Anatomy Lecture #4 (Cardio) Flashcards
History of Heart Shape
The cartoon heart shape was a decorative design in the past (unclear if it symbolized love in the begining)
Had hearts in a Code of Arms image - don’t know it the hearts were asociated with love/affections
Later - have a letter that expressed love that had an upside down heart –> first indication of heart being used for love
- Upside down heart has a shape similar to real heart
- Have movement for heart to be connected to love
Victorian times –> heart was used to symbolize love (used in valtentines crads)
History of Anatomy (Galin)
Galin - observer of anatomy –> his ideas were maintained for 1700 years (was the gold standrad)
- Was good because promoted excimtment but also hindered because all of medicine used his ibservations
Galin = first to say the heart was the soul (creates connections and love)
Galin = Thought the arteries were fillied with air (because mostly saw vessles in dead animals/people where the vessels were exposed –> arteries would evacuate the blood
- No blood in arteries but had blood in veins (because veins walls are more flexible) = Galin thought this is how it is when alive
History of Anatomu (Servatus)
Servatus wrote a treatus on cataholsism + talked about anatomy + astronolmy (all together because hard to publish)
- Talked about circulatory system in Treatus
***He was burned in spain for treatus because he dissed catholism
Galin vs. Servatus
Galin = herat is the exchaneg between air and blood (No blood in arteries; blood in veins)
Servtus = thought heart is pump and blood fills both arteries and veins
- Explains pulminary circut (blood goes to the heart and body + said blood goes to lungs where there is an exchnage occuring)
Anatomy History (Harvey)
Physician in england (observer of human body)
Overall: Pushed idea of circulatory system
He put tornaque on limbs and saw the veins negorge (saw blood going into the limb (when put tornaque on saw blood can go in but it could not go out)
- Veins = superficial = blocked BUT the arteries were not blocked
- When veins engorged = saw bulbus area –> saw there are valve (first to descrive venous valves)
Left (showing Anterior to posterior)
- See corany artery on surface
- Covered with epicardial fat
Right (showing posterior to anterior)
Heart Overall
Heart = Muscilar pump
- Weighs ~1 lb
Pumpes 1.5 gallons of blood/minutes ;
Pumoes to to 5 gallons of blood/minute during excersize
Adults = have 4-5 quarts of blood
takes 1 miniues for the blood to circulate (1 minute to return to heart from extremities)
Cardiomegly
Bigger heart (heart is working harder)
Heart beats
Averrage resting heart rate = 72 (higher in women)
Means 1440 beats/min –> 104,000 beats per day –> 37,325,000 beats per year –> 2.8 billions beats over teh course of 90 years
***During meditations can get heartrate to 40-50
Reserach on nutritiant + longevity
Reserach showed that organisms with slower Hearteates live longer than organisms with higher heart rates (Numver of heart beats coorelates with longevity)
- Faster heart rates = using up heart beats in lifetime
- Want to decrease HR to increase lifespan
- Doing excersuze decreases resting HR = increases longevity
HR is a factor of mortality – resting HR = independent prediction of cardiovascular mortality
Circulatory networks
- Systemic
- Pulimary
- Portal
Systemic circulatory
Getting blood out to periphery + taking used blood from tissue to hear
Includes - Head/neack + upper limbs + body wall + pelvis + lower limb + lymph nodes
Image - blue highlighted = part of system
Pulimary Circut
Takes blood from the heart to the lungs
- Drops waste out of blood + gets oxgen
Going from heart –> lungs –> heart etc.
Portal Circut
Blood of the intestins drain through the liver –> liver has capilary netowkr –> network will bring blood (conatins nutreients) from intestine to liver to be broken down and metabolsized –> once metabolized the blood will go to the inerfior vena cava and go to the right side of the heart
- Not used arterial/venous capilaries
- Not taking oxygen out of blood BUT the liver takes some oxygen from the bloood but MOST of teh oxygen will be taken in the systemic (joins the systemic circut in the inferior vena cava)
- Blood goes to diegstive system –> gets nutrients –> metabolizes the nuerteints using the protal curcits –> stored
Function - take the blood to be metabolized
- Uses Liver + Intestinal tract
What does the Portal system affects
Affects the dosage and way that you can take certain medications
Ibeprofin
Kindey = metabolized ibeprofin
Ibeprofin = foes to the systemic circut where it is able to work THEN –> goes to the kidneys –> kidney will filter the blood
Tylanon
Metabolized in the liver
Tylonal = absorbed through the digestive –> goe sinto the portal system –> takes the tylonal form the blood to the liver –> liver metabolizes the tylonal = tylonal s metabolized fatser because it is going straight to the liver
- To get dosage = need to see how much is metabolized by the liver (not all of it will be some will go to the body and work)
Nitroglycin
Certain drugs can’t be taken orally (Ex. Nitroglycin - used for heart issue; can jump start the heart)
Nitroglycin = If goes to protal system = fully metabolized by the liver = when it is taken orally it is fully netabolized
Soution = put a tablet under tongue = oes to blood trasnmucosuly –> eventually it will be metabolized b the liver BUT not during the first pass
Remdenovear
Antiviral medication - taken via ijections or IV (rarly but sometimes transmucosuly) –> can’t take it orally because the protal system would fully metabolize it
Space in the body
There is not a lot of space in the body
- There could be some space under the liver or gut BUT it is usually filled with fat or fluid
- Lungs around heart pretty tight
Where is the heart (genrally)
Heart is located between the lungs (In the midline)
- Apex = pointed part at the bottom (points to left)
- Apex = usually at level of xyphoid process
- Base = upper part (geeat vessels come and go form the base)
In center of lungs = have media stinem - sock of tugh tissue –> goes to the diaphram (CHECK THIS)
Heart = sits on diaphram
Diaphram
Musclular floor of thoraci cavity/ roof of abdominal cavity
As breath diaphram comes up and down - big part of breathing
Heart vs Sternum
Heart = lower part of he sternum
Above the heart = have the clavicles + great vessles
- Great vessles = right behind the sternum (at the base of top of heart)
Thoracis vs. Abdomincal cavity
Thoracis cavity = seperate from abdominal cavity
Peretinium = covering of abdonmial cavity
Abdomonal + thoraci cavites = surrounded by tissue
- Only connection ebtween the 2 cavities is the hiatus (asophogus goes to the sternum) ; only communication between the abdomen and thoracic cavities
Division of thoracis cavity
Divided into three parts:
1. Left lung
2. Right lung
3. Media stinum - suspended sock of issue in which heart is housed (not tightly fixed = heart can move)
Developing CPR
William Kowheven + Knickbocker + Jude developed CPR
They noticed when they were putting electrical leeds on test subjkects the blood pressure increased –> they wanted to replicate this
- When compress chest to put electrodes on = change volume = chnage pressure in chest –> means that when press on heart = compress heart = mimics pumping of blood = made CPR
Axial section
Blue circle = heart
Black line at top = Sterum
Top circle under heart = Asophygus
To right of asphogus = thoracis aorta –> arches to the left and goes behind the heart
How to do CPR
One person doing it - 15 compressions and 2 breaths
Two people doing it - 5 compressions and 1 breath
New guidlines = can do CPR without respitory –> because have enogh oxygen in blood to keep tissue viable BUT if doing CPR for longer time = need to strat doing respirations because oxygen is being used (after 21-25 minutes)
- BUT if dorwning/if doing CPR on child/if drug iverdose = need to always do respirations
Speed of compresions = “staying alive” beat
CPR story
Rini and dad were driving to clevland –> sw cars were pulled over –> they pulled over and saw there was a guy on the ground —> the guy had. aherat attck –> rini and dad started to do CPR (rini did chest and dad did respirations) –> highw ay potrol came + ambulence came –> guy survived
- Dad had a hankerchif and put on mouth of guy
Rini now carried around kit to do respirations (got from lifeguard son)
Right vs. left side of heart
Right side of heart - gets deoxygenated blood from body
Blood Circulation
Right side gets deoxygenated blood from body - suprioir vena cava takes the blood from the heads and the upper limbs ; Inferor vena cava takes the blood from the legs and the tourose + takes blood from the portak vein that has been metabolized
BOTH vena cavas dumps the blood into the the right atrium –> contraction of the upper peart of the heart pushes the blood into the right ventricle –> blood goes through the puminary trunk —> blood goes to the right and left pulminary artery –> blood goes to the lung
AFTER lungs (exchnage in aveoli) –> pulminary vein bring sblood into the heart –> blood goes to the left atrrium –> atrium fire –> blod goes to the left ventrcile –> left ventricle puts the blood to aorta –> blood goes to the body
Thickness of heart wals
Right atrium - thin
Right ventrcile - tocker than right atrrium
Left ventrcile - thickest wall –> because putting blod througha small vessle = need lots of power = need strong pump = thick walls in ventrcile
Artery vs. vein
based on flow from heart
- Arteries = blood away from heart (usually oxygenated)
- Veins = blood towards heart (blood returning to the heart)
Pulmary artery - artery even though dexygentaed
Aorta gives rise to
Vessles in aorta give rise to subclavical arteries + brachial arteries
Purpose of heart valves
Letting the blood through and making sure the blood does not regergitate (doesn’t flow back through)
When the heart relaxes after it pumps = create snegative ressure = could pull blood back BUT the valve stops this
Valves in the heart
Tricuspid (has 3 leaves) - between the Right atrium and Right ventricle
Biscupid (aka mitral valve) = between the Left Atrium and the Left ventricle
- Bishops wear and miter (looks like mitral valve)
Pulimary valcle = at the base of the pulminary trunk
- Weakest of the valves (because have less resistence in the lungs = blood is not trying to flow back = weakest)
Aortic valve (aka semilunar valvle) - Have lots of pressure going through the valve
Valve replament
Image - shows an early replacment
- Circle = Annulice = this annulice is sutured around the natural annulice in the valve –> when blood goes past the valve the ball hits the cage = the ball is against the cage if the blood tries to regergitate = blood cam’t regergitate
- Issue with eraly valves = very audible
Newer valves = like flaps – look like natural valve
Rini Uncle Story
Rinis uncle was a very eraly recepient of a pig heart valve –> lasted longer than expected
- He had to take antirejection meds for a while but he was weened off of them
Chordae tendinae
Stringy looking tissue that connect to the wall of the heart and valves (connectoin between pailary muscles and send cords to valves)
- Part of opening and closing affect on valves
Trabecular carnea
Muscular surface of the inside of the heart - part of wall of the heart
Papillary muscle
Pulls leaflets of the valcles to functions
TAVR
Transcathertirc aortic valvle replacment
Past - did an invasive surgery to replace the valavle (had to open the heart –> stop the heart –> go on bypass –> open aorta –> get out diseased vlave –> suture in new valve
Now - use TAVR - done thorugh catheter –> insert catheter in leg or subclavian into aorta –> inflate balooon to hold the artery open + in a second area use deploy new valve
- All through the vessles (not openning the heart)
- dont cut out old valave they just push it out
Aortic valve
Side veiw - has leaflets = like a sack
- Curve of leaflets goes with the flow of the blood
Image - looking down wiards heart in the leaflet - have 2 openings going to the corated artery
- Corany arteries are tucked low in the aorta (inside where the valve is) - come out of level of the valve
Pericordium
Covering of the heart
Fiberous peracardium –> Serious percardium –> Visceral peracardoium (epicardium) –> myocardium –> Endocradium
Fiberous peracardium
Top layer of the Peracardium (Layer around the heart)
Looks like Dura/Fassa
Makes up the ‘sock’ of the medial stinum
Not touching heart there is a space underneath it
Based on the diaphram
Connections betwene pareintal paracardium and the lining of the chest cavity (thoracic lining) –> come togetehr and forms the foberous peracardoim
Serious percardium
Second layer of teh Percardium
Secretes serious fluid = decreases friction around teh heart –> fluid + layers of seruous slide on surfaces vecause if space = less friction
Divides to Peracadrial Space + Pariteal Percardium + Vsiceral pericardium
Sereous percardium = turns on itself and joins
Heart exits the covering through the great vesslves
Covering ends supriory
Peracardium space
Filled with serous fluid - allows heart to beat and move in the media stiunum
Peracardits
Infection in space in serious peracrdium = get inflamatory response = increase white cell counts –> adds friction to beating of heart
Pariteal Percardium
Covering of the heart - Outter intermeidate wall
- Protexts the heart
Comes into contact with the fiberous percardoum
Joins with the toracic lining to form the fiberous paracerdium
Stops and turns on itself and get the coverings of the vessels (stops on area on great vessles where it reflexes on itself)
Visceral peracardoium (epicardium)
Outter wall of heart proper (right on the heart; surface of the heart)
Similar to the piamoter
can’t dissect away
Opens to the sereous space
Layers of the Visveral percardiums
Epicardum (outter) - becomes the lining of the inside of the vessels
Mycodcradium - musclarlar layer (heart muscle)
Endocardium - inner lining of the heart
Layers of the heart itself
Cardiac tempenad
After trauma = Percadiial space can fill with blood –> blood crowds the heart –> impedes on the hearts ability to expand and contract
Example - occurs after stab or gunshot or accdient or issue in surgery
Yellow lin next to SVC = frenic nerve –> goes to the diaphram = regulates breathing
- Comes from C2/C3 = high in neck
- Polio = affects the frenic nerves = kids used iron lungs
See recurent larengeal - goes under the aorta - goes to the larynx
See Ducto arelerosa
Bottom = diapgram
Legamentam arteriousum
Connection between arterial and venous blood in fetus
Closes within minutes of birth
Hole in septum
Septumus valley - mixed bloodin fetal circulartion –> if it doesn’t close = might need to do surgery to fix
Dr. Motts Story
Dr. Motts used to talk to med students and would tell a story that he had a pateints with ____ –> needed to close the hole = he needed t use fossa but he didn’t wnat to use something from the body
he was having dinner and saw the rubber things that they use to ppen lids –> he wanted to use that –> he autoclaved it and expreimented –> talked to a manufacter and made it to use
NOW this would take 5 years to do with the FDA but at the time it took weeks
Line a the base of heart = fiberous peracardeium
Sinual Atriual (SA) node
Uper medial surface of the Right atrium
Functon - pacemaker of the heart –> makes the aorta contract –> ushes blood through valves to the ventrciles
Nerve impulses goes down = delays then fires the AV node and disrubutes in the ventricle –> ventrciel contracts
- Pause when AV node and when ventrciles fire - as ventrcile pushes blood = gives the atria a chnace to fill with blood as SA node recharges
Controled by Parasympathetic
AV node
Futher down from the Right atrium
Blood supply to the heart itself
Blood is rushing through the heart but the heart doesn’t access that blood
Heart muscles and the covering of the heart are profused by vessles on the surface of the heart
- Profused by the right coranry oartery and the left coranary artery (both come from perferastions in the aortic valve)
Right coranry –> righy marginal –> right deceding
- Right cornary comes down and comes aorund from the back goes down to an appendage by the aorta
- Sends right marginal branch and then comes down to posterior decending
Left - perferations of the aorita –> left coranary –> cicumfelx branch of left cornary (goes to back of heart) –> left marginal –> left anterior interventricular branch (Left anterior decding) –> left
- Most common plae to have coranary artery bypass (worse one to have blocked vecayse feeds the left ventrcile)
Left circumfelx
Left circumfelx = comes off the LAD - feeds the back of the heart
KNOW major branches
Blocked vessles
To treat you have to bypass the blocked vessels (Ex. 80% block of LAD)
Can use the saphanoid vein –> suture the vein shut in leg –> bring to chest cavity –> suture vein from one side of bloackge to ther other –> shunts over the bloackage (leave the blockage)
- Use graft to jump it
- Use interval ___ artery and bring down distally to blockage
- Use angiogram to see blockage
NEW surgery = put catheter through groin –> put in heart –> put in vesslve –> deloy baloon with cage around it –> delfate the baloon –> leaves the cage –> cage pushes the spot open
Otto Foreman
German Physician
Put catheters into vessels –> his assstant Gerta sisun said she was willing to help him BUt she asked him to do it to her –> he set up and OR and draped her –> Gerta put her arm through –> he wanted to go to radiology to insert the cather and when he removed the drape she saw that he did it to himeself –> they went to radiology and got into his heart
His child = also smart – made lithotriosy (breaks up kideney stones)
Back of the heart
Back of the heart = has vessles that go to the corranry sinus
On the posterior side of the heart - dumping place for venous blood
venous colection from correted = collected in veins –> veins run along with the arteries colllect into posterior surface of the heart - go to corenary sinus
- Corenary sinus = made by the covering of the heart
- Corenaru sinus = dumps blood into the right atrium
Pictre of great vessels
BIG RED = arch of aorta vessel –> turns on itself
Brachiocephalic trunk
Gives rise to the right subclavian artery and the right common coratoid artery
Left common coratoid aterry
Comes right off the aorta (NOT througha brachiocepjalic trunk)
Artheriosceosis
Have plaques in vessel (can be in coranry or corated artery)
- Mostly in femeral and coroted ateriosis
Have a decrease in ability of vesslves
Can be a slow process and can intervene
If have a blood clot of a peice of plaque breaks off and lodeges elswhere= can have massive heart attck
Symptoms = can have dimmersia like chnage if the blood goes to the brain is slower or humbness in limbs
To test = take blood pressure on arm and on leg - if there is a big difference = know there is a bloackage
Coranary vs. Corrated
Coranry - based at base of aorta - go to heart (feed heart - artery of heart)
Coraots - somes off brachiospaharlic trunnk or off arch of aorta on left and go to head
What do veins in body have
Veins in body have vlaves to prevent backflow (only in beins because less pressure???)
- Blood has to be pushed back to the heart = prevents backflow
Where blood goes against gravity = need valves (legs) - have blood under lower pressure going back up and being osuhed weakly = need valves
Veracose veins
Valves in the veins brak down OR have a buildup of pressure
- Valves don’t work = enlarges veins
- Can Take vessles it because often have colateral circulation
Example - chronic drinkers - have vercosous because have serousous in liver = blocks the portal vein = increases venous pressure = gert vercoious in the nose or in asophogus r in abdome
Arterial venous fistula
Happens in people getting dualysis because you connect the artery and the veins = enlrages the vein
- Often can handle dialysis but things can go bad (ex if the vein is too enlarged)
Plaque buildup in neck
If have plaque build up in neck –> enzie the neck —> open coroted –> put bypas shunt to keep blood in brain –> scrape away the plaque
Pressure points
Stops bleeding
Can put pressure on femeral artery –> oushing restrcts the blood but not entriley (safer than a tarnaqute because the teornaqutes can cause cerosis) –> if pressure us effective to stop th ebleeding then it is safer
Overview of veins and arteries in body (general layout)
Heart —> Arch of aorta –> right have brachosophalic trunk and right common corated and then furtehr divides
have subclavina and axiallary going to the radial on right
Left = same as right but common correted comes wight of the aorata and subclavial comes of seperated
Arch of aorta - goe sbehind the heart and goes down to throarci ad then adbmon arota then branch to cmoon inliac then the femeral and supply the leg
Veins go up - femeral veins runs right next to femeral nerve –> come together
- Internal Illaics come together to form infriror vena cava - dupts to right atrium
Right - Sbclavians come in and dump to sueprior vena cava to irght atriums
Mammory vessels
Used for bypass surgery
