Heart Lecture-Khaleel Sunba PDF

‫بسم هللا الرحمن الرحيم‬ Khaleel Sunba Thorax: Heart Khaleel Sunba [email protected] ANAT 301: Internal Structure of Brain 1 2/3/2016 HEMA-312 Lecture: Introduction to Autoimmunity 2 Objectives: By the end of the lecture the students should be able to: • Identify and describe externa...

‫بسم هللا الرحمن الرحيم‬ Khaleel Sunba Thorax: Heart Khaleel Sunba [email protected] ANAT 301: Internal Structure of Brain 1 2/3/2016 HEMA-312 Lecture: Introduction to Autoimmunity 2 Objectives: By the end of the lecture the students should be able to: • Identify and describe external and internal structure of the heart including the pericardium. • Describe the major relationships of the heart and pericardium. • Identify and explain the anatomy of Coronary circulation • Describe the origin, course and relationships of the great vessels in the thorax.. ANAT 301: Anatomic Organization of the Lower Limb 3 The Mediastinum • Central compartment of the thoracic cavity • Contains all thoracic structures except the lungs • Between sternum (anteriorly) & thoracic vertebrae (posteriorly) The Mediastinum • Central compartment of the thoracic cavity • Contains all thoracic structures except the lungs • Between sternum (anteriorly) & thoracic vertebrae (posteriorly) • It is divided into: • Superior • Inferior • Anterior • Middle • Posterior The Mediastinum • Central compartment of the thoracic cavity • Contains all thoracic structures except the lungs • It can be divided into: • Superior: above the thoracic plane (from sternal angle to the space between T4-T5 • Inferior which is further divided into • Anterior: • Middle: contains the pericardium including the heart • Posterior Heart & Blood Flow Overview • Consist of Four Chambers: • Two atria and two ventricles • The atria contract together followed by the ventricles contracting together. • The great vessels of the heart are: • • • • Inferior and superior vena cava Pulmonary trunk Pulmonary veins Aorta Pericardium • Consists of two layers: • Fibrous • Serous • Parietal serous layer Pericardial cavity(contains serous fluid to allow heart movement) • Visceral (epicardium) Fibrous Pericardium • The external layer of pericardium is conical in shape, similar to the heart, formed by three collagen layers. • Works as a barrier from diseases and limits heart stretching. • The fibrous pericardium is anchored through: • Continuity with the great vessels adventitia and pretracheal fascia • Pericardiophrenic ligament • Sternopericardial ligament • Related posteriorly to structures of the posterior mediastinum Fibrous Pericardium • The external layer of pericardium is conical in shape, similar to the heart, formed by three collagen layers. • Works as a barrier from diseases and limits heart stretching. • The fibrous pericardium is anchored through: • Continuity with the great vessels adventitia and pretracheal fascia • Pericardiophrenic ligament • Sternopericardial ligament • Related posteriorly to structures of the posterior mediastinum Fibrous Pericardium • The external layer of pericardium is conical in shape, similar to the heart, formed by three collagen layers. • Works as a barrier from diseases and limits heart stretching. • The fibrous pericardium is anchored through: • Continuity with the great vessels adventitia and pretracheal fascia • Pericardiophrenic ligament • Sternopericardial ligament • Related posteriorly to structures of the posterior mediastinum https://fcit.usf.edu/ Serous Pericardium • Parietal layer: • Internal surface of the fibrous pericardium • Reflects at the great vessels of the heart with the visceral layer • Visceral layer: • Forms the epicardium (the outer most layer of the heart) Two tubes are formed at the great vessels ending: 1- surrounds the aorta and pulmonary trunk 2- Surrounds the inferior vena cava and pulmonary veins Institute of Human Anatomy Serous Pericardium • Parietal layer: • Internal surface of the fibrous pericardium • Reflects at the great vessels of the heart with the visceral layer • Visceral layer: • Forms the epicardium (the outer most layer of the heart) Two tubes are formed at the great vessels ending: 1- surrounds the aorta and pulmonary trunk 2- Surrounds the inferior vena cava and pulmonary veins Serous Pericardium • Parietal layer: • Internal surface of the fibrous pericardium • Reflects at the great vessels of the heart with the visceral layer • Visceral layer: • Forms the epicardium (the outer most layer of the heart) Two tubes are formed at the great vessels ending between the two layers: 1- surrounds the aorta and pulmonary trunk 2- Surrounds the inferior vena cava and pulmonary veins Pericardial Sinuses • Transverse Sinus Between the epicardial tube(containing aorta and pulmonary trunk) and the superior vena cava Used for ligation during Surgery • Oblique Sinus: Posterior to the left atrium between the four pulmonary veins and posteriorly by the four Pericardium Blood Supply • 80% from internal thoracic artery through pericardiophrenic branch • Musculophrenic, superior phrenic arteries (inferiorly) • Posteriorly ascending aorta or esophageal • The pericardiophrenic veins are tributaries to the brachiocephalic through the internal thoracic veins as well as the azygos system. Pericardium Blood Supply • 80% from internal thoracic artery through pericardiophrenic branch • Musculophrenic, superior phrenic arteries (inferiorly) • Posteriorly ascending aorta or esophageal • The pericardiophrenic veins are tributaries to the brachiocephalic through the internal thoracic veins as well as the azygos system. Pericardium Blood Supply • 80% from internal thoracic artery through pericardiophrenic branch • Musculophrenic, superior phrenic arteries (inferiorly) • Posteriorly ascending aorta or esophageal • The pericardiophrenic veins are tributaries to the brachiocephalic through the internal thoracic veins as well as the azygos system. Pericardium Blood Supply • 80% from internal thoracic artery through pericardiophrenic branch • Musculophrenic, superior phrenic arteries (inferiorly) • Posteriorly ascending aorta or esophageal • The pericardiophrenic veins are tributaries to the brachiocephalic through the internal thoracic veins as well as the azygos system. Pericardium Innervation • Phrenic nerve (C3-C5): pain from fibrous and parietal pericardium. • Vagus nerve through esophageal plexus and left recurrent laryngeal nerve. • Sympathetic trunk (vasomotor) and pain from serious layer. Pericardium Innervation • Phrenic nerve (C3-C5): pain from fibrous and parietal pericardium. • Vagus nerve through esophageal plexus and left recurrent laryngeal nerve. • Sympathetic trunk (vasomotor) and pain from serious layer. Clinical Cases • Pericarditis- Inflammation may result in toughening serous pericardium resulting in friction sounds that can be auscultated over the left sternal borders and upper ribs. • Pericardial effusion: the results of fluid accumulation. • Cardiac tamponade: non-inflammatory effusion resulting from accumulation of capillary blood preventing the heart from fully expanding and contracting and can lead to heart failure. • Pain can be referred to in the supraclavicular region of the shoulder. The Heart • A conical shape structure contains a base and apex • Consists of four champers: • Right and left atrium • Right and left ventricles • Consists of grooves: • Atrioventricular or coronary sulci (grooves) • Anterior and posterior interventricular sulci The base of the heart is formed by mostly by left atrium and, also, the right atrium. The apex is formed by inferiolateral part of the left ventricle Borders of Heart • Superior: formed by right and left atria and auricles • Inferior: formed by right and left ventricles • Right: formed by the right atrium extending between superior and inferior vena cava • Left: formed by left ventricle and left auricle of left atrium • Apex: formed by the inferolateral part of the left ventricle Surfaces of Heart • Sternocostal: Right ventricle • Diaphragmatic Surface: mainly left ventricle and partly by the right ventricle • Right pulmonary: by the right atrium. • Left pulmonary surface: by the left ventricle External Features of Heart • Right atrium: right auricle • Left atrium: left auricle • Coronary (atrioventricular sulcus): separates atrium from ventricles and include coronary vessels • Anterior interventricular sulcus • Posterior interventricular sulcus The Right Atrium • Receives blood from Superior and inferior vena cava • Receives most venous drainage of the heart through coronary sinus • Right auricle: contains pectinate muscles rough surface separated from the smooth surface of crista terminalis • Sinus venarum: thin part smooth surface • Artioventricular part: • Membranous septum • Tricuspid valve (opening) • Separated by smooth interatrial septum from the left atrium • Contains fossa ovalis The Right Ventricle • Tricuspid valve with three leaflets • Chorda tendineae • Three papillary muscles • Rough muscular wall (trabeculae carneae) • Conus arteriosus smooth leading to pulmonary valve • Septomarginal trabecula (moderator band) • Interventricular Septum • Membranous part • Muscular part The left atrium • Valveless pulmonary veins • Auricle with pectinate muscles • Fossa ovalis is ridged with a valve • Thicken than the right atrium • Atrioventricular orifice of a mitral bicuspid valve The Left Ventricle • Bicuspid valves • Two papillary muscles • Chordae tendineae • Walls are thicker that are covered mostly with trabeculae carneae • Aortic semilunar valve The Left Ventricle • Bicuspid valves • Two papillary muscles • Chordae tendineae • Walls are thicker that are covered mostly with trabeculae carneae • Aortic semilunar valve Fibrous Skeleton of Heart • Consists of four fibrous rings connected to each others by fibrous trigones. • Pulmonary and aorta are surrounded by coronets (crown like) rings. • Atrioventricular valves are surrounded by rings. • Membranous portion creating interatrial, interventricular and atrioventricular membranous parts of septa. Fibrous Skeleton of Heart • Keeps the orifices open • Attachments for the leaflets and cusps • Atrioventricular valves are surrounded by rings. • Attachments for the ventricular myocardium. • Electrical insulator to allow separation between atrial and ventricular contractions Anatomy of Heart Contractions Anatomy of Heart Contractions- Right Side Anatomy of Heart Contractions- Left Side Conduction System • Sinu-atrial node(SA): the pacemaker • Speed to both atria • Myogenic conduction transmits to atrioventricular node • Atrioventricular node (AV): • Continues as atrioventricular bundles (of His) • Moderator band: • The continuation of the bundle in the septomarginal trabecula • Purkinje fibers: • fibres that run within subendocardial fascicles embracing the papillary muscles and the ventricular wall. Clinical Cases • Valvular Stenosis: Narrowing of the heart causing reducing blood flow. e.g. Aortic stenosis & mitral stenosis • Valvular Regurgitation Dysfunctional valves that doesn’t close which allows blood leak and return. e.g. aortic and mitral regurgitation. Cardiac Blood Supply: • Coronary arteries: first branches of aorta • Right coronary artery: • SA nodal • Right marginal • Left coronary artery: • Anterior interventricular(left anterior descending LAD) • Left marginal Cardiac Blood Supply: • Coronary arteries: first branches of aorta • Right coronary artery: • • • • SA nodal Right marginal AV nodal Posterior interventricular • Left coronary artery: • Anterior interventricular(left anterior descending LAD) • Left marginal • Circumflex Cardiac Blood Supply: • Coronary arteries: first branches of aorta • Right coronary artery: • • • • • SA nodal Right marginal AV nodal Posterior interventricular Atrioventricular bundle branches • Left coronary artery: • Anterior interventricular(left anterior descending LAD) • Left marginal • Circumflex • Septal branches Cardiac Blood Supply • Coronary sinus: the main vein of heart • Anterior ventricular vein accompanies anterior interventricular artery before it continues as great cardiac vein. • Middle cardiac vein accompanies posterior interventricular artery. • Small cardiac vein accompanies right marginal branch. • Anterior cardiac vein drains the right ventricle directly into the right atrium. Lymphatic Drainage • Lymphatic vessels form plexuses coming from different layers of the heart. • At the coronary sulcus, they follow the arteries. • They end usually on the right side draining in a single vessel that joins the tracheobronchial lymph nodes. Innervation of the Heart • Sympathetic supply: • Pre-synaptic fibers from the T1-5(6) Segments • Postsynaptic fibers coming from the cervical ganglions and superior thoracic paravertebral ganglia • Parasympathetic Supply • Comes from the vagus nerve and has intrinsic ganglia near SA and AV Nodes in the atrium Together they create the cardiac plexuses. Responsible for regulating blood pumping speed, coronary circulations, and nociceptive and reflexive fibers of the heart. Innervation of the Heart • Sympathetic supply: • Pre-synaptic fibers from the T1-5(6) Segments • Postsynaptic fibers coming from the cervical ganglions and superior thoracic paravertebral ganglia • Parasympathetic Supply • Comes from the vagus nerve and has intrinsic ganglia near SA and AV Nodes in the atrium Together they create the cardiac plexuses. Responsible for regulating blood pumping speed, coronary circulations, and nociceptive and reflexive fibers of the heart. Clinical Application • Myocardial infarction: caused by a blockage of the arterial heart supply causing mycordial necrosis which results from lipid depositing (atherosclerosis). • Angina Pectoris Clinical Application • Myocardial infarction: caused by a blockage of the arterial heart supply causing mycordial necrosis which results from lipid depositing (atherosclerosis). • Angina Pectoris References Drake, Richard, A. Wayne Vogl, Adam WM Mitchell, Richard Tibbitts, and Paul Richardson. Gray's Atlas of Anatomy E-Book. Elsevier Health Sciences, 2020. Hansen, John T. Netter's Clinical Anatomy E-Book. Elsevier Health Sciences, 2017. Moore, Keith L., Anne MR Agur, Arthur F. Dalley, and Keith L. Moore. Essential clinical anatomy. Wolters Kluwer Health,, 2015. Netter, Frank Henry. Atlas of human anatomy. Saunders Elsevier, 2006.. Standring, Susan, ed. Gray's anatomy e-book: the anatomical basis of clinical practice. Elsevier Health Sciences, 2015.