Body Planes, Basic Cardiac Anatomy, & Oxygen Saturation

1. Body Planes, Basic CardiacBody Planes, Basic Cardiac
Anatomy and Oxygen SaturationAnatomy and Oxygen Saturation
Jordan Gosnell, BS, RDCS (AE)(PE)Jordan Gosnell, BS, RDCS (AE)(PE)
Grand Valley State UniversityGrand Valley State University
Grand Rapids, MichiganGrand Rapids, Michigan

2. Coronal Plane
(Frontal Plane)
 A vertical planeA vertical plane
running from siderunning from side
to side;to side;
 Divides the body orDivides the body or
any of its parts intoany of its parts into
anterior andanterior and
posterior portions.posterior portions.

3. Sagittal Plane
(Lateral Plane)
 A vertical planeA vertical plane
running from frontrunning from front
to back;to back;
 Divides the bodyDivides the body
or any of its partsor any of its parts
into right and leftinto right and left
sides.sides.

4. Median Plane
Sagittal plane
through the
midline of the
body; divides the
body or any of its
parts into right
and left halves.

5. Axial Plane
(Transverse
Plane)
A horizontalA horizontal
plane; divides theplane; divides the
body or any of itsbody or any of its
parts into upperparts into upper
and lower parts.and lower parts.

6. 1. Which plane1. Which plane
divides intodivides into
anterior andanterior and
posterior?posterior?

7.  Which planeWhich plane
divides intodivides into
superior andsuperior and
inferior?inferior?
 Name anName an
inferior organ.inferior organ.

8. Basic Cardiac AnatomyBasic Cardiac Anatomy

9. Basic Cardiac AnatomyBasic Cardiac Anatomy
The HeartThe Heart
 Weighs 7 and 15 ounces (200 toWeighs 7 and 15 ounces (200 to
425 grams)425 grams)
 Size is a little larger than the sizeSize is a little larger than the size
of your fist.of your fist.
 Average rate: 80 times a minuteAverage rate: 80 times a minute
(BPM)(BPM)
– By the end of a long life, a person'sBy the end of a long life, a person's
heart may have beat (expanded andheart may have beat (expanded and
contracted) more than 3.5 billioncontracted) more than 3.5 billion
times.times.
– Each day the average heart beatsEach day the average heart beats
100,000 times, pumping about 2,000100,000 times, pumping about 2,000
gallons (7,571 liters) of blood.gallons (7,571 liters) of blood.

10. Basic Cardiac AnatomyBasic Cardiac Anatomy
Cardiac MuscleCardiac Muscle
 Involuntary striated muscleInvoluntary striated muscle
– Actin (thin) and myosin (thicker)Actin (thin) and myosin (thicker)
 Numerous myoglobinsNumerous myoglobins
(oxygen storing pigment)(oxygen storing pigment)
 Cardiac myocytesCardiac myocytes
– Averaging 10–20 µm in diameter and 50–100 µm inAveraging 10–20 µm in diameter and 50–100 µm in
lengthlength
– Cardiac muscle cells are mechanically, chemically,Cardiac muscle cells are mechanically, chemically,
and electrically connected to one another, the entireand electrically connected to one another, the entire
tissue resembles a single, enormous muscle cell.tissue resembles a single, enormous muscle cell.

11. Basic Cardiac AnatomyBasic Cardiac Anatomy
MyocytesMyocytes
 Highly resistant to fatigueHighly resistant to fatigue
 Large number of mitochondriaLarge number of mitochondria
– Mainly aerobic conditionsMainly aerobic conditions
 Only 1% of energy is derived from anaerobic metabolismOnly 1% of energy is derived from anaerobic metabolism
 Under moderate hypoxic conditions may be 10%Under moderate hypoxic conditions may be 10%
Mitochondria= red
Blue = nucleus
F-actin = green
visservices.sdsc.edu/.../cell_cardiac_3.med.jpg

12. Basic Cardiac AnatomyBasic Cardiac Anatomy
MyocytesMyocytes
 Basal aerobic conditionsBasal aerobic conditions
– 60% of energy comes from fat60% of energy comes from fat
 (free fatty acids and triacylglycerides),(free fatty acids and triacylglycerides),
– 35% from carbohydrates, and35% from carbohydrates, and
– 5% from amino acids and ketone bodies.5% from amino acids and ketone bodies.
– Proportions vary widely according to nutritional state.Proportions vary widely according to nutritional state.

13. Basic Cardiac AnatomyBasic Cardiac Anatomy
Cardiac MuscleCardiac Muscle
 StimulationStimulation
– MyogenicMyogenic
 Self-excitableSelf-excitable
– Inherent contractile abilityInherent contractile ability
 Heavily regulated by autonomic nervous systemHeavily regulated by autonomic nervous system
– TransmissionTransmission
 Intercalated discsIntercalated discs
– Conduct electrochemical potentials directly betweenConduct electrochemical potentials directly between
cytoplasms of adjacent cells through gap junctionscytoplasms of adjacent cells through gap junctions

14. Basic CardiacBasic Cardiac
AnatomyAnatomy
 Blood vesselsBlood vessels
– Arteries transport blood from theArteries transport blood from the
heart to the body tissues.heart to the body tissues.
– Veins carry blood back to the heart.Veins carry blood back to the heart.
 Four valves to prevent backwardFour valves to prevent backward
flow of blood.flow of blood.
– Each valve has flaps, called leaflets,Each valve has flaps, called leaflets,
that allow the forward flow of bloodthat allow the forward flow of blood
and prevent the backward flow.and prevent the backward flow.
 An electrical system of the heartAn electrical system of the heart
that controls how fast it beats.that controls how fast it beats.

17. Elements of BloodElements of Blood
 Red blood cells (erythrocytes)Red blood cells (erythrocytes)
 White blood cells (leukocytes)White blood cells (leukocytes)
 Platelets (thrombocytes)Platelets (thrombocytes)
 PlasmaPlasma

18. Red blood cells (erythrocytes)Red blood cells (erythrocytes)
45% of blood volume45% of blood volume
Biconcave discs that are produced in the red bone marrow via a processBiconcave discs that are produced in the red bone marrow via a process
called erythropoesiscalled erythropoesis
Carry the pigment called hemoglobin which combines with and transportsCarry the pigment called hemoglobin which combines with and transports
oxygen.oxygen.
Constitute approximatelyConstitute approximately
White blood cells (leukocytes)White blood cells (leukocytes)
1% of blood volume1% of blood volume
PlateletsPlatelets
<1% of blood volume<1% of blood volume
Play important role in blood coagulationPlay important role in blood coagulation
PlasmaPlasma
55% of blood volume55% of blood volume
Fluid in which form elements are suspended.Fluid in which form elements are suspended.
Carries proteins, electrolytes, enzymes, hormones, cholesterol and uricCarries proteins, electrolytes, enzymes, hormones, cholesterol and uric
acid.acid.

19. Elements of BloodElements of Blood

20. Elements of BloodElements of Blood
 NeutrophilsNeutrophils
– Defense against bacterial or fungal infectionsDefense against bacterial or fungal infections
 PhagocytosisPhagocytosis
– Usually first responderUsually first responder
– Activity and death result in pusActivity and death result in pus
– 65% of leukocytes65% of leukocytes

21. Elements of BloodElements of Blood
 EosinophilEosinophil
– Deal mainly with parasitic infectionsDeal mainly with parasitic infections
– Approximately 4% of leukocytesApproximately 4% of leukocytes

22. Elements of BloodElements of Blood
 BasophilBasophil
– Allergic and antigen response releasing histamine causingAllergic and antigen response releasing histamine causing
inflammationinflammation
– <1% of leukocytes<1% of leukocytes

23. Elements of BloodElements of Blood
 LymphocytesLymphocytes
– B CellsB Cells
– T CellsT Cells
– Approximately 25% of leukocytesApproximately 25% of leukocytes

24. Elements of BloodElements of Blood
 Monocytes (develop into macrophages)Monocytes (develop into macrophages)
– PhagocytosisPhagocytosis
 Similar function as neutrophilSimilar function as neutrophil
 Work with T cells for defenseWork with T cells for defense
 Approximately 6%Approximately 6%

25. Composition of bloodComposition of blood
Basic TerminologyBasic Terminology
 PlasmacritPlasmacrit
 PolycthyemiaPolycthyemia
 AnemiaAnemia
 LeukocytosisLeukocytosis
 LeukopeniaLeukopenia
 HematocritHematocrit

26.  PlasmacritPlasmacrit
– Percentage of plasma presentPercentage of plasma present
 PolycthyemiaPolycthyemia
– Abnormal increase in the number of red blood cellsAbnormal increase in the number of red blood cells
 AnemiaAnemia
– Abnormal decrease in the number of red blood cellsAbnormal decrease in the number of red blood cells
 LeukocytosisLeukocytosis
– Abnormal increase in the number of white blood cellsAbnormal increase in the number of white blood cells
 LeukopeniaLeukopenia
– An abnormal decrease in the number of white cellsAn abnormal decrease in the number of white cells
 HematocritHematocrit
– Percentage of red blood cells presentPercentage of red blood cells present

27. Arterial Blood PressureArterial Blood Pressure
 Blood pressure rises and falls corresponding to theBlood pressure rises and falls corresponding to the
phases of the cardiac cyclephases of the cardiac cycle
 Ventricular systole: myocardial muscle cells contractVentricular systole: myocardial muscle cells contract
ejecting blood out of ventricles into the pulmonary andejecting blood out of ventricles into the pulmonary and
aortic arteriesaortic arteries
– Pressures in these arteries increase sharply: highest pressure =Pressures in these arteries increase sharply: highest pressure =
systolic pressuresystolic pressure
– Relaxation of the ventricles (diastole) causes pressures inRelaxation of the ventricles (diastole) causes pressures in
arteries to drop: lowest pressure = diastolic pressurearteries to drop: lowest pressure = diastolic pressure

28. Arterial Blood PressureArterial Blood Pressure
 In the U.S., the optimal blood pressureIn the U.S., the optimal blood pressure
(sometimes referred to as the ‘gold standard’)(sometimes referred to as the ‘gold standard’)
targets are:targets are:
– Systolic: less than 120 mmHgSystolic: less than 120 mmHg
– Diastolic: less than 80 mmHgDiastolic: less than 80 mmHg
 PrehypertensivePrehypertensive
– Above 120 mmHg but below 140 mmHg systolicAbove 120 mmHg but below 140 mmHg systolic
– Or above 80 mmHg but below 95 mmHg diastolicOr above 80 mmHg but below 95 mmHg diastolic

29. Arterial Blood PressureArterial Blood Pressure
Even without any symptoms, a blood pressure
level in the prehypertensive range can increase
your risk of stroke, heart attack, heart failure and
kidney failure. High blood pressure is often called
the “silent killer” because you can have it for years
without knowing it. In fact, nearly one-third of
the 72 million Americans with high blood pressure
don't know they have it.
Symptoms such as headaches, dizziness or
nosebleeds typically don’t occur until high blood
pressure has advanced to a higher stage — one
that may be critical to your health. But many
people with uncontrolled high blood pressure
never have any of these symptoms.

30. Arterial Blood PressureArterial Blood Pressure
 PulsesPulses
– Surge of blood in arterialSurge of blood in arterial
system during ventricularsystem during ventricular
systole distends thesystole distends the
elastic walls of theelastic walls of the
arteriesarteries
– Pressure drops almostPressure drops almost
immediately asimmediately as
contraction ends:contraction ends:
consequentially recoilingconsequentially recoiling
– Alternate expanding andAlternate expanding and
recoiling is felt as a pulserecoiling is felt as a pulse

31. Diastole and SystoleDiastole and Systole
http://www-medlib.med.utah.edu/kw/pharm/hyper_heart1.htmlhttp://www-medlib.med.utah.edu/kw/pharm/hyper_heart1.html
DiastoleDiastole-- Blood flow from atria,Blood flow from atria,
through atrioventricular valves andthrough atrioventricular valves and
into the ventriclesinto the ventricles
Systole-Systole- Blood flow from theBlood flow from the
ventricles, through the semilunarventricles, through the semilunar
valves and out of the aorta andvalves and out of the aorta and
pulmonary arteriespulmonary arteries

32. Arterial Blood PressureArterial Blood Pressure
 Factors influencing arterialFactors influencing arterial
blood pressureblood pressure
– Heart functionHeart function
 Volume of blood discharged fromVolume of blood discharged from
the ventricle with each contraction:the ventricle with each contraction:
stroke volume (approx 70 mL atstroke volume (approx 70 mL at
rest)rest)
 Cardiac output = stroke volume *Cardiac output = stroke volume *
heart rateheart rate
– Blood volumeBlood volume
 Sum of the formed elements andSum of the formed elements and
plasma volume in the vascularplasma volume in the vascular
system (usually 5 L in adults)system (usually 5 L in adults)
– Arterial resistanceArterial resistance

33. Arterial Blood Pressure -Arterial Blood Pressure - ContinuedContinued
 Factors influencing arterial blood pressureFactors influencing arterial blood pressure
– Peripheral resistancePeripheral resistance
 Friction between the walls of the blood vessels andFriction between the walls of the blood vessels and
the bloodthe blood
 Determined by elasticity of walls of the bloodDetermined by elasticity of walls of the blood
vesselsvessels

34. Arterial Blood Pressure -Arterial Blood Pressure - ContinuedContinued
 Factors influencing arterial blood pressureFactors influencing arterial blood pressure
 ArteriesArteries
– Elastic, thick walled blood vesselsElastic, thick walled blood vessels
– Expand during systole then recoil during diastole to keep bloodExpand during systole then recoil during diastole to keep blood
flow moving forwardflow moving forward
 VeinsVeins
– Thin walled blood vessels that collapse easilyThin walled blood vessels that collapse easily
– Able to expand rapidly to accommodate large volumes of bloodAble to expand rapidly to accommodate large volumes of blood
– Contain the majority of circulating bloodContain the majority of circulating blood

35. Arterial Blood Pressure -Arterial Blood Pressure - ContinuedContinued
 Factors influencing arterial bloodFactors influencing arterial blood
pressure …continuedpressure …continued
– Blood viscosityBlood viscosity
 Physical property related toPhysical property related to
the ease with which itsthe ease with which its
molecules flow past onemolecules flow past one
anotheranother
 Greater theGreater the
viscosity=greater forceviscosity=greater force
needed to move it throughneeded to move it through
the vascular systemthe vascular system

38. Oxygen SaturationOxygen Saturation
 Oxygen saturation: relative measure of the amount of oxygen that isOxygen saturation: relative measure of the amount of oxygen that is
dissolved or carried in a given mediumdissolved or carried in a given medium
 One hemoglobin can carry a maximum of 4 molecules of oxygenOne hemoglobin can carry a maximum of 4 molecules of oxygen
 In medicine: Oxygen saturation (SaOIn medicine: Oxygen saturation (SaO22) measures the percentage of) measures the percentage of
hemoglobin binding sites in the blood stream occupied by oxygenhemoglobin binding sites in the blood stream occupied by oxygen
 SaOSaO22 refers torefers to arterial oxygen saturationarterial oxygen saturation
 SaOSaO22 value below 90% is considered hypoxemicvalue below 90% is considered hypoxemic

40. Oxygen SaturationOxygen Saturation

41. ReferencesReferences
 Feigenbaum H, Armstrong W. (2004).
Echocardiography. (6th Edition). Indianapolis. Lippincott
Williams & Wilkins.
 Goldstein S., Harry M., Carney D., Dempsey A., Ehler
D., Geiser E., Gillam L., Kraft C., Rigling R., McCallister
B., Sisk E., Waggoner A., Witt S., Gresser C. (2005).
Outline of Sonographer Core Curriculum in
Echocardiography.
 Harry M. (2005). Essentials of Echocardiography and
Cardiac Hemodynamics. (2nd
Edition). Forney, Texas.
Pegasus Lectures, Inc.
 Otto C. (2004). Textbook of Clinical Echocardiography.
(3rd Edition). Elsevier & Saunders.