Transcript right Bundle Branch

Operative surgery of heart
and organs of mediastinum
Associate-professor Kovryha M.F
Anterior Mediastinum Organs
Posterior Pericardial Wall, Oblique &
Transverse Sinuses
Pericardium is Removed, Roots of
Great Vessels
Pericardial sac
Heart (General anterior view)
Heart (Anterior & Posterior View)
Radiograph of Chest
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T1-body of the first
thoracic vertebra
 C-clavicle
 RA-right atrium
 SVC-superior vena cava
 IVC-inferior vena cava
 A-»aortic knob»
 PT-pulmonary trunk
 LAA-left auricular
appendage
 LV-left ventricle
Heart Valves
•Auscultation points are the areas where sounds
from each of the heart's valves may be heard
most distinctly through a stethoscope. They do
not represent the location of the valves projected
on the surface of the chest, although for the
tricuspid and pulmonary valves location and
sound are quite close. Aortic and mitral valves are
deep in the chest and their sounds are heard best
at the points where the direction of blood flow is
closer to the chest wall. Aortic (A) and Pulmonary
(P) areas are in the second interspace to the right
and left of the sternal border. The Tricuspid area
(T) is near the left sternal border in the 5th or 6th
interspace. The Mitral valve (M) is heard best
near the apex of the heart in the 5th intercostal
space in the midclavicular line.
Heart Auscultation Points
Heart Arterial Supply
Coronary Arteries
Types of Heart Blood Supplying
Cardiac Veins
Heart Conducting System
Nerves of the Heart
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The Sinu-atrial (SA) Node in the wall of the right atrium near the upper end
of the sulcus terminalis and extending over the front of the opening of the
superior vena cava. The SA Node is the "pacemaker" of the heart because it
initiates cardiac muscle contraction and determines the heart rate. It is
supplied by the sinus node artery, usually a branch of the right coronary
artery.
Contraction spreads through the atrial wall until it reaches the Atrioventricular (AV) Node in the right atrial side of the interatrial septum just
above the opening of the Coronary sinus. After a brief delay contraction
passes to the ventricles. The AV Node is usually supplied by the distal right
coronary artery.
The A V Bundle (B) passes from the AV Node in the membranous part of
the interventricular septum and divides into right and left Bundle Branches
on either side of the muscular part of the septum.
The right Bundle Branch travels down the septum to the anterior wall of the
ventricle, enters the base of the anterior papillary muscle, and excitation
spreads to the right ventricular wall.
The left Bundle Branch is a thin, broad band which usually divides into two
divisions which enter papillary muscles and excitation of the muscular walls
of the left ventricle occurs.
Damage to the conducting system (often by
compromised blood supply as in coronary artery
disease) leads to disturbances of cardiac muscle
contraction. Damage to the AV Node results in "heart
block" as the atrial excitation wave does not reach the
ventricles which begin to contract independently at their
own rate which is slower than that of the atria. Damage
to one of the branches results in "bundle branch block"
in which excitation goes down the unaffected branch to
cause systole of that ventricle. The impulse then
spreads to the other ventricle producing later
asynchronous contraction.
Aorto-coronary Shunting
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