Cardiac anatomy in ep akram - eladl - adel
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The document outlines the objectives and content of a lecture on cardiac anatomy and physiology. It begins with the objectives of describing the orientation and features of the heart chambers, embryological development of the atria, ionic basis of pacemaker action potentials, and mechanisms of heart rhythm disorders. The document then presents various slides on topics including the anatomy of the heart chambers and conduction system, embryological development of the heart, and ionic basis of automaticity and disorders of heart rhythm conduction and formation.
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Cardiac anatomy in ep akram - eladl - adel
- 1. Dr. Akram Jaffar CCaarrddiiaacc AAnnaattoommyy iinn EEPP Dr. Akram Jaffar Dr. Mohammed Eladl Dr. Adel Elmoselhi
- 2. Dr. Akram Jaffar Objectives • Outline the orientation of the chambers of the heart. • Highlight the gross features of the inside of the heart. • Summarize the embryology of the heart with an emphasis on the development of the atria. • Describe the ionic basis of pacemaker action potential. • Explain mechanisms of heart rhythm disorders (e.g. impulse reentry) and how catheter ablation target those mechanisms.
- 3. Dr. Akram Jaffar Heart Symbol
- 4. Dr. Akram Jaffar Chinese and Indian Medicine
- 5. Dr. Akram Jaffar Ibn-Sina (Avicenna) • “Abu Ali placed his hand on the patient’s pulse, and mentioned the names of the different districts and continued until he reached the name of a quarter at the mention of which, as he uttered it, the patient’s pulse gave a strange flutter. Then Abu Ali repeated the names of different streets of that district and different houses till he reached the name of a house at the mention of which the patient’s pulse gave the same flutter. Finally, he uttered the name of different households of that house until he reached a name at the mention of which that strange flutter resumed. Thereupon he said: This man is in love with such-and-such a girl, in such-and-such a house, in such-and-such a street, in such-and- such a quarter: the girl’s face is the patient’s cure”.
- 6. Dr. Akram Jaffar Heart Symbol
- 7. Dr. Akram Jaffar Orientation of the heart PPhhyyssiioollooggiisstt’’ss hheeaarrtt AAnnaattoommiisstt’’ss hheeaarrtt
- 8. L. atrium Dr. Akram Jaffar Anterior surface of the heart R.V. R.A. L.V.
- 9. Dr. Akram Jaffar Inferior (diaphragmatic) surface R.V. R.A. L.V. L.A. Post. IV groove IVC
- 10. Dr. Akram Jaffar Posterior surface (base) L.A. RR.. vveennttrriiccllee RR.. aattrriiuumm LL.. vveennttrriiccllee LL.. aattrriiuumm
- 11. Dr. Akram Jaffar R. atrium IVC L. ventricle R. ventricle
- 12. Musculi pectinati Dr. Akram Jaffar Chambers of the heart: Right atrium auricle Crista terminalis Inter-atrial septum Annulus ovalis Fossa ovalis RR.. AA--VV oorriiffiiccee Tricuspid valve (septal cusp) Coronary sinus (rudimentary valve) SVC (no valve) IVC (rudimentary valve)
- 13. Tendon of Todaro Dr. Akram Jaffar Triangle of Koch and Cavo-tricuspid isthmus Tricuspid valve (septal cusp) Coronary sinus AV node
- 14. Pulmonary orifice R post cusp of aortic valve Dr. Akram Jaffar Skeleton of the heart Right fibrous trigone (central fibrous body) Fibrous rings Fibrous trigones
- 15. Chordae tendineae Dr. Akram Jaffar Right ventricle Papillary muscle (septal) Tricuspid valve Tricuspid valve (septal cusp) (anterior cusp) Tricuspid valve (inferior cusp) Pulmonary orifice & valve Supraventricular crest Papillary muscle (anterior) Papillary muscle (posterior) Septo-marginal trabecula (Moderator band) infundibulum Trabeculae carnae IIVV sseeppttuumm
- 16. Dr. Akram Jaffar Left atrium auricle Pulmonary v. A-V orifice & mitral valve
- 17. mitral valve Post. cusp Dr. Akram Jaffar Left ventricle Papillary muscle (anterior) Papillary muscle (posterior) mitral valve Ant. cusp IIVV sseeppttuumm
- 18. Dr. Akram Jaffar Conducting system of the heart SA node (pace maker) AV node AV bundle R bundle branch L bundle br. Purkinje fibers
- 19. DDEEVVEELLOOPPMMEENNTT OOFF tthhee hheeaarrtt Dr. Akram Jaffar
- 20. Dr. Akram Jaffar DEVELOPMENT OF THE HEART PPVV PPAA
- 21. DDRR MM EELLAADDLL Dr. Akram Jaffar TTAA BBCC PPVV PPAA DEVELOPMENT OF THE HEART TTAA BBCC PPVV PPAA ssvv sv PA PV BC TA
- 22. Dr. Akram Jaffar DEVELOPMENT OF THE HEART TTAA BBCC PPVV PPAA ssvv TTAA BBCC PPVV PPAA ssvv TTAA BBCC PPVV ssvv PPAA
- 23. Dr. Akram Jaffar
- 24. Dr. Akram Jaffar Langman’s Medical Embryology 11th Edition
- 25. Dr. Akram Jaffar
- 26. Dr. Akram Jaffar SEPTUM PRIMUM • A sickle shaped septum (septum primum) grows from the roof of the primitive atrium towards the septum intermedium. • The lower rim of the septum primum is separated from the septum intermedium by opening called the foramen primum. • Before complete closure of the foramen primum, the upper part of septum primum will breaks down to form the foramen secondum (between the upper margin of septum primum and the roof of primitive atrium), allowing a free passage of blood flow from right to left side.
- 27. Dr. Akram Jaffar SEPTUM SECONDUM • A cresentic fold from the cephalic wall of the primitive atrium grows downward towards the septum intermedium, but not fused with it. • The septum secondum lies to the right side of septum primum. The free concave edge of the septum secondum begins to overlap the foramen secondum. • The new passage formed between the right and left atrium is called the foramen ovale. • The foramen ovale is not a simple orifice, but an oblique passage.
- 28. Dr. Akram Jaffar Before Birth Pressure in the right atrium is higher because: – The lungs are not functioning – More oxygenated blood reaches the right atrium from the placenta via the IVC. This allows the blood stream to pass from right atrium to left atrium through the foramen ovale.
- 29. Dr. Akram Jaffar After Birth Pressure inside the left atrium increases and exceeds that of the right atrium due to: – Stoppage of the placental circulation – Exposure to cold, which stimulates the respiration and lung functions, more blood reaches the left atrium (from the lungs) The difference in the pressure between the two atria presses the septum primum against the septum secondum and the two septa become fused together, and as a result of this: – The lower edge of septum secondum will form the annulus ovalis . – The septum primum will form the fossa ovalis (the depression below the annulus ovalis).
- 30. Dr. Akram Jaffar HHeeaarrtt CCoonndduuccttiioonn SSyysstteemm && IIoonniicc BBaassiiss ooff AAuuttoommaattiicciittyy
- 31. Lilly L., Heart Pathophysiology, 4th E Dr. Akram Jaffar Heart Conduction System & Ionic Basis of Automaticity Action Potential of a Pacemaker Cells
- 32. Dr. Akram Jaffar Disorders of heart rhythm are due to alterations in: • Impulse formation • Impulse conduction • Both
- 33. Dr. Akram Jaffar Alterations of impulse formation • Altered automaticity (↓ or ↑ sinus node automaticity mainly due to change in ANS) • Abnormal automaticity (leaky membrane due to cell injury) • Triggered activity - afterdepolarization Lilly L., Heart Pathophysiology, 4th E e.g. Long-QT syndrome e.g. Digitalis intoxication
- 34. Dr. Akram Jaffar Alterations of impulse conduction Two critical conditions for reentry: •Unidirectional conduction block (e.g. Functional or Fixed block) •Slow conduction through reentry path Mechanism of the reentr y L illy L., Heart Pathophysiology, 4th E e.g. Wolf- Parkinson- White (WPW) Syndrome
- 35. Dr. Akram Jaffar How catheter ablation wwoorrkkss iinn ddiiffffeerreenntt ttyyppeess ooff ttaacchhyyccaarrddiiaass?? Miller J M , and Zipes D P Circulation. 2002;106:e203-e205
- 36. Dr. Akram Jaffar Which of the following statements best describes the triangle of Koch? A. Is the central fibrous body of the skeleton of the heart B. Provides attachement for the anterior cusp of the tricuspid valve C. Is a landmark for the AV node D. Transmits the right bundle branch E. Is located at the tip of the auricle of the right atrium
- 37. In postnatal life, the right atrium contains the fossa ovalis, a shallow depression in the interatrial septum. Which embryonic structure forms the floor of the fossa? Dr. Akram Jaffar A. Septum secundum B. Septum primum C. Endocardial cushion D. Bulbus cordis E. AV node
- 38. Dr. Akram Jaffar All the following criteria are essential for the impulse reentry mechanism EXCEPT A.Bidirectional conduction B.Slow direction for reentry path C.Unidirectional conduction
- 39. Dr. Akram Jaffar THANK YOU..
Notas del editor
- VSD: ventricular septal defect
- While the primitive right atrium enlarges by incorporation of the right sinus horn, the primitive left atrium is likewise expanding. Initially, a single embryonic pulmonary vein develops as an outgrowth of the posterior left atrial wall, just to the left of the septum primum. This vein gains connection with veins of the developing lung buds. During further development, the pulmonary vein and its branches are incorporated into the left atrium, forming the large smoothwalled part of the adult atrium. Although initially one vein enters the left atrium, ultimately, four pulmonary veins enter as the branches are incorporated into the expanding atrial wall. In the fully developed heart, the original embryonic left atrium is represented by little more than the trabeculated atrial appendage, while the smooth-walled part originates from the pulmonary veins. On the right side, the original embryonic right atrium becomes the trabeculated right atrial appendage containing the pectinate muscles, and the smooth-walled sinus venarum originates from the right horn of the sinus venosus.
- Figure 1. How catheter ablation works in different types of tachycardias. Sections of heart muscle where tachycardia originates are depicted. A, A focus (*) is repeatedly firing to cause tachycardia by spreading outward to other cells; the ECG below shows SVT at 200 beats/min. A catheter with a large electrode at its tip is in contact with the focus; after ablation (right), the area of the focus has been damaged and is no longer firing. Arrows show normal electrical propagation and the ECG below is normal. B, A reentrant circuit is shown with electrical propagation around a nonconducting barrier to produce VT at a rate of 180 beats/min, as shown in the ECG below. The impulse must pass through a narrow “bottleneck” to continue. This is an area (where catheter tip is pointing) at which a small amount of damage can eliminate reentry; after ablation, the bottleneck is sealed off, preventing reentry. The ECG rhythm below is normal.
- Septum primum*
- Septum primum*