1. Kaan Yücel M.D., Ph.D. 14. 10. 2014 The Two Fridas 1939 by Frida Kahlo

2. 2 Trapezoidal in A-P dimensions Tipped-over pyramid in 3-D crucial organ of the human body

3. 3 Right heart (Suction) poorly- oxygenated(venous) blood from the body from the body superior vena cava & inferior vena cava right atrium right ventricle pulmonary arteries lungs Left heart (Pumping) well- oxygenated (arterial) blood from the lungs from the lungs pulmonary veins pulmonary veins left atrium left ventricle left atrium left ventricleaorta the body

4. 4 right and left atria & right and left ventricles Atrium – plural atria Receiving chambers Ventricles Discharging chambers cardiac cycle 1.Ventricular filling (diastole) 2. Ventricular emptying (systole) Blood pressure 120-80 mm/Hg

5. 5 The fibrous skeleton of the heart Keeps the orifices of the AV & semilunar valves patent prevents them from being overly distended by an increased volume of blood. Provides attachments for the valves & myocardium. Forms an electrical «insulator» separating impulses of the atria & ventricles  they contract independently surrounding and providing passage for the initial part of the AV bundle

6. 6 coronary sulcus (atrioventricular groove) between atrium & ventricles anterior & posterior interventricular (IV) sulci (grooves) between right and left ventricles

7. 7 apex located inferiorly & base located superiorly Apex projects forward, downward and to the left Base faces in a posterior direction

8. 8 Anterior (sternocostal) surface o mostly of right ventricle o some of the right atrium on the right o some of the left ventricle on the left Diaphragmatic (inferior) surface o formed mainly by the left ventricle o partly by the right ventricle o related to central tendon of diaphragm. Right pulmonary surface o formed by the right atrium. Left pulmonary surface o left ventricle & a portion of left atrium.

9. 9 RIGHT ATRIUM forms the right border of the heart Receives venous blood from the SVC, IVC, and coronary sinus. Through the right atrioventricular orifice, discharges the poorly oxygenated blood it has received into the right ventricle.

10. 10 RIGHT VENTRICLE forms largest part of the anterior surface of the heart a small part of the diaphragmatic surface almost the entire inferior border of the heart.

11. 11 Bulges into the cavity of the right ventricle. Superiorly and posteriorly, a thin membrane, forms the much smaller membranous part of the IVS. interventricular septum (IVS) muscular and membranous parts obliquely placed partition between the right and left ventricles, forming part of the walls of each

12. 12 LEFT ATRIUM right and left pulmonary veins enter here. Tubular, muscular left auricle, Its wall trabeculated with pectinate muscles. forms most of the base of the heart A semilunar depression in the interatrial septum Floor of the oval fossa surrounding ridge Valve of the oval fossa

13. 13 LEFT VENTRICLE forms the apex of the heart, left (pulmonary) surface & border, most of the diaphragmatic surface. Compared to the right ventricle Walls 2-3 times thicker Trabeculae carneae finer and more numerous Cavity longer Anterior & posterior papillary muscles larger

14. 14 aortic valve semilunar valve between the left ventricle & ascending aorta obliquely placed.

15. 15 Guards the left AV orifice. Has two cusps, anterior and posterior. mitral valve double-leaflet mitral valve

16. 16 SEMILUNAR VALVES Semilunar cusps of the pulmonary valve anterior-right-left Seminular cusps of the aortic valve posterior-right-left concave when viewed superiorly no tendinous cords to support

17. 17 VASCULATURE OF THE HEART embedded in fat course across the surface of the heart just deep to the epicardium. coronary arteries & cardiac veins

18. 18 first branches of the aorta supply the myocardium and epicardium Anastomoses between the branches of the coronary arteries exist, which enables the development of the collateral circulation.

19. 19 STIMULATING, CONDUCTING, & REGULATING SYSTEMS OF HEART 1. sinuatrial (SA) node initiates the heartbeat & coordinates contractions of the four heart chambers 2. atrioventricular (AV) node 3. bundles highly specialized conducting fibers for conducting impulses rapidly to different areas of the heart o Propagation of the impluse o Simultaneous contraction of the cardiac striated muscle cells

20. 20 pacemaker of the heart @junction of the SVC & right atrium near to the superior end of the sulcus terminalis

21. 21 stimulated by sympathetic division of the autonomic nervous system to accelerate the heart rate inhibited by parasympathetic division to return to or approach its basal rate. pacemaker of the heart

22. 22 a smaller collection of nodal tissue than the SA node in the posteroinferior region of the interatrial septum near the opening of the coronary sinus

23. 23 JOURNEY OF THE SIGNAL Generated @ SA node Passed through the walls of the right atrium Propageted by the cardiac muscle Signal passed from SA node to AV node Distributed to the ventricles through the AV bundle

24. 24 passes from the AV node through the fibrous skeleton of the heart and along the membranous part of the IVS. @ junction of membranous & muscular parts of the IVS divides into : right bundle & left bundle. AV bundle the only bridge between the atrial and ventricular myocardium

25. 25 right and left bundles proceed on each side of the muscular IVS deep to the endocardium then ramify into subendocardial branches (Purkinje fibers ) extend into the walls of the respective ventricles.

26. 26 autonomic nervous system, cardiac plexus Cardiac plexus posterior to the ascending aorta and bifurcation of the pulmonary trunk

27. 27 Parasympathetic supply presynaptic fibers of the vagus nerves Slows the heart rate Reduces the force of the contraction Constricts the coronary arteries saving energy autonomic nervous system, cardiac plexus

28. 28 sympathetic supply presynaptic fibers cell bodies in the intermediolateral cell columns (IMLs) of the superior 5 or 6 thoracic segments postsynaptic sympathetic fibers cell bodies in the cervical and superior thoracic paravertebral ganglia of the sympathetic trunks. causes increased heart rate increased impulse conduction, increased force of contraction, increased blood flow through the coronary vessels increased activity.

29. 29 9. SEPTAL DEFECTS Atrial Septal Defects (ASD) congenital anomaly of the interatrial septum a hole between the two atria What happens? Oxygenated blood from the lungs Left atrium Right atrium Results in enlargement of right atrium & ventricle dilation of the pulmonary trunk More blood in the right heart

30. 30 Ventricular Septal Defects (VSD) What happens? Results in membranous part of the IVS common site of VSDs rank first on all lists of cardiac defects Oxygenated blood from the ventricles Left ventricle Right ventricle in pulmonary blood flow severe pulmonary disease (hypertension) cardiac failure

31. 31 10. VALVULAR HEART DISEASES Disturb pumping efficiency of the heart. Stenosis (narrowing) or insufficiency Both result in an increased workload for the heart. Valvuloplasty repairing the heart valves

32. 32 Scarring and shortening of the cusps results in insufficiency Restricts the outflow of the left ventricle Leads to the hypertrophy of the myocardium During ventricular systole, blood regurgitates back to the left atrium A hurt murmur will be heard.

33. 33 Narrowing of the mitral orifice. Restricts the outflow of the left atrium. A murmur will be heard during atrial contraction.

34. 34 Narrowing of the pulmonary valve due to the fused cusps. Restricts the outflow of the right ventricle. Leads to the hypertrophy of the myocardium.

35. 35 Incomplete closure of the cusps due to thickening of their free margins due to a disease. During diastole, blood regurgitates back to the right ventricle from the pulmonary trunk. Heart murmur could be heard.

36. 36 Blood is unable to flow freely from left ventricle to aorta. A result of degenerative calcification, fusion of the aortic cups as a result. Causes extra work for the heart, resulting in left ventricular hypertrophy. most frequent valve abnormality

37. 37 During diastole blood regurgitates from aorta back to the left ventricle. A hurt murmur will be heard during diastole.

38. 38 could be heard by stethoscope. produced due to the turbulence caused by the blood passing from a narrow opening into a larger vessel or chamber. a pathologic sound

39. 39 tricuspid valve behind the right half of the sternum opposite 4th intercostal space mitral valve behind the left half of the sternum opposite 4th costal cartilage pulmonary valve behind the medial end of the 3rd left costal cartilage and adjoining part of the sternum aortic valve behind the left half of the sternum opposite 3rd intercostal space.

40. 40S1 produced by contraction of the ventricles closure of the tricuspid & mitral valves (AV valves)S2 produced by the sharp closure of the aortic & pulmonary valves hear sounds produced at each valve with the minimum of distraction or interference

41. 41 tricuspid valve right half of lower end of the body of the sternum pulmonary valve medial end of the second left intercostal space aortic valve medial end of the second right intercostal space mitral valve apex beat fifth left intercostal space, 9 cm from the midline

42. 42 PERICARDIUM a closed sac with two layers fibrous pericardium serous pericardium parietal layer visceral layer –heart & great vessels. fibroserous membrane, covers the heart & beginning of its great vessels

43. 43 Continuous inferiorly w/ central tendon of the diaphragm Attached anteriorly to the sternum by sternopericardial ligaments Site of continuity pericardiacophrenic ligament Inner surface lined by parietal layer of the serous pericardium Protects the heart against sudden overfilling. fibrous pericardium continuous superiorly w/ tunica adventitia of the great vessels & w/pretracheal layer of deep cervical fascia

44. 44 contains a thin film of fluid : pericardial fluid enables the heart to move and beat in a frictionless environment. pericardial cavity potential space between opposing layers of the parietal & visceral layers of serous pericardium

45. 45 GREAT VESSELS posterior to the sternoclavicular (SC) joints. brachiocephalic veins unite to form the SVC. @ inferior border of the 1st right costal cartilage shunt blood from the head, neck, & upper limbs right atrium. formed by the union of internal jugular & subclavian veins

46. 46 Returns blood from all structures superior to the diaphragm except the lungs & heart. Passes inferiorly and ends by entering right atrium of the heart.

47. 47 begins at the aortic orifice. only branches coronary arteries, arising from the aortic sinuses.

48. 48 begins posterior to the 2nd right sternocostal (SC) joint at the level of the sternal angle. ligamentum arteriosum remnant of the fetal ductus arteriosus root of the left pulmonary artery inferior surface of the arch of the aorta The usual branches of the arch 1)brachiocephalic trunk 2)left common carotid artery 3)left subclavian artery. curved continuation of the ascending aorta

49. 49 arises posterior to the manubrium. ascends superolaterally divides into right common carotid & right subclavian arteries. first and largest branch of the arch of the aorta

50. 50 arises o posterior to the manubrium, o slightly posterior and to the left of the brachiocephalic trunk. second branch of the arch of the aorta

51. 51 arises from the posterior part of the arch posterior to left common carotid artery. ascends lateral to trachea & left common carotid artery. Leaves the thorax and enters the root of the neck. third branch of the arch of the aorta

52. 52 responsible for detecting changes in blood chemistry, primarily oxygen content

53. 53 Abdominal aorta

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