DR.M. ZAFAR QURESHI

INTRODUCTION

Cardiovascular system comprises of Heart Arteries Veins Capillaries

INTRODUCTION

Heart is a muscular organ & functions as a pump.

Works in conjunction with lungs & vascular system

Functionally two hearts & one lung Blood from venous system Rt side of

heart to lungs via pulm. trunk back to Lt side of heart via pulm. veins To the entire body via aorta back to venous system

LOCATION

Middle mediastinum

1/3 lies on the rt & 2/3 on the left of median point of sternum.

Second to fifth rib

Skeleton of the heart

It is formed by fibrous rings around the valves

It gives origin to the whorls of the cardiac muscle

It keeps the heart valves in an un collapsible state

It acts as an insulator for the spread of electrical stimulus b/w atria & ventricles

FEATURES OF HEART

Conical Hollows organs. Situated in the middle mediastinum

enclosed with in pericardium. Placed obliquely behind the body of

sternum and adjoining part of costal cartilages.

1/3 of heart lies to the right and 2/3 to the left of median plane of sternum.

Heart Measures about 12x9 cm or 5x3 inches (volume/ circumference) and weight about 300g in males and 250g in females.

4 chambers 2 atria

2 ventricles 4 Borders

Upper border Lower or inferior Right border Left border

Formed by border formed formed by formed by

2 atria mainly by right right artium. Mainly Left

Left. Ventricle. ventricle

& partly left

aricle.

Circulation of blood through heart

4 SURFACES

Anterior Inferior surface Posterior surface left surface

surface (Base) left ventricle & (left Ventricle)

formed by left atrium

Right atrium fommed by left atrium

& Rt ventricle). & small part of Rt atrium

.

AN APEX (LEFT VENTRICLE)( In 5th intercostal space just inner to mid-

clavicular line )3 GROOVS OR SULCI

Atrio ventrienlar Inter atrial Inter ventricular

(coronary) groove. groove.

ATRIO VENTRICULARGROOVE CIRCULAR SULCUS WHICH LODGES.

Coronary Small Coronary

Sinus. Cardiac arteries.

vein.

It obliterated interiorly by ascending aorta and pulmonary trunk.

INTER ATRIAL GROOVE:- Faintly visible posteriorly while anteriorly it

is hidden by the aorta and pulmonary trunk.

ANTERIOR INTER VENTRICULAR GROOVE:-

Near to the left margin of the heart.

It contain anterior inter ventricular branch of the left coronary artery and great cardiac vein.

Lower end of groove separates apex from rest of the inferior border of the heart.

POSTERIOR INTER VENTRICULAR:-

(i) Is situated on the diaphragmatic (inferior) surface of the heart.

(ii) It lodges posterior inter ventricular branch of the right coronary artery and middle cardiac vein.

(iii)Two (post & ant) inter ventricular grooves meet at the inferior border near the apex, the incisura apices cordis.

FEATURES OF RT ARTIUM:- From Rt border, Sternocostal surface & part of base of heart. Elongated chamber. Receiving sup & I.V.C. Interior is sponge like & prevent free flow of blood and favours

thrombosis. These thrombi when disloged during auricular fibrillation cause

pulmonary embolism. Suleus terminalis is a shallow vertical groove along right

border b/w sup & I.V.C. It is produced by an internal muscular ridge called crista terminalis.

The upper part of suleus termanalis contains (SA) sinoatrial node which act as the pace makes of the heart.

Left atrium lies behind the right atrium.

TRIBUTARIES (INLETS) OF RT ARTIUM:-

(i) S.V.C. ( gaurded eustachian valve) rudimentry.

(ii) I.V.C. ( Gaurded eustachian valve) rudimentry.

(iii) Coronary sinus ( Gaurded by Thebasian valve)

(iv) Anterior cardiac veins.(v) Venae cordis minimi( Thebasian vessels)(vi) Some time Rt marginal veins. OUT LETS OF RT ARTIUM:- (i) Tricuspid valve.(ii) Venae cordis mininmae (numerous mall pits

in all 4 chambers more on right sides to ensure blood supply i.e why M.I. more common on left side.)

Interior of right atrium is DIVIDED INTO 2 PARTS

(A) Smooth posterior Rough anterior Part (sinous venarum) part or Pectinate or

Auricle

(A)SMOOTH PART (POSTERIOR)OR SINUS VENARUM

Derived from right horn of sinus venosus Coronary sinus opens b/w I.V.C. and right

atrioventricular openings & guarded by valve of coronary sinus (Thebasian valve).

Venae cordis minimae are numerous small pits, in all four chambers & opens through foramina venarum minimarum. These are more numerous on right side ensuring better blood supply to the myocardium than that on left side that is why M.I. is more common on left side than right.

Intervenous tubercle of lower is a very small projection, visible on the posterior wall of Rt atrium just blow the opening of S.V.C.

During embryonic life it directs the superior caval blood to the right ventricle

(B)ROUGH ANTERIOR PART

PECTINATE PART (AURICLE) Devlopmentally derived from Primitive

atrial chamber. It presents a series of transverse muscular

ridges called musculi pectinati. They raise from crista teaminalis and run forward and downward towards the atrioventricular orifice, giving appearance of teeth of comb.

Muscles in auricle are interconnected to form reticular network.

Septal wall

From the centeral part of posterior wall.

Developmentally derived from septum primum and septum secondum.

Present fossa ovalis, a shallow saucer –shaped depression, in the lower part, formed by septum primum.

RIGHT VENTRICLE (triangular chamber)

It form inferior border & large part of sernocostal surface and a small part of the diaphragmatic surface of heart.

It receives blood from right atrium and pumps it to the lungs.

Externally

Anterior (sternocostal ) Inferior (diaphragmatic)

has two surface

Interior

Inflowing part is rough Outflowing part or infundibulnm due to musclular ridges is smooth and form the upper called trabeculae carnae one inch conical part of right ventricledevelop from primitive which gives rise pulmonary trunk ventricle heart tube. ( develops from the bulbs cordis).

has 2 parts

MUSCLAR PARTof Rt ventricle

TRAECULEA CARNAE

Muscular ridges

Fixed elevation (muscular ridges)

Bridges c’ 2 endsFixed & free at Centre

Pillar (papillary muscles) one endconnected to ventricle wall &other c’cusps ofTricvsprid valve by chordaetendinae

Septomarginal trabecula (musclar ridges) contains right branch of bundle of his & prevents over distension of right ventricle.

Right ventricle is (cresent) shaped due to bulging of interventricular septum.

Wall of right ventricle is thinner than left ventricleRatio 1:3

Left atrium (feature)

Quadrangular chamber.

Situated posteriorly

Interiorly overlaped by right auricle.

FORMS

2/3 OF BASE OF HEART

GREATER PARTOF UPPERBORDER

STERNOCOSTAL& LEFT

SURFACE

PART OF LEFT BORDER

OF HEART

LEFT ATRIUM

Posterior surface from anterior wall of oblique sinus of pericardium.

Anterior wall from the interatrial septum. 2 pulmonary veins open on each side of posterior

wall. Greater part is smooth wall derived from the

absorption of pulmonary veins which open into it. Muscli pectinati (muscular part (rough ) present

only in the auricle. Septal wall shows fossa lunata correspond to

fossa ovalis of left atrium

TRIBUTARIES

4 pulmaryveins

Venal cordisminimi

Left ventricle ( features )

Receives qxygenated blood from left atrium.

From apex of heart.

Externally forms

(3 surfaces)

Anterior part form left surface forms most of left

Sternocostalborder

inferior surface forms 2/3 of left diaphragmatic surface of heart

Interior of left ventricle

-Lower rough part with -upper smooth part (aortic vestibule)

Trabeculae corae, Develops which gives origin to ascending aorta,

From primitive ventricle of develops from bulbus cordis.

Heart tube. -Vistibule lies between membranous

part of the inter ventricuar septum and

anterior (aortic) cusps of mitral valve.

2 orifices

Left A.V orifice (bicuspid)aortic orifice (guarded by

Mitral valveaortic valve) (tricuspid)

2 papillary muscles

Ant post

Both attached to cusps of mitral valve by chordae tendinae

-Wall of left ventricle is 3 time thicker then those of right ventricle.

Blood supply of heart

Supplied by 2 coronary arteries arises from ascending aorta

Right coronary artery left coronary-smaller than left -larger than right-origin=Int aortic sinus -origin=post

aortic sinus

BLOOD SUPPLY OF HEART

Right coronary branches

Large branches small branches

1-Marginal 1-Nodal in 60%2- Posterior 2-Right Atrial interventricular 3-

Infundibular4-Terminal

Left coronary branches

Large branches small branches1-Anterior ventricular 1-Left atrial2-Diaphragmatic 2-pulmonary

branches branches to 3-Terminal

branches Left venricle

Course Right C.A (course)

It passes forward & to the right to emerge b/w the root of pulmonary trunk and right auricle.2ndit runs downwards in the right anterior cornerary sulcus to the junction of the right and inferior border of heartNext it winds round and continuous in the posterior coronary sulcus upto the posterior interventicular groove.On entering the left coronary sulcus it terminates by anastomosing with the left coronary artery.

Left C.A. (course) It passes forward & to the

left to emerge b/w the pulmonary trunk and left auricle & gives interventricular branch which runs down in its groove & continuation of left coronary artery is called as circumflex artery

Then it runs towards the left anterior coronary sulcus

Next it winds round and continuous in the left posterior coronary sulcus upto close to posterior interventericular grooves where it terminate by anastomosing with right coronary artery

INTERNAL STRUCTURE OF HEART

Four chambers in the heart Rt atrium with rt auricle Rt ventricle Lt atrium with lt auricle Lt ventricle

INTERNAL STRUCTURE OF HEART

Rt atrium: Cuboidal

chamber, smooth (sinus venarum) & rough (musculi pectaniti) parts, four openings Rt auricle SVC IVC Coronary sinus

Rt ventricle Occupies most of the

ant surface Tapers above into conus

arteriorus which is the outflow part

Inside of the inflow part is rough due to trabeculae carnae

Tricuspid AV valve b/w rt atrium & rt ventricle It is crescent shaped in

cross section

Rt ventricleSmooth & rough parts are separated by

ridgeTricuspid valve has 3 cuspsWalls are 3 times thinner than lt ventEach has a free & attached marginFree margins are attached to papillary

muscles by cords like a parachute3 papillary muscles in rt vent The valve prevents backflow while

contracting

Interventricular septum Strong obliquely placed partition Upper part is membranous Rest is muscular & convex to the rt Pulmonary valve is at the apex of conus

art 3 semilunar cusps Valve closes during diastole to prevent

backflow

LT atrium Forms most of the base Receives opening of lt auricle Also receives 4 pulm veins Leads to lt ventricle through lt AV or Mitral

valve Mitral valve has 2 cusps Prevents backflow during systole

Circulation of blood through heart

Lt ventricle Forms the apex & pulm surface 3 times thicker walls Conical cavity Numerous muscles Out flow part is anterosuperior Aortic orifice lies at the summit of outflow

part It has 3 c Semilunar cusps to prevent backflow during

diastole

ARTERIAL SYSTEM

VENOUS SYSTEM

BLOOD SUPPLY OF HEART

Vasculature of the heart

Vessels are embedded in the fat just deep to the epicardium

Vessels receive both sympathetic & para sympathetic supply

Coronary arteries are the first branches from aorta

Vasculature of the heart

Arterial supply of heart

Rt coronary artery

Arises from rt aortic sinusDescends in the coronary grooveBranches

Rt atrialSA nodal branchRt marginal branch for the rt borderAV nodal branchPosterior interventricular branches

Area of supply of rt artery Rt atrium Most of rt ventricle Diaphragmatic part of rt ventricle Post third of IV septum SA node ( in 60 % people ) AV node ( in 80 % people )

Left coronary artery

Arises from lt aortic sinus Runs towards lt in the AV groove Branches

SA nodal branch Anterior interventricular branch Circumflex branch Lt marginal branch

Area of supply of lt artery

Lt atrium Most of the lt ventricle Part of rt ventricle Ant two third of IV septum SA node ( in 40 % people )

Vasculature of the heart

Vasculature of the heart

Dominence of the rt or lt side It depends on the posterior inter

ventricular branch Rt artery is dominant in75 % people Lt is dominant in 10 % Co-dominance in 15 %

Venous drainage of heart

Coronary sinus which drains most part of the heart via numerous small tributaries

Coronary sinus drains into the rt atrium

Small veins that drain directly into the rt atrium

Venous drainage of heart

Venous drainage

Tributaries of the coronary sinusGreat cardiac veinMiddle cardiac veinSmall cardiac veinsLt post ventricular veinLt marginal vein

MI & bypass grafting

PERICARDIUM:-

Fibrous Pericardium Serous Pericardium

Epicardium or Parietal

Visceral Pericardium Pericardium

FIBROUS PERICARDIUM (Deriud from septum transversum)

Def :-Conical , tough, fibers single layer sac

which support the delicate period layer of the serous pericardium & firmly adherent to it.

CHARACTERISTS OF FIBROUS PERICARDIUM1: Apex is blunt and fused with the roots

of the great vessels and the pericardium fascia behind the sternal angle.

2: Base is broad & lies on diaphragm and in seprably blended with the central of the diaphragm. But in lawer animal it is separated from diaphragm.

3: Anteriorly it is connected to the upper and lower ends of body of sternum by weak

4: Posteriory related to principal brochi oesophagus with nerve plexus around it, and desending thoracice aorta.

5: On each side (right & left) related to mediastinal pleura, mediastinal surface of the lung, pheremic nerve and pericardio phermic vessels.

SEROUS PERICARDIUM

(1)Perietal Visceral Pericardium

Pericardium (epicardium) (outer) (inner)

Double layer serous membrem line by mesothlium, having postential space known as pericardial cavity, containing thin layer (film) of serous fluid which lubericate the apposed during continuous heart beat

CONTENTS OF PERICARDIUM

1: Heart & cardiac vessels and nervous.2: Ascendimg aorta.3: Pulmonary Trunk4: lower ½ half of Superior Vena cava.5: Terminal parts of inferior vena cava.6: Terminal parts of 4 Pulmonary Veins.SINUES OF PERICARDIUM:

Oblique sinous of Transverse sinus of pericardium pericardium

TRANSVERSE SINUS:

B/w Areterial & Venous tubes i.e , arterial tubes eneloses the asending aorta and pulmonary trunk and the Venous tubes enelosed 2 venae cavac and 4 pulmonary Veins & the passage b/w arterial & Venous tubes is known as transverse sinus.

OBLIQUE SINUS OF PARICARDIUM:

A narrow gap behind stomach. It is bounded anteriorly by the left atrium and posteriory by the parietal pericardium.Functionally, since permits the Pulsatiom of left artium.

ARTERIAL SUPPLY:-Branches of:-(i) Internal thoracic of artery.(ii) Muscular pherenic artery.(iii) Desending thoracic aorta.

NERVE SUPPLY:-Fibrous & parietal percardia are pain

sensitive & Supplied by phrenie nerve Epicardium is supplied automatic nerves of the heart and pain insensitiue.

Pain of peri-carditis originates in the pericardium alone.

Pain of angina (cardiac pain) originates in the muscles of the vessels.

(1)CONTRICTIUE PERICARDITIS:

And pericarditis with effusion cause ‘cardiac temponad’ where the heart can not dilate freely. Heart is not filled properly and the cardiac output is diminshed. There is marked staris (Stagnation) of the venous blood in the whole body, neck veins are excessinely prominent, liver is enlarged and the pulse is feeble with a pulsus pericardium character. (Marked decerased during mspiration)

(2)PERICARDIUM IN TERMINAL URAEMIA)

(3) Pericardial effusion can be drained by puncturing in 5th-6th inter-costal space just lateral to the apex beat or in the angle b/w xiphoid process and left costal margin eith meedle direction upward & backward & to the left.

Pericardium

Double walled fibroserous sac Tough external fibrous layer Bound to diaphragm by

pericardiacophrenic ligament To sternum by sternipericardiac

ligament The internal surface is lined by

glistening serous membrane called the parietal layer

Pericardium

Pericardium

The serous layer is reflected on the heart as the visceral layer

It is closely adherent to cardiac muscle & is also called the epicardium

The fibrous pericardium protects the heart against sudden overfilling

It fuses with adventitia of all the great vessels

Pericardial cavity

Potential space Thin film of fluid Heart can move or beat without

friction Two sinuses present b/w the roots of

great vessels Transverse sinus Oblique sinus

Pericardial sinuses

Collection of fluid in the pericardial cavity

Pericardial effusion

Conducting system of heart Components Sinuatrial node Atrioventricular node Atrioventricular bundle Rt bundle branch Lt bundle branch Perkunji fibres

Conducting system

Conducting system

Conducting system

Conducting system of heart

Electrocardiograph