22/02/2024

PHARMACY ONLY.

ANA 201: CARDIOVASCULAR SYSTEM

HEART:

The heart is a roughly cone-shaped muscular organ. It is about 10cm long and

about the size of the owner’s fist. It weighs about 255g in women and is heavier

in men.

The heart is in the thoracic cavity in the middle mediastium between the lungs.

It lies obliquely, a little more to the left than the right, and presents a base above

and an apex below. The apex is about 9cm to the left of the median plane at the

5th intercostals space on the mid-clavicular line. The base extends to the level of

the 2nd rib.

RELATIONS:

a) Superiorly: the great blood vessels, i.e. the aorta, superior vena cava,

pulmonary artery and pulmonary veins.

b) Inferiorly: The apex rests on the central tendon of the diaphragm.

c) Posteriorly: The oesophagus, trachea, left and right bronchus,

descending aorta, inferior vana cava and thoracic vertebrae.

d) Laterally: The lungs – the left lungs overlaps the left side of the heart.

e) Anteriorly: The sternum, the ribs and the intercostals muscles.

The heart is composed of 3 layers of tissue

1. The Pericardium

Which is made up of two sacs. The outer sac consists of fibrous tissue

and the inner of a double layer of serous membrane.

2. The Myocardium:

The Myocardium is composed of specialized muscle tissue known as

cardiac muscle, only found in the heart.

3. The Endocardium:

This forms a lining to the myocardium and is a thin, smooth, glistening

membrane consisting of flattened epithelial cells continuous with the

lining of the blood vessels.

INTERIOR OF THE HEART

The heart is divided into a right and left side by a partition of muscular and

endocardium known as septum. After birth, blood cannot pass directly from the

left to the right side of the heart or vice versa. Each side is divided into an upper

and a lower chamber by a valve. The valves ensure that the blood flow in one

direction only – from the upper chamber or atrium to the lower chamber or

ventricle. The heart therefore, has 4 chambers.

atrium from the right ventricle is known as the right atrio – ventricular valve

(tricuspid valve) and is made up of 3 flaps or cusps. The valve separating the

left atrioventricular valve (mitral valve) and is composed of 2 flaps or cusps.

The valves between the atrio and the ventricles open and close as a result of

changes in the pressure of blood within the chambers. The pressure in the

ventricles rises higher than in the atrio and backwards flow of blood is

prevented by the closure of the valves. They are prevented from opening

upwards by the chordate tendineae (tendinous cords), which extend from the

inferior surface of the cusps to the walls of the ventricles have little mucles

projections, called papillary muscles to which the chordate tendinea are

attached. The papillary muscles are covered by endothelium.

FLOW OF BLOOD THROUGH THE HEART

The 2 largest veins of the body, the superior and inferior venae cavae, empty

their contents into the right atrium. This blood via the right atrioventricular

valve into the right ventricle and from the right ventricle it is pumped into the

pulmonary artery or trunk (the only artery in the body which carries venous or

deoxygenated blood). The opening of the pulmonary artery is guarded by a

valve known as the pulmonary valve and is formed by 3 semi lunar cusps. The

valve prevent the backflow of blood into the right ventricle when the ventricular

muscle relaxes. The pulmonary artery. These arteries carry the venous blood to
the lungs where the interchange of gases occurs, carbon dioxide is excreted and

oxygen is absorbed.

The arterial or oxygenated blood is carried from each lung by 2 pulmonary

veins and the 4 pulmonary veins empty their contents into the left artuim of the

heart. This blood passes through the left artrioventiricular valve into the left

ventricle, and from there it is pumped into the aorta, the first artery of the

general circulation. The opening of the aorta is guarded by the aortic valve

which is formed by 3 semi lunar cusps.

The muscle layer of the walls of the atria is very thin in comparism with that of

the ventricles. This is consistent with the amount of work it does. The atria

propel the blood through the arioventricular valve into the ventricles while the

ventricles pump into the lungs and round the whole body. The muscle layer is

thickest in the wall of the left ventricle. The vessels carrying blood to the heart

are veins. The vessels carrying blood away from the heart are arteries.

BLOOD SUPPLY TO THE HEART

The heart is supplied with arterial blood by the right and left coronary arteries.

These are the first branches from the aorta immediately distal to the aortic

valve.

The venous return is by the coronary sinus which empties into the right atrium.
THE CONDUCTING SYSTEM OF THE HEART

The heart has an intrinsic system whereby the muscle is stimulated to contract

without the need for nerve supply from the brain. However, the intrinsic system

can be stimulated or depressed by nerve impulses initiated in the brain.

There are small groups of specialized neuromuscular cells in the myocardium

which initiate and conduct impulses of contraction over the heart muscle.

THE SINUATRIAL NODE (SA NODE)

The small mass of specialised cells is in the wall of the right atrium near the

opening of the superior vena cava. The sinuatrial node is often described as the

“pace-maker” of the heart because it is capable of initiating impulses which

stimulate the myocardium to contract without any outside influence from the

nervous system.

THE ATRIOVENTRICULAR NODE (AV NODE)

This mass of neuromuscular tissue is stimulated in the wall of the atrial septum

near the artioventricular valves. Normally, the artrioventricular node is

stimulated by the contraction which sweeps over the atrial myocardium.

However, it too is capable of initiating impulses of contraction but at a slow rate

than the SA node, if there is no stimulation by the nervous system.

This consists of a mass of specialized fibres which originates from atriventicular

node and passes downwards in the septum that separates the right and left

ventricles. This bundle of fibres (called bundle of His) then divides into 2

branches, one going to each ventricle. Within the myocardium of the ventricle

the branches break up into a network of fibre filaments or fibres known as the

fibres of Purkinje. The AV bundle and the Purkinje fibres convey the impulse of

contraction from the AV node to the myocardium of the ventricles.

The impulses of contraction initiated by the sinuatrial node stimulate the

myocardium of the atria to contract. This wave of contraction stimulates the

atrioventricular node to produce impulses which pass to the apex of the heart in

the purkinje fibres then over the muscle of the ventricles. In this way, the

ventricular wave of contraction begins at the apex of the heart and blood is

forced into the pulmonary artery and into the aorta which leave the heart near its

base.

NERVE SUPPLY TO THE HEART

In addition to the intrinsic stimulation of the myocardium described above the

heart is influenced by nerves originating in the cardiac centre in the medulla

oblongata which reach it through the autonomic nervous system. These are the
parasympathetic and sympathetic nerves and they are antagonistic to one

another.

The vagus nerves (parasympathetic) tend to slow the rate at which impulses are

produced by the sinuatrial node therefore decreasing the rate and force of the

heart beat.

The sympathetic nerves tend to speed up the reate of impulse production by the

SA node thus increasing the rate and force of the heart beat.

FUNCTION

The function of the heart is to maintain a constant circulation of blood

throughout the body. The heart acts as a pump and its action consists of a series

of events known as the cardiac cycle.

THE CARDIAC CYCLE

In a human being, when the heart is beating normally the cardiac cycle occurs

about 74 times per minutes. Thus, each cycle losts about 0.8 of a second. The

cardiac cycle consists of:

a) Atrial systole – contraction of the atria

b) Ventricular Systole – contraction of the ventricule

c) Complete cardiac diastole – relaxation of the atria and ventricles.