ANATOMY AND PHYSIOLOGY

OF
CARDIOVSCULAR SYSTEM






TYPES OF MUSCLE
 ~ 5,5mld cardiomyocytes HEART MUSCLE SYSTEM
(10-20µm x 50=100µm)


three layers: 

- longitudinal, 

- circular 

- transverse


Sceletal system connecting
ventricular and atrial muscle

Heart muscle „tape - like” – helix

surrounding heart chamber

✓ One single heart fiber shortened about 20%, during systole

✓ 3 – layer 3 – direction of systole of the LV
✓ LV during systole eject 60% of end diastolic volume

 Anatomy of mitral valve

During systole of LV thrue

mitral valve 50–100 ml of
blood.

Normal opening mitral valve

area 4–6 cm2.

Low pressure with low

gradient 4 – 6 mmHg mm

 Anatomy of aortic valve

Normal Aortic consist

3 semilunar leaflets:
Left coronary
Right coronary
Non-coronary

Normal opening area 3–4 cm2

Normal Aortic pressure

< 12 mm Hg.



 Anatomy of tricuspid valve

3 leaflets:

Anterior ATL
Posterior PTL
Septal STL
+
additional 8 in total.

 Anatomy of main pulmonary artery MPA

Three leaflets:

Anterior,
Right
Left

 Conducting system of the heart

Sino – atrial node - „pacemaker”

Spontaneus electric impulses
60-100/’

A-V fascicle
Conducts impulses
Atrio – ventricular node thrue sceleton of the
slower electrical potential 40-60/’ heart – velicity: ~2m/
sec

Right and left bundle of His

conducts electrical impuls
to the heart muscle

Włókna Purkinjego:
Conducting velocity ~4m/sec
: 20-40 BPM

 70%
95%

15-30/4-12mmHg 75%
72%
2-15mmHg 95%
3–8mmHg
75%
80%
95%
100-140/
15-30/
3-12mmHg
3-8mmHg 75%
 Autonomic system of the heart
Sympathetic
(C8) Th1-Th4 (Th5).

Left trunk affects ventricles

Right trunk affects left and right
atrium and S-A node

Parasympathetic – vagal
nerw:

Affetts S-A node, A-V node ,

atrial muscle

 PHYSICAL EXAMINATION
Diagnostic
Steps SYMTPOMS

of cardiovascular CHEST PIN

PILSE ON THE CHEST WALL
DYSPNOE
system OOEDEMA
ASCULTATION
VASCULAR PALPATION
ARRYTHMIA
SYNCOPE

ECHO

 PULSE PALPATION

BILATERAL:
CAROTID ARTERIES , FEMORAL, POPLITEAL
.

BLOOD PRESSURE

Normal value : <135/85 mmHg

Bordeline 140/90mmHg
In aortic regurgitation: diastolic < 40 mmHg
Pulse pressure : Systolic – diastolic pressure 40 – 50 mmHg

 HEART ASCULTATION
I tone – closure of atrio – ventricular valves
II tone – closure of aortic and pulmonic valve

II right intercostal II left intercostal

IV–V right intercostal

V left intercostal

 SYSTOLIC MURMUR DIASTOLIC MURMUR PERMAMENT MURMUR

❑ Aortic steosis ❑ Aortic regurgitation ❑ Persistent ductus

❑ MPA stenosis ❑ Pulmonary regurgitation arteriosus - Botall
❑ Mitral insufficiency ❑ Mitral stenosis (PDA)
❑ Tricuspid insufficiency ❑ Tricuspid stenosis ❑ Combined congenital
❑ Ventricular septal defect valve disease
(VSD)
❑ Atrial septal defect (ASD)
❑ Hypertrophic cardiomyopathy
(HCM, )
 PATOPHYZJOLOGIY OF FEW DISEASES
OF
CARDIOVASCULAR SYSTEM




 HEART DISEASE
CORONARY
DISEASE CARDIOMYOPATHY
ARRYTHMIA - DILATTIVE
CONDUCTING - HYPERTROPHIC
DIS.
- RESTRICTIVE

PROGRESIVE HEART
VALVULAR DIS.
FAILURE ENDOCARDIAL DIS.:
CONGENITAL,
SUDDEN CARDIAC INFECTIVE
ACCUIRED
DEATH RHEUMATIC FEVER
THROMBO-EMBOLIC
COMPLICATIONS
MYOCARDITIS

NEOPLASM:
PERICARDIAL DIS. PRIMARY,
PERICARDITIS SECNDARY,
TAMPONADE METASTATIC
CONSTRICTIVE PERICARDITIS

 OXYGEN
balance between demand and suplementation
NON-CAD ANAEMIA
VARIANT Mimetics Cardiomyo
CAD: CARBOXY
ANGINA ALFA
ACS HEMOGLOBIN pathy
VASCULITIS BETA
SCD METHEMOGLOBIN
HCM
VALVES AMPHETAMINA
MI DISEASE Takotsubo
SMALL VESSEL










 NEW DEFINITION OF MYOCARDIAL INFARCT ESC (2018)
Type 1 MI ---- DIAGNOSIS:
rupture of Type 5
atheromatic SIGNIFICANT ELEVATION OF TROPONIN LEVEL > connected
plaque with CABG
+

• ACUTE ISCHEMIC SIGNS – chest pain during exercise or stress !!

❖ NEW CHANGES IN EKG: pathologic Q wave , elevation of ST

Type 4
❖ new regional contractile dysfunction in ECHO connected
Type 2 PCI
abnormal balance ❖ Thrombus in coronarography or autopsy !!!.
of demand and
suplementation SEVERE NARROWING OF ATHEROMATIC PLAQUE
SPASM OF CORONARY VESSEL Type 3
sudden death
DISSECTION OR THROMBOEMBOLIC MATERIAL with typical
signs of
INBALANCE BETWEEN SUPLEMENTATION AND DEMAND OF O2 ( SEVERE ANAEMIA !)
myocardial
infarct….












Classification of chest pain:

According to Diamond, mod. ESC 2006
TYPICAL STENOCARDIA 3 factors:
1. Dyscomfort near sternum with typical duration
2. Connected with physical activity or stress
3. Usually disapear with rest or NTG
administration
ATYPICAL STENOCARDIA – PROBABLE : 2 out of 3
factors
NON TYPICAL PAIN in chest : only 1 factor….

Canadian Coronary Syndrom – CCS

according to Canadian Cardiovascular Society
Class I : long severe exercise

Class II : low level of exercise (> 200m, steps…)

Class III : limited physical activity (100-200m, I floor )

Class IV : every acivity – physical or at rest - indication to HOSPITALIZACTION AND

CORONAROGRAPHY

 CORONARY DISEASE

Stable
coronary
disesse

AC
CO UTE
RO
NA
Y R
SYN
✓ HISTORY RISK FACTORS ; PHYSICAL EXAMINATION D RO
M
✓ DIAGNOSTIC METHODS : EKG, ECHO, EXERCISE TEST, DOBUTAMINE
✓ farmacological treatment : 2Aspirin, ACE blokers, B – blokers Statin
ISCH
✓ INVASIVE TREATMENT : PCI, CABG KARD EMIC
IOM
✓ TREATMENT OF HEART FAILURE YOP
Y ATH
✓ Electrotherapy: ICD, CRTD, pacemaker
✓ Rehabiltation

 AORTIC STENOSIS

Valve area [cm2] Maximum aortic velocity [m/s] Mean pressure gradient [mmHg]
mild 1,5-2,0 2,5-3,0 <25
moderate 1,0-1,5 3,0-4,0 25-40
severe 0,6-1,0 >4,0 >40
critical <0,6
 ✓ THE MOST OFTEN VALVE DIS.,
AORTIC STENOSIS ✓ 2-7% population after 65.
years
✓ degeneration the same –
atheromatosis calcification,
restriction of mobiity :
❑ hypertension
❑ diabetes
❑ hyperlipidemia
❑ obesity
❑ smoking
❑ Renal failure
❑ Hyper parathyreosis

 SEVERE AORTIC stenosis AS

STENOCARDIA:

SYNCOPE

SUDDEN CARDIAC DEATH,

ARRYTHMIA
DYSPNOE, OEDEMA


 Ethiology
AORTIC REGURGITATION (AR)
✓ Marfan syndrom – enlarged
ascending aorta > 5 cm !! n= 3,8
cm.

✓ DISSECTION OF ASCENDING
AORTA.

✓ BICUSPID AO. VALVE -2%

population , mainly in men.

✓ Infective endocarditis

✓ Rheumatic disease

 PHYSICAL EXAMINTATION IN AR

Blood pressure:
Low diastole !!
High pulse
pressure
Ex :140/40 – O!!
mmHg

 MITRAL REGURGITATION ( MR )
PRIMARY
• DEGENERATIVE
✓ (INFECTIVE ENDOCARDITIS , RHEUMATIC
FEVER )
✓ MITRAL VALVE PROLAPS…
= Barlow syndrom ……. myxomatous
degeneration

SECONDARY
REMODELING OF THE LV, AFTER
MYOCARDIAL INFARCT:
✓ DILATATIVE CARDIOMYOPATHY

 CLINICAL PICTURE OF MR

✓ LONG TIME WELL TOLERATED

✓ FATIGUE

✓ PALPITATIONS (AF)

✓ PERIPHERIAL EMBOLI

✓ ENLARGED LV - DYSFUNCTION

✓ RV DYSFUNCTION –
PULMONARY HYPERTENSION

 PRIMARY TRICUSPID REGURGITATION - TR

PRIMARY - RARE – AFECTING VALVES

✓ RHEUMATIC FEVER
✓ Infective – drug abuse !!!!!!
✓ CARCINOID
✓ TRAUMA

SECONDARY –
• TOGETHER WITH LV DYSFUNCTION
• MR,
✓ MS
✓ 1 - PULMONARY HYPERTENSION