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Chapter: Clinical Anesthesiology: Anesthetic Management: Cardiovascular Physiology & Anesthesia

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Physiology & Anesthesia: The Heart

Although anatomically one organ, the heart can be functionally divided into right and left pumps, each consisting of an atrium and a ventricle.

The Heart

Although anatomically one organ, the heart can be functionally divided into right and left pumps, each consisting of an atrium and a ventricle. The atria serve as both conduits and priming pumps, whereas the ventricles act as the major pumping chambers. The right ventricle receives systemic venous (deoxygenated) blood and pumps it into the pulmonary circulation, whereas the left ventricle receives pulmonary venous (oxygenated) blood and pumps it into the systemic circulation. Four valves normally ensure unidirectional flow through each chamber. The normal pumping action of the heart is the result of a complex series of electrically driven and mechanical events. Electrical events precede mechanical ones.

The heart consists of specialized striated muscle in a connective tissue skeleton. Cardiac muscle can be divided into atrial, ventricular, and specialized pacemaker and conducting cells. The self-excitatory nature of cardiac muscle cells and their unique organization allow the heart to function as a highly efficient pump. Serial low-resistance connections (intercalated disks) between individual myocardial cells allow the rapid and orderly spread of depolar-ization in each pumping chamber. Electrical activity readily spreads from one atrium to another and from one ventricle to another via specialized conduction pathways. The normal absence of direct connections between the atria and ventricles except through the atrioventricular (AV) node delays conduction and enables atrial contraction to prime the ventricle.

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