anatomy of the cardiovascular system 11/7/12 betty smoot, pt,...
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Anatomy of the Cardiovascular System 11/7/12
Betty Smoot, PT, DPTSc
BIOGRAPHY: Betty Smoot, PT, DPTSc is Assistant Professor in the Department of Physical Therapy and Rehabilitation Science and in the Department of Anatomy. After completing her undergraduate degree in Biology she received her first physical therapy degree from UCSF in 1983. She earned her Doctor of Physical Therapy Science degree from UCSF in 2009. In 2012, Dr. Smoot completed a 2 year advanced-study program in Anatomy. She is a member of the American Association of Anatomists; the American Physical Therapy Association sections on orthopedics, oncology, acute care, and research; and the International Society of Lymphologists. Dr. Smoot teaches Physical Therapy Assessment, Research Design, Evidence Based Practice, and Anatomy in the UCSF Graduate Program in Physical Therapy. She is course co-director for the Prologue Block, and teaches Anatomy in all blocks for 1st and 2nd year medical students. She also teaches in the anatomy course for UCSF pharmacy students. Dr. Smoot is passionate about anatomy teaching and its importance in clinical medicine. She was awarded the Excellence in Teaching Award in medical education from the Haile T. Debas Academy of Medical Educators in 2012. BIBLIOGRAPHY: Drake R, Vogl W, Mitchell A. Gray’s Anatomy for Students. 2nd Ed. Philadelphia, PA: Churchill Livingstone; 2009 Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. 6th Ed. Baltimore, MD: Lippincott Williams & Wilkins; 2009. Chapter 1. Thorax. Netter FH. Atlas of Human Anatomy. 5th Ed. Philadelphia, PA: Saunders; 2011 Peto J. The Heart. Welcome Trust Collection. 2007 Standring S. Gray’s Anatomy, The Anatomical Basis of Clinical Practice. 40th Ed. Churchill Livingstone; 2008. Section 7. Thorax. Micheal Gatzoulis, Section Editor .
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10/29/2012
1
The Cardiovascular
System
Part 1:Anatomy of the heart
Components of the cardiovascular system
o Heart
o Blood vessels
o Arteries
o Veins
o Capillaries
o Pulmonary circulation
o Systemic circulation
o Coronary circulation
Objectives: The heart
1. Describe the location of the heart in the thorax and mediastinum.
2. Relate thorax surface anatomy to underlying cardiovascular structures.
3. Describe the anatomy of the heart, including its coverings, chambers,
and walls.
4. Identify the valves of the heart. Explain their function, and
consequences of valve incompetence.
5. Apply your knowledge of anatomy to understanding clinical conditions
related to the heart.
The thorax
Netter’s Atlas of Human Anatomy 5th Edition
Costal cartilage
Jugular notch
Sternal angle
Xiphoid process
Clavicle
Manubrium
Body of sternum
Rib
Thoracic vertebra
I
II
III
IV
V
VI
VII
VIII
IX
X
XI
XII
Thoracic cage
Intercostal spaces
Netter’s Atlas of Human Anatomy 5th Edition
Surface anatomy
Jugular notch
Clavicle
Manubrium
Body of sternum
Sternal angle
Costal cartilage
Costal margin
Rib X
Xyphoid process
Rib I Coracoid process
Sternoclavicular joint
Drake et al: Gray's Anatomy for Students 2E
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Surface anatomy
3rd costal cartilage
6th costal cartilage
2nd intercostal space
5th intercostal space
Mid-clavicular
line
Drake et al: Gray's Anatomy for Students 2E
The mediastinumThe heart in situ
Common carotid artery
Internal jugular vein
Phrenic nerveLeft lung
Right lung
Diaphragm
Superior vena cava
Aorta
Pericardium
Left subclavian artery and vein
Parietal pleura
Ribs
Netter’s Atlas of Human Anatomy 5th Edition
PericardiumHeart removed
Left lungRight lung
Diaphragm
Pericardium
Superior vena cava
Aorta
Inferior vena cava
Pulmonary trunk
Left pulmonary veinsRight pulmonary veins
Netter’s Atlas of Human Anatomy 5th Edition
Pericardium
3 layers of the pericardium:
1
3
2
Drake et al: Gray's Anatomy for Students 2E
Cardiac tamponade
Pericardiocentesis for diagnosis and decompression
Venous pressure elevated
Neck veins distended
Decreased arterial and pulse pressures
Compression of the heart when blood or fluid accumulates in the
pericardial cavity
Netter’s Atlas of Human Anatomy 5th Edition
Anatomy of the heartOrientation
Left lung
Right lung
Netter’s Atlas of Human Anatomy 5th Edition Drake et al: Gray's Anatomy for Students 2E
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Anatomy of the heartThe great vessels
Superior vena cava (cut)Carrying de‐oxygenated blood
Pulmonary trunkTo right and left pulmonary arteries to right and left lungs Carrying de‐oxygenated blood
Aorta (cut)Carrying oxygenated blood
Inferior vena cava (cut)Carrying de‐oxygenated blood
Right pulmonary veins from right lung to the left atriumCarrying oxygenated blood
Left pulmonary veins from left lung to left atrium Carrying oxygenated blood
RA
LA
RV LV
Netter’s Atlas of Human Anatomy 5th Edition
Anatomy of the heartAnterior view
Drake et al: Gray's Anatomy for Students 2E
Anatomy of the heartPosterior view
Drake et al: Gray's Anatomy for Students 2E
Anatomy of the heartThe 4 chambers & their walls
The heart has 4 chambers.
1. Right atrium (RA)
2. Right ventricle (RV)
3. Left atrium (LA)
4. Left ventricle (LV)
Walls of the chambers:
1. Endocardium
2. Myocardium
3. Epicardium
RV
RA
LV
LASVC
Aorta
Pulmonary veins
Netter’s Atlas of Human Anatomy 5th Edition
Anatomy of the heartRight atrium
SVC
IVC
Fossa ovalis
Pectinate muscle
Opening of the coronary sinus
Crista terminalis
Right auricle
Septal cusp of tricuspid valve
Inter‐atrial septum
Netter’s Atlas of Human Anatomy 5th Edition
Anatomy of the heartRight ventricle
Pulmonary trunk
Pulmonary valve
Papillary muscles
Trabeculae carnae
Chordae tendineae
Tricuspid valve
Aorta
SVC
RA
Conus arteriosus
Netter’s Atlas of Human Anatomy 5th Edition
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Anatomy of the heartLeft atrium
Right pulmonary veins
Left auricle Aorta
Pulmonary arteries
Left atrium
Coronary sinus
LV
IVC
Netter’s Atlas of Human Anatomy 5th Edition
Anatomy of the heartLeft ventricle
Papillary muscles
Trabeculae carnae
Chordae tendineae
Pulmonary veins
Left atrium
Coronary sinus
IVC
Mitral valve
Pulmonary arteries
Aorta
Left ventricle
Netter’s Atlas of Human Anatomy 5th Edition
• Network of collagen & elastin fibers
• Consists of 4 dense connective tissue rings surrounding the four cardiac valves
• 4 important functions:
1. anchors the valve cusps
2. prevents over‐dilation of the valve openings
3. provides attachment point for the myocardium
4. blocks the direct spread of electrical impulses from atria to ventricles
Anatomy of the heartThe valves and fibrous skeleton
Pulmonary valve
Aortic valve
Tricuspid valve
Mitral (bicuspid) valve
Heart in diastole
Heart in systole
Fibrous rings
Netter’s Atlas of Human Anatomy 5th Edition
Conducting system
SA node
AV node
AV Bundle of His
Right bundle
Purkinje fibers
Fibrous ring or tricuspid valve
Netter’s Atlas of Human Anatomy 5th Edition
Anatomy of the heartValves of the right
Pulmonary trunk
Pulmonary valve
Tricuspid valve
RA
Netter’s Atlas of Human Anatomy 5th Edition
Anatomy of the heartValves of the left
Pulmonary veins
Left atrium
Coronary sinus
Mitral valve
Pulmonary arteries
Aortic valve
Netter’s Atlas of Human Anatomy 5th Edition
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Valvular heart disease
Netter’s Atlas of Human Anatomy 5th Edition
Aortic stenosis: Aortic valve becomes narrow;
Valve fails to open fully
Mitral valve prolapse:Incompetent mitral valve;
Blood regurgitates back into the left atrium during systole and a murmer is heard
Auscultation positions for valves
Drake et al: Gray's Anatomy for Students 2E