Thursday, July 24, 2014

THE HEART: BASIC ANATOMY


The heart is a four chambered, muscular organ that functions as a powerful pump. About the size of a fist, the heart is located in the chest between the lungs, just to the left of center. The heart continuously pumps blood through the body’s extensive network of arteries and veins. Arteries transport blood away from the heart, and veins blood back to the heart. The circulation of blood delivers oxygen and nutrients to the body while removing waste products.
 

Blood Supply to the Heart

The coronary arteries supply the myocardium, the muscular layer of the heart wall, with oxygen and nutrients. These arteries originate from the aorta and lie within the epicardium, the outermost layer of the heart wall. Smaller arterial branches penetrate the myocardium. The cardiac veins collect venous blood from the heart wall and return it to the right atrium.

Heart Valves

There are two pair of heart valves that regulate blood flow within the heart, the atrioventricular valves and the semilunar valves. The atrioventricular (AV) valves lie at the borders of the atria and the ventricles and prevent blood from flowing back into the atria during systole. The two semilunar valves are located at the bases of the pulmonary trunk and aorta. They consist of three half-moon shape cups and prevent backflow of blood into the ventricles.

Heart Sound

The sound of one heartbeat is created by the two set of heart valves closing during the cardiac cycle. These heart sounds can be heard through a stethoscope and are described phonetically as “lub-dub”. The first sound, or “lub”, is produced by the closing of the AV valves during systole, the second sound, or “dub” is made by the closing of the semilunar valves during the diastole.

Cardiac Cycle

The cardiac cycle refers to the alternating contraction and relaxation of the heart during one heartbeat. One cardiac cycle takes about four-fifths of a second to complete and repeats continuously. At rest, the heart beats an average of 60-80 times per minute. The cardiac cycle consists of two phases, diastole and systole. In diastole, the ventricles relax and fill with blood. In systole, the ventricles contract forcing blood into the arteries.







Electrical Pathways

The steady beating of the heart is regulated by electrical impulses traveling through the heart. The impulses originate in the sinoatrial node, also known as the body’s pacemaker. The impulses spread across the atria, causing then to contract. Next the impulses travel to the atrioventricular node, pause, then spread through the ventricles along special conduction pathways called bundle branch and Purkinje fibers. This causes the ventricles to contract.
 
 
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Tuesday, July 15, 2014

CARDIO-THORACIC RATIO


Cardio-Thoracic ratio: Widest diameter of the heart compared to the widest internal diameter of the rib-cage.













Figure 1 Cardio-thoracic ratio

Sometime the Cardio-Thoracic ratio (CTR) is more than 50 % but the heart is Normal, it can be possible due to extra-cardiac causes of cardiac enlargement like:

Ø  Portable AP films

Ø  Obesity

Ø  Pregnant

Ø  Ascities

Ø  Straight back syndrome

Ø  Pectus excavatum


 
 
 
 
 
 

Figure 2 CTR >50 %

On the picture 2 we can see a heart that is larger than 50 % of the CTR, but it is still normal, because there is an extra-cardiac cause for the apparent cardiomegalic, on the lateral films we see the red arrow point to the inward displacement of the lower sternum in a pectus excavatum deformity.

Also we can found the CTR less than 50 % but the heart is abnormal.

Causes:

Ø  Obstruction to Outflow of the ventricles

Ventricle hypertrophy

Ø  “Must look at cardiac contours”


 
 
 
 
 
 
 

Figure 3 CTR < 50 %

This is an example of heart which is less than 50 % of the CTR in which the heart is still abnormal, yellow arrow show a recognizable abnormal contour to the heart.

Retrieved from: http://www.learningradiology.com/lectures/cardiaclectures/abcsflashnew.swf