Heart outline pulmonary & systemic circulation location of heart in thorax pericardium external anatomy of heart internal anatomy of heart coronary circulation CAD, angina and heart attacks heart valves conduction system of heart EKG’s

Pulmonary circuit Systemic circuit artery vein artery vein CO2 O2 Systemic circuit

CPR, xyphoid process Auscultating the heart….where? Press down 4-5 cm

T9

Looking at left side of heart Looking at right side of heart

Pericardial cavity For you only – already did

Visceral pericardium Myocardium Endocardium Fibrous pericardium Parietal pericardium Visceral pericardium Myocardium Endocardium Cardiomyopathy: heart muscle disease Extrinsic (mostly coronary art issues – lack of oxygen to muscle) Intrinsic (drug & alcohol toxicity, hep C, genetic) Genetic issues: thickened, stiff or spongy muscle – young athletes with heart failure Hypertrophic cardiomyopathy… Epicardium = visceral pericardium + adipose cardiomyopathy

Pericarditis = inflammation of the pericardium Inflammation: infection, cancer, trauma, radiation, auto-immune, no cause Symptoms: chest pain, fever, increased heart rate, none Constrictive pericarditis: severe pericarditis, pericardium sticks together, heart can’t expand – breath shortness, tired, edema… Pericarditis = inflammation of the pericardium peri = ? cardi = ? -itis = inflammation

Fibrous skeleton: collagen & elastic fibers between chambers & around valves structural support prevents valves from being overly distended anchors myocardium electrical “insulator” between atria and ventricles

Superior vena cava PV Inferior vena cava Anterior View aorta Pulmonary artery PV Right atrium LA Right ventricle LV Inferior vena cava Anterior View

Left atrium RA Use model Left ventricle RV Posterior view

Chambers of the Heart 4 chambers 2 upper atria (atria = entry hall) (auricle = little ear) 2 lower ventricles (ventricles = little bellies) Auricle

Right atrium SVC Coronary Sinus (opening) Pectinate muscle PFO – 15% of adults, can get bigger Fossa ovalis IVC Right AV orifice

Right ventricle Pulmonary valve Trabeculae carneae Tricuspid valve Papillary muscle with tendinous cords

Left ventricle Aortic valve Mitral (bicuspid) valve Papillary muscles with chordae tendineae Trabeculae carneae Thrombi form on walls of left ventricle with certain types of heart disease – stroke or VA

Right atrium & ventricle Left atrium & ventricle

Coronary circulation Deep to epicardium Symp and para innervation (sym dilates)

Coronary circulation RCA Coronary sinus LCA (Under auricle) RCA L & R coronary artery = directly off aorta just distal to aortic valves Coronary sinus = drains into right atrium

Coronary sinus R & L coronary arteries Aortic valve

Fig. 20.12 Coronary artery disease (CAD) narrowing of coronary arteries leading cause of death in US Atherosclerosis fatty plaque on arterial walls

By-pass Graft

Myocardial infarction (MI) dead tissue areas in myocardium caused by interruption of blood flow cardiac muscles cells don’t regenerate replaced by scar tissue scarred or ischemic cardiac muscle can’t pump or conduct electrical impulses arrhythmias (ventricular fibrillation) Angina pectoris (chest pain)

Referred pain: Organ & skin pain fibers travel to the spinal cord together Organ pain misinterpreted as skin pain (referred pain)

Aortic valve (semilunar valve) Pulmonary valve (semilunar valve) Bicuspid or Mitral valve Tricuspid valve

Atrioventricular (AV) valves Semilunar valves aortic & pulmonary valves each has 3 cusps (no tendinous cords) close when pressure in ventricles falls Atrioventricular (AV) valves tricuspid and bicuspid (Mitral) tricuspid = 3 cusps, bicuspid = 2 connected to papillary muscle via tendinous cords close when pressure in ventricles increases

Cardiac Cycle = 1 heartbeat Diastole = relaxation Systole = contraction

Atrioventricular Valves Open Ventricles = diastole Atria = systole (atrial pressure > ventricle pressure)

Atrioventricular Valves Close Ventricles = systole Atria = diastole Ventricle pressure > atrial pressure A-V valves close preventing backflow of blood into atria

What are the ventricles doing in A? Valve Function Review A B TP slide What are the ventricles doing in A? Is blood flowing into the coronary arteries in A or B?

Murmurs – any abnormal heart sound Stenosis – narrowing of valve orifice Congenital, rheumatic fever Mitral most common (aortic) Insufficiency or regurgitation – incomplete closure of valve Many causes (MI, RF, HF, prolapse) Aortic and mitral most common Prolapse: most common valve disease CT diseases or genetic Rheumatic fever - strepA Stenosis – mitral = rheumatic fever, aortic = congenital, RF, calcification disease of elderly Causes LV hypertrophy, LV failure (angina, dyspnea) insufficiency (blood regurgitates – murmur): mitral = MI, RF, HF, prolapse Nodules can form on valve, scar and shorten, CT or PM get diseased (AIDS and anti-parkinson drugs cause valve diseases) Pulmonary and tricuspid valves: uncommon stenosis>regurgitation (tricuspid w/RF)

Cardiac Cycle = 1 heartbeat How does the heart beat? Cardiac Cycle = 1 heartbeat

Conduction System of Heart SA node – AV node – AV bundle of His (between ventricles) – Purkinje fibers How does your heart rate change? Nervous control (ANS) hormones drugs Need to coordinate contractions SA node: 100/min ANS innervated (para keeps it slower) AV node: ANS innervated Ventricles can beat on own (20-30/min – too slow) AV node can be an ectopic focus Most ectopic foci beat too slowly to sustain life Beta blockers – block sym response during MI Heart block: electrical signals blocked Bundle branch block or total heart block Ectopic focus Arrhythmia: irregular heart beat Fibrillations: uncoordinated contractions

EKG = electrocardiogram Recording electrical currents in heart P wave atrial contraction P to Q interval time for impulse to travel from SA node to AV node QRS complex ventricular contraction T wave ventricular relaxation

Heart failure Impairment of the heart to fill or pump a sufficient amount of blood through the body right side peripheral edema ascites jugular venous distention left side dyspnea (shortness of breath) orthopnea pulmonary edema