CARDIOVASCULAR SYSTEM

ACHMAD AMINUDDIN
 PERICARDIUM

• FIBROUS PERICARDIUM.
• SEROUS PERICARD
– PARIETAL LAYER lines fibrous pericardium.
– VISCERAL LAYER become outermost layer of
wall of heart – the epicardium.
• PERICARDIAL CAVITY.
 HEART
• WALL OF THE HEART
– EPICARDIUM.
– MYOCARDIUM.
– ENDOCARDIUM.
• FOUR CHAMBER
– ATRIA - receiving chamber.
• Right.
• Left.
– VENTRICLES - discharging chamber.
• Right.
• Left.
 THE FIBROUS SKELETON OF THE
HEART
• KEEP THE ORIFICES OF THE A.V AND
SEMILUNAR VALVES PATENT.
• PROVIDES ATTACHMENTS FOR THE
LEAFLETS AND CUSPS OF THE VALVES.
• PROVIDES ATTACHMENTS FOR THE
MYOCARDIUM.
• FORM AN ELECTRICAL INSULATOR.
 THE APEX OF THE HEART
• Isformed by the inferolateral part of the left
ventricle.
• Lie posterior to the 5th intercostal space in
adults, usually approximately 9 cm from the
median plane.
• Remains motionless throughout the cardiac
cycle.
• Is where the sounds of mitral valve closure are
maximal ( apex beat )
 THE BASE OF THE HEART
• Is the heart ‘ s posterior aspect.
• Is formed mainly by the left atrium, with a
lesser contribution by the right atrium.
• Faces posteriorly toward the bodies of
vertebrae T6 – T9 and is separated from
them by the percardium, oblique
pericardial sinus, esiphagus and aorta.
• Extend superiorly
 THE BASE OF THE HEART

• Extends superiorly to the bifurcation of the

pulmonary trunk and inferiorly tothe
coronary groove.
• Receives the pulmary veins on the right
and left sides of its left atrial portion and
the superior and inferior venae cavae at
the superiror and inferior ends of its right
atrial portion.
 THE FOUR SURFACES OF THE
HEART
• ANTERIOR ( STERNOCOSTAL ) SURFACE
- formed mainly by the right ventricle.
• DIAPHRAGMATIC ( INFERIOR ) SURFACE
- formed mainly by the left ventricle and
partly by the right ventricle.
• RIGHT PULMONARY SURFACE
- formed mainly by the right atrium.
• LEFT PULMONARY SURFACE
- formed mainly by the left ventricle.
 THE FOUR BORDERS OF THE
HEART
• RIGHT BORDER
- the right atrium and extending between
the SVC and the IVC
• INFERIOR BORDER
- mainly by the right ventricle and slightly by the
left ventricle.
• LEFT BORDER
- mainly by the left ventricle and slightly by the
left auricle.
• SUPERIOR BORDER
- formed by the right and left atria and auricles
 RIGHT ATRIUM
• FORM THE RIGHT BORDER.
• RIGHT AURICLE
• THE INTERIOR OF THE R. A
– SINUS VENARUM.
– PECTINATE MUSCLES.
– OPENING OF
• S.V.C. I.V.C.
• CORONARY SINUS.
– RIGHT A.V ORIFICE.
– FOSSA OVALIS.
 RIGHT VENTRICLE
• FORM THE LARGEST PART OF THE ANTERIOR SURFACE.
• CONUS ARTERIOSUS – PULMONARY TRUNK.
• TRABECULAE CARNEAE.
• SUPRAVENTRICULAR CREST.
• RIGHT A.V. ORIFICE.
• TRICUSPID VALVE
• INTER VENTRICULAR SEPTUM
– MEMBRANOUS PART.
– MUSCULAR PART.
• SEPTO MARGINAL TRABECULA
– CARRIES PART OF THE RIGHT A.V. BUNDLE.
 THE PULMONARY VALVE
• AT THE APEX OF THE CONUS ARTERIOSUS.
• AT THE LEVEL OF THE LEFT 3rd COSTAL
CARTILAGE.
• THREE VALVES
– ANTERIOR.
– RIGHT.
– LEFT.
• PULMONARY SINUS.
 LEFT ATRIUM
• FORM MOST OF THE BASE OF THE HEART.
• LEFT AURICLE
– FORM THE SUPERIOR PART OF THE LEFT BORDER
OF THE HEART.
– ITS WALL TRABECULATED WITH PECTINATE
• INTERIOR
– PECTINATE M.
– PULMONARY VEINS.
– INTER ATRIAL SEPTUM.
– LEFT A.V. ORIFICE.
 LEVT VENTRICLE
• FORM THE APEX OF THE HEART.
• INTERIR
• ITS WALLS THAT ARE TWO TO THREE TIMES
AS THICK AS THAT OTHE R.V.
• TRABECULAE CARNEAE.
• PAPILLARY M
– ANTERIOR – POSTERIOR.
• AORTIC VESTIBULUM –AORTIC ORIFICE.
• CUSPS OF THE AORTIC VALVE
– RIGHT – POSTERIOR – LEFT.
 MITRAL VALVE

• HAS TWO CUSPS

– ANTERIOR – POSTERIOR.
– TENDINOUS CORD –PAPILLARY M.
• LOCATED POSTERIOR TO THE STERNIM
AT HE LEVEL OF THE 4 th COSTAL
CARTILAGE.
 THE AORTIC ORIFICE

• AORTIC VALVE
– OBLIQUALLY PLACED, IS LOCATED
POSTERIOR TO THE LEFT SIDE OF THE
STERNUM AT THE LEVEL OF THE 3rd
intercostal space.
• AORTIC SINUS
 AORTIC SINUS

• RIGHT AORTIC SINUS.

– THE MOUTH OF THE RIGHT CORONARY A.
• POSTERIOR AORTIC SINUS
• LEFT AORTIC SINUS
– THE MOUTH OF THE LEFT CORONARY A.
VASCULATURE OF THE HEART
• CORONARY A
– RIGHT CORONARY A.
– LEFT CORONARY A.
• CARDIAC V
– Draining into the CORONARY SINUS.
 RIGHT CORONARY A.

• ARISE FROM THE RIGHT AORTIC SINUS.

• ITS BRANCHES
– SINUATRIAL NODAL BRANCH.
– RIGHT MARGINAL BRANCH.
– ATRIOVENTRICULAR NODAL BRANCH.
– POSTERIOR INTERVENTRICULAR BRANCH.
 TYPICALLY THE R.C.A. SUPPLIES

• THE RIGHT ATRIUM.

• MOST OF RIGHT VENTRICLE.
• PART OF THE LEFT VENTRICLE ( diaphrag
matic surface ).
• PART OF THE I.V. SEPTUM (posterior 3 rd
• THE S.A. NODE ( 60 0/0 OF PEOPLE ).
• THE A.V. NODE ( 80 0/0 OF PEOPLE ).
THE LEFT CORONARY ARTERY
• ARISES FROM THE LEFT AORTIC
SINUS.
• BRANCHES
– ANTERIOR INTERVENTRICULAR BRANCH
• LATERAL BRANCH.
– CICUMFLEX BRANCH
• LEFT MARGINAL ARTERY.
TYPICALLY THE L.C.A. SUPPLIES

• THE LEFT ATRIUM.

• MOST OF THE LEFT VENTRICLE.
• PART OF THE RIGHT VENTRICLE.
• MOST OF THE I.V.S. ( ANTERIR 2/3 ),
THE A.V. BUNDLE.
• THE S.A. NODE ( 40 0/0 )
 MYOCARDIAL INFARCTION
• The three most common site of coronary artery
occlusion

* Anterior IV ( LAD ) branch of the LCA

( 40 – 50 % )
* RCA ( 30 – 40 % ).
* Circumflex branch of the LCA ( 15 – 20 % )
VENOUS DRAINAGE OF THE
HEART
• BY VEINS THAT EMPTY INTO
– CORONARY SINUS, receives blood from
• GREAT CARDIAC V.
• LEFT POSTERIOR VENTRICULAR V.
• LEFT MARGINAL V.
• MIDDLE CARDIAC V ( POSTERIOR I.V. VEIN ).
• SMALL CARDIAC V.
• OBLIQUE VEIN OF LEFT ATRIUM.
– ANTERIOR CARDIAC V
– SMALLEST CARDIAC V
CONDUCTING SYSTEM OF THE
HEART
• THE SINUATRIAL ( S. A ) NODE.
• THE ATRIOVENTRICULAR ( A.V.) NODE.
• THE A.V. BUNDLE.
• SUBENDOCARDIAL BRANCHES.
 THE SINUATRIAL NODE
• LOCATED ANTEROLATERALLY JUST DEEP TO THE
EPICARDIUM AT THE JUNCTION OF THE S.V.C.AND
RIGHT ATRIUM, NEAR THE SUPERIOR END OF THE
SULCUS TER MINALIS.
• A SMALL COLLECTION OF NODAL TISSUE
• THE PACEMAKER OF THE HEART.
• REGULATED THE IMPULSES FOR CONTRACTION
APPROXIMATELY 70 TIMES PER MINUTE.
• SUPPLIED BY SINUATRIAL NODE ARTERY
– R.C.A. ( 60 0/0 ).
– L.C.A. ( 40 0/0 ).
• STIMULATED BY THE AUTONOMIC NERVOUS
SYSTEM.
THE ATRIOVENTRICULAR NODE

• SMALLER COLLECTION OF NODAL TISSUE

• LOCATED IN THE POSTEROINFERIOR
REGIO OF THE INTERATRIAL SEPTUM
NEAR THE OPENING OF THE CORONARY
SINUS.
• STIMULATED BY THE AUTONOMIC
NERVOUS SYSTEM.
THE ATRIOVENTRICULAR BUNDLE

• PASSES FROM THE A.V. NODE THROUGH THE

INSULATING FIBROUS SKELETON OF THE
HEART.
• DIVIDES INTO RIGHT AND LEFT BUNDLES AT
THE JUNCTION OF THE MEMBRANOUS AND
MUSCULAR PART OF THE SEPTUM.
• SUBENDOCARDIAL BRANCHES ( PURKINJE
FIBERS ).
INNERVATION OF THE HEART
 INNERVATION OF THE HEART
• CARDIAC PLEXUS.
– LIES
• ANTERIOR TO BIFURCATION OF THE TRACHEA.
• POSTERIOR TO THE ASCENDING AORTA.
• SUPERIOR TO THE BIFURCATION OF THE
PULMONARY TRUNK.
– AUTONOMIC NERVOUS SYSTEM
• SYMPATHETIC
• PARASYMPATHETIC
 THE SYMPATETHIC SUPPLY
• PRESYNAPTIC
– CELL BODIES ARE LOCATED IN THE LATERAL HORN OF THE
SUPERIOR 5 OR 6 THORACIC SEGMEN OF THE SPINAL CORD.
• POSTSYNAPTIC
– CELL BODIES ARE LOCATED IN THE CERVI-CAL AND SUPERIOR
THORACIC PARAVERTE-BRAL GANGLIA OF THE SYMPATHETIC
TRUNK.
• SYMPATHETIC STIMULATION
– INCREASE HESRT RATE.
– INCREASE IMPULSE CONDUCTION.
– INCREASE FORCE OF CONTRACTION.
– INCREASE BLOOD FLOW ( B2 RECEPTOR ).
 THE PARASYMPATHETIC SUPPLY
• PRESYNAPTIC FIBERS
– FROM THE VAGUS N.
• POSTSYNAPTIC CELLS BODIES
– LOCATED IN THE ATRIAL WALL AND INTER ATRIAL SEPTUM NEAR THE
S.A. AND A.V. NODES AND ALONG THE CORONARY ARTERIES.
• POSTSYNAPTIC PARASYMPATHETIC FIBERS
– RELEASE ACETYLCHOLINE, WICH BINDS WITH MUSCARINIC
RECEPTOR.
• STIMULATION
– SLOW THE HEART RATE.
– REDUCE THE FORCE OF THE CONTRACTION.
– CONSTRICS THE CORONARY A.
– SAVING ENERGY BETWEEN PERIODS OF INCREASED DEMAND.
SURFACE ANATOMY OF THE
HEART
 AXILLARY ARTERY
• The first part of the axillary artery -
between the lateral border of the first rib
and the medial border of the pectoralis
minor.
- enclosed in the axillary sheath.
- branch : the superior thoracic artery.
• The second part of the axillary artery
- posterior to the pectoralis minor
- branches : the thoracoacromial artery
the lateral thoracic artery
 AXILLARY ARTERY
• The third part of the axillary artery
- from the lateral border of the pectoralis
minor to the inferior border of the teres
major.
- branches : the subscapular artery
the anterior circumplex humeral a
the posterior circumflex humeral a