Medicine

Dr. Jawad

Introduction to CVS

ANATOMY
 The position of the heart in the mediastinum is as such that >2/3 of its mass to
the left of the midline
 The long axis oriented towards the apex
 The base of this triangle formed by the plane of the AV groove.
 Thymus related anteriorly & oesophagus posteriorly

 In the frontal plane as seen on chest X-ray

 The normal heart occupy <50% of the transthoracic diameter.
 The left border formed by the
 Aortic arch,pulmonary trunk,left atrial appendge & the left venticle
 On the right superior vena cava & right atrium,the lower right border formed
by right venticle.

Coronary circulation

 The LMCA & RCA arises from Lt & Rt coronary sinuses,just distal to the
aortic valve.
 The LMCA with in 2.5 cm divided into LAD&LCX
 The LAD supply supply ant.part of the LV,apex & septum .
 The LCX supply the posteroinferior surfuce of left ventrivle
 The RCA supply right atrium& ventricle & inferoposterior part of left
ventricle

The venous drainage of the heart follows the coronary circulation & drain through the
coronary sinus into the right atrium.

Nerve supply of the heart

 The sympathetic fibers supply the heart through the adrenergic nerve fibers.
 The parasympathetic supply mediated through the vagus nerve which is the
dominant effect ar resting condition.

1
Physiology

 The basic unit of contraction is the sarcomer.

 Which composed of actin-myosine structures.
 Actin-myosin interdigitation—sarcomer shortening,resulting in muscle
contraction.
 The force of contraction regulated by influx of calcium ions.

Factors influencing cardiac output

 Cardiac output is the product of stroke volume & heart rate.

 Stroke volume is dependent on end-diastolic pressure (preload) & peripheral
vascular resistance (after load).
 Stretching of cardiac muscle (end diastolic volume) results in increase in force
of contraction (stroke volume).this relation ship known as starling´s law of the
heart.

The arterial pulse

 It depend on stroke volume & arterial compliance.

 Small volume pulse---heart failure ,hypovolaemia.
 Large pulse volume---fever,anaemia,AR
 Pulsus alternans---heart failure.
 Pulsus paradoxus---COAD,pericardial tamponade.
 Pulsus bisferiencs---AS+AR,HOCMP

Jugular venous pulse

 Reflect right atrial pressure.

 Is the vertical height between the manubriosternal angle & top of the venous
wave (normally 3-4 cm).
 Abnormally low venous wave occurs in hypovolaemia (haemorrahge).
 Elevated JVP occurs in all kind of heart failure.

2
JVP

 The (a) wave produced by atrial systole,abolished in AF & became prominent

in pulmonary hypertension,RVH & tricusped atresia.
 Canon wave (very large a wave) & occur in complet heart block & ventricular
tachycardia.
 The (v) wave produced during ventricular systole,giant v occur in tricusped
regurgitation.
 Prominent y decent occur in constrictive pericarditis.
 Prominent x occur in pericardial tamponade.

Prepared by:
Rand Aras Najeeb