Download Day 18 Cardiovascular Anatomy and Physiology

Cardiovascular Anatomy and
Physiology
AFAMS Residency Orientation
April 16, 2012
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Heart Facts
•
•
•
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Human heart is 13 x 9 cm
Weighs about 1 kg
Beats 100, 000 times a day
Pumps 7600 L of blood
daily
• Circulates blood
completely about 1000 x a
day
• Pumps blood through
100,000 km of vessels
• Cardiovascular Death is
most common cause of
death worldwide
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Purpose of Cardiovascular System
• Deliver blood to tissues
and organs
– Nutrients
– Oxygen
• Remove used blood
from organs and tissues
– Deoxygenated
hemoglobin
• Deliver deoxygenated
blood to lungs for reoxygenation
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Cardiac Anatomy
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Cardiac Anatomy
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Cardiac Anatomy: Chambers
• Right Atrium (RA)
– Receives deoxygenated blood from
venous circulation
– Pumps blood to RV
• Right Ventricle (RV)
– Receives deoxygenated blood from
RA
– Pumps deoxygenated blood to
lungs
• Left Atrium (LA)
– Receives oxygenated blood from
pulmonary vein
– Pumps blood to LV
• Left Ventricle (LV)
– Receives oxygenated blood from LA
– Pumps oxygenated through aorta
to body
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Gross Anatomy
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Cardiac Anatomy: Valves
• Classification
– A-V valves
• Tricuspid
– Separates RA and RV
• Mitral
– Separates LA and LV
– Systemic Valves
• Aortic
Aortic Valve
– Separates LV and Aorta
• Pulmonic
– Separates RV and
Pulmonary artery
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Mitral Valve
Cardiac Anatomy: Outflow
• Pulmonary Artery
– Arising from Right Ventricle
(RV)
– Blood from RV to lungs
• Aortic Arch
– Arising from Left Ventricle
(LV)
– Blood from LV to body
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Normal Regional Circulation
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Cardiac Anatomy: Coronary Arteries
• Left Main (LM)
• Left Anterior Descending
(LAD)
– Septal Perforating Branches
– Diagonal Branches
• Left Circumflex (LCx)
– Obtuse Marginals
• Right Coronary Artery (RCA)
– Acute Marginals
– Posterior Descending
– Posterior Lateral Branch
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Coronary Anatomy
LAO Caudal View
LAO Cranial View
LAD
LM
LM
OM1
PDA
D1
LCx
RCA
PLB
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Left Ventricular Volumes
• End Diastolic Volume
(EDV)
– Volume of blood in LV
and end diastole
– Directly proportional to
venous return
• End Systolic Volume
(ESV)
– Volume of blood in LV at
the end of systole
(contraction)
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Left Ventricular Volumes
• Stroke Volume (SV)
– EDV - ESV
• Ejection Fraction (EF)
– SV/EDV
– Normal resting EF: 60%
• Best predictor of heart
performance and heart
disease prognosis
– Normal exercising EF:
80%
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Left Ventricular Volumes
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Cardiology Physiology
• Cardiac Output (CO)
– HR x SV
• Cardiac Index (CI)
– CO / BSA
• Preload
– Volume of blood in the left
ventricle at end diastole
– Dependent upon venous return
and compliance of left ventricle
• Afterload
– Amount of resistance the heart
has to overcome to pump
blood forward
• Mean Arterial Pressure
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Cardiology Physiology
• Myocardial Contractility
– Amount of force with
which the heart contracts
at a given preload
– Dependent upon
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Sympathetic Nerve activity
Catecholamines
Myocardial mass
Drugs
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Contractility
• Increased Cardiac Contractility
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–
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Exercise: increased sympathetic tone
Catecholamines: epinephrine and norephinephrine
Excitement / Fear: Fight of flight response
Drugs: Digitalis and sympathomimetics
• Decreased Cardiac Contractility
– Loss of Contractile Mass: Secondary to myocardial
infarction
– Myocardial muscle disease: Cardiomyopathy
– Drugs: anesthetics and barbituates
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Starling Curve
• In a normal heart
– Increasing preload (EDV
or EDV) increases SV
– Increasing contractility
increases stroke volume
at a constant preload
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Definitions
• Systolic Blood Pressure
(SBP): blood pressure in
brachial artery during systole
• Diastolic Blood Pressure
(DBP): blood pressure in
brachial artery during
diastole
• Mean Arterial Pressure
(MAP): average blood
pressure against the walls of
the aorta throughout a
complete cardiac cycle
– MAP = [(2 x DBP) + SBP] / 3
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Vascular Anatomy
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Abdominal Blood Supply
Importance:
• Surgical Procedures
• Renal Artery Stenosis
• Embolic Events to the GI
tract
• Watershed areas
• Differential diagnosis of
abdominal organ failure
• Nutritional Implications
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Abdominal Blood Supply
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Vascular Anatomy of the Neck
Importance:
• Central Venous Access
– Internal Jugular Vein
– Subclavian Vein
• Stroke
– Carotid artery
arteriosclerosis
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Neck Arteries
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Veins of the Neck
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Arteries of the Brain
Importance:
• Localizing site of stroke
• Watershed areas
• Localizing site of
aneurysm
• Importance of
understanding cerebral
perfusion
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Arteries of the Brain
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Arteries of the Brain
3D MRI with Gadolinium
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Gross Anatomy of Circle
of Wilis
Arm Vasculature
Importance:
• Placement of peripheral
IVs
• Central Venous
Catheters
– Brachial vein
• Placement of radial
arterial line
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Arm Vasculature
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Lower Extremity Vascular Anatomy
• Importance:
• Central Venous Catheter
– Femoral Vein
• Arterial Line
– Femoral Arterial
• Localizing Peripheral
Arterial Disease
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Lower Extremity Vascular Anatomy
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Lower Extremity Vascular Anatomy
• Angiogram of
Peripheral arterial
Disease
CFA: Common femoral artery
DFA: Deep Femoral Artery
SFA: Superficial Femoral Artery
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STENT
Conclusions
• Presentation was brief
overview of the
cardiovascular system
• Understanding vascular
anatomy important for
every doctor
• Cardiovascular Disease
is leading cause of
death
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