SlideShare ist ein Scribd-Unternehmen logo
1 von 74
Downloaden Sie, um offline zu lesen
Blood supply of the
Heart & Conduction
System
Arterial supply of Heart
 

Right coronary artery
Left coronary artery
Right Coronary Artery
 

Arises from anterior aortic sinus of the 
Ascending Aorta.
It descends in the right atrioventricular 
groove.
Near inferior border continuous 
posteriorly along the atrioventricular 
groove. 
Anastomose with left coronary artery in 
the posterior interventricular groove.
Right Coronary Artery
 

Branches of Right
Coronary Artery

1.Right conus artery:
       Supplies rt ventricular outflow tract. 
2.Rt marginal branch:
Supply free wall of rt ventricle. 
 

3.

Branches of Right
Coronary Artery

Rt posterolateral branch:
goes back of lt ventricle
        supply inferior aspect of interventricular
        septum
4. Atrial branches:
Supply anterior and lateral surface of the 
right atrium. One branch supply posterior 
surface of both right and left atria. 
Artery of Sinuatrial Node (60%)
 

Branches of Right
Coronary Artery

5. Posterior interventricular (descending) 
artery

Runs towards apex in the posterior 
interventricular groove.

Supply right & left ventricles, including 
its inferior wall.

Supply posterior part of the ventricular 
septum (Excluding Apex). 
   Large septal branch Supply 
Atrioventricular Node. 
Clinical division of the RCA





Proximal - Ostium to 1st main RV branch
Mid
- 1st RV branch to acute marginal
branch
Distal
- acute margin to the crux
Area of distribution RCA









Rt atrium
Greater part of rt ventricle except area
adjoining ant interventricular groove
Small part of lt ventricle adjoining post
interventricular groove
Whole of conducting system of heart
except part of lt branch of AV bundle
SA Node –supplied by LCA (40%)
Left Coronary Artery
 

Larger then Right coronary artery.
Arises from posterior aortic sinus of the 
Ascending Aorta.
Passes between pulmonary trunk and left 
auricle.
It enters in the atrioventricular groove and 
divides into an anterior interventricular branch 
and a circumflex branch.
Supply greater part of the left Atrium, left 
ventricle and ventricular septum.
 

Branches of Left Coronary
Artery

1. Anterior interventricular (descending) artery:
   Runs in the anterior interventricular groove to 
         the Apex.

Passes around the Apex to enter the posterior    
         
interventricular groove & anastomoses 
with the   terminal branches of Right coronary 
artery. 
   Supply right and left ventricles & anterior 
part of ventricular septum.
   Left diagonal branch  
    wrap over anterolateral free wall of lt ventricle
Left Coronary Artery
 

2.


Branches of Left Coronary
Artery

Circumflex artery:
Winds around the left margin of the heart 
in the atrioventricular groove.

obtuse marginal branch:
      supply lateral free wall of lt ventricle
      does not reach crux in pt with rt dominant 
        circulation 
 Atrial branches: Supply left atrium.
    Artery of Sinuatrial Node (40%)
Clinical division of the LAD




Proximal - Ostium to 1st major septal perforator
Mid
- 1st perforator to D2 (90 degree angle)
Distal
- D2 to end
Clinical division of the LCX





Proximal - Ostium to 1st major obtuse marginal
branch
Mid
- OM1 to OM2
Distal
- OM2 to end
Area of distribution of LCA








Lt atrium
Greater Prt of lt ventricle except post
interventricular groove
Small part of rt ventricle adjoining ant
interventricular groove
Ant part of interventricular septum
Lt branch of AV bundle
Conducting system of
Heart
   S-A Node: Right coronary artery (60%)
                       Left coronary artery (40%)
 
 A-V Node and A-V Bundle: Right coronary artery
 Right Bundle branch: Left coronary artery 
 Left Bundle branch:  Right & Left coronary  
   arteries 
Coronary segment
classification system



CASS investigators – 27 segments
BARI – 29 segments ( ramus intermedius
and 3rd diagonal branch)

- Obstructive CAD : > 50% stenosis
Cardiac dominance
85%-rt dominant coronary artery
 8% lt dominant-post descending,posterolateral lt
ventricular and AVnodal artery all supplied by
terminal portion of lt circumflex coronary artery.rt
coronary artery small and supply only rt atrium
and rt ventricle
 7%-codominant
 RCA-PDA and terminates,circumflex artery-all
post
Lt ventricular branches

Congenital anomaly of coronary
circulation




Anomalous pulmary origin of coronary
artery(APOCA)
Most common-origin of LCA from
pulmonary artery
Aortography-large RCA with absence of lt
coronary ostium in lt aortic sinus
Anomalous coronary artery
from opposite sinus


Origin of LCA from rt aortic sinus
causes sudden cardiac death after
exercise
in young person
Coronary artery fistula


Abnormal communication between
coronary artery and major vessels such as
venacava,pulmonary artery or vein
Myocardial bridging


All 3 major coronary artery generally
course along epicardial surface of heart
sometime short coronary artery segment
descend into myocardium for variable
distance
occurs in 5-12% of pt and confined to LAD
Coronary artery spasm
Dynamic and reversible occlusion of
epicardial coronary artery caused by focal
constriction of smooth muscle cell within
arterial wall
occurs in prinzmetal angina
aggrevated by cigaratte smoking,cocaine
alcohal,GA
Not aggrevated by emotion,cold

Most common-separate ostium for LAD
and lcx,simillarly in RCA-conus branch
may have
Separate ostium
Origin of circumflex from rt coronary artery
RCA-originate high in aortic root

“ Dominance ”




A misnomer
giving rise to PDA, at least 1 PLV & AV
nodal A
(BARI classification)

- 85% right dominant
- 8% left dominant
- 7% co-dominant

(70%/ 10%/ 20% – Hurst’s THE HEART)


Left dominance is 25-30% in Bi-AoV

Gensini GG. Coronary Arteriography. Mount Kisco,NY: Futura Publishing Co; 1975:260–274.
Venous Drainage of Heart
 

 Coronary Sinus: 
Runs in the coronary sulcus (posterior 
atrioventricular groove).
Largest vein of heart
About 3 cm long
Ends by opening into post wall of rt 
atrium
Tributaries:
 Great cardiac vein
 Middle cardiac vein


Small cardiac vein

Post vein of lt ventricle
 Oblique vein of lt atrium
 Rt marginal vein
All drains into coronary sinus which opens
into rt atrium

1.

2.

3.

4.

Great cardiac vein-accompany ant
interventricular artery and then
LCA
Middle cardiac vein –accompany post
interventricular artery and joins middle part of
coronary sinus
Small cardiac vein-accompany rt coronary
artery
Post vein of lt ventricle-runs on diaphragmatic
Surrface of lt ventricle and ends in middle of
coronary sinus
5 oblique vein of lt atrium-small vein
running on post surface of lt atrium
6 rt marginal vein-accompany marginal
branch of rt coronary artery
Contents of Heart grooves
1.   Right atrioventricular groove:

 

       Right coronary artery
       Small cardiac vein
2.    Left anterior atrioventricular groove:
       Left coronary artery       
3.    Left posterior atrioventricular groove:
       Coronary sinus
4.    Anterior interventricular groove:
       Anterior interventricular artery 
       Great cardiac vein
5.    Posterior interventricular groove:
       Posterior interventricular artery 
       Middle cardiac vein
Venous drainage
Ant cardiac vein and venae cordis minimi
opens directly into rt atrium
Ant cardiac vein
3-4 small vein running parrelel to one
another on ant wall of rt ventricle
venae cordis minimi-Thebesian vein or
smallest cardiac vein
Small vein present in all chambers of heart

Cardiac Veins (Sternocostal Surface)

Anterior cardiac veins
Cardiac Veins (Diaphragmatic
Surface)
Conducting System






Network of
specialized
tissue that
stimulates
contraction
Modified
cardiac
myocytes
The heart can
contract
without any
innervation
The  Cardiac  Conduction  System  
The impulse conduction system of the heart consists 
of four structures:
1.  The sinoatrial node (SA node)
2.  The atrioventricular node (AV node)
3.  The atrioventricular bundle (AV bundle)
4.  The Purkinje fibers
The cardiac muscle fibers that compose these 
structures are specialized for impulse 
conduction,rather than the normal specialization of 
muscle fibers for contraction.
The sinoatrial node

”. SA node-located at junction of sup vena cava 
   and rt atrium
  SA node-discharge mostrapidly,depolarisation
Spread from it to other region before they 
discharge spontaneously
Its rate of dischage determine rate at which 
heart beat
This is also why the SA node is said to be the 
“pacemaker” of the heart
Spread of cardiac exitation







Atrial activation
Septal activation
Activation of anteroseptal region
Activation of major portion of ventricular
myocardium
Activation of posterobasal portion of lt
ventricle
Impulses from the SA node are then conducted across
the atria from right to left. The impulse does not
however pass directly to the ventricles.
When both the
right and left atria
are completely
depolarized, they
contract
simultaneously.
As the atria depolarize, the impulse is picked up by
another group of specialized muscle fibers called the
atrioventricular node. The AV node is located in the
floor of the right atrium next to the interatrial
septum. This group of fibers is the only conduction
pathway between the atria and ventricles.
As the impulse is conducted through the AV node, its
speed is reduced. This is due to the extremely small
diameter of the conducting fibers.
This is an extremely important phenomenon because
the delay in the transmission from atria to ventricles
allows time for the atria to completely depolarize and
contract, thus emptying their contents into the still
fully relaxed ventricles.
From the AV node, the impulse travels down
the atrioventricular bundle. The AV bundle
divides into two lines of transmission just
below the AV node and these conduct the
impulse down the length of the interventricular
septum. An important fact about the fibers that
make up the AV bundle is that they are large in
diameter and therefore the impulse speed
increases so it is conducted very rapidly down
them.
About halfway down the interventricular
septum the “bundle branches” themselves begin
to branch off into enlarged conduction fibers
called Purkinje fibers. These fibers extend out
to all areas of the two ventricles and since they
are further enlarged, the speed of the impulse
conduction is also additionally increased. Upon
completion of impulse transmission through the
Purkinje fibers, the ventricles will fully
depolarize and then contract simultaneously.
What causes what ?


Conduction problem in AV
NODE & HIS BUNDLE1st, 2nd & 3rd degree heart
blocks
 Conduction problems in
left & right bundle
branches- RBBB
LBBB
LAHB
LPHB
Bi & Tri
–
Ventricular Conduction
Disorders.
Left Bundle Branch Block.
Right Bundle Branch Block.
Other related blocks.
Left Bundle Branch Block.








Block of the left bundle
or both fasicles of the
left bundle.
Electrical potential must
travel down RBB.
De-polarisation from
right to left via cell
transmission.
Cell transmission
longer due to LV mass.
Left Bundle Branch Block (LBBB).
ECG Criteria for LBBB.





QRS Duration >0.12secs.
Broad, mono-morphic R wave leads I and
V6.
Broad mono-morphic S waves in V1 (can
also have small 'r' wave).
LBBB consequence.


Mostly abnormal ECG finding - indicates
heart disease.









Coronary artery disease (indication for
thrombolysis - if associated with chest pain and
raised Troponin).
Valvular heart disease.
Hypertension.
Cardiomegaly.
Heart failure.
Impacts on prognosis - QRS duration.
Use of Bi-Ventricular Pacemakers.
Right Bundle Branch Block.








Impulse transmitted
normally by left bundle.
Blocked right bundle
results in cell
depolarisation to
spread impulse
(slower).
Impulse to IV septum
and RV delayed.
Results in an additional
vector.
Right Bundle Branch Block (RBBB).
Additional Info RBBB.









Can be normal.
Sometimes related to asthma or other
airway conditions.
Possibly due to RVH in young individuals.
Usually due to CAD in older persons.
Often related to congenital heart disease
(particularly ASD).
Often apparent following cardiac surgery.
Left Anterior Hemi-block
Appearance.
ECG Features of Left Anterior
Hemi-block.










Abnormal left axis deviation (between -30
and -900).
Either a qR complex or an R wave in lead
I.
rS complex in lead III (possibly also II and
aVF).
Extremely common and un-diagnosed
ECG feature.
NOT ALWAYS ASSOCIATED WITH BBB.
ECG Features Left Posterior Hemiblock.






Axis of 90 - 180o - (right axis).
An s wave in lead I and a q wave in lead III.
Exclusion of RAE or RVH.

REMEMBER - most common cause of right
axis is RVH so this must be excluded before
you diagnose LPH.
Left Posterior Hemi-block.
INTRODUCTION TO HEART
BLOCKS






OCCUR WHEN THERE IS A PARTIAL
OR COMPLETE INTERRUPTION IN THE
CARDIAC ELECTRICAL CONDUCTION
SYSTEM.
CAN OCCUR ANYWHERE IN THE ATRIA
BETWEEN THE SA NODE AND THE AV
JUNCTION.
IN THE VENTRICLES BETWEEN THE
AV JUNCTION AND PURKINJE FIBERS.
For more medical presentations www.pmcosa.com
FIRST-DEGREE HEART
BLOCK






DELAY OF IMPULSE BETWEEN THE
ATRIA AND BUNDLE OF HIS.
OCCURS WHEN THERE IS A PARTIAL
INTERRUPTION ANYWHERE IN THE
ATRIAL OR AV JUNCTIONAL
CONDUCTION SYSTEM.
THE IMPULSE IS EVENTUALLY
CONDUCTED BUT IS DELAYED.
For more medical presentations www.pmcosa.com
degree heart block
Just prolongation
of PR interval.
 Normal PR 1 st = .2
Sec
 Here it is .28 Sec

MOBITZ I HEART BLOCK







MOBITZ I ( WENCKEBACH OR SECONDDEGREE HEART BLOCK, TYPE I).
PROGRESSIVE BLOCK.
IMPULSE FROM THE ATRIA IS
INTERRUPTED AT THE AV JUNCTION.
THE INTERRUPTION BECOMES LONGER
WITH EACH IMPULSE DELAYING
DEPOLARIZATION OF THE VENTRICLES
UNTIL A COMPLETE INTERRUPTION
BLOCKS THEFor more medical presentations IMPULSE.
www.pmcosa.com
For more medical presentations www.pmcosa.com
MOBITZ II HEART
BLOCK






OCCURS DUE TO AN INTERMITTENT
INTERRUPTION NEAR OR BELOW THE
AV JUNCTION.
INTERRUPTION IS NOT
PROGRESSIVE, BUT OCCURS
SUDDENLY AND WITHOUT WARNING!!
P WAVES BEFORE EVERY QRS
COMPLEX AND ALL ARE THE SAME
SIZE AND SHAPE. presentations For more medical
www.pmcosa.com
For more medical presentations www.pmcosa.com
THIRD-DEGREE HEART
BLOCK






COMPLETE HEART BLOCK OR
COMPLETE AV DISSOCIATION.
IMPULSE IS COMPLETELY BLOCKED
BETWEEN THE ATRIA AND THE
VENTRICLES.
USUALLY TAKES PLACE BETWEEN
THE AV JUNCTION AND BUNDLE OF
HIS.
For more medical presentations www.pmcosa.com
Third degree heart block

For more medical presentations www.pmcosa.com
Blood supply of heart (1)
Blood supply of heart (1)
Blood supply of heart (1)
Blood supply of heart (1)
Blood supply of heart (1)
Blood supply of heart (1)
Blood supply of heart (1)
Blood supply of heart (1)
Blood supply of heart (1)

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Anatomy of the heart
Anatomy of the heartAnatomy of the heart
Anatomy of the heart
 
Anatomy and function of the coronary arteries
Anatomy and function of the coronary arteriesAnatomy and function of the coronary arteries
Anatomy and function of the coronary arteries
 
Vena cava anatomy and variants
Vena cava anatomy and variantsVena cava anatomy and variants
Vena cava anatomy and variants
 
the cardiovascular system and Physiology of heart
the cardiovascular system and Physiology of heartthe cardiovascular system and Physiology of heart
the cardiovascular system and Physiology of heart
 
Anatomy of heart
Anatomy of heartAnatomy of heart
Anatomy of heart
 
The valves of the heart
The valves of the heartThe valves of the heart
The valves of the heart
 
Internal feature of right and left atria
Internal feature of right and left atriaInternal feature of right and left atria
Internal feature of right and left atria
 
Coronary artery anatomy
Coronary artery anatomyCoronary artery anatomy
Coronary artery anatomy
 
Interior of right atrium
Interior of right atriumInterior of right atrium
Interior of right atrium
 
Cardio vascular system Anatomy and physiology
Cardio vascular system Anatomy and physiology Cardio vascular system Anatomy and physiology
Cardio vascular system Anatomy and physiology
 
2. External features of the heart
2. External  features of the heart2. External  features of the heart
2. External features of the heart
 
The heart chambers
The heart chambersThe heart chambers
The heart chambers
 
Cardiovascular System
Cardiovascular SystemCardiovascular System
Cardiovascular System
 
Right atrium of heart
Right atrium of heartRight atrium of heart
Right atrium of heart
 
The pericardium
The pericardiumThe pericardium
The pericardium
 
Blood supply and venous drainage of heart
Blood supply and venous drainage of heartBlood supply and venous drainage of heart
Blood supply and venous drainage of heart
 
The heart walls
The heart wallsThe heart walls
The heart walls
 
Blood supply of heart
Blood supply of heartBlood supply of heart
Blood supply of heart
 
Thoracic aorta
Thoracic aortaThoracic aorta
Thoracic aorta
 
3. internal structure of the heart
3. internal structure of the heart3. internal structure of the heart
3. internal structure of the heart
 

Andere mochten auch

Andere mochten auch (8)

Structure Of A Heart
Structure Of A HeartStructure Of A Heart
Structure Of A Heart
 
Heart
HeartHeart
Heart
 
Heart Slides
Heart SlidesHeart Slides
Heart Slides
 
Heart Anatomy and Physiology:Review
Heart Anatomy and Physiology:ReviewHeart Anatomy and Physiology:Review
Heart Anatomy and Physiology:Review
 
blood supply of heart
blood supply of heartblood supply of heart
blood supply of heart
 
Heart Presentation
Heart PresentationHeart Presentation
Heart Presentation
 
Anatomy of the Heart
Anatomy of the HeartAnatomy of the Heart
Anatomy of the Heart
 
THE HEART PPT
THE HEART PPTTHE HEART PPT
THE HEART PPT
 

Ähnlich wie Blood supply of heart (1)

Cornary blood supplay.ppt
Cornary blood supplay.pptCornary blood supplay.ppt
Cornary blood supplay.pptAdelSALLAM4
 
Anatomy of heart dr nikunj shekhada (mbbs,ms gen surg ,dnb cts SR) 11 6-18
Anatomy of heart dr nikunj shekhada (mbbs,ms gen surg ,dnb cts SR) 11 6-18Anatomy of heart dr nikunj shekhada (mbbs,ms gen surg ,dnb cts SR) 11 6-18
Anatomy of heart dr nikunj shekhada (mbbs,ms gen surg ,dnb cts SR) 11 6-18DR NIKUNJ SHEKHADA
 
Cardiac anatomy and physiology
Cardiac anatomy and physiologyCardiac anatomy and physiology
Cardiac anatomy and physiologykamalrajkumar1
 
1. cardiovascular system
1. cardiovascular system1. cardiovascular system
1. cardiovascular systemAhmad Hamadi
 
The cardiovascular system
The cardiovascular systemThe cardiovascular system
The cardiovascular systemIndia™
 
4. BLOOD SUPPLY OF HEART 1.pdf
4. BLOOD SUPPLY OF HEART 1.pdf4. BLOOD SUPPLY OF HEART 1.pdf
4. BLOOD SUPPLY OF HEART 1.pdfsajadkhan30
 
Cardiovascular system
Cardiovascular systemCardiovascular system
Cardiovascular systemNazmul Huda
 
Cardiac A&P Review - BMH/Tele
Cardiac A&P Review - BMH/TeleCardiac A&P Review - BMH/Tele
Cardiac A&P Review - BMH/TeleTeleClinEd
 
The heart and heart disease
The heart and heart diseaseThe heart and heart disease
The heart and heart diseasesharon49
 
Cardiac anatomy and physiology
Cardiac anatomy and physiologyCardiac anatomy and physiology
Cardiac anatomy and physiologyJose Escanuela
 
Coronary circulation 14 10-14
Coronary circulation 14 10-14Coronary circulation 14 10-14
Coronary circulation 14 10-14Aftab Hussain
 
8. The Cardiovascular System
8. The Cardiovascular System8. The Cardiovascular System
8. The Cardiovascular SystemSUNY Ulster
 
heart-180521025843.pdf
heart-180521025843.pdfheart-180521025843.pdf
heart-180521025843.pdfshilpas275123
 

Ähnlich wie Blood supply of heart (1) (20)

Cornary blood supplay.ppt
Cornary blood supplay.pptCornary blood supplay.ppt
Cornary blood supplay.ppt
 
Anatomy of heart dr nikunj shekhada (mbbs,ms gen surg ,dnb cts SR) 11 6-18
Anatomy of heart dr nikunj shekhada (mbbs,ms gen surg ,dnb cts SR) 11 6-18Anatomy of heart dr nikunj shekhada (mbbs,ms gen surg ,dnb cts SR) 11 6-18
Anatomy of heart dr nikunj shekhada (mbbs,ms gen surg ,dnb cts SR) 11 6-18
 
Cardiac anatomy and physiology
Cardiac anatomy and physiologyCardiac anatomy and physiology
Cardiac anatomy and physiology
 
Cardiovascular adi
Cardiovascular adiCardiovascular adi
Cardiovascular adi
 
Cardiovascular system
Cardiovascular systemCardiovascular system
Cardiovascular system
 
1. cardiovascular system
1. cardiovascular system1. cardiovascular system
1. cardiovascular system
 
Chapter19 heartmarieb
Chapter19 heartmariebChapter19 heartmarieb
Chapter19 heartmarieb
 
The cardiovascular system
The cardiovascular systemThe cardiovascular system
The cardiovascular system
 
4. BLOOD SUPPLY OF HEART 1.pdf
4. BLOOD SUPPLY OF HEART 1.pdf4. BLOOD SUPPLY OF HEART 1.pdf
4. BLOOD SUPPLY OF HEART 1.pdf
 
The Heart
The HeartThe Heart
The Heart
 
Cardiovascular system
Cardiovascular systemCardiovascular system
Cardiovascular system
 
Cardiac A&P Review - BMH/Tele
Cardiac A&P Review - BMH/TeleCardiac A&P Review - BMH/Tele
Cardiac A&P Review - BMH/Tele
 
The heart and heart disease
The heart and heart diseaseThe heart and heart disease
The heart and heart disease
 
Cardiac anatomy and physiology
Cardiac anatomy and physiologyCardiac anatomy and physiology
Cardiac anatomy and physiology
 
Coronary circulation 14 10-14
Coronary circulation 14 10-14Coronary circulation 14 10-14
Coronary circulation 14 10-14
 
the normal heart
the normal heartthe normal heart
the normal heart
 
CVS handouts
CVS handoutsCVS handouts
CVS handouts
 
Chapter 20
Chapter 20Chapter 20
Chapter 20
 
8. The Cardiovascular System
8. The Cardiovascular System8. The Cardiovascular System
8. The Cardiovascular System
 
heart-180521025843.pdf
heart-180521025843.pdfheart-180521025843.pdf
heart-180521025843.pdf
 

Kürzlich hochgeladen

How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesCeline George
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxKatherine Villaluna
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxraviapr7
 
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxiammrhaywood
 
How to Add a New Field in Existing Kanban View in Odoo 17
How to Add a New Field in Existing Kanban View in Odoo 17How to Add a New Field in Existing Kanban View in Odoo 17
How to Add a New Field in Existing Kanban View in Odoo 17Celine George
 
M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxDr. Santhosh Kumar. N
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptxSandy Millin
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxraviapr7
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17Celine George
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapitolTechU
 
UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024UKCGE
 
Quality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICEQuality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICESayali Powar
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...raviapr7
 
Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfMohonDas
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.raviapr7
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxheathfieldcps1
 
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxPISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxEduSkills OECD
 

Kürzlich hochgeladen (20)

How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 Sales
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptx
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptx
 
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
 
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdfPersonal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
 
How to Add a New Field in Existing Kanban View in Odoo 17
How to Add a New Field in Existing Kanban View in Odoo 17How to Add a New Field in Existing Kanban View in Odoo 17
How to Add a New Field in Existing Kanban View in Odoo 17
 
Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 
M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptx
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptx
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptx
 
UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024
 
Quality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICEQuality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICE
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...
 
Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdf
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptx
 
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxPISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
 

Blood supply of heart (1)

  • 1. Blood supply of the Heart & Conduction System
  • 2. Arterial supply of Heart   Right coronary artery Left coronary artery
  • 5.   Branches of Right Coronary Artery 1.Right conus artery:        Supplies rt ventricular outflow tract.  2.Rt marginal branch: Supply free wall of rt ventricle. 
  • 6.   3. Branches of Right Coronary Artery Rt posterolateral branch: goes back of lt ventricle         supply inferior aspect of interventricular         septum 4. Atrial branches: Supply anterior and lateral surface of the  right atrium. One branch supply posterior  surface of both right and left atria.  Artery of Sinuatrial Node (60%)
  • 7.   Branches of Right Coronary Artery 5. Posterior interventricular (descending)  artery  Runs towards apex in the posterior  interventricular groove.  Supply right & left ventricles, including  its inferior wall.  Supply posterior part of the ventricular  septum (Excluding Apex).     Large septal branch Supply  Atrioventricular Node. 
  • 8. Clinical division of the RCA    Proximal - Ostium to 1st main RV branch Mid - 1st RV branch to acute marginal branch Distal - acute margin to the crux
  • 9. Area of distribution RCA      Rt atrium Greater part of rt ventricle except area adjoining ant interventricular groove Small part of lt ventricle adjoining post interventricular groove Whole of conducting system of heart except part of lt branch of AV bundle SA Node –supplied by LCA (40%)
  • 11.   Branches of Left Coronary Artery 1. Anterior interventricular (descending) artery:    Runs in the anterior interventricular groove to           the Apex.  Passes around the Apex to enter the posterior               interventricular groove & anastomoses  with the   terminal branches of Right coronary  artery.     Supply right and left ventricles & anterior  part of ventricular septum.    Left diagonal branch       wrap over anterolateral free wall of lt ventricle
  • 13.   2.  Branches of Left Coronary Artery Circumflex artery: Winds around the left margin of the heart  in the atrioventricular groove.  obtuse marginal branch:       supply lateral free wall of lt ventricle       does not reach crux in pt with rt dominant          circulation   Atrial branches: Supply left atrium.     Artery of Sinuatrial Node (40%)
  • 14. Clinical division of the LAD    Proximal - Ostium to 1st major septal perforator Mid - 1st perforator to D2 (90 degree angle) Distal - D2 to end
  • 15. Clinical division of the LCX    Proximal - Ostium to 1st major obtuse marginal branch Mid - OM1 to OM2 Distal - OM2 to end
  • 16. Area of distribution of LCA      Lt atrium Greater Prt of lt ventricle except post interventricular groove Small part of rt ventricle adjoining ant interventricular groove Ant part of interventricular septum Lt branch of AV bundle
  • 17. Conducting system of Heart    S-A Node: Right coronary artery (60%)                        Left coronary artery (40%)    A-V Node and A-V Bundle: Right coronary artery  Right Bundle branch: Left coronary artery   Left Bundle branch:  Right & Left coronary      arteries 
  • 18. Coronary segment classification system   CASS investigators – 27 segments BARI – 29 segments ( ramus intermedius and 3rd diagonal branch) - Obstructive CAD : > 50% stenosis
  • 19. Cardiac dominance 85%-rt dominant coronary artery  8% lt dominant-post descending,posterolateral lt ventricular and AVnodal artery all supplied by terminal portion of lt circumflex coronary artery.rt coronary artery small and supply only rt atrium and rt ventricle  7%-codominant  RCA-PDA and terminates,circumflex artery-all post Lt ventricular branches 
  • 20. Congenital anomaly of coronary circulation   Anomalous pulmary origin of coronary artery(APOCA) Most common-origin of LCA from pulmonary artery Aortography-large RCA with absence of lt coronary ostium in lt aortic sinus
  • 21. Anomalous coronary artery from opposite sinus  Origin of LCA from rt aortic sinus causes sudden cardiac death after exercise in young person
  • 22. Coronary artery fistula  Abnormal communication between coronary artery and major vessels such as venacava,pulmonary artery or vein
  • 23. Myocardial bridging  All 3 major coronary artery generally course along epicardial surface of heart sometime short coronary artery segment descend into myocardium for variable distance occurs in 5-12% of pt and confined to LAD
  • 24. Coronary artery spasm Dynamic and reversible occlusion of epicardial coronary artery caused by focal constriction of smooth muscle cell within arterial wall occurs in prinzmetal angina aggrevated by cigaratte smoking,cocaine alcohal,GA Not aggrevated by emotion,cold 
  • 25. Most common-separate ostium for LAD and lcx,simillarly in RCA-conus branch may have Separate ostium Origin of circumflex from rt coronary artery RCA-originate high in aortic root 
  • 26. “ Dominance ”   A misnomer giving rise to PDA, at least 1 PLV & AV nodal A (BARI classification) - 85% right dominant - 8% left dominant - 7% co-dominant (70%/ 10%/ 20% – Hurst’s THE HEART)  Left dominance is 25-30% in Bi-AoV Gensini GG. Coronary Arteriography. Mount Kisco,NY: Futura Publishing Co; 1975:260–274.
  • 27. Venous Drainage of Heart    Coronary Sinus:  Runs in the coronary sulcus (posterior  atrioventricular groove). Largest vein of heart About 3 cm long Ends by opening into post wall of rt  atrium Tributaries:  Great cardiac vein  Middle cardiac vein
  • 28.  Small cardiac vein Post vein of lt ventricle  Oblique vein of lt atrium  Rt marginal vein All drains into coronary sinus which opens into rt atrium 
  • 29. 1. 2. 3. 4. Great cardiac vein-accompany ant interventricular artery and then LCA Middle cardiac vein –accompany post interventricular artery and joins middle part of coronary sinus Small cardiac vein-accompany rt coronary artery Post vein of lt ventricle-runs on diaphragmatic
  • 30. Surrface of lt ventricle and ends in middle of coronary sinus 5 oblique vein of lt atrium-small vein running on post surface of lt atrium 6 rt marginal vein-accompany marginal branch of rt coronary artery
  • 31. Contents of Heart grooves 1.   Right atrioventricular groove:          Right coronary artery        Small cardiac vein 2.    Left anterior atrioventricular groove:        Left coronary artery        3.    Left posterior atrioventricular groove:        Coronary sinus 4.    Anterior interventricular groove:        Anterior interventricular artery         Great cardiac vein 5.    Posterior interventricular groove:        Posterior interventricular artery         Middle cardiac vein
  • 32. Venous drainage Ant cardiac vein and venae cordis minimi opens directly into rt atrium Ant cardiac vein 3-4 small vein running parrelel to one another on ant wall of rt ventricle venae cordis minimi-Thebesian vein or smallest cardiac vein Small vein present in all chambers of heart 
  • 33. Cardiac Veins (Sternocostal Surface) Anterior cardiac veins
  • 35. Conducting System    Network of specialized tissue that stimulates contraction Modified cardiac myocytes The heart can contract without any innervation
  • 36. The  Cardiac  Conduction  System   The impulse conduction system of the heart consists  of four structures: 1.  The sinoatrial node (SA node) 2.  The atrioventricular node (AV node) 3.  The atrioventricular bundle (AV bundle) 4.  The Purkinje fibers The cardiac muscle fibers that compose these  structures are specialized for impulse  conduction,rather than the normal specialization of  muscle fibers for contraction.
  • 38. Spread of cardiac exitation      Atrial activation Septal activation Activation of anteroseptal region Activation of major portion of ventricular myocardium Activation of posterobasal portion of lt ventricle
  • 39. Impulses from the SA node are then conducted across the atria from right to left. The impulse does not however pass directly to the ventricles. When both the right and left atria are completely depolarized, they contract simultaneously.
  • 40. As the atria depolarize, the impulse is picked up by another group of specialized muscle fibers called the atrioventricular node. The AV node is located in the floor of the right atrium next to the interatrial septum. This group of fibers is the only conduction pathway between the atria and ventricles. As the impulse is conducted through the AV node, its speed is reduced. This is due to the extremely small diameter of the conducting fibers.
  • 41. This is an extremely important phenomenon because the delay in the transmission from atria to ventricles allows time for the atria to completely depolarize and contract, thus emptying their contents into the still fully relaxed ventricles.
  • 42. From the AV node, the impulse travels down the atrioventricular bundle. The AV bundle divides into two lines of transmission just below the AV node and these conduct the impulse down the length of the interventricular septum. An important fact about the fibers that make up the AV bundle is that they are large in diameter and therefore the impulse speed increases so it is conducted very rapidly down them.
  • 43. About halfway down the interventricular septum the “bundle branches” themselves begin to branch off into enlarged conduction fibers called Purkinje fibers. These fibers extend out to all areas of the two ventricles and since they are further enlarged, the speed of the impulse conduction is also additionally increased. Upon completion of impulse transmission through the Purkinje fibers, the ventricles will fully depolarize and then contract simultaneously.
  • 44. What causes what ?  Conduction problem in AV NODE & HIS BUNDLE1st, 2nd & 3rd degree heart blocks  Conduction problems in left & right bundle branches- RBBB LBBB LAHB LPHB Bi & Tri –
  • 45. Ventricular Conduction Disorders. Left Bundle Branch Block. Right Bundle Branch Block. Other related blocks.
  • 46. Left Bundle Branch Block.     Block of the left bundle or both fasicles of the left bundle. Electrical potential must travel down RBB. De-polarisation from right to left via cell transmission. Cell transmission longer due to LV mass.
  • 47. Left Bundle Branch Block (LBBB).
  • 48. ECG Criteria for LBBB.    QRS Duration >0.12secs. Broad, mono-morphic R wave leads I and V6. Broad mono-morphic S waves in V1 (can also have small 'r' wave).
  • 49. LBBB consequence.  Mostly abnormal ECG finding - indicates heart disease.        Coronary artery disease (indication for thrombolysis - if associated with chest pain and raised Troponin). Valvular heart disease. Hypertension. Cardiomegaly. Heart failure. Impacts on prognosis - QRS duration. Use of Bi-Ventricular Pacemakers.
  • 50. Right Bundle Branch Block.     Impulse transmitted normally by left bundle. Blocked right bundle results in cell depolarisation to spread impulse (slower). Impulse to IV septum and RV delayed. Results in an additional vector.
  • 51. Right Bundle Branch Block (RBBB).
  • 52. Additional Info RBBB.       Can be normal. Sometimes related to asthma or other airway conditions. Possibly due to RVH in young individuals. Usually due to CAD in older persons. Often related to congenital heart disease (particularly ASD). Often apparent following cardiac surgery.
  • 54. ECG Features of Left Anterior Hemi-block.      Abnormal left axis deviation (between -30 and -900). Either a qR complex or an R wave in lead I. rS complex in lead III (possibly also II and aVF). Extremely common and un-diagnosed ECG feature. NOT ALWAYS ASSOCIATED WITH BBB.
  • 55. ECG Features Left Posterior Hemiblock.     Axis of 90 - 180o - (right axis). An s wave in lead I and a q wave in lead III. Exclusion of RAE or RVH. REMEMBER - most common cause of right axis is RVH so this must be excluded before you diagnose LPH.
  • 57. INTRODUCTION TO HEART BLOCKS    OCCUR WHEN THERE IS A PARTIAL OR COMPLETE INTERRUPTION IN THE CARDIAC ELECTRICAL CONDUCTION SYSTEM. CAN OCCUR ANYWHERE IN THE ATRIA BETWEEN THE SA NODE AND THE AV JUNCTION. IN THE VENTRICLES BETWEEN THE AV JUNCTION AND PURKINJE FIBERS. For more medical presentations www.pmcosa.com
  • 58. FIRST-DEGREE HEART BLOCK    DELAY OF IMPULSE BETWEEN THE ATRIA AND BUNDLE OF HIS. OCCURS WHEN THERE IS A PARTIAL INTERRUPTION ANYWHERE IN THE ATRIAL OR AV JUNCTIONAL CONDUCTION SYSTEM. THE IMPULSE IS EVENTUALLY CONDUCTED BUT IS DELAYED. For more medical presentations www.pmcosa.com
  • 59. degree heart block Just prolongation of PR interval.  Normal PR 1 st = .2 Sec  Here it is .28 Sec 
  • 60. MOBITZ I HEART BLOCK     MOBITZ I ( WENCKEBACH OR SECONDDEGREE HEART BLOCK, TYPE I). PROGRESSIVE BLOCK. IMPULSE FROM THE ATRIA IS INTERRUPTED AT THE AV JUNCTION. THE INTERRUPTION BECOMES LONGER WITH EACH IMPULSE DELAYING DEPOLARIZATION OF THE VENTRICLES UNTIL A COMPLETE INTERRUPTION BLOCKS THEFor more medical presentations IMPULSE. www.pmcosa.com
  • 61. For more medical presentations www.pmcosa.com
  • 62. MOBITZ II HEART BLOCK    OCCURS DUE TO AN INTERMITTENT INTERRUPTION NEAR OR BELOW THE AV JUNCTION. INTERRUPTION IS NOT PROGRESSIVE, BUT OCCURS SUDDENLY AND WITHOUT WARNING!! P WAVES BEFORE EVERY QRS COMPLEX AND ALL ARE THE SAME SIZE AND SHAPE. presentations For more medical www.pmcosa.com
  • 63. For more medical presentations www.pmcosa.com
  • 64. THIRD-DEGREE HEART BLOCK    COMPLETE HEART BLOCK OR COMPLETE AV DISSOCIATION. IMPULSE IS COMPLETELY BLOCKED BETWEEN THE ATRIA AND THE VENTRICLES. USUALLY TAKES PLACE BETWEEN THE AV JUNCTION AND BUNDLE OF HIS. For more medical presentations www.pmcosa.com
  • 65. Third degree heart block For more medical presentations www.pmcosa.com