Anatomy

1

• Anatomy
• And
• Physiology
• THE HEART
• AND
• HEART
• DISEASES
• Dr. Jay Shahed

2
External anatomy

• Wall muscle layers
• Epicardium the most outer
• Myocardium the middle layer (thickest)
• Endocardium the most inner layer

3
Pericardium

• A membrane that wraps around the external wall of
  the heart
• Parietal layer
• Visceral layer
• Pericardial space
• The space between the visceral and the parietal
  pericardium.

4
The coronary vessels

• (arteries and veins)
• Anterior coronary artery and vein
• Posterior coronary artery and vein
• Circumplex artery and vein

5
Aorta and aortic arch

• Large artery exiting from the left ventricle

6
Pulmonary trunk and arteries

• Exiting from the right ventricle going into the
  lung

7
Pulmonary veins

• Drains blood from both lungs into left atrium

8
Inferior and superior vena cava

• Large veins entering the right atrium

9

• LOCATION
• In the lower part of the mediastinum between the
  pleural cavities.
• SHAPE
• Triangular organ
• SIZE
• Closed fist
• POSITION
• The apex is deviated to the left, with its base
  on the fifth rib.

10
The internal anatomy

• The four chambers (cavities)
• Right atrium
• Left atrium
• Right ventricle
• Left ventricle

11
Septums

• Interatrial septum
• Muscle divides the right and left atria.
• Interventricular septum
• Muscle divides the right and left ventricles.
• Interatrialventricular septum
• Muscle divides atria from ventricles.

12
Valves

• Atrial ventricular valves (AV valves)
• Tricuspid between the right atrium and the right
  ventricle
• Bicuspid (mitral) between the left atrium and
  the left ventricle
• Semilunar valves
• Aortic valve opening of aorta into the left
  ventricle
• Pulmonary valve opening of the pulmonary trunk
  into the right ventricle

13
Chordae tendineae

• Muscle fibers that open and closes the valves

14
The conduction system of the heart

• The cell wall of the myocardial cells goes
  through inervation in order to contract and pump
  the blood.

15

• Polarization when the charges outside and inside
  the cell wall are at rest ( no contraction is
  followed)
• Depolarization when the charges outside
  exchanges with the charges inside (contraction is
  followed)
• Repolarization when the charges return to the
  initial stage of polarization

16
The conductivity sequence

• SA---- AV----BOH----PF
• The initiation of depolarizing the muscles of the
  heart starts at the SA NODE

17
SA NODE

• A clump of nerve cells that are located at the
  posterior wall of the right atrium.
• It is also called the (pace maker)of the heart or
  the starter.
• The conductivity is initiated involuntarily by
  the SA NODE then spread all along the right and
  left atria. (Polarization followed by
  depolarization followed by repolarization)

18

• After the repolarization of the atria it is
  followed by contraction of muscles. Then pumping
  of the blood into the right and left ventricles
• The depolarization of the atria is represented by
  the p-wave on the EKG
• The repolarization of the atria is not
  represented by any waves in the EKG

19
AV NODE

• Atrioventricular node
• A buddle of nerve cells that are located between
  the right atria and right ventricle.
• Will eventually pick Up some Of The charges sent
  By The SA NODE And send it down To The bundle OF
  his.

20
Bundle Of his

• The tract of nerve cells lining the
  interventricular septum.

21
Perkinje fibers

• Branches of BOH that extend and spreads all over
  the left and right ventricular walls.
• The depolarization of the ventricles are
  represented by the QRS wave.
• The repolarization of the ventricles are
  represented by the T wave.

22

• THE CARDIAC CYCLE

23
1. Phase one (diastole)

• The deoxgynated blood enters the right atrium
  through the inferior and superior vena cava, and
  the oxygenated blood enters through the
  pulmonary veins into the left atrium.

24

• The SA node in the right atrium depolarizes the
  atria followed by contraction of atria and the
  pumping of the blood into the ventricles.
• That is represented by the p-wave on the EKG.

25

• The blood flows from both atria into the RT.
  LT. Ventricles through the tricuspid valve into
  the right ventricle and through the bicuspid
  (mitral) valve into the left ventricle.

26

• This is followed by the closer of both AV values
  and causing the first heart sound ( S1 ).
• This is followed by the repolarization of the
  ventricles that is represented by the t-wave on
  the EKG.

27
II. Phase two (systole)

• A. The AV node send charges into the bundle of
  his into the perkunjie fibers that causes the
  depolarization of both ventricles followed by its
  contractions.
• That will be represented by the QRS wave on the
  EKG.

28

• B.The deoxygenated blood will eject into the
  pulmonary trunk from the RT. Ventricle and the
  oxygenated blood will eject the LT. Ventricle
  into the aorta through the aortic semi lunar
  valve into the body.

29

• C.This is followed by the closer of the semi
  lunar valves and the creation of the second heart
  sound (S2).

30
Cardiac output

• The amount of blood ejected form the heart in a
  minute.
• ( 5 liters)

31
Stroke volume (SV)

• The amount of blood ejected from the heart in
  one beat.
• ( 70ml)

32
Heart rate

• The number of beats in one minute
• 70 beats / minute

33
CO SV X HR

• 70 ml/ minute x 70 beats/minute
• 4900 ml/ minute

34
Diseases

• Coronary arteries
• Atherosclerosis the build up of cholesterol in
  the bypass or lumen of the arteries. Balloon
  angioplasty and control cholesterol level
• Embolism a moving clot that comes from other
  parts of the body and blocks the coronary artery.
  TX angioplasty, bypass or anticoagulants.
• Thrombosis a build up of a clot in the coronary
  artery that causes in the blockage of the blood
  flow.

35

• TX. Anticoagulants

36
Angina pectoris

• A severe chest pain that is
• Usually due to the lack of blood supply to the
  muscles of the heart.

37
TX.

• Nitrotroglycerin

38

• A.Ischemic heart disease
• The bruising of the heart muscles due to the lack
  of the oxygen supply to tissues. Usually leades
  to angina pectoris.
• Myocardial infraction
• The death of tissue (necrosis) around a clot in
  the coronary artery which leads to difficulty in
  blood supply to that tissue.

39
Treatment

• Anticoagulant
• Nitroglycerin
• Beta blockers

40
B. Cardiac muscles

• Cardiomyopathay
• Diseased heart muscles due to atrophy, megaty or
  ristructive surgery.

41
Congestive heart failure (CHF)

• The congestion of blood in the muscles of the
  heart that leads to failure in pumping. Usually
  due to myocardial infarction or other diseases.
• TX. Digitalis, calcium channel blockers,
  b-blockers, anticoagulants, diuretics

42
Cardiac arrhythmias (dysrrhythmias)

• Heart block
• Impulse is blocked from transferring in its
  original pathway due to death of tissue at the
  block site.
• Example
• Av-block
• Complete heart block

43

• Bradycardia/ tachycardia
• Fast heart rate vs. Slow heart rate.

44

• Sinus arrhythmia (dysrrhythmia)
• Variation of the heart rate during the breathing
  cycle.

45

• Premature contractions (
  extrasystoles)
• Could be normal, due to lack of sleep.

46
Fibrilation

• Atrial
• Due to mitral stenosis, rheumatic heart disease,
  muocardial infarctions.
• Ventricular
• Life threatening, lack of ventricular pumping can
  lead to death.