8/5/2021 MAGNETIC RESONANCE ANGIOGRAPHY/MRI

VASCULAR SYSTEM  Isolates the blood vessel by magnet resonance imaging

Anatomy: CONTRAST PHLEBOGRAPHY/VENOGRAPHY
 Arteries/Arterioles  Reveals unfilled segments in a filled vein
 thick-walled
 carry blood from heart-tissues Varicose Veins
 Capillaries Hemorrhoids – dilation of veins in the anus
 thin-walled
 rapid/efficient transports nutrients to cells and removal of LYMPHOSCINTIGRAPHY
metabolic wastes
Ascites – accumulates fluid in the peritoneum
 Veins/Venules
 thin, less muscles vein walls THE HEART

Buerger's disease - (also known as thromboangiitis obliterans) affects

blood vessels in the body, most commonly in the arms and legs.
Blood vessels swell, which can prevent blood flow, causing clots to
form. This can lead to pain, tissue damage, and even gangrene (the
death or decay of body tissues).

Arteriosclerosis is a disease that blocks the wall of arteries due to

aging. Whereas atherosclerosis is a medical disorder that damages
the lumen of the arteries by plaque deposits. Atherosclerosis is
mostly a failure of controlled cholesterol and fat levels in the body.

Side by side with lungs in the thoracic area

Functions of the Vascular System: Position:
 Circulatory needs of tissues  Lies within the pericardium in middle mediastinum
 Blood flow  Behind the body of sternum and the 2nd to 6th costal
 Capillary filtration and reabsorption cartilages
 Hemodynamic resistance  In front of the 5th to 8th thoracic vertebrae
 Peripheral vascular regulating mechanisms  A third of it lies to the right of median plane and 2/3 to the
Diagnostic Evaluation: left
 Anterior to the vertebral column, posterior to the sternum
DOPPLER ULTRASOUND FLOW STUDIES  Midclavicular line, 5th intercostal pulse = point of maximal
impulse) PMI
 Detect blood flow in vessels
 Emits a continuous signal Anatomy:

Narrowing=less blood flow to the area

Infarction – death of tissues of a certain organ/obstruction of the

blood flow

EXERCISE TESTING

 How long a patient can walk to measure ankle systolic blood

pressure

DUPPLEX ULTRASONOGRAPHY

 Grayscale imaging of tissue, organs, blood vessels

 Level, extent, chronicity of venous diseases
 Can diagnose arteriosclerosis

COMPUTED TOMOGRAPHY SCAN

 Cross-sectional images of soft tissue

 Large vessels/Aneurysm
Outside air = Positive pressure
Do not massage the area with aneurysm
Pleural Space = Negative pressure
ANGIOGRAPHY

 Determine where the blockage of certain vessels

Cardiac tamponade - is a serious medical condition in which blood or A superficial fibrous pericardium
fluids fill the space between the sac that encases the heart and the
heart muscle. A deep two-layer serous pericardium

External Characteristics:
A hollow muscular organ, pyramidal in shape, somewhat larger than
a closed fist; consists of four chambers (right and left atria, right and
left ventricles)
Cardiac Apex is formed by left ventricle and is directed downwards
and forwards to the left. It lies at the level of the fifth left intercostal
space, 1~2cm medial to the left midclavicular line (9cm from the
midline)
The parietal layer lines the internal surface of the fibrous
pericardium
The visceral layer or epicardium lines the surface of the heart
They are separated by the fluid-filled pericardial cavity called the
pericardial cavity
Protects and anchors the heart
Prevents overfilling of the heart with blood

The apex beat 【 point of maximum impulse (PMI) 】 , is the Allows for the heart to work in a relatively friction-free environment
furthermost point outwards (laterally) and downwards (inferiorly)
from the sternum at which the cardiac impulse can be felt. Interatrial septum

Lateral and/or inferior displacement of the apex beat usually  Located between right and left atria
indicates enlargement of the heart, called cardiomegaly  Contains fossa ovalis

Approximately the size of your fist weigh. = 250-300 grams Interventricular septum

Cardiac base is formed by the left atrium and to a small extent by  Located between right and left ventricles
the right atrium. It faces backward, upward and to the right  upper membranous part
 thick lower muscular part
Two surfaces:

Sternocostal surface is formed mainly by the right atrium and

right ventricle, and a lesser portion of its left is formed by the left
auricle and ventricle. It is directed forwards and upwards

Diaphragmatic surface is formed by the ventricles － chiefly the

left ventricle, directed backwards and downwards, and rests upon
the central tendon of the diaphragm

Three borders:

Right border－vertical, is formed entirely by right atrium

Left border－round, is mainly formed by the left ventricle and partly

by the left auricle

Inferior border － horizontal, is formed by the right ventricle and

cardiac apex

Four grooves:

Coronary sulcus (circular sulcus) which marks the division between

atria and ventricles, contains the trunks of the coronary vessels and
completely encircles the heart

Interatrial groove － separates the two atria and is hidden by

pulmonary trunk and aorta in front

Interventricular grooves － anterior and posterior, mark

the division between ventricles (which separates the RV from the
LV),

the two grooves extend from the base of the ventricular portion to a
notch called: the cardiac apical incisure

Covering of the heart:

Visceral – nakadikit organ

Capillary muscles – helps in pumping
Parietal – nakadikit wall

Pericardium – a double-walled sac around the heart

Composed of:
Layers of the wall: Interatrial septum

 Epicardium – visceral pericardium  Located between right and left atria

 Myocardium – cardiac muscle layer forming the bulk of the  Contains fossa ovalis
heart
 Endocardium – endothelial layer of the inner myocardial Interventricular septum
surface  Located between right and left ventricles
 upper membranous part
 thick lower muscular part

Fibrous skeleton

 Fibrous rings that surround the

atrioventricular, pulmonary, and aortic orifices
 Left and right fibrous trigons

 Atria - receiving chambers of the heart

 Receive venous blood returning to heart
 Separated by an interatrial septum (wall)
 Foramen ovale - opening in interatrial septum in fetus
 Fossa ovalis - remnant of foramen ovale
 Each atrium has a protruding auricle
 Pectinate muscles mark atrial walls
 Pump blood into ventricles  Heart valves ensure unidirectional blood flow through the heart
 Blood enters right atria from superior and inferior vena cava  Composed of an endocardium with a connective tissue core
and coronary sinus Two major types:
 Blood enters left atria from pulmonary veins
 Atrioventricular valves
Pag atrium mag pump, aortic and pulmonary valve mag close  Semilunar valves
 Ventricles are the discharging chambers of the heart  Atrioventricular (AV) valves lie between the atria and the
 Papillary muscles and trabeculae carneae muscles mark ventricles
 ventricular walls  R-AV valve = tricuspid valve
 Separated by an interventricular septum  L-AV valve = bicuspid or mitral valve
 Contains components of the conduction system  AV valves prevent backflow of blood into the atria when
 Right ventricle pumps blood into the pulmonary trunk ventricles contract
 Left ventricle pumps blood into the aorta  Chordae tendineae anchor AV valves to papillary muscles of
ventricle wall
 Thicker myocardium due to greater work load
 Prevent prolapse of valve back into atrium
 Pulmonary circulation supplied by right ventricle is a much
 Semilunar valves prevent backflow of blood into the ventricles
low pressure
 Have no chordae tendineae attachments
 system requiring less energy output by ventricle
 Aortic semilunar valve lies between the left ventricle and the
 Systemic circulation supplied by left ventricle is a higher-
aorta
pressure system and thus requires more forceful
contractions  Pulmonary semilunar valve lies between the right ventricle and
 Left Ventricle pulmonary trunk
 Its wall is three times thicker than that of right ventricle  Heart sounds (“lub-dub”) due to valves closing
 One inlet – left atrioventricular orifice “Lub” - closing of atrioventricular valves (systolic) (ventricles pumps)
 One outlet – aortic orifice
 Two parts divided by anterior “Dub”- closing of semilunar valves (diastolic) (atrium pumps)
 cusps of mitral valve
 Inflow tract – rough walls
 Outflow tract – aortic vestibule smooth area leading to
aortic orifice
  Sinoatrial (SA) node sets the inherent rate of contraction
Tricuspid valve Ecg/ekg – electrocardiogram

 Guards right atrioventricular orifice Eeg – electroencephalogram

 Three triangular cusps: anterior, posterior and septal, the
base of cusps is attached to fibrous ring surrounding the
atrioventricular orifice

Chordae tendineae － fine, white, connective tissue cords, attach

margin of cusps to papillary muscles

Mitral valve

 Guards left atrioventricular orifice

 Two triangular cusps – anterior and posterior with Similar
structures to those of right

Pacemaker

SA node>AV node>Bundle>Purkinje Fibres>Pump

 Innervation
 Heart rate is altered by external controls
 Nerves to the heart include: Visceral sensory fibers
 Parasympathetic branches of the vagus nerve
 Sympathetic fibers – from cervical and upper thoracic chain
ganglia

Red = arteries

Blue = veins

Conducting System of the Heart:

Cardiac muscle tissue has intrinsic ability to:

 Generate and conduct impulses

 Signal these cells to contract rhythmically

Conducting system

 A series of specialized cardiac muscle cells

Afferent nerves – relating messages to the brain (dorsal part of the BLOOD FLOW
spinal cord)

Efferent nerves – relating signals to the organ

Sinoatrial node (SA node)

 Called the pacemaker cell (P cell)

 Located at the junction of right atrium and superior vena
cava, upper part of the sulcus terminalis, under the
epicardium

Atrioventricular node (AV node)

 Located in the lower part of interatrial septum just above

the orifice of coronary sinus, under the endocardium
 Lower part related to membranous part of interventricular
septum

Atrioventricular bundle (AV bundle)

Disorders of the Heart
 Passes forward through right fibrous trigon to reach inferior
border of membranous part  Coronary artery disease
 Divides into right and left branches at upper border of  Atherosclerosis – fatty deposits
muscular  Arteriosclerosis - hardening of the arteries
 part of interventricular septum  Angina pectoris – chest pain
 Myocardial infarction – blocked coronary artery
Major Vessels of the Heart:
 Silent ischemia – no pain or warning
Vessels returning blood to the heart include:  Fibrillation - irregular heart beat; may occur in either atria
or ventricles
 Superior and inferior venae cavae
 Open into the right atrium Enlarged heart – boot shaped in xray
 Return deoxygenated blood from body cells The vasa vasorum is a network of small blood vessels that supply
Coronary sinus the walls of large blood vessels, such as elastic arteries (e.g., the
aorta) and large veins (e.g., the venae cavae). The name derives from
 Opens into the right atrium Latin 'the vessels of the vessels'.
 Returns deoxygenated blood from heart muscle (coronary
veins) Vibrissae

Right and left pulmonary veins

 Open into the left atrium

 Return oxygenated blood from lungs

Vessels conveying blood away from the heart include:

Pulmonary trunk

 Carries deoxygenated blood from right ventricle to lungs

 Splits into right and left pulmonary arteries

Ascending aorta

 Carries oxygenated blood away from left atrium to body

 organs

Three major branches

 Brachiocephalic
 Left common carotid, (posterior vertebral)
 Left subclavian artery