Lecture 7 - Heart Flashcards
Where does the heart sit in the body?
Chest NOT directly on the midline slightly rotated most obvious part=ventricles Heart of Males and Immature Females is at Nipple level
Base=area where heart is attached to the rest of the body=”anchoring point”=where vessels enter/exit
Apex=pointy part of LV
=point INferiorly(down), ANTeriorly(forward), to the LEFT
2/3 of mass lies to the LEFT of the midline, slightly Rotated
1/3 of mass lies to right of midline
How is the heart orientated relative to the midline?
2/3 of the heart is on the LEFT of the midline (sqewd to the left), and is SLIGHTLY ROTATED
1/3 of the heart is on the right if the midline
How is the heart protected?
most of the heart is protected by the Sternum
the Left Ventricle (LV) ISNT protected by the sternum
What are the borders of the heart?
RIGHT border is formed mainly by the R.Atrium
INFERIOR border is formed mainly by the R.Ventricle
LEFT border is formed mainly by the L.Ventricle
What is the Base and Apex of the heart?
Base=TOP=area where the heart is attached to the rest of the body
=attachment/entry and exit point
=ANCHORING point
Apex=BOTTOM
Heart sits free to move/unattached other than at the base
Why are the borders of the heart important?
Cadaver= brown skin with not alot of colour
Chest X-rays
when the shape changes, you can see what part of the heart is causing the problem
What is the Diaphragm?
Boundary between the Abdomen and Thorax
What is Cardiohypertrophy?
Enlarged
Boot shaped heart
(bulging out LV
Deformed RA)
x-ray shows Cardio-throacic ratio is LArger than normal (greater than 50% of rib-to-rib line)
aortic stenosis (narrowing due to rheumatic fever) causes cardiohypertrophy= LV becomes even thicker and ore muscular to compensate the decreased integrity of the valve opening (due to lumpy/vegetation/scar tissue formation) =pressure
LV wall significantly thicker but LUMEN TINY
=less space to fill
heart struggles to INFLATE=doesn’t pump as well
Decrease in Flexibility (LOSS of COMPLIANCE)=harder to fill
cardiac OUTPUT DROPS=(GREATER AFTERLOAD)
So large that they OUTSTRIP ability to SUPPLY OXYGEN to all the LV muscle cells= fail
What do Radiographers look out for?
Cardiac Thoracic ratio
Line from Rib to Rib
Heart should be LESS than 50% between the two lines
too big=heart occupies and area greater than 50% of the Rib-to-Rib line
What is composed of alot of collagen?
Valve leaflets
the mass of collagen in Valve Leaflets contributes to them being Tough but Flexible
What is Aortic Stenosis?
Narrowing
Stiffer Outlet
often due to Rheumatic Fever=STREPTOCOCCUS infection
body produces antibodies(immune system) which attacks your own bodily CT tissue (endocardium,myocardium and pericardium)
tends to attack collagen heavy tissues especially=valve leaflets (e.g aortic valve)
Able to Rebuild, but doesn’t rebuild as well=
scar tissue + vegetation + lumps on valve flaps form
= different efficiency in function
=RUINS INTEGRITY of the valve flaps
Narrower and Stiffer outlet RESTRICTS blood flow, as the L.V. has to Squeeze/WORK HARDER and become MORE MUSCULAR, undergoing hypertrophy to compensate and get the blood UP through the NARROW HOLE
(muscle which works harder builds muscle)
LV wall significantly thicker but LUMEN TINY
=less space to fill
heart struggles to INFLATE=doesn’t pump as well
Decrease in Flexibility (LOSS of COMPLIANCE)=harder to fill
cardiac OUTPUT DROPS=(GREATER AFTERLOAD)
So large that they OUTSTRIP ability to SUPPLY OXYGEN to all the LV muscle cells= fail
What is the Pericardium?
the Bag the Heart sits in
what you see when the rib cage is first opened
“a continuous layer of PARIETAL and VISCERAL Pericardium which SURROUNDS and PROTECTS the heart”
most of the Pericardium is serous membrane/mesothelial cells
How fast does your heart beat?
50-80 times per minute
dependant on health status
What are the surrounding structures of the heart?
Lungs either side
infront = Sternum
behind= Boney rod= Vertebral Column
Heart and lungs both move upon breath
Heart will rub up against its neighbours
What is the universal method that the body uses to deal with friction?
2x Serous membranes with serous liquid between them
Thin, Transparent, really slippery when wet
What is a serous membrane?
Thin= simple=single layer flattened cells (squamos) attached to each other forms a continuous sheet secretes serous fluid "Mesothelial cells"
MESOthelial cells are similar to epithelial cells but are found INSIDE your body
ORGANS which are INSIDE your body (not gut lining as that is Epithelial cells) typically have mesothelium/serous membrane around them
= great at reducing friction
What is the Visceral Pericardium?
the VISCERAL pericardium is the INNER walls of the serous membrane of the heart (pericardium) which ADHERES to the heart’s outer surface (EPIcardium)
“viscera”=organ=”belongs to the organ”
What is the name of the heart’s Outer surface?
EPIcardium
What is the Parietal Pericardium?
the PARIETAL pericardium is (away from organ) the OUTER wall of the heart’s serous membrane (pericardium) which LINES a TOUGH FIBROUS SAC called the FIBROUS PERICARDIUM -DENSE IRregular
What is the Fibrous Pericardium?
the TOUGH fibrous SAC (on the outside of the heart)
LINED with PARIETAL Pericardium
“outer layer of collagenous tissue”
more of a PROTECTIVE layer, rather than a lubricating layer
FIBRES/COLLAGEN can RESIST TENSION
DENSE IRRegular CT
What is the Pericardial Space?
capillary thin space
contains serous fluid
“pericardinal space is a very thin film of fluid”
=contains only fluid, not the heart=IMPORTANT
REDUCES friction
acts as a LUBRICANT to PREVENT HEAT from rubbing against the THORACIC CAVITY with friction, as the heart beats
surrounded by the inner and outer wall of the Pericardium/Serous membranes, which is comprised by a singe layer of squamous mesothelial cells which SECRETE serous fluid
What is inside the Peritoneal cavity?
*Exam question
fluid
no organs inside the peritoneal cavity
What is the distribution in the heart wall?
composed of 3x layers “fist against water filled balloon”
Thin Inner layer=Lumen=ENDOcardium
Thick Middle layer =MYOcardium(muscle)
Very Thin Outer layer =EPIcardium (epi=outside)=Visceral pericardium
What types of layers are there in the heart?
PROTECTIVE layer and LUBRICATING layer(s)
PROTECTIVE layer=FIBROUS pericardial sac
LUBRICATING layer(s)=Visceral and Parietal Pericardium(s)
What is the Fibrous Skeleton of the Heart?
DENSE CT rings Coarse fibres
purpose:
1. STRENGTHEN HOLES/valves (inlet/outlets)
2. ELECTRICAL INSULATOR b/w atria/ventricles (nerve impulses cannot pass through)
3. PREVENT OVER-STRETCHING of valves
inlet/outlet valves form a continuous line/plateau across the heart
openings=weakened area =
b/w Thin-walled Atria and Thick-walled Ventricle
Want to be strong as valve leaflets are attached to here
Stops the distortion of valve leaflets, which otherwise would compromise valve
Mitral Inlet and Aortic Outlet valves are HIGH PRESSURE valves and have FULL SKELETAL RINGS to Prevent Stretching
TRIcuspid Inlet has a PARTIAL ring and the PULMONARY valve has NO ring.
instead the Tricuspid and Pulmonary valves have LOOSE Fibres and FATTY tissue (not a true fibrous ring)
What is Cardiac Tamponade?
During a MYOCARDIAL INFARCTION “dying of the muscles of the heart” (heart attack) part of your heart muscle dies
(tissue INFARKTs) (not enough blood supply/oxygen)
Infections causes puss and fluid to enter the Pericardium = PERICARDITIS = inflammation
Although macrophages clean up dead tissue and our line area becomes replaced with scar tissue, which makes it THIN and WEAKER
the High PRESSURE of LEFT.V, blood can move out through weakened area and blood moves into the Pericardial Space as L.V. RUPTURES
Every time the LV contracts, blood squirts into the Pericardial Space (affecting the hearts ability to fill every beat)
FIBROUS Pericardium is quite RIGID, so instead of the bag (pericardium) EXPANDING (due to the COLLAGEN which RESISTS TENSION), the heart will be SQUEEZED SMALLER and smaller, due to the ACCUMULATION of blood in the pericardial space
Causes:
- COMPRESSING of the heart
- Ventricular FILLING DECREASED
- CARDIAC OUTPUT Decreased
- VENOUS RETURN to heart Diminishes
- Blood PRESSURE FALLS
- BREATHING Difficulty
What is a heart attack called?
Myocardial Infarction
“dying of the muscle of the heart”
What does infarkt mean?
tissue dying
What is an infection of the heart called?
Puss and fluid enter the Pericardial Space
Pericarditis
“inflammation of the heart”
What is the Conduction System of the heart?
The method by which the HEART BEATS are INITIATED and
he method by which the heart is ELECTRICALLY STIMULATED
No in-built nerves within its muscle fibres
ONLY INFLUENCED by nerves
Instead has highly modified cardiac muscle fibres
What is special about cardiac muscle fibres?
designed to conduct nerve impulses
AUTO-rhythmic fibres
SELF-Excitable = can repeatedly Generate ACTION POTENTIALS triggering heart contraction
allows for a WAVE of EXCITATION
-but still Weakly Contractile UNLIKE nerve fibres
What is the function of a Pacemaker?
sets the RHYTHM of electrical excitation –> contraction
in the SinoAtrial Node (SA)
What is the function of the Cardiac Conduction System?
Cardiac Conduction System is a network of Specialised cardiac muscle fibres that PROVIDE PATH for each cycle of Cardiac Excitation to pass through the heart
What are the differences between Myocytes and Purkinje Cells?
Myocytes in the Atria
Purkinje Cells in the Ventricles
Purkinje cells are LARGER and WIDER than cardiac myocytes
(Larger=good WIRING for the heart)
Purkinje cells DONT BRANCH and DONT CONDUCT action potentials well
Purkinje cells are WEAKLY CONTRACTILE
are the “WIRING of the heart”
What is the overall pathway in the conduction system?
- SA node/Atrial Muscle
- AV Node
- AV bundle/Purkinje cells
What is the overall transitions in speed of conduction during the conduction pathway? What does each step result in?
1. slow=0.5m/s Atrial contraction (Uniformly)
- very slow=0.05m/s
100m/s delay
Smaller Diameter between junctions - fast=5m/s
Even, Rapid Ventricular Contraction = SYSTOLE