The Heart

By
Carlos Suárez-Quian, Ph.D.
• Mediastinum, dfn
• Coronary circulation
• Heart: Structure & Function
Mediastinum: Anterior View
Lungs Remnants of thymus
Int. thoracic art.

Heart R. Lung in pleural Pericardium

cavity
 Mediastinum: Sagittal Plane
Superior Mediastinum
SVC
Brachiocephalic v.
Arch of aorta
Thoracic duct Inferior
Trachea
Esophagus
Thymus
Vagus n.
L. recurrent laryngeal n.
Posterior
Phrenic n.
Esophagus
Middle Thoracic aorta
Anterior Pericardium Azygos
Thymus Heart Hemiazygos
Lymph nodes Roots of great vessels Vagus n.
Connective tissue Arch azygos v. Symphathetic trunks
Main bronchii Splanchnic nerves
Physiological Systems
 Peter Houghton
1938-2007, was the longest surviving
artificial heart transplant patient in the UK

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
 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
Serous
pericardium • Fused to tunica
adventitia of great
vessels
Parietal layer
• Bound to central tendon
Visceral layer of diaphragm
• Attached to posterior
surface of sternum
• Function: Protects heart
against sudden over
filing
Potential
space
Pericardial Sac Pathology

• Pericarditis:
(inflammation of
pericardium)
• Possible causes:
1. Virus
2. Bacteria (prophylaxis
treatment by dentists)
Cardiac Tamponade: Fluid or Blood
(Hemopericardium) accumulation in pericardial cavity

Patient is variable
degrees of shock or in
extremis Neck veins distended

Heart sounds distant

Venous pressure elevated
(pathognomonic)
Decreased arterial
& pulse pressures
often exist but not
pathognomonic Causes
• Ruptured aortic
aneurism
• Ruptured myocardial
infarct
Pericardial tap
at Larrey’s
• Penetrating injury
point
(diagnostic &
decom-
pressive)
Pericardiocentesis
Pericardiocentesis
 Cardiac Sinuses
Transverse Transverse
pericardial sinus pericardial sinus

Oblique
pericardial
sinus

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 Heart
Anterior Posterior

L. auricle
R. atrium L. atrium

Coronary
sulcus

Ant. & Post.

Interventricular
Grooves
R. auricle

R. ventricle L. ventricle
 Coronary Veins & Arteries
Sinuatrial node branch
Ant. cardiac v.
Great cardiac v.

L. coronary art.

Circumflex
R. coronary art. L.A.D.

Coronary
sinus

R. marginal
Small cardiac v. branch
Middle cardiac v.
Post. interventricular branch: Dominance of the
coronary arterial system is defined by which artery gives
rise to this branch.
 Left Coronary Arteriogram

Left coronary art.

Circumflex art.

catheter

Anterior interventricular art.

Right Coronary Anteriogram
Sinuatrial nodal art.

R. Coronary art.

catheter
Post. Interventricular art.
Coronary Artery Occlusion
 Coronary By-Pass Surgery
Grafting of Internal thoracic Artery Grafting of saphenous veins

R. coronary
L.A.D.

L.A.D

R. coronary

Plaques
Percutaneous
transluminal
angioplasty
Stents
 Right auricle
The Heart
Left atrium

R. atrium L. atrium
(receiving) (receiving)

Right ventricle

Right atrium R. ventricle L. Ventricle

(discharging) (discharging)
Left ventricle

Right ventricle
 Right Atrium

Musculi pectinati
Anterior wall

Crista terminalis

Fossa ovalis
Valve of coronary sinus
 Right Ventricle
Pulmonary trunk

Interventricular septum

Trabeculae carneae

Anterior cusp

Septomarginal trabecula
Tendinous cords (moderator band)

Anterior papillary muscle

 Left Ventricle
Orifice R. coronary art.
Post. cusp of aortic valve
Orifice L. coronary art.

Mitral valve cusps

Tendinous cords

Posterior papillary
muscle

Anterior papillary
muscle
Trabeculae carneae
Blood Flow Through Heart
 Cardiac Cycle
“dub”

“lub”
 Conduction System of Heart
Sinuatrial node
Atrioventricular node

Opening of coronary sinus

R. & L. bundle branches

Interventricular septum

Subendocardial branches
Ant. papillary muscle
(Purkinje fibers)

Moderator band
Conventional Chest Film

SVC
A Pa

Pt
RA

RV LV