1 cardiovascular system heart dr.kumar.k.v 04.01.2011
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CARDIOVASCULAR SYSTEM
HeartDr.kumar.k.v04.01.2011
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Functions of the Heart Center of the cardiovascular system, the heart. Connects to blood vessels that transport blood
between the heart and other body tissues. arteries carry blood away from the heart veins carry blood back to the heart
Arteries carry blood high in oxygen. (except for the pulmonary arteries)
Veins carry blood low in oxygen. (except for the pulmonary veins)
Arteries and veins entering and leaving the heart are called the great vessels.
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Pulmonary and Systemic Circuits The pulmonary circuit consists of the
chambers on the right side of the heart (right atrium and ventricle) as well as the pulmonary arteries and veins. conveys blood to the lungs via
pulmonary arteries to reduce carbon dioxide and replenish
oxygen levels in the blood Blood returns to the heart in pulmonary
veins
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Pulmonary and Systemic Circuits Blood returns to the left side of the
heart, where it then enters the systemic circuit.
The systemic circuit consists of the chambers on the left side of the heart (left atrium and ventricle), along with all the other named blood vessels. carries blood to all the peripheral organs
and tissues of the body
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Pulmonary and Systemic Circuits Oxygenated blood from the left side of the
heart is pumped into the aorta the largest systemic artery in the body then into smaller systemic arteries.
Gas exchange in tissues occurs from capillaries.
Systemic veins then carry deoxygenated blood (high in carbon dioxide) and waste products.
Most veins merge and drain into the superior and inferior venae cavae
drain blood into the right atrium. There, the blood enters the pulmonary circuit,
and the cycle repeats .
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Anatomy of the Heart Relatively small, conical organ approximately
the size of a person’s clenched fist. it weighs about 250 to 350 grams
Located left of the body midline posterior to the sternum in the middle mediastinum.
Rotated such that its right side or border (right atrium and ventricle) is located more anteriorly, while its left side or border (left atrium and ventricle) is located more posteriorly.
Located in the middle mediastinum
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Anatomy of the Heart The posterosuperior surface of the heart, formed
primarily by the left atrium, is called the base. The pulmonary veins that enter the left atrium
border this base. The inferior, conical end is called the apex.T,9cm
from the he apex is the extreme left part of the left atrium located at the fifth intercostal space ,9cm from the midline of the sternum
It projects slightly anteroinferiorly toward the left side of the body.
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Pericardium Fibrous and serous sac
Contains the heart In the middle mediasdtinum mediastinum Held in place by connective tissue
The external wall of the great vessels’ superior to the heart
diaphragm inferior.
Restricts heart movements Prevents the heart from overfilling with
blood.
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Pericardium Outer portion
tough, dense connective tissue called the fibrous pericardium. attached to both the sternum and the
diaphragm Inner portion
thin, double-layered serous membrane called the serous pericardium.
parietal layer visceral layer
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FIBROUS PERICARDIUM
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Pericardium seen after the removal of the heart
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PERICARDIAL SINUS
• Dilated pericardial cavities located in two areas of the pericardial cavity
• Transverse sinus located between pulmonary trunk and aorta in the front and superior venacava behind
• Oblique sinus –enlarged cavity located just behind the left atrium ,that is between the four pulmonary veins. The arteries can be tied during cardiac surgery using the transverse sinus
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Pericardial cavity
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• Pericardial sack :The cavity is a potential space between the outer fibrous and inner viscera layer. The amount of pericardial fluid within the cavity is about 15-50ml which lubricate the pericardial surfaces to avoid friction.Pericarditis is the inflammation of the pericardium whereby increase amount of fluid accumulate and this may restrict diastole and filling capacity of the heart .This clinical condition known as TAMPONADE
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Heart Wall Structure Three distinctive layers:
external epicardium middle myocardium internal endocardium
Epicardium outermost heart layer also known as the visceral layer of serous pericardium. Simple squamous epithelium underlined by fat
As we age, more fat is deposited in the epicardium
this layer becomes thicker and more fatty.
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Heart Wall Structure Myocardium
middle layer of the heart wall composed chiefly of cardiac muscle tissue. thickest of the three heart wall layers. lies deep to the epicardium and
superficial to the endocardium Endocardium
covers internal surface of the heart and the external surfaces of the heart valves
thin endothelium areolar CT under the endothelium
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External Anatomy of the Heart Chambers:
four hollow chambers: two smaller atria two larger ventricles.
Atria thin-walled, located superiorly. anterior part of each atrium is a wrinkled, flaplike
extension called an auricle Atria receive blood through both circulatory circuits.
right atrium receives blood from the systemic circuit left atrium receives blood from the pulmonary circuit
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External Anatomy of the Heart Blood that enters an atrium is passed to
the ventricle on the same side of the heart.
Ventricles the inferior chambers. Two large arteries, the pulmonary trunk and
the aorta exit the heart at the basal surface. The pulmonary trunk carries blood from
the right ventricle into the pulmonary circuit.
The aorta conducts blood from the left ventricle into the systemic circuit
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External Anatomy of the Heart Atria are separated from the ventricles
externally by coronary sulcus (or atrioventricular sulcus) extends around the circumference of the
heart. On both the anterior and posterior
surfaces of the heart, the anterior interventricular sulcus and the posterior interventricular sulcus are located between the left and right ventricles.
These sulci extend inferiorly from the coronary sulcus toward the heart apex.
SURFACES AND BORDERS Sterno costal surface: formed
mainly the right ventricle and partly by the left ventricle
Diaphragmatic surface(inferior):formed by the right and left ventricles
Right border: by the superior vena cava and the right atrium
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Surface ,bordersSurface ,borders Left border formed by the left ventricle Apex also formed by the left ventricle
at the 5th left intercostals space Base :or the Posterior surface is formed
by the left atrium groove or line :formed between
Coronary sulcus:the the atria and the ventricles
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Internal Anatomy of the Heart There are four heart chambers:
right atrium right ventricle left atrium left ventricle
Each plays a role in the continuous process of blood circulation.
Valves permit the passage of blood in one direction and prevent its backflow.
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Right Atrium Receives venous blood
from the systemic circuit from the heart muscle itself.
Three major vessels empty into the right atrium: superior vena cava (SVC)
drains blood from the head, upper limbs, and superior regions of the trunk
inferior vena cava (IVC) drains blood from the lower limbs and trunk
coronary sinus drains blood from the heart wall The interatrial septum forms a wall between
the right and left atria.
INTERIOR OF RIGHT ATRIUM Left atrium has the entry of
svc,ivc,coronary sinus(vein),venaecordis minimae,anterior cardiac veins
Fossa ovalis: located in the interatrial septum is the closed part of the fetal foramen ovale which shunts oxygenated blood from the right to left atrium .after birth foramen ovale closes down to form the fossa ovalis
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RIGHT ATRIUM Posterior wall smooth due to the
tentry of ivc and svc Anterior wall is rough due the
presence of muscular ridges called as Musculus pectinati(comb like)
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Right Atrioventricular (AV) Valve Separates the right atrium from the right
ventricle. Also called the tricuspid valve.
has three triangular flaps Venous blood flows from the right atrium,
through the valve into the right ventricle. Is forced closed when the right ventricle
begins to contract preventing blood backflow into the right
atrium
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Right Ventricle Receives deoxygenated venous blood
from the right atrium. An interventricular septum forms a wall
between the right and left ventricles. Papillary muscles
on the internal wall surface cone-shaped, muscular projections anchor chordae tendineae
attach to the cusp of the right AV valve and prevent everting and flipping into the atrium when contracting
RIGHT VENTRICLE
Trabacula cornae are irregular muscular ridges seen within both ventricles.
Papillary muscles are special modified conical ridges ,connected to valves.
Moderator bands are ridges connected between interventricular septum to the anterior papillary muscle ,which conducts impulses for contraction
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Pulmonary Trunk At its superior end it narrows into a
smooth-walled, conical region called the conus arteriosus.
The pulmonary semilunar valve marks the end of the right ventricle and the entrance into the pulmonary trunk.
Pulmonary trunk divides shortly into right and left pulmonary arteries. carry deoxygenated blood to the lungs
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Semilunar Valves Located within the walls of both ventricles
immediately before the connection of the ventricle to the pulmonary trunk and aorta.
Composed of three thin, pocketlike semilunar cusps.
As blood is pumped into the arterial trunks, it pushes against the cusps
forcieg the valves open. When ventricular contraction ceases
blood is prevented from flowing back into the ventricles. causes the cusps to “inflate” and meet at the artery
center, effectively blocking blood backflow
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Left Atrium Once gas exchange occurs in the lungs, the
oxygenated blood travels through the pulmonary veins to the left atrium.
Smooth posterior wall of the left atrium contains openings for approximately four pulmonary veins.
two left pulmonary veins two right pulmonary veins
Has pectinate muscles along its anterior wall as well as an auricle.
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Left Atrioventricular (AV) Valve Separates the left atrium from the left ventricle. Also called the bicuspid valve or the mitral
valve. Left AV valve has chordae tendineae similar to
those of the right AV valve. Oxygenated blood flows from the left atrium into
the left ventricle. Is forced closed when the left ventricle begins to
contract prevents blood backflow into the left atrium
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Left Ventricle Largest of the four heart chambers. Wall is typically three times thicker than the
right ventricular wall. Requires thick walls in order to generate
enough pressure to force the oxygenated blood from the lungs into the aorta and then through the entire systemic circuit.
right ventricle only has to pump blood to the nearby lungs
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Left Ventricle Trabeculae carneae in the left ventricle are
more prominent. Two large papillary muscles attach to the
chordae tendineae that help support the left AV valve.
At the superior end of the ventricular cavity, the aortic semi lunar valve marks the end of the left ventricle and the entrance into the aorta.
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Conduction System of the Heart – Sinoatrial (SA) Node Heartbeat is initiated by the cardiac
muscle fibers of the sinoatrial (SA) node. located in the posterior wall of the right atrium,
adjacent to the entrance of the superior vena cava
Act as the pacemaker. rhythmic center that establishes the pace for
cardiac activity Initiates impulses 70 - 80 times per
minute.
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Heart Sounds
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Innervation of the Heart Innervated by the autonomic nervous
system. Consists of both sympathetic and
parasympathetic components. referred to as the coronary plexus
Autonomic innervation by autonomic centers in the hindbrain doesn’t initiate heartbeat, but it can increase or decrease the heartbeat.
Rich innervation to SA and AV nodes, but also to myocardial cells.
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Parasympathetic Innervation Parasympathetic innervation
decreases heart rate, but tends to have no effect on the force of contractions, except in special circumstances
comes off of the medulla oblongata via right and left vagus nerves (CN
X)
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Coronary Circulation Left and right coronary arteries travel in the
coronary sulcus (atrioventricular groove) of the heart to supply the heart wall.
the only branches of the ascending aorta Located immediately superior to the aortic
semilunar valve. The right coronary artery typically branches
into the marginal artery
supplies the right border of the heart posterior interventricular artery
supplies both the left and right ventricles
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Left coronary artery typically branches into the anterior interventricular artery. also called the left anterior descending artery supplies the anterior surface of both ventricles
and most of the interventricular septum Circumflex artery.
supplies the left atrium and ventricle Arterial pattern can vary greatly among
individuals.
LEFT CORONARY ARTERY
RIGHT CORONARY ARTERY .Originates from the right aortic sinus. Travels in the coronary sulcus and
divides into Marginal,which supplies the inferior border upto the apex.
The main branch continues to the inferior (diaphragmatic) surface as the POSTERIOR INTERVENTRICULAR branch.
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RIGHT DOMINANCE(90%) IN 90% of the individuals the
posterior interventricular branch is from the right coronary artery and supply more area of the myocardium.
This is known as Right Dominance. The r.c.a also supplies SA
node,Avnode,right atria and ventricle
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LEFT DOMINANCE(10%) If the posterior interventricular
branch is from the LCA( 10%).The left artery supplies the left atrium, left ventricle. and anterior 80% present area of the interventricular septum.
Left dominance occur only in 10% of the individuals.
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CORONARY SINUS(VEIN)
• Mainly formed by three major veins.• Great cardiac vein which lies in the anterior
interventricular groove.• Middle cardiac vein: located in the posterior
interventricular groove.• Small cardiac vein: placed in the right
margin.• All three veins together forms the coronary
sinus which drains into the right atrium.64
BALOON ANGIOPLASTY
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