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Heart PDF
Heart PDF
Heart PDF
pulmonary artery
base pulmonary veins
(4 total)
right atrium
(behind and lateral) left atrial appendage
apex
Two Pumps
To Lungs From Lungs
Right Ventricle
Left Atrium
From Lungs
From Body
RV outflow tract
Right Atrium
Right Ventricle
Left Atrium
Left Ventricle
Coronary Arteries
Heart Valves
Conducting System
Myocardium
Parts of the Adult Heart
Coronary Arteries
Heart Valves
Conducting System
Myocardium
Coronary Arteries
Left Right
Left Main
LCx
RCA
LAD
PDA
Major Coronary Artery Supplies
LAD Right CA
~50% of LV 30% LV
RV
LCX
~20% of LV
Posteriolateral LV
Anterolateral papillary
muscle
Coronary Artery Dominance
Whichever of the LCA or RCA gives rise to
the posterior descending artery (PDA) and
posterior lateral artery (PLA) is said to be
dominant.
~70-80% of hearts are right side dominant
~10-20% co-dominant
~10% left side dominant
Coronary Artery Dominance
Right Dominant Left Dominant
LCX LCX
RCA
RCA
Posterior Descending Artery
RV
LV
LAD
Coronary artery angiogram (slice through the ventricles)
Parts of the Adult Heart
Coronary Arteries
Heart Valves
Conducting System
Myocardium
Heart Valves
Anterior
Tricuspid
Septal
Posterio-lateral
Pulmonic Left Right
Anterior
Anterior
Mitral
Left Right
Aortic Posterior
Coronary Coronary
Non-Coronary
Aortic Valve
Coronary Orifice
Mitral Valve
Mitral Valve
Parts of the Adult Heart
Coronary Arteries
Heart Valves
Conducting System
Myocardium
Conduction System
SA Node
AV Node
SA and AV nodes
Parts of the Adult Heart
Coronary Arteries
Heart Valves
Conducting System
Myocardium
Myocardial Wall
[Na+] = ~ 10 mM
ATP
[Ca++] = ~ 100 nM
Na +
K+
SR Ca + + ADP + Pi
Ca + +
ATP ADP + Pi Ca + +
[Na+] = ~ 145 mM Ca + + 3 Na +
[Ca++] = ~ 1.5 mM
Cardiac Myocyte Action Potential
20
K+ Efflux, Ca++ Influx
0
-20
-40 K+ Efflux
-80
-100
Bers D @WWW
ESPVR Normal
Normal
Stroke Volume
ESPVR
Pressure
Failing Failing
EDV
LV End-Diastolic Volume
Volume (or End-Diastolic Pressure)
Any Questions so far?
Diseases of the Heart
Heart disease can be classified
by anatomy or by etiology, and
I will use a combination of
both. And I want to emphasize
the relative frequency of each,
so we will go from most
common to least common, by
etiology, and then by anatomy.
Leading Causes of Death in US, 2003
500 483,842
426,772
400
300 286,741
267,902
200
100
76,923 60,456 65,672
35,217 45,058 38,748
0
Males Females
CVD COPD
Cancer Diabetes Mellitus
Accident Alzheimer
Hypertension Coronary
6% Heart
Heart Failure Disease
6% 53%
Stroke
17%
800
700
600
500
400
300
200
100
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Year
Coronary emboli
Coronary spasm
MAJOR SYNDROMES
ANGINA PECTORIS
STABLE ANGINA
UNSTABLE ANGINA
MYOCARDIAL INFARCTION
SUDDEN CARDIAC DEATH
ISCHEMIC CARDIOMYOPATHY
PREVALENCE OF ISCHEMIC
HEART DISEASE
13.5 million Americans (7% of adult population)
have symptomatic IHD evidenced by:
Angina Pectoris (50%)
Previous MI (>50%)
or both
ENDOCARDITIS
MYOCARDITIS
PERICARDITIS
INFECTIVE
NON-INFECTIVE
Acute bacterial endocarditis of aortic valve
NON-INFECTIVE ENDOCARDITIS
Nonbacterial Thrombotic Endocarditis (NBTE)
Marantic Endocarditis
Predisposing Factors
Malignancy or debilitating chronic disease
Hypercoagulable state
Scarred valves
Cardiomyopathies
Congenital Heart Defects
Incidence: 0.3 - 1.0% of live births
Classified as:
dilated
hypertrophic
restrictive
Dilated Cardiomyopathy
Typically biventricular dilation, due to
poor contractile function of individual
myocytes
Stroke Volume
ESPVR
Pressure
Failing Failing
EDV
LV End-Diastolic Volume
Volume (or End-Diastolic Pressure)
Images from Netters Atlas of Human
Anatomy, Sheppard and Davies Practical
Cardiovascular Pathology, Harrisons
Internal Medicine, and Don Bers website
Additional reading