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)
