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ANATOMY AND PHYSIOLOGY

ANATOMY OF THE HEART The Heart is composed 3 layers. The Inner layer or the endocardium consist of endothelial tissues and lines the inside of the heart and valves. The Middle layer or myocardium, is made up of muscle fibers and is responsible for the pumping action and the exterior layer of the heart is called the epicardium. The Heart is encased in a thin , fibrous sac called the pericardium which is composed of two layers adhering to the epicardium is the visceral pericardium enveloping the visceral pericardium , a tough fibrous tissue that attaches to the great vessels , diaphragm ,sternum and vertebral column and supports the mediastenum .. The space between these two layers (pericardial space) is filled with about 30 ml of fluid. Which lubricates the surfaces of the heart and reduces friction during systole Heart Chamber The four chambers of the heart constitute the right and left sided pumping system the right side of the heart made up of the right atrium and right ventricles , distributes venous blood ( deoxygenated blood ) to the lungs via the pulmonary artery ( pulmonary circulation ) for oxygenation the right atrium receives blood returning from the superior vena cava ( head , neck , and upper extremities ) inferior vena cava ( trunk , and lower extremities ) and coronary sinus ( coronary circulation ) the left side of the heart composed of the left atrium and left ventricles distributes oxygenated blood to the remainder of the body via the aorta ( systemic circulation ) .

The left atrium receives oxygenated blood from the pulmonary circulation via the pulmonary veins. The varying thickness of the atrial and ventricular walls relate to the work loads required by each chamber. The atria are thin walled because blood returning to these chambers generates low pressures. In contrast, the ventricular walls are thicker because they generate greater pressures during systole. The right ventricle contrast against low pulmonary vascular pressure and has thinner walls than the left ventricles. The left ventricle, with walls two and half times more muscular than those of the right ventricles, contrast against high systemic pressure. Because the heart lies in a rotated position with in the chest cavity. The right ventricle lies anteriorly ( just beneath the sternum ) and the left ventricles lies anteriorly ( just beneath the sternum ) and the left ventricle is situated posteriorly the left ventricle is responsible for the apical beat for the point of maximum impulse ( PMI ) which is normally palpable in the left midclavicular line of the chest wall at the fifth intercostal space . Heart Valves The four valves in the heart permit blood to flow only one direction. the valves, which are composed of thin leaflets of fibrous tissues , open and close in response to the movement of blood and pressure changes within the chambers . There are two types of valve: atrioventricular and semilunar. Atrioventricular Valve The valves that separate the atria from the ventricles are termed atrioventricular valves. The tricuspid valve, so named because it composed of three cusps or leaftlets separates the right ventricles. The mitral or bicuspid valve (two cups) lies between the left atrium and the left ventricles. Normally, when the ventricles contract, ventricular pressure increases closing the atrioventricular valve leaflets. Two additional structures, the pappilary muscles and the chordae tendineae, maintain the valve closure. The papillary muscles located on the sides of the ventricular walls are connected to the valve leaflets by thin fibrous bands called chordate tendinae. During systole, contraction of the papillary muscles causes the chordate tendinae to become tact, keeping the valve leaflets approximately and closed. Semilunar Valves The two semilunar valves are composedof three half moons like leaflets. The valve between the right ventrivles and the pulmonary artery is called pulmonic valve. The valve between the left ventricle and the aorta is called the aortic valve. Coronary Arteries The left and right coronary arteries and their branches supply arterial blood to the heart. These arteries originate from the aorta just above the aortic valve leaflets. The Heart has large metabolic requirements, extracting approximately 70% to 80% of the oxygen delivered (other organs exract 25%) unlike other arteries, the coronary arteries are perfused during diastole; the increase in heart rate shortens diastole and can decreased myocardial perfusion. Patients particularly those with CAD, can develop myocardial ischemia (inadequate oxygen supply) when the heart rate accelerates.

The left coronary artery has three branches. The artery from the point of origin to the first major branch called the left main coronary artery. Two branches arise off the left main coronary artery. The left anterior descending artery which courses down the anterior wall of the heart, and the circumflex artery, which encircles around to the lateral left wall of the heart. The posterior wall of the heart receives its blood supply by an additional branch from the right coronary artery called the posterior descending artery. Superficial to the coronary arteries are the coronary arteries are the coronary veins. Venous blood from these veins to the heart primarily through the coronary sinus. This is located posteriorly at the right atrium. PHYSIOLOGY OF THE HEART The cardiac conduction system generates and transmits electrical impulses that stimulate contraction of the myocardium.Under normal circumstances; the conduction system first stimulates contraction of the atria and then the ventricles. The synchronization of the atrial and ventricular events allows the ventricles to fill completely before ventricular ejection, thereby maximizing cardiac output. Three physiological characteristics of two specialized electrical cells, the nodal cells and the purkinje cells, provide this synchronization. AUTOMATICITY-ability to initiate an electrical impulse. EXITABILITY-ability to respond to an electrical impulse. CONDUCTIVITY-ability to transmit an electrical impulse from one cell to

another

Both the sinoatrial (SA) node and the atrioventricular (AV) node are composed of nodal cells. The SA node, the primary pacemaker of the heart, is located at the junction of the superior vena cava and the right atrium. The SA node in a normal resting adult heart has an inherent firing rate of 60 to 100 impulses per minute, but the rate can change in response to the metabolic demands of the body. The electrical impulses initiated by the SA node are conducted along the myocardial cells of the atria via specialized tracts called intermodal pathways. The impulses cause electrical stimulation and subsequent contraction of his atria. The impulses are then conducted to the AV node, which is located in the right atrial wall near the tricuspid valve.

ANATOMY OF THE KIDNEY

The kidneys are pair of bean-shaped, brownish red structures located retroperitoneal on the posterior wall of the abdomen from the twelfth thoracic vertebra to the third lumbar vertebra in the adult. The average adult kidney weights approximately 113-170 g. (about 4.5 oz) and is 10-12 cm long and 2.5 cm thick. The right kidney is slightly lower than the left due to the location of the liver. Externally, the kidneys are well protected by the ribs and by the muscles of the abdomen and back. Internally, fat deposit surround each kidney, providing fat are suspended from the abdominal wall by renal fascia made of connective tissue, the fibrous connective tissue, blood vessel, and lymphatic surrounding each kidney are known as the renal capsule. An adrenal glands lies on top of each kidney, each organ is independent in terms of its function, blood supply and innervations. The renal parenchyma is divided into two parts: the cortex and medulla. The medulla which approximately 5cm wide is the inner portion of the kidney. It contains the loop of henle, the vasa recta, and the collecting ducts of the juxtamedullary cortical nephrones connect to the renal pyramids, which are triangular and are situated with the base facing the concave surface of the kidney point (papilla) facing the hilum, or pelvis. Each kidney contains approximately 8-18 pyramids, the pyramids drains into 4-13 million calices which drain 2-3 major calices that open directly into the renal pelvis is the beginning of the collecting system and composed of structures that are design to collect and transport urine. Once the urine leave the renal pelvis, the composition on amount of urine does not change. The cortex which is approximately 1cm wide is located farthest from the center of the kidney and around the outer most edges. It contains the nephron (functional unit of the kidney). BLOOD SUPPLY TO THE KIDNEYS The hilum or the pelvis is the concave portion of the kidney through which the renal artery enters and the ureters and renal vein exit. The kidney receives 20-25% of the total cardiac output, which means that all of the bodys blood circulates through the kidneys approximately 12 times per hour. The renal artery (arising from the abdominal aorta) divides into smaller and smaller vessels, eventually forming the efferent arterioles. Each arteriole branch to perform a glumerolus which is the capillary bed responsible for the glumerular filtration. Blood leaves the glumerolus through efferent arteriole through a network of capillary and veins.