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Chest, Heart and Lungs

Chest
 Mediastinum

• Superior mediastinum:
• Contents:
• thymus gland
• veins – tend to be anterior & towards the
right.
• arteries – behind the vein and to the left.
 Thymus gland
• In the superior and anterior mediastinum, beneath the manubrium
& upper sternum, extends laterally beneath the upper 4 costal
cartilage.
• rises into the base of neck under the sternohyoid & sternothyroid
muscles.
• lies anterior to the aorta, brachiocephalic vein and fibrous
pericardium.
• varies in size:
• *at birth it is 10 – 15 gm.
• *Puberty it is 30 – 40 gms
• *late adult it regress by involution and fatty atrophy to <10 gms.
• Very important lymphoid organ associated with immunologic
recognition.
• Thymomectomy is done for myasthenia gravis
• ( autoimmune disorder with neuromuscular junctions ).
 Brachiocephalic veins:

• right & the longer diagonal left unite to

form the SVC.
• SVC receives the azygos veins before
emptying into the right atrium.
 Ascending aorta

• emerges from the pericardial sac between

the SVC and pulmonary trunk.
• Runs superiorly and towards the right
before arching posteriorly as the aortic
arch.
 Aortic arch

• “aortic knob” , a radiographic landmark at the (L)

mediastinum.
• Branches are:
– left and right coronary arteries
• brachiocephalic artery ( r side only) forms
the RCA
• and RSA.
– LCCA = sometimes arise from BCA in blacks.
– LSubclavian Artery
 POSTERIOR Mediastinum
• lies behind the pericardial sac.
• From Vertebra level T4 to T12.
• Bounded by the:
• mediastinal pleura on the sides
• diaphragm below.
• posterior, continous with the superior
mediastinum.
 Structures of posterior
mediastinum
• Descending aorta
• ligamentum arteriosum = from the ductus
arteriosus.
• Intercostal arteries = supply the thoracic wall,
anastomose with anterior intercostal branches of
internal thoracic arteries(mammary).
• Bronchial arteries = supply the bronchial tree.
• Esophageal arteries = supply the midportion of
esophagus
 Structures of posterior
mediastinum…..
• Esophagus
• 25 – 30 cm long, cm. shorter in females.
• Lies anterior to the prevertebral fascia,
midline behind the trachea.
• Inferior to the tracheal bifurcation.
• Thoracic duct
• Thoracic lymph nodes
• Venous drainage
• Thoracic sympathetic trunk
• Vagus nerve
Heart Anatomy
• The heart weighs between 7 and 15
ounces (200 to 425 grams) and is a little
larger than the size of your fist. By the end
of a long life, a person's heart may have
beat (expanded and contracted) more than
3.5 billion times. In fact, each day, the
average heart beats 100,000 times,
pumping about 2,000 gallons (7,571 liters)
of blood.
The Heart Anatomy
 The Heart Anatomy….
• Your heart is located between your lungs in the middle of
your chest, behind and slightly to the left of your
breastbone (sternum).
• A double-layered membrane called the pericardium
surrounds your heart like a sac.
• The outer layer of the pericardium surrounds the roots of
your heart's major blood vessels and is attached by
ligaments to your spinal column, diaphragm, and other
parts of your body.
• The inner layer of the pericardium is attached to the
heart muscle.
• A coating of fluid separates the two layers of membrane,
letting the heart move as it beats, yet still be attached to
your body.
 The Heart Anatomy….
• The heart has 4 chambers. The upper chambers
are called the left and right atria, and the lower
chambers are called the left and right ventricles.
A wall of muscle called the septum separates
the left and right atria and the left and right
ventricles. The left ventricle is the largest and
strongest chamber in your heart. The left
ventricle's chamber walls are only about a half-
inch thick, but they have enough force to push
blood through the aortic valve and into your
body.
 Four types of valves regulate
blood flow through your heart
• The tricuspid valve regulates blood flow between the
right atrium and right ventricle.
 
• The pulmonary valve controls blood flow from the right
ventricle into the pulmonary arteries, which carry blood
to your lungs to pick up oxygen.
 
• The mitral valve lets oxygen-rich blood from your lungs
pass from the left atrium into the left ventricle.
 
• The aortic valve opens the way for oxygen-rich blood to
pass from the left ventricle into the aorta, your body's
largest artery, where it is delivered to the rest of your
body.
The Conduction System
 The Conduction System
• Electrical impulses from your heart muscle (the
myocardium) cause your heart to contract. This
electrical signal begins in the sinoatrial (SA)
node, located at the top of the right atrium. The
SA node is sometimes called the heart's "natural
pacemaker." An electrical impulse from this
natural pacemaker travels through the muscle
fibers of the atria and ventricles, causing them to
contract. Although the SA node sends electrical
impulses at a certain rate, your heart rate may
still change depending on physical demands,
stress, or hormonal factors.
 Conduction system….
• Electrical impulses from your heart muscle
(the myocardium) cause your heart to beat
(contract). This electrical signal begins in
the sinoatrial (SA) node, located at the top
of the right atrium. The SA node is
sometimes called the heart's "natural
pacemaker." When an electrical impulse is
released from this natural pacemaker, it
causes the atria to contract
 The Conduction System
• When the SA node sends an electrical impulse,
that impulse first travels through the heart's
upper chambers (the atria). It then passes
through a small group of cells called the
atrioventricular (AV) node. The AV node checks
the impulse and sends it along a track called the
bundle of His. The bundle of His divides into a
right bundle branch and a left bundle branch,
which lead to your heart's lower chambers (the
ventricles).
 The Conduction System
• Sometimes the electrical
impulse cannot travel
throughout the heart
because part of the
heart's conduction
system is "blocked." If an
impulse is blocked as it
travels through the
bundle branches, you are
said to have bundle
branch block.
 What causes bundle branch
block?
• For the left and right ventricles to contract
at the same time, an electrical impulse
must travel down the right and left bundle
branches at the same speed. If there is a
block in one of these branches, the
electrical impulse must travel to the
ventricle by a different route.
 Bundle branch block, cause…..
• When this happens, the rate and rhythm of your
heartbeat are not affected, but the impulse is slowed.
Your ventricle will still contract, but it will take longer
because of the slowed impulse. This slowed impulse
causes one ventricle to contract a fraction of a second
slower than the other.
• The medical terms for bundle branch block are derived
from which branch is affected. If the block is located in
the right bundle branch, it is called right bundle branch
block. If the block is located in the left bundle branch, it is
called left bundle branch block.
• The block can be caused by coronary artery disease,
cardiomyopathy, or valve disease. Right bundle branch
block may also occur in a healthy heart.
 What are the symptoms of
bundle branch block?
• If there is nothing else wrong with your
heart, you probably will not feel any
symptoms of bundle branch block. In fact,
some people may have bundle branch
block for years and never know they have
the condition. In people who do have
symptoms, they may faint (syncope) or
feel as if they are going to faint
(presyncope).
 So why should we worry about
bundle branch block?
• Because it can be a warning sign of other,
more serious heart conditions. For
example, it might mean that a small part of
your heart is not getting enough oxygen-
rich blood. Also, researchers have found
that people who have left bundle branch
block may be at greater risk for heart
disease than are people who do not have
the condition.
 How is bundle branch block
diagnosed?
• Doctors can use an
electrocardiogram (EKG or ECG) machine
to record the electrical impulses of your
heart. Bundle branch block shows up on
the EKG tracing. The electrical patterns
recorded by the EKG machine can even
show your doctor whether the block is
located in the right or left bundle branch.
 How is bundle branch block
treated?
• In most cases, bundle branch block does not
need treatment. But patients who have bundle
branch block along with another heart condition
may need treatment. For example, if bundle
branch block develops during a heart attack, you
may need a pacemaker. After a heart attack,
your heart is fragile, and bundle branch block
may cause a very slow heart rhythm
(bradycardia). A pacemaker will help regulate
the heart's rhythm after a heart attack.
 How is bundle branch block
treated…….
• For patients with both bundle branch block
and dilated cardiomyopathy, a new type of
pacing called cardiac resynchronization
treatment (CRT) may be used. Normally,
pacemakers pace only one of the lower
heart chambers (the ventricles) at a time.
But CRT re-coordinates the beating of the
two ventricles by pacing them at the same
time.
 Arrhythmia
• Your heart pumps nearly 5 quarts of blood
through your body every minute. Even while you
are sitting still, your heart beats (expands and
contracts) 60 to 80 times each minute. These
heartbeats are triggered by electrical impulses
that begin in your heart's natural pacemaker,
called the sinoatrial node (SA node). The SA
node is a group of cells located at the top of your
heart's upper right chamber (the right atrium).
 Arrhythmia …..
• Any irregularity in your
heart's natural rhythm is
called an arrhythmia.
Almost everyone's heart
skips or flutters at one
time or another, and
these mild, one-time
palpitations are harmless.
But there are about 4
million Americans who
have recurrent
arrhythmias, and these
people should be under
the care of a doctor.
 Categories of Arrhythmia
• Arrhythmias can be divided into two categories:
ventricular and supraventricular.
• Ventricular arrhythmias happen in the heart's
two lower chambers, called the ventricles.
• Supraventricular arrhythmias happen in the
structures above the ventricles, mainly the atria,
which are the heart's two upper chambers.
 Arrhythmias …..
• Arrhythmias are further defined by the speed
of the heartbeats:
• Bradycardia = A very slow heart rate, means the
heart rate is less than 60 beats per minute.
• Tachycardia is a very fast heart rate, meaning
the heart beats faster than 100 beats per minute.
• Fibrillation, the most serious form of arrhythmia,
is fast, uncoordinated beats, which are
contractions of individual heart-muscle fibers.
 What is heart block?

• Heart block happens when the SA node's

electrical signal cannot travel to the heart's
lower chambers (the ventricles).
 What causes an arrhythmia?
• Many factors can cause your heart to beat
irregularly. Some people are born with
arrhythmias, meaning the condition is
congenital. Some medical conditions,
including many types of heart disease and
high blood pressure, may be factors. Also,
stress, caffeine, smoking, alcohol, and
some over-the-counter cough and cold
medicines can affect the pattern of your
heartbeat.
 What are the symptoms of
arrhythmias?
• Whether you have symptoms and what
those symptoms feel like depend on the
health of your heart and the type of
arrhythmia you have. Symptoms also
depend on how severe the arrhythmia is,
how often it happens, and how long it
lasts. Some arrhythmias do not produce
any warning signs. Contrary to popular
belief, heart palpitations do not always
mean that you have an arrhythmia.
 Symptoms of arrhythmias….
• Symptoms of bradycardia
• You may feel tired, short of breath, dizzy, or
faint.
• Symptoms of tachycardia
• Your heartbeat may feel like a strong pulse in
your neck, or a fluttering, racing
• beat in your chest.

• You may feel chest discomfort, weak, short of

breath, faint, sweaty, or dizzy.
 How is an arrhythmia
diagnosed?
• The following techniques are used to diagnose
arrhythmias.
• A standard electrocardiogram (ECG or EKG) is the best
test for diagnosing arrhythmia. This test helps doctors
analyze the electrical currents of your heart and
determine the type of arrhythmia you have.
 
• Holter monitoring gets a non-stop reading of your heart
rate and rhythm over a 24-hour period (or longer). You
wear a recording device (the Holter monitor), which is
connected to small metal disks called electrodes that are
placed on your chest. With certain types of monitors, you
can push a "record" button to capture a rhythm when you
feel symptoms
 How is an arrhythmia
diagnosed?
• Electrophysiology studies (EPS) are usually done in a
cardiac catheterization laboratory. A long, thin tube
called a catheter is inserted into an artery in your leg and
guided to your heart. A map of electrical impulses from
your heart is sent through the catheter. This map helps
doctors find out what kind of arrhythmia you have and
where it starts. During the study, doctors can give you
controlled electrical impulses to show how your heart
reacts. Medicines may also be tested at this time to see
which will stop the arrhythmia. Once the electrical
pathways causing the arrhythmia are found, radio waves
can be sent through the catheter to destroy them
 How is arrhythmia treated?
• Anti-arrhythmic medicines, including
digitalis, beta-blockers, and calcium
channel blockers, are often the first
approach taken for treating arrhythmia.
Other treatments include percutaneous
(catheter) interventions, implantable
devices, and surgery (for severe cases).
 Conduction system….
• The signal then passes through the
atrioventricular (AV) node. The AV node
checks the signal and sends it through the
muscle fibers of the ventricles, causing
them to contract. The SA node sends
electrical impulses at a certain rate, but
your heart rate may still change depending
on physical demands, stress, or hormonal
factors.
 How is arrhythmia treated…..

• Ventricular tachycardia and ventricular fibrillation can be treated

by an implantable cardioverter defibrillator (ICD). This is a device
that applies electric impulses or, if needed, a shock to restore a
normal heartbeat. The device's power source is implanted in a
pouch beneath the skin of your chest or the area above your
stomach and connected to patches placed on your heart. Newer
implantable devices are inserted through blood vessels, which
means that you do not need open-chest surgery.
 
• An electronic pacemaker is used in some cases of slow heart rate.
Smaller than a matchbox, the pacemaker is surgically implanted
near the bone below your neck (the collarbone). The pacemaker's
batteries supply the electrical energy that acts like your heart's
natural pacemaker.
 arrhythmia treated…
• Radiofrequency ablation is a procedure
that uses a catheter and a device for
mapping the electrical pathways of the
heart. After you are given medicine to
relax you, a catheter is inserted into a vein
and guided to your heart, where doctors
use high-frequency radio waves to destroy
(ablate
 arrhythmia treated…
• A technique called cryoablation can then be used to
eliminate tissue with a cold probe and destroy the
"misfiring" cells.
 
• Maze surgery may be recommended if you have atrial
fibrillation that has not responded to medicines or
electrical shock (cardioversion therapy) or to pulmonary
vein ablation (a procedure similar to radiofrequency
ablation). Surgeons create a number of incisions in the
atrium to block the erratic electrical impulses that cause
atrial fibrillation.
 
• Ventricular resection involves a surgeon removing the
area in the heart's muscle where the arrhythmia starts.
 arrhythmia treated…
• In other cases, no treatment is needed.
Most people with an arrhythmia lead
normal, active lifestyles. Often, certain
lifestyle changes, such as avoiding
caffeine (found in coffee, tea, soft drinks,
chocolate, and some over-the-counter
pain medicines) or avoiding alcohol, are
enough to stop the arrhythmia.
 Categories of Arrhythmias
• Arrhythmias are generally divided into two
categories: ventricular and supraventricular.
• Ventricular arrhythmias occur in the lower
chambers of the heart, called the ventricles.
• Supraventricular arrhythmias occur in the
area above the ventricles, usually in the upper
chambers of the heart, called the atria. The
irregular beats can either be too slow
(bradycardia) or too fast (tachycardia).
Bradycardia
 Bradycardia
• Bradycardia is a very slow heart rate of
less than 60 beats per minute. It happens
when the electrical impulse that signals
the heart to contract is not formed in your
heart's natural pacemaker, the sinoatrial
node (SA node), or is not sent to the
heart's lower chambers (the ventricles)
through the proper channels.
 Bradycardia…..
• Bradycardia is a very slow heart rate of
less than 60 beats per minute. It happens
when the electrical impulse that signals
the heart to contract is not formed in your
heart's natural pacemaker, the sinoatrial
node (SA node), or is not sent to the
heart's lower chambers (the ventricles)
through the proper channels.
 Bradycardia….
• most often affects elderly people, but it may
affect even the very young. It may be caused by
one of two sources:
• 1. The central nervous system does not signal
that the heart needs to pump more, or
• 2. the SA node may be damaged. This damage
might be related to heart disease, aging,
inherited or congenital defects, or it might be
caused by certain medicines—including those
used to control arrhythmias and high blood
pressure.
 Tachycardia
• Tachycardia is a very fast heart rate of
more than 100 beats per minute. The
many forms of tachycardia depend on
where the fast heart rate begins. If it
begins in the ventricles, it is called
ventricular tachycardia. If it begins above
the ventricles, it is called supraventricular
tachycardia.
 Ventricular Arrhythmias
• Ventricular Tachycardia
• Ventricular tachycardia is a condition in which
the SA node no longer controls the beating of
the ventricles. Instead, other areas along the
lower electrical pathway take over the
pacemaking role. Since the new signal does not
move through your heart muscle along the
regular route, the heart muscle does not beat
normally. Your heartbeat quickens, and you feel
as if your heart is "skipping beats." This rhythm
may cause severe shortness of breath,
dizziness, or fainting (syncope).
 Ventricular Fibrillation
• Ventricular Fibrillation
• The most serious arrhythmia is ventricular fibrillation, which is an
uncontrolled, irregular beat. Instead of one misplaced beat from the
ventricles, you may have several impulses that begin at the same
time from different locations—all telling the heart to beat. The result
is a much faster, chaotic heartbeat that sometimes reaches 300
beats a minute. This chaotic heartbeat means very little blood is
pumped from the heart to the brain and body and can result in
fainting. Medical attention is needed right away. If cardiopulmonary
resuscitation (CPR) can be started, or if electrical energy is used to
"shock" the heart back to a normal rhythm, then the heart may not
be too damaged. About 220,000 deaths from heart attacks each
year are thought to be caused by ventricular fibrillation. People who
have heart disease or a history of heart attack have the highest risk
of ventricular fibrillation.
 Premature Ventricular
Contractions
• A less serious type of ventricular arrhythmia is a
premature ventricular contraction (PVC). As the name
suggests, the condition happens when the ventricles
contract too soon, out of sequence with the normal
heartbeat. PVCs (sometimes called PVB for premature
ventricular beat) generally are not a cause for alarm and
often do not need treatment. But if you have heart
disease or a history of ventricular tachycardia, PVCs can
cause a more serious arrhythmia. Although most PVCs
happen quickly and without warning, they can also
happen in response to caffeine, which is found in coffee,
tea, sodas, and chocolate. Some kinds of over-the-
counter cough and cold medicines may also cause
PVCs.
Supraventricular Arrhythmias
• Supraventricular arrhythmias happen in the
upper chambers of the heart. Generally,
supraventricular or "atrial arrhythmias" are not
as serious as ventricular arrhythmias.
Sometimes, they do not even require treatment.
Like PVCs, atrial arrhythmias can happen in
response to a number of things, including
tobacco, alcohol, caffeine, and cough and cold
medicines. The disorder also may result from
rheumatic heart disease or an overactive thyroid
gland (hyperthyroidism).
Supraventricular Tachycardia…..

• Supraventricular tachycardia is a rapid,

regular heart rate where the heart beats
more than 150 times per minute in the
atria. Unlike other types of arrhythmias,
supraventricular tachycardia does not start
in the SA node.
 Atrial Fibrillation
• Atrial fibrillation is a fast, irregular rhythm where single
muscle fibers in your heart twitch or contract. According
to the National Institutes of Health (NIH), about 2.2
million Americans have atrial fibrillation. It is a main
cause of stroke, especially among elderly people. Atrial
fibrillation may cause blood to pool in the heart's upper
chambers. The pooled blood can lead to the formation of
clumps of blood called blood clots. A stroke can occur if
a blood clot travels from the heart and blocks a smaller
artery in the brain (a cerebral artery). About 15% of
strokes happen in people with atrial fibrillation.
 Atrial fibrillation….
• Atrial fibrillation is a fast, irregular rhythm where single
muscle fibers in your heart twitch or contract. According
to the National Institutes of Health (NIH), about 2.2
million Americans have atrial fibrillation. It is a main
cause of stroke, especially among elderly people. Atrial
fibrillation may cause blood to pool in the heart's upper
chambers. The pooled blood can lead to the formation of
clumps of blood called blood clots. A stroke can occur if
a blood clot travels from the heart and blocks a smaller
artery in the brain (a cerebral artery). About 15% of
strokes happen in people with atrial fibrillation.
 Wolff-Parkinson-White Syndrome
• Wolff-Parkinson-White (WPW) syndrome
is a group of abnormalities caused by
extra muscle pathways between the atria
and the ventricles. The pathways cause
the electrical signals to arrive at the
ventricles too soon, and the signals are
sent back to the atria. The result is a very
fast heart rate. People with this syndrome
may feel dizzy, have chest palpitations, or
have episodes of fainting.
 Atrial Flutter

• Atrial flutter happens when the atria beat

very fast, causing the ventricles to beat
inefficiently as well.
 Premature Supraventricular
Contractions

• Also called "premature atrial contractions"

(PACs), they happen when the atria
contract too soon, causing the heart to
beat out of sequence.
 Heart Block
• Heart block takes place when the SA node
sends its electrical signal properly, but the signal
is not sent through the atrioventricular (AV) node
or lower electrical pathways as quickly as it
should be. The condition is most often caused
by aging or by the swelling or scarring of the
heart that sometimes results from coronary
artery disease. There are several types of heart
block, and they are named by their degree of
severity.
 Heart Block….

• First-degree heart block means that impulses are moving through

the AV node too slowly.
 
• Second-degree heart block means that impulses are traveling
through the heart's atria but are delayed in the AV node. Because of
this delay, the ventricles do not beat at the right moment.
 
• Third-degree heart block means that no impulses are reaching the
ventricles. To make up for this, the ventricles use their own "backup"
pacemaker with its slower rate. Because a gap in time is likely to
occur between the impulse from the atria and the impulse from
the "backup" pacemaker in the ventricles, a person may faint. This
is known as a Stokes-Adams attack. Third-degree heart block is
very serious and can lead to heart failure or death.
 Long Q-T Syndrome
• Long Q-T syndrome (LQTS) is a disorder of the
heart's conduction system. The disorder affects
a process called repolarization, which is the
recharging of the heart after each heartbeat.
Congenital LQTS is a rare disorder that is
usually inherited (passed down through family
members). In other cases, LQTS can be caused
by certain medicines, or it can be the result of a
stroke or some other neurologic disorder. LQTS
can lead to an abnormal heart rhythm
(arrhythmia); fainting or loss of consciousness
(syncope); or even sudden death.
 What causes LQTS?

• When your heart contracts, it sends out an

electrical signal. The signal is produced by
the flow of ions (potassium, sodium, and
calcium) within the heart's cells. The ions
flow in and out of the heart's cells through
ion channels.
 Torsade de pointes
• . A prolonged Q-T interval can increase your risk
for a type of arrhythmia called torsade de
pointes. When torsade de pointes occurs, your
heart cannot pump enough oxygen-rich blood to
the rest of your body, especially your brain.
• Torsade de pointes can also lead to ventricular
fibrillation, a dangerous form of arrhythmia that
causes rapid, uncoordinated contractions in the
muscle fibers of the ventricles. With ventricular
fibrillation, the heart cannot pump oxygen-rich
blood to the rest of the body, which can lead to
death.
 Who is at risk for LQTS?
• Long Q-T syndrome can occur in people who
seem very healthy. It usually affects children or
young adults. You also have an increased risk
for LQTS if other members of your family have
the disorder.
• In some cases, medicines used to treat
conditions such as arrhythmia (antiarrhythmics)
or depression (antidepressants) may also put
you at risk for LQTS.
 What are the signs and
symptoms of LQTS?
• People with LQTS may not have any signs or symptoms.
For those who do have symptoms, fainting and
arrhythmia are the most common. People with LQTS
often show a prolonged Q-T interval during exercise,
intense emotion (such as fright, anger, or pain), or as a
reaction to a loud or startling noise.
• People with LQTS have usually had at least one episode
of fainting by the time they are 10 years old. Others may
just have 1 or 2 episodes of fainting as children, and
then never have another episode again.
• In one type of inherited long Q-T syndrome, deafness is
part of the disorder.
 How is LQTS diagnosed?

• A standard electrocardiogram (EKG or ECG) is the best test for

diagnosing LQTS. The EKG machine records your heart's electrical
activity in waveforms, which can show a prolonged Q-T interval.
 
• An exercise EKG, also known as a stress test, can show an
abnormal Q-T interval that may otherwise be normal during a resting
EKG.

•  
• Holter monitoring gets a continuous reading of your heart rate and
rhythm over a 24-hour period (or longer). You wear a recording
device (the Holter monitor), which is connected to small metal disks
(called electrodes) on your chest. Doctors can then look at a printout
of the recording to see if it shows a prolonged Q-T interval
 Treatment for LQTS
• Lifestyle changes
• If you are active in competitive sports, talk to
your doctor about how this may affect your
condition. Often, once treatment in started,
patients with LQTS can participate in
recreational sports or other activities in
moderation. If you have episodes of fainting
while you exercise, you may want to think about
exercising with a friend or a family member who
can call for help if you need it.
 Treatment for LQTS
• Medicines
• Medicines called beta-blockers are the most
common type of medicine given to patients with
LQTS. These medicines do not cure LQTS, but
they have been shown to reduce the symptoms
of LQTS for those who have them. Beta-blockers
are also effective for patients who have been
diagnosed with LQTS but do not have any
symptoms. In these cases, doctors will most
likely prescribe a beta-blocker to prevent the
symptoms of LQTS.
 Treatment for LQTS
• Surgery
• When LQTS causes uncontrolled ventricular
fibrillation, you might need an implantable
cardioverter defibrillator (ICD). An ICD is a
device that sends an electric shock to your heart
to restore a normal heartbeat. The device is
placed under the skin of your chest or abdomen
and is connected to leads, which are passed
through your veins to your heart
 Bundle Branch Block
• The heart has a natural "pacemaker"
called the sinoatrial (SA) node. The SA
node is a specialized group of cells at the
top of your heart's upper-right chamber
(the right atrium). Anywhere between 60
and 100 times a minute, the SA node
sends an electrical impulse throughout
your heart to cause it to beat (contract).
 The Circulatory System
• Your heart and circulatory system make up your
cardiovascular system. Your heart works as a pump that
pushes blood to the organs, tissues, and cells of your
body. Blood delivers oxygen and nutrients to every cell
and removes the carbon dioxide and waste products
made by those cells. Blood is carried from your heart to
the rest of your body through a complex network of
arteries, arterioles, and capillaries. Blood is returned to
your heart through venules and veins. If all the vessels of
this network in your body were laid end-to-end, they
would extend for about 60,000 miles (more than 96,500
kilometers), which is far enough to circle the earth more
than twice!
 Coronary vessels..
Arteries:
• Right coronary artery- originate from the right aortic
sinus beneath ® auricle to the coronary sulcus
• Left coronary artery- from the (L) aortic sinus under left
auricle:
• Anterior descending branch to A.Interv.S to apex
• Circumflex coronary artery to posterior interv.sulcus
 Coronary vessels…
Veins:
• Coronary sinus, at post.coronary sulcus, receives most
veins and empties into the right atrium.
• Great cardiac veins from apex, AIS, to coronary sinus
• Small cardiac veins from right side coronary sulcus
• Right marginal veins
• Middle cardiac veins from apex to post. Long. Sulcus
• Posterior veins of left ventricle on diaphragmatic surface
• Oblique veins of left atrium from dorsum of atrium
• Thebesian veins – opens directly to atrium
 Pericardium
• Fibrous sac closed above by attachments to the
great vessels.
• Serous smooth membrane with mesothelial layer
lining the fibrous sac converting the heart
surface into:
Visceral pericardium (pericardium)-heart surface
Parietal pericardium-lines the inner surface of
the fibrous pericardium
 Pericardium….
• Pericardial cavity- potential space between the
parietal and visceral pericardium. The pericardial
surface are in contact and is covered with a
pericardial watery fluid to allow free movement
during contraction.
• Mesocardium- the reflection of the epicardium
along the great vessels and into the pericardail
sac
 Interior of the heart
• Right atrium – divided into parts by a ridge the
crista terminalis.
Auricle – a blind pocket, lined by a parallel ridge,
pectinate muscle.
Sinus of vena cavae:
SVC, IVC, coronary sinus, small coronary
veins and atrioventricular orifice (R ventricle)
 Interior of the heart
• Left atrium – has a
smooth walled portion
and small muscular
auricle.
• 4 pulmonary veins open
in the smooth walled
portion.
 Interior of the heart
• Right ventricle – occupies
most of the sternocostal
surface from coronary to
anterior longitudinal sulci.
• Parts:
a.conus arteriosus ( infundibulum)
b. supraventricular crest-muscular
ridge between venous outflow and
inflow.
c. ventricle proper
Trabeculae carnei
moderator band(septomarginal)
papillary muscle
d. chordae tendinae
e. Interventricular septum
* Left ventricle – small part of the
sternocostal/diaphragmatic surface
 Valves of the heart

• Pulmonary valve (semilunar valve)– at the 3rd costosternal union left

side
• Aortic valve ( semilunar valve) – at oppostie articulation of the 3rd
costosternal joint
• Left atrioventricular (bicuspid or mitral)– opposite 4th costosternal
articulation
• Right atrioventricular ( tricuspid ) – near sternal margin, opposite 4th
interspace.
The Heartbeat
 The Heartbeat
• A heartbeat is a two-part pumping action that
takes about a second. As blood collects in the
upper chambers (the right and left atria), the
heart's natural pacemaker (the SA de) sends out
an electrical signal that causes the atria to
contract. This contraction pushes blood through
the tricuspid and mitral valves into the resting
lower chambers (the right and left ventricles).
This part of the two-part pumping phase (the
longer of the two) is called diastole.
 The Heartbeat
• Systole…..
• The second part of the pumping phase begins
when the ventricles are full of blood. The
electrical signals from the SA node travel along
a pathway of cells to the ventricles, causing
them to contract. This is called systole. As the
tricuspid and mitral valves shut tight to prevent a
back flow of blood, the pulmonary and aortic
valves are pushed open. While blood is pushed
from the right ventricle into the lungs to pick up
oxygen, oxygen-rich blood flows from the left
ventricle to the heart and other parts of the body.
 The Heartbeat
• After blood moves into the pulmonary artery and the
aorta, the ventricles relax, and the pulmonary and aortic
valves close. The lower pressure in the ventricles causes
the tricuspid and mitral valves to open, and the cycle
begins again. This series of contractions is repeated
over and over again, increasing during times of exertion
and decreasing while you are at rest. The heart normally
beats about 60 to 80 times a minute when you are at
rest, but this can vary. As you get older, your resting
heart rate rises. Also, it is usually lower in people who
are physically fit.
 The Heartbeat
• Your heart does not work alone, though. Your
brain tracks the conditions around you—climate,
stress, and your level of physical activity—and
adjusts your cardiovascular system to meet
those needs.
• The human heart is a muscle designed to
remain strong and reliable for a hundred years
or longer. By reducing your risk factors for
cardiovascular disease, you may help your heart
stay healthy longer.
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