Dr. I Gusti Ayu Widianti, M.Biomed

ANATOMY DEPARTMENTUDAYANA UNIVERSITY

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Cardiovascular system

Circulatory System

The heart (cor) System of blood vessel System of lymphatics

Heart disease Malignant neoplasms Cerebrovascular diseases, Chronic obstructive pulmonary

disease Pneumonia and influenza Accidents Diabetes mellitus Suicide, nephritis, chronic liver

disease, etc etc

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National Health Statistics, 1999

The heart: Coronary artery disease → ischemic heart disease → myocardial infarction The blood vessels: → atherosclerosis → hypertension varicose vein

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The general design

Two major components: The heart and system of blood vessels

Major functions: Transport of oxygen and nutrients Transport of CO2 and waste products

Two major divisions Major or systemic circulation Lesser or pulmonary circulation

Oxygenated blood (O2 & nutrients)

Deoxygenated blood (CO2 & waste products)

Systemic circulation

Pulmonary circulation

Oxygenated blood Deoxygenated blood

RV LA

RA LV

RA=right atrium, LA=left atrium, RV=right ventricle, LV=left ventricle

Lungs

Heart

Whole body

Heart

Veins Arteries

Venules Arterioles

Capillaries

Circulation

Venules=very small veins; arterioles=very small arteries

Aorta Vena cava

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OVERVIEW OF THE CARDIOVASCULAR SYSTEM

The Heart

A four-chamber, powerful, muscular pump Divided into two halves: left heart & right

heart.

Left heart: left atrium & left ventricle Receives oxygenated blood (“arterial blood“)

from the lungs Distributes it to the whole body.

Right heart: right atrium & right ventricle Receives deoxygenated blood (“venous

blood”) from the whole body, sends it to the lungs.

The walls of the left ventricle is the thickest.

Is the central compartment of the thoracic cavity

It does not contain the lungs Extends :

› from the superior thoracic aperture to the diaphragm inferiorly

› From the sternum and costal cartilages anteriorly to the bodies of the thoracic vertebrae posteriorly

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MEDIASTINUM:MEDIASTINUM:1. The superior mediastinum : extends

inferiorly from the superior thoracic aperture to the horizontal plane (transverse thoracic plane), contains:◦ Superior venae cava◦ Brachiocephalic veins◦ Arc of aorta◦ Thoracic duct◦ Trachea◦ Esophagus◦ Thymus◦ Vagus nerve◦ Left recurrent laryngeal nerve◦ Phrenic nerve

2. The inferior mediastinum2. The inferior mediastinum: : between the transverse thoracic plane between the transverse thoracic plane and the diaphragmand the diaphragm

The anterior mediastinum contains: remnants of the thymus, lymph nodes, fat and connective tissue

The middle mediastinum contains: the pericardium, heart, roots of the great vessels, arch of azygos vein and main bronchi

The posterior mediastinum contains the esophagus, thoracic aorta, azygos and hemiazygos veins, thoracic duct, vagus nerve, sympathetic trunks and splanchnic nerves

MIDDLE MEDIASTINUMMIDDLE MEDIASTINUMBoundaries: left and right pleural cavities, diaphragm, anterior and posterior leaves of fibrous

pericardium, and superior aspect of the left and right

pulmonary arteries

Contents: Heart and pericardium Roots of the great vessels Arch of azygos vein Main bronchi

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HEART

The wall consist of three layers: Epicardium: a thin external layer

(mesothelium) formed by the visceral layer of serous pericardium

Myocardium : a thick middle layer composed of cardiac muscle

Endocardium: a thin internal layer (endothelium and subendothelial connective tissue) or lining membrane of the heart that also covers its valves

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PERICARDIUM

Double-walled fibroserous sac, encloses the heart and the roots of its great vessels

Pericardial cavity:

The potential space between the opposing layers of the parietal and visceral of serous pericardium. It normally contains a thin film of serous fluid that enables the heart to move and beat in a frictionless environment

Transverse pericardial sinus : Posterior aorta & pulmonary trunk Anterior SVC

Oblique pericardial sinus SCV, IVC and pulmonary veins

EXTERNAL HEART STRUCTURE Boundaries: Apex of the heart apex beat Base of the heart----the heart’s posterior

aspect Four surfaces of the heart Four borders of the heart

Apex of the heart:

Is formed by the left inferolateral part of the left ventricle

Is located posterior to the left 5th intercostal space in adults, usually 9 cm from the median plane

Is where maximal pulsation of the heart (apex beat).

Base of the heart:

Is the heart’s posterior aspect (opposite the apex) as it lies in the thorax

Is formed mainly by the left atrium , with a lesser contribution by the right atrium

Faces posteriorly toward the bodies of vertebrae T6 through T9

Extends superiorly to the bifurcation of the pulmonary trunk and inferiorly to the coronary groove (sulcus)

Four surfaces of the heart:

Anterior (sternocostal) surface, formed mainly by the right ventricle

Diaphragma (inferior) surface, formed mainly by the left ventricle and partly by the right ventricle, is related to the central tendon of the diaphragm

Left pulmonary surface, formed mainly by the left ventricle, it formed the cardiac impreeion of the left lung

Right pulmonary surface, formed mainly by the right atrium

Four borders of the heart:

Right border (vertical, slightly convex), formed by the right atrium and extending between the SVC and IVC

Inferior borders (nearly horizontal), formed mainly by the right ventricle and only slightly by the left venricle

Left borders (oblique, nearly vertical) formed mainly by the left ventricle and slightly by the left auricle

Superior borders, formed by the right and left atria and auricles in an anteriorly view, ascending aorta and pulmonary thrunk emerge from the superior border, and the SVC enter its right side.

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Heart

Divisions: Four chambers: - right and left atria - right and left ventricles The right atrium: superior & inferior

vena cava coronary sinus The right ventricle: the largest portion

of the anterior (sternocostal) surface

Coronary arteries (RCA and LCA): › The first branches of the aorta› Arises from the corresponding aortic

sinuses at the proximal part of the ascending aorta, just superior to aortic valve

› Supply the myocardium and epicardium Coronary arteries: supply both the atria

and ventricles, however the atrial branches are usually small

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The heart is drained mainly by veins that empty into the coronary sinus and partly by small anterior cardiac veins that empty directly into the right atrium and the other chambers (smallest cardiac veins)

SA node: pacemaker of the heart, is located anterolaterally just deep to the epicardium at the junction of the SVC and right atrium

AV node is smaller collection of nodal tissue located in the posteroinferior region of the interatrial septum near the opening of the coronary sinus.

◦The impuls SA node : conducted to cardiac m. fibers in the atria, causing them to contract.

◦The impuls spreads by myogenic conduction that rapidly transmits the impuls from the SA node to the AV node.

◦From the AV node through the AV bundle and the right and left bundle branches (on each side of the IV septum) to supply subendocardial branches to the papillary m. and the wall of the ventricle

A-V node (atrioventricular node)Conduction through the atrial wall

Sinoatrial node (sinus node)

A-V bundle (bundle of His)

Right & left branches

Purkinje fibers

INNERVATION OF HEART :INNERVATION OF HEART :Autonomic nerve fibers (from

superficial & deep cardiac plexuses)◦sympathetic :

sympathetic stimulation : increase HR & contraction (tachycardia), dilatasi coronary a.

◦Parasympathetic : parasympathetic stimulation : slow HR, reduces

heart beat (bradycardia), constric coronary a. , saving energy

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Two most common sites: In the side of the neck: carotid pulse by

palpating the common carotid artery At the wrist: radial pulse by palpating

the radial artery

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Lymphatic plexuses Lymphatics Lymph nodes Aggregations of lymphoid tissue Circulating lymphocytes

The ground plan of lymphatic The ground plan of lymphatic drainagedrainage

Right lymphatic duct (ductus lymphaticus dexter):

The right halves of head, neck and thorax, and the right upper limb

Left lymphatic duct = The thoracic duct (ductus lymphaticus sinister):

The remainder of the bodyBoth duct eventually open into the

corresponding subclavian veins (venous angles)