Cavities,valves, vessels, nerves, developmentCavities,valves, vessels, nerves, development

Author: David Sedmera Subject: Anatomy 2

Date: 12. - 19. 3. 2012

Univerzita Karlova v Praze - 1. Léka ská fakultař

The HeartThe Heart

Institute of Anatomy

The Heart : 1.Cavities, Wall, Valves

• Why heart?• What’s heart?• How heart?

-Structure-Function-Disease

The Heart as Whole

• Incoming vessels• Cardiac chambers• Valves and support• Outgoing vessels

Posterior View

•SVC•IVC•Pulmonary veins

•Aorta•Pulmonary trunk

The Cavities: Four-Chamber View

Four-Chamber View: ECHO

Dr. M. Kocík, IV. Int. klinika

If you want to see the movies,You need to come to the lectures.

Chambers of the Heart

• Left atrium• Right atrium• Left ventricle• Right ventricle

Atrio-ventricular valves

Semilunar valves

•Interatrial septum•Interventricular septum

Chambers of the Heart: Connections

Right Ventricle - Inflow

Right Ventricle - Outflow

Left Ventricle - Inflow

Left Ventricle - Outflow

Layers of chamber wall

3 layers, from outside in:

• epicardium

• myocardium

• endocardium

Myocardial Organization

3 layers of muscle:• Outer oblique• Middle circular• Inner longitudinal

Myocardial Contraction

Short axis view• Shortening velocity (cm/s)• Ejection fraction (%)• Paradoxical movement (MI)

The Valves 1. Nomenclature

• pulmonary• tricuspid

• aortic• mitral

• fibrous skeleton

(view from the top)Posterior

Anterior

The Valves 2. Support

Papillary muscles

Tricuspid valve Mitral valve

Cardiac Skeleton

The Valves 3. Function

(ventricle)

The Heart Cycle

1st

2nd

The Heart Sounds

First sound:AV valves closure

Second sound:arterial valves closure

Valve auscultation

A P

T M

All Physicians Take Money

Heart Murmurs

Valve replacement

The Heart: 2.Vessels, Nerves, Conduction System &

Development• Coronary arteries• Cardiac veins

•Lymphatics•Sympathetic nerves•Parasympaticus•Pacemaking &

Conducting system•Heart development

Surface of the Heart

Overview of Blood Supply

The Blood Supply: Origin

Leftcoronaryartery

Right coronary artery

The Blood Supply: Course

The Blood Supply: X-ray - right

The Blood Supply: X-ray - left

Review: Coronary Arteries and Veins

Review: Coronary Arteries and Veins

Left coronary artery:-anterior interventricular branch --diagonal branch-circumflex branch--obtuse marginal branch

Right coronary artery:-artery to SA node-acute marginal branch-posterior interventricular branch

Great cardiac vein

Left oblique atrial vein (of Marshall) => coronary sinus

Middle cardiac vein (with posterior interventricular branch)

Small cardiac vein

Anterior cardiac veins (to right atrium)

Thebesian veins

The Lymphatic Drainage

Along the blood vessels

The Blood Supply: Troubles...

Stenosis of anterior interventricular ramus of left coronary artery

The Blood Supply: Solution !?

PTCA:PercutaneousTransluminarCoronaryArterioplasty

Via catheter with balloon

The Innervation

Parasympathetic: n. X (vagus) - rr. cardiaciStimulation slows down the rate (S-A node), conduction(A-V node) and decreases force of contraction (viacoronary vasoconstriction).

Sympathicus comes from C and T region via cardiac plexustogether with coronary arteries - nn. cardiaciStimulation increases heart rate (S-A node), shortens A-Vdelay, increases force of contraction (directly) and dilatescoronary arteries. Afferent fibers carry pain (MI).

The Innervation

The Innervation

The Conduction System

S-A node(Internodal tracts)A-V nodeHis bundleLeft and Rightbundle branchesPurkinje fibersWorking myocardium

Electrical insulation

AV node and Bundle Branches

LBB RBB

Triangle of Koch: delimited by the venous valve->the tendon of Todaro and the anulus of the tricuspid valve.

GFP:Cx40 labeling of conduction system

Septum

Ventricular walls

Purkinje fibers

Left bundle

branches

Lucille Miquerol, IBDM, Marseille

Tawara: ventricular conduction system

Septum

Ventricular walls

Purkinje fibers

Left bundle

branches

Tawara (1906)

Right Bundle Branch in Action

Chick Mouse Rat human

Isochronal activation maps

Cardiac development

• ATTENTION: aortic arches and their derivatives are NOT considered here.

Milestones of cardiac development

• Precardiac mesoderm• Cardiac tube

• Heart loop• Four compartments

Septation of atria and ventricles

Morfogenetic mechanisms

• Proliferation• Migration

• Diferentiation• Cell death

(programmed)

Outflow tract septation

Role of neural crest in outflow tract septation

NB coronary vessels also have extracardiac origin

Analysis of neural crest cell migration using chick - quail chimera

aortico-pulmonal septum!

Congenital heart disease

• Cardiac tube - cardia bifida (lethal)• Impaired looping - dextrocardia• Deficient septation - ASD, VSD• Outflow tract defects - PTA, DORV, TGA

• Causes: genetics (Nkx2.5), environment / drugs (Etretinate)

in utero

Fetal and postnatal circulation

post partum

Fetal and postnatal circulation

Remodeling after birth

The Heart: 3.Pericardium, Topography &

Projections• Projection on body surface• Chest X-ray

•Valve projections•Syntopies•The Pericardium•Pericardial cavity

and sinuses

Position of the Heart in the Chest

Position of the Heart 2. X-Ray

Position of the Heart 2. X-Ray

Position of the Heart 2. X-ray

Position of the Heart 2. MRI

Position of the Heart 2. MRI

Projection and auscultation points of cardiac valves on body surface

Projection on the body surface

Movements with respiration

Position in differently shaped chests

The Pericardium

• Parietal pericardium• Pericardial fluid• Visceral pericardium (epicardium)• fat

Heart in the pericardial cavity

Pericardial cavity with the heart removed

Pericardial Cavity & Sinuses

• Transverse sinus• Oblique sinus

X

Transverse and oblique pericardial sinus

Hydropneumopericardium

Development of the pericardium

Development of the pericardium

Pericardium gives rise to:-cardiac fibroblasts-coronary smooth muscle-subepicardial fat

Coronary endothelium-derived from the liver

A bit of histology - endocardium

Some more histology - epicardium

Yet more histology - valve

References• ihák: Anatomie 3.Č• Told: Anatomical atlas• Netter: Anatomical atlas• Grant: Anatomical Dissector• Anderson and Becker: Cardiac Anatomy• Morphology for Pharmacy students• Sadler: Human Embryology• Junquiera: Basic Histology• Original research papers• Internet (radiographs)• Dr. Kocík (echos)