cardiovascular anatomy and physiology afams residency orientation april 16, 2012 armed forces...

Cardiovascular Anatomy and Physiology

AFAMS Residency OrientationApril 16, 2012

ARMED FORCES ACADEMY OF MEDICAL SCIENCES

Heart Facts• Human heart is 13 x 9 cm• Weighs about 1 kg• Beats 100, 000 times a day• Pumps 7600 L of blood

daily• Circulates blood

completely about 1000 x a day

• Pumps blood through 100,000 km of vessels

• Cardiovascular Death is most common cause of death worldwide


Purpose of Cardiovascular System

• Deliver blood to tissues and organs– Nutrients– Oxygen

• Remove used blood from organs and tissues– Deoxygenated

hemoglobin• Deliver deoxygenated

blood to lungs for re-oxygenation


Cardiac Anatomy


Cardiac Anatomy: Chambers

• Right Atrium (RA)– Receives deoxygenated blood from

venous circulation– Pumps blood to RV

• Right Ventricle (RV)– Receives deoxygenated blood from

RA– Pumps deoxygenated blood to

lungs• Left Atrium (LA)

– Receives oxygenated blood from pulmonary vein

– Pumps blood to LV• Left Ventricle (LV)

– Receives oxygenated blood from LA

– Pumps oxygenated through aorta to body


Gross Anatomy


Cardiac Anatomy: Valves

• Classification– A-V valves

• Tricuspid– Separates RA and RV

• Mitral– Separates LA and LV

– Systemic Valves• Aortic

– Separates LV and Aorta

• Pulmonic– Separates RV and

Pulmonary artery


Aortic Valve Mitral Valve

Cardiac Anatomy: Outflow

• Pulmonary Artery– Arising from Right

Ventricle (RV)– Blood from RV to lungs

• Aortic Arch– Arising from Left Ventricle

(LV)– Blood from LV to body


Normal Regional Circulation


Cardiac Anatomy: Coronary Arteries

• Left Main (LM)• Left Anterior Descending

(LAD)– Septal Perforating Branches– Diagonal Branches

• Left Circumflex (LCx)– Obtuse Marginals

• Right Coronary Artery (RCA)– Acute Marginals– Posterior Descending– Posterior Lateral Branch


Coronary Anatomy


LAO Caudal View LAO Cranial View

OM1

LM

RCA

D1LCx

LADLM

PLB

PDA

Left Ventricular Volumes

• End Diastolic Volume (EDV)– Volume of blood in LV

and end diastole– Directly proportional to

venous return• End Systolic Volume

(ESV)– Volume of blood in LV at

the end of systole (contraction)



• Stroke Volume (SV)– EDV - ESV

• Ejection Fraction (EF)– SV/EDV– Normal resting EF: 60%

• Best predictor of heart performance and heart disease prognosis

– Normal exercising EF: 80%


Cardiology Physiology• Cardiac Output (CO)

– HR x SV• Cardiac Index (CI)

– CO / BSA• Preload

– Volume of blood in the left ventricle at end diastole

– Dependent upon venous return and compliance of left ventricle

• Afterload– Amount of resistance the heart

has to overcome to pump blood forward

• Mean Arterial PressureARMED FORCES ACADEMY OF MEDICAL

SCIENCES

Cardiology Physiology

• Myocardial Contractility – Amount of force with

which the heart contracts at a given preload

– Dependent upon• Sympathetic Nerve activity• Catecholamines• Myocardial mass• Drugs


Contractility

• Increased Cardiac Contractility– Exercise: increased sympathetic tone– Catecholamines: epinephrine and norephinephrine– Excitement / Fear: Fight of flight response– Drugs: Digitalis and sympathomimetics

• Decreased Cardiac Contractility– Loss of Contractile Mass: Secondary to myocardial

infarction– Myocardial muscle disease: Cardiomyopathy– Drugs: anesthetics and barbituates


Starling Curve• In a normal heart

– Increasing preload (EDV or EDV) increases SV

– Increasing contractility increases stroke volume at a constant preload


Definitions• Systolic Blood Pressure (SBP):

blood pressure in brachial artery during systole

• Diastolic Blood Pressure (DBP): blood pressure in brachial artery during diastole

• Mean Arterial Pressure (MAP): average blood pressure against the walls of the aorta throughout a complete cardiac cycle– MAP = [(2 x DBP) + SBP] / 3


Vascular Anatomy


Abdominal Blood Supply

Importance:• Surgical Procedures• Renal Artery Stenosis• Embolic Events to the

GI tract• Watershed areas• Differential diagnosis of

abdominal organ failure• Nutritional Implications


Abdominal Blood Supply


Vascular Anatomy of the Neck

Importance:• Central Venous Access

– Internal Jugular Vein– Subclavian Vein

• Stroke– Carotid artery

arteriosclerosis


Neck Arteries


Veins of the Neck


Arteries of the Brain

Importance:• Localizing site of stroke• Watershed areas• Localizing site of

aneurysm• Importance of

understanding cerebral perfusion




3D MRI with Gadolinium

Gross Anatomy of Circle of Wilis

Arm Vasculature

Importance:• Placement of peripheral

IVs• Central Venous

Catheters– Brachial vein

• Placement of radial arterial line


Arm Vasculature


Lower Extremity Vascular Anatomy

• Importance:• Central Venous

Catheter– Femoral Vein

• Arterial Line– Femoral Arterial

• Localizing Peripheral Arterial Disease



• Angiogram of Peripheral arterialDisease

CFA: Common femoral arteryDFA: Deep Femoral ArterySFA: Superficial Femoral Artery


STENT

Conclusions

• Presentation was brief overview of the cardiovascular system

• Understanding vascular anatomy important for every doctor

• Cardiovascular Disease is leading cause of death


cardiovascular anatomy and physiology afams residency orientation april 16, 2012 armed forces...

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