Heart PowerPoint Presentation

Slide 1 -

Heart David Kachlík, Štěpán Jelínek

Slide 2 -

Heart situation

Slide 3 -

Heart development sinus venosus common atrium ventricle bulbus cordis truncus arteriosus atrium - sinus venarum cavarum atrium (separated with crista terminalis) ventricle (inflow part) ventriculus (outflow part separated with crista supraventricularis) aorta + truncus pulmonalis

Slide 4 -

Heart description basis x apex facies sternocostalis s.anterior facies diaphragmatica s. inferior /=posterior wall in clinic/ facies pulmonalis dx. + sin. margo dexter /former acutus/ margo sinister /former obtusus/ incisura apicis cordis auricula dextra et sinistra sulcus coronarius sulcus interventricularis ant. + post.

Slide 5 -

Heart structure endocardium = tunica intima myocardium = tunica media working myocardium excitomotor apparatus (EA) = conducting m. fibrous skeleton of heart pericardium

Slide 6 -

Endocardium continuous with vessels´ tunica intima 4 layers: endothelial subendothelial – collagenous fibres fibromuscular - collagenous, elastic connective tissue, smooth muscle cells – thicker in atria subendocardial – containing conducting myocardium, loose connective tissue endocardium forms heart valves

Slide 7 -

Heart valves duplication of endocardium Internal fibrous lamina – collagenous + elastic fibres endothelium superficially attached to fibrous anuli without blood or lymph vessels cuspidal, semilunar, other leaflets

Slide 8 -

Myocardium cardiomyocytes 3 layers in ventricles spiral (vortex), circular, longitudinal 2 in atria – internal layer = mm. pectinati 3x thicker in left ventricle than in right one conducting system is different in both function and structure

Slide 9 -

Myocardium

Slide 10 -

Pericardium

Slide 11 -

Pericardium Pericardium fibrosum – ligg. sternopericardiaca, membrana bronchopericardiaca Pericardium serosum lamina paretalis = pericardium lamina visceralis = epicardium = tunica serosa = mesothel tela subserosa (fat tissue, vessels) Cavitas pericardii Sinus obliquus + transversus Liquor pericardii - 20 ml N. phrenicus, a.+ vv. periacardiacophrenicae puncture (in case of tamponade) below processus xiphoideus (dorsocranially) 4th / 5th intercostal space left of sternum (less frequently)

Slide 12 -

Heart cavities atrium dextrum + sinistrum septum interatriale septum atrioventriculare ventriculus dexter + sinister septum interventriculare (pars membranacea + muscularis)

Slide 13 -

Atrium dextrum (right atrium). foramen v. cavae inf. valvula v.c.i. Eustachii foramen v. cavae sup. tuberculum intervenosum Loweri ostium sinus coronarii valvula s. coronarii Thebesii ostia vv. ventriculi dx. anteriorum foramina venarum minimarum fossa ovalis / foramen ovale cordis limbus fossae ovalis

Slide 14 -

Atrium dextrum (right atrium) auricula dextra sinus venarum cavarum crista terminalis mm. pectinati ostium atrioventriculare dextrum trigonum nodi atrioventricularis Kochi

Slide 15 -

Ventriculus dexter (right ventricle) ostium atrioventriculare dextrum valva tricuspidalis cuspis anterior, posterior, septalis mm. papillares anterior, posterior, septalis chordae tendineae chordae tendineae falsae s. spuriae trabeculae carneae trabecula septomarginalis

Slide 16 -

Ventriculus dexter (right ventricle) crista supraventricularis pars glabra = infundibulum = conus arteriosus = outflow part ostium trunci pulmonalis valva trunci pulmonalis valvulae semilunares dx., sin., ant. /semilunar cusps/ noduli Aranzii lunulae commissurae

Slide 17 -

ppt slide no 17 content not found

Slide 18 -

Right-sided compartments

Slide 19 -

Atrium sinistrum (left atrium) auricula sinistra ostia venarum pulmonalium mm. pectinati valvula foraminis ovalis (= former falx septi Parchappei)

Slide 20 -

Ventriculus sinister (left ventricle) ostium atrioventriculare sinistrum valva mitralis s. bicuspidalis cuspis anterior, posterior (cc. commissurales) mm. papillares anterior, posterior chordae tendinaeae trabeculae carneae vestibulum aortae ostium aortae valva aortae valvulae semilunares dx., sin., post. /semilunar cusps/ noduli Aranzii, lunulae, commissurae sinus aortae Valsalvae (correspond to valvulae)

Slide 21 -

ppt slide no 21 content not found

Slide 22 -

ppt slide no 22 content not found

Slide 23 -

Left-sided compartments

Slide 24 -

ECHO

Slide 25 -

Fibrous skeleton of heart anulus fibrosus dexter + sinister trigonum fibrosum dextrum /= central fibrous body/ + sinistrum anulus aorticus + a. trunci pulmonalis tendo infundibuli tendo valvulae venae c. inf. Todaroi pars membranacea septi interventricularis fibrous connective tissue valve support myocardium insertion electric isolation of atrial and ventricular myocardium

Slide 26 -

ppt slide no 26 content not found

Slide 27 -

ppt slide no 27 content not found

Slide 28 -

Heart supply arteries – 2 coronary arteries (ACS, ACD) vinculum, ponticulus veins – 3 systems, without valves lymph drainage – 3 plexuses, 2 truncs (right one to ductus thoracicus, left one to ductus lymphaticus dexter !) nerves – automatical impulses autonomic system (sympathetic, parasympathetic) viscerosensory fibers

Slide 29 -

Coronary arteries

Slide 30 -

Arteria coronaria dextra (ACD) sinus aortae (Valsalvae) dexter → ACD r. coni arteriosi → Vieussens´ circle r. nodi sinuatrialis (65%) rr. atriales r. marginalis dexter (RMD) r. interventricularis posterior (RIP) r. nodi atrioventricularis (80%) r. posterolateralis dexter (RPLD)

Slide 31 -

ppt slide no 31 content not found

Slide 32 -

ppt slide no 32 content not found

Slide 33 -

Arteria coronaria sinistra (ACS) sinus aortae (Valsalvae) sinister → short (2-3cm) → ACS r. interventricularis ant. (RIA) – clinically „left anterior descending“ (LAD) r. coni arteriosi → Vieussens´ circle r. diagonalis (RD) r. circumflexus (RC) rr. atriales r. marginalis sinister (RMS) r. posterolateralis sinister (RPLS) r. intermedius (RIM) – 25%, from ACS bifuraction

Slide 34 -

Coronary arteries

Slide 35 -

Arteria coronaria sinistra ACS in posteroanterior projection ACS in lateral projection (right to left) ACS in lateral projection (left to right)

Slide 36 -

Ponticulus

Slide 37 -

Stenosis in ACS

Slide 38 -

Arteria coronaria dextra ACS in posteroanterior projection ACS in lateral projection (right to left) ACS in lateral projection (left to right)

Slide 39 -

Collateral vessels

Slide 40 -

Heart veins Sinus coronarius → atrium dextrum ← v. cardiaca (cordis) magna ← v. interventricularis anterior ← v. maginalis sinistra name change when crossing left border (Vieussens´valve !) ← v. ventriculi sinistri posterior ← v. obliqua atrii sinistri Marshalli ← v. cardiaca (cordis) media (= v. interventricularis post.) ← v. cardiaca (cordis) parva ← v. marginalis dextra

Slide 41 -

ppt slide no 41 content not found

Slide 42 -

ppt slide no 42 content not found

Slide 43 -

Heart veins Vv. ventriculi dextri anteriores = vv. cardiace (cordis) anteriores → atrium dextrum Vv. cadiace (cordis) minimae Thebesii → all cavities without any major clinical importance 

Slide 44 -

Nerves – autonomic system Sympathetic – nn. cardiaci cervicales sup.+ medii + inf., thoracici positive dromotropic, bathmotropic, inotropic, chronotropic effect β1 receptors Parasympathetic – n. X → rr. cardiaci cervicales sup.+inf., thoracici negative effect Viscerosensory fibres (T1-T4) Head´s zone behind sternum and in ulnar edge of left upper limb

Slide 45 -

ppt slide no 45 content not found

Slide 46 -

Conducting system of heart Complexus stimulans cordis Systema conducens cordis „Excitomotor apparatus“ enables generation of heart automatic impulse formed with modified cardiomyocytes: less myofibrils placed in periphery no intercalar discs connections by desmosomes and nexuses different size glycogen gathered around the nucleus

Slide 47 -

Conducting system of the heart - parts nodus sinuatrialis (Keith-Flack) right atrium near foramen v. cavae superioris interatrial connections (fasciculi atriales) fasciculus interatrialis (Bachmann) další svazky sporné anterior (James), medius (Wenckebach), posterior (Thorel) nodus atrioventricularis (Aschoff-Tawara) right atrium in Koch‘s triangle near ostium atrioventriculare dextrum myocytes smaller than those of working myocardium rich blood supply

Slide 48 -

ppt slide no 48 content not found

Slide 49 -

Conducting system of heart fasciculus atrioventricularis (atrioventricular bundle) His-Kent-Gaskell AV blockage of 1st-3rd grade truncus f.a. crus f.a. (Tawara) dextrum sinistrum limbus anterior limbus posterior rami subendocardiales (Purkyně) larger than typical cardiomyocytes with lighter cytoplasma quick impulse conduction towards heart apex accessory connections → preexcitation syndrom WPW (Wolf-Parkinson-White)

Slide 50 -

ppt slide no 50 content not found

Slide 51 -

Purkyně fibres (HE + elastin)

Slide 52 -

artificial pacemaker

Slide 53 -

 Physiology Heart cycle systole diastole Pulse and volumes EKG curve Arterial pulse curve with dicrotic notch Endocrinne function - ANF

Slide 54 -

Examination physical examination (aspection, percussion, palpation, ausculatation) EKG, Holter echocardiography, oesophageal echok. (X-ray of heart and lungs) coronarography nuclear medicine biochemistry: troponins, CK MB, myoglobin

Slide 55 -

Auscultation Testut‘s points = 4 auscultation points

Slide 56 -

Auscultation – Testut´s points 4 auscultation points Valva mitralis – 5th intercostal space left of strenum in medioclavicular line Valva tricuspidalis – 4th intercostal space left (or right) of strenum Valva aortae – 2th intercostal space right of sternum Valva trunci pulmonalis – 2th intercostal space left of sternum Erb´s point (3rd intercostal space left of sternum) - murmurs

Slide 57 -

Systolic/ diastolic pressures in the heart chambers

Slide 58 -

ppt slide no 58 content not found

Slide 59 -

Basic clinical units Endocardium: endocarditis, valvular defects (inborn, acquired) Myocardium: ischmeic heart disease (AP, IM), myocarditis, cardiomyopathy Pericardium: pericarditis, tamponade Conducting system: arrythmia Developing defects: septal defects, transposition of large vessels, Fallot´s tri-, tetra-, pentalogy, opened Botallo´s duct, aorta coarctation

Slide 60 -

Heart X-ray

Slide 61 -

Heart X-ray

Slide 62 -

Rheumatic vegetations

Slide 63 -

Endocarditis

Slide 64 -

Valvular insufficiency (regurgitation) and stenosis

Slide 65 -

Myocardial infarction

Slide 66 -

Cardiac aneurysm

Slide 67 -

Pericarditis

Slide 68 -

Cardiac trauma

Slide 69 -

Cardiac tamponade

Slide 70 -

The heart during CPR

Slide 71 -

Basic therapeutic operations PTCA (= percutaneous transfemoral coronary angioplasty)

Slide 72 -

Basic therapeutic operations by-passing venous grafts (v. saphena magna) arterial grafts (a. radialis) artery lifting (a. thoracica interna, a. gastroomentalis sinistra) a.thoracica interna (clinically „a. mammaria interna – left/right = „LIMA, RIMA“) valve replacement (porcine, plastic) transplantation

Slide 73 -

ppt slide no 73 content not found

Slide 74 -

Valvular replacement

Slide 75 -

Valvular replacement

Slide 76 -

Cardiac transplantation

Slide 77 -

Practical training X-ray of heart and lungs Valve auscultation Heart specimen – whole x dissected Histological slides of heart muscle

Slide 78 -

Thank you for attention….. ... and finaly several important notes: speciality of the cnducting system the worst blood supply of subendocardial layers - ↑ risk of hypoxia The thickest muscular wall of left ventricle - ↑ risk of hypoxia