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THE CIRCULATORY SYSTEM 4-6-99 Terms of the day: Chondromalcia, febrile /pyrexia, Autopsy, Carcinogen, Tactile, Exopthalmus, Antagonist, Hyptonia, Anaphylaxis, Ambulate Ramus – a branch or primary divisions of a nerve or blood vessel. One of the primary divisions of a cerebral sulcus. A part of an irregularly shaped bone (less slender than a “process”) which forms an angle with the main body. Prolapse – to sink down, a sinking of an organ or other part, especially its appearance at a natural or artificial orifice. Palsy – often connotes partial paralysis or paresis. Somnolence – a condition of semiconsciousness approaching coma, sleepiness; an inclination to sleep. Ptarmic – sternutatory, causing to sneeze. Entropion – the infolding of the margin of an eyelid, inversion or turning inward of a part. Paresis – Partial or incomplete paralysis. Anamnesis – The act of remembering. The medical or developmental history of a patient. Anisosocoria – unequal pupil size Introduction Functions of the circulatory system 1. Transportation RBC’s carry O2 and CO2 nutrients waste products hormones 2. Protection WBC’s, immune cells, antibodies Major components of the circulatory system 1. Blood 2. Blood vessels 3. Heart The Heart p. 529-538 Location and General Description Hollow, 4 chambered muscle 2/3 of the heart are located to the left of the midline the base of the heart is just inferior to the angle of Louis Apex is distal to the base, between 5th and 6th ICS( intercostal space ) Mediastinum - median portion of the thoracic cavity, contains all thoracic viscera except the lungs. Pericardium – surrounds the heart 1. fibrous pericardium – thick sac that does not expand - primary reason for air bags 2. serous pericardium a. parietal serous pericardium b. visceral serous pericardium - epicardium pericardial cavity – between the parietal and visceral pericardium N 200 Heart wall 1. epicardium – visceral serous epicardium 2. myocardium 3. endocardium Heart Chambers and Valves N 212 4 chambers, 2 upper atria (receive blood from body and lungs) and 2 lower ventricles (pumping chambers to body and lungs). Atria contract simultaneously, and the ventricles contract simultaneously. interatrial septum interventricular septum atrial walls and much thinner than ventricular walls, and the left ventricle is much thicker than the right atrioventricular valves - right and left semilunar valves - aortic and pulmonary Marie Paas 60 Anatomy Tri1 05/02/17 Circulation of blood through the heart Blood from the body right atrium right AV valve right ventricle semilunar valve pulmonary trunk lungs pulmonary veins left atrium left AV valve left ventricle semilunar valve aorta body Right Atrium Vessels entering the right atrium 1. superior vena cava 2. inferior vena cava 3. coronary sinus Pectinate muscles – walls of atria Fossa ovale – adult structure of the foramen ovale N 208 Right Ventricle Right atrioventricular valve - tricuspid valve Chordae tendineae – prevent inversion of the valves into the atrium, act like guide wires 3 Papillary muscles – anchor the chordae tendinae Trabeculae carneae – correspond to the pectinate muscles of the atria Conus arteriosus – infundibulum, funnels blood toward the p. trunk Pulmonary valve - pulmonary semilunar valve Pulmonary trunk – dilated by blood recoils elastic fibers, valve closes Left Atrium Pulmonary veins - 4 N 209 Left Ventricle Left atrioventricular valve - bicuspid valve or mitral valve Aortic valve - aortic semilunar valve Aorta Conduction System of the Heart N 213 Atria contract from base to apex, ventricles contract from apex to base. Impulses in the heart are carried by conductive cells that have very leaky membranes to Na. Na/K is constantly selfdepolarizing the heart. The Vagus nerve makes the membranes less permeable to Na ( i.e. slows HR), and Norepi makes the membranes more permeable to Na ( i.e. increases HR) Sinoatrial node (70-80 BPM) SA node - internodal fibers carry impulses down to the ventricles Atrioventricular node or AV node – delays the impulse so that the atria contract fully, then the impulse is carried to the … Atrioventricular Bundle - Bundle of His which in turn branches into L and R and passes the impulse along to the … Conduction Myofibers - Purkinje Fibers Systole - contraction of the heart, especially the ventricles Diastole - postsystolic dilation of the heart, in which the chambers fill with blood. Contract empty relax fill Heart sounds first heart sound - Lub - closing of the AV valves, during ventricular systole second heart sound - dup - closing of the semilunar valves, during ventricular diastole N 210 The Coronary Vessels p. 534-535 Blood flows through the coronary vessels during ventricular diastole. The aortic sinus prevents the aortic valves from sticking – it is where the coronary arteries go off. 1. Right Coronary Artery Right marginal artery Posterior Interventricular artery – goes down the sulcus 2. Left Coronary Artery – divides almost immediately Anterior Interventricular artery Circumflex artery – goes to the dorsum 3. Coronary Veins Great cardiac vein Marie Paas 61 Anatomy Tri1 05/02/17 Middle cardiac vein – psterior interventricular septum Coronary sinus into right atrium The Blood Vessels p. 538-562 Blood Pressure N 204 PR = peripheral resistance – the resistance on blood by blood vessels, affected by: 1. diameter of the vessel – increased diameter less resistance, decreased diameter increased resistance 2. length of the vessel – the longer the vessel, the higher the resistance ( each pound of fat adds 10 miles of capillaries for blood to travel) 3. viscosity – thickness of the blood ( essential high BP ) BP = CO x PR, CO = cardiac output CO = HR x SV systolic pressure – pressure of ejection from ventricle diastolic pressure – vascular tone of the blood vessels - controlled by ANS The Arteries Aortic Arch – 3 branches off here ( TEST) 1. Brachiocephalic Trunk a. Right common carotid artery b. Right subclavian 2. Left common carotid artery 3. Left subclavian N 225 Blood Supply to the Neck and Head N 130 1. Common carotid artery – bifurcates at the angle of the jaw to deliver 50% of blood going to the brain A. Internal carotid artery 1. ophthalmic artery 2. posterior communicating artery 3. anterior cerebral artery 4. middle cerebral artery B. External carotid artery – supplies the superficial face ( the detail of this vessel just FYI for now) 1. superior thyroid a. 2. ascending pharyngeal a. 3. lingual a. 4. facial a. 5. maxillary a. 6. superficial temporal a. 7. posterior auricular a. 8. occipital a. Arteries to the Shoulder and Upper Extremity 1. Subclavian artery Vertebral artery – is the first branch off, ascending in the transverse foramen of superior C6 continues on posteriorly over the posterior arch of the atlas towards the foramen magnum to join at the anterior surface of the medulla to form the… basilar artery which splits to join the posterior communicating artery Circle of Willis N 133 1. posterior cerebral artery 2. posterior communicating artery 3. internal carotid artery The anterior communicating artery joins the anterior cerebrals. The anterior communicating artery sometimes has a defect in its wall and develops an aneurism. Incidence is higher in females, called Berry aneurism ( Berry, very bad). First sign is sudden blindness due to pressure on the optic chiasma. Terms for the day: Dysmenorrhea, cachexia, thoracocenthesis, antiemetic, bruit, Cathartic, Arborize Melena – passage of dark colored, tarry stools Carminative – An agent that relieves flatulence Marie Paas 62 4-13-99 Anatomy Tri1 05/02/17 Admexa – parts accessory to the main organ or structure 2. Thyrocervical trunk supplies thyroid gland, trachea and larynx inferior thyroid a. suprascapular a. transverse cervical a. 3. Costocervical trunk supplies upper intercostal m., spinal cord, meninges, posterior neck muscles. superior intercostal a. deep cervical a. Internal thoracic a. is the last branch off, runs inside the chest wall along the posterior surface of the anterior wall To determine what artery you are looking at, look at 3 things: 1. location 2. what does it supply? 3. where does it come from? Axillary artery ( once the subclavian artery passes the first rib it becomes the axillary artery ) • • • • • N 398 superior thoracic a. thoracoacromial a. acromial a. deltoid a. pectoral a. clavicular a. lateral thoracic a. subscapular a. circumflex scapular a. thoracodorsal a. anterior and posterior circumflex humeral aa. Brachial artery (once the axillary artery drops inferior to the teres major m.) profunda a. superior ulnar collateral a. inferior ulnar collateral a. • Radial artery – ultimate termination artery – pulse/BP joins ulnar to form the superficial palmar arch swings posteriorly, can be palpated in anatomic snuff box • Ulnar artery – ultimate termination artery superficial palmar arch Branches of the Thoracic Portion of the Aorta 1. pericardial arteries 2. bronchial arteries 3. esophageal arteries 4. posterior intercostal arteries – run in intercostal space along with vein and nerve 5. superior phrenic arteries Branches of the Abdominal Portion of the Aorta The descending thoracic aorta become the abdominal aorta when in passes through the hiatus in the diaphragm • • • Inferior phrenic a. Celiac Trunk (for foregut derivatives: stomach, spleen, liver) – comes off anteriorly left gastric a. common hepatic a. splenic a. Superior mesenteric a.(for midgut derivatives: pancreas and duodenum) 5 basic branches ( there are hundreds of branches off here) Marie Paas 63 Anatomy Tri1 05/02/17 1. inferior pancreaticoduodenal a. – pancreas and duodenum 2. jejunal and ileal aa. 3. Ileocolic a. – Ileocecal valve 4. right colic a. – ascending colon 5. middle colic a.- transverse colon • • • • • Inferior mesenteric a. (for hind gut derivatives) left colic a. – descending colon sigmoid a. – sigmoid colon superior rectal a. – superior aspect of rectum N 286 Renal arteries 20% of cardiac output through here suprarenal a. Gonadal arteries testicular a. - male ovarian a. - female N 287 Lumbar arteries Middle sacral a. Arteries of the Pelvis and Lower Extremity Common iliac arteries N 477 External iliac a. turns into the femoral artery once it passes the inguinal ligament femoral a. – superficial circumflex iliac a. – superficial epigastric a. – superficial external pudendal a. – deep external pudendal a. – profunda femoris a. - medial and lateral femoral circumflex aa. – Popliteal a. – Anterior Tibial a. - dorsal pedal a and arcuate a. – Posterior Tibial a. - peroneal a. and medial and lateral plantar aa. Internal iliac a. N 338 internal pudendal a. and perineal a. – this can be occluded in long distance bikers and cause impotence. The Veins Veins that Drain the Brain Dural Sinuses superior sagittal sinus inferior sagittal sinus straight sinus confluence of sinuses transverse sinus sigmoid sinus internal jugular vein Miscellaneous Veins 1. Medial cubital vein cubital fossa 2. Great saphenous vein – medial aspect of thigh and leg 3. Azygos vein N 97 N 448 N 508 Normally, circulation goes: heart artery capillary vein heart Portal systems are the exception to the rule. Here the blood flow is as follows: heart artery capillary vein capillary vein heart 1. Hepatic portal vein superior mesenteric vein } splenic vein } combine to form the portal vein liver drained by the hepatic vein which empties into the inferior vena cava Marie Paas 64 N 293 Anatomy Tri1 05/02/17 2. Hypophyseal portal system N 141 Located between the hypohysis and the pituitary gland, its main function is to transport hormones from the hypothalamus to the pituitary gland. superior hypophyseal a. primary plexus long and short hypophyseal portal veins - to adenohypophysis secondary plexus efferent hypophyseal veins to cavernous sinus Fetal circulation - p. 560-562 The End of Systemic Anatomy Lecture Material Marie Paas 65 Anatomy Tri1 05/02/17