Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download The Heart - Univerzita Karlova
Document related concepts
Cardiovascular disease wikipedia , lookup
Remote ischemic conditioning wikipedia , lookup
Saturated fat and cardiovascular disease wikipedia , lookup
Cardiac contractility modulation wikipedia , lookup
Heart failure wikipedia , lookup
Cardiothoracic surgery wikipedia , lookup
History of invasive and interventional cardiology wikipedia , lookup
Electrocardiography wikipedia , lookup
Hypertrophic cardiomyopathy wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Lutembacher's syndrome wikipedia , lookup
Mitral insufficiency wikipedia , lookup
Artificial heart valve wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Heart arrhythmia wikipedia , lookup
Coronary artery disease wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
Transcript
Univerzita Karlova v Praze - 1. Lékařská fakulta The Heart Cavities,valves, vessels, nerves, development Institute of Anatomy Author: David Sedmera Subject: Anatomy 2 Date: 12. - 19. 3. 2012 The Heart : 1. Cavities, Wall, Valves • Why heart? • What’s heart? • How heart? -Structure -Function -Disease The Heart as Whole • • • • Incoming vessels Cardiac chambers Valves and support Outgoing vessels Posterior View •SVC •IVC •Pulmonary veins •Aorta •Pulmonary trunk The Cavities: Four-Chamber View Four-Chamber View: ECHO If you want to see the movies, You need to come to the lectures. Dr. M. Kocík, IV. Int. klinika Chambers of the Heart • • • • Left atrium Right atrium Left ventricle Right ventricle Atrio-ventricular valves Semilunar valves •Interatrial septum •Interventricular septum Chambers of the Heart: Connections Right Ventricle - Inflow Right Ventricle - Outflow Left Ventricle - Inflow Left Ventricle - Outflow Layers of chamber wall 3 layers, from outside in: • epicardium • myocardium • endocardium Myocardial Organization 3 layers of muscle: • Outer oblique • Middle circular • Inner longitudinal Myocardial Contraction Short axis view • Shortening velocity (cm/s) • Ejection fraction (%) • Paradoxical movement (MI) The Valves 1. Nomenclature Anterior • pulmonary • tricuspid • aortic • mitral • fibrous skeleton Posterior (view from the top) The Valves 2. Support Papillary muscles Tricuspid valve Mitral valve Cardiac Skeleton The Valves 3. Function (ventricle) The Heart Cycle 2nd 1st The Heart Sounds First sound: AV valves closure Second sound: arterial valves closure Valve auscultation A T P M All Physicians Take Money Heart Murmurs Valve replacement The Heart: 2. Vessels, Nerves, Conduction System & Development • Coronary arteries • Cardiac veins •Lymphatics •Sympathetic nerves •Parasympaticus •Pacemaking & Conducting system •Heart development Surface of the Heart Overview of Blood Supply The Blood Supply: Origin Left coronary artery Right coronary artery The Blood Supply: Course The Blood Supply: X-ray - right The Blood Supply: X-ray - left Review: Coronary Arteries and Veins Review: Coronary Arteries and Veins Left coronary artery: -anterior interventricular branch --diagonal branch -circumflex branch --obtuse marginal branch Great cardiac vein Right coronary artery: -artery to SA node -acute marginal branch -posterior interventricular branch Small cardiac vein Left oblique atrial vein (of Marshall) => coronary sinus Middle cardiac vein (with posterior interventricular branch) Anterior cardiac veins (to right atrium) Thebesian veins The Lymphatic Drainage Along the blood vessels The Blood Supply: Troubles... Stenosis of anterior interventricular ramus of left coronary artery The Blood Supply: Solution !? PTCA: Percutaneous Transluminar Coronary Arterioplasty Via catheter with balloon The Innervation Parasympathetic: n. X (vagus) - rr. cardiaci Stimulation slows down the rate (S-A node), conduction (A-V node) and decreases force of contraction (via coronary vasoconstriction). Sympathicus comes from C and T region via cardiac plexus together with coronary arteries - nn. cardiaci Stimulation increases heart rate (S-A node), shortens A-V delay, increases force of contraction (directly) and dilates coronary arteries. Afferent fibers carry pain (MI). The Innervation The Innervation The Conduction System S-A node (Internodal tracts) A-V node His bundle Left and Right bundle branches Purkinje fibers Working myocardium Electrical insulation AV node and Bundle Branches LBB RBB Triangle of Koch: delimited by the venous valve->the tendon of Todaro and the anulus of the tricuspid valve. GFP:Cx40 labeling of conduction system Septum Left bundle branches Purkinje fibers Ventricular walls Lucille Miquerol, IBDM, Marseille Tawara: ventricular conduction system Septum Left bundle branches Purkinje fibers Ventricular Tawara (1906) walls Right Bundle Branch in Action Chick Mouse Rat Isochronal activation maps human Cardiac development • ATTENTION: aortic arches and their derivatives are NOT considered here. Milestones of cardiac development • Precardiac mesoderm • Cardiac tube • Heart loop • Four compartments Septation of atria and ventricles Morfogenetic mechanisms • Proliferation • Migration • Diferentiation • Cell death (programmed) Outflow tract septation Role of neural crest in outflow tract septation NB coronary vessels also have extracardiac origin Analysis of neural crest cell migration using chick - quail chimera aortico-pulmonal septum! Congenital heart disease • • • • Cardiac tube - cardia bifida (lethal) Impaired looping - dextrocardia Deficient septation - ASD, VSD Outflow tract defects - PTA, DORV, TGA • Causes: genetics (Nkx2.5), environment / drugs (Etretinate) Fetal and postnatal circulation in utero Fetal and postnatal circulation Remodeling after birth post partum The Heart: 3. Pericardium, Topography & Projections • Projection on body surface • Chest X-ray •Valve projections •Syntopies •The Pericardium •Pericardial cavity and sinuses Position of the Heart in the Chest Position of the Heart 2. X-Ray Position of the Heart 2. X-Ray Position of the Heart 2. X-ray Position of the Heart 2. MRI Position of the Heart 2. MRI Projection and auscultation points of cardiac valves on body surface Projection on the body surface Movements with respiration Position in differently shaped chests The Pericardium • Parietal pericardium • Pericardial fluid • Visceral pericardium (epicardium) • fat Heart in the pericardial cavity Pericardial cavity with the heart removed Pericardial Cavity & Sinuses • Transverse sinus • Oblique sinus Transverse and oblique pericardial sinus X Hydropneumopericardium Development of the pericardium Development of the pericardium Pericardium gives rise to: -cardiac fibroblasts -coronary smooth muscle -subepicardial fat Coronary endothelium -derived from the liver A bit of histology - endocardium Some more histology - epicardium Yet more histology - valve References • • • • • • • • • • • Čihák: Anatomie 3. Told: Anatomical atlas Netter: Anatomical atlas Grant: Anatomical Dissector Anderson and Becker: Cardiac Anatomy Morphology for Pharmacy students Sadler: Human Embryology Junquiera: Basic Histology Original research papers Internet (radiographs) Dr. Kocík (echos)
