Echo class 2_05262015
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The document provides an extensive overview of the cardiovascular system, focusing on the anatomy and physiology of the heart, including its major arteries and veins, the pathway of blood flow, and the cardiac cycle. It details the functions of various coronary arteries and how different segments of the heart are supplied with blood, as well as the intrinsic conduction system regulating heartbeats. Additionally, it discusses factors affecting cardiac output and stroke volume alongside the structure of the heart and its coverings.
Echo class 2_05262015
- 1. External Heart: Arteries that Supply the Heart • Coronary circulation is the functional blood supply to the heart muscle itself (i.e. the fuel for the heart) • Collateral routes ensure blood delivery to heart • even if major vessels are occluded/clogged
- 2. Different parts of the heart are supplied by different coronary artery segments Heart chambers in geometric models are subdivided into perfusion zones using anatomic knowledge in the FMA ontology
- 3. CORONARY ARTERIES SUPPLYING THE HEART WITH OXYGEN-RICH BLOOD Right Coronary Artery (RCA) Right Coronary Artery (RCA) Left Main Coronary Artery (LMCA) Left Main Coronary Artery (LMCA) Left Anterior Descending Artery (LAD) Left Anterior Descending Artery (LAD) Posterior Descending Artery (PDA) Posterior Descending Artery (PDA) Left Circumflex Coronary Artery (LCx) Left Circumflex Coronary Artery (LCx)
- 5. External Heart: Arteries that Supply the Heart • Right coronary artery (in atrioventricular groove) – Supplies the right atrium and nearly all the right ventricle – marginal –supply the myocardium of the – lateral right side of the heart – posterior interventricular artery – supply the – interventricular septum and adjacent portions of the ventricular walls
- 6. External Heart: Arteries that Supply the Heart • Left coronary artery: – Circumflex supplies the left atrium and the posterior wall of the left ventricle – Anterior interventricular artery supplies the anterior wall of both ventricles
- 7. CERTAIN HEART WALL SEGMENTS ARE FED BY CERTAIN CORONARY ARTERIES AS SPECIFIED BELOW: BASE MID APEX A4C A2C PARASTERNAL LONG-AXIS Key: Red = LAD Yellow = LCx Green = RCA LAD = Left Anterior Descending Coronary Artery, LCx = Left Circumflex Coronary Artery, RCA = Right Coronary Artery
- 8. DIVIDING THE LEFT VENTRICLE INTO KEY SEGMENTS Apical Third Apical Third Mid Third Mid Third Basal Third Basal Third
- 9. FURTHER DIVIDING THE LEFT VENTRICULAR WALLS INTO 17 SPECIFIC SEGMENTS DEFINED AS: AnteriorAnterior AnterolateralAnterolateral InferolateralInferolateral InferiorInferior InferoseptalInferoseptal AnteroseptalAnteroseptal ApexApex AnteriorAnterior AnteroseptalAnteroseptal InferoseptalInferoseptal AnterolateralAnterolateral InferolateralInferolateral InferiorInferior AnteriorAnterior SeptalSeptal LateralLateral InferiorInferior ApexApex BasalBasal Mid- Cavity Mid- Cavity ApicalApical 1. Basal Anterior 2. Basal Anteroseptal 3. Basal Inferoseptal 4. Basal Inferior 5. Basal Inferolateral 6. Basal Anterolateral 7. Mid Anterior 8. Mid Anteroseptal 9. Mid Inferoseptal 10. Mid Inferior 11. Mid Inferolateral 12. Mid Anterolateral 13. Apical Anterior 14. Apical Septal 15. Apical Inferior 16. Apical Lateral 17. Apex 1. Basal Anterior 2. Basal Anteroseptal 3. Basal Inferoseptal 4. Basal Inferior 5. Basal Inferolateral 6. Basal Anterolateral 7. Mid Anterior 8. Mid Anteroseptal 9. Mid Inferoseptal 10. Mid Inferior 11. Mid Inferolateral 12. Mid Anterolateral 13. Apical Anterior 14. Apical Septal 15. Apical Inferior 16. Apical Lateral 17. Apex
- 10. PUTTING IT TOGETHER: HEART WALL SEGMENTS AND CORRESPONDING CORONARY ARTERIES Coronary Artery: Segments: LAD 1, 2, 7, 8, 13, 14, 17 RCA 3, 4, 9, 10, 15 LCX 5, 6, 11, 12, 16 Coronary Artery: Segments: LAD 1, 2, 7, 8, 13, 14, 17 RCA 3, 4, 9, 10, 15 LCX 5, 6, 11, 12, 16 LAD = Left Anterior Descending Artery RCA = Right Coronary Artery LCX = Left Circumflex Artery LAD = Left Anterior Descending Artery RCA = Right Coronary Artery LCX = Left Circumflex Artery AnteriorAnterior AnterolateralAnterolateral InferolateralInferolateral InferiorInferior InferoseptalInferoseptal AnteroseptalAnteroseptal ApexApex AnteriorAnterior AnteroseptalAnteroseptal InferoseptalInferoseptal AnterolateralAnterolateral InferolateralInferolateral InferiorInferior AnteriorAnterior SeptalSeptal LateralLateral InferiorInferior ApexApex
- 11. ANOTHER PERSPECTIVE – 17 SEGMENT MODEL OF LEFT VENTRICLE 1. Basal Anterior 2. Basal Anteroseptal 3. Basal Inferoseptal 4. Basal Inferior 5. Basal Inferolateral 6. Basal Anterolateral 7. Mid Anterior 8. Mid Anteroseptal 9. Mid Inferoseptal 10. Mid Inferior 11. Mid Inferolateral 12. Mid Anterolateral 13. Apical Anterior 14. Apical Septal 15. Apical Inferior 16. Apical Lateral 17. Apex 1. Basal Anterior 2. Basal Anteroseptal 3. Basal Inferoseptal 4. Basal Inferior 5. Basal Inferolateral 6. Basal Anterolateral 7. Mid Anterior 8. Mid Anteroseptal 9. Mid Inferoseptal 10. Mid Inferior 11. Mid Inferolateral 12. Mid Anterolateral 13. Apical Anterior 14. Apical Septal 15. Apical Inferior 16. Apical Lateral 17. Apex
- 12. SAMPLE – SEGMENTAL SCORING Ortiz-Perez, J. T. et al. J Am Coll Cardiol Img 2008;1:282-293
- 13. Representative Segmentation and Pattern of Contrast HE Over 17-Segments of the LAD, RCA, and LCX Arteries Ortiz-Perez, J. T. et al. J Am Coll Cardiol Img 2008;1:282-293
- 14. HEART ANATOMY – COVERINGS OF THE HEART • Coverings of the Heart: Anatomy • Pericardium – a double-walled sac around the • heart composed of: • A superficial fibrous pericardium • A deep two-layer serous pericardium • The parietal layer lines the internal surface • of the fibrous pericardium • The visceral layer or epicardium lines the • surface of the heart • They are separated by the fluid-filled • pericardial cavity • Coverings of the Heart: Physiology • The pericardium: • Protects the heart
- 15. COVERINGS OF THE HEART: PHYSIOLOGY • The pericardium: – Protects and anchors the heart – Prevents overfilling of the heart with blood – Allows for the heart to work in a relatively – friction-free environment
- 16. PERICARDIUM OF THE HEART • Pericardium (3 layers) • 1) Outer-fibrous pericardium – Serous pericardium • 2) parietal • 3) visceral (epicardium) • Pericardial Cavity – between layers of serous pericardium – serous fluid – lubricate heart while beating
- 17. Pericardial Layers of the Heart
- 18. Heart Wall – Layers of the Heart • Epicardium – visceral layer of the serous • pericardium • Myocardium – cardiac muscle layer forming • the bulk of the heart • Fibrous skeleton of the heart – crisscrossing, • interlacing layer of connective tissue • Endocardium – endothelial layer of the inner • myocardial surface • Cardiac Muscle Bundles • External
- 19. Cardiac Muscle 1000X intercalated disc striations nucleus
- 21. EXTERNAL FEATURES OF THE HEART • Interventricular sulcus • Coronal/Coronary sulcus • Auricles of atria • Apex • Base • Coronary vessels • Ligamentum Arteriosum
- 22. External Heart: Major Vessels of the Heart (Anterior View) • External Heart: Major Vessels of the Heart (Anterior View) • Vessels returning blood to the heart include: – Superior and inferior vena cava – Right and left pulmonary veins • Vessels conveying blood away from the heart: – Pulmonary trunk, which splits into right and – left pulmonary arteries – Ascending aorta (three branches) – – brachiocephalic, left common carotid, and – subclavian arteries
- 23. External Heart: Veins that Drain the Heart
- 24. External Heart: Major Vessels of the Heart (Posterior View) Vessels returning blood to the heart include: •Right and left pulmonary veins • Superior and inferior vena cava • Vessels conveying blood away from the heart include: • Aorta • Right and left pulmonary arteries
- 25. FLOW OF BLOOD • O2-poor blood (S+I VC, Coronary Sinus) enters Rt Atrium • Travels through Tricuspid Valve into Rt Ventricle • Pumped out through Pulmonary Semilunar Valve into Pulmonary trunk (branches into Pulmonary Arteries) and to lungs •After circulating through lungs, O2-rich blood returns to the heart through 4 Pulmonary veins • The O2-rich blood enters the Left Atrium • Travels through Bicuspid/Mitral Valve into Left Ventricle • Pumped out through Aortic Semilunar Valve into Aorta to be distributed to rest of body by descending aorta and branches of aortic arch
- 26. Pathway of Blood Through the Heart and Lungs Right atrium > tricuspid valve > right ventricle > pulmonary semilunar valve > pulmonary arteries > Lungs > pulmonary veins > left atrium > Mitral valve > left ventricle > Left ventricle > aortic semilunar valve > aorta > systemic circulation
- 27. THE PATHWAY OF THE HEART
- 28. Cardiovascular Flow of Blood • HeartArteries(conducting-distributing) ArteriolesCapillaries of tissues • At Capillaries O2 is delivered and CO2 picked up •CapillariesVenulesVeinsHeart
- 29. DETAILED IMAGES OF THE HEART’S ANATOMY – CHORDAE TENDONAE
- 32. Cardiac Intrinsic Conduction IMPORTANT - Various nodes and intrinsic Heart Rate Generated: • SA Node – 60 – 100 Beats/min • AV Node – 40 – 60 Beats/min • Bundle of His – 40 – 60 Beats/min •Purkinje Fibers – Last resort – 20 – 40 Beats/min IMPORTANT - Various nodes and intrinsic Heart Rate Generated: • SA Node – 60 – 100 Beats/min • AV Node – 40 – 60 Beats/min • Bundle of His – 40 – 60 Beats/min •Purkinje Fibers – Last resort – 20 – 40 Beats/min
- 33. Heart Excitation Related to ECG atrial excitation begins Impulse delayed at AV node Impulse passes to heart apex; ventricular excitation begins Ventricular excitation complete SA node AV node Purkinje fibers Bundle branches
- 34. Electrocardiography Electrical activity is recorded by electrocardiogram (ECG) • P wave corresponds to depolarization of SA •node •QRS complex corresponds to ventricular •depolarization •T wave corresponds to ventricular repolarization •Atrial repolarization record is masked by the •larger QRS complex
- 36. Electrocardiography PR interval •Atrial depolarization and contraction •QT interval •Ventricular depolarization, contraction and repolarization •PR segment •Atrial contraction •ST segment •Ventricular contraction •ECG Tracings •Heart
- 38. Cardiac Cycle Cardiac cycle refers to all events associated with blood flow through the heart •Systole – contraction of heart muscle •Diastole – relaxation of heart muscle
- 39. Phases of the Cardiac Cycle Phases of the Cardiac Cycle • Isovolumetric relaxation – early diastole • Ventricles relax • Backflow of blood in aorta and pulmonary trunk closes semilunar valves • Dicrotic notch – brief rise in aortic pressure caused by backflow of blood. This backflow • causes the valve to close and creates a slight pressure rebound
- 40. Phases of the Cardiac Cycle
- 42. Cardiodynamics Cardiac output (CO) : the amount of blood pumped by each ventricle in one minute •Cardiac output equals heart rate times stroke volume Cardiac output (ml/min) = Heart Rate (HR) (beats/min) X Stroke Volume (SV) (ml/beat)
- 43. Cardiodynamics Heart rate (HR) : number of heart beats in a minute •Stroke volume (SV) – amount of blood ejected from the ventricles with each beat •SV = EDV - ESV
- 44. Cardiac Output: Example CO (ml/min) = HR (75 beats/min) x SV (70 ml/beat) •CO = 5250 ml/min (5.25 L/min)
- 45. Cardiodynamics Ventricular pressure increases forcing blood through the semilunar valves: ventricular Ejection •End-systolic volume (ESV) •Amount of blood that remains in the ventricles after the contraction and closing of the semilunar valves
- 46. Factors Affecting stroke volume (EDV-ESV) EDV (end diastolic volume) is affected by •Venous return - amount of blood returning to the heart or blood flow during filling time •High venous return= high EDV •Slow heartbeat and exercise increase venous return to the heart, increasing SV
- 47. Factors Affecting stroke volume (EDV-ESV) Filling time -duration of ventricular diastole •Depends on the heart rate •Blood loss and extremely rapid heartbeat decrease SV •The longer the filling time the higher the EDV will be
- 48. Factors Affecting stroke volume (EDV-ESV) Preload • Stretchiness of the ventricles during Diastole • Directly proportional to the EDV • Frank-Starling principle (“more in = more out”) or increased EDV=increased SV
- 49. Factors Affecting stroke volume (EDV-ESV) ESV (end systolic volume). It is influenced by: •Contractility • Force produced during a contraction • Positive inotropic (increase Calcium entry) • Increased sympathetic stimuli • Certain hormones, some drugs • Increase SV by decreasing ESV
- 50. Factors Affecting stroke volume (EDV-ESV) Afterload •The pressure that must be overcome for the ventricles to eject blood (back pressure exerted by blood in the large arteries leaving the heart) • Increased afterload will increase ESV and decrease SV • Increased by factors that restricts arterial blood flow
- 51. PRELOAD AND AFTERLOAD DEPICTED
- 53. Stress- Perfusion Rest- Perfusion Baseline LV contrast uptake RV contrast uptake Myocardial contrast uptake Viability and coronary angiography
- 57. Walls of the ventricles: Left wall is thicker!
- 59. Find: 1. Walls of the ventricles 2. Auricles 3. Inner walls of the atria 4. Fossa ovalis 5. Trabeculae carnae 6. Atrioventricular valve (a) "Bicuspid valve" (b) "Tricuspid valve" 7. Chordae tendonae 8. Papillary muscles 9. Aortic & pulmonary valves
- 60. Coronary arteries are the FIRST branches of the aorta! 1. Coronary arteries (a) Left coronary artery (b) Right coronary artery (c) Interventricular branches (d) Right marginal branch 2. Cardiac veins
- 61. Heart in VENTRAL view. (You see mostly right ventricle!)
- 62. Heart in DORSAL view. (You see mostly left ventricle.)
- 63. Intrinsic regulation of heart beat 1. Sinoatrial node is PACEMAKER OF HEART, and beginning of process. Geenrates periodic impulses that initiate contraction of right atrium. 2. Signal then runs to Atrioventricular node. Message is passed along a track of Purkinje fibers called the... 3. Atrioventricular bundle. Atrioventricular bundle then splits into right and left limbs/branches that pass to individual inner ventricular walls on right and left.
- 66. Maximum Heartrate Calculation (Suggested) MAXIMUM HEARTRATE can be calculated by the formula: 208 - (0.7)(your age) = normal maximum heartrate.
- 67. Heartrate Resting heartrate average is variable depending on ages, sex, weight, etc. MAXIMUM HEARTRATE used to be calculated by the formula: 220 - your age = normal maximum heartrate. (This is now known to be oversimplified and incorrect.)