Anatomy of the Cardiovascular System 11/7/12. Betty Smoot, PT, DPTSc

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1 Anatomy of the Cardiovascular System 11/7/12 Betty Smoot, PT, DPTSc BIOGPHY: Betty Smoot, PT, DPTSc is Assistant Professor in the Department of Physical Therapy and Rehabilitation Science and in the Department of Anatomy. After completing her undergraduate degree in Biology she received her first physical therapy degree from UCSF in She earned her Doctor of Physical Therapy Science degree from UCSF in In 2012, Dr. Smoot completed a 2 year advanced-study program in Anatomy. She is a member of the American Association of Anatomists; the American Physical Therapy Association sections on orthopedics, oncology, acute care, and research; and the International Society of Lymphologists. Dr. Smoot teaches Physical Therapy Assessment, Research Design, Evidence Based Practice, and Anatomy in the UCSF Graduate Program in Physical Therapy. She is course co-director for the Prologue Block, and teaches Anatomy in all blocks for 1 st and 2 nd year medical students. She also teaches in the anatomy course for UCSF pharmacy students. Dr. Smoot is passionate about anatomy teaching and its importance in clinical medicine. She was awarded the Excellence in Teaching Award in medical education from the Haile T. Debas Academy of Medical Educators in BIBLIOGPHY: Drake R, Vogl W, Mitchell A. Gray s Anatomy for Students. 2nd Ed. Philadelphia, PA: Churchill Livingstone; 2009 Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. 6th Ed. Baltimore, MD: Lippincott Williams & Wilkins; Chapter 1. Thorax. Netter FH. Atlas of Human Anatomy. 5th Ed. Philadelphia, PA: Saunders; 2011 Peto J. The Heart. Welcome Trust Collection Standring S. Gray s Anatomy, The Anatomical Basis of Clinical Practice. 40th Ed. Churchill Livingstone; Section 7. Thorax. Micheal Gatzoulis, Section Editor.

2 Components of the cardiovascular system The Cardiovascular System Part 1: o Heart o Blood vessels o Arteries o Veins o Capillaries o circulation o Systemic circulation o Coronary circulation Objectives: The heart The thorax 1. Describe the location of the heart in the thorax and mediastinum. 2. Relate thorax surface anatomy to underlying cardiovascular structures. 3. Describe the anatomy of the heart, including its coverings, chambers, and walls. 4. Identify the s of the heart. Explain their function, and consequences of incompetence. 5. Apply your knowledge of anatomy to understanding clinical conditions related to the heart. Thoracic cage Surface anatomy Clavicle Jugular notch Manubrium Intercostal spaces I II III IV V Jugular notch Sternal angle Body of sternum Sternoclavicular joint Manubrium Body of sternum Rib I Clavicle Coracoid process Sternal angle Rib Thoracic vertebra XI XII VI Xiphoid process VII VIII Costal IX cartilage X Xyphoid process Rib X Costal cartilage Costal margin 1

3 Surface anatomy The mediastinum The heart in situ Common carotid artery Left subclavian artery and vein Internal jugular vein 3 rd costal cartilage 6th costal cartilage 2 nd intercostal space 5th intercostal space Midclavicular line Superior vena cava Phrenic nerve Right Left Ribs Parietal pleura Diaphragm Heart removed 3 Superior vena cava Right pulmonary veins Left pulmonary veins 3 layers of the pericardium: Right Left Inferior vena cava Diaphragm 2 1 Cardiac tamponade Compression of the heart when blood or fluid accumulates in the pericardial cavity Orientation Neck veins distended Venous pressure elevated Right Left Decreased arterial and pulse pressures Pericardiocentesis for diagnosis and decompression 2

4 The great vessels Anterior view Left pulmonary veins from left to left atrium Carrying oxygenated blood Right pulmonary veins from right to the left atrium Carrying oxygenated blood LA RV LV To right and left pulmonary arteries to right and left s Carrying de oxygenated blood Superior vena cava (cut) Carrying de oxygenated blood Inferior vena cava (cut) Carrying de oxygenated blood (cut) Carrying oxygenated blood Posterior view The 4 chambers & their walls The heart has 4 chambers. veins Walls of the chambers: 1. Right atrium () 2. Right ventricle (RV) 3. (LA) SVC LA 1. Endocardium 2. Myocardium 3. Epicardium 4. Left ventricle (LV) LV RV Right atrium Right ventricle SVC Right auricle Crista terminalis Tricuspid SVC Conus arteriosus Inter atrial septum Fossa ovalis Pectinate muscle Septal cusp of tricuspid Chordae tendineae Papillary muscles IVC Opening of the coronary sinus Trabeculae carnae 3

5 Left ventricle Left auricle arteries Trabeculae carnae Mitral arteries veins LV Right pulmonary veins Papillary muscles IVC Coronary sinus Left ventricle Chordae tendineae IVC Coronary sinus Network of collagen & elastin fibers Consists of 4 dense connective tissue rings surrounding the four cardiac s 4 important functions: 1. anchors the cusps The s and fibrous skeleton 2. prevents over dilation of the openings 3. provides attachment point for the myocardium 4. blocks the direct spread of electrical impulses from atria to ventricles Mitral (bicuspid) Fibrous rings Aortic Tricuspid Heart in diastole Heart in systole SA node AV node Fibrous ring or tricuspid Conducting system AV Bundle of His Right bundle Purkinje fibers Valves of the right Valves of the left Mitral Aortic arteries Tricuspid veins Coronary sinus 4

6 Valvular heart disease Auscultation positions for s Aortic stenosis: Aortic becomes narrow; Valve fails to open fully Mitral prolapse: Incompetent mitral ; Blood regurgitates back into the left atrium during systole and a murmer is heard 5