CARDIOVASCULAR MODULE

Anatomy & Physiology

HEART • VENTRICLE: pumping chamber

• Cone shaped structure/inverted pyramid/blunted cone o Ridges of cardiac muscle fibers / trabeculae carnae
• Small, same size as a closed fist o Papillary muscle = cone shape structure of trabeculae
carnae
• Rest: Diaphragm
▪ Where the chordae tendinae are attached
• Location: Mediastinum
o When the papillary muscle contracts, it pulls chordae
o Mass of tissue extending the sternum to the vertebral tendinae so that the valves will CLOSE.
column between the 2 lungs o Interventricular septum: divides the left and right
• 2/3 mass → L body’s midline ventricles

Base Apex VALVES OF THE HEART

Orientation Post. superior Ant. inferior I. AV Valves
To the R To the L • Between the atria and ventricle
Level 2nd-3rd rib 5th rib • “inlet” valves
• Tricuspid valve: R side
PERICARDIUM • Bicuspid/Mitral valve: L side
• Fibrous connective sac that encloses the heart
• Protects the heart from trauma and infection II. SL Valves
• 2 LAYERS: • “outlet” valves
1. Fibrous Pericardium • Aortic valve: aorta
• Outermost covering • Pulmonic valve: pulmonary artery
• Prevents the heart from overstretching
• Anchors the heart from mediastinum BLOODFLOW INSIDE THE HEART
2. Serous Pericardium • The aorta is the great artery leaving the left ventricle chamber of
• Innermost layer of pericardium the heart
• Serves as a double layer • The pulmonary artery is the great artery leaving the right ventricle
• 2 layers: chamber of the heart
o Viscera / Epicardium
▪ Adheres tightly in the heart
o Parietal
▪ Outermost layer
▪ Adheres tightly in the fibrous
pericardium
• Pericardial Fluid
o Decreases friction in the heart
o Location: between the VSP & PSP
o Normal amount: 50 ml
↓ PF ↑ PF
(+) pericardial rub = Cardiac tamponade
pericarditis
Marami fluid → mahirapan
contract → no oxygen na lalabas

SURFACES OF THE HEART 1. Deoxygenated blood

Anterior Sternocostal surface RA & RV 2. SVC & IVC
RV = most anterior 3. RA
Posterior Base surface RA & LA 4. Tricuspid valve
LA = most posterior 5. RV ↓ pressure
Inferior Diaphragmatic surface RV & LV 6. Pulmonary valve
LV = apex 7. Pulmonary artery
8. Lungs
CHAMBERS OF THE HEART 9. Oxygenated blood
Right Atrium Left Atrium 10. Pulmonary veins
Right Ventricle Left Ventricle 11. LA
12. Mitral valve
• ATRIA: receiving chamber 13. LV ↑ pressure
o Anterior wall of the 2 atria is rough due to the presence of 14. Aortic valve
pectinate muscle 15. Aorta
o Interatrial septum: oval depression or fossa ovalis 16. System
(remnant of the F. Ovale)
▪ Opening of the interatrial septum of a fetal heart BRANCHES OF AORTA
that normally closes after birth • Ascending aorta → arch of aorta → brachiocephalic artery →
▪ (-) close = congenital anomaly** bifurcates → (1) Common Carotid artery & (2) Subclavian artery
• Common Carotid Artery = (1) External CCA and (2) Internal CCA
1
 o External CCA: terminates at TMJ & supplies superficial
structures of the skill II. Conducting System
o Internal CCA (ACA and MCA) SA • “Sinoatrial node” /
• Subclavian Artery Node “Sinus node”
o Axillary Artery → Brachial Artery → Radial & Ulnar Artery • Primary pacemaker
o Vertebral Artery → Basilar Artery → PCA • Initiate depolarization
• (-) L Brachiocephalic Artery • Location:
• L CCA & L Subclavian Artery rise directly at Arch of Aorta o RA, superior
septal wall of
the RA,
immediately
below slightly
lateral to the
opening of
the SVC
AV • “Junctional node”
Node • MC site of heart block
• Location:
Behind the tricuspid v.
Bundle • Location:
of His Interventricular
septum

Purkinje • Location:
Fibers 2 ventricles
• Largest pacemaker

CORONARY ARTERY
• Responsible for the blood supply in the heart

RCA LCA
1. RA 1. LA
2. RV (majority) 2. LV (majority)
3. LV (minor) 3. RV (minor)
4. SA node
Branches:
• Descending Aorta → Thoracic Aorta → Abdominal Aorta → • LADA
Common Iliac Artery → (1) Ext CIA and (2) Int CIA → Left Anterior Descending A.
• Internal CIA • Circumflex artery
o Aka Hypogastric artery
o Supply blood at pelvis, buttocks & genitals
• External CIA
o Femoral artery → Popliteal artery → Tibial artery

HEART SOUNDS
S1 LUBB Longer, Closure Start of MYOCARDIAL INFARCTION
louder, of AV Ventricular • Occlusion at RCA:
lower in valve Systole
o Problem with SA node (primary pacemaker)
Stethoscope pitch (contraction)
(audible) • Occlusion at LCA:
S2 DUBB Shorter, Closure Start of
not as of SL Ventricular o Left ventricle (pump oxygenated blood)
loud as valve Diastole o MC CA occluded
S1 (relax) ▪ Size of the artery = lagi dinadaanan ng dugo =
S3 Ventricular Gallop Rapid Filling deposition is more common
Phono of Ventricles
cardiogram S4 Atrial Gallop Atrial CARDIAC ACTION POTENTIAL
Systole • -85 mV
S3: CHF (3 letters) Phase 0 Depolarization Inward current of Na+
S4: MI, Hypertension (From negative to positive)
Phase 1 Initial Repolarization • Decreased influx of
2 GREAT CONTROLLING CENTERS OF THE HEART Na+
I. ANS o Gate for Na are
a. Sympa – ↑ contraction slowly closing
b. Para – ↓ contraction • Outward current of K+
(From positive to negative)
Phase 2 Plateau Maintained depolarization
Inward current of Ca2+
Phase 3 Repolarization • Decreased influx of
Ca2+

2
 o Gate for CA are • The moment na bumaba pressure inside sa ventricles, ang dugo
slowly closing na nasa pulmonary artery & aorta gusto bumalik sa ventricles
•
Outward current of K+ (suction effect), kaya lang hindi magaganap backflow sa blood
Phase 4 RMP •
Returns into negative due to closure of SL valves.
-85 mV • SL Valves: Closed
Ca will always maintain the cardiac action muscle potential. • AV Valves: Closed ----- Open

SKELETAL MUSCLE CARDIAC MUSCLE

Contraction Voluntary Involuntary
HEMODYNAMICS
Sarcoplasmic Reticulum Sarcoplasmic Reticulum
Organelles
(abundant Ca2+ inside) (few Ca2+ inside) • Systolic
o Highest arterial pressure
Both have striations (has actin & myosin)
o 120 mmHg
NOTE:
• Diastolic
• Sarcoplasmic reticulum – storage of calcium. Calcium is important for
muscle contraction.
o Lowest arterial pressure
• The heart will always depend on the calcium coming from the extracellular o 80 mmHg
fluid. • Pulse Pressure
o Difference between the SBP and DBP
CARDIAC CYCLE o SBP – DBP
• Pumping action o Normal: 40 mmHg
• Diastole (ventricular relaxation) o Importance: Average pressure of the peripheral pulse
• Systole (ventricular contraction) • End Diastolic Volume
• 4 periods o Amount of blood left after the diastole / ventricular
relaxation
DIASTOLE o Normal: 120 mL = Preload (initial stretching)
I. Period of Rapid Filling of Ventricles • End Systolic Volume
• First third of diastole = 75% of blood: Atria → Ventricles o Amount of blood left after systole / ventricular contraction
(passively) o Normal: 50 mL
• Middle third = continuous blood flow ▪ ↑ ESV = CHF
• Last third = 25% of blood: Atria → Ventricles (Atrial systole/Atrial • Stroke Volume
Kick) o Amount of blood pumped by the ventricles per
contraction
• AV Valves: Open
o EDV – ESV
• SL Valves: Closed
• Cardiac Output
o Amount of blood pumped by the ventricles per minute
Q: When is the most amount of blood transferred to the ventricles from
o Normal: 4-6 Liters (resting CO)
atrium in period of rapid filling?
o SV x HR
SYSTOLE • Mean Arterial Pressure
II. Period of Isovolumic Contraction o Average pressure with respect to time
o DBP + 1/3 (PP)
• Blood is in the ventricles
o mmHg
• ↑ ventricular pressure
o Importance: Average pressure of the large arteries
• Contraction happens but no emptying yet
• AV Valves: Closed (prevent backflow)
Q: What is the amount of blood after ventricular relaxation?
• SL Valves: Closed Q: What is the amount of blood after ventricular contraction?

Q: What is the only period where both AV and SL valves are closed? ECG

III. Period of Ejection

• RV = 8 mmHg (P. artery)
• LV = 80 mmHg (Aorta) Afterload
• Kailangan lagpasan ng venrticles para mag open ang SL valves.
Once mag open SL valves, magkakaroon period of ejection.
• AFTERLOAD: ventricular force required to open the SL valves
• First third of ejection: 70% of blood: Ventricles → P. Artery &
Aorta
Last two third: 30% of blood: Ventricles → P. Artery & Aorta
• SL Valves: Open
• AV Valves: Closed
• P wave = Atrial Depolarization
Q: Pressures which the ventricles must overcome over the o P: Pacemaker
aorta/pulmonary artery is called?
• QRS complex = Ventricular Depolarization
• T wave = Ventricular Repolarization
IV. Period of Isovolumic Relaxation
o Charge of cell is negative → relax
• Blood in the blood vessel
• Lumuwag na ventricles → pressure inside is decreased

3
Segment (short)
• PR segment
o End of P wave to beginning of QRS complex
• ST segment
o End of QRS complex to the beginning of T wave

Interval (long segment)

• PQ/PR interval
o Beginning of P wave to beginning of QRS complex
o P wave / atrial depo / atrial contraction
o QRS complex / ventricular depo / ventricular contraction
(systole)

• QT interval
o Beginning of QRS complex to end of T wave
o T wave / ventricular relax / ventricular repo

Prolonged PR Interval
• Heart block
Wide, bizarre, odd QRS complex
• Premature ventricular contraction (skipping a heartbeat)
Elevated ST segment
• Myocardial Infarction (myocardium)
Depressed ST segment
• Myocardial Ischemia (decreased blood supply)

Q1: What is the interval between the beginnings of Atrial Depolarization

to Ventricular Depolarization?

Q2: What is the Interval between the beginnings of Ventricular

depolarization to end of Ventricular repolarization?

Q3: What is the Segment between the end of Atrial depolarization to the
beginning of ventricular depolarization?

Q4: What is the segment between end of ventricular depolarization to

the end of ventricular repolarization?

LOCATION OF THE VALVES

AUSCULTATION OF THE VALVES