The Heart By Carlos Suárez-Quian, Ph.D. • Mediastinum, dfn • Coronary circulation • Heart: Structure & Function
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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
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