LSM 2212 Cardiovascular System PDF

Cardiovascular System LSM 2212 Dr Arthur Lau Chin Haeng...

Cardiovascular System LSM 2212 Dr Arthur Lau Chin Haeng Lecturer at Department of Anatomy [email protected] ©©Cop Copyrig yrighthtNational NationalUn Univer iversity sityofofSingap Singapore. ore.AAllllRights RightsReserved. Reserved.  Learning Outcomes 1. To be able to identify, locate and describe the functions of key anatomical landmarks of the heart in terms of gross anatomy and its histological features. 2. To be able to describe the innervation and blood supply to the heart. 3. To be able to describe the cardiac cycle & conduction system of the heart. 4. To be able to appreciate the visualisation of the heart in medical imaging. 5. To be able to differentiate the characteristics between arteries and veins in terms of histological features and function. 6. To be able to correlate the anatomical knowledge of the cardiovascular system with its clinical applications © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  PART 1 PART 2 © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  The Heart 1. Functional Overview 2. Gross Anatomy 3. Cardiac Cycle 4. Pericardial Sac 5. Bloody Supply via Coronary Arteries 6. Conduction System and Innervation 7. Histological Features 8. Clinical Applications & Medical Imaging Image source: Drake, R.L., Vogl, W. and © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Mitchell, A.W., 2019. Gray's anatomy for students. Elsevier Health Sciences TW.  Functional Overview Functions as a muscular pump to help circulate blood around the human body. Supporting blood circulation which in turn, helps to circulate oxygen and nutrients throughout the body. Why? To keep us alive! Pulmonary vs Systemic Circulation Portal System – we will come to later © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Superior Aorta Vena Cava Pulmonary Gross Anatomy Artery Left Atrium Right Atrium Left Ventricle Right Ventricle Inferior Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's anatomy for Vena Cava © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. students. Elsevier Health Sciences TW. Image: Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc. LOCATION Thorax region: Anterior (Front) View Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. anatomy for students. Elsevier Health Sciences TW.  Lungs Removed Lungs Removed Diaphragm Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. anatomy for students. Elsevier Health Sciences TW.  Aorta Superior Vena Superior Vena Cava (SVC) Cava (SVC) Pulmonary Artery Pulmonary Veins Inferior Vena Inferior Vena Cava (SVC) Cava (SVC) Anterior (Front) View (External Surface of the Heart) Inferior (Bottom) View (External Surface of the Heart) © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's anatomy for students. Elsevier Health Sciences TW.  Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's anatomy for Aorta students. Elsevier Health Superior Vena Sciences TW. Cava (SVC) Pulmonary Artery Pulmonary Valve Crista Terminalis Trabeculae Musculi Tricuspid Valve Carneae Pectinati Papillary Muscles Inferior Vena Chordae Cava (SVC) tendineae Lateral (Side) View RIGHT SIDE OF THE HEART Anterior (Front) view (Internal surface of Right Atrium) © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. (Internal Surface of Right Ventricle) Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's anatomy for Aorta students. Elsevier Health Sciences TW. Pulmonary Artery Pulmonary Veins Bicuspid Valves Papillary Muscles Trabeculae Carneae Chordae tendineae Lateral (Side) View Left side of the Heart Lateral (Side) View © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. (Internal surfaces of Left Atrium) (Internal surfaces of Ventricles)  Aorta PA Papillary Muscle RA Tricuspid valve RV LV Anterior (Front) View of the Heart Anterior (Front) View of the Heart Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's anatomy for students. Cadaveric Prosections Elsevier Health Sciences TW. Abrahams, P.H., © CopBoon, J.M. and yrig ht National Elsevier Health Sciences. Un iverSpratt, J.D., sity of Singap ore.2019. McMinn's A ll Rights Reserved. clinical atlas of human anatomy. of the Heart Cardiac Cycle © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Aorta During ventricular During atria PT contraction (blood is contraction & LA ejected from the ventricular ventricles to the outflow relaxation (blood RA tracts: Aorta & PT) fills the ventricles) LV RV Contraction of papillary Opening and Atrioventricular (AV) Valves muscles pull the AV (Mitral and Tricuspid Valves) valves down, preventing closing of blood from returning into the atria valves © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Image source: Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc.  During ventricular During ventricular relaxation (backflow contraction (blood is from outflow tract to ejected from the the ventricles but ventricles to the outflow prevented with the tracts: Aorta & PT) shutting of the semilunar valves) Semilunar Valves (Aortic and Pulmonary Valves) © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Image source: Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc.  Heart Sounds Heart First Heart Sound (S1) Second Heart Sound Sounds (S2) Sound Lub Dub Valves Bicuspid (Mitral) and Aortic and Pulmonary Shutting Tricuspid valves Semilunar valves Phases Ventricular Contraction Ventricular Relaxation (Systole) (Diastole) For references only, to hear the heart sounds: https://www.youtube.com/watch?v=zNHI-l_c-ls © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Coronal Section of Aorta Left Coronary Artery (LCA) Arterial Supply to the Heart Right Coronary Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's anatomy for students. Elsevier Health Sciences TW. Entry of blood into right and Artery (RCA) Abrahams, P.H., Boon, J.M. and Spratt, J.D., 2019. McMinn's clinical atlas of human anatomy. Elsevier Health Sciences. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc. left coronary arteries Venous Drainage to the Heart Coronary Sinus Lateral View Valve of the Coronary Sinus Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's anatomy for Anterior View © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. students. Elsevier Health Sciences TW.  Mitral Valve Regurgitation secondary to Myocardial Infarction (MI) Image source: Martini, F., Timmons, M.J., Tallitsch, R.B., Ober, W.C., Garrison, C.W., Welch, K.B. and Hutchings, R.T., 2006. Human anatomy (p. 904). San Francisco, CA: Image source: Mitral valve regurgitation causes, symptoms, diagnosis, treatment & prognosis Pearson/Benja © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. (healthjade.net) min Cummings.  For your own reference only © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Image source: Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's anatomy for students. Elsevier Health Sciences TW.  Pericardial Sac Fibrous Pericardium Fibrous pericardium intact with heart Serous Pericardium (Parietal Layer) Pericardial Cavity Serous Pericardium When heart and visceral layer of serous (Visceral Layer) Image source: Drake, R.L., Vogl, W. and Mitchell, © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. A.W., 2019. Gray's anatomy for students. Elsevier pericardium removed Health Sciences TW.  Pericardial Sac A two layer (fibrous and serous) and pericardium that encloses the heart. Fibrous Pericardium Serous Pericardium Function: (Parietal Layer) Position the heart between the lungs in the chest cavity. Lubricates the surface of the Pericardial Cavity heart to reduce friction when beating. Serous Pericardium Prevents overfilling. (Visceral Layer) Image source: Drake, R.L., Vogl, W. and Mitchell, © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. A.W., 2019. Gray's anatomy for students. Elsevier Health Sciences TW.  Pericardial effusion A medical condition when there is an abnormal large amount of fluid accumulation in the pericardial sac. Symptoms: Chest pain, Shortness of breath, fatigue. Why? © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Image source: https://www.mountsinai.org/health- library/diseases-conditions/cardiac-tamponade  Pericardial effusion Fibrous layer of pericardium does not distend -> limited space -> reduced filling of blood in the ventricles -> reduced cardiac output -> symptoms presentation. Treatment: Pericardiocentesis -> a procedure which involves draining excess fluid using a needle Image source: https://interventionalradiology.co.in/procedures/pericardial- © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. effusion-percutaneous-drainage/ Conduction System of the Heart 1) Sino atrial Node (SA node) – natural pacemaker SA Node 2) Atrioventricular Node (AV node) AV Node 3) Atrioventricular Bundle (AV bundle or Bundle of His) Right Bundle Branch Left Bundle Branch 4)Purkinje Fibre Image source: Marieb, E.N. and Keller, S.M., © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc.  Atria Depolarisation Right and left atria depolarizes (causing atria contraction), which is initiated by the SA node. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Delayed at AV node After atrial depolarisation, the electrical impulse is delayed at the AV node. Why? To allow time for the atria to contract completely and the blood to fully fill the ventricles. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Ventricle Depolarisation From the AV node, the electrical impulse travels down the AV bundle and to the apex of the heart. From the apex of the heart, the impulse moves upwards on the walls of the ventricles and begin depolarisation which triggers the ventricular contraction from bottom up. Why? Allows ejection of blood upwards into aorta and pulmonary trunk. Meanwhile, the atria repolarise which result to atria relaxation. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Ventricle Repolarisation The ventricles repolarise which result to ventricular relaxation. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Innervation to the heart: Autonomic Nervous System (ANS) Autonomic Sympathetic Activity Parasympathetic Activity Nervous (Fight or Flight) (Rest and Digest) System Chemical Epinephrine (adrenaline)/ Messenger/ Norepinephrine Acetylcholine Neurotransmitter (noradrenaline) Receptors Beta-adrenergic receptors M2 muscarnic receptors Effects 1. Increase in heart rate 1. Decrease in heart rate 2. Increase in heart 2. Decrease in heart contraction contraction 3. Vasoconstriction 3. Vasodilation Image source: Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Education, Inc.  100-150 beats per minute Beta-blockers Medication for increased blood pressure (for e.g hypertension) or increase heart rate (for e.g arrhytmias such as atrial fibrillation) Atenolol or Bisoprolol Binds to beta-receptors on the heart and vessels and prevents adrenaline (epinephrine)/ noadrenaline (norephinephrine) from binding. Causes reduced heart rate, heart contraction and vasodilation. Image source: Tachycardia: Fast Heart Rate | American Heart Association and © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Understanding Blood Pressure Readings | American Heart Association  INTERNAL EXTERNAL © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Histological Features of the Heart Muscle Image source: Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Intercalated Disc Desmosomes: function as an anchor and prevent adjacent cells from separating from each other during contraction Gap junction: a pathway which allows ions to pass from one cell to another, allowing electrical impulse to spread throughout the myocardium. This causes a contraction as one unit also termed as functional syncytium. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Image source from: Farone Exam 4 Cardio Flashcards | Chegg.com  Chest X-ray Image source: https://my.clevelandclinic.org/health/dia gnostics/10228-chest-x-ray Image soure: Normal, Labelled, Chest x-ray – Undergraduate © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Diagnostic Imaging Fundamentals (pressbooks.pub)  Ultrasound of the Heart Ultrasound is a medical imaging technique which uses high frequency sound waves transmitted through a transducer. Sound waves bounces off tissues, organs or structures which creates echoes that are captures on a screen in real time. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Image source: https://www.seemyheart.org/heart- ultrasound/types-of-heart-ultrasound/  Blood Vessels: Arteries and Veins 1. Histological Features 2. Function 3. Clinical Applications Image source: Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. 12th. Pearson Education, Inc. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Histology © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Differences between arteries and veins Vessels Arteries Veins Function Transport oxygenated Transport deoxygenated blood blood Appearance Rounded shape Irregular shape Wall Thicker walls to sustain Thinner walls as it does not need thickness pulsatile pressure to sustain pulsatile pressure Valves No valves Contain valves to allow one way direction (most veins*) Pulsation Present Absent Direction of Away from the heart Toward the heart Blood Flow © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Layers of Blood Vessels Inner most layer - Tunica Intima: Endothelial lining of the lumen, form by simple squamous epithelium (squamous means: scale like or flat appearance) Contains basement membrane and loose connective tissue to support endothelial lining. Contains internal elastic lamina. Middle layer - Tunica Media: Contains smooth muscle which is responsible for the vasodilation and vasoconstriction, depending on the input from the ANS. Contains external elastic lamina. Outer most layer -Tunica Adventitia: Contains own blood supply from its own vessels termed as vasa vasorum. Contains collagen providing structural support and protection to the vessel. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Venous blood travels through superficial and deep veins Varicose Veins – when valves fail toward the heart (proximal direction); can also travel from superficial vein to deep veins via perforator veins. Image source: Martini, F., Timmons, M.J., Tallitsch, R.B., Ober, W.C., Garrison, C.W., Welch, K.B. and Hutchings, R.T., 2006. Human anatomy (p. 904). San Francisco, CA: Pearson/Benjamin Cummings. Image source: Marieb, E.N. and Keller, S.M., Image source: Terms & Definitions - Vein 2018. Essentials of Human Anatomy and Physiology. Specialists of Alaska (veinspecialistsalaska.com) © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. 12th. Pearson Education, Inc. and Varicose (veins) (venacare.ch) For reference only Image source: Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. For reference only Image source: Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Hepatic Portal System A portal system is a connection in which blood passes through two sets of capillary systems before retuning to the heart. 1st capillary system: Digestive organs 2nd capillary system: Liver Image source: Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  Hepatic Portal System A portal system is a circulation in which blood passes through two sets of capillary systems before retuning to the heart. 1st capillary system: Digestive organs 2nd capillary system: Liver © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved. Image source: https://socratic.org/questions/what-is-a-portal-system- what-is-the-purpose-of-the-hepatic-portal  Summary The function of the heart and the circulations. The four chambers of the heart. The cardiac cycle in terms of blood flow through the four chambers and the respective valves. The conduction system and its influence by the ANS. The blood supply, the pericardial sac and medical imaging of the heart. The histological features of the heart muscle and the blood vessels. Relevant clinical applications. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  References: © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  SCAN ME to access NUS HALO https://medicine.nus.edu.sg/ant/nushalo/ pages/sys_cardio.html https://medicine.nus.edu.sg/ant/nushalo/ © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.  THANK YOU Any questions? ©©Cop Copyrig yrighthtNational NationalUn Univer iversity sityofofSingap Singapore. ore.AAllllRights RightsReserved. Reserved.  References: 1. Drake, R.L., Vogl, W. and Mitchell, A.W., 2019. Gray's anatomy for students. Elsevier Health Sciences TW. 2. Abrahams, P.H., Boon, J.M. and Spratt, J.D., 2019. McMinn's clinical atlas of human anatomy. Elsevier Health Sciences. 3. Drake, R.L., Vogl, A.W., Mitchell, A.W., Tibbitts, R. and Richardson, P., 2020. Gray's Atlas of Anatomy. Elsevier Health Sciences. 4. Marieb, E.N. and Keller, S.M., 2018. Essentials of Human Anatomy and Physiology. 12th. Pearson Education, Inc. 5. Marieb, E. N., & Hoehn, K., 2018. Human anatomy & physiology. 11th. Pearson education. 6. Martini, F., Timmons, M.J., Tallitsch, R.B., Ober, W.C., Garrison, C.W., Welch, K.B. and Hutchings, R.T., 2006. Human anatomy (p. 904). San Francisco, CA: Pearson/Benjamin Cummings. © Cop yrig ht National Un iver sity of Singap ore. A ll Rights Reserved.