1. Concorde Career College, Portland
ST120 Unit 2: The Heart
Concorde Career College, Portland

2. The Heart Objectives: Evaluate the anatomic development of the heart
Describe the basic anatomy of the heart, including coverings, wall, chambers, and valves
Trace the flow of blood into, through, and out of the heart
Evaluate myocardial infarction
Describe the conduction system of the heart
Describe basic cardiac dysrhythmias and electrocardiogram elements

3. The Heart: Part of the Cardiovascular System
Cardiovascular (Circulatory) System
Blood
Heart
Arteries
Veins
Capillaries

4. Cardiovascular System
Cardiovascular Pertaining to the heart and blood vessels.

5. Cardiovascular System
Heart
the pump
Peripheral vascular system
arteries – carry blood AWAY from the heart
Veins – carry blood TOWARD the heart
capillaries – tiny webs that connect the arteries and veins peripherally; gas exchange takes place called internal respirations
The lymphatic system also part of the circulatory system

6. Function of the Blood Circulatory System-- Simply→ Transportation
Blood Transports
Hormones
Enzymes
Oxygen
Carbon dioxide
Carries nutrients (from various organs) and oxygen (from the lungs) to the body’s cells for use, which creates waste
The waste (includes carbon dioxide) is carried from the cells to the excretory organs. Example-Lungs expires carbon dioxide

7. Cardiovascular System
The Heart

8. Cardiovascular System
General Information
Located in the mediastinum
Slightly bigger than a fist
Contracts approximately 72 times per minute
2/3 of the heart is located toward the left of the thoracic cavity

9. Cardiovascular System
Function of the Heart
Pump
Systole (contraction)
Diastole (relaxation)

10. Coverings of the Heart
Pericardium – loose fitting sac that covers the entire heart
Serous pericardium – inside the pericardium; composed of two layers
Parietal layer- lines the inside of the pericardium
Visceral layer- thin layer that covers the heart
Pericardial cavity – space located between the Parietal layer and the Visceral layer; contains pericardial fluid to reduce friction

11. Pericardium

12. Heart Anatomy Epicardium is the outer layer of the heart wall
Each chamber is lined by a thin layer of tissue called the endocardium
The wall of each chamber is composed of cardiac muscle tissue called the myocardium
Pericardium - Fibrous sac that encloses the heart.
Epicardium - Thin, outermost layer of the heart wall (contiguous with the pericardium.
Myocardium - Muscle of the heart.
Endocardium lines the interior of the heart.

13. Cardiovascular System
Chambers of the Heart
Atria (receiving chambers)
Ventricles (pumping chambers)
Separated into right and left sides by the septum
Right atrium - thin walled chamber that receives blood from the venae cavae (inferior and superior).
Right ventricle - pumps deoxygenated blood from the right atrium to the lungs via the pulmonary arteries.
Left atrium - receives oxygenated blood from the lungs via the pulmonary veins.
Left ventricle - Chamber with the thickest wall that pumps oxygenated blood from the left atrium to all parts of the body.

14. HEART CHAMBERS
UPPER CHAMBERS – RIGHT AND LEFT ATRIA which receives oxygen poor blood returning from lungs and body
LOWER CHAMBERS – RIGHT AND LEFT VENTICLES moves oxygen rich blood into arteries
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15. Cardiovascular System
Heart Valves
Tricuspid (right atrioventricular)
Bicuspid (mitral or left atrioventricular)
Pulmonary (semilunar)
Aortic (semilunar)
Tricuspid (right atrioventricular) - Allows blood to flow from the right atrium to the right ventricle.
Bicuspid (mitral or left atrioventricular) - Allows blood to flow from the left atrium to the left ventricle
Pulmonary (semilunar) - Allows blood to flow from the right ventricle to the pulmonary artery (deoxygenated blood to the lungs)
Aortic (semilunar) - Allows blood to flow from the left ventricle to the aorta.

16. HEART VALVES why do we need heart valves?
To keep the blood flowing one direction
The valve that separates the right atrium from the right ventricle is called the?
TRICUSPID VALVE
The valve that separates the left atrium from the left ventricle is called the?
BICUSPID VALVE or MITRAL
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17. Heart Valves
SL or semilunar valves located between the two ventricles and the arteries that carry the blood away from the heart
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18. Heart Valves
Pulmonary semilunar valve is located at the beginning of the pulmonary artery that allows blood to flow from the right ventricle to the lungs
Aortic semilunar valve is located at the beginning of the aorta and allows blood to flow out of the left ventricle into the aorta
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19. Cardiovascular System
Chordae Tendineae
Stabilize valve flaps to promote one way blood flow

20. Cardiovascular System
Myocardial Blood Supply
Right coronary artery
Left coronary artery
Circumflex artery
Right marginal branch
Anterior and posterior interventricular arteries

21. Coronary arteries and Coronary veins.

22. Blood Flow through the Heart
The right side of the heart receives oxygen-poor blood from the veins
Blood enters right atrium through the superior vena cava and the inferior vena cava
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23. Blood Flow through the Heart
When the heart “beats”, first the atria contract simultaneously (atrial systole)
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24. Blood Flow through the Heart
Then the ventricles fill with blood and they contract together
When the ventricles contract, blood in the right ventricle is pumped through the pulmonary semilunar valve into the pulmonary artery and to the lungs, where it is oxygenated
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25. Blood Flow Through the Heart
Oxygenated blood returns to the left atrium through 4 pulmonary veins
It then passes through the left AV or bicuspid valve to the left ventricle
Bicuspid = mitral
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26. Blood Flow Through the Heart
From the left ventricle, the blood is pumped out through the aortic semilunar valve to the aorta
From the aorta to the rest of the body!
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27. Conduction System Electrical impulses that signal the heart to beat
All cardiac muscle fibers in each region of the heart are electrically linked together!
Intercalated disks are electrical connectors that join the muscle fibers
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28. Cardiovascular System
Conduction System
Sinoatrial (SA) node
Atrioventricular (AV) node
Bundle of His
Right and left bundle branches
Purkinje fibers
The vital control center in the medulla oblongata influences the heart rate and provides autonomic innervation (vagus nerve - X cranial) of the heart, but the heart beat itself is initiated within the heart.
1. The SA node generates the electrical impulse that begins the heartbeat.
2. The electrical impulse travels throughout the muscle of the atria causing contraction.
3. The AV node is stimulated.
4. The impulse travels through the bundle of His, the right and left bundle branches and the Purkinje fibers causing ventricular contraction.

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30. Cardiac Cycle Each complete heartbeat is called a cardiac cycle
Consists of alternating systole (contraction) and diastole (relaxation) of atria and ventricles
Stroke volume is the volume of blood ejected from the ventricles during each beat
Cardiac output is the volume of blood ejected from the left ventricle into the aorta
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31. Pathology
Coronary Atherosclerotic Heart Disease - a condition in which fatty material collects along the walls of arteries. This fatty material thickens, hardens (forms calcium deposits), and may eventually block the arteries; endothelial cell dysfunction
Myocardial Ischemia - (reduced blood supply) of the heart muscle, usually due to the blockage caused by Coronary Atherosclerosis
Angina pectoris – chest pain due to Myocardial Ischemia
Myocardial Infarction (MI) – death of heart muscle tissue from Myocardial Ischemia, which leads to sudden cardiac death

32. Pathology
Ventricular fibrillation – major dysrhythmia of the ventricles. They flutter without coordination which results in lack of blood pumped out of the heart
Heart block – a disease in the electrical system of the heart
Asystole – cardiac arrest
Myocardial rupture – blood escaping the ventricles and entering the pericardial sac; can result in cardiac tamponade
Cardiac aneurysm – ballooning of the ventricular wall resulting in increases pressure in the ventricles

33. Coronary Atherosclerotic Heart Disease
Macrophage (big eater: type of monocyte) - Macrophages function in both non-specific defense (innate immunity) as well as help initiate specific defense mechanisms (adaptive immunity) of vertebrate animals. Their role is to phagocytose, or engulf and then digest, cellular debris and pathogens, either as stationary or as mobile cells. They also stimulate lymphocytes and other immune cells to respond to pathogens. They are specialized phagocytic cells that attack foreign substances, infectious microbes and cancer cells through destruction and ingestion.

34. Coronary Atherosclerotic Heart Disease
Foam cell - Foam cells are a variety of macrophages, or immune system cells, that try to cope with excessive cholesterol. They are found in blood vessel walls and are filled with fatty material. Foam cells are often found in cases of atherosclerosis.

35. Coronary Atherosclerotic Heart Disease
"Bad" cholesterol, also called low-density lipoprotein (LDL), has chemical properties that can damage arteries. Damaged areas allow more LDL to penetrate artery walls. The LDL gets stuck and accumulates in the artery's wall.
"Good" cholesterol, known as high-density lipoprotein (HDL), is the yin to LDL's yang. HDL is on your side: it circulates through your body, acting like a cholesterol magnet. HDL diverts and delivers cholesterol away from your arteries. Much of the cholesterol is either eliminated from the body, delivered to tissues such as the liver, or used to make hormones.

36. Treatments Preformed in the Cardiac Catheterization lab (Cath Lab)
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Coronary Stent
Intra-coronary Thrombolysis

37. Coronary Stent - A Treatment for Coronary Atherosclerotic Heart Disease

38. Percutaneous Transluminal Coronary Angioplasty (PTCA)

39. Treatments Preformed in the Heart Room in the OR Suite
Coronary Artery Bypass Grafting (CABG)
Permanent pacemaker

40. Surgical Treatment : Coronary Artery Bypass Grafting (CABG)

41. Possible Grafts for CABG 1. Saphenous vein 2
Possible Grafts for CABG 1. Saphenous vein 2. Internal thoracic arteries (mammary) 3. Radial Artery
For patients with triple-vessel disease undergoing CABG, radial artery grafts appear to be less likely than saphenous veins to become occluded in the long term, according to randomized trial.

42. Saphenous Vein Harvesting

43. Postoperative Healing

44. Endoscopic Saphenous Harvesting

45. Mammary Artery Harvesting

46. Internal Mammary Artery

47. Radial Artery Harvesting

48. Cardiopulmonary Bypass
Identify the locations of the tube insertions into the circulatory system
Venous cannulation: right atrium or venae cavae
Arterial cannulation: ascending aorta

49. Permanent Pacemaker

50. Dysrhythmias
Sinus Dysrhythmia – most common; related to vagal nerve impulses to the SA node; benign
Sinus Tachycardia – heart rate of 100 beats or more per minute
Sinus Bradycardia - heart rate of 60 beats or less per minute

51. Atria Dysrhythmias Dysrhythmias originating in the atria:
Premature atrial beat – often associated with stress or consumption of caffeine or nicotine
Atrial tachycardia – atrial rate of beats per minute; usually benign
Atrial flutter - atrial rate of beats per minute; can result in increased ventricular rate and decrease in oxygen
Atrial fibrillation - atrial rate of beats per minute; results in increased ventricular rate and decrease in oxygen

52. Ventricular Dysrhythmias
Benign PVC’s – less than 5 per hour; absence of heart disease
Complex PVC’s – greater than per hour; with or without heart disease
Malignant PVC’s – same as complex except with left ventricular dysfunction
Ventricular tachycardia – beats per minute
Ventricular flutter – regular contractions but at a fast rate of per minute

53. Electrocardiogram ECG or EKG
Electrical signals can be picked up form the body surface and transformed into visible tracings by an instrument called an electrocardiograph
The electrocardiogram is the graphic record of the heart’s electrical activity

54. ECG 3 characteristic deflections or waves
P wave – depolarization (triggers contraction) of atria
QRS complex - depolarization (triggers contraction) of ventricles
T wave - repolarization of ventricles

55. Cardiothoracic Procedures
Features of the ECG Paper

56. ECG Electrical Correlation

57. Electrocardiograph (Normal Sinus Rhythm)

60. Sinus Rhythm

61. Occasional (Incidental) PVC

62. Bigeminy (PVC Every Other Beat)

63. Ventricular Fibrillation (V Fib)

64. Premature Atrial Contraction (PAC)

65. Atrial Fibrillation

66. Asystole