Heart.txt

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emm64
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107971
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Heart.txt
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2011-10-10 23:19:52
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Heart Gross anatomy
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Heart gross anatomy
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  1. Mediastinum
    • �rectangular� space in the thoracic cavity between the lungs and two pleural cavities.
    • Superior Mediastinum � superior t]oT4/T5 T1-T4.
    • Inferior Mediastinum -inferior to diaphram T5-T12.
    • Anterior Mediastinum � is anterior to the heart.(T5-T8)
    • Middle Mediastinum -the heart (and includes the pericardium, phrenic nerve, and pericardiacophrenic vessels). (T5-T8)
    • Posterior Mediastinum (T5-T12)
  2. pericardial cavity
    • formed by the two layers of the serous pericardium containing serous fluid.
    • oblique sinus and the transverse sinus. Posterior to the pericardial cavity are some of the structures of the posterior mediastinum: esophagus, descending aorta, & left vagus n.
  3. Pericardial Sac
    • posterior to the body of the sternum
    • comprised of two basic components: the fibrous pericardium and serous pericardium.
  4. Fibrous pericardium
    outer coating of fibrous connective tissue that coats the serous pericardium.
  5. Serous pericardium
    serous membrane (which secretes serous fluid) that has two parts: the parietal and visceral pericardium
  6. Parietal pericardium
    forms the wall of the pericardial sac (�parietum� means �wall�).
  7. Visceral pericardium
    covers the heart itself and cannot be separated from it (�viscus� means �organ�; �viscera� is the plural form). The visceral pericardium is also known as the �epicardium� of the heart.
  8. Pericardial cavity
    space between the parietal and visceral pericardium. It contains nothing except a thin layer of serous fluid.
  9. oblique sinus
    pericardial sinus, posterior superior aspect of the pericardial cavity. It forms a �blind pouch� behind the heart
  10. transverse sinus
    pericardial sinus between the great arteries and great veins of the heart.
  11. Right atrium
    • 1. Pectinate muscle - the "roughened muscle" on the inside of the atrium.
    • 2. Crista terminalis - is a crest formed between the pectinate muscle and the smooth muscle wall of the atrium.
    • 3. Fossa ovalis - is a "depression" in the interatrial wall. It is a remnant of the embryological structure called "the foramen ovale" (which shunted blood from the right atrium to left atrium).
    • 4. IVC valve- is a flap of tissue (valve) at the opening of the IVC into the right atrium.
    • 5. Coronary sinus valve - is a flap of tissue (valve) at the opening of the coronary sinus into the right atrium.
    • 6. Right auricle - is the "ear-like" extension of the right atrium.
  12. Right ventricle
    • 1. Papillary muscle � finger-like muscles which attach to tiny chordae tendinae
    • 2. Chordae tendineae � chord-like tendons which attach from the papillary muscles to the AV valves
    • 3. Trabeculae carneae � is the roughened, cavernous-like muscle of the ventricle
    • 4. Moderator band � is a band of tissue within the trabeculae carnae that transmits some of the right bundle branches to one of the papillary muscles.
    • 5. Tricuspid valve � (also known as the right AV valve) is a three leafed valve between the right atrium and right ventricle. It closes to prevent backflow of blood into the right atrium.
    • 6. Pulmonary valve � is the semilunar valve between the right ventricle and pulmonary trunk.
    • 7. Interventricular septum � is the wall that separates the right and left ventricles.
    • 8. Infundibulum � is the smooth, inverted cone-like narrowing of the right ventricle as it leads into the pulmonary trunk.
  13. Left Atrium
    fairly unremarkable in terms of features. It has a left auricle and the openings of the pulmonary veins.
  14. Left Ventricle
    • features are largely the same as the right ventricle.
    • 1. Papillary muscle � finger-like muscles which attach to tiny chordae tendinae
    • 2. Chordae tendineae � chord-like tendons which attach from the papillary muscles to the AV valves
    • 3. Trabeculae carneae � is the roughened, cavernous-like muscle of the ventricle
    • 4. Bicuspid valve � (also called the �mitral valve� or �left AV valve�) is a three-leafed valve between the left atrium and left ventricle. It closes to prevent backflow of blood into the left atrium.
    • 5. Aortic valve � is the semilunar valve between the left ventricle and aorta.
    • 6. Interventricular septum � is the wall that separates the right and left ventricles.
  15. AV valve system
    • tricuspid (or right AV btwn RA and RV) valve
    • bicuspid (mitral or left AV between LA and LV) valve.
    • This system has flat cusps, papillary muscles and chordae tendinae.
    • passive system � the valves are opened passively by blood flow
    • purpose of the papillary muscles & chordae tendineae is to tighten during ventricular contraction to keep the cusps in a closed position to prevent the backflow of blood into the atria. The papillary muscles & chordae tendinae DO NOT OPEN OR CLOSE THE VALVES.
  16. semilunar valve system
    • aortic valve (betwn LV and Aorta)
    • pulmonary valve (betwn RV and pulmonary trunk).
    • This system has pocket-like cusps & sinuses and no papillary muscles or chordae tendinae.
    • Characterized by pocket-like cusps and sinuses. The cusps are shaped like �half-moons� � hence the name �semilunar.�
    • The sinuses are spaces that are created between the cusps and the wall. Note that the coronary arteries originate in the sinuses of the aortic valve. When the cusps meet in the center, a thickening of tissue on each cusp comes together to form the nodule.
    • passive system � the valves are opened passively by blood flow. When blood flows from the ventricles into the aorta or pulmonary trunk, the cusps are pushed toward the walls and the valve opens. When blood tries to flow back into the ventricles, it flows into the sinuses � which forces the cusps to meet at the center � and the valve closes.
  17. Post-Natal Flow
    • Deoxygenated blood from the body flows into the right side of the heart, through the right atrium & right ventricle and into the pulmonary trunk and pulmonary arteries to the lungs (into the pulmonary circulation). Oxygenated blood from the lungs flows into the left side of the heart, through the left atrium & left ventricle and into the aorta to the rest of the body (into the systemic circulation.
  18. Fetal Blood Flow
    Before birth, the fetus needs a reduced blood flow to the lungs (since they aren�t functioning). So blood must be diverted from the right side to the left side of the heart. This is accomplished with two �shunts:� the foramen ovale and ductus arteriosus. The foramen ovale shunts blood from the right atrium into the left atrium. The ductus arteriosus shunts blood from the pulmonary trunk into the aorta. Since the blood coming to the fetus does not need to be detoxified by the liver, there is also a shunt (the ductus venosus) which allows blood to bypass the liver.
  19. After Birth Blood Flow
    these shunts (foramen ovale and ductus venosus) must close down in order for normal post-natal blood flow to occur. The foramen ovale closes and becomes the fossa ovalis. The ductus arteriosus closes down and becomes the ligamentum arteriosum. The ductus venosus closes down and becomes the
  20. Blood Supply to the Heart
    • right and left coronary arteries. These arteries originate from the right and left aortic sinuses (of the aortic valve).
    • The blood from the heart tissue is drained by the cardiac veins: the great, middle, and small cardiac veins.
    • Blood from these veins drains into the coronary sinus � which drains into the right atrium. The pattern of arteries and veins is variable. The classic pattern is described here.
  21. Coronary arteries
    • The heart itself is supplied by the right and left coronary arteries and their branches. The right coronary artery originates in the right aortic sinus. The left coronary artery originates in the left aortic sinus. The right coronary artery runs in the coronary sulcus (groove) between the atria and ventricles. The left coronary artery lies between the left auricle and pulmonary trunk
  22. right coronary artery
    • has two branches: the right marginal a. & posterior interventricular a.
    • 1. The right marginal a. runs along the inferior margin of the heart.
    • 2. The posterior interventricular a. runs in the posterior interventricular groove on the posterior aspect of the heart.
    • 3. Anastomosis - The right coronary a. may anastomose with the circumflex a. along the posterior surface of the heart.
  23. left coronary artery
    • has two branches: the circumflex a. & anterior interventricular a.
    • 1. The circumflex a. runs in the coronary sulcus (groove).
    • 2. The anterior interventricular a. runs in the anterior interventricular groove on
    • the anterior aspect of the heart.
    • 3. Anastomosis - the anterior interventricular a. may anastomose with the posterior
    • interventricular a. along the posterior surface of the heart.
  24. cardiac veins
    • The heart tissue is drained by the direct or indirect tributaries of the coronary sinus. The following veins are tributaries of the coronary sinus: small cardiac vein, middle cardiac vein, great cardiac vein, the oblique vein of the left atrium. The coronary sinus occupies the coronary sulcus and is formed by the coming together of the great cardiac v. and oblique v. of the l. atrium. There are some small anterior cardiac veins drain directly into the right atrium.
  25. Conduction System of the Heart -
    • The heart has its own internal conduction system which allows it to beat on its own.
    • The major components of the conduction system - are the SA node, AV node, the AV Bundle (of His), and Right & Left AV Bundles. These components are histological in nature and cannot be seen on a gross level. However, the location of these components should be learned as they relate to visible structures and landmarks of the heart.
    • Component Locations:
    • 1. SA node � at the junction of the right auricle and SVC
    • 2. AV node � just superior to the coronary sinus opening in the interatrial wall
    • 3. AV Bundle of His � in the membranous part of the interventricular septum
    • 4. Right & Left AV Bundles � in the muscular part of the interventricular septum. The right bundle branches then spread throughout the right ventricle. The left bundle branches spread throughout the left ventricle.
  26. SA node
    • the �pacemaker� node of the heart. It initiates and sets the normal rate of the heart. The fibers of the SA node spread throughout the atria. However, the signal from these fibers is prevented from reaching the ventricles by the cardiac skeleton � which acts as an insulator. Otherwise the ventricles would contract at the same time as the atria. Thus, the signal passes to the AV node.
    • From the AV node, the signal passes to the AV Bundle (of His) and then to the R. & L. AV Bundle Branches � which send fibers throughout the ventricles.
    • It is the insulating action of the cardiac skeleton which results in the specific path, timing, and coordination of the signal through the atria and ventricles. This results in a properly coordinated heart beat.
  27. Cardiac Skeleton
    • structure comprised of four fibrocartilaginous rings(anuli fibrosi) which provide the internal support (�skeleton�) of the heart. It has the following functions:
    • (1) provides an attachment site for the valves of the heart
    • (2) provides an attachment site for the musculature of the heart
    • (3) acts as an electrical insulator between the atria and ventricles.
    • Structure - the cardiac skeleton is comprised of 4 fibrocartilaginous rings (called anuli fibrosi). These rings are on the same plane as the 4 valves of the heart.
    • Function - Within the cardiac skeleton there are two areas called the right and left fibrous trigones. Coursing through the right fibrous trigone is the AV Bundle (of His). This is the only pathway by which the neuronal signal can pass to the ventricles.
  28. Cardiac Plexus
    • visceral nerve plexus of the heart. As you know, the heart has its own internal conduction system and so can beat on its own. The cardiac plexus provides external input to the heart in order to increase or decrease the heart beat.
    • The cardiac plexus has superficial part and a deep part. It is comprised of VA & VE fibers. The VE fibers are both parasympathetic preganglionic (para/pre) fibers from the vagus nerve (CN X) and sympathetic postganglionic (symp/post) fibers from the sympathetic chain ganglia.
    • The sympathetic fibers increase the heart rate & dilate the coronary arteries. In a �flight or fight� response, the heart rate pumps faster and therefore the heart tissue needs more blood.
    • The parasympathetic fibers decrease the heart rate & constrict the coronary arteries. At rest, the heart rate slows down and therefore the heart tissue does not need as much blood.
  29. superficial part of the cardiac plexus
    • is located over the arch of the aorta.
  30. deep part of the cardiac plexus
    • is located over the tracheal bifurcation.
  31. VA Cardiac Plexus
    VA fibers follow both the sympathetic and parasympathetic fibers back. The VA fibers following the sympathetic fibers convey pain info. Their cell bodies are located in the DRGs. The VA fibers following the parasympathetic fibers cover reflex info (from pressure and chemoreceptors). Their cell bodies are in the vagal sensory ganglia (VSGs).
  32. Ascultation Sites
    covered by bone so listen �downstream� from the valve location and in a position not covered by bone.
  33. Cardiac (Radiographic) Shadow
    • the radiographic image that the heart produces. It is instructive to examine the cardiac shadow with respect to the normal anatomical relationships of the heart. For example, which chambers/features/great vessels of the heart form the right margin of the cardiac shadow? Which form the left margin? Which form the apex? Examination of the cardiac shadow is also instructive in that it allows us to appreciate the variability of the shape of the heart within the same individual and between individuals.
    • There is variation in the cardiac shadow within the same individual due to different phases of respiration.
    • There is variation in the cardiac shadow between individuals due to different body types.

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