Location and Structure of the Heart

Location: Heart lies in the mediastinum, behind the sternum; mostly to the left of the
midline, with one-third on the right.
Misconception: Heart is not completely on the left side of the chest.
Positioning:

●​ Apex: Near the diaphragm (lower portion).

●​ Base: Below the second rib (superior portion).

Structure: Four-chambered muscular organ, size of a closed fist.

Development:

●​ At birth: Transverse and large relative to the chest.

●​ By age 25: Achieves adult shape and weight.

Shape Variations:

●​ Thin individuals: Elongated heart.

●​ Short individuals: Wider heart.

Coverings of the Heart

Coverings of the Heart: Protect and reduce friction during heartbeats.
Pericardium: Multi-layered sac (pericardial sac) covering the heart.

●​ Fibrous Layer: Tough outer layer of fibrous tissue forming a loose covering.
●​ Serous Pericardium: Smooth, double-layered membrane:
○​ Parietal Layer: Attached to the inside of the fibrous pericardium.
○​ Visceral Layer (Epicardium): Covers the outer surface of the heart.

Pericardial Space: Space between the serous layers containing pericardial fluid,
enabling frictionless movement during heartbeats.

Heart Wall Layers:

●​ Epicardium:
○​ Outer layer.
○​ Visceral layer of the serous pericardium.
●​ Myocardium:
 ○​ Middle, muscular layer.
○​ Thick, contractile layer responsible for compressing the heart chambers
(atria and ventricles).
○​ Mnemonic: "M" for middle and muscle.
●​ Endocardium:
○​ Inner layer.
○​ Thin endothelial tissue lining the heart and vessels.

Chambers and Valves

Heart Chambers

●​ Atria (Superior Chambers):

○​ Known as "receiving chambers."
○​ Relax to fill with blood from veins (body and lungs) and contract to push
blood into ventricles.
○​ Myocardium: Thinner than ventricles since less force is required to move
blood.
●​ Ventricles (Inferior Chambers):
○​ Known as "pumping chambers."
○​ Push blood into the body (systemic circulation) or lungs (pulmonary
circulation).
○​ Myocardium: Thicker than atria to generate more force for blood
circulation.

Heart Valves

●​ Function: Ensure one-way blood flow by preventing backflow.

Atrioventricular (AV) Valves:

●​ Separate atria and ventricles; prevent backflow into atria.

○​ Tricuspid Valve:
■​ Right AV valve.
■​ Between right atrium and right ventricle.
■​ Three flaps of endocardium ("tri" = three).
■​ Mnemonic: "TRIcuspid = R (Right side)."
○​ Bicuspid Valve (Mitral Valve):
 ■​ Left AV valve.
■​ Between left atrium and left ventricle.
■​ Two flaps of endocardium ("bi" = two).
■​ Mnemonic: "BIcuspid/Mitral = L (Left side)."

Semilunar Valves:

●​ Prevent backflow into ventricles from large arteries.

○​ Pulmonary Valve:
■​ Between right ventricle and pulmonary trunk.
○​ Aortic Valve:
■​ Between left ventricle and aorta.
○​ Naming: "Semilunar" due to crescent, half-moon shape.

Flow of Blood Through the Heart

One-Way Flow:

●​ Blood flows in one direction; valves prevent backflow.

Right Side (Deoxygenated Blood):

●​ Flow Path:
○​ Blood returns from the body via the superior vena cava (upper body) and
inferior vena cava (lower body).
○​ Enters the right atrium.
○​ Passes through the tricuspid valve into the right ventricle.
○​ From the right ventricle, blood flows through the pulmonic valve into the
pulmonary arteries.
○​ Pulmonary arteries carry deoxygenated blood to the lungs for
oxygenation.

Left Side (Oxygenated Blood):

●​ Flow Path:
○​ Oxygenated blood returns from the lungs via the pulmonary veins.
○​ Enters the left atrium.
○​ Passes through the mitral (bicuspid) valve into the left ventricle.
○​ From the left ventricle, blood flows through the aortic valve into the aorta.
○​ The aorta distributes oxygenated blood throughout the body.
Pulmonary Arteries and Veins (Unique Roles):

●​ Pulmonary Arteries: Carry deoxygenated blood from the heart to the lungs
(opposite of typical arteries).
●​ Pulmonary Veins: Carry oxygenated blood from the lungs to the heart (opposite
of typical veins).

Coronary Circulation

Coronary Circulation

1.​ Purpose: Supplies the heart with oxygen and nutrients.

2.​ Coronary Arteries:
○​ Branch off the aorta.
○​ Include the left coronary artery and right coronary artery.
○​ Fill with blood during ventricular relaxation (diastole).
3.​ Blood Supply to Heart Chambers:
○​ Ventricles: Receive blood from both left and right coronary arteries.
○​ Atria: Receive blood from the corresponding coronary artery:
■​ Left atrium: From a branch of the left coronary artery.
■​ Right atrium: From a branch of the right coronary artery.
4.​ Left Ventricle:
○​ Receives most of the coronary blood supply.
○​ Largest muscular area, requiring the most oxygen and glucose to pump
blood throughout the body.

Coronary Arteries:

●​ Blood Supply to the Heart: Coronary arteries branch from the aorta and fill during
ventricular relaxation (diastole).
●​ Key Arteries:
○​ Left Coronary Artery:
■​ Branches into:
■​ Left Anterior Descending (LAD) Artery: Supplies the left
ventricle.
 ■​ Circumflex Artery: Wraps around the posterior side of the
heart.
○​ Right Coronary Artery: Supplies other areas of the heart.

Heart Attack (Myocardial Infarction):

●​ Cause: Blockage in a coronary artery → Blood flow stops → Oxygen and glucose
can't reach heart tissue → Ischemia and tissue death.
●​ Impact: Dead tissue reduces the heart's pumping efficiency.

Treatment:

1.​ Medications:
○​ Antiplatelets and Blood Thinners: Thin blood and reduce clotting.
2.​ Stent Placement:
○​ Non-invasive procedure using cardiac catheterization (via wrist).
○​ Catheter identifies the blockage, and a stent reopens the artery.
3.​ Cardiac Bypass Surgery:
○​ For extensive damage or unmanageable blockages.
○​ Involves grafting a new vessel to bypass the blockage (invasive surgery).

Coronary Veins:

●​ Function: Return deoxygenated blood from the heart tissue to the right atrium.
●​ Pathway: Parallels coronary arteries and includes cardiac veins.
●​ Goal: Deoxygenated blood is sent to the lungs for oxygenation.

Conduction System of the Heart

Auto-Rhythmic Myocardium:

●​ Definition: The myocardium can generate its own action potentials without motor
nerve signals.
●​ Purpose: Allows the heart to initiate and maintain its rhythm independently.

Nerve Supply to the Heart:

●​ Role: Adjusts the heart rate (increases or decreases) when needed.

●​ Innervation:
 ○​ Sympathetic Division: Increases heart rate.
○​ Parasympathetic Division: Decreases heart rate via the vagus nerve.
●​ Pathway: Nerve fibres connect near the arch of the aorta and follow coronary
arteries into the heart.
●​ Targets:
○​ Sinoatrial (SA) Node: Acts as the heart’s pacemaker.
○​ Atrioventricular (AV) Node and Atrial Myocardium: Secondary targets for
nerve fibres.

Heart’s Function:

1.​ Electrical Component:

○​ Refers to the heart’s conduction system, which:
■​ Initiates action potentials.
■​ Coordinates heart contractions.
■​ Ensures a synchronized pumping cycle.
2.​ Mechanical Component:
○​ Refers to the pumping action of the heart muscle.
○​ Effectively moves blood through the body.

There are four major structures that make up the heart's conduction system:
1.​ The sinoatrial node or SA node
2.​ The atrioventricular node or AV node
3.​ The AV bundle or bundle of His
4.​ The subendocardial branches or the Purkinje fibres

Electrical Conduction System of the Heart

Function:

●​ Ensures rhythmic contraction of the myocardium for an even and appropriate

heartbeat.
●​ Comprised of specialized structures that generate and transmit action potentials,
not muscle contractions.

Sinoatrial (SA) Node:

○​ Role: The heart’s pacemaker, initiating each heartbeat.

 ○​ Location: In the right atrium, where blood flow begins after returning from
the body.
○​ Intrinsic Rhythm: Sets the heart rate at 60–100 beats per minute (normal
range).
○​ Action:
■​ Starts the electrical current.
■​ Stimulates atrial muscle fibres → Atrial contraction begins.

Electrocardiogram (ECG)

Electrocardiogram (ECG)

Purpose:

●​ Records the electrical activity of the heart.

●​ Used to diagnose heart conditions, such as chest pain or irregular heartbeats.

How It Works:

●​ Electrical impulses from the heart spread through surrounding tissues to the
body’s surface.
●​ ECG Machine (Electrocardiograph) picks up these electrical currents from the
skin.

Procedure:

1.​ Electrode Placement:

○​ Electrodes (small stickers) are attached to specific areas of the body.
○​ For a 12-lead ECG:
■​ 6 electrodes on the chest.
■​ 4 electrodes on the limbs.
2.​ Reading:
○​ Leads are connected to the machine, which generates a record of the
heart’s electrical activity (ECG).

The ECG is a major diagnostic tool for heart conditions. An ECG alone can tell us
whether a person is having a major heart attack. For some other types of heart attacks,
blood work is also helpful, but if the occlusion is fully blocking an artery, it will be picked
up on an ECG.
ECG Waveforms and Heart Activity

●​ Action Potentials and ECG:

○​ ECG reflects the depolarization and repolarization of heart muscle cells.
○​ These electrical changes, caused by ion movement across cell
membranes, create distinct waves in the ECG.

ECG Wave Components:

1.​ P Wave:
○​ Represents atrial depolarization (the electrical activity that causes atrial
contraction).
2.​ QRS Complex:
○​ The big spike in the middle of the ECG.
○​ Represents ventricular depolarization (the electrical activity causing
ventricular contraction).
○​ Also includes atrial repolarization (though it’s masked by the larger QRS
wave).
3.​ T Wave:
○​ Represents ventricular repolarization (the return of electrical charge in the
ventricles).

Why the QRS is Larger:

●​ Ventricles are a larger muscle area, requiring more electrical activity to stimulate
contraction.
●​ This makes the QRS wave much larger than the P wave.

In mechanical terms:

●​ P Wave = Atrial contraction.

●​ QRS Complex = Ventricular contraction.

Cardiac Cycle

The cardiac cycle is the sequence of events that makes up one complete heartbeat,
consisting of both contraction and relaxation phases.

Phases:
 1.​ Systole (Contraction):
○​ Atria contract first, pumping blood into the ventricles.
○​ Ventricles contract next, pumping blood to the lungs and the rest of the
body.
2.​ Diastole (Relaxation):
○​ Atria relax after contraction and fill with blood from the body and lungs.
○​ Ventricles relax after contracting to refill with blood from the atria.

Heart Sounds

During the cardiac cycle, the heart produces two main sounds, commonly described as
“lub-dub”. These sounds are caused by the opening and closing of the AV and
Semilunar valves.

Heart Sounds:

1.​ First Heart Sound (S1) – The “lub” sound:

○​ Caused by the closing of the AV valves during ventricular contraction
(systole).
2.​ Second Heart Sound (S2) – The “dub” sound:
○​ Caused by the closing of the Semilunar valves during ventricular
relaxation (diastole).