ANATOMY AND

1st Year, 1st Semester

PHYSIOLOGY MIDTERMS

CARDIOVASCULAR SYSTEM: HEART

OUTLINE - Blood flows in color red and blue

I. Overview o Red : oxygenated blood
II. Functions & Characteristics of the Heart o Blue : deoxygenated blood
III. Anatomy of the Heart
A. Pericardia
- Heart → Systemic Circulation (OXGYGENATED)
B. Heart Wall
C. External Anatomy • these are blood that have been oxygenated thru
D. Chambers and Valves the lungs
IV. Route of Blood Flow - If it passes to diff organs (violet portion of the pic), as
V. Histology blood flow thru the arteries, it becomes smaller,
A. Heart Skeleton arterioles, and it passes thru the capillaries where
B. Cardiac Muscle
nutrient and gas exchange happens
VI. Electrical Properties
A. Action Potential Path - Oxygen diffuses from the blood to the diff
B. Electrocardiogram organs/tissues at the same time the nutrients
VII. Cardiac Cycle - As cellular metabolism happens, the byproduct of
A. Sequence of Events energy which is CO2 and waste products diffuse from
B. Heart Sounds the cell to the blood
C. Aortic Pressure Curve - As these networks converge into a large blood
D. Heart Valve Locations
vessel known as a venule and then into a vein, it
VIII. Regulation of the Heart
A. Types goes back to the heart that’s why it’s called circulatory
system bc blood just circulates around
THE CARDIOVASCULAR SYSTEM - Heart is the seat of emotions
1. Heart - Heart ensures that the vital functions of the body are
2. Blood (next chapter) maintained
3. Blood Vessels - Without the heart, blood cannot travel and perfuse
to different tissues of the body; all organs are
dependent on the blood that is pumped by the heart
and is oxygenated by the lungs

- These 3 are part of the circulatory system bc its

primarily the circulation of blood thru the the
networks or pipes known as blood vessels with the
heart functioning as the main pumping chamber - Series of pipes where blood flows thru and is pumped
- Blood is pumped by the heart around the circuit of by the heart
vessels as it passes again and again thru the various - Red = networks of oxygenated blood passing thru
circulation of the body arteries

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

• supply oxygenated blood to the diff organs of the - Systemic and pulmonary circulations are
body, as a counterpart, since the organs will separated by the heart
produce waste products in CO2, they will diffuse - It ensures that blood is oxygenated first by the
thru the blood again to the veins. lungs before it is being pumped out to the general
- Blue = networks of deoxygenated blood passing circulations
through veins - We cannot have tissues receiving deoxygenated
blood or else cellular metabolism will be impacted
Ø HEART
- Distributes and receives blood thru vessels known 3. ENSURES ONE-WAY BLOOD FLOW
as arteries and veins - Whenever blood or deoxygenated blood comes
back to the heart, it passes thru a series of
Ø ARTERIES chambers
- Carry blood away from the heart - Those chambers open and closes based on the
- Branched and decreased in size gates they have in the middle and we call it as the
- Ending as arterioles that flow into microscopic valves
capillary bed - Valves of the heart ensure one-way blood flow
thru the heart and blood vessels
Ø ARTERIOLES
- Gases and nutrients are exchanged 4. REGULATES BLOOD SUPPLY
- Oxygen-poor blood leaves the capillary beds thru - Whenever there is a decrease supply of
venules that converge into progressively larger oxygenated blood to our tissues, our heart
veins which carry blood toward the heart compensates that’s why sometimes we can feel,
- Smaller blood vessels / smaller arteries at times, it increases in terms of heart rate or in
- As blood flows from the heart to the aorta (one of other cases it decreases
the major arteries of the body), it branches out into - The changes in the rate or force of heart
arterioles contraction match the flow to the changing
- Further project to the networks of capillaries which metabolic needs of the different organs of the
are very small blood vessels that allows diffusion body
or exchange of gas, nutrients, and waste products - The rate and force of heart contractions change
to meet the metabolic needs of the tissues, which
Ø VEINS vary depending on such conditions as rest,
- Those networks (from arterioles) will comprise of exercise, and changes in body position.
the blood going back to the heart thru a series of - If specific organs, require more nutrients, the
pathways known as veins blood will work double time in order to pump that
- Venules – smaller veins blood enough in order to supply the needs of that
organ
FUNCTIONS OF THE HEART
HEART CHARACTERISTICS
1. GENERATES BLOOD PRESSURE
- Every time the heart beats, it exerts a force in –– SIZE
order for the blood to pass thru the networks of - Size of a fist
pipes - <1 lb
- With that force, it generates blood pressure - Average mass of 250 g in females and 300 g in
- Without this pumping chamber/pressure, we males
cannot expect the blood to flow thru these - It is larger in physically active adults com- pared
networks or pipes with other healthy adults.
- The heart generally decreases in size after 65 y/o,
2. ROUTES BLOOD especially in people who are not physically active.

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

–– SHAPE KNOWLEDGE OF THE HEART POSITION IS

- shaped like a blunt cone and is approximately the IMPORTANT FOR:
size of a closed fist - Knowing where to place the steth to hear the heart
sounds specifically the apical ehart sounds
–– LOCATION - Choosing the heart sound
- Between lungs in thoracic cavity - Performing CPR
- Heart lies in the mediastinum together with the - Possible to perform CPR on yourself by periodic very
trachea and esophagus or the middle region of the forceful coughs appear to squeeze enough blood
thorax amount of the heart to sustain circulation until
- Within the 2nd-6th ribs (precise location of the emergency help arrives
heart)
- Projects toward the left side • Mainly RV
Anterior Surface
• Slightly LV
–– ORIENTATION Right Pulmonary Surface • RA
- Inverted blunt-cone shaped appearance • Mainly LV
- Apex (bottom) towards left side ; projects Inferior Surface
• Slightly RV
anteriorly and inferiorly and is projected towards
• Mainly LA
the left side Base (Posterior Surface)
• Slightly RA
- Base projecting superiorly and posteriorly
• Mainly LV
Left Pulmonary Surface (Lateral)
• Sightly LA
Apex • LV

ANATOMY OF THE HEART

HEART
- The heart is a muscular organ that is essential for life
because it pumps blood thru the body
o Comprised of cardiac muscles
o REMEMBER: Whenever the heart pumps, it
exerts a pressure towards the liquid or blood itself
(fluid connective tissue) as it passes thru the pipe
–– BASE bc without this pumping chamber, blood can’t pass
- Beneath the 2nd rib thru the series of networks or blood vessels
- Projects posteriorly - The heart of a healthy adult, at rest, pumps
and superiorly approximately 5 liters (L) of blood per minute
- For most people, the heart continues to pump at
–– APEX approx. that rate for more than 75 yrs
- Blunted end of the o Heart never fails to pump or beat
heart o As we grow older, heart tissue degenerates which
- Most inferior, lateral impacts the overall capacity of your heart to pump
and anterior part of blood
the heart
- Beneath the 5th intercostal space Left Mid- PERICARDIA
Clavicular Line (LMCL) in the middle of the collar → REMEMBER: Heart is located in the pericardial cavity
bone - The pericardial cavity is comprised of pericardium
which is also subdivided into 2 layers:
-

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

1. Fibrous Pericardium – tough, fibrous layer and that pressure is not allowing the heart to pump
2. Serous Pericardium – second inner layer; effectively
subdivided into two - If the heart is not able to pump effectively then the
§ Parietal pericardium perfusion of the organs will be compromised
§ Visceral pericardium/epicardium
- Serous membranes provide cushion to the heart
- In order for the heart not to produce friction in the
neighboring organs while beating, the serious fluid
produced by the serous membranes allow for that
cushion

PERICARDIUM
- Double-layered sac that anchors and protects
heart

PARIETAL PERICARDIUM:
- Membrane around heart’s cavity
- Lines fibrous pericardium HEART WALL

VISCERAL PERICARDIUM: EPICARDIUM

- aka Epicardium - the superficial layer of the heart wall
- Membrane on heart’s surface - The serous pericardium is called the epicardium
- Outer layer of the heart wall when considered a part of the heart and the
visceral pericardium when considered a part of
PERICARDIAL CAVITY: the pericardium.
- Space around heart
- In between the parietal and visceral pericardium MYOCARDIUM
which is an open space where serous pericardial - Thick, middle layer of the hear
fluid is found - Composed of cardiac muscle cells and is
o Reduces friction as the heart moves within the responsible for the heart's ability to contract.
pericardial sac
ENDOCARDIUM
CARDIAC SKELETON/FIBROUS SKELETON - Deep to the myocardium.
- Provides a framework thru which the valves are - Forms the smooth, inner surface of the heart
held in place chambers → allows blood to move easily
- This is different from the pericardia through the heart
- The endocardium also covers the surfaces of the
heart valves.
PERICARDITIS
- The pericardium is inflamed PECTINATE MUSCLES
- Could be bc of an infection/bacterial invasion in the - Muscular ridges in the right atrial wall / both
area auricles
- Could interfere with the production of serous fluid
CRISTA TERMINALIS
- Separate the pectinate muscles of the RA from
CARDIAC TAMPONADE larger portions of the atrial wall
- Build up of serous fluid could be bc of the muscles
of the heart ruptured causing bleeding and the TRABECULAE CARNEAE
blood is contained within the pericardial cavity so - Bigger ridges that help with forceful ejection of
together with the serous fluid, it creates pressure blood from the ventricles

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

• Superior vena cava and inferior vena cava

(largest veins in the body) carry blood from the
body to the right atrium
1. SVC –– the largest vein that drains blood from
the upper extremities as well as your head and
neck
2. IVC –– another large vein that drains the blood
from your abdomen and lower limbs
o SVC and IVC, both drain to the right atrium
where deoxygenated blood goes thru first
from the general circulation back to the heart
o They both drain from the head and the neck
(IVC AND SVC) and from the lower portions
of the body and from the right atrium, blood
passes thru the right ventricle and from the
RV, blood is pumped to the pulmonary trunk
which divides into the pulmonary artery, the
only artery in the adult circulation that carries
deoxygenated blood
• Once the pulmonary arteries go to the pulmonary
capillaries for diffusion of gases that happens in
the lungs it goes back to the heart thru the 4
pulmonary veins

ARTERIES
• Blood away from the heart
1. PULMONARY TRUNK – carries deoxygenated
blood to the lungs
o Arises from the right ventricle, splits into the
EXTERNAL ANATOMY OF THE HEART
right and left pulmonary arteries, which carry
BLOOD VESSELS
blood to the lungs
• CORONARY SULCUS – Extends around the
2. AORTA – carries blood from the heart to the
heart, separating the atria from the ventricles
general circulation
• SULCI – grooves ; indicate the division between
o Arises from the left ventricle, carries blood to
the right and left ventricles, extend inferiorly from
the rest of the body
the coronary sulcus
• The 2 are often called the great vessels or great
1. ANTERIOR INTERVENTRICULAR SULCUS ––
arteries bc of their large size
extends inferiorly from the coronary sulcus on the
anterior surface of the heart
BLOOD SUPPLY TO THE HEART
2. POSTERIOR INTERVENTRICULAR SULCUS –
extends inferiorly from the coronary sulcus on the
–– ARTERIES
posterior surface of the heart
1. RIGHT CORONARY ARTERY – usually smaller
in diameter than the left one, and it does not carry
VEINS
as much blood as the left coronary artery.
• Blood towards the heart
a. RIGHT MARGINAL ARTERY –– supply
• PULMONARY VEINS – Four pulmonary veins
blood to the lateral wall of the right ventricle
carry blood from the lungs to the left atrium (RPV,
b. POST. INTERVENTRICULAR ARTERY –
LPV, IVC, SVC)
lies in the posterior interventricular sulcus

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

and supplies blood to the posterior and 2. SMALL CARDIAC VEIN – drains the right margin
inferior part of the heart. of the heart
2. LEFT CORONARY ARTERY – has three major • CORONARY SINUS
branches - The 2 veins converge toward the posterior part of
a. ANT. INTERVENTRICULAR ARTERY (left the coronary sulcus and empty into the coronary
anterior descending artery) – It extends sinus
inferiorly in the anterior inter-ventricular - Clinical Significance: Draining most of the
sulcus and supplies blood to most of the deoxygenated blood leaving the heart muscle
anterior part of the heart. - Heart does not only supply blood to the rest of the
b. LEFT MARGINAL ARTERY – supplies body, the heart also supplies blood to itself or else
blood to the lateral wall of the left ventricle. the myocardial/myocardium/heart muscles won’t
c. CIRCUMFLEX ARTERY – extends around be able to function
to the posterior side of the heart in the - When oxygenated blood is delivered to the heart
coronary sulcus. Branches of the circumflex muscle for it to continuously pump and then on the
artery supply blood to much of the posterior flip side, it also creates its waste
wall of the heart. products/byproducts of metabolism and those
blood that is deoxygenated flows back to the heart
REMEMBER: There are 2 pulmonary arteries, the thru the coronary sinus
pulmonary trunk bifurcates to the left and right - It also drains to the right atrium
pulmonary arteries and once blood has been diffused
with oxygen, it goes back into the pulmonary veins, we ASSOCIATED GREAT VESSELS OF THE HEART
have 4 of those all draining in the left atrium and in the - Pulmonary trunk – if not bc of this deoxygenated
left atrium, blood flows in the left ventricle, from the left blood would not be able to reach the lungs
ventricle it goes to the aorta which carries from the left - Aorta – if not bc of this oxygenated blood would
ventricle to the body not be delivered to the systemic circulation or the
general systems

ANASTAMOSES – direct connections between arteries

• If one artery becomes blocked, the areas
primarily supplied by that artery may still receive
some blood through other arterial branches and
anastomoses.
–– VEINS
1. GREAT CARDIAC VEIN – drains blood from the
left side of the heart

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

HEART CHAMBERS AND VALVES • INTERATRIAL SEPTUM – wall of tissue that

separates RA and LA
- Fossa Ovalis – slight, oval depression on the
right side of the interatrial septum marking the
former location of the foramen ovale
- Foramen Ovale – opening between the right and
left atria in the embryonic and fetal heart
o Allows blood to flow from the right to the left
atrium and bypass the pulmonary circulation
o When we were still babies, di pa ganun katas
ung pressure sa heart that’s why interatrial
septum are still open BUT when the baby is
born, that pathway shall close and become
the fossa ovalis; normally closes after birth
- Fossa ovalis is only a depression and not an
opening bc if it remains open, that will cause a
problem bc the right atrium is only designed to
receive deoxygenated blood whereas your left
atrium shall receive oxygenated blood
- Walls of the heart is not fully closed in the atrium,
deox and ox blood will mix
ATRIA
• Small, thin walled; contract minimally to push blood • AURICLES – little ears; earlike flap protruding from
into ventricles each atrium ; What makes the atrium special
• Reservoir of blood bc its function is to accept blood - Clinical Significance: If u open these auricles,
being drained back to the heart and then it allows WITHIN u will find pectinate muscles, which are
blood to flow to the ventricles responsible in adding contractile power to ur
atrium
o Atria contracts but only bc it needs to push the
- Atrium is able to contract but not as much as the
blood into the ventricles not bc it needs to push ventricles do
the blood away from the heart - Like an appendage arising from each atrium
o That’s why myocardial cells are more resembling an earlobe
predominant on the ventricles than on the atrium
• R. ATRIUM REMEMBER: Heart muscles need oxygenated blood for
- Has three major openings: (1) an opening from it to continuously pump and at the same time, it releases
the SVC, (2) an opening from the IVC, and (3) an byproducts of energy metabolisms, they will be drained
opening from the coronary sinus. thru the coronary sinus back to the RA
- SVC & IVC (receive blood fr body) ; C.S (receive
blood fr heart) –– VENTRICLES
• L. ATRIUM • Pumping chambers; thick, strong walled; contract
- Has four relatively uniform openings from the four forcefully to propel blood out of heart
pulmonary veins that receive blood from the • Pump AWAY from the heart
lungs.
- Form most of the base of the heart • R VENTRICLE – blood will go to pulmonary trunk
- Receives oxygenated blood through the 4 next
pulmonary veins o Forms most of the heart’s anterior surface
- Has a smooth posterior and anterior wall o Contains ridges formed by raised cardiac
- Pectinate muscles are confined to the auricle muscle fibers called trabeculae carneae which
conveys part of the heart’s conduction system

TRANSCRIBED BY: @pdfiies on twitter

ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

o Contains chordae tendineae, tendon-like - Interventricular Septum – separates lv and rv

chords that connect the trabeculae carneae, the septum
papillary muscles of which is connected to the
AV valves/atrioventricular valves; the valve is
They are diff from the coronary sulcus, anterior and
like a gate the separates your RA and RV
o Valves actually open and close posterior interventricular sulcus bc the chambers are
o Whenever blood passes from the RA to RV then best described as an internal part of the heart anatomy
these valves close so as not to allow blood to
backflow When we talk abt sulcus, these are all part of the
o In order for that to close, requires coordination surface anatomy
with the chordae tendineae and papillary - Coronary sulcus – separates both atria from
muscles that are attached to the trabeculae
the lungs
carneae
o Has a thinner muscular wall compared to the left
ventricle CHORDAE TENDINEAE – attached to the free margins
of the cusps of your AV valves supporting its closure
Ø When the right ventricle contracts, it pushes the whenever an increase in pressure in the ventricles
blood to the pulmonary trunk then the pulmonary happen; that is when blood from the atrium goes to the
trunk bifurcates to the left and right pulmonary ventricles and it fills enough pressure in order to close it
arteries o Attached to papillary muscles = when these contract,
Ø The pulmonary arteries carry/deliver the blood the chordae tendineae tension is increased closing the
towards the lungs for oxygenation and then goes valves preventing blood flowing from the ventricles to
back to the left and right pulmonary veins and then backflow to the atrium
drains it to the left atrium down to the left ventricle - When blood passes from the RA down to the RV,
and up to the aorta when blood pulls in the RV pressure increases and
Ø The aorta makes a U-turn, blood goes to the head makes ventricles contract
and neck and then blood goes down to the - When the ventricles contract, the papillary muscles
abdomen and lower limbs also contract, tension in the chordae tendineae also
increase closing the valve separating the RA and RV
• L VENTRICLE – blood will go to the aorta next - Once blood is in the RV, it should not go back to RA
o Largest, high pressured and mostly muscular anymore, in order for that to happen the valve
o Thicker compared to the right ventricle bc the separating these 2 chambers must close and the
function of the RV is to pump blood to the lungs closure of those valves are done by the contractions
which is shorter in distance but the LV should of your papillary muscles and increasing tension of
exert a force necessary to allow the blood to your chordae tendineaes; same with LV and LA
pump to the general circulation
o General circulation = not only head neck, –– VALVES
thorax, but also the abdomen, pelvis, and lower
extremities and that is how powerful LV is
o Also contains trabeculae carneae and
chordae tendineae; bc it has to hold the AV
valve
§ RV and RA has its own valve
§ LV and LA has its own valve as well
o Has a thicker muscular wall than the RV

• SEPTUM
- Like a wall
- Interatrial Septum – separates the left and Ø Structures that ensure one way blood flow
right atrium

TRANSCRIBED BY: @pdfiies on twitter

ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

1. ATRIOVENTRICULAR – separates the atrium and 2. SEMILUNAR—found when the ventricles pump
and ventricles blood, they are the gatekeepers between the
- Ensure blood flows from the atria into the ventricles and associated great vessels of the heart
ventricles (prevents blood backflow) - Pulmonary Semilunar Valve/Pulmonic Valve
- Tricuspid = atrioventricular valve between RA – separating RV and Pulmonary Trunk; base of
and RV (has 3 cusps) pulmonary trunk
- Bicuspid valve/Mitral Valve = atrioventricular - Aortic Semilunar Valve – separates the LV
valve between LA and LV (2 cusps) and aorta; base of aorta
- Each ventricle contains cone-shaped, muscular
pillars called papillary muscles - One important function of the heart is to ensure one-
o Attached by chordae tendineae to the free way blood flow ; blood should not backflow
margins of the cups of the AV valves - If ever there would be a backflow, that’s an issue
o When the ventricles contract, the papillary between the valves itself
muscles contract and prevent the valves
from opening into the atria by pulling on the
chordae tendineae attached to the valve
cusps; with that being said, blood does not
backflow or go back to the atria
o When blood needs to flow from RA to RV,
the papillary muscles are relaxed keeping
the valve open
o If the valves are closed, with the papillary HEART ATTACK / MYOCARDIAL INFARCTION – death
muscles contracted increasing tension to of cardiac muscles; comes from coronary artery diseases
the chordae tendineae, and that tension CORONARY ARTERY DISEASE – blockage because of
would close the AV valve fatty deposit
–– Cardiac Muscles doesn’t receive enough oxygen
which causes anaerobic respiration; produces lactic acid
and results to chest pain
STROKE – blockage of veins that supply blood to the
brain; masakit ulo

ROUTE OF BLOOD FLOW

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

- The left side of the heart pumps blood to all other

tissues of the body and back to the right side of the
heart through vessels of systemic circulation
o Pumping of oxygenated blood to the rest of the
body or the general system
- Blue Color = deoxygenated blood
- Red Color = oxygenated blood

- Venous blood from the heart itself enters the RA from

the coronary sinus Why does it need to go to the lungs? The circulation
- Contraction of the RA forces blood through the Right of blood to the lungs involves pulmonary circulation bc
AV valve (also known as the tricuspid valve) and into the main purpose of that is the oxygenation of blood
the RV before it’s delivered to the general circulation;
- Right ventricular contraction then propels the oxygen- deoxygenated blood passes thru (refer to the pic ni sir
poor blood through the pulmonary (or semilunar) dun daw sa chamber na yun) and goes to either left or
valve and into the pulmonary trunk right lung for oxygenation; it passes thru capillary beds
- The pulmonary trunk divides into a right and left where diffusion happens, where oxygen comes in bc
pulmonary artery, which carry oxygen-poor blood to we inhale oxygen, it diffuses from the alveoli of the
their respective lung for gas exchange. These are the lungs to the blood vessels and then the blood becomes
only arteries that carry oxygen-poor blood oxygenated and in turn deoxygenated blood that
- Oxygen-rich blood returns from the lungs through 4 carries CO2 diffuses out, so when we exhale, we
pulmonary veins to the left atrium. These are the only exhale CO2.
veins that carry oxygen-rich blood
- Contraction of the LA forces blood through the left AV - Once the blood has been oxygenated, it goes back to
valve (also known as the bicuspid or mitral valve) and your heart and the heart will pump the blood to
into the left ventricle general circulation going up to the brain and down to
- Left ventricular contraction propels the oxygen-rich your abdomen and lower limbs
blood through the aortic (or semilunar valve) and into - As the oxygenated blood perfuses to different organs
the aorta for distribution to the body of the body, they lose their oxygen, they gain again
CO2 and waste products so they go back to the veins
TYPES OF CIRCULATION and go back to the heart the systems repeats itself
- The heart is actually 2 pumps in one, with the heart’s again
right side pumping to the lungs and back to the left
side of the heart thru vessels of the pulmonary NOTE :
circulation - Fetal circulation is different from a usual adult
o Pumping of blood to the lungs for oxygenation circulation

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

- Liver, being the largest internal organ in the body, - The pulmonary arteries in an adult or usual human
also has its own type of circulation circulation carries deoxygenated blood bc it carries it
to the lungs for oxygenation
SYSTEMIC CIRCULATION - In the pulmonary capillaries, gas exchange happens,
• Carries blood from the heart to tissues of the body so O2 diffuses into the blood vessels going to the
and returns it to the heart blood and from there, it is now drained as a pulmonary
- Left side vein back towards the heart
- Oxygen-rich blood is pumped from the left ventricle - In essence, arteries are the ones that carry blood
into the ascending aorta away from the heart, whereas your veins carry blood
- The aorta then makes an inverted u-turn to form the back to the heart
aortic arch, which gives rise to branches that supply - The only thing diff for these structures, the pulmonary
the head, neck, and upper limbs arteries carry deoxygenated blood away from the
- The aorta continues posterior to the heart as the heart to the lungs for gas exchange and pulmonary
descending aorta, which travels through the thoracic veins drain back oxygenated blood to the heart for the
and abdominopelvic cavities. It supplies the organs systemic circulation
of these cavities and the lower limbs
- In the systemic capillaries, oxygen is exchanged for HISTOLOGY
CO2, resulting in oxygen-poor blood
- The oxygen-poor blood enters the right atrium via the HEART SKELETON
superior and inferior vena cava • A plate of connective tissue, sometimes called the
cardiac skeleton, or fibrous skeleton,
PULMONARY CIRCULATION • Consists of a plate of fibrous connective tissue
between the atria and the ventricles
• The pulmonary circulation carries blood from the
• Forms fibrous rings around the atrioventricular and
heart to the lungs for gas exchange and then returns
semilunar valves
it to the heart
• Provides solid support for them, reinforcing the valve
- Right side
opening
- Oxygen-poor blood is pumped from the right ventricle
o This is to ensure that the valves remain in place
into the pulmonary trunk. The large pulmonary trunk bc we are talking abt pressure changes
divides into the right and left pulmonary arteries. • Fibrous connective tissue plate serves as electrical
These arteries transport blood to the right and left insulation between the atria and the ventricles and
lungs provides a rigid site for attachment of the cardiac
- In pulmonary capillaries, CO2 is exchanged for muscles.
oxygen. This results in oxygen-rich blood that then • For example: As the RA fills with blood collected
flows through the four pulmonary veins and enters from the SVC, IVC, and coronary sinus, pressure
the left atrium increases in the RA and that pressure will be enough
to open the tricuspid valve, when that valve opens
NOTE: then blood flows to the RV and as the RV fills with
- Pulmonary arteries contains oxygen-poor blood sa blood, pressure increases which is enough for
pulmonary circulation contraction and closure of the tricuspid valve
- Contrary to the popular opinion that all arteries carry • Since there are pressures involve, the valves should
oxygenated blood while veins carry deoxygenated
remain in place and be supported by this cardiac
blood, such is not the same when we talk about the
skeleton/fibrous skeleton
pulmonary arteries and pulmonary veins inside the
heart
- The pulmonary trunk (one of the great vessels of your
heart) that receives blood pumped by your right
ventricle bifurcates it to the pulmonary arteries

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

- Ca 2+ and ATP used for contractions

- It has intercalated disks which are specialized gap
junctions and desmosomes so when the a.p start to
one muscle it easily propagates to bone muscles
allowing them to beat rhythmically so magiging one
system sila compared to the skeletal muscle na
specific lang
- Connect cells
- Striations not as uniform as skeletal
- Calcium binds to troponin to stimulate contractions
- Auto rhythmic fibers – one of the characteristics of
cardiac muscles
- Cardiac skeleton is diff from the pericardium bc: o It has fibers that generate a.p that
o Cardiac skeleton = pertains to the framework thru triggers heart contractions
which the valves are anchored and supported o Ensure heart muscles continue to
o Pericardium = serves as covering of the heart contract and does not stop
o Even if you are resting your heart
contracts
CARDIAC MUSCLE
• Elongated, branching cells that have one, or CARDIAC MUSCLE ACTION POTENTIALS
occasionally two, centrally located nuclei
• contain actin and myosin myofilaments organized to Same concept with the skeletal muscle we have
form sarcomeres depolarization & repolarization phase because cells
§ Sarcomeres – join end-to-end to form myofibrils should not always be in the contracted phase lagi dapat
may resting phase
• The actin and myosin myofilaments are responsible
for cardiac muscle contraction, and their organization • Sodium major extracellular ion
gives cardiac muscle a striated look • Potassium major intracellular ion
• The striations are less regularly arranged and less • the interaction of sodium and potassium requires the
numerous than in skeletal muscle sodium-potassium exchange ion pump
• Cardiac muscle has a smooth sarcoplasmic • Doesn’t only require sodium and potassium, also
reticulum, which stores Ca2+ needs calcium which is importance in attaining
maintaining the plateau phase
• The repo for cardiac muscle is longer to take effect
than skeletal muscle; c.m has the plateau phase

PACEMAKER POTENTIAL – Changes in membrane

channels permeability are responsible for producing A.P

1. DEPOLARIZATION
• Na+ channels open – allowing sedum to enter the
cardiac muscles
• Ca2+ channels open
• If a threshold is reached in cardiac muscles, there
would be a plateau phase:
- 1-2 central located nucleus
- Branching cells 2. PLATEAU
- Rich in mitochondria • Na channels close - NO Sodium to enter
- Striated (actin and myosin

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

• Some K channels open – allows some potassium who need a somatic neuron to carry a neural impulse
ions to escape from the ic to ec for the skeletal muscles to function
o Ca channels remain open for longer - Sinoatrial node – pacemaker of the heart
depolarization and prolonging action a.p - Atrioventricular node – gives rise to a conducting
bundle of the heart
3. REPOLARIZATION - Bundle of His / AV bundle – collection of cells that
• K channels open carry electrical signals from the AV node to the
• -Ca channels close bundle branches
• Once K ions escape from the ic to ec it brings back → This bundle passes through a small opening in
the resting membrane potential, the ic becomes the fibrous skeleton to reach the interventricular
more negative doesn’t allow sodium and potasssium septum, where it divides to form the right and left
to enter bundle branches, which extend beneath the
endocardium on each side of the interventricular
Plateau phase prolongs action potential by keeping Ca2+ septum to the apex of both the right and the left
channels open ventricles.

In skeletal muscle action potentials take 2 msec, in - Purkinje Fibers – inferior terminal branches of the
cardiac muscle they take 200-500 msec bundles
- Basta masmatagal cardiac kasi may plateau phase - Those mentioned propagates a.p all over the heart
and skeletal walang plateau phase kaya faster carries by the SA and AV
- Prolonging the a.p propagation is essential during
rhythmic contraction of the heart 2. EXCITABILITY
- ability to respond to an electrical respond – heart
chamber will contract as a result of their excitability
characteristics generated by the SA and AV node

3. CONDUCTIVITY
- ability to transmit an electrical impulse from one cell
to another; intercalated disks – specialized gap
junctions and desmosomes allows a.p to be
propagated immediately to all the cardiac muscles

CONDUCTION SYSTEM
4. REFRACTORINESS
- Generation and coordination of the electrical
- cannot be re-stimulated to contract
impulse to the cells
- Result of sequential Atrioventricular conjunction
which provides the most effective flow of the blood
- Contraction of the atria and ventricles is coordinated
by specialized cardiac muscle cells in the heart wall
that form the conduction system of the heart
- All the cells of the conduction system can produce
spontaneous action potentials

PROPERTIES:
1. AUTOMATICITY
- ability to initiate an electrical impulse; heart is
capable to make its own electrical impulse
- Some parts in the illustration can produce their own
electrical impulse compared to the skeletal muscles

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

ELECTRICAL POTENTIALS They then pass thru the AV bundle which extends from
AV node to interventricular septum. AV bundle divides
ACTION POTENTIAL PATH THROUGH HEART into the Right and left bundle branches and a.p descend
1. SA node – can generate electrical impulses that can rapidly to the apex of each ventricle along the bundle
allow the heart to beat branches. A.P are carried by the purkinje fiber from the
2. AV node (atrioventricular) bundle branches to the ventricular walls.
3. AV bundle – carry electrical impulses which separates
to: The rapid conduction from the AV bundles to the ends of
4. Right and Left Bundle branches Purkinje fiber allows the ventricular muscles cells to
5. Purkinje fibers – innervates the ventricular walls contract in unison providing a strong contraction

SINOATRIAL NODE (SA) SIR: It started with the SA node, it fires and a.p that goes
- In RA to AV node to AV bundle to the Bundle Branches to the
- Where action potential originates Bundle of His and to the Purkinje Fibers
- Functions as pacemaker - structures involved in the conduction sys of the
- Large number of calcium ion channels heart
- Can make the heart beat 50-100 bpm
- Most heart beat rate is influences by the SA node bc 1st degree/2nd degree/ 3rd degree heart block – talks about
it has large number of calcium channels heart conduction sys; at one point if the a.p was blocked
it will result to an issue regards to the heart’s ability to
ATRIOVENTRICULAR NODE (SA) contract bc the ability of the heart to contract is due to a.p

- Located in the lower portion of the right atrium

If the SA node of a person fails to provide an a.p? Parts
- Action potentials from SA node sent to this node
of the conduction sys of the heart has the ability to
- Action potentials spread slowly through it
conduct their own a.p, the SA node is the primary
- Slow rate of action potential conduction allows the
influencer of that bc they start the firing they contribute to
atria to complete their contraction before a.p are
your heart beat of 50-100 beats but in case the SA has an
delivered to the ventricles
issue then we go to the AV node. The AV node can
conduct a.p but not as strong as SA node. SA node can
ATRIOVENTRICULAR BUNDLE
give us 100 beats/contractions but AV will only give 40-60
- action potentials from AV node travel to AV bundle beats expect your heart to beat slower if your SA node is
- AV bundle divides into a left and right bundle not functioning well.
branches
Ectopic beats – if the heart beat begins from another part
PURKENJE FIBERS aside from the SA node
- At the tips of the left and right bundle branches, are If you have ectopic beats you are vulnerable and can
Purkinje fibers experience various irregular heart rhythms or arrhythmia
- Purkinje fibers pass to the apex of the heart and then
extend to the cardiac muscle of the ventricle walls ELECTROCARDIOGRAM
- Action potentials are rapidly delivered to all the
cardiac muscle of the ventricles ECG (EKG)
• Record of electrical events in heart
SA → AV → AV BUNDLE → PURKENJE • Diagnoses cardiac abnormalities
• Uses electrodes
[ YT VIDEO TRANSCRIPT ] • Contains p wave, qrs complex, t wave
A.P.originate in the SA node and travel across the wall of
the atrium from the SA node to the AV node. A.p. passes - The electrical conduction of the heart can be
slowly thru the AV node to give the atria time to contract. measure thru the surface of the skin thru the

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

electrodes that are placed in the certain areas of our Any widening of this ECG or waves this may indicate
body like our chest and upper body like chest and the underlying issues of your electric conductivity
upper and lower extremities where the conduction
system is evaluated CARDIAC CYCLE
- Take note: only electrical events not mechanical - The cardiac cycle is a summative description of all
(pressure, amount of blood volume ejected – best the events that occur during one single heartbeat.
measured thru diff apparatus or test) - The heart is a two-sided pump, with the atria being
- Can help detect cardiac abnormalities primers for pumps and the ventricles being the actual
- Changes of the heart rhythm can be observed in pumps.
EKG - When ventricles and atrium contract it pertains to
pressure
COMPONENTS OF ECG/EKG - Systole – contraction
- Diastole – relaxation
P wave depolarization of atria - The cardiac cycle tells all events happened in the
heart every contraction
depolarization of ventricles
QRS o Whenever a heart contracts it involves a series
complex of changes in your atrium and ventricles, they
contains Q, R, S waves
also relax
T wave: repolarization of ventricles

Repolarization of atria happens during depolarization of HEART CHAMBER CONTRACTIONS

ventricles - Cardiac muscle contractions produce pressure
changes within heart chambers allowing the
blood to flow in one direction
- Pressure changes are responsible for blood
movement.
- Blood moves from areas of high to low pressure.

Blood fills in one chamber of the heart, as it fills its

pressure also increases that increase of pressure
allow the blood to travel from that chamber to another
chamber

As atria contracts the ventricles relaxes and v.v.

SEQUENCE OF EVENTS
1. Atrial systole – active ventricular filling.
• The atria contract, increasing atrial pressure and
completing ventricular filling while the ventricles are
Beginning of P wave – atrial contraction
After Atrial depolarization - QRS complex begins which relaxed.
is the ventricular depolarization / ventricular contraction
T wave – ventricular relaxation / repolarization of 2. Ventricular systole – period of isovolumetric
ventricles contraction
PQ/ PR interval – time it takes the atria to contract and • The atria are relaxed, and blood flows into them from
relax the veins. Ventricular contraction causes ventricular
QT interval – length of time required for the ventricles to pressure to increase and causes the AV valves to
contract and relax close, which is the beginning of ventricular systole.

TRANSCRIBED BY: @pdfiies on twitter

ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

The semilunar valves were closed in the previous EXTRA NOTES FROM SIR :
diastole and remain closed during this period. Atrial systole contraction of atria
Ventricular systole contraction of ventricles
3. Ventricular systole – period of ejection. Atrial diastole relaxation of atria
• Continued ventricular contraction causes a greater Ventricular diastole relaxation of ventricles
increase in ventricular pressure, which pushes blood
out of the ventricles, causing the semilunar valves to - Starts with the Atrium and ventricles relaxed and AV
open. valves open and then the blood from the right atrium
will go to the right ventricle
4. Ventricular diastole – period of isovolumetric - Up to 70% of the right ventricle is filled wt blood and
relaxation. if it is filled wt that amount it creates pressure enough
• As the ventricles begin to relax at the beginning of for the atrium to contract and eject blood to the right
ventricular diastole, blood flowing back from the ventricle and then when the pressure builds up in the
aorta and pulmonary trunk toward the relaxing right vent the chordae tendinae and papillary
ventricles causes the semilunar valves to close. Note muscles increase the contraction and tension and
that the AV valves are closed also. closes the AV valves so the blood in the right vent
will be pumped into the pulmo valve to the pulmonary
5. Ventricular diastole – passive ventricular filling. trunk
• As ventricular relaxation continues, the AV valves - Contraction of the ventricles causes pressure to
open, and blood flows from the atria into the relaxing increase, AV valves closes which causes the first
ventricles, accounting for most of the ventricular heart sound and the pressure in the ventricles
filling. continues to increase enough to open the semilunar
valves so when that happened the blood flows or
pushed to the pulmo trunk to the valve
- For every heart beat both of your ventricles contract,
so blood goes to the lungs for oxygenation and blood
in the left ventricular goes to the central systemic
circulation
- The cycle continues every heart bc this happens in
one go
- 120/80
o 120 – systolic
o 80 – diastolic
- Whenever the left ventricle pushes blood in the
general systemic circulation pressure it exerts is
120mmhg and whenever it is in a relax state the
pressure is 80
- If a person with hypertension or any heart related
disease it alters the blood pressure that’s why we can
observe 140/90 bp sumtimes

HEART SOUNDS
- Heart sounds are produced due to the closure of
heart valves.
- A stethoscope is used to hear heart sounds
- The first heart sound makes a ‘lubb’ sound.
- The second heart sound makes a ‘dupp’ sound.

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

- The first heart sound is due to the closure of the CARDIAC OUTPUT:
atrioventricular valves. - volume of blood pumped by a ventricle in 1 min.
- The second heart sound is due to the closure of the - 5 Liters/min.
semilunar valves. - Cardiac output equals stroke volume multiplied
times heart rate
2 HEART SOUNDS/ S1 and S2 - CO = SV x HR
The sounds are produced by the closing of the hard
valves TYPES OF REGULATION
- Lub / S1 – closure of AV valves
- DuB / S2– closure Semilunar valves 1. INTRINSIC REGULATION OF THE HEART
• refers to the mechanisms contained within the heart
If you hear any swishing sounds either between the lub itself that control cardiac output.
and the duB or after the 2nd sound/dupp b4 the first
sound/lubb it may mean incompetent heart valves VENOUS RETURN:
• the amount of blood that returns to heart
- The valves ensure one-way flow of the blood if its • the amount of blood carried by the veins to the heart
incompetent there may be a chance that blood for reoxygenation
may go back to the valves or a leakage
- Ex. From the left atrium to left vent the biscuspid PRELOAD:
valve may be incompetent and there would be • the degree in which ventricular walls are stretched at
leakage of blood back to the left atrium end of diastole
- If you hear swishing sound b4 2nd heart sound • the stronger the stretch bc of the higher blood volume
after 1st sound it is called murmurs returned to the heart the higher the preload is going
to be
HEART VALVE LOCATIONS • Preload determines the stroke volume
- Pertains to the • Cardiac contractions are related to the degree of how
placement of much your cardiac muscle is stretched; the more
stethoscope stretched they are the higher or the stronger the
- If you want to contraction is
hear any • As the chambers of the blood fills up, the pressure
concerns or also increases bc it stretches the chambers more
abnormalities • The amount of venous is high, the contraction also is
in the tricuspid strong
valve then we
use this Venous return, preload, and stroke volume are related to
location (refer each other
to the pic)
STARLINGS LAW OF THE HEART:
REGULATION OF HEART FUNCTION • relationship between preload and stroke volume
• influences cardiac output
STROKE VOLUME • Example - exercise increases venous return,
- Volume of blood injected/pumped per contraction preload, stroke volume, and cardiac output
- 70 milliliters/beat – normal • Frank starling
• Increase in venous return, it will also increase the
HEART RATE stretch in your muscles fiber thereby increasing your
- Number of heart beats in 1mins preload and if the preload is increased the stroke
- 72 beats/min – normal accdg to book volume and cardiac output also increases

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

After load: [ YT VIDEO TRANSCRIPT ]

• pressure against which ventricles must pump blood Increased blood pressure stretches the carotid arteries
• pressure facilitated in the pipes or in the blood and the aorta causing for the baroreceptor to increases
vessels their basal rate of a.p. generation. Ap is conducted by the
glossopharyngeal ang vagus nerve to the
Hypertension is increased blood pressure, if the blood cardioregulatory and vasomotor in the medulla oblongata.
vessels already increased imagine how much the left vent As a result of increased stimulation of baroreceptors, the
have to fight in order to pump blood away from the heart cardioregulatory center increases the parasympathetic
to the general circulation stimulation to the heart w/c decreases the heart rate. Also,
the result of the increases simulation of baroreceptors the
Our hearts also get tired/exhausted bc of the too much cardiovascular decreases sympathetic regulation in the
pressure outside so need niya galingan mag pump heart w/c decreases heart rate and stroke volume. The
vasomotor center decreases sympathetic stimulation to
2. EXTRINSIC REGULATION OF THE HEART blood vessels causes vasodilation. Vasodilation along
• Extrinsic regulation refers to mechanisms external to with decrease h.r and s.v brings the elevated k blood
the heart, such as either nervous or chemical pressure back to our door wall. If the initial problems were
regulation. at decrease in b.p the activities and effects of
baroreceptors, cardiovascular center and vasomotor
• Nervous system control of the heart occurs through
center is the opposite of what’s illustrated.
the sympathetic and parasympathetic divisions of the
autonomic nervous system. influences of heart
SIR:
activity are carried through the autonomic nervous
→ When there is increase in blood pressure it signals as
system.
cycle as response how baroreceptors will create a.p send
• Both sympathetic and parasympathetic nerve fibers
to the medulla and the medulla will stimulate either
innervate the SA node.
parasympathetic or sympathetic fibers to carry out signals
• Mechanisms external to the heart
so the heart can balance out again
• Pertains to how it influences the heart
• Neural and endocrine system happens
If there is increase b.p, heart rate decreases bc when h.r
decrease the cardiac output also decrease so with lesser
BARORECEPTORS
cardiac output lesser b.p will be end game
• The baroreceptor reflex is a mechanism of the
nervous system that plays an important role in CHEMORECEPTORS
regulating heart function.
• The chemoreceptor reflex involves chemical
• monitor blood pressure in the aorta and carotid regulation of the heart.
arteries
• Chemicals can affect heart rate and stroke volume.
• changes in blood pressure cause changes in
• frequency of action potentials CHEMICAL ACTIONS:
• involves the medulla oblongata • epinephrine and norepinephrine from the adrenal
• Found in carotid artery and base of aorta medulla can increase heart rate and stroke volume
• Baroreceptor are sensitive to stretch (sympathetic response)
• If they sense that the stretch is getting stronger they • excitement, anxiety, and anger can increase cardiac
notify / send a.p signal to the cardioregulatory center output
• Cardio regulatory center – in medulla oblongata • depression can decrease cardiac output
• It will result to how the heart will compensate to • medulla oblongata has chemoreceptors for changes
maintain balance or homeostasis in pH and CO2
• K+, Ca2+, and Na+ affect cardiac function
• Chemical regulations of the heart
o Involves Power of pH / HYDROGEN

TRANSCRIBED BY: @pdfiies on twitter

 ANATOMY AND
1st Year, 1st Semester
PHYSIOLOGY MIDTERMS

o Normal ph 7.35 – 7.45 any above that is Remember, the carotid arteries and the aorta we have
alkalosis any below that is acidosis their sensory fiber carried by the glossopharyngeal and
o Whenever blood pH goes up or down beyond vagus nerves, they carry it with signal to the medulla
the normal range it will trigger a series of oblongata w/c determines if the deviation to normal is up
scenarios that will help the heart balance it or down and sends signal either by parasympathetic or
again sympathetic fibers which controls or manages how the
- Medulla has chemoreceptors that detects change in hearts responses to the changes in the pressure or in the
pH and in CO2 chemicals of the body
- If there is an increase in CO2 or acidosis in our blood
and our pH goes down, so our blood needs to pump Q&A END
more blood that’s why we experience - Swishing sound can be produced by the incompetent
HYPERVENTILATION when we experience acidosis heart valves, it just depends on when did you hear
the sound, in the end of S2 or in the start of S1,
[ YT VIDEO TRANSCRIPT ] whenever those heart sounds are heard it will result
Chemoreceptors in the aortic and carotid bodies monitor to abnormal heart sounds
blood oxygen, carbon dioxide and Blood pH. Impulses - Murmurs are what you hear when you have
from these chemoreceptors are conducted to the control incompetent heart valves, results for the blood to go
center for the heart and blood centers via the back to the previous chamber or the valves is
glossopharyngeal and vagus nerve. Chemoreceptors in stenosed which means the pathway is narrow
medulla oblongata monitor blood Carbon dioxide and - The incompetent heart sounds are called murmurs
blood pH. Decrease blood oxygen, increases CO2 or w/c is a result of faulty valves; when they fail to close
decrease pH, decrease parasympathetic stimulation tightly, so the blood leaks thru the valve when it is
which increases the heart rate. Decrease blood oxygen closed making a swishing sound
increase CO2 and decrease pH, increase sympathetic - If the valve is stenosed the swishing sound will be
stimulation of the heart resulting to increases h.r and s.v. hearing prior the first heart sound, bc the sound is
Increased sympathetic stimulation of blood vessels produced by the AV valves so b4 u can hear heart
increases vassal constriction. sound there is already swishing sound precede it bc
the blood passing thru the valve is already narrowed
SIR: or stenosis
→ How the heart answers or responses to the changes of - Same lang daw may swishing sound kahit
the chemical structure in our body like when we have incompetent heart valve o stenosed depende lang
increase and decrease pH what would be the effect of the daw kung kelan narinig
heart, will it result to parasympathetic or sympathetic
stimulation

TRANSCRIBED BY: @pdfiies on twitter