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The Heart

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  1. The Heart • 1-Conical in shape: Apex directed forward downward to the left- Base backwards upward to the right. • 2-Weight = about 300 gm. • 3-Lie in the chest between the two lungs, behind the sternum = 1/3 on the Right , 2/3 on the left • 4- The heart directed downward forward and to the left “45 to the left”. dr.mon5@hotmail.com

  2. 5- Covered by pericardial sac, which have 2 layers: • a- The outer layer cover and emerged with the major vessels of the heart. • b- The inner layer is covering the muscular part of the heart. • c- In between fluid for lubrication of the heart and allow its movement, so prevent cardiac detachment. dr.mon5@hotmail.com

  3. The heart has 3 layers a) Outer layer, fibrous tissue: epicardium, b) Middle layer, muscular tissue: myocardium. c) Inner layer epithelial tissue : endocardium Separeatd from the thoracic cage by the pericardium and surrounded by pericardial sac that contain 300 ml fluid lubricating the heart dr.mon5@hotmail.com

  4. Surface (1) Sterno-costal surface: - formed by Rt atrium and Rt Ventricle (2) Diaphragmatic surface: - Formed by both ventricles. (3) Posterior surface: left atrium and small part of Rt atrium. dr.mon5@hotmail.com

  5. 1 st = left 2 nd costal cartilage: 3 cm from midline. 2 nd = Rt 3 rd Cost, cartilage 4 cm from Medline. 3 rd = Rt 6 costal cartilage ;4 cm from midline. 4 th = left ICS MCC;9 cm from Medline. The heart have (4) Main Points dr.mon5@hotmail.com

  6. (1) Rt border:- - Between 2nd and 3rd points. - formed by Rt atrium. (2) Inferior border :- - Between 3rd and 4th points. - Formed mainly Rt ventricle and left ventricle. (3) Left border :- - Between 4rd and 1st points. - Formed mainly by left ventricle and by left atrium. (4) Superior border:- - Between 1st and 2nd points. - Formed by Both atria. Borders dr.mon5@hotmail.com

  7. Chambers dr.mon5@hotmail.com

  8. Tricusped valve: Regulate blood flow between the right atrium and right ventricle. Pulmonary valve: Control blood flow from the right ventricle and the pulmonary arteries. Mitral valve: Lets oxygenated blood pass from left atrium to left ventricle. Aortic valve: open the way for blood to pass from the left ventricle to the aorta. Valves dr.mon5@hotmail.com

  9. Dimension • Up-down :12 cm • Antero- posterior :6 cm • Side to side :8 cm dr.mon5@hotmail.com

  10. Nerve Supply dr.mon5@hotmail.com

  11. the function of the heart is to deliver nutrition and remove metabolites from all over the body cell. • This requires delivery system: • High pressure delivary system: the left side of the heart. • Area of exchange. • Low pressure returns system: venous and return system. dr.mon5@hotmail.com

  12. The heart has two main pumps • Left ventricular pump’’ pressure pump: • The left ventricle pumps blood at high pressure gradient to systemic circulation. • Right ventricular pump’’ volume pump’ • The right ventricle pumps the same volume at low pressure to the pulmonary vein. dr.mon5@hotmail.com

  13. Congenital Heart Disease • A congenital heart disease is a defect is a defect in the structure of the heart and great vessels of a new born. Most heart defects either obstruct blood flow in the heart or vessels near it or cause blood to flow through the heart in an abnormal pattern. dr.mon5@hotmail.com

  14. 1-Atrial septal defect: • Def: It is a form of congenital heart defect that enables blood flow between the left and right atria via the inter-atrial septum. This allows blood to travel from the left side of the heart to the right or vice versa. This results in mixing of arterial and venous blood. • During development of the fetus, the interatrial septum develops to separate the left and right atria. dr.mon5@hotmail.com

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  16. Clinical Picture Symtoms: • Parients may have a prolonged symtoms free period. • Palpitation. • Fatigue. • Dyspnea on exertion. • Orthopnea. • Frequent respiratory tract infection. dr.mon5@hotmail.com

  17. Signs: • Wide fixed splitting of the S2 heart sound. • Systolic ejection murmer. • Distention in neck vein, ascitis, and oedema. dr.mon5@hotmail.com

  18. Chest X-ray: • Increased pulmonary blood flow: Increase pulmonary vascular markings in the lung: Shunt-Vasulature dr.mon5@hotmail.com

  19. Catherterization: • Passage of the catheter across the atrial defect. • The pressure between the two atrium are equal. Echocardiography: • Enlargement of the right atrium. • Appearance of the septal defect. Doppler: • Abnormal flow of blood. Treatment: • 1-Surgery. • 2-Alternatively by catheter based device. dr.mon5@hotmail.com

  20. Ventricular Septal Defect • Definition Defect in the ventricular septum. • The most common congenital deformity. • The blood flow from the left ventricle to the right ventricle increase pulmonary blood flow pulmonary hypertension. dr.mon5@hotmail.com

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  22. Clinical Picture Symptoms: • Left and right side heart failure. Signs: • Sternal left. • Systolic murmer : along the left sterna border. X-ray: • Enlarged heart. • Shunt Vasularity dr.mon5@hotmail.com

  23. Catheterization: Echocardiography. Doppler. Treatment: • Repair of the defect….open heart machine. dr.mon5@hotmail.com

  24. Patent Ductus Arteiosis Definition: It is a congenital heart defect where the child’s ductus arteriosis fail to close after birth. Pathology: • Normally present in the developing fetus, allowing more amount of blood to bypass the lung directly to the aorta with help of the maternal prostaglandin. dr.mon5@hotmail.com

  25. Patent ductus arteriosis allow oxygenated blood to move from the aorta to the pulmonary arteries, so some of the oxygenated blood fall to reach the general circulation. Also, volume overload is imposed on the left ventricle (why) left ventricular failure. The increased pulmonary blood flow pulmonary hypertension and right ventricular failure dr.mon5@hotmail.com

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  27. Clinical Picture Symptoms: • Tachycardia. • Shorteness of breath. Signs: • Murmer: continuous murmer. • Pulses: bounding pulse. Chest X-ray: • Enlarged heart. • Shunt Vascularity. dr.mon5@hotmail.com

  28. Echocardiography: • May reveal the patent duct. • Dopller : Abnormal blood flow. Catheterization: • Detect the duct. • Pulse oximeter. Treatment: Surgical correction. dr.mon5@hotmail.com

  29. Tetralogy of Fallot Definition:It a congenital cardiac defect which classically have four anatomical defects. • Ventricular sebtal defect. • Pulmonic Stenosis. • Overriding Aorta: • Right ventricular hypertrophy: more muscular than normal. • Results from environmental or genetic factors. dr.mon5@hotmail.com

  30. Clinical Picture • Low blood oxygen saturation. • Central cyanosis. • Murmer. • Dypsnea on Exertion. • Clubbing of finger. • X-ray: boot like appearance. Treatment: emergency care with corrective surgery. dr.mon5@hotmail.com

  31. Aortic Corarctation Definition:Isnarrowing of aorta where the ductus arteriosis insert. Pathophysiology:often leads to hypertension. • If the stenosis is sever ,it limit the aortic flow distal to the stenosis; distal tissues are pefused by extensive collateral circulation. • The kidney is perfused at subnormal blood pressure. dr.mon5@hotmail.com

  32. Clinical Picture: • Symptoms: • Headache. • Leg fatigue. • Signs: • Blood pressure. • Habitus: The upper body is well developed while the lower one is underdeveloped. • Murmer: Mid systolic dr.mon5@hotmail.com

  33. X-ray: • Enlarged heart. • Figure of 3 appearance. • Cardiac MRI. • Catheterization. Treatment:Correction dr.mon5@hotmail.com

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  37. Cardiac Surgery dr.mon5@hotmail.com

  38. Open Cardiac Surgery I. Coronary Artery Bypass Graft: • Pathogenesis • The common indication of cardiac surgery is narrowing of the coronary arteries which supply the muscle of the heart, which may end into complete closure. • The causes of coronary disease is atheeroschosis which may be due to genetic defect or life style. dr.mon5@hotmail.com

  39. The signs and symptoms • Shortness of breath with exertion • Chest pain • Nousea and sweating. • The heart lung machines: • A) The Extra corporal circulation: • The deoxygenated blood is drained from the SVC or the IVC through a canula. • As the blood is shifted from the heart, rapid drop in pressure occurred. Heart • stop to pump. • The blood then cooled or heated, filtered and passed into the oxygenater. dr.mon5@hotmail.com

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  41. The oxygenator: • The deoxygenated blood is then oxygenated by 3 types of oxygenators : • Bubble oxygenator. • Disc oxygenator. • Membrare oxygenator. C) The pumping machine: • It must be capable of moving 5 liters of blood \ minute to the general circulation through a canula inserted into aorta. • It contain filter to remove any fibrin, debris and air embolism dr.mon5@hotmail.com