Cardiovascular system - .ramus lateralis (a. diagonalis) rami interventriculares septales ramus circumflexus

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  • Cardiovascular system

    1. Cardiovascular system general overview

    2. Heart surface anatomy, external and internal features

    3. Cardiac chambers and heart valves

    4. Structure of the heart wall

    5. Cardiac blood and nerve supply

    6. The conducting system of the heart

    7. The pericardium

    8. Radiological appearance, development and abnormalities of the heart

  • Cardiovascular system

    2

    Angiology (Gr. , angeon, vessel"; -, -logia)= vascular medicine

    Cardiovascular system: central organ

    heart

    blood vessels arteries capillaries veins

  • Circulatory system Two parts (systems):

    blood-vascular system

    arterial system

    venous system

    lymphatic system

    3

  • Central organ

    4

    Heart cor, (Gr. cardia):

    left (arterial) heart

    right (venous) heart

    Functional compartments:

    atria left and right

    chambers left and right

    Blood circulation:

    systemic circuit

    portal circulation

    pulmonary circuit

  • 5

    Blood flow (circulation)

    Blood vessels, vasa sanguinea:

    arteries, arteriae

    arterial system

    capillaries

    microcirculatory compartment

    veins, venae

    venous system

    Collateral circulation

    Blood-vascular system

  • 6

    Arterial system Arterial tree, Gr. (artria); , air (Galen)

    principle of divergence

    arterial tree

    arterial branches monotomous

    and dichotomous branching

    o collateral arteries, vas collaterale

    o terminal branches vs. end-arteries

    anastomoses, vas anastomoticum

    intrasystemic and intersystemic

    arteriovenous anastomoses (shunts)

    o anastomosis arteriovenosa simplex

    o anastomosis arteriovenosa glomeruloformis

    o obturator arteries

  • 7

    Microcirculatory compartment

    Microcirculation:

    material exchange

    anastomoses end (terminal) arteries

    Microcirculatory bed:

    precapillary (terminal)

    arterioles 30-50 m metarterioles

    capillaries

    venules:

    postcapillary 8-30 m

    collecting

    Capillaries:

    anastomoses capillary networks

    transcapillary vs.

    juxtacapillary route(arteriole-venule shunt)

  • 8

    Venous system Venous bed:

    principle of convergence tributaries(excl. portal venous system)

    have thinner wall and valves

    low blood pressure and flow store blood 3 l. blood available

    larger number and more anastomoses venous networks and plexuses

    superficial and deep veins

  • Heart topography

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    Location asymmetric position

    in middle mediastinum

    upon centrum tendineum

    Somatotopy:

    lateral pericardium and

    mediastinal pleura

    at the front sternum and

    IV-VIth rib cartilage

    at the back esophagus and thoracic aorta

  • Cardiac surface anatomy

    10

  • Heart external surface

    External morphology:

    shape an irregular cone

    weight ~300 g (); 220 g ()

    size:

    longitudinal 10-12 cm

    transverse 9-10.5 cm

    anterior-posterior 6-7 cm

    Cavities four chambers:

    two atria left and right

    two chambers left and right

    11

  • Cardiac chambers The right atrium, atrium dextrum:

    auricula dextra with mm. pectinati

    v. cava superior et v. cava inferior

    tuberculum intervenosum

    valvula v. cavae inferioris

    ostium et valvula sinus coronarii cordis

    foramina venarum minimarum (Thebesii)

    septum interatriale with fossa ovalis

    12

  • Cardiac chambers

    13

    The right ventricle, ventriculus dexter:

    the outflow tract conus arteriosus

    ostium trunci pulmonalis;

    valva trunci pulmonalis

    inflow tract body, corpus

    ostium atrioventriculare dextrum;

    valva antrioventricularis dextra

    trabeculae carneae

    trabecula septomarginalis (da Vinci)

    right A-V bundle (of His)

    crista supraventricularis

    septum interventriculare

  • Cardiac chambers

    The left atrium, atrium sinistrum:

    auricula sinistra with mm. pectinati

    vv. pulmonales

    septum interatriale with fossa ovalis

    14

  • Cardiac chambers

    The left ventricle, ventriculus sinister:

    an outflow orifice and tract ostium aortae with valva aortae

    an inflow orifice and tract ostium atrioventriculare sinistrum;

    valva antrioventricularis sinistra

    15

  • Heart valves

    Right atrioventricular (tricuspid) valve, valva antricularis dextra s. valva tricuspidalis:

    cuspis anterior,

    posterior et septalis

    chordae tendineae

    mm. papillaris anterior,

    posterior et septalis

    16

  • Heart valves

    Pulmonary valve, valva trunci pulmonalis:

    valvula semilunaris anterior,

    dextra et sinistra

    lunula et nodulus

    valvulae semilunaris

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  • Heart valves

    18

    Left atrioventricular (bicuspid, mitral) valve, valva antricularis sinsitra s. valva bicuspidalis (mitralis):

    cuspis anterior et posterior

    chordae tendineae

    mm. papillaris anterior et posterior

    trabeculae carneae

  • Heart valves

    Aortic valve, valva aortae:

    valvula semilunaris

    posterior, dextra et sinistra

    lunula et nodulus

    valvulae semilunaris

    sinus aortae (Valsalva)

    19

  • Heart valves

    20

    Function and biomechanics:

    diastole

    systole

  • Structure of the heart wall internal layer, endocardium:

    stratum endotheliale

    stratum subendotheliale

    stratum myoelasticum

    atrioventricular valves

    tela subendocardialis

    cells of Purkinje

    middle layer, myocardium

    external layer, epicardium

    pericardium

    21

  • Microscopic structure ofatrioventricular valve

    22

    AV valve leaflet: endocardium

    elastic fiberssmooth muscle cells

    fibrous skeleton dense connective tissue chordae tendineae

    endocardium

  • The cardiac muscle, myocardium

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    Cardiac muscle tissue, myofibrae cardiacae

    labor cardiac musculature

    impulse-conducting system

    cardiac myoendocrine cells

    (atrial cardiomyocytes)

    atrial natriuretic peptide (cardiodilatin)

  • Labor cardiac musculature Structural features:

    defines the heart thickness

    separate for the atria and ventricles

    atria two layers

    (superficial and deep layers)

    ventricles three layers

    substantially thicker in the ventricles

    attached to the fibrous skeleton

    24

  • Fibrous skeleton of the heart

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    The fibrous skeleton:

    two fibrous rings:

    right AV ring, anulus fibrosus dexter

    left AV ring, anulus fibrosus sinister

    two fibrous trigones:

    right trigone, trigonum fibrosum dexter

    left trigone, trigonum fibrosum sinister

  • Cardiac blood supply

    26

    Arteries of the heart, aa. cordis:

    left coronary artery

    right coronary artery

    beginning of aortic sinuses

    Varieties in arterial blood supply:

  • Blood supply of the heart

    The right coronary artery, a. coronaria dextra: ramus coni arteriosus

    ramus nodi sinuatrialis

    rami atriales

    ramus marginalis dexter

    ramus atrialis intermedius

    ramus interventricularis posterior

    rami interventriculares septales

    ramus nodi atrioventricularis

    Areas of blood supply: the right ventricle

    the right atrium

    posterior part of the left ventricle

    posterior papillary muscle

    posterior of the interventricular septum

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  • Blood supply of the heart The left coronary artery,

    a. coronaria sinistra: ramus interventricularis anterior

    ramus coni arteriosus

    ramus lateralis (a. diagonalis)

    rami interventriculares septales

    ramus circumflexus

    ramus atrialis anastomoticus ( Kugel)

    rami atriales

    rami atrioventriculares

    ramus marginalis sinister

    variable branches

    Areas of blood supply: anterior wall of the right ventricle left atrium most of the left ventricle anterior of the interventricular septum

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  • Blood supply of the heart

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    Normal type:

    in 75% of human population

    Left coronary artery

    dominance:

    in 11% of cases

    Right coronary artery

    dominance:

    in 14% of cases

  • Clinical relevance Coronary stenosis:

    coronary catheterization

    coronary angiography

    coronary stenting

    echocardiography

    30

  • Venous drainage of the heart

    31

    The cardiac veins, venae cordis:

    coronary sinus, sinus coronarius

    v. cardiaca magna et media

    vv. ventriculi dextri anteriores

    vv. cardiacae minimae (Thebesius)

    vv. cardiacae parvae:

    vv. atriales

    vv. ventriculares

    vv. atrioventriculares

  • The coronary sinus

    32

    The coron