heart organogenesis
(cardiogenesis) occurs between the 4th and the 6th
weeks of pregnancy.
cardiogenic plate : an area of splanchnic
mesoderm, at first cephalad and later in the pharyngeal region of the embryo,
from which the heart arises.
Spitzer's theory : the formation of the septa in the heart are teleologically
conditioned, phylogenetically brought about, and mechanically achieved
by the appearance and development of the lungs through phylogeny.
bulbus cordis / bulb of heart / bulbus
arteriosus : the foremost of the 3 parts of the primordial heart of
the embryo
bulbar ridges : spiral endocardial thickenings in the bulbus cordis
that fuse to form the bulbar septum, separating the bulbus cordis into
aortic and pulmonary trunks
bulbar septum : a septum, formed by fusion of the bulbar ridges,
that divides the bulbus cordis into aortic and pulmonary trunks
cardiac jelly : a gelatinous substance
present between the endothelium and myocardium of the embryonic heart,
which transforms into the connective tissue of the endocardium.
limbic bands : a superior and an inferior muscular band developed
in the right atrium of the fetal heart that become the basis of Lower's
tubercle and the sinus septum.
Lower's tubercle / tuberculum intervenosum
/ intervenous tubercle : a more or less distinct ridge across the inner
surface of the right atrium between the openings of the venae cavae
endocardial cushions : elevations
of embryonic connective tissue covered by endothelium bulging into the
atrioventricular canal of the embryonic heart, which later fuse with the
free edge of the septum primum to separate the right and left atria
septum primum : the first septum in
the embryonic heart, dividing the primitive atrium into right and left
chambers
septum secundum : the second septum
in the embryonic heart to the right of the septum primum; after birth it
fuses with the septum primum to close the foramen ovale and form the interatrial
septum
ostium primum / interatrial foramen primum
: an opening in the lowest aspect of the septum primum of the embryonic
heart, posteriorly in the neighborhood of the primordial atrioventricular
valves
ostium secundum / interatrial foramen
secundum : an opening high in the septum primum of the embryonic heart,
approximately where the foramen ovale will develop
foramen ovale cordis / oval foramen of fetal
heart / oval foramen of fetus : the aperture in the septum secundum
of the fetal heart that provides a communication between the atria
valvula foraminis ovalis : a fold in the left atrium of the fetal
heart, derived from the embryonic septum primum
septum spurium / spurious septum :
a structure formed by union of the 2 folds, one on either side, guarding
the opening of the sinus venosus into the dorsal wall of the right atrium
of the heart in the early embryo.
sinus reuniens : the sinus venosus
of the embryonic heart into which empty all the veins that go to the heart
valvula vestibuli : either of the
2 thin folds bordering the opening of the sinus
reuniens into the right atrium of the embryonic heart; they develop
into the valves of the inferior vena cava and coronary sinus
cardinal veins : embryonic vessels that include ...
common cardinal veins / ducts or sinuses of Cuvier : 2 short venous
trunks in the embryo that open into the primordial atrium of the heart;
the right one combines with the anterior cardinal vein to become the superior
vena cava
postcardinal veins / posterior cardinal veins : paired vessels in
the embryo caudal to the heart
precardinal veins / anterior cardinal veins : paired venous trunks
in the embryo cranial to the heart
primary head veins : vessels alongside the embryonic brain that
continue into the precardinal veins.
subcardinal veins : paired vessels in the embryo, replacing the
postcardinal veins and persisting to some degree as definitive vessels
supracardinal veins : paired vessels in the embryo, developing later
than the subcardinal veins and persisting chiefly as the inferior segment
of the inferior vena cava
microRNA-1-1 (miR-1-1) and miR-1-2 are specifically expressed in cardiac
and skeletal muscle precursor cells : the miR-1 genes are direct transcriptional
targets of muscle differentiation regulators including serum response factor,
MyoD and Mef2. Correspondingly, excess miR-1 in the developing heart leads
to a decreased pool of proliferating ventricular cardiomyocytes. Hand2,
a transcription factor that promotes ventricular cardiomyocyte expansion,
is a target of miR-1. miR-1 genes titrate the effects of critical cardiac
regulatory proteins to control the balance between differentiation and
proliferation during cardiogenesisref
Morphology : normal weight is about 350 g
(up to 900 g in hypertrophic cardiomyopathies).
Chambers of heart :
atrium of the heart (atrium cordis)
right atrium (RA) / atrium dextrum :
the atrium of the right side of the heart; it receives blood from the superior
and the inferior venae cavae, and delivers it to the right ventricle.
Chiari's network : a network of fine
fibers which sometimes extend across the interior of the right atrium of
the heart from the valve of coronary sinus
and the valve of inferior vena cava to the crista
terminalis; it is believed to represent incomplete resorption of the
septum
spurium. It may act as a nucleus for thrombus formation.
crista terminalis atrii dextri / terminal
crest of right atrium / taenia terminalis : a ridge on the internal
surface of the right atrium of the heart, located to the right of the orifices
of the superior and inferior venae cavae, and separating the sinus venarum
cavarum from the atrium proper and auricle. The pectinate muscles of the
right atrium are attached at this crest. It corresponds to a groove on
the external surface, the sulcus terminalis
valvula venae cavae inferioris / valve
of inferior vena cava / caval or eustachian valve / valve of Sylvius
: the variably sized crescentic fold of endocardial tissue, enclosing a
few muscle fibers, that is attached to the anterior margin of the opening
of the inferior vena cava into the right atrium of the heart. Rudimentary
in the adult, in the fetus it directs blood flow from the inferior vena
cava into the left atrium via the foramen ovale
sinus of venae cavae / sinus venarum
cavarum : the portion of the right atrium bounded medially by the interatrial
septum and laterally by the crista terminalis,
and into which the superior and inferior venae cavae empty; it is often
called the sinus venosus because it develops from that embryonic structure.
sinusoidal ostium : any of the openings of the anterior cardiac
veins into the right atrium of the heart.
Waterston's or Sondergaard's
groove between the connections of the vena cavas to the right atrium
and the right pulmonary veins to the left atrium
triangle of Koch : a roughly triangular
area on the septal wall of the right atrium, bounded by the base of the
septal leaflet of the tricuspid valve, the anteromedial margin of the orifice
of the coronary sinus (or the Thebesian valve), and the Eustachian valve
along with its anterior extension, the tendon
of Todaro; it marks the site of the atrioventricular node and bundle
of His.
tendon of Todaro : a palpable subendocardial
collagen bundle in the wall of the right atrium, extending from the central
fibrous body across the torus aorticus toward the medial extremity of the
valve of the inferior vena cava
left atrium (LA) / atrium sinistrum :
the atrium of the left side of the heart; it receives blood from the pulmonary
veins, and delivers it to the left ventricle
ventriculus cordis dexter/sinister / right/left ventricle of heart
: the pair of cavities, with thick muscular walls, that make up the bulk
of the heart
right ventricle (RV) of heart / ventriculus
dexter cordis : the cavity of the heart that propels the blood through
the pulmonary trunk and arteries into the lungs.
left ventricle (LV) of heart / ventriculus
sinister cordis : the cavity of the heart that propels the blood out
through the aorta into the systemic arteries
interatrial septum of heart / septum
interatriale cordis : the wall that separates the atria of the heart.
atrioventricular septum of heart
/ septum atrioventriculare cordis : the portion of the membranous part
of the interventricular septum between the right atrium and left ventricle
interventricular or ventricular
septum of heart / septum interventriculare cordis : the partition that
separates the left ventricle from the right ventricle, consisting of a
muscular and a membranous part
crux of heart : the intersection of
the walls separating the right and left sides and the atrial and ventricular
chambers of the heart.
valvula foraminis ovalis / valve
of foramen ovale / falx septi : in the adult, a crescentic ridge on
the left side of the interatrial septum, representing the edge of what
was the septum primum before fusion of the septum
interatrial groove : a slight depression
on the external surface of the heart, marking the separation of the atria
coronary tendons : the anuli fibrosi
cordis (fibrous rings) surrounding the aortic and pulmonary trunk orifices
trigonum fibrosum sinistrum cordis / left fibrous trigone of heart
: a thickened and irregularly triangular portion of the fibrous skeleton
of the base of the heart, located between the left atrioventricular fibrous
ring and the left posterior margin of the aortic fibrous ring.
Tissues :
endocardium
parietal endocardium
valvular endocardium (see also
diseases
of heart valves)
composes the cardiac valves (valves that control the flow of blood
through and from the heart)
atrioventricular valves
valva atrioventricularis sinistra / left atrioventricular valve / valva
mitralis / bicuspid or mitral valve (MV)
: the valve between the left atrium and left ventricle of the heart; it
usually has 2 cusps (anterior and posterior), but additional small cusps
may be present
valva atrioventricularis dextra / right atrioventricular valve / valva
tricuspidalis / tricuspid valve (TV)
: the valve between the right atrium and right ventricle of the heart;
it usually has 3 cusps (anterior, posterior, and septal), but additional
small cusps may be present
Albini's nodules : gray nodules of the size of small grains, sometimes
seen on the free edges of the atrioventricular valves of infants; they
are remains of fetal structures.
semilunar or "swallow nest"-shaped valves
valva trunci pulmonalis / valve of pulmonary trunk / pulmonary or pulmonic
valve / valva pulmonaria : a valve composed of 3 semilunar cusps or
segments (semilunar cusps of pulmonary valve), guarding the pulmonary orifice
in the right ventricle of the heart; it prevents backflow of blood into
the right ventricle
Morgagni's nodules / noduli valvularum semilunarium valvae trunci pulmonalis
/ nodules of semilunar cusps of pulmonary valve / nodules of pulmonary
valve : small fibrous tubercles, one at the center of the free margin
of each semilunar cusp
valvula semilunaris anterior valvae trunci pulmonalis / anterior cusp
of the valve of the pulmonary trunk
valvula semilunaris dextra valvae trunci pulmonalis / right cusp of
the valve of the pulmonary trunk
valvula semilunaris sinistra valvae trunci pulmonalis / left cusp of
the valve of the pulmonary trunk
valva aortae / aortic valve : a valve
composed of 3 semilunar cusps or segments (semilunar cusps of aortic valve),
guarding the aortic orifice in the left ventricle of the heart; it prevents
backflow into the left ventricle
nodules of Arantius / Bianchi's nodules / nodules of Kerckring / nodules
of aortic valve / noduli valvularum semilunarium valvae aortae / nodules
of semilunar cusps of aortic valve : small fibrous tubercles, one at
the center of the free margin of each semilunar cusp of the valve.
valvula semilunaris sinistra valvae aortae / left cusp of the aortic
valve / valvula coronaria sinistra valvae aortae
valvula semilunaris dextra valvae aortae / right cusp of the aortic
valve / valvula coronaria dextra valvae aortae
valvula semilunaris posterior valvae aortae / the posterior cusp of
the aortic valve / valvula non coronaria valvae aortae
sinus aortae / aortic sinus / Petit's sinus / sinus of Morgagni / sinus
of Valsalva : a dilatation between the aortic wall and each of the
semilunar cusps of the aortic valve; from two of these sinuses the coronary
arteries take origin
myocardium / cardiac muscle (see also diseases
of myocardium)
: the muscle of the heart, comprising the chief component of the myocardium
and lining the walls of the large vessels joined to the heart; it is composed
of fibers of striated but involuntary muscle. The composition and organization
of its fibers resemble those of skeletal muscle, but instead of forming
a syncytium, its branched, mononucleate cells are linked end to end by
intercalated disks that provide both mechanical and ionic coupling for
coordination of the entire muscle
Cell types :
cardiomyocytes
Eberth's lines : microscopic broken or scalariform lines at the
junction of the cardiac muscle cells.
pacemaker (P), automatic or nodal cells
(automatism or spontaneous diastolic depolarization during
phase 4) : poorly staining, pale, small cells almost devoid of myofibrils,
mitochondria, or other organelles (see also EKG)
cardiac pacemaker / pacemaker of heart : the group of cells rhythmically
initiating the heart beat, characterized physiologically by a slow loss
of membrane potential during diastole. Usually the pacemaker site is the
sinoatrial node
ectopic, latent or secondary pacemaker : any biological cardiac
pacemaker other than the sinus node; under normal conditions it is not
active.
atrioventricular junctional pacemaker : an ectopic pacemaker occurring
in the atrioventricular junction.
ventricular pacemaker : an ectopic pacemaker occurring in a ventricle.
escape pacemaker : an ectopic pacemaker that assumes control of
cardiac impulse propagation because of failure of the sinoatrial node to
generate one or more normal impulses.
wandering atrial pacemaker : a condition in which the site of origin
of the impulses controlling the heart rate shifts from one point to another
within the atria, including the sinus node, changing with almost every
beat. P waves and PR intervals vary, and the rate of impulse formation
is somewhat irregular. It occurs when the rate of sinus impulses falls
below a critical level or fails.
sinoatrial (SA)
or Keith-Flack's node at the joining between upper cava vein and right
atrium, vascularized by the right coronary
artery : the left portion is a.k.a.
Pace-Bryni-Segre node. HR
=
130-160 bpm in babies before age 2
100 bpm after 3 years
60-100 bpm in resting adults
200 bpm under effort in young people
140 bpm under effort in elderlies
HR varies physiologically during respiration (up to 5% during normal respiration,
up to 30% during deep respiration).
complexus stimulans cordis / conducting
system of heart / systema conducens cordis : a system of specialized
muscle fibers that generate and rapidly transmit cardiac impulses and serve
to coordinate contractions, comprising the sinoatrial node, atrioventricular
node, bundle of His and its right and left bundle branches, and the subendocardial
branches (rami subendocardiales) of Purkinje fibers
atrial conduction bundles / internodal tracts : specialized conduction
pathways (conduction rate = 1,000 mm/s), designated anterior, middle, and
posterior, that preferentially transmit the cardiac impulse through the
atria; their existence and details remain controversial
anterior internodal tract
left branch / Bachmann's bundle : a group of fibers of the anterior
internodal tract that penetrate the interatrial septum and diverge in the
left atrium, connecting the atria.
right branch
intermediate internodal tract
posterior internodal tract
atriohisian tracts : myocardial fibers that bypass the physiologic
delay of the atrioventricular node and connect the atrium directly to the
bundle of His, allowing preexcitation of the ventricle.
atrioventricular
(AV) or Tawara-Aschoff's node in lower region of right atrium, vascularized
by the left coronary artery
central fibrous body
of the heart / trigonum fibrosum dextrum cordis / right fibrous trigone
of heart : a thickened, irregularly triangular portion of the fibrous
skeleton of the base of the heart, located between the right and left atrioventricular
fibrous rings, posterior to the aortic orifice
accessory conducting pathway
: myocardial fibers that propagate the atrial contraction impulse to the
ventricles but are not a part of the normal atrioventricular conducting
system; impulses conducted over such a pathway can cause preexcitation
atriohisian tracts : myocardial
fibers that bypass the physiologic delay of the atrioventricular node and
connect the atrium directly to the bundle of His, allowing preexcitation
of the ventricle.
Kent's bundle / atrioventricular pathway
: a muscular bundle in the heart of several mammalian species forming a
direct connection between the atrial and ventricular walls; it occasionally
occurs in the human heart, where it can form an accessory conducting pathway
allowing the preexcitation of the ventricle that occurs in the Wolff-Parkinson-White
syndrome
James fibers : junctional tissue or a
tract which bypasses the atrioventricular node, thus permitting ventricular
preexcitation (Lown-Ganon-Levine
syndrome).
Thorel's bundle : a bundle of muscle
fibers in the human heart, connecting the sinoatrial and atrioventricular
nodes, and passing around the mouth of the inferior vena cava.
Mahaim fibers : specialized tissue connecting
components of the conduction system directly to the ventricular septum,
usually important functionally only when abundant; they are often classified
as ...
fasciculoventricular fibers
: connect the bundle of His directly to the ventricular myocardium.
nodoventricular fibers : connect
the atrioventricular node directly to the ventricle.
His-Purkinje system : a portion of the conducting system of the
heart, usually referring specifically to the segment beginning with the
bundle of His and ending at the terminus of the Purkinje fiber network
within the ventricles.
(common) trunk of atrioventricular (AV) bundle (AV) / bundle of Kent-His
/ fasciculus atrioventricularis : a small band of atypical cardiac
muscle fibers that originates in the atrioventricular node in the interatrial
septum, passes through the atrioventricular junction (penetrating portion),
and then runs beneath the endocardium of the right ventricle on the membranous
part of the interventricular septum (distal portion). It divides
at the upper end of the muscular part of the interventricular septum into
right and left bundle branches which descend in the septal wall of the
right and left ventricle, respectively, to be distributed to those 2 chambers.
This bundle propagates the atrial contraction rhythm to the ventricles,
and its interruption produces heart block. The term is often used to refer
specifically to the trunk of the bundle (truncus fasciculi atrioventricularis)
rather than the entire bundle
right bundle branch (RBB)
left bundle branch (LBB) : greater diameter => faster conduction
(shorter refractory period) than right branch
left anterior or superior bundle branch
left posterior or inferior bundle branch : better vascularization,
thicker and shorter => rarer blocks than in left anterior bundle branch
Purkinje's system / Purkinje fibers of the heart : modified cardiac
fibers composed of Purkinje cells (large, clear, tightly packed
cells with many gap junctions
between them and thus conduct impulses rapidly), occurring as an interlaced
network in the subendocardial tissue and constituting the terminal ramifications
of the conducting system of the heart. The term is sometimes used loosely
to denote the entire system of conducting fibers (15 < HR < 40 bpm;
conduction rate = 4,000 mm/s)
rami subendocardiales / subendocardial branches / Purkinje network /
subendocardial terminal network : small ramifications of the conducting
system of the heart (Purkinje fibers), which form a plexus in the papillary
muscles and ventricles
conduction ratio : in cardiac physiology, the ratio of atrial to
ventricular depolarizations, measured as the ratio of P waves to QRS complexes
in the electrocardiogram; it is normally 1:1.
transitional cells : in the sinoatrial and atrioventricular nodes,
small, slow-conducting, heterogeneous cells interposed between the P cells
and Purkinje cells; they are thought to link the impulses generated by
the P cells with the rest of the myocardium.
working cells / ordinary cell
atrial working cells
musculi pectinati atrii dextri / pectinate muscles of right atrium
: small ridges of muscle fibers projecting from the inner walls of the
right auricle of the heart and extending in the right atrium to the crista
terminalis
musculi pectinati atrii sinistri / pectinate muscles of left atrium
: small ridges of muscle fibers projecting from the inner walls of the
left auricle of the heart.
ventricular working cells
sinospiral or sinuspiral fibers : spiral muscle fibers that begin
near the posterior aspect of one or both atrioventricular fibrous rings
and spiral upward in bundles within one or both ventricles.
subvalvular apparatuses :
trabeculae carneae cordis / fleshy trabeculae of heart : irregular
bundles and bands of muscle projecting from a great part of the interior
of the walls of the ventricles of the heart. They occur as 3 types :
simple muscular ridges
bundles attached at both ends but free in the middle
musculi papillares / papillary muscles : conical muscular projections
from the walls of the cardiac ventricles, attached to the cusps of the
atrioventricular valves by the 1st order chordae tendinea
cordis (the tendinous cords that connect each cusp of the two atrioventricular
valves to appropriate papillary muscles in the heart ventricles. The cords
are of varying lengths and thicknesses and are frequently branched) =>
2nd
order => 3rd order. There is an anterior and a posterior
papillary muscle in each ventricle, as well as a group of small papillary
muscles on the septum in the right ventricle
musculus papillaris anterior ventriculi dextri / anterior papillary
muscle of right ventricle : the papillary muscle arising from the sternocostal
wall of the right ventricle.
trabecula septomarginalis / septomarginal trabecula : a bundle of
muscle at the apical end of the right ventricle of the heart, connecting
the base of the anterior papillary muscle to the interventricular septum;
it usually contains a branch of the atrioventricular bundle. It has been
thought to prevent ventricular overdistention and thus is called also Leonardo
da Vinci's moderator band.
musculus papillaris anterior ventriculi sinistri / anterior papillary
muscle of left ventricle : the papillary muscle arising from the anterior
wall of the left ventricle.
musculus papillaris posterior ventriculi dextri / posterior papillary
muscle of right ventricle : the papillary muscle arising from the diaphragmatic
wall of the right ventricle.
musculus papillaris posterior ventriculi sinistri / posterior papillary
muscle of left ventricle : the papillary muscle arising from the posterior
wall of the left ventricle
papillary muscle of conus arteriosus : a septal papillary muscle
arising near the septal end of the supraventricular crest and attached
to the anterior and septal cusps of the tricuspid valve.
septal papillary muscles of right ventricle : several small papillary
muscles in the right ventricle of the heart, arising from the interventricular
septum and attaching to adjacent cusps of the tricuspid valve via chordae
tendineae
absolute or effective refractory period (ERP) : from phase 0 to
half of phase 3 (corresponding to the gap between beginning of Q wave and
apex of T wave on EKG)
relative refractory period : from half of phase 3 to the beginning
of phase 4 (corresponding to the gap between apex and end of T wave on
EKG)
fascia adherens : an extensive adherent
junction
analogous to the zonula adherens but occurring in cardiac myocytes, primarily
in the transverse portions of intercalated disks; it has multiple dense
attachment plaques acting as sites of insertion of actin filaments into
the sarcolemma and thus linking the cellular membrane and contractile apparatus
with those of adjacent cells.
vortex cordis / vortex of heart : the whorled arrangement of muscle
fibers at the apex in the left ventricle of the heart, through which the
more superficial fibers pass to the interior of the left ventricle toward
the base.
Atrial myocardium is separated by ventricular myocardium by fibrous tissue
: communication occurs only through conduction system. Ventricular systole
occurs from heart apex to heart basis.
interstitial Cajal-like cells (ICLC) in human atrial and ventricularref
myocardium. They represent ~32% of the number of interstitial cells and
the ratio cardiomyocytes/ICLC is about 70/1. In the interstitium, ICLC
establish close contacts with nerve fibers, myocytes, blood capillaries
and with immunoreactive cells (stromal synapses). ICLC show characteristic
cytoplasmic processes, frequently two or three, which are very long (tens
up to hundreds of mum), very thin (0.1-0.5 mm
thick), with uneven caliber, having dilations, resulting in a moniliform
aspect. Gap junctions between such processes can be found. Usually, the
dilations are occupied by mitochondria (as revealed by Janus green B and
MitoTracker Green FM) and elements of endoplasmic reticulum. Characteristically,
some prolongations are flat, with a veil-like appearance, forming a labyrinthic
system. ICLC display caveolae (about 1 caveola/ 1mum cell membrane length,
or 2-4% of the relative cytoplasmic volume). Mitochondria and endoplasmic
reticulum (rough and smooth) occupy 5-10% and 1-2% of cytoplasmic volume,
respectively. IHC revealed positive staining for CD34, EGFR and vimentin
and, only in a few cases for CD117. IHC was negative for: desmin, CD57,
tau, chymase, tryptase and CD13. IF showed that ventricular ICLC expressed
connexin 43. We may speculate that possible ICLC roles might be: intercellular
signaling (neurons, myocytes, capillaries etc.) and/or chemomechanical
sensors. For pathology, it seems attractive to think that ICLC might participate
in the process of cardiac repair/remodeling, arrhythmogenesis and, eventually,
sudden death.
plexus cardiacus / cardiac plexus : the plexus around the base of
the heart, chiefly in the epicardium. It is formed by cardiac branches
from the vagus nerves and the sympathetic trunks and ganglia, contains
visceral afferent fibers, and shows subdivisions related to the arch of
the aorta, right and left atria, and right and left coronary arteries.
The cardiac plexus is continuous with the right and left pulmonary plexuses.
deep or great cardiac plexus : the larger part of the cardiac plexus,
situated between the aortic arch and the tracheal bifurcation
anterior or superficial cardiac plexus : the part of the cardiac
plexus that lies beneath the aortic arch to the right of the ligamentum
arteriosus
the parasympathetic system sends nerve fibers to the SA node, where they
release ACh to decraese the heart rate.
cardiac depressor fibers : vagal fibers to the heart which when
activated cause a decrease in cardiac output
The relationship between heart rate variability (HRV) and parasympathetic
effect on the sinus node is unclear. Some investigatorsref1,
ref2
have demonstrated a direct relationship between HRV and parasympathetic
effect. Others have cautioned that increased parasympathetic effect may
saturate the HRV responseref1,
ref2,
ref3,
ref4,
ref5,
which we have demonstratedref.
This study was therefore designed to evaluate the relationship of HRV to
parasympathetic effect by use of baroreflex-mediated parasympathetic stimulation
and withdrawal. The importance of understanding this relationship is underscored
by studiesref1,
ref2,
ref3
that established that in normal individuals in the resting, supine state,
the majority of HRV is related to parasympathetic effects. There is substantial
variance in HRV in normal individualsref1,
ref2;
the source of this variability is unclear. It may reflect real differences
in parasympathetic effects on the sinus node. In this case, defining the
relationship between HRV and parasympathetic effect would be helpful in
explaining the variance of HRV in normal individuals and relating these
differences to specific differences in parasympathetic effect. Alternatively,
there may be substantial interindividual variances in HRV even at equivalent
levels of parasympathetic effect. In this case, each individual may have
his or her own curve relating HRV to parasympathetic effect. In this situation,
it would be difficult to make inferences about interindividual differences
in parasympathetic effect based on single HRV measurements. The relationship
between HRV and parasympathetic effect is best described by a function
in which there is an ascending limb where HRV increases as parasympathetic
effect increases until it reaches a plateau level; HRV then decreases as
parasympathetic effect increases. Because there is marked interindividual
variation in this relationship, differences in HRV between individuals
may reflect differences in this relationship and/or differences in autonomic
effectsref
the sympathetic nervous system sends nerve fibers to both the SA node,
where they release norepinephrine to increase the heart rate, and to the
ventricular muscle cells, where norepinephrine increases the force of contraction
anterior or right coronary plexus of heart : a plexus of sympathetic
nerve fibers anterior to the heart and related chiefly to the branches
of the left coronary artery
posterior or left coronary plexus of heart : a plexus of sympathetic
nerve fibers posterior to the heart and related chiefly to the branches
of the right coronary artery
cardiac pressor fibers : sympathetic
nerve fibers to the heart which when activated cause an increase in cardiac
output
accelerating, accelerator, augmentor or cardiac accelerator fibers:
adrenergic fibers that transmit the impulses that accelerate the heartbeat
myogenic theory : the theory that the muscle fibers of the heart
possess in themselves the power of originating and maintaining the contraction
of the heart.
pericardium (see also diseases
of pericardium)
: the fibroserous sac that surrounds the heart and the roots of the great
vessels. Pericardial fluid < 100 mL. The base of the pericardium is
attached to the central tendon of the diaphragm
pericardium fibrosum / fibrous
pericardium : the external layer of the pericardium, consisting of
fibrous tissue.
pericardium serosum / serous pericardium
: the inner serous portion of the pericardium consisting of 2 layers,
lamina parietalis pericardii serosi, which is apposed to the fibrous
pericardium
lamina visceralis pericardii serosi / epicardium,
which is reflected onto the roots of the great vessels and the heart
oblique sinus of pericardium
/ sinus obliquus pericardii : a recess of serous pericardium that passes
upward behind the left atrium and between the left and right pulmonary
veins.
sinus transversus pericardii / transverse sinus of pericardium :
a passage behind the aorta and pulmonary trunk and in front of the atria;
it is lined by serous pericardium.
The space between the 2 layers is the cavitas pericardialis.
Cell types : serous cell in mesothelium
fatty tissue
Sala's cells : star-shaped cells of connective tissue in the fibers
that form the sensory nerve endings situated in the pericardium
oblique sinus of pericardium / sinus obliquus pericardii : a recess
of serous pericardium that passes upward behind the left atrium and between
the left and right pulmonary veins.
sinus transversus pericardii / transverse sinus of pericardium :
a passage behind the aorta and pulmonary trunk and in front of the atria;
it is lined by serous pericardium.
cardiac cycle : a complete cardiac movement
or heart beat, lasting 0.8 s. The period from the beginning of one heart
beat to the beginning of the next; the systolic and diastolic movement,
with the interval between them.
diastole
isovolumetric relaxation
ventricular filling
rapid phase (80%)
slow phase / diastasis (5%)
atrial systole (15%)
systole
end-diastolic volume (EDV)
left ventricle EDV (LVEDV) = 80-90 mL = 76-115 mL / m2BSA
right ventricle EDV (RVEDV) = 100-160 mL
end-systolic volume (ESV)
= 19-55 mL / m2BSA
average resting heart rate (HR)
= 58-86 bpm (periodically also 45-100)
maximum tolerated heart rate
in males : 220 - age (yrs)
in females : 200 - age (yrs
left ventricle ejection
time (LVET) = time interval from the B point to the X point on the
dZ/dt waveform = the interval from systole to closure of the aortic valve,
measured on the carotid pulse tracing from the beginning upstroke to the
dicrotic notch; it is one of the systolic time intervals measured to assess
left ventricular performance
pre-ejection period (PEP)
= time interval from the beginning of the Q wave on the ECG to the B point
on the dZ/dt waveform, depends on HR, preload, and contractility
systolic time ratio (STR)
= PEP / LVET = 0.3 - 0.5
isovolumic relaxation
time (IVRT) : 50-70 msec.
end-systolic stress (ESS)
volume
of electrically participating tissue (VEPT) : volume conductor for
size of thorax affected by height, weight, and sex
thoracic fluid content (TFC)
: the electrical conductivity of the chest cavity, which is primarily determined
by the intravascular, intraalveolar, and interstitial fluids in the thorax
males : 30-50 / kW
females : 21-37 / kW
total stroke volume (SV) =
EDV - ESV = VI × LVET × VEPT = 70-80 mL / beat
Fick's method : CO = (VO2 in inspirated air - VO2
in expirated air) / (( [v/v O2]artery
- [v/v O2]right atrium) .
t) [mL / ((mL/mL) . min)]
thermodilution during Swan-Ganz catheterization : injection of a
defined amount of cold fluid into right atrium, whose heating rate directly
relates to CO
Derived units :
cardiac output curve : a graphic representation of cardiac output
as a function of atrial pressure; it is a measure of the pumping ability
of the heart under specific conditions.
Frank-Starling law of the heart or mechanism : the energy liberated
with each contraction of the heart is a function of the length of the fibers
composing its muscular walls; increased preload causes increased end-diastolic
volume (or pressure), which increases the force of ventricular contraction
Starling ventricular function curve : a graphic representation of
cardiac output, or other measure of ventricular performance, as a function
of ventricular filling for a given level of contractility; as atrial pressure
and venous return increase, cardiac output initially increases proportionately,
then plateaus and decreases
venous return curve : a graphic representation of venous return
as a function of atrial pressure; it measures the contributions of peripheral
factors that affect the flow of blood from the veins to the heart. Multiple
curves generated under varying conditions are combined with similarly obtained
cardiac output curves to analyze cardiac regulation
cardiac work : kinetic energy (1%) +
potential energy (99% : dilatation of elastic arteries)
left cardiac work (LCW) =
(MAP - PAOP) . CO . 0.0144 = 5.4-10 kg .
m
left cardiac work index
(LCWI) = (MAP - PAOP) . CI . 0.0144 = 3.0-5.5
kg . m / m2BSA
right cardiac work (RCW)
= (MPAP - CVP) . CO . 0.0144
right cardiac work index
(RCWI) = (MPAP - CVP) . CI . 0.0144
stroke work (SW) = SV .
aortic mean pressure = 50-85 gmM / m2
LV stroke work (RVSW)
RV stroke work (RVSW)
fraction index (FI) = 1.0 GmM
/ m2
cardiac index (CI) = CO / BSA =
2.5÷4.7 [L / min / m2]
right atrium
pressure (RAP) / central venous pressure (CVP) = RVEDV = right
ventricular preload
systolic components
c peak : backward bulging of closed tricuspid valve into
right atrium at isovolumetric right ventricular contraction, follows
QRS complex on EKG, located at the beginning of systole
x fall : the atrium further relaxes and forward bulging of the tricuspid
valve into the right ventricle
v peak : 2-10 mmHg : venous blood accumulates in right atrium
and venae cavae with closed tricuspid valve (ventricular systole), follows
T wave on EKG, located at end-systole
diastolic components
y fall : -2 ÷ 2 mmHg, due tro opening of tricuspid valve
and filling of right ventricle
a peak : 3÷7 mmHg, due to atrial systole, follows
P wave on EKG, located at end-diastole
mean : 4 mmHg (+1-3 mmHg during mechanical ventilation)
Measured with the proximal opening in Swan-Ganz catheter. CVP should be
measured as the "a peak" value at end-expiration, when pleural and pericardial
pressures equate the atmospheric pressure in both spontaneous and mechanical
ventilation. On the contrary spontaneous inspiration causes a fall in both
pleural and pericardial pressures (underestimate), while mechanical ventilation
causes rise in the same pressures (overestimate).
right ventricle pressure
(RVP)
right ventricle systolic pressure (RVSP) : 15÷30 mmHg
protodiastolic : -5 ÷ 0 mmHg
right ventricle diastolic pressure (RVDP) : 4-12 mmHg
end-diastolic = 2÷7 mmHg = right atrium pressure
mean = 9-16 mmHg
recorded during left heart catheterization
left atrium pressure (LAP)
/ left atrium filling pressure (LAFP) (~ pulmonary capillary wedge
pressure (PCWP) / pulmonary artery occlusion pressure (PAOP)) = left
ventricular preload
a wave : 3-15 mmHg
v wave : 3-12 mmHg
mean : 1-10 mmHg
PCWP (measured with Swan-Ganz catheter) is not a reliable surrogate for
LAP and LVEDP in patients who underwent valvulopasty, because of remodeling
in left ventricle compliance and pulmonary circulation. If LV compliance
is normal LVEDP relates with LVEDV, the best index of left ventricular
preload.
LAP can be measured placing a catheter in the right pulmonary vein
forward to left atrium under heart anesthesia. The catheter requires heparin
wash-outs and should be removed before thoracic drainages due to risk of
mediastinic hemorrhage at removal.
diastolic = 60-90 mmHg (thanks to elastic arteries, perfusion isn't pulsatory,
ie occurs even out of systole, which occupies just 1/10 of cardiac cycle)
mean = 70-90 mmHg
Anrep effect : abrupt elevation of aortic pressure results in a
positive inotropic effect, augmented resistance to outflow in the heart;
also called homeometric autoregulation because it is independent
of muscle length
Laplace's law : tension or stress on the cardiac ventricular walls
is proportional to the intraventricular pressure and internal radius and
inversely proportional to the wall thickness; for a sphere it is most simply
expressed as: average circumferential wall stress = (pressure x radius
of curvature of the wall) / (2 x wall thickness); more complex equations
describe ellipsoidal or other shapes.
Coronary circulation :
coronary arteries : the walls of
the heart are too thick to permit blood in the chambers to supply an appreciable
amount of oxygen (and other nutrients) to the heart muscle. Rather, blood
for the heart itself must be supplied by the coronary circulation, consisting
of subepicardiac arteries that arise from 2 of the 3 sinuses of Valsalva
at the root of aorta (the conduction bundle is located between the non-coronary
sinus and the right coronary sinus). Ca2+ influx through a1H
T-type Ca2+ channels is essential for normal relaxation of coronary
vascular smooth muscle : 80% of coronary resistance lies in arterioles.
Oxygen extraction (75%) cannot increase, but only flow.
left coronary artery (the one
with wider vascularizing tissue)
common trunk (sometimes
absent !)
left oranterior
interventricular descending (LAD) branch
lower wall of left ventricle [ in
individuals with right dominant circulation (90%) ]
venae cordis / cardiac veins :
the veins of the heart, which drain blood from the various tissues making
up the organ.
venae atrioventriculares cordis / atrioventricular veins of heart :
the veins that supply the atria and ventricles of the heart
venae atriales dextrae / right atrial veins : the veins of the right
atrium of the heart
venae atriales sinistrae / left atrial veins : the veins of the
left atrium of the heart.
venae ventriculares cordis : the veins of the ventricles of the
heart
venae cardiacae minimae / smallest cardiac veins / thebesian veins /
venae cordis minimae : numerous small veins arising in the muscular
walls and draining independently into the cavities of the heart, and most
readily seen in the atria
thebesian circulation : the circulation of blood through the venae
cordis minimae (thebesian veins)
foramina venarum minimarum atrii dextri / foramina of smallest veins
of heart / Lannelongue's foramina, Vieussens' foramina, and thebesian foramina
: minute openings in the walls of the heart, through which small veins,
the venae cardiacae minimae, empty their blood directly into the heart;
they are most numerous in the right atrium and ventricle, occasional in
the left atrium, and rare in the left ventricle
vena marginalis dextra / right marginal vein : a vein ascending
along the right margin of the heart, draining adjacent parts of the right
ventricle and opening into the right atrium or anterior cardiac veins.
venae ventriculi dextri anteriores / anterior veins of right ventricle
/ venae cardiacae anteriores / venae cordis anteriores / anterior cardiac
veins / anterior veins of heart : small veins that drain blood from
the ventral aspect of the right ventricle and empty into the right atrium
sinus coronarius / coronary sinus
: the terminal portion of the great cardiac vein, which lies in the coronary
sulcus between the left atrium and ventricle, and empties into the right
atrium between the orifice of the inferior vena cava and the atrioventricular
orifice.
ostium sinus coronarii / opening of coronary sinus / orifice of coronary
sinus : an opening in the wall of the right atrium, situated between
the opening of the inferior vena cava and the atrioventricular opening,
the lower part of which is covered by the ...
valvula sinus coronarii / valve of coronary sinus / thebesian
valve : a fold of endocardium along the right and inferior margins
of the opening of the coronary sinus into the most posteroinferior corner
of the right atrium of the heart; it covers the lower part of the sinus
and prevents regurgitation into the sinus during atrial contractions. A
commissure is formed between the Thebesian valve and Eustachian valve of
the inferior vena cava, which extends as a fibrous strand known as the
tendon
of Todaro to insert into the central fibrous body. .
vena obliqua atrii sinistri / oblique vein of left atrium / vein of
Marshall / Marshall's oblique
vein : a small vein from the left atrium that opens into the coronary
sinus
vena ventriculi sinistri posterior / vena posterior ventriculi sinistri
cordis / posterior vein of left ventricle : the vein that drains blood
from the posterior surface of the left ventricle into the coronary sinus
vena coronaria dextra / right coronary vein : the portion of the
middle cardiac vein that receives blood from the posterior interventricular
vein and empties into the coronary sinus
vena coronaria sinistra / left coronary vein : the portion of the
great cardiac vein lying in the coronary sulcus; it receives blood from
the anterior interventricular vein and empties into the coronary sinus
vena cardiaca magna / great cardiac vein / vena cordis magna : a
vein that collects blood from the anterior surface of the ventricles, follows
the anterior longitudinal sulcus, and empties into the coronary sinus
vena interventricularis anterior / anterior interventricular vein :
the portion of the great cardiac vein ascending in the anterior interventricular
sulcus and emptying into the left coronary vein.
left marginal vein : a vein ascending along the left margin of the
heart that drains the left ventricle and empties into the great cardiac
vein
vena cardiaca media / middle cardiac vein / vena cordis media :
a vein that collects blood from the diaphragmatic surface of the ventricles,
follows the posterior longitudinal sulcus, and empties into the coronary
sinus
vena cardiaca parva / small cardiac vein / vena cordis parva : a
vein that collects blood from both parts of the right heart, follows the
coronary sulcus to the left, and opens into the coronary sinus
Modern anatomical description divides the cardiac veins into two groups:
tributaries of the greater cardiac vascular system (GCVS) and tributaries
of the smaller cardiac vascular system (SCVS), consisting of the
Thebesian vessels. Both systems intercom municate extensively. With the
exception of the oblique vein of the left atrium (Marshall's vein), veins
draining the walls of both the left and right atrium have not been well
illustrated or described in anatomical atlases and textbooks. Consequently,
we do not know exactly to which of the 2 groups (GCVS or SCVS) the atrial
veins belong. There are three groups of left atrial veins: (1) tributaries
of the left coronary vein and the coronary sinus; (2) special veins draining
the right-sided walls of the left atrium that terminate via intramural
sinuses in the right atrium, which vessels occur in 92% of cases and belong
to the GCVS; (3) in 81% of cases special veins drain the myocardium of
the posterior and superior walls of the left atrium. In most cases they
empty into the left atrium itself; in almost 40% of the cases they are
connected with mediastinal veins. These veins, also belonging to tributaries
of the GCVS, constitute a distinctly separate category of cardiac veins
and should be designated proper veins of the left atrium. The veins draining
the walls of the right atrium fall also into three groups: (1) In most
cases there are short or large intramural tunnels or sinuses in the basic
walls of the auricle and atrioventricular node area. The generally valveless
openings of all the venous tunnels and sinuses are lined up on a circle
just above the tricuspid valve and between the openings of both venae cavae.
(2)There are also thin veins at the junction of the right atrium with both
the superior and inferior vena cava. (3) In addition, there are numerous
cardiac veins of the smallest size (real Thebesian veins).