05 the heart

The HeartBy

Carlos Suárez-Quian, Ph.D.

• Mediastinum, dfn

• Coronary circulation

• Heart: Structure & Function

Mediastinum: Anterior ViewRemnants of thymus

PericardiumHeart

Lungs

R. Lung in pleuralcavity

Int. thoracic art.

Mediastinum: Sagittal PlaneSuperior MediastinumSVCBrachiocephalic v.Arch of aortaThoracic ductTracheaEsophagusThymusVagus n.L. recurrent laryngeal n.Phrenic n.

Inferior

AnteriorThymusLymph nodesConnective tissue

MiddlePericardiumHeartRoots of great vesselsArch azygos v.Main bronchii

PosteriorEsophagusThoracic aortaAzygosHemiazygosVagus n.Symphathetic trunksSplanchnic nerves

Physiological Systems

Peter Houghton

My heart is fixed, O God, my heart is fixed: I will sing and give praise.-- Psalms 57:7

The heart has its reasons which reason knows nothing of.-- Blaise Pascal

Nobody has ever measured, even poets, how much a heart can hold.-- Zelda Sayre Fitzgerald

Everybody's at war with different things. . . . I'm at war with my own heart sometimes.-- Tupac Shakur

As a man thinks in his heart, so is he.-- Proverbs 23:7

1938-2007, was the longest surviving artificial heart transplant patient in the UK

Heart Disease Facts• One in five males and females has some form of cardiovascular

disease

• Congenital and acquired diseases of the heart are the leading causes of morbidity and mortality in the U.S. and other developed countries

• There are approximately one million deaths per year in the U.S. due to heart disease of some form

• Since 1900, CVD has been the number one killer in the U.S. every year except 1918

• CVD claims almost 10,500 more lives each year than the next six leading causes of death combined

• 90% of sudden death fatalities (approximately 460,000 per year) are due to heart disease

• Approximately 75% of all sudden cardiac deaths occur in men

• 90% of victims are males between the ages of 45-64

• Approximately 15,000 hearts are needed annually for transplantation, but only about 1-2,000 are available

Problems with Heart Disease

• Estimated that 60,800,000 Americans have one or more types of cardiovascular disease (CVD)

• High blood pressure – 50,000,000

• Coronary artery disease – 12,400,000

• Myocardial infarction – 7,300,000

• Angina pectoris – 6,400,000

• Stroke – 4,500,000

• Congenital cardiovascular defects – 1,000,000

• Congestive heart failure – 4,700,000

Pericardial Sac

Fibrous pericardium

• Fused to tunica adventitia of great vessels

• Bound to central tendon of diaphragm

• Attached to posterior surface of sternum

• Function: Protects heart against sudden over filing

Parietal layer

Visceral layer

Serous pericardium

Potentialspace

Pericardial Sac Pathology

• Pericarditis: (inflammation of pericardium)

• Possible causes:

1. Virus

2. Bacteria (prophylaxis treatment by dentists)

Neck veins distended

Patient is variable degrees of shock or in extremis

Heart sounds distant

Venous pressure elevated (pathognomonic)

Decreased arterial & pulse pressures often exist but not pathognomonic

Pericardial tap at Larrey’s point (diagnostic & decom-pressive)

Causes• Ruptured aortic

aneurism

• Ruptured myocardial infarct

• Penetrating injury

Cardiac Tamponade: Fluid or Blood (Hemopericardium) accumulation in pericardial cavity

Pericardiocentesis

Pericardiocentesis

Cardiac SinusesTransversepericardial sinus

Transversepericardial sinus

Oblique pericardialsinus

Location of transverse pericardial sinus is exploited during coronary by-pass surgery. Surgical clamp is introduced into the space and blood flow of aorta and pulmonary trunk stopped momentarily before great vessels are connected to bypass machine.

Inspection of HeartAnterior Posterior

Ant. & Post.InterventricularGrooves

Coronary sulcus

R. atrium

R. ventricle L. ventricle

L. auricle L. atrium

R. auricle

Coronary Veins & Arteries

Great cardiac v.

Middle cardiac v.Small cardiac v.

Coronary sinus

Ant. cardiac v.

L. coronary art.

R. coronary art.

Sinuatrial node branch

R. marginalbranch

Post. interventricular branch: Dominance of the coronary arterial system is defined by which artery gives rise to this branch.

Circumflex

L.A.D.

Left Coronary Arteriogram

Anterior interventricular art.

Circumflex art.

catheter

Left coronary art.

Right Coronary Anteriogram

catheter

Sinuatrial nodal art.

R. Coronary art.

Post. Interventricular art.

Coronary Artery Occlusion

Coronary By-Pass SurgeryGrafting of Internal thoracic Artery Grafting of saphenous veins

Plaques

L.A.D

R. coronary

R. coronaryL.A.D.

Percutaneous transluminal angioplasty

Stents

The Heart

R. atrium(receiving)

L. atrium(receiving)

R. ventricle(discharging)

L. Ventricle(discharging)

Right atrium

Left atrium

Left ventricle

Right ventricle

Right ventricle

Right auricle

RA

LA

LVRV

RA

LA

LVRV

Right Atrium

Fossa ovalis

Valve of coronary sinus

Crista terminalis

Musculi pectinatiAnterior wall

Right Ventricle

Anterior papillary muscle

Tendinous cords

Septomarginal trabecula(moderator band)

Trabeculae carneae

Interventricular septum

Pulmonary trunk

Anterior cusp

Left Ventricle

Trabeculae carneae

Posterior papillary muscle

Anterior papillarymuscle

Tendinous cords

Mitral valve cusps

Post. cusp of aortic valve

Orifice L. coronary art.

Orifice R. coronary art.

Blood Flow Through Heart

Cardiac Cycle“dub”

“lub”

Conduction System of HeartSinuatrial node

Atrioventricular node

Opening of coronary sinus

R. & L. bundle branchesInterventricular septum

Moderator band

Ant. papillary muscleSubendocardial branches(Purkinje fibers)

Conventional Chest Film

RA

RV LV

A

Pt

Pa

SVC