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


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

    Cardiovascular system: central organ


    blood vessels arteries capillaries veins

  • Circulatory system Two parts (systems):

    blood-vascular system

    arterial system

    venous system

    lymphatic system


  • Central organ


    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


    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


    material exchange

    anastomoses end (terminal) arteries

    Microcirculatory bed:

    precapillary (terminal)

    arterioles 30-50 m metarterioles



    postcapillary 8-30 m



    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


    Location asymmetric position

    in middle mediastinum

    upon centrum tendineum


    lateral pericardium and

    mediastinal pleura

    at the front sternum and

    IV-VIth rib cartilage

    at the back esophagus and thoracic aorta

  • Cardiac surface anatomy


  • Heart external surface

    External morphology:

    shape an irregular cone

    weight ~300 g (); 220 g ()


    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


  • 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


  • Cardiac chambers


    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


  • 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


  • 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


  • Heart valves

    Pulmonary valve, valva trunci pulmonalis:

    valvula semilunaris anterior,

    dextra et sinistra

    lunula et nodulus

    valvulae semilunaris


  • Heart valves


    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)


  • Heart valves


    Function and biomechanics:



  • 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



  • Microscopic structure ofatrioventricular valve


    AV valve leaflet: endocardium

    elastic fiberssmooth muscle cells

    fibrous skeleton dense connective tissue chordae tendineae


  • The cardiac muscle, myocardium


    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


  • Fibrous skeleton of the heart


    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


    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


  • 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


  • Blood supply of the heart


    Normal type:

    in 75% of human population

    Left coronary artery


    in 11% of cases

    Right coronary artery


    in 14% of cases

  • Clinical relevance Coronary stenosis:

    coronary catheterization

    coronary angiography

    coronary stenting



  • Venous drainage of the heart


    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


    The coron