Transcript cardiovascular system

DR.M. ZAFAR
QURESHI
INTRODUCTION
 Cardiovascular system comprises of
 Heart
 Arteries
 Veins
 Capillaries
INTRODUCTION
 Heart is a muscular organ & functions as a
pump.
 Works in conjunction with lungs & vascular
system
 Functionally two hearts & one lung
 Blood from venous system Rt side of
heart to lungs via pulm. trunk back to Lt
side of heart via pulm. veins To the entire
body via aorta back to venous system
LOCATION
 Middle
mediastinum
 1/3 lies on the rt &
2/3 on the left of
median point of
sternum.
 Second to fifth rib
Skeleton of the heart
 It is formed by fibrous rings around the valves
 It gives origin to the whorls of the cardiac
muscle
 It keeps the heart valves in an un collapsible
state
 It acts as an insulator for the spread of
electrical stimulus b/w atria & ventricles
FEATURES OF HEART
 Conical Hollows organs.
 Situated in the middle mediastinum enclosed
with in pericardium.
 Placed obliquely behind the body of sternum and
adjoining part of costal cartilages.
 1/3 of heart lies to the right and 2/3 to the left of
median plane of sternum.
 Heart Measures about 12x9 cm or 5x3 inches
(volume/ circumference) and weight about 300g
in males and 250g in females.
4 chambers
4 Borders
2 atria
2 ventricles
Upper border Lower or inferior Right border
Left border
Formed by border formed formed by
formed by
2 atria mainly by right
right artium.
Mainly Left
Left.
Ventricle.
ventricle
& partly left
aricle.
Circulation of blood through
heart
4 SURFACES
Anterior
Inferior surface Posterior surface left surface
surface
(Base)
formed by
Right atrium
left ventricle &
left atrium
fommed by left atrium
& Rt ventricle). & small part of Rt atrium
.
(left Ventricle)
AN APEX (LEFT VENTRICLE)
( In 5 intercostal space just inner to mid-clavicular line )
th
3 GROOVS OR SULCI
Atrio ventrienlar
(coronary)
Inter atrial
groove.
Inter ventricular
groove.
ATRIO VENTRICULAR
GROOVE
CIRCULAR SULCUS
WHICH LODGES.
Coronary
Sinus.
Small
Cardiac
vein.
Coronary
arteries.
 It obliterated interiorly by ascending aorta
and pulmonary trunk.
INTER ATRIAL GROOVE:Faintly visible posteriorly while anteriorly it is hidden
by the aorta and pulmonary trunk.
ANTERIOR INTER VENTRICULAR
GROOVE: Near to the left margin of the heart.
 It contain anterior inter ventricular branch of the left
coronary artery and great cardiac vein.
 Lower end of groove separates apex from rest of the
inferior border of the heart.
POSTERIOR INTER VENTRICULAR:-
(i) Is situated on the diaphragmatic
(inferior) surface of the heart.
(ii) It lodges posterior inter ventricular
branch of the right coronary artery and
middle cardiac vein.
(iii) Two (post & ant) inter ventricular
grooves meet at the inferior border near
the apex, the incisura apices cordis.
FEATURES OF RT ARTIUM:




From Rt border, Sternocostal surface & part of base of heart.
Elongated chamber.
Receiving sup & I.V.C.
Interior is sponge like & prevent free flow of blood and favours thrombosis.
These thrombi when disloged during auricular fibrillation cause pulmonary
embolism.
 Suleus terminalis is a shallow vertical groove along right border b/w sup &
I.V.C. It is produced by an internal muscular ridge called crista terminalis.
 The upper part of suleus termanalis contains (SA) sinoatrial node which act
as the pace makes of the heart.
 Left atrium lies behind the right atrium.
TRIBUTARIES (INLETS) OF RT ARTIUM:(i)
(ii)
(iii)
(iv)
(v)
(vi)
S.V.C. ( gaurded eustachian valve) rudimentry.
I.V.C. ( Gaurded eustachian valve) rudimentry.
Coronary sinus ( Gaurded by Thebasian valve)
Anterior cardiac veins.
Venae cordis minimi( Thebasian vessels)
Some time Rt marginal veins.
OUT LETS OF RT ARTIUM:(i) Tricuspid valve.
(ii) Venae cordis mininmae (numerous mall pits in all 4
chambers more on right sides to ensure blood
supply i.e why M.I. more common on left side.)
Interior of right atrium is DIVIDED
INTO 2 PARTS
(A) Smooth posterior
Part (sinous venarum)
Rough anterior
part or
Pectinate or Auricle
(A)SMOOTH PART (POSTERIOR)
OR SINUS VENARUM
 Derived from right horn of sinus venosus
 Coronary sinus opens b/w
I.V.C. and right
atrioventricular openings & guarded by valve of
coronary sinus (Thebasian valve).
 Venae cordis minimae are numerous small pits, in all
four chambers & opens through foramina venarum
minimarum. These are more numerous on right side
ensuring better blood supply to the myocardium
than that on left side that is why M.I. is more
common on left side than right.
 Intervenous tubercle of lower is a very small
projection, visible on the posterior wall of Rt
atrium just blow the opening of S.V.C.
 During embryonic life it directs the superior
caval blood to the right ventricle
(B)ROUGH ANTERIOR PART
PECTINATE PART (AURICLE)
 Devlopmentally derived from Primitive atrial
chamber.
 It presents a series of transverse muscular ridges
called musculi pectinati. They raise from crista
teaminalis and run forward and downward towards
the atrioventricular orifice, giving appearance of
teeth of comb.
 Muscles in auricle are interconnected to form
reticular network.
Septal wall
 From the centeral part of posterior wall.
 Developmentally derived from septum
primum and septum secondum.
 Present fossa ovalis, a shallow saucer –
shaped depression, in the lower part, formed
by septum primum.
RIGHT VENTRICLE
(triangular chamber)
 It form inferior border & large part of
sernocostal surface and a small part of the
diaphragmatic surface of heart.
 It receives blood from right atrium and pumps
it to the lungs.
Externally
has two surface
Anterior (sternocostal )
Inferior (diaphragmatic)
Interior
has 2 parts
Inflowing part is rough
due to musclular ridges
called trabeculae carnae
develop from primitive
ventricle heart tube.
Outflowing part or infundibulnm
is smooth and form the upper
one inch conical part of right ventricle
which gives rise pulmonary trunk
( develops from the bulbs cordis).
MUSCLAR PART
of Rt ventricle
TRAECULEA CARNAE
Muscular ridges
Fixed elevation
(muscular ridges)
Bridges c’ 2 ends
Fixed & free at
Centre
Pillar (papillary
muscles) one end
connected to ventricle
wall &other c’cusps of
Tricvsprid valve by chordae
tendinae
Septomarginal trabecula (musclar ridges) contains right
branch of bundle of his & prevents over distension of right
ventricle.
Right ventricle is (cresent) shaped due to bulging of
interventricular septum.
Wall of right ventricle is thinner than left ventricle
Ratio 1:3
Left atrium (feature)
 Quadrangular chamber.
 Situated posteriorly
 Interiorly overlaped by right auricle.
FORMS
2/3 OF BASE
OF HEART
GREATER PART
OF UPPER
BORDER
STERNOCOSTAL
& LEFT
SURFACE
PART OF
LEFT BORDER
OF HEART
LEFT ATRIUM
 Posterior surface from anterior wall of oblique sinus of





pericardium.
Anterior wall from the interatrial septum.
2 pulmonary veins open on each side of posterior wall.
Greater part is smooth wall derived from the absorption of
pulmonary veins which open into it.
Muscli pectinati (muscular part (rough ) present only in the
auricle.
Septal wall shows fossa lunata correspond to fossa ovalis of
left atrium
TRIBUTARIES
4 pulmary
veins
Venal cordis
minimi
Left ventricle ( features )
 Receives qxygenated blood from left atrium.
 From apex of heart.
Externally
forms
(3 surfaces)
Anterior part form left surface forms most of left
Sternocostal
border
inferior surface forms 2/3 of left diaphragmatic surface of
heart
Interior of left ventricle
-Lower rough part with
-upper smooth part (aortic vestibule)
Trabeculae corae, Develops
which gives origin to ascending aorta,
From primitive ventricle of
develops from bulbus cordis.
Heart tube.
-Vistibule lies between membranous
part of the inter ventricuar septum and
anterior (aortic) cusps of mitral valve.
2 orifices
Left A.V orifice (bicuspid) aortic orifice (guarded by
Mitral valve
aortic valve) (tricuspid)
2 papillary muscles
Ant
post
Both attached to cusps of mitral valve
by chordae tendinae
-Wall of left ventricle is 3 time thicker
then those of right ventricle.
Blood supply of heart
 Supplied by 2 coronary arteries arises from
ascending aorta
Right coronary artery
-smaller than left
-origin=Int aortic sinus
left coronary
-larger than right
-origin=post aortic sinus
BLOOD SUPPLY OF HEART
Right coronary branches
Large branches
1-Marginal
2- Posterior
interventricular
small branches
1-Nodal in 60%
2-Right Atrial
3-Infundibular
4-Terminal
Left coronary branches
Large branches
1-Anterior ventricular
2-Diaphragmatic
branches to
Left venricle
small branches
1-Left atrial
2-pulmonary branches
3-Terminal branches
Course
Right C.A (course)
It passes forward & to the right to
emerge b/w the root of pulmonary
trunk and right auricle.
2ndit runs downwards in the right
anterior cornerary sulcus to the
junction of the right and inferior
border of heart
Next it winds round and continuous in
the posterior coronary sulcus upto the
posterior interventicular groove.
On entering the left coronary sulcus it
terminates by anastomosing with the
left coronary artery.
Left C.A. (course)
 It passes forward & to the left to
emerge b/w the pulmonary trunk
and left auricle & gives
interventricular branch which runs
down in its groove & continuation
of left coronary artery is called as
circumflex artery
 Then it runs towards the left
anterior coronary sulcus
 Next it winds round and
continuous in the left posterior
coronary sulcus upto close to
posterior interventericular grooves
where it terminate by
anastomosing with right coronary
artery
INTERNAL STRUCTURE OF
HEART
 Four chambers in the heart
 Rt atrium with rt auricle
 Rt ventricle
 Lt atrium with lt auricle
 Lt ventricle
INTERNAL STRUCTURE OF
 Rt atrium: Cuboidal
chamber, smooth (sinus
venarum) & rough
(musculi pectaniti) parts,
four openings
 Rt auricle
 SVC
 IVC
 Coronary sinus
HEART
 Rt ventricle
 Occupies most of the ant




surface
Tapers above into conus
arteriorus which is the outflow
part
Inside of the inflow part is
rough due to trabeculae
carnae
Tricuspid AV valve b/w rt
atrium & rt ventricle
It is crescent shaped in cross
section
 Rt ventricle
Smooth & rough parts are separated by ridge
Tricuspid valve has 3 cusps
Walls are 3 times thinner than lt vent
Each has a free & attached margin
Free margins are attached to papillary muscles by
cords like a parachute
3 papillary muscles in rt vent
The valve prevents backflow while contracting
 Interventricular septum






Strong obliquely placed partition
Upper part is membranous
Rest is muscular & convex to the rt
Pulmonary valve is at the apex of conus art
3 semilunar cusps
Valve closes during diastole to prevent backflow
 LT atrium






Forms most of the base
Receives opening of lt auricle
Also receives 4 pulm veins
Leads to lt ventricle through lt AV or Mitral valve
Mitral valve has 2 cusps
Prevents backflow during systole
Circulation of blood through
heart
 Lt ventricle








Forms the apex & pulm surface
3 times thicker walls
Conical cavity
Numerous muscles
Out flow part is anterosuperior
Aortic orifice lies at the summit of outflow part
It has 3 c
Semilunar cusps to prevent backflow during diastole
ARTERIAL SYSTEM
VENOUS SYSTEM
BLOOD SUPPLY OF HEART
Vasculature of the heart
Vessels are embedded in the fat just deep to
the epicardium
Vessels receive both sympathetic & para
sympathetic supply
Coronary arteries are the first branches from
aorta
Vasculature of the heart
Arterial supply of heart
Rt coronary artery
 Arises from rt aortic sinus
 Descends in the coronary groove
 Branches
Rt atrial
SA nodal branch
Rt marginal branch for the rt border
AV nodal branch
Posterior interventricular branches
Area of supply of rt artery
 Rt atrium
 Most of rt ventricle
 Diaphragmatic part of rt ventricle
 Post third of IV septum
 SA node ( in 60 % people )
 AV node ( in 80 % people )
Left coronary artery
 Arises from lt aortic sinus
 Runs towards lt in the AV groove
 Branches
 SA nodal branch
 Anterior interventricular branch
 Circumflex branch
 Lt marginal branch
Area of supply of lt artery
 Lt atrium
 Most of the lt ventricle
 Part of rt ventricle
 Ant two third of IV septum
 SA node ( in 40 % people )
Vasculature of the heart
Vasculature of the heart
Dominence of the rt or lt
side
 It depends on the posterior inter ventricular
branch
 Rt artery is dominant in75 % people
 Lt is dominant in 10 %
 Co-dominance in 15 %
Venous drainage of heart
 Coronary sinus which drains most part of the
heart via numerous small tributaries
 Coronary sinus drains into the rt atrium
 Small veins that drain directly into the rt
atrium
Venous drainage of heart
Venous drainage
Tributaries of the coronary sinus
Great cardiac vein
Middle cardiac vein
Small cardiac veins
Lt post ventricular vein
Lt marginal vein
MI & bypass grafting
PERICARDIUM:Fibrous Pericardium Serous Pericardium
Epicardium or
Visceral Pericardium
Parietal
Pericardium
FIBROUS PERICARDIUM
(Deriud from septum transversum)
Def :Conical , tough, fibers single layer sac which
support the delicate period layer of the
serous pericardium & firmly adherent to it.
CHARACTERISTS OF FIBROUS
PERICARDIUM
1: Apex is blunt and fused with the roots of the
great vessels and the pericardium fascia
behind the sternal angle.
2: Base is broad & lies on diaphragm and in
seprably blended with the central of the
diaphragm. But in lawer animal it is separated
from diaphragm.
3: Anteriorly it is connected to the upper and
lower ends of body of sternum by weak
4: Posteriory related to principal brochi
oesophagus with nerve plexus around it, and
desending thoracice aorta.
5: On each side (right & left) related to
mediastinal pleura, mediastinal surface of the
lung, pheremic nerve and pericardio phermic
vessels.
SEROUS PERICARDIUM
(1)Perietal
Pericardium
(outer)
Visceral Pericardium
(epicardium)
(inner)
Double layer serous membrem line by
mesothlium, having postential space known
as pericardial cavity, containing thin layer
(film) of serous fluid which lubericate the
apposed during continuous heart beat
CONTENTS OF PERICARDIUM
1: Heart & cardiac vessels and nervous.
2: Ascendimg aorta.
3: Pulmonary Trunk
4: lower ½ half of Superior Vena cava.
5: Terminal parts of inferior vena cava.
6: Terminal parts of 4 Pulmonary Veins.
SINUES OF PERICARDIUM:
Oblique sinous of
pericardium
Transverse sinus of
pericardium
TRANSVERSE SINUS:
B/w Areterial & Venous tubes i.e , arterial tubes
eneloses the asending aorta and pulmonary
trunk and the Venous tubes enelosed 2 venae
cavac and 4 pulmonary Veins & the passage
b/w arterial & Venous tubes is known as
transverse sinus.
OBLIQUE SINUS OF PARICARDIUM:
A narrow gap behind stomach. It is
bounded anteriorly by the left atrium
and posteriory by the parietal
pericardium.
Functionally, since permits the
Pulsatiom of left artium.
ARTERIAL SUPPLY:Branches of:(i) Internal thoracic of artery.
(ii) Muscular pherenic artery.
(iii) Desending thoracic aorta.
NERVE SUPPLY:Fibrous & parietal percardia are pain sensitive &
Supplied by phrenie nerve Epicardium is
supplied automatic nerves of the heart and pain
insensitiue.
Pain of peri-carditis originates in the pericardium
alone.
Pain of angina (cardiac pain) originates in the
muscles of the vessels.
(1)CONTRICTIUE PERICARDITIS:
And pericarditis with effusion cause ‘cardiac
temponad’ where the heart can not dilate
freely. Heart is not filled properly and the
cardiac output is diminshed. There is
marked staris (Stagnation) of the venous
blood in the whole body, neck veins are
excessinely prominent, liver is enlarged
and the pulse is feeble with a pulsus
pericardium character. (Marked decerased
during mspiration)
(2)PERICARDIUM IN TERMINAL
URAEMIA)
(3) Pericardial effusion can be drained by
puncturing in 5th-6th inter-costal space
just lateral to the apex beat or in the
angle b/w xiphoid process and left costal
margin eith meedle direction upward &
backward & to the left.
Pericardium
 Double walled fibroserous sac
 Tough external fibrous layer
 Bound to diaphragm by pericardiacophrenic
ligament
 To sternum by sternipericardiac ligament
 The internal surface is lined by glistening
serous membrane called the parietal layer
Pericardium
Pericardium
 The serous layer is reflected on the heart as
the visceral layer
 It is closely adherent to cardiac muscle & is
also called the epicardium
 The fibrous pericardium protects the heart
against sudden overfilling
 It fuses with adventitia of all the great vessels
Pericardial cavity
 Potential space
 Thin film of fluid
 Heart can move or beat without friction
 Two sinuses present b/w the roots of great
vessels
 Transverse sinus
 Oblique sinus
Pericardial sinuses
Collection of fluid in the
pericardial cavity
Pericardial effusion
Conducting system of heart
Components
 Sinuatrial node
 Atrioventricular node
 Atrioventricular bundle
 Rt bundle branch
 Lt bundle branch
 Perkunji fibres
Conducting system
Conducting system
Conducting system
Conducting system of heart
Electrocardiograph