CardiovascularPathology:ReviewofAnatomyandHistology 8/20/12 By8weeks,allpartsoftheheartareinplace Afterthat,onlyremodelingoccurs PregnancyTerminology:DatingPregnancies GestationalAge=postmenstrualage Archaicsystemthatwearestuckwith "26weekspregnant"usedincommoncontextmeansgestationalage DevelopmentalAge=PostconceptualAge Usedbypathologists/embryologists ChestAnatomyFactstoknow Thymusissmallinadults,prominentininfants Positionoftheheartinthechest Bulgesmoretotheleftthantheright "Dextracardia"=shiftedtotheright

Heartsitsonthediaphragm Diaphragmaticsurface=posteriorsurface=posterialinferiorsurface Parietalandvisceralpericardium Fluidsitsinbetween ConfigurationofRightAtrialAppendage LocationofLeftAnteriorDescendingcoronaryartery AortaisalwaystotherightofthePulmonaryTrunk

HeartAnatomyItemstoknow Cruxiswherethefourchambersmeet ThreebranchescomingoffAorticArch(fromrighttoleft) 1.Brachiocephalic>RCommonCarotid+RSubclavian 2.LCommonCarotid 3.LSubclavian FourPulmonaryVeinsenteringLeftAtrium PosteriordescendingCoronaryArtery InteriorHeartAnatomyStructurestoKnow

InferiorVenaCava+SuperiorVenaCava OstiumofCoronarySinus EustachianValve InflowandOutflowtractsofRightVentricle Comefromdifferentembryologicsources ConusmuscleinterposedbetweenAVvalveandSemilunarValve

LeftVentriclewallismuchthickerthanright LeftVentriclegetssmoothertowardsasyougosuperior HelpfulinIDingventriclesiftheyareswapped HeartMeasurements Terminfant=20g Adult=250350(males>female) LVwall>RVwall(1.4vs.4) MyocardiumDevelopment 7WeeksDevelopmentalAge(9weekgestationalage) Lotsandlotsofglycogen Largeembryonalbloodcellsincapillaries Nucleatedbloodcells!!!

AdultMyocardium Anastomosingfibers CentralNuclei

aretheblackdotsnearthenuclei?

glycogen

Myofiber=musclefiber=musclecell(multinucleated) ComposedofMyofibrils imageshowsthicknessofititrunsfromtopleftcornertobottomright. Myofibril=Manymyofilamentstogethertoformafunctionalunit(sarcomere) Myofilaments=actinandmyosin Greatpicturerepresentation:http://en.wikipedia.org/wiki/File:Skeletal_muscle.jpg Myocyte branching intercalateddisks canbeapartofmorethanonefiber

Contrastwithskeletalmusclefibers: Donotanastomose Peripheralnuclei

SarcomeregoesfromZbandtoZband

TheConductionSystem SpecializedmyocytesintheSAandAVnodeshavespecialpropertiesofexcitationand/orconductionofelectrical impulses Locationhelpsyouunderstandpathologyofconductiondisorders DemandPacemakers: Onlytakeoverwhenrequired SANode=~70bpm AVNode=4050bpm HISBundle/Purkinje=1620bpm SANode Locationrightonthecrestofappendage

ShownisSAnodeArteryspecializedmyofibersruninalldirections andhelpSAnodeconduction

Showsthecontrastbetweennormalatrialmyofibers(left)and specializedmyofibersortheSAnode(right) AVNodeHisBundle LocationIntheTriangleofKoch,inthelowerportionoftheAtrialSeptum OnceitlosescontactwiththeAtrialMyocardium,itbecomestheHisBundle.

HistologicalProgressionfromAVNodetoHisBundle:

BundleBranches RightBundleBranch Location:

Histology:

RightbundlebrancheventuallyturnsintoPurkinjefibersoftheRightVentricle LeftBundleBranch Notreallyabranchmorelikeawaterfallingcascadeoffibers Location:

Histology:

CoronaryArteryAnatomy LeftanteriorcoronarycuspLeftmaincoronaryarteryLeftAnteriorDescending(LAD)+LeftCircumflex(LCX) LAD:runsalonganteriorsurfaceoverlyingtheseptum Branches:Firstdiagonal,FirstSeptalPerforator,otherseptals,2ndDiagonal,RightVentricular, Apical LCX:CoursestotheleftwithintheAVgroove,inferiortoleftatrialappendage Branches:ObtuseMarginalBranch(suppliesthelateralwall) RightanteriorcoronarycuspRightcoronaryartery(RCA)BranchtotheConus+SANodal+RightVentricular+ RightAtrial+AcuteMarginal Lotsofposteriorbranches=ifblocked,lotsofposteriordamage 85%ofpeopleareRightCoronaryDominant,meaningtheposterioroftheheartismainlysuppliedbythe RCA 15%ofpeopleareLightCoronaryDominant,meaningthattheLCAtakesthisroleinstead

versus

(LCADominant15%)

TheCircleandtheUhelpfulconcepttoremembercoronaryarterypositions CircleformedbyRCAandLCX UformedbyLADandPosteriorDescending

ValveStructure AtrioventricularValves(TricuspidandMitral)leaflets LaminaFibrosa=densefibrouscore Spongiosalooseconnectivetissueonatrialaspect AVvalvesarecoveredbythinlayeroffibroelastictissue&endocardium alsohaveBVs,lymphatics,nerve,smoothmuscle,striatedmuscle BloodCystscanforminnewbornsalonglinesofclosuretheycanbeanormalfinding

SemilunarValvescusps Nostriatedmuscle,BVs,nerves,orlymphatics!!!!! BothaspectsofthecusparecoveredbyFibroelastictissueandendocardium

BloodVessels Wallsconsistmostlyofendothelialcellsandsmoothmusclecells(SMC) AlsocontainsExtracellularmatrix(ECM)elastin+collagen+GAGs Threelayers:Intima,Media,Adventitia Intimaendothelialcells+thinlayerofECM Externaltointimaisinternalelasticmembrane(lamina) MediaSmoothmusclecells+ECM Somearteriesalsohaveanexternalelasticmembrane AdventitialooseCT+nervefibers+smallervessels(ie:vasovasorum,supplymuscleofthearteryitself)

LargeArteries Aorta,Aortaslargebranches(subclavian,commoncarotid,iliacs),Pulmonarytrunkandarteries Elasticfibersalternatewithsmoothmusclecellsinlayers Elasticrecoilprovidesenergytopropelbloodduringdiastole

Aortawall MediumArteries Otheraorticbranchescoronaryarteries,renalarteries,mesentericarteries Branchesfromlargeaorticbranches Media=Smoothmusclecellswithelasticfibersininternalandexternalelasticmembranes SmallArteriesandArterioles Arterioles=20100mmindiameter SmallArteries=2mmorless Media=essentiallyallsmoothmuscle Capillaries VerysmalldiameteronlysufficientforfreeflowofRBCs NOMEDIA! Onlyendotheliallining Essentiallyatubeofendothelialcellssurroundedbybasallamina(protectsendothelialcells) PostcapillaryVenules Largeranddistinguishedbypresenceofpericytes Veins Thinnerwallsthanarteries Thinnermedia Smalleramountofsmoothmuscle Containelasticandreticularfibers Valvesarepresent!!!