Anatomy Lecture #4 (Cardio)

Question 1

History of Heart Shape

Answer 1

The cartoon heart shape was a decorative design in the past (unclear if it symbolized love in the begining)

Had hearts in a Code of Arms image - don’t know it the hearts were asociated with love/affections

Later - have a letter that expressed love that had an upside down heart –> first indication of heart being used for love
- Upside down heart has a shape similar to real heart
- Have movement for heart to be connected to love

Victorian times –> heart was used to symbolize love (used in valtentines crads)

Question 2

History of Anatomy (Galin)

Answer 2

Galin - observer of anatomy –> his ideas were maintained for 1700 years (was the gold standrad)
- Was good because promoted excimtment but also hindered because all of medicine used his ibservations

Galin = first to say the heart was the soul (creates connections and love)

Galin = Thought the arteries were fillied with air (because mostly saw vessles in dead animals/people where the vessels were exposed –> arteries would evacuate the blood
- No blood in arteries but had blood in veins (because veins walls are more flexible) = Galin thought this is how it is when alive

Question 3

History of Anatomu (Servatus)

Answer 3

Servatus wrote a treatus on cataholsism + talked about anatomy + astronolmy (all together because hard to publish)
- Talked about circulatory system in Treatus

***He was burned in spain for treatus because he dissed catholism

Question 4

Galin vs. Servatus

Answer 4

Galin = herat is the exchaneg between air and blood (No blood in arteries; blood in veins)

Servtus = thought heart is pump and blood fills both arteries and veins
- Explains pulminary circut (blood goes to the heart and body + said blood goes to lungs where there is an exchnage occuring)

Question 5

Anatomy History (Harvey)

Answer 5

Physician in england (observer of human body)

Overall: Pushed idea of circulatory system

He put tornaque on limbs and saw the veins negorge (saw blood going into the limb (when put tornaque on saw blood can go in but it could not go out)
- Veins = superficial = blocked BUT the arteries were not blocked
- When veins engorged = saw bulbus area –> saw there are valve (first to descrive venous valves)

Question 6

Answer 6

Left (showing Anterior to posterior)
- See corany artery on surface
- Covered with epicardial fat

Right (showing posterior to anterior)

Question 7

Heart Overall

Answer 7

Heart = Muscilar pump
- Weighs ~1 lb

Pumpes 1.5 gallons of blood/minutes ;
Pumoes to to 5 gallons of blood/minute during excersize
Adults = have 4-5 quarts of blood
takes 1 miniues for the blood to circulate (1 minute to return to heart from extremities)

Question 8

Cardiomegly

Answer 8

Bigger heart (heart is working harder)

Question 9

Heart beats

Answer 9

Averrage resting heart rate = 72 (higher in women)

Means 1440 beats/min –> 104,000 beats per day –> 37,325,000 beats per year –> 2.8 billions beats over teh course of 90 years

***During meditations can get heartrate to 40-50

Question 10

Reserach on nutritiant + longevity

Answer 10

Reserach showed that organisms with slower Hearteates live longer than organisms with higher heart rates (Numver of heart beats coorelates with longevity)
- Faster heart rates = using up heart beats in lifetime
- Want to decrease HR to increase lifespan
- Doing excersuze decreases resting HR = increases longevity

HR is a factor of mortality – resting HR = independent prediction of cardiovascular mortality

Question 11

Circulatory networks

Answer 11

1. Systemic
2. Pulimary
3. Portal

Question 12

Systemic circulatory

Answer 12

Getting blood out to periphery + taking used blood from tissue to hear

Includes - Head/neack + upper limbs + body wall + pelvis + lower limb + lymph nodes

Image - blue highlighted = part of system

Question 13

Pulimary Circut

Answer 13

Takes blood from the heart to the lungs
- Drops waste out of blood + gets oxgen

Going from heart –> lungs –> heart etc.

Question 14

Portal Circut

Answer 14

Blood of the intestins drain through the liver –> liver has capilary netowkr –> network will bring blood (conatins nutreients) from intestine to liver to be broken down and metabolsized –> once metabolized the blood will go to the inerfior vena cava and go to the right side of the heart
- Not used arterial/venous capilaries
- Not taking oxygen out of blood BUT the liver takes some oxygen from the bloood but MOST of teh oxygen will be taken in the systemic (joins the systemic circut in the inferior vena cava)
- Blood goes to diegstive system –> gets nutrients –> metabolizes the nuerteints using the protal curcits –> stored

Function - take the blood to be metabolized
- Uses Liver + Intestinal tract

Question 15

What does the Portal system affects

Answer 15

Affects the dosage and way that you can take certain medications

Question 16

Ibeprofin

Answer 16

Kindey = metabolized ibeprofin

Ibeprofin = foes to the systemic circut where it is able to work THEN –> goes to the kidneys –> kidney will filter the blood

Question 17

Tylanon

Answer 17

Metabolized in the liver

Tylonal = absorbed through the digestive –> goe sinto the portal system –> takes the tylonal form the blood to the liver –> liver metabolizes the tylonal = tylonal s metabolized fatser because it is going straight to the liver
- To get dosage = need to see how much is metabolized by the liver (not all of it will be some will go to the body and work)

Question 18

Nitroglycin

Answer 18

Certain drugs can’t be taken orally (Ex. Nitroglycin - used for heart issue; can jump start the heart)

Nitroglycin = If goes to protal system = fully metabolized by the liver = when it is taken orally it is fully netabolized

Soution = put a tablet under tongue = oes to blood trasnmucosuly –> eventually it will be metabolized b the liver BUT not during the first pass

Question 19

Remdenovear

Answer 19

Antiviral medication - taken via ijections or IV (rarly but sometimes transmucosuly) –> can’t take it orally because the protal system would fully metabolize it

Question 20

Space in the body

Answer 20

There is not a lot of space in the body
- There could be some space under the liver or gut BUT it is usually filled with fat or fluid
- Lungs around heart pretty tight

Question 21

Where is the heart (genrally)

Answer 21

Heart is located between the lungs (In the midline)
- Apex = pointed part at the bottom (points to left)
- Apex = usually at level of xyphoid process
- Base = upper part (geeat vessels come and go form the base)

In center of lungs = have media stinem - sock of tugh tissue –> goes to the diaphram (CHECK THIS)

Heart = sits on diaphram

Question 22

Diaphram

Answer 22

Musclular floor of thoraci cavity/ roof of abdominal cavity

As breath diaphram comes up and down - big part of breathing

Question 23

Heart vs Sternum

Answer 23

Heart = lower part of he sternum

Above the heart = have the clavicles + great vessles
- Great vessles = right behind the sternum (at the base of top of heart)

Question 24

Thoracis vs. Abdomincal cavity

Answer 24

Thoracis cavity = seperate from abdominal cavity

Peretinium = covering of abdonmial cavity

Abdomonal + thoraci cavites = surrounded by tissue
- Only connection ebtween the 2 cavities is the hiatus (asophogus goes to the sternum) ; only communication between the abdomen and thoracic cavities

Question 25

Division of thoracis cavity

Answer 25

Divided into three parts: 1. Left lung 2. Right lung 3. Media stinum - suspended sock of issue in which heart is housed (not tightly fixed = heart can move)

Question 26

Developing CPR

Answer 26

William Kowheven + Knickbocker + Jude developed CPR They noticed when they were putting electrical leeds on test subjkects the blood pressure increased --> they wanted to replicate this - When compress chest to put electrodes on = change volume = chnage pressure in chest --> means that when press on heart = compress heart = mimics pumping of blood = made CPR

Question 27

Answer 27

Axial section Blue circle = heart Black line at top = Sterum Top circle under heart = Asophygus To right of asphogus = thoracis aorta --> arches to the left and goes behind the heart

Question 28

How to do CPR

Answer 28

One person doing it - 15 compressions and 2 breaths Two people doing it - 5 compressions and 1 breath New guidlines = can do CPR without respitory --> because have enogh oxygen in blood to keep tissue viable BUT if doing CPR for longer time = need to strat doing respirations because oxygen is being used (after 21-25 minutes) - BUT if dorwning/if doing CPR on child/if drug iverdose = need to always do respirations Speed of compresions = "staying alive" beat

Question 29

CPR story

Answer 29

Rini and dad were driving to clevland --> sw cars were pulled over --> they pulled over and saw there was a guy on the ground ---> the guy had. aherat attck --> rini and dad started to do CPR (rini did chest and dad did respirations) --> highw ay potrol came + ambulence came --> guy survived - Dad had a hankerchif and put on mouth of guy Rini now carried around kit to do respirations (got from lifeguard son)

Question 30

Right vs. left side of heart

Answer 30

Right side of heart - gets deoxygenated blood from body

Question 31

Blood Circulation

Answer 31

Right side gets deoxygenated blood from body - suprioir vena cava takes the blood from the heads and the upper limbs ; Inferor vena cava takes the blood from the legs and the tourose + takes blood from the portak vein that has been metabolized BOTH vena cavas dumps the blood into the the right atrium --> contraction of the upper peart of the heart pushes the blood into the right ventricle --> blood goes through the puminary trunk ---> blood goes to the right and left pulminary artery --> blood goes to the lung AFTER lungs (exchnage in aveoli) --> pulminary vein bring sblood into the heart --> blood goes to the left atrrium --> atrium fire --> blod goes to the left ventrcile --> left ventricle puts the blood to aorta --> blood goes to the body

Question 32

Thickness of heart wals

Answer 32

Right atrium - thin Right ventrcile - tocker than right atrrium Left ventrcile - thickest wall --> because putting blod througha small vessle = need lots of power = need strong pump = thick walls in ventrcile

Question 33

Artery vs. vein

Answer 33

based on flow from heart - Arteries = blood away from heart (usually oxygenated) - Veins = blood towards heart (blood returning to the heart) Pulmary artery - artery even though dexygentaed

Question 34

Aorta gives rise to

Answer 34

Vessles in aorta give rise to subclavical arteries + brachial arteries

Question 35

Purpose of heart valves

Answer 35

Letting the blood through and making sure the blood does not regergitate (doesn't flow back through) When the heart relaxes after it pumps = create snegative ressure = could pull blood back BUT the valve stops this

Question 36

Valves in the heart

Answer 36

Tricuspid (has 3 leaves) - between the Right atrium and Right ventricle Biscupid (aka mitral valve) = between the Left Atrium and the Left ventricle - Bishops wear and miter (looks like mitral valve) Pulimary valcle = at the base of the pulminary trunk - Weakest of the valves (because have less resistence in the lungs = blood is not trying to flow back = weakest) Aortic valve (aka semilunar valvle) - Have lots of pressure going through the valve

Question 37

Valve replament

Answer 37

Image - shows an early replacment - Circle = Annulice = this annulice is sutured around the natural annulice in the valve --> when blood goes past the valve the ball hits the cage = the ball is against the cage if the blood tries to regergitate = blood cam't regergitate - Issue with eraly valves = very audible Newer valves = like flaps -- look like natural valve

Question 38

Rini Uncle Story

Answer 38

Rinis uncle was a very eraly recepient of a pig heart valve --> lasted longer than expected - He had to take antirejection meds for a while but he was weened off of them

Question 39

Chordae tendinae

Answer 39

Stringy looking tissue that connect to the wall of the heart and valves (connectoin between pailary muscles and send cords to valves) - Part of opening and closing affect on valves

Question 40

Trabecular carnea

Answer 40

Muscular surface of the inside of the heart - part of wall of the heart

Question 41

Papillary muscle

Answer 41

Pulls leaflets of the valcles to functions

Question 42

TAVR

Answer 42

Transcathertirc aortic valvle replacment Past - did an invasive surgery to replace the valavle (had to open the heart --> stop the heart --> go on bypass --> open aorta --> get out diseased vlave --> suture in new valve Now - use TAVR - done thorugh catheter --> insert catheter in leg or subclavian into aorta --> inflate balooon to hold the artery open + in a second area use deploy new valve - All through the vessles (not openning the heart) - dont cut out old valave they just push it out

Question 43

Aortic valve

Answer 43

Side veiw - has leaflets = like a sack - Curve of leaflets goes with the flow of the blood Image - looking down wiards heart in the leaflet - have 2 openings going to the corated artery - Corany arteries are tucked low in the aorta (inside where the valve is) - come out of level of the valve

Question 44

Pericordium

Answer 44

Covering of the heart Fiberous peracardium --> Serious percardium --> Visceral peracardoium (epicardium) --> myocardium --> Endocradium

Question 45

Fiberous peracardium

Answer 45

Top layer of the Peracardium (Layer around the heart) Looks like Dura/Fassa Makes up the 'sock' of the medial stinum Not touching heart there is a space underneath it Based on the diaphram Connections betwene pareintal paracardium and the lining of the chest cavity (thoracic lining) --> come togetehr and forms the foberous peracardoim

Question 46

Serious percardium

Answer 46

Second layer of teh Percardium Secretes serious fluid = decreases friction around teh heart --> fluid + layers of seruous slide on surfaces vecause if space = less friction Divides to Peracadrial Space + Pariteal Percardium + Vsiceral pericardium Sereous percardium = turns on itself and joins Heart exits the covering through the great vesslves Covering ends supriory

Question 47

Peracardium space

Answer 47

Filled with serous fluid - allows heart to beat and move in the media stiunum

Question 48

Peracardits

Answer 48

Infection in space in serious peracrdium = get inflamatory response = increase white cell counts --> adds friction to beating of heart

Question 49

Pariteal Percardium

Answer 49

Covering of the heart - Outter intermeidate wall - Protexts the heart Comes into contact with the fiberous percardoum Joins with the toracic lining to form the fiberous paracerdium Stops and turns on itself and get the coverings of the vessels (stops on area on great vessles where it reflexes on itself)

Question 50

Visceral peracardoium (epicardium)

Answer 50

Outter wall of heart proper (right on the heart; surface of the heart) Similar to the piamoter can't dissect away Opens to the sereous space

Question 51

Layers of the Visveral percardiums

Answer 51

Epicardum (outter) - becomes the lining of the inside of the vessels Mycodcradium - musclarlar layer (heart muscle) Endocardium - inner lining of the heart Layers of the heart itself

Question 52

Cardiac tempenad

Answer 52

After trauma = Percadiial space can fill with blood --> blood crowds the heart --> impedes on the hearts ability to expand and contract Example - occurs after stab or gunshot or accdient or issue in surgery

Question 53

Answer 53

Yellow lin next to SVC = frenic nerve --> goes to the diaphram = regulates breathing - Comes from C2/C3 = high in neck - Polio = affects the frenic nerves = kids used iron lungs See recurent larengeal - goes under the aorta - goes to the larynx See Ducto arelerosa Bottom = diapgram

Question 54

Legamentam arteriousum

Answer 54

Connection between arterial and venous blood in fetus Closes within minutes of birth

Question 55

Hole in septum

Answer 55

Septumus valley - mixed bloodin fetal circulartion --> if it doesn't close = might need to do surgery to fix

Question 56

Dr. Motts Story

Answer 56

Dr. Motts used to talk to med students and would tell a story that he had a pateints with ____ --> needed to close the hole = he needed t use fossa but he didn't wnat to use something from the body he was having dinner and saw the rubber things that they use to ppen lids --> he wanted to use that --> he autoclaved it and expreimented --> talked to a manufacter and made it to use NOW this would take 5 years to do with the FDA but at the time it took weeks

Question 57

Answer 57

Line a the base of heart = fiberous peracardeium

Question 58

Sinual Atriual (SA) node

Answer 58

Uper medial surface of the Right atrium Functon - pacemaker of the heart --> makes the aorta contract --> ushes blood through valves to the ventrciles Nerve impulses goes down = delays then fires the AV node and disrubutes in the ventricle --> ventrciel contracts - Pause when AV node and when ventrciles fire - as ventrcile pushes blood = gives the atria a chnace to fill with blood as SA node recharges Controled by Parasympathetic

Question 59

AV node

Answer 59

Futher down from the Right atrium

Question 60

Blood supply to the heart itself

Answer 60

Blood is rushing through the heart but the heart doesn't access that blood Heart muscles and the covering of the heart are profused by vessles on the surface of the heart - Profused by the right coranry oartery and the left coranary artery (both come from perferastions in the aortic valve) Right coranry --> righy marginal --> right deceding - Right cornary comes down and comes aorund from the back goes down to an appendage by the aorta - Sends right marginal branch and then comes down to posterior decending Left - perferations of the aorita --> left coranary --> cicumfelx branch of left cornary (goes to back of heart) --> left marginal --> left anterior interventricular branch (Left anterior decding) --> left - Most common plae to have coranary artery bypass (worse one to have blocked vecayse feeds the left ventrcile)

Question 61

Left circumfelx

Answer 61

Left circumfelx = comes off the LAD - feeds the back of the heart KNOW major branches

Question 62

Blocked vessles

Answer 62

To treat you have to bypass the blocked vessels (Ex. 80% block of LAD) Can use the saphanoid vein --> suture the vein shut in leg --> bring to chest cavity --> suture vein from one side of bloackge to ther other --> shunts over the bloackage (leave the blockage) - Use graft to jump it - Use interval ___ artery and bring down distally to blockage - Use angiogram to see blockage NEW surgery = put catheter through groin --> put in heart --> put in vesslve --> deloy baloon with cage around it --> delfate the baloon --> leaves the cage --> cage pushes the spot open

Question 63

Otto Foreman

Answer 63

German Physician Put catheters into vessels --> his assstant Gerta sisun said she was willing to help him BUt she asked him to do it to her --> he set up and OR and draped her --> Gerta put her arm through --> he wanted to go to radiology to insert the cather and when he removed the drape she saw that he did it to himeself --> they went to radiology and got into his heart His child = also smart -- made lithotriosy (breaks up kideney stones)

Question 64

Back of the heart

Answer 64

Back of the heart = has vessles that go to the corranry sinus On the posterior side of the heart - dumping place for venous blood venous colection from correted = collected in veins --> veins run along with the arteries colllect into posterior surface of the heart - go to corenary sinus - Corenary sinus = made by the covering of the heart - Corenaru sinus = dumps blood into the right atrium

Question 65

Answer 65

Pictre of great vessels BIG RED = arch of aorta vessel --> turns on itself

Question 66

Brachiocephalic trunk

Answer 66

Gives rise to the right subclavian artery and the right common coratoid artery

Question 67

Left common coratoid aterry

Answer 67

Comes right off the aorta (NOT througha brachiocepjalic trunk)

Question 68

Artheriosceosis

Answer 68

Have plaques in vessel (can be in coranry or corated artery) - Mostly in femeral and coroted ateriosis Have a decrease in ability of vesslves Can be a slow process and can intervene If have a blood clot of a peice of plaque breaks off and lodeges elswhere= can have massive heart attck Symptoms = can have dimmersia like chnage if the blood goes to the brain is slower or humbness in limbs To test = take blood pressure on arm and on leg - if there is a big difference = know there is a bloackage

Question 69

Coranary vs. Corrated

Answer 69

Coranry - based at base of aorta - go to heart (feed heart - artery of heart) Coraots - somes off brachiospaharlic trunnk or off arch of aorta on left and go to head

Question 70

What do veins in body have

Answer 70

Veins in body have vlaves to prevent backflow (only in beins because less pressure???) - Blood has to be pushed back to the heart = prevents backflow Where blood goes against gravity = need valves (legs) - have blood under lower pressure going back up and being osuhed weakly = need valves

Question 71

Veracose veins

Answer 71

Valves in the veins brak down OR have a buildup of pressure - Valves don't work = enlarges veins - Can Take vessles it because often have colateral circulation Example - chronic drinkers - have vercosous because have serousous in liver = blocks the portal vein = increases venous pressure = gert vercoious in the nose or in asophogus r in abdome

Question 72

Arterial venous fistula

Answer 72

Happens in people getting dualysis because you connect the artery and the veins = enlrages the vein - Often can handle dialysis but things can go bad (ex if the vein is too enlarged)

Question 73

Plaque buildup in neck

Answer 73

If have plaque build up in neck --> enzie the neck ---> open coroted --> put bypas shunt to keep blood in brain --> scrape away the plaque

Question 74

Pressure points

Answer 74

Stops bleeding Can put pressure on femeral artery --> oushing restrcts the blood but not entriley (safer than a tarnaqute because the teornaqutes can cause cerosis) --> if pressure us effective to stop th ebleeding then it is safer

Question 75

Overview of veins and arteries in body (general layout)

Answer 75

Heart ---> Arch of aorta --> right have brachosophalic trunk and right common corated and then furtehr divides have subclavina and axiallary going to the radial on right Left = same as right but common correted comes wight of the aorata and subclavial comes of seperated Arch of aorta - goe sbehind the heart and goes down to throarci ad then adbmon arota then branch to cmoon inliac then the femeral and supply the leg Veins go up - femeral veins runs right next to femeral nerve --> come together - Internal Illaics come together to form infriror vena cava - dupts to right atrium Right - Sbclavians come in and dump to sueprior vena cava to irght atriums

Question 76

Mammory vessels

Answer 76

Used for bypass surgery