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Anatomy & Physiology of Heart Geu-Ru Hong, MD, Ph. D Associate Professor Director of Anatomy & Physiology of Heart Geu-Ru Hong, MD, Ph. D Associate Professor Director of Echocardiography Yonsei University, Seoul, Korea

Agenda Day 1: Heart anatomy & Physioligy, Ultrasound physics & Hemodynamic Assessment Day 2: Agenda Day 1: Heart anatomy & Physioligy, Ultrasound physics & Hemodynamic Assessment Day 2: Standard Imaging, Systolic & diastolic function Assessment Day 3: Valvular heart disease & Ischemic heart disease Day 4: Cardiomyopathy & Congenital heart disease Day 5: Pericardial disease, tumor, aortic disease, New technology in echo

Understanding Heart Disease From Discovery to Application Leonardo Da Vinci 1452 -1519 Understanding Heart Disease From Discovery to Application Leonardo Da Vinci 1452 -1519

Borrowed an Ultrasonic Reflectroscope from a Shipyard in Malmo used for testing Metals. May Borrowed an Ultrasonic Reflectroscope from a Shipyard in Malmo used for testing Metals. May 1953 - Detected moving echoes by the Ultrasound Reflectroscope. Edler – cardiologist at the Dept. of Cardiology at the University of Lund. Hertz - graduate in Physics

True Breakthroughs in Echo. . . 1984: 3 D 1954: B-Mode 1966: Real-Time B-Mode True Breakthroughs in Echo. . . 1984: 3 D 1954: B-Mode 1966: Real-Time B-Mode 1950: A-Mode 1964: M-Mode 1980: Doppler 1983: Color Flow

Clinical Impact of Echocardiography v Most used cardiac imaging test l 23 million echo Clinical Impact of Echocardiography v Most used cardiac imaging test l 23 million echo studies in US annually l 2. 5 million stress echo v Most common use l LV function assessment l Valvular heart disease l Hemodynamics v Essential in management of all forms of heart disease

Heart Anatomy Heart Anatomy

Heart Anatomy Left atrium Right atrium Left ventricle Right ventricle Ant Apex Left ventricle Heart Anatomy Left atrium Right atrium Left ventricle Right ventricle Ant Apex Left ventricle Right ventricle Post

Heart Anatomy Aorta Superior vena cava Inferior vena cava Ant Post Heart Anatomy Aorta Superior vena cava Inferior vena cava Ant Post

Heart Anatomy Aorta Pulmonary artery (trunk) Pulmonary veins Ant Post Heart Anatomy Aorta Pulmonary artery (trunk) Pulmonary veins Ant Post

Pathway of Blood Through the Heart Pathway of Blood Through the Heart

Heart Anatomy Aorta Coronary arteries Cardiac veins Ant Coronary sinus Post Heart Anatomy Aorta Coronary arteries Cardiac veins Ant Coronary sinus Post

Coronary Circulation Coronary Circulation

Coronary Circulation Coronary Circulation

Heart Anatomy (Heart Valve) Heart Anatomy (Heart Valve)

Atrioventricular Valves Left atrium (from pulmonary veins) Right Atrium (from vena cavae) Tricuspid valve Atrioventricular Valves Left atrium (from pulmonary veins) Right Atrium (from vena cavae) Tricuspid valve Right Ventricle (from right atrium) Bicuspid valve Left ventricle (from left atrium)

Atrioventricular Valves Aortic semilunar valve (internal) Pulmonary semilunar valve Bicuspid (mitral) valve Chordae tendieae Atrioventricular Valves Aortic semilunar valve (internal) Pulmonary semilunar valve Bicuspid (mitral) valve Chordae tendieae Tricuspid valve Papillary muscles Septum

Semilunar Valves Aortic valve Pulmonary valve Right Atrium (from vena cavae) Right Ventricle (from Semilunar Valves Aortic valve Pulmonary valve Right Atrium (from vena cavae) Right Ventricle (from right atrium) Left atrium (from pulmonary veins) Left ventricle (from left atrium)

Atrioventricular Valve Function Atrioventricular Valve Function

Semilunar Valve Function Semilunar Valve Function

Heart Anatomy The Wall Heart Anatomy The Wall

Strucure of Pericardium Strucure of Pericardium

Cross section of Myocardium Cross section of Myocardium

Heart physiology - Hemodynamics - Electrophysiology Heart physiology - Hemodynamics - Electrophysiology

Heart physiology 1 Hemodynamics 2 Electrophysiology Heart physiology 1 Hemodynamics 2 Electrophysiology

Preload & Afterload Preload & Afterload

Frank Starling Rule v Preload is the most important factor for strove volume v Frank Starling Rule v Preload is the most important factor for strove volume v Venous return ↑ SV ↑ v CO=SV x HR (heart rate) 심초음파 인증의 연수교육

Stroke volume v CO (ml/min) = HR (75 beats/min) x SV (70 ml/beat) v Stroke volume v CO (ml/min) = HR (75 beats/min) x SV (70 ml/beat) v CO = 5250 ml/min (5. 25 L/min) CO: cardiac output, HR: heart rate, SV: strove volume

Factor for effect cardiac output v Artery l Venous tone l Blood volume l Factor for effect cardiac output v Artery l Venous tone l Blood volume l Total peripheral resistance (affects preload) v Heart l Contractility l Total peripheral resistance (affects afterload)

Changes in contractility v Digoxin: l inhibits Na-K ATPase l Ca++ builds up Changes in contractility v Digoxin: l inhibits Na-K ATPase l Ca++ builds up

Changes in volume v Decreased blood volume v Decreased venous compliance Changes in volume v Decreased blood volume v Decreased venous compliance

Changes in Peripheral Resistance v Constrict arterioles l Increased afterload l Decreased venous return Changes in Peripheral Resistance v Constrict arterioles l Increased afterload l Decreased venous return

Pressure-Volume Loop Normal Factors v Preload v Afterload v Contractility Pressure-Volume Loop Normal Factors v Preload v Afterload v Contractility

Pressure-Volume Loop v↑Preload v ↑Afterload v ↑Contractility Pressure-Volume Loop v↑Preload v ↑Afterload v ↑Contractility

Pressure-Volume Loop v ↑Preload v↑Afterload v ↑Contractility Pressure-Volume Loop v ↑Preload v↑Afterload v ↑Contractility

Pressure-Volume Loop v ↑Preload v ↑Afterload v ↑Contractility Pressure-Volume Loop v ↑Preload v ↑Afterload v ↑Contractility

Heart Physiology Heart Physiology

Changes of ECG due to conduction Changes of ECG due to conduction

Cardiac Cycle v Cardiac cycle l Systole muscle – contraction of heart l Diastole Cardiac Cycle v Cardiac cycle l Systole muscle – contraction of heart l Diastole muscle – relaxation of heart

Phases of the Cardiac Cycle l Atria relax l Rising ventricular pressure results in Phases of the Cardiac Cycle l Atria relax l Rising ventricular pressure results in closing of AV valves l Isovolumetric l Ventricular contraction phase ejection phase opens semilunar valves

Phases of the Cardiac Cycle v Isovolumetric relaxation – early diastole Ventricles relax l Phases of the Cardiac Cycle v Isovolumetric relaxation – early diastole Ventricles relax l Backflow of blood in aorta and pulmonary trunk closes semilunar valves l

Phases of the Cardiac Cycle v Ventricular filling Heart blood pressure is low as Phases of the Cardiac Cycle v Ventricular filling Heart blood pressure is low as blood enters atria and flows into ventricles l AV valves are open, then atrial systole occurs l

Hemodynamic & ECG changes Hemodynamic & ECG changes