1. The HEART
Medical Therapeutics

2. Introduction Triangular shape Size of your fist
Located between the lungs in lower portion of mediastinum behind sternum
Blunt end is called apex and points toward left
Site where heart sounds are best heard

3. Heart Chambers Organ is hollow Divided into right and left sides
Septum divides
Contains four hollow chambers
Atria- top chambers or receiving chambers
Ventricles-lower chambers or discharging chambers
Atria are smaller than ventricle
Have right and left atria as well as right and left ventricles

4. Chambers of the Heart

5. Layers of Heart Endocardium- inner most layer of thin smooth tissue
Myocardium-middle muscular layer
Pericardium-outer layer that consist of two layers of fibrous tissue
Visceral Pericardium or epicardium- inner layer of pericardium produces pericardial fluid
Parietal Pericardium- loose fitting covering on the outside of the heart
Epi-upon or on Endo-within or in

6. Heart Action Heart is a muscular pumping device
Systole- contraction of the heart
Diastole relaxation of the heart
When heart beats→atria contract first (atria systole)→forcing blood into ventricles
Once filled→two ventricles contract (ventricular systole)→blood forced out of heart

7. Blood Flow Right Side Enters heart through Superior/Inferior Vena Cava
Blood is oxygen poor from the body
Goes to Right Atrium
Through Tricuspid Valve
Into Right Ventricle
Through Pulmonary Valve
To Pulmonary Artery and into lungs

8. Blood Flow Left Side
From lungs where O2 is added and CO2 removed goes to
Pulmonary Veins O2 rich and then into
Left Atrium then through
Mitral Valve to the
Left Ventricle then through
Aortic Valve to the
Aorta where it is carried to all parts of the body

9. Anatomy of Heart

10. Heart Valves
Atrioventricular Valves-separate the atria from the ventricles
Triscupid valve- between right atrium and ventricle
Bicuspid or Mitral valve-between left atrium and ventricle
Prevents backflow of blood into the atria when the ventricles contract
Chordae tendineae-attaches AV valves to the wall of the heart

11. Atrioventricular Valves

12. Heart Valves
Semilunar Valves-located between the two ventricular chambers and large arteries that carry blood away from the heart
Pulmonary semilunar valve- located between right ventricle and pulmonary artery
Aortic semilunar valve- located between left ventricle and aorta
Both valves prevent backflow of blood into ventricles

13. Semilunar Valves

14. Disorders of Valves
Incompetent valves-allow some blood to flow back into the chamber from which it came
Stenosed Valves- valves that are narrower than normal, slowing blood flow from a heart chamber
Mitral Valve Prolapse- (MVP) when the flaps of the Mitral valve extend back into the left atrium, causing incompetent valves

15. transesophageal Echocardiogram
Transesophageal Echocardiogram anatomy

16. Diseases of Layers
Endocarditis-inflammation or infection of inner layer of heart
Myocarditis-infection or inflammation of myocardium
Pericarditis-inflammation or infection of pericardium

17. Diseases Thrombosis- blood clot
Caused by endocardial lining becoming rough and abrasive to RBC’s passing over its surface.
As blood flows over a rough surface clots are subject to form
Embolis-blood clot that is flowing in blood stream

18. Diseases of Layers
Pericardial Effusion-when pericardial fluid, pus or blood may accumulate in the space between two pericardial layers and impairs the pumping action of the heart
Cardiac Tamponade- when pericardial effusion gets worse and develops a serious compression of the heart

19. Heart Sounds
Listen with stethoscope on anterior wall of chest ( auscultate )
Rhythmic and repetitive sounds “Lub dub”
First sound or lub-caused by vibration and abrupt closure of AV valves as ventricles contract
Longer sound with a lower pitch
Second sound or dub-caused by closure of semilunar valves during diastole

20. Heart Sounds
Heart Murmurs-abnormal heart sounds caused by disorders of valves
Incompetent valves cause a swishing noise as a “lub” or Dub” ends
Stenosed valves, often cause swishing sounds just before “lub” or “dub”

21. Coronary Circulation
Heart muscle or myocardium requires on going supply of blood to function
Coronary circulation-the delivery of oxygen and nutrient rich arterial blood to the cardiac muscle and removal of oxygen-poor blood from the active tissue to the venous system
Blood flows into the heart muscle by way of two small vessels called Right Coronary Artery and Left Coronary Artery

22. Coronary Circulation
Coronary arteries are the first branches of the aorta
Myocardial Infarction or heart attack occurs when one of these arteries are occluded with a blood clot or plaque
Tissue death occurs when area is deprived of oxygen ( ischemia )
Symptoms – pain, nausea, irreg. pulse, cold and clammy, anxiety, SOB
Reduce activity, NTG

23. Coronary Circulation

24. Blood Flow Through the Heart
Superior & inferior vena cava
Right atrium
Tricuspid valve
Right ventricle
Pulmonary semilunar valve
Pulmonary arteries
Lungs to exchange gases
Pulmonary veins
Left atrium
Bicuspid / Mitral valve
Left ventricle
Aortic semilunar valve
Aorta all parts of the body
Arteries
Arterioles
Capillaries
Venules
Veins

25. Conduction System How does the heart know when to pump?
What makes the atria contract before ventricles?
How do we evaluate the conduction system?

26. Conduction System
Upon completion of this lesson students will be able to give purpose and importance of the heart conduction system and identify placement of EKG leads.

27. Conduction System
The heart is a large muscle that acts as a pump, but it has to have an impulse from the brain and electrical stimulation to tell it how fast and when to beat.

28. Conduction
Special tissues in the heart transmit electrical impulses.
These impulses cause the heart to contract and relax.
electrical system of heart

29. Conduction System
Cardiac muscles are coordinated by electrical impulses
Heart has own built in conduction system that is embedded into wall of the heart to generate and conduct impulses

30. Sinoatrial node (SA) node
pacemaker of the heart. This is where transmission begins and sets the rhythm of the heart. Normal pulse rate is 60 to 100 beats per minute.
The  SA node is located high on the right atrium close to where the superior vena cava enters the right atrium.

31. Internodal Pathway
Located in the walls of the atria.
Links the SA node to the AV node
It takes about 0.03 seconds for the impulse to travel from the SA to AV node.

32. Atrioventricular node (AV node)-
AV node is located on the interatrial septum close to the tricuspid valve.
Pulse rate here about 40 to 60 beats per minute.

33. Bundle of HIS- AV Bundle ( Bundle Branches)
The only electrical connection between the atria and the ventricles
emerges from the AV node to begin the conduction of the impulse from the AV node to the ventricles.
Pulse rate is about 30 to 40 beats per minute.

34. Bundle Branches- Right and Left
R Bundle- R Ventricle
L Bundle- L Ventricle

35. Purkinje Fibers distribute the impulse to the ventricular muscle.
The rate here is also about 30 to 40 beats per minute or less.

36. Conduction pattern Sinoatrial (SA) node Internodal Pathways
Atrioventricular (AV) node
Bundle of HIS -AV
R & L Bundle Branches
Purkinje Fibers

37. Repolarization- Period of Electrical Recovery
Conduction System
Depolarization- initiates chain that results in contraction of the heart
Repolarization- Period of Electrical Recovery

38. Electrical complex- (PQRST) Interpreting EKG video

39. P wave represents the Atria contracting
sinoatrial (SA) node.
QRS complex represents the contraction of the ventricle
T wave Repolarization of Ventricles
Go to skills Lab

40. PR interval- time for impulse to travel from SA node to AV node

41. Q-T interval- time for ventricles to contract, recover, and repolarize

42. S-T segment- time between contraction of ventricles and recovery.

43. Cardiac Leads
Each lead indicates the walls of the heart. There is front, back, and sides.
Abnormal findings can indicate problems.
This is how the location of an MI (heart attack) is determined.
ECG placement
On a routine EKG there are 10 lead positions
Chest wall 6 locations
Left arm
Right arm
Left leg
Right leg

44. Conduction System

45. Normal Electrocardiograph

46. Conduction System
Electrodes- electrical impulse sensors that transmit information from body to machine that produce an electrical tracing.

47. Cardiac Arrhythmia
Bradycardia- slow heart rate, most often caused by defective SA node
Tachycardia-fast heart rate, improper autonomic control of the heart
Sinus arrhythmia-variation of heart rate during breathing cycle
Heart rate increases with inspiration and decreases with expiration

48. Cardiac Arrhythmia
Fibrillation-a condition in which cardiac muscle fibers contract out of step with each other
Atrial Fibrillation-common in elderly, can be treated with medications or defribrillation called cardioversion or even ablation – atria quivering
Ventricular Fibrillation- life-threatening condition in which defribillation is a must (shocking with defibrilator) – ventricles are quivering

49. Cardiac Arrhythmia How to perform an EKG
Arrhythmia abnormal heart rhythm
Ventricular Fibrillation

50. Cardiac Arrhythmia
Premature Contractions- contractions that occur before the next expected contraction in a series of cardiac cycles

51. Cardiac Arrhytmias

52. Coronary Diseases
Atherosclerosis- “hardening of the arteries” due to a build up of lipids or other substances inside walls of blood vessels
Causes Hypertension, diabetes, overweight,heredity, smoking, lack of exercise, diet high in cholesterol
Coronary Artery Disease - Khan

53. Coronary Diseases
Angina Pectoris-Severe chest pain due that occurs when the myocardium is deprived of oxygen
Usually a warning sign that the arteries are no longer able to supply enough blood and Oxygen to the heart muscle
Treat with Nitroglycerin

54. Coronary Circulation Treatment
Coronary Artery Bypass Graft-Surgery to bypass a damaged or occluded coronary artery

55. Heart Failure Inability to pump enough returned blood to sustain life
Right-sided heart failure-failure of the right side of the heart to pump blood, usually because the left side is not pumping effectively
Left-Sided heart failure- Congestive Heart Failure-inability of left ventricle to pump effectively

56. Congestive Heart Failure
Heart enlarges due to poor blood flow (hypertrophy)
Symptoms – Hemoptysis, cough, dyspnea, orthopnea, ascites, neck vein distention,fatigue, hypoxia, confusion, edema, cyanosis
Treatments – Lasix, low sodium diet,restrict fluids, daily wt.

57. Vessels
Arteries – Muscular, O2 rich, carry blood away from the heart Vein
Veins – Valves, Co2 rich, carry blood toward the heart
Capillaries – walls 1 cell thick, gas
and nutrient exchange takes place

58. Peripheral Vascular Disease
Vessels in extremities damaged
Symptoms – burn during exercise, hair loss on feet and legs, thick toenails, red or brown skin, dry,scaly or shiny skin, edema,

59. Blood Plasma – liquid, clear yellow, 55% blood
Erythrocyte – RBC, Have a protein called hemoglobin that carries O2
Lymphocyte – WBC fights infection
Thrombocyte – Platelet, blood clotting
Kahn Blood testing

60. Anemia Pernicious anemia – lack of B12 Sickle cell – hereditary
Iron Def. – diet, loss of blood
Symptoms- no energy, pale, dyspnea, rapid pulse, cold, dizzy,tachypnea