1^st week

Heart I

1. Introduction into the cardiovascular system

- history of the study of the cardiovascular system:

1543 Vesalius – Fabrica: basic description of main blood vessels;

1616 – 1628 Harvey – short and systemic circuit

1661 Malpighi – capillaries

17^th century – injection school in Leyden;

1874 Ranvier – pericytes

1920 Krogh – Nobel price for anatomy and physiology of the capillaries

1940 Zweifach – microcirculation

1967 Rhodin – ultrastructure of the microcirculation

1980 Palade – Nobel price for endothelial /electron-microscopical/ studies

now: pericytes → stem cells?

- history of clinical cardiovascular aspects:

1910 Carell – technique of the surgical suture of the blood vessels (Nobel price)

1929 Forsmann – first catetherisation of the rigth heart

1939 USA – first surgical closure of the ductus arteriosus in a child

1967 Barnard – first heart transplantation

last 20 years – invasive cardiology

- basic parts of the cardiovascular systém

• heart

• arteries – elastic and muscular type

• arterioles – important for peripheral blood pressure regulation

• capillaries and sinusoids

• venules and veins

• microcirculatory bed

• lymphatics

• the total length of the vascular system – approx. 40 000 km, the surface of endothelium: approx. 200 m² , importance of endothelial vasoactive factors

• the percentage of blood distribution during the time unit:

heart (coronary vessels) → 5%

brain → 15%

muscles → 15%

inner organs → 35%

kidneys → 20%

skin, bones etc. → 10%

2. Basic structure of the heart

Development – bulboventricular cardial loop, branchial arches III.-VI.

Fetal heart, oval foramen and ductus arteriosus Botali

Structure of the heart wall – endocardium, myocardium, epi- and pericardium

Hearet fibrous skeleton

Cardial valves, papillary muscles

Basic description of the surface and all heart cavities

EKG curve – explanation

• heart arteries – a. coronaria sin. (r. interventricularis ant. RIA, r. circumflexus RC, r. diagonalis RD, r. marginalis sin. RMS) et dx. (r. interventricularis post. RIP, r. margianlis dx. RMD)

• heart veins: vv. cordis minimae, vv. ventriculi dx. anteriores, sinus coronarius – v. cordis magna, media et parva)

• pericardium: arterial and venous porta, pericardial sinuses

• shape of the X-ray picture of the heart - draw and explain!

• 4 points of heart auscultation (points of Testut)

Heart II

• conducting system of the heart:

sinuatrial node Keith-Flack – frequency 72/min è atrial bundles (doubtful existence – Thorel, Bachmann, Wenckenbach) è atrioventricular node Achoff-Tawara – frequency 40/min. è atrioventricular fascicle Kent-Gaskell-His (passage via trigonum fibrosum dx. = central fibrous body of heart skeleton) è rigth and left branch (crus Tawara) (left divided in anteriro and posterior branch ) è rami subendocardiales Purkyně (= Purkinje´s fibers)

importance of the myocardial overlapping of the pulmonary veins for the possible origin of arrhytmias)

• embryology of heart – develoment of heart tube, tributaries to sinus venosus, septation of heart, develomental malformations (foramen interventriculare persitens, foramen ovale persitens, Fallot´s tetralogy, dcutus arteriosus persistens (Botalli), coarctatio aortae...)
basic histological strcture (3 layers) + structure of cardimyocytes

2^nd week

Aortic arch, arteries of the neck and head

 Development of arteries

• dorsal aorta
• ventral aorta
• aortic arches (6) and their derivates
• vitelline arteries
• umbilical arteries

Gereral structures of vessels, differences between arteries and veins, 4 types of capillaries

Segments of aorta:

- ascending aorta (origin of the coronary arteries)

- aortic arch (brachiocephalic trunc, left common carotid and subclavian artery)

- descending aorta – thoracic and abdominal part

A. Common carotid artery: topography,bifurcation at C4 level (glomus c., sinus c.)

External carotid artery: 3 groups of branches and 2 terminal branches

• group of ventral branches: superior thyroid., lingual., facial

• medial branch: ascending pharyngeal

• dorsal branches: posterior auricular and occipital

• terminal branches: superficial temporal, maxillary a. (with 3 segments and their branches, e.g. inferior alveolar, middle meningeal, muscular branches, spenopalatine, superior alveolar, infraorbital, nasal, palatine

Internal carotid artery: ophthalmic, ant. and middle cerebral aa., circle of Willis (= circulus arteriosus cerebri Willisi), siphon caroticum

Subclavian a.: topography in the region of superior thoracic inlet and in the scalenic fissure (intra-, inter- et extrascalenic portion)

Main branches:

• vertebral a.

• internal thoracic a. (importance in cardiosurgery – an artery of the elastic type!)

• thyrocervical trunc (inferior thyroid., ascending cervical, superficial cervical, suprascapular)

• costocervical trunc (supreme intercostal a., deep cervical a.)

• transversal cervical a.

3^rd week 4^th week

Descending aorta

1. Thoracic aorta

a) parietal branches – post. intercostal aa., subcostal a.

b) visceral branches: bronchial, oesophageal, pericardiac and mediastinal branches

2. Abdominal aorta

a) paired parietal branches – inf. phrenic a., lumbar aa.

b) impaired parietal branches – median sacral a. (aa. lumbales imae, coccygeal body)

c) paired visceral branches – middle suprarenal a., renal a., testicular/ovarian a.

d) unpaired visceral branches:

- coeliac trunk – left gastric a.

- common hepatic a. (hepatic a. proper – left branch + right branch - cystic a.), right gastric a., gastroduodenal a. (right gastro-omental aa., sup. pancreaticoduodenal a.)

- splenic a. (+ left gastro-omental a.)

- sup. mesenteric a. – inferior pancreaticoduodenal a., jejunal et ileal aa., ileocolic a.(- appendicular a.) , right and middle colic a.

- inf. mesenteric a. – left colic a., sigmoideal aa., sup. rectal a.

along the coln marin marginal colic a. of Drummond (its part close to left colic flexure = great anastomosis of Haller),

e) temrinal branches – common iliac aa.

3. Common iliac a. - aortic bifurcation L4

a) Internal iliac a.:

- parietal branches – iliolumbar a., lateral sacral aa., sup. et inf. gluteal aa., obturatory a. (pubic ramus, „corona mortis Hesselbachi“)

- visceral branches – umbilical a. (- sup. vesical aa.), inf. vesical a., a. to ductus deferens / uterine a. (- ovaric + tubarian branch), vaginal a, middle rectal a., int. pudendal a.(- inf. rectal a., perineal a., aa. penis/clitoridis – urethral a., a. bulbi p./c., deep a. of p./c., dorsal a. of p./c.)

b) External iliac a.: inf. epigastric a., deep ilium circumflex a. (pubic ramus, „corona mortis Hesselbachi“)

5 ^th week

Veins

1. Sup. vena cava:

- intracranial venous sinuses

- int. jugular vein

- pterygoid plexus (+ its connections to the cavernous sinus, orbit and face) – retromandibular v.

- ext. jugular vein

- brachiocephalic vein (venous angle, impair thyroid plexus)

- azygos vein + hemiazygos v. + accessory hemiazygos v.

2. Inferior vena cava:

a) ext. and int. iliac veins, pelvic veins – parietal and visceral (organ venous plexuses, pelvic thromboembolism, the risk of bleeding from pelvic plexuses), cavocaval anastomosis

b) portal vein, portocaval anastomoses, hepatic veins

6 ^th week

Lymphatic system

a) general structure of the lymphatic vessels and nodes, thymus

b) thoracic duct, cisterna chyli, lymphatic truncs: jugular,subclavian and bronchomediastinal, lumbar and intestinal

c) lymphatic outflow from:

- head and neck

- upper extremity

- thorax (mammary gland – „axillar sentinel node“ of Sorgius)

- abdomen (stomach, small and large intestine)

- pelvis (rectum and uterus)

- gonads (testis, ovary, scrotum)

- lower extremity

7^th week

Integrative conference „Circulatory system“

Endocrine glands

gross anatomy and topography of hypophysis, thyroid and parathyroid glands, suprarenal gland, testis and ovary, (paraganglia)