Transcript Heart - Dr Magrann

Heart
Anatomy of the Heart with 2D animation
Note: by moving the mouse over the heart students will
be able to hear the pronunciations.
http://www.nucleuscatalog.com/cardiovascularsystem/search?search_category=3556
1
In a particular hospital’s Intensive Care Unit, patients always died in
the same bed, on Sunday morning, at about 11:00 a.m., regardless of
their medical condition. This puzzled the doctors and some even
thought it had something to do with the supernatural. No one could
solve the mystery as to why the deaths occurred around 11:00 a.m. on
Sunday, so a Worldwide team of experts was assembled to investigate
the cause of the incidents.
The next Sunday morning, a few minutes before 11:00 a.m., all of the
doctors and nurses nervously waited outside the ward to see for
themselves what the terrible phenomenon was all about. Some were
holding wooden crosses, prayer books, and other holy objects to ward
off the evil spirits.
Just when the clock struck 11:00, Pookie Johnson, the part-time
Sunday sweeper, entered the ward and unplugged the life Support
system so he could use the vacuum cleaner.
2
CIRCULATORY SYSTEM
FUNCTIONS:
Transport (nutrients, wastes, oxygen,
CO2, hormones)
Immunity (leukocytes, antibodies)
Temperature regulation (when you
are cold, blood vessels constrict;
when hot, they dilate)
Penile erection
3
COMPONENTS OF
CIRCULATORY SYSTEM
Heart
Blood
Blood vessels (arteries, capillaries,
veins)
Lymph vessels and nodes
4
THE HEART
The heart is the simplest organ in the body.
It does only one thing: pumps blood.
It beats 42 million times a year.
It’s about the size of your clenched fist.
Some of you have big fists, some have
smaller fists.
Its location is deep to the sternum. Take
your left fist and place it on the sternum,
then angle the bottom of your wrist to the
left. When you say the Pledge of
Allegiance, your hand is not over your
heart. It’s not on the left, it’s in the center.
5
6
Location of the Heart in the Thorax
The heart is located in
the MEDIASTINUM,
which is the central
compartment of the
thoracic cavity.
7
Layers of tissues around the heart:
PERICARDIUM
1) Parietal pericardium
2) Pericardial cavity
3) Visceral pericardium
Visceral
pericardium
HEART
1) Epicardium (same as
visceral pericardium)
2) Myocardium
3) Endocardium
Parietal
pericardium
8
PERICARDIUM
Surrounds the heart (like a heart in
baggie).
The function is to lubricate the heart, so
as it beats, it won’t rub against
anything.
The pericardium is divided into two
layers with a space between them
filled with fluid:
PARIETAL PERICARDIUM
PERICARDIAL CAVITY
VISCERAL PERICARDIUM
9
PARIETAL PERICARDIUM
This is actually the outermost layer of
thoracic cavity. Two layers:
SEROUS LAYER (simple squamous
epithelium). Watery fluid.
FIBROUS LAYER (moderately dense
fibrous connective tissue)
10
VISCERAL PERICARDIUM
(aka EPICARDIUM)
Outermost layer of heart.
It also has two layers:
– SEROUS LAYER
– FIBROUS LAYER
11
Layers of tissues around the heart:
PERICARDIUM
1) Parietal pericardium
2) Pericardial cavity
3) Visceral pericardium
Visceral
pericardium
HEART
1) Epicardium (same as
visceral pericardium)
2) Myocardium
3) Endocardium
Parietal
pericardium
12
Structure of the Heart
Parietal
pericardium
Pericardial cavity
Visceral pericardium
Myocardium of heart
Endocardium of heart
Inside chamber of heart
13
Figure 18.3
MYOCARDIUM
The heart muscle itself
(myocardium) is made of what
tissue?
Cardiac muscle.
14
ENDOCARDIUM
The lining on the inside of the heart.
Has two layers:
ENDOTHELIUM (simple squamous
epithelium that provides a smooth
surface for the blood to pass by).
If there are any irregularities in the
smoothness of the endothelium, a platelet
could catch on it and start a blood clot.
Loose connective tissue (deep to the
endothelium)
15
PERICARDITIS
Inflamed outer layer of heart.
Fluid accumulates in pericardial cavity,
putting pressure on heart.
Pericarditis can also be caused by damage
to the blood vessels  blood leaks into
pericardial cavity  pressure.
Pericarditis can lead to pericardial friction
rub, adhesions, and additional excess fluid
in the pericardial cavity. It does NOT lead
to a myocardial infarct (heart attack).
16
PERICARDITIS
CARDIAC TAPENADE: In severe cases of
pericarditis, for example if there is a stab wound to
the heart wall that causes fluid to exude into the
pericardial cavity so much that the excess fluid
compresses the heart and diminishes the heart’s
ability to pump and it causes an irregular heart
beat. An irregular heart beat is called
arrhythmia. But don’t get this confused with
arrhythmia that is caused from a problem with the
SA or AV node. The irregular heart beat from
cardiac tapenade is caused from fluid entering the
pericardial cavity and putting pressure on the
heart.
Treatment is to stick a needle in the pericardial
cavity and drain the fluid.
17
http://catalog.nucleusinc.com/generateexhibit.php?ID=68030&ExhibitKeywordsRaw=&TL=&A=2
ENDOCARDITIS
More serious:
Bacteria enter bloodstream from a break
in the skin (dental procedures, IV drug
abuse, catheter)  damage to lining
and valves  blood clots.
Those who already have damaged heart
valves need prophylactic antibiotics.
Don’t get endocarditis (bacterial
infection) mixed up with pericarditis,
which can lead to cardiac tapenade.
18
THE HEART IS TWO PUMPS:
LEFT AND RIGHT
LEFT PUMP:
From lungs to body
RIGHT PUMP:
From body to lungs
19
The Pulmonary and Systemic
Circuits
20
Figure 18.1
Heart Chambers
• Each pump has two types of chambers:
ATRIUM and VENTRICLE
Left Atrium
Right Atrium
Right Ventricle
Left Ventricle
21
Blood Flow
Deoxygenated blood from body
enters the RA through the superior
and inferior vena cava.
It pours through the TRICUSPID
(RIGHT AV) VALVE into the right
ventricle.
Right atrium contracts, pushes blood
into the right ventricle  ventricle
expands, then contracts with force.
To prevent the blood from going back
up into the atrium, need a valve.
22
Blood Flow
• Blood comes from the superior or inferior vena cava, into the right
atrium, past the tricuspid valve, into the right ventricle. It then goes
past the pulmonary semilunar valve, and into the pulmonary arteries.
SVC
RA
Pulmonary
arteries
Pulmonary
Semilunar valve
Tricuspid valve
RV
IVC
23
VALVES
Valves are like a swinging door that can
only open one direction. But you can push
against this door, since it’s only tissue.
But if you tie a rope to the doorknob, it
won’t be able to go the wrong way. The
ropes are called CHORDAE TENDONAE,
(“heart strings”) which are anchored to
pieces of myocardium called PAPILLARY
MUSCLES.
The contraction of the papillary muscles
pulls on the chordae tendonae to close the
valves, preventing a PROLAPSED VALVE
(turned inside out).
24
Valves
25
Figure 18.9a
Function of the Atrioventricular
Valves
26
Figure 18.9b
Heart Valves – Valve Structure
27
Figure 18.8a
Trabeculae carneae
(spongy meat)
Trabeculae carnae are masses of irregular spongy
tissues which project from the inner surface of the
right and left ventricles.
The purpose of the trabeculae carneae is to
prevent suction that would occur with a flat surface
and thus impair the heart's ability to pump
efficiently.
The trabeculae carneae also serve a similar
function to papillary muscles in that their
contraction pulls on the chordae tendineae,
preventing prolapsed mitral (bicuspid) and
tricuspid valves.
28
Trabecula Carnae
29
What is an artery?
An artery is a vessel that carries
blood AWAY from the heart. It does
not matter if it is oxygenated or
deoxygenated blood.
A vein is a vessel that carries blood
TOWARD the heart. It does not
matter if it is oxygenated or
deoxygenated blood.
30
Blood Flow
With the ventricular contraction, blood can go only one way: into the
PULMONARY ARTERY (one of the few arteries with deoxy blood).
When the ventricles relax, the PULMONARY SEMILUNAR VALVE
closes to prevent blood from going from the pulmonary artery
back into the right ventricle.
SVC
Pulmonary
arteries
Pulmonary
veins
RA
Pulmonary
semilunar valve
Tricuspid valve
RV
IVC
31
Function of the Semilunar Valves
32
Figure 18.10a, b
Blood Flow
When the ventricles relax, the
PULMONARY SEMILUNAR VALVE
closes to prevent blood from going from
the pulmonary artery back into the right
ventricle.
Do the semilunar valves have a chordae
tendonae?
No; the blood is not being forced back (with
a contraction), it just falls back with gravity,
so there’s not as much pressure.
33
Blood Flow
• Blood then goes into lungs, gets oxygenated, and returns on the left
side through the PULMONARY VEINS (one of the few veins with
oxy blood), into the LEFT ATRIUM.
Pulmonary
arteries
Lungs
Pulmonary
veins
LA
Tricuspid valve
Bicuspid (mitral)
valve
LV
34
Blood Flow
From the LEFT ATRIUM, it goes through the MITRAL VALVE
(BICUSPID VALVE) into the LEFT VENTRICLE(there are also
chordae tendonae here), which contracts. Therefore, the left ventricle is
the chamber which is responsible for generating the largest pressure
upon contraction.
Lungs
Pulmonary
arteries
Pulmonary
veins
LA
Tricuspid valve
Bicuspid (mitral)
valve
LV
35
Mitral Valve
The mitral valve gets its name from
being the shape of a Bishop’s hat,
called a mitre.
36
Blood Flow
• The blood then goes past the AORTIC SEMILUNAR VALVE, into
the AORTA, and out to the body.
Aorta
The semilunar
valves are
located
between the
ventricles and
the great
arteries.
SVC
Pulmonary
arteries
Pulmonary
veins
LA
RA
Pulmonary semilunar valve
Bicuspid valve
Tricuspid valve
RV
LV
IVC
37
38
VALVES: “Try before you
Buy”
TRICUSPID VALVE
BICUSPID VALVE (MITRAL VALVE)
PULMONARY SEMILUNAR VALVE
AORTIC SEMILUNAR VALVE
Structures associated with tricuspid
and bicuspid valves
CHORDAE TENDONAE
PAPILLARY MUSCLES
39
Blood Flow
Deoxy blood  sup/inf vena cava  R atrium  tricuspid valve  R ventricle
 pulmonary semilunar valve  pulmonary artery  lungs  pulmonary
veins  Left atrium  mitral (bicuspid) valve  Left ventricle  aortic
semilunar valve  aorta  rest of body.
Aorta
SVC
Pulmonary
arteries
Pulmonary
veins
LA
RA
Pulmonary semilunar valve
Bicuspid valve
Tricuspid valve
Aortic semilunar valve
RV
IVC
LV
40
Heart Chambers
41
Figure 18.5e
Heart Chambers
42
Figure 18.5b
Inferior View of the Heart
43
Figure 18.5d
44
Atrial
septum
Right atrium
Right
ventricle
Apex
Interventricular
septum
Left atrium
Left
ventricle
45
Aortic
semilunar
valve
Mitral
(bicuspid)
valve
Cordae
tendonae
Trabeculae
carnae
Papillary
muscles
46
Mitral Valve Stenosis
• If there is stenosis (blockage) of the mitral valve, where will the
blood back up into?
• Answer: the pulmonary circulation.
Pulmonary
arteries
Lungs
Pulmonary
veins
LA
Tricuspid valve
Bicuspid (mitral)
valve
LV
47
HEART BEATS
The pressure of blood against blood vessel
walls is called blood pressure.
Blood pressure is recorded systole over
diastole. Normal resting blood pressure is
said to be 120/80. When blood pressure is
too high, it is called HYPERTENSION.
The sound your heart makes when it is
beating is the sound of the blood hitting the
valves after they are closed.
The heart normally beats at a rate of 60-80
beats per minute. A faster (tachycardia) or
slower (bradycardia) heart rate is an
indication of a problem.
48
HEART BEATS
All four chambers cannot contract at
the same time. Only two at a time can
contract.
The left and right ventricles contract
at the same time = SYSTOLE.
When the ventricles are relaxed =
DIASTOLE.
At which stage do the atria contract?
Diastole.
49
HEART BEATS
SYSTOLE:
Ventricles contract
Atria relax
DIASTOLE:
Ventricles relax
Atria contract
50
HEART BEATS
Start of Systole: Closing of valves
(tricuspid and mitral) causes blood to
hit the valves, making a sound.
Systole of the ventricle means that
this chamber is contracting.
End of Systole: Closing of semilunar
aortic and pulmonary valves causes
blood to hit the valves, making a
sound
51
HEART BEATS
Lub-Dub is the sound of the blood
hitting the closed valves.
Start of Systole: Closing of the large
valves (tricuspid and mitral) = “LUB”
sound from blood hitting them.
End of Systole: Closing of semilunar
valves (aortic and pulmonary)=
“DUB” sound (“Dub”) from blood
hitting them.
52
Heart Sounds
53
Figure 18.11
Valve Problems
HEART MURMUR
If the valve leaks, it doesn’t close all
the way
“Lub-squirt”
Most murmurs are benign; fairly
common, esp. in babies and some
adults.
54
Abnormal Heart Sounds
Friction rubs
Gallops
Murmurs
•
http://www.wilkes.med.ucla.edu/intro.html
56
Valve Problems
• PROLAPSED VALVE is more serious. The valve turns
all the way inside out.
• Mitral valve is most likely to prolapse because it pumped
the hardest. See how much thicker the left ventricle is?
Mitral Valve Prolapse is the most common heart valve
disorder. Might need artificial valve.
57
Artificial Valve
• The Sapien Transcatheter
Heart Valve (THV) is made of
cow tissue and polyester
supported with a stainless
steel mesh frame. To replace
the diseased valve, the Sapien
THV is compressed into the
end of a long, thin, tube-like
device called a delivery
catheter, which is slightly wider
than a pencil, and inserted into
the femoral artery through a
small cut in the leg and
threaded to the site of the
diseased valve.
58
Porcine (Pig) Valve
59
60
61
What controls the heart beat?
There is a small region in the right
atrium = SA NODE (Sino-atrium node) =
pacemaker of the heart. Its job is to
speed up or slow down the heart rate as
needed.
SA node sends an electrical signal
(action potential) to the AV NODE (atrioventricular node)  atrium contraction
 then the signal pauses before the
signal is transmitted to both ventricles
(atria are now relaxing)  sends the
action potential to all parts of the heart
so it can contract.
62
Conducting System
PLAY
Intrinsic Conduction System
63
Figure 18.12
Heart Beats
The heart does not need a nerve to stimulate it to
contract; rather, specialized heart cells can
spontaneously start an action potential that
spreads to depolarize the rest of the cardiac
muscle cells. These are the specialized cells:
A. SA node
B. AV node
C. Bundle of His (AV bundle)
D. left and right bundle branches
E. Purkinje fibers
64
Heart Beats
This is the order in which these specialized cells function:
First the Sinoatrial (SA) node starts an action potential which
causes the atria to depolarize.
This depolarization will then reach the AV node at the bottom
portion of the right atrium and there is a delay here because these
cells are so small in diameter.
Another delay in the transmission of the depolarization at the
bundle of His (AV bundle) because these special heart cells travel
through the atrioventricular septum which is non-conductive fibrous
connective tissue. The Bundle of His slows down the electrical
pathway to give the atria a chance to finish contacting.
Next, the depolarizing event travels through the left and right
bundle branches, found in the interventricular septum, to finally
arrive at the Purkinje fibers in the lateral walls of the myocardium
of the ventricles.
65
Conducting System
PLAY
Intrinsic Conduction System
66
Figure 18.12
67
Impulse Pathway
• SA node
• AV node
• Bundle of His (conduction
slows down here because this
area is fibrous connective
tissue, not muscle cells. This
gives the atria time to contract
before the ventricles
• Right and left bundle branches
on the IV septum
• Purkinje fibers on the lateral
wall of the ventricles…now
they contract
http://www.phschool.com/science/biology_place/biocoach/cardio1/electrical.html
68
EKG
69
Problems
ARRHYTHMIA
Problem with the SA or AV node 
improper heart beat.
Treatment is medicines or a
pacemaker.
70
Fibrillation
FIBRILLATION is when the heart
beat is not really present…it just
vibrates.
A heart in fibrillation does not contract
rhythmically; it just quivers without
pumping blood.
The ventricles are unable to pump
blood efficiently due to rapid, random
contraction of cardiac muscle fibers.
The muscle doesn’t contract as a unit.
71
FIBRILLATION
Treatment is defibrillate with electric shock
 closes down heart  maybe it will
restart.
This machine is never used when
someone’s heart is beating with a lub-dub
sound, even if it is irregular, because it
causes the heart to stop.
Whatever caused the fibrillation in the first
place is not treated, so it may not work, but
it’s worth a try!
Most large public facilities have them.
There are several on most college
campuses. Disneyland has one every 100
yards.
72
Fun Fact
If someone with a pacemaker dies,
does their heart keep beating?
No. A pacemaker can only stimulate
an irregularly beating heart, not a
dead one. The pacemaker would
almost certainly be triggered, since it
would detect the absence of a regular
heartbeat, but it would be to no avail.
73
THE HEART NEEDS ITS OWN
BLOOD/O2
The endocardium gets plenty of O2 from
the blood cells that touch this layer as they
travel through the heart, but the oxygen
does not diffuse all the way into the
myocardium, which is a deeper layer.
74
THE HEART NEEDS ITS OWN
BLOOD/O2
Therefore, the myocardium needs its
own blood supply by CORONARY
ARTERIES and VEINS.
They are on the surface of the heart,
and there are four of them.
75
Coronary Vessels
1) Right coronary artery
The left one is too short to be counted
2) Circumflex artery
3) Anterior Interventricular artery
4) Posterior Interventricular artery
The coronary sinus is a collection of veins joined
together to form a large vessel that collects blood
from the myocardium of the heart and delivers it
into the right atrium.
76
Heart Chambers
77
Figure 18.5b
Inferior View of the Heart
78
Figure 18.5d
THE HEART NEEDS ITS OWN
BLOOD/O2
The more you do aerobic exercise, the more
branches of these arteries are formed between
themselves (anastomosis), and the better the
blood supply to the heart.
When blood vessels fuse together where they
meet it is said that they ANASTOMOSE.
This is a safety mechanism that allows blood to
get through if one of the vessels gets clogged.
People who exercise have the same number of
heart attacks as those who don’t, but they tend to
survive them because they have more
anastomoses.
79
THE HEART NEEDS ITS OWN
BLOOD/O2
If one of the four coronary arteries
becomes clogged, ISCHEMIA (lack of
oxygen) to part of the heart muscle will
result.
This is a painful condition, and the pain of it
is called ANGINA (heart pain).
If nothing is done immediately to increase
the blood flow, the myocardial tissue can
die; this condition is called a myocardial
infarct (HEART ATTACK). VIDEO
http://www.dnatube.com/video/1966/Myocardial-Infarction
80
Diagnosis of MI
Abnormally high cardiac enzymes in the blood is evidence of a heart attack.
The most commonly tested cardiac enzyme is creatinine phosphokinase
(CPK isoenzymes test).
Creatinine phophokinase is present in heart, brain, and skeletal muscle, so
having it elevated may only mean the person was physically active recently.
However, these enzymes can be detected as separate types:
CPK-BB (CPK-1) - concentration in the brain and lungs (caused by stroke,
or lung injury)
CPK-MM (CPK-3) - found mostly in the skeletal muscle.
CPK-MB (CPK-2) - found mostly in the heart (also called Troponin-I )
CPK-2 level increases after three to six hours following a heart attack,
peak within 12- 24 hours (or longer depending on the severity of the
heart attack) and return to normal level 12 - 48 hours after tissue death.
Confirmation of heart attack when CK-MB is elevated and the ratio of
CK-MB to total CK (relative index) greater than 2.5 - 3. 9 A hospital
patient can be diagnosed with a normal electrocardiogram but have
elevated creatinine phosphokinase (CPK-MB) elevation indicating a
heart attack.
81
Angina Attack
People who have an angina attack can
take nitroglycerine as a tablet under the
tongue that dissolves quickly.
This medicine will dilate the blood vessels.
82
Weird ER Story
A 28-year old male was brought into
the ER after an attempted suicide.
The man had swallowed several
nitroglycerine pills and a fifth of
vodka.
When asked about the bruises about
his head and chest he said that they
were from him ramming himself into
the wall in an attempt to make the
nitroglycerine explode.
83
Coronary Bypass
When a person has their first angina
attack, the doctor will order an
ANGIOGRAM to look for a narrowing
in an artery, especially in one of the
coronary arteries.
84
ANGIOGRAM
An ANGIOGRAM is a procedure to
inject dye into the arteries and x-ray
to see if there is narrowing (sclerosis)
of a vessel. This can be done
anywhere in the body that is of
interest, but frequently it is done to
check the coronary arteries.
85
Angiogram
86
ANGIOPLASTY
If an artery is too narrow, an
ANGIOPLASTY can be performed to
open it up. This involves sticking a
balloon into the artery and inflating it,
causing the vessel to enlarge a little
to increase blood flow. This can be
done anywhere in the body, but is
frequently done in coronary arteries.
87
Angioplasty
Stent Video 1
Stent Video 2
88
Scientists
develop a gel
that mimics
mollusc glue to
coat the insides
of blood vessels.
http://www.thescientist.com/?articles.view/articleNo/3
4766/title/Mimicking-Mussels/
89
Coronary Bypass
If a coronary artery is found to have a
severe blockage, they can do a
CORONARY BYPASS.
In this procedure, the doctor takes
another blood vessel graft (from the
greater saphenous vein in the thigh)
and sews it in around the blockage.
For double or triple bypasses, that’s
how many vessels are affected.
90
Blood Supply to the Heart
91
Figure 18.14
R. common carotid artery
R. subclavian artery
Brachiocephalic trunk
Aorta
Superior vena cava
Pulmonary trunk
Auricle (ear-shaped
flap on the right atrium
R. Coronary
artery
Anterior
interventricular
artery
Left
common
carotid
artery
Left
subclavian
artery
L.
Pulmonary
artery
Pulmonary
veins
L. Coronary
artery
Circumflex
artery
92
TERMS
ANGINA: heart pain, usually
caused from not enough oxygen to
the myocardium (ischemia)
ISCHEMIA: lack of blood/oxygen
MYOCARDIAL INFARCTION: heart
attack (cardiac tissue death) from a
clot in coronary artery, causing
ischemia (lack of oxygen), which
causes angina (heart pain).
93
HEART ATTACK
Not enough blood to the heart’s
myocardium layer  MILD ISCHEMIA 
severe pain: ANGINA (angina pectoris)
Treatment is nitroglycerine to open arteries
Complete blockage  not enough O2 to
that area = SEVERE ISCHEMIA  that
part of heart muscle dies = MYOCARDIAL
INFARCTION.
Heart muscle never regenerates. If a large
area dies, person will die.
94
HEART ATTACK
What are symptoms of a heart attack? Chest pain,
pain down left arm, shortness of breath, nausea,
tight pressure in chest. A common symptom is
death. 50% of first heart attacks are fatal within 2
hours. If a person receives good treatment in the
first 2 hours, they are more likely to survive. About
¾ million people die each year from heart attacks.
A drug that can stop heart attacks in progress by
dissolving clots is t-PA (also used to dissolve clots
that are causing a stroke)
Angioplasty is a surgical procedure to clean out a
clogged artery.
A beta blocker is a drug that slows down the heart
rate (used for tachycardia)
Aspirin reduces blood clot formation
Nitroglycerine dilates the coronary arteries so
95
more blood can get in.
Fun Fact
If a person takes an aspirin once a
day to prevent clots or a heart attack,
they should take it at NIGHT.
Aspirin has a half life of 24 hours, so
its effect is strongest in the morning.
Most heart attacks occur in the
morning!
96
Bayer has new Quick Release
crystals that dissolve faster in
your mouth.
97
Heart Medicines
t-PA (dissolves blood clots)
Beta-blockers (slows heart rate)
Aspirin (prevents blood clots)
Nitroglycerine (dilates coronary
arteries)
98
FUN FACTS ABOUT THE HEART
--According to German researchers, the risk of
heart attack is higher on Monday than any other
day of the week; there is more stress on that day.
--A Giraffe’s heart is 2 feet across.
--Heart disease is a big killer, but what animal
causes the most human deaths?
Sharks kill 10 people per year.
100 people die each year from being stepped on
by cows.
99
--But a cow is
not the world’s
most deadly
animal, which
kills the most
people.
What IS the
world’s most
deadly
animal?
100
--The whitetail deer causes the most deaths because of
all the traffic accidents they cause.
101
Blue Whale Heart Size
102
Videos
Heart 5 mins
Capillaries 3 mins
103
CIRCULATORY DISEASE
CONDITIONS
The leading cause of untimely death in the
Western countries of the world is
cardiovascular disease.
There are several hereditary factors that
influence whether a person will get
cardiovascular disease:
1. family history of heart attack
2. gender (males are high risk)
3. race/ethnicity (African Americans high
risk)
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CIRCULATORY DISEASE
CONDITIONS
Whether or not you have a hereditary
factor, there are some things you can do to
prevent heart disease with diet and
exercise. Included in this is knowing your
cholesterol level, lowering your LDL intake,
use olive and canola oil rather than
butter/cream.
Some studies also suggest that antioxidant
vitamins (A, E, and C) may help, but
remember that too much vitamin A and E
cause a lot more harm to the liver than
good to the circulation.
105
Causes of High Blood
Pressure
ARTERIOSCLEROSIS (hardening of the arteries):
caused by a build-up of calcium deposits in the
artery wall; artery cannot expand with blood
surges.
The blood vessel becomes hard like a rock;
it can’t expand or contract, causes increase
in blood pressure. Tends to be hereditary.
Diet and exercise don’t help this much.
Both arteriosclerosis and atherosclerosis
cause high blood pressure.
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Areteriosclerosis
107
Causes of High Blood
Pressure
ATHEROSCLEROSIS (a build-up of
fat in the arteries): caused from eating
fatty food  narrowing of artery 
Spasm shut or blood clot.
108
Atherosclerosis
109
EMBOLISM
When fat builds up in a lump in one
place, it is called a PLAQUE. It
causes the lumen to narrow,
restricting blood flow.
If this fatty plaque breaks off and
travels in the bloodstream, it is now
called an EMBOLISM. An embolism
can also be made of blood instead of
fat.
110
How a thrombus becomes
embolism
If a platelet catches on a piece of this fat, it
can start a blood clot (thrombus).
If a piece of the clot (thrombus) breaks
off and enters the circulation, it is now
called an embolism, it can lodge in a
smaller blood vessel and block the oxygen
to all the tissue past that point, and the
tissue dies.
111
A thrombus can become an
embolism
A thrombus is made of BLOOD. It is a
blood clot that is located on the inside wall
of a blood vessel (usually a vein but not
always) and it has not moved anywhere
(yet).
An embolism can be made of FAT or
BLOOD. It is either a build up of fat in a
vessel (usually an artery but not always)
that has broken off a piece or a blood clot
(usually in a vein but not always) that has
broken off a piece. It travels and gets
lodged in a smaller vessel somewhere.
112
Blockage of blood vessel
If the embolism lodges in the coronary
arteries  myocardial infarct (Heart
attack).
If the embolism lodges in an artery in
the brain  stroke
If the embolism lodges in the lungs
 pulmonary embolism
113
Pulmonary Embolism
114
VENTRICULAR FIBRILLATION
Even a small clot can be a problem. If
it happens to enter the interior of the
heart and lodge in the wall of the
atrium, it can block the conduction of
the signal of the AV node 
VENTRICULAR FIBRILLATION.
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ANEURYSM
High blood pressure is due to high
pressure of blood against the walls of the
blood vessels; the blood vessels
compensate by developing a thicker wall.
The vessels can no longer expand during
systole, so the vessel gets thicker and
thicker, and the blood pressure goes up
more.
If the blood pressure gets too high, an
ANEURYSM can form, which is a
weakening in the wall of the blood vessel,
causing it to expand like a balloon.
116
ANEURYSM
Thus, an aneurysm is a sac-like
outpouching of an artery.
If it ruptures, it’s very dangerous. The
aorta is the first artery that leaves the
heart. It is under high pressure, so it
is susceptible to getting aneurysims
that can easily rupture; you’ll be dead
in three heart beats.
Can also get aneurysms in the brain
that can rupture and causes stroke.
Aneurysms often have no symptoms.
117
Coronary artery disease terms
Coronary artery disease
Atherosclerosis – fatty deposits
Angina pectoris – chest pain
Myocardial infarction – blocked coronary artery
Silent ischemia – lack of blood flow that
happens to not cause any pain or other
symptoms until it hits a critical threshold; leads
to an unexpected heart attack.
Stroke – ruptured blood vessel or blood clot in
the brain. The proper medical term for a stroke
is a Cerebral Vascular Accident (CVA)
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Clarification of Terminology
A blocked artery can occur anywhere in the body.
A blocked CORONARY artery is what causes a
heart attack. The coronary arteries are those that
supply the myocardium of the heart.
Ischemia is a lack of oxygen from lack of blood
flow. It can occur anywhere in the body.
When there is ischemia in your leg from sitting on
it wrong, it is from lack of blood flow to the
muscles of your leg. it gives you a pins and
needles feeling but it will repair itself when you
restore the blood flow.
119
Clarification of Terminology
When there is ischemia in the heart, it is from a
lack of blood flow to the myocardium of the heart
(the actual muscle tissue of the heart).
The only arteries that supply the heart are the
coronary arteries. Therefore, ischemia in the heart
can only be caused by some blockage in at least
one coronary artery.
In this case, a heart attack will ensue because
ischemia in the heart causes permanent damage
quickly.
Fortunately. there are four coronary arteries, so
many people can survive a heart attack if not all of
them are blocked. That's why some heart attacks
are called "mild heart attacks"; only a small piece
of the myocardium died off and the heart is able to
keep beating properly.
120
Predictors of Heart Attack
High Blood Pressure
High Cholesterol
Large Waist Size
121
Predictors of Heart Attack
Normal blood pressure is 120/80.
Pre-hypertension is 120 to 139
(systolic) and/or 80 to 89 (diastolic).
Hypertension – also known as high
blood pressure -- is 140 or higher
(systolic) and 90 or higher (diastolic).
One in three adults in the U.S. has
high blood pressure or prehypertension.
122
Predictors of Heart Attack:
Cholesterol levels you DON’T want
Triglycerides of greater than 150 mg/dL.
Total cholesterol higher than of 200 mg/dL.
HDL ("good" cholesterol) lower than 50 mg/dL (females) or
40 mg/dL (males).
LDL (“bad” cholesterol) higher than 100
Unless you have other major risk factors, like diabetes,
you want your LDL closer to 70.
The new standards are to look at the ratio of Total
Cholesterol to HDL; it should be less than 5.
Example: 200/50 = 4 (healthy).
Estrogen in women contributes to higher HDL levels, which
decrease after menopause.
Is your boss watching your
cholesterol? http://fxn.ws/RwNGS1
123
Left = Normal
Right three = 44 years old, total cholesterol of
464, triglycerides are 3500
124
Predictors of Heart Attack
FEMALES: waist size more than 35 inches
MALES: waist size more than 40 inches
Measure around your belly button.
If patients lose even 1 inch off their waist,
there are improvements in all the other
heart health numbers
If they gain even 1 inch, there is a
worsening in those numbers. It's a much
better indicator of heart health than weight.
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Other Heart Conditions
Congestive Heart failure
Progressive weakening of the heart
Blood backs up into lungs (may cough
up blood)
Cannot meet the body’s demands for
oxygenated blood
Hypertrophic cardiomyopathy
Congenital condition where the walls of
the left ventricle are so thick that the
lumen is too small to hold much blood.
126
Disorders of Conduction
Ventricular fibrillation
Rapid, random firing of electrical
impulses in the ventricles of the AV node
Atrial fibrillation
Rapid, random firing of electrical
impulses of the SA node
127
Most Common Heart Problems
Atherosclerosis
Ventricular fibrillation
Congestive heart failure
Hypertrophic cardiomyopathy
128
FUN FACT
Can you die from laughing?
It's certainly possible to die while laughing -probably by choking on something. But laughing is
actually very good for you. According to the
Indiana University School of Medicine, laughing
helps relax tense muscles, lowers blood pressure,
and even burns calories. People with heart
disease are 40% less likely to laugh in a given
situation than people without heart disease. The
key here seems to be stress reduction; stress
impairs the production of endothelial cells, which
form a protective lining in our blood vessels. A
weak endothelium can lead to hardened arteries
and, quite literally, a hardened heart.
129
EMBRYONIC DEVELOPMENT OF
THE HEART
The heart is the most common site for
congenital defects (those one is born
with).
During fetal life, the mother provides
the oxygen and nutrients through the
placenta. If there is a problem with the
baby’s heart, it is not a problem until
birth, although it can be detected by
ultrasound.
130
EMBRYONIC DEVELOPMENT OF
THE HEART
• The earliest heart chambers
131
Figure 18.16a, b
The Heart Throughout Life
132
Figure 18.16c–e
EMBRYONIC DEVELOPMENT OF
THE HEART
At 28 days (two weeks after a woman
misses her period), the human heart
first starts to beat and pump blood in
the embryo (at the end of the fourth
week).
You have to stop smoking and
drinking before you get pregnant. By
the time you know you’re pregnant,
it’s too late for the baby’s heart.
133
Fetal Heart
Where is the fetus getting the oxygen
during the nine months in the womb?
The mother, not the lungs of the fetus.
So there’s no sense in sending half of
the fetus’s body’s blood to the lungs
for oxygen.
134
Fetal Blood Vessels
► When oxygenated blood from the placenta is
carried to the fetus by the umbilical vein, where
does it go?
► About half of this blood enters the inferior vena
cava of the fetus, while the other half enters
the liver of the fetus.
► The blood in the inferior vena cava empties into the
right atrium of the heart, and then moves directly
into the left atrium instead of going to the lungs.
► Blood moves from the right atrium to the left atrium
by going through a hole called the foramen ovale.
► Thus, blood bypasses the pulmonary circulation
135
(does not go to the lungs of the fetus).
missinglink.ucsf.edu
136
FORAMEN OVALE
►There is a foramen ovale in the skull and
another one in the heart, between the two
atria. The foramen ovale in the heart
normally closes shortly after birth, and is
then called the FOSSA OVALIS.
►A ‘blue baby” has low oxygen levels in the
blood that may be due to failure of the
foramen ovale to close at birth.
►When the foramen ovale fails to close, it is
called a patent foramen ovale.
►Patent (Pay-tent) means “open”
137
Foramen Ovale
138
kardiol.com
Fetal Circulation
►Not all of the blood in the right atrium goes
through the foramen ovale to bypass the
pulmonary circulation, because the lung
tissue needs some oxygen.
►Therefore, some of the blood entering the
right atrium does not pass directly to
the left atrium through the foramen ovale,
but enters the right ventricle (same as an
adult) and is pumped into the pulmonary
artery and goes to the lungs.
139
Fetal Circulation
►However, the lung tissue of the fetus do
not need that much blood, so there is a
special connection between
the pulmonary artery and the aorta in the
fetus, which directs most of this blood
away from the lungs and back to the
aorta.
►This connecting blood vessel is called
the ductus arteriosus.
140
kvitters.com
Adult
Fetus
141
Changes at Birth
►At birth, there is an immediate change.
Half of the blood needs to go to the
lungs.
►At the first breath, a flap closes over
the foramen ovale, and a muscle
around the ductus arteriosus
constricts, causing instant closing, and
seals shut permanently.
►The foramen ovale is now called the
fossa ovalis, and the ductus arteriosus
is now called the ligamentum
arteriosum.
142
Ductus Arteriosus (fetus only)
143
Ligamentum arteriosum (after birth)
144
Patent Foramen Ovale
►When a baby has not started walking, it
doesn’t need as much oxygen, so a patent
foramen ovale might not be noticed until they
start to walk and run at age 2-3.
►However, every time the baby cries, it might
turn blue.
►A patent foramen ovale can be surgically
closed by going through the blood vessels
without cutting into the heart tissue.
►A patent foramen ovale in an adult is just a
tiny opening and can be heard as a heart
murmur.
►You can also have a patent ductus
arteriosus, which also requires surgery.
145
Heart Deformities
More significant problems:
interventricular septal defect (between
right and left ventricle).
Requires open heart surgery.
146
Congenital Heart Defects
147
Figure 18.17a, b
Artificial Heart
• If heart is
totally
deformed,
need
transplant.
148
Fetal Circulation
►In the fetus, there is a branch off the internal iliac
artery, called the umbilical artery.
►When blood from the aorta reaches the internal
iliac artery, some blood goes into the umbilical
arteries and re-enters the placenta, where carbon
dioxide and other waste products from the fetus
are taken up by the maternal circulation.
149
150
chw.org
The Heart in Adulthood and Old Age
Age-related changes
Hardening and thickening of valve cusps
Decline in cardiac reserve
Sympathetic control over heart is less
efficient
Less severe in the physically active
Fibrosis of cardiac muscle tissue
Lowers the amount of blood the heart can
pump
151