the heart 2., subsystems - anat.lf1.cuni.czanat.lf1.cuni.cz/souhrny/alekls0402.pdf · the heart...
TRANSCRIPT
![Page 1: The Heart 2., subsystems - anat.lf1.cuni.czanat.lf1.cuni.cz/souhrny/alekls0402.pdf · The Heart –2., subsystems: Vessels, Nerves, Conduction System & Topography • Coronary arteries](https://reader030.vdocuments.us/reader030/viewer/2022040712/5e157c827fe4c3083277c636/html5/thumbnails/1.jpg)
The Heart – 2., subsystems:Vessels, Nerves, Conduction System
& Topography
• Coronary arteries
• Cardiac veins
• Lymphatics
• Sympathetic nerves
• Parasympaticus
• Pacemaking &
Conducting system
• TopographyDavid Sedmera
Charles University
First Faculty of Medicine
Institute of Anatomy
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Surface of the Heart
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Some histology - epicardium
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A bit of histology - endocardium
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Some more histology – AV valve
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Overview of Blood Supply
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The Blood Supply: Origin
Left
coronary
artery
Right
coronary
artery
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The Blood Supply: Course
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The Blood Supply: X-ray - right
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The Blood Supply: X-ray - left
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Review: Coronary Arteries and
Veins
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Review: Coronary Arteries and
Veins
Left coronary artery:
-anterior interventricular
branch
--diagonal branch
-circumflex branch
--obtuse marginal branch
Right coronary artery:
-artery to SA node
-acute marginal branch
-posterior interventricular
branch
Great cardiac vein
Left oblique atrial vein (of
Marshall) => coronary sinus
Middle cardiac vein (with
posterior interventricular
branch)
Small cardiac vein
Anterior cardiac veins (to
right atrium)
Thebesian veins
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The Lymphatic Drainage
Along the blood vessels
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The Blood Supply: Troubles...
Stenosis of the anterior
interventricular ramus of
the left coronary artery
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The Blood Supply: Solution !?
PTCA:Percutaneous
Transluminar
Coronary
Arterioplasty
Via catheter with balloon
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The Innervation
Parasympathetic: n. X (vagus) - rr. cardiaci
Stimulation slows down the rate (S-A node), conduction
(A-V node) and decreases force of contraction (via
coronary vasoconstriction).
Sympathicus comes from C and T region via cardiac plexus
together with coronary arteries - nn. cardiaci
Stimulation increases heart rate (S-A node), shortens A-V
delay, increases force of contraction (directly) and dilates
coronary arteries. Afferent fibers carry pain (MI).
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The Innervation
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The Innervation
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The Conduction System
S-A node
(Internodal tracts)
A-V node
His bundle
Left and Right
bundle branches
Purkinje fibers
Working myocardium
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Electrical insulation
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AV node and Bundle Branches
LBB RBB
Triangle of Koch: delimited by the venous valve->the
tendon of Todaro and the anulus of the tricuspid valve.
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Tawara: ventricular conduction system
Septum
Ventricular walls
Purkinje fibers
Left bundle
branches
Tawara (1906)
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GFP:Cx40 labeling of conduction system
Septum
Ventricular walls
Purkinje fibers
Left bundle
branches
Lucille Miquerol, IBDM, Marseille
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Position of the Heart in the Chest
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Position of the Heart 2. X-Ray
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Position of the Heart 2. X-Ray
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Position of the Heart 2. X-ray
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Position of the Heart 2. MRI
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Position of the Heart 2. MRI
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Syntopy of the heart - CT
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Projection and auscultation
points of cardiac valves on
body surface
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Projection on the body surface
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Movements with respiration
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Position in differently shaped chests
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The Pericardium
• Parietal pericardium
• Pericardial fluid
• Visceral pericardium
(epicardium)
• fat
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Heart in the pericardial cavity
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Pericardial cavity
with the heart removed
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Pericardial Cavity & Sinuses
• Transverse sinus
• Oblique sinus
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X
Transverse and oblique
pericardial sinus
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Hydropneumopericardium
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Development of the pericardium
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Development of the pericardium
Pericardium gives rise to:
-cardiac fibroblasts
-coronary smooth muscle
-subepicardial fat
Coronary endothelium
-derived from the liver
sinusoids
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References
• Čihák: Anatomie 3.
• Told: Anatomical atlas
• Netter: Anatomical atlas
• Anderson a Becker: Cardiac Anatomy
• Grant’s Dissector
• Original research & review papers