浙江大学医学院：心脏（PPT讲稿）The Heart

The heart Gregory Shen(沈啸),MD Department of physiology Room 516, Research Building C School of Medicine, Zijingang Campus Email:shen@zju.edu.cn

The Heart Gregory Shen (沈啸), MD Department of Physiology Room 516, Research Building C School of Medicine, Zijingang Campus Email: shenx@zju.edu.cn 1

Functions of the heart umping(泵血) Endocrine(内分泌) Atrial natriuretic peptide(ANP) Other bioactivators Atrial di stenson Sympathetic sti mul ation Angiotensin Il ANp NEP Degradation ↓ Aldosterone 」svR 」c ↓ Renin Arterial Blood Pressureˇ Volume Natriuresis- D Abbreviations: ANP, atrial natriuretic peptide: NEP, neutral peptidase: GFR, glomerular filtration rate CVP, central venous pressure co, cardiac output; SVR, systemic vascular resistance

Functions of the heart • Pumping（泵血） • Endocrine（内分泌） – Atrial natriuretic peptide (ANP) – Other bioactivators

Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display Arteries to head and arms ight p ry artery Right pulmonary veins Left pulmonary arte Superior vena cava Left pulmonary atrial septum Pulmonary trunk Left atrium Left(bicuspid) AV valve Right atrium Aortic semilunar valve Right AV (tricuspid) valve Left ventricle Papillary muscle Inferior vena cava Interventricular septum Chordae tendineae Myocardium Right ventricle Epicardium Pericardial fluid/space Pulmonary Pericardium semilunar valve

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Copyright@ The McGraw-Hill Companies, Inc. Permission required for reproduction or display (a Pulmonary semilunar valve Valve partly open arteries Aortic semilunar valve Left AV(bicuspid)- valve Right AV (tricuspid) Valve almost completely close From R Carola. J P, Harley, and C, R. Noback, Human Anatomy and Physiology, McGraw Hill, New York, 1990(photos by Dr. Wallace McAlpine). Valves of the heart

Valves of the heart 4

Pulmonary trunk Pulmonary arteries The general route of the blood Capillaries of lungs hrough the body is shown Pulmonary veins including passage through the heart (colored box Pulmonary valve Left atrium To Body Right ventricle Left AV valve From Body X Right AV valve Left ventricle Right atrium Aortic valve >To L To Lung From From→ Lung Aorta Lung Arteries Arterioles Capillaries engles From bod Veins Vena cavae

The general route of the blood through the body is shown, including passage through the heart (colored box). 5

Cardiac muscle The major types of cardiac muscle Atrial muscle Contractile cells (收缩细胞) Ventricular muscle Specialized excitatory and conductive Autorhythmic cells muscle (自律细胞)

• The major types of cardiac muscle: – Atrial muscle – Ventricular muscle – Specialized excitatory and conductive muscle Contractile cells （收缩细胞） Autorhythmic cells （自律细胞） Cardiac muscle 6

Cardiac muscle metabolism At rest, cardiac muscle consumes fatty acids to supply most of its energy (70% fatty acids vs. 30% carbohydrates Under fasting state, almost all of the energy comes from fatty acid oxidation Under anaerobicor ischemic conditions, glycolysis is required which consumes tremendous amounts of blood glucose and forms large amount of lactic acids

Cardiac muscle metabolism • At rest, cardiac muscle consumes fatty acids to supply most of its energy (70% fatty acids vs. 30% carbohydrates). • Under fasting state, almost all of the energy comes from fatty acid oxidation. • Under anaerobic or ischemic conditions, glycolysis is required, which consumes tremendous amounts of blood glucose and forms large amount of lactic acids. 7

Conducting system of the heart Copyright e The McGraw-Hill Companies, Inc. Permission required for reproduction or display perior Atrioventricular node vena cava Bundle of His Sinoatrial node Left atrium Right atrium Right bundle branch ventricle Right ventricle fibers Inferior vena cava Interventricular Left bundle branch 8

Conducting system of the heart 8

Innervation Parasympathetic Innervation Sympathetic Innervation (cholinergic: Vagus nerves) (adrenergic) Acetylcholine Norepinephrine B1 adrenergic receptor M acetylcholine receptor Epinephrine Adrenal gland Kidney

Innervation Norepinephrine β1 adrenergic receptor M acetylcholine receptor Acetylcholine Kidney Adrenal gland Epinephrine 9

Cardiac cells gap junction Cardiac cells are electrically coupled through gap junctions. Is an electrical synapse that permits electrical current to flow between neighboring cells Gap junctions Myocatdial cells

Cardiac cells’ gap junction • Cardiac cells are electrically coupled through gap junctions. • Is an electrical synapse that permits electrical current to flow between neighboring cells. . 10