Heart Anatomy Only Students

HEART and
NECK VESSELS
ANATOMY
CARDIOVASCULAR SYSTEM
▪ this is a highly complex system that includes the heart and a closed
system of blood vessels
HEART and GREAT VESSELS
HEART
 is a hollow, muscular, four-chambered (left and right atria and left and right
ventricles) organ located in the middle of the thoracic cavity between the lungs
in the space called the MEDIASTINUM
 size: about the size of a clenched fist; app. 255g in women and app. 310g in
men
 the upper portion, near the left second ICS, is the base and the lower portion,
near the left fifth ICS and the left MCL, is the apex.
 the anterior chest area that overlies the heart and great vessels is called the
PRECORDIUM
HEART and GREAT VESSELS
GREAT VESSELS
 large veins and arteries leading directly to and away from the heart
 SUPERIOR VENA CAVA - carries blood from the head, neck, arms, and chest
blood enters in the right atrium
 INFERIOR VENA CAVA - carries blood from the legs, feet, and organs in the
abdomen and pelvis
 PULMONARY ARTERY - exits the right ventricle, bifurcates, and carries

blood to the lungs
 PULMONARY VEIN - return blood to the left atrium

HEART CHAMBERS and HEART VALVES
HEART CHAMBERS
 consists of four chambers or cavities
separated by a
a) two upper chambers : LEFT and RIGHT ATRIA partition called
b) two lower chambers : LEFT and RIGHT VENTRICLE SEPTUM
 ATRIA – thin walled; receives blood returning to the heart and pumps blood to
the ventricles
 VENTRICLES – thick walled; pumps blood out of the heart;
LEFT VENTRICLE is thicker than RIGHT

VENTRICLE due to a GREATER WORKLOAD
HEART VALVES
 the entrance and exit of each ventricle are protected by one way valves that direct the flow
of blood through the heart.
 ATRIOVENTRICULAR VALVES (AV VALVES) – located at the entrance

of the ventricles; 2 AV Valves
a) TRICUSPID VALVE - composed of three cusps or flaps and is located between the
right atrium and the right ventricle
b) BICUSPID VALVE (MITRAL VALVE) - composed of two cusps or flaps and is
located between the left atrium and the
left ventricle
 CHORDAE TENDINAE - anchor the AV valve flaps to papillary muscles within the
ventricles
CHORDAE TENDINAE
HEART VALVES
 SEMILUNAR VALVES – located at the exit of each ventricle at the beginning of the
great vessels
a) PULMONIC VALVE - located at the entrance of the pulmonary artery as it exits

the right ventricle
b) AORTIC VALVE - located at the beginning of the ascending aorta as it exits the
left ventricle
HEART COVERINGS and HEART WALLS
 PERICARDIUM - a tough, inextensible, loose-fitting, fibroserous sac that

attaches to the great vessels and, thereby, surrounds the
heart
 EPICARDIUM - the outer surface of the heart

 MYOCARDIUM – thickest layer of the heart and is made up of
contractile muscle cells
 ENDOCARDIUM - thin layer of endothelial tissue that forms the innermost
layer of the heart and is continuous with the endothelial
lining of blood vessels
 PARIETAL PERICARDIUM - serous membrane lining that secretes a small

amount of pericardial fluid that allows for
smooth, friction-free movement of the heart
ELECTRICAL CONDUCTION OF THE HEART
CARDIAC CYCLE
 the generation and conduction of electrical impulses by specialized sections of
the myocardium regulate the events associated with the filling and emptying of
the cardiac chambers
CARDIAC MUSCLE CELLS

 have a unique inherent ability. They can spontaneously generate an electrical
impulse and conduct it through the heart.
PATHWAYS
SINOATRIAL NODE (SA NODE or SINUS NODE) – 1st

 located on the posterior wall of the right atrium near the junction of the
superior and inferior vena cava
 generates impulse of 60 to 100 per minute
 they are conducted over both atria, causing them to contract simultaneously
and send blood into the ventricles.
ATRIOVENTRICULAR NODE (AV NODE) – 2nd

 located in the lower interatrial septum; slightly delays incoming electrical impulses
from the atria
ATRIOVENTRICULAR BUNDLE (BUNDLE OF HIS) -3rd

 located in the upper interventricular septum
 has a electric discharge of 40 to 60 per minute
PATHWAYS
PURKINJE FIBERS – 4th

 located in the myocardium of both ventricles
ELECTRICAL ACTIVITY
 electrical impulses, which are generated by the SA node and travel throughout
the cardiac conduction circuit, can be detected on the surface of the skin
ECG – ELECTROCARDIOGRAM – a procedure that records the heart’s

electrical activity through repeated cardiac
cycle; depolarization and repolarization
DEPOLARIZATION - contraction
REPOLARIZATION - relaxation
ELECTRICAL ACTIVITY
P WAVE - “ATRIAL DEPOLARIZATION” ; originates from SA node conduction of the impulse throughout
the atria
PR INTERVAL - Time from the beginning of the atrial depolarization to the

beginning of ventricular depolarization
QRS WAVE - “VENTRICULAR DEPOLARIZATION” ; conduction of the impulse throughout the Bundle
of His
ST SEGMENT - period between ventricular depolarization and the beginning of ventricular repolarization
T WAVE - “VENTRICULAR REPOLARIZATION” ; resting phase after the ventricular contraction
QT INTERVAL - total time for ventricular depolarization and repolarization, that is, from the beginning of
the Q wave to the end of the T wave
U WAVE - may or may not be present; if it is present, it follows the T wave and represents the final phase of
ventricular repolarization
CARDIAC CYCLE
 refers to the filling and emptying of the heart’s chambers. This has 2 phases:
 DIASTOLE - relaxation of the ventricles, known as filling

 SYSTOLE - contraction of the ventricles, known as emptying
DIASTOLE
VENTRICULAR DIASTOLE - AV valves are open and ventricles are relaxed

EARLY or PROTODIASTOLIC FILLING - blood rushes through the atria into the ventricles in an
early, rapid, passive filling; producing the S3 SOUND
from a rapid passive filling to a slow passive filling
PRESYSTOLE or ATRIAL SYSTOLE or ATRIAL KICK - atria contracts and complete emptying
of blood from the atrias happen by propelling it to the ventricles; producing the S4 SOUND
CARDIAC CYCLE
SYSTOLE
When is the beginning and end of SYSTOLE?
Since the ventricles are now filled with blood, the AV valves close, producing the S1
SOUND.
If the ventricles are now filled with blood, the ventricles has higher pressure than the
atrias. This high pressure causes ventricles to contract and the Aortic Valve and
Pulmonic Valve to open
If these valves open, emptying of blood in the ventricles happen
If the ventricles are now emptied, pressure falls and this semilunar valves close,
producing the S2 SOUND. - this is also the end of systole
HEART SOUNDS
 produced by valve closure
 normal heart sounds, characterized as “LUB DUBB” (S1 and S2)
NORMAL HEART SOUNDS
S1 sound / “LUB” - AV valves closing

 heard best at the apex
usually heard as one sound but may be heard as two sounds

HEART SOUNDS
NORMAL HEART SOUNDS
S2 sound / “DUBB” - Semilunar valves closing

 heard best at the base of the heart
usually heard as one sound but may be heard as two sounds

HEART SOUNDS
EXTRA HEART SOUNDS
 S3 (ventricular gallop) and S4 (atrial gallop) sounds - referred to as diastolic

filling sounds or extra heart sounds, which result from ventricular vibration
secondary to rapid ventricular filling
 S3 can be heard early in diastole after S2 ; S4 is heard late in diastole just

before S1.
HEART SOUNDS
MURMURS
 these are turbulent blood flow in which a swooshing or blowing sound may be
auscultated over the precordium
a) increase blood viscosity - hypertension
b) structural valve defects REGURGITATION

STENOSIS
c) valve malfunction ATRESIA
d) abnormal chamber openings - ASD or VSD
CARDIAC OUTPUT
 this is the amount of blood pumped by the ventricles during a given

period of time (usually 1 min) and is determined by the stroke volume
(SV) multiplied by the heart rate (HR)
SV x HR = CO
 The normal adult cardiac output is 5 to 6 L/min

NECK VESSELS
VESSELS OF THE NECK
a. CAROTID ARTERY
b. JUGULAR VEINS
CAROTID ARTERY PULSE

 located in the groove between the trachea and the right and left
sternocleidomastoid muscles; slightly below the mandible
 they supply the neck and head, including the brain, with oxygenated blood
 because it is close to the heart, the pressure wave pulsation coincides closely
with ventricular systole
 good for assessing amplitude and contour of the pulse wave
 should normally have a smooth, rapid upstroke that occurs in early systole and
a more gradual downstroke
NECK VESSELS
JUGULAR VENOUSE PULSE and PRESSURE
 two sets of jugular veins: INTERNAL and EXTERNAL
INTERNAL - lie deep and medial to the sternocleidomastoid muscle

EXTERNAL - more superficial; they lie lateral to the sternocleidomastoid muscle
and above the clavicle
 jugular veins return blood to the heart from the head and neck by way of the
superior vena cava
 assessment of the jugular venous pulse is important for determining the

hemodynamics of the right side of the heart
a. increased jugular venous pressure - possibly a right sided heart failure

b. decreased jugular venous pressure - possibly reduced left ventricular output or reduced volume

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HEART and

 PULMONARY ARTERY - exits the right ventricle, bifurcates, and carries

 PULMONARY VEIN - return blood to the left atrium

 VENTRICLES – thick walled; pumps blood out of the heart;

LEFT VENTRICLE is thicker than RIGHT

 ATRIOVENTRICULAR VALVES (AV VALVES) – located at the entrance

a) PULMONIC VALVE - located at the entrance of the pulmonary artery as it exits

 PERICARDIUM - a tough, inextensible, loose-fitting, fibroserous sac that

 EPICARDIUM - the outer surface of the heart

 PARIETAL PERICARDIUM - serous membrane lining that secretes a small

the cardiac chambers

CARDIAC MUSCLE CELLS

SINOATRIAL NODE (SA NODE or SINUS NODE) – 1st

ATRIOVENTRICULAR NODE (AV NODE) – 2nd

ATRIOVENTRICULAR BUNDLE (BUNDLE OF HIS) -3rd

PURKINJE FIBERS – 4th

ECG – ELECTROCARDIOGRAM – a procedure that records the heart’s

PR INTERVAL - Time from the beginning of the atrial depolarization to the

T WAVE - “VENTRICULAR REPOLARIZATION” ; resting phase after the ventricular contraction

 DIASTOLE - relaxation of the ventricles, known as filling

VENTRICULAR DIASTOLE - AV valves are open and ventricles are relaxed

from a rapid passive filling to a slow passive filling

When is the beginning and end of SYSTOLE?

If these valves open, emptying of blood in the ventricles happen

 produced by valve closure

 normal heart sounds, characterized as “LUB DUBB” (S1 and S2)

NORMAL HEART SOUNDS

S1 sound / “LUB” - AV valves closing

usually heard as one sound but may be heard as two sounds

NORMAL HEART SOUNDS

S2 sound / “DUBB” - Semilunar valves closing

usually heard as one sound but may be heard as two sounds

EXTRA HEART SOUNDS

 S3 (ventricular gallop) and S4 (atrial gallop) sounds - referred to as diastolic

 S3 can be heard early in diastole after S2 ; S4 is heard late in diastole just

a) increase blood viscosity - hypertension

b) structural valve defects REGURGITATION

 this is the amount of blood pumped by the ventricles during a given

 The normal adult cardiac output is 5 to 6 L/min

VESSELS OF THE NECK

CAROTID ARTERY PULSE

JUGULAR VENOUSE PULSE and PRESSURE

 two sets of jugular veins: INTERNAL and EXTERNAL

INTERNAL - lie deep and medial to the sternocleidomastoid muscle

 assessment of the jugular venous pulse is important for determining the

a. increased jugular venous pressure - possibly a right sided heart failure

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