Heart Chambers & Blood Vessels PDF

Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili Heart Chembers Right Atrium Right Atrium Right Ventricle Papillary muscles in the right ventricle T...

Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili Heart Chembers Right Atrium Right Atrium Right Ventricle Papillary muscles in the right ventricle Tricuspid valve Pulmonary Valve Left Atrium Left Ventricle  Mitral (bicuspid) Valve Orifece is closed during ventricular contraction by the mitral valve (left atrioventricular valve), which is also referred to as the bicuspid valve because it has two cusps, the anterior and posterior cusps. The bases of the cusps are secured to a fibrous ring surrounding the opening, and the cusps are continuous with each other at the commissures. The coordinated action of the papillary muscles and chordae tendineae is as described for the right ventricle.  Posterior medial anterior lateral Posterior medial anterior lateral Aortic Valve normal Bicuspid aortic valve Valves of the Heart  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili  Body Systems III – Cardiovascular and Respiratory Systems New Vision Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili  01 Wall of the heart 02 Arteries of the heart 03 Veins of the heart 04 Pulmonary circulation. Coronary circulation Right coronary artery Anomalus origin of RCA Branches of the RCA Branches of the RCA What does the right coronary artery supply? SN and AV 1/3 nodes interventricular Right ventricle septum Right atrium & Interatrial Portion of the left septum ventricle RCA LCA-Left Coronary Artery Anomalus origin of LCA Anomalus origin of LCA Branchies of LCA Branchies of LCA What does the Left coronary artery supply? Interventricular septum Atrioventricular Left ventricle bundle Left atrium His bundle and Purkinje fiber LCA Distriution patterns of coronary ateries Percutaneus Intervention https://www.youtube.com/watch?v=bzasYRhmOW Cardiac veins cardiac veins Cardiac veins Cardiac veins  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili  Body Systems III – Cardiovascular and Respiratory Systems New Vision Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili Main ponts Innervation of the heart Conductive system SA node AV nodes bundle of His Cardiac innervation Cardiac plexus Parasympathetic innervation Sympathetic innervation Visceral afferents Cardiac conduction system Components Network Sinu-atrial node Atrioventricular node Atrioventricular bundle The left bundle brunch  Body Systems III – Cardiovascular and Respiratory Systems new vision Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili Main ponts 1 Systemic circulation Aorta: parts 2 aortic arch branches 3 Carotid arteries Subclavian arteries. 4 Systemic circulation Ascending Aorta Aortic arch A- most commo n B and C BOVINE pattern ARCH D-bicarotid trunk The first branch Innominate(brachiocephalic) artery stenosis The Second branch The Third branch Ligamentum arteriosum 16 Coarctation Dissection Aortic arch anomalies Common carotid arteries Baroreceptors Internal and external carotid arteries Subclavian Artery 23 Segments of Subclavian Artery 24 1st part 25 Vertebral Artery Thyrocervical Trunk ❖Inferior thyroid artery ❖Suprascapular artery ❖Transverse cervical artery Thyrocervical Trunk Branches Thyrocervical Trunk Branches Internal thoracic artery (mammary) 2nd part 31 Costocervical Trunk Branches 3rd part 33 Subclavian steal syndrom  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili  Body Systems II – Cardiovascular and Respiratory Systems European University Program: MD Program Faculty: Medicine Semester II Invited Lecturer- Ivditi Okuashvili  Main ponts What… 1 Parts of the brain are supplied by the: 2 ICA? 03 Vertebrobasilar arteries? 4 Is the circle of Willis? Blood supply of the brain The brain receives its arterial supply from two pairs of vessels, the vertebral and internal carotid arteries (Fig. 8.38), which are interconnected in the cranial cavity to produce a cerebral arterial circle (of Willis). Common carotid arteries The two internal carotid arteries enter the cranial cavity through the carotid canals on either side. Internal carotid arteries The two internal carotid arteries arise as one of the two terminal branches of the common carotid arteries (Fig. 8.38). They proceed superiorly to the base of the skull where they enter the carotid canal. Entering the cranial cavity each internal carotid artery gives off the ophthalmic artery, the posterior communicating artery, the middle cerebral artery, and the anterior cerebral artery Ophthalmic artery Vertebral arteries The two vertebral arteries enter the cranial cavity through the foramen magnum and just inferior to the pons fuse to form the basilar artery. Each vertebral artery arises from the first part of each subclavian artery (in the lower part of the neck, and passes superiorly through the foramen transversarium of the upper six cervical vertebrae. On entering the cranial cavity through the foramen magnum each vertebral artery gives off a small meningeal branch Continuing forward, the vertebral artery gives rise to three additional branches before joining with its companion vessel to form the basilar artery. The first is a posterior inferior cerebellar artery The posterior inferior cerebellar artery (or PICA) is an artery that provides blood flow to the cerebellum, a part of the brain located behind the top of the brain stem, which helps with functions related to movement and coordination. Out of all the cerebral arteries, the posterior inferior cerebellar artery is considered the most variable.  A second branch is the posterior spinal artery, which passes posteriorly around the medulla and then descends on the posterior surface of the spinal cord in the area of the attachment of the posterior roots—there are two posterior spinal arteries, one on each side (although the posterior spinal arteries can originate directly from the vertebral arteries, they more commonly branch from the posterior inferior cerebellar arteries).  A third branch joins with its companion from the other side to form the single anterior spinal artery, which then descends in the anterior median fissure of the spinal cord. The basilar artery travels in a rostral direction along the anterior aspect of the pons (Its branches in a caudal to rostral direction include the anterior inferior cerebellar arteries, several small pontine arteries, and the superior cerebellar arteries. The basilar artery ends as a bifurcation, giving rise to two posterior cerebral arteries.  Circle of Willis Cerebral arterial an anterior circle The cerebral communicating artery arterial circle (of connecting the left and Willis) is formed at right anterior cerebral the base of the brain arteries to each other, by the and interconnecting vertebrobasilar and two posterior internal carotid communicating arteries, systems of vessels one on each side, (Fig. 8.38). This connecting the internal anastomotic carotid artery with the interconnection is posterior cerebral artery accomplished by: Case A 32-year-old man was brought to the emergency service by ambulance. 30 minutes ago, he lost consciousness, began to palpitate. He has been suffering from severe headache for the last 1 week. Upon entering the clinic, according to the initial assessment, he answers questions late, has difficulty speaking, and makes slow movements. VS T/A -90/60 mm.Hg. HR-61 SaO2- 95% RR-28 CT angiography  Body Systems II – Cardiovascular and Respiratory Systems Cranial blood supply- Pages: 868-882 European University Program: MD Program Faculty: Medicine Semester II Invited Lecturer- Ivditi Okuashvili  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili The external carotid artery is one of the two main divisions of the common carotid artery, which stems from the aortic arch on the left side and from the brachiocephalic trunk on the right side. The external carotid artery climbs the lateral sides of the neck within the carotid sheath, which is found just behind the sternocleidomastoid muscle. The carotid bifurcation occurs at the level of the thyroid cartilage in the larynx. The external carotid artery is the only division of the common carotid that gives branches to the neck region and supplies the external structures of the head and face. This article will discuss the course and the anatomy of the external carotid artery.  Superior thyroid artery Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular artery Maxillary artery Superficial temporal artery Mnemonic: Some Anatomists Like Freaking Out Poor Medical Students Border s Medially: Hyoid bone, wall of pharynx, superior laryngeal nerve, parotid gland Laterally: Internal carotid artery, superior laryngeal nerve Posterosuperiorly: Styloglossus muscle, stylopharyngeus muscle, glossopharyngeal nerve, pharyngeal branch of vagus nerve, parotid gland Anteriorly: Skin, superficial fascia, platysma, deep cervical fascia, sternocleidomastoid muscle  Relation s Structures which cross over artery: Nerves: Hypoglossal nerve, lingual nerve Veins: Vena comitans of hypoglossal nerve, common facial vein, superior thyroid vein, temporal veins, maxillary veins Muscles: Digastric muscle, stylohyoid muscle  Supplies (S): Thyroid gland, infrahyoid muscles, sternocleidomastoid muscle (A): Pharynx, prevertebral muscles, middle ear, cranial meninges (L): Intrinsic muscles of the tongue, floor of the mouth (F): Tonsils, palate, submandibular glands (O): Posterior region of the scalp (P): Parotid gland, facial nerve, ear, scalp (M): External acoustic meatus, tympanic membrane, dura mater, calvaria, mandible, gingivae, teeth; temporal, pterygoid, masseter, buccinator muscles (S): Temporal region of the scalp  Superior thyroid The superior thyroid artery artery is the first branch of the external carotid artery. It arises from the external carotid artery at the level of the hyoid bone. It descends from the anterior surface of the external carotid artery along the lateral border of the thyrohyoid muscle towards the apex of the thyroid gland  Branches The superior thyroid artery has several branches which include the superior laryngeal artery, arteries which supply the sternocleidomastoid, cricothyroid and infrahyoid muscles, as well as the anterior, posterior and lateral glandular branches. the thyroid gland and tissue of the upper part of the larynx. You can remember the branches of the superior thyroid artery by using the  The ascending pharyngeal artery arises from the medial surface of the external Additionally, it gives off several unnamed branches which carotid artery between the internal carotid artery supply surrounding musculature. and pharynx to reach the base of the cranium. It Structures supplied by the ascending pharyngeal artery include is the smallest branch of the external carotid the pharynx, soft palate, the ear, meninges, muscles of the artery. neck (longus capitis, longus coli), the sympathetic trunk, the The ascending pharyngeal artery gives rise to the hypoglossal, glossopharyngeal and vagus nerves as well as posterior meningeal artery, the inferior tympanic some cervical lymph nodes. artery and several pharyngeal branches.  The lingual artery The lingual artery arises from the anteromedial aspect of the external carotid artery at the level of the great cornu of the hyoid bone. It emerges from the external carotid artery between the superior thyroid and facial arteries and is divided into three parts according to the hyoglossus muscle.  Parts of the lingual artery The first part of the lingual artery courses medially within the carotid triangle of the neck. It ascends and descends to form a loop which is crossed by the hypoglossal nerve. The second part of the lingual artery courses along the superior border of the hyoid bone and passes between the hyoglossus muscle and middle constrictor muscle of the pharynx. The third part of the lingual artery is also known as the deep lingual artery. At the anterior border of the hyoglossus muscle, the deep lingual artery ascends between the genioglossus muscle medially and the inferior longitudinal muscle of the tongue laterally. Throughout its course the lingual artery gives off several branches which include the dorsal lingual, sublingual and deep lingual branches. The lingual artery also gives off branches which form a rich (1) Facial artery; (2) lingual artery; (3) external carotid artery; (4) superior thyroid artery; (5) hypoglossal anastomosis that supplies the musculature of the nerve; (6) hypoglossus muscle; (7) hyoid bone; (8) sublingual artery; (9) genioglossus muscle; (10) tongue. The lingual artery provides arterial supply geniohyoid muscle; (11) sublingual salivary gland; (12) deep lingual artery; (13) styloglossus muscle. to the tongue and floor of the mouth.  The facial artery The facial artery emerges from the external carotid artery just above the lingual artery within the carotid triangle. Occasionally the facial artery will arise from a common trunk with the lingual artery. It travels in an anterosuperior direction, deep to the digastric and stylohyoid muscles, curving around the inferior border of the mandible to enter the face. It ascends along the angle of the mouth and passes deep to the zygomaticus major and risorius muscles, ascending along the lateral side of the nose before terminating at the medial angle of the orbit. Branches The facial artery gives rise to the following branches including the ascending palatine, submental, inferior and superior labial and angular arteries as well as tonsillar and glandular branches. The facial artery ​supplies all structures in the face from the inferior border of the mandible anterior to the masseter muscle to the medial corner of the eye. It also supplies the soft palate, palatine tonsil, pharyngotympanic tube and submandibular gland.  The occipital artery The occipital artery arises from the posterior aspect of the external carotid artery. It courses posterior and superiorly, deep to the posterior belly of the digastric muscle. It passes between the transverse process of the atlas (C1) and the mastoid process of the temporal bone. It extends through the occipital groove of the temporal bone where it is joined by the greater occipital nerve. It pierces the investing layer of deep cervical fascia to ascend within the dense superficial fascia of the scalp. Main branches of the occipital artery include the upper and lower sternoclediomastoid branches. Additionally the occipital artery gives off the auricular, mastoid, occipital, meningeal and descending branches. The occipital artery supplies the sternocleidomastoid, trapezius and deep muscles of the neck as well as the  The posterior auricular The posterior auricular artery arises from the posterior aspect of the external carotid artery, above the posterior belly of digastric. It ascends in the neck between the parotid gland and styloid process. It then travels in a groove which lies between the auricular cartilage and mastoid process of the temporal bone.  Branches The posterior auricular artery gives off the stylomastoid and posterior tympanic arteries as well as auricular, occipital and parotid branches. Within the neck the posterior auricular artery provides arterial supply to the digastric, stylohyoid and sternocleidomastoid muscles as well as the parotid gland. Within the head the posterior auricular artery supplies the extrinsic auricular muscles, the external acoustic meatus, the auricle, middle ear, facial nerve and mastoid air cells. The maxillary artery The maxillary artery is the larger of the two terminal branches and arises from the external carotid artery within the parotid gland. From the parotid gland, the maxillary artery passes anteriorly between the neck of the mandible and the sphenomandibular ligament to enter the infratemporal fossa. It then extends between the pterygoid muscles to enter the pterygopalatine fossa via the pterygomaxillary fissure. The maxillary artery is divided into three parts according to its location. The first part is located between the neck of the mandible and sphenomandibular ligament. The second part is associated with the lateral pterygoid muscle while, the third part lies within the pterygopalatine fossa. Branches of the first part include: the middle meningeal and inferior alveolar arteries as well as the smaller deep auricular, anterior tympanic and accessory meningeal arteries. The superficial temporal artery The superficial temporal artery arises as the smaller terminal branch of the external carotid artery. It similarly arises within the substance of the parotid gland behind the neck of the mandible. It ascends from the parotid gland superficially alongside the auriculotemporal nerve to the scalp. It terminates by dividing into its terminal frontal and parietal branches.  Branches Branches of the superficial temporal artery include the transverse facial, zygoaticoorbital and middle temporal arteries. Additionally it provides parotid, anterior auricular, occipital frontal and parietal branches. The superficial temporal artery provides arterial supply to the skin and muscles of the side of the face and scalp. It also provides arterial supply to the parotid gland and temporomandibular joint.  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lectorer- Ivditi Okuashvili https://www.youtube.com/watch?v=EHTKufQ50WE https://www.youtube.com/watch?v=PXq7qwhgqxA https://www.youtube.com/watch?v=4j5AbArXYLg  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili Main Points Vessels of the upper limb Arteries and Veins of Hand Fascia and Compartments of Palm Axillary artery brunches Superficial veins Axillary vein Brachial Artery Profunda brachii artery Brachial Veins Radial artery branches Ulnar Artery Ulnar Artery branches Interosseous Artery 17 Palm arteries Superficial palmar arch Deep palmar arch Dorsal venous network Palmar aponevrousis  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester II Invited Lecturer- Ivditi Okuashvili  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili  Main Points Thoracic aorta Abdominal aorta Branches Branches Visceral Visceral Parietal Parietal 3 Thoracic Aorta Branches of Thoracic Aorta Branches of Thoracic Aorta- mnemonic PEPSi My Best Soda Postintercostal, Esophageal, Pericardial, Subcostal, Mediastinal, Bronchial, Superior phrenic 6 7 8 9 Abdominal Aorta In- inferior Phranic Case- Celiac My – Middle Suprarenal Students- Superior Mesenteric Really- Renal Love- Lumbal Games- Gonadal I'm- Inferior Mesenteric Monopoly Medial Sacral Visceral Branches:. ❖Unpaired ▪ Celiac Trunk ▪ Superior Mesenteric ▪ Interior mesenteric ❖Paired ▪ Middle suprarenal ▪ Renal ▪ Testicular/Ovarian Parietal Branches. ❖Inferior Phrenic ❖lumbal 15 Branches of Celiac Trunk Branches of Celiac Trunk Branches of Celiac Trunk Superior Mesenteric Artery Brunches Superior Mesenteric Artery Brunches Superior Mesenteric Artery Brunches Inferior Mesenteric Artery Brunches Inferior Mesenteric Artery Brunches  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili  Main Topics 1 Venous system 2 Superior vena cava 3 inferior vena cava 4 hepatic portal circulation Superior vena cava Left and right brachiocephalic Azygos system Hemiazygos system and Accessory hemiazygos vein Inferior vena cava Tributaries to the inferior vena cava  Superior Mesenteric vein Veins from pancreas and duodenum Veins from ascending colon Superior Mesenteric vein tributaries  Inferior Mesenteric vein Dranage pattern of Inferior mesenteric vein Splenic vein Pancreatic veins Hepatic Portal System Hepatic Portal System Portacaval anastomoses Blockage of the Hepatic Portal vein Blockage of the Hepatic Portal vein Rectal varicies Caput Medusae  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili 1 2 3 4 5 Femoral artery  Origin Continuation of the external iliac artery The external iliac artery is a branch of the common iliac artery, which, in turn, is a terminal branch of the abdominal aorta. Course Begins at the midinguinal point posterior to the inguinal ligament. Descends along the anterior aspect of the thigh, within the femoral triangle Gives off the profunda femoris and continues as the superficial femoral artery Passes anteromedially to enter the adductor canal Continues as the popliteal artery by passing through the adductor hiatus into the popliteal fossa  Branches and supply ⮚ Profunda femoris: muscles of the thigh ⮚ Descending genicular artery: knee joint (genicular anastomosis ⮚ External pudendal arteries (superficial and deep): perineum and scrotum or labia majora ⮚ Superficial epigastric artery: skin over the lower abdomen  The femoral artery lies at the base of the femoral triangle , between the femoral nerve and the femoral vein Femoral triangle Definition: a triangular intermuscular space in the superomedial aspect of the anterior thigh through which the major neurovascular structures of the lower limb pass Clinical significance Easy access into the arterial system via the femoral artery (e.g., coronary angiography) Easy access into the central venous system via the femoral vein Profunda femoris artery Origin and Course Main branch of the femoral artery Arises from the posterolateral aspect of the femoral artery ∼ 4 cm below the inguinal ligament Descends in the medial compartment of the thigh Terminates by anastomosing with branches of the popliteal artery  Branches and supply Medial and lateral Numerous muscular branches: circumfleMedial and lateral all muscular compartments of circumflex femoral arteries the thigh femoral arteries femoral head and neck Anatomical relations The adductor longus lies between the profunda femoris and the femoral artery 16 Popliteal artery Anatomical relations Anterior Tibial artery Branches and supply Anatomical relations Dorsalis pedis artery Origin and Branches and Course supply Anatomical relations Porsterior Tibial artery Origin and Course Fibular artery  Branches and Origin and Course supply Anatomical relations 34 35 36 37 38 39  Body Systems III – Cardiovascular and Respiratory Systems Program: MD Program Faculty: Medicine Semester III Invited Lecturer- Ivditi Okuashvili