Anatomi Kardio.pdf

Oleh Dr Regina M Hutasoit M Kes Departemen anatomi Fakultas Kedokteran Universitas Nusa Cendana 2019

ANATOMI CARDIOVASKULER (BLOK CARDIO)

SURFACE ANATOMY 

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INCISURA JUGULARIS STERNI ANGULUS STERNI LOUISI/ludovici PROCESSUS XIPHOIDEUS Patokan Angulus Sterni (Costa II)

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PROYEKSI LETAK JANTUNG 

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Tepi kiri-cranial berada pd tepi caudal pars cartilaginis costa II sin, di lateral tepi sternum Tepi kiri-caudal berada pd ruang intercostalis 5, kira-kira 9 cm di kiri linea mediana atau 2 cm di medial linea medioclavicularis

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Tepi kanan-cranial berada pd tepi cranialis pars cartilaginis costa III, 1 cm dari tepi lateral sternum Tepi kanan-caudal berada pd tepi cranial pars cartilaginis costa VI, 1 cm di lateral tepi sternum

PERKUSI JANTUNG 

Percussion is performed at the 3rd, 4th, and 5th intercostal spaces from the left anterior axillary line to the right anterior axillary line (Fig. B1.17)

Auskultasi area

MEDIASTINUM: CENTRAL COMPARTEMENT OF THE THORACIC CAVITY 

berisi jantung, aorta, dan arteri besar, pembuluh darah vena besar, trakea, kelenjar timus, saraf, jaringan ikat, kelenjar getah bening dan salurannya

Terdiri dari 1.Mediastinum Superior 2.Mediastinum Inferior :  MEDIASTINUM ANTERIUS  MEDIASTINUM MEDIUM  MEDIASTINUM POSTERIUS

This vertical movement of mediastinal structures must be considered during physical and radiological examinations in the erect and supine positions..

LAPISAN STRUKTUR JANTUNG 1.PERICARDIUM, tdd: -lapisan Fibrosa -lapisan Serosa ; parietal dan viseral ---pericardial cavity 2.MYOCARDIUM 3.ENDOCARDIUM

MORFOLOGI JANTUNG

UKURAN : P = 12 cm , L = 8 – 9 cm, Tebal = 6 cm

BASIS CORDIS 

Dibentuk oleh : ATRIUM SINISTRUM + ATRIUM DEXTRUM + bag.prox.PEMBULUH DRH BESAR

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Setinggi vertebrae T6-T9 dipisahkan olehpericardium, oblique pericardial sinus, esophagus, and aorta.

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BATAS : Superior = bifurcatio a.pulmonalis Inferior = sulcus coronarius Dexter = sulcus terminalis Sinister = v.obliqua atrii sinistri

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APEX CORDIS 

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Dibentuk oleh inferolateral VENTRICULUS SINISTER (L) Letak caudo-ventral sinister Ruang intercostal 5 sinister Kira-kira 9 cm dari Linea mediana atau 2 jari di medial linea medioclavicularis sinister

Remains motionless throughout the cardiac cycle. Is where the sounds of mitral valve closure are maximal (apex beat

COR IN SITU The four surfaces of the heart : 1.Anterior (sternocostal) surface, formed mainly by the right ventricle. 2.Diaphragmatic( inferior) surface, formed mainly by the left ventricle and partly by the right ventricle; it is related mainly to the central tendon of the diaphragm. 3.Right pulmonary surface, formed mainly by the right atrium. 4.Left pulmonary surface, formed mainly by the left ventricle; it forms the cardiac impression of the left lung

ATRIUM KANAN (ATRIA DEXTRA) -Dinding anterior kasar--MM.PECTINATI -Dinding posterior lebih halus---tdpt fosa ovale mrpkan intraatrial septum, asal dari sinus venosus Dipisahkan oleh sulcus terminalis dan crista terminalis

MUARA dari : 1.VENA CAVA SUPERIOR (tdk berkatup)---at the right 3rd costal 2.VENA CAVA INFERIOR– the 5th costal cartilage ( has a rudimenter valve) 3. SINUS CORONARIUS : dari vena vena cordis- is between the right AV orifice and the IVC orifice. Foramen Ovale : has a flap-like valve that permits a right to left shunt of blood but prevents a left to right shunt. closed oval foramen is represented in the postnatal interatrial septum by the depressed oval fossa. ----ASD (atrial septal defect) 

VENTRIKEL KANAN 

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the largest part of the anterior surface of the heart almost the entire inferior border of the heart The interior of the right ventricle has irregular muscular elevations (trabeculae carnae). Thick interior wall

Orificium AV(tricuspid valve) located : -inferior dan posterior -post manubrium sterni -the level of the 4th and 5th intercostal spaces. Katup tricuspid: Chordae tendinae (mm.Papilaris) attach to free edge and ventrikel surface anterior posterior and septal.

The pulmonary valve at the apex of the conus arteriosus is at the level of the left 3rd costal cartilage. The semilunar valves.

ATRIUM KIRI (L) Karakteristik 1.A larger smooth-walled part and a smaller muscular auricle containing pectinate muscles. 2.Four pulmonary veins (two superior and two inferior) entering its smooth posterior wall 3.A slightly thicker wall than that of the right atrium.

4.An interatrial septum that slopes posteriorly and to the right. 5.A left AV orifice (mitral valve)

-Pembentuk basis cordis -Muara V.PULMONALIS DEXT et SIN yang tidak berkatup

VENTRIKEL KIRI (L) Karakteristik :  Tebal 2-3x Ventrikel kanan  Dindingnya dipenuhi oleh trabecula carneae lebih banyak dibanding ventrikel kanan.  Bentuknya lebih seperti conus dibanding ventrikel kanan.  Katup mitral  An aortic orifice that lies in its right posterosuperior  the ascending aorta begins at the aortic orifice.

Mitral valve is located posterior to the sternum at the level of the 4th costal cartilage. 

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Each of its cusps receives tendinous cords from more than one papillary muscle. MEMBENTUK APEX CORDIS DAN FACIES DIAFRAGMA

The semilunar aortic valve, between the left ventricle and the ascending aorta, is obliquely placed At the level of the 3rd intercostal space.

KATUP KATUP JANTUNG 

“Tricuspid” valve 

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Pulmonary or pulmonic valve 

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RV to pulmonary trunk (branches R and L)

Mitral valve (the bicuspid one) 

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RA to RV

LA to LV

Aortic valve 

LV to aorta

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NODUS SINUATRIALIS SA NODE PACE MAKER Berada pada ujung cranial sulcus terminalis, di anterolateral muara vena cava superior pd atrium dextrum Suplai darah dari a.coronaria dextra Diinnervasi oleh N.vagus dexter

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NODUS ATRIOVENTRICULARIS AV NODE 

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Berada pada septum atriorum, di cranialis muara sinus coronarius Suplai darah dari a.coronaria dextra Innervasi oleh N.vagus sinister

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FASCICULUS ATRIOVENTRICULARIS CRUS DEXTER (RAMUS DEXTER) :  Berada di kanan Septum ventriculorum, menuju ke apex cordis, masuk ke moderator band; mencapai dinding ventriculus dan m.papillaris anterior  Membentuk anyaman serabut Purkinje, di dalam m.papillaris dan dinding ventriculus dexter 

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 CRUS

SINISTER (Ramus sinister) :

1 – 3 berkas, berbentuk bulat atau datar  Ke ventral menuju ke apex cordis  M.papillaris  Anyaman Purkinje pd lapisan subendocardial 

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INNERVASI C O R SYMPATHIS :  Ggl.paravertebrale Th.1 – 5  Ggl.cervicale PARASYMPATHIS : N.VAGUS  R.cardiacus superius  R.cardiacus inferius  R.cardiothoracis

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REFERRED PAIN  

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Tidak sensitive touch, cutting, cold, and heat; sensitif :ischemia dan sisa metabolit ---nyeri pada miokard. afferent pain fibers run centrally in the middle and inferior cervical branches and especially in the thoracic cardiac branches of the sympathetic trunk. The axons of these primary sensory neurons enter spinal cord segments T1 through T4 or T5, especially on the left side.

VASCULARISASI Arteri coronaria cab ke 1 aorta > A.CORONARIA DEXTRA > A.CORONARIA SINISTRA A.CORONARIA DEXTRA memperdarahi  Sulcus atrioventricularis  Sulcus coronarius, menuju ke Crux cordis  R.marginalis, r.transversus,r.descendens posterior  The right atrium.  Most of right ventricle.  Part of the left ventricle (the diaphragmatic surface).  Part (usually the posterior third) of the IV septum.  The SA node (in approximately 60% of people).  The AV node (in approximately 80% of people).

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A.CORONARIA SINISTRA    

Pendek Membentuk ramus descendens anterior dan ramus circumflexus Kadang-kadang ada ramus medianus Sulcus longitudinalis anterior

Memperdarahi: -left atrium. -Most of the left ventricle -Part of the right ventricle. -Most of the IVS (usually its anterior two thirds), including the AV bundle of the conducting system of the heart, through its perforating IV septal branches. -The SA node (in approximately 40% of people). 

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CORONARY ARTERY <1> Tipe Kanan, paling banyak, dominan a.coronaria dextra, vascularisasi facies posterior ventriculus dext et sinister <2> Tipe Simetris, percabangan r.descendens post tidak melewati sulc.long.post <3> Tipe Kiri, paling sedikit, a.cor.dext hanya sampai margo acutus

Lokasi infark

ALIRAN DARAH VENA SINUS CORONARIUS menerima darah dari:  V.CARDIACA MAGNA>>  V.CARDIACA MEDIA—frm RCA  V.POSTERIOR VENTRICULI SINISTRI  V.CARDIACA PARVA—frm RCA  V.OBLIQUE ATRII SINISTRI (Marshalli)—sisa fetal 

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AORTA Ventriculus sinister  Diameter 3 cm  Ascendens, lalu kedorsal kiri  Hiatus aorticus diaphragmatis 

AORTA ASCENDENS  ARCUS AORTAE  AORTA DESCENDENS (aorta thoracalis – aorta abdominalis ) 

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a.Carotis communis sinistra

Arteri Anonyma Arcus aorta

a.Subclavia sinistra

Aorta descendens

Aorta ascendens a.Coronaria sinistra a.Coronaria dextra

AORTA ASCENDENS Panjang 5 cm  Ditutupi oleh pericardium viscerale  Berjalan oblique ke cranial, anterior, kanan  Pangkal : sinus aorticus anterior, sinus aorticus sinister dan sinus aorticus dexer 

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ARCUS AORTA Tepi cranial artic.sternoclavucularis 1.Ascendens, dorsal  Ventral trachea, lalu ke kiri trachea  Descendens di kiri corpus vert.thor. 2.AORTA DESCENDENS  Lig.arteriosum Botalli  A.ANONYMA,  A.CAROTIS COMMUNIS,  A.SUBCLAVIA 

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A.PULMONALIS Kelanjutan dari Conus arteriosus ventriculus dexter  Panjang 5 cm  Ramus sinister dan Ramus dexter a.pulmonalis  Ramus dexter, lebih besar dan lebih panjang  Ramus sinister, pendek, kecil 

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VENAE PULMONALIS 4 buah  Bermuara kedalam Atrium sinistrum  V.pulmonalis dextra berada didorsal Atrium dextrum, diantara v.cava superior dan vena cava inferior  V.pulmonalis sinistra berada dicaudal a.pulmoalis 

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CIRCULASI SISTEMIK ALIRAN DARAH  ARTERI : dinding otot polos, berdenyut  VENA : dinding tipis, valvula  COR(ventricle sin.) – AORTA – ARTERI – ARTERIOLE – CAPILER – JARINGAN  capiler – venule – vena – vena cava superior et inferior-cor (Atrium dextra) 

VENTRICULUS SINISTER Aorta ascendens – arcus aortae – aorta descendens (= aorta thoracalis ) – aorta abdominalis – arteria iliaca communis – a.iliaca interna-a.ilica externa – a.femoralis – a.poplitea – a.tibialis anterior – a.tibialis posterior – a.dorsalis pedis

ALIRAN DARAH VENA :

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EXTREMITAS INFERIOR : vena saphena magnav.saphena parva – v.femoralis – v.iliaca – vena cava inferior

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EXTREMITAS SUPERIOR : v.cephalica, v.ulnarisv.radialis – v.brachialis – v.axillaris-v.subclavia – vena cava superior

CIRCULASI PULMONAL ventriculus dexter  arteria pulmonalis  pulmo  vena pulmonalis  atrium sinistrum  Pergantian Karbon dioksida dengan Oksigen ( darah – eritrosit ) 

BASIC PATHWAY OF BLOOD FLOW SVC

IVC

Right Atrium

Tricuspid Valve

Right Ventricle

Systemic Capillaries

Pulmonary Semilunar Valve

Pulmonary Trunk

Aorta

Pulmonary Arteries

Aortic Semilunar Valve Left Ventricle

Pulmonary Capillaries Bicuspid Valve

Left Atrium

Pulmonary Veins

TERIMAKASIH