Kaan Yücel M.D., Ph.D.

1. CARDIOVASCULAR SYSTEM TheTwoFridas1939 byFridaKahlo 14. 10. 2014 Kaan Yücel M.D., Ph.D.

2. 1. HEART (1)7.3 million • Trapezoidalin A-P dimensions • Tipped-over pyramid in 3-D • crucial organ of the human body 30%

3. Leftheart (Pumping) well- oxygenated(arterial) blood fromthelungs pulmonaryveins leftatriumleftventricle aorta the body Right heart (Suction) poorly- oxygenated(venous) blood fromthe body superior vena cava & inferior vena cava rightatriumrightventricle pulmonaryarteries lungs

4. The four chambers of the heart right and left atria & right and left ventricles Ventricles Dischargingchambers Atrium – pluralatria Receivingchambers cardiac cycle • Ventricularfilling (diastole) • Ventricularemptying (systole) Blood pressure 120-80 mm/Hg

5. The fibrous skeleton of the heart • Keeps the orifices of the AV &semilunar valves patent • prevents them from being overly distended by an increased volume of blood. • Provides attachments for the valves & myocardium. • Forms an electrical «insulator» • separating impulses of the atria & ventricles  they contract independently • surrounding and providing passage for the initial part of the AV bundle

6. Sulci/Grooves in the heart coronary sulcus (atrioventricular groove) betweenatrium & ventricles anterior &posterior interventricular (IV) sulci (grooves) betweenright and left ventricles

7. Apex &base of the heart apex located inferiorly & base located superiorly • Apexprojectsforward, downwardandtotheleft • Base faces in a posteriordirection

8. The four surfaces of the heart • Anterior (sternocostal) surface • mostly of right ventricle • someof the right atrium on the right • some of the left ventricle on the left • Diaphragmatic (inferior) surface • formed mainly by the left ventricle • partly by the right ventricle • related to central tendon of diaphragm. • Right pulmonary surface • formed by the right atrium. • Left pulmonary surface • left ventricle &a portion of left atrium.

9. RIGHT ATRIUM forms the right border of the heart • Receives venous blood from the SVC, IVC, and coronary sinus. • Through the right atrioventricular orifice, • discharges the poorly oxygenated blood it has received • into the right ventricle.

10. RIGHT VENTRICLE • forms • largest part of the anterior surface of the heart • a small part of the diaphragmatic surface • almost the entire inferior border of the heart.

11. interventricular septum (IVS) obliquely placed partition between the right and left ventricles, forming part of the walls of each muscular and membranous parts • Bulgesinto the cavity of the right ventricle. • Superiorly and posteriorly, a thin membrane, forms the much smaller membranous part of the IVS.

12. LEFT ATRIUM forms most of the base of the heart • right and left pulmonary veins enter here. • Tubular, muscular left auricle, • Itswall trabeculated with pectinatemuscles. • A semilunar depression in the interatrial septum • Floor of the oval fossa • surrounding ridge • Valveof the oval fossa

13. LEFT VENTRICLE forms the apex of the heart, left (pulmonary) surface & border, most of the diaphragmatic surface. • Comparedtotherightventricle • Walls 2-3 times thicker • Trabeculaecarneaefiner and more numerous • Cavity longer • Anterior &posterior papillary muscles larger

14. aortic valve • semilunarvalve • between the left ventricle &ascending aorta • obliquely placed.

15. mitral valve double-leaflet mitral valve • Guardsthe left AV orifice. • Has two cusps, anterior and posterior.

16. SEMILUNAR VALVES Semilunarcusps of thepulmonaryvalveanterior-right-left Seminularcusps of theaorticvalveposterior-right-left concavewhen viewed superiorly notendinouscords to support

17. VASCULATURE OF THE HEART coronary arteries & cardiac veins • embedded in fat • course across the surface of the heart just deep to the epicardium.

18. Arterial Supply of the Heart coronary arteries first branches of the aorta supply the myocardium and epicardium Anastomoses between the branches of the coronary arteries exist, which enables the development of the collateral circulation.

19. STIMULATING, CONDUCTING, & REGULATINGSYSTEMS OF HEART 1.sinuatrial(SA) node initiates the heartbeat &coordinates contractions of the four heart chambers • 2.atrioventricular (AV) node • 3.bundles • highly specialized conducting fibers for conducting impulsesrapidly to different areas of the heart • Propagation of theimpluse • Simultaneouscontraction of thecardiacstriatedmusclecells

20. sinuatrial (SA) node pacemaker of the heart • @junction of the SVC&right atrium • near tothesuperior end of thesulcus terminalis

21. sinuatrial (SA) node pacemaker of the heart stimulated by sympathetic division of the autonomic nervous system to accelerate the heart rate inhibited by parasympathetic division to return to or approach its basal rate.

22. atrioventricular(AV) node a smaller collection of nodal tissue than the SA node • in the posteroinferior region of the interatrialseptum • near the opening of the coronary sinus

23. JOURNEY OF THE SIGNAL • Generated @ SA node • Passedthrough the walls of the right atrium • Propagetedbythecardiacmuscle • Signalpassedfrom SA nodeto AV node • Distributed totheventriclesthroughthe AV bundle

24. BUNDLES AV bundle the only bridge between the atrial and ventricular myocardium • passes from the AV node • through the fibrous skeleton of the heart and along the membranous part of the IVS. • @ junction of membranous & muscularparts of the IVS • dividesinto : rightbundle & leftbundle.

25. BUNDLES right and left bundles proceed on each side of the muscular IVS deep to the endocardium then ramify into subendocardialbranches (Purkinje fibers) extend into the walls of the respective ventricles.

26. Innervationof the Heart autonomicnervoussystem, cardiacplexus Cardiacplexus posterior to the ascending aorta and bifurcation of the pulmonary trunk

27. Innervationof the Heart autonomicnervoussystem, cardiacplexus • Parasympatheticsupply • presynaptic fibers of the vagusnerves • Slows the heart rate • Reducesthe force of the contraction • Constrictsthe coronary arteriessaving energy

28. Innervationof the Heart • sympathetic supply • presynaptic fibers • cell bodies in the intermediolateral cell columns (IMLs) of the superior 5or 6thoracic segments • postsynaptic sympathetic fibers • cell bodies in the cervical and superior thoracic paravertebral ganglia of the sympathetic trunks. • causes increased heart rate • increased impulse conduction, increasedforce of contraction, • increased blood flow through the coronary vessels increased activity.

29. 9. SEPTAL DEFECTS Atrial Septal Defects (ASD) congenital anomaly of the interatrialseptum a hole betweenthetwoatria Results in Whathappens? enlargement of right atrium & ventricle dilation of the pulmonary trunk Oxygenatedbloodfromthelungs Leftatrium Right atrium Moreblood in therightheart

30. VentricularSeptalDefects (VSD) rank first on all lists of cardiac defects membranous part of the IVS common site of VSDs Results in Whathappens? in pulmonary blood flow severe pulmonary disease (hypertension) cardiac failure Oxygenatedbloodfromtheventricles Leftventricle Right ventricle

31. 10. VALVULAR HEART DISEASES • Disturb pumping efficiency of the heart. • Stenosis(narrowing) or insufficiency • Both result in an increased workload for the heart. • Valvuloplastyrepairingtheheartvalves

32. Mitral Valve Insufficiency • Scarring and shortening of the cusps results in insufficiency • Restricts the outflow of the left ventricle • Leadsto the hypertrophy of the myocardium • During ventricular systole, blood regurgitates back to the left atrium • A hurt murmur will be heard.

33. Mitral Valve Stenosis • Narrowing of the mitral orifice. • Restricts the outflow of the left atrium. • A murmur will be heard during atrial contraction.

34. Pulmonary Valve Stenosis • Narrowing of the pulmonary valve due to the fused cusps. • Restricts the outflow of the right ventricle. • Leadsto the hypertrophy of the myocardium.

35. Pulmonary Valve Incompetence • Incomplete closure of the cusps due to thickening of their free margins due to a disease. • During diastole, blood regurgitates back to the right ventricle from the pulmonary trunk. • Heartmurmurcould be heard.

36. Aortic Valve Stenosis most frequent valve abnormality • Blood is unable to flow freely from left ventricle to aorta. • Aresult of degenerative calcification, fusion of the aortic cups as a result. • Causesextra work for the heart, resulting in left ventricular hypertrophy.

37. Aortic Valve InsufficiencY • During diastole blood regurgitates from aorta back to the left ventricle. • A hurt murmur will be heard during diastole.

38. HEART MURMUR a pathologic sound • could be heard by stethoscope. • produced due to theturbulencecaused by the blood passing from a narrow opening into a larger vessel or chamber.

39. tricuspid valve behind the right half of the sternum opposite 4th intercostal space mitral valve behind the left half of the sternum opposite 4th costal cartilage pulmonary valve behind the medial end of the 3rd leftcostal cartilage and adjoining part of the sternum aortic valve behind the left half of the sternum opposite 3rd intercostal space.

40. S1 produced by contraction of the ventricles closure of the tricuspid &mitral valves (AV valves) S2 produced by the sharp closure of the aortic & pulmonary valves hear sounds produced at each valve with the minimum of distraction or interference

41. mitral valveapex beat fifth left intercostal space, 9 cm from the midline tricuspid valve right half of lower end of the body of the sternum pulmonary valve medial end of the second left intercostal space aortic valve medial end of the second right intercostal space

42. PERICARDIUM fibroserousmembrane, covers the heart & beginning of its great vessels a closed sac withtwo layers fibrous pericardium serous pericardium parietal layer visceral layer –heart & greatvessels .

43. fibrous pericardium continuous superiorly w/ tunica adventitia of the great vessels & w/pretracheallayer of deep cervical fascia • Continuous inferiorly w/ central tendon of the diaphragm • Attachedanteriorly to the sternum bysternopericardial ligaments • Siteof continuity pericardiacophrenic ligament • Inner surface lined by parietal layer of the serous pericardium • Protectsthe heart against sudden overfilling.

44. pericardial cavity potential space between opposing layers of the parietal & visceral layers of serous pericardium • contains a thin film of fluid : pericardialfluid • enables the heart to move and beat in a frictionless environment.

45. GREAT VESSELS right &left brachiocephalic veins formedbytheunion of internal jugular & subclavian veins posterior to the sternoclavicular (SC) joints. brachiocephalic veins unite to form the SVC. @ inferior border of the 1st right costal cartilage shunt blood from the head, neck, &upper limbs right atrium.

46. superior vena cava (SVC) • Returnsblood from all structures superior to the diaphragm • except the lungs & heart. • Passes inferiorly and ends by entering right atrium of the heart.

47. ascending aorta • begins at the aortic orifice. • only branches coronary arteries, arising from the aortic sinuses. ascendingaorta

48. Arch of the aorta (Aorticarch) curved continuation of the ascending aorta • begins posterior to the 2nd right sternocostal (SC) joint at the level of the sternal angle. • ligamentumarteriosumremnant of the fetal ductusarteriosus • root of the left pulmonaryarteryinferior surface of the arch of the aorta • The usual branches of the arch • brachiocephalic trunk • left common carotid artery • left subclavianartery.

49. brachiocephalic trunk first and largest branch of the arch of the aorta • arises posterior to the manubrium. • ascends superolaterally • divides into right common carotid &right subclavian arteries.

50. left commoncarotIdartery second branch of the arch of the aorta • arises • posterior to the manubrium, • slightly posterior and to the left of the brachiocephalic trunk.