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  • These are casts of human coronary arteries and ventricles with the muscle dissolved away. So, what we see are the interior contents of the chambers and vessels as on an angiogram. Note the color legend. Each persons coronary arrangement is different, especially the crux area which determines coronary dominance. This model is fairly normal, except here the diagonals arise perpendicularly to the LAD. From Hurst, Atlas of the Heart.
  • Schematic of the evolution of the atherosclerotic plaque. Accumulation of lipoprotein particles in the intima. The modification of these lipoproteins is depicted by the darker color. Modifications include oxidation and glycation. Oxidative stress including products found in modified lipoproprotiens can induce local cytokine elaboration. The cytokines thus induce increased expression of adhesion molecules for leukocytes that cause their attachment and chemoattractant molecules that direct their migration into the intima. Blood monocytes, on entering the artery wall in response to chemoattractant cytokines such as monocyte chemoattractant protein 1 (MCP-1), encounter stimuli such as macrophage colony stimulating factor (M-CSF) that can augment their expression of scavenger receptors. Scavenger receptors mediate the uptake of modified lipoprotein particles and promote the development of foam cells. Macrophage foam cells are a source of mediators such as further cytokines and effector molecules such as hypochlorous acid, superoxide anion (02-), and matrix metalloproteinases. Smooth muscle cells in the intima divide, and other smooth muscle cells migrate into the intima from the media. Smooth muscle cells can then divide promoting extracellular matrix accumulation in the growing atherosclerotic plaque. In this manner, the fatty streak can evolve into a fibrofatty lesion. In later stages, calcification can occur (not depicted) and fibrosis continues, sometimes accompanied by smooth muscle cell death (including programmed cell death, or apoptosis), yielding a relatively acellular fibrous capsule surrounding a lipid-rich core that may also contain dying or dead cells and their detritus. LDL = low-density lipoprotein; IL-1 = interleukin-1.
  • Ap3

    1. 1. Cardiovascular Anatomy <ul><li>(adapted from another slideshow on slideshare.com) </li></ul>
    2. 2. The Capillary Beds
    3. 3. The Cardiovascular System <ul><li>Heart – the pump </li></ul><ul><li>Vasculature – the conduits </li></ul><ul><li>Pulmonary circuit </li></ul><ul><li>Systemic circuit </li></ul>
    4. 4. The Vasculature <ul><li>A closed system of vessels that moves blood around the body </li></ul><ul><li>Arterial vessels: aorta, arteries, arterioles (vascular resistance) </li></ul><ul><ul><li>Carry blood away from the heart to the: </li></ul></ul><ul><li>Capillary beds </li></ul><ul><li>Venous vessels: venules, veins, venae cavae </li></ul><ul><ul><li>Carry blood toward the heart </li></ul></ul>
    5. 6. 3 layers of an artery <ul><li>1. Adventitia: tough covering. </li></ul><ul><li>2. Media: muscle and elastic membrane </li></ul><ul><li>3. Intima: delicate inner lining. </li></ul>
    6. 9. The Heart <ul><li>A 4-chambered organ located in the middle mediastinum </li></ul>
    7. 13. CABG video 1:26ff <ul><li>Cardiac bypass surgery. </li></ul>
    8. 14. Functional Purpose of the Heart <ul><li>Four Chamber pump that provides blood supply to: </li></ul><ul><ul><li>Systemic circulation left heart </li></ul></ul><ul><ul><li>Pulmonary circulation right heart </li></ul></ul><ul><li>Right and left atria: receiving chambers </li></ul><ul><li>Right and left ventricles: pumping chambers </li></ul><ul><li>Suspended at the base by the great vessels </li></ul>
    9. 15. Heart Wall <ul><li>Epicardium </li></ul><ul><ul><li>Outer layer, inner visceral layer of pericardium </li></ul></ul><ul><li>Myocardium </li></ul><ul><ul><li>Middle muscle layer, interlacing bundles of fiber </li></ul></ul><ul><li>Endocardium </li></ul><ul><ul><li>Inside of the heart, covers valves </li></ul></ul>
    10. 16. Myocardium <ul><li>specialized muscle </li></ul><ul><li>Performs the work of the heart </li></ul><ul><li>Makes up the majority of the mass </li></ul>
    11. 17. Heart Wall Figure 20.4
    12. 18. Cardiac Chambers
    13. 19. Right Atrium (RA) <ul><li>Receives blood from the body or systemic venous circulation </li></ul><ul><li>Forms the right cardiac border </li></ul><ul><li>Receives blood from vena cava (SVC & IVC) and coronary sinus </li></ul>
    14. 20. Right Ventricle (RV) <ul><li>Provides blood flow to the pulmonary circuit </li></ul><ul><li>Low pressure pump </li></ul><ul><ul><li><35 mmHg </li></ul></ul><ul><li>Crescent-shaped wraps around the LV </li></ul><ul><li>Most anterior heart structure </li></ul>
    15. 21. Left Atrium (LA) <ul><li>Receives blood from the lungs (oxygenated) </li></ul><ul><li>Smooth walled except appendage </li></ul><ul><li>Most posterior cardiac chamber </li></ul><ul><li>Receive blood through right and left pulmonary veins </li></ul>
    16. 22. Left Ventricle (LV) <ul><li>Provides blood flow to the systemic circuit </li></ul><ul><li>High pressure pump </li></ul><ul><ul><li>>100 mmHg </li></ul></ul><ul><li>Egg shaped (ellipse) </li></ul><ul><li>Forms the left cardiac border </li></ul>
    17. 23. Structural Differences between the Left and Right Ventricles Figure 20.7a-c
    18. 24. Cardiac Tissues <ul><li>Annuli fibrosi </li></ul><ul><ul><li>Non-conducting fibrous connective tissue </li></ul></ul><ul><ul><li>Referred to as the skeleton </li></ul></ul><ul><ul><li>Forms support for the valves tissue (annulus) </li></ul></ul><ul><ul><li>Separates the atria and ventricles and ventricles and great vessels </li></ul></ul>
    19. 25. Valves of the Heart Figure 20.8a
    20. 26. Atrioventricular: Mitral and Tricuspid <ul><li>Separate the atria and their respective ventricles </li></ul><ul><li>Tricuspid, Bicuspid </li></ul><ul><li>Attached at the base to the annulus and at the tips to the papillary muscles via chordae tendinea </li></ul>
    21. 28. Semilunar: Aortic and Pulmonic <ul><li>Separate the ventricles and their respective arteries </li></ul><ul><li>Three cusp, attached at the base to the annulus </li></ul><ul><li>Pressure sensitive valve, opening and closing activated by change in pressure </li></ul>
    22. 29. Coronary Arteries <ul><li>Supplies blood supply to the heart </li></ul><ul><li>Two primary arteries from the aorta </li></ul><ul><li>Left </li></ul><ul><ul><li>Left Main </li></ul></ul><ul><ul><li>Left Anterior Descending </li></ul></ul><ul><ul><li>Circumflex </li></ul></ul><ul><li>Right </li></ul><ul><ul><li>Right </li></ul></ul><ul><ul><li>Posterior Descending </li></ul></ul>
    23. 30. Heart Casts - Muscle Removed
    24. 31. Left Main LAD Diagonal Septal perforators Circumflex Left atrial branch Obtuse Marginal
    25. 32. Right Coronary Artery <ul><li>RA, RV, Inferior LV, SA Node, AV Node </li></ul><ul><li>Conus branch (RVOT) </li></ul><ul><li>Sinus node branch ( SA node, RA) </li></ul><ul><li>RV Branches </li></ul><ul><li>Acute Marginal branches (RV) </li></ul><ul><li>AV nodal artery (AV node, IAS) </li></ul><ul><li>Posterior descending artery (inferior IVS) </li></ul><ul><li>Left ventricular branch-PLA’s (inferior LV) </li></ul>
    26. 33. Conus branch Sinus node branch Acute Marginal Posterior descending artery Left ventricular branch RV branch
    27. 34. RAO Circumflex LAD Diagonal Septal
    28. 35. LAD
    29. 36. Evolution of fibrous plaque LDL Monocyte endothelium Cell adhesion factors Foam Cells 1 1. LDL enters 2. & Oxidizes 3. Monocytes adhere & 4. cross intima become macrophages macrophage 5. Macrophages Eat Fat become Foam cells 6. muscle cells multiply & 7. enter intima 8. Muscle cells die & harden plaque -Calcium develops
    30. 38. Fuster V, et al. N Eng J Med 1992;326:311-318. 2. Photos courtesy of Boehringer Ingleheim International GmbH, by Lennart Nilsson Braunwald E, et al. 2002 http://www.acc.org/clinical/guidelines/unstable/unstable.pdf
    31. 39. Coronary Artery Disease
    32. 40. Aortic valve <ul><li>Normal aortic valve area is 2.5 to 4.0 cm 2 </li></ul><ul><li>Diseased aortic valve. Narrowed opening. </li></ul>