• Embed Doc
  • Copy Link
  • Readcast
  • Collections
  • CommentGo Back
Download
 
CARDIOVASCULAR DISORDERS: HEART DISEASE: INTRODUCTION
Diseases of the cardiovascular system frequently confront the physician involved in the day-to-day care of patients. Knowledge of the underlying pathophysiologic processes associated with diseases of the heart and blood vessels provides a critical framework forpatient management. This chapter deals with diseases of the heart and the next one with diseases of the blood vessels. Normalcardiac structure and function are summarized here, and pathophysiologic mechanisms for commonly encountered cardiacproblems are then discussed, with emphasis on arrhythmias, congestive heart failure, valvular heart disease, coronary arterydisease, and pericardial disease.
ANATOMY
The heart is a complex organ whose primary function is to pump blood through the pulmonary and systemic circulations. It iscomposed of four muscular chambers: the main pumping chambers, the left and right ventricles, and the left and right atria, whichact as "priming pumps" responsible for the final 20–30% of ventricular filling (Figure 10–1A). Peripheral venous return from theinferior and superior venae cavae fills the right atrium and ventricle (through the open tricuspid valve) (Figure 10–1B). With atrialcontraction, additional blood flows through the tricuspid valve and completes the filling of the right ventricle. Unoxygenated bloodis then pumped to the pulmonary artery and lung by the right ventricle through the pulmonary valve (Figure 10–1C). Oxygenatedblood returns from the lung to the left atrium via four pulmonary veins (Figure 10–1D). Sequential left atrial and ventricularcontraction pumps blood back to the peripheral tissues. The mitral valve separates the left atrium and ventricle, and the aorticvalve separates the left ventricle from the aorta (Figures 10–1D and 10–1E).
Figure 10–1.
Page 1 of 48AccessMedicine | Print: Chapter 10. Cardiovascular Disorders: Heart Disease
 
Page 2 of 48AccessMedicine | Print: Chapter 10. Cardiovascular Disorders: Heart Disease
 
 
The heart lies free in the pericardial sac, attached to mediastinal structures only at the great vessels. During embryologicdevelopment, the heart invaginates into the pericardial sac like a fist pushing into a partially inflated balloon. The pericardial sac iscomposed of a serous inner layer (visceral pericardium) directly apposed to the myocardium and a fibrous outer layer called theparietal pericardium. Under normal conditions, approximately 40–50 mL of clear fluid, which probably is an ultrafiltrate of plasma,fills the space between the layers of the pericardial sac.The left main and right coronary arteries arise from the root of the aorta and provide the principal blood supply to the heart (Figure10–2). The large left main coronary artery usually branches into the left anterior descending artery and the circumflex coronaryartery. The left anterior descending coronary artery gives off diagonal and septal branches that supply blood to the anterior walland septum of the heart, respectively. The circumflex coronary artery continues around the heart in the left atrioventricular grooveand gives off large obtuse marginal arteries that supply blood to the left ventricular free wall. The right coronary artery travels inthe right atrioventricular groove and supplies blood to the right ventricle via acute marginal branches. The posterior descendingartery, which supplies blood to the posterior and inferior walls of the left ventricle, arises from the right coronary artery in 80% of people (right-dominant circulation) and from the circumflex artery in the remainder (left-dominant circulation).
Anatomy of the heart.
A:
Anterior view of the heart.
B:
View of the right heart with the right atrial wall reflected to show the right atrium.
C:
 Anterior view of the heart with the anterior wall removed to show the right ventricular cavity.
D:
View of the left heart with the leftventricular wall turned back to show the mitral valve.
E:
View of the left heart from the left side with the left ventricular free wall and mitralvalve cut away to reveal the aortic valve.(Reproduced, with permission, from Cheitlin MD, Sokolow M, McIlroy MB:
Clinical Cardiology,
6th ed. Originally published by Appleton & Lange. Copyright © 1993 by The McGraw-Hill Companies, Inc.)
Figure 10–2.
Page 3 of 48AccessMedicine | Print: Chapter 10. Cardiovascular Disorders: Heart Disease
of 00

Leave a Comment

You must be to leave a comment.
Submit
Characters: ...
You must be to leave a comment.
Submit
Characters: ...