Heart David Kachlk tpn Jelnek Heart situation Heart
- Slides: 78
Heart David Kachlík, Štěpán Jelínek
Heart situation
Heart development o sinus venosus o atrium - sinus venarum cavarum o common atrium o atrium (separated with crista o ventricle terminalis) o ventricle (inflow part) o ventriculus (outflow part separated with crista supraventricularis) o bulbus cordis o truncus arteriosus o aorta + truncus pulmonalis
Heart description o basis x apex n facies sternocostalis s. anterior n facies diaphragmatica s. inferior /=posterior wall in clinic/ n facies pulmonalis dx. + sin. n margo dexter /former acutus/ n margo sinister /former obtusus/ n incisura apicis cordis o auricula dextra et sinistra o sulcus coronarius o sulcus interventricularis ant. + post.
Heart structure o endocardium = tunica intima o myocardium = tunica media working myocardium n excitomotor apparatus (EA) = conducting m. n fibrous skeleton of heart o pericardium n
Endocardium o continuous with vessels´ tunica intima o 4 layers: n endothelial n subendothelial – collagenous fibres n fibromuscular - collagenous, elastic connective tissue, smooth muscle cells – thicker in atria n subendocardial – containing conducting myocardium, loose connective tissue o endocardium forms heart valves
Heart valves o duplication of endocardium o Internal fibrous lamina – collagenous + elastic fibres o endothelium superficially o attached to fibrous anuli o without blood or lymph vessels o cuspidal, semilunar, other leaflets
Myocardium o cardiomyocytes o 3 layers in ventricles n spiral (vortex), circular, longitudinal o 2 in atria – internal layer = mm. pectinati o 3 x thicker in left ventricle than in right one o conducting system is different in both function and structure
Myocardium
Pericardium
Pericardium o Pericardium fibrosum – ligg. sternopericardiaca, membrana bronchopericardiaca o Pericardium serosum n n n lamina paretalis = pericardium lamina visceralis = epicardium = tunica serosa = mesothel tela subserosa (fat tissue, vessels) o Cavitas pericardii n Sinus obliquus + transversus n Liquor pericardii - 20 ml o N. phrenicus, a. + vv. periacardiacophrenicae n puncture (in case of tamponade) p below processus xiphoideus (dorsocranially) p 4 th / 5 th intercostal space left of sternum (less frequently)
Heart cavities o atrium dextrum + sinistrum o septum interatriale o septum atrioventriculare o ventriculus dexter + sinister o septum interventriculare (pars membranacea + muscularis)
Atrium dextrum (right atrium). o ostium v. cavae inferioris n valvula v. c. i. Eustachii o ostium v. cavae superioris n tuberculum intervenosum Loweri o ostium sinus coronarii n valvula s. coronarii Thebesii o ostia vv. ventriculi dx. anteriorum o foramina venarum minimarum o fossa ovalis / foramen ovale cordis n limbus fossae ovalis
Atrium dextrum (right atrium) o auricula dextra o sinus venarum cavarum o crista terminalis o mm. pectinati o ostium atrioventriculare dextrum o trigonum nodi atrioventricularis Kochi
Ventriculus dexter (right ventricle) o ostium atrioventriculare dextrum n valva tricuspidalis p cuspis anterior, posterior, septalis o mm. papillares n anterior, posterior, septalis n chordae tendineae p chordae tendineae falsae s. spuriae o trabeculae carneae n trabecula septomarginalis
Ventriculus dexter (right ventricle) o crista supraventricularis o pars glabra = infundibulum = conus arteriosus = outflow part o ostium trunci pulmonalis n valva trunci pulmonalis p valvulae semilunares dx. , sin. , ant. /semilunar cusps/ n noduli Aranzii lunulae commissurae
Right-sided compartments
Atrium sinistrum (left atrium) o auricula sinistra o ostia venarum pulmonalium o mm. pectinati o valvula foraminis ovalis (= former falx septi Parchappei)
Ventriculus sinister (left ventricle) o ostium atrioventriculare sinistrum n valva mitralis s. bicuspidalis p cuspis anterior, posterior p (cc. commissurales) o mm. papillares n anterior, posterior n chordae tendinaeae o trabeculae carneae o vestibulum aortae o ostium aortae n valva aortae p valvulae semilunares dx. , sin. , post. /semilunar cusps/ n p noduli Aranzii, lunulae, commissurae sinus aortae Valsalvae (correspond to valvulae)
Left-sided compartments
ECHO
Fibrous skeleton of heart o anulus fibrosus dexter + sinister o trigonum fibrosum dextrum /= central fibrous body/ + o o sinistrum anulus aorticus + a. trunci pulmonalis tendo infundibuli tendo valvulae venae c. inf. Todaroi pars membranacea septi interventricularis o fibrous connective tissue o valve support o myocardium insertion o electric isolation of atrial and ventricular myocardium
Heart supply o arteries – 2 coronary arteries (ACS, ACD) n vinculum, ponticulus o veins – 3 systems, without valves o lymph drainage – 3 plexuses, 2 truncs (right one to ductus thoracicus, left one to ductus lymphaticus dexter !) o nerves – automatical impulses n autonomic system (sympathetic, parasympathetic) n viscerosensory fibers
Coronary arteries
Arteria coronaria dextra (ACD) sinus aortae (Valsalvae) dexter → ACD o r. coni arteriosi → Vieussens´ circle o r. nodi sinuatrialis (65%) o rr. atriales o r. marginalis dexter (RMD) o r. interventricularis posterior (RIP) o r. nodi atrioventricularis (80%) o r. posterolateralis dexter (RPLD)
Arteria coronaria sinistra (ACS) sinus aortae (Valsalvae) sinister → short (2 -3 cm) → ACS o r. interventricularis ant. (RIA) – clinically „left anterior descending“ (LAD) n n r. coni arteriosi → Vieussens´ circle r. diagonalis (RD) o r. circumflexus (RC) n rr. atriales n r. marginalis sinister (RMS) n r. posterolateralis sinister (RPLS) o r. intermedius (RIM) – 25%, from ACS bifuraction
Coronary arteries
Arteria coronaria sinistra ACS in posteroanterior projection ACS in lateral projection (right to left) ACS in lateral projection (left to right)
Ponticulus
Stenosis in ACS
Arteria coronaria dextra ACS in posteroanterior projection ACS in lateral projection (right to left) ACS in lateral projection (left to right)
Collateral vessels
Heart veins o Sinus coronarius → atrium dextrum n ← v. cardiaca (cordis) magna p← v. interventricularis anterior p ← v. maginalis sinistra name change when crossing left border (Vieussens´valve !) n n ← v. ventriculi sinistri posterior ← v. obliqua atrii sinistri Marshalli ← v. cardiaca (cordis) media (= v. interventricularis post. ) ← v. cardiaca (cordis) parva p← v. marginalis dextra
Heart veins o Vv. ventriculi dextri anteriores = vv. cardiace (cordis) anteriores → atrium dextrum o Vv. cadiace (cordis) minimae Thebesii → all cavities without any major clinical importance
Nerves – autonomic system o Sympathetic – nn. cardiaci cervicales sup. + medii + inf. , thoracici n n positive dromotropic, bathmotropic, inotropic, chronotropic effect β 1 receptors o Parasympathetic – n. X → rr. cardiaci cervicales sup. +inf. , thoracici n negative effect o Viscerosensory fibres (T 1 -T 4) n Head´s zone behind sternum and in ulnar edge of left upper limb
Conducting system of heart Complexus stimulans cordis Systema conducens cordis „Excitomotor apparatus“ o enables generation of heart automatic impulse o formed with modified cardiomyocytes: n less myofibrils placed in periphery n no intercalar discs n connections by desmosomes and nexuses n different size n glycogen gathered around the nucleus
Conducting system of the heart - parts o nodus sinuatrialis (Keith-Flack) n right atrium near foramen v. cavae superioris o interatrial connections (fasciculi atriales) n fasciculus interatrialis (Bachmann) n další svazky sporné p anterior (James), medius (Wenckebach), posterior (Thorel) o nodus atrioventricularis (Aschoff-Tawara) n right atrium in Koch‘s triangle near ostium atrioventriculare dextrum o myocytes smaller than those of working myocardium o rich blood supply
Conducting system of heart o fasciculus atrioventricularis (atrioventricular bundle) His-Kent-Gaskell AV blockage of 1 st-3 rd grade n truncus f. a. crus f. a. (Tawara) n dextrum p sinistrum n limbus anterior n limbus posterior rami subendocardiales (Purkyně) n p p larger than typical cardiomyocytes with lighter cytoplasma quick impulse conduction towards heart apex o accessory connections → preexcitation syndrom WPW (Wolf-Parkinson-White)
Purkyně fibres (HE + elastin)
artificial pacemaker
Physiology o Heart cycle n n systole diastole o Pulse and volumes o EKG curve o Arterial pulse curve with dicrotic notch o Endocrinne function - ANF
Examination o physical examination (aspection, percussion, palpation, ausculatation) o EKG, Holter o echocardiography, oesophageal echok. o (X-ray of heart and lungs) o coronarography o nuclear medicine o biochemistry: troponins, CK MB, myoglobin
Auscultation Testut‘s points = 4 auscultation points
Auscultation – Testut´s points 4 auscultation points o Valva mitralis – 5 th intercostal space left of strenum in medioclavicular line o Valva tricuspidalis – 4 th intercostal space left (or right) of strenum o Valva aortae – 2 th intercostal space right of sternum o Valva trunci pulmonalis – 2 th intercostal space left of sternum o Erb´s point (3 rd intercostal space left of sternum) - murmurs
Systolic/ diastolic pressures in the heart chambers
Basic clinical units o Endocardium: endocarditis, valvular defects (inborn, acquired) o Myocardium: ischmeic heart disease (AP, IM), myocarditis, cardiomyopathy o Pericardium: pericarditis, tamponade o Conducting system: arrythmia o Developing defects: septal defects, transposition of large vessels, Fallot´s tri-, tetra-, pentalogy, opened Botallo´s duct, aorta coarctation
Heart X-ray
Heart X-ray
Rheumatic vegetations
Endocarditis
Valvular insufficiency (regurgitation) and stenosis
Myocardial infarction
Cardiac aneurysm
Pericarditis
Cardiac trauma
Cardiac tamponade
The heart during CPR
Basic therapeutic operations o PTCA (= percutaneous transfemoral coronary angioplasty)
Basic therapeutic operations o by-passing n venous grafts (v. saphena magna) n arterial grafts (a. radialis) n artery lifting (a. thoracica interna, a. gastroomentalis sinistra) p a. thoracica interna (clinically „a. mammaria interna – left/right = „LIMA, RIMA“) o valve replacement (porcine, plastic) o transplantation
Valvular replacement
Valvular replacement
Cardiac transplantation
Practical training o X-ray of heart and lungs o Valve auscultation o Heart specimen – whole x dissected o Histological slides of heart muscle
Thank you for attention…. . . and finaly several important notes: o speciality of the cnducting system o the worst blood supply of subendocardial layers - ↑ risk of hypoxia o The thickest muscular wall of left ventricle - ↑ risk of hypoxia
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- Contraindications of tpn
- Tpn nutrition
- Ppn vs tpn
- Ppn vs tpn
- Tpn calculation
- Ppn vs tpn
- Calculating parenteral nutrition
- Ppn vs tpn
- Ppn vs tpn
- Addaven içerik
- Vanilla tpn
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- How to do tpn calculations
- Isaac asimov introduction
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- Periferik parenteral beslenme
- Tpn komplikasyonları
- Cost of tpn per day
- Loi des gaz parfaits
- Tpn cycling
- Blood transfusion
- Life expectancy on tpn
- Tpn guidelines for pharmacist
- Lafw hood
- Parenteral nutriton
- Dra piccline
- Complication of parenteral nutrition
- Tpn avec instillation
- Holliday segar yöntemi
- Tpn epilogue
- Ruptura perinea
- Regiony evropy
- Nina tpn
- Kanadsk
- Tpn chapter 47
- Parenteral nutrition types
- Idols of the heart and vanity fair
- Heart border percussion of heart
- Left atrium sheep heart
- Star plowhorse puzzle dog
- Situation, task, action, result examples
- Real life applications of piecewise functions
- Write the integer for each situation
- How would you say for the following situations
- Types of selling situation
- Situation adidactique
- Ainsworth 1978
- Strange situation experiment
- Size up a situation
- Cluster sampling example situation
- Fletcher's four working principles
- Situation appraisal meaning
- Present continuous remember
- Situation initiale
- Situation-background-assessment-recommendation
- Cluster sampling advantages and disadvantages
- Quota sampling
- Rugby cycle 2
- Rhetorical patterns of development
- Habit 4 examples
- Polynomial real life problems
- Rational graphs in the real world
- Rule 14 head-on situation
- Situation de proportionnalité seconde
- Difference between problem and situation
- Contoh sostac
- Scqa
- 2. what are the modifiers of human act?
- Microteaching cycle
- Mdh situation update
- Site vs situation factors
- What is site vs situation
- Situation de passage le dernier jour d'un condamné
- Résumé de chapitre 26 le dernier jour d'un condamné
- Chapitre 23 le dernier jour d'un condamné analyse
- Texte narratif secondaire 1
- Key issue 2 why are situation and site factors important
- Mary ainsworth