Gross Anatomy (pp.674-683)

1. Cardiovascular system overview
   1.   Pulmonary circuit
   • Served by right heart
   • Supplies blood to pulmonary alveoli only
   • Serves for O₂ loading and CO₂ unloading
   2.   Systemic circuit
   • Served by left heart
   • Supplies blood to all organs
   • Delivers oxygen and nutrients; removes CO₂
2. Heart overview
   1.   Location
   2.   Base and apex
3. Pericardium
   1.   Parietal pericardium
   2.   Visceral pericardium
   3.   Pericardial cavity and fluid
4. Heart wall
   1.   Epicardium, myocardium, and endocardium
   2.   Fibrous skeleton
5. Chambers
   1.   Right and left atria
   2.   Right and left ventricles
   3.   Atrioventricular (coronary) sulcus
   4.   Interventricular sulci
   5.   Interatrial and interventricular septa
   6.   Trabeculae carneae
6. Valves
   1.   Semilunar valves
   • Pulmonary semilunar (right)
   • Aortic semilunar (left)
   • Three pocketlike cusps
   2.   Atrioventricular (AV) valves
   • Tricuspid (right)
   • Bicuspid or mitral (left)
   • Chordae tendineae
   • Papillary muscles
   3.   Operation of AV and semilunar valves
   4. Blood flow through heart chambers
7. Blood flow through myocardium
   1.   Left coronary artery
   • Anterior interventricular artery
   • Circumflex artery
   2.   Right coronary artery
   • Posterior interventricular artery
   • Marginal artery
   3.   Arterial anastomoses
   4.   Venous drainage
   • Great cardiac vein (anterior)
   • Middle cardiac vein (posterior)
   • Coronary sinus
   5.   Coronary perfusion
8. Development of the heart
   1.   Evolution
   • Importance of double circulation
   • Importance of separate ventricles
   2.   Embryology
   • Endothelial tube fusion; heart tube
   • Flexion into U and S shape
   • SA node development from sinus venosus

Cardiac Muscle and the Cardiac Conduction System (pp.683-685)

1. Structure of cardiac muscle
   1.   Short branching cells
   2.   Scanty sarcoplasmic reticulum
   3.   Numerous large mitochondria
   4.   Intercalated discs
   • Interdigitating folds of membrane
   • Desmosomes
   • Gap junctions (electrical synapses)
   5.   Behavior as a functional syncytium
2. Metabolism of cardiac muscle
   1.   Variety of energy substrates
   2.   Fatigue resistance
   3. Myogenic control and autorhythmicity
3. Cardiac conduction system
   1.   Sinoatrial (SA) node–pacemaker
   2.   Atrioventricular (AV) node
   3.   Atrioventricular bundle
   4.   Right and left bundle branches
   5.   Purkinje fibers

Electrical and Contractile Activity of the Heart (pp.686-691)

1. Systole and diastole
2. The cardiac rhythm
   1.   Normal sinus rhythm
   2.   Ectopic foci
   3.   Nodal rhythm
3. Physiology of SA node
   1.   Production of the pacemaker potential
   2.   Production of the action potential
   3.   Influence of vagal tone
4. Impulse conduction to the myocardium
   1.   Route of the conduction pathway
   2.   Variations in conduction speed
5. Electrical behavior of the myocardium
   1.   Stable RMP of –90 mV
   2.   Opening of voltage-regulated Na+ gates
   3.   Positive feedback cycle and depolarization
   4.   Action potential peaks at +30 mV
   5.   Ca²⁺ release from Sr
   6.   Opening of slow Ca²⁺ channels; influx from ECF
   7.   Plateau of 200 to 250 msec
   8.   Sustained contraction
   9.   Long absolute refractory period
6. Electrocardiogram
   1.   P wave: atrial depolarization
   2.   P–Q segment: atrial systole
   3.   QRS complex
   • Ventricular depolarization
   • Atrial repolarization
   4.   S–T segment: ventricular systole
   5.   T wave: ventricular repolarization

Blood Flow, Heart Sounds, and the Cardiac Cycle (pp.691-695)

1. The cardiac cycle–definition and major phases
2. Principles of pressure and flow
   1.   Measurement of pressure
   2.   Pressure gradients and flow
   3.   Relationship to heart valve operation
3. Heart sounds S1 to S3
4. Phases of cardiac cycle
   1.   Quiescent period (late diastole)
   • All chambers relaxed
   • AV valves open
   • Ventricles fill to 70% of EDV
   2.   Atrial systole
   • SA node fires and atria depolarize, producing P wave of ECG
   • Atrial systole adds 30% of EDV
   3.   Isovolumetric contraction
   • Ventricles depolarize, producing QRS complex of ECG
   • Ventricular systole
   • Ventricular pressure AV valves close; semilunar valves remain closed
   • Heart sound S1
   • No blood ejected
   4.   Ventricular ejection
   • Ventricular pressure > arterial pressure
   • Semilunar valves open
   • Rapid and reduced ejection
   • Stroke volume (SV) about 70 mL
   • Ejection fraction = SV/EDV
   • End-systolic volume (ESV) remains
   5.   Isovolumetric relaxation
   • Ventricular repolarization, producing T wave of ECG
   • Ventricular diastole
   • Semilunar valves close
   • Heart sound S2
   • No ventricular filling
   6.   Ventricular filling
   • Atrial pressure > ventricular pressure
   • AV valves open
   • Rapid ventricular filling
   • Slower ventricular filling (diastasis)
   • Atrial systole
5. Representative volume changes
   1.   End-systolic volume (ESV), 60 mL
   2.   End-diastolic volume (EDV), 130 mL
   3.   Stroke volume (SV), 70 mL
   4.   Importance of balanced output
   • Left failure and pulmonary congestion
   • Right failure and systemic congestion

Cardiac Output (pp.696-699)

1. Cardiac output (CO)
   1.   Definition: mL/min ejected by each ventricle
   2.   CO = heart rate x stroke volume
   3.   Cardiac reserve
   4.   Chronotropic and inotropic agents
2. Heart rate
   1.   Normal rates relative to age and sex
   2.   Tachycardia and bradycardia
   3.   Effects of autonomic nervous system
   • Cardiac center of medulla oblongata
   • Input from other parts of brain
   • Input from peripheral receptors
     • Proprioceptors
     • Chemoreceptors
     • Baroreceptors
   4.   Cardioacceleratory center and sympathetic afferents
   5.   Cardioinhibitory center and parasympathetic (vagal) afferents
   6.   Chronotropic effects of chemicals
   • Epinephrine and norepinephrine
   • Thyroid hormone
   • Electrolytes
3. Stroke volume
   1.   Preload
   • Role of venous return
   • Frank-Starling law of the heart
   2.   Contractility and inotropic agents
   • Calcium ions
   • Epinephrine and norepinephrine
   • Glucagon
   • Digitalis
   • Negative inotropic agents
   3.   Afterload-resistance to ventricular ejection
4. Exercise and cardiac output

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