Anatomy / Pathology

The heart
1. The four interior of the heart
The heart is a muscle with four different interiors. It is divided into two halves of the heart, Left Heart half Rights cardiac half The heart of the vaginal wall (septum) are completely separated. Each half is in the heart atrium (atrium) and chamber (ventricle) divides. ) right atrium ( trium de!trum) ") right chamber (#entriculus de!ter) $) left atrial (sinistrum trium) %) left ventricle (#entriculus sinister) &) pulmonary and re li (artery pulmonales) ') pulmonary () )pper *ohlvene (superior vena cava) +) Tri,uspidal,lappe ((-.ipflige sails flap) /) lower *ohlvene (inferior vena cava) 0) main artery (aorta) 1) orten,lappe 2) pulmonary vein and re li (Pulmonalvenen) 3) 4itral,lappe ('-.ipflige sails flap) &5) *eart vaginal wall (septum) &&) pulmonary artery (truncus pulmonalis) &') head arteries &() nec, arteries

2. Which blood vessels and lead arise from cardiac atria and heart chambers?

right atrium Artrium de!trum"

6 upper *ohlvene (superior vena cava) 6 lower *ohlvene (inferior vena cava)

Rights Association #entriculus de!ter"

6 ' pulmonary arteries right ( . pulmonalis de!tra) and 6 ' pulmonary arteries left ( . pulmonalis sinistra) arise from the 6 pulmonary artery (Trun,us pulmonalis)

left atrium Artrium sinistrum"

6 ' pulmonary veins left (venae pulmonales) 6 ' pulmonary veins right (venae pulmonales) left chamber #entriculus sinister" 6 7arge body artery (aorta) 6 8 arteries are the arteries from the heart of outgoing vessels 6 capillary vessels 8 e!change between arteries and veins 6 8 veins are veins to the heart 7eading the way #essels

$. Where are the various fla%s and ho& do you 'no&?

The heart valves are located at the entrances and e!its of the chamber (ventricle) to provide a directed flow of blood through the heart and prevent the return of blood. Right in the heart are the 6 Tri,uspidal,lappe (( .ipflige sails flap) "etween right atrium and right chamber

6 pulmonary (poc,et flap) t the outflow to train lung artery (between re. $hamber and pulmonary artery) Lin's in the heart is 6 4itral,lappe 9 "i,uspidal,lappe (' .ipflige sails flap) "etween left atrium and left chamber 6 orten,lappe (poc,et flap) t the outflow to train aorta (between li. $hamber and aorta) A function of heart valves Each heart valve, blood can flow only in one direction pressing. If the pressure from the other side, it proposes to and obstruct the path, so ma,e the healthy heart valves that the blood only in the direction of the physiological provided blood pumped to the river

(. Which tas's right atrium) right ventricle) left heart atrium) left ventricle?
bout the lower and upper *ohlvene arrived :!ygen arm blood in the right atrium ( trium), and from there on the right chamber (ventricle) into the lungs. There, it was with o!ygen and streams as o!ygen-rich blood through the pulmonary veins and the left atrium, then into the left chamber and then through the aorta into the systemic circulation.

*. What layers is the heart &all constructed?

The heart wall is from the inside outwards divided into three layers; 6 Endocardium 9 heart inner s,in dressed the entire interior of the heart, are the heart valves. 6 myocardium 9 heart muscle layer "etween Endocardium and epicardium is the layer of the heart muscle, the myocardium 6 epicardium 9 heart outer s,in The epicardium is the inner sheet of the heart The pericardium, the outer sheet of the heart "etween the two bags heart is fluid. The heart bag is the $onnective tissue hull of the heart.

+. ,escribe the -!citation educationand e!citatory transmission system in the heart.

e!citation and arousal management system of the heart is for the rhythmic contractions of the heart muscles. The heart wor,s automatically, which means he ma,es action potentials (e!citement) without a cause from the outside. s,eletal muscles through a nerve must be e!cited to be stated. The heart muscle has its own e!citement $enter, which means the heart muscle fibers can form electrical impulses and forward.

-!citation education and e!citatory transmission system consists of/ sinus node the natural %acema'er" - <itting in the wall of the right atrium, near the mouth of the upper *ohlvene - $onsists of speciali.ed cardiac muscle cells - *e aroused the atrial muscle - rousal without special control system passed in = Atrioventri'ular node A# node" - 7ies at the heart vaginal wall (septum) between right nd right atrium chamber - $ollect the electrical impulses *ere is e!citement "oard delayed so that the time before the atria chambers contract = His 0sche bundle - >uns in the bottom of the right chamber forecourt in the direction of separating wall - There it is in = 1hamber rights and left leg 2 Ta&araschen'el - E!citation of the chamber wall separating = 3rur'in4e fibers 2 -ndab5&eigungen the 1hamber leg - E!citation is from here directly to the $hamber muscles - E!citation with a high speed on the entire heart muscle distributed

6. The heart &or's on the all7or7nothing basis. What is the meaning of this statement?
$ardiac muscles are not against electrically isolated, so there is no limit to the e!citement. n agitation always covered all the heart muscle cells. ttraction produced either e?ual or no contraction 9 ll or @othing principle

8. Why are the electrolytes) es%ecially %otassium and calcium) in the right concentration in the blood is vital for the heart?
Aor an undisturbed heart activity, it is important that the electrolytes in the blood are not too low and not too highly concentrated. 1alcium $a' B ions are important for muscle contraction. Chile the action potential enter $a-DanEle a large ?uantity of calcium from the outside into the cell and uses the contraction mechanism in motion. It is therefore only to a muscle contraction, if enough $a' B is present. 3otassium If too little potassium (hypo,alemia) in the fluid surrounding the heart present, it is easier to arouse training and -ausbreitung. This can lead to cardiac arrhythmia with e!trasystoles to ventricular fibrillation. Too much potassium in the blood (hyper,alemia) can be reversed to a paralysis of the heart to a standstill, a moderate increases hyper,alemia, however, the Erreggungsbildung und-leitung.

9. What influence has the vegetative nervous system sym%athetic and 3arasym%athi'us on the heart?
:ym%athetic 6 increasing the cardiac output 9 heart beats faster 6 contraction force 9 enhances the strength of the heart muscle 6 shoc, e!citation fre?uency 9 line will be accelerated 3arasym%athi'us 6 reduction of cardiac output 9 heart beats slower 6 contraction force 9 reduces the strength of the heart muscle 6 shoc, e!citation fre?uency 9 line is slowed

natomy / 3athology

The heart
1. ,escribe the follo&ing cardiac investigations and the conclusions that the doctor dra&n from the results. A" 2 -1; electrocardiogram
4easurements of the electrical currents heart >esting EDF / E$F 7ong-term ('+<td.) <tress E$F ( GcyclingG) $larification; cardiac rhythm disorders, circulatory disorder

<" =ltrasonic
- Phono,ardiogramm 9 representation of the heart sounds $larification; heart valve defects, 4yo,ardiopathien (cardiac muscle disease) - Echocardiogram 9 G*eart EchoG representation of the heart by ultrasound - Cith additional function G%opplerG representation of the blood flows (Aun,tionsdiagnosti,) )nder load (cycling) 9 <tress Echo $larification; change in the heart, for e!ample, The si.e TEE - (trans esophagus echo), ultrasound probe is swallowed by the esophagus can buy especially the left atrium (atrium) good Hudge. $larification; eg @arrowing the wreath #essels

1" >7ray
G$hestG 9 assessment of cardiac si.e $larification; heart failure, heart rhythm disturbances, tachycardia (fast pulse)

," ?@R A @RB A @?R slice %rocedures &ith the use of a magnetic field"
Identification of water and fat tissue, as a bright area *ydrogen arm tissues, and schnellstrImende blood units as a dar, area $larification; edema, hemorrhage, necrosis

-" 1ardiac catheteri5ation

Introduction of a thin, with saline-filled hose from the arm vein directly from the heart. <mall-cardiac catheter 9 right heart catheteri.ation ccess; venous *emodynamic measurements of the blood flow right Pressure measurements in the pulmonary circulation 7arge-heart catheteri.ation 9 left heart catheter ccess; rterial (7eistenarterie) *Emodinami, measurements of blood flow left Doronardiagnosti,, Doronarangiographie $larification; eg "efore heart :Ps on heart defects, FefEJverengungen, blood gas analysis

C" Doronarangiogra%hie 2 >7ray e!amination

$ontrast media is controlled by a catheter directly inHected into the coronary arteries. >epresentation of the coronary vessels in the form of a schnellen ufnahmeserie in several levels. $larification; acute Doronarinsuffi.iens, Doronararterienembolie, heart attac,, >hytmusstIrungen.

;" @yo'ards5intigra%hie 7o,ale circulatory disorders are associated with the administration
(inHection) of radioactive substances.

2. -!%lain %lease stand 3T1A. Bm%lementation and Target"

3T1A 2 percutane transluminal $oronar-angio-plastie Bm%orted instrumental method for e!%ansion arterios'lerotisch delimited coronary artery using a balloon. bout the artery femuralis under K-ray control a management catheter in the left or right Doronararterie introduced and the first stenosis (narrowing), with contrast medium. fter pled a ALhrungsdrahtes (a 9 wire mesh stent to DoronargefEJe open to ,eep) for the correct placement of the balloon is in the area of the stenosis at the

end of the catheter balloon inflated located (balloon dilatation) This is the arteriosclerotic pla?ue in the blood vessels Pressed together what as a rule to a free blood flow.

$. What is a by%ass? Weche forms do you 'no&?

A by%ass is - diversion or a bridging a pathologically altered blood vessel section, by implanting a piece of a (mostly body) vein or artery or a Dunstoffschlauches. 6 In the vein coronary artery by%ass graft A1#<", the patient one or more pieces of vein removed (mostly from the vena saphena magna, a blood vein from the inside of the company or thigh), and between the her.nahen section of the aorta and the coronary artery distal (far away from) the narrow or obstruction. 6 lternatively, behind the sternum obli?ue artery thoracica interna distal separated and behind the narrow gap of Doronararterie newly implanted @ammaria7<y%ass" A") aorto'oronarer vein by%ass <". @ammaria7'oronarer <y%ass

ACVB Vena saphena-magna Transplantat

Neueinplanzung der Arteria thoracica interna b.

a.

*. Ho& do su%raventri'ulEren of ventricular e!trasystoles?

Aor premature heart beats occur outside the regular basic rhythm. fter the place under M divorced man supraventricular and ventricular e!trasystoles. :u%raventri'ulEre e!trasystole *ave originate above the *is-"Lndels in the sinus node, # node or #orhofmyo,ard (atrium) They come in healthy and sic, at heart. :ne treatment is only for fre?uent occurrence directly after necessary, as the threat of #orhofflatterns ('/5-(55 beats / min.) :r atrial fibrillation (N (55 beats / min.). #entri'ulEren e!trasystole $an all parts of the Dammermyo,ards (ventricle) or the *is-"Lndel out. >epeat it often is often an organic $oronary heart disease such as heart disease, and it threatens a lebensgefEhrliches fibrillation. Treatment drugs or electric shoc,s.

*. When a %atient receives a heart %acema'er) and ho& does the device?
A %acema'er is in cardiac arrhythmia, when the sinus node is not wor,ing properly, and the redirection no longer wor,s correctly. pacema,er is a control center rhythmically repetitive functions, which ordered structures his rhythm auf.wingt. Cunction/ ,evice features data and ad4usts the heart rate bout the thin cable, the pacema,er- ggregate ongoing information about the heart rhythm and then reviewed by comparison with its programmed data, whether the heart is too slow or too fast, and whether the function regularly or irregularly. %ata on arrhythmias to be saved. Aor e!ample, if The pacema,er to a slow heart rate determines he electrical signals from the electrodes to the heart and it will be to encourage faster beating. The battery, which provides the necessary energy, holds appro!imately /-&' years, depending on the strain. Then an aggregate e!change. 3rogramming and customi5ation through s%eciali5ed doctor ll data that the pacema,er stores, by the physician with a special device to display. The device includes a magnetic head, on the s,in over the pacema,er is located and where the desired data receives and forwards. "ased on these data, the doctor then further treatment, and also the settings of the pacema,er e!actly to the needs of the wearer wishes.

+. What is a heart failure? <orders %lease com%ensated by the congestive heart failureO
Heart failure is a heart muscle &ea'ness 9 low cardiac output. The & 4in. Arom the *eart ausgetriebene blood volume is too low. If there is supply problems of the heart, heart muscle cells die of lac, of o!ygen and the heart muscle is wea,ened. $an the heart to supply the body re?uired pumping capacity is no longer provide one spea,s of a heart failure. Is the right side affected heart 9 right heart failure, the heart is the left side affected 9 left heart failure, it affects the whole global heart failure 1om%ensated heart failure Chen compensated heart failure, the heart through various adHustment mechanisms, the performance still so far maintained that the ordinary stress of daily life only minor complaints. $ongestive heart failure ,e'om%ensiert is heart failure, when the signs of heart failure even with light loads are. %ue to the reduced pumping capacity of the heart, the o!ygen content of blood from the tissues more e!hausted than normal. This builds up in blood sauerstoffentladenes blaufarbiges hemoglobin. It creates a cyanosis ("luish discoloration of the s,in). The heart failure can be so strong that it shortness of breath (dyspnea) and water (edema) may occur.

6. What is the abbreviation 1H, and &hat sym%toms it is clear from the clinical %icture?
Arom a 1H, 9 $oronary heart disease (mismatch between o!ygen demand of 4yocards and o!ygen supply) occurs when the coronary arteries in sediments have accumulated, and the vessel walls narrow. This *er.,ran.gefEJverengungen (Doronarstenosen), for e!ample, Through blood metabolic disorders and smo,ing heavily promoted. It then flows less blood through the coronary arteries, and the o!ygen supply to the heart muscle is worse. tightness in the chest is therefore Hust as sic, of this picture, such as a heart attac, or sudden cardiac . Her5rythmus disorders Angina %ectoris heart attac' Herinsuffi5ien5 :udden cardiac

8. -!%lain the causes) sym%toms and treatment of angina %ectoris. What danger arises for the %atients in the clinical %icture?
Angina %ectoris chest tightness"
1auses/ atherosclerosis in the coronary arteries (calcification and #erfettung) :ym%toms/ Pain and a tightness in the chest, shortness of breath or a muffled pulling in the heart area, which are signs of angina pectoris. The pain can occur seconds to a few minutes. The symptoms are very varied and are often misinterpreted. Thera%y/ in case emergency measure 9 @irtogly.eringabe leads within '-/ minutes to the complaint, or -linderung (Important demarcation point for heart attac,. combat the ris, factors drug administration as nitrates) lead by an enlargement of the coronary arteries to a better su%%ly to the heart muscle &ith o!ygen. <eta7rece%tor bloc'er) off the heart and save o!ygen. calcium antagonists reduce the consum%tion of o!ygen. Chen an angina pectoris noted, it is important that the factors leading to a narrowing of arteriosclerotic coronary arteries have led to treatments. Is this part of the treatment of neglected or overloo,ed, then the ris, of a heart attac, is not reduced.

9. Fne of the most common causes of death in ;ermany is a heart attac'? Ho& is he? :ym%t%mati'? Thera%y? Ris' factors A com%lications? Heart attac'
In an acute heart attac, a blood clot closes one *er.,ran.arterie. rterios,lerotische deposits (pla?ues) brea,. Through these crac,s and brea,s in the build-up there will be a process of blood platelets (platelet), a thrombus (blood clot). This process is nothing more than a repair mechanism that the closure of a wound e!pires. The process of blood clotting for internal and e!ternal wounds will be further described here. The thrombus can be solved and a clog coronary vessel. %uring a heart attac, usually dies in muscle tissue (irreversible), which is behind the impermeable blood vessel is not long and with o!ygen has been supplied. :ym%toms Pain in the chest, arm, shoulder, nec,, chin, bac, and abdomen. Tightness in the chest, nausea, vomiting, fear of death, pale face, cold sweat, respiratory, circulatory collapse Thera%y Emergency measures mong the measures ta,e effect immediately, nor in the ambulance, which will include; 6 Transfer of 4orphinprEparaten for pain relief 6 transfer of o!ygen through a nasal probe 6 administration of nitrates The drug therapy is based on the health situation of the individual concerned. In the hospital, the therapy began. <eta7bloc'er To slow the heart rate and the contraction speed. Thus, the demand of the heart muscle of o!ygen is reduced and the heart can be better with the available o!ygen paraphernalia. A1- inhibitors Inhibit substances that are normally used for the storage of water in body tissue and lead to vessel constriction, and so positive effect on the o!ygen supply . He%arin >educe the growth of thrombus and prevents the formation of new clots. Thrombolytics re drugs, which can dissolve thrombus active. This measure is crucial for the treatment of acute heart attac, Ris' factors They include Physical inactivity, high blood pressure, obesity, drin,ing coffee, smo,ing, diabetes, lipid metabolism disorders, and stress in the family occurring heart disease. 1om%lications *eart rhythm, cardiogenic shoc,, Papillarmus,elabriss muscle of the heart valves holds), *er.ruptur (Einriss wall of the heart), heart valve insufficiency, thrombosis, embolism.