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Transcript
BASIC CARDIAC ANATOMY AND PHYSIOLOGY BASICCARDIACANATOMYANDPHYSIOLOGY INTRODUCTION Theheartcontractsinresponsetoelectricalstimulationandpumpsbloodouttothebodytoprovideenergyandnutrients tothebody'stissueswhilealsoremovingwasteproducts. NORMALCARDIACANATOMY • Deoxygenatedvenousbloodfromthebodyreturnstotherightatriumviathe superiorandinferiorvenacavae. • Bloodflowsfromtherightatrium—>tricuspidvalve—>rightventricle—> pulmonaryvalve—>mainpulmonaryartery • Mainpulmonaryarterydividesintorightandleftpulmonaryarteriesthrough whichdeoxygenatedbloodentersthelungs • Inthelungs,thepulmonaryarteriesbranchintocapillarieswheregas exchangeoccurs. • Oxygenatedbloodleavesthelungsthroughthepulmonaryveins(4intotal,2 left,2right)andenterstheleftatrium • Bloodflowsfromtheleftatrium—>mitralvalve—>leftventricle—>aortic valve—>aortaandrestofbody CARDIACVALVES Theheartcontains4valves: Tricuspidvalve-locatedbetweenrightatriumandrightventricle Pulmonaryvalve-locatedbetweenrightventricleandpulmonaryartery Mitralvalve-locatedbetweenleftatriumandleftventricle Aorticvalve-locatedbetweenleftventricleandaorta • Valveleaflets=flapsoftissuecomprisingeachvalveandprotectheartvalve opening • Papillarymuscles=extensionofheartmusclethatfacilitateopeningand closingofvalvestherebypreventingvalvularregurgitationandprolapse • Chordaetendinae=tissueattachmentbetweenvalveleafletsandpapillary muscles CORONARYARTERIES • Branchofsystemiccirculationsupplyingoxygenandnutrientstotheheart muscleitself • Majorcoronaryarteries=rightandleftbranches • Leftcoronaryarteryoriginatesfromsingleopeningbehindleftaorticvalve leaflet • Branchesintoleftanteriordescendingandleftcircumflexarteries • Rightcoronaryarteryoriginatesfromopeningbehindrightaorticvalveleaflet • Branchesinto3arteries:conusbranch,rightmarginalbranch,and posteriordescendingbranch Mainpulmonaryartery Superiorvenacava Rightpulmonary artery Right pulmonaryveins Aorta Leftpulmonary artery Leftatrium Rightatrium Inferiorvena cava Leftventricle Rightventricle Figure1:Basiccardiacstructures Pulmonaryvalve Tricuspidvalve Mitralvalve Leaflets Aorticvalve Cordae tendinae Papillarymuscle Figure2:Cardiacvalvesandvalve components Leftcoronary artery Rightcoronary artery Circumflex artery Conusbranch Marginalbranch Posteriordescending branch Leftanterior descendingartery Figure3:Themaincoronaryarteries CPAP PAGE 1 of 2 BASIC CARDIAC ANATOMY AND PHYSIOLOGY CORONARYVEINS • Afternutrientexchange,bloodfromthecoronaryarteriesdrainsinto coronaryveinsbeforereturningtosystemiccirculation. • Smallercoronaryveinsconvergetoformthegreatcardiacveinandthe coronarysinus • Coronarysinusdrainsdeoxygenatedbloodintorightatrium Greatcardiac vein Coronary sinus Figure4:Coronaryveins CARDIACCONDUCTIONSYSTEM • Sinoatrialnode:locatedbetweenjunctionofrightatriumandsuperiorvena cava • Primaryoriginofelectricalimpulsestravelingthroughtheheart • Electricalimpulsesfromthesinoatrialnodetraveltotherightandleftatria, resultinginatrialcontraction • Afteratrialcontraction,electricalimpulsestravelthroughtheatrioventricularnodetotherightandleftventricles • Intheventricles,electricalimpulsestravelthroughthebundleofHis—>right andleftbundlebranches—>Purkinjefibers,resultinginsynchronized ventricularcontraction Sinoatrialnode BundleofHis Rightbundle branch Atrioventricular node Leftbundle branch Purkinjefibers Figure5:Cardiacconductionsystem ELECTROCARDIOGRAM • Pwave=atrialcontraction • PRinterval=timebetweenonsetofatrialcontractiontoonsetofventricularcontraction • QRScomplex=ventricularcontraction • STsegment=timebetweenendofventriculardepolarizationandonsetofrepolarization • ElevationordepressionofSTsegmentmayindicateheartmuscleischemia • QTinterval=timebetweencompleteventriculardepolarizationandrepolarization • ProlongedQTinterval=riskfactorforsuddencardiacdeathandventriculararrhythmias Figure6:DifferentphasesofanECGtracing INTRACARDIACPRESSURES • Leftsidedcardiacpressuresareusually3xgreaterthatrightsidedcardiacpressures • Normalrightatrialpressure=3mmHg(2-8mmHg) • Normalleftatrialpressure=8mmHg(6-12mmHg) This document is meant to be used as an educational resource for physicians and other healthcare professionals. It is in no way a substitute for the independent decision making and judgment by a CPAP qualified health care professional. Users of this guideline assume full responsibility for utilizing the information contained in this guideline. OPENPediatrics™ and its affiliations are not responsible or liable for any claim, loss, or damage resulting from the use of this information. OPENPediatrics™ attempts to keep the information as accurate and up to date as possible. However, as recommendations for care and treatment change, OPENPediatrics™ does not assume any legal liability or responsibility for the accuracy, completeness or usefulness of any information on this guideline. PAGE 2 of 2
