CARDIOVASCULAR SYSTEM:

Heart

Size: 12 cm (5 in.) long, 9 cm (3.5 in.) wide at broadest point, 6 cm (2.5 in.) thick Shape: pear-shaped Weight: Males: 300-350g Females: 250-300g Location: rests on the diaphragm to the midline of the thoracic cavity Lies in the mediastinum, an anatomical region that extends from: the sternum to the vertebral column the first rib to the diaphragm and between the lungs 2/3 of its mass lies the left side of the body Apex: formed by the tip of the left ventricle and rests on the diaphragm; directed anteriorly, inferiorly and to the left Base: the posterior surface; formed by the atria of the heart, mostly left atrium Surfaces and Borders: anterior surface- deep to the sternum and ribs inferior surface- part of the heart between the apex and right border; rest mostly on the diaphragm right border-faces the right lung and extends from the inferior surface of the base left border- pulmonary border; faces the left lung and extends from the base to the apex

Pericardium
-a sac that covers and protects the heart -confines the heart to its position in the mediastinum while allowing sufficient freedom of movement for contraction -reduces friction between heart and surrounding organs -TWO main parts: Fibrous pericardium -Outer membrane -tough, inelastic, dense irregular connective tissue that resembles a bag that rests on & attaches to the diaphragm -prevents overstretching of the heart, provides protection, and anchors the heart in the mediastinum Serous pericardium -Inner membrane; thinner and more delicate -Forms a double layer: outer parietal layer & inner visceral layer (epicardium) -contains the pericardial fluid (thin film of lubricating serous fluid that reduces friction between layers of the serous pericardium as the heart moves

Heart Wall
EPICARDIUM visceral layer of the serous membrane; outermost, thin transparent layer -composed of mesothelium and delicate connective tissue that imparts a smooth, slippery, texture to the outermost surface of the heart MYOCARDIUM middle layer; bundles of cardiac muscles; makes up about 95% of the heart -responsible for the pumping action;

 ENDOCARDIUM innermost layer of endothelium overlying a thin connective tissue; provides smooth lining for the chambers of the heart, covers the valves of the heart; continuous with endothelial lining of large blood vessels attached to the heart -minimizes surface friction as blood passes through the heat and blood vessels

PERICARDITIS: inflammation of the pericardium -Types: acute pericarditis- chest pain on left shoulder to left arm, pericardial friction; last one week with antiinflammatory drugs chronic pericarditis- build up of pericardial fluid compresses heart cardiac tamponade that results to ventricular filling decrease, CO reduced, venous return to heart decrease, BP falls, breathing difficulty Pericardiocentesis: procedure that uses needle to remove fluid from the pericardial sac, the tissue that surrounds the heart.

Chambers of the Heart

-Function of the Chambers: RV pumps blood at a fairly low pressure to the lungs LV pumps blood at a higher pressure to all parts of the body -Anatomy of the Chambers: LV wall 2-4 times THICKER than RV Atria- superior receiving chambers; entry halls Right atrium -receives blood from 3 veins: superior vena cava, inferior vena cava, coronary sinus [Veins always return blood to the heart] interatrial septum: partition between left and right atrium fossa ovalis: prominent feature of the septum; depression or opening of in the interarterial septum of fetal heart that closes upon birth -remnant of foramen ovale pectinate muscles- muscular ridges ridges present in the posterior wall of the RA that causes it to be rough (anterior wall of RA smooth, but posterior is rough) Triscupid valve/ right atrioventricular valve - valve between right atrium to right ventricle -composed of dense connective tissue covered by endocardium Left atrium -forms most of the base of the heart -receives blood from the lungs through the four pulmonary veins -both anterior and posterior surfaces of LA are smooth Biscuspid (mitral valve)/ left atrioventricular valce: left atrium left ventricle Ventricles- inferior pumping chambers Right ventricle -forms most of the anterior surface of the heart Trabeculae carneae-raised bundles of cardiac muscle

 Chordae tendinae- where the cusps of the tricuspid valve are connected; also connected to coneshaped trabeculae carnae, papillary muscles Interventricular septum- a partition that separates the right ventricle from the left ventricle Pulmonary valve/ pulmonary semilunar valve- right ventricle pulmonary trunk, arteries lungs [ARTERIES always take the blood away from the heart] Left ventricle -thickest chamber of the heart -forms the apex of the heart -Also contains trabeculae carnea and chordae tendinae Aortic valve: left ventricle ascending aorta -some blood in aorta flows to coronary ateries ascending aorta -remainder blood passes into the arch of the aorta and descending aorta (thoracic and abdominal) throughout the body Auricle-wrinkled pouch-like structure on anterior surface of each atrium; increases the capacity of an atrium so it can hold a great blood volumes Sulci- series of grooves on the surface of the heart that contains the coronary blood vessels and variable amount of fat -marks the external boundary between the superior atria and inferior ventricles -coronary sulcus: deep; encircles most if the heart and marks the external boundary between thee superior aorta and inferior ventricles -anterior and posterior interventricular sulcus: shallow groove on the anterior surface of the heart that marks the external boundary between right and left ventricles

Heart Anatomy

Heart Valves
-Thin leaflets of tissue which open and close at the proper time during each heart beat cycle -dense connective tissue covered by endocardium -open and close in response to pressure changes -ensures the one way flow of blood by opening to let blood through and then closing to prevent its backflow ATRIOVENTRICULAR (AV) VALVES situated between an atrium and a ventricle 1. when it opens, the rounded ends of the cusps project into the ventricles 2. when the ventricles are relaxed, papillary muscles relax, chordae tendineae slack, blood moves from the higher pressure in the atria to the lower pressure in the ventricles

3. at same time, papillary muscle contract to pull and tighten chordae tendinae (prevents the valves to open into the atria due to high ventricular pressure) Tricuspid valve: right AV valve; RA RV Bicuspid or mitral valve: left AV valve; LA LV SEMILUNAR (SL) VALVES- made up of three crescent moonshaped cusps -allow ejection of blood from the heart into arteries but prevent backflow of blood into the ventricles 1. Free border of the cusps project into the lumen of the artery 2. When ventricles contract, pressure builds up within the chambers 3. SL valves opens when pressure in the ventricles exceeds the pressure in the arteries 4. Blood ejected from ventricles into the pulmonary trunk and aorta 5. When ventricles relaxes, blood will flow back to the heart 6. Backward flow of blood will fill the valve cusps that causes SL valves to close tightly Pulmonary SL valve: RV pulmonary trunk Aortic SL valve: LV aorta

STENOSIS: narrowing of the heart valve that restricts blood flow INSUFFICIENCY/INCOMPETENCE: failure of a valve to close completely mitral stenosis- scar formation or a congenital defect causes narrowing of mitral valve mitral insufficiency- caused by mitral valve prolapsed -there is a backflow of blood from the left ventricle into the left atrium) -one or both cusps of MV protrudes into the left atrium during ventricular contraction Aortic stenosis- aortic valve is narrowed Aortic insufficiency- backflow of blood from the aorta to LV

Systemic &Pulmonary Circulations

-arranged in series 1. RIGHT side: pump for pulmonary circulation Right atrium receives deoxygenated blood from systemic circulation 2. Right ventricle ejects blood into pulmonary trunk 3. From pulmonary trunk, it divides into pulmonary arteries that carry blood to lungs -pulmonary capillaries, unload of CO2 and pick up O2 oxygenated blood 4. LEFT side: pump for systemic circulation

Left atrium receives oxygenated blood from lungs 5. Left ventricle ejects the blood into aorta 6. From aorta, blood divides into separate streams, entering progressively smaller systemic arteries (throughout the body expect lungs) -arteries arterioles systemic capillaries -loss of O2, and picks up CO2 -Systemic venules carry deoxygenated blood away from tissue systemic veins right atrium

Coronary Circulation: Blood Supply of the Heart

-network of blood vessels of cells s that are to help diffuse nutrients quickly from blood in the chambers of the heart to supply all the -acute systemic inflammatory disease layers of cells that make up the heart wall that usually occurs after a Coronary arteries streptococcal infection (group B -branch from the ascending aorta and encircle the heart hemolytic streptococcus) such as left coronary artery strep throat or scarlet fever anterior interventricular branch / left anterior descending artery -the bacteria trigger an immune -is in the anterior interventricular sulcus and supplies response in which the antibodies oxygenated blood to the walls of both ventricles produced to destroy the bacteria circumflex branch instead attack and inflame the -lies in the coronary sulcus connective tissues in joints, heart -distributes oxygenated blood to the walls of left ventricle valves, and other organs and left atrium right coronary artery- supplies small branches (atrial -may weaken the entire hear wall, branches) to the right atrium and continues inferior to the most often damages the bicuspid and right auricle aortic valves posterior interventricular branch -follows the posterior interventricular sulcus and supplies the walls of the two ventricles with oxygenated blood marginal branches -transports oxygenated blood to the myocardium of the right ventricle *anastomoses- connections between branches of more than one artery that supply blood to the same region *collateral circuits- alternated routes provided by anastomoses for blood to reach a particular organ or tissue Coronary veins -Blood from the arteries capillaries, where it delivers oxygen and nutrients and collects CO2 and wastes veins (Coronary Veins) -the main veins that carry blood into the coronary sinus: Great cardiac vein- drains the areas of the heart supplied by the left coronary artery Middle cardiac vein-drains the areas supplied by the posterior interventricular branch of the right coronary artery ( left and right ventricles) Small cardiac vein- drains the right atrium and right ventricle

RHEUMATIC FEVER -infectious disease that damage or destroy the heart valves

 Anterior cardiac vein- drains the right ventricle and open directly into the right atrium *reperfusion- deprivation of oxygen to the heart muscle due to the blockage of a coronary artery -during reestablishment of blood flow, may cause more tissue damage due to the formation of free radicals from the reintroduced oxygen Coronary sinus -where deoxygenated blood from myocardium drains into -on posterior surface of the heart RA -large vascular sinus *vascular sinus- thin-walled vein that has no smooth muscle to alter its diameter CORONARY ARTERY DISEASE (CAD) -results from the effects of the accumulation of atherosclerotic plaques in coronary arteries -leads to a reduction in blood flow to the myocardium -inadequate blood flow to coronary arteries hypoxia -RISK FACTORS: smoking, high BP, diabetes, high cholesterol levels, obesity, type A personality, sedentart lifestyle, family history of CAD -TYPES: Partial obstruction Complete obstruction

-TREATMENT: Drugs: antihypertensive, nitroglycerine, beta blockers, cholesterol lowering drugs, clot-dissolving agents Coronary artery bypass grafting (CABG) -surgical procedure in which a blood vessel from another part of the body is attached grafted to a coronary artery to bypass an area of blockade

Percutaneous Transluminal Coronary Angioplasty (PTCA) -non-surgical procedure, in which a balloon catheter with un-inflated balloon is threaded to obstructed area in artery Stent in an artery -a stent is a stainless steel device, resembling a spring coil -to correct the renarrowing from PTCA