CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM

ACHMAD AMINUDDINACHMAD AMINUDDIN

PERICARDIUMPERICARDIUM

• FIBROUS PERICARDIUM.FIBROUS PERICARDIUM.

• SEROUS PERICARDSEROUS PERICARD– PARIETAL LAYER lines fibrous PARIETAL LAYER lines fibrous

pericardium.pericardium.– VISCERAL LAYER become outermost VISCERAL LAYER become outermost

layer of wall of heart – the epicardium.layer of wall of heart – the epicardium.

• PERICARDIAL CAVITY.PERICARDIAL CAVITY.

HEARTHEART

• WALL OF THE HEARTWALL OF THE HEART– EPICARDIUM.EPICARDIUM.– MYOCARDIUM.MYOCARDIUM.– ENDOCARDIUM.ENDOCARDIUM.

• FOUR CHAMBERFOUR CHAMBER– ATRIA - receiving chamber.ATRIA - receiving chamber.

• Right.Right.• Left.Left.

– VENTRICLES - discharging chamber.VENTRICLES - discharging chamber.• Right.Right.• Left.Left.

THE FIBROUS SKELETON OF THE FIBROUS SKELETON OF THE HEARTTHE HEART

• KEEP THE ORIFICES OF THE A.V AND KEEP THE ORIFICES OF THE A.V AND SEMILUNAR VALVES PATENT.SEMILUNAR VALVES PATENT.

• PROVIDES ATTACHMENTS FOR THE PROVIDES ATTACHMENTS FOR THE LEAFLETS AND CUSPS OF THE LEAFLETS AND CUSPS OF THE VALVES.VALVES.

• PROVIDES ATTACHMENTS FOR THE PROVIDES ATTACHMENTS FOR THE MYOCARDIUM.MYOCARDIUM.

• FORM AN ELECTRICAL INSULATOR.FORM AN ELECTRICAL INSULATOR.

THE APEX OF THE HEART

• Isformed by the inferolateral part of the left ventricle.

• Lie posterior to the 5th intercostal space in adults, usually approximately 9 cm from the median plane.

• Remains motionless throughout the cardiac cycle.

• Is where the sounds of mitral valve closure are maximal ( apex beat )

THE BASE OF THE HEART

• Is the heart ‘ s posterior aspect.• Is formed mainly by the left atrium, with

a lesser contribution by the right atrium.•Faces posteriorly toward the bodies of

vertebrae T6 – T9 and is separated from them by the percardium, oblique pericardial sinus, esiphagus and aorta.

•Extend superiorly

THE BASE OF THE HEART

•Extends superiorly to the bifurcation of the pulmonary trunk and inferiorly tothe coronary groove.

•Receives the pulmary veins on the right and left sides of its left atrial portion and the superior and inferior venae cavae at the superiror and inferior ends of its right atrial portion.

THE FOUR SURFACES OF THE HEART

• ANTERIOR ( STERNOCOSTAL ) SURFACE - formed mainly by the right ventricle.• DIAPHRAGMATIC ( INFERIOR ) SURFACE - formed mainly by the left ventricle and partly by the right ventricle.• RIGHT PULMONARY SURFACE - formed mainly by the right atrium.• LEFT PULMONARY SURFACE - formed mainly by the left ventricle.

THE FOUR BORDERS OF THE HEART

• RIGHT BORDER - the right atrium and extending between the SVC and the IVC• INFERIOR BORDER - mainly by the right ventricle and slightly by the left ventricle.• LEFT BORDER - mainly by the left ventricle and slightly by the left auricle.• SUPERIOR BORDER - formed by the right and left atria and auricles

RIGHT ATRIUMRIGHT ATRIUM

• FORM THE RIGHT BORDER.FORM THE RIGHT BORDER.• RIGHT AURICLERIGHT AURICLE• THE INTERIOR OF THE R. ATHE INTERIOR OF THE R. A

– SINUS VENARUM.SINUS VENARUM.– PECTINATE MUSCLES.PECTINATE MUSCLES.– OPENING OF OPENING OF

• S.V.C. I.V.C.S.V.C. I.V.C.• CORONARY SINUS.CORONARY SINUS.

– RIGHT A.V ORIFICE.RIGHT A.V ORIFICE.– FOSSA OVALIS.FOSSA OVALIS.

RIGHT VENTRICLERIGHT VENTRICLE

• FORM THE LARGEST PART OF THE ANTERIOR FORM THE LARGEST PART OF THE ANTERIOR SURFACE.SURFACE.

• CONUS ARTERIOSUS – PULMONARY TRUNK.CONUS ARTERIOSUS – PULMONARY TRUNK.• TRABECULAE CARNEAE.TRABECULAE CARNEAE.• SUPRAVENTRICULAR CREST.SUPRAVENTRICULAR CREST.• RIGHT A.V. ORIFICE.RIGHT A.V. ORIFICE.• TRICUSPID VALVETRICUSPID VALVE• INTER VENTRICULAR SEPTUMINTER VENTRICULAR SEPTUM

– MEMBRANOUS PART.MEMBRANOUS PART.– MUSCULAR PART.MUSCULAR PART.

• SEPTO MARGINAL TRABECULASEPTO MARGINAL TRABECULA– CARRIES PART OF THE RIGHT A.V. BUNDLE.CARRIES PART OF THE RIGHT A.V. BUNDLE.

THE PULMONARY VALVETHE PULMONARY VALVE

• AT THE APEX OF THE CONUS AT THE APEX OF THE CONUS ARTERIOSUS.ARTERIOSUS.

• AT THE LEVEL OF THE LEFT 3AT THE LEVEL OF THE LEFT 3rdrd COSTAL COSTAL CARTILAGE.CARTILAGE.

• THREE VALVESTHREE VALVES– ANTERIOR.ANTERIOR.– RIGHT.RIGHT.– LEFT.LEFT.

• PULMONARY SINUS.PULMONARY SINUS.

LEFT ATRIUMLEFT ATRIUM

• FORM MOST OF THE BASE OF THE HEART.FORM MOST OF THE BASE OF THE HEART.• LEFT AURICLELEFT AURICLE

– FORM THE SUPERIOR PART OF THE LEFT FORM THE SUPERIOR PART OF THE LEFT BORDER OF THE HEART.BORDER OF THE HEART.

– ITS WALL TRABECULATED WITH PECTINATE ITS WALL TRABECULATED WITH PECTINATE • INTERIORINTERIOR

– PECTINATE M.PECTINATE M.– PULMONARY VEINS.PULMONARY VEINS.– INTER ATRIAL SEPTUM.INTER ATRIAL SEPTUM.– LEFT A.V. ORIFICE.LEFT A.V. ORIFICE.

LEVT VENTRICLELEVT VENTRICLE

• FORM THE APEX OF THE HEART.FORM THE APEX OF THE HEART.• INTERIRINTERIR• ITS WALLS THAT ARE TWO TO THREE ITS WALLS THAT ARE TWO TO THREE

TIMES AS THICK AS THAT OTHE R.V.TIMES AS THICK AS THAT OTHE R.V.• TRABECULAE CARNEAE.TRABECULAE CARNEAE.• PAPILLARY MPAPILLARY M

– ANTERIOR – POSTERIOR.ANTERIOR – POSTERIOR.• AORTIC VESTIBULUM –AORTIC ORIFICE.AORTIC VESTIBULUM –AORTIC ORIFICE.• CUSPS OF THE AORTIC VALVECUSPS OF THE AORTIC VALVE

– RIGHT – POSTERIOR – LEFT.RIGHT – POSTERIOR – LEFT.

MITRAL VALVEMITRAL VALVE

• HAS TWO CUSPSHAS TWO CUSPS– ANTERIOR – POSTERIOR.ANTERIOR – POSTERIOR.– TENDINOUS CORD –PAPILLARY M.TENDINOUS CORD –PAPILLARY M.

• LOCATED POSTERIOR TO THE LOCATED POSTERIOR TO THE STERNIM AT HE LEVEL OF THE 4 th STERNIM AT HE LEVEL OF THE 4 th COSTAL CARTILAGE.COSTAL CARTILAGE.

THE AORTIC ORIFICETHE AORTIC ORIFICE

• AORTIC VALVE AORTIC VALVE – OBLIQUALLY PLACED, IS LOCATED OBLIQUALLY PLACED, IS LOCATED

POSTERIOR TO THE LEFT SIDE OF POSTERIOR TO THE LEFT SIDE OF THE STERNUM AT THE LEVEL OF THE THE STERNUM AT THE LEVEL OF THE 33rdrd intercostal space. intercostal space.

• AORTIC SINUSAORTIC SINUS

AORTIC SINUSAORTIC SINUS

• RIGHT AORTIC SINUS.RIGHT AORTIC SINUS.– THE MOUTH OF THE RIGHT THE MOUTH OF THE RIGHT

CORONARY A.CORONARY A.

• POSTERIOR AORTIC SINUSPOSTERIOR AORTIC SINUS

• LEFT AORTIC SINUSLEFT AORTIC SINUS– THE MOUTH OF THE LEFT CORONARY THE MOUTH OF THE LEFT CORONARY

A.A.

VASCULATURE OF THE VASCULATURE OF THE HEARTHEART

• CORONARY ACORONARY A– RIGHT CORONARY A.RIGHT CORONARY A.– LEFT CORONARY A.LEFT CORONARY A.

• CARDIAC VCARDIAC V– Draining into the CORONARY SINUS.Draining into the CORONARY SINUS.

RIGHT CORONARY A.RIGHT CORONARY A.

• ARISE FROM THE RIGHT AORTIC ARISE FROM THE RIGHT AORTIC SINUS.SINUS.

• ITS BRANCHESITS BRANCHES– SINUATRIAL NODAL BRANCH.SINUATRIAL NODAL BRANCH.– RIGHT MARGINAL BRANCH.RIGHT MARGINAL BRANCH.– ATRIOVENTRICULAR NODAL BRANCH.ATRIOVENTRICULAR NODAL BRANCH.– POSTERIOR INTERVENTRICULAR POSTERIOR INTERVENTRICULAR

BRANCH.BRANCH.

TYPICALLY THE R.C.A. TYPICALLY THE R.C.A. SUPPLIESSUPPLIES

• THE RIGHT ATRIUM.THE RIGHT ATRIUM.

• MOST OF RIGHT VENTRICLE.MOST OF RIGHT VENTRICLE.

• PART OF THE LEFT VENTRICLE PART OF THE LEFT VENTRICLE ( diaphrag matic surface ).( diaphrag matic surface ).

• PART OF THE I.V. SEPTUM (posterior 3 PART OF THE I.V. SEPTUM (posterior 3 rdrd

• THE S.A. NODE ( 60 0/0 OF PEOPLE ).THE S.A. NODE ( 60 0/0 OF PEOPLE ).

• THE A.V. NODE ( 80 0/0 OF PEOPLE ).THE A.V. NODE ( 80 0/0 OF PEOPLE ).

THE LEFT CORONARY THE LEFT CORONARY ARTERYARTERY

• ARISES FROM THE LEFT AORTIC ARISES FROM THE LEFT AORTIC SINUS.SINUS.

• BRANCHESBRANCHES– ANTERIOR INTERVENTRICULAR ANTERIOR INTERVENTRICULAR

BRANCHBRANCH•LATERAL BRANCH.LATERAL BRANCH.

– CICUMFLEX BRANCHCICUMFLEX BRANCH•LEFT MARGINAL ARTERY.LEFT MARGINAL ARTERY.

TYPICALLY THE L.C.A. SUPPLIESTYPICALLY THE L.C.A. SUPPLIES

• THE LEFT ATRIUM.THE LEFT ATRIUM.

• MOST OF THE LEFT VENTRICLE.MOST OF THE LEFT VENTRICLE.

• PART OF THE RIGHT VENTRICLE.PART OF THE RIGHT VENTRICLE.

• MOST OF THE I.V.S. ( ANTERIR MOST OF THE I.V.S. ( ANTERIR 2/3 ), THE A.V. BUNDLE.2/3 ), THE A.V. BUNDLE.

• THE S.A. NODE ( 40 0/0 )THE S.A. NODE ( 40 0/0 )

MYOCARDIAL INFARCTION

• The three most common site of coronary artery occlusion

* Anterior IV ( LAD ) branch of the LCA ( 40 – 50 % ) * RCA ( 30 – 40 % ). * Circumflex branch of the LCA ( 15 – 20

% )

VENOUS DRAINAGE OF THE VENOUS DRAINAGE OF THE HEARTHEART

• BY VEINS THAT EMPTY INTO BY VEINS THAT EMPTY INTO – CORONARY SINUS, receives blood fromCORONARY SINUS, receives blood from

• GREAT CARDIAC V.GREAT CARDIAC V.

• LEFT POSTERIOR VENTRICULAR V.LEFT POSTERIOR VENTRICULAR V.

• LEFT MARGINAL V.LEFT MARGINAL V.

• MIDDLE CARDIAC V ( POSTERIOR I.V. VEIN ).MIDDLE CARDIAC V ( POSTERIOR I.V. VEIN ).

• SMALL CARDIAC V.SMALL CARDIAC V.

• OBLIQUE VEIN OF LEFT ATRIUM.OBLIQUE VEIN OF LEFT ATRIUM.

– ANTERIOR CARDIAC VANTERIOR CARDIAC V– SMALLEST CARDIAC VSMALLEST CARDIAC V

CONDUCTING SYSTEM OF CONDUCTING SYSTEM OF THE HEARTTHE HEART

• THE SINUATRIAL ( S. A ) NODE.THE SINUATRIAL ( S. A ) NODE.

• THE ATRIOVENTRICULAR ( A.V.) THE ATRIOVENTRICULAR ( A.V.) NODE.NODE.

• THE A.V. BUNDLE.THE A.V. BUNDLE.

• SUBENDOCARDIAL BRANCHES.SUBENDOCARDIAL BRANCHES.

THE SINUATRIAL NODETHE SINUATRIAL NODE

• LOCATED ANTEROLATERALLY JUST DEEP TO LOCATED ANTEROLATERALLY JUST DEEP TO THE EPICARDIUM AT THE JUNCTION OF THE THE EPICARDIUM AT THE JUNCTION OF THE S.V.C.AND RIGHT ATRIUM, NEAR THE SUPERIOR S.V.C.AND RIGHT ATRIUM, NEAR THE SUPERIOR END OF THE SULCUS TER MINALIS.END OF THE SULCUS TER MINALIS.

• A SMALL COLLECTION OF NODAL TISSUEA SMALL COLLECTION OF NODAL TISSUE• THE PACEMAKER OF THE HEART.THE PACEMAKER OF THE HEART.• REGULATED THE IMPULSES FOR CONTRACTION REGULATED THE IMPULSES FOR CONTRACTION

APPROXIMATELY 70 TIMES PER MINUTE.APPROXIMATELY 70 TIMES PER MINUTE.• SUPPLIED BY SINUATRIAL NODE ARTERYSUPPLIED BY SINUATRIAL NODE ARTERY

– R.C.A. ( 60 0/0 ).R.C.A. ( 60 0/0 ).– L.C.A. ( 40 0/0 ).L.C.A. ( 40 0/0 ).

• STIMULATED BY THE AUTONOMIC NERVOUS STIMULATED BY THE AUTONOMIC NERVOUS SYSTEM.SYSTEM.

THE ATRIOVENTRICULAR THE ATRIOVENTRICULAR NODENODE

• SMALLER COLLECTION OF NODAL SMALLER COLLECTION OF NODAL TISSUETISSUE

• LOCATED IN THE POSTEROINFERIOR LOCATED IN THE POSTEROINFERIOR REGIO OF THE INTERATRIAL SEPTUM REGIO OF THE INTERATRIAL SEPTUM NEAR THE OPENING OF THE NEAR THE OPENING OF THE CORONARY SINUS.CORONARY SINUS.

• STIMULATED BY THE AUTONOMIC STIMULATED BY THE AUTONOMIC NERVOUS SYSTEM.NERVOUS SYSTEM.

THE ATRIOVENTRICULAR THE ATRIOVENTRICULAR BUNDLEBUNDLE

• PASSES FROM THE A.V. NODE THROUGH PASSES FROM THE A.V. NODE THROUGH THE INSULATING FIBROUS SKELETON OF THE INSULATING FIBROUS SKELETON OF THE HEART.THE HEART.

• DIVIDES INTO RIGHT AND LEFT BUNDLES DIVIDES INTO RIGHT AND LEFT BUNDLES AT THE JUNCTION OF THE MEMBRANOUS AT THE JUNCTION OF THE MEMBRANOUS AND MUSCULAR PART OF THE SEPTUM.AND MUSCULAR PART OF THE SEPTUM.

• SUBENDOCARDIAL BRANCHES ( PURKINJE SUBENDOCARDIAL BRANCHES ( PURKINJE FIBERS ).FIBERS ).

INNERVATION OF THE INNERVATION OF THE HEARTHEART

INNERVATION OF THE INNERVATION OF THE HEARTHEART

• CARDIAC PLEXUS.CARDIAC PLEXUS.– LIESLIES

•ANTERIOR TO BIFURCATION OF THE ANTERIOR TO BIFURCATION OF THE TRACHEA.TRACHEA.

•POSTERIOR TO THE ASCENDING AORTA.POSTERIOR TO THE ASCENDING AORTA.•SUPERIOR TO THE BIFURCATION OF THE SUPERIOR TO THE BIFURCATION OF THE

PULMONARY TRUNK.PULMONARY TRUNK.

– AUTONOMIC NERVOUS SYSTEMAUTONOMIC NERVOUS SYSTEM•SYMPATHETIC SYMPATHETIC •PARASYMPATHETICPARASYMPATHETIC

THE SYMPATETHIC SUPPLYTHE SYMPATETHIC SUPPLY

• PRESYNAPTICPRESYNAPTIC– CELL BODIES ARE LOCATED IN THE LATERAL HORN OF CELL BODIES ARE LOCATED IN THE LATERAL HORN OF

THE SUPERIOR 5 OR 6 THORACIC SEGMEN OF THE SPINAL THE SUPERIOR 5 OR 6 THORACIC SEGMEN OF THE SPINAL CORD.CORD.

• POSTSYNAPTICPOSTSYNAPTIC– CELL BODIES ARE LOCATED IN THE CERVI-CAL AND CELL BODIES ARE LOCATED IN THE CERVI-CAL AND

SUPERIOR THORACIC PARAVERTE-BRAL GANGLIA OF THE SUPERIOR THORACIC PARAVERTE-BRAL GANGLIA OF THE SYMPATHETIC TRUNK.SYMPATHETIC TRUNK.

• SYMPATHETIC STIMULATIONSYMPATHETIC STIMULATION– INCREASE HESRT RATE.INCREASE HESRT RATE.– INCREASE IMPULSE CONDUCTION.INCREASE IMPULSE CONDUCTION.– INCREASE FORCE OF CONTRACTION.INCREASE FORCE OF CONTRACTION.– INCREASE BLOOD FLOW ( B2 RECEPTOR ).INCREASE BLOOD FLOW ( B2 RECEPTOR ).

THE PARASYMPATHETIC THE PARASYMPATHETIC SUPPLYSUPPLY

• PRESYNAPTIC FIBERSPRESYNAPTIC FIBERS– FROM THE VAGUS N.FROM THE VAGUS N.

• POSTSYNAPTIC CELLS BODIESPOSTSYNAPTIC CELLS BODIES– LOCATED IN THE ATRIAL WALL AND INTER ATRIAL SEPTUM LOCATED IN THE ATRIAL WALL AND INTER ATRIAL SEPTUM

NEAR THE S.A. AND A.V. NODES AND ALONG THE CORONARY NEAR THE S.A. AND A.V. NODES AND ALONG THE CORONARY ARTERIES.ARTERIES.

• POSTSYNAPTIC PARASYMPATHETIC FIBERSPOSTSYNAPTIC PARASYMPATHETIC FIBERS– RELEASE ACETYLCHOLINE, WICH BINDS WITH MUSCARINIC RELEASE ACETYLCHOLINE, WICH BINDS WITH MUSCARINIC

RECEPTOR.RECEPTOR.• STIMULATIONSTIMULATION

– SLOW THE HEART RATE.SLOW THE HEART RATE.– REDUCE THE FORCE OF THE CONTRACTION.REDUCE THE FORCE OF THE CONTRACTION.– CONSTRICS THE CORONARY A.CONSTRICS THE CORONARY A.– SAVING ENERGY BETWEEN PERIODS OF INCREASED DEMAND.SAVING ENERGY BETWEEN PERIODS OF INCREASED DEMAND.

SURFACE ANATOMY OF THE SURFACE ANATOMY OF THE HEARTHEART