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ANATOMY AND PHYSIOLOGY OF THE CARDIOVASCULAR SYSTEM

HEART

LOCATED ON THE DIAPHRAGM

NEAR THE MIDLINE OF THE THORACIC CAVITY

HEART  LOCATED ON THE DIAPHRAGM  NEAR THE MIDLINE OF THE THORACIC CAVITY

The heart=a muscular double pump with 2 functions

Overview

The right side receives oxygen- poor blood from the body and tissues and then pumps it to the lungs to pick up oxygen and dispel carbon dioxide Its left side receives oxygenated blood returning from the lungs and pumps this blood throughout the body to supply oxygen and nutrients to the body tissues

Heart’s position in thorax

In mediastinum – behind sternum and pointing left, lying on the diaphragm It weighs 250-350 gm (about 1 pound)

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Feel your heart beat at apex
Feel your heart beat at apex

(this is of a person lying down)

Location and Surface Projection

The heart is hollow, cone-shaped, about the size of a closed fist . Lies in the mediastinum between the lungs and rests upon the diaphragm Two-thirds of its mass lies to the left of the midline Apex - lower, pointed end Base - broader, superior portion

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Heart’s position in thorax

Heart’s position in thorax 9

Layers of Heart Wall

Pericardium - membrane (sac) that surrounds and protects the heart, it has two layers:

(a) Fibrous pericardium - superficial layer, tough, inelastic, prevents overstretching, provides protection, and anchors the heart in place (b) Serous pericardium - deeper layer, thin; (i) parietal layer - fused to the fibrous pericardium, and (ii) visceral layer (or epicardium) adheres to the heart itself Pericardial cavity (between the two layers) is filled with pericardial fluid which reduces friction.

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Layers of Heart Wall

Layers of Heart Wall 11

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PERICARDIUM

12 PERICARDIUM
 FIBROUS:THIN INELASTIC, DENSE IRREGULAR CONNECTIVE TISSUE ---HELPS IN PROTECTION, ANCHORS HEART TO MEDIASTINUM 

FIBROUS:THIN INELASTIC, DENSE IRREGULAR CONNECTIVE TISSUE

---HELPS IN PROTECTION, ANCHORS HEART TO MEDIASTINUM

SEROUS: THINNER, MORE DELICATE DIVIDED INTO PARIETAL AND VISCERAL

EPICARDIUM : COMPOSED OF MESOTHELIUM AND DELICATE CONNECTIVE TISSUE (IMPARTS A SLIPPERY TEXTURE TO THE OUTER SURFACE OF THE HEART).

: COMPOSED OF MESOTHELIUM AND DELICATE CONNECTIVE TISSUE (IMPARTS A SLIPPERY TEXTURE TO THE OUTER SURFACE

MYOCARDIUM :RESPONSIBLE FOR PUMPING

ENDOCARDIUM : THIN LAYER OF ENDOTHELIUM WHICH IS CONTINOUS WITH THE LINING OF THE LARGE BLOOD VESSELS ATTACHED TO THE HEART.

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CHAMBERS OF THE HEART

CHAMBERS OF THE HEART

Chambers of the heart

Two atria

Right atrium

Left atrium

the heart  Two atria  Right atrium  Left atrium

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Two ventricles

Right ventricle

Left ventricle

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 Two ventricles  Right ventricle  Left ventricle 17

Chambers of the heart

divided by septae:

Two atria-divided by

interatrial septum

Right atrium

Left atrium

Two ventricles-divided by

interventricular septum

Right ventricle

Left ventricle

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 Left atrium  Two ventricles- divided by interventricular septum  Right ventricle  Left ventricle

Myocardial Thickness and Function

The atria are thin-walled as they deliver blood under less pressure The ventricles have thick walls since they pump blood at a higher pressure and over greater distances The right and left ventricles eject equal amounts of blood The left ventricle is thicker because it pumps under higher pressure and over a greater distance than the right ventricle (Fig. 14.4c)

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ATRIOVENTRICULAR & SEMILUNAR VALVES

ATRIOVENTRICULAR & SEMILUNAR VALVES

Heart Valves - Atrioventricular

The four valves prevent backflow of blood in the heart after blood passes through them Atrioventricular (AV) valves

- tricuspid valve between the right atrium and the right ventricle

atrium

- bicuspid (mitral) valve - between the left

and the left ventricle Chordae tendineae and associated papillary muscles permit flow but prevent backflow

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Heart Valves - Semilunar

Two semilunar (SL) valves each having three semilunar cusps Allow ejection of blood from the ventricles into the pulmonary trunk and aorta Prevent backflow of blood into the heart Pulmonary valve - between the pulmonary trunk and the right ventricle Aortic valve - between the aorta and the left ventricle

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SYSTEMIC AND PULMONARY CIRCULATION

LEFT SIDE IS A PUMP TO THE SYSTEMIC CIRCULATION. RIGHT SIDE IS A PUMP TO THE PULMONARY CIRCULATION.

CIRCULATION  LEFT SIDE IS A PUMP TO THE SYSTEMIC CIRCULATION.  RIGHT SIDE IS A

Circulation of Blood

The heart pumps blood into two circuits arranged in series (connected end to end) Systemic circulation - left side of heart receives oxygenated blood from the lungs Pumps this blood into the aorta which branches into systemic arteries that carry blood to all organs except alveoli of the lungs Arteries branch into arterioles and eventually into systemic capillaries where nutrients, gases, wastes, etc. are exchanged with the surrounding cells; venules and subsequently systemic veins return the deoxygenated blood to the right atrium

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Circulation of Blood

Pulmonary circulation - the right ventricle pumps blood into the pulmonary trunk which branches into the pulmonary arteries This blood goes to the pulmonary capillaries where the blood becomes oxygenated Pulmonary veins carry the oxygenated blood to the left atrium

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Coronary (Cardiac) Circulation

Two coronary arteries, the left and right coronary arteries branching from the ascending aorta supply the myocardium Left coronary artery divides into the anterior interventricular branch (or left anterior descending artery) and the circumflex branch Right coronary artery divides into the posterior interventricular branch and marginal branch

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Coronary Arteries

30 Coronary Arteries

Cardiac Conduction System

Sinoatrial (SA) node - the heart’s natural pacemaker, initiates each heartbeat Other components of of the conduction system include:

Atrioventricular (AV) node, Atrioventricular bundle or bundle of His, right and left bundle branches, Purkinje fibers The nervous system and certain hormones can alter the pace of contractions but the nervous system does not initiate contractions

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Electrical conduction system: specialized cardiac muscle cells that carry impulses throughout the heart musculature,

Electrical conduction system:

specialized cardiac muscle cells that carry impulses throughout the heart musculature, signaling the chambers to contract in the proper sequence

Conduction system

SA node (sinoatrial)

In wall of RA

Sets basic rate: 70-80

Is the normal pacemaker

Impulse from SA to atria Impulse also to AV node via internodal pathway AV node

In interatrial septum

Conduction continued

SA node through AV bundle (bundle of His)

Into interventricular septum

Divides

R and L bundle branches

become subendocardial branches (“Purkinje fibers”)

Contraction begins at apex

Divides R and L bundle branches become subendocardial branches (“Purkinje fibers”)  Contraction begins at apex

CARDIAC CYCLE

ATRIAL SYSTOLE

LASTS FOR 0.1 SEC ATRIAL DEPOLARIZATION CAUSES ATRIAL SYSTOLE IT CONTRIBUTES A FINAL 25mL OF BLOOD TO EACH VENTRICLE END OF ATRIAL SYSTOLE IS ALSO END OF VENTRICULAR DIASTOLE END-DIASTOLIC VOLUME IS 130 mL

TO EACH VENTRICLE  END OF ATRIAL SYSTOLE IS ALSO END OF VENTRICULAR DIASTOLE  END-DIASTOLIC

VENTRICULAR SYSTOLE

LASTS FOR 0.3 SEC IT IS CAUSED BY VENTRICULAR DEPOLARIZATION ISOVOLUMETRIC CONTRACTION LASTS FOR 0.05 SECONDS WHEN BOTH THE SEMILUNAR AND ATRIOVENTRICULAR VLAVES ARE CLOSED.

 ISOVOLUMETRIC CONTRACTION LASTS FOR 0.05 SECONDS WHEN BOTH THE SEMILUNAR AND ATRIOVENTRICULAR VLAVES ARE CLOSED.

THE SL VALVES OPEN WHEN -THE LEFT VENTRICULAR PRESSURES SURPASSES AORTIC PRESSURE(80 MM OF MERCURY) -THE RIGHT VENTRICULAR PRESSURE RISES ABOVE PULMONARY PRESSURE (20 mmHg)

SL VALVES OPEN FOR 0.25 SEC

THE LEFT VENTRICLE EJECTS ABOUT 70 ML INTO THE AORTA THE RIGHT VENTRICLE EJECTS THE SAME VOLUME INTO THE PULMONARY TRUNK. END SYSTOLIC VOLUME IS 60mL IN EACH VENTRICLE .

HEART SOUNDS

PRODUCED FROM BLOOD TURBULENCE CAUSED BY CLOSING OF HEART VALVES S1 – ATRIOVENTRICULAR VALVE CLOSURE S2 – SEMILUNAR VALVE CLOSURE S3- RAPID VENTRICULER FILLING S4- ATRIAL SYSTOLE

VALVE CLOSURE  S2 – SEMILUNAR VALVE CLOSURE  S3- RAPID VENTRICULER FILLING  S4- ATRIAL

CARDIAC OUTPUT

CO

=

mL/min

SV

X HR

mL/beat

(Beats/min)

FOR A RESTING ADULT

CO = 70mL/beat x75beats/min

= 5250 mL/min

= 5.25 L/min

CO = mL/min SV X HR mL/beat (Beats/min)  FOR A RESTING ADULT CO = 70mL/beat
HEMODYNAMIC MONITORING OF HEART

HEMODYNAMIC MONITORING OF HEART

HEMODYNAMIC MONITORING OF HEART
HEMODYNAMIC MONITORING OF HEART
CVP

CVP

CVP

PAP

PAP

SWAN-GANZ CATHETER

SWAN-GANZ CATHETER
SWAN-GANZ CATHETER

INSERTION OF CATHETER

INSERTION OF CATHETER

CHEST X RAY

CHEST X RAY

MRI

MRI
MRI
TRADE MILL STRESS TESTING

TRADE MILL STRESS TESTING

TRADE MILL STRESS TESTING
TRADE MILL STRESS TESTING

BRONCHOSCOPY

BRONCHOSCOPY
PFT  SPIROMETERY

PFT

SPIROMETERY

PFT  SPIROMETERY
PFT  SPIROMETERY
PFT  SPIROMETERY

ECG

ECG
ECG
ECG
ECG
ECG
ECG
ECG
ECG
ECG

OTHER BLOOD TEST

OTHER BLOOD TEST
OTHER BLOOD TEST
OTHER BLOOD TEST

PACEMAKER

PACEMAKER

PACEMAKER LOCATION

PACEMAKER LOCATION

DEFIBRILLATORS

THANK YOU

THANK YOU