CASE PRESENTATION ANATOMY AND PHYSIOLOGY >HEART< FUNCTIONS OF THE HEART 1.

1. Generating blood pressure Contractions of the heart 2. Routing blood Pulmonary circulation and systemic circulation 3. Ensuring one-way blood flow Valves of the heart 4. Regulating blood supply Match blood flow to the changing metabolic needs SHAPE and SIZE: Shaped like a blunt cone and is approximately the size of the fist. APEX Blunt, round point of the cone portion. BASE Larger, flat portion of the heart at the opposite end of the cone. LOCATION: The heart is located in the thoracic cavity between the two pleural cavities that surrounds the lungs, deep and slightly to the left of the fifth intercostal space, approximately 7-9cm to the left of the sternum where the midclavicular line intersects with the fifth intercostal space. MEDIASTINUM The midline potion which is formed by the heart, trachea, esophagus and other associated structures. PERICARDIAL CAVITY Surrounds the heart. POSITION: The heart lies obliquely in the mediastinum, with its base directed posterior and slightly superior while the apex is directed anterior and slightly inferior. The apex is also directed to the left so that approximately 2/3 of the hearts mass lies on the left of the sternum. The base of the heart is located deep to the sternum and extends to the level of the second intercostal space approximately 7-9cm to the left of the sternum.

ANATOMY and PHYSIOLOGY PERICARDIUM/PERICARDIAL SAC Forms the pericardial cavity Surrounds the heart and anchors it to the mediastinum. 2 Layers of the Pericardium: 1. Fibrous pericardium tough fibrous connective tissue; outer layer. 2. Serous pericardium thin layer of connective tissue which composes the inner layer. 2 portions of serous pericardium: a. Parietal pericardium lining the fibrous pericardium b. Visceral pericardium/Epicardium covers the heart surface PERICARDIAL FLUID Fills the pericardial cavity, located between the visceral and parietal pericardia. Produced by serous pericardium. Reduce friction as the heart moves within the pericardial sac.

SIX LARGE VEINS AND ARTERIES OF THE HEART: Carry blood from the body to the 1. SUPERIOR VENA CAVA right atrium 2. INFERIOR VENA CAVA 3. PULMONARY VEINS carry blood from the lungs to the left atrium 4. PULMONARY TRUNK arise from the right ventricle and splits into right and left pulmonary arteries 5. AORTA exits the heart towards the rest of the body 6. PULMONARY ARTERIES carry blood to the lungs FOUR CHAMBERS OF THE HEART: LEFT and RIGHT ATRIUM LEFT and RIGHT VENTRICLES ATRIA/ATRIUM (Left and Right) Entrance chamber Located at the base of the heart Receives blood from the veins Function as reservoir > where blood returning from the veins collects before enters the ventricles RIGHT ATRIUM > receives blood from three major openings (Superior vena cava, inferior vena cava and smaller coronary sinus) SVC and IVC drains blood from most of the body Smaller coronary sinus drains from most of the heart muscle LEFT ATRIUM > receives blood from the four pulmonary veins (drains blood from the lungs OXYGENATED BLOOD) INTERATRIAL SEPTUM > partition that separates the left and right atrium VENTRICLES (Left and Right) Extends from the base of the heart towards the apex Major pumping chambers Ejects blood into the arteries and force it to flow through the circulatory system RIGHT VENTRICLE > pumps blood into the pulmonary trunk LEFT VENTRICLE > pumps blood into the aorta INTRAVENTRICULAR SEPTUM > separates the left and right ventricles CORONARY SULCUS Extends around the heart, separating the atria from the ventricles. ANTERIOR INTERVENTRICULAR SULCUS extends inferiorly from the coronary sulcus on the anterior surface of the heart. POSTERIOR INTERVENTRICULAR SULCUS extends inferiorly from the coronary sulcus on the posterior surface of the heart. HEART VALVES: 1. ARTERIOVENTRICULAR VALVES (AV) located between the right atrium and right ventricle, the left atrium and left ventricle. a. TRICUSPID VALVE AV valve between the right atrium and right ventricle; three cusps

b. BICUSPID VALVE AV valve between the left atrium and left ventricle; two cusps 2. SEMILUNAR VALVES half moon-shaped valves. Located between the ventricles and one major artery or vein (aorta and pulmonary trunk). a. AORTIC SEMILUNAR VALVE between the left ventricle and aorta b. PULMONARY SEMILUNAR VALVE between the right ventricle and the pulmonary trunk *Consist of three pocket-like semilunar cusps ROUTE OF BLOOD THROUGH THE HEART:

BLOOD SUPPLY: 1. CORONARY ARTERIES Originates from the base of the aorta, just above the aortic semilunar velves LEFT CORONARY ARTERY > originates on the left side of the aorta THREE MAJOR BRANCHES: a. Anterior interventricular artery lies in the anterior interventricular sulcus b. Circumflex artery extends around the coronary sulcus on the left posterior of the heart c. Left marginal artery extends inferiorly along the lateral wall of the left ventricle from the circumflex artery RIGHT CORONARY ARTERY > originates on the right side of the aorta. It extends around the coronary sulcus on the right to the posterior surface of the heart. TWO MAJOR BRANCHES: a. Posterior interventricular artery lies in the posterior interventricular sulcus b. Right marginal artery extends inferiorly along the lateral wall of the right ventricle 2. CARDIAC VEINS Drains blood from the cardiac muscle. CARDIAC SINUS > large vein located within the coronary sulcus on the posterior aspect of the heart; where blood is drained. HEART WALL (LAYERS) 1. EPICARDIUM/VISCERAL PERICARDIUM Thin serous membrane forming the smooth outer surface of the heart Consist of simple squamous epithelium overlying a layer of loose connective tissue and fat 2. MYOCARDIUM Thick middle layer of the heart Composed of cardiac muscle cells and is responsible for contraction of heart chambers 3. ENDOCARDIUM Inner surface of the heart chambers Allows blood to move easily through the heart CARDIAC MUSCLE CELLS > elongated, branching cells that contain one or more centrally located nuclei ATP (ADENOSINE TRIPHOSPHATE) > provides energy for cardiac muscle contraction; depends on oxygen availability

ELECTRICAL ACTIVITY OF THE HEART DEPOLARIZATION >> EARLY REPOLARIZATION >> PLATEAU PHASE >> FINAL REPOLARIZATION PHASE Channels: Na+ channels, K+ channels, Ca+ channels 1. Depolarization phase Na+ channels open K+ channels close Ca+ channels begin to open 2. Early repolarization and plateau phase Na+ channels close Some K+ channels open, causing early repolarization Ca+ channels are open, producing the plateau by slowing further repolarization 3. Final repolarization phase Ca+ channel close Many K+ channels open SINOATRIAL NODE (SA NODE) functions as the pacemaker of the heart. Located in the superior wall of the right atrium and initiates the contraction of the heart. Produces action potentials at a faster rate than other areas of the heart. CONDUCTION SYSTEM OF THE HEART SINOATRIAL NODE ARTERIOVENTRICULAR NODE located in the lower portion of the right atrium. ARTERIOVENTRICULAR BUNDLE bundle of specialized cardiac muscle. LEFT AND RIGHT BUNDLES division of AV bundle PURKINJE FIBERS pass to the apex of the heart and then extend to the cardiac branches. It is composed of specialized cardiac muscle fibers that conduct action potentials more rapidly. *ECTOPIC BEAT results when action potentials originate in an area of the heart other than the SA node 1. 2. 3. 4. 5.

>LUNGS< FUNCTIONS OF THE RESPIRATORY SYSTEM 1. Gas exchange Allows oxygen from the air to enter the blood and carbon dioxide to leave the blood and enter the air. 2. Regulation of blood pH Alters blood pH by changing blood carbon dioxide levels. 3. Voice production Air movement past the vocal cords makes sounds and speech possible. 4. Olfaction Sensation of smell occurs when airborne molecules are drawn into the nasal cavity. 5. Innate immunity Provides protection against some microorganisms by preventing their entry into the body and by removing them from respiratory surfaces. ANATOMY and PHYSIOLOGY UPPER RESPIRATORY TRACT External nose Nasal cavity Pharynx and associated structures LOWER RESPIRATORY TRACT Larynx Trachea Bronchi Lungs

NOSE Consist of the external nose and nasal cavity. EXTERNAL NOSE > visible structure that forms a prominent feature of the face. Most of it is composed of hyaline cartilage, through the bridge consist of bone. NASAL CAVITY > extends from the nares to the choane. NARES/NOSTRILS > external openings of the nose . CHOANE > openings to the pharynx NASAL SEPTUM > partition dividing the nasal cavity into left and right parts. HARD PALATE > forms the floor of the nasal cavity, separating the nasal cavity from the oral cavity. CONCHAE > three prominent ridges which are present on the lateral walls on each side of the nasal cavity. PHARYNX Common passageway of both the respiratory and digestive systems. It receives air from the nasal cavity and air, food, and water from the mouth. (inferiorly) leads to the rest of the respiratory system through the opening into the larynx and to the digestive system through the esophagus. THREE REGIONS: 1. Nasopharynx

Superior part of the pharynx. It is located posterior to the choanae and superior to the SOFT PALATE > an incomplete muscle and connective tissue partition separating the nasopharynx from the oropharynx. UVULA > posterior extension of the soft palate PHARYNGEAL TONSILS > located at the posterior part of the nasopharynx, it aids in defending the body against infection. 2. Oropharynx Extends from the uvula to the epiglottis It is where the oral cavity opens Lined with stratified squamous epithelium which protects against abrasion. TWO SETS OF TONSILS: 1. PALATINE TONSILS 2. LINGUAL TONSILS 3. Larygopharynx Passes posterior to the larynx and extends from the tip of the epiglottis to the esophagus. Lined with stratified squamous epithelium and ciliated columnar epithelium. LARYNX Located in the anterior throat and it is continous superiorly with the pharynx and inferiorly with the trachea. Consist of an outer casing of nine cartilages that are connected to one another by muscles and ligaments. TRACHEA/WINDPIPE It is a membranous tube that consists of connective tissue and smooth muscle. Projects through the mediastinum and divides into the right and left primary bronchi at the level of the fifth thoracic vertebra. Lined with pseudostratified columnar epithelium which contains numerous cilia and goblet cells. BRONCHI Divides into left and right MAIN/PRIMARY BONCHI > each connects to a lung. The left main bronchus is more horizontal than the right main bronchus because it is displaced by the heart. LUNGS Principal organs of respiration. Each lung is cone-shaped with its base resting on the diaphragm and its apex extending superiorly to a point about 2.5cm above the clavicle. RIGHT LUNG > has three lobes: superior, middle, inferior lobes. LEFT LUNG > has two lobes: superior and inferior lobes. LOBES of the lungs are separated by deep, prominent fissures on the surface of the lung. Each lobe is divided into BRONCHOPULMONARY SEGMENTS separated from one another by connective tissue septa. TRACHEOBRONCHIAL TREE > formed by the main bronchi branch LOBAR/SECONDARY BRONCHI > division of the main bronchus, two in the left lung and three in the right lung.

SEGMENTAL/TERTIARY BRONCHI > extends to the bronchopulmonary segmants of the lungs. It continue to branch out and give rise to BRONCHIOLES >> TERMINAL BRONCHIOLES >> RESPIRATORY BRONCHIOLES >> ALVEOLAR DUCTS ALVEOLAR DUCTS > long, branching hallways with many open doorways. These doorways open into ALVEOLI, which are small air sacs. RESPIRATORY MEMBRANE > where the gas exchange between the air and blood takes place. It is mainly formed by the walls of the alveoli and surrounding capillaries.

PLEURAL CAVITIES Lined with serous membrane called PLEURA PLEURA > consist of parietal and visceral part 1. PARIETAL PLEURA Lines the walls of the thorax, diaphragm, and mediastinum 2. VISCERAL PLEURA Covers the surface of the lung Between the parietal and visceral pleurae, is filled with a small volume of pleural fluid produced by the pleural membranes. Two functions of the pleural fluid: 1. It acts as a lubricant, allowing the visceral and parietal pleurae to slide past each other as the lungs and thorax change shape during respiration. 2. It helps hold the pleural membranes together. It acts like a thin film of water between two sheets of glass. VENTILATION AND LUNG VOLUMES VENTILATION/BREATHING Process of moving air into and out of the lungs. Two phases: 1. Inspiration/Inhalation Involves > diaphragm and muscles that elevate the ribs and sternum, such as external intercostals 2. Expiration/Exhalation Involves > internal intercostals, depresses the ribs and sternum DIAPHRAGM > large dome of skeletal muscle that separates the thoracic cavity from the abdominal cavity. TWO PHYSICAL PRINCIPLES IN RESPIRATION: 1. Change in volume result in changes in pressure As the volume of a container increases, the pressure within the container decreases. 2. Air flows from areas of higher to lower pressure If the pressure is higher at one end of a tube than at the other, air or fluid flows from the area of higher pressure toward the area of lower pressure. CYCLE OF INSPIRATION AND EXPIRATION: 1. At the end of expiration, the alveolar pressure, which is the air pressure within the alveoli, is equal to atmospheric pressure, which is the air pressure outside the body.

2. During inspiration, contraction of the muscles of the inspiration increases the volume of the thoracic cavity. The increased thoracic volume causes the lungs to expand, resulting in an increase in alveolar volume. 3. At the end if inspiration, the thorax and alveoli stop expanding. When the alveolar pressure and atmospheric [pressure become equal, airflow stops. 4. During expansion, the thoraxic volume decreases, producing a decreases in alveolar volume. LUNG RECOIL Is the tendency for an expanded lung to decrease in size. TWO REASONS FOR LUNG RECOIL: 1. The elastic fibers in the connective tissue of the lungs 2. The surface tension of the film of fluid that lines the alveoli SURFACE TENSION Exist because the oppositely charged ends of water molecules attract each other. TWO FACTORS THAT KEEP LUNGS FROM COLLAPSING: 1. SURFACTANT 2. PRESSURE IN THE PLEURAL CAVITY SURFACTANT It is a mixture of lipoprotein molecules produced by secretory cells of the alveolar epithelium. PLEURAL PRESSURE Pressure in the pleural cavity, is less than alveolar pressure, the alveoli tends to expand. PULMONARY VOLUME AND CAPACITIES: TIDAL VOLUME volume of air inspired or expired with each breath. INSPIRATORY RESERVE VOLUME is the amount of air that can be inspired forcefully after inspiration of the resting tidal volume. EXPIRATORY RESERVE VOLUME is the amount of air that can be expired forcefully after expiration of the resting tidal volume. RESIDUAL VOLUME is the volume of air still remaining in the respiratory passages and lungs after maximum expiration.

>RENAL< FUNCTIONS OF THE URINARY SYSTEM: 1. Excretion The kidneys are the major excretory organs of the body. They remove waste products. 2. Regulation of blood volume and pressure The kidneys play a major role in controlling the extracellular fluid volume in the body. 3. Regulation of the concentration of solutes in the blood The kidneys help regulate the concentration of the major molecules and ions. 4. Regulation of extracellular fluid pH The kidneys secrete variable amounts of H+ to help regulate extracellular fluid pH. 5. Regulation of red blood cell synthesis The kidneys secrete a hormone >> ERYTHROPOETIN, which regulates the synthesis of the RBC in the bone marrow. 6. Vitamin D synthesis The kidneys play an important role in controlling blood levels of Ca^2+ by regulating the synthesis of vitamin D. ANATOMY and PHYSIOLOGY KIDNEYS - Bean-shaped organs, each about the size of a tightly clenched fist. - They lie on the posterior abdominal wall, behind the peritoneum, with one kidney on either side of the vertebral column. - RENAL CAPSULE > connective tissue that surrounds each kidney. It is surrounded by fat that serves as its shock absorber. - HILUM > located at the medial side of the kidney. It is where the renal artery and nerves enter and where the renal vein and urether exits the kidney. - RENAL SINUS > a cavity where hilum opens. It contains the blood vessels and it is a part of the system for collecting urine and fat. - TWO DIVISIONS OF THE KIDNEY: 1. OUTER CORTEX 2. INNER MEDULLA - RENAL PYRAMIDS > located at the boundary between the cortex and medulla. Its tips project towards the center of the kidney. - CALYX > funnel-shaped structure that surrounds the tip of each renal pyramid. - RENAL PELVIS > a larger funnel that is formed as the calyces from all renal pyramids join. - URETHER >