DR.M. ZAFAR QURESHI
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