CASE 1

1. CASE 1 Group B

2. A 50-year-old football coach visited the doctor complaining of chest pain. The patient said he has been experiencing chest pain for the past three months with the intensity of pain increasing over the past two weeks. The pain is located in his left shoulder, radiating from there to the sternum and to the pit of the stomach. The patient tells the doctor that the pain usually comes while he is coaching football practice, or other similar physical activity. He finds that if he takes a 5 to 10 minute break the chest pains go away. Upon physical examination, the doctor finds no abnormality in movement of the shoulder joint. There is an absence of pain while abducting and laterally rotating the arm, thus ruling out the possibility of inflammation of the pectoralis major muscle. An echocardiogram (EKG), which examines the size and functioning of the heart, reveals that the patient’s heart is slightly enlarged. When the doctor palpates two arteries that run superficially in the arm, the radial and brachial arteries, he notes that they are thickened. The physician presupposes that this is due to the buildup of plaque within the arteries.

3. What is the Function of the Heart? • Pumps blood throughout the entire body • Beats approximately 72 beats per minute supplying cells of the body with nutrients they need to survive

4. When looking at an image, the right and left are defined as the right and left of the patient. • This means right and left are reversed when looking at an image. • In this image of the heart, “right” is to the left of the image and “left” is to the right of the image. RIGHT LEFT

5. The Heart Contains Four Compartments:2 Atrial and 2 Ventricular Compartments

6. Atrial Compartments of the Heart Pectinate Muscle The atria of the heart are receiving chambers. The right atrium receives blood from the body via the superior and inferior vena cava and the left atrium receives blood from the lungs via the pulmonary veins. The SA node is also contained within the right atrium and is the site at which electrical impulse to the heart originates. Right Atrium Fossa Ovalis The atrial chambers contain pectinate muscles within the walls of the chamber. Blood passes from the atria to the ventricles through a one-way opening called the atrioventricular valve. Atrial Compartments

7. Ventricular Compartments of the Heart Right Ventricle The ventricles are the discharging chambers. The right ventricle pumps blood away from the heart to the lungs via the pulmonary arteries and the left ventricle pumps blood away from the heart to the body through the aorta. The ventricular chambers contain trabeculae carneae muscle. Ventricular chambers are more muscular and larger in size because they must pump blood away from the heart into a system under higher pressure, the pulmonary arteries or aorta. The left ventricle is the most muscular since it functions to pump blood to the entire body via the aorta. Papillary Muscle Trabeculae Carnaae Muscle Ventricular Compartments

8. As blood fills the atria, the pressure rises and forces the blood into the ventricle through the one-way atrioventricular valve. The period of ventricular filling is called diastole in the cardiac cycle. When a physician listens with a stethoscope, the ventricle filling with blood sounds like a “lub”. When the ventricles fill, an electrical impulse signals them to contract to push the blood into the pulmonary artery (right ventricle) or into the aorta (left ventricle). This period of ventricular contraction is called systole in the cardiac cycle. When a physician listens with a stethoscope, the ventricle squeezing blood out of the heard sounds like a “dub”. What is the direction of blood flow in the heart?

9. How Does Blood Flow in the Heart? The right atrium receives deoxygenated blood from the body 1 1 Blood then flows to the right ventricle and is pumped to the lungs to become oxygenated 2 2

10. How Does Blood Flow in the Heart? To The Body Oxygenated blood from the lungs is brought back into the heart and deposited into the left atrium 3 5 3 4 Blood then flows into the left ventricle 4 Oxygenated blood is then distributed to the body via the aorta 5

11. Interatrial Septum The septa of the heart divide the left and right sides of the heart. There are two types of septa in the heart: the thin, membranous septum between the right and left atria and the thick, muscular septum between the right and left ventricles. Both septa help to maintain deoxygenated blood on the right side and oxygenated blood on the left side of the heart. The atrial and ventricular compartments remain divided by valves known as the tricuspid and mitral valves. Interventricular Septum What would happen if either the tricuspid or mitral valves were damaged ?

12. Tricuspid Valve Mitral Valve The tricuspid valve is found in between the right atrium and the right ventricle. It is called tricuspid because it has three cusps. The mitral valve is found in between the left atrium and the left ventricle and has two cusps. Both valves prevent backflow of blood into the preceding atrium. The papillary muscle within the walls of the ventricles attach to either the tricuspid or mitral valve and help to regulate the opening and closing of the valves.

13. Pulmonary Valve Pulmonary Valve • The pulmonary valve is found in between the right ventricle and the pulmonary artery leading to the lungs. • The pulmonary valve contains three cusps. • The pulmonary valve helps to regulate blood flow into the lungs.

14. Aortic Valve • The aorta is the largest blood vessel in the body. • Blood passing from the left ventricle to the aorta must pass through the aortic valve. • The aortic valve contains three cusps, the right, posterior and left cusps How does blood enter the coronary arteries?

15. Aortic Valve • The right and left cusps of the aortic valve contain sinuses leading to the right and left coronary arteries. The right and left coronary arteries provide oxygenated blood supply to the muscle tissue of the heart. Opening to Left Coronary Artery Opening to Right Coronary Artery Aortic Cusp

16. Right Coronary Artery The coronary arteries provide blood supply to the heart. In particular, the right coronary artery provides blood supply to the right side of the heart which includes the right atrium and the right ventricle. The right coronary artery branches into three main branches: Sinoatrial(SA) nodal branch, the Right Marginal Branch, and the Posterior Interventricular Branch. Right Marginal Branch Right Coronary Artery Posterior Interventricular Branch Anterior View Posterior View

17. Left Coronary Artery Left Coronary Artery Circumflex Branch The left coronary artery provides blood supply to the left side of the heart, which includes the left atrium, the left ventricle and the muscular septum between the ventricles. The left coronary artery branches into two main branches: the Anterior Interventricular Branch and the Circumflex branch. Anterior Interventricular Branch

18. Blockage of Coronary Arteries The coronary arteries may gradually become occluded due to the build up of plaque over a period of time. Plaque is composed of deposits of fats, cholesterol, and calcium within the artery’s walls. Atherosclerosis, the build up of plague over a long period of time, often results in coronary artery disease. Plaque in Coronary Artery How would blockage of the coronary arteries cause a problem during physical activity?

19. If the right coronary artery is blocked by a build-up of plaque, the heart is unable to receive an adequate amount of oxygen due to a shortage in the blood supply. During physical activity, such as coaching football practice, the patient’s heart has to contract more rapidly to supply blood to the body. This, ultimately causes the patient to experience a sensation of pain within the chest region. An angiography, which tests for blockage of the coronary arteries, confirms that the patient has coronary artery disease causing approximately 85% of the right coronary artery to be blocked and 70% of the anterior interventricular artery to be blocked. Based on the clinical observations and tests, the physician diagnoses the patient with angina, a pain originating from the heart that is a result of low blood oxygen reaching the heart muscle. The doctor prescribes medication to dilate the coronary arteries, thus allowing more blood oxygen to reach tissues of the heart. The patient is also put on a low fat diet and regular exercise program to promote cardiovascular wellness.