Anatomy and physiology

The Right Heart

pulmonary circulation

The Left Heart

systemic circulation

The Right Heart has \____ pressure, \_____ resistance, and \_____ oxygen saturation

Low pressure, Low Resistance, Low Oxygen Saturation

The Left Heart has \____ pressure, \_____ resistance, and \_____ oxygen saturation

High pressure, High Resistance, High Oxygen Saturation

What is Pulmonary artery pressure ( or PAP)?

the pressure within the pulmonary arteries

Normal systolic PAP (SPAP) at Rest \=

15-25 mmHg

SPAP greater than mmhg at rest (or \> mmhg with exercise) is elevated and signifies Pulmonary Hypertension.

25 mmhg with Rest; 30 mmhg with exercise

Pulmonary Capillary Wedge Pressure (PCWP)

The pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch.

Normal PCWP range

2-12 mmhg

is an indirect measurement of the left atrial pressure

PCWP

blood pressure

the pressure that is exerted by the blood against the walls of systemic circulatory system

Systolic BP

pressure when heart contracts

Diastolic BP

Pressure in the arteries when the heart is relaxed

Which BP is written as the upper number of the fraction?

Systolic Blood Pressure

Which BP is written as the lower number of the fraction?

Diastolic Blood Pressure

normal BP range

120/80 mmHg

Stage 1 hypertension (HTN)

130-139/80-89 mmHg

Stage 2 Hypertension (HTN)

140+/90+ mmhg

hypertensive crisis

180+/120+ mmhg

heart location

left side of the mediastinum

2nd - 5th intercostal space

The base of the heart is located

at the superior (upper) end of the heart

apex of the heart

tip of the heart pointing down toward the 5th left intercostal space

Pericardium

Membrane surrounding the heart

fibrous pericardium

tough, white fibrous connective tissue that is the outer layer of the pericardium

serous pericardium

thinner, more delicate membrane that forms a double layer around the heart

two layers of serous pericardium

parietal layer and visceral (Epicardium) layer

epicardium

outer layer of the heart

Myocardium

center layer of the heart that is thick muscular tissue (main pumping machnism)

Endocardium

thin layer of endothelial tissue that lines the inner surface of the heart chambers, valves, chordae tendineae, and papillary muscles

Atria

upper "Filling" chambers of the heart

Ventricles

Lower "Pumping"chambers of the heart

foramen ovale

a shunt through the Interatrial septum (IAS) that bypasses the lungs and goes from RA to LA

attach to the superior aspect of the ventricles and carry the blood away from the heart

Great Vessels

Great Vessels

Superior Vena Cava, Pulmonary Artery, Pulmonary veins, Aorta

atrioventricular valves (AV)

tricuspid and mitral valve

5 components that make up the TV and MV

The mother of all arteries

Aorta

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Normal AO pressure

120/80

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Normal AO O2 Sat

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98%

3 arteries that branch off of the aortic arch

brachiocephalic, left common carotid, left subclavian

fetal duct that connects the aorta and pulmonary artery...should close after birth

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ductus arteriosis

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What becomes of the ductus arteriosis after birth

ligamentum arteriosum

The first 2 branches off of the AAO form the

coronary artery system

Coronary arteries originate at the \_________________ and travel down the outside of the heart muscle

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sinuses of Valsalva

lack of oxgenated blood

ischemia

Two primary coronary arteries

left and right coronary

The left coronary artery branches into the (2)

left anterior decending artery & left circumflex artery

The right coronary artery branches into the (2)

acute marginal artery & posterior descending artery

pericardial space/cavity

contains 10-30 ml of pericardial fluid for lubrication during both stages of Systole and diastole

What are the semilunar valves?

pulmonary valve and aortic valve

what valve become open during diastole?

TV and MV

What valves become open during systole?

Semilunar (Aorta and Pulmonic valve)

Semilunar valves are significantly than AV valves

Smaller

Normal IVC diastolic diameter

1.2 - 2.1 cm

Thebesian valve

valve of coronary sinus into RA

Eustachian valve

normal embryonic remnant at the junction of the IVC and RA

Chiari Network

normal variant located near the Eustachian valve that looks like vegetation (web-like structure)

Normal mean right atrial pressure (RAP)

2-8 mmhg

Normal TV orifice

7-9 cm^2

normal TV velocity

0.3-0.7 m/sec

What is the most anterior chamber of the heart?

right ventricle

Normal RV pressure

15-25 mmhg (peak systolic) ÷

2-8 mmhg (end diastolic)

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pulmonic valve

right semilunar valve separating the right ventricle and pulmonary artery (Has 3 cusps: Anterior, Right Posterior, and Left Posterior)

Normal PV valve orifice

\> 2.0 cmˆ2

normal PV velocity

0.6-0.9 m/s

Normal PA dimension

3 cm wide x 5 cm long

Normal PA pressure

15-25 mmhg (Systole) ÷

4-12 mmhg (diastolic)

Normal mean pulmonary capillary wedge pressure (PCWP)

2-12 mmhg

The MV has leaflets; what are they called?

2 leaflets; Anterior and Posterior MV leaflets

Where do the AMVL and PMVL join together?

The Antero-Lateral (Ant-Lat) commissures and postero-medial (post-med) commissure

Normal LV pressure

< 120 mmhg (systolic )/ 3-12 mmhg (end diastolic)

AOV has 3 cusps, name them

Right coronary cusp (RCC), Left coronary cusp (LCC), and non-coronary cusp (NCC)

Sinus of Valsalva

the portion of the aortic root just distal to the aortic valve containing the coronary ostia (medical term for small opening)

RCC gives rise to the

Right coronary artery (RCA)

LCC gives rise to the

Left coronary artery (LCA)

The nodule of Arantius ensures complete of the valve.

Closure ; (if valve thickened, the valve may not close properly and a leak (regurgitation) could result

normal AOV orifice

\> 2.0 cm ^2

Normal AOV velocity

1.0-1.7 m/sec

Normal AO pressure (systemic pressure)

80 mmhg

85% of the population has what type of coronary artery system

Right dominant

8% of the population has this type of coronary artery system

left dominant

7% of the population has this type of coronary artery system

co dominant

The area between the left subclavian artery and the ligamentum arteriosum

AO isthmus

4 Phases of the cardiac cycle

-isovolumic contraction time

-systole

-isovolumic relaxation time

-diastole

This phase of the cardiac cycle immediately precedes systole....all 4 valves are closed.....ventricular volumes remain constant while artial volumes change and the ventricular pressure rises

Isovolumic contraction time (IVCT)