (nerve cells) that extends from your AV node. This fiber bundle receives
the electrical signal from the AV node and carries it to the Purkinje fibers.
• Purkinje fibers: are branches of specialized nerve cells. They send electrical signals very quickly to your
right and left heart ventricles. When the Purkinje fibers deliver electrical signals to your ventricles, the
ventricles contract. As they contract, blood flows from your right ventricle to your pulmonary arteries and
from your left ventricle to your aorta. The aorta is the body’s largest artery. It sends blood from the heart
to the rest of your body.
CHAPTER 1

Pacing and conduction system of the heart

The heart conduction system is the network of nodes, cells and signals that controls your heartbeat. Each time
your heart beats, electrical signals travel through your heart. These signals cause different parts of your heart to
expand and contract. The expansion and contraction control blood flow through your heart and body.
 CHAPTER 1

Pacing and conduction system of the heart

The heart conduction system is the network of nodes, cells and signals that controls your heartbeat. Each time
your heart beats, electrical signals travel through your heart. These signals cause different parts of your heart to
expand and contract. The expansion and contraction control blood flow through your heart and body.

Conduction System of the Heart

•Step 1: Stimulation of the sinoatrial node.
•Step 2: Stimulation of the atrioventricular node.
•Step 3: Propagation to the AV bundle.
•Step 4: Splitting into the bundle branches.
•Step 5: Propagation up the Purkinje fibers
(subendocardial conducting network).

Watch the animation about Cardiac Conduction.

 CHAPTER 1

The heart's own blood vessels

The heart's own vessels are the coronary arteries supplying blood to the heart muscle.
Like all other tissues in the body, the heart muscle needs oxygen-rich blood to function.
Also, oxygen-depleted blood must be carried away.

Right coronary artery Left coronary artery

The left main coronary artery The right coronary artery supplies
supplies blood to the left side of blood to the right ventricle, the right
the heart muscle (the left atrium, and the SA (sinoatrial) and
ventricle and left atrium).
Subtitle 2 AV (atrioventricular) nodes, which
regulate the heart rhythm.
The left main coronary divides
into branches. The right coronary artery divides
into smaller branches, including the
right posterior descending artery
and the acute marginal artery.
CHAPTER 2

How the heart works

The heart is a pump, usually beating about 60 to
100 times per minute. With each heartbeat, the
heart sends blood throughout our bodies, carrying
oxygen to every cell.

After delivering the oxygen, the blood returns to

the heart. The heart then sends the blood to the
lungs to pick up more oxygen. This cycle repeats
over and over again.

Blood moves through the circulatory system as a

result of being pumped out by the heart.

Watch the intro video about the functioning

of the heart here.
CHAPTER 2

The role of the heart and the circulatory system

What does the How does the What are the circulatory
circulatory system do? circulatory system work? system circuits?
The heart and blood vessels make up The circulatory system functions with Replace this text with information on
the circulatory system. The main the help of blood vessels that include the topic of the course.
function of the circulatory system is to arteries, veins and capillaries.
To replace the photo, delete the image
provide oxygen, nutrients and hormones These blood vessels work with your
and click on the picture icon in the blank
to muscles, tissues and organs heart and lungs to continuously
area, then select a new photo on your
throughout your body. Another role of circulate blood through your body.
computer.
the circulatory system is to remove
• The pulmonary circuit
waste from cells and organs so your
• The systemic circuit
body can dispose of it. • The coronary circuit
 CHAPTER 2

Vascular structure and function

The vessels of the blood circulatory system are:

• Arteries - Blood vessels that carry oxygenated

blood away from the heart to the body.

• Veins - Blood vessels that carry blood from the

body back into the heart.

• Capillaries - Tiny blood vessels between

arteries and veins that distribute oxygen-rich
blood to the body.
CHAPTER 2

Blood circulation

Blood comes into the right atrium

from the body, moves into the right
ventricle and is pushed into the
pulmonary arteries in the lungs.

After picking up oxygen, the blood

travels back to the heart through the
pulmonary veins into the left atrium,
to the left ventricle and out to the
body's tissues through the aorta.
Quiz
Test your knowledge of the anatomy of the heart with this multiple-choice picture quiz!

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CHAPTER 3

Regulation of heart
function
Cardiovascular regulation depends on the constant
monitoring of arterial pressure, central venous
pressure, and cardiac rate and force.

Heart rate is determined by four factors:

• Intrinsic rate: The natural rate of discharge of

cardiac tissue in the absence of other factors.

• Sympathetic activity: Increases heart rate.

• Parasympathetic activity: Decreases heart rate.

• Pharmacologic: Increases or decreases heart rate

depending on the drug.
CHAPTER 3

Excentric heart regulation

CHAPTER 3

Measuring heart related vital signs

Pulse rate Blood pressure

As the heart forces blood through the arteries, Blood pressure is the force of the blood pushing against the artery walls during
you feel the beats by firmly pressing on the contraction and relaxation of the heart. Each time the heart beats, it pumps blood
arteries, which are located close to the surface into the arteries, resulting in the highest blood pressure as the heart contracts.
of the skin at certain points of the body. The When the heart relaxes, the blood pressure falls.
pulse can be found on the side of the neck, on
Two numbers are recorded when measuring blood pressure. The higher number, or
the inside of the elbow, or at the wrist.
systolic pressure, refers to the pressure inside the artery when the heart contracts
The normal pulse for healthy adults ranges and pumps blood through the body. The lower number, or diastolic pressure, refers
from 60 to 100 beats per minute. to the pressure inside the artery when the heart is at rest and is filling with blood.

Normal blood pressure is systolic of less than 120 and diastolic of less than 80
(120/80)
CHAPTER 3

Cardiovascular pharmacology
o Cardiovascular pharmacology focuses on the fundamental mechanisms of cardiovascular
cells and how drugs influence the heart and vascular system.

o A wide range of medications are used to treat various heart conditions.

o Researchers in the department exploit novel technologies such as induced pluripotent stem
cells, automated electrophysiology and genomics to investigate the causes of sudden cardiac
death, congenital arrhythmias and cardiac toxicity of chemotherapeutic drugs.
CHAPTER 3

Cardiovascular pharmacology
Cardiovascular Drugs

• Anticoagulants or blood thinners – Prevent coagulation or

clotting of the blood. These drugs do not dissolve existing
blood clots but are preventive agents in patients who have
had a heart attack.

• Antiplatelet agents - Play an important role in blood clotting

and the formation of platelet plugs that prevent bleeding.
They are used as preventive agents in patients who have had
a heart attack.

• Thrombolytic agents - Used to break up blood clots that

have formed.
CHAPTER 3

Cardiovascular pharmacology
Cardiovascular Drugs

• Angiotensin-converting enzyme (ACE) inhibitors – Expand

blood vessels by lowering levels of angiotensin II, a potent
vasoconstrictor that drives blood pressure up. ACE inhibitors
are used to treat high blood pressure, heart failure and heart
attacks.

• Angiotensin II receptor blockers (ARBs) – Prevent

angiotensin II from having any effects on the heart and
blood vessels by blocking the receptors it usually binds to.
These agents are useful in the treatment of high blood
pressure, heart failure and heart attacks.
CHAPTER 3

Cardiovascular pharmacology
Cardiovascular Drugs

• Calcium channel blockers – Stop the movement of calcium into the cells of the heart and
blood vessels. This relaxes the vessels and reduces blood pressure. Calcium channel
blockers are useful therapies in high blood pressure, angina, and some forms of arrhythmia.

• Diuretics – Increase the excretion of water and sodium in the urine, therefore decreasing
the total blood volume. This reduces blood pressure and the heart's workload.

• Vasodilators – Relax the blood vessels and cause blood pressure to fall. They are useful in
the treatment of high blood pressure, heart failure, angina and heart attacks.

• Digoxin – Stimulate heartbeat in some cases of heart failure.

• Statins – Reduce the synthesis of blood cholesterol in the liver. High blood cholesterol is
one of the major causes of atherosclerosis.
Summary

Takeaway 1 Takeaway 4
The circulatory system functions with the help
The human heart is a four-chambered
of blood vessels that include arteries, veins and
muscular organ, that ensures a constant
capillaries. These blood vessels work with your
blood flow .
heart and lungs to continuously circulate blood
through your body.

Takeaway 2 Takeaway 5
The circulatory system ensures the Intrinsic rate: The natural rate of discharge of
transport of respiratory gases and cardiac tissue in the absence of other factors.
Sympathetic activity: Increases heart rate.
nutrients, maintaining homeostasis. Parasympathetic activity: Decreases heart rate.
Pharmacologic: Increases or decreases heart rate
. depending on the drug.
Takeaway 3
The heart conduction system is the
network of nodes, cells and signals that Takeaway 6
controls your heartbeat. Each time your The normal pulse for healthy adults ranges
heart beats, electrical signals travel from 60 to 100 beats per minute. Normal blood
through your heart. pressure is systolic of less than 120 and
diastolic of less than 80 (120/80)
These signals cause different parts of
your heart to expand and contract. The
expansion and contraction control Takeaway 7
blood flow through your heart and body. Type of cardiovascular drugs.
Quiz
Test your knowledge of the anatomy of the heart with this multiple-choice picture quiz!

Exit