memmler s the human body in health and disease 11 th edition
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Memmler’s The Human Body in Health and Disease 11 th edition. Chapter 14 The Heart and Heart Disease. Circulation and the Heart. Circulation Continuous one-way circuit of the blood vessels Propelled by heart. Location of the Heart. Between the lungs Left of the midline of the body

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circulation and the heart
Circulation and the Heart

Circulation

  • Continuous one-way circuit of the blood vessels
  • Propelled by heart
location of the heart
Location of the Heart
  • Between the lungs
  • Left of the midline of the body
  • In mediastinum
  • Apex pointed toward left
structure of the heart
Structure of the Heart

Three tissue layers

  • Endocardium lines heart’s interior
  • Myocardium is thickest layer; the heart muscle
  • Epicardium is thin outermost layer
the pericardium
The Pericardium

The sac that encloses the heart

  • Fibrous pericardium holds heart in place
  • Serous membrane
    • Parietal layer
    • Pericardial cavity
    • Visceral layer (epicardium)
slide6
Layers of the heart wall and pericardium. The serous pericardium covers the heart and lines the fibrous pericardium.

ZOOMING IN

• Which layer of the heart wall is the thickest?

question which layer of the heart is the heart muscle a epicardium b myocardium c pericardium
Question:Which layer of the heart is the heart muscle?a. epicardiumb. myocardiumc. pericardium
slide9
Checkpoint 14-1:What are the names of the innermost, middle, and outermost layers of the heart?

Checkpoint 14-2:What is the name of the sac that encloses the heart?

special features of the myocardium
Special Features of the Myocardium

Cardiac muscles

  • Are lightly striated (striped)
  • Have single nucleus cells
  • Are controlled involuntarily
  • Have intercalated disks
  • Have branching muscle fibers
divisions of the heart
Divisions of the Heart

Double pump

  • Right side pumps blood low in oxygen to the lungs
    • Pulmonary circuit
  • Left side pumps oxygenated blood to remainder of body
    • Systemic circuit
four chambers
Four Chambers
  • Right atrium
    • Receives low-oxygen blood returning from body tissue through superior vena cava and inferior vena cava
  • Left atrium
    • Receives high-oxygen blood from lungs
  • Right ventricle
    • Pumps blood from right atrium to lungs
  • Left ventricle
    • Pumps oxygenated blood to body
slide13
The heart as a double pump. The right side of the heart pumps blood through the pulmonary circuit to the lungs to be oxygenated; the left side of the heart pumps blood through the systemic circuit to all other parts of the body.

ZOOMING IN

• What vessel carries blood into the systemic circuit?

slide14
The heart and great vessels.

ZOOMING IN

• Which heart chamber has the thickest wall?

slide15
Checkpoint 14-3:The heart is divided into four chambers. What is the upper receiving chamber on each side called? What is the lower pumping chamber called?
slide16

Question: Which chamber of the heart receives oxygenated blood coming in from the lungs in the pulmonary veins?a. right atriumb. left ventriclec. left atrium

four valves
Four Valves
  • Atrioventricular valves
    • Entrance valves
    • Right atrioventricular (AV) valve (tricuspid valve)
    • Left atrioventricular (AV) valve (bicuspid valve)
  • Semilunar valves
    • Exit valves
    • Pulmonary valve
    • Aortic valve
slide19
Valves of the heart (superior view from anterior, atria removed). (A) When the heart is relaxed (diastole), the AV valves are open and blood flows freely from the atria to the ventricles. The pulmonary and aortic valves are closed. (B) When the ventricles contract, the AV valves close and blood pumped out of the ventricles opens the pulmonary and aortic valves.ZOOMING IN • How many cusps does the right AV valve have? The left?
slide20
Pathway of blood through the heart.

Blood from the systemic circuit enters the right atrium (1) through the superior and inferior venae cavae, flows through the right AV (tricuspid) valve (2), and enters the right ventricle (3). The right ventricle pumps the blood through the pulmonary (semilunar) valve (4) into the pulmonary trunk, which divides to carry blood to the lungs in the pulmonary circuit.

Blood returns from the lungs in the pulmonary veins, enters the left atrium (5), and flows through the left AV (mitral) valve (6) into the left ventricle (7). The left ventricle pumps the blood through the aortic (semilunar) valve (8) into the aorta, which carries blood into the systemic circuit.

blood supply to the myocardium
Blood Supply to the Myocardium

Coronary circulation

  • Right coronary artery
  • Left coronary artery
  • Coronary sinus
slide23
Blood vessels that supply the myocardium. Coronary arteries and cardiac veins are shown. (A) Anterior view. (B) Posterior view.
slide24
Opening of coronary arteries in the aortic valve (anterior view). (A) When the left ventricle contracts, the aortic valve opens. The valve cusps prevent filling of the coronary arteries. (B) When the left ventricle relaxes, backflow of blood closes the aortic valve and the coronary arteries fill.
slide25
Checkpoint 14-5:The myocardium must have its own vascular system to supply it with blood. What name is given to this blood supply to the myocardium?
function of the heart
Function of the Heart

Left and right sides of heart work together in cardiac cycle (heartbeat)

  • Systole (active phase, contraction)
  • Diastole (resting phase)
slide27
The cardiac cycle.

ZOOMING IN • When the ventricles contract, what valves close? What valves open?

cardiac output
Cardiac Output

Calculating cardiac output

  • Cardiac output (CO)
  • Stroke volume (SV)
  • Heart rate (HR)
  • CO = HR 3 SV
slide29
Checkpoint 14-6:The cardiac cycle consists of an alternating pattern of contraction and relaxation. What name is given to the contraction phase?

Checkpoint 14-7: Cardiac output is the amount of blood pumped by each ventricle in 1 minute. What two factors determine cardiac output?

the heart s conduction system
The Heart’s Conduction System

Electrical energy stimulates heart muscle

  • Nodes
    • Sinoatrial (SA) node (pacemaker)
    • Atrioventricular (AV) node
  • Specialized fibers
    • Atrioventricular bundle (bundle of His)
    • Purkinje fibers (conduction myofibers)
  • Intercalated disks
slide31
Conduction system of the heart. The sinoatrial (SA) node, the atrioventricular (AV) node, and specialized fibers conduct the electrical energy that stimulates the heart muscle to contract.

ZOOMING IN

• What parts of the conduction system do the internodal pathways connect?

the conduction pathway
The Conduction Pathway

Sinus rhythm

  • Sinoatrial (SA) node
  • Atria
  • Atrioventricular (AV) node
  • Internodal pathways
  • Bundle of His
  • Bundle branches and Purkinje fibers
  • Ventricles
slide33
Checkpoint 14-8:The heartbeat is started by a small mass of tissue in the upper right atrium. This structure is commonly called the pacemaker, but what is its scientific name?
control of the heart rate
Control of the Heart Rate

Influences that allow heart to meet changing needs rapidly

  • Autonomic nervous system (ANS)
  • Sympathetic nervous system
  • Parasympathetic system
    • Cranial nerve X
variations in heart rates
Variations in Heart Rates
  • Bradycardia
  • Tachycardia
  • Sinus arrhythmia
  • Premature beat (extrasystole)
heart sounds
Heart Sounds
  • Lub
  • Dup
  • Murmurs
    • Organic
    • Functional
slide37
Checkpoint 14-9:What system exerts the main influence on the rate and strength of heart circulation?

Checkpoint 14-10:What is a heart murmur?

slide38
Question:What is the medical term for a heart rate of more than 100 beats/min? a. bradycardiab. hypercardiac. tachycardia
heart disease
Heart Disease

Most common cause of death in industrialized countries is heart and circulatory system disease

classifications of heart disease
Classifications of Heart Disease
  • Anatomical classification
    • Endocarditis
    • Myocarditis
    • Pericarditis
  • Causative factors classification
    • Congenital heart disease
    • Rheumatic heart disease
    • Coronary artery disease
    • Heart failure
congenital heart disease
Congenital Heart Disease

Congenital heart disease often results from fetal development defects

  • Atrial septal defect
  • Patent (open) ductus arteriosus
  • Ventricular septal defect
  • Coarctation of the aorta
  • Tetralogy of Fallot
rheumatic heart disease
Rheumatic Heart Disease
  • Streptococci release toxins during infection
  • Antibodies that combat toxin also attack heart valves
  • Heart valves become inflamed
  • Valve cusps thicken and harden
  • Pulmonary congestion occurs
coronary artery disease
Coronary Artery Disease

Coronary arteries can degenerate

  • Myocardial infarction
    • Creatine kinase released upon any muscle damage. Tests for certain forms of CK indicate whether an MI occurred.
  • Angina pectoris
  • Abnormalities of heart rhythm
  • Treatment of heart attacks
slide47
Checkpoint 14-13:Narrowing or blockage of the vessels that supply the heart muscle causes coronary artery disease. What degenerative process commonly causes narrowing of these vessels?
slide48

Question:What is the name of the fatty substance that builds up inside the vessel walls in atherosclerosis?a. plaqueb. lumenc. thrombus

heart failure
Heart Failure

Heart is unable to pump sufficient blood

  • Heart chambers enlarge
  • Blood backs up into lungs
  • Ventricular muscles have decreased ability
  • Fluid accumulates in lungs, liver, abdomen, legs
the heart in the elderly
The Heart in the Elderly

How the heart can age

  • Heart shrinks
  • Decreased contraction strength
  • Valves become less flexible
  • Murmur develops
  • Cardiac output decreases
  • Abnormal rhythms
  • Heart block
prevention of heart disease
Risk factors that cannot be modified

Age

Gender

Heredity

Body type

Risk factors that can be modified

Smoking

Physical inactivity

Weight

Diet

Blood pressure

Diabetes, gout

Prevention of Heart Disease
heart studies
Heart Studies
  • Stethoscope
  • Electrocardiograph (ECG or EKG)
    • Electrodes
  • Catheterization
    • Fluoroscope
  • Echocardiography (ultrasound cardiography)
    • Oscilloscope
treatment of heart disease
Treatment of Heart Disease
  • Medical approaches
  • Surgical approaches
  • Combined approaches
medications
Medications
  • Digitalis
  • Nitroglycerin
  • Beta-adrenergic blocking agents (beta-blockers)
  • Antiarrhythmic agents
  • Slow calcium-channel blockers
  • Anticoagulants
    • Aspirin
correction of arrhythmias
Correction of Arrhythmias
  • Artificial pacemaker
    • Set rate
    • Only when heart skips beat
    • Adjustable pacing rate
  • Implantable cardioverter-defibrillator (ICD)
heart surgery
Heart Surgery
  • Coronary artery bypass graft (CSBG)
  • Angioplasty
  • Valve replacement
  • Surgical transplantation of heart or heart and lungs
  • Artificial heart
slide59
Checkpoint 14-15:What technique is used to open a restricted coronary artery with a balloon catheter?
slide60

Question:The technique to restore normal heartbeat by either electric shock or drugs is known as:a. defibrillationb. cardioversionc. ablation

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